Discussion

Instructions
1.Make thoughtful comments on each section or ask clarifying questions to facilitate discussion.

2. Submit a list of concepts that you believe are in each section(what you think the section is about, conceptually)(Review the attached document Carper’s Article listed under files tab)
Validate whether you agree, or add others if you think some have been overlooked.

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3. Find a nursing theory or shared theory from another discipline that you think relates to each section and discuss how it relates.

Address each item above for each section. Address numbers one through three for section 1. Start a new page and address numbers one through three for section 2. Be sure to cite sources in APA Format.

Section 1

That day started like any other day for me. I woke up, brushed me teeth, straightened my hair, put on my makeup, made my coffee, grabbed my lunch, and headed for work. I remember driving to work that morning wondering how many nurses I would have to staff the floor that day. The sun was just starting to peak on the horizon as I pulled into the parking lot. I sat in my car and finished the song that was playing on the radio before I headed inside for my 12 ½ hour shift. I made my way up the stairs to the unit I call home, 2N. I immediately heard all the familiar sounds that echo the hallways of my unit; the call lights, the Bipap alarms, the telemetry monitors.
I dropped my stuff off at the back nurse’s station where I usually sit at as the charge nurse. I grabbed my pens and stethoscope and headed for morning shift huddle in the conference room. I saw the assignments for the day and noticed I had the patient in room 2120. I grabbed his report sheet and immediately thought “wow, he’s only 27 years old”. As I listened to huddle from the night charge, she briefly went over every patient. She got to 2120. “He’s a 27-year-old male with chronic alcohol abuse. He recently tried to stop drinking by going cold turkey. He came in with an electrolyte imbalance and went to the cath lab. While in cath lab, he went into PEA and was shocked around 40 times. Unfortunately, he took an anoxic hit to his brain and will not recover. He is now a noCPR-comfort and is end of life”. I will never forget the somber look on the faces of the staff as we realized the reality of what we do. Internally, I was horrified thinking I would watch a young man 10 years younger than me die today. Yet, as the charge nurse, my team looks to me for leadership; so, I put on my brave face and hit the floor for report.
Donna, the night charge nurse, grabbed me and we headed to room 2120 to bedside handoff. We walked into the room and my first thought was “he looks like a baby.” In fact, he reminded me vividly of my nephew Anthony. We sat down on the couch as there were no family members present and talked about the in’s and outs of this young man’s history. He had been drinking alcohol from the age of 13. His father was very abusive, and he used alcohol to escape. His mother died a few years ago so all he has at this time are his siblings and his aunt. We finished report and I went on about my morning with my meetings and various charge nurse responsibilities. I stopped in frequently to see Dominic (name changed for privacy). I talked to him as I do any patient, dying or not. I opened the blinds and allowed the sunrise to hit his skin. I gave him comfort medications when I could see his breathing and vitals had changed. I washed all the crud out of his hair from his monitors in the CCC and made him look presentable to his family.
Dominic’s sisters and friends showed up later in the evening. They even commented on how nice he looked, and how he would have been appreciative of me fixing his hair for him. I guess he loved his hair to look nice. I handed Dominic back off to the night charge Donna. I hoped I got to see Dominic the next day, but I also had a gut feeling he would not live to see tomorrow’s sunrise. I woke up the next morning and repeated the same routine as I had time and time again. I got to the floor and noticed Dominic was no longer on telemetry. Donna confirmed that he had passed early that morning and family was still at the bedside grieving. I received handoff and waited until the family came out a few hours later to tell me I could call the coroner and funeral home. After the calls were made, the CNA and I performed post-mortem care as we do to all patient’s that have passed away in our care. I had to wipe away my tears as we cleaned him up. The funeral home then came up to the unit to pick Dominic up. I remember the security guarding coming to me and saying “you did say room 2120, right? He looks like a young boy.” I said “yes, he is only 27 years old. But yes, that is Dominic.”
Analysis
This narrative seeks to reflect the common social, ethical, and systemic issues we see in our patients as nurses and health care providers.
Social/Ethical
I feel the social and ethical dimensions are intertwined in this narrative. As a nurse, I am not new to seeing patients die. However, most of the dying patient’s I see are elderly or have some severe medical condition that has progressed. For me, it was tough to see a 27-year-old person laying in that bed that day dying. Dominic’s social issues were a burden on his physical health. I wondered during his care if someone had intervened earlier in his life and stopped the abuse if he would still be laying there dying. Taking care of him really made be think about my faith and why some people suffer at the hands of their own family, especially their own parents. This narrative needs to include the burden on my own faith.
Systemic
The system not only failed Dominic as a child, but also as an adult. He was tired of his addiction but did not know how or where to get help. Dominic quit drinking cold turkey due to the lack of resources for people like him: low socioeconomic status and lack of health insurance. This narrative probably should have included that information for the reader to better understand what brought him to me in the first place.
Key Concepts
This story revolves around death, caring, comfort, and grief. As stated before, death is not a new experience as a nurse. I showed a side of caring by brushing Dominic’s hair, even when he could not express that desire to me. I expressed comfort by providing Dominic with medications to ease his breathing and anxiety. Grief was expressed by both myself in the narrative and Dominic’s family; I gave them as much time as they needed with him after he passed. I wept a few times on shift for him as I tried to carry on with my day and take care of the rest of the patients on the floor. According to a study on nursing responses to patient death, several themes were identified with include “… (c) nurses’ coping responses incorporate spiritual worldviews and caring rituals; and (d) remaining “professional” requires compartmentalizing of experience (Gerow et al., 2010)”. I believe this study applies to my narrative because I performed post-mortem duties for the patient which helps show a sense of caring. Also, while I did shed some tears for Dominic, I remained professional throughout my experiences as I had to carry on with my day.
Fundamental Patterns of Knowing in Nursing
Let us look at how Carper’s Patterns of Knowing apply to this narrative.
Empiric Pattern
An example of empirics in this narrative is the reference to Dominic being in PEA in the cath lab and being shocked around 40 times, thus suffering an anoxic brain injury. These are all direct observations or verified by scientific measures like CT scans. I also based my comfort measures given to him by my direct observations of him and his vitals.
Ethical Pattern
An example of ethics in this narrative is my desire for Dominic to be comfortable when he cannot express that himself to me. This also confronts my ethics in questioning why a 27-year-old would be on hospice and if it that was appropriate for his diagnosis. His care made me question my faith, which often extends to my morals and ethics.
Aesthetic Pattern
An example of aesthetics’ in this narrative is me raising the shades so Dominic could feel the sun shining on him one last time. Although I do not know if he could feel it, I felt if there was a chance, then it was valuable. I also brushed Dominic’s hair to give him some dignity in his last final days.
Personal Pattern
This narrative is an entire reflection of self. I am aware that death is just a part of my job sometimes. But I try not to let that jade me. I am not going to treat every dying patient or their family members the same as each experience is unique. As I started out the narrative, each day is the same routine for me. I tried to give the reader an insight into my day prior to the experience and after the experience. While I did shed a few tears throughout the shift, I ultimately carried on with my day as that is what is expected of me as a nurse and charge nurse.

References
Gerow, Lisa, et al. “Creating a Curtain of Protection: Nurses’ Experiences of Grief Following
Patient Death.” Journal of Nursing Scholarship, vol. 42, no. 2, 2010, pp. 122–129., doi:10.1111/j.1547-5069.2010.01332.x.

Section 2

The COVID-19 pandemic has not been easy for anybody, but it has especially put a strain on nurses and other healthcare workers. When I began working on my unit eight months ago, approximately one hundred nurses and patient care technicians were employed on the unit and we had forty-four beds available. The plan was to continue to expand in order to allow us to provide care for an increasing number of patients. Management talked highly of our unit and explained that it would become one of the largest neurological intensive care units in the nation. I started my job eager and ready for the new challenge of working in a developing unit. As the number of COVID-19 cases increased, morale in the unit continued to decrease. Caregiver burnout has been a huge problem since the beginning of the COVID-19 pandemic.
Nurses that I looked up to and strived to be like were leaving the bedside as quickly as possible. The number of experienced nurses was dropping, and the unit went from a close-knit family to a unit filled with new faces each day. I can easily list at least twenty names of nurses who have left the unit due to a lack of job satisfaction over the past four months. When I began working in the unit, I genuinely enjoyed my job. I loved taking care of my patients and felt a sense of joy in my work. I was surrounded by nurses with decades of experience that were willing to help me with anything that I needed. This is no longer the case as a majority of the exceptional nurses that I worked with have left and I am now considered to be one of the “experienced” nurses. The pandemic has caused caregiver burnout and compassion fatigue to healthcare providers. Each day I walk into work blindly and have no idea what to expect. I do not know if we will have enough nurses available or if we will be taking care of two or three critically ill patients. There are days when we are running out of personal protective equipment and we are forced to re-wear masks and face shields, but there are also days when we have an abundance of supplies. Many supplies that are typically stocked in the units, such as suction cannisters and needles, are on back order across the nation. The uncertainty and anxiety that nurses are facing right now is an all-time high, and something needs to be done to ensure that nurses are being taken care of.
Key Players and Stakeholders
The COVID-19 pandemic has impacted myself and my fellow nurses in my unit immensely. The key players include the patients, nurses, and hospital administrators as they are quite involved in this whole process. Many stakeholders are impacted by the increased levels of burnout by nurses. Patients are the main stakeholders because their outcomes often depend on the care they receive from their nurses. If their nurses are distracted, do not have access to supplies, have more patients than they can handle, or do not want to be there, their patients may not receive the exceptional care that they expect from such a well-known hospital. The nurses are also stakeholders because they can face legal action and potentially lose their nursing licenses if an adverse event were to occur, even if it occurred due to poor staffing ratios or lack of supplies. Nurses are also leaving their jobs and struggling with physical and mental health issues due to the pandemic. The hospital administrators are stakeholders because they are forced to fill full-time nurse positions with contract nurses instead of their own employees. These contract nurses are paid significantly more than the full-time staff nurses. This ultimately costs the hospital a lot of money. Overall, numerous people are impacted by the effects of caregiver burnout that have resulted from the COVID-19 pandemic.
Analysis
Social/Relational Dimensions
As nurses see their coworkers unhappy and leaving for new job opportunities, they are likely to follow them. Nurses continue to leave for jobs where they will be paid better wages and experience safer staffing ratios. I have noticed a shift of morale on my floor as more travel nurses begin to flood the assignment board. Patients with specific needs that our nurses would catch quickly and fix are not being caught by foreign eyes. Therefore, the patients are feeling the effects of the shift of staffing, as well as the feelings of frustration and stress from our nurses due to the patients being improperly cared for. The dynamic of patients and nurses are held closely together and once one is affected, so is the other.
Ethical Dimensions
It is the nurse’s ethical role to ensure that he or she is providing the patient with the best possible care. In order to do so, the nurse must ensure that they are mentally and physically ready to do so. If a nurse is feeling tired, overwhelmed, or stressed, they need to make their nurse leader aware so they can find someone to assist the nurse or cover their assignment. It is the hospital administrator’s ethical responsibility to ensure that nurses have proper equipment to keep themselves safe and to care for their patients.
Systemic Dimensions
Many nurse managers are overwhelmed with the pandemic and do not have time to ensure their employees are emotionally and physically well. Also, hospital administrators are busy trying to figure out how to staff units within the hospital, so they do not have enough resources to take care of their current staff. This leads to dissatisfied staff, which further prompts no incentive for the current staff to stay in their current position.
Concept
Burnout/Compassion Fatigue
Burnout and compassion fatigue are the most important concepts in this narrative. All of the implications from the COVID-19 pandemic have led to increased rates of burnout and compassion fatigue on my unit. From what I have seen, when nurses experience burnout, they are unable to provide their patients with the best possible care. This can lead to poorer patient outcomes and decreased job satisfaction.
Uncertainty
Uncertainty is a major concept in the narrative, because the world is filled with uncertainty right now. The end of COVID-19 is unclear and the effectiveness of the vaccine and its effects are unsure. Nurses are unsure about staffing ratios, availability of supplies, and pandemic itself. Many nurses walk into work each day not knowing what to expect, and this has led to many issues and tension amongst providers and the public.
Stress
Stress is an important concept in the narrative, because high levels of stress related to the pandemic have led to decreased job satisfaction. Nurses are leaving the bedside at an alarming rate, and stress has played a major role in this caregiver burnout and compassion fatigue.
Article
Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic.
Carper’s Patterns
Empiric Pattern
It is important to look at data regarding levels of burnout and anxiety among caregivers throughout the decades. Determining this information can allow us to utilize this data to find a solution. By utilizing data and evidence-based research, we are able to confidently explain the extent of this topic.
Ethical Pattern
From an ethical perspective, nurse managers and leaders should determine causes of burnout among caregivers and try to perform interventions to reduce burnout. Nurses should be able to speak to their managers in confidence without fearing that their concerns could impact their employment status. Additionally, nurses should ensure that they are in the right mindset to go to work. If nurses are feeling overwhelmed or anxious, they should take time to meet their personal needs. Nurses cannot adequately provide care for their patients if they are unable to care for themselves.
Aesthetic Pattern
All of the nurses on the unit should come together to voice their concerns. Once they are aware of how their coworkers are feeling, the nurses on the unit should work together to find ways to destress, unwind, and find joy in their work again. This could include art therapy, meditation, or even physical activity.
Personal Pattern
I am able to identify when I am feeling fatigued, and I attempt to perform self-care activities to promote my mental health and well-being. Early in the pandemic, I was working four to five twelve-hour shifts each week, because the hospital was short staffed, and I felt like it was my duty to fill the gaps. I have recently found that doing so is not good for my well-being and have decided to only work my required three days each week. When I am at work, I make sure that I take a thirty-minute meal break each day to ensure that I am relaxed, nourished, and prepared to safely care for my patients.

Works Cited:
Fernandez, R., Lord, H., Halcomb, E., Moxham, L., Middleton, R., Alananzeh, I., & Ellwood, L. (2020, May 8). Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. Retrieved January 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206441/

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