Capstone 1: Discussing Patient Care, Homelessness, Immunizat

Capstone 1: Discussing patient care, homelessness, immunizations, and clinical experi

A few days ago, I cared for a patient on the COVID unit at my hospital who was desaturating to 68%, despite wearing a non-rebreather mask and receiving 15 L/min oxygen. This patient was an elderly gentleman in his late 80s, with a history of long-term smoking and a positive COVID-19 diagnosis. Due to his deteriorating condition, a rapid response was called because he could not be stabilized on the unit. He was subsequently transferred to the Critical Care Unit (CCU), where he was eventually intubated after BiPAP treatment proved insufficient. This scenario underscores the significant impact of smoking as a determinant of health, as highlighted by the Healthy People 2020 initiative, which emphasizes the importance of smoking cessation at any age to improve overall health outcomes (Office of Disease Prevention and Health Promotion, 2020). Had I been involved in his care earlier, I would have spoken with him about the critical importance of quitting smoking and provided resources to aid in cessation. Smoking cessation can lead to lung function recovery within months, including better mucus clearance and reduced infection risk (American Cancer Society, 2020). Unfortunately, since I did not interact with him before his hospitalization, I am unable to offer these preventative health interventions at this stage.

Paper For Above instruction

The case of the elderly male patient on the COVID unit exemplifies the profound consequences of smoking as a modifiable health behavior. Smoking is a leading preventable cause of respiratory and cardiovascular diseases, which exacerbate outcomes in infectious diseases like COVID-19. Research demonstrates that smoking damages cilia and impairs mucociliary clearance, leading to increased susceptibility to respiratory infections and worse disease severity (Gordon et al., 2020). For individuals with comorbidities such as COPD and heart disease, COVID-19 poses heightened risks, often resulting in rapid deterioration as observed in this patient. Prevention strategies should focus on early intervention, including health education regarding smoking risks, especially targeting high-risk populations. Healthcare providers can utilize motivational interviewing techniques to promote smoking cessation, which has proven effective (Hughes et al., 2018). The benefits of quitting smoking extend beyond respiratory health; cessation improves cardiovascular health, reduces cancer risk, and enhances immune function (Centers for Disease Control and Prevention [CDC], 2021). Incorporating smoking cessation programs into routine care, especially in outpatient settings, offers an opportunity to instill healthier behaviors before critical illnesses develop. The integration of such preventive measures can reduce the incidence and improve outcomes of severe infections like COVID-19, ultimately reducing hospitalizations and healthcare costs.

Shifting focus to homelessness, I work in downtown Los Angeles, where homelessness is prevalent and significantly impacts community health. Many homeless individuals frequent the emergency department for various needs, including dressing changes, pain management, or simply to seek warmth. Despite their needs, the lack of stable housing restricts their access to consistent healthcare, hygiene, and nutrition, contributing to worse health outcomes (Brown-Yung, 2016). Homelessness leads to exposure-related skin breakdown, increased infectious disease risk, substance abuse, trauma, and mental health issues. As a healthcare worker, I have witnessed conditions such as roaches crawling out of bandages, and patients with no familial support, highlighting their vulnerability. Providing basic necessities like clothing, blankets, and food is essential, but addressing homelessness requires comprehensive solutions involving policy and community outreach. Some choose homelessness; others fall into it due to financial or health crises. Despite offering housing or healthcare access, sustained change depends on individuals' motivation and support systems (Gaetz et al., 2013). Systemic interventions, including supportive housing, mental health services, and substance abuse programs, are essential to tackle this complex issue, which is recognized as a key social determinant of health (Fazel et al., 2014).

Immunizations are among the most effective public health tools, preventing millions of illnesses and deaths annually. According to Zuanna et al. (2018), vaccines represent a triumph of medical science, yet vulnerable populations like immigrants and refugees often lack access to immunization services due to barriers such as language, transportation, and healthcare disparities. To address these gaps, community partnerships with schools, faith-based organizations, shelters, and clinics should be developed to promote vaccination outreach. Engaging community leaders and using culturally tailored educational materials can increase acceptance and demand. Additionally, immunization building requires time, as it depends on immune response development after exposure to antigens. Strategies like school entry laws have successfully increased vaccine coverage (CDC, 2015). Providing accessible clinics, mobile units, and outreach programs, especially in areas with high immigrant or refugee populations, are effective methods to improve immunization rates. These efforts not only protect individuals but also contribute to herd immunity, reducing disease outbreaks (Olson et al., 2020). Promoting immunizations is vital for achieving health equity and preventing vaccine-preventable diseases within vulnerable communities.

In clinical practice, I recently performed a straight catheterization on a male patient experiencing urinary urgency, abdominal swelling, and a sensation of fullness. Under the supervision of my preceptor, I prepared the sterile field, explained the procedure to the patient, and carefully inserted the catheter until urine flowed. This experience reaffirmed the importance of mastering basic nursing skills essential for patient care. Such procedures are routine yet critical for managing urinary retention and preventing infections. Hands-on practice under supervision helps build confidence and technical competence, vital for safe patient interventions. Daily in pediatric settings, I encounter diverse cases that require applying various techniques, emphasizing the importance of clinical skills proficiency (Potter et al., 2017). The process also highlighted the significance of communication, aseptic technique, and patient comfort. Skill mastery is fundamental to nursing practice and directly impacts patient outcomes. Continuous practice, ongoing education, and reflective learning are necessary to maintain competence in routine procedures like catheterization.

At an adult daycare center, safety and medication management are top priorities. My preceptor and I regularly update medications for approximately 50 clients who have specific health needs, including diabetes and cognitive impairments. The medication area is secured to prevent unauthorized access, reflecting safety protocols. We review each client’s medication, check expiration dates, and contact healthcare providers for necessary updates. Accurate documentation, both in charts and electronically, ensures continuity of care and reduces medication errors (Nursing & Midwifery Board of Australia, 2016). Regular communication with families, caregivers, and physicians is critical to maintaining appropriate medication regimens and addressing any adverse effects. Gaps in medication management can lead to safety issues, especially in clients with complex health conditions. Ensuring proper storage, documentation, and communication minimizes risks and promotes safe care (American Society of Health-System Pharmacists, 2020). As healthcare professionals, vigilance in medication administration is essential to safeguarding patient safety and improving health outcomes in the community setting.

References

• American Cancer Society. (2020). Benefits of quitting smoking. https://www.cancer.org
• Centers for Disease Control and Prevention (CDC). (2021). Benefits of smoking cessation. https://www.cdc.gov
• Centers for Disease Control and Prevention (CDC). (2015). Strategies to increase immunization coverage. https://www.cdc.gov
• Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology and implications for policy and practice. The Lancet, 384(9953), 1529-1540.
• Gates, T. (2021). Addressing health disparities among homeless populations. Journal of Community Health Nursing, 38(2), 91-102.
• Gaetz, S., Dej, E., Richer, F., & Rhodes, A. (2013). The state of homelessness in Canada: The need for comprehensive solutions. Canadian Journal of Public Health, 104(2), e113–e117.
• Gordon, B. R., Cheng, S., & Prieto, M. (2020). Impact of smoking on respiratory infection severity. Respiratory Medicine, 171, 106108.
• Hughes, J. R., et al. (2018). Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews, (12), CD006611.
• Olson, R., et al. (2020). Strategies for improving immunization coverage in vulnerable populations. Vaccine, 38(4), 644-651.
• Office of Disease Prevention and Health Promotion. (2020). Healthy People 2020: Smoking & Tobacco Use. https://www.healthypeople.gov
• Potter, P. A., Perry, A. G., & Stockert, P. (2017). Fundamentals of nursing. Elsevier.
• Nursing & Midwifery Board of Australia. (2016). National competency standards for registered nurses. NMBA.
• Brown-Yung, K. (2016). Homelessness and health: An overview. Journal of Community Health, 41(4), 877-885.
• Zuanna, G. D., et al. (2018). Public health and immunization programs in the US. Vaccine, 36(42), 6306-6312.