Professional Goals and Background
Personal statement
Practicing nursing as a career is one of the most crucial areas of human life. It is a course that I have been passionate about since when I was young. Professionally, I am a dynamic, patient-focused, and a professional who is compassionate in health care. This has been facilitated by extensive background, both academically and through experience that has enabled me to develop proven skills in nursing. Such has been a milestone towards the development of patients’ assessment skills, evaluation, planning, and the implementation of a plan of care. Those above were realized by extensive education from bachelor levels, masters, and various professional training and certifications. Through my experience as a nurse, I have been an excellent patient advocate. The fulfillment of my duties as a patient advocate was centered on educating patients, families, and healthcare professionals’ duties regarding preventive wellness, best practices, and disease treatment process. I was able to deliver such tasks due to my excellent communication skills, collaborative skills, and interpersonal abilities, which have enhanced how I relate to healthcare professionals and patients.
I begun my professional career in 2005 as a rehab nurse at Wyckoff Heights Medical Centre in New York. I rendered primary psychiatric nursing care to patients with mental disorders and administering my services to 24-bed patients. Through teamwork with other professionals, I was able to provide individualized counseling activities to patients and families. Such was aimed at ensuring that the parties involved were able to understand the illness and ways of living a productive lifestyle with the condition. I also engaged in evaluating patient’s mental needs, developing treatment plans, administering medication, and provision of personalized care. The setting of the practice was hospital-based, and I used to work for 12 hours. Don't use plagiarised sources.Get your custom essay just from $11/page
Nonetheless, I was also entitled to carry out minor and medical-surgical examinations and procedures, assessment and interpretation of hearth and breath sounds, and assessment of peripheral pulses. I covered a population of between 50 and 100 outpatient. The role was mainly carried out in Good Samaritan Medical Centre. As a progressive care unit nurse, I was a committed therapeutic care provider with the pediatric and geriatric population. My duties were limited to a nurse-patient ratio of 1:4 of both the pediatric and geriatric patients. As such, the roles I performed were not limited to one medical care. For instance, in the area, I worked in Duke regional hospital in as PACU, Packard Children Hospital, as pediatric CVICU. I also worked with pediatric and geriatric patients at Carrington College, San Jose, in 2018, where I worked as a pediatric clinical instructor. My roles in the hospitals above included fulfillment of various responsibilities and duties in areas of emergency, monitoring, and helping the patients through the healthcare continuum and also observed cardiac telemetry monitors. The tasks above were performed for patients with a cerebrovascular accident, multiple co-morbidities, orthopedic surgeries, and myocardial infarct.
My short time goal in nursing practice is to improve on the wellness of geriatric and pediatric patients with myocardial infarct, cerebrovascular accident, and multiple co-morbidities. This has been influenced by the growing number of children diagnosed with heart-related issues. My long-term goals are geared towards the development of an evidence-based intervention of heart-related problems among the children. The condition prevalence is increasing at an alarming rate, and as such, ways of curbing it using best and, evidence-based approaches need to be addressed. Specializing in pediatric patients in DNP has been dramatically influenced by BSN, and as such, having Bachelors’s in Sociology has been one of the fundamentals areas which helped in shaping how one can approach the children.
Nonetheless, since I graduated with a Bachelor of Science in Nursing, my main interests and practice have been delivering services among pediatrics. Through my Masters in Health Informatics, I was able to discover that children’s heart-related prevalence is increasing. Such has prompted my desire to study the population to enhance my research in establishing the reasons behind it. As well, the development of measures that can help in addressing the pandemic.
My DNP studies have been influenced by my previous studies both in masters and bachelor’s level, professional training and certifications, professional affiliation, continuing education, and practice history. Primarily, through the bachelor’s in Sociology, I was able to learn how to develop collaborative and interpersonal skills not only with colleagues but also with patients. Such has helped in passionately delivering my duties. Nonetheless, through my Masters in Science in Health Informatics, the information regarding heart-related challenges among children population has also shaped my desire to pursue DNP in Pediatric Nurse Practitioner. Master education was propelled by continuous education which obtained via various professional training and certification. Through the training, I was able to learn and received certificates relating to cardiac life. For instance, Advanced Cardiac Life Support (ACLS) Certification and Basic Cardiac Life Support (BCLS) Certification, I was able to learn on airway management, related pharmacology, effective communication, basic life support skills, and early management.
Such information is crucial in advancing my research on pediatric and aging population cardiac problems. Apart from that, having certification regarding the Emergency Nursing Pediatric Course (TNCC) is also has contributed to the knowledge which I desire to expound in DNP. Such will help in better understanding and addressing the co-morbidities related to cardiovascular conditions among children. My working experience, which stems for more than 15 years, has also helped in shaping my choice for DNP in geriatrics and pediatrics. I have to hold nursing positions in pediatrics such as Pediatric UVICU and Pediatric Clinical Instructor. The experience will help in the establishment of my DNP project by fostering on issues I faced in practice. Various professional affiliations such as being the president, American Medical Students helped in developing interpersonal and collaborative skills. Such will be helpful in my DNP research since teamwork will be essential in the development of health interventions for cardiac challenges facing children. As well, it will help in the management of various groups of healthcare practitioners in the pediatric unit. Nonetheless, being a member of T. Leroy Jefferson Medical society allowed me to discuss on various medical issues affecting the children, more so cardiac problem. The information will help in further research on the menace. I was also the clinical nurse manager, a position I used to mentor, planned, and supervised both staff and patients for better service delivery and best patient outcomes.
Obtaining DNP will be crucial in the attainment of my goals in pediatric care. Such will facilitate quality improvement since it will equip me with the knowledge to deliver interdisciplinary processes projected to organizational goals. It is will also facilitate measurement, improvement, and control of nursing-sensitive indicators, which have adverse outcomes on the patients’ outcomes. My clinical strengths in the area are based on working with pediatric with co-morbidities, myocardial infarct, and also holding a management position in the field. Assuming full responsibility for 60-bed skilled rehabilitation from previously below 35 –bed capacity and managing the team will significantly impact my DNP since it more of management. I would also wish to lead the admission to know that I can withstand lengthy healthcare procedures.
PART 2: Scholarly Interest
Practice-based problem
The main area of study in which one is interested in DNP is to study Pediatric Nurse Practitioner. However, one will be limited to steroids in pediatric heart surgery. Steroids are given to children who have undergone cardiac surgery to blunt systemic inflammation response. The medication is induced using an extracorporeal circuit, which is aimed at improving the clinical outcomes. However, based on research and my practice in the pediatric department, controversies regarding the clinical impacts of steroids after a child has undergone heart surgery have emerged. According to Graham (2014), administering of steroids in children who had just experienced open operation showed reduced lysosome injury. However, the author suggests that apart from reduced lysosome injury, there were no clear benefits relating to the best clinical outcomes in which the child received. The author outlines that the patients only showed “better general appearance and state postoperatively” (Principi et al., 2018). In response to surgery clinical understanding, one’s blood contact with endotoxemia-reperfusion, endotoxemia, and extracorporeal induces generalized immune system activation. The induced immune system is called a systemic inflammatory response. As outlined by Stendahl et al. (2012), it is believed that there is existence in a balance between good and bad inflammation. The good inflammation acts as prime to the immune system, whereas bad inflammation leads to multiple end-organ failures; however, in some cases, it leads to mortality cases. In pediatrics, the response of surgical inflammation is amplified as a result of lower circulating blood volume. Such is in relation to extracorporeal circuit size and due to usage of deep hypothermic arrest surgery. The use of steroids, despite that it is not used more often, it is recommended for high-risk cases such as deep hypothermic cardiac arrest. The steroids are also used for children with relatively insufficiency adrenal. The various studies in place which conducted on the correlation between less inflammation and better clinical outcomes regarding the usage of steroids in children during cardiac surgery provided different results. For instance, some studies outlined that steroids led to blunt inflammation, whereas some provided opposite results. As such, through my perspective, I asked myself, if at all those who showed the effect to show blunt inflammation, then to what extent? Therefore, from the analysis of Graham (2014), it is clear that the presumed it is unclear on the extent to which the anti-inflammatory effect can translate to better clinical outcomes after the surgery. Such as outlined by Principi et al. (2018) have been caused by the fact that it is difficult for one to characterize the multifaceted nature of steroids response in the event whereby a variety of cytokines has been activated. Such may lead to interaction in a complex and unpredictable manner. The clinical outcomes of the steroids have been stated by Graham (2014) have been influenced in its result by the different types of steroids used, administration routes as well as various regiments. As such, Stendahl et al. (2012) outline that it is the leading cause of difficulties in establishing of correlation existing between the clinical outcomes an inflammation. Such information prompted by the question, if the same type of steroid and regiments are used in different hospitals for cardiac surgery in children, will there be a definite result in inflammation and clinical outcome? From the research context, the information regarding the study is minimal, and it displays variability on the inflammation and clinical outcomes both at the primary and secondary levels. As outlined by Graham (2014), it is assumed that the standard corticosteroid regimen administered to different patients will not be able to address individual inflammation; rather, the regimen might be one for all.
Importance of the problem in healthcare delivery
The use of steroids in hearth surgery and its failure to have any clinical outcome is crucial in healthcare. The use has led to emerging conflicting information, which has been debated extensively by medical practitioners and scientists. As such, it has been established that there is an ongoing trial of 190 neonates, which can thus give further information regarding the usage. The reason for its view as a problem in health is the fact that the worth of risks associated with steroids use in surgery among pediatrics is not known. Such has been ascribed to a lack of sufficient powered studies. The challenges have led to failure in both short and long-term risk assessments associated with the administration of the steroid. Despite that, several associations dealing with children’s surgery have documented information regarding that, there are no clinical outcomes; some have raised concerns relating to infections among the steroid-treated groups. According to the analysis conducted by Principi, et al. (2018), based on a population of 50, 345 children, and the resultant outcome on clinical perspective was zero. However, from the population, the morbidity factors among the steroid-group increased. As such, it has been established that there are potential risks emergence among the children administered with the steroids. In children of school-going age, the administration of steroids was found to have detrimental effects. Primarily, such children were associated with cognition and neuromotor challenges. The problem of importance in healthcare has also been stimulated with the fact that steroid usage was found to be associated with an increase in incidences of developmental delays and cerebral palsy. As a result, the research in the usage of steroids among the children during heart surgery requires studies with long-term follow-up, which are designed to measure its effects. The studies should be related to its clinical outcome, inflammation effect, and its dangers (Graham, 2014). The information can help the healthcare practitioners in ruling on either it can be maintained for operation purposes or it not. The existing data and information are conflicting. Thus leading to the limitations among the clinicians regarding the guidelines on its usage.
DNP study of steroid usage in children
Despite the issues in which various scholars have highlighted regarding the usage of steroids in surgical operations among patients with cardiovascular issues, one desires to use the meta-analysis approach in the study. Since I already have extensive practice in health care, one plans to carry out randomized control trials concerning steroids in pediatric cardiac operations. Since the previous studies were mainly affected by a lack of sufficient data, I desire to use large data by utilizing the information from the Pediatric Health Information System Database.
I will work closely by monitoring information in the database and also joining in the discussion among the practitioners in the 38 US centers offering congenital heart surgery among the children. During the research, I will be updating the information regarding its usage by studying multivariable analysis. I will use the report to obtain information regarding the steroid effects, inflammation, and clinical outcome by adjusting the propensity score and the performance of each child based on their covariates. From the total population, one will focus on the child stay in the intensive care unit, infection rate, and use of insulin due to its relation to its adrenal insufficiency. The analysis mentioned above will be done using extensive follow up in different follow-up and information from the practitioners handling the cases. The data tabulated will be based on the differences which exist among children on mechanical ventilation or mortality. For the information regarding medical research to be standardized, it requires various variables. As such, one will also indulge in research regarding the use of multivariable analysis. Such will be based on a stratified risk adjustment for children with the congenital heart surgery category. The category will mainly be used in the establishment of the morbidities and benefits in clinical perspectives in which the children in the category may reap. From the Pediatric Health Information System Database, there are 25 centers in which heart surgery for children with cardiac diseases is done (Graham, 2014). As such, to provide sufficient information concerning steroid effects, one will use the centers as part of the research centers to sources of relevant information. Similarly, one is interested in providing clear distinction and similarities regarding the three issues under scrutiny about steroid usage.
Through the information, I will be obtained from the different centers; one will base the results on the patient’s adjustment and center characteristics. One will also establish the steroid use based on the surgical risks by evaluating association existing with methylprednisolone regimen and its outcome. In the previous studies, it was outlined that the failure to provide rich information regarding the results on the usage of steroids in surgical operations among pediatrics is related to insufficient data. Therefore, using different categories for learning purposes can help in establishing on ways through which pediatric surgical operations by use of steroids can be harmonized. Since I am interested in tabulating effective information in pediatric care, majorly on surgical operations among children with cardiac issues, one will research on the steroid usage in a large randomized controlled pediatric trial. I will focus on the trials on the children undergoing cardiac surgery with cardiovascular bypass and the surgeons who utilize either single or two steroid groups. Since the time factor is essential for recovery purposes, I will confine myself to the study of the surgery done within the same time frame. Such information will be valuable in establishing whether steroids are useful in reducing inflammation markers. As such, I will use the information to further deduce on steroids ability regarding clinical outcomes and how harmful is its usage in operations. The investigation will be vital in my nursing practice while dealing with a pediatric health unit with cardiac problems.
References
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Graham, E. M. ( 2014). The utility of steroids in pediatric cardiac operations. Pediatric Critical Care Medicine, 15, 5, 492-493. Retrived from; http://www.ncbi.nIm.nih.gov.>pmc.
Principi, T., Schonfeld, D., Weingarten, L., Schneeweiss, S., Rosenfield, D., Ernst, G., Schuh, S., … Scolnik, D. (2018). Update in Pediatric Emergency Medicine: Pediatric Resuscitation, Pediatric Sepsis, Interfacility Transport of the Pediatric Patient, Pain and sedation in the Emergency Department, Pediatric Trauma.
Stendahl, G., Bobay, K., Berger, S., & Zangwill, S. ( 2012). Organizational structure and processes in pediatric heart transplantation: A survey of practices. Pediatric Transplantation, 16, 3, 257-264.
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