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340ann: I think any therapeutic relationship begins with trust. I would find a way to establish this trust with all the students that I work with in the school. Then I also would look at finding some common ground with this student. I think it is important to have some self-disclosure with the student while also ensuring I am being honest with the student. Depending on what is going on with this student they need to understand that they are talking to another human and not someone that is above them or doesn’t have feelings like they do. I think all too often children look at adults as someone that can handle everything and that the adults do not understand what they are going through. I think by disclosing to the student that I am also human and have feelings or guilt, worry, or fear helps to open the student up to conversation. A recent study did show that self- disclosure is good to a certain level but to be careful not to disclose too much information. (Steuber, P., & Pollard, C. 2018) I think that it is also important that if I am unable to reach the child that I reach out to my team to see if they have rapport with the student so that they may speak to them. 
340tatyana: In order to develop a therapeutic alliance with this student who is hesitant to share his thoughts with me I would use various techniques that create strong connections. Heather Craig, BPsySc., suggests that there are 12 ways to build trust which include: being true to your word, communicating effectively, building trust gradually, making decisions carefully, being consistent, participating openly, being honest, helping people, showing your feelings, avoid self-promotion, do what you believe is right, and admit mistakes. The first strategy would be to make the environment welcoming by being friendly. For instance, I would start the session with open dialogue and a personal story. Second, I would demonstrate empathy by demonstrating to the student that I understand their sentiments and would understand what they communicate with me, even if the client does not discuss the problem. Last but not least, I would employ the “positive regard strategy,” which demonstrates my current esteem for the kid through my behaviors. For instance, I would view the time we spend together not as “work,” but rather as an opportunity to assist the student.
490victoria: My experiences in the emergency room mainly included discovering the importance of effective communication and collaboration among different healthcare professionals. In the emergency department, the patient’s condition can be critical and time is of the essence. Effective communication and collaboration among different healthcare professionals, such as physicians, nurses, paramedics, and other specialists, is essential to ensuring that patients receive timely and appropriate care (Finkelman, 2017). Interprofessional teams in the ER must work together to assess, diagnose, and treat patients quickly and efficiently. This requires effective communication, active listening, and a willingness to collaborate and share expertise. Effective communication and collaboration were also important for ensuring continuity of care, as patients can be transferred to other facilities for further treatment. In such situations, it is important for the interprofessional team to communicate and share information about the patient’s condition and treatment to ensure that the patient receives appropriate care (Finkelman, 2017). When working in the emergency department, there was a situation in which I could have spoken when I realized that a senior nurse was not following the hand hygiene protocol to prevent infections. One of the main reasons why I did not speak up was the fear of retribution and confrontation. At the time, I also did not have adequate confidence in my skills and knowledge and feared that the senior nurse would question my skills if I spoke out against them. Therefore, the fear of retribution and confrontation kept me from speaking up. However, I have come to learn that it is important for nurses to advocate for their patients, even if it means correcting other nurses and finding a way to find common ground with other interprofessional team members to provide quality healthcare services.
490karen: Thinking back to when I was working as a new graduate nurse, there were times when the Physical Therapist in home health discharged a patient due to “all goals met”.  There was a patient that I believed could have benefited from more PT visits for home health but I did not speak up. Now that I am more knowledgeable with what each disciplines can provide and with my assessment skills, I can confidently advocate for the patients. Home health has interdisciplinary teams such as PT, OT and medical social workers and the nurse can profoundly make a difference in a patient’s care by speaking up on individual patient needs. The nurse is the patient’s voice in interdisciplinary teams in providing holistic care (Finkleman, 2017). 
495ann: After review of the Center for Healthcare Strategies website regarding trauma-informed care, I can honestly say that I have not heard of this concept before. Many of the ideas surrounding the concept I have heard of such as providing patient empowered care. The core principles of trauma-informed care is that of safety, trustworthiness & transparency,  peer support, collaboration, empowerment, humility & responsiveness. (Center for Healthcare Strategies. 2021) It has been shown that a history of trauma can affect health outcomes, relationships, and the ability to adopt healthy lifestyles. Adopting a trauma-informed care program also means taking care of staff as well as they are subjected to secondary trauma. The program thrives to incorporate mindfulness, meditation, and yoga into the daily practices of the healthcare workers. This can easily be done in quick one-minute mindfulness sessions before a meeting or huddle. This is low cost way to bring trauma-informed care to a healthcare environment. (Center for Healthcare Strategies. 2021). While I think this is a great thing, I do not see a way to implement this into our daily workflow in the environment that I currently work in. I also do not see it being something that lasts long term. I do believe that everyone including the patients would benefit from this program, I do not see how to make it work. 
495erika: I had the opportunity to witness my preceptor become or be promoted to Director of Nursing (DON) of the hospice facility I’m working with. And I was able to sit down with her and review and learn what her work will involve as a DON. I learned that she has to cover start of cares (SOC) or admissions when one comes in after hours and if no other RN is available to cover the SOC. Being in leadership has its rewards and price to pay as well. I learned that the DON has three pages of responsibilities, and I’m sure a few more, but that is what my preceptor/DON, shared during my learning session. Within those three pages, along with training staff, hiring new staff, reviewing of new patient referrals and determining if appropriate for admission or not, communicating with the owner and MD of the facility about denials of new admissions, the DON also coordinates and reminds staff of the IDG (interdisciplinary group) meetings which occur every Monday. It brings all staff together, including the MD on staff to discuss progress or  updates on cases. Prior to my preceptor making her switch into the DON position, she had the responsibility of reviewing all the files and making sure all the care plans and information in the files were up to date for the IDG meetings. IDG meetings and collaboration is very important in this type of work and really in any patient care setting because as a team you try to bounce ideas off each other to ensure patients and families receive the best possible care you can give and try to meet all their needs. One article notes, “Hospice care is coordinated through an interdisciplinary team (IDT), which assures that a holistic care plan based on the patient’s wishes is implemented. The extent to which an IDT provides quality care may be associated with how effectively they communicate within the team as well as with patients, caregivers, and families” (Moore, Bastian, Apenteng, 2016, p. 1) I fully agree with this and that is why as a DON in hospice you have to understand all the factors that help to make such a difficult situation for both patients and families the smoothest possible with the team support and collaboration.  That takes good leadership and Sandra the new DON is certainly qualified.

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