A 62-year old male is admitted through the Emergency Department (ED) with a fifty-hour history of worsening sore throat, cough, and increased work of breathing.
Author: Anna Marie Nieboer
School: Frontier Nursing University
Area of Study: Certified Nurse-Midwifery Master’s Program with Companion DNP
There is a certain threshold of activity that motivates a person to excel in each task they perform and find purpose in those tasks. For me, that threshold of activity needs to include intentional planning and completion of both personal goals and professional goals that work in synchrony to drive me forward. I enjoy efficiently using my time, and have found that I have hours at home that could be utilized to accomplish a study of Nurse Midwifery. As an on-call labor and delivery nurse, one day of work a week leaves me wanting more involvement in the world of obstetrics. Integrating the study of midwifery into my off-work days would work to fulfill this desire and bring purpose to my non-productive hours that currently stagnate my growth personally and professionally.
This passion for improving birth for mothers and their families has driven me to begin my journey of attaining my Master’s degree and becoming a Certified Nurse Midwife within the next three years through Frontier Nursing University. A scholarship from the American Medical Resource Institute would allow me to pursue my Master’s in Nurse-Midwifery and keep my part time hours as a labor and delivery nurse. I would then be able to preserve my valuable roles at home and as a volunteer in the community. As a professional, I desire to provide holistic care in order to improve the lives of women and families long after they go home. This goal carries into my personal life as my husband and I nurture a safe environment for our own children, as well as foster children through our role as licensed foster parents. With two biological children, one on the way, and numerous placements of foster children, I feel very passionate about the lives of the future generation and supporting their caregivers. These professional and personal areas of my life work together to motivate my journey into graduate education that will in turn yield greater inspiration for my life to come.
Caring for women during childbirth evokes a natural instinct to uphold the holistic wellbeing of the family in those called to be midwives. There is an indescribable sense of peace when a baby can be delivered into an environment of love that was fostered by birth attendants who are sincerely interested in making birth better. My journey in the world of obstetrics has led me to believe that birth and the events surrounding it matter greatly to mothers and babies in terms of their emotional, spiritual, and physical health. This belief motivates my desire to become a Certified Nurse-Midwife in order to impact individual families in their birth experience, as well as support the greater movement towards restoring holistic birth for all women, no matter their method of delivery.
Delivering babies has always been a deep desire of mine since I first held a newborn baby. I decided I would become an OBGYN in elementary school and then changed my career path to a labor & delivery nurse so I could help deliver babies while also welcoming my own. My steps towards a career in obstetrics have been very strategic. After high school I obtained my nurse aid certification to gain clinical experience while attaining my BSN from Hope College in just three and a half years. I then transitioned from my nurse extern position in obstetrics at Bronson Methodist Hospital to a labor and delivery nurse position within the first year. Since becoming an obstetric nurse at Bronson, I have obtained my Registered Nurse Certification in Inpatient Obstetrics, as well as had two children of my own and several foster babies.
The hospital where I am employed has been an integral part of my inspiration to pursue nurse-midwifery graduate education. Working at a hospital that offers excellence in care to every individual it encounters is a commitment that speaks to the human experience in a way that transforms the surrounding community. Bronson’s Standards for Excellence of integrity, patient and family-centered care, teamwork, evidence-driven improvement, education, and community commitment serve as a core structure on which the people of Bronson build extraordinary experiences that uplift individuals, families, and the community in the most difficult of times. Being raised in the community that this hospital is based in, I was drawn to the dynamic organization because of the values that define it and have come to embody its Standards of Excellence in order to further expand the positive impact I can have through healthcare.
As a labor and delivery registered nurse, the hospital re-enforces my philosophy on whole-person healthcare and aligns with both my personal and professional values. Integrity shows through in my job when I strive to provide the same excellent level of honesty, empowerment, and support to each mother delivering there, no matter her circumstance. Patient and family-centered care is made clear to my patients through actions like acknowledging and introducing myself to every individual in the labor room, hanging a patient’s birth plan beside the bed for all caregivers to see, and making sure to keep eye contact and open dialogue with a patient at all times possible during emergent situations. I value and utilize the standard of teamwork in my job, especially in emergent situations when respectful, clear communication can save a baby’s or mother’s life by employing all the resources co-workers have to offer. Evidence-driven improvement is a standard I exemplify by seeking current research articles and presenting them to co-workers, care providers, and patients on topics such as skin-to-skin in the OR, delayed cord-clamping with cord blood donation, slow-flow nipple use for supplementation, and pumping for labor augmentation. I demonstrate the standard of education to my patients by ensuring they understand what labor medications are being administered and their effects, as well as providing staff education in-services such as “Facilitating Physiologic Birth.” The final standard of community commitment is one that I support greatly with only making local food purchases while working at the hospital, as well as doing all grocery shopping for my family at local vendors in order to support access to healthy food for all individuals in my community.
My clinical and personal experience has given me a passion for recognizing the importance of childbearing women and those who care for them during this critical time. The impact of a delivery provider reaches beyond the delivery room to families, communities, and society. This idea inspires my pursuit of a Certified Nurse-Midwifery degree and a position as a midwife in my current hospital or community setting, so that I may have such impact on the future of birth. Furthermore, I plan to conduct and utilize evidence-based practice on physiologic birth to guide my practice. With this research, I hope to influence the transformation of Western medicinal birth practices into a more holistic and effective physiologic birth process.
My professional training as a nurse in advanced cardiac life support has touched more areas of my life than just work. The components of basic life support, in addition to advanced cardiovascular life support, are useful in situations outside of the medical setting and valuable in the unexpected emergencies that can occur at any time. I learned this lesson well when I was confronted with a life and death situation in my own home on February 25th 2015.
Ten days after we took a preterm, four-pound foster baby boy into our home he stopped breathing. The tiny neonate became blue and lifeless in my arms while our family was eating dinner. In that moment, rational thinking became almost impossible as panic and fear took hold of me when no amount of stimulation would return the baby to consciousness. I laid the neonate on the kitchen counter and began to cry, as I knew we had failed this child that the state had entrusted in our care.
My husband dialed 911 and urged me to remember the information I had been taught as a labor and delivery nurse. I had been training in basic life support, advanced cardiovascular life support, and neonatal resuscitation and had just practiced my skills at work the day before. Immediately I remembered the actions I had practiced so many times and put my hands on the cold, motionless child in front of me. Neonatal resuscitation focuses on breaths rather than compressions first, so that is where I began. I tilted his head back to open his airway, covered his nose and mouth with my mouth, and filled his lungs with my breath. To my amazement, his chest rose with my efforts and he made a small squeak after several breaths. He still remained lifeless, so I thought through the next steps in the protocol of neonatal resuscitation and wrapped my hands around his tiny chest to give chest compressions. When I returned my focus to giving rescue breaths, the infant let out a weak cry and had the stirrings of life. We were able to stimulate and keep him awake until the ambulance arrived and took him to the hospital where he made a full recovery.
This experience proved how being prepared with the right information can be critical in determining the outcome of another person’s life. I knew my techniques to resuscitate this infant were evidence-based, safe, and would be effective due to the research it was based on. The frequent certification renewal of basic life support and advanced cardiovascular life support can seem monotonous at times, but it is vital for care providers to be able to respond correctly in emergency situations such as this.
When I reflect back on this event and think about future applications of advanced cardiovascular life support, I think the most difficult part of applying the process in real life is working through the empathy elicited for the person in need. In the classroom, the lifeless practice models have no name or personality. But in real life, the lifeless person in need of help has an entire life that could be ended in that moment if you do not act quickly and correctly. Human beings have complex, interconnected energies that influence how we interact with one another. Performing life-saving measures on someone is an interaction, even if that person is unconscious. The person performing basic or advanced cardiovascular life support may be overcome with a variety of emotions as they encounter an unconscious individual, especially if they do not see it often. There is a degree of grief that emerges for many care providers when they see another person who is so close to death and may or may not be revived. This is a natural human reaction that reminds health care workers why they do the difficult work that they do in order to help others achieve full and healthy lives.
Dealing with this initial reaction of empathy and the following emotions was something I had to overcome when I needed to provide life-saving measures to our premature foster baby. I was amazed how many thoughts of the past and future ran through my head in the first moments of finding the baby unresponsive. These thoughts elicited panic, fear, sorrow, and worry that paralyzed me. It was only at the prompting of my husband that I was able to refocus and perform the actions I had reviewed many times as a result of my schooling and hospital training in basic life support, advanced cardiovascular life support, and neonatal resuscitation. This is why teamwork, especially in situations where advanced cardiovascular life support is used, is essential to keep everyone thinking clearly when emotions can be so strong and interfere with the evidenced-based, life-saving process that must be carried out.
Seeing the impact of the knowledge I had been given in this situation motivates me to pursue a master’s degree in Nurse-Midwifery in order to further impact good outcomes in the lives of mothers and babies. By becoming proficient in physiologic birth and what facilitates it, I will be attune to any variations from normal and respond to them promptly before they become an emergency. If emergencies do occur, I will be able to trust on my bi-annual training in basic and advanced cardiovascular life support to guide me in the optimal response. Keeping education and skills up to date in healthcare professions is fundamental to providing excellent care that saves lives.