May Rewind

Well Senior Year is practically over now and I am glad to say that I am officially graduating! I passed my Senior Presentation with an A, which is a major change from failing the 30 minute one. Now all that's left is the evening tradeshow on Wednesday and we are finished. It's been an amazing Senior Year and I absolutely loved all the new experiences from Prom to Hiking and all the work it was a great learning experience. I'm glad to leave iPoly on a high note.

Blog 22 Senior Project Reflection

1. I'm really proud of my Final Presentation and how my project turned out as a whole. I've learned a lot of information and I actually surprised myself with how much information I retained while presenting. This had been a remarkable improvement from the 30minute one I sadly failed. We've spent an entire 9 months on this project and it really is my baby.

2a. P

2b. P
3. I met time, mentioned sources, and people were commending me afterwards so that's good. I'm pretty sure I'm graduating too.
4. I definitely would've prepared myself better with the 30 minute presentation and looked for more research to back up everything.
5. I now know what it takes to create a quality research paper with expert sources from the ESA which I showed through my iSearch paper. I'm confident on my ability to speak when called to seeing as I actually almost went over time during the Senior Presentation. I've also confirmed that I will take nursing after high school.

Hour Presentation Prep

I'm taking a break from working on my senior presentation to give a little update and a sneak peek of what's to come. I present tomorrow and have been working for the past week on my presentation. The content is good, in my opinion, it's just a matter of getting the information out there. Presenting for an entire hour is really nerve wracking and I have to give props to all the teachers that do it every single morning. As long as I get past that hour and meet all the minimum requirements I will officially be graduating! Whoops. I almost forgot that there's also that evening trade show next week, but it's no biggie. Here are a couple of props I will bring Thursday morning:

I actually had to return the dosage calculations one

I'm so proud I made this one myself!

Minus the badge on this one

 

Already  prepared for nursing school ;)

I am super excited and terrified! Wish me luck c:

Blog 21: Mentorship

Literal
Mentorship Log - 56 hours total

Michael Bravo (Volunteer Coordinator) - San Dimas Community Hospital

Interpretive
The most important thing I have taken away from volunteering with San Dimas Community Hospital for the Senior project is the experience I have culminated. Senior Project prompted me to take this opportunity which I never would have taken advantage of had I not been required to. I am almost certain after taking into full consideration my experience that I will not go into nursing. I have seen both the good and bad in it and don't think it is the best course to take. However, I am sure that health care is something I want to continue exploring and still holds my interests, perhaps the research aspect of it. What I have accomplished up to this point in time however is truly remarkable. Taking advantage of the Senior Project, I have explored a future career and have been given access to an experience that not anyone can get by just walking into a hospital. I've become an integral part of the health care staff as a volunteer by talking to patients and helping nurses with what I can. Apparently, I've even made it farther than many volunteers who I've heard left maybe after a month. By sticking it through, I learned more and more each day about nursing and the hospital setting as a whole too and how it is all integrated.

Applied

Mentorship has helped me answer my EQ by providing a real life application of research to what I observed at the hospital. I watched as the entire health care team utilizes the patient assessments that nurses make. I've also watched many assessments take place (not up close for privacy reasons obviously). I see how nurses take an advantage of the interaction with their patients to communicate an understanding of what's going on and how they are doing in terms of health and recovery. These observations helped me cement my best answer as well as the others, watching all the measures staff take with sanitation and infection prevention every single day. My mentor, Aubrey Abiva, also helped  make my answers concrete through our interviews as well as discussing them with other nurses when I could.

April Update

Everything is really starting to come together now. Exit interviews are coming upon us; research and mentorship hours are due soon; prom, senior breakfast, and graduation night are around the corner; the ever-looming Final Presentations are almost here. I'm still nervous as ever, but slowly working towards the last presentation.
Today, I had 3 committee meetings happening all at once. This is such a stressful time. Core classes are being jam packed into busy days already full of Senior Project work to be done.This week alone, aside from core class HW, I had a 5th interview with a Junior, 2nd part of a Lab Report, Research checks, prom committee (it's getting down to the wire and I had to help take charge), a Civics Award presentation, iSearch essay. It's been difficult keeping up with my extra curriculars outside of school because I keep cancelling to stay home and do work. I now know that because I had to skip a couple mentorship days for HW and even though I went during Spring Break, my goal of 100 total hours at the hospital will remain unattainable at 86 hours. :(
One more month to go. Just need to make it past there and I am free... until college debt hits me.

Blog 20: Exit Interview

Content
1) What is the best way a nurse can help a patient recover from knee surgery?

• Answer 1: For a successful post-knee surgery it is essential for a nurse to perform accurate patient assessments throughout recovery.
• Answer 2: A nurse must prevent muscle atrophy and practice proper sanitation, and aseptic techniques. 
• Answer 3: Decrease recovery time by involving patients in the process of their own care.

Best answer is 1 because accurate assessments allow the nurse to track the progress of patients and act accordingly based on findings which incorporates answers 2 and 3. 

 
2) Talking with my mentor and through research.
3) Changing the basis of my topic from patient-centred care to recovery. Research, research, research.
4) Mentorship/Mentor and research. Formatting and coming up with answer. Giving real life applications from those found in research. Giving my project depth.

Blog 19: Independent Component 2

Literal

a) I, Allyana Salud, affirm that I completed my independent component which represents 30 hours of work.

b) My mentorship with San Dimas Community Hospital and mentor, Aubrey Abiva, RN, helped me complete the independent component.

c) Independent Component Log - The log is combined with my Mentorship log which can be found at the right-hand side of this blog.

d) For my 2nd Independent Component, I completed an extra 32 hours at my mentorship in addition to the 50 required. At San Dimas Community Hospital, I volunteer at the Medical Surgical Unit of the hospital every Thursday from 4-8PM.

Interpretive
At San Dimas Community Hospital I help nurses by, taking call lights from patients and directing the right nurse depending on the subject matter to their patient, running specimens to the laboratory, clerical work, relaying paperwork from one wing of the unit to the other, putting up patient assignments for the night shift, making rounds to talk with patients and get them what I can, stocking rooms with gloves and carts with Personal Protective Equipment (PPE), as well as anything else a nurse might ask of me. The most significant things I have learned from the Independent Component were gathered through my interviews, shadowing my mentor, and observations made.

A letter of proof showing I have done at least 30 hours of work.

Volunteering at a hospital is serious business and there are many laws (that I researched and learned about in orientation), such as HIPPA, that were made to protect the privacy of all patients in the hospital. The pictures displayed are the ones I was given the permission to take for this component.

                              

                 

My mentor, Aubrey Abiva, has been a guiding                        A majority of my time is spent at one of the  

    force throughout the senior project. She                             nursing stations in the Medical Surgical Unit.

agreed to be the interviewee for my interviews                       There I manage call lights, prepare charts for

   3 and 4 and let me shadow her while she                            incoming patients, and update the assignment

gave me topics to research as well as advice on                       board. When I'm not doing clerical work I 

     the answers I came up with for my EQ.                          observe nurses or make rounds on the floor to

                                                                                          see if I can assist patients with anything.

                            

 The outside of the rooms in this unit have 2                                  I am not allowed to enter isolation 
  crucial signs about patients for nurses and                                 rooms even with personal protective      visitors to keep in mind. The falling star is a                              equipment (PPE). This is important for 
sign for those that are prone to falling and the                                controlling the spread of infection
 stop sign warns them if they are in isolation                                 which I learned more about through
      or shouldn't be in direct contact with.                                      research. If a nurse were to go into 
                                                                                             one of these rooms without PPE they 
                                                                                                could endanger other patients and 
                                                                                                          the health care team.

                               

 This chart talks about contact precautions with                     This is a box of safety gowns that includes 

 the patient or patients inside. Visitors are to go                     instructions on how to use them. They are

  to a nursing station before entering and will be                 sitting on a small rolling cabinet which contains

 briefed by the nurses there. They'll be told what              other PPE such as, gloves, masks, and antiseptic

   PPE to wear and what or what not to do while                 wipes. One is located in front of each room that

visiting. Again, this has to do with controlling the                  houses a patient in isolation or with contact 

      spread of infection for the safety of all.                       precautions. Although, I cannot enter these 

                                                                                    rooms I make sure the cabinets are stocked. 

My Story - Video Maker

"My Story" is an example of patient-centred care implemented at San Dimas Community Hospital. I observed one of the nurses using it with patients and now visit other patients throughout the medical/surgical unit when I volunteer to give them the care package if nurses are busy. 

     The first picture in the short video I created displays the contents of the bag I delivered to patients. It contained an eye mask and ear plugs in a little zipped pouch along with the little booklet titled "My Story". The second shows the front cover of the booklet which reads, 

     "The care that San Dimas Community Hospital provides reaches beyond clinical expertise. Working together as your partner in healthcare our passion and commitment is to care for you and your loved ones with, warm, personalized attention."

     The inside is where I helped patients tell the staff more about them so they could get to know them and make them feel more at ease during their stay. From my research and the nurse who showed me "My Story", I learned that interaction helps create a comfortable bond between health care team and patient.  Connecting on a more personal level will help the patient be more confident in their nurse's directions and even to ask questions or for recovery advice.

Applied

At the hospital, my mentor, Aubrey Abiva, helped me come up with 2 answers to my EQ through interviews and shadowing. One of them was about deterioration of the patient's condition as a result of infection and muscle atrophy and the other was about increasing a patient's understanding and comfort level. She told me about muscle atrophy while shadowing, and in the interview she explained how pain control is important to dispel any discomfort so patients can gradually start to exercise. This will help them regain their strength preventing muscle wastage and recover from surgery. I observed the precautions her and the other nurses took when going into isolation rooms. They have a procedure to put PPE before they enter the patient's room and take it off immediately after. Throughout the day, they will be going back and forth to other rooms and if an infection happens because of something left on their PPE the results could be very harmful to a patients recovery. She also talked about how increasing a patient's understanding makes a more compliant patient. The nurse knows best and following their instructions can lead to faster recovery. She showed me some of the packets and pamphlets they give to patients based on their condition and the advice it has for them. According to one of them, for recovery from knee surgery, it is best to rest and not strain yourself before you are ready to move. Exercise is important to prevent muscle wastage, but can lead to dire consequences if done too soon.
From other observations, I noted just the sheer number of times I had to restock PPE cabinets or put gloves in rooms shows that there really is a great importance in prevention of the spread of disease. I also how important documentation was, by seeing the amount of times doctors, nurses, dieticians and more consulted a patient's chart for information and updated it with new findings.

March Madness

This was a very hectic month filled with senior project work, committees, powder puff, and what all 4 years of i-Poly has lead up to... selling chocolate bars.

For senior project we formulated our 3rd answer for approval and created our 4th interview questions. I scheduled my interview right after I came up with the questions and have actually finished early. We also had our 3rd Advisory meeting where we turned in our research grid and did our 3 column, which is conveniently posted to the right of my blog page.
I feel that my research is coming along great now that I know what I'm looking for exactly. It'll help me find more credible sources to back up my answers. My research regarding the ESA component has not been favorable. I knew exactly what I wanted to find statistics on to backup my answers. However finding data and being able to interpret them represented a challenge. I wish we'd had more time to work on it because I was unable to complete it, but will continue to work on it if only for my own personal benefit.
On another note I have completed my hours at the hospital for both mentorship and independent component 2. All I have to do is update my log with all the details of what my hours entailed. I will continue to do extra hours at the hospital to gain more insight and observe things I have found through my research in real time.
It seems that committees are in full swing and many are running at the same time. We have fundraisers left and right, drives one after another, and prom coming up. Thankfully, Powder Puff is over now and we're able to devote more time to these other events. It's been a great run for the Class of 2014 and I'm glad we had the chance to play. I had fun (winning felt pretty great too) and I'm really proud of everyone who participated: the coaches, players, cheerleaders, announcer, sign makers, and the ones who cheered us on. The guys have really grown from last year's performance, but are still as energetic as ever ↓
Oh yeah and I sold my chocolate bars (not really).    \(^.^)/ 

Blog 18: Third Answer

EQ
What is the best way for a nurse to help a patient recover from surgery?

Answer #3
Decrease recovery time by involving patients in the process of their own care.

3 details

• Patients' active participation can contribute to increased motivation to improve, follow prescription orders, get better treatment results and have a high satisfaction with received care. Patient and carers create a Q&A notebook throughout stay in Massachusetts General Hospital, Boston.
• Ensure that the patient/ client is at the centre of care delivery through the formation of relationships between provider and patient. John Hopkins Medicine Pediatrics Hospital implemented family centered rounds where physicians, nurses and other members of the health care team met with patients and their families all together. From 2012 to 2013, they went from the 56th percentile to the 94th.
• In 2004, the National Institute of Medicine published a report stating that nurses have a critical role in securing patient safety. At my mentorship/ independent component I see that whenever a situation arises, an alarm goes off or a patient that isn't supposed to be moving and is at risk for falling starts to get up, it is the nurse that goes to patients' rooms to talk and make sure they understand that everything is okay and how they can help their own recovery or impede it.

Research Sources

• KAE Plos, et al. "Patient Participation In Nursing Care From A Patient Perspective: A Grounded Theory Study." Scandinavian Journal Of Caring Sciences 21.3 (2007): 313-320. CINAHL Plus with Full Text. Web. 20 Sept. 2013.
• McCance, T., McCormack, B., Dewing, J., (May 31, 2011) "An Exploration of Person-Centredness in Practice" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 1. Web. 2 Oct. 2013.
• Fink, Shawn. "Trust in us." Nurse. Gannett Company. 5 Aug. 2013. Web. 22 Aug. 2013.
• Dunton, N., Gajewski, B., Klaus, S., Pierson, B., (September 30, 2007) "The Relationship of Nursing Workforce Characteristics to Patient Outcomes" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 3. Web. 9 Oct. 2013.
• Mentorship/ Independent Component

Concluding Sentence
Involving patients in their own care by developing interpersonal relationships between patient and provider allows both to meet each others needs resulting in decreased recovery time.

Blog 17: Fourth Interview

1. What experiences have you had with patients and surgery?

2. What type of surgery has been the most challenging to work with and why?

3. How would you help a patient regain their physical and mental strength after surgery?

4. What is the best way to prevent a patient from deteriorating after surgery?

5. How do you keep patients motivated to recover?

6. What is the importance of pain management throughout recovery?

7. What role does medication play in a patient after surgery?

8. What is your number one priority when it comes to helping patients recover?

9. How do assessments help with the improvement of patients?

10. How do you conduct a proper patient assessment?

11. What are the different safety precautions a patient has to be aware of?

12. How do you educate a patient on safety measures?

13. What safety precautions do you and others in your station take?

14. What equipment is most useful to you and helping your patients?

15. What can be done to see the best improvement in a patient?

16. What is the importance of communication between patient, and not just the nurse, but the entire healthcare team?

17. What is the importance of patient understanding and participation for recovery?

18. How do you deal with those that have trouble complying with orders (confused, mentally disabled, and stubborn)?

19. What can you do to ensure that the patient recovers from surgery?

20. What struggles have you had with helping a patient and how did you overcome them?

21. Out of all your patients, which one or moment sticks out the most and why?

22. How do you keep from slowing down and losing interest in your job?

February Reflection

This month, I completed my third interview with, Aubrey Abiva, a nurse at San Dimas Community Hospital and iPoly alumni. She is really knowledgeable and was able to give me a really good interview since she's comfortable talking with people, which is an essential skill for the job. She talked about how pain management is important. An important aspect she also talked about was communication, you need to develop a relationship in order to help understand each other's needs. I believe communication will be part of my 3rd answer.

We completed 2 Advisory meetings this month, which I found to be very helpful. In the first meeting, I learned what I need to research more on. During the meeting today, Mrs. Pittman helped me format my second answer along with everybody else's. This allows us to better prepare ourselves for the final senior presentations and I appreciate the valuable advice we were given.

Tomorrow, I will start conducting the long overdue extra research for my senior topic. I need to stop procrastinating and get a move on meeting the research requirements early.

Blog 16: Advisory Meeting #2

EQ
What is the best way a nurse can help a patient recover from knee surgery?

Answer #2
In order to help a patient recover from knee surgery, a nurse must take necessary protection measures.

3 details

• According to Nursing Times, The "ABCDE" approach is to be performed for deterioration prevention when patients are transferred or during emergency situations.
• WHO estimates 99,000 deaths annually in the US due to infections as a result of health care. 
• A study of patient participation in the Scandanavian Journal of Caring Sciences determined that activeness and patient understanding contributes to increased motivation to improve, follow prescription orders, and get better treatment results. 

Research Sources

• Mentorship
• Liddle, Cathy. "Principles of Monitoring Postoperative Patients." Nursing Times. Vol. 109 No. 22 Pp 24-26. 31 May 2013. Web. 23 Jan. 2014.
• Liddle, Cathy. "How to Reduce the Risk of Deterioration After Surgery." Nursing Times. Vol, 109 No. 23. Pp 16-17. 7 June 2013. Web. 23 Jan. 2014.
• Royal College of Nursing. "Essential Practice for Infection Prevention and Control." Royal College of Nursing. 2012. Web. 6 Feb. 2014.
• KAE Plos, et al. "Patient Participation In Nursing Care From A Patient Perspective: A Grounded Theory Study." Scandinavian Journal Of Caring Sciences 21.3 (2007): 313-320. CINAHL Plus with Full Text. Web. 20 Sept. 2013.

Concluding Sentence
Protection measures are necessary for the nurse to take in order to prevent or stop deterioration, infection, and help patient understanding.

Blog 15: Independent Component 2 Approval

1. I plan to continue my mentorship at San Dimas Community Hospital for 30 hours, in addition to the 50 I have already completed.
2. I am not allowed to take pictures of people at the hospital due to liability issues so I will keep a log of my hours. However, I will try to take pictures if allowed to.
3. Continuing mentorship will allow me to gain more experience and observe what nurses do for their patients after surgery. I can talk to patients as well as nurses for their opinions and knowledge. It specifically pertains to my topic since I am assigned to the Medical/Surgical Unit of the hospital.
4. I have decided to continue logging my hours in the Mentorship Log on the right-hand side of my blog, but labeling which hours are Mentorship and which are Independent Component.

Blog 14: Independent Component 1

Literal

I, Allyana Salud, affirm that I completed my independent component which represents 30 hours of work.

My teachers Jeanette Ellis, David Greene, and Noemi Barajas (who filled in for Mr. Greene when he went on medical leave) as well as these 2 books helped me complete my independent component:

Comprehensive Medical Terminology by Betty Davis Jones 

&

Dosage Calculations by Gloria D. Pickar

I attended the course on Mondays and Wednesdays from 2:40-5:10P

Syllabus

For my first independent component, I took a class at Citrus College. The Intro to Health Occupations course was a prerequisite for the Licensed Vocational Nurse (LVN) Program. Four different classes took the same course taught by several professors on Pharmacology & Anatomy/Physiology. Only the top 15% students out of all 4 classes would pass and be eligible to join their LVN Program.  

Interpretive

The class had a very rigorous schedule with tests almost every day. Every Monday and Wednesday I would lug my textbooks to study at school for the coming tests. Although it was a challenging course, I learned an extensive amount of information. Studying and class time is equal to over 30 hours of work as evidenced by me passing the class. I was accepted into the nursing program, but opted not to join the LVN Program in order to finish high school at iPoly. However, it was a rewarding feeling to know that I have what it takes. 

I have Transcript Evidence, which is also located at the right hand side of the blog.

Applied

The class has helped me develop a sense of medical terminology, familiarize myself with the human body, and what nurses do. In order to delve deeper into the topic of nursing I felt it was important to build on the basics first. I've learned how to examine patients, determine pathological conditions possible treatments, calculate dosages, properly document a Medication Administration Record (MAR), and know the legal side of nursing as well. When presenting on the topic of nursing a lot of medical jargon tends to come up. I can now easily break that down. For my activity during the 30 minute presentation the word hepatitis is mentioned. From class I know that "itis" means swelling or inflammation  and "hepat" means liver. Therefore, "hepatitis" is the swelling or inflammation of the liver. When I observe nurses and doctors at my mentorship I have a better grasp on what they're saying (body parts and pathology), can understand what's happening around me, and see how they work together with staff and patients. The class also helped me develop my first answer, which was Patient Assessments. We had a whole section on the topic and I learned how much emphasis was put on it and why.

Presentation Pressure

-Henry Ford

Failure. It happens.

I honestly shouldn't have been surprised at the end result of my presentation. Even though the info was in my head, I let the pressure and stress of presentation anxiety get to me and blanked out. Sitting in my chair, it was disappointing at the time to know right after the failed presentation yesterday that I was thinking of all the things I could've said but didn't do.

Now I understand that I need to work on stressing out less and practicing for presentations more. I do realize that it is okay to fail as long as I pick myself up and try again. Luckily, there's still time for me to prepare and raise my grade. The 2-hour (more like 1.5) final senior presentation is yet to come. In the mean time, I'll sell a box of chocolate to improve my public speaking skills and hopefully instill confidence.

Blog 13: Lesson 2 Reflection

Content:

1. Positive Statement
I'm really proud of the lesson I made for this presentation.
2. Questions to Consider
   a) NC
   b) There was a mandatory 10 minute answer driven speaking time that I did not meet.
3. What Worked For You
I created my lesson ahead of time instead of doing it all the night before.
4. What Didn't Work
Not presenting as well as I could have. Maybe I should have practiced more. Being over stressed and nervous didn't help me at all either. I should have calmed down and relaxed because I did know my info and only blanked out because I was so worried.
5. Finding Value
Two possible answers I'm thinking about are Hygiene Technique Implementation and Developing A Patient's Knowledge and Understanding.

Blog 12: Third Interview Questions

1. What is the best way a nurse can help a patient recover from illness?

2. What challenges have arisen while you were helping a patient recover from illness? 

3. How did you overcome them?
4. What steps did you take to ensure the patient was under the best care possible?
5. What techniques would you use to help a patient with regaining their strength after illness?
6. Which technique has yielded the most effective results and why?

7. What is the most important step in your assessment and management of the patient?
8. What are the best ways to ensure a patient is happy?
9. How do you determine if a patient is satisfied with their experience?
10. What methods are commonly used when a patient is showing anguish/pain?
11. How do you prepare a patient for care after the hospital?

12. Which sources would you recommend for further research in my topic?

Blog 11: Mentorship 10 Hours

1. Where are you doing your mentorship?
San Dimas Community Hospital

2. Who is your contact?
Michael Bravo - Volunteer Service Coordinator

3. How many total hours have you done?
40 hours

4. Summarize 10 hours of service you did.
I was really nervous and excited to begin volunteering at the hospital. I had never worked a desk before so it took me awhile to get the hang of it. My job was to intercept calls from patients' rooms and figure out what they wanted; whether it was a blanket, water, meds, assistance, etc. I then called either the RN, LVN, or CNA depending on what they needed and directed them to the patient.

The next 2 weeks, in addition to taking calls from patient rooms, I helped assist the day shift transition to night. I prepared binders before they were filled up with the sensitive documents of incoming patients. I also wrote down the assignments (extension #s and patients assigned to) for nurses on the white board. During transition time I got numerous calls from patients which was stressful because all the AM nurses are briefing the PM nurses on their patients so there was no one to assist them. I also completed my 2nd interview with one of the RNs. It can be difficult to stop and chat with the nurses when they have to continuously move from room to room accommodating patients with their needs. 

5. Email your house teacher the name of your contact and their phone number confirming who they should call to verify it.
Done.

Blog 10: Senior Project - The Holiday

1. What did you do over the break with your Senior Project?
    The first week of break I went out of town with my family and was unable to work on my senior project. However, I was able to continue my mentorship at San Dimas Community Hospital the next week. I volunteered for my usual 4 hour shift in the Medical/Surgical Unit.

2. What was the most important thing you learned from what you did and why? What was the source of what you learned?
    Through experience on the floor of my unit and being given the opportunity to talk to patients I learned just how important interaction with patients can be. I met an elderly patient while making my rounds through the rooms asking if  anyone needed anything. Since I was almost finished I decided to stay and chat a bit since he seemed a little lonely. He seemed really eager to talk and began to regale me with stories of being a US Air Force Pilot in Korea and about his life in general. After all had been said, I found the man in tears when I had to go.  He thanked me for the company and told me how glad he was that someone had come to chat with him. It was a touching experience to find just how much giving a part of your day to someone can mean. I've also seen this happen when the nurses would stop and talk to their own patients if only for a few minutes.

3. If you were going to do a 10 question interview on questions related to answers of your EQ, who would you talk to and why?
    I would talk to one of the nurses at the hospital I volunteer at, specifically in the Medical/Surgical Unit which is what my EQ is geared towards. I'm familiar with a couple of them (like former iPoly student Aubree) because I've volunteered there for a while now and they have more patient contact than any other hospital staff.