Tuesday, August 24, 2010

Rock, Paper, Scissors

I'm proud of this reflection, and of the day. My professor is using this paper as an exemplar.

Rock, paper, scissors. That’s how we determined who would watch the paracentesis. There were three of us students, but only one would be allowed into the room.

Marco the porter had clued us in to the situation. While we waited by the empty gurney, we played the kid’s game to decide who got to see the good stuff.
I lost right away. Damn.

So which patient is it, anyway? I asked Marco. He pointed to one of the rooms. Oh. One of mine. Double damn. She was an end-stage liver patient. When the CNA, (Ana) and I went in for her vitals that morning, she was on 5L O2 and never opened her eyes. He daughter was lying on a cot in the corner. She told us that her mom had fought the mask the night before. It was a rough night and she was exhausted.

My clinical instructor, 'Linda', found us and asked what was going on. We told her the situation and she tried her best to get us all in (she’s fantastic, by the way). No luck. She asked us what would cause edema in end-stage liver failure. One guess was portal hypertension. I threw out my idea; the liver was no longer making albumin, so without it, water was leaving the vessels. Linda smiled. I had my gold star for the day. But I still wasn’t going downstairs.

I kept my ears open and later found out that my patient was not coming back up, but was being transferred to the ICU instead. Ana and I went to her room to help her daughter load up their stuff to take downstairs.

On the way down, she started crying. I put my hand on her shoulder and told her it was ok to cry. She said she was afraid that they wouldn’t let her stay in the ICU, and if that were the case, she’d sleep outside the door if she had to. I told her that to my knowledge, they would let her stay (my mother-in-law had been allowed to stay with my father-in-law in the same ICU for several days). Then she talked a little about her mom, about what she meant to her.

When we got downstairs, I asked one of the nurses right away if she’d be allowed to stay, and of course she was. I helped her unload, and she thanked me for listening. She’d come out to Colorado expecting her mom to recover after a couple of days. That was a month and a half ago. They had no one else in town.

Later when we debriefed at the end of the day, we heard about the paracentesis. Yes, I still wish I could have seen it, but then I would have missed helping my patient’s daughter. In the end, I think I was in the right place. This is the kind of nurse I want to be; one who remembers that her patients are people with families and lives outside of their disease. By helping her daughter, I indirectly helped her.

Sunday, August 22, 2010


I'm a nursing student, as you've probably gathered already.  At this point, I'm halfway through my first year in a two-year program, taking the traditional route rather than the accelerated (I'm crazy, not masochistic).

My first rotation was Med-Surg I, or Medical-Surgical for those who haven't experienced this particular torture.  What can I say?  It was the best of times, it was the worst of times has already been taken.  My lecture professor and my clinical instructor both asked us to write reflection papers.  At the time it was difficult to come up with a staggering nursing insight at 2 AM when I needed to get up at 4 and hie on over to the hospital. But now I'm grateful to have a written record of those days.

So I thought I'd share these reflection papers.  Most of you are old friends, many who knocked on the bolted door of the Nursing Cave to see if I was still alive, and too often heard the sound of crickets chirping in response.  Here's what I was up to.

I'm hoping too that I can attract a few other nursing students to this site, or maybe some hapless souls who are thinking of going into this line of work vocation.  Maybe this will give you some idea of what you're in for.  Of course it's like parenting or marriage -- you can read all you want on the subject but until it's actually happening to you, you have no idea what it's like.  

I'd like to stay anonymous here, so those of you who know my by one or more of a legion of names, chuckle knowingly to yourselves and stick to some form of Student Nurse Ninja in the comments.  Thankeesai!

I'll post my first paper tomorrow or Monday. 

What My Ideal Nursing Practice Looks Like

This was before I stated in the hospital.  Ah, ideals!  Aren't they cute?

My ideal nursing practice? Well, that's simple. I'd never get the meds wrong. I'd perform every procedure flawlessly and painlessly the first time. I'd catch the patient hours before she'd start circling the drain. I'd say the right words at the right time in the right tone to comfort the bereaved (not that their loved one would ever die on my shift, of course). And I'd spend hours researching best practices and find a way to implement them all. Do you hear those trumpets playing, too?

Ok, back on earth. I like making people feel better. That's my tagline for my ideal nursing practice.

I think one of the most important factors to feeling better is getting rid of the fear factor. The best way I know to do that is through education and keeping the patient in the loop about his or her treatment. When a patient or family member has a question about a procedure or a drug, I want to take the time and explain it to them until I see the light bulb go on. Not only would I get a personal thrill from doing that, but knowing what is going to happen, and the rationale behind it, takes away some of the patient's anxiety. Higher levels of anxiety have been associated with higher levels of pain, (Loncar, Zoran, 06/2006) so managing that anxiety could potentially reduce my patients' pain. So, my ideal nursing practice would include a lot of patient education.

I would like a clinical setting where prevention is also taught and encouraged. I think I would volunteer for a lot of community health fairs and clinics in my practice.

My desire to educate extends to other nurses as well. I can see my ideal nursing practice including a preceptor role. Again, I would want to do more than just send my student off to take vitals, or 'show 'em how it's done' with a procedure. I would really want to explain the ins and outs, and make sure my student was comfortable with her role. If I could reduce his or her anxiety about nursing, I'd walk home on clouds.

So, aside from being Nurse Poppins (practically perfect in every way), my ideal nursing practice would include a strong element of research and education, and focus on anxiety and fear reduction for both patients and new nurses/students.

Loncar, Zoran (06/2006). "The relationships between burn pain, anxiety and depression". Collegium antropologicum (0350-6134), 30 (2), p. 319.