Today I worked again but I think I will have the rest of the week off to study (not booked in for any more teaching this week). Last week I went to uni to return library books and borrow more books for both exam studying and my assignment. I've had the same books out all semester and renewed them three times (the maximum) for a total of three months. It's saved me a lot of money on buying text books. The books that come in handy the most a small ones that I can take with me to labs but for big expensive textbooks I think it's best to borrow them from the library.
I've been catching up on a few lectures that I hadn't got round to doing before my clinical placement. These are the topics:
• Neurological Assessment (includes all the senses)
• Anti-depressants and mood-stabilizing drugs
• Anti-psychotic drugs
• Anxiolytic drugs
• Psychotropic and anti-cholinergic drugs
Now I've completed all the lectures, every single one including all the online ones and the ones recorded live at uni. Currently I'm working on my assignment, have done the outline and research, and I'm also working my way through all my vocabulary, which is a huge list of about 200 medical words that have come up in lectures that I don't know the meaning of. I'm using my medical dictionary that I bought recently and is probably the most useful of all my books. When I was going to classes I took it to uni every day and got a lot of use out of it.
Last week Manny had a big operation. He had teeth cleaning to remove a buildup of plaque and four teeth were extracted due to gingivitis. He had to go under general anaesthesia and have an IV drip! He had a bandage on his arm from the IV and as soon as he got home he took it off, LOL. For the last few days he's been on a soft food diet and as of tomorrow he'll be on a special diet to keep his teeth healthy. He also needs to lose 500g to get his BMI in the 'healthy' range. I can't believe he's 'overweight'. If Manny's overweight, the majority of cats in my neighbourhood must be OBESE! I think it's a case of 'average' not necessarily indicating 'normal' or 'healthy'. A lot of humans in western countries are overweight but they think they are 'normal/healthy' because in those countries the 'average' person is overweight!
Monday, May 31, 2010
Thursday, May 27, 2010
Back into Study mode
For the last three days I have been working at my teaching job and today was the first day I got stuck into the studying again after my clinical placement.
This is what I got done today:
Reading
• Stockings for DVT prevention – how they work and how to use them
• Intravenous Therapy
• Guidelines for use of the National Inpatient Medication Chart
Pharmacology Online Tutorial
• Answered and submitted about 10 questions. This took quite a while because I had to research and provide references for the answers.
Online Ethical Discussion for Medications in Nursing
• I should have done this ages ago but kept putting it off. Had to contribute to two of the ethical issues on the subject's online discussion board. These were the questions I chose and the answers I wrote:
1. Your patient is confused and is refusing their prescribed medicatons which include an antihypertensive drug. Your patient's BP is 160/95 and the RN Div I asks you to crush the medications and mix them with the patient's breakfast. What do you do?
Medication should not be crushed and added to an adult patient's food without their knowledge. If you do not have the patient's consent to administer the drug, it is unethical and beyond scope of practice to do so. As a student, you can and should refuse to follow an order from an RN nurse if you know it is unethical, illegal or not best practice.
In the case of this patient, I would try to find out why the patient is confused, and why they are refusing their antihypertensive. It may be a good idea to come back an hour later when the confusion might have eased. If they are still refusing I would ask them to give their reason why. It might be necessary to re-educate them about what the drug is for.
I would educate them that the reason they have been prescribed the drug is that persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic renal failure.
His blood pressure of 160/95 suggests he is on the borderline between Stage 1 and Stage 2 Hypertension. It is normal for blood pressure to be highest in the morning [www.merck.com/mmhe/sec03/ch022/ch022a] so on average he probably has Stage 1 hypertension and therefore taking the anti-hypertensive is very important in preventing him from getting to Stage 2.
If he is still refusing, I would page his doctor to come up and have a chat with him.
2. Is it okay to provide a placebo medication if it is in the patient's best interest?
Firstly, the placebo response is when the mere taking of a medicine has a psychological effect that produces a beneficial physical response. This response is often an important contribution to the overall effectiveness of a chemically active drug. It is most commonly seen in analgesics, antidepressants, and anti-anxiety drugs. There are also certain types of people, known as "placebo responders" who are more likely to experience the effect than others. (Royal Australian College of Practitioners New Guide to Medicines and Drugs, 2008)
In my opinion, as an ethical rule, doctors should not prescribe placebos because it is dishonest. Transparency and informed consent are very important aspects of medical treatment, and it would not be fair on the patient to provide a placebo but make them believe they are taking a real drug.
However in some situations it can be okay to provide a placebo, such as:
- in drug trials, to find out the differences between placebo responses and chemical responses, and the effectiveness of the drug. However, whether providing a placebo in this case is 'in the patient's best interest' or not is questionable. If it is part of their informed consent that they understand some participants will be provided with a placebo, then I think it is ok.
- in children when they bump their head or have a tiny scratch on their leg but are crying really uncontrollably, you could rub a little bit of lipbalm into the skin and tell them 'this is special ointment that will make it better'. In this case it is definitely in their best interest because it will help calm them down.
These are the only two ethical examples I can think of where it would be ok to provide a placebo.
This is what I got done today:
Reading
• Stockings for DVT prevention – how they work and how to use them
• Intravenous Therapy
• Guidelines for use of the National Inpatient Medication Chart
Pharmacology Online Tutorial
• Answered and submitted about 10 questions. This took quite a while because I had to research and provide references for the answers.
Online Ethical Discussion for Medications in Nursing
• I should have done this ages ago but kept putting it off. Had to contribute to two of the ethical issues on the subject's online discussion board. These were the questions I chose and the answers I wrote:
1. Your patient is confused and is refusing their prescribed medicatons which include an antihypertensive drug. Your patient's BP is 160/95 and the RN Div I asks you to crush the medications and mix them with the patient's breakfast. What do you do?
Medication should not be crushed and added to an adult patient's food without their knowledge. If you do not have the patient's consent to administer the drug, it is unethical and beyond scope of practice to do so. As a student, you can and should refuse to follow an order from an RN nurse if you know it is unethical, illegal or not best practice.
In the case of this patient, I would try to find out why the patient is confused, and why they are refusing their antihypertensive. It may be a good idea to come back an hour later when the confusion might have eased. If they are still refusing I would ask them to give their reason why. It might be necessary to re-educate them about what the drug is for.
I would educate them that the reason they have been prescribed the drug is that persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysms, and is the leading cause of chronic renal failure.
His blood pressure of 160/95 suggests he is on the borderline between Stage 1 and Stage 2 Hypertension. It is normal for blood pressure to be highest in the morning [www.merck.com/mmhe/sec03/ch022/ch022a] so on average he probably has Stage 1 hypertension and therefore taking the anti-hypertensive is very important in preventing him from getting to Stage 2.
If he is still refusing, I would page his doctor to come up and have a chat with him.
2. Is it okay to provide a placebo medication if it is in the patient's best interest?
Firstly, the placebo response is when the mere taking of a medicine has a psychological effect that produces a beneficial physical response. This response is often an important contribution to the overall effectiveness of a chemically active drug. It is most commonly seen in analgesics, antidepressants, and anti-anxiety drugs. There are also certain types of people, known as "placebo responders" who are more likely to experience the effect than others. (Royal Australian College of Practitioners New Guide to Medicines and Drugs, 2008)
In my opinion, as an ethical rule, doctors should not prescribe placebos because it is dishonest. Transparency and informed consent are very important aspects of medical treatment, and it would not be fair on the patient to provide a placebo but make them believe they are taking a real drug.
However in some situations it can be okay to provide a placebo, such as:
- in drug trials, to find out the differences between placebo responses and chemical responses, and the effectiveness of the drug. However, whether providing a placebo in this case is 'in the patient's best interest' or not is questionable. If it is part of their informed consent that they understand some participants will be provided with a placebo, then I think it is ok.
- in children when they bump their head or have a tiny scratch on their leg but are crying really uncontrollably, you could rub a little bit of lipbalm into the skin and tell them 'this is special ointment that will make it better'. In this case it is definitely in their best interest because it will help calm them down.
These are the only two ethical examples I can think of where it would be ok to provide a placebo.
Thursday, May 20, 2010
Last Day of Clinical!
Today is the last day of my first clinical placement. This week has been really good compared to last week. I haven't been stressed at all. Yesterday I got a chance to watch a surgery - plastic surgery on a hand. I had the opportunity to stay with and look after the patient - a Vietnamese butcher who cut his hand with a knife - from when he was brought up to the ward from emergency until he had his surgery and went home. Unfortunately for him that took more than 2 days but for some people it takes longer because what they need isn't high on the priority list. It was interesting to see the whole process of putting the patient under general anaesthesia and watching them wake up. He was very talkative when he woke up and wanted to know how the surgery went so it was good for him that I was there, otherwise he wouldn't have had anyone to talk to. He said 'you look apter me bery bery goo. my English no goo but you alway understan me'.
Another great thing yesterday was that I had my final assessment with my clinical teacher and I have passed this clinical placement satisfactorily. We don't get any grade, just satisfactory or unsatisfactory. I also gave two injections yesterday - woohoo! Everyone else had an opportunity already and I was waiting and waiting, hoping I would get a patient who needed one. Now I feel complete, LOL. My patients didn't wince or cry, they both said 'you did it good'.
Another great thing yesterday was that I had my final assessment with my clinical teacher and I have passed this clinical placement satisfactorily. We don't get any grade, just satisfactory or unsatisfactory. I also gave two injections yesterday - woohoo! Everyone else had an opportunity already and I was waiting and waiting, hoping I would get a patient who needed one. Now I feel complete, LOL. My patients didn't wince or cry, they both said 'you did it good'.
Tuesday, May 18, 2010
Day 7 Clinical Placement
Just finished day 2 of my second week of placement. This week I am on the ENT (ear, nose, throat) and Plastics ward, and I'm also doing evenings instead of mornings. I'm finding the shift goes quicker even though I feel less busy, and I also don't get as hungry as I did on the morning shift. I like saying 'good night' and seeing the patients go to sleep at the end of the shift.
I'm enjoying the mix of patients, all ages, and learning about and caring for their conditions which are all very different. I have been looking after a room of boys (last week I was looking after a women's room). Two of them are very low maintenance (only have to do something for them twice in a shift, usually towards the end of the shift) and the others have been more high maintenance with lots of things to do and lots of checking up.
Today I had my first post-op patient which was good because that's one of the things we've been learning in this subject. We brought him up from recovery and then had to do half hourly observations of vital signs and pain level and the circulation to his fingers and check that the wound (on his hand) wasn't bleeding.
The other high maintenance patient has a tracheostomy (breathing through a hole in his throat) and needs continuous oxygen therapy. He also has a naso-gastric tube. He can only communicate through body language or a notepad because he can't talk due to the trachy. I haven't learned tracheostomy care yet so for that I've just been observing my nurse buddy but I've been able to do everything else. We also took him for a chest x-ray after the naso-gastric tube got dislodged.
I've had more opportunities to give drugs via different routes - several by IV port injection, crushed up pills via naso-gastric tube, mouth drops, and eye drops.
I've also chosen the patient I am going to use for my assignment which is a 2000 word nursing care plan due 2 weeks after this placement and it's worth 50% of my grade. The challenge was finding something not too complicated and not too simple and something that I find interesting. The patient I've chosen is a 20 year old male with a condition call arteriovenous malformation (AVM) which is a bleeding disorder for which he has needed major facial reconstructive surgery and has lost vision in one eye and also has only one ear. I looked after him on Monday and tomorrow I've arranged to do an interview with him. Since I haven't been too busy I've had the chance to read through his entire file and look at all the history and treatment he's had, and also do a bit of research on the internet about it.
I'm enjoying the mix of patients, all ages, and learning about and caring for their conditions which are all very different. I have been looking after a room of boys (last week I was looking after a women's room). Two of them are very low maintenance (only have to do something for them twice in a shift, usually towards the end of the shift) and the others have been more high maintenance with lots of things to do and lots of checking up.
Today I had my first post-op patient which was good because that's one of the things we've been learning in this subject. We brought him up from recovery and then had to do half hourly observations of vital signs and pain level and the circulation to his fingers and check that the wound (on his hand) wasn't bleeding.
The other high maintenance patient has a tracheostomy (breathing through a hole in his throat) and needs continuous oxygen therapy. He also has a naso-gastric tube. He can only communicate through body language or a notepad because he can't talk due to the trachy. I haven't learned tracheostomy care yet so for that I've just been observing my nurse buddy but I've been able to do everything else. We also took him for a chest x-ray after the naso-gastric tube got dislodged.
I've had more opportunities to give drugs via different routes - several by IV port injection, crushed up pills via naso-gastric tube, mouth drops, and eye drops.
I've also chosen the patient I am going to use for my assignment which is a 2000 word nursing care plan due 2 weeks after this placement and it's worth 50% of my grade. The challenge was finding something not too complicated and not too simple and something that I find interesting. The patient I've chosen is a 20 year old male with a condition call arteriovenous malformation (AVM) which is a bleeding disorder for which he has needed major facial reconstructive surgery and has lost vision in one eye and also has only one ear. I looked after him on Monday and tomorrow I've arranged to do an interview with him. Since I haven't been too busy I've had the chance to read through his entire file and look at all the history and treatment he's had, and also do a bit of research on the internet about it.
Friday, May 14, 2010
Thank God It's Friday
Today was my last day in the oncology and haematology ward and it was a very emotional day for me. I had a new nurse buddy (fifth one in five days) and she was really really nice - a very good teacher and challenged me to do things as independently as possible and explain the rationale behind all my procedures and clinical decisions, but she wasn't mean when I didn't know something or if I wasn't confident and asked for her assistance or checking. She also encouraged me a lot and told me I was doing really well and we shared the same philosophy about nursing that I talked about in my previous post. She was also a grad nurse. Each nurse I have worked alongside is so different in their bedside manner, the way they do procedures, the way they teach, the way they write notes in the file. It can be confusing and frustrating. But I was grateful to have her with me today and my clinical teacher was very supportive in making sure I was not buddied up with yesterday's nurse. I got the same room with the same patients though.
The difficult parts of today were firstly one of my patients I've been looking after deteriorated a lot overnight. She has end stage cancer of the colon, liver and kidneys. Although she's only in her sixties she looks very very old, is bald, very skinny but with a very very inflated abdomen, like someone who is about to have a baby. When she lies in bed with no movement she says she's comfortable but as soon as she has to move for anything it's very painful and difficult. It's the first time I've seen someone in that condition in real life. Although I was able to have a nice conversation with her a couple of days ago, this morning it was hard to wake her up. When I took her to the toilet I asked her if she wanted to have a shower or a wash (she was in a commode which is a kind of toilet chair on wheels) and she said 'I'd prefer to have one in the morning'. I told her it is morning now and she suddenly looked really confused and upset. I said 'just relax, you're a little confused that's all, I'm just going to ask you some questions'.I began asking her questions such as 'do you know what day it is? do you know what the date is? the month?' she wasn't sure and seemed upset with herself that didn't know. then i asked questions such as 'do you know where you are?' 'who is the prime minister of australia?' she was able to answer those questions correctly. later that day it began to appear that was losing the ability to control her hands and legs. when she had the cup in her hand she could bring it to her mouth but then couldn't bring it back down it would just drop out of her hand. and she couldn't balance when we tried to get her to sit on the side of the bed. her hands were so cold and we had to tuck her in with lots of blankets like a cocoon. i felt so sorry for her and really wanted to help her and comfort her. I began to feel a bit emotional.
After that my teacher came and got me to go through my first formal assessment of how I've gone so far on this clinical placement. There are some skills that I'm not competent in yet, in the sense that I am not confident doing them independently without any guidance or checking, and I need to be in order to pass this clinical placement. I couldn't help myself, I cried, but he assured me I'm not going to fail and he is going to support me 100% to make sure I succeed. I couldn't stop crying for about half an hour. He said I am a very caring and sensitive person and because of that I'm going to be affected in this career more than some people, but I will get stronger as time goes on. I hope so. I don't want to become insensitive but I need to be strong in the sense that I keep my emotions under control. All the students in my group (all girls) have cried at some stage this week. Between the four of us, four patients have died, and we've seen some really sick people who have little hope of getting any better, so we've all been supporting each other a lot. I'm lucky to have such a nice teacher and nice group but it's still stressful. I haven't been this stressed in a long time.
The difficult parts of today were firstly one of my patients I've been looking after deteriorated a lot overnight. She has end stage cancer of the colon, liver and kidneys. Although she's only in her sixties she looks very very old, is bald, very skinny but with a very very inflated abdomen, like someone who is about to have a baby. When she lies in bed with no movement she says she's comfortable but as soon as she has to move for anything it's very painful and difficult. It's the first time I've seen someone in that condition in real life. Although I was able to have a nice conversation with her a couple of days ago, this morning it was hard to wake her up. When I took her to the toilet I asked her if she wanted to have a shower or a wash (she was in a commode which is a kind of toilet chair on wheels) and she said 'I'd prefer to have one in the morning'. I told her it is morning now and she suddenly looked really confused and upset. I said 'just relax, you're a little confused that's all, I'm just going to ask you some questions'.I began asking her questions such as 'do you know what day it is? do you know what the date is? the month?' she wasn't sure and seemed upset with herself that didn't know. then i asked questions such as 'do you know where you are?' 'who is the prime minister of australia?' she was able to answer those questions correctly. later that day it began to appear that was losing the ability to control her hands and legs. when she had the cup in her hand she could bring it to her mouth but then couldn't bring it back down it would just drop out of her hand. and she couldn't balance when we tried to get her to sit on the side of the bed. her hands were so cold and we had to tuck her in with lots of blankets like a cocoon. i felt so sorry for her and really wanted to help her and comfort her. I began to feel a bit emotional.
After that my teacher came and got me to go through my first formal assessment of how I've gone so far on this clinical placement. There are some skills that I'm not competent in yet, in the sense that I am not confident doing them independently without any guidance or checking, and I need to be in order to pass this clinical placement. I couldn't help myself, I cried, but he assured me I'm not going to fail and he is going to support me 100% to make sure I succeed. I couldn't stop crying for about half an hour. He said I am a very caring and sensitive person and because of that I'm going to be affected in this career more than some people, but I will get stronger as time goes on. I hope so. I don't want to become insensitive but I need to be strong in the sense that I keep my emotions under control. All the students in my group (all girls) have cried at some stage this week. Between the four of us, four patients have died, and we've seen some really sick people who have little hope of getting any better, so we've all been supporting each other a lot. I'm lucky to have such a nice teacher and nice group but it's still stressful. I haven't been this stressed in a long time.
Thursday, May 13, 2010
Day 4 Acute Placement - Frustrated Rant!
Just one more day of placement this week and then i'll have the whole weekend to relax and I cannot wait because I am so exhausted. Each day I've been waking up between 4:30 and 5:00am and walking to the station in freezing cold rainy darkness. Today I missed the express by 30 seconds and ended up being 10 minutes late which isn't good.
I've been learning a lot and am gaining confidence in the basic skills of communicating with the patient, taking observations (blood pressure, pulse, pain assessment and so on), giving out and researching the actions of lots and lots of oral drugs as per the orders and under supervision of my buddy nurses or my clinical teacher, doing wound dressings, writing progress notes in the patient files, and administering IV fluids and drugs through the port of the cannula which is already in place in the patient's vein.
I have been looking after the same room each day which has four patients in it. Three of them have been there all week, two older ladies and one 21 year old girl with leukemia, and have enjoyed getting to know them. I feel like I've developed a good rapport and they have all been really supportive and told me I am doing a great job. My philosophy is to be very warm and friendly, when they are in pain I offer my hand for them to squeeze and stroke their arm/leg/back and I try to be sympathetic. Whenever I walk past them I smile and ask 'do you need anything?' or 'how are you feeling?' I haven't been taught these approaches at uni or by the other nurses, I just do this according to the motto 'do unto others as you would want them to do unto you'. Also, I draw from my own experiences as a patient in various settings throughout my life and try to remember and imitate how the nice nurses/doctors I had were. At this stage I absolutely refuse to be one of those nurses that is really business like and cold, shows no affection and talks to the patient as if they have a low IQ. I've even seen fellow students doing that with the dummies at uni, as if that is how a nurse should act and I can't stand it. Receiving TLC, understanding and respect is a huge part of feeling better when you are in pain or feeling like crap.
Although I've been looking after the same patients, each day I have had a different nurse buddy. As I mentioned in my previous post on my first day my buddy was so nice. She was nice to me and nice to the patients. She gave one of them a hug when they were discharged. The second day I had what I call a 'mean nurse'. She was mean to me, very critical, no encouragement and had a cold bedside manner with the patients. She expressed her disapproval of the fact that I hadn't done first year and said I shouldn't have got any credit for my other degrees and life experience because they have got nothing to do with nursing. She also wasn't interested in finding out anything about me. On the third day my nurse buddy was a 'nice nurse'. She was in her grad year (first year out of uni) and was really understanding that this was my first placement and was really encouraging, saying things like 'I'm still learning new things everyday' and 'you're doing so well for someone on their first placement' and 'your background will really come in handy in your nursing career because you're used to communicating with people from different cultures and you have so much teaching experience' and so on. She gave me the chance to do the things I was confident doing independently and talked me through anything I wasn't totally confident in, even if I'm 'supposed to know it'.
Today unfortunately I had a 'mean nurse' buddy and this one really got to me. She was also a grad year nurse on her first rotation so only been a nurse for about 6 months, 22 years old, but she was so full of herself, acted and talked like a 50 year old matron, and criticised everything I did, even things the other nurses had shown me how to do, she said 'I don't do it that way' or 'that's not necessary'. Like my Tuesday buddy she also said it wasn't good that I had missed out on first year and when I told her what my background is she said in a patronising tone 'you obviously get bored very easily' and said 'teaching isn't a hard job at all'. I asked her 'have you been a teacher?' and she just snapped 'no but I know it's an easy job'. As the day went on she frustrated me more and more. I didn't like her bedside manner with the patients, she talked to them like they were children and shouted even though none of the patients are hard of hearing. I speak to them softly and have never had to repeat myself. When I was putting fresh sheets on a patient's bed because the sheets had gotten wet she said I hadn't done the hospital corners correctly, so I asked her to show me because that's one of the things I missed out on from first year. She did show me the correct way but while she was doing it she said 'this is the most basic skill of nursing that you should be able to do perfectly. you should be practising at home every day.' I told her that the reason I don't practise this at home is because I just have a doona, and she said: 'Well go out and buy a sheet. I've been doing hospital corners on my bed since I was FIVE YEARS OLD!' This was nearly the end of the day so I just said 'Good for you!' and walked out of the room and left her to finish making the bed by herself. I went and found my clinical teacher and told him that her attitude was really bothering me and I would like him to observe for the next half hour or so. When he was there helping she wasn't as much of a b*tch. I've only mentioned a couple of things here but she pretty much rubbed me the wrong way all day and by the end of the day I was feeling really upset. I'm sure being tired is a factor but it doesn't help being spoken to and treated like that, especially when I'm there to learn and practise, and she being such a junior herself. If she was a more senior nurse in age and experience maybe it wouldn't have bothered me as much. My clinical teacher was understanding but said it's something that I will have to learn to deal with because it is going to happen a lot throughout my uni placements and in my nursing career. Nevertheless I have requested not to be 'buddied up' with that nurse again. I hope I can work in the same room again tomorrow though as I really like the patients and I know they like me. Time to relax now, I'm going to watch Napoleon Dynamite (one of my favourite comedies) to cheer myself up and take my mind of things.
I've been learning a lot and am gaining confidence in the basic skills of communicating with the patient, taking observations (blood pressure, pulse, pain assessment and so on), giving out and researching the actions of lots and lots of oral drugs as per the orders and under supervision of my buddy nurses or my clinical teacher, doing wound dressings, writing progress notes in the patient files, and administering IV fluids and drugs through the port of the cannula which is already in place in the patient's vein.
I have been looking after the same room each day which has four patients in it. Three of them have been there all week, two older ladies and one 21 year old girl with leukemia, and have enjoyed getting to know them. I feel like I've developed a good rapport and they have all been really supportive and told me I am doing a great job. My philosophy is to be very warm and friendly, when they are in pain I offer my hand for them to squeeze and stroke their arm/leg/back and I try to be sympathetic. Whenever I walk past them I smile and ask 'do you need anything?' or 'how are you feeling?' I haven't been taught these approaches at uni or by the other nurses, I just do this according to the motto 'do unto others as you would want them to do unto you'. Also, I draw from my own experiences as a patient in various settings throughout my life and try to remember and imitate how the nice nurses/doctors I had were. At this stage I absolutely refuse to be one of those nurses that is really business like and cold, shows no affection and talks to the patient as if they have a low IQ. I've even seen fellow students doing that with the dummies at uni, as if that is how a nurse should act and I can't stand it. Receiving TLC, understanding and respect is a huge part of feeling better when you are in pain or feeling like crap.
Although I've been looking after the same patients, each day I have had a different nurse buddy. As I mentioned in my previous post on my first day my buddy was so nice. She was nice to me and nice to the patients. She gave one of them a hug when they were discharged. The second day I had what I call a 'mean nurse'. She was mean to me, very critical, no encouragement and had a cold bedside manner with the patients. She expressed her disapproval of the fact that I hadn't done first year and said I shouldn't have got any credit for my other degrees and life experience because they have got nothing to do with nursing. She also wasn't interested in finding out anything about me. On the third day my nurse buddy was a 'nice nurse'. She was in her grad year (first year out of uni) and was really understanding that this was my first placement and was really encouraging, saying things like 'I'm still learning new things everyday' and 'you're doing so well for someone on their first placement' and 'your background will really come in handy in your nursing career because you're used to communicating with people from different cultures and you have so much teaching experience' and so on. She gave me the chance to do the things I was confident doing independently and talked me through anything I wasn't totally confident in, even if I'm 'supposed to know it'.
Today unfortunately I had a 'mean nurse' buddy and this one really got to me. She was also a grad year nurse on her first rotation so only been a nurse for about 6 months, 22 years old, but she was so full of herself, acted and talked like a 50 year old matron, and criticised everything I did, even things the other nurses had shown me how to do, she said 'I don't do it that way' or 'that's not necessary'. Like my Tuesday buddy she also said it wasn't good that I had missed out on first year and when I told her what my background is she said in a patronising tone 'you obviously get bored very easily' and said 'teaching isn't a hard job at all'. I asked her 'have you been a teacher?' and she just snapped 'no but I know it's an easy job'. As the day went on she frustrated me more and more. I didn't like her bedside manner with the patients, she talked to them like they were children and shouted even though none of the patients are hard of hearing. I speak to them softly and have never had to repeat myself. When I was putting fresh sheets on a patient's bed because the sheets had gotten wet she said I hadn't done the hospital corners correctly, so I asked her to show me because that's one of the things I missed out on from first year. She did show me the correct way but while she was doing it she said 'this is the most basic skill of nursing that you should be able to do perfectly. you should be practising at home every day.' I told her that the reason I don't practise this at home is because I just have a doona, and she said: 'Well go out and buy a sheet. I've been doing hospital corners on my bed since I was FIVE YEARS OLD!' This was nearly the end of the day so I just said 'Good for you!' and walked out of the room and left her to finish making the bed by herself. I went and found my clinical teacher and told him that her attitude was really bothering me and I would like him to observe for the next half hour or so. When he was there helping she wasn't as much of a b*tch. I've only mentioned a couple of things here but she pretty much rubbed me the wrong way all day and by the end of the day I was feeling really upset. I'm sure being tired is a factor but it doesn't help being spoken to and treated like that, especially when I'm there to learn and practise, and she being such a junior herself. If she was a more senior nurse in age and experience maybe it wouldn't have bothered me as much. My clinical teacher was understanding but said it's something that I will have to learn to deal with because it is going to happen a lot throughout my uni placements and in my nursing career. Nevertheless I have requested not to be 'buddied up' with that nurse again. I hope I can work in the same room again tomorrow though as I really like the patients and I know they like me. Time to relax now, I'm going to watch Napoleon Dynamite (one of my favourite comedies) to cheer myself up and take my mind of things.
Monday, May 10, 2010
First Day of Clinical Placement
Today was my first day of my first clinical placement - how exciting and nerveracking! This week I am on the Oncology and Haematology ward - cancer and blood borne diseases. My hours this week are 7am - 3:30pm with just a half hour break for lunch. Very tiring but it goes really quickly. I have to wake up at 5am!!! Last night I took a sleeping pill because there is no way I would have been able to get to sleep, I would have been way too anxious that I would miss my alarm and be late. Actually most of the other people in my group said they couldn't sleep last night. Not me, I slept like a log, LOL.
There are four students including me on the same ward as me and four more on the floor below which is the Ear, Nose, Throat and Plastics (Facial Reconstructive Surgery) ward. Next week we'll be swapping - awesome!!! We're all so grateful to be placed on these two wards because they are so interesting. Next week we'll also be changing our schedule to afternoons, so it'll be 1:00 - 9:30pm.
Today we had a bit of orientation with our clinical educator who oversees our placement and assesses us. Then we went up to our respective wards and were assigned a 'buddy' who is one of the registered nurses. Mine was so nice and taught me so much. She just explained everything in lots of detail without me having to ask too many questions and feel stupid - everything from what all the medications are for, what diseases the patients have and how they are treated, how all the machines work, all the procedures, how to write notes in the patient's files, everything. I just followed her around all day and by that I mean I RAN! Omg, nurses are constantly on the move and work really quickly.
I didn't practice that many nursing skills today because I just wanted to get orientated and see how it all happened. Actually right after we arrived on the ward there was an emergency situation and one of the patients died. What a reality check. Later that day I saw the family come in who were naturally very upset and sat beside the body for a while. Most of the patients are being treated for cancer and are having chemotherapy. One of them is a prisoner and there were two prison guards sitting outside the room at all times. They just sit there doing nothing all day which looks pretty boring, not even reading.
The only skills I did were some urine dipstick analyses (for the chemotherapy patients because their pH needs to be a certain level before they are given the drugs), and a wound dressing for a small ulcer. I was hoping to do some basic OBS (blood pressure, temperature, pulse etc) but the patient had gone walkabout and then when they came back the equipment had been taken by another nurse. I'm sure I'll get plenty of opportunities later in the week.
We were all so exhausted at the end of the day, but I feel it was more because of the early start than working hard. I'm looking forward to tomorrow. Unfortunately I won't have the same lovely buddy nurse again because she is not working for the next couple of days.
Tonight I am just going to pop down to Woolies for a quick grocery shop, make lunch for tomorrow, eat dinner and watch Wife Swap, do a bit of reading about Chemotherapy and then in bed by 9pm.
There are four students including me on the same ward as me and four more on the floor below which is the Ear, Nose, Throat and Plastics (Facial Reconstructive Surgery) ward. Next week we'll be swapping - awesome!!! We're all so grateful to be placed on these two wards because they are so interesting. Next week we'll also be changing our schedule to afternoons, so it'll be 1:00 - 9:30pm.
Today we had a bit of orientation with our clinical educator who oversees our placement and assesses us. Then we went up to our respective wards and were assigned a 'buddy' who is one of the registered nurses. Mine was so nice and taught me so much. She just explained everything in lots of detail without me having to ask too many questions and feel stupid - everything from what all the medications are for, what diseases the patients have and how they are treated, how all the machines work, all the procedures, how to write notes in the patient's files, everything. I just followed her around all day and by that I mean I RAN! Omg, nurses are constantly on the move and work really quickly.
I didn't practice that many nursing skills today because I just wanted to get orientated and see how it all happened. Actually right after we arrived on the ward there was an emergency situation and one of the patients died. What a reality check. Later that day I saw the family come in who were naturally very upset and sat beside the body for a while. Most of the patients are being treated for cancer and are having chemotherapy. One of them is a prisoner and there were two prison guards sitting outside the room at all times. They just sit there doing nothing all day which looks pretty boring, not even reading.
The only skills I did were some urine dipstick analyses (for the chemotherapy patients because their pH needs to be a certain level before they are given the drugs), and a wound dressing for a small ulcer. I was hoping to do some basic OBS (blood pressure, temperature, pulse etc) but the patient had gone walkabout and then when they came back the equipment had been taken by another nurse. I'm sure I'll get plenty of opportunities later in the week.
We were all so exhausted at the end of the day, but I feel it was more because of the early start than working hard. I'm looking forward to tomorrow. Unfortunately I won't have the same lovely buddy nurse again because she is not working for the next couple of days.
Tonight I am just going to pop down to Woolies for a quick grocery shop, make lunch for tomorrow, eat dinner and watch Wife Swap, do a bit of reading about Chemotherapy and then in bed by 9pm.
Wednesday, May 5, 2010
World's Oldest Yoga Teacher
I saw this video about a beautiful woman who teaches yoga and competes in dance competitions at the age of 92! What an inspiration! I would like to be living life like her when I am an 'old lady'. Check it out!
http://www.yogabodynaturals.com/oldest-yoga-teacher-in-the-world
http://www.yogabodynaturals.com/oldest-yoga-teacher-in-the-world
Week before placement
Yesterday I went to uni for a pre-clinical workshop and I turned up on the wrong day - oops! Luckily I didn't miss out, it was actually today. Today's workshop was only two hours but Friday's will be eight hours. We didn't really cover that much today. In the last couple of days I have been reading up on acute care skills. This is what I've covered and summarised in my notebook. I might put some of the more interesting summaries on my blog later on.
Preparing the Patient for Surgery:
• Deep Vein Thrombosis Prevention
• Preoperative Assessment
• Preoperative Teaching
• Physical Preparation for Surgery
Caring for the Postoperative Patient
• Immediate Post-anaesthesia phase
• Post Op orders
• Drainage
• Steps before discharge
Surgical Wound Care
• Cleansing a drain site
• Monitoring and emptying drainage devices
• Types of drainage devices
• Removing drains
• Removing staples, sutures and applying steri-strips
After I got home today I went grocery shopping and then did a huge load of laundry sorting and ironing. I watched The Duchess while I did that - great movie. Keira Knightley is so elegant and was very good in the role.
Last night I watched Anatomy for Beginners on SBS. This show is like a horror movie! Each week they disect a dead human body. The one this week had only died very recently so the body was still quite fresh with blood in it. One by one the organs in the abdominal and thorasic cavities were located and taken out. The most disturbing thing I thought about this show is that the anatomist, Professor von Hagens was wearing a wide brimmed black felt hat, had a strong German accent and seemed quite gleeful during the whole process. I don't understand why he needed to use a knife that was about a metre long (looked like a sword to me) to cut the heart in half. It's all a bit serial killerish. Nevertheless I will most probably watch the next two episodes in this series anyway. These shows really help to consolidate my anatomy knowledge because I think I learn and remember a lot more when I see something audiovisually, rather than just reading.
Preparing the Patient for Surgery:
• Deep Vein Thrombosis Prevention
• Preoperative Assessment
• Preoperative Teaching
• Physical Preparation for Surgery
Caring for the Postoperative Patient
• Immediate Post-anaesthesia phase
• Post Op orders
• Drainage
• Steps before discharge
Surgical Wound Care
• Cleansing a drain site
• Monitoring and emptying drainage devices
• Types of drainage devices
• Removing drains
• Removing staples, sutures and applying steri-strips
After I got home today I went grocery shopping and then did a huge load of laundry sorting and ironing. I watched The Duchess while I did that - great movie. Keira Knightley is so elegant and was very good in the role.
Last night I watched Anatomy for Beginners on SBS. This show is like a horror movie! Each week they disect a dead human body. The one this week had only died very recently so the body was still quite fresh with blood in it. One by one the organs in the abdominal and thorasic cavities were located and taken out. The most disturbing thing I thought about this show is that the anatomist, Professor von Hagens was wearing a wide brimmed black felt hat, had a strong German accent and seemed quite gleeful during the whole process. I don't understand why he needed to use a knife that was about a metre long (looked like a sword to me) to cut the heart in half. It's all a bit serial killerish. Nevertheless I will most probably watch the next two episodes in this series anyway. These shows really help to consolidate my anatomy knowledge because I think I learn and remember a lot more when I see something audiovisually, rather than just reading.
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