I'm gonna be a psychiatric nurse!

I got my first choice of grad years! I am so happy and feel like all the hard work and time I put in these past two years has paid off. What a great way to finish the uni semester! I still have to pass all my subjects and get registered but I'm sure that will not be a problem.

My grad year will start on January 30 so until then I'm going to be doing some teaching, some aged care nursing home work, and have a bit of a holiday until then.

Handed in two more assessments and had my last day of clinical placement yesterday. Also got my mark back for the oral presentation - 12.5/15!! wow, was not expecting that.

I also got my clinical appraisal back from my nurse buddy who had to rate me in about 40 different aspects of nursing, and he rated me "independent" for EVERYTHING!! That means I'll get a perfect mark of 50/50 for the placement which is actually graded this semester, not just pass or fail, and is worth 50%. My final piece of assessment is for other 50% of that subject and is my portfolio. I have to proofread and edit what I've already done and also write up a 700 word management plan for the symptom of uncontrolled nausea. I've done the research for it and will do it when i get back from my holiday. It's not due for about another 10 days after I get back, so no stress there.

So good to have all this off my shoulders, finish a week and a half early and now going on a mini-break to europe to visit my brother and be a bridesmaid for one of my best friends! wooohoooooooo!

This blog will be ending very soon

Sorry I have been so slack updating my blog . . . I don't have long to go now. I feel like I'm about 98% finished.

Tuesday is the last day of clinical placement.

Tomorrow I find out where I'm going to be working next year.

I have finished all my assignment but one, which I'll do when I get back from a one week holiday in Europe (for a friend's wedding) that I'm about to embark on this week.

The assessments I've done recently:

Got my Managing Chronic Conditions Essay about schizophrenia back and the mark was 40/50 which I am very pleased with. Recently finished the final piece of assessment for that subject which was an education pamphlet about the non-pharmacological aspects of managing schizophrenia in the community. I'm expecting to get quite a good mark in this subject, either an A or B.

For my communication subject, in the last two weeks I have done all three assessments. First was my oral presentation which was about male/female cultural socialisation and how that affects professional communication in nursing. I overprepared and planned to talk about biological differences in the communication styles (a la Men are from Mars, Women are from Venus), religion (eg Muslim and orthodox Jewish), professional boundaries, appropriate use of touch, disclosure of self, talking about sexuality with your patient and a few other topics . . but as the presentation was only 5 minutes I ran out of time quickly. I also have a tendancy to ad lib which doesn't help, but although I was disappointed in myself my teacher gave me good feedback and said she thought I seemed confident and that my presentation was really interesting. It was worth 15%

My second assessment for that subject was an online multiple choice exam of worth 30%. I did all the reading preparation and was pretty happy with it, although I didn't get to find out my score straight away. The third thing was an essay I just completed about a challenging communication encounter I've had on placement, 2500 words and worth 55%. I've just finished it, and will hand that in today. It was about a patient and the patient's full time carer who both had mental illness and drug addiction issues and were quite demanding with staff, especially about what drugs they wanted the patient to get (opioids and benzodiazepines - basically morphine and valium). The medical team restricted them and that made the patient and carer really angry. The essay isn't due for another week but I've been trying to get it done so I can hand it in before I go on my trip. So that's two subject now completed.

My final subject is my Clinial Practice Consolidation subject and the assessment is made up of how I perform on placmenent and a 4000 word folio of about ten different topics. That is 80% completed and not due for another 10 days after I get back so I'm going to finish that off then. As for my placement I think I've done well. I've had a really great buddy who is very experienced and has worked in several different countries. He's given me good feedback and taught me a lot, and there haven't been any issues. He's very cool, calm and collected, knowledgable, loved by the patients and lightning fast so it's been great to learn alongside someone like that.

One of the major things I experienced on this placement happened just last week. One of my patients died. He was palliative, so not for resuscitation and it was only a matter of time, but it was still a shock because I was the one who walked into the room and found him dead. He was an old man and had kidney failure, heart failure and a bad diarrhoea infection, but he kept in good spirits right to the end. I had been doing his care for the previous two hours and had just left the room to prepare everything to give him a wash. I told him I'd be back in 5 - 10 minutes and he cheerily said "ok". Then when I walked back in I saw he had vomited something on himself and he was very pale, and I couldn't get any response from him. I knew then that he was dead and went to find my buddy and the nurse in charge. I was upset about it for a little while and took a break to collect myself and have a cup of tea and talk to my colleague. Then when I went back I had to talk to the family and after that clean up the body and prepare it for the morgue, put in a plastic body bag and so on. Tough day.

I'll update this blog a couple more times as I finish up everything and find out my results but then it will come to an end. I've already sent off my nursing registration application and very soon, in a couple of months, I will be a registered practicing full-time nurse!

First assessment out of the way - only 8 to go

This week as well as being on clinical for 5 days straight, which made me very tired indeed by the end of the week, I've been focused on preparing for my first assessment task for the semester, an online multiple choice quiz made up of 30 questions based on a set of journal articles that we were given. It's worth 10% of the total mark for the Managing Chronic Conditions subject. Some of the readings I mentioned in my previous post, and these were the rest of them:

• The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes
• Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people
• The patient’s vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workers
• Prioritizing Illness: Lessons in Self-Management Multiple Chronic Diseases
• From the sidelines: Coaching as a nurse practitioner strategy for improving health outcomes
• Motivational interviewing-based health coaching as a chronic care interventions
• Nurse Coach: Healthcare Resource for this millenium
• Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm
• What skills do primary health care professionals need to provide effective self-management support? Seeking consumer perspectives
• Chronic illness self-management: taking action to create order
• Nursing Science and Chronic Illness: Articulating suffering and possibility in family life
• Youth Health - sex, drugs and chronic illness: health behaviours among chronically ill youth

I didn't actually read every word of all the articles because I ran out of time. I read about half of them trying to understand the main gist of them. But the some of the questions in the quiz were quite detailed so for those ones I had to go back and find the answer. Some questions could just be answered by common sense and elimination. Anyway, I just completed the quiz and got 9.67 which means I got 29/30 right! Woo hoo!

One down, eight to go.

Other things I've got done this week:

Lectures
• Communicating around dying and grief
• Advance care planning

Also this week, I attended a 2 hour workshop for Communications in Nursing subject, then met with group to plan our topic and division of work the Managing Chronic Conditions nursing care plan assignment. There are 8 people in the group and we each have to write one nursing diagnoses and interventions. Because there are so many of us we only have to write about 300 words each. We decided to do it on Chronic heart failure, and my nursing diagnosis is activity intolerance.

Next week I need to start and complete a 2000 word essay worth 50%. I've decided to do it on schizophrenia so I can learn more about it in preparation for working as a psychiatric nurse next year. I've already done a bit of research and found some interesting articles. That will be my focus this week along with 3 more grad program interviews. Another very busy week ahead! Need to make sure I get at least 8 hours sleep as many nights as possible.

Group interview experience

The semester is well under way now. In the next four weeks I have 3 more job interviews (already had one this week), one online exam, one 2000 word essay and one group assignment, as well as 2 or 3 days a week of clinical placement. From Saturday to Wednesday I will have five days in a row of clinical placement and then work at my teaching job on Thursday and Friday, AND do an online exam by Friday. In that time I also have to study the material that the exam will be based on because I've only read about a quarter of it so far. I'm getting stuck into that tonight and will continue over the weekend whenever I get a chance. Hopefully get some of it done while I'm on the ward as I still only have to look after 1-2 patients at this stage in the semester.

So the grad year interview I attended earlier this week was with my current number one choice. It was a group interview and I wasn't sure what to expect with that. There were 6 of us doing the interview together and we had to introduce ourselves, interview each other a bit and handover to the rest of the group and the panel about the other person and go to a table to select cards which represent our strengths and 'things we want to work on' and then explain them to the group. I chose reliability and kindness for strengths, and capability and bravery for things I want to work on. There were a few clinical questions about time management and prioritisation of care of a newly admitted suicidal patient. Then we each were interviewed individually which wasn't too harrowing or very long. I felt good about how the whole thing went and I like the 3 people who conducted the interview. For now I will keep them as my first choice, but I still have 3 to go.

Study done so far this week (not much) . .

Lectures
• Chronic Conditions and Models of care
• Psychological aspects of chronic disease
• Culturally appropriate communication

Reading
• Assertiveness skills
• Conflict resolution
• Clinical Practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers

Called in sick

I called in sick for my second night duty tonight. I'm not grossly unwell, just feeling rather run down with a sniffle and sore throat so I thought it would be best to stay away from the patients and try to recuperate at home. I slept from 9:30am till 5:30pm today. I heard about research that has shown that even if you are getting sufficient sleep during the day, working nights is not good for you. The body needs to be asleep during the wee hours (2am to 5am) to tap into the universal energy that assists the body to heal and recover. There is a higher incidence of diseases like heart disease, common colds, and depression amongst people who work nights or early morning shifts. Something to be aware of . . .

I've got a good chunk of study done in the last couple of days:

Lectures
• Time Management and prioritisation of care
• Delegation
• Managing Chronic Conditions: Arthritis

Reading
• Awareness of the other
• 'Other’-centred communication
• Non- verbal communication
• Ethical communication
• Assessment of Digestive and Gastrointestinal Function – upper gastrointestinal tract imaging, lower gastrointestinal tract imaging, CT scans, MRI, positron emission tomography, scintigraphy, gastrointestinal motility studies, oesophagogastroduodenoscopy (try pronouncing that one!), proctoscopy, sigmoidoscopy, fibreoptic colonoscopy, small bowel endoscopy, endoscopy through ostomy, defaecograpy, gastric analysis, gastric acid stimulation test, pH monitoring, laparoscopy, and psychological considerations.

Tonight I'm going to relax and probably watch a movie, drink lots of fluids and eat some nutritious food then get to bed by about midnight so I can back onto normal rhythm tomorrow. Tomorrow I'm planning to get a half hour massage. Hopefully that will be what I need to be fighting fit once more.

Night shift

End of week two . . .

This week I did two night shifts on Monday and Tuesday night. They're pretty long shifts, from 9pm till 7:30am so I needed Wednesday to recover. At this stage in the semester I only have to take one patient, but it will increase gradually up to a full load as the weeks go by. One patient on a night shift is very boring! Because there's not much to do between 10:30pm and 6:00am. However, I made good use of time and got heaps of reading for uni done and got a couple of tasks out of the way for my clinical learning portfolio which will be worth 55%.

This week I also finished my job applications for next year. I've already heard back from two of them for an interview in the next couple of weeks. I've applied to four different psychiatric grad nursing programs. It was so hard to narrow it down to just four places, and also choose whether I wanted to do general medical/surgical or psychiatric, or community. In the end I chose psychiatric because it's what I'm most interested in and enjoy doing, I can increase my qualifications during the program, and there are opportunities to work in acute inpatient care, community, teenagers, emergency, drug and alcohol . . . there's a lot of choice within psych so I don't feel as though I'm limiting myself by choosing that path.

Here's a summary of what I've been studying this week:

Lectures
• The impact of chronic conditions
• Promoting comfort_and managing symptoms

Reading
• The social construction of chronicity: a key to understanding chronic care transformations
• Healthcare providers’ perspectives : estimating the impact of chronicity
• Chronicity and complexity: is what’s good for the diseases always good for the patients?
• Clinical Practice Consolidation subject guide
• Ward Orientation
• Journal article case study: An 81 year old man with massive rectal bleeding – this was related to one the patients I had on the ward.
• Journal article: Nurofen Plus misuse, an emerging cause of perforated gastric ulcer – again this is related to a patient on the ward who had been abusing a packet a day of nurofen plus, which is ibuprofen plus codeine. They abuse it for the codeine and you don’t need a prescription to get it. The problem is because it has the ibuprofen it wears away the lining of the stomach over time.
• Assessment of Digestive and Gastrointestinal Function – anatomy of the gastrointestinal tract, chewing and swallowing, gastric function, small intestine function, colonic function, waste products digestion, age related changes in the gastrointestinal system, assessing pain, indigestion, intestinal gas, nausea and vomiting, changes in bowel habits and stool characteristics, physical assessment, foods and medications that alter stool colour, stool tests, breath tests, Australian guidelines for colorectal cancer screening, abdominal ultrasonography, genetics and gastrointestinal disorders.

This week I have two more nightshifts again so I'm going to get as much reading done as I can while I've got the chance.

Final Semester!

Long time, no blog post . . . well here I am, it's my final semester already. By the end of october I will be FINISHED! I am very busy right now, with getting stuck into the lectures, reading and assignments for my new subjects, as well as working 2 - 3 days a week, and applying for graduate nursing positions.

First let me wrap up last semester. It was a stressful one but I made it through. My results weren't as high as I've gotten in the past but they were okay:

Complex Care Nursing - 60
Professional Transitions in Nursing - 69
Nursing Older People - 70

I did bang out most of the assignments at the last minute and got between 65 - 75 for most of them. I seem to get the best scores in oral presentations. All in all, I'm not too disappointed because the academic transcript that went out with my job applications had only A's, B's and C's on it, no D's.

I had to make up 2 days of my Nursing Older People clinical placement before my holiday and I did that at an aged care nursing home which was good because I got to experience the nursing side of it, rather than just the caring side.

This semester my subjects are:

Consolidation of Clinical Practice - which includes 240 hours of acute care placement. I requested another ward and this semester I'm going to be on the gastrointestinal ward.

Managing Chronic Conditions - this subject is taught completely online, even the exam. There are several assignments including group assignments and online discussion groups.

Challenging Interactions in Nursing - this subject is about communication which I find really interesting.

So far, I've mainly been listening to lectures and reading for Challenging Interactions in Nursing:

Lectures
• Awareness of Self & Others
• Conflict Resolution
• Managing aggression - De-escalation
• Managing aggression - Professional Boundaries
• Lecture notes: De-escalation strategies
• Strategies and skills for dealing with unprofessional workplace behaviour
• My Experience in Hospital: Interview with a patient who had a negative experience
• Ideal Situation for dealing with complaints

Reading
• Talking with patients
• Common communication issues
• Egan's Three Stage Helping Model: Problem clarification, setting goals, and facilitating action
• Heron's six-categories of counselling interventions – supportive, informative, cathartic, prescriptive, catalytic, and confronting
• Strategies for managing aggressive behaviour

In the workshops so far we have done some roleplaying of difficult communication situations in nursing, including asking probing questions when the patient is reluctant or unable to explain why they are noncompliant, and responding to inappropriate or threatening comments.

I'll write more about my job applications and other subjects in upcoming posts . . . stay tuned!

Exam

Just got home from the exam - it went okay. I answered all the questions and was confident about my answers for most of them except a couple of questions about ECGs (which coronary arteries each of leads corresponds to) and underwater chest drainage. But those questions were only worth 5 points out of 50. I just guessed the answers for those.

This is the preparation I did and most of it was actually very useful.

Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting

Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient

Also, got some results back for my group's Falls Prevention presentation. We got 17.5 out of 20 (worth 20%), so that's very good.

3 weeks off uni now during which time I'll be working, doing my graduate nursing applications and spending one week in Bali. This weekend I'll be relaxing - catching up on non-uni related reading, watch a movie and go to yoga.

Exam prep

Listened to lectures (someone them I re-watched):
• Congestive Heart Failure
• Evidence based treatments for coronary heart disease
• Exam preparation tips
• Nutrition in the Acute Care Setting
• Stroke
• Intracranial Hypertension
• Neurological Observations
• Pain in the Acute setting

Reading revision
• Cardiovascular System Anatomy, Physiology and Assessment
• Respiratory System Anatomy, Physiology and Assessment
• Neurological System Anatomy, Physiology and Assessment
• Non-invasive ventilation
• Stroke
• Intracranial pressure and hydrocephalus
• ECG interpretation
• Chest drains/underwater seal drainage management
• Central venous line management
• Enteral medication administration
• Basic life support
• Heart Failure (this topic is so complicated!)
• Acute Coronary Syndromes & Myocardial Infarction
• Nasogastric Tube Insertion
• Assessment and Care of the Tracheostomy Patient

Results
• 17.5/20 for group Falls Prevention presentation

Big update

Sorry for the lack of updates recently. I've been working a lot and doing assignments. I've now finished all my assignments for this semester which is a relief. In the last couple of weeks I handed in a 2000 word Clinical Case Management Review of one the patients I looked after in my geriatric nursing placement. That was worth 50% so I hope I did ok on that. Also did a 1500 word report about advances in the care of older people with depression, dementia, and end-of-life care, worth 30%. Before that I did a professional development reflective essay worth 40%. So basically one assignment a week for the last three weeks.

Other homework I've doing are a discussion board research posting about nursing care of Stroke patients, types of stroke and how they affect the patient, readings on Systematic review of treatments for depression in older people and End-of-life care and dementia.

Got some grades back for assignments I did earlier on in the semester - one worth 50% and another worth 40%. I can't remember the exact numbers but there were both in the 70s, which is "very good", so I was happy with those results.

Other than that I've also been doing a lot of research and thinking about where I want to work when I graduate. I've been attending a few career information nights with different organisations including the Royal District Nursing Service and Royal Melbourne Hospital. I need to apply for graduate positions by the end of July, and then interviews will take place in August followed by job offers in early October. So I will know before I finish my final semester where I will be working. Apparantly, most student end up getting their first preference so I have to think really carefully about my preferences and what I want. Also, I can only chose and apply to four places and I have to put those in order of preference. It's like applying to uni after year 12. So far I'm most interested in psych nursing programs at the major hospitals which have rotations in acute inpatient care, youth inpatient care and community care. There are three of these programs that I like the look of at Royal Melbourne, the Austin and the Alfred. At the Austin and the Alfred there are also programs that have two six month rotations - one in med/surg and one in psych, so you can consolidate your skills and experience both areas. However, they do not have the post graduate study included or an ongoing position. As well as all those programs, I'm also keen on community nursing with the Royal District Nursing Service which involves driving around Melbourne giving nursing care to people in their own homes for medication, wounds, dementia, diabetes and so on. I'm pretty sure I don't want to go straight to ward nursing on a busy med/surg ward. It just doesn't feel satisfying or interesting to me compared to psych or community nursing. So I have a lot to think about, and next week will start preparing my applications and making a decision about my preferences.

On Friday this week I have my one and only exam for Complex Care Nursing which is worth 40%. I've been told there are no exams next semester so this could be my last exam for quite a while. It's an open answer exam, not multiple choice like all the others in second year so could be difficult. Over the next four days I'm going to review about 10 of the lectures, the assignment, and all aspects of the two patient scenarios we studied in workshops for this subject. Hopefully that will get me through.

For the last two weeks I've been on my Nursing Older People Clinical placement. It was at a smaller suburban hospital in a geriatric rehab ward and I really enjoyed it. The nurses and patients were very nice and it was general medical and rehab nursing care, so the focus is on systems and functioning - renal, gastrointestinal, mobility and so on. Lots of tests like blood tests, urine tests, faecal specimens, xrays, CT scans and ultrasounds. I got to go with a patient for her CT brain scan and bladder/kidney ultrasound which was interesting. Unfortunately there was an outbreak of the Noro virus (a gastro bug) which I caught and had to stay home for two days. I had diarrhea and severe vomiting for about 18 hours but I wasn't allowed to come back until 48 hours after my last symptom. So I'll have to make up two days later on. Luckily I was better in time for my team's presentation on the last day which was worth 20% of our assessment. This weekend I'm trying to get an assignment done that's due on Monday, and then I've got another one due on Friday, and another one on the following Friday. Then it'll be time to study for the final exam and start doing grad year job applications.

Assessments:
• Team Presentation on preventing falls in acute care facilities
• Discussion board research postings (about 1000 words)- Clopidogrel (an antiplatelet drug) and Percutaneous Aortic Valve Replacement Post-procedure nursing care

Reading:
• Palliative Care Therapeutic Guidelines
• Advances in palliative care relevant to the wider delivery of healthcare
• Heart Disease – Health gums and a health heart: the perio-cardio connection

Lectures:(online)
• The Role of a Clinical Nurse Manager in ICU (Operations)
• The Role of a Clinical Nurse Manager in ICU (Quality & Risk)
• Mental Health: the state of the nation part 1
• National Legislation for Registration & Professional Development
• Preventing falls and functional decline

Update

Sorry about the lack of updates over the past few weeks. I haven't actually had classes or placement for the last five weeks, and I've been working in aged care, doing assignments and spending time with family. Next week I'm starting my final placement for the semester, a two-week geriatric acute care placement. I think the paid work I've been doing recently is really good experience and preparation for my next placement. Today I did a shift in a secure high level dementia wing. They basically need everything done for them and are very confused. It's really sad. I also have classes during those two weeks and have two assignments to do! So I'm going to be very busy.

Here's a summary of what I've done study-wise in the last few weeks:

Assignments
• Professional Transitions in Nursing Developing a Professional Development Portfolio – I got 70% for this assignment
• Professional Transitions in Nursing Group Oral Presentation (worth 20%) – my group’s topic was the nursing implications of patient aggression, such as clinical risk management, chemical and mechanical restraint, isolation, and law. We started it off with a role play which always gets a few brownie points and reaction from the audience. Our overall score was 75%. Well done.
• Complex Nursing Care – 2500 word assignment on pulmonary oedema and non-invasive ventilation, worth 40% - still waiting for the mark on this one.

Lectures
• Introduction to the subject
• The physiology of ageing – lecture and quiz
• Geropharmacology – lecture and quiz
• Strategic planning for an ageing population
• Delerium, dementia and depression
• Nursing: Taking Care of Our Future – a lecture about managing human resources in nursing. Brought up and interesting point about the ethics of recruiting nurses from overseas to make up the numbers needed here, because it is contributing to worsening healthcare systems in developing countries where there are not nearly enough nurses either.

For the rest of this week I'm going to try to get as much of my second PTN assignment (about professional development) done as I can, and I have to do about 1200 words worth of research and discussion for the online discussion board for complex care nursing (at least 3 posts).

Brain tumors

A bit about brain tumors that I learned while on clinical placement:

Symptoms:
• headache
• vomiting
• dizziness
• strabismus (uneven eyes)
• meningismus (three symptoms occurring together - neck stiffness, sensitivity to light, and headache)

The most common type of brain tumour is a meningioma, a benign tumor that grows out of the meninges. 8/10 are treatable with surgery, steroid drugs, and/or anti-seizure drugs.

Goals of brain tumour treatment:
• decompression to relieve intracranial pressure (surgery)
• diagnose the type of tumour (histopathology)
• management plan (radiotherapy, rehab or palliative care)
• peritoneal shunt (if there is hydrocephalus)

This week I did two aged care shifts (paid work) and have been going to class three days a week. Next week I have a group presentation worth 20% and an assignment worth 40% to do.

Videos
• Nurse TV: Nursing Makes a Difference http://www.youtube.com/watch?v=TOiK5Cbz97U&feature=related
• Nurse TV: No lift policy http://www.youtube.com/watch?v=xQTJd_-QSXE
• Safe Needles Save Lives

Reading
• Reflective Practice: A Guide for Nurses and Midwives
• Neurologic Assessment Skills for the Acute Medical Surgical Nurse
• Neurovascular Observation

Lectures
• Adverse events and root cause analysis
• Quality and risk management
• Implementing Change
• Leadership in nursing
• Clinical leadership and management

Third and final week of placement

Had six shifts in a row this week and most of them were earlies so I've been very sleep deprived and tired. But the placement has been great. I have one more day to go (tomorrow). Also starting tomorrow I have two weeks of classes for my Professional Transitions in Nursing subject.

Here are some of the things I did this week:
• Had the flu vaccine (for free)
• Observed and assisted with the fitting of a halo brace. Involves full spinal care manual handling (five people) and the doctor put the brace on, screwing it into the skull (with local anaesthetic). My role besides the manual handling was to hold the patient’s hand and tell her she is being so brave. They needed her to stay really still and she squeezed my hand really hard when they were injecting all around her head with the anaesthetic. I put a picture of a halo brace a couple of blog posts ago.
• Administered intravenous drugs via a PICC line (directly into the heart), using sterile technique.
• Looked after five separate patients that were IV drug users and had head injuries due to either a fall or a car accident while intoxicated. Two of them were in nappies and had to be spoon fed all their meals. Another had to be shackled to his bed because he was non compliant and would put his head drains out IV lines if his hands weren’t tied up.
• Planned and carried out all the care and documentation for two patients each shift. Some things, like give drugs, I had to do under supervision but everything else I did myself.
• Got a really good final assessment and feedback from my clinical educator and successfully passed the placement.

Understanding the nursing handover and patient notes

Acronyms from ONE SHIFT:

ABX - antibiotics
NAD - nil abnormalities
CP - chest pain
THR - total hip replacement
OSA - obstructive sleep apnoea
HOB - head of bed
BOS - base of skull
TTE - trans thoracic echogram
AXR - abdominal xray
TOV - trial of void
VSS - vital signs stable
IVDU - intravenous drug user
ORIF - open reduction internal fixation
MVA - motor vehicle accident

Cardiovascular System Review

The three body systems I am revising and expanding my knowledge on this semester are cardiovascular, respiratory and neurological. These are the systems that are most relevant to what we're learning in classes and on placement. I'm reading three different textbooks for each, and then doing the review questions at the end of the chapter in one of the textbooks. I recently completed Cardiovascular System Anatomy, Physiology, Diseases and Disorders. Here's a summary:

1. Which of the following risk factors are controllable or modifiable?
a. Heredity b. Diet c. Age d. Stress
e. Smoking f. Exercise

2. Which of the following statements are correct in relation to coronary artery disease?
a. It is often called coronary heart disease.
b. Slow, progressive occlusion of arteries often leads to development of collateral arteries that extend into ischaemic tissue, providing some protection against infarction.
c. It will always lead to a myocardial infarction.
d. Diagnosis of CAD is made by evaluating the history, ECG, and angiograms.
e. The disease is commonly due to atherosclerosis.

3. Define the following terms related to haemorrhage:
a. Petechiae – small pinpoint haemorrhages (like varicose veins)
b. Ecchymosis – larger area of purplish colour commonly called a bruise
c. Purpura – spontaneous bleeding into the tissues related to a haemorrhagic disease that may be characterised by both petechiae and ecchymosis.

4. What are the functions of the cardiovascular system?
The most basic function is to pump blood around the body and supply all organs and tissues with freshly oxygenated, nutrient rich blood. Waste products of cell function are removed with the blood as it leaves . The cardiovascular system also transports other vital substances, such as hormones and immune cells.

5. Which signs and symptoms are associated with common cardiovascular system disorders?
Dyspnea (difficulty breathing), fatigue, tachycardia (rapid heart rate), chest pain, pain in the left arm and/or jaw, heart palpitations, sweating, edema in the extremities, nausea, vomiting, cyanosis.

6. Which diagnostic tests are most commonly used to determine the type and/or cause of cardiovascular system disorders?
Auscultation of the chest, blood pressure measurement, ECG, angiogram, blood test, cardiac catheterisation.

7. What symptoms are usually seen in congestive heart failure?
Gradual increase in dyspnea, tachycardia, tachypnea (rapid breathing), neck vein distension, edema in the ankles and lower legs.

8. What is the difference between phlebitis and thrombophlebitis?
Phlebitis is the inflammation of superficial veins and may be caused by injury, obesity, poor circulation, prolonged bed rest, and infection. Thrombophlebitis is the development of a clot in an inflamed vessel. Clots in superficial veins rarely embolise (break loose and travel), but clots in deep veins often do and are a serious concern (deep vein thrombosis).

9. What are the most common signs and symptoms of shock?
Extremely low blood pressure, facial pallor, cool and clammy skin, cyanosis, tachycardia, tachypnea, altered mental status, syncope (fainting), unconsciousness, oliguria (lack of urine).

10. What are some of the changes occurring in the cardiovascular system with age?
The heart muscle loses some of its contractility, causing decreased cardiac output and/or increased heart rate to compensate. Vessels lose elasticity and become more rigid and narrowed. Valves become thick and sclerotic and lose some functioning. Decreased peripheral circulation results in cool and pale extremeties, improper healing, and edema in the legs and feet.

Homework summary

In addition to my placement I've also being doing a lot of study recently. I have to, because it's relevant to what I'm doing on placement, so will help me get more out the experience, and I have assignments and homework tasks due.

Here is everything I've got done in the last 1 - 2 weeks:

Lectures
• Psychiatric Complexities in Acute care settings
• Pain management in the acute care setting
Reading
• Excellence in practice: technology and the registered nurse
• Establishing and maintaining a professional profile
• The theory-practice gap in clinical practice
• Reflective practice for the graduate nurse
• Anatomic and physiologic overview of neurological system – neurons, neurotransmitters, the brain (cerebrum, brain stem, cerebellum), structures protecting the brain, cerebrospinal fluid, cerebral circulation (arteries and veins), blood-brain barrier,
• Neurological Observation
• Professional Learning Outcomes Assignment (1600 words)- this assignment included a cover letter, curriculum vitae, and essay about my learning needs in order to transition confidently from student to graduate nurse. I finished it over the weekend and am handing it in today.

Neuro placement - week 2

I'm about half way through my placement, still have 8 days to go, and am loving it.

This week I've been doing nursing care for an elderly Russian man who speaks very limited English and had come into the ED after having increasing headaches over the last 12 months, and then had some kind of seizure while driving. The did a CT Brain scan and found something looking like this:


Then they did a craniotomy to take a biopsy and it turned out to be Gliobastoma Multiforme, one of the worst kind of brain tumors which has a very grim prognosis - 6 months to a year. After the surgery. A few days after the surgery he went into a coma for about 24 hours. As part of the neurological observations we had to do sternal rubs and press hard on the nail beds to inflict pain (to assess whether the brain is responding to painful stimulus). It leaves a pretty nasty bruise when it is done over and over.

I accompanied him to get an EEG done which measures the electrical activity of the brain. His brain function was normal and they did some other test where they lift up an arm and it flops back down to the bed quickly when let go. However when the arm was lifted and let go close to the face, the arm stopped falling a couple of centimetres from the face, which showed that there was some kind of consciousness there because otherwise they would have hit themselves in the face. The findings were consistent with a psychogenic pseudo coma which is a state mimicking acute unconsciousness with intact self-awareness, due to severe depression, inability to cope, near death experience and a number of other factors. They become 'locked-in' to this state.

As soon as the patient's family left, I decided to check on him and he started waking up! Since then he has been awake and fully conscious and has also said he can remember everything his family were saying to him while he "was asleep" and complained that people kept "pinching and punching" him. So bizaare.

Another patient I had this week had epididmo-orchitis which is inflammation of the testicles, causes by trauma or STD infection. He said he was hit in the balls by a soccer ball. It make the testicle that is inflamed change shape and become really large so they are in a lot of pain and have difficulty walking. He was given IV antibiotics and pain relief.

If you want to see what it actually looks like you can do a google image search. Decided not to put a picture of someone's inflammed testicles on my blog, lol.

Yesterday two males in their 20s were admitted after a single vehicle car crash. Lots of lacerations to the face and body from smashing the windscreen, but no seat belt bruises on either of them. They both said the other one had been driving and they both had illicit drugs in their system. They had neck braces on and were supposed to be lying straight and avoid moving their spine until it could be confirmed that they didn't have any spinal fractures, but they were both completely non compliant and insisted on getting out of bed and taking their neck brace off because it's too tight. Idiots!

Had my first formal feedback from my clinical educator and she thinks I'm doing really well. She said my strengths are: performing nursing care in accordance with recognised standards of practice, seeking additional knowledge when presented with unfamiliar situations, demonstrating increased responsibility and accountability, approaching patient assessments in and organised and structured way, and ensuring my nursing practice is sensitive and supportive to cultural, social and psychological issues. The things I need to develop are my drug knowledge and interpreting supplementary data such as blood test results to help me plan care and interventions for my patients.

Last night I slept for 12 hours to catch up on sleep debt. Today I'm working on an assignment that's worth 40% and due Monday.

Neurosurgery clinical - Day 2

Very long and productive day today. From 9 - 11am I had a lab class in which we did Basic Life Support (CPR) practice and refresher, nasogastric tube insertion, and epidural management. Not all nurses can insert and remove epidurals, you have a gain specific accreditation at least a couple of years into practice. But we will be expected to assist, assess and document.

Then I had a break and spent some time in the library researching for my assignment that I'm currently working on. Reading I did today:
• Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse
• Continuing Competency Framework
• Managing the Transition from Student to Graduate Nurse
• Becoming a competent, confident, professional practitioner
• Becoming part of a Team
• Managing approaches to nursing care delivery

Following that I had a very interesting shift with some new experiences:
• Neurological observations on a patient with Post Traumatic Amnesia (he was assaulted to the head in a nightclub)
• Neurological observations, full nursing care (hygiene), pressure area care, and drug administration via PEG (directly to the stomach) on an unconscious patient.
• Care of a patient with halo brace, accompanied him to his x-rays and helped him sit up and get out of bed for the first time since his accident.



I didn't get home till 10:30pm. Luckily tomorrow I am on afternoon shift again. But then on Wednesday I have an early start. I don't like late finish then early start because it is impossible to get 8 hours sleep in between. The most I could get would be six hours. If I get home at 10:30 there's no time to wind down afterwards, and I have to be up again at 5:00am to shower, have breakfast, catch the tram and be there again by 6:45. I'm not complaining but I wouldn't like to have to do that on a regular basis. It really messes with your body clock.

3rd year clinical - first shift

I did my shift on Friday even though I'm not 100% better. My clinical educator said it was ok. I was still coughing a bit and felt guilty but I made sure I did hand hygeine all the time and I made it through the shift, and there were actually a few other staff members with what sounded like the same cough as me, so I didn't feel so bad.

I am on the neurotrauma and neurosurgery ward, which has some overflow from the orthopedic ward too. The patient I was mainly looking after was an orthopedic patient - an 80 year old Greek lady with the broken femur who was day 4 post surgery and needed full nursing care for everything. She had a 'pad' which is actually an adult nappy, but they call it a pad because I guess it doesn't sound as bad, and was having diarrhoea. The pad needed changing 3 times during my shift and because even rolling to her side caused a lot of pain, 2 nurses were needed to change it. The smell was so bad. I don't know if I'll ever get used to dealing with faeces, but it's part of the job. I feel sorry for people who are incontinent and it makes me never want to get to that state. All the more reason to keep up my yoga and pilates and try to keep my bowels healthy.

Did my first blood transfusion on her as well (her haemoglobin levels were low after the surgery) which was good after learning all about it last year but not having had a chance to do it yet. Had to educate her first about the reasons using simple language because her English was a bit limited, then get consent, do the baseline assessment and monitor for adverse reactions, as well as set up and start the actual transfusion.

Also did my first drug administration per vagina. Not as bad as it sounds. The tablet comes in a disposable applicator. Just like inserting a Tampax tampon. It was an oestrogen tablet that absorbs at the site of the cervix.



Also removed an IV catheter for the first time. My nurse buddy was very nice and I think we worked well together. She's young and only a couple of years out. I'll be working alongside her for all of next week too. I'm glad I wasn't asked to come in this weekend to make up the shifts I missed, better to have the weekend to recuperate and make up the shifts when I'm fighting fit.

Currently working on my Professional Transitions in Nursing Assignment which is due next Monday. I also have two 2 hour classes next week as well as 5 x 8 hour shifts of clinical, so very very busy this week.

Sick

Sorry for the lack of blog updates. Last week I only had to go into uni for one day. We did a clinical simulation session with a dummy to 'prepare us for clinical' but I'm pretty sure the main purpose was to participate in research study on 'whether clinical simulation actually helps prepare students for clinical placements' that one of our teachers is doing. In my opinion it does not, because it is unrealistic, there is no RN and it's just 5 or 6 students fussing around a dummy with not much idea whether they're doing the right thing. Clinical placement is nothing like that of course.

A week ago I did my first paid nursing shift as a PCA (patient care assistant)! I got called at 5:45am and had to be there at 7am. It was an aged care nursing home and my job was to get the patient's up, dressed and showered and take them to breakfast. Quite a few of them had dementia, urinary and bowel incontinence, or ataxia (unbalanced). So I had to change their nappies, give full assistance with showering and dressing and remind them where they are and what's going on. It was great experience and the other staff were very nice to me. And I got paid! I had another interview for another agency last week as well and got accepted so hopefully that will lead to more work and more variety of experience.

The last two days have been orientation to our wards for clinical placement. We had to do one patient assessment and figure out everything that's going on with them and put together a care plan. I've been studying a lot of new things to do with neurological assessment and diseases and will do some blog posts about them later. I'm really looking forward to getting started on the placement but unfortunately right now I'm sick so today I didn't go in for my shift and I'm going to stay home tomorrow as well. Hopefully I'll be good to go on Friday. I am usually very resilient to coughs and colds that go round, especially in the last three years I've been getting adequate sleep and taking vitamins. However, over the weekend I came into contact with a couple of people that had a very nasty cough and unfortunately I seem to have picked it up. If I have been affected by it, it must be very contagious, so the last thing I would want is to give it to the patients or other students. My clinical coordinator will try to slot me into some other shifts, maybe weekend shifts, in the next three weeks to make up the hours. Just resting, drinking hot tea with honey and lemon, and trying to get a bit of study done, although it's hard to find the mental energy. I've worked a bit on two different assessments in the last 24 so I'm happy with that, but my main focus is getting better.

Complex Care Nursing Week 2

Some things I've covered in this subject this week . . .

Lectures
• The Coronial Process – special lecture from the Coroner

Drugs:
• Clopidogrel – antiplatelet, prevents clotting
• Perhexiline – antiangina, decreases heart’s oxygen demand
• Lignocaine – local anaesthetic injection, but can also be taken orally for heart arrhythmia
• Perindopril – ACE inhibitor, lowers blood pressure
• Frusemide – loop diuretic, lowers blood pressure and reduces oedema (build up of fluid in the tissues)
• Prazosin – blocks alpha-1 receptors which are responsible for the vasoconstrictive action of norepinephrine, which would normally raise blood pressure. By blocking these receptors, prazosin reduces blood pressure.
• Atenolol - is a selective β1 receptor antagonist belonging to the group of beta blockers, works by slowing down the heart and reducing its workload, thus reducing hypertension
• Caltrate - used for relief of the symptoms of indigestion and heartburn. The active ingredient, calcium carbonate, neutralises excess acid produced by the stomach.
• Trimethoprim - antibiotic used for the treatment of urinary tract infections , traveler's diarrhea, respiratory and middle ear infections
• N-Acetyl-Cysteine – mucolytic (mucus dissolving) agent used in respiratory conditions with excessive and/or thick mucus production, such as emphysema, bronchitis, tuberculosis, bronchiectasis, amyloidosis, pneumonia, cystic fibrosis and COPD Chronic Obstructive Pulmonary Disease. It is also used to treat paracetamol overdose.

Labs
• Head to Toe Assessment
• Central Venous Line Management

• Respiratory Assessment
• Tracheostomy care and suctioning


Online Modules
• Chest Drainage 101

Videos
• Oasis Dry Suction Chest Drains Parts 1 - 4
• Atrium’s Ocean Chest Drain Set Up and Operation Parts 1 - 5 – indication for chest drains - http://www.youtube.com/watch?v=Hn0SHGuUVak&feature=related
• Central Venous Catheter Connectors Positive Displacement
• Central Venous Catheter Negative Pressure in Catheter Lumens
• Tracheostomy Care
• Tracheostomy Suctioning
• Intubation and Mechanical Ventillation - http://www.youtube.com/watch?v=V8VIw0fk4X0

Things to look forward to

My first clinical placement this semester starts on March 14 and is for 3 weeks. Found out that I will be on the Neurosurgery and Neurotrauma ward. Head injury, brain damage and brain surgery - very interesting! Haven’t done anything like this before.

From April 16 to May 22 I will not have any classes or clinical placements! That’s FIVE WEEKS off in the middle of the semester! I hope to do lots and lots of paid work during this time, as well as spend plenty of quality time with my family during the Easter period.

Professional Transitions in Nursing Week 1

Subject Description:

Students will focus on issues that impact on nurses and nursing work. They will focus on personal and professional development with an emphasis on registration requirements, job application, transition to the role of RN Division 1 and future career directions. Students will explore contemporary factors impacting on professional nursing practice, including the role of the nurse in health care and the effect of political and/or economic decisions on the provision of care.

Assessment:

1. Professional portfolio worth 40% with letter of application, curriculum vitae and 1200 word discussion paper on maintaining competence in nursing practice.

2. Group presentation worth 20%

3. 1600 word Professional Development Plan for final year of Bachelor of Nursing, identifying learning needs and reflections on how I achieved them on clinical placement, worth 40%.

So far the lectures and workshops for this subject have been about Grad year, what is involves, the application process, the interview process, the challenges, the benefits and so on. Yesterday in workshop we did mock job interviews in our groups and gave each other feedback. This is really good practice. We were given a list of about 50 questions that often get asked in grad interviews, so we can plan and practice our answers. I'll be applying for graduate positions in June/July this year, so this subject will be really useful for getting on with that.

Nursing Older People Week 1

Subject Description
Students will encounter the health needs of older people in diverse settings, but particularly in acute care settings. They will consider the biopsychosocial aspects of ageing, older persons’ responses to multiple pathology and recent advances in the ability to regulate the biology of ageing. They will further develop skills in advanced nursing assessment. The importance of the nursing roles in promoting, maintaining, and restoring the health of older adults will be a major focus. Consideration will be given to the potential negative impact of care on the older individual’s ability to live a meaningful, productive, autonomous and responsible life.

So, basically after this subject, I will encourage all my elderly patients to start using anti-ageing cream if they haven’t already, to prevent ageing, LOL.

Assessment:
• 20 minute Group presentation in final workshop worth 20%
• 1500 word individual report on healthcare issues for elderly patients worth 30%
• 2000 word individual case management review based on real patient from clinical placement worth 50%
• 2 week clinical placement start May 23.

I won’t be doing much for this subject until the second half of the semester because I am in the last placement group and most of my workshops are also later in the semester.

Complex Care Nursing Week 1

This is my biggest subject for the semester with twice as much content as the other two. This is the subject description:

Students will work as a member of a health care team and investigate the usefulness of selected therapies for individual clients in an acute health care setting. The impact of complex health problems on the individual and carers will be emphasised. Students will develop knowledge and skills in order to engage in person-centred care with individuals experiencing a range of complex acute and chronic health care issues. In the clinical setting, there will perform focused assessment and apply clinical reasoning to further develop their skills in planning and delivering care that incorporates pathophysiology principles, medical technology and discharge plans.

My assessment for this subject:
• Three week clinical placement – must complete this satisfactorily to pass the subject. My placement starts very soon on March 14th!
• 2500 word assignment worth 40%
• 2.5 hour open answer exam worth 50%
• Workshop participation (homework tasks) worth 10%

This week this is what we covered in the subject:

Lectures
• Advance Care Planning: respecting patient choices and withdrawal of treatment - this is about trying to find out what people want for themselves before it too late to ask (lose their capacity to make a decision). It takes the burden off families to make those difficult decisions. The principles of respecting patient choices are dignity, autonomy, informed consent, and prevention of suffering. Everyone has their own feelings about what make each day meaningful for them, such as spending time with loved ones, eating delicious food, mobility and able to carry out basic activities of daily living, and environment. Situations one might consider unacceptable are not being able to recognise or communicate with loved ones, not being about to eat or do basic activities of daily living independently such as toileting and bathing. Also some people like the idea of a quick death rather than a long drawn out death with lots of pain, suffering and boredom, so they have a preference that if their heart stops they do not want to be resuscitated. It's important to think about these things and tell your next of kin - partner, son/daughter, mother/father - what your wishes are. Or you could just get a tattoo.



Labs
• Emergency scenario – focused assessment
• Performing an ECG (we learnt this last year so it was just practice)
• Interpreting an ECG
• Management of underwater seal chest drains



• Management of central venous line catheters



Workshops:
• Reviewed pathophysiology of the heart
• ECG interpretation
• Patient scenario health issues and procedures:
• Transischaemic attack




• Percutaneously inserted valve



• Transesophageal echo probe


• Angioplasty




• Angiogram



• Aortic stenosis (showing up in angiogram)

Week 1 - Hospital Orientation

A whole day of lectures was devoted to introducing us to the hospital's philosophy of care and policies.

Patient outcomes:
• Health goals are met
• Positive experience
• Not harmed
• Timely communication

Regular assessment of patients’ basic needs (hourly checks):
• Pain
• Toileting
• Mobility
• Environment
• Other – ie, “is there anything I can do for you?”

Criteria for a MET (Medical Emergency Team) call:
• Resp rate > 36 resps per minute or < 6
• Oxygen saturation of <90% on oxygen
• Threatened airway
• Systolic blood pressure < 90
• Heart rate > 140 or < 40 beats per minute
• Sudden drop in Glasgow Coma Scale by 2 points (neurological score)
• Prolonged seizures (could be a stroke)
• Uncontrolled pain
• Other serious concern (eg. uncontrolled bleeding)

Nurses’ role during a medical emergency:
• CPR – compressions and/or bagging (breaths)
• Medication
• Reassurance
• Runner
• Scribe
• Remove clutter
• Reassure other patients and visitors who are nearby
• Information
• Delegate roles
• Interventions

Policies:
• Hand hygiene
• Manual Handling
• Risk assessment and management
• Patient aggression
• Infection control - For gastroenteritis, staff must not come to work for 48 hours after their last symptom of vomiting or diarrhoea, because they will still be infectious. Gastro can KILL elderly people, infants, and those with compromised immune systems.

Adverse Events
In Australia the statistics are that 16% of patients admitted to hospital experience one of the following during their stay:
• Medication error
• Fall
• Pressure ulcer
• Wrong blood
• Hospital acquired infection
• Wrong site surgery or wrong procedure.

New semester - final year!

Wow, this week is so jam packed with classes and I also have heaps of homework to do to keep up. I'm going to try to find time to update my blog during the week because there is lots to write about but homework, staying organised and getting enough sleep are my priorities. I'll definitely update on the weekend though.

Basic Life Support Update

At the beginning of last year I did my First Aid Certificate and every 12 months I need to do a refresher for the CPR component. With my new job, I'm lucky that I can do Continuing Professional Education Updates online and it is subsidised. I just did the Basic Life Support Update which was an online tutorial covering the updated guidelines for CPR and basic life support from the Australian Resuscitation Council. The new guidelines incorporate the latest evidence for:
1. Managing an emergency
2. Unconsciousness
3. Airway
4. Breathing
5. Compressions
6. Automated External Defibrillation
7. Cardiopulmonary Resuscitation

It cost $12 to do the update which will be deducted from my first pay. For the assessment there are 3 attempts allowed before you have to pay again. In the first attempt I got 8/10 and I checked which ones I got wrong then did the second attempt straight away. The second time I got 10/10.

There are lots of other updates I can do if I want but I'll leave them for now because they cost money. Closer to the time I apply for grad positions I might do a few more because it will be good for my resume.

Found out my timetable which starts next week. It's jam packed with classes Monday to Friday for at least the first few weeks, so I'll be pretty busy and have lots to blog about.

Yay! I got my first nursing job!

So, spent last week relaxing and finishing off my assignment (mostly relaxing). Handed in the assignment on Friday so should get my result for Mental Health Nursing soon. Also sent out a my CV to a few nursing agencies last week and today I had a job interview with one of them and I got the job! They're taking me on as a Personal Care Attendant/Assistant in Nursing. I already got a uniform! Hoping I can get one shift a week, preferably on the weekends, which also pays more than weekday.

I don't know my uni timetable yet but I did find out today which clinical school I'm in this year (very happy with it, very good hospital, and convenient for me to get to by public transport). And classes will start a week earlier than I expected, which means they start next Monday the 21st.

Will enjoy doing nothing for the rest of this week, just relaxing, because I'm sure things will start getting very busy very soon.

Final week of placement - finished!

Today was the last day of my placement! It has been awesome. This week I spent lots of time with the psychiatrists sitting in on their daily meetings with the patients where they talk about how the patient has been feeling, how their medications are going, how they've been behaving on the ward (good or bad), whether they can have their leave increased or restricted and plans for after discharge. It's been really interesting, and because I've been having quite a bit to do with the patients' care the doctors asked me what I think about the patients' mental state too.

I also got to teach yoga and meditation again this week because one of the patients requested it. Four people came to the class which is the maximum number that can fit in the room.

Sat in on a few Mental Health tribunal hearings as well. This is part of the Civil and Administrative Tribunal and is an actual legal proceeding with a tribunal member, two independent doctors, the patient's psychiatrist, and nurse. In the first hearing I went to the patient was very articulate, eloquent, answered the questions and talked about his mental illness (bipolar) with a lot of insight. It was surprising because most of the time he is really annoying and immature and non-stop talking about anything and everything. I told him I was impressed and he said he behaves and speaks differently when he's in front of the judge. I told him he should at least try to be like that all the time and he would be out of here a lot quicker. The second hearing I went to was a patient that was completely delusional, thinks he is a world champion kick boxer, international secret agent, knight and saint, a billionaire and the list goes on. He also thinks he has a really fit amazing body. The reality is he looks like a homeless bum and has a huge gut and lots of health problems, and is unemployed and living on the disability support pension. He thinks they must be confusing him with someone else.

Today I went in with the doctor (who is African) to review the mental state of this patient. The patient mumbles and rambles quite a bit and uses a lot of jargon which makes it difficult for the doctor to understand him. So I had to help interpret. Then we went and reviewed another patient who was delusional that he and his parents were murdered when he was a baby, and that he is a clone of his former self and his 'parents' are imposters. He also believes that he has a silicone computer chip in this thumb that he can set off atomic bombs that are located in Croatia and because of that a local gang, the Cro Boys are after him and want to kill him. He only feels safe in the psych unit. In addition, he says he is Jesus Christ and that's why all the Jews and athiests want to kill him. If that wasn't enough stress already, he also has bikie gangs after him, the police want to kill him because he is privy to the knowledge that some police officers use drugs, and he needs to get surgery that will stop him from being able to get an erection because he is due to start military training (also a delusion) and in the army it's not allowed to masturbate or have erections. He asked me to organise this for him because it's his body and his right. "What are my chances for approval?" I just said "I'm not sure".

There have been a lot of delusional patients this week, very paranoid, shouting, smashing things, verbally abusing staff and each other. The atmosphere has been crazy. Also it was really hot the first two days this week and then it's been hot and humid for the last three days so that makes it even worse, and the patients have more trouble sleeping. There aren't enough beds in the high dependency unit (only 4 because one of the rooms is unoccupiable due to a leaky ceiling), and there are probably around 10 patients that need high dependency care at the moment. But they have to be in the low dependency unit instead and that upsets all the other patients because the environment's not as calm, and they get wound up.

Anyway, all in all the placement has been a fantastic experience. All the staff have been so wonderful, caring, patient and keen to pass on knowledge. They've also been very complimentary and encouraging, giving me lots of (but not too much) responsibility. I've been encouraged by quite a few of them, including my clinical educator who did my assessment, to pursue a career in mental health nursing. I could certainly see myself doing it for a few years, and there is no shortage of jobs, just a big shortage of nurses it seems. They even said we hope you come back and work here. At the very least, it is a very good referee to have on my resume for my job hunting this year and for grad positions.

Big drive back to Melbourne tomorrow.

More experiences from week 3

Accompanied a patient to get an x-ray on his hand after he punched a wall in frustration. He broke his knuckle in two places, the radiographer said it’s unlikely to heal on it’s own and he’ll probably need surgery. The patient was totally in denial, “I’ve got really strong hands because I played hockey for years, it’ll be no problem”.

Observed a dermatology review on a patient that has weird rashes all over his body.

Did an ECG on a patient with my fellow student.

Sat in on the morning multi-disciplinary team meeting. This is like handover except it’s with all the psychiatrists, doctors, welfare officer, head nurse, activities coordinator and social worker on the unit.

Held a beauty therapy group that I was asked to run (because the activities coordinator was allergic to the products). Only one person came, so I asked her if she’d like a facial and manicure. She couldn’t stop rambling from topic to topic the whole time (part of her illness) so I had to keep saying to her in a soft voice “just try to not to talk, relax and enjoy it”. She said she really enjoyed it and that it was so relaxing, despite not being able to stop talking for more than 10 seconds.

I approached one patient who has been wearing the same shirt everyday for the last 2 weeks and some people have commented that he stinks. I suggested he wash his shirt, gave him a sachet of washing powder and offered him a hospital shirt. He was very offended and said, “I’m a grown man, I know when to change my shirt, it’s not your job to tell me”. I said I didn’t mean to offend him, it was just a suggestion and totally up to him whether he wants to wash it, and thought maybe he didn’t have any other shirts.” He said “well I just washed this shirt two days ago actually”, although it looked really dirty and gross. So I just said, “no worries, that’s fine”. Then five minutes later I saw him change into a new shirt and take the other one to the laundry, LOL.

Only one more week to go now, I have a feeling it will go by fast. I’ve done a lot of work on my assignment again this weekend, but it’s still not finished.

Lots of drama in the psych ward

Time to catch up on what's been happening. Today was a hectic day, the unit was very understaffed with 2 nurses (out of 6) calling in sick and no one else could (or would) come in to fill in. So me and the other student nurse were given the responsibility of doing the ward rounds all day (checking on each patient every 30 minutes). I did that for the first couple of hours and then he took over. Also, the night before one of the patients had trashed his room destroying everything he could including smashing the window. So the smoking courtyard which the window was connected to was out of bounds because of all the broken glass. The rest of the patients were unsettled by it of course and needed to have their smokes so they just smoked inside. The patients was put into the high dependency unit and then he smashed that room too even though it has very thick hard to break special glass. He somehow managed to pull the bench which was bolted down and used that to smashed it. And there was blood all over the floor. He was taken into police custody after that.

So today the ward was pretty frantic. I got asked to run a yoga and meditation class in the morning which went really well for those who attended. One of them was from the high dependency unit and the staff said it was the calmest they had ever seen her. I have been doing a lot of one on one time with this patient over the last two weeks because I have a good rapport with her and she behaves well whenever I am around but unfortunately can be very childish and aggressive with other staff. So we've been bribing her with the promise of 'time with Kate' if she is good for a few a hours. I usually take for a walk around the other part of the ward for 30 minutes to an hour, sit out in the courtyard, chat, encourage her to write in her journal, and help her interact positively with the other patients. The other day I was allowed to take her outside the unit and outside on hospital grounds which was the first time she had left the building in about a month. She needed money from the ATM to buy cigarettes and it turned into a bit of a shopping spree buying something from the cafe (capuccino for her, and donut for me), gifts (for herself) from the gift shop, and so on.

With the same patient I also got the chance to look in her ear with an otoscope because she thought she 'might have a cigarette filter stuck in there'. When I asked how it got in there and when it happened she said she 'was trying to block out the voices' and that it was 'about a month ago'. I looked in her ear and it was indeed lodged in there. Got one of the doctors on the ward to try to get it out with tweezers but it was too delicate so she had to go to the ear specialists in the other part of the hospital. After that she said 'I've learnt my lesson', LOL.

Electroconvulsive Therapy

Had an interesting day today. Got to observe a patient having electro convulsive therapy, aka electric shock treatment. It was first thing in the morning and along with another nurse I accompanied the patient down to the theatre, witnessed all the pre-op stuff and putting her under general anaesthesia, doing the electric shock which gives them a seizure, staying with her for half an hour while she woke up and then take her back to the ward. It was nothing dramatic like in the movies where the patient screams, only lasted about 1 minute and they are completely unconscious, but very interesting none the less. As she woke up from the anaesthesia she was very wriggly and restless, ripping blood pressure cuff and cords off her, and kept trying to get out of bed so we had to hold her down and tell her to relax. Then when she start talking it was absolute gibberish, like another language, or english but 'word salad'. Then she'd ask perfectly 'I'm not making any sense am I?' or 'Do you know what I mean?' And we'd laugh and say no.

This weekend I worked really hard on my assignment which is worth 50% and has to be done while I'm on this placement. It's gotta be handed in (in Melbourne) 5 days after the placement finishes so I'm trying to get it pretty much all done while I'm here. More on what it's about later.

I've got lots more to write about on my blog, things I've been experiencing and learning about, but I will try to catch up a bit more tomorrow because I need to go and start getting dinner ready tomorrow. Have

Week 1 on psych ward

Day 2

• Four hour training workshop on how to use the computer record keeping system.
• Back to the psych unit and buddied up with one of the nurses. Went round with her to meet the patients. Part of the nurse’s duties is to check on the patients every 30 minutes or hour (depending on their risk level) and record where they were and what they were doing. This is a legal document (duty of care). Some patients burst into rambling talk when you say hi to them and I’ve noticed that sometimes the nurses just walk away while they’re doing that. At first I thought it was rude but what else can you do. You could spend half an hour just standing their listening to the nonsense coming out of their mouths.
• Besides that, just gave out meds when they were due, including one anti-psychotic injection in the arm, and responded to patients’ requests. One patient requested use of the boxing gloves which they can use if they want to punch the wall or whatever to release frustration, then I had to take them back off him 10 minutes later when I realized he was using them to have a real boxing match with another patient.

Day 3• In the morning, the clinical placement officer from my university called me to and told me there had been a ‘mix up’ which was why the psych ward had no idea I was coming, but that she’d talked to them and ‘luckily they will take me’. Found out later that actually my clinical educator on the ward had called her and slightly reprimanded her for not organizing my placement properly, and insisted she call me and apologise because it must have been a bit stressful for me after driving all the way up from Melbourne. Hah! Some apology. My uni is incapable of ever admitting to making mistakes. Everything is the students’ fault and we should just be grateful for all the hard work they put into getting our placements at all times. I’m so over complaining. I just want to get through the rest of my course now, get my degree and get on with my nursing career.
• Back to my placement - the mental health nurses on the ward all seem like a really nice bunch of people. They are very welcoming and helpful. Today I chaperoned a patient to another part of the hospital to get an echocardiogram. That’s an ultrasound of the heart and needs to be done before commencing Clozapine treatment for psychosis. The drug can cause myocarditis, an infection of the heart muscle, so the heart has to totally free of any pre-existing heart disease. It’s a last resort treatment when other drugs haven’t worked.

Typical day for the mental health nurse:• Handover (1 hour)
• Unit rounds, check on the patients
• Give out meds when they are due
• Do any obs as required such as vital signs, alcohol or drug withdrawal scale, weight, or wound dressings.
• Participate in activities with patients
• Attend to the patients’ issues and requests, including counseling, admissions and discharges.
• Write up file notes.

Day 4• Two hour manual handling workshop. Learned how to use all the special equipment for moving patients. Probably won’t need this on my placement because on the psych ward the patients are not immobile but it’s a requirement for anyone working or doing a placement at the hospital.
• After that I went back to the ward and this time I was placed in the High Dependancy Unit. This is the section for patients that need to be checked on every 15 minutes because of suicide risk or risk of ‘misadventure’ which means they are likely to do crazy things such as have sex with another patients or start a fight with another patient. The nurses stay behind a screen to keep an eye on them and for their own safety. Even the chairs in there are all soft so they can’t do any damage. Their cigarette intake is controlled (eg. no more than one per hour) and the nurses have to give them their cigarettes and light them for them. Usually they don’t let students work in that unit until the third or fourth week of their placement so it was pretty cool that they thought I could handle it. The patients in that section are pretty scary.

First Day of Mental Health Placement

Arrived in Canberra safe and sound with my cat after a 7.5 hour drive from Melbourne. Exhausted yesterday but recovered today in time for my first day.

A bit of a shaky start, nothing too bad but they didn't even know I was coming! I had called the 'clinical educator's mobile about a week ago to confirm and ask where I have to go and what time to be there etc and I didn't get any reply. Tried again a couple of times but always straight to voicemail. So this morning I called the hospital phone number the from my uni's info and no answer. Ended up just called the main hospital reception and asked to be put through to the nurse's station in the psych ward. They told me that clinical educator doesn't work there anymore and just come down and we'll get you sorted out. When I got there they said they didn't even know I was coming! But there were three other students from Albury-Wodonga campus that were all totally organised. My campus' clinical placement office lived up to their terrible reputation of being very disorganised. Anyway, not my fault, and luckily they said it's no problem.

As usual didn't do much today being the first day. Got a tour around the hospital and the ward. It's the only involuntary mental health ward in the state and has a high dependency unit where patients are monitored every 15 mins. Read through all the policies and procedures and welcome pack and sat in on handover. The nursing staff seem nice and welcoming and my clinical educator is very nice and accomodating. Patients are mainly bipolar, schizophrenia and depression (suicide risk).

For the first two weeks I'll be doing afternoon shift (1:30 - 10:00pm) and for the second two weeks I'll be on morning shift (7:00am - 3:30pm).

Should be a very interesting placement and I will keep you posted!