Clinicals with a Side of Philosophy

I walked into the room to find a large woman sitting up in a reclining chair. I introduced myself and she immediately told me how she hadn't slept very well that night. It had been difficult for her to become comfortable. She was in the hospital because she had fallen a few days before, and lay on the floor for over seventeen hours before she was found. She was "sore all over". She wanted to go home.

They were keeping her there for observation: making sure she was eating and drinking, watching over her so she wouldn't fall again as her muscles recovered from the strain... you know the drill. (Hospitals like observing people.) That day she was scheduled for a stress test, and she bemoaned the fact that she wasn't allowed to eat anything until it was over. She was more than eager to discuss her many pains.

I did my basic health assessments. It's like a game of twenty questions. Twenty times twenty! During musculoskeletal evaluations I saw she had some limitation to her range of motion. (I think this is just because she was in pain from the fall, mostly. I know I would be if I was stuck for so long.)

After I found her a pillow for her legs, transport arrive to take her to the stress test. The nuclear medicine nurse proceeded to scare the daylights out of my patient by describing the potential side effects of an adenosine injection. I asked my patient what she was thinking about while we waited, and she revealed to me her deep-seated fear of "drugs". She didn't trust medicine... especially the kind she didn't understand. I re-explained the procedure, and she didn't seem nearly as worried. That made me happy.

I mentioned she was a large woman. It wasn't exactly easy to get her onto the scanning table. She moaned when she had to lay flat on her back (remember, the fall), and had a great deal of trouble getting her arms up. You're supposed to lie with them behind your head... but she could hardly bring them past eye-level. With nothing to rest her hands on, she was distraught. So I stood behind her, and held her arms up for her.

I didn't have much success supporting her. The angle was all wrong, and anyone who knows me personally knows my arms are like two noodles. I apologized to her. "Sorry I can't do anything more to support your arms."

And she said "That's okay. You're giving me courage."

When I started nursing school, I had no idea what I was getting myself into. I'm someone who was born with too many interests and too many talents: I can't focus on anything! I stumbled into Nursing because it was some kind of mind-body-spirit breakfast blend... something to make me enough money to chase my dreams. Something to fill the time until I figure out what I'm supposed to do with myself.

But I'm thinking that maybe... maybe this IS what I'm supposed to do. All the time I am finding more reasons to believe that this path is the Good Path. My Path.

I've always known that a career doesn't really define who I am. Everyone has things they want to do better and worse, potentials they've not yet achieved, dreams they've not yet realized. But...when I'm standing there in the hospital with my coat and clipboard... I feel like who I am is both amplified and simplified.

I feel like nothing is being wasted.

Practicum #1

Today was my first practicum in health assessment.

The exam consisted of walking into a room containing my instructor and lab partner. I then roll-played as if this were a real examination scenario, assessing more than seventy different required points from memory. Each of those items is a single point, and documentation is 25 points, so missing anything can be detrimental to the grade. The instructor held a long checklist and furiously made marks on it as I talked.

Good thing I nailed it. Despite my fever.

The secret was to memorize a script of things to say and do in the evaluation that touched on every required aspect. I knew everything about my partner from our previous practice sessions, so things went smoothly.

Hopefully I'll make a high A on the test... if my instructor can figure out how to use Blackboard. She is awesome, but not so tech-saavy.

A long weekend

Friday's Pathophysiology class convened late and got out early because of the coming hurricane.

The power went out all weekend.

When it came back on, I logged into Blackboard to discover all NSU campuses are closed Monday.

I'm enjoying my unexpected holiday! (...mostly by preparing for practicum exams)

Nursing Fundamentals and Lab

Thursdays focus more on developing hand-on skills. Morning lecture relates various safety risks and complications patients can experience. Afternoon lab applies those ideas. Today the big topic was mobility, so we spent the afternoon hefting people from beds to stretchers and back, and lifting each other into wheelchairs. I actually enjoy Thursdays a little because they're not critical thinking courses. I get a little break from the "assess assess assess" part of nursing and concentrate on the physical activities.

Before lab began I actually took a test on putting on sterile gloves. There's this way you have took hook your hand along the inside and not allow the sterile and non-sterile fields to touch... it was easy. Those are the kinds of tests I want to take every time. The next practical exam I have to take in that class involves reading a chart and drawing up medicine, then injecting it. It's good, since once you understand all the rules, you're pretty much set. Little study involved.

Of course, my break didn't extend into the evening. I still had paperwork left to do from Wednesday. Every part of our clinical experience is painstakingly documented on all kinds of forms. Skin, hair, nails, musculoskeletal system, pain... and every week we add something to keep track of. By the end of the year I'll be carrying "Patho" and "Drug" cards describing everything wrong with the patient, what all their meds do, and all the potential complications, interactions, and interventions I need to be aware of in order to best serve them. Which is as it should be, nurses need to understand disease. But it amounts to a lot of busywork.

Class may or may not be cancelled tomorrow. Hurricane Rita is bearing down on us all, and the slightest bit of wind here seems to knock the power out for a week. So we'll just see what happens. If I lose power, I'll probably not post for a while.

Clinicals, Week 1

Today was my first day on the hospital floor. My lab partner Cris and I were assigned a ninety-eight year old woman from a nursing home down south: one of the Katrina evacuees. (HIPAA forbids me talk about her particular condition, so I can't tell you why she was there or anything. Even though I doubt anyone would sue over it; it's nothing too unusual.)

As a new student I was not responsible for anything like medications or IV fluids; mostly we provided her with AM care. Feeding, bathing, linens, diapers, skin care and assessment.

After feeding my patient, I told her "You ate more than usual today. Good job." She didn't understand me, and her eyes got wide. "You think I'm gonna die?" she blubbered. "No! You're doing just fine!" I said.
Later I told her we were going to check her skin. "We're just going to look at you".
Her eyes widened again. "But I don't wanna go!"
"You're not going anywhere! I'm just going to look at your arm now."

She was confused by the evacuation, I think.

I felt a great deal of sympathy for this woman when I held her hand and spoon fed her processed meat and eggs. Her hands were smooth like my mother's... smooth like my grandmother's were before she died. Its true that old people can be burdensome. Its true that some lack cognition. But underneath that I constantly see these very fragile beings, full of fear and confusion. Just wanting someone to take some time with them.

I wish there was more I could do to comfort her.

Oh, for the record, I did change a diaper today. I thought it was going to be more traumatizing than it actually was. That summer working in the daycare has already acquainted me with poop of all forms, so this little old lady's output was nothing to frighten me.

Good thing I'm an optimist. :P

Assessment Lab... and Rest

Tuesdays only officially have class until noon, but that is so students will have time to research their clinical assignments for Wednesday. In the future I will be assigned a patient the day before reaching the hospital, and will be expected to know everything pertaining to this person's disease and treatments before setting foot on the floor. For now, I don't have to worry about that, since all I'm allowed to do at the moment is give baths and change linens. Next week, I'll be able to take vitals and do skin assessments, and test range of motion. So the intense study begins next week. Today I can take a breather.

I still have to get up at 0515 though.

Health Assessment and the Student Nursing Association

Health Assessment

The faculty was kind enough to schedule Monday classes at 10 am rather than 9. Perhaps they felt it would make up for our early Wednesdays at the hospital. I was thankful for the extra hour of sleep. Although... I'd almost rather go ahead and get up at 9 for the extra hour of lecture. Health Assessment has been crammed into a two hour block once a week... and we might just need that extra time.

Nursing school is infamous for test questions asking "Which of the following would you do FIRST?" Vocabulary, structure, and function are taken for granted; you will not be tested on the normal lab values or definitions of diseases. You are given scenarios. Hypothetical cases. You're asked to assess the person completely, and relate a nursing diagnosis and nursing care plan. My Monday Health Assessment class focuses on the many, many variables a nurse should consider in patient care. Practicum exams involve going into a room and noticing every detail of that long list for the patient, then returning to an empty room to document each finding from memory.

In essence, the purpose of nursing school is to make you obscenely observant.

My first Health Assessment exam is in two weeks, and will cover 270 pages of material. That's about a third of the textbook.
Thankfully I've kept up with the weekly assignments, and have read all 12 of those chapters. But I'm still a little anxious about the upcoming test. The grade scale is such that you must make at least an 80% to pass. I've already taken an exam in two other subjects thusfar (and scored 96 and 90, an A and B). But this class is supposed to be "the hard one". I've already started reviewing the material.

SNA Meeting

I joined the Student Nurses Association, and was glad to attend their first meeting of the year this afternoon. It was during lunch break, so they thankfully fed us free sandwiches. A better meal than I would have time to acquire myself. So far this whole pre-professional organization thing looks promising.

SNA apparently sends students nursing journals as part of their membership: reason enough to join. But they also focus on several community service projects throughout the year. They talked about making shoebox care packages to Katrina victims today, which is a nice idea. I am apparently designing the T-shirt for this year, so hopefully I'll be able to come up with something interesting in the next few days.

I'm looking forward to becoming more actively involved at school this year. I've been a pretty lazy college student up until now; even though I am completely capable of leading, I often don't volunteer for projects. Since I've been spending such a ridiculous amount of time up at the school lately, I've started to feel pride in my alma mater and degree. I want to be in SNA... maybe even in SGA too. I want to be involved in campus policy and in helping the community under NSU's name.

(I'll be honest. I've never really thought much of the main campus because of its lower standards. Now that I'm in the next tier of students... now that I've seen that there are plenty of intelligent, dedicated students and faculty in this college... I'm proud to be a Demon. )

(Who'd have ever thought? )

Saturday CPR Class

CPR mannequins creep me out.

The soft, silicon faces can be detached and swapped out for each student so that no two people have to share saliva when they practice rescue breathing. When I walked into the room this morning I found a pile of them on the table. Here's a couple pictures I took with my phone:


That one is me holding the adult face in front of my own. These things look like something you'd see in a horror movie. Spooky.

As a health care professional, it makes sense for me to learn basic life support. I've earned a card from the Red Cross in the past, but the school requires our training come from the American Heart Association. There are minor differences between the two programs, but they still amount to the same thing: several hours of watching videos and pumping the chests of armless, legless dolls.

I think my favorite part of the entire certification process was the AED machine. AED's weren't part of the program the last time I did CPR training, but I'm glad they've come into common use. The thing is essentially a talking, idiot-proof ECG + defibrillator that calculates when and how hard to shock a person in cardiac arrest. Technology is a beautiful thing.

I won't have to renew my certification for another year now, which is good because no one likes an early Saturday class. To reward myself for a hard week of work, I went to Coldstone for some icecream. I was pretty disappointed that blueberry is no longer the flavor of the month, but chocolate mint served me just as well.

Only one test and two practicums to study for next week. It'll be nice to have the break.

Introductions

I had the idea to start writing this a few weeks ago, but only found a free moment today.

It's been almost a month since the semester started, so you've already missed out on quite a few things. I've purchased scrubs, taken exams, and walked around my hospital floor. I've visited with nursing home residents. I've learned how to take blood pressure. I've spent more hours reading textbooks than ever before in my college career.

These days I'm waking up between 0530 and 0700. After classes I study in the library. I have established a routine, and all before you met me. We have a lot of catching up to do.

Instead of trying to cram everything into one post, I'll just fill you in as we go. More fun for both of us that way. Look for updates each weekday around 4-5 PM, CST (I'll be in the library after class anyway. Might as well wind down by telling you how it went.) For now, its definitely bedtime. Mandatory Saturday class tomorrow on CPR from 9-5. Hopefully no one tries to give me mouth to mouth.