Monday, January 10, 2011

End of the First/Start of the Second

I've heard that the first semester of Upper Division is the hardest, and I really hope that's true. Despite working harder than I ever have in my life (I've always worked hard in school, but, until this semester, I knew I could work hard, but not too hard, and still get the grades I wanted), I now feel more strongly than ever that this was the right choice. The burnout for the semester was unbelievable, and by exam week, admittedly, I was kind of done; somehow I managed to keep my GPA above my goal of a 3.5, and I feel I learned more than I did in high school or the first 2 years of college.
The second semester is made up of two clinicals and their lectures, along with a couple of other classes. Half of us take psychiatric/mental health nursing this semester, while the other half takes pediatrics/obstetrics; we'll switch next semester and take the other so that everyone gets the same clinicals. In addition to psych or peds/OB, we all take medical/surgical nursing. Those of us in psych have room for one nursing elective (either genetics or emergency preparedness) and, because of my interest in disaster response kinds of things, I enthusiastically chose emergency prep. We all also have a skills lab for med/surg in addition to the clinical and lecture times, and an online research class (which I'm already forgetting assignments for because it gets put on the back burner. Ah crap). I think it will be another challenging, busy semester, but I'm even more excited about what we're going to learn than I was last semester. Here's to learning a lot, having fun, a still graduating with honors!

Thursday, December 16, 2010

Patients

Due to HIPAA (Health Insurance Portability and Accountability Act), I can't ever discuss the details of a patient's medical history, treatment, etc. with anyone besides the other healthcare providers working with that patient. That being said, I can share certain things with family, friends, etc. so long as I don't say the patients' names. I have talked and will talk more about the procedural aspects of nursing school and about what we're doing in regards to my life, but I wanted to take a minute and talk about, not the medical aspect of these patients' lives, but the human aspect. As even a nursing student, we're given an amazing opportunity to be let into people's lives and to really talk to them and get to know them; that's probably the main reason I chose nursing over being a physician, and I'm more than thrilled to see that it's already coming into play this early in my career. Even though it's only necessary to look in their chart for what's medically relevant to our patients, one thing I really like knowing personal details about the person so they feel like a human being instead of just a diagnosis and a list of meds. It's so easy to see the patients in the nursing home just for what they are now - old, broken down, sick, but these people's lives are just as complex as ours. They were our age once, and have done so much more with their lives than sit in a nursing home. One of my patients was in the Air Force, and probably fought in at least one war; it was odd because when you picture military, you think of men and women in the height of their physical strength and capability, but now that he's older, it's hard to imagine the man that he was. One of my favorite patients was born in Germany (in the same area where my family is from, actually) so I loved talking to her about it; then she told me she hadn't been home in 30-something years, and I tried to imagine what it was like the last time she went. Then I remembered her date of birth; she was my age when World War II started. I never did ask when she left Germany, but I imagine it was before or during the war, and I tried to imagine how I would feel, at my age or younger, leaving my country because of a war in our backyard. I would have liked to talk with her about it, but I didn't know how bad of a memory it was; if she hasn't been home very often, maybe it's because she wants to forget. I just would love to see through her eyes how different the world is now versus when she was my age. Another lady was in a similar situation, (she was never my patient so I didn't talk to her long), but from Italy. She, like the other lady, had just a hint of an accent in her English, which I absolutely loved. She told me about how she ended up in the nursing home after a car accident but also said she was grateful that her body was what failed her instead of her mind. She told me about her late husband who had remained in great physical shape all of his life, but his dementia got so bad that all he could remember was his name and Pearl Harbor. He didn't even remember his wife (he recognized her as a friend, but not as his wife), but he remembered what had happened to him at Pearl Harbor. That really stuck with me because I'm sure the same thing will be said about 9/11, which happened in my lifetime and which, since I was 11 at the time, I'm still processing. It just really put things into perspective and made me realize how complex people and life are. One thing that all of the patients told me was to "stay young and beautiful." Every time they said it, I would laugh a little, but in a way, it's great advice; I realize it's not actually possible to avoid aging (celebrities: that means stop trying), but seeing how much of a struggle it can be to simply get out of bed or walk or feed yourself had made me appreciate my health and youth so much more. Youth and life are so fleeting, so I plan to make the most out of it while I can; the worst thing in life, I think, wouldn't be to die young, but to be 80 years old, feeling like I wasted my life or didn't make the most of what I had when I had it. I hope not to ever be in a nursing home, but if I am, I want to be as inspiring to the nursing students taking care of me as my patients were.

Thursday, October 21, 2010

Trial By Fire

Wow, I have been slacking in the blog department, though I think I have pretty good reason; the week of my first rotation was also the week of Fall Break, so I was busy finishing up some assignments and packing for my trip to Chicago. As soon as I got back and after my second day of rotation, I was studying for a fundamentals test the next day. So, even though I still have 2-3 assignments to do in the next few days, I wanted to go ahead and blog since I have a lot to say about rotations :)
Initially I was too tired my first morning to be nervous (waking up at 5:15 is not an easy feat for someone who’s not a morning person), but as my classmate Haley and I were on the way to the nursing home, we starting talking about what we would be doing, and I got really nervous (though nowhere near my nervousness the very first day of clinicals in the CSL). I already knew who my patient would be and general info about his health history and treatment plans, but I still had no idea what to expect upon actually meeting and working with him. Tracey took Danielle (my partner for the day) and me to our patient’s room, and basically said, “Take his vitals, get him in his wheelchair, and make his bed.” Ready GO! There were a few seconds of Danielle and me staring at each other, somewhat dumbfounded, before we got to work as best as we could. The first day was a roller coaster ride of insecurity and confidence; one minute I would feel totally unprepared and spastic, but the next I was surprising myself by doing something right or without having to be told. Starting at 7 am definitely has its benefits because we get to help with A.M care (bathing, making beds, transporting into the wheelchair), feeding them breakfast, and observing them in rehab; it’s not the most exciting stuff by any means, but staying busy makes the time move quickly, and each thing we get to do is a deposit in the “experience bank,” if you will. The thing I noticed most quickly was that it was so much less awkward touching the patients, especially in private areas, than I expected; I was expecting to be really uncomfortable with things like bathing, but when you’re in a situation where you’re caring for a patient, and especially one who has been in a situation for a while that lets them be at least somewhat used to being changed, bathed, etc. by a stranger, the necessity of what you’re doing makes it less awkward. I don’t really know how to explain it, but I guess it’s a “do what you gotta” kind of mindset. The other healthcare providers, especially the nurse techs we were working most closely with, were so helpful and patient with us; I do realize that we slow things down and get in the way at times, but how else are we supposed to learn? They made a point to commend us on what we were doing well and to thank us for helping them out; it was just a really great experience overall, especially when I’ve heard stories of more experienced HCPs being rude and impatient with us “newbies.” The patients were also really helpful and patient with us; most of them have been there long enough that they know how things are done even better than we do, and I can’t even say how much I appreciate them and their families letting us learn with them. I stayed with my patient for a while until he didn’t need anything else, and then floated around to help my classmates or whoever needed it. In rehab, we just watched the physical therapists work with the patients, which was interesting to compare with my experiences in athletic PT and volunteering with a PT in the hospital; plus it was (finally) an opportunity to sit down. Our lunch break was spent working on our care webs for the week while hastily eating (get used to it, right?). I feel like what I need to work with the most is interpersonal interactions, especially with the patients; I could tell how awkward I was when talking to them, mostly because of being afraid to say the wrong thing. I don’t enjoy being awkward, though I’m almost used to it by now haha, but I know that will come with experience, so I’m not being too hard on myself. I was also proud of how well everyone in my group did, and once again, I’m glad to be working alongside them. My experience with one of my patients really showed me how much I’ve changed in the past few years: I had gotten her to the bathroom and waited outside to give her some privacy. The tech had gone to get something from her car, but I was under the impression that she was coming back, mostly because she didn’t tell me what to do beyond getting the patient to the bathroom and that we were bathing her after. When the lady finished, I was scrambling to figure what to do next and one of my classmates walked in; the patient then starts telling her how she’s been sitting there forever and complaining about me when I was standing right there; in reality, she had been sitting there for maybe two minutes after she had finished. I actually started laughing (not in front of the patient of course) because I knew I hadn’t done anything wrong, but I realized that a year or two ago, I probably would have taken it really personally and gotten upset. The last thing we did was observe an in-and-out catheter; the patient had prostate enlargement so he couldn’t urinate on his own and instead of a continuous catheter, he was just to be catheterized 2-3 times daily to empty his bladder. Our classmate, Christian, actually did the catheter and did it well, which was impressive on his part, especially being watched by all of us. It was another interesting experience with how things are done in simulation versus in “real life.” I also have a new appreciation for my physical independence after seeing just how helpless someone can actually become; we try to maintain independence as much as possible, but it has to be frustrating for the patients, and I’m trying to start sympathizing and thinking more about how I would feel if the roles were reversed. My patient was doing relatively well when I was with him, but knowing his history, it was really sad to realize, in talking with Tracey, just what all he’s dealing with and what kind of prognosis he probably has; it’s sad any time you hear about someone in poor health, but when you’ve met and worked with the person, it’s a new level of emotion. Overall, it was a great experience getting to know a patient as more than a diagnosis and to start gaining experience in the technical and interpersonal aspects.

Monday, October 4, 2010

Orientation

Today we had our orientation at the nursing home; even though it was just an overview and tour of the facility, it got me excited for the upcoming weeks there. We'll be working with rehab and short-term patients (as opposed to Alzheimer's or other long-term patients), so we'll be doing a lot of assisting them with ADLs (Activities of Daily Living) and their rehab. Even though it's not our area, Tracy still had us go through the Alzheimer's unit, and my personal experiences with my grandparents made something already really sad hit even more closely to home. One of the patients there even looked like my grandmother; it was a good lesson in learning how to use your emotions and experiences to your benefit and the benefit of the patients instead of just crying (which I almost did. Day one. Go me). It definitely wasn't all sad though; some of the patients we encountered in the hallways were legitimately excited to see us, which immediately made my day; I'm really excited to see how I can not only make someone feel physically better but also emotionally. We'll each be assigned a patient per week and, since there isn't the constant influx and outflow of patients like in a hospital, will probably have some of the same patients. I'm really excited to be assigned a patient and get to see the diagnosis and treatment process first-hand, as well as to get to know that person as more than a diagnosis. We're given access, even just as nursing students, into patients' confidential information and their physical privacy; it really demonstrates the trust that people give to nurses and that we really need to respect that trust. Once we get our patients at the end of this week, we have to start learning all about them from their medical information, and then next Monday we'll actually meet them and start getting to know them for who they are not on paper. I'm so excited about being a part of the health care team; we meet with the other health care professionals (HCPs) to discuss the patients and the process. Basically, my feelings of legitimacy are off the chart right now haha I think this experience will definitely be challenging at times, but I can't wait to start really being a part of the medical field and start learning who I really am as an almost-nurse.

Tuesday, September 28, 2010

Last Week in the CSL

As much as I've enjoyed learning the basic skills in the Clinical Simulation Lab, I also feel like it's time to move on to the clinical setting. I don't feel too much more prepared than I did a month ago, but I do realize that most of the skills, both technical and interpersonal, that we're going to develop will come from trial-and-error in a "real life" setting. This week we learned how to put in foley catheters and care for wounds. Catheterizing was surprisingly easy (well, on mannequin genitalia), but I just feel like between the patient's unease in addition to my own when I first do it (which may not even be this semester), it's going to be Awkward City. Each of us doing the catheter for both male and female genitalia took most of the morning, so we didn't get to wound care until after lunch. (P.S I love that already it's not a problem to discuss wound care and catheters and God knows what before, during, or after eating haha) Again, it was pretty simple, but I feel like it's going to be a different story when you see (and smell, honestly) a person's wound, particularly if it's a nasty one. The idea doesn't bother me though because I knew that's what I was getting myself into from the day I decided on a career in the medical field. I'm going to miss the comfort and community that we had being in the CSL, and I'm definitely going to miss walking around on campus in my scrubs because that makes me feel like the coolest thing ever haha but I also can't wait to move on to less comfortable but definitely more relevant things in the nursing home.

Tuesday, September 21, 2010

Clinicals Week Five

This week in clinicals was spent learning how to administer medications, which I’m actually really excited to do in a real, clinical setting; I think it will be really intimidating the first time I give a shot (especially in some of the sites on the body, which I’ll get to in a minute), but it was oddly fun. We started with oral medications and other forms like transdermal patches, which were interesting, but intramuscular and subcutaneous injections were where the fun started (because we finally got to use needles! Like real healthcare professionals! I felt so legit). It wasn’t all fun and games though; I’m seriously concerned about sufficiently getting air bubbles out of solutions before injecting them because if you don’t, that will straight up kill someone. Terrifying. Of course accidental needle sticks are a real possibility, and I actually read somewhere that, statistically speaking, it will happen to every nurse at some point in his/her career. Also terrifying. We practiced drawing up the dosages (more technical than you would think, but easy enough. Again, I felt so legitimate.) and giving injections on fake skin; supposedly “back in the day” nursing students practiced on each other, and I haven’t yet decided if that would be a good or bad thing. We practiced finding the injection sites on each other and on the dummies; everyone has gotten a deltoid injection (in the upper arm) with vaccines, but there are tons of other sites (the big muscle in the thigh, one near the hipbone, and one right where the back and butt meet). Even though hitting bone or a vein (you actually have to draw back on the syringe when you put it in the muscle to make sure you aren’t in a vein. I swear I’ve never noticed anyone doing that, and I watch when I get shots; they must just be that good at it!) wouldn’t be pleasant, what was the scariest, specifically about the location near the buttocks, is the possibility of hitting the nearby sciatic nerve (hit that and your patient is going to be in major pain. ::salutes and says “Major Pain:: sorry, How I Met Your Mother reference) or some major arteries (“Major Arteries.” Man, I’m on a roll!). All insecurities (and jokes) aside, I enjoyed giving the injections to the fake skin, and I hope I’m as good at it on a real person. Last year the first-semester clinicals students helped give flu shots on campus (I know because I recognized the guy who gave me mine as having been in my class the semester before haha), and I really hope we get the chance to do that this year; it would be intimidating, but I feel like after just a day of doing it, we would really have the hang of it. I’d rather learn get practice with it on young, healthy patients so I’m more comfortable doing it with sick, possibly frail elderly patients in the nursing home this semester.



While I ate lunch, I worked on some of my other assignments, did some studying, and refilled on coffee; I feel like that’s about my normal routine these days haha once we met back with our clinical group, we had our medical calculation test; now, I’m not a math person and never have been, but I did enjoy the objectivity of the math test after how subjective some of our other tests have been and will be. And I won’t complain about a relatively easy 100 either :) While each person individually went over their tests and evaluations for the week with our clinical instructor, the rest of us had a chance to talk and get to know each other better. I really do like my group; I love that we all get along so well and work together even though we all met only about a month ago. I hope that kind of camaraderie will be a theme throughout the rest of nursing school and in my career as a nurse.

Tuesday, September 14, 2010

Week Three

After not having our clinical last Monday because of Labor Day (mind you, I was still doing work and studying for classes that day anyway), it was nice to be back this week. Since the lecture that corresponds with our lab is on Tuesday and we had lab Monday, the first two weeks we did skills before having learned about them; now that we’re technically a week “behind,” we’ll discuss the skills before actually trying to do them in the lab, which is preferable. This week we learned about oxygenation (how to decide when to use and how to properly apply a nasal cannula, face mask, etc.), suctioning, and tracheotomy care. The skills were pretty easy (on the mannequins) and went pretty quickly, but I feel doing things like trach care will be a totally different ball game on a real patient. Once again, I thoroughly enjoyed the time in the lab and did well, building my confidence.

Speaking of…my confidence is like a constant roller coaster these days, I mean more than usual. Now that we’re all in Upper Division, the competition should pretty much be over. Yes, we’re competing for jobs against someone (and since I plan to leave South Carolina, I’m probably not competing with a single person in my class for a job), but for the most part, as long as we graduate, it won’t matter if our GPA was a tenth of a point higher or if we had one more extracurricular activity. I feel like now we should focus on actually learning the material (which grades are not necessarily a reflection of, by the way), bettering ourselves as nurses, and helping each other through instead of worrying about being better; if we all graduate the same, but someone is badly representing our university and the nursing profession, no one wins. Now, I’m a perfectionist, so usually I’m not totally satisfied with anything less than an A, and I got good grades in high school, so there’s already been some adjustment not making straight-A’s in college, but for the most part, I’m happy with my success in college so far. I realize I sacrificed some experiences and grades to study abroad, but in the long-run of life, that was much more important than even a few tenths of a GPA. And even though I’m never happy about a low grade, I’m usually happy when I get a grade that reflects the effort I put into whatever the assignment was; what always screws me up is when I compare myself with other people and start feeling self-conscious. In the end, I got a B+ on the exam; not an A, but considering what I put in and how I felt on the exam, I was happy with that grade. Comparing with others is such a Catch-22 because I felt simultaneously more confident when I did better than someone and less confident when I did worse, obviously; I've learned that you don't get to feel great doing better than others if you don't want the reverse feeling when you do worse than someone. My goal is to stop comparing myself with others and just be happy with myself and my accomplishments. No, a little friendly competition isn’t a bad thing, but when it gets to the point where people turn every little thing into a competition, it has gone too far.

Anyway, back to my clinical day. The Student Nurses’ Association on campus had its semi-annual Back-to-School Bash from 4:30-7, and since I was still up on campus when we got done with clinicals at 2:30 and was planning to go to it anyway, I decided to help them with set up. In the mean time, I got some work done in the computer lab in the nursing building, so already it had been a long, productive day. Helping set up was also a good way to meet some of the other students in SNA, particularly some in Upper Division with me; throughout the Bash, I also talked with some of my professors, which is always a good experience. I was still wearing my scrubs from clinicals, and I honestly feel like between that and being an Upper Division student, I’m really being taken much more seriously than I was even a month ago. It’s really nice to already get respect wearing the uniform, so I can’t wait until I feel more like I deserve it and am more confident in my abilities. After I had spent some time at the Bash and before it was over, I met with my pharmacology professor and a few of my classmates to go over our first exam; it was nice to finally meet the professor (my closest friends in UD with me already knew her from taking one of her classes last semester), to see what I got right/wrong (some educated guessing happened on that exam haha), and again to mingle with some of the other Upper Division students. Then I helped break down from the Bash, which meant I spent a whopping 11 hours at the College of Nursing in one day. Long day, but definitely a good, productive one; I met 3 professors, some of my nursing peers, and talked with some other professors/students I hadn’t seen in a while, in addition to feeling like a more appreciated part of nursing.