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I Sent A Man To The Hospital

This Saturday I sent a man to the hospital. In a good way.

Every Saturday/Shabbat, myself or someone from our synagogue goes to the nearby Assisted Living Facility (ALF) to get one of its residents, GU (initials only for privacy), to come spend morning prayers with us and then we take him back after lunch. It’s about his one outing for the week and his one chance to do some serious exercise, walking the 2.5 blocks between the two locations. He’s in his 80s, but he’s strong and fairly independent, which is great and how I would like to keep it. When I pick him up, I walk alongside, stop as often as he needs to, but always encourage him to walk by himself as opposed to using a wheelchair as some have suggested. He does have mild dementia in that he’s always reminiscing about WWII and all the twists and turns that caused in his life, but it’s not like he’s not aware of the current time and place as well. GU is feisty and strong and he has it in him to keep on ticking.

So when I went to pick him up this past Shabbat and did not find him in his usual spot waiting for me, I thought that strange. Even more strange was that the nurse’s aide found him in his room, in bed. He said he didn’t feel well, and my reply was, “Oh, ok, no worries. Tell him that I came and I’ll see him next week.” This is where it turns out it was a good thing I was the one to go pick him up instead of another man from the synagogue: the nurse’s aide said that he had had an incontinence episode. I know GU and that is entirely out of character for him. When she offered me the chance to go see him in his room, I took it.

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The Thing About Being A Nurse…

The thing about being a nurse, even a student nurse, is that you see so much suffering and so much that could go wrong that it puts everything into perspective. You stop complaining a lot about little things, appreciate your health over money, and want to smack people over the head when they whine needlessly.

Seriously. I had been told this by my nurse friend, but I was surprised how quickly it kicked into effect on me. I still bitch about little things, I still complain about being broke, and I still whine needlessly from time to time, but I know I’ve been doing it less and many times I just keep it to myself. Because I’ve seen glimpses of the bigger picture, and you know what, I have very little, if anything, to bitch about.

(With apologies to those who already read part of this when I posted it to Facebook and Twitter.)

One Month Down, Eleven To Go

January is over, which means I’ve survived the first month of this year-long crazy train that is the Accelerated Option program. In one month I’ve gone from being a newbie with no actual Nursing knowledge to having the rudimentary skills necessary to be thrown into a clinical rotation at a nursing home and be expected to not hurt anyone.

January has been tough. Getting used to the new academic methods used in nursing, the constant studying, the sheer amount of information being thrown at you, all of these have been tough on me. But I’ve survived. Mostly. I’ve already had two nervous breakdowns, one at the start and one at the end of the month, so it seems I’m right on track, based on what my nurse friends have told me. But you know what? I’m loving it.

In this first month I’ve had five examinations:

  • Nursing Fundamentals Skills: Passed.
  • Nursing Fundamentals Lecture exam: A
  • Nursing Assessment quiz: A
  • Intro to Math & Pharmacology exam: still waiting
  • Nursing Assessment midterm: still waiting

I should have the grades to the last two this coming week, when I will also have my midterm in Fundamentals Lecture. Yeah, we go that fast.

This past week was also my first week of clinicals. My group is doing two visits a week at the Villa Maria Nursing Center in North Miami Beach. Our first day was all orientation, but on the second day we got divided across the various wings and assigned to the CNAs (Certified Nurse Assistants) on the floor. I ended up changing the bedding on a few beds, seeing the wound care nurse change dressings on a few nasty wounds, and giving a bed bath to an almost-total-care patient. Didn’t have to deal with poop on my first day, though I know that won’t last.

It was a humbling experience, really. I knew I knew my material, and then it seems I forgot it all when we were on the floor. But then as we did things, it all came back and I was fine. It was emotionally charged, and during our post conference various students broke down as well. I don’t think you can be a nurse and not go through this process; you’d be heartless, otherwise, and you can’t be heartless as a nurse. Tough, yes, but not heartless. I can’t wait to go back there this week.

So that’s month one done. Let’s see what February has in store.

I Was In An Accident Today

While taking the bus from MDC Medical Campus to my home, I was on the M-119 Metrobus when it collided with a FedEx truck at the intersection of NW 17th Street and 7th Avenue. The FedEx truck was traveling south on 7th Ave and took the red light. The Metrobus driver slammed on the brakes but it wasn’t enough and the delivery truck crashed onto the front of the bus. Channel 7 News has a report on their website with some video where you can see the scene from the air, but this is a pic I took a few minutes after the collision (click for larger version).

And here are five other pics.

I didn’t really see what happened, as I was looking down at my phone when I heard people gasp, the brakes screech, the two vehicles slam and people cry out as they flew about the bus. I was sitting at the back, by the rear door, and thankfully tensed up automatically and did not move from my seat, though I did suffer a glancing blow to the forehead where my head hit a tube. It was a few seconds, then it all stopped. People started to cry, and complain of pain. Our last stop had been Jackson Hospital and we had two wheelchair-bound riders as well as a few elderly and an obese lady who literally flew like 5 feet from her seat and landed near the entrance to the bus.

I am fine, overall. After making sure I wasn’t bleeding I helped out the people around me. A man was lying on the floor next to me; he had been tossed like 4 feet from the back of the bus and could not get up. A young guy across from me slammed his chest onto the hard plastic of the seat in front of him and had acute pain. A lady behind me hurt her hand as she tried to wedge herself against the jolt. And so on.

The whole event served to remind me why I want to be a nurse: I hated the feeling of uselessness as I sat there with all these people in pain and need around me.

I know, it’s only been three weeks of class, but I wanted to do more, help people more. I wanted to tell the guy with the chest pain what to do to minimize that pain; the man on the floor what to do to make sure nothing was broken; the lady with the hurt hand how to put it so it would hurt less. But I couldn’t because I don’t know yet what to do. I kept racing through what we’ve learned in class, in skills lab, in my readings, and nothing useful would come up. It was frustrating. So I did what I could: I helped make sure people were ok, calm. I moved from person to person, asking them how they felt, if I could help them with anything. Most said they were fine. I helped some sit better on their seats, I helped retrieve stuff that had flown about and give it back to the owners, helped the guy with the chest pain calm down and take slower, less painful breaths. The EMTs took it from there once they arrived.

It was about an hour later, as I walked to the nearby train station to finally get home, that it dawned on me that I had indeed helped out. I wrote about Nursing Diagnoses, and while I cannot state for sure any specific diagnosis and interventions, I wouldn’t be off the mark saying that my mind assessed a diagnosis of Anxiety Related To Vehicular Accident on those people around me. My intervention was to ask open questions of each person to assess how I could ease their anxiety at my level of proficiency. I was then able to evaluate progress by reading their body postures and facial expressions.

Listen, I’m not saying I actually thought of all this as I helped people out, but the fact remains that it is how the nursing process applies and is put into effect on a subconscious level. Were I a regular person, I would’ve been simply helping out. As a nurse student, I was engaging in basic practice of the principles of my new profession. And you know what? Once I realized this, I felt better because I did help out in the one way I could.

I wasn’t planning on being in an accident today, and thank G-d I wasn’t hurt. But I was there for whatever reason, and it was my duty to provide help in any way I could. I can honestly say that, while I may not have been able to help at a physiological level those hurt around me, at least I was able to provide actual care well within the scope of nursing, and see a positive reaction to it. And that felt pretty damn good.

The Scope of Nursing

While studying this past weekend for my first Nursing Fundamentals exam, I read the chapter on Nursing Diagnosis, a part of the Nursing Process. When we all think of nurses, we probably can agree that the general idea is that of someone who takes care of a patient, which is actually quite right on the mark. Thinking back to Mom’s time in the hospital, I can never forget the amazing care the nurses assigned to her took to make sure that she had the best time possible during a terrible ordeal. As I’ve said before, it was precisely witnessing the difference that care made on my mother that made me want to pursue this new career.

As I read my chapter, however, I realized that nursing care is actually a very codified activity. Yeah, nurses care for patients, and I always thought that they simply did what needed to be done. Thinking back to Mom again, the nurses brought her meds, yes, but also were there to alleviate her doubts, clarify her questions, soothe her sadness, monitor her progress, advocate for her needs. I took all those actions in stride, as part of “care.” Well, they are, but I’ve learned that each one of those actions is part of a specific nursing diagnosis which the nurses were addressing, seeking a positive outcome.

There is great emphasis on the independence of the nursing profession, and nursing diagnoses are arguably the primary way in which this achieved. These are actions the nurse can take independent of a physician’s orders, and define the variety of areas the nurse can intervene on to care for a patient. And the variety of areas honestly astounded me. Take a look at some example nursing diagnoses to see what I mean:

  • Anxiety
  • Disturbed Body Image
  • Decreased Cardiac Output
  • Risk for Caregiver Role Strain
  • Risk for Contamination
  • Acute Pain
  • Post-Trauma Syndrome
  • Chronic Low Self-Esteem
  • Sexual Dysfunction
  • Sleep Deprivation
  • Ineffective Thermoregulation

There are 188 nursing diagnoses and what was a revelation to me was understanding the scope of the word “care” when it comes to what a nurse does. In that small sample you can see the nurse addressing physical issues you’d expect someone in a hospital to be facing, but notice also the mental and social issues being addressed as well. Why? Because our patients aren’t only a medical diagnosis, they are an entire human being who isn’t only facing a physical ailment, but also is facing related factors such as anxiety from procedures, deficiency in knowledge of what’s being done, or even spiritual distress.

Oh yeah, that’s another nursing diagnosis: Spiritual Distress or Risk for Spiritual Distress. The Fundamentals of Nursing book says, “Nurses have a responsibility to assess client’s spiritual needs and intervene to meet those needs.” (Perry, Potter pg 342) That is fascinating! Our work as nurses extends to all levels of the human being, including the spiritual arena. And it’s easy to understand why: a patient that is in spiritual distress will not be in the right mindset to heal; she will be stressed, and that stress will prevent the physiological processes from taking their restorative course. And yes, I asked, even Atheism can be addressed via this diagnosis if needed.

So, thinking back to Mom’s care, what I took for granted to be nursing care was actually a series of nursing diagnoses that addressed issues my mom was having as a patient, whether those were Nausea Related To Impaired Digestive Function (and I’m making this diagnosis up, though I’m sure there is a correct one that addresses this issue Mom had) or Emotional Distress or Spiritual Distress. It’s not that nurses’ care was less than genuine, but that now I understand the codification that went on in the background to address each of those nursing interventions and how that codification allowed the nurses to objectively track my mother’s progress day by day.

As I said, I am fascinated by this realization. The scope of nursing is amazing, and the idea that we are allowed, encouraged and expected to take care of our patients on a holistic level–and that we have this codified system backing our assessments and interventions–fills me with excitement.

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