30/5/14
A tale of woe today. Shift started out well, I performed a sterile wound wash and dressing on a midline incision that had dehisced. The patient was a diabetic (who often do not heal quickly due to circulatory and immune problems) and the wound had simply reopened after the sutures were removed. So I steri-stripped it back together and dressed it in its Sunday best.
Later I was in the patient's room about to perform a blood sugar level test when the patient decided to get up for the loo. She sat on the edge of the bed and tried to stand up, but the bed was too high (due to an extra mattress designed to prevent pressure areas) and the patient's legs were not strong enough to hold herself up as she started to slip down the side. I ran around the bed and tried to help her to stand or to sit back on the bed, but the bed was too high and the knees too weak. In now way could I lift this woman back to bed. I made the instant decision to help the patient to the floor. She ended up sitting on the floor by her bed, I had managed to help her lower herself down slowly without injury. It took two nurses and two doctors to get her back on her feet and back to bed. And bless, she was apologising the whole time.
Unfortunately due to the nature of hospital work the incident had to be reported and I felt my head was on the chopping block. Despite no-one being injured the facts remained that I, a student nurse, was alone in the room with a patient when she had a 'fall'. So down goes my name in the incident report. Happily the nurse I was working with was lovely and did not try to pin blame on me.
I was told that I may have to talk to the powers that be about the incident (which made me shrivel up inside). At course they told us never to sign anything during an incident as a previous student had misguidedly signed a report putting all liability for the accident on herself. So my pens were shoved deep into the recesses of my pockets. Luckily nothing came of the incident, I suspect due to the fact no-one was injured. The doctor assessed the patient and found her to be no worse for wear. I think it affected me much more than anyone else, I kept wondering what I could've done differently. But the facts remain that the patient had been independent prior to the incident, she was in her eighties and her legs just happened to be a bit weaker at that time, and that there was no way I could've stopped her falling without doing damage to myself.
One of the things I remember the best from my first year placement is the charge nurse telling us to never try and stop people falling, but to help the fall gently, get them a pillow and a blanket, make them comfortable, get them a cup of tea, and then figure out how the hell to get them off the floor again.
Monday, 23 June 2014
Sunday, 15 June 2014
Day Nine
29/5/14
Nearly the end of week two already! And another flat out shift!
Highlights of today were working with patients I have been with all week. Its nice to get to know the patients who are staying longer on the ward, and to see them improve and progress towards being discharged home.
I was given free reign to remove the remaining staples from an abdominal surgery of which there were approximately thirty. The patient was a very small woman and the staples ran from navel to pubis. As I was a tad nervous and turning red from concentration, I didn't notice the patient's discomfort until I had taken out about 5 clips. We had a wee break and she perked up immediately once we began talking about cooking. She talked me through her favourite family recipe (baked fish) while I removed the remaining 25 clips (which she later told me she'd barely felt). It felt like rather a steep learning curve and a bit of a eureka moment for me. There will always be times when patients will experience discomfort, changing a dressing or removing clips, and besides pumping them full of painkillers using distraction techniques by simply having a good conversation can work very well just to get you both through the experience. It's something that I already knew in theory, but I had been too focused on getting the procedure correct to remember the person underneath the staples. These are the lessons you cannot learn in a classroom.
Nearly the end of week two already! And another flat out shift!
Highlights of today were working with patients I have been with all week. Its nice to get to know the patients who are staying longer on the ward, and to see them improve and progress towards being discharged home.
I was given free reign to remove the remaining staples from an abdominal surgery of which there were approximately thirty. The patient was a very small woman and the staples ran from navel to pubis. As I was a tad nervous and turning red from concentration, I didn't notice the patient's discomfort until I had taken out about 5 clips. We had a wee break and she perked up immediately once we began talking about cooking. She talked me through her favourite family recipe (baked fish) while I removed the remaining 25 clips (which she later told me she'd barely felt). It felt like rather a steep learning curve and a bit of a eureka moment for me. There will always be times when patients will experience discomfort, changing a dressing or removing clips, and besides pumping them full of painkillers using distraction techniques by simply having a good conversation can work very well just to get you both through the experience. It's something that I already knew in theory, but I had been too focused on getting the procedure correct to remember the person underneath the staples. These are the lessons you cannot learn in a classroom.
Thursday, 12 June 2014
Day Eight
28/5/14
Took a two patient load myself today, including planning, medications, cares and notes writing. Certainly a big step up from the last years experience. Prepped and administered a round of medications (under supervision) including another subcut injection weeee!
First time removing a catheter today, which I can tell you is much easier and more comfortable for all involved than insertion. Also did a couple of surgical wound cleanings and dressing changes, no drama.
Removed another cannula, this one deciding not to bleed til the patient bent her arm five minutes later. And then it gushed, all over the floor in fact. (I may be exaggerating slightly). But been there and done that all before so no stress there either.
If it sounds like quiet a relaxing shift, I can tell you it was flat out. Funnily enough though its always hard to remember what you've been running around doing for the last eight hours. Time flies
Took a two patient load myself today, including planning, medications, cares and notes writing. Certainly a big step up from the last years experience. Prepped and administered a round of medications (under supervision) including another subcut injection weeee!
First time removing a catheter today, which I can tell you is much easier and more comfortable for all involved than insertion. Also did a couple of surgical wound cleanings and dressing changes, no drama.
Removed another cannula, this one deciding not to bleed til the patient bent her arm five minutes later. And then it gushed, all over the floor in fact. (I may be exaggerating slightly). But been there and done that all before so no stress there either.
If it sounds like quiet a relaxing shift, I can tell you it was flat out. Funnily enough though its always hard to remember what you've been running around doing for the last eight hours. Time flies
Wednesday, 11 June 2014
Day Seven
27/5/14
A busy day yet again where I plodded along, picking up things as we went. Including the art of mixing up IV antibiotics, which can often come in power form in tiny, vacuum sealed glass jars. I invariably spilt some by accidently squeezing down on the syringe plunger causing it to shoot out like an open artery. (oops)
I also removed clips (staples) from an abdominal wound! A most exciting experience. All you need is a special pair of scissors, and they just pop out. Hopefully without causing too much discomfort to any patients or family members involved (think, ricochet zone).
Another new today was observing the removal of vaginal packing, which is essentially a roll (or possibly two) of gauze that is packed in post-operatively to prevent per vaginam bleeding, also know as pv loss. Pv loss can occur for many gynae procedures, such as hysterectomy and the packing prevents bleeding and promotes clotting in the same way as putting pressure on a wound. As 50% of us can all to readily imagine, the packing can cause great irritation and discomfort due to the nature of the beast.
Last and best for today, the tale of the Teds. Every patient who spends any time in bed in hospital has to wear compression stockings. This we all know to be true. Compression stockings or TEDs prevent edema, phlebitis, and thrombosis. What they don't tell you in class is just how bloody hard they are to get on yourself, let alone someone else. The task fell to me to help a woman put on her stockings. I started strong but my resolve withered under their unforgiving elasticity. I got one halfway up only to be met by a stubborn pyjama leg that refused to budge higher than mid calf. I requested my nurses advice and was met with a snigger. Pants would not come off over stocking, stocking could not go higher over pyjama. We were at a stand off. Collectively we decided to remove Ted and start over. As you may have guessed the removal is an ordeal in itself. She braced on the head of the bed, I braced against the foot and we pulled and pulled and just like that I was sent flying several metres, over the wheely trolley and into the wall with a great thud. The only cushioning to my fall were the peals of laughter from everyone in the room.
Sometimes, you have to learn the hard way.
A busy day yet again where I plodded along, picking up things as we went. Including the art of mixing up IV antibiotics, which can often come in power form in tiny, vacuum sealed glass jars. I invariably spilt some by accidently squeezing down on the syringe plunger causing it to shoot out like an open artery. (oops)
I also removed clips (staples) from an abdominal wound! A most exciting experience. All you need is a special pair of scissors, and they just pop out. Hopefully without causing too much discomfort to any patients or family members involved (think, ricochet zone).
Another new today was observing the removal of vaginal packing, which is essentially a roll (or possibly two) of gauze that is packed in post-operatively to prevent per vaginam bleeding, also know as pv loss. Pv loss can occur for many gynae procedures, such as hysterectomy and the packing prevents bleeding and promotes clotting in the same way as putting pressure on a wound. As 50% of us can all to readily imagine, the packing can cause great irritation and discomfort due to the nature of the beast.
Last and best for today, the tale of the Teds. Every patient who spends any time in bed in hospital has to wear compression stockings. This we all know to be true. Compression stockings or TEDs prevent edema, phlebitis, and thrombosis. What they don't tell you in class is just how bloody hard they are to get on yourself, let alone someone else. The task fell to me to help a woman put on her stockings. I started strong but my resolve withered under their unforgiving elasticity. I got one halfway up only to be met by a stubborn pyjama leg that refused to budge higher than mid calf. I requested my nurses advice and was met with a snigger. Pants would not come off over stocking, stocking could not go higher over pyjama. We were at a stand off. Collectively we decided to remove Ted and start over. As you may have guessed the removal is an ordeal in itself. She braced on the head of the bed, I braced against the foot and we pulled and pulled and just like that I was sent flying several metres, over the wheely trolley and into the wall with a great thud. The only cushioning to my fall were the peals of laughter from everyone in the room.
Sometimes, you have to learn the hard way.
Tuesday, 10 June 2014
Day Six
26/5/14
Weese is fantastic. This, my eureka moment for an early monday morning. Urine has so many clues to a persons health and often holds the key to revealing invisible problems if you know where to look.
Today was the first day of morning shifts 7am-3.30pm. This requires getting up at 5.45am and I'm not easily roused. The morning was busy and full on, with just that much more to do what with getting people up and showered and fed, then doctors rounds, medication, wound dressings, mobilising patients then lunch. Somehow you have to fit a great deal of people into a relatively small ward. Standing room only doctors, please and thank you. Observed an enema today, used more frequently than you'd think. The combination of anaesthetic, pain relief, hospital diet, and lying in bed all day is a colon's worst nightmare. Happily I was with a lovely nurse again today who decided I should take a one patient load, meaning I was in charge of the full cares of one patient (under direct supervision). Though nerve-wracking it was all just a game of connect the dots between the cares I had been doing last week. Having to plan it out myself showed me how to structure planned nursing care, and just what a juggling match it is.
Weese is fantastic. This, my eureka moment for an early monday morning. Urine has so many clues to a persons health and often holds the key to revealing invisible problems if you know where to look.
Today was the first day of morning shifts 7am-3.30pm. This requires getting up at 5.45am and I'm not easily roused. The morning was busy and full on, with just that much more to do what with getting people up and showered and fed, then doctors rounds, medication, wound dressings, mobilising patients then lunch. Somehow you have to fit a great deal of people into a relatively small ward. Standing room only doctors, please and thank you. Observed an enema today, used more frequently than you'd think. The combination of anaesthetic, pain relief, hospital diet, and lying in bed all day is a colon's worst nightmare. Happily I was with a lovely nurse again today who decided I should take a one patient load, meaning I was in charge of the full cares of one patient (under direct supervision). Though nerve-wracking it was all just a game of connect the dots between the cares I had been doing last week. Having to plan it out myself showed me how to structure planned nursing care, and just what a juggling match it is.
Day Five
23/5/14
Was a bit of a dud today, being the day of angry preceptor who decided the best way to deal with me was by ignoring my existence. I followed her around for a good wee while but soon tired of her cold shoulder. I went about the duties which I knew needed to be done and then asked the other nurse for jobs. Happily (for my modest student nursing ego) I wasn't the only person nurse ratched ignored. She failed to take the time to even properly introduce herself to her patients and inquire about their day/pain/bowels/sleep/wound/comfort and so forth. Here, I told myself, I could come into my own. Most of the patients I knew from previous days and I was content to spend the time hearing about their lives and validating their concerns. Such rapport! I congratulated myself on what a genteel and pretty little nurse I was becoming.
That all changed when the incontinence began.
Suddenly nurse ratched became my most ardent admirer. How fabulous I was there. How helpful I was. Oh by the way, I almost forgot (wink wink, nudge nudge), could you please clean up the volcanic faecal incontinence which is spreading across the floor as we speak if its not terribly too much trouble?
And it wasn't of course.
Despite being literally left in the shit, I was more than happy to help the patient shower, mop and disinfect the floor, and change the bed four times in a row. Because I can only imagine the shame and embarrassment that anyone must feel when faced with public incontinence. And if I'm ranting like a fool it's only because the nurse, who'd had years of experience to know better, scrunched up her nose in disgust.
So I cleaned and chatted and found yet again that humour is the best comfort for difficult situations, so we cracked jokes as I scrubbed the walls (yes, the walls).
Was a bit of a dud today, being the day of angry preceptor who decided the best way to deal with me was by ignoring my existence. I followed her around for a good wee while but soon tired of her cold shoulder. I went about the duties which I knew needed to be done and then asked the other nurse for jobs. Happily (for my modest student nursing ego) I wasn't the only person nurse ratched ignored. She failed to take the time to even properly introduce herself to her patients and inquire about their day/pain/bowels/sleep/wound/comfort and so forth. Here, I told myself, I could come into my own. Most of the patients I knew from previous days and I was content to spend the time hearing about their lives and validating their concerns. Such rapport! I congratulated myself on what a genteel and pretty little nurse I was becoming.
That all changed when the incontinence began.
Suddenly nurse ratched became my most ardent admirer. How fabulous I was there. How helpful I was. Oh by the way, I almost forgot (wink wink, nudge nudge), could you please clean up the volcanic faecal incontinence which is spreading across the floor as we speak if its not terribly too much trouble?
And it wasn't of course.
Despite being literally left in the shit, I was more than happy to help the patient shower, mop and disinfect the floor, and change the bed four times in a row. Because I can only imagine the shame and embarrassment that anyone must feel when faced with public incontinence. And if I'm ranting like a fool it's only because the nurse, who'd had years of experience to know better, scrunched up her nose in disgust.
So I cleaned and chatted and found yet again that humour is the best comfort for difficult situations, so we cracked jokes as I scrubbed the walls (yes, the walls).
Wednesday, 28 May 2014
Day Four
22/5/14
Today was interesting, being the first day I had a different nurse as my preceptor. Funnily enough the nurses were both relieving for the sick nurses who were rostered, so I was more familiar with the ward and the patients then they were. They were fabulous and lovely, and I had a great shift.
Started out watching the bundles of procedure surrounding blood transfusions, and ended up doing regular blood transfusion obs, watching for any reaction or issue. I also assisted with the mountains of paperwork that accompanies discharges and admissions. And believe me there is buckets.
Removed a cannula without any fuss *self hi-five*, thankfully no haemorrhaging occurred but by God I was prepared if it did. Also must admit I'm feeling pretty confident with subcutaneous injections, with patients saying they can't even feel when I administer it. I wrote a couple of sets of patient notes, then it was home time. Not all that much to report really, although during the shift you feel you are working flat out. Enjoying clinical to the extreme, but it feels like it's going pretty fast already. Must keep on top of sleep.
Today was interesting, being the first day I had a different nurse as my preceptor. Funnily enough the nurses were both relieving for the sick nurses who were rostered, so I was more familiar with the ward and the patients then they were. They were fabulous and lovely, and I had a great shift.
Started out watching the bundles of procedure surrounding blood transfusions, and ended up doing regular blood transfusion obs, watching for any reaction or issue. I also assisted with the mountains of paperwork that accompanies discharges and admissions. And believe me there is buckets.
Removed a cannula without any fuss *self hi-five*, thankfully no haemorrhaging occurred but by God I was prepared if it did. Also must admit I'm feeling pretty confident with subcutaneous injections, with patients saying they can't even feel when I administer it. I wrote a couple of sets of patient notes, then it was home time. Not all that much to report really, although during the shift you feel you are working flat out. Enjoying clinical to the extreme, but it feels like it's going pretty fast already. Must keep on top of sleep.
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