Wednesday, April 05, 2006

You know what....?

When my clinical instructor came to visit me the other day at my site, she mentioned something that after a few days of thought rings true to me. The senior clinical is to prepare one to work in the real world of nursing, not learn how to deal with difficult people. It is designed to teach you how to organize your day and coordinate everything learned over the past four years. Since I no longer have the preceptor problem, I have noticed that I can focus on the really important thing. Patient care. So I will devote this entire post to my clinical experiences and patient care activities.

The first time I ever saw a patient with a ventilator and more than one IV pole and tubes in every orifice I thought to myself, I will never be able to take care of a patient with so many things going on at once. Then all of a sudden I had to take care of one. I will admit, it was somewhat intimidating because I was positive that I would attempt to turn the patient and completely extubate him, and I have. I thought OMG I am going to program the levophed pump totally wrong ant the patient is going to have a stroke because I gave too much medicine, which I once almost did. But I liken this nursing thing to having mother's wit.

When I first brought my son home from the hospital I thought it wouldn't be any different than babysitting my younger siblings. It was totally different. I held this baby in my arms for the first time and realized that he was totally vulnerable and dependent on me for all his care. I decided that I wanted to nurse him because I read all the top baby books and read that nursing was the best thing for him. I had a full thickness episiotomy and when my epidural wore off I wanted medication to prevent excruciating pain. The doctor ordered tylenol three and one day after giving birth I was discharged from the hospital.

I realized that three days had passed and I had only nursed my son once. My son was sleeping all the time and my Mom made the suggestion that I stop taking the pain medication. I couldn't sit, I couldn't go to the bathroom. I was miserable, but my baby was nursing again. He and I would spend afternoons gazing into each other's eyes, and before his Dad went to work on day three of my son's life he noticed that the baby was looking kind of strange and was coughing. He said the baby looks like he is choking, and when he turned my son around to me his little face was turning purple. I was terrified. Before I knew it, I had his little body laid across my lap. I quickly grabbed the bulb syringe and suctioned his mouth. I got nothing. Then I suctioned his right nostril and a big gray plug of mucus came out. I looked at him again and just as quickly his color returned and he was back to being a normal yet perfect newborn. In that moment, my son could have died right there in his father's arms. But something clicked inside of me, and in a moment's notice I saved my baby's life.

When I am in clinical, my patients are number one. And in the ICU, you only have two patients, so I take my time and give them a good cleansing bath. I talk to them if they are not sedated. The ventilator has become not so scary. That one time I turned a patient and almost extubated him, I was turning the patient slowly and noticed resistance. Instead of yanking really hard, I decided to look to see what was catching and noticed that the suction catheter got caught. Awesome catch I must say. And the day that I almost set the levophed pump too high I got a message on the pump that said this is "levophed, are you sure you want to do that?" And even when I fixed it I called my preceptor to check it again before I set the pump. It made me feel better just to have a second set of eyes.

As far as the therapeutic relationship, this has never been a problem for me. The only difference is that in the ICU, the likelihood of patient death is a lot higher. A few weeks ago I had a patient who was on a ventilator, but was improving so was put on a high flow mask. I talked to her and she asked me if I could help her with her hair. It was almost time for me to leave, but I was going to stay late and do her hair for her. Nurse preceptor battle ax said I couldn't do it and so I went home. Two weeks later I am in the break room and notice that there is a sympathy card sitting on the table. It was for the patient who asked me to do her hair. I felt so bad. I am so glad to finally have an opportunity to develop this area of my nursing practice even though it is so late in the game.

-DiVa,...The student nurse for only a few more weeks!

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