Reflection Time…

So I’ve had a very busy month, and an array of patients with interesting stuff going on; but the most time consuming part of nursing doesn’t seem to be the charting – its the family members. Family members can be helpful, complex or just down right annoying. I’ve had all and in between over the last month. One stuck out to me though. He was the son of an elderly woman; he and his sister took turns in caring for her. One week she was with one family, next week with the other, like a child in the middle of a divorce or something. The patient and her two children were so happy though, it seemed that the sharing of caring had totally eliminated that air of burnout which is so common among caregivers.

I went in to check in on the patient and the son was there chatting with her. He said he had something to show me and pulled out his cell phone. He showed me a picture of the most beautiful beach sunrise, it was just idyllic. I told him how pretty it was and how much it made me want to go to the beach. He told me that he took that picture that very morning. I was amazed to think that something that beautiful had happened a few blocks from where I live but, I was so preoccupied I missed it. Sure I was at work, but I never even thought about the sunrise, I was focused on work/details/tasks. He told me that he makes a point of taking a picture every day of the sunrise, to remind him how lucky he is. I was so humbled by this, I understood what he meant, but I saw it as such a feat, that he would fit that moment into his daily life.

I reflected on this throughout my busy day. I thought about how many wonderful things happen everyday and I as so focused that I miss them. So consumed with work, the serious nature of nursing, and the responsibility that comes with it, somehow clouds our view of the small, wonderful things happening around us.

With this, I pass on my reflection to you the reader. Take one moment to reflect on the beautiful things that happen each day. You don’t have to be by the beach like me, but regardless, the sun still rises and falls everyday, giving us one more day to live our lives – that is something to be grateful for.

Cardiac Tamponade

This has nothing to do with tampons in the heart ok! Just an FYI.

When blood or fluid accumulate in the sac which surrounds the heart it exerts pressure against the heart, making it harder for the heart to pump. As you can imagine, if the ventricles cannot fill fully or contract effectively then cardiac output decreases. Decrease cardiac output is not good news!

So how do you know if someone has this?

Well the symptoms are nothing unusual: chest pain, restlessness, quick shallow breathing, palpitations, pallor, tachycardia, weak peripheral pulses, pulsus paradoxical, distended neck veins, low BP… (do these all sound a little familiar? MI anyone?) Well causes of cardiac tamponade can be MI, Dissecting aortic aneurysm (thoracic), end-stage lung cancer, heart surgery, Pericarditis caused by bacterial or viral infections, or direct wounds to the heart.

How do we diagnose? Echocardiogram is the usual diagnostic tool, but MRI, CT, CXR or EKG can also highlight or confirm this.

Can you see the halo of fluid around the heart?

This is an emergency! The fluid must be drained to reduce damage to the myocardium and reestablish cardiac output.

Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart. The patient will be hyperoxygenated, given fluids to maintain blood pressure. It is important to note that a pericardiocentesis may have to be repeated because cardiac tamponade can return. With fast treatment the outcome is usual good, without treatment death is immanent.

A pericardial draining tube may be placed during surgery to keep in place postop. The drainage will be measured every shift and documentation on the color, amount and consistency is very important! The tube will usually be removed slowly over the postop recovery weeks at the discretion of the cardiologist.

Nurse Humor: “When there’s a shortage on the one drug I really need…”

My Reaction:

 

Repost from the amazing http://whatshouldwecallnursing.tumblr.com/

Your patients will most likely be taking one of these!

(click the picture to enlarge)

Get to know your psych meds!

Many of them interact with other drugs, foods or supplements. Be sure to ask all pertinent questions when admitting a patient. People often don’t consider garlic, ginger, ginkgo or St. John’s Wort as medication, so be specific when asking your assessment questions!

The Nursing School Letdown

While in clinicals I met a lot of other students from other schools. I was always amazed at the camaraderie and closeness of their clinical groups, unfortunately mine was just not like that. There were times when I thought that it was me, maybe I wasn’t embracing my classmates or I was distancing myself; then over time I realized that I just so happened to be put in a group of people which just didn’t work well together. Very much like some of the units I worked on – sometimes the characters just don’t mesh and it alters the whole atmosphere of the unit.

I know friends from other nursing schools who have made life long friends through the bonding that nursing school fosters, but for me, I’ll probably never see or speak to my clinical group classmates again.

One thing I believe is that nursing school is what you make of it. I chose to buckle down, fight through it and stay focused. I have never been a slacker, and so I couldn’t connect with those in my clinical group who would slink off the unit for a long trip to the cafeteria or for a quick cigarette outside. I was there to learn, and would totally kick myself if I missed a learning opportunity. This mentality automatically separated me from the group, and ultimately caused a cold and nonchalant ending at graduation.

So why am I writing about this? Well because there may be someone reading this who feels the same way about their clinical group or nursing class. They have no-one in there that has their back, and in nursing school that really can make all the difference.

Luckily for me I had a very good and loyal friend in a different clinical group who I had all my other classes with, and together we helped each other through. I am so happy that my friend and I are such good friends and have shared our nursing journey together. She now works as a Med-Surg nurse in a huge healthcare system in South Florida and I’m a Telemetry nurse – we still call each other to celebrate our nursing triumphs!

Although my clinical group was a letdown, the fact is that sometimes you just have to make the most of a situation knowing that your apart of a dysfunctional team. Nothings to say that you won’t walk out of nursing school and find the same situation on your unit – the mix of people make the culture of a unit, so hopefully the former experience will lend some guidance. I feel that I learned a lot from my letdown, and even so I still wish all my old classmates much success in their nursing careers.

A Little Self-Care…

So Nurses are renowned for caring for others, right? It is the essence as who were as individuals and professionals, but how to we maintain this lovely nature without becoming the crabby, unhelpful coworker in the corner?

SELF CARE

Self-care is something that is certainly more frequently discussed in hospitals and healthcare facilities. As she research into workplace abuse, horizontal violence and employee retention increases, it it beginning to be noticed by administrations and managers everywhere. Our environments and relationships with other members of the interdisciplinary team certainly reflects on our mood and overall job satisfaction, but how to we maintained centered in who we are as people? How to we keep that excitement for our profession alive? You got it, self care.

So self-care is something nurses struggle to find time for, yet it is such a vital component of personal well being. When was the last time you shut your phone off and went to do something you enjoy? If you can recall a time less that one week ago, you are doing great, if you can think of something longer than 1 month ago or not at all – you need an intervention!!!

Self care is all about the “ME” time. Some of you are moms and dads, or caregivers for family members, have multiple jobs and so much more…. but beneath the busy schedule there is just you. You may act like a superhero most of the time (lets face it, Superman’s got nothing on nurses!) but, everyone needs to have a little time to re-center and take a breather.

What ways can self-care be done?

A great option for self care is a healthy option. Running around that hospital unit might be exercise, but it doesn’t contribute to your self care. How about a walk along the beach or in a park? Trip to the salon? Nails or massage? (No acrylics though! hahah!) Is there something that you’ve always wanted to do but never had the time, such as salsa classes or yoga classes? Go and book that class! Force yourself to be accountable to attending one a week, so you are guaranteed that “me” time.

Cut the Crap! How about switching that lunchtime extra large coke for an extra large water? (Its so hard – need caffeine IV stat!) Think about your body, how can you help you? In a 12 hour shift, did you put out 30ml/hr? Huh? We don’t want kidney stones now do we?

There are so many options for self-care so do some soul searching and see what lifestyle change might be right for you. Nurse to nurse caring is so important, so make sure you encourage your nursing colleagues to do the same so we can have a HAPPY, HEALTHY workforce!

Related articles

• Burnout, Recovery and Work-Life Balance for Nurses (digitaldoorway.blogspot.com)
• On the nurse manifest project and creating change (nursemanifestblog.wordpress.com)

My Biggest Shock As A Nursing Student

I’m gonna give you a little insight into my first experiences in nursing as a student. Some of it is funny, some of it is sad and some of it it plain ole’ X rated haha! I’m mainly writing this because when I first switched my major to nursing I tried to do a lot of research into what it really is like to be a nursing student: what’s difficult? What’s the best bit? Worst bit? Etc. I worked with a girl who was currently in an AS nursing program, but she wasn’t much help to be honest (I realized when I became a nursing student, that no-one really understands what a nursing student is going through except a nursing student, so she flat out didn’t even try to scare me with the deets).

So let me begin by hoping that my insight through this blog can help everyone, but particularly those nursing students or pre-nursing students who have NO medical background at all – I was one of you. (Yes you smarty-pants CNA‘s you already know all about it, this isn’t for you guys lol!). My pharmacology prior to nursing school consisted of Tylenol and Motrin. I had been to the ER three times as a child, but never for anything major, the usual kid stuff: sprained ankle, needing eye wash and I trapped my fingers in a car door – yes that sounds stupid now, I know. I honestly knew zero about nursing. No family members had even finished college, let a lone entered a medical profession. I really had no idea what I was getting myself into.

The biggest shock hit me on the first day of clinicals, those of you already in clinicals can probably guess what I’m going to say.

The biggest shock was – NAKEDNESS!

Seriously, I was bombarded with saggy boobs and more abdominal rolls than I even thought anatomically possible. As someone who enjoys my personal space and certainly maintains other peoples, I found myself really uncomfortable touching all these body parts and all that skin. The best part was that most of the old people didn’t care at all! Old men would ask me to put their penis in the urinal and I had to be OK with it, they couldn’t do it for themselves. Many of my first patients were stroke patients, and by being thrown into mostly total-care situations, I learned very quickly to be comfortable in other people’s personal bubbles, but still being sensitive that I was touching someone. I tried to use empathy in every situation, and somehow the nakedness began to blur into the busy day and eventually I didn’t notice it at all.

When patients come into the hospital, many of them are not prepared for the amount of “touching” that is necessary to fulfill nursing care. It is so important to ask permission to touch someone and ensure they are comfortable with you assisting them in personal tasks. For the majority of my patients it was not their first rodeo and they quite enjoyed the help, but for those who are admitted for the first time or have cultural differences, this can be a big shock therefore, as nurses we need to show sensitivity and cultural competence in these situations.

For those of you which are pre-nursing – Congratulations, if nursing really is for you, it will be the most patience testing, trying, exhausting and fulfilling thing you ever do in life. For those of you that are in it for the money? I’ll be generous and give you a year at it. If it’s not for you then don’t waste your time, you have to have a genuine desire to qualify. Period. Just wait until your first anal suppository! *High five!

So embrace the nakedness! Let’s face it, we’re all naked under our clothes anyway! 🙂