Saturday, March 7, 2009
Midterms, round 4
Once I'm done this set, I should be done with midterms until September. Good riddance! I actually prefer finals to midterms because even though there's more ground to cover, they usually aren't as gruesomely detailed as midterms are. And you don't have to fit studying around class time. This weekend I've got the table pulled up to the couch again, basking in my Koi scrub pants because they are just so freekin' comfy, spread end to end with Micro and Physiology.
You may remember that I bombed my first clinical reflective journal. I basically rehashed my post about my first day which I thought was adequately reflective. WRONG! I got 2/5, which is 3% off my final grade. I was so pissed about the whole thing that I wasn't open to learning what I did wrong. Actually, it ended up being a really good experience for me to get a bad mark like that. I don't usually bomb on assignments that I even put a partial effort into. Sometimes getting a slap in the face from reality is a good thing!
So I took it seriously on the second journal. The topic was to reflect on our use of therapeutic touch to provide comfort. I think the big problem I had (as did many of my classmates) was looking past the word "journal". It was not a journal so much as a researched paper that wasn't in APA. I referenced Potter & Perry many times and material from my lecture. I actually ended up putting in a couple of hours into it. Happily, the teacher marked it yesterday and I got 5/5! More so, she said it was "the perfect journal" and she wants to use it as an example for future clinical groups. I'm so thrilled. Like I said, I'm actually glad I did so badly because I was able to really focus on how to do it right the next time.
In case you're wondering, here's an excerpt of how my school wants a clinical reflective journal to look (because I couldn't find an example online when I wanted one!) P.S. Please don't plagiarize. That's just not classy.
In Potter and Perry, it was mentioned that students can find touch stressful, but they learn to cope with intimate contact by changing their perceptions. As we were getting Mrs. E into bed, she was so tense that she was lifting her head and shoulders right off the bed. As I started the bed bath for her, it was initially very task-oriented for me: now I dip the washcloth in the basin, now I wring it out, is it too wet, oh, now is it too cold? Now I make the mitt – how does that go again? Now I touch the skin, not too firmly, not too gently. As I started getting the hang of it I realized I had run out of limbs to clean and it was time to do her abdomen. Mrs. E didn’t bat an eye when I undid her gown and she had her most private self exposed to me, but I saw a body that at one time had probably been reserved only for her parents or husband to see. And now, just about anyone wearing a uniform and an ID tag could see it.
I knew then that my perception had changed. She was much, much more than the unlucky recipient of my first bed bath. She was a person all her own and I had the privilege of helping her with her most intimate necessities. After that moment I began cleansing her abdomen knowing I was washing a unique human being. The task of washing became more of an act of caring. No longer did I concentrate so hard on the procedure. My focus was on helping Mrs. E take care of her needs. From there, I was more comfortable handling her body and the washcloth. As I relaxed, so did she! By the end of the bath she was lying flat out, completely relaxed. I could see that my touch had probably helped provide both relief from feeling unclean and, when I relaxed, my touch eased her into finding a position of comfort.
Clinical, as I've said, has been just awesome. I've pretty much had the same patient all along - that is, my friend Mrs. E with that whole catheter thing. I gotta say, she's really grown on me since that first day. I've helped her with her bed bath, cath/peri care, bed changes, transfers, ambulation, and pretty much all of the tasks that I can currently do.
My big breakthrough, though, has been with her roommate who is a large German lady with mild dementia who yells a lot and is often in wrist restraints, with high anxiety and restless legs. I wasn't technically assigned to her but I found myself really drawn to her. I went to check her brief and she locked eyes with me, pleading in perfect English - "Please take these things off me. I hate them!", gesturing to her tied wrists. Of course I couldn't, as she had a tendency of removing her IV and whatever else, but I felt really awful that she was so coherent and tied up like that. Then I peeked in her room around suppertime and I saw that her food tray was on her table, right over her lap, and her arms were still in restraints so all she could do was smell her food. That got me kind of mad, actually. How inappropriate is that?? If she can't eat yet, don't park her freakin dinner right under her nose.
Later the shift, we helped with getting the patients ready for bed. That's where the little story in my reflective paper came from. I also helped get the German lady ready for bed. The change in her was remarkable when we took the time to reposition her onto her side - her legs stopped swinging back and forth across the bed. She was so relaxed and comfortable that my clinical instructor ok'd taking off her restraints. I helped her with her mouth care and brushed her hair and she practically melted under my touch. By the time we left the room both of the ladies were totally unconscious and resting really comfortably. I felt sooooo good being able to do that for them.
Last Monday I was assigned to that room again and continued trying to figure out the German lady. We were on from 0700 to 1500 so I popped in right after report to say hi. She didn't remember me (it had been a week so that's cool). This time they were both in restraints. My friend Mrs. E had pulled out her foley catheter the night before. After hearing her moan every time anyone touched it for the last few shifts, I couldn't BELIEVE that she had done that to herself. I mean, the size of that balloon?? Yeeowch! When Mrs. E woke up and found herself in wrist restraints she really started hollering. Poor woman with dementia waking up from a dead sleep to find herself tied up. She was in quite a panic.
The nurse assigned to my room was nice enough but had a really thick accent and, I think, wasn't able to or didn't want to speak in a soothing manner to either woman. She was, IMO, really patronizing, calling them Grandma or Mama. She watched me take down the covers and said "Careful, she may punch you". All of this in front of a perfectly competent person! The nurse had to do some blood draws and told her those five awful words - 'This Won't Hurt A Bit' which it did and that really set her off! She started calling the nurse a liar: "Everything that comes out of your mouth is a lie", and in general being very vocal and upset.
The physicians came in a little while later asking her for some information to which she remained silent. They looked at me questioningly, saying "Is she refusing to speak today?" I just shrugged at that. It was clear that this woman's biggest problem was people were treating her like a problem.
I was pulled from the room for a while but I returned after lunch. She was nodding off and I asked her if she was feeling good, if she had enjoyed lunch, if she was comfortable. She said something distantly and looked away. I suddenly put my hand on her arm and asked her if she would like me to take her tray away. For me to spontaneously touch people is a huge step! She locked eyes with me and said, "Yes, thank you..." and then I asked her if she'd like some more tea. "Yes, please... could I have a cookie too? That would help me feel so much more at home. You know, my husband lives just a few blocks from here. I so wish I could just get up out of this bed and walk home!"
My heart totally went out to her and I said of course you can have some more tea and a cookie. I'll be right back!
So I came back with the tea and 3 cookies and she was totally thrilled. She started talking and talking and it was clear to me that all she wanted was someone to talk to her like she was a person and not a noisy lump in bed 8-1! I crouched down by her bed as she kept talking and she paused, saying "Thank you - thank you for staying to hear my story - no one ever does."
Yep, my big breakthrough so far. The problem in 8-1 is, in fact, a really nice lady who is someone's wife and grandma, and who just wants to be treated like a human being with thoughts and feelings. I'm so sure that one day I'm going to read this post again, when I'm a burned out fulltime nurse somewhere, and I hope I remember what it felt like for me to make such a tiny, significant, difference in someone's life.
That's about my spiel for today. Pearl Harbor's on - is it bad for me to love to watch the Army nurses giddily traipse around Hawaii and then watch them handle the triage and trauma after the attack? I also love to see them in full nursing regalia - knee length skirts, heels, tights, and caps, of course.
I'm thinking about writing a letter to the dean of my program complaining about the biased language that the profs seem to be using in all the classes. Most of the profs are MN or PhD, and yet on the midterms or in examples, the nurses are always she and the physicians are he. Usually the patients are he's, too. I feel so bad for the male students - they must feel so excluded when they see that. The annoying part is that if we ever submitted a paper with biased language like that we'd be taken out for sure. They just don't seem to realize that biased language is perpetuated by everyone who uses it! So, we'll see how that goes.
I also took a picture with the nursing union president for my scholarship. There was soooo much authority in that room I just about crapped my pants. I hate taking pictures! But I'm $1k richer so I can't complain. That is going straight into my ING account and hopefully I can pay for next year out of pocket.
Unfortunately when I saw my pictures from the photo shoot I was like, holy shit, where did all that come from? I'm definitely packing some face fat which makes me look like a whole different person. Someone I'm not especially excited to be. So I joined Weight Watchers a few weeks ago along with the rest of my female family (they've been on it for a while and had really good success), and you can see my progress at the bottom of the page if you're interested. I like it so far. I'm not one to stick with regimented diets so the choices really appeal to me. I'm hoping to drop about 30 lbs and get back to my high school body - wish me luck :) Slow and steady is my plan. Cutting out all the extra noms that I love so much. As long as the scale is going down and not up, I'm happy.
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1 comments:
Haha, I watched Pearl Harbor last night too, it was on A&E channel.
Your 3rd to last paragraph--thank you for noticing!! :)
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Thanks for your thoughts :)