Friday, December 24, 2010

I think I have finally found my niche in life...reflections on nursing school

I started nursing school in September.  The lecture portion is rather challenging but also common sense to me. I have been doing rather well between my personal background & experience and our texts & lectures, my grades truly reflect my knowledge and effort.  In the beginning of December, we started our clinical rotations.  For the current rotation, our class has been divided between three sites. A rehabilitation hospital, a long term care/rehab facility, and a sub acute facility that also has long term patients.  My first stop for the month of December has been the rehabilitation hospital. The first half I was on the medium stay wing with mostly surgical/orthopedic patients. Patients on this wing are inpatient for 1-6 weeks depending on their condition and medical history. 

At first it was daunting to assume the role as student nurse and have a higher level of responsibility for patient care. While previous patient care experience taught me how to interact with patients and do some simple procedures (such as blood pressure, dressing changes, and the like) it was still a subordinate role that was directed by an RN or an LPN (and in some cases the MD/DO).  The level of documentation as a nurse is vastly different of that required of a PCA, CNA, or EMT.  After the first day, it was a bit easier.

It was truly awesome to see the changes in patients over a short period of time. For example, the woman who the first day I saw her was very anxious and needy, in addition to being doubtful of her own abilities. She told me initially that she could not do anything herself, and was worried that she'd have another complication that would send her back to the acute care hospital. I worked on building her confidence, and reminding her of what she COULD do rather than what she couldn't do.  I told her I would help her do what her present condition prevented her from doing, and the health care team would work together to build her independence.  She was apprehensive but was proud to tell me what she could do. (She did think it was funny that I had a hard time helping her with her hair clips. I don't use them in my own hair and I have a son...) 
The best part was when I came back the following week, another student told me to go in and help her with care, stating that "she requires a lot of help."  I walked into the room and asked her how I could help her, she told me she just needed her reading glasses. I obliged, and when she 'dismissed me' I reminded her that I was only a call button away if she needed me.  The most incredible part was what I overheard when I was outside the room working on my paperwork.  She had gotten a new roommate the evening before. The roommate was tired and apprehensive. The patient proudly told her of her recent accomplishments towards independence, and even said "(This team) is great, in a week you'll be surprised at what you can do by yourself again."  The primary nurse for the day was next to me and smiled, "That is what this job is all about."

I most certainly think I have made the right choice going into nursing. 

These past two weeks I was on the other side of the hospital. While a still a sub acute unit, the patients required a higher level of care due to their more complex conditions; plus their length of stay is much longer often 2-3 months.  I had my "own" patient assignment, this week I had another gentleman.  He explained why the holidays are such a difficult time for him.  (We had just finished our nursing fundamentals unit on communication & therapeutic communication/emotional support the day before our assignment shifted.)  Now previously I might have said "I understand how you feel.", "It must be tough for you." but this time I did not.  I reflected on my own experiences and the lecture on how frustrating these seemingly empathetic statements can be to someone.

Simply, I said "There is nothing that I can say that is going to make it better." My patient brightened a bit and said "You know you are right." Then I did the skill that is probably the most difficult skill to master, I simply listened to him. I was silent, as that was most appropriate. After listening to him for a while, I could hear the pride in his voice when he casually mentioned his family.  When it was time, I asked him if his family was nearby....the reaction was amazing.

My patient was rather ill, in addition to being despondent.  He lit up like a Christmas tree when talking about his children and grandchildren.  He showed me the items decorating his room that his adult children had delivered. He proudly told me of his youngest grandchild that was able to visit him.

When I returned this week, he had taken a few steps backward in the way he was feeling. His plan of care altered as nursing & medicine in general must be flexible.  But again he greatly improved when his family visited or when given an opportunity to (boast proudly)talk about his family.  I reinforced small accomplishments, such as finishing getting ready nearly 20 minutes faster than the day prior. (We are there 2 days a week.)

I knew, at least emotionally, he was feeling better when he commented on receiving a physician's order for a day pass to go to his family's home for Christmas Day.  He even smiled and said that he knew who would be picking him up. I took the 'bait' and asked him "Who?" He said since his pass is for 7AM, he knew that it would be his daughter with his youngest grandchild, since like most young children she had everyone up at the crack of dawn on Christmas morning to see what Santa had left overnight. I had to smile. 

This week's experience helped me to see the true value in silence and active listening. If I hadn't been listening the first day, I would not be aware that he had a positive relationship with his children. Asking if his children was nearby could have royally backfired if he felt that his children "abandoned" him or if they were not on speaking terms.  By taking cues from our conversation, I was able to know when to gently transition the conversation to his pride and joy, his family.  Even with my female patient last week, she started off nervous and negative about her ability, but asking her if she could do simple tasks and seeing her smile & say "I CAN do that!" (and more excitedly with each task that she realized she could still do) was wonderful and enlightening..

I also learned how much a person's emotional state and their self-confidence can impact their medical condition(s) and progress. Simply empowering a patient toward independence can positively impact their ability to recover, in addition to raising their self-confidence.  I also realized that permitting a patient to share their positive experiences or talk about a source of pride (in my one patient's case--his family) can improve their overall appearance.  Happiness and comfort can affect our vital signs (blood pressure, pulse, respiration rate) and our ability to heal.  While I may have always known this in my heart, it was amazing to see the effect in clinical practice.  To know that even as a student, I was able to play a minuscule part in raising a person's self confidence and self esteem is humbling. To know I had an effect on the life of another...well there are no words for that.

Sure I have had a direct impact on my son's life, emotional state and well being, but that is harder to see because I am with him everyday.  Kind of like losing weight gradually, you may not notice until someone else comments (or preferably compliments. :) )

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