Monday, 23 March 2009

More Placement Thinking

I had these really current and up to date posts typed up in draft form and thought Blogger saved them for me. I was wrong. So I'll be quick, instead.

I am in the middle of a mini-week off. I spent four nights in work, adapting temporarily to the life of a vampire nurse. Stealing pinpricks of blood and walking around silently.

It was a mixed week in the end. There were a few less than hum drum moments in which I thought nursing wasn't for me after all, and there were more than a few moments in which my faith in the profession was reinvigorated. The nurses I was working directly under, one my main mentor, one a complete random, were helpful in this. They told me how I was fitting in with the team well and coming off as competent, to say the least, which helps.

All a bit vague, I realise and apologise.

To be honest, I think I thought ICU was going to be a more intense experience than it has been. Maybe I'm getting off easy. Or maybe I'm emotionally hardier than I thought.

That's being 25 for you...

I'll get back here with more specific things soon. Right now, I'm enjoying a mini-week off, due to the glory of how my shifts are arranged. Time off is almost as important as time on, after all...

Sunday, 22 March 2009

Second Week, ICU and bedpans.

This post isn't really about bedpans. It's just better if these things come in threes.

Although, come to think of it, my patient today (my third one, something I'll touch on in a bit) did think the bedpan/bowl I was holding with a hat. We decided it'd pass for formal wear if it was painted black.

Well, sort of we. They are a funny one.

I post today for various reasons. My mentor gave me a few hints of things to reflect on, and I will choose to reflect on here, in my trademark glib manner before putting pen to paper and going all serious and shit.

The long and short? A Band 7 spoke to my associate mentor, and I, like we were pieces of shit on their boot. Backstory:

We started the day in a side ward, with one patient who had been placed there with a suspicion of C. diff, although by the time we came on shift she had quite formed stools, so we were happy. This patient was a bit... mobile around the bed. And unresponsive to commands, but generally well. Quickly as possible, we did all the transfer stuff for a step down to NeuroHDU.

This was all the more rushed as there was a patient in surgery, awaiting the bed we were clearing. Excited, I was going to see an admission and discharge on one day! This stuff is important so you're not completely clueless, really.

The fly in the ointment was a logistical one*. There was a member of the nursing team close to finishing their supervised placement who it was said would take point on the admission. My actual mentor said I could still be there, though, and that was agreed by all the staff on the floor to be a good idea.

However, Band 7 comes along and - with one of those laughs you want to swap, in your head, for the sound of rancid, jagged nails down a blackboard - gives this: "I didn't realise you had a student with you!" (When she hadn't actually popped out from behind the nurse's station since start of the shift). They proceeded to tell us their brilliant plan involving my associate mentor supervising the admission and the new nurse doing it. We kinda looked at each other and said: 'That's what's happening, yes, we thought.' They proceeded to say how that meant three people would be far too much. We replied with what we'd all discussed on the floor and they said, I shit you not: "This is *my* plan. Two of you."

Enough said. Moron.

A patient I wasn't looking after, someone who has been in ICU for a while and is making some progress, decided to pull out their tracheostomy tube today and refuse to let it stay back in. It brought up an interesting ethical dilemma, as I discussed with my mentor. Patient autonomy is important, naturally, and yet there's an issue as to whether a patient can make an informed choice on below 85% oxygen saturation, something which was happening. The patient had been in ICU for over a week, too, and there's also the issue of ICU-created psychosis, which is more common than I'd thought. My third patient today had it, but - as mentioned - they are a bit of a funny one, either way. I reckon, with the ability to breathe and talk, they would probably be a bit odd. In a nice way.

The medics, in this case, decided to remove of the trachy-tube and replace it with a trachy-mask, even with the risk of desaturation and respiratory distress. They also removed their arterial line in an effort to make them feel less tied to a machine. It was very difficult the patient grievance when they could not actually talk. The patient was was mouthing something about having waited 5 days for something, but it was unclear. An accelerated step down from trachy-mask to uncuffed tube to fenestrated tube would end up with the patient being able to articulate, verbally. Only then would someone be able to decide if his ability to stop such treatment was an informed choice. And I think, ethically and professionally, the medics made the right choice.

The patient was uncooperative to the nurse, but I don't think the nurse in this case was very understanding. They displayed what I thought was a short fuse and seemed bereft of empathy. I go onto nights tomorrow so it'll be interesting to see how the patient in question is doing then, either way.

*Logistical flies in ointments are the worst kind.

Saturday, 14 March 2009

ICU, one week down.

Indeed, my first week of placement on ICU is finished. Sadly!

I'm enjoying it, thus far. It's difficult, y'see, in a challenging, rather than dangerous and horrible, way. As a taste, for the first day, I witnessed back-to-back tracheotomies and helped on the second, which was not entirely by-the-book. You'd think holding a tube would be pretty easy, but it's really not. The doctors were awesome, though, talking me through all the curves.

I'm a bit tired, after two Long Days in a row. Suffice to say, I've learnt a lot already. I like my mentors (associate ones) and I like the staff I've met.

The first patient I had, in shaky writing (since they were one of the trachee'd patients), expressed disbelief it was only my first day. It was sweet.