Indeed, on Monday I spent a day with the Ambulance services, touring around this fair (unnamed) county. It was enjoyable. I put some effort in, where I was allowed, and (unlike in ICU) it was appreciated!
The crew were tip-top. They were both technicians, which (to paraphrase them) meant if we were sent to any RTAs or the like we were pretty much fucked. Technicians are somewhere below Paramedics. They can't give out strong medication, etc. But one of the technicians I was working with had passed all the exams and was just waiting for a 'medic spot to open up. It's all about the money, as usual.
Anyway. Despite this excellent book and the attached blog and the warnings thereof, we received no pointless calls! All day! I was almost shocked.
We went to a couple of falls of old people who were frail enough to require a trip to hospital. We attended one patient whose shoulder had popped out of joint, for the 35th time, and was in intense amounts of pain.
Could someone from A&E tell me why such a patient wasn't given morphine when the patient was brought in? Weird, I thought.
We attended an old dear with dementia who had been found half collapsed in the street. The police gave them some water as we turned up. The patient's offspring also arrived, someone with the patience of a saint. This elderly patient gave us various stories and wives' tales during our little check up. This patient also refused to go to hospital, despite appearing in massive amounts of pain, at points. There was a large amount of paperwork to fill in for someone who a) declined a trip to hospital and b) didn't appear to have capacity to make such a decision. The offspring signed it off, we put them both in their car, and waved them off.
That is a whole different kettle of fish. Although the old dear received some help at home, it didn't seem like enough from what we could gleam. And it's funny, but not shocking, to think of paramedics dealing with the fallout from shit government policy.
It was a good day. I gained awareness and a bit more of the love I've lost on ICU. For helping people, etc.
Tuesday, 21 April 2009
Friday, 17 April 2009
Good news..
... and the bad news.
More feedback from my day calling the shots.
Positive:
Improvements in mouth care, eye care, ANTT, dressing changes.
My planning began well, especially given there are only some things I can plan for. It was my second long day and my first ever day planning a day for a patient. I kept an eye on infusions, which is something I haven't been too good at before. I planned for turns and the like in advance.
Negative:
I think too 'medically' and need to take a step back from this.
My planning became less effective as the day went on and our patient deteriorated.
I was too rigid and set towards set times, when working on ICU involves doing some things early, some things later, not necessarily on the hour.
Basic cares still need improvement.
I need to not talk to doctors without speaking with nurses first.
---
These are the views of my associate mentor. I'll talk about how I feel re: them later, but just wanted to get them down. It is the end of my last two long days in a row, I'm teary and generally irritable. I'm conciously accentuating the positive and eliminating the negative, as the song goes, and will reflect again soon.
Progress, though, is important! It should be noted I also directed all medical questions from the family to someone else, which is more progress.
Right now, though, I hate this placement and parts of me hate nursing because of it.
I do need some sleep, though.
More feedback from my day calling the shots.
Positive:
Improvements in mouth care, eye care, ANTT, dressing changes.
My planning began well, especially given there are only some things I can plan for. It was my second long day and my first ever day planning a day for a patient. I kept an eye on infusions, which is something I haven't been too good at before. I planned for turns and the like in advance.
Negative:
I think too 'medically' and need to take a step back from this.
My planning became less effective as the day went on and our patient deteriorated.
I was too rigid and set towards set times, when working on ICU involves doing some things early, some things later, not necessarily on the hour.
Basic cares still need improvement.
I need to not talk to doctors without speaking with nurses first.
---
These are the views of my associate mentor. I'll talk about how I feel re: them later, but just wanted to get them down. It is the end of my last two long days in a row, I'm teary and generally irritable. I'm conciously accentuating the positive and eliminating the negative, as the song goes, and will reflect again soon.
Progress, though, is important! It should be noted I also directed all medical questions from the family to someone else, which is more progress.
Right now, though, I hate this placement and parts of me hate nursing because of it.
I do need some sleep, though.
Thursday, 16 April 2009
Positivity!
So yeah, I'm bouncing back.
I had a good shift today. My removal of another central line was good, if a little methodical. My planning was more than adequate. I worked more things through than I usually do. And! I even managed to keep my mouth shut to various people and played the good little student nurse.
I'm happy. This placement is up and down and today is an up.
My associate mentor said she's going to e-mail my main mentor informing her of my solid progress. At the same time, working with her tomorrow, she plans to give more authority for planning and implementing to me tomorrow. Which I'm looking forward to, big-time!
I had a good shift today. My removal of another central line was good, if a little methodical. My planning was more than adequate. I worked more things through than I usually do. And! I even managed to keep my mouth shut to various people and played the good little student nurse.
I'm happy. This placement is up and down and today is an up.
My associate mentor said she's going to e-mail my main mentor informing her of my solid progress. At the same time, working with her tomorrow, she plans to give more authority for planning and implementing to me tomorrow. Which I'm looking forward to, big-time!
Monday, 13 April 2009
Negative Feedback
Indeed, I received some less than positive feedback today.
It was delivered nicely. Almost apologetically. I'm worried, but I would've been *very* worried if it was delivered in a stern sort of way.
Anyway. For almost two years now, I've been pretty up on my A&P. And my time with cardiac rehabilitation had me talking, at an easy to understand level, with patients and their relatives. It's a trend I have continues, since my last mentors seem to like it.
However, this is not how it's seen on ICU. There have been some queries and complaints made about me overstepping my bounds and doing this too much, which has been pointed out to me. I don't think, with two weeks left, this is a failing thing.
Personally, I think it's better to be keen than not interested. Obviously, if my behaviour would've become dangerous to patients, then it would've been too much. I was warned, for example, for giving internal suction when my mentor wasn't really watching. Someone has trained me, though, and I have done it before. More than once. So is this my fault?
Either way, I'm reining in my exuberance. It's a fine line to walk, and I'm not entirely happy with my progress, but it is progress.
And my patient today was very happy with my nursing. So I must be doing something right.
It was delivered nicely. Almost apologetically. I'm worried, but I would've been *very* worried if it was delivered in a stern sort of way.
Anyway. For almost two years now, I've been pretty up on my A&P. And my time with cardiac rehabilitation had me talking, at an easy to understand level, with patients and their relatives. It's a trend I have continues, since my last mentors seem to like it.
However, this is not how it's seen on ICU. There have been some queries and complaints made about me overstepping my bounds and doing this too much, which has been pointed out to me. I don't think, with two weeks left, this is a failing thing.
Personally, I think it's better to be keen than not interested. Obviously, if my behaviour would've become dangerous to patients, then it would've been too much. I was warned, for example, for giving internal suction when my mentor wasn't really watching. Someone has trained me, though, and I have done it before. More than once. So is this my fault?
Either way, I'm reining in my exuberance. It's a fine line to walk, and I'm not entirely happy with my progress, but it is progress.
And my patient today was very happy with my nursing. So I must be doing something right.
Tuesday, 7 April 2009
Interesting times.
As the old Chinese curse goes, this is not always a nice thing to say.
It's Tuesday, right? My days are all off kilter. Tuesday. I like Tuesdays! I'll get to them later.
Monday was the aforementioned interesting. Sunday, as you may or may not remember, involved me following a patient with some neurological problems into surgery. I was with this patient again for the whole of Monday. From a nursing perspective, my mentor was very good in letting me plan out the day and - for an hour - we stuck to it. Then the doctors arrived and announced the necessary (if fucking irritating) plan of letting this patient off sedation.
For those not educated in the fine arts of critical care, this involves turning off the sedation and waiting for the patient to react, which is often by coughing and choking. With this ability to protect one's airway, the ET tube can be pulled out and replaced by a face mask ('weaning'). Patients are generally confused when 'waking up' from sedation, which is usually fine. It lasts for a little while and they settle down. Sometimes you have to be firm with them in order to keep the face mask on them and oxygen going into them, essentially life preserving treatment (the idea of taking someone from ventilation down to simply breathing room air is not often a good one for patients in ICU).
This patient had quite the chequered history. I am mentioning no names or no real details here, therefore am not breaking confidentiality I rush to remind readers. The patient was involved with the police. The patient had a history of drug and alcohol abuse, the former of which meant we needed visors, to start with. The patient was agitated on the cessation of sedation (try saying that ten times fast). This continued and continued until we couldn't keep a mask on this patient with just two nursing staff and one doctor. We, with effort, swapped them to nasal specs (those tubes which pop up each nostril) and the patient seemed to relent at pulling at them.
This was the beginning of problems. The patient was also riddled with lines used for feeding, medication and monitoring and the patient decided to turn their wrath on these lines next. This reaction is not uncommon, as the feeling of intrusions into the body isn't very nice. However, they're all vital so, short of sitting on the patient, I managed to keep them in for a bit.
By now, the patient was swearing, shouting, digging nails in and generally being abusive to us. This is not uncommon, but is hardly helpful. The doctor had left by now, leaving myself and my mentor to try and keep the patient from from hurting themselves.
This is a big issue within nursing. You can talk about the right to autonomy as much as you like in the class room, but should someone be autonomous in causing themselves large amounts of damage in (and out) of a hospital bed?
Anyway. An hour after this and the patient is still agitated, still physically and verbally aggressive. My mentor and I (after consulting the information at hand as well as the patient family, who simply laughed off the aggression as something apparently hilarious) decided the patient was actually quite orientated and just a bit of a nasty. The patient began, from then on, to verbally and physically refuse cares. During this drawn out period we were punched at, kicked at (he missed, just about, with one on each), bitten at, swore at and successfully scratched on more than one occasion. With the help of another nurse we managed to pin the patient down for long enough to change his trousers, clean up his entire body (the patient had had a bowel movement and spread it all over themselves, their catheter and their femoral central line. Faeces staying around this area? To call that simply 'an infection risk' would be like calling Nick Griffin 'a bit old fashioned'.
During this time, we were shockingly nice. Vocally and in general. My mentor continued to give the patient pain relief, despite being told - in no uncertain terms - to 'fuck offffff!'. We continued to put our bodies into the line of fire to keep the patient in bed and generally safe. We removed all the lines as quickly as possible and were generally worn out by the end of the shift.
We weren't, for the record, allowed to place 'boxing gloves' (i.e. the act of bandaging the hands) on the patient. The coordinator said, because there were two of us (I'm not supposed to be in the numbers, remember), we weren't allowed. I viewed this, as well as the whole lack of staff and support as a shocking let down for us. As did my mentor and the nurse who helped us, and we all filed incident reports after shift. Otherwise nothing'll get done. Nothing will get done regardless, but at least we tried!
More on this later.
It's Tuesday, right? My days are all off kilter. Tuesday. I like Tuesdays! I'll get to them later.
Monday was the aforementioned interesting. Sunday, as you may or may not remember, involved me following a patient with some neurological problems into surgery. I was with this patient again for the whole of Monday. From a nursing perspective, my mentor was very good in letting me plan out the day and - for an hour - we stuck to it. Then the doctors arrived and announced the necessary (if fucking irritating) plan of letting this patient off sedation.
For those not educated in the fine arts of critical care, this involves turning off the sedation and waiting for the patient to react, which is often by coughing and choking. With this ability to protect one's airway, the ET tube can be pulled out and replaced by a face mask ('weaning'). Patients are generally confused when 'waking up' from sedation, which is usually fine. It lasts for a little while and they settle down. Sometimes you have to be firm with them in order to keep the face mask on them and oxygen going into them, essentially life preserving treatment (the idea of taking someone from ventilation down to simply breathing room air is not often a good one for patients in ICU).
This patient had quite the chequered history. I am mentioning no names or no real details here, therefore am not breaking confidentiality I rush to remind readers. The patient was involved with the police. The patient had a history of drug and alcohol abuse, the former of which meant we needed visors, to start with. The patient was agitated on the cessation of sedation (try saying that ten times fast). This continued and continued until we couldn't keep a mask on this patient with just two nursing staff and one doctor. We, with effort, swapped them to nasal specs (those tubes which pop up each nostril) and the patient seemed to relent at pulling at them.
This was the beginning of problems. The patient was also riddled with lines used for feeding, medication and monitoring and the patient decided to turn their wrath on these lines next. This reaction is not uncommon, as the feeling of intrusions into the body isn't very nice. However, they're all vital so, short of sitting on the patient, I managed to keep them in for a bit.
By now, the patient was swearing, shouting, digging nails in and generally being abusive to us. This is not uncommon, but is hardly helpful. The doctor had left by now, leaving myself and my mentor to try and keep the patient from from hurting themselves.
This is a big issue within nursing. You can talk about the right to autonomy as much as you like in the class room, but should someone be autonomous in causing themselves large amounts of damage in (and out) of a hospital bed?
Anyway. An hour after this and the patient is still agitated, still physically and verbally aggressive. My mentor and I (after consulting the information at hand as well as the patient family, who simply laughed off the aggression as something apparently hilarious) decided the patient was actually quite orientated and just a bit of a nasty. The patient began, from then on, to verbally and physically refuse cares. During this drawn out period we were punched at, kicked at (he missed, just about, with one on each), bitten at, swore at and successfully scratched on more than one occasion. With the help of another nurse we managed to pin the patient down for long enough to change his trousers, clean up his entire body (the patient had had a bowel movement and spread it all over themselves, their catheter and their femoral central line. Faeces staying around this area? To call that simply 'an infection risk' would be like calling Nick Griffin 'a bit old fashioned'.
During this time, we were shockingly nice. Vocally and in general. My mentor continued to give the patient pain relief, despite being told - in no uncertain terms - to 'fuck offffff!'. We continued to put our bodies into the line of fire to keep the patient in bed and generally safe. We removed all the lines as quickly as possible and were generally worn out by the end of the shift.
We weren't, for the record, allowed to place 'boxing gloves' (i.e. the act of bandaging the hands) on the patient. The coordinator said, because there were two of us (I'm not supposed to be in the numbers, remember), we weren't allowed. I viewed this, as well as the whole lack of staff and support as a shocking let down for us. As did my mentor and the nurse who helped us, and we all filed incident reports after shift. Otherwise nothing'll get done. Nothing will get done regardless, but at least we tried!
Sunday, 5 April 2009
It's not brain surgery...
Actually it is. What I saw, today.
It started off as a normal long day of a shift. My associate mentor is still off, so I was placed with a Band 5/6 and set about working. Or trying to. Despite the fact that Annoying-Band-7 told us our patient was ready to be moved into a side ward due to an infection, he really wasn't. In fact, the night nurse had no idea he was moving.
That put us back about two hours, with a patient who was already quite sick. Sedated, ventilated and bed bound. With a history as long as your arm and a very poor prognosis. A history of strange behaviour and substance abuse. After a day of helping provide care to this quite Level 3 patient, of which I was mostly successful, and then got to go and watch him in surgery.
I got to scrub up, which was more than interesting as an experience, and then I got to watch the worrying experience of cutting open a head, drilling through the skull and taking out flaps. It was... an eye opening experience. Which, given what was happening to the patient, was probably quite a luck event. I'd rather have my eyes opened than my skull...
It started off as a normal long day of a shift. My associate mentor is still off, so I was placed with a Band 5/6 and set about working. Or trying to. Despite the fact that Annoying-Band-7 told us our patient was ready to be moved into a side ward due to an infection, he really wasn't. In fact, the night nurse had no idea he was moving.
That put us back about two hours, with a patient who was already quite sick. Sedated, ventilated and bed bound. With a history as long as your arm and a very poor prognosis. A history of strange behaviour and substance abuse. After a day of helping provide care to this quite Level 3 patient, of which I was mostly successful, and then got to go and watch him in surgery.
I got to scrub up, which was more than interesting as an experience, and then I got to watch the worrying experience of cutting open a head, drilling through the skull and taking out flaps. It was... an eye opening experience. Which, given what was happening to the patient, was probably quite a luck event. I'd rather have my eyes opened than my skull...
Friday, 3 April 2009
Another two long days down and out.
And I'm tired. The random nurse I spent the PM working under let me off an hour early, for which I was thankful. Tired but happy, I got home in one piece and drank some tea. Only then was I ready to write this.
It was a good day. Hilariously, none of my mentors were around to see it. But I planned well, I pushed on with my essential skills (a trachy-dressing, with some assistance and minor mistakes) as well as planning the day and going through with my plans. Management-tastic. A good day.
I have the day off tomorrow, in which I'm shopping for more of my packed lunch and going the bookies. Not in that order. And then I'm going to curl up, cat-like, and sleep.
It was a good day. Hilariously, none of my mentors were around to see it. But I planned well, I pushed on with my essential skills (a trachy-dressing, with some assistance and minor mistakes) as well as planning the day and going through with my plans. Management-tastic. A good day.
I have the day off tomorrow, in which I'm shopping for more of my packed lunch and going the bookies. Not in that order. And then I'm going to curl up, cat-like, and sleep.
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