[CLINICAL ROTATION] Patient by Patient

 

 

Patient by Patient

On busy days, it can be easy to flit from patient to patient with a laser focus on what our patients “need” in the moment, meeting that need, making sure the call bell is within reach, and heading off to the next patient, or call bell.  On those days, it is important to remember that what all of our patients needs is personalized care, therapeutic communication and the feeling that they have been listened to and heard.

This week we seemed to have a number of crotchety and uncommunicative patients.  That kind of patient can really make the day longer and more challenging.  Talking with patients who just want us out of their space for whatever reason can be difficult.  I had a wonderful conversation with my patient’s partner who was also a cancer survivor.  She had popped in on her way to Rochester for a biopsy.  Her boyfriend, my patient, was a completely different story.  He wanted nothing to do with me.  He was relatively tolerant of my necessary assessments, but wanted to lay back, enjoy the morphine drip and nap in peace.  Even his physicians wanted him to go home, but –with no roommate- the hospital environment was pretty chill riding the opioid pony.  The only real distraction was me.

In these situations, I think that it is important for me to remember that all patients have individualized needs.  Although I have an assessment sheet that I am anxious to fill with details that are important to personalize my care, that sometimes that means care from a distance.  Re-approaching, re-framing, and re-phrasing during hourly rounds to address questions and concerns sometimes doesn’t draw a patient out.  In those cases, providing care with respect to their desire to be left alone is also part of nursing and frees us up to pop into other rooms and ask how people are doing and if they need anything.  Nursing care is determined patient by patient.

It was comforting to hear some of the other stories from fellow students in post-conference of their patient experiences.  It seemed like it was just “that kind of day.”  It was also encouraging to hear about some of the brilliant successes that fellow students had, as well. 

Going into next week, I am looking forward to the opportunity to take on more patients, to get in another med pass and to have my observational experience.  So much to look forward to as I reflect on the near-misses and successes of the week.

Wishing you a wonderful weekend. 

Be well.

 

Let’s Talk About Sex.

“Let’s talk about sex, baby
Let’s talk about you and me
Let’s talk about all the good things
And the bad things that may be
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex
Let’s talk about sex

Let’s talk about sex for now to the people at home or in the crowd
It keeps coming up anyhow
Don’t decoy, avoid, or make void the topic
Cuz that ain’t gonna stop it
Now we talk about sex on the radio and video shows
Many will know anything goes
Let’s tell it how it is, and how it could be
How it was, and of course, how it should be
Those who think it’s dirty have a choice
Pick up the needle, press pause, or turn the radio off
Will that stop us, Pep? I doubt it
All right then, come on, Spin” ~Salt N Pepa

The second sheet of the Patient assessment can be daunting.  However, it is the part that I love best.  I love people and it’s important for me in my role as a student nurse to find out what is really going on with them on a personal and psychosocial level.  All the issues that concern them when they return home can hit like a freight train and returning to daily living can provide numerous challenges.  The second sheet can give them the opportunity to start thinking, marinating – if you will – about reentry into their roles and relationships after their hospital stay, procedures, and subsequent home care.  Sexuality is one of those issues.

We are all sexual beings.  That’s how we are created.  Our identity is tied into our intimate life whether with a partner, or with ourselves and physical and emotional trauma effect the way that we perceive ourselves and our roles in our relationships.  “I feel like I’m not whole.”  “Who would want me looking the way that I do?”  “I can’t even bear to look at myself, how is my partner ever going to find me attractive again?”  These are just the tip of the iceberg when it comes to the questions patients have about their sexual identities and their roles as a partner with whom they have an intimate relationship.

I love the second page.  Sometimes, I can nonchalantly ask very personal questions during the assessment.  Sometimes not.  Patients in a hospital setting can feel very vulnerable, but they can also feel a desperate need to talk with someone about their pressing and sometimes embarrassing questions.  Only a select few patients will initiate a conversation about intimacy, but gently developing a rapport and a feeling of mutual trust can powerfully influence their ability and willingness to open up about such deeply personal issues. 

Often, I introduce the subject when I am doing something else.  They don’t have to look me in the eye.  I gauge their receptiveness in their response.  I revisit the subject when we discuss their discharge from the hospital, again, gently.  I leave the conversation open for further discussion and I remind them that they can talk with me –confidentially- about anything that is on their minds, or hearts.  I follow-up late with an open-ended question about how they are feeling about resuming daily life activities and again state my willingness to talk about any concerns they may have and list a couple of pertinent topics, slipping intimate relationships into the conversation.

In my work in the cancer community, one of the topics I speak about and have participated in panels and radio programs about is sexuality.  In these settings, I have the benefit of creating a completely safe environment and offering myself up for additional time to share in their questions, or concerns after the session, via  facebook, by email, etc. 

I primarily work with young adult cancer survivors who have LOTS of questions about resuming sexual activity, psychosocial effects, partnering, parenting, fertility, the whole gambit.  Honoring that time together, listening to their concerns, reframing, and asking questions to gain more insight into their situations and deeper issues is important to me.  I think that this is one reason that I love the second sheet.  Co-creating a safe environment where a patient can offer up very personal and intimate concerns and have them listened to, addressed, and normalized is a gift to me.

Today, after clinical in post-conference I had a moment to reflect about why the second sheet comes so easily to me when so many students struggle with it.  I think the answer lies in that that I have done this, I have read and researched, I have had my own personal experiences where I wished that someone had discussed the myriad effects that a procedure, or treatment would have on my self-image, immediate effects on my body, long term psychosocial effects and late effects.  My nurses seemed so busy.  So unavailable.  I didn’t want to “bother” them with issues that were not applicable to their job, or care.  There were no bonds formed and certainly no place to think about, or discuss what might happen next.  The second sheet came as a complete surprise to me.  I would have never fathomed that we could, or should introduce these types of conversations.

So, I relish the opportunity to incorporate the second sheet.  To delve into a patient experience on a holistic level.  The reality of time constraints for RNs is becoming more real to me as clinicals progress.  Nurses are busy.  There is little, or no time –often- to ease into delicate, yet important subject matter.  I am relishing the opportunity to forge these relationships, to create a space for learning, understanding, teaching, and support that I hope to continue to create space for as a practicing RN.

[VOICES of EXPERIENCE] Advice for Nursing Students From the Field

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Voices of Experience…  Advice for Nursing Students

Some words of experience from men and women who are working nurses in a variety of settings, with myriad skills, perspectives, and levels of education.  Thank you to all of the nurses who have been so forthcoming in sharing their views and experiences !

It takes a lot of hard work and determination. You can start off by job shadowing at the hospital, that way you can get a feel for the nurse’s role first hand. I saw that you were an observer for a medical team which is a good start. If anything, for now get your prerequisites out the way. A community college is a good start for those, save you some money, just make sure your classes will transfer to the prospective nursing programs. I would definitely recommended getting your BSN though, it will be beneficial to you in the long run. Just know that nursing is a whole different field, a different way of thinking. Good luck to you! ~Jwana

 

Get ready to change your way of life! I was 47 yrs. old before I started nursing school.
I had to eat, breathe, and sleep nursing. I traveled 70 miles one way to class.
I ate my sandwich walking across campus to my next class. Maybe you can partner up
with a friend. I did and we traveled together. By the way,neither of us had prior nursing experience. We quizzed each other on what we had studied on the way, to and from class. I studied on the couch sometimes until 2;00 A.M.and set my alarm clock. I had to wake up early early in a.m. to hook up with my ride and get to class on time.

It won’ t be easy, but you can do it. You really have to be determined that you will make
it through the course and graduate. By the way, if you are married or in a relationship,
I hope you have a supportive spouse or partner. That will help a whole lot.

Nursing was the experience of a lifetime. You will never be sorry. Being a nurse will do
a lot of things for you. It will makes you a more caring, organized, stronger person (emotionally), able to make right decisions for your patients. It teaches you a different way of thinking. I had a little trouble leaving my patients at the hospital, when my shift ended. I hope that you learn to do that. Be determined and stick with it. Do not let the words, “I quit!” creep into your mind. Good luck!
mind, no matter what. ~Katie

Get as organized in your life as possible.
Make sure you have everything in your life done ahead of time. Get all your dental, medical, car appointments, etc….. done beforehand. We weren’t allowed many absences and if you missed something it was hard to fill in the gap.
Expect for your world to revolve around school and most things will be second.
Best of wishes, ~Lynda