Intensive Care by Echo Heron

There is so much I can say about this novel, but for the sake of time and to entice more readers I will only speak to a few main points I took from it.

One of the first things I would like to point out is that Echo was a mother while also going through nursing school. She raised her child to the best of her ability and did have some "real-life" events that threw her off her guard at points. The fact that she included these life events in her book as well really influenced my perspective of her as a nurse and her as an author. 

It truly is easy to become swept up in the grandeur of medicine and forget about the bad days, hard decisions, and inevitable consequences of others' decisions. Intensive Care is a great reminder of the challenges nurses face. It is also a gleaming example of all that is important about nursing. The compassion Echo shows her clients is incredible! I think every nurse strives to provide the best care for their patients and the stories Echo shares are only a few examples of the ways we can do so.

That being said, I encourage all healthcare providers and families of healthcare providers to read this in order to gain a deeper insight into one woman's perspective of the healthcare industry. It hopefully will gain us nursing students some compassion and nurses a little more respect than frequently experienced.

Clinical Observations, Part 1

At the moment I am doing my mental health rotation in which I work with patients with behavioral disorders. I am thoroughly enjoying the experience and can picture myself working in mental health in the future.

Some thing I noticed recently is of nurses' expectations for the patients. Our S.M.A.R.T. (Specific, Measurable, Attainable, Reasonable, Timely) goals are a bit different from other nursing areas. For instance, one might be for the patient to only rely on PRN anxiolitics only six days out of seven and instead utilize coping strategies for one day to reduce agitation. For some behavioral patients, that is a tall order. For others, that is an attainable goal.

Our job as mental health nurses is not to diagnose patients. Our job is to treat and help manage the treatment of our patients, especially because in this area, many cannot do so themselves. For example, for someone with ulcerative colitis who also suffers from bipolar disorder, sticking to a safe nutritional diet can be challenging if not near impossible for those that cope through eating. Nurses must help manage the ulcerative colitis exacerbations as well as the bipolar disorder.

That being said, mental health nurses have to be far more observant in changes in patients' behaviors than nurses in other areas of healthcare. What seems like laziness and sitting around is actually persistent monitoring of patients and charting their behavior in a subjective, non-judgmental manner.

For an example of how difficult this type of writing can be, take a moment to look at a person nearby and describe them without using words such as "cool," "nice," and "cute." Post your observations in the comments below. It is can be a very arduous task if one is describing multiple patients with similar behaviors.

My point being, each patient is an individual and one is most reminded of that in behavioral health.

Frazzled by Learning, Astounded by Knowledge

With all the studying I have been doing lately, I have rarely taken even a moment to appreciate how much I already know. Instead, I have (as usual) become slightly overwhelmed at how much I do not know. 

Tonight, as I was sifting through my overloaded email inbox, I found this gem:

Language
by J. Mark 

It's tragic
the way that everything falls away
when you name it:
those there, looming over this
here, their darkness,
their ability to catch the light
from that, there, hanging brightly.
It sounds so ridiculous to say it that way,
but there they all are:
the sun in the sky
over the small green earth, the peaks
that pull the horizon so close, so high,
glowing, their valleys blue-black
with shadow.
In our eyes they are the mountains
that we were promised: immutable.
But in word
they may as well be made of sugar.
They melt under their names
as under a hot running tap.
I could say nothing,
I should
give up singing these empty psalms,
hold your face tenderly between my hands
and turn it towards the view 

The idea that something as simple as describing something can be so complex in a multi-dimensional way.  It may just be deliriousness from sleep deprivation, but this poem reminded me that I know things that other people (or rather, other little people) do not know yet. For that, I should be mind blown. Yes, I am sure children will grow up and learn all about the sun and the stars - but will they know the things I know about schizophrenia, GERD, or animism? They might... but then again, they might not.

My clinical advisor recently reminded me of the quote, "Anything you learn becomes yours." That makes me feel pretty well off.

My New Best Friend

I made a friend today at clinical! Unfortunately my friend suffers from severe dementia.

Many of my interactions with my friend prior to today were brief and tense. I had heard that my friend liked to twist arms, bite, and lick and the thought of a person like that kind of made me nervous. Today however, I was in a strange mood because of the death of a patient I had worked with and my friend must have picked up on that. My friend clung to me all night and kept telling me that I was loved and how special I was.

Although my friend's speech pattern was very strange, I immediately picked up on things by the way it was said. Our communication kind of reminded me of how I interpreted my brother's speech when we were younger. I know that seems awful comparing my brother to a person with dementia, but bear with me.



Saul, my brother, used to talk in a roundabout way. Getting from one point to the next was a journey, but not always a linear one. To get from A to B, he might skip to H or P before implying B. He did not speak in word salad (unintelligible mixture of words and phrases) like my friend, but it was sometimes hard to tell what Saul was actually talking about.

Over the years, Saul has developed in so many ways and I have honed my skill of interpretation. It may be the fact that I am his sister, but most often I know exactly what he means when he says something unclear to others. Whatever the case may be, my friend today reminded me of one of the many reasons I love and miss my brother. I am now going to try and get over my homesickness with - you guessed it - sleep.

A Tasty Halloween

Halloween this year was rather eventful - but not in the orthodox sense. I had been scheduled to man the Dia de Los Muertos corner from 10am until I left for clinical at 2pm. Typically clinical ends at 9:30pm. With such a long day before me, I did the one thing that could immediately make it better - I dressed up!

My costume this year was Snow White. I have always been keen on the Disney princess and after watching the television show Once Upon a Time I have become more and more attached to her. I made myself as pale as I could look without looking dead, and wore a bright shade of lipstick to complete the look.

My friend dressed up as Red Riding Hood, who, in Once Upon a Time is best friends with Snow White. It was a perfect match! We hung out pretty much all day just for effect. (Not really, we just like hanging out together - plus we are in the same clinical group). I even had the honor of curling her luscious blond hair! I think I had far too much fun helping her with her costume.

In fact, I helped put together costumes for several of my friends! If there's one thing I truly appreciate about Halloween, it's the opportunity to show off a great costume. Maybe it's from theatre withdrawals...

Anyway, one of my first tasks of the day included whipping up a batch of champurrado (Mexican hot chocolate) for our Dia de Los Muertos celebration. It was so easy to make and delicious! I decided not to post my own photos with the recipe because the ones I took did not do it justice.

As I mentioned, I was scheduled for the M.E.Ch.A. corner all morning, but some replacements came in time for me to complete a festive scavenger hunt around school. Of course, Red was my hunting companion. Scuttling around campus, we saw all sorts of costumes! The faculty and staff had some of the best costumes.

Unfortunately my day was cut short by clinical. Although I did end up throwing some swimming goggles around my neck to participate in the sports-themed festivities at the care facility, I did not feel quite so enthused about the holiday. Fortunately, we did get off early (by 15 minutes, but still).

As soon as I returned, I gathered my friends and we ventured out to 23rd to hit up Little Big Burger before it closed to get our beloved truffle fries. After satisfying our salty cravings, we then satisfied our sweet cravings through Salt'N'Straw. The icing on the cake was that Salt'N'Straw - pause for effect - did not have a line. The day could not have gotten any better.

From left: Tinkerbell (Milly), Esmeralda (Amanda),
Snow White (Me), and Red Riding Hood (Emily).

...And that was the extent of my Halloween festivities. I returned from the outing exhausted and heading towards a food coma, or as I recently learned, a postprandial somnolence. (What can I say? I'm still a nursing student.)

Thankful Thursday

It seems as though I have spent far too much time complaining/discussing things I do not like and not appreciating/endorsing things I do like. So, without further ado, I introduce the first Thankful Thursday! ("A month before Thanksgiving? She's crazy." you say? BA HUMBUG.) I will simply write a list of little things that I am especially thankful for.

• sleeping in a whopping 25 minutes
• finding/playing the fishing game on the rowing machine at the gym
• taking a 20 minute nap
• having a nice, warm cup of coffee
• seeing the gorgeous weather and colors of nature outside
• getting my prescription refilled within less than 10 minutes
• being complimented for my shirt
• running late without causing any trouble
• eating a fresh carrot and tomato spinach salad with a slice of bread and an apple for dinner
• figuring out why my resident was anxious around me
• (subsequently) putting my resident to bed
• receiving support from the CNAs and LPN at clinical
• finding out an assignment is due later than I thought

Some of them are not very exciting, but each event made me happy today and I thought I would share some of my happiness. That is all.

It's Been a Rough Week.

This week has challenged me more mentally and physically than any other week of nursing school. Returning from my relaxing week back home, I literally hit the ground running - I was going to miss the streetcar and have to wait another twenty-something minutes for the next one. I had several meetings scheduled and events to arrange as well as homework and working out. Yet with all that I am doing, I could not outrun the cold that is going around campus. I am currently fighting, tooth-and-nail to get over it, but for some reason, I cannot shake it! I need not tell you how FRUSTRATING IT IS.

With all that is going on, I am more frustrated with the sources of my friends' worries. One of the biggest concerns has been clinical sites that lack concern for residents to the extent that the residents are not receiving adequate care. Another concern has been our research course, which does not seem to satisfactorily prepare nursing students for the papers assigned. The last major concern has been keeping track of all the assignments due for each class. Although it does not seem like a significant concern, the Linfield nursing curriculum is linked with four classes a semester that must be taken concurrently and sometimes course assignments seem to run into each other because they are similar in topic.

 It is unfortunate that some clinical sites do not provide adequate care for its residents, however, as nursing students we should take that upon ourselves to make a good example. This is what we are taught to do - to develop our critical thinking skills and make the healthcare community better as best as we can! It seems daunting for a first semester nursing student, but we are also adults with two years of education behind us.

As far as our research course goes, I applaud students' efforts to go above and beyond realistic expectations of educational standards of nurses. Not many nursing students will go into research, but they still feel the need to learn the material. The students are struggling to write a literature review. Not only have we had very little experience with APA formatting, we do not understand the structure of a literature review. It is one thing to have very little instruction but plenty of resources and it is another thing to have very little instructions and very little resources. Fortunately, students have bonded together and commiserated over the lack of collective knowledge.

The last concern my friends' had was over the seemingly haphazard scheduling of assignments. One piece of advice given to us at orientation was to write all the assignments and projects out in our planners so we would always have a complete reference. The unfortunate part of this, is that professors often rearrange schedules and accommodate to the learning styles of each class. This can form a jumble of problems for those nursing students who like to have clearly defined schedules.

I apologize for my rant, I just want people to realize that nursing students are humans too. My friends and I are all compassionate people that want to be the best nurses, and people, we can be. Nursing school is challenging me in ways I had not even imagined - and it is only the first semester! If all weeks are like this, I may need more support, but I refuse to give in and fall into the monotonous stereotype of a nurse. I am not going to college, putting in this much work, and drinking this much caffeine to end up like that.

Oh My.

It is definitely getting busier and busier here in nursing school - we are past the introductory stage and into the learn-what-you-want-to stage. As stressed as I may feel, I know it is only because I am pushing myself to get things done ahead of time so I have time to catch up if I have questions or if I want to look up other related things. For instance, the other day in class we watched part of a YouTube video on congestive heart failure (CHF). Our professor showed it to us because of its relation to ineffective tissue perfusion (oxygen not getting to the body parts that need it), but I was really interested in it because I know someone who suffers from CHF so I "wasted" 10 minutes watching the rest of the video after class.

Even today at clinical I felt like I was bustling about the entire time - because I was! I had the opportunity to speak with the physical therapist, occupational therapist, and each of the nurses and CNAs. I also was able to help with perineal care, wound care, physical therapy, toileting, showering, feeding, and drug administration. I even had time to conduct a full health assessment (including vital signs; listening to bowel, lung, and heart sounds; and skin assessment) and work on paperwork on my resident for IEL!

I kept myself as busy as I could (1) because everything is still pretty new to me and (2) I wanted to have as many experiences as I could within the few weeks we have left. Needless to say, I am exhausted and it FEELS SO GOOD!

FIRST DAY OF CLINICALS!!

Basically all of my morning led up to clinical. Or at least that's how I felt. I was not nervous or anxious until I went searching for my ID badge. For some reason I had slipped it into the front pocket of my backpack and skipped over that pocket until about a minute before I was supposed to leave. My frantic search built up my anxiety for the evening ahead and arriving early definitely made it worse. Fortunately there was a chapel nearby so I took a moment to duck in and say a quick prayer.

Anyway, there was no need to worry. The nurses, CNAs, and staff were more than accommodating and many of the residents we encountered were encouraging and glad to have us there. Clinical proved itself to be an integral part in our education - for instance, I knew the steps to transfer a patient, but in actually doing it I realized sensitivity and forethought must accompany the steps. Thoughts such as adjusting pillows before seating a resident or scooting the resident back in the seat to make the resident more comfortable are simple things that one may not think about when learning from a textbook or practicing on a fully functional partner.

For fear of HIPAA and falling asleep at the keyboard (it has been a very long evening), I will cut myself off here. I hope to share more of my thoughts about and adventures in clinical in the future!