Nursing - General Care

Paediatric Nursing – it has so much to offer

Saturday, June 5th, 2010 by niknak30

nik and pepper 2In my group of friends at university when I was studying nursing, I was one of the few who knew that Paediatrics was where I was heading. I didn’t know what area of Paediatrics but I knew that my nursing career was headed in the direction of looking after sick children. In fact, in my year 12 year book I even said that it was where I wanted to be in 10 years time.

I was lucky enough after a 12 month new grad (nurse transition) program that had no paediatrics in it to get a job at a children’s hospital. I cried when I was offered the position!

People often say to me that it takes a special person to look after sick children and yes I guess that is true but as I always say, I get so much more from the job than I could ever give to it.

There is something unique about looking after children for so many reasons

  1. children are so brutally honest….. if you are fat, thin, tall, funny or even sick, a sick child will tell you in the bluntest manner. I am always amused when a child tells me I have a big bottom…. they are telling the truth, and the look on their parents face is worth it every time. Total embarrassment. I always giggle!
  2. as the nurse, we see sick children at their worst but also parents at their worst. Being able to be a part of that is something very special because more often than not we see that turn around into a celebration and it is great to be there for that.
  3. we get to go fun things at  work and it is accepted. Whether it be dress up in costume, wear pigtails in your hair, sing or dance or be sillynik. We are often celebrating a fundraiser, a special day or a hospital event and we always get involved and do it. It’s a great part of the job.
  4. A hospitalised child is often the worst experience  that will effect their family and often we have 16 children in that situation in our ward alone. It is wonderful to be able to help these families to deal with the trauma of that. Their child may be in for something simple or perhaps a long road of visits but being there is something quite rewarding. Knowing that you make the smallest difference is one of the reasons we go to work every day.
  5. adolescents will give you a challenging day just as much as a baby but getting to combine a little of both in each and every work day is truly rewarding

Would I recommend a job in the field of paediatrics?

I could not speak more highly of it as a career. You still get to chose between medical, surgical, intensive care, recovery, theatre, emergency or community but you also get to be involved in the lives of people who appreciate what we do in more ways than they could ever express. Helping a child return home to their families really does give you that warm fuzzy feeling.

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Arrested Development

Wednesday, May 19th, 2010 by niknak30

It’s a sound that rings through your ears and your heart momentarily stops.  You think to yourself “OMG, is it real?” No matter what time of day, no matter what you are doing, you are always on alert for THAT sound….. the one that makes your heart race, jump to attention and head in whatever direction it is coming from.

alert lamp

alert lamp

Fortunately for me, working in a Children’s Hospital, more often than not the arrest buzzer is set off by mistake because a parent has leaned on it, pushed it thinking it was the regular nurse call bell or because a sibling has wondered what that red light does when you push it!   However, on those days when the arrest buzzer goes off and it’s for real, not only do we deal with whatever situation we find whether it be a respiratory arrest, seizure or other emergency, the shrill cry of a scared parent often follows.

In fact, not only does the adrenalin kick in and we do whatever is required to help the child in question, we are also instantly aware that a child’s mother, father, relative etc who is at the bedside wants to know how we can fix this.  As in any area of nursing, we do all that we can and then we help the parents in any way possible before we then look after ourselves.

Looking after the nurses after a situation where resuscitation is required cannot not effect you in one way or another.  Some people go for a cigarette, some people need to talk then and there, some choose to discuss it at home and others need a more formal debriefing of a situation to know that regardless of the outcome, we did the best we could.

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Cardiac Arrest – the first time I saw it happen!

Thursday, May 6th, 2010 by patience

CCC_InTraumaThe first time I saw a patient have an arrest was when I was 17 years old. It was 1975 and I was a 1st year nurse with all of 6 months experience in the care of sick people.

I was working on night duty in a nephrology/oncology ward. The ward was divided into 3 sections and I was in-charge of one of them under the supervision of an RN. My section was the least acute, but still it seems ridiculous to think back and remember that hospital management thought it perfectly okay to leave a 17 year-old in charge of 12 fairly sick patients. But so it was and we didn’t think anything of it at the time.

This particular night was my 5th on night duty and I knew all my patients pretty well. There was one gentleman in particular that I had connected with – as we nurses often do. This man was in renal failure and quite unwell. He would spend most of his nights awake, so I would often sit with him and we would quietly chat and share jokes while the other patients slept fitfully. I liked him and he liked me.

Well it was about 6am on this chilly winter morning and I was looking forward to the dawn and the end of my shift. I was doing my usual 6am rounds, checking the all-important fluid balances and doing observations. The patients were rousing sleepily about me.

As I headed towards my favourite patient I could immediately see that something wasn’t right. He was lying on his back and I could hear gurgling noises coming from him! I moved quickly and the first thing I did was roll him onto his side and grab the suction equipment as I thought he was choking. But as I started to suction I realised that he was arresting. With a hot and frightened rush of adrenaline and with shaking hands I grabbed his buzzer and buzzed 3 times. The ward emergency signal.

My favourite patient was a big man and I was a rather petit teenager, but at that moment I seemed to have added strength and with some effort I rolled him onto his back. With a racing heart and sweaty palms I realised that the CPR was up to me and so I started it, all the while silently hoping the RN would answer the emergency buzzer as quickly as possible.

Time seemed to stand still and I seemed to move in slow motion while I initiated CPR. I remember feeling hot and cold flushes as I desperately tried to remember all I had been taught. I hadn’t even seen an arrest before let alone be the nurse to find someone having an arrest and be the one to begin CPR! Fortunately I remembered what I was supposed to do, and even though time seemed to drag, the RN and the other nurse were with me within a very short time. The code was called, the RN took over, the resus team arrived and I faded into the background to finish my shift, shattered and shaking. I went home feeling as if I been in a car crash!

When I returned to work that night I found out that my favourite patient didn’t survive his arrest and I felt as if I had let him down and hadn’t done a good enough job in trying to resusitate him. Fortunately, even though debriefing wasn’t something that was commonly done, the RN was able to reassure me that he had been a very sick man and that I had done exactly as I should have. And that was the end of it.

I saw and participated in quite a few more arrests after that one and I have to admit that I never got used to them and found them all a nerve-wracking experience. However, all those subsequent arrests have faded from my memory, but the arrest of my favourite patient is as clear today as it was 35 years ago.

My memories aren’t just because of my fear and anxiety over participating in my first medical emergency though that of course is a big part of it.

It was also because a patient I had connected to died and I couldn’t help him. This particular experience really brought home to me what nursing is all about. It’s the sort of experience that made some of the 17 year-olds I worked with hand in their resignations!

For me it gave me a deeper understanding of what nursing is all about.

Nursing is about connecting with people, caring for them, helping them and saying good bye. And the goodbyes can be either  happy and sad.

So that was my first arrest! how about yours?

photo courtesy of www.hospital.com

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Murder in Chatswood

Thursday, April 29th, 2010 by shoils

I am sure everyone has by now heard about the murder that occurred in Chatswood on the 27.4.10.

stalker

This murder took place around the corner from my workplace (that is a scary thought in its self) but reports state that the murder may have been by the victim’s patient.

The report doesn’t say that she works in the mental health field but it does say that they suspect that it was one of her mental health outpatients.

It is very worrying to think that the patients we look after, whether we work in mental health or not, can get a hold of where we live, who our family members are and our personal details. How does this happen? How is it that our personal details are so accessible to the people that we look after?

I have a very close friend that works at Long Bay as a mental health nurse. She once told me that they are not to bring in their mobile phones to ensure their security and to keep as little detail of their personal life out of the facility. This may make it harder for her patients to track her down in the outside world but in reality all they need to know is her full name and they can track down her address, phone number, and who her family is. It is not hard.

When I was in training I did a placement at Rozelle Acute Mental Health Hospital and one of the nurses there told me about how she had to move house because one of her patients stalked her when he was discharged.

According to law our work place is not allowed to disclose any personal details to anyone, including fellow work mates but in today’s day and age is this enough?  When this law was passed we didn’t have internet and whilst back then this may have been enough to protect nurses from patients or their relatives from finding us but now it is all too easy to look someone up on the internet and find all of their details. So how are we supposed to protect ourselves? Would it be wrong if nurses remained anonymous at work? Or, we use nick names instead of our real names?  And our  name badges have our selected names on it instead of our real names?

How are we to protect ourselves from patients finding us and causing emotional/physical  harm?

Do you have any suggestions? Have you experienced a scary situation with a patient or their relative? Please share your stories or Ideas.

Image source (http://www.fotosearch.com.au/photos-images/stalking.html)

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Malnutrition Allegations in Aged Care (Part 2 of 2)

Wednesday, April 14th, 2010 by shoils

man on scales This is the second part of this article. Please go to Part 1 if you have missed it.

The DAA suggests that we catch the problem early and monitor food intake in our residents. Every facility, no matter which provider they belong to, should have some kind of a food intake monitoring form. If you are concerned with intake you don’t need a GP or dietician approval to start one of these, you simply state in the residents notes that you are concerned about nutritional intake and you want to start investigating, thus you are commencing a food intake form. This is where who ever is the person to feed this resident/pt needs to be diligent in documenting exactly what he/she ate for that meal. All 3 shifts must do this for however many days the form stipulates.  Then, when you have evidence that intake has in fact decreased you can raise your concern with the GP or dietician. They will be pleasantly surprised that you have already completed the form and have the data waiting for them. Then you can start other investigations like find out if they are in pain, are no longer able to eat on their own, have problems swallowing, are becoming depressed, decreased cognitive ability etc.

The other way you know if someone is getting malnutrition is by regularly weighing them. They may have a great appetite but may not be absorbing  anything. At our facility we weigh people monthly and have a special obs form that it goes into and I as the care manager type it onto a special excel program that our IT department developed, and it  shows me if someone is starting to become malnutritioned. When I can see someone is starting to lose weight, according the amount of weight the person has lost I am to follow certain directives to try and reverse the malnutrition process. You don’t need a fancy system however to tell you there is a problem, all you have to do is weigh them and write it down somewhere in their file, if there is a weight loss do some investigating, consult their GP and their family maybe they have an explanation, or have noticed something that you haven’t.  There are also a huge range of great products now that help boost protein and caloric intake which I am sure you provider already has or can easily order, and these days they come in lots of different flavours that your residents will love.

You may not be able to stop everyone from becoming malnutritioned, but you can reduce the numbers with very small simple steps. Simple observations in behaviour, intake, and surroundings will prove very useful in aiding you to look after our frail and aged.

How do you feel about the statistics of malnutrition in our elderly? How have you helped a person from becoming malnutritioned? Have you witnessed some poor practices that have resulted in malnutrition?

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What to Expect at Your First Day of Nursing

Thursday, January 14th, 2010 by ara-c2009

It was a morning shift, my first day as a nurse. We were in the nurses’ station of a 30 bedded medical-surgical ward…listening to the handover that the night staff was giving in a low soft tone voice.

nursing handover

From the corner where I’m standing, trying to understand every jargon their are saying as:

“Mr. X  is for ERCP”

“NBM since 12 MN”

“Mr. S is for Angiogram at 10 am all cardiac meds given aspirin withheld,ECG done.”

“Mrs. F Day 10 post CS”

“HB 9 had BT 1 unit

It was endless  until the last patient had been handed over. Handover during those days lasted for about 30 minutes, as you have  to write everything on your piece of paper (unlike today, you are given a print out of the handover, all you need to do is listen and add a little if  it’s  needed).

After that, it’s time to do the walking handover as we went to each room, where patients’ contraptions were checked, each dressings examined and every IVF checked.

That is how vigorous the start of the day was. Next on the agenda was to check all the progress notes of patient assigned to me (usually about 20 as the 10 patients were in the second level, occupying the private rooms).

As I was new, I have to be buddied to a senior nurse to give me support and assistance as I needed it. But more than usual, I was left on my own. My senior nurse buddy was needed to accompany the doctor’s round as she was the senior nurse and she knew the consultant’s routine. I was left to attend to call bells of patient needing help.

During my eight hour shift, everything had to be done on schedule but that did not happen all the timethough as I was interrupted by patients, relatives, technicians, and doctors.

A two-minute  procedure like diluting an antibiotic took several minutes at times because everybody were busy attending calls. I guess it had helped that back then, we utilised functional nursing as well as primary nursing.

Functional nursing means that as we are given functions like one nurse was assigned to do the intravenous medications, one  to do oral medications, one to carry out doctor’s orders and one to do observations.  Primary nursing was also utilized in a way when we admit patient, whomever admitted the patient, planned for her/his care until discharge.

Every day was a new experience as I worked with different sets of nurses. I’ve gained some of their good techniques especially with dealings with patients and their relatives.

I’ve seen and worked with empathetic and wonderful nurses but sad to say, I’ve also seen some bad ones. And when I say bad ones, I really mean the bad ones – those nurses who don’t even support you and who performed their nursing duties that I don’t believe should have been acceptable.

The only thing that I didn’t like during those first days were the thought of having not done what I was supposed to do.

My concerns invaded my dreams even – I have dreamt of not giving antibiotics and so many other things related to work. Even when it was my day off, take a guess what I did first thing after I woke up? I rang the ward to confirm if I indeed have given the meds.

That’s how much nursing would invade your life. It’s not just your day (or your night job!). It invades even your dreams! How ridiculous is that? Have you experienced that too?

Can you remember your first days as a newbie nurse? What was your experience?

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When Relatives Are Your Best Ally

Wednesday, October 7th, 2009 by NU_Editor

I recently had the experience of being able to teach my sister how to care for her daughter when she was hospitalised recently. This was good for the following reasons: my niece enjoyed and preferred to be cared for by her mother, my sister felt empowered as she was able to help in a direct way, she felt more aware of her daughter’s condition and needs, and the nurses had less direct care to provide as this role was now being shared with us (the rellies) and the nurses.

zoo

In my nursing experience, it has always been worthwhile to involve family members in the care of their family member who is the patient. In most cases where patients have chronic illness, the family have often been providing care at home. So, this enables them to continue to provide care for the patient while they are hospitalised. This creates a win/win outcome as both the patient and the relative/s are happy; and I have some of my time freed up so I can provide care to the patients that don’t have relatives to care for them.
I always treat a patient with a family that provides patient care as a bonus and never just expect that they will automatically continue to provide that care as they may actually require some respite from doing that. I find it is best to simply offer the family the opportunity to provide care if they show an interest in doing so. I have however observed over the years that I have been nursing that there is a diminishing level of care that can now be delivered at the bedside by the nurses as a result of the diminishing staffing level that is allocated to provide that care.
So, I feel we should all welcome and show our appreciation when a patient comes with rellies that want to provide care. I recently saw a story on TV about robot technology and how the Japanese baby boomers don’t have enough nurses to look after them as they are all getting on in years and are now looking to robots to fill this role (just like ROBONURSE).

As a nurse, I find the role of providing care to another person satisfying as it enables me to connect on a deeper level. I am certain our patients will not get this same connection from being cared for by a robot. I believe as nurses we should all encourage family members to provide care for their loved one (the patient) whenever possible and practical.

What have your experiences been with dealing with your patient’s relatives who want to provide care for their loved one?

Rich

Photo from www.photoxpress.com by jeancliclac

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So, What Do You Do?

Wednesday, August 26th, 2009 by NU_Editor

Whenever I am asked what I do for a living I commonly get one of two responses, either “Oh, well, if you’re a nurse, I have this rash…” or “Wow, I have so much respect for you and what you do”.

australia nurses

Although, obviously the latter response is very flattering and the respect that the general public have for my profession is appreciated, I often wonder if the non-medico person knows what it is I do and, in fact, what it is they have respect for.

I think that the recent series of ads by the NSW Nurses’ Association, such as Kim’s story and Scott’s story help to display to the community the high level of technical competency and the wide range of communication and management skills we require to be effective members of a multidiciplinary team. This kind of publicity also displays the diverse areas in which nurses work.

Additionally, we as nurses meet a wide range of patients and their families from varying socio-economic and cultural backgrounds and consequently get the opportunity to see the world from a wide range of perspectives and learn from people who we may not normally meet.

I think an important aspect of my role as a nurse  is the responsibility I have for my patients and the people I may meet who could be suffering for some reason or another. We constantly act as advocates for our patients rights and this role also carries out into the community. This is apparent by actions taken by nurses such as supporting the abolishment of the Australian Building and Construction Commission (ABCC) which directly threatens the workers rights of Australia by helping bosses get away with bad safety practices and stop unions from doing their jobs.

The other nurses and I also support the Close the Gap campaign which calls on federal, state and territory governments to commit to closing the life expectancy gap between indigenous and non-indigenous Australians within a generation.

Does anyone else have any other campaigns or social issues they support? Or any stories to share about what they think the public think about the nursing profession?

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A Day in the Life of a newbie ICU Nurse

Thursday, August 20th, 2009 by Ruth Guevarra

t’s been nine weeks since I first landed at the Intensive Care Unit (ICU) at Nepean Hospital.

icu

I remember feeling very scared in the beginning. I felt I have been taken out of my comfort zone. I have been an EEN for 3 years but I have mainly worked in the wards.

I spent my first 4 months as a new graduate in Endoscopy, so ICU is definitely a whole new unknown world for me. The orientation helped a lot plus the one week that I am a supernumerary – I worked with a nurse buddy for the whole shift. My buddy showed me the basic stuff and the routine.

After 9 weeks working at the ICU, I am ready to give you an idea of what a day in the life of an ICU nurse is like….

At the start of each shift we get the complete handover at the nurses’station then a bedside handover of the patient (ventilated)/patients (non-ventilated/cleared for ward) we are allocated for the day.

I start by doing a complete physical assessment on my patient. I also check my equipment and set my alarms.  I check what drips are running and label each lines especially if the patient have central line with chooks foot extension.

Then I update my ICU flowchart, follow doctors’ orders for the day, administer medications due.

When it’s quieter, I focus on patient care. I Give them a wash or shower whichever is applicable. Oral, eye and pressure area care is very important especially with patients on ventilatory support.

We always put them on special mattressess and sequentials to assist with circulation. We encourage relatives to visit as this assists the patient’s quick recovery.

Most ICU patients feel isolated and helpless that they lose their confidence and interests. Lack of sleep is also a big problem due to the noise of alarms and the bright lights and the constant prodding of nurses, doctors and physios.

I can relate to this so whenever I can, I give my patients time to rest and sleep by reducing the background noise and turning down the lights in the room. The last thing I do before leaving the patients is make sure that they have enough pain relief if they need it.

The last part of my shift is spent documenting everything I did for the day. Then I know I’m ready to handover my patient to next nurse.

What about you? What is your typical day like in your department or unit? Share it with us.

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Be The Master Nurse of First Impressions

Sunday, August 9th, 2009 by NU_Editor

When a patient is admitted to your ward, department, service or nursing home, you and your workplace will be making a first impression on your new admission. Like it or not, you will either make a good one or a not so good one.

hospital

After 10 years in Patient Transport I have personally witnessed hundreds of new admissions to both hospitals and nursing homes and due to the hectic workloads we now face I have observed a big range in what my patients have experienced when first being admitted, from not being made feel welcome at all to feeling like they are returning home to family.

I have 4 quick tips on what can help to make the first few minutes of the admission process run smoothly for your patients and they only take minutes to implement.

1/ Smile: Even if you are frantic and you have nowhere to put the unexpected admission that has just arrived…remember it’s not the patient’s fault, so making them feel at ease by offering a friendly smile will go a long way towards a making a good first impression.

2/ Be friendly: While offering your smile be friendly by saying “hello and welcome” or “how was your trip?” will definitely help your patient to feel at ease and give the impression that you care about them as a person. As the first person they meet on your ward, you are in fact representing your whole ward and the patient in those precious first few minutes will be forming their opinion about your whole ward based on what you do and say.

3/ Make them comfortable: tea and flowerAny small comfort measures can make a big impression. Make them feel warm by offering a blanket from the blanket warmer. Offer a cup of tea, often a real favourite with the seniors. Many patients are transported over meal times so they miss their meal at both ends so offering a sandwich or snack can also be well received. Some patients may also require pain relief upon arrival.  Note: Some patients may be fasting or on dietary restrictions.

4/ Tell them your first name: This is what you would do for any guest visiting your home so why not extend the same courtesy to all your new admissions. Wearing a badge with your first name in big print can also act as a reminder as your new patient will no doubt be meeting many new faces with many names to remember.

You may be reading this and be thinking that I am trying to teach you how to “suck eggs”…well if you feel that way that is great as it probably means that you are already doing way more than my basic tips and are in fact treating all your new admissions to your personal VIP treatment.

I would love to hear back from you so please post a comment about what you or your ward does to roll out the red carpet.

Rich

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