I'll never be a nurse now!

I had an experience today that made me wonder if I will ever make it through nursing school. We had an opportunity to see/do a dressing change on a patient with a PEG tube (percutaneous endoscopic gastrostomy aka a feeding tube). The patient is not responsive, so this was the perfect opportunity for us. Well...all of us except me. I had to leave the room because I almost passed out. How embarrassing. I don't know what happened because there was no blood or anything, just a hole with a tube in it. Hopefully repeated exposure to such situations will cause this phenomenon to subside. Otherwise, I might have to consider a career change.

Self diagnosis

Today in class our professor walked in and told us to take out a sheet of paper (a statement which usually causes extreme panic). She told us to write out a nursing diagnosis for ourselves this morning. Nursing diagnoses are designed to address human responses to disease processes. There is a standardized list of diagnoses and they follow a specific format. There is the diagnosis, the etiology, and the signs and symptoms. Here's what I came up with

"Ineffective coping related to being in class on Friday when there is fresh snow to be skied in, as manifested by increased blood pressure, extreme agitation, and a lack of interest in the present class."

I volunteered to read my diagnosis out loud in class. Luckily our professor is one of those people that not only understands, but also appreciates sarcasm.

Let the clinicals begin!

On Tuesday we had our first clinical day at the Anchorage Pioneer's Home. Luckily, it wasn't nearly as scary as I thought it would be. In class our professor made it sound like they were just going to turn us loose on our elders (that's what they call the residents of the Pioneer Home) for seven hours. Good thing that wasn't really the case! Our clinical instructor (whose name is also Martha) gave us a tour of the facility and then introduced each of us to our elder. We ended up spending most of the day going through their charts to get some information for the paperwork that we have to fill out. We will be doing a complete "mini" assessment of our elder (assessing the major functional areas of their life: activity/exercise, mental status, nutrition, health maintenance, cognition, self-perception, role/relationship, values/beliefs, as well as their medications) and creating an individualized care plan for them.

The facility was very nice and most of the elders seemed to enjoy living there. My elder said that they do a good job of providing a variety of activities and that the staff is all great. The one thing that I found somewhat amusing was the area for those who tend to wander off (I believe it is the acute Alzheimer's unit). There is a set of locked double doors and the side facing the unit is wall papered to look like a brick wall, which keeps them from trying to leave. I just find it amazing that it works!

Dummies

So this week in our skills lab we learned about changing dressings on wounds and catheterization. Here's the problem with putting in a catheter on a dummy...dummies are not exactly anatomically correct. The male and female anatomy on a dummy is somewhat out of proportion (i.e. the target is MUCH larger than it would be in real life). I have a feeling when any of us get the opportunity to actually put in a catheter, we will all be slightly surprised at how much more difficult it is in real life (at least I realize the hole it goes in really isn't a 1/2 inch in diameter, right?).

Nurse...or mom?

After class yesterday I was thinking about all that I have learned in the last week or so. I have acquired all kinds of useful skills such as hand washing, feeding others, moving people in bed, bathing people in bed, providing assistance with various aspects of personal hygiene (hair care, mouth care, etc.) and changing linens while someone is in the bed. Am I going to school to learn how to be a nurse, or a mom? I'll have to get back to you on that one...

Also I learned that I'm not going to the Mary Conrad Center next week, I'll be going to the Anchorage Pioneers Home (http://www.hss.state.ak.us/dalp/anchorage/default.htm) instead.

What a week!

Last semester, students from the semester ahead of us warned us that we would feel overwhelmed and confused at the beginning our next semester, but by the third week it would all make sense. Even after being warned about it, I was still thoroughly overwhelmed and confused. Having one class with four parts that all relate to each other makes for a lot of confusion. Not to mention the fact that in every part of that one class they talk about "in clinical you will be doing this" and "in clinical you will be doing that"...well, clinical starts in a week and there is no way I'm going to know all that before I go! On top of the feeling that I have no idea what I am doing, I also have no idea what I am supposed to read or turn in when or who I am supposed to turn things in to. Why? The calendar is broken down by week and assignments that are due are listed on the week, but with no specific date, who you turn things in to depends on which part of the class it is for and what day it is due and readings vary depending on where you look. Confusing! I hope the "more seasoned" students were right and it will all make sense in a few weeks.

Despite feeling lost and overwhelmed, I do feel like I actually accomplished something. Here's what I learned this week:

• When taking a history you actually have to ask, "with what gender do you identify?"
• Having your finger poked to check your blood sugar hurts more than you think it might
• Feeding fellow students pudding is hard to do without laughing
• People actually agree to be filmed receiving enemas so students like us can learn proper technique (I'm not kidding, I saw the video)
• I'm not as good at washing my hands as I thought
  
• Talking to dummies (the inanimate kind) is also hard to do without laughing
• When inserting an NG (naso-gastric) tube into a dummy, it is not ok to stick your finger in their mouth to check whether it has reached the esophagus...you have to use a tongue depressor (something about pretending to be in a clinical setting...)
• It is also not ok to accidentally stab them with a safety pin when attaching the NG tube to their gown
  
• People do not volunteer to be filmed while having an NG tube inserted

Back to school

The last three weeks off from school were much needed. I was able to catch up with a few friends who were in town for the holidays, work a little (but not too much of course), and play outside in the much anticipated snow!

Yesterday it was back to school. My feelings are a little mixed. I am glad to have something to focus on and to be on a schedule again, but I am not excited for all the work! This semester we only have two classes, but one of them has four parts. It's going to be a challenge just to figure out where I am supposed to be each day. In addition to Pharmacology, I am taking Foundations of Nursing II: Therapeutics. Foundations consists of four parts: theory, clinical, assessment lab, and skills lab. For the first two weeks we don't have clinical because apparently we need to learn skills in the lab before we can go into a clinical setting and practice. After the first two weeks we will spend three weeks in long-term care facility. I will be going to the Mary Conrad Center, a 24-hour nursing care and rehabilitation facility (http://www.providence.org/alaska/facilities/mary_conrad/default.htm). In the long-term care facility I will have one patient for three weeks. I will do a complete health assessment of my patient and complete a set of nursing related tasks (analyze the information, identify nursing diagnoses, and write a care plan). After completing three weeks in long-term care, I will spend the remaining nine weeks of the semester in acute care at the Alaska Native Medical Center. I will complete many of the same activities in acute care as I did in long-term care, but with more patients.

Today instead of having clinical (being the first week) we had a lab. We spent seven hours watching videos about patient confidentiality, hand washing, fire safety, and moving/positioning patients. Not the most mentally stimulating day. Tomorrow I have assessment lab where we will practice the art of interviewing patients and taking histories. The most exciting part is that I get to break in my new stethoscope!