It was a bittersweet day ending out little clinic in the transitional homeless community, where we open for business and do assessments, administer OTCs and triage. We stocked up the medicine cabinet, cleaned up and put out a new sign that read, "while TNT clinic hours are done, we will be back as nurse volunteers throughout the winter to assist you with your health needs. Look for our doors to be back open in November.
We spent the last week doing a lot of patient teaching, handing out OTCs for colds, muscle aches and even assessed a client who had been in a motorcycle accident. Our clinic room houses educational materials, an examination table, medicine cabinet, scale and two desks where we park it during our clinic hours. We did smoking cessation, Hepatitis C education, followed a skin cancer patient and handed out goodie bags. We decided we'd partner up with the Recreation Social Worker intern and do a couple movie/education nights in the Rec Room in Nov. just to get people together and talking about their health. We were able see our regular HTN/diabetic patients and get a lot of homework done. There is something about an open door that says c'mon in, because people came by to talk and we listened...because that what nurses do.
We are planning our class pinning ceremony with all the zest of people who are about to be released from captivity...not necessarily the serious POW kind, but in a sense, the walls of our classroom have no windows and some days feel like hostage crisis, Day 283, especially today. So with a little creativity and somewhere sandwiched between mental and community health, a couple classmates put their photography skills to work shooting headshots and candids of all our classmates for our pinning ceremony, to be held on Dec. 10, 2009, approximately 57 days from now (not that I have a countdown on my lap top or anything like that!)
As we approach this milestone, thoughts about the people I've shared my life with over the last 283 days are fond. We navigated some serious landmines in theory and clinical, shared a lot of laughs and tears. I made friends in nursing school that will be life long friends, professional colleagues I know I could turn to in a crisis. ABSN programs are unique nursing programs, pouring out insane amounts of learning wherein 38 adults from all walks of life, dedicate a year of their lives in pursuit of a common goal, supporting each other, knowing what we have emotionally, physically and financially invested in this journey. I can't begin to count the sacrifices we and our loved ones have had to make in order for us to get to this point. These are the best people...super human student nurses, supported by super human family and friends. The nursing profession is going to benefit from the heart this ABSN centennial class will bring to it. That's not to say there haven't been moments of sheer irritation. It's a lot like family.
Breathe. The roller coaster is starting to slow down. Hallelujah.
Psych nursing is different. You have the med room, the nurses' station and the hallway. Interspersed are bare bones rooms without any exterior trimming to allow for someone to harm themselves. The inpatient facility where we are rotating resembles a really old prison ward. There is a day room and a TV room. The facility is locked down and the LPTs wander the halls looking after the clients. The clients have access to meds (which they obtain at the nurses' station) from the med room nurse, and they have access to television. Other than that, there is groups during the day to attend, and meetings with psychiatrists/conservators and family members. If you are not insured, this is where you go and to be honest, if it were not for the generally optimistic people that work there; hell would be a picnic. Comrade X talked once about how painting a psych intake room the color pink would, in effect, calm a patient who was in crisis. After being in the concrete walled rooms of this facility, especially the intake/isolation rooms, I got the picture and thought it was research worth looking into. I've seen better dog beds at Costco. It's a sad indictment. Luckily, the best thing going at this agency, are the employees and it seems the long termers...the nurses and social workers, truly care about the patients.
My last day of clinical involved interviewing a paranoid schizophrenic patient with a long involved psych history and drug abuse history. This patient also had a history of violence and conduct disorder as well as developmental delays. It was not a situation where you would sit down and talk, much like the patients I met with who had major depressive disorders, bipolar and personality disorders. This patient was suspicious and tentative, was careful to keep his distance and took a very long time to get comfortable with me. I sat across the room so that he could get his bearings and then waited. It was a long wait. When he was ready, he talked. I didn't ask a lot of questions, because I noticed one thing about this patient that I had not experienced with any of the others...this patient made no sense at all. Disjointed sentences, with little connection between first and second thoughts, subject verb agreement, word salad...people inserted into thoughts that had no congruence or meaning. "I worked at a top secret place, my land lord dipped me upside down into a vat. She does not hear me. It didn't burn it did. He will kill me. They kicked me out. My parents are dead. I was adopted. I saw my dad today. I have 4 brothers. 2 brothers. Four years....and...."
This went on for an hour. Any attempt to redirect failed. Any thought became negated by another or an illusion. He could not maintain eye contact as he was always checking around us to see if I had moved was planning to move, or if someone else was coming. The affect was guarded and tense. As long as I wasn't talking, he was calm. It became apparent that interactions on the simplest terms could affect these patients dramatically, as if their sensory perceptions were all on another plane or out of whack or heightened or lessened.
I waited a long time to write about this because I realized that there was absolutely nothing I could do first as a student, or as nurse, other than listen, redirect, listen, accommodate and accommodate. Nothing I said mattered. I haven't been around someone whose defensiveness was so palpable. It was an interesting learning experience that I won't soon forget. Mental illness can not be dismissed or trivialized. How we deal with the mentally ill in society is certainly an ongoing subject that needs to be addressed, because obviously not much is left for the mentally ill other than hopelessness, despair, long roads and new challenges.
The best laid plans have side roads...and due to timing and circumstance, I will not be precepting at the VA after all. There is simply not enough time to secure a contract with my school.
In any event, I found out that I will be precepting as an oncology nurse for 7 weeks (120) hours at a local hospital with a reputable cancer program. So much ahead @ and only 71 days to pinning! I had no idea it would go this way. I hope I learn a lot in this last clinical rotation.
We have one month left in psych and community health. After that we slide into home plate with leadership, senior synthesis (policy) and preceptorship, in what will have been the longest baseball game of my life....nursing school.
Having this rotation during the health care reform debate has been interesting to say the least. In order to better understand what homeless people have available to them at the county level, Trude & I went to the county to check out the services and waiting areas of the local primary care center. More on that eye opener in a bit.
Our community health site is located on a closed air force base. Volunteers of America and the county share responsibility over various work/educational programs affiliated with this transitional housing venue that utilizes what's left over from the abandoned military barracks. Most of the residents are recovering alcoholics, drug addicts, parolees, or simply those down on their luck. There are two sides to the resident program (a singles side and a family side). Trude and I have the single resident students. We go to their community meetings each week and staff clinical office hours.
Our office was an old apartment that had a lot of broken down furniture, bags of old stuff, expired medical supplies and dirt. After we cleaned the place up, Trude managed to get an old exam table and now it looks like a little medical clinic office. We have a locked medicine cabinet with OTC medications, first aid supplies and health education materials.
TNT Tuesdays (Trude & Tam) opened with people getting their BP and blood glucose checked. We have smoking cessation materials, movie nights (coming up) and have set up free teeth cleaning appointments and mammograms. We're always looking for health related materials for our residents.
It's been one of those experiences that started out with a lot of cynicism on my part (lack of available resources, budget cuts) and we're having to reinvent the wheel. Trude's got her creative juices flowing and a sense of optimism to outweigh my cynicism, so we're pulling rabbits out of our hats when we can. When the staff has us speak at the meetings, they refer to us as the 'nurses'. We talk to the residents, counsel them, teach them. Taking a little bit of knowledge and applying it in a dignified manner, respecting each person where they are at. Once again, the patient is the best teacher.
The biggest challenge currently being faced at this site, is the potential closure of the entire program due to a long term, ongoing county budget crisis. We attend the community meetings and have witnessed the despair the VOA staff members are experiencing in trying to convey the latest news to the residents. There is a Board of Supervisors meeting this week. We're going to try and get to the meeting to support the residents.
Now, back to the county health primary care center. The building is relatively new and is easily accessed. What blew me away was how apathetic, rude and mean the staff at the bullet-proof glass windows were. The waiting rooms were empty and the staff looked like they would rather have a root canal rather then be at the window assisting patients. No wonder no one wants to access the county system for health care. What a sad indictment on government run health care. At least the veterans get better care at the VA, currently, the highest rated health care system in the country.
Fall semester is the back end of our nursing program. It essentially takes the entire nursing program and puts what we learned into action. We are put back into the community in public health settings, psychiatric inpatient and outpatient settings, management and preceptorship nursing practicum, essentially where the whole thing ends (the icing on the cake of nursing school).
I picked a community health site that appealed to my sense of stepping outside my comfort zone. It is a transitional homeless shelter program.
My psych clinical site is a locked 16 bed facility. Patients are voluntarily admitted, or admitted on legal holds. Some are on conservatorships. It is a whole different level of theory and clinical that is bent more on service and safety.
I deliberately stopped writing Tales during my pediatric rotation for many reasons. My stress levels increased significantly over the summer and came to a peak and I was simply too exhausted to write anymore. We had a bunch of busy work and it seemed I was treading water trying to stay ahead of all the projects, papers, research and clinical expectations. So I shut down on the one thing I always used to de-stress...writing. Instead, I stayed above ground and when I wasn't doing anything related to school, I slept. Seems like we took a running leap into this program, kinda like leaping off an endless abyss, and the fall at the end of it was hard. It took several weeks, plus a summer break to come out of it. Sheer exhaustion.
When I started pediatrics, I was going into a facility where my kids have been patients. Specifically, one of my kids was critically ill in this facility and walking the halls was all too familiar. I also had memories of helping a family who had roomed with us say goodbye their child and part of our helping them was being there when their daughter passed away and helping them with the funeral. I know the room that MJ died in. I had patients in the same room she shared with my daughter and where my daughter's PICC line was inserted. It was surreal, but being there as a nursing student was different. Significantly different.
As I mentioned in the previous post, I asked to be put with the sickest kids for a reason. I wanted the cancer kids, the CF kids, the heart kids and the dying kids. I definitely wanted a NICU and PICU experience. I got everything I asked for and then some.
As a nurse on the other side of the nurse's station, I saw the other side of the story. The family dynamics, the innocence of sick children along with the functionality of strong families, coupled with the weaknesses of the broken families.
My patients had leukemia, hypertrophic heart problems, cystic fibrosis, sickle cell crisis, post op complications, brain injuries, respiratory and renal failure. The babies I took care of were preemies and had a host of complications, namely they were too fragile and small to be cared for outside the clinical setting; one patient I cared for on a Saturday NICU rotation had been a patient her entire life, 13 months to be exact. She still has a long road until they she can grow up outside the hospital.
There were heartbreaking stories in the PICU of viral meningitis, heart/kidney/respiratory failure, Valley Fever...and bad prognoses. With one admission, I looked into the faces of the parents and I instantly saw people I knew. My daughter recovered. I knew that theirs wouldn't.
After my clinical final evaluation, my clinical instructor asked why I wanted a generalized preceptorship. She thought I should specialize. "You're good with the patients and their families, you connect with the kids and have the critical thinking skills"
The answer is simply this...if you could guarantee that I could work two years with critically ill kids...without falling apart after every shift, I would consider it. The challenge is to find the area of nursing that is most comfortable, where I can give without losing myself and or ability to function outside the clincial setting. Dying kids is a tough job for anyone. Pediatric nurses are special. I'm not so sure I could do this for too long.
When names are mentioned pertaining to either people who might be described as a classmate, nursing/clinical instructor, or a patient I've interacted with, no real names will be used in order to protect individual privacy.
Posts
