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Short week this week!  We did have a simulation on Monday evening, as well as our Bridging class got moved to Monday afternoon.  Then we had regular theory lecture Tuesday and Wednesday.  But, since it's midterm evaluation week, we had no clinical on Thursday or Friday!  Sleep, lovely sleep!  I did spend all of Thursday doing our taxes, which shows you just how much fun *I* know how to have...

Our Bridging class, which I've only rarely mentioned, is pretty relaxed.  Mostly, we have some assigned readings, a couple of written assignments, and a couple of computerized exams at the end, along with 64 hours of clinical at the end of the semester.  Lecture topics are based on issues that are important in terms of career development and adapting to the role of 'nurse' in a professional setting.  Topics so far have included this concept of role-adaptation (many new nurses go through a fairly predictable course of adaptation in the years after graduation); leadership; conflict resolution; teamwork; etc...  This past week, one of the other nursing instructors who is also a legal expert talked to us about Ethics.  It was well-timed, in light of the recent California nursing home death.  (If you've somehow missed hearing about this, an independent-living resident of a multi-level-care facility collapsed in a dining area.  A recording of the 911 call, in which a person who claims to be a nurse refuses to give CPR because of 'agency policy,' has circulated the media this week.)  Our class was held on Monday, and the event had just occurred over the weekend, so few details had been published yet.  However, it was a good example of the type of ethical difficulty [ie: when two needs are in direct, unresolvable conflict with each other] a nurse may be required to face--violate policy and potentially lose her job vs. try to save someone's life.  (Personally, I feel like this one is a little more clear-cut than other ethical dilemmas might be.  As one of the Emergency Department nurses told me, "If you're ever asking yourself 'should I be doing CPR right now?' the answer is 'yes.  Do CPR.'")

Our simulation this week was based on Management and Delegation, but the structure of it was a little strange.  First, normally 2 groups of 6 do their simulations at the same time.  Within each group, one student is assigned to be the 'primary' RN, one the 'secondary' RN, and one the Charge nurse.  One person is a 'family member' (and has a script), and the remaining 2 are observers who help the group critique their process at the end.  It's stressful being one of the nurses, but no one is graded on the simulation (just on the written prep work we have to do).  For this simulation, they chose one group to actually perform and the entire other group observed, along with the observers from the performing group!  We'll switch groups for our last simulation.  My group was the observing group, so we just had to watch!  The nurses in the performing group had 2 patients, one of whom seemed to be the 'higher priority' at first--abnormal labs, various other issues.  But in the middle of the time, the other patient became distressed and also needed attention.  The 3 nurses had to figure out what to do and when to do it.  Ultimately, it was more an exercise in prioritization than delegation (for example, there were no 'nurse aides' to whom some tasks could be delegated).

In our Theory class, we continued learning about blood disorders (anemia, leukemias, and lymphomas) and then did a short unit on oncology (focusing mostly on breast cancer as a general exemplar).  I also learned that I'll be assigned to the oncology floor for our final rotation.  I was hoping for this--I think it's an area where I'd like to work--but I'm nervous about it at the same time.  I'm well aware that there could be patients on this floor whose situation is very similar to my mother's.  This could be hard for me to cope with, but also (and I think this will be harder) difficult to tread the line between hope and realism.  I've accepted the fact that my mother's death was medically inevitable, but I think it's better that she never knew that until the very end (the last few days of her life).  I'm not talking about deception--all of the scans and tests that the doctor ordered just didn't show how far the cancer had spread until the final, revealing, liver biopsy.  So, I expect this floor to bring some new challenges!   

Date: 2013-03-14 11:28 pm (UTC)
From: [identity profile] lytnmyiz.livejournal.com
Obviously outright lying is not okay, but I wouldn't feel guilty about the hope part. With the roller coaster my dad and our family rode off and on for about four years, the doctors commented about how his attitude in regards to not giving up helped keep him from unknowingly self-sabotaging. Sort of a "help me, help you" effect that enabled him to communicate better, keep a level head about his options, and allowed him to be considered as a candidate for some of the more advanced procedures and methods. For a guy who wasn't supposed to make it through the night back in 2001 when one hospital mistook the two liver tumors nobody realized he had - and one of which had apparently burst - for kidney stones until they realized he was in liver failure, I wouldn't trade those four bonus years I got with him for anything.

Just remind your patients that predicting reality is no more definitive than predicting the weather. It might sound cliche, but it's sort of true. Extremely intelligent people do the best with the information they have and they will keep striving to gain more, but things change and at the end of the day, nobody knows for sure what will end up being 'real'.

Date: 2013-03-23 02:47 am (UTC)
From: [identity profile] pantshead.livejournal.com
Thanks, Kris! I think my mother's approach was similar to your father's, and it helped her stay focused and believe that she could keep making progress. Granted, she never had a middle-of-the-night "might not make it 'til morning" crisis--that would be very scary but also possibly energizing at the same time.

Another thing I saw last week (this week is Spring Break) is that it's just easier to be positive. I had a patient with extensive bone-weakening due to an advanced cancer. The patient could barely walk after many days of bedrest. But it's easier to stay focused on the future and say "before you start walking at home, make sure your spouse or an aide has moved any throw rugs out of the way so your walker doesn't get hung up." At first the patient was like "I can barely walk one step right now!" but eventually began to embrace the idea that s/he really was working towards walking, and that his/her current situation wasn't necessarily predictive of the whole future.

Date: 2013-03-26 04:18 pm (UTC)
From: [identity profile] lytnmyiz.livejournal.com
That's a fantastic example! The older we get and the more we encounter, the more situations we end up relating to and sympathizing with. Any department is bound to have its hard days, but I'm pretty confident that you'll be fantastic in whichever one you choose. If something hits a little too close to home with your mom, just remember that the cancer was not her. The cancer was just a blip on the screen in the timeline of her life and accomplishments. The compassion you have though is definitely an asset. If there were ever a situation where I'd want to feel like I wasn't just a number in a huge world, it'd probably involve the vulnerability of needing medical care.

Date: 2013-04-01 01:54 am (UTC)
From: [identity profile] pantshead.livejournal.com
"If there were ever a situation where I'd want to feel like I wasn't just a number in a huge world, it'd probably involve the vulnerability of needing medical care."

This, definitely! And thanks for the encouragement and kind words!


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