You are currently browsing the monthly archive for April 2007.

Scott Adams has made a couple posts regarding copyright infringement on his Dilbert Blog, and I took the opportunity to share my helpful analogy with him by way of a comment.

My understanding is he reviews all the comments before they appear, so I have no idea if he’ll accept my post or not. I basically pulled the analogy out of my post on the same topic and sent it off.

On a related note, I find it annoying to be forced to supply an email address to leave a comment. I don’t want people emailing me. I don’t like leaving my email address laying around. But I thought he was missing the mark (so to speak) in his analogy, and wanted to put my 2 cents in so badly I posted even with that silly restriction.

Demon stirring pot

I’m in the midst of my Peds rotation. I’m not really all warm and fuzzy about it.

The dosing for a medication is fraught with stress, as any mistakes are even more important to avoid in the smaller pediatric patients who can’t bounce back as the adults can. There are more mechanical skills to learn having to do with the special infusion pumps and associated IV lines that I’ll need to practice with.

Patient A:
The patient was a 15 year old with a surgical wound infection. No one realized it when he arrived, as there was only some redness and swelling at the site. But we had a little surprise when he sat up in bed to eat breakfast and the incision popped open.

Draining the wound was probably the single most disgusting thing I’ve ever witnessed. The doc came by to do it, and asked for some instruments. He then followed the nurse and me out of the room and asked for a mask because the smell was making him nauseous. I then watched as he pressed and squeezed the area around the incision like a giant pimple to push out all the infected nastiness. He even inserted a couple fingers (one at a time) to pop any pockets and abscesses to completely drain the fluid. The patient was flopping and whimpering even with a couple of doses of morphine. That had to be uncomfortable.

I should note that the patient’s family was in the room. Mom was literally leaning in over the Dr’s hands trying to see inside the kids’ wound. Dad was watching from further back, eating the forgotten remains of the kids’ breakfast. No joke, I looked over to see him cram an entire muffin in his mouth. I thought I would end up doing a Heimlich maneuver to clear the resulting obstruction, but he somehow was able to swallow the gob. It probably broke up from the orange juice he was downing.

The patient felt better over the next several hours, and was relatively pain free by the time lunch came around. This was a bit eerie, as the kids’ mom was feeding him. Feeding a 15 year old. His arms and hands were fine, but she was feeding him regardless. I understand reverting to earlier behavior is a way some people deal with the stress of hospitalization and illness, but I still found it a bit creepy.

Patient B:
I had visited the hospital the day before, to get information on my patient for the next day. I was totally bummed. I was dreading going in the next day, as I had a little 7 year old with cancer. I wasn’t familiar with the type, so it wasn’t until I did some research that I found out she wasn’t necessarily terminal, which was an enormous relief. How could I possibly spend all day around a first grader that wouldn’t see second grade? What do you talk about beyond the next day or week?

In reality, she was a sweet thing, and very charming. I was able to get her to giggle and smile throughout the day, and I congratulated myself a lot for this accomplishment. I was even able to arrange for the pet therapy dog to come by for a visit when I found out she liked dogs.

My nurse yesterday was a little tense, but took time to teach and show me things instead of just running about her business. I felt like I learned several useful tips and skills during the day. I was more comfortable with the medication calculations, and even did well when my nurse quizzed me on some flow rates for IV.

The day ended less than spectacularly, however, when I went over my paperwork from the previous week with my instructor. I had turned it in late, because I’m an idiot. Seriously, I have no real excuse other than I forgot to do it by Thursday morning. She sent a general email out on Friday about something else, and BING! the little alarm went off. I emailed her about the delay and was able to sit down and send it off Sunday morning.

So, the next day she went over it with me, and wasn’t very happy. She wrote me up for being late on the assignment. Here, sign this, a copy will be sent to your advisor and the dean. I made it very clear I was at fault and didn’t hold her responsible for me not turning the assignment in on time. I also made it very clear that finding out that I would be written up for being late only after it happened was very frustrating.

I’m still thinking about sending an email off to the department about it. Especially since I learned another student was also late (not as late as me, granted) but didn’t get written up.

Rodin’s Thinker

Recently my class and I have been discussing Critical Thinking. It’s now a portion of the curriculum for nursing students. This is interesting, because there are several theories about what it is and how exactly to nurture it in someone. Is it an innate skill only? Can it be taught? Many people are sure their answer is correct, and everyone else has been helping themselves to the happy pills.

Critical thinking, when considered in the most general context, is really about making good decisions. Assimilating all the available information, bringing known rules to bear, pattern recognition, as well as intuition all play a part in this skill.

We are but lowly peon nursing students, with not-quite-idealistic but still limited practical experience. It’s like that famous ruling on pornography in the late 80s “I can’t define what it is, but I know it when I see it” (or something like that, I’m paraphrasing from memory because it scares me to think about trying to do a search involving the word ‘pornography’). Likewise, we can sense when nurses we’re working with and around are good at the cogitating portion of their work. They look, perform some mental gymnastics, and are able to execute the preferred path seamlessly.

Then there are those which simply stop and can’t seem to get past the fact that they have a decision to make. They perceive it should be something they’re responsible for, and have a vague thought that they should resolve it, but don’t seem to make the connection regarding their involvement.

Unfortunately, these seem to make up a noticeable portion of the nurses. No numbers, as we’ve not done any type of investigation, but it “feels like a lot”.

How can it not be important to be able to make a decision and move forward? The consensus we’ve arrived at is it simply was not taught until recently. Curriculum is constantly changing and re-focusing on new areas. Fads come and go.

But wouldn’t you pick it up along the way? How is it that this percentage of nurses still exists in the real world? Thankfully they aren’t the majority. Most nurses can make a decision or take a direction when the need exists. But it just seems odd that Darwinism hasn’t removed those who aren’t cutting it. From another perspective, maybe it’s the units we’re spending time on. We aren’t in the ED with split-second timing necessary consistently. Important choices need to be made on a typical Med/Surg unit, but there’s a bit more grace period. Perhaps the temperament of the nurse dictates the area to such a degree that this critical thinking facility is a major component of “fit” for where someone is likely to work comfortably.

It’s hard to feel good about your fellow countrymen (and women) when they go and do stuff like this.

Probably the editing is deliberately skewed, but still. Can we maybe collectively put down the XBox controls and read a newspaper or something?

Tired bear

First clinical day on my Pediatric rotation.

Up at 5am, off to bed now (11pm).

Change of Shift banner

My hero, Kim, is hosting this edition on Emergiblog.

I haven’t read it yet, but I’m looking forward to getting some quality time with my laptop to peruse the latest offerings.