Today I was in the stabilization area of rehab and it was pretty cool for a couple reasons.
Background on the unit: After patients have completed their stay in detox, they are strongly encouraged to join an inpatient stabilization program. Many patients take this advice, however some choose other stabilization programs for various reasons (cost, closer to their home, etc). In this particular unit, patients stay for about 14 days and begin the AA or NA 12-step process. Their days are filled with a lot of different group sessions and activities to help them evaluate ways to change their life but in a group, or milieu, setting where they can bond with others and form social networks that will help in the long-term success of their recovery.
The first and primary reason it was awesome was that about four of the patients I had worked with previously in detox had now made their way over to stabilization. The most touching of these was the gentleman I had worked with a lot last week (giving meds, the TB injection, and general care). When I last saw him he was very groggy from all the detox medications and was not fully aware of his surroundings. This week he was much more alert and seemed to be responding well to group therapy. A sad part of his story is that as he came out of detox they realized he might have more severe memory loss than that which is expected with substance abuse, so he will be going to the gero psych unit later to be tested for dementia. Overall though it was really nice to sit in on a couple group therapy sessions and see just how much better everyone was looking than the last time I saw them.
The second reason it was awesome is that I had my first moment of realizing that even as a student, we have the power to effect institutional change. One of the sessions today covered the symptoms of acute alcohol and narcotic withdrawal. A majority of the patients in this session were not aware of the continued symptoms, such as hallucinations and tremors, and were greatly relieved to know that what they were experiencing was normal for their situation and not a sign of additional psychiatric problems. After openly confessing what they had experienced, many of them realized that they were not the only ones going through these symptoms as they had previously thought. My partner and I had a lengthy talk about how horrible it would be to not understand why or be told what to expect of your recovery until this late into the program (about a week after finishing detox). After talking it over with our clinical instructor, the both of us decided to create a simple document that either the nurses or the counselors can hand out to the patients during detox. This way they a) know what to expect and for how long and b) have a hard copy that they can reference since memory retention is a problem for recovering addicts. My partner and I will have to present this to the head of detox and what not, so its not official yet. However it's really cool to know that the two of us will be creating a document that has a very high chance of being used in a hospital for years and years, especially since it would be impacting a unit that has a lot of room for growth towards more therapeutic and positive patient care. And that's how we got published!
Until next week!
Thursday, April 22, 2010
Thursday, April 15, 2010
Driving That Train, High on Cocaine
Holy Cow. If you would have asked me a week ago if I would have ever considered a day working in detox "awesome" I would have laughed. Guffawed even.
I won't go too into detail as I've recounted this to many people already, but last weeks shift in detox was everything I don't want to be as a nurse. Sloppy unprofessional dress, combative language with every patient, and no interaction besides going into the room to give someone meds then leaving and returning to Farmville on facebook. Everyone hits burnout in their given profession at sometime, but I hope its never as bad as what I saw last week. Lordy.
However, today was a different set of nurses and that changed the atmosphere tremendously. Also, with a better concept of things I was able to do in detox I worked on being more vocal about things I could do, which helped so very much. The two main things I involved myself in were observing psychiatric assessments and administering medications.
What I love about psychiatric assessments is that it gives you a chance to really understand how someone became so involved in drugs and/or alcohol that they reached a point of dependency. It puts a face to notes like "drinks a fifth of vodka every day" or "has 29-36 beers a night" and humanizes addictions that can affect everyone and anyone. The assessment that struck the closest to home for me today was a young man who had spent a significant amount of time in the military and had been deployed to Iraq twice. His heavy drinking began when he entered the military and continued to get worse once he left for medical reasons and because of boredom from unemployment. None of his medical conditions were that surprising: PTSD, tinnitus from being to close to an explosion, anxiety and depression. The one that I thought was most interesting was that his chronic psoriasis, in his case tied directly to his stress levels, was only completely cleared up two times in his life: both of his tours in Iraq. He explained that while its stressful over there, and the cause of his PTSD, you don't have the same kind of stress like you do here (i.e. financial, relationships, etc). You have an assigned duty and you know where you are going to be and what you are going to be doing at all times. Anyways, I was most touched by this particular patient because of how young he was and because I am always fascinated by people who have life experiences that are so completely different from mine. I hope he is able to get his life back together and recover from his addiction.
To end on an exciting note, today was my first day EVER of administering medications!! I felt like a real nurse and am so in love with using the automated medication carts. Nothing beats flashing lights, popping drawers, and getting your fingerprint scanned! I also got to administer my first tuberculin skin test which was frightening and exciting at the same time. The patient had super thick skin which made the process difficult and extra scary, but in the end he had a bubble under his skin so my job was successful!
I am absolutely pooped now, and my time in detox is over. Next week I'll begin a two day stint in the stabilization aspect of recovery. Until next week!
I won't go too into detail as I've recounted this to many people already, but last weeks shift in detox was everything I don't want to be as a nurse. Sloppy unprofessional dress, combative language with every patient, and no interaction besides going into the room to give someone meds then leaving and returning to Farmville on facebook. Everyone hits burnout in their given profession at sometime, but I hope its never as bad as what I saw last week. Lordy.
However, today was a different set of nurses and that changed the atmosphere tremendously. Also, with a better concept of things I was able to do in detox I worked on being more vocal about things I could do, which helped so very much. The two main things I involved myself in were observing psychiatric assessments and administering medications.
What I love about psychiatric assessments is that it gives you a chance to really understand how someone became so involved in drugs and/or alcohol that they reached a point of dependency. It puts a face to notes like "drinks a fifth of vodka every day" or "has 29-36 beers a night" and humanizes addictions that can affect everyone and anyone. The assessment that struck the closest to home for me today was a young man who had spent a significant amount of time in the military and had been deployed to Iraq twice. His heavy drinking began when he entered the military and continued to get worse once he left for medical reasons and because of boredom from unemployment. None of his medical conditions were that surprising: PTSD, tinnitus from being to close to an explosion, anxiety and depression. The one that I thought was most interesting was that his chronic psoriasis, in his case tied directly to his stress levels, was only completely cleared up two times in his life: both of his tours in Iraq. He explained that while its stressful over there, and the cause of his PTSD, you don't have the same kind of stress like you do here (i.e. financial, relationships, etc). You have an assigned duty and you know where you are going to be and what you are going to be doing at all times. Anyways, I was most touched by this particular patient because of how young he was and because I am always fascinated by people who have life experiences that are so completely different from mine. I hope he is able to get his life back together and recover from his addiction.
To end on an exciting note, today was my first day EVER of administering medications!! I felt like a real nurse and am so in love with using the automated medication carts. Nothing beats flashing lights, popping drawers, and getting your fingerprint scanned! I also got to administer my first tuberculin skin test which was frightening and exciting at the same time. The patient had super thick skin which made the process difficult and extra scary, but in the end he had a bubble under his skin so my job was successful!
I am absolutely pooped now, and my time in detox is over. Next week I'll begin a two day stint in the stabilization aspect of recovery. Until next week!
Wednesday, April 14, 2010
It's okay if he bleeds, just use some toilet paper.
That was my advice as I prepared to shave my client's face today with a single blade disposable razor. I only needed two toilet paper squares, but in all honestly I probably didn't do the greatest job either as it is terrifying to shave someone's face with a blade so terribly crappy.
Today was my first day in the gerontological nursing setting. This term we have two clinical rotations, the other being in psychiatric nursing (Thursdays).
Moment of honesty: I have a strong aversion to working with elderly patients. It's nothing about them specifically, but its mostly because I don't like confronting the very real possibilities that occur as our bodies age. Luckily, medical research has made enormous strides in recent years that has shown us that a) significantly improved rehabilitation techniques following such events as falls and strokes and b) there is a ton of preventative medicine you yourself can engage in during your younger years to prevent diseases commonly associated with old age that don't need to be.
That being said, this term is my chance to begin assuaging my fears of aging and feeling more comfortable working with a population that will inevitably be in any aspect of medicine I choose to specialize in (I suppose with the exception of peds or maternity for obvious reasons).
My clinical site for gerontological nursing couldn't be more awesome: Pike's Place Market overlooking the sound. This not only enables some awesome window watching of ferries and barges floating by, but gives residents access to a plethora of walking adventures. The facility is very basic assisted living, so most of the patients are in relatively good health.
My morning started off with some basic wake-up prep work so that residents could make their way down to the cafe for breakfast (which is a popular meal among the elderly, nearly everyone I talked to said that breakfast was their favorite and that they've gained 20-30 pounds since moving in). During this wake-up prep work, I learned a couple of seemingly universal lessons:
And that concluded my first day in gero. I survived, some of my fears have been lessened, and I think it should be an interesting term at both clinical sites!
Today was my first day in the gerontological nursing setting. This term we have two clinical rotations, the other being in psychiatric nursing (Thursdays).
Moment of honesty: I have a strong aversion to working with elderly patients. It's nothing about them specifically, but its mostly because I don't like confronting the very real possibilities that occur as our bodies age. Luckily, medical research has made enormous strides in recent years that has shown us that a) significantly improved rehabilitation techniques following such events as falls and strokes and b) there is a ton of preventative medicine you yourself can engage in during your younger years to prevent diseases commonly associated with old age that don't need to be.
That being said, this term is my chance to begin assuaging my fears of aging and feeling more comfortable working with a population that will inevitably be in any aspect of medicine I choose to specialize in (I suppose with the exception of peds or maternity for obvious reasons).
My clinical site for gerontological nursing couldn't be more awesome: Pike's Place Market overlooking the sound. This not only enables some awesome window watching of ferries and barges floating by, but gives residents access to a plethora of walking adventures. The facility is very basic assisted living, so most of the patients are in relatively good health.
My morning started off with some basic wake-up prep work so that residents could make their way down to the cafe for breakfast (which is a popular meal among the elderly, nearly everyone I talked to said that breakfast was their favorite and that they've gained 20-30 pounds since moving in). During this wake-up prep work, I learned a couple of seemingly universal lessons:
- TED hose, or compression stockings, are terrifying to put on anybody but especially the delicate skin of the elderly. Especially if they are yelling at you that you don't know what you are doing and to get the regular nurse before you rip their skin off
- Some patients are very comfortable with their nakedness. One of the patients was just hanging out in his chair, free as you please and not a care in the world. Part of his care plan was to put lotion on his back because of dry skin and the other student nurse I worked with teased me because I lotioned him up before even putting his pants on. What a treat that must have been for him.
And that concluded my first day in gero. I survived, some of my fears have been lessened, and I think it should be an interesting term at both clinical sites!
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