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PICU Reflection September 3, 2007

Posted by danucube in Nursing, Nursing School, reflections.
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Here is a short reflection paper I did for my one-day PICU observation. Hopefully this will give more of a sense what my summer was like.


What I like about the PICU is the low nurse-patient ratio. It gives one time to really focus on a patient and his/her family. It also gives one time to connect with the patients and their families, which is always important to me. I do not like environments like the ED or OR where I have very little opportunities to know my patients and their families. However, this environment comes with a price, a heavy price where the patients have multiple drips coming out and many tasks and assessments being done to the patient throughout the shift. It is an environment where one is acutely aware that the patient’s well being is literally in your hands and one has an extremely heavy responsibility as a result. It is an environment where things can get bad really fast due to the severity of the medical conditions and the fact that it is a pediatric population where things can get bad or good at lighting speed.

It is an environment where one sees the best and the worst in a family. From my extremely limited brush with the PICU, I had the privilege of working with my patient’s mother who literally knows everything about how to take care of her son. I admire her steadfast, loyal, and faithful commitment to her son. Across the other side of the room where my patient is, I have a family with a developmental delayed child who had multiple seizures. Despite the medical condition, the child has a smile that lights up the whole room. It is a smile that renews all of us who see more suffering than most people see in a lifetime. It is a smile that lightens the silent sorrows in our hearts. And her parents, it is quite obvious, that they do not see her developmental delay because they only see her smiles.

Although PICU is not my cup of tea, I am glad to have the opportunity to experience it for a brief time with great nurses, amazing patients, and their loyal and loving parents who demonstrate the best of humanity in an unbelievable stressful environment.


I survived maternity and peds!!!!!!!!!!!!!!!! September 3, 2007

Posted by danucube in Nursing, Nursing School, Providence.
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I survived maternity and peds!!!!!!!!!!! Actually it was not as bad as I thought. Before I would not touch it with a 1000 ft pole… now I just woldn’t touch it with a 100 ft pole.

It has been a tough summer session in nursing school. We took 6
classes at breakneck summer speed which is a bit on the ridiculous
side. What really helped was that we had excellent professors. In
maternity-pediatric theory, I got one of the lowest grade in class, a
B. Lots of people got As since they really like these topics. I am
really happy with a B, a happy B given that I have no intuitive feel
for these subjects.

Hard to describe this summer. So what I’ll do is to give some
snapshots of different scenarios (some are funny).

The following are just snapshots or short stories to give you a taste
of the summer:

* This is the story we heard during our clinical conference at the end
of a clinical day. In pediatrics, one of my classmates had one patient
who is around 4 or 5 years old who just had surgery. Well anyway, she
was suppose to try to get the kid to walk as soon as possible to
prevent postop complications. She tried and tried and tried, the kid
just refuse to walk (the kid got all the pain meds already and so it
was not due to pain). Even her RN tried and the RN could not get the
kid to walk. Anyway, she tried for more than 2 hours and finally
decided to get our clinical instructor. Our clinical instructor went
into the room, talked to the kid for about 2 minutes and went, “Hey!
You want to go to the play room!?” The kid went, “Ok!” and got off
the bed and walked to the playroom with the instructor. My classmate
was REALLY upset now because she tried for 2 hours and all she got was
frustration and our clinical instructor tried for 2 minutes and got
the kid to walk!

This frustration did not stop though. In the playroom, the kid
continue to refuse to do anything my classmate was trying to get him
to do. So our instructor got myself and another male classmate to
play with the kid . We went to the play room, had no problem with the
kid and started to play with the kid. Now our other classmate was
steamed! Again because she tried so hard with no results and here two
guys walked in and immediately have no problems whatsoever with HER
patient (by the way, both of us are nervous about pediatrics and she
knows it; here are two guys who are supposed to be not very good with
kids are having no problem with HER patient). Anyway during
conference, we found out that the instructor took an educated guess
base on her experience that the kid might like a male adult instead of
a female adult better; so she got the guys in the clinical to interact
with the kid and she was right. Anyway, our other classmate now try
to avoid kids at that age range like me trying to avoid maternity. She
said at one point during conference something to the effect, “Give me new borns and toddlers,
I have control over them. Don’t give me these kids at the higher age
range because they run over me, they manipulate me, they mess with me,
and they control me…”

* During one of our conference, we somehow got into a discussion of
what procedure we like to do. Our clinical instructor chimed in and
said that she likes to start IVs. Another classmate went she likes to
give shots (she is really good at it). Then one of the classmates
went, “I like depository.” Silence… for about 2 seconds… half the
clinical group ended up on the ground… laughing…. Noticing there
is still half the clinical group not on the ground, this classmate of
ours went again, “Oh no, I don’t mean I like to receive them, I mean I
like to give them.” Well… now everyone is on the ground…
laughing…. finally… our clinical instructor got her composure back
and went, “are you the class clown?” Well, she may not be the class
clown, but she is real funny sometimes.

* In the postpartum ward, the first day I was already lost. I had to
get out to get something and went out the wrong door… all the alarms
went off… ooops!… it did have this huge sign saying something like
don’t go through this or else alarm will sound. My instructor said
she was surprised I am still alive… but according to her… every
semester… someone will go through that door… I got the record of
doing it so early in the semester… oh… by the way… it was always
a guy who went through the door so far.

* One of the things I get to do in a new born nursery (beside giving
shots, administering eye med which is hard, giving the new born a
bath, setting things up, assessing,… etc) is to get a foot print of
the new born (like getting finger prints). Anyway I got the baby’s
foot print and it did not come out good. Well, it looked like the baby
had 20 toes and the baby had only 10 (I counted, ten). Anyway, the two
nurses in the nursery took one look at the foot print… acted very
professionally and did not laugh at all… for about 5 seconds… and
then they lost it and could not stop laughing.

* The classmate I carpooled with had not slept for 2 days. As we were
going to clinical early in the morning, she was nodding off. Well, I
was not exactly awake either since I am not a morning person. Anyway,
the exit was coming up and I was like 3 or 4 lanes over still and
showed no sign of turning into the exit. All of a sudden she noticed
and she woke up really fast, panic, yelled on top of her lungs, “Exit!
Exit! Turn! Exit!” Well, that woke me up and I cut across (luckily it
was really early in the morning and that was really no cars) and made
it. My classmate now was wide awake … for about 10 minutes. During
conference at the end of the day, she was extremely agreeable as she
nod her head to everything everybody said… with her eyes closed.

* The pediatric clinical instructor let us start a 1/2 hour later than
usual because she notice all of us are burning out due to lack of
sleep. Well, the classmate I carpooled with and I forgot all about it
and we got there like an hour early that day (5:30am instead of
6:30am). We were wondering where everyone was. Then it dawned on us
and I almost got killed by her because I was the one who got to her
house, woke her up, her husband, and her kids by ringing the doorbell
early in the morning where it was pitch black outside. Then when the
instructor came in and said, “Isn’t it nice that we get to start later
in the morning?” Everybody agreed except the two of us. My classmate
whom I carpooled with looked at me with a look that could kill…
nursing school can be down right dangerous sometimes…

* First day in pediatric clinical… real bad day for our clinical
instructor; with me leading off in giving her a bad day. I was giving
some liquid med in a syring (we squirt the med into the kids mouth) to
my patient who screamed and yelled on top of his lung… his mom
looked totally flustered, and my instructor manage to open my patient
mouth for a moment and I went straight in and squirt… or rather try
to squirt… the liquid med is really thick and I was having problem
squirting it into the kids mouth… my instructor asked me to just push the plunger hard.
So I push the plunger really hard and the medicine finally went into the my patient mouth (remember my
instructor is holding the kid’s mouth open)… well… the medication… well… half the medication went into the kid’s mouth… the other half… because I pushed it too hard… it went into the
kids mouth and out came the meds out of the kid’s mouth and splashing
it on my instructor’s face. My instructor’s face was all red… I
don’t know if it was because the medication is red or because she was
totally flustered with a student who did exactly what she said to
do… the joy of teaching nursing students… you never know what will
happen… even when they do exactly what you told them to do…

Anyway, with me leading off in giving her a bad day… she then
proceed to lose some money… then she could not get into the medicine
dispenser and a new person who was trying to help wiped the finger
print scanner with alcohol (big no-no) and the whole machine stopped
working and nobody can get any medication and had to call the service

The joy of teaching nursing clinical…

* In pediatrics, one of my very small patient wet his diaper and I
changed the diaper and went outside to find a scale. I found a large
scale and rolled the scale into the patient’s room so I can weigh the
diaper with the urine in it. My nurse gave me this really weird look
and finally asked me what I was doing. I told her I am going to weigh
the wet diaper on the scale. She wiped off a smirk real fast and told
me I got the wrong scale. The scale I got is for weighing the infants,
not diapers. She showed me in another hallway where there are these
small scales to weigh the diapers. I told my clinical instructor what
happened and her response was that I was not the first student who
done that. Come to think of it, as she was reflecting, according to
her experience, all her students who made the same mistake as I did
were all guys! She concluded that it must be a “guy” thing.

* I was with a teenage mother who has some serious medical problem
plus some serious psychosocial issue. After she found out that Child
Protective Services is going to take away her new born, she started to
cry. That is just great… her medical condition requires her to be
calm… and now I am assessing her and watching her like a hawk. I did
not say much or do much except listen. Then she blurted out that she
has not even name her baby yet… I picked up on that and asked her to
write what name she wants her baby to have and sign it. Afterwards, I
gave the signed paper to my nurse. My nurse looked at it and went
away, telling me that she can’t guarantee anything, but she’ll try to
do something. About an hour later, someone from the birth registry
came and asked my patient what the name of the new born child should
be. That was very meaningful to me because I advocated for her as her
nursing student (that is what we were taught to do, advocate for your
patient) and her nurse took time out and fought for her patient so she
can name her child (her nurse is very busy, despite her lack of time,
she advocated for her patient).

* I had to do this procedure on this kid. Well,
I waited for my clinical instructor to do it with me. There were a
long line of other classmates who were waiting for my clinical
instructor also. Well… things did not go well at all…

What happened was that I got this huge syringe and some meds for the
kid. Set everything up, and I dropped the meds on the floor. And we
had to go through the whole process to get the meds again from the
machine. The machine would not let us get the med and we were having
problem overriding the machine. Did I mention that there was a long
line of my classmate waiting for my clinical instructor? Finally we
got someone to override it. My instructor told me not to drop the
medicine… what gave her that funny idea?

Anyway we started this procedure with this huge syringe… it was not
going well… the dad who was helping went, “Bro, I think your syringe
is leaking.” Oh yea… did I tell you now the dad call me “Bro”… as
we finally had a connection after some rocky start. Back to the
syringe… yep… the syringe was leaking… of all the syringe I
picked, I picked the one that leaked… now we needed a new syringe
and had to refill the syringe again… did I mention that there was a
long line of my classmates who were waiting for my clinical
instructor? They are going to kill me. My instructor went out real
quick and got everything… like a syringe that does not leak…
finally the procedure is over… just a bad day… except I was the
only one the dad called “bro” as far as I know.

* Since I did really well with a mother who had some mental health related
issues in labor and delivery, my clinical instructor asked me if I
want another labor and delivery rotation. I immediately went, “No!”
She then asked me if I would be interested if she can find a mother
with some kind of mental health issue. I paused… and gave a soft…
“ok…” Afterwards, I can’t believe I took the bait!!!!!!

* Talking about PICU, one of my classmate who is also sponsored by the
same hospital as I am was interested in neonatal. She was thinking if
she can’t get neonatal, maybe pediatricas would be nice, maybe
something in PICU. I warned her that in our sponsoring hospital, PICU
is not Pediatrics Intensive Care Unit… it is Psychiatric Intensive
Care Unit. Don’t want her to have the surprise of her life if she
applied to PICU and got in and ended up seeing me working there and
wondering why I am in a pediatric unit and why the unit is locked.

* During one of my vaginal labor and delivery rotation, one of the
nurse was stationed in the corner of the room ready to receive the
baby and help do the assessment immediately and any suctioning. She
was very funny because she refused to look at the mother who was going
through labor because she said that if she looks, she’ll never never
never going to have any kids.

Well, hope you have a good taste of what happened during summer.
Fall started already. It basically is going to be community health
nursing plus preceptorship (I got into acute psychiatric nursing).

Taking 5 classes this semester and to my surprise again… two of my professors are psych nurses. I am always surprised since psych nursing is not exactly popular as it too has its own stigma associated with it. So far, I had 6 professors who are psych nurses, one TA who is also a psych nurse, and my preceptor and my hospital manager are also psych nurses. Educational levels of these psych nurses ranged from a BSN to Master degrees, to doctorate degrees,quite diverse. I am just amazed how God leads.

God is full of surprises because two of my most meaningful clinical days (up to this point) are in the maternity rotation where I played a significant role in taking care of the mothers… mothers who have some serious mental health issues… mothers who many people would rather not have anything to deal with if they have a choice.  And no, I am not going into maternity… I am staying with psych.