I've had enough days off between work days to not dread going to work. Actually, I rarely dread going . . . some days I even look forward to the change in routine. The routine is a bit different every day, so it's nice to have that variety.
There wasn't a nurse Saturday or last night, so SL was extra "funky-no-bath" smelling when I got there. UGH. I think I get her cleaner when I give her a bedbath--I can get to all of her "parts," including her back, much better than I can in the shower. But her mom really likes her to have a shower, so today I gave her one.
She has a custom-built shower chair, and we use a lift to transfer her from her bed to the shower. She's a tall girl, so it's tricky to get her from the bed to the shower without bumping her head or feet on something. Today I was thinking thru the process and realized that if I turned the shower chair the other way, I would not have to turn SL completely around between her bed and the shower, and again on the way back to her bed.
I got her undressed completely and got the sling positioned under her in bed. I took a few minutes to make sure everything was set up in the bathroom, and then transfered her to the shower chair. The shower went OK . . .but my legs got soaked! I'm not the most graceful person in the world when it comes to water . . .
I did SL's trach and g-tube care while she was in the shower; it was nice to do it in the bathroom where all the supplies are located. I enjoy doing those technical tasks; it makes me really feel like I'm using my nursing education.
When I went to put pads and a towel on the bed before I took SL back to bed, I discovered that in the time she'd been on the sling and before I took her to the tub, she'd urinated a LOT--and I had to do a quick linen change. ARGH! Monday.
SL did NOT like her shower . . . and it took longer than giving her a bedbath and washing her hair in bed . . . plus I had to wash her back and bottom when I got her back in bed, to complete the bath. I know it's important to her mom . . . so I'll continue to do it, at least once in awhile!
Private Duty/Home Health nursing is different than acute care nursing in that family preferences and routine dictate OUR routine much more than they do in the hospital. This can be good . . . or bad! Most of the parents are extremely knowledgeable about their child's illness or condition and medications and treatments. All the parents I've met in doing private duty/home health nursing have had at least one quirk relating to the care of their child . . . but then again, ALL of us have quirks when dealing with our children! The majority of the parents have been easy to work around, at least for me.
Part of what I love about private duty/home health (from now on known as PD/HH) nursing IS the usually relaxed pace of only having one patient. Even if the patient has multiple medications and treatments, and/or needs constant supervision . . . the nurse can do everything without that feeling of having three more patients down the hall waiting for their own medication/treatment/cares, etc.
Time to check my other patient . . . my son! More about him tomorrow.
Monday, June 16, 2008
Friday, June 13, 2008
Trip to the Doctor, Four Hours; Time in the Doctor's Office, Five Minutes
Her mom and I took SL to see her pulmonologist for a routine visit. He's in a large town about 100 miles away. The drive was two hours--each way. We sat in the waiting room less than 3 minutes (literally; I timed it!). The nurse got her vitals, and we sat in the exam room long enough for me to start her charting (I'd done her assessment and vitals before we left).
The Pulmonologist came in, took a cursory look at the chart (he'd seen her one other time, about a year ago), and asked me if she'd been coughing. I replied that she hadn't been coughing much, her secretions were think and white, and her SpO2's had been in the 94-96% range.
He took out his stethescope and listened to her chest . . . in exactly two places. OVER her shirt. He made the brilliant observation that, "Her color looks good!" said to make no changes and come back in a year.
I think SL's respiratory status has been very good, but wouldn't you think a specialist would want to do a more thorough exam?
Oh well. It made for a quick day at work and I think SL enjoyed the change in routine.
The Pulmonologist came in, took a cursory look at the chart (he'd seen her one other time, about a year ago), and asked me if she'd been coughing. I replied that she hadn't been coughing much, her secretions were think and white, and her SpO2's had been in the 94-96% range.
He took out his stethescope and listened to her chest . . . in exactly two places. OVER her shirt. He made the brilliant observation that, "Her color looks good!" said to make no changes and come back in a year.
I think SL's respiratory status has been very good, but wouldn't you think a specialist would want to do a more thorough exam?
Oh well. It made for a quick day at work and I think SL enjoyed the change in routine.
Wednesday, June 11, 2008
Charting on Sick Kids
Teenage Son (from here on out known as "TS") was still having abdominal pain yesterday. I called the doctor's office and left a message with the receptionist, describing his symptoms. (sidenote: I really like my doctor . . . but after going to several of my patient's doctors with her, I like his office less and less. SL gets into the exam room within MINUTES of walking in the door, and so do any other patients sitting there. It routinely takes more than 30 minutes to get into the exam room at my doctor's office, even if the appointment was set up far in advance.)
The nurse called back within an hour (another complaint; usually it's at least 2-3 hrs. before they call back), saying the doctor wanted to see TS for an office visit.
TS was very unhappy to have to go to the doctor; he's generally very healthy so not used to going. To make matters worse, the visit began with a blood draw. He HATES needles (which is much better in my mind than LIKING them!), but didn't want to hold my hand, or even have me near the table he was lying on when the blood was drawn. He DID, however, have his cell phone in a death grip . . . I guess somehow that helped him feel connected to and comforted by his girlfriend and other friends, who he'd been texting throughout the visit (when the doctor and nurse were not in the room, of course).
A few minutes after the blood was drawn, the doctor came in to examine TS. His tentative diagnosis leaned toward mono; his bowel sounds were normal, his WBC count was not up, and the location of the pain wasn't typical of that for appendicitis, although the doctor did say that often the appendix was in an atypical position, producing atypical pain. The doctor did a throat swab also, saying he'd had several cases of kids presenting with both mono and strep. YIKES!
A few minutes later the doctor was back with the diagnosis of mono; the pain was from his liver and spleen being enlarged and inflamed. The doctor talked about the importance of rest and avoiding any type of contact sport, like sledding (potential of running into a tree, but humorous as it's been 80+ degrees and any potential snow is months away!), belly flop contests, and bull riding. I appreciated that the doctor took the time to talk directly to my son, and answer any and all of our questions.
The strep test came back negative, but the rapid tests often give false negatives, so it's been sent to a lab. TS's throat isn't sore today, so I don't think strep is part of this illness.
Before the doctor left the room he said that he wanted to check liver enzymes, too. TS made a face at the prospect of another blood draw, but the doctor said that his nurses were used to him ordering additional tests after examining the patient, so they always drew extra blood right away--smart nurses! I was impressed.
The enzymes were up, so son is now on a decreasing dose of steroids. The instructions were not complicated--three tablets a day for three days, two tablets a day for three days, and so on . . . but I can't keep track of meds that have to be taken more than once a day, not to mention keeping track of how many days I've taken how many meds . . . so I made a medication chart. TS asked a very pertinent question; "Do I have to take them an equal number of hours apart, through the night, or just while I'm awake?"
TS has been happy to take it easy today. I think, however, in a few days he'll be itching to get back to his normal active routine! I'm thankful it wasn't something serious, or appendicitis . . . although TS did point out that if it would have been, he'd have been "better" much quicker.
The nurse called back within an hour (another complaint; usually it's at least 2-3 hrs. before they call back), saying the doctor wanted to see TS for an office visit.
TS was very unhappy to have to go to the doctor; he's generally very healthy so not used to going. To make matters worse, the visit began with a blood draw. He HATES needles (which is much better in my mind than LIKING them!), but didn't want to hold my hand, or even have me near the table he was lying on when the blood was drawn. He DID, however, have his cell phone in a death grip . . . I guess somehow that helped him feel connected to and comforted by his girlfriend and other friends, who he'd been texting throughout the visit (when the doctor and nurse were not in the room, of course).
A few minutes after the blood was drawn, the doctor came in to examine TS. His tentative diagnosis leaned toward mono; his bowel sounds were normal, his WBC count was not up, and the location of the pain wasn't typical of that for appendicitis, although the doctor did say that often the appendix was in an atypical position, producing atypical pain. The doctor did a throat swab also, saying he'd had several cases of kids presenting with both mono and strep. YIKES!
A few minutes later the doctor was back with the diagnosis of mono; the pain was from his liver and spleen being enlarged and inflamed. The doctor talked about the importance of rest and avoiding any type of contact sport, like sledding (potential of running into a tree, but humorous as it's been 80+ degrees and any potential snow is months away!), belly flop contests, and bull riding. I appreciated that the doctor took the time to talk directly to my son, and answer any and all of our questions.
The strep test came back negative, but the rapid tests often give false negatives, so it's been sent to a lab. TS's throat isn't sore today, so I don't think strep is part of this illness.
Before the doctor left the room he said that he wanted to check liver enzymes, too. TS made a face at the prospect of another blood draw, but the doctor said that his nurses were used to him ordering additional tests after examining the patient, so they always drew extra blood right away--smart nurses! I was impressed.
The enzymes were up, so son is now on a decreasing dose of steroids. The instructions were not complicated--three tablets a day for three days, two tablets a day for three days, and so on . . . but I can't keep track of meds that have to be taken more than once a day, not to mention keeping track of how many days I've taken how many meds . . . so I made a medication chart. TS asked a very pertinent question; "Do I have to take them an equal number of hours apart, through the night, or just while I'm awake?"
TS has been happy to take it easy today. I think, however, in a few days he'll be itching to get back to his normal active routine! I'm thankful it wasn't something serious, or appendicitis . . . although TS did point out that if it would have been, he'd have been "better" much quicker.
Monday, June 9, 2008
Mondays
I work every Monday. I don't mind working every Monday; in fact, it gets the week off to a productive start. What does bother me is what goes on--or does not go on--with my patient all weekend when there are no nurses there.
It's certainly not abuse, and couldn't be defined as neglect, either. It's just that SL is not getting as good of care as she should. When I get there Monday morning her lips are coated with "gunk". Her limbs are tight; I don't think her mom does range-of-motion all weekend. Her mom doesn't get her up in her wheelchair all weekend, after having wrist surgery--more than a year ago (she's been OK's by the doctor--months ago--to resume every activity, including lifting, that she did before the surgery. Besides, there's a lift she could use)! SL's back is red; thankfully there have been no open areas--at least not yet. But it's clear that she doesn't get repositioned regularly. Her hair is very greasy, and while her body odor is not terrible, it definitely falls into the category of "funky and unbathed for two days."
I feel bad for my patient; those basic nursing cares--oral care, repositioning, getting up, and so on--are necessary health-wise as well as comfort-wise. I think we have a duty to make our patients comfortable, no matter what their level of alertness or mental status.
It also bothers me because performing these very basic nursing cares--oral care, repositioning, getting a patient up in her wheelchair, and so on--are so important to preventing potentially dangerous complications like mouth sores, skin ulcers, blood clots, pneumonia, and so on. My patient is only in her 20's, and I think that's why she's been able to fend off these complications . . . at least so far. However, it's not a given that she'll be able to resist complications indefinitely! Her respiratory status is poor to begin with, and she had a UTI a few weeks ago. Performing these cares and basic tasks would probably take less than an hour, at the most, every day. Yet her mom doesn't do them.
Today, shortly after I arrived, SL was wet. She was also moving her legs kind of like riding a bicycle--very UNcharacteristic for her. When I changed her, I noted that her peri area was extremely red, almost raw in some places. Obviously it was very painful when her urine touched those areas. I washed the area off with a soft cloth and left it open to air for about 15 minutes, and the redness was dramatically decreased. I told her mom I'd done this, hoping that she would leave her bottom open to air when she was in bed later in the day. Before I left, I positioned SL on her side, with her brief open, to get the pressure off of her bottom and leave the area open to air. I told her mom I'd done this, too, but got the impression her mom was unhappy, because later she'd have to remove the pillows and reposition SL on her back again.
The other nurses and I are in a tough spot. SL's mom DOES change her brief whenever she is wet or has a BM (although there is often some BM in the cracks {sorry!} when I change her the next time she's wet and do peri care). She DOES give SL her meds and formula on time. She just doesn't do the basics that she probably feels are "extras" . . . but nurses know are part of basic good care. We do all the teaching we can . . . we all reinforce what the other nurses have said. But if we "push" too hard, SL's mom gets defensive and is less likely to listen to us.
But I can't say that SL would be better off in a long-term-care unit . . . although if she was there, she would get much more stimulation, PT, etc. Maybe. Depending on staffing and how good the particular staff members were. We have absolutely no basis for "turning her in" to social services or even calling the doctor about it. SL's mom has successfully kept her at home for more than 20 years--who are we to question what she does???
All we can do is teach why it's important, and give the care WE know is the best we can give. When I put her arm braces on before I leave, I know they'll be on at least a few hours until her mom gives her meds later in the afternoon and takes them off. When I position her on her side, I know she will be that way for at least a few hours, too. When I give peri care I know she will have no BM on her skin until she has another BM, usually not until the next day. When I clean her mouth and lips, I know she is refreshed for at least a few hours.
Although it's all I can do for her . . . some Mondays it feels like it's not quite enough.
It's certainly not abuse, and couldn't be defined as neglect, either. It's just that SL is not getting as good of care as she should. When I get there Monday morning her lips are coated with "gunk". Her limbs are tight; I don't think her mom does range-of-motion all weekend. Her mom doesn't get her up in her wheelchair all weekend, after having wrist surgery--more than a year ago (she's been OK's by the doctor--months ago--to resume every activity, including lifting, that she did before the surgery. Besides, there's a lift she could use)! SL's back is red; thankfully there have been no open areas--at least not yet. But it's clear that she doesn't get repositioned regularly. Her hair is very greasy, and while her body odor is not terrible, it definitely falls into the category of "funky and unbathed for two days."
I feel bad for my patient; those basic nursing cares--oral care, repositioning, getting up, and so on--are necessary health-wise as well as comfort-wise. I think we have a duty to make our patients comfortable, no matter what their level of alertness or mental status.
It also bothers me because performing these very basic nursing cares--oral care, repositioning, getting a patient up in her wheelchair, and so on--are so important to preventing potentially dangerous complications like mouth sores, skin ulcers, blood clots, pneumonia, and so on. My patient is only in her 20's, and I think that's why she's been able to fend off these complications . . . at least so far. However, it's not a given that she'll be able to resist complications indefinitely! Her respiratory status is poor to begin with, and she had a UTI a few weeks ago. Performing these cares and basic tasks would probably take less than an hour, at the most, every day. Yet her mom doesn't do them.
Today, shortly after I arrived, SL was wet. She was also moving her legs kind of like riding a bicycle--very UNcharacteristic for her. When I changed her, I noted that her peri area was extremely red, almost raw in some places. Obviously it was very painful when her urine touched those areas. I washed the area off with a soft cloth and left it open to air for about 15 minutes, and the redness was dramatically decreased. I told her mom I'd done this, hoping that she would leave her bottom open to air when she was in bed later in the day. Before I left, I positioned SL on her side, with her brief open, to get the pressure off of her bottom and leave the area open to air. I told her mom I'd done this, too, but got the impression her mom was unhappy, because later she'd have to remove the pillows and reposition SL on her back again.
The other nurses and I are in a tough spot. SL's mom DOES change her brief whenever she is wet or has a BM (although there is often some BM in the cracks {sorry!} when I change her the next time she's wet and do peri care). She DOES give SL her meds and formula on time. She just doesn't do the basics that she probably feels are "extras" . . . but nurses know are part of basic good care. We do all the teaching we can . . . we all reinforce what the other nurses have said. But if we "push" too hard, SL's mom gets defensive and is less likely to listen to us.
But I can't say that SL would be better off in a long-term-care unit . . . although if she was there, she would get much more stimulation, PT, etc. Maybe. Depending on staffing and how good the particular staff members were. We have absolutely no basis for "turning her in" to social services or even calling the doctor about it. SL's mom has successfully kept her at home for more than 20 years--who are we to question what she does???
All we can do is teach why it's important, and give the care WE know is the best we can give. When I put her arm braces on before I leave, I know they'll be on at least a few hours until her mom gives her meds later in the afternoon and takes them off. When I position her on her side, I know she will be that way for at least a few hours, too. When I give peri care I know she will have no BM on her skin until she has another BM, usually not until the next day. When I clean her mouth and lips, I know she is refreshed for at least a few hours.
Although it's all I can do for her . . . some Mondays it feels like it's not quite enough.
Sick Kids
No, I'm not talking about Pediatrics in the hospital . . . I'm talking about the difference between sick "patients" and when your own kids are sick.
Thankfully, my kids have only been seriously ill or hurt a small number of times. The scariest was when our son was in 1st grade and developed asthma. When I got him to the ER his SpO2 was only 84% . . . very scary! A couple of nebulizer treatments turned him around very quickly . . . and I never forgot the lesson of going to the ER sooner rather than later when it comes to respiratory problems. Thankfully he outgrew the asthma but during the years he had asthma I had inhalers in every vehicle, every home he regularly went to, every purse I carried . . .
Our son rarely gets sick, but when he's sick, he's SICK, and not just a little bit. He's usually in bed for at least a day or two. Yesterday we were out of town and he complained about having a bad headache and a stomach ache. . . within half an hour he was laying in the truck, napping, which he did for several hours while our daughter participated in her events. Of course, being a nurse, I didn't think about him having eaten bad fast food or anything simple like that. I thought about pancreatitis, a kidney infection, stomach ulcers . . . sometimes nurses know too much!
It was difficult when the kids were babies, and couldn't tell us where it hurt or what was wrong. I remember feeling soooo helpless when they cried, and cried, and cried, and we couldn't figure out what was wrong. All we could do was rock, hold, and cuddle them. Those memories are bittersweet; of course I didn't want the kids to be sick, but there is something that touches a mom to the core to know that she, and only she, can comfort a sick child.
Now the kids can tell us what is wrong when they don't feel good . . . IF they feel like it. Our daughter is usually more than willing to detail all aspects of any ache or pain . . . while son is often reluctant to do so. His side of the conversation this morning went like this: "I don't know where I don't feel good, I just feel bad . . . yes, my head hurts . . . I can't rate it on the pain scale! . . . my stomach doesn't feel good . . . I don't know if I feel like throwing up . . . I don't WANT to rate it on the pain scale . . . OK, FINE, it's about a 5 or 6 . . . what do you mean by 'localized or general pain'? "
Five or 6 on the pain scale is where I start to get concerned, but it's been steady or decreasing since then so I'm not too worried. He's been eating and drinking a little throughout the day, and the pain has not localized, as it would with appendicitis or anything more serious. I will take him to the doctor tomorrow if it gets worse. He's been sleeping much of the day, so I think it's some type of virus/flu that's been going around.
Sick teenagers are crabby, just like sick babies. The only trouble is, my sick teenage boy won't let me "cuddle" him ("Mom, you're WEIRD!"). He has, however, kept his cell phone close all afternoon. In between questions about his pain, going to the bathroom ("Mom, that's SICK to talk about!"), and eating and drinking, I found out that he's texting his girlfriend. I guess when you're a teenager in 2008, texting your girlfriend when you're sick takes the place of cuddling with your mom.
Thankfully, my kids have only been seriously ill or hurt a small number of times. The scariest was when our son was in 1st grade and developed asthma. When I got him to the ER his SpO2 was only 84% . . . very scary! A couple of nebulizer treatments turned him around very quickly . . . and I never forgot the lesson of going to the ER sooner rather than later when it comes to respiratory problems. Thankfully he outgrew the asthma but during the years he had asthma I had inhalers in every vehicle, every home he regularly went to, every purse I carried . . .
Our son rarely gets sick, but when he's sick, he's SICK, and not just a little bit. He's usually in bed for at least a day or two. Yesterday we were out of town and he complained about having a bad headache and a stomach ache. . . within half an hour he was laying in the truck, napping, which he did for several hours while our daughter participated in her events. Of course, being a nurse, I didn't think about him having eaten bad fast food or anything simple like that. I thought about pancreatitis, a kidney infection, stomach ulcers . . . sometimes nurses know too much!
It was difficult when the kids were babies, and couldn't tell us where it hurt or what was wrong. I remember feeling soooo helpless when they cried, and cried, and cried, and we couldn't figure out what was wrong. All we could do was rock, hold, and cuddle them. Those memories are bittersweet; of course I didn't want the kids to be sick, but there is something that touches a mom to the core to know that she, and only she, can comfort a sick child.
Now the kids can tell us what is wrong when they don't feel good . . . IF they feel like it. Our daughter is usually more than willing to detail all aspects of any ache or pain . . . while son is often reluctant to do so. His side of the conversation this morning went like this: "I don't know where I don't feel good, I just feel bad . . . yes, my head hurts . . . I can't rate it on the pain scale! . . . my stomach doesn't feel good . . . I don't know if I feel like throwing up . . . I don't WANT to rate it on the pain scale . . . OK, FINE, it's about a 5 or 6 . . . what do you mean by 'localized or general pain'? "
Five or 6 on the pain scale is where I start to get concerned, but it's been steady or decreasing since then so I'm not too worried. He's been eating and drinking a little throughout the day, and the pain has not localized, as it would with appendicitis or anything more serious. I will take him to the doctor tomorrow if it gets worse. He's been sleeping much of the day, so I think it's some type of virus/flu that's been going around.
Sick teenagers are crabby, just like sick babies. The only trouble is, my sick teenage boy won't let me "cuddle" him ("Mom, you're WEIRD!"). He has, however, kept his cell phone close all afternoon. In between questions about his pain, going to the bathroom ("Mom, that's SICK to talk about!"), and eating and drinking, I found out that he's texting his girlfriend. I guess when you're a teenager in 2008, texting your girlfriend when you're sick takes the place of cuddling with your mom.
Saturday, June 7, 2008
An Open Mind
I went to an interesting workshop yesterday and today, on the topic of psychiatric nursing. I enjoyed it very much. The instructors were very good--they had a sense of humor and gave pertinent, interesting, useful information.
I learned that Psych Nursing is one of the oldest nursing specialties, as the McLean Hospital in NY began training nurses in psych in the late 1800's.
From the information they gave I diagnosed a 'friend'/former friend with a personality disorder (I'm not sure exactly which one, but one of them for sure!) and my father-in-law with Narcissistic Personality Disorder. (One day this week he asked when I was going to let my hair go back to its original blond color and let it grow long again, because HE liked it better that way . . . yesterday I bought another box of red hair dye and this week I'm going to get it cut again!) I had a few signs and symptoms of Generalized Anxiety Disorder but not enough to make that diagnosis on myself (WHEW!).
We didn't have time to get into "Inability to put Dishes into the Dishwasher" or "Permanent Cell-Phone to Ear" (for my husband), or "Chronic Bickering" or "'I Didn't Hear You Say That' Syndrome," both of which would fit my teenagers.
I think if we studied the whole DSM-IV, we could come up with a diagnoses (or two, or three!) for everyone in our lives, including ourselves!
A neat part of psych nursing is that it can be used in ALL areas of nursing, and in personal relationships, too. When we know more about why people behave the way they do (whether it's part of their personality or a disorder or disease), we can learn techniques to deal with the those aspects of their personalities.
Even simple communications techniques that are used with patients--active listening, paraphrasing, clarification, reflecting, etc--can be used when talking with friends and family. ("So, son, from the look on your face and the way you're struggling to get away from me, I sense that you are uncomfortable with the words 'penis,' 'teenage sex--DON'T DO IT!!!!' and 'erection'" . . . )
Psych nursing is my favorite area of nursing. I find the way the mind works fascinating! It's interesting to learn about the "why's" of people acting the way they do. Sometimes it seems there are more questions than answers--do people develop disorders due to biology, or environment? Certainly both are factors, but how much of a factor does each play? Or are some people predisposed to disorders and environment and stress brings them out? Can any of these diseases be cured? IS everything listed in the DSM really a disease? How much of the behavioral aspects of these "diseases" or diseases can be controlled? What part should medication play?
One of the nurses today told us that taking some medications can actually change the chemistry of the brain, potentially "curing" depression and anxiety permanently. WOW! Our daughter suffered from panic attacks after changing schools last fall, and took Lexapro for about 9 months. She has begun to wean herself off of the medication because she's tired of taking it. Thankfully, she had no serious side effects from it. It has been, and probably always will be in my mind that perhaps she's at higher risk of suffering from anxiety and/or depression later in life . . . it was nice to hear of the possibility of her brain chemicals being permanently changed for the positive from her time on the medication.
My first job out of nursing school was in a small psych hospital for children and adolescents. I absolutely loved working there--the other staff members were wonderful, and I learned so much. I don't know, however, if I would have the patience to work in psych again. I do know, though, that attending this workshop sparked my interest in psych again, and reminded me why I love nursing.
I learned that Psych Nursing is one of the oldest nursing specialties, as the McLean Hospital in NY began training nurses in psych in the late 1800's.
From the information they gave I diagnosed a 'friend'/former friend with a personality disorder (I'm not sure exactly which one, but one of them for sure!) and my father-in-law with Narcissistic Personality Disorder. (One day this week he asked when I was going to let my hair go back to its original blond color and let it grow long again, because HE liked it better that way . . . yesterday I bought another box of red hair dye and this week I'm going to get it cut again!) I had a few signs and symptoms of Generalized Anxiety Disorder but not enough to make that diagnosis on myself (WHEW!).
We didn't have time to get into "Inability to put Dishes into the Dishwasher" or "Permanent Cell-Phone to Ear" (for my husband), or "Chronic Bickering" or "'I Didn't Hear You Say That' Syndrome," both of which would fit my teenagers.
I think if we studied the whole DSM-IV, we could come up with a diagnoses (or two, or three!) for everyone in our lives, including ourselves!
A neat part of psych nursing is that it can be used in ALL areas of nursing, and in personal relationships, too. When we know more about why people behave the way they do (whether it's part of their personality or a disorder or disease), we can learn techniques to deal with the those aspects of their personalities.
Even simple communications techniques that are used with patients--active listening, paraphrasing, clarification, reflecting, etc--can be used when talking with friends and family. ("So, son, from the look on your face and the way you're struggling to get away from me, I sense that you are uncomfortable with the words 'penis,' 'teenage sex--DON'T DO IT!!!!' and 'erection'" . . . )
Psych nursing is my favorite area of nursing. I find the way the mind works fascinating! It's interesting to learn about the "why's" of people acting the way they do. Sometimes it seems there are more questions than answers--do people develop disorders due to biology, or environment? Certainly both are factors, but how much of a factor does each play? Or are some people predisposed to disorders and environment and stress brings them out? Can any of these diseases be cured? IS everything listed in the DSM really a disease? How much of the behavioral aspects of these "diseases" or diseases can be controlled? What part should medication play?
One of the nurses today told us that taking some medications can actually change the chemistry of the brain, potentially "curing" depression and anxiety permanently. WOW! Our daughter suffered from panic attacks after changing schools last fall, and took Lexapro for about 9 months. She has begun to wean herself off of the medication because she's tired of taking it. Thankfully, she had no serious side effects from it. It has been, and probably always will be in my mind that perhaps she's at higher risk of suffering from anxiety and/or depression later in life . . . it was nice to hear of the possibility of her brain chemicals being permanently changed for the positive from her time on the medication.
My first job out of nursing school was in a small psych hospital for children and adolescents. I absolutely loved working there--the other staff members were wonderful, and I learned so much. I don't know, however, if I would have the patience to work in psych again. I do know, though, that attending this workshop sparked my interest in psych again, and reminded me why I love nursing.
Thursday, June 5, 2008
My Favorite Patient
My favorite patient is my private duty patient. I've had a longer relationship with her than with any other patient--so far about 2 1/2 years.
She was born "normal" (as normal as any of us are!) but sustained a brain injury when she was a toddler. The injury left her totally dependent on others. She cannot dress, bathe, reposition, or feed herself. She's in her 20's now, and it's amazing that she is as stable as she is!
She cannot talk . . . but I can tell she knows me from the look of recognition on her face when I say "hello" to her in the morning when I arrive for my shift. She expresses her likes and dislikes by her facial expressions, also.
She's on multiple medications for her seizures and other hazards of immobility. She's fed through a g-tube, and receives medication through an implanted port periodically to treat her osteoporosis. She has a trach, although I'm not sure it was necessary to perform as she's never been on a ventilator. Her past records are not in the chart, and her mom isn't clear on the reasons for the trach, either.
I've found that in this situation I care for the family (especially her mom) as much as for my patient, who I'll call SL (NOT her real initials!). DL, her mom, has built her life around SL. There are a lot of interesting interpersonal facets to the family, which also includes DL's husband, KL, and their other children (who are on their own), CL and GL. I enjoy using my Behavioral Science/Psych training with all of them!
I enjoy the job because I am able to use my technical skills, but am not pressured by having several patients to care for at a time. I can take my time with SL and spend time talking with her mom, when she needs to talk.
It's time to make supper for my family now (hamburgers on the George Foreman grill), but I'll be back within the next few days!
She was born "normal" (as normal as any of us are!) but sustained a brain injury when she was a toddler. The injury left her totally dependent on others. She cannot dress, bathe, reposition, or feed herself. She's in her 20's now, and it's amazing that she is as stable as she is!
She cannot talk . . . but I can tell she knows me from the look of recognition on her face when I say "hello" to her in the morning when I arrive for my shift. She expresses her likes and dislikes by her facial expressions, also.
She's on multiple medications for her seizures and other hazards of immobility. She's fed through a g-tube, and receives medication through an implanted port periodically to treat her osteoporosis. She has a trach, although I'm not sure it was necessary to perform as she's never been on a ventilator. Her past records are not in the chart, and her mom isn't clear on the reasons for the trach, either.
I've found that in this situation I care for the family (especially her mom) as much as for my patient, who I'll call SL (NOT her real initials!). DL, her mom, has built her life around SL. There are a lot of interesting interpersonal facets to the family, which also includes DL's husband, KL, and their other children (who are on their own), CL and GL. I enjoy using my Behavioral Science/Psych training with all of them!
I enjoy the job because I am able to use my technical skills, but am not pressured by having several patients to care for at a time. I can take my time with SL and spend time talking with her mom, when she needs to talk.
It's time to make supper for my family now (hamburgers on the George Foreman grill), but I'll be back within the next few days!
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