I've been in OB now for 6 weeks, and ...

I was pretty appalled by the births I've had a chance to witness at Antelope Valley Hospital. I don't know enough to criticize, but ... well, I will anyway, because I was so disappointed with what I saw.

What ever happened to natural childbirth? Or at least a semblance of it? Maybe it's just the AV, I don't know. I was really surprised that babies were kept laying in warmers for no discernible reason for half an hour after birth with no attempt to let their moms hold them; one mom was sent off for a c-section after the nurse was not helpful at all during her labor, when a little support could have meant a vaginal birth for her; pitocin and epidurals are practically universal unless the mom REALLY insists she doesn't want them.

It was a happy relief to watch the documentary "The Business of Being Born," which contrary to how the title makes it sound is all about the benefits of a natural, often at-home, birth. I highly recommend it.

I am now even more grateful than before for the great birth experiences I had back in the '80's, and am sad for these new moms today who have no idea what they're missing.

A little cap nostalgia

Doing a little research on the history of nurses' caps and I came across this very nice Canadian site on the topic: "Symbol of a Profession: One Hundred Years of Nurses' Caps."

I know not too many people agree with me, but I miss the caps. I'll never even get to wear one, but I miss them, and wish I'd gotten to. They and the old uniform are symbols of how nursing used to be, and that's changed a lot. Nurses have more autonomy now, and more power, and hopefully are more help to their patients.

But I think that old uniform gave patients a good feeling. Like, ah, here's someone who knows what they're doing! This person will help me feel better. And now nurses come into a patient's room, and what is the patient thinking? Probably something like Oh, another person in scrubs. I wonder who they are and what they know and what they're gonna do?

To my mind scrubs just don't give that feeling of capability and authority that the old nursing uniform and cap did. Okay, if you're thinking about Nurse Ratched, maybe that's a good thing. :\

Eek! Mini Care Plans

Care plans are the bane of nursing students' lives. Oh, I imagine they're the bane of nursing teachers' lives as well. We students have to do six of them during this 8-week rotation in Chronic -- that's 6 x 40 = 240 care plans -- and the poor teachers have to read and correct them all. At least they're "mini" ones.

Strange though it may seem, and contrary to what their name implies, care plans are never actually used to plan care for patients. Each day, after I've already cared for my 2 patients to the best of my ability, I must choose one of them and use my notes to sort of "back-form" a care plan for that particular patient. It's a beloved (NOT) nursing school exercise whose avowed purpose is to teach us how to structure our thoughts about patient care.

Here's how it works: we come up with a "Nursing Diagnosis," and then use this as the basis to 1) discuss what the patient usually is able to do for himself, but can't right now because he's sick; and 2) describe what the next steps in helping him back to independence might be.

So far so good. The hard part comes when we have to take this nice, straight-forward description of the patient's situation and crow-bar it into the weird and convoluted system of nursing-research-speak known as "Orem's Self-Care Theory." Don't ask. Suffice to say Orem is full of jolly little aphorisms like: "Human beings experience limitations in ability to engage in the inputs for self and others for sustaining life and regulating function."

???

If she means people get sick and can't take care of themselves I wish she'd just say so, for crying out loud.

First day back as Second semester student

In actual fact Monday was our first day back, but that was just for lecture. Mrs Beatty talked about chronic illnesses in general and diabetes in particular in Medical/Surgical Nursing. And Mrs Curry gave the Professional Nursing II lecture. Looks like a lot of the focus this term will be on the nurse's role as a teacher. Not my favorite aspect of the job.

But today we started back at AV Hospital, now old hands at the job; no longer wet-behind-the-ears first-semester students. It was my first 12-hour shift ever. I've often wondered why nurses do 12-hour shifts. Here are people who especially need to be on their toes, and they're working these exhaustingly long hours. But I actually liked being on the floor all day. My feet didn't like it, but I did.

I had more time to get things done, for one thing. And it felt more real, being there for almost the same time as the nurses (we leave a little bit before the 7 pm shift comes on), and getting to see the patients through the whole arc of the day.

I still felt crazed and overwhelmed and ignorant. But I remembered some stuff from last semester, and all in all it was a good day.

My Spring 2010 class schedule

It's been good to have this long break from nursing school, but I'm starting to look forward to going back to classes and the hospital too. Maybe I just don't remember how really hard it was.

Thought I'd post my new schedule here:

Feb 8-Apr 4
MON 7 am-1:30 pm MED/SURG LECTURE (Beatty/Curry, Rm T503-A)
MON 2:20-3:25 pm PROF NURSING (Beatty/Curry, Rm T503-A)
WED 6:50 am-6:40 pm MED/SURG CLINICAL (Lanz, Hospital)

Apr 12-June 4
MON/TUES 1:00-8:10 pm OBSTETRICS CLINICAL (Sly, Hospital)
WED 8-11:30 am OBSTETRICS LECTURE (Scudmore, Rm T503-A)

Merry Christmas!

Passed first semester Nursing with a B. Very happy about that. Survived Christmas and have a month off to look forward to. Very very happy about that too.

Nutrition, me, and the DRV

While doing some last-minute studying for our 4th exam (coming up in, oh, just about 95 minutes), I came across a website called hpathy.com that lets you input your gender, height, weight, age and activity level. It then tells you how much protein, carbs and fats to consume each day (the DRV, or Daily Reference Value, for those nutrients) to maintain your weight, or to lose or gain weight. For me to lose 1/2 pound per week, I should eat daily:

Calories: 2363
Carbohydrates (55%) cal = 1299 (325 gm)
Proteins (15%) cal = 354 (88 gm)
Fats (30%) cal = 709 (78 gm)

http://www.hpathy.com/healthtools/calories-need.asp

En el hospital

Yesterday an LVN asked me to help her move a patient up in bed, and when I went into the room I heard the lady speaking Spanish to her daughter, who was visiting.

So after we'd moved the patient up I asked her in Spanish how she was feeling. She answered, "Como una cucaracha machacada." ("Like a squashed cockroach.")

LAST DAY of 1st semester clinical

Wow, today was our clinical group's last day at the hospital. Whew. We made it. And I didn't kill anybody -- I don't think.

Just an old-fashioned hospital day

"This is a great room!" That's a quote from one of my two patients at AV Hospital Monday. There were three women in my patient room that morning, all ambulatory and all friendly.

My first patient, the social director of the group and a cancer patient, ordered a pizza delivered for all of them to share, and would go sit on her roommates' beds and chat with them so they wouldn't feel lonely.

My second patient was a charming older lady who was my meds guinea pig for the day. I only dropped ONE of her 6 pills on the floor -- thanks for getting me a replacement, Mrs Harmon -- and when I checked her blood sugar I managed to stab her finger just a tad close to the joint. She mildly informed me that that "stung a bit." Aaaack! So I learned something about Accu-checking: aim for the fleshy part of the finger.

Patient #3 wasn't assigned to me, but when she asked for my help with walking to the bathroom, I found out that it's okay to temporarily unplug an IV pump from the wall socket -- the pumps run on rechargeable batteries, like our blood-pressure/thermometer machines. Useful to know.

Maybe Monday was what it was like in the good old days in hospitals, when people weren't ALL quite so sick, and the pace was slower. I even had a chance to sit down and chat for a little while myself.