Autumn 2009

It's 6:30 am and I'm up reading about "moral distress" for our ethics paper in Nursing 110. And it's actually cool enough to put on my felted slippers (wool; mondo warm). Cold weather is the best, and it's finally on its way.

Moral distress is not the best. It's defined in one nursing article as "the feelings and experiences which result from a moral conflict where one knows the correct action to take, but constraints lead to either inability to implement this action, or an attempt to carry out moral action which fails to resolve the conflict."

Another definition goes like this: Moral distress occurs when you know the ethically appropriate action to take, but you are either unable to act upon it, or you act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity.

In other words, it's what doctors and nurses feel when they know the right thing to do, but they can't do it.

Back to reading.

A first

Tomorrow we wear our nursing student uniforms for the first time. It's a pretty big deal for me. You see, I have always wanted to work in a field where you don't have to think of something new to wear every day. So yay! It begins. :)

(A lot of students found out that the nursing uniform sizes ran larger than expected, and mine was no exception. Happily my sister is a wizard with a sewing machine, and she was kind enough to tweek it for me. Thanks Juli!)

Me and Mr. Smith

Hmm, I'm not getting any pulse ...

Yesterday dear Mr. Smith became paralyzed on his right side. Poor Mr. Smith. He's made of plastic and spends all his time in the nursing skills lab (Rm. 115) at AVC.

The life of a medical mannequin is not easy. Lugged hither and yon by students, stuck up on a shelf when we need their beds, and doomed to endure not only one terrible illness after the other, but the associated tests and procedures, administered by none-too-skilled wannabe nurses.

Yesterday it was my assignment to help Mr. Smith into a wheelchair, take him down to x-ray, then help him back into bed and into the lateral, side-lying position. It didn't go well.

First I brought the wrong wheelchair. Go to the other end of the lab, get the other one, come back.

Then I got him all nice and sitting up in bed, dangling his legs over the edge, when I realized I hadn't brought the gait belt (what you put around unsteady people to hang onto them by). I can't just leave him there, he'll fall over on his paralyzed right side! Back to bed, Mr. Smith.

OK, got that fixed. Get him up, into the wheelchair, down to x-ray, back in bed. So far so good. Bed UP, rail DOWN, and ... oh crap, I'm on the wrong side of the bed. Rail UP, go around the bed, rail DOWN, and pull him over onto his side. Now where are those pillows I brought to tuck under him. Oh, there they are -- on the other side of the room. Crap crap. Okay, bed DOWN, rail UP, go get the pillows ...

Did I mention this is a TIMED procedure? Time was running out for me and Mr. Smith as I got him nicely situated with his pillows. Then Mrs. Stewart asks, what's the longest you can leave him in that position? 2 hours, Heyerman. 2 hours. (Not 4, which is what I answered).

I'll have another chance with Mr. Smith on Monday. And I'll have transfer and positioning DOWN. But by then he will have recovered from his paralysis (these mannequins are such quick healers) and he'll undoubtedly need a cleansing enema and a wound dressing changed.

I better get practicing.

Interesting article about UTIs -- yes, really!

So I was reading up a bit on how to prevent nosocomial UTI's (urinary tract infections people get after they come into the hospital) from Foley (long-term) catheters.

And I came across an article where this hospital didn't make any changes EXCEPT they started giving the nursing staff a quarterly report with catheter-related UTI rates depicted graphically by unit.

That's right, it's a picture of how crappy your unit is doing compared to all the other units! That's all it took to get those nurses' butts in gear:

After 18 months, the hospital's nosocomial UTI's had dropped by nearly half.

(if you'd like more info, I put the journal citation and abstract on my Notes and Summaries page).

My favorite textbook

A wopping 6,867. That's how many pages the required textbooks for our first semester of nursing tally up to.

But my own vote for Favorite Textbook doesn't figure as part of those pounds and pounds of required pages. No, it's only a lowly "recommended," but I find myself poring over it more than any of the others. It's Taber's Cyclopedic Medical Dictionary, 21st Edition, with 2,846 pages of more medicalese than you can shake a stick at, and simply charming etymologies full of those Latin and Greek roots so beloved by ancient physicians. Plus lots of colorful pictures of weird conditions like "keratoacanthoma" (don't ask, you don't want to know).

But if you do, you'll find it in Taber's.

You say Dimensional Analysis, I say "Fuggedaboudit!"

WE'RE HAVING A TEST!

OK, Heyerman, don't panic, it's not right now. But in Week 10 (this is Week 4 right now) we'll have a test on how to calculate the dosages of medicines, and I've gotta pass it with a pretty high grade, like 90% or something.

So, if

Your patient weighs 149 pounds and is to receive Drug X 25,000 units per kg per 24 hours given in six equally divided doses. Medication is available 1,000,000 units per vial with direction for dilution with 9.6 mL diluent to make a concentration of 100,000 units/mL.

... How many mL for a single dose?

It's not too hard, if we practice every day like Mrs. Harmon (Nursing Teacher Extraordinaire) told us to, which I am trying to do!

Hi Ali!

Thanks for coming to see my blog, kiddo. You are the best granddaughter a grandma could have. Have a great day, Alison Wonderland. :D

Today I'm....

...reading, reading, reading, because I have the house to myself. :) Fundamentals of Nursing, by Taylor, Lillis, et. al. is, after all, a

VERY BIG BOOK -- 8 lbs and over 2 inches thick. So there's no time to waste.

...but right before that...

On Saturday, August 22, I couldn't sleep because my arm was hurting like the dickens. So at midnight, 2 days before nursing school is starting I am at the emergency room at AV Hospital. It was actually pretty cool to see all the nurses and doctors and stuff in action right before I was to (sort of) join their echelons.

Bend those elbows, International Symbol man!

Oh, the reason my arm hurt was because I injured my rotator cuff (in my right shoulder). I think I did it learning CPR! How's that for ironic?

My first blog post

What's this all about? I started nursing school at Antelope Valley College on Monday, August 24, 2009! Finally, after a zillion years of waiting. Actually since summer 2007, when I took Chemistry, the first of the pre-requisite classes for the program. It was a long wait, and a lot of red tape, and it's a great relief to have it all over.