Surviving Online Study

After studying my Diploma of Nursing, which required 3 days a week, 40 weeks a year of physical contact and attendance at CQUniversity then transitioning to the Bachelor of Nursing which was almost completely online, with 12 contact days aver a two year period, I was a little shell shocked. But I developed a series of survival skills that saw me graduate with a Credit Average, and awarded the Associate Vice Chancellors Medallion for 2019.

The most important thing to remember is Time Management. It is all too easy to put off watching lectures, reading chapters of books, or studying for exams. It’s also too easy to feel the urge to simply cram in the final minutes. While I was studying Full Time I was also working Full Time as an Enrolled Nurse, working all shifts, 40 hours a week. I needed perfect Time Management if I was even going to survive, let alone pass. I found it easiest to physically write all of my assessments and their due dates on a white board next to my desk, have all of the readings and lectures written down as well, and simply divide the week into different Classes on different days. Some Classes I found could be knocked over quicker than others, and others required more time in study. This just meant I needed to move the schedule around a little.

Time Management

Time Management

Make sure you don’t cram anything into the last minute. No matter how good it sounds, no matter how many times other students tell you “Cramming is Super Effective”, it’s not! For you to effectively retain the information you will need to repetitively cover the information, absorb it in a number of different ways, and most importantly, study to perform your job not to pass an exam. You shouldn’t also study with loud music, drinking your sixth red bull, and eating a bowl of chocolate covered nuts. Studies have shown that you should study how you are examined, this will assist in memory recall in the exam.

Don't Cram

Don’t Cram

To get yourself in the study mindset remember why you’re studying in the first place. For me I wanted to be a Nurse, working in Health Care, and helping people. Cliched I know, but you won’t find many Nurses who are in it for the Glory, Money, or to Marry a Doctor, well at least not that I am aware of anyway. So if you are studying Physiotherapy to work with top athletes at the Olympics, use that. If you are trying to remember 4923 equations to become an Engineer so you can work on Space Craft, use that. If you are studying English so that you can become a Citizen of the greatest Country in the world, use that.

Remember the Reason

Remember the Reason

Avoid distractions by being deliberate about your study. Set aside a time every day where you are going to study. Have a designated space to study, not the lounge room, not your bedroom, and certainly not in the kitchen. Ensure those who you live with, namely partners and children, are aware that you are studying and it is paramount to work, thus they need to respect your space and time required and may need to leave you alone long enough to write that fourth essay this week.

Avoid Distraction

Avoid Distraction

The best online study aid is anything that keeps you on track, focussed, and on time. I found the best tool during my study was a program called Zotero. Zotero is a cataloguing and referencing software that stores all of your previous references, books, journals, and other material. It creates snapshots of online material, references in APA or Harvard (along with a myriad of others), and even creates a perfect Bibliography for you at the end of your document. It may not be strictly a study tool, but it sure saved me from a lot of headaches when it came to referencing my material.

Zotero

Zotero

My tip for studying at home with children is DON’T! But seriously, if you find it difficult to study at home with the children, whether your partner is away for work, or you are a single parent, or whatever your situation, you need to find the time and space to study. I knew plenty of students who studied at the Library prior to returning home because their lovely little cherubs made any study near impossible. You could also limit your study to after bed time, which is what I did most of the time. This works great as your children can’t interrupt your study if they are asleep.

Children

Children

My final thought on Surviving Online Study is, do what works for you. There will be a myriad of differing tips and tricks for studying online, but ultimately you need to find what works for you. I found that the aforementioned survival tools is what worked for me. I hope you find what works for you sooner, rather than later.

Maintain the Rage

Luke Sondergeld

Preventative Nursing

In an age of Chronic Disease, Misinformation, and Coronavirus, Health Care workers have an important Front-line role to ensure the effective care and accurate information delivery to our patients. We often think this role is for our Primary Healthcare providers like GPs, their Nurses, and even hospitals. But the journey really starts well before that. Today I want to share a little bit about my journey through Preventative Nursing and the role it plays in our society.

For those who haven’t been keeping up with my recent posts, I have been Nursing for a Local Meat Works as their onsite Nurse. Not what I pictured myself doing post-grad, but I truly love my job and wouldn’t change it for anything. Among other things like emergency response, daily dressings, wound management, immunisations, and medical screening, I have also been made responsible for the entire COVID-19 response. This has meant that I have been the one to organise the hand sanitiser, temperature screening of staff, declarations for visitors, and implementing some 15 new policies and procedures into the workplace. None of this is what would be considered main stream Nursing, but it is all preventative. Without these measures the plant is vulnerable to COVID-19, and Influenza, the Common Cold, and a myriad of other diseases to which the precautionary measures will be effective as well. By taking these measures, and ensuring the safety of all 685 staff, it also means there aren’t a ton of new patients for the GPs, and hospitals.

Outside of COVID-19 the Preventative measures don’t stop, there is still Influenza Vaccines, Physio programs, Stretching and Workplace exercises, Health promotional activities, and general workplace safety. All of these measures are designed and implemented to ensure that the staff are kept out of mainstream medical centres and avoid being injured or falling ill. This also limits the number of sick days being taken, which is great for the business, and also great for the staff.

I am not the only type of Preventative Nurse out there, there are also our Aged Care brothers and Sisters, Community Care Nurses, and the extensive Multi-Disciplinary team such as Chiropractors, Physiotherapists, Nutritionists, and Exercise Physiologists. All of whom work tirelessly to manage Chronic Disease, limit Acute Illnesses, and ensure the best physical shape a person can achieve.

Who out there would consider themselves a Preventative Nurse? Is there a field I have missed? Comment below and share your experiences through your every day role.

Maintain the Rage

Luke Sondergeld

Outside the Box

When we think of Nursing, or for those outside the field, Nurses, we tend to think of Hospitals, Doctors Surgeries, and Aged Care Homes. But, as my recent furor with the job  market will attest, there are plenty of unknown opportunities. I was unaware that some Schools still employ Nurses, there is the Prison system which employs on site Nurses, the Meat Works employs Nurses as I will bear witness to, along with some Mine Sites, Cattle Stations, and of course the Military. My advice to you, as the potential Graduate Nurse, or Re-Deploying Nurse are the following three things; Look Wide, Ask Everyone, Talk to People.

Nursing Imagery

Nursing Imagery

Look Wide

As I have hinted towards already there is a large and varied workforce in which to select from when it comes to Nursing. Each one has its own pros and cons, and you as the Nurse will have to weight those up for yourself. For example, I would trade salary for time with family and availability to volunteer. So a Monday to Friday, Dayshift, or at least rotating roster were you can plan more than two weeks ahead, was worth more to me than an extra couple of dollars an hour. To this end, when you have decided what you want out of the job look everywhere, even places you wouldn’t expect. Look outside of Seek, Job Search, or the local Paper, jobs these days are also advertised on LinkedIn, Company Websites, or even FaceBook. Look in places that you would not have normally considered like Schools, Meat Works, the Military. Apply for EVERYTHING as you may not be successful your first few interviews, regardless of experience.

Dreaded Job Hunt

Dreaded Job Hunt

Ask Everyone

Don’t be afraid to ask around, ask those in the field, ask your friends, ask your acquaintances, or do what I did and ask FaceBook. Whatever your tactic for this particular portion is, be ruthless. Don’t be afraid to ask people you haven’t spoken to in a while, don’t be afraid to ask people if there is a job at their workplace, ask if they have heard anything, ask if they know someone who knows someone who might know about a job. The point being ASK EVERYONE!

Social Callout

Social Callout

Talk to People

While I was looking for a Registered Nurses Job one of the things I took it upon myself to do was to email EVERY SINGLE GP Clinic in my Hometown, Rockhampton. I must have sent out 30 emails to all of the Practice Managers with my Resume and a Written Reference. Some wrote back to me fairly quickly with a Dear John email stating they didn’t have any positions at the time. I had two interviews, and a call back for a third after I accepted my job at Teys. I also applied to the Three Hospitals Nursing Pool, and directly to several of the wards. None of these places were advertising for Nurses, none of them were asking for my application, and most of them at least wrote back to me in some form or another. As I mentioned in Ask Everyone, most of the Nursing jobs secured, especially in a small town such as mine, will be by who you know. With a little bit of what you know as well. The job I ended up with wasn’t advertised, was a suggestion by a mate of mine, and started with an unsolicited email to the HR manager of Teys. So Talk to People, it may land you the job you didn’t even know existed.

Never Know Who Will Have the Job

Never Know Who Will Have the Job

These are three quick and helpful hints to assist you with your Job Hunt, whether it’s for a Graduate Position, a Re-Deployment, First Enrolled Nurse Job, or Re-Entering the Workforce after a sabbatical. Don’t be afraid to pick up the phone, drop an email, post on Social Media, or do the classic walk around with your Resume. When it comes to Employment it may not come easy, you may have to work for it, but it will all be worth it once you are working in the best profession in the World.

Maintain the Rage

Luke Sondergeld

 

Weight Loss Since January 1: 5kg

Answered Prayers

I have always believed that Social Media should be exactly that, Social. I also believe that when used properly, great things can be done; whether it be raising funds for a charitable cause, spreading warnings about flood or fire, sharing News about a lost child, or in my case finding myself a job. During this whole process there were many people involved, many shares, many likes, many comments, there was also a team of people who were praying for me, for the right job, at the right place, with the right conditions. These prayers are the ones that have been answered.

Social Callout

Social Callout

Social Media whether it be FaceBook, Twitter, Instagram, Twitch, SnapChat, or otherwise has a lot of bad press. And for very good reason. These platforms are no longer about the sharing of ideas, photos, moments in time, memories, or life together but instead have become a platform of hate, ill will, debauchery, filth, and simply put Anti-Social Behaviour. I was glad, and not to mention a little surprised, by the overwhelming positive feedback, comments, likes, and conversation that my post generated. Now, it was in no means trending or ‘going viral’ but it still reached a large, and appropriate, audience. And most importantly it landed on the screen of someone who had just the right job in mind.

Anti-Social Media

Anti-Social Media

Now it shouldn’t come as a surprise to my regular readers, but I do actually attend a Church on a regular basis, and with that comes a pretty tight knit community of people who are genuinely concerned about how you are travelling. So as you can imagine when I posted on Facebook that I was looking for work the prayer warriors did two things; 1) Kept an eye and ear out for an RN job and 2) Began fervently praying for the right Job, at the Right place, with the Right conditions, and the Right renumeration. I don’t normally pray for myself, I find it oddly self servient and distasteful. But, on this occasion, I prayed for myself. I prayed for the same thing the prayer warriors were, I was believing in the perfect Job, the one He set aside for me. Well, the Prayers were answered, and with Gusto.

Answered Prayers

Answered Prayers

My perfect RNs role, for this moment in my life, involved a number of different things;

  1. Stability – Being able to plan my life further then 2 weeks in advance
  2. Workplace – Being part of a Workplace that is people focussed
  3. Distance – Close to home, not that anything in Rockhampton is ‘Far Away’
  4. Renumeration – A comfortable amount of money to bring into the House
  5. Flexibility – The ability to arrange my Work life to suit my Home life if needed
  6. Challenging – A workplace that would challenge my skills
  7. Time – Somewhere where I was actually able to see my children and wife on a regular basis and not just in passing between shifts and sleep

And thats the role I have found. For those astute enough, and those who subscribe to my Social Media, would know the position is at Teys Rockhampton, one of the local Beef Processing Facilities. It is one of the largest employers in Rockhampton and they have been without a Nurse for nearly two years, in fact in that time I was the first to be interviewed. Talk about God holding a position open for you.

I look forward to the new challenges ahead in Occupational Nursing and I am thankful for my opportunities a HillCrest whilst I was there. I look forward to new connections, new skills learnt, new language barriers overcome, new cultural issues overcome. I look forward to a workplace that empowers me to be me, and facilitates that wherever possible. I look forward to what the future holds. 2020 has started off really well so far, here’s hoping it keeps it up.

Maintain the Rage

Luke Sondergeld

Final Placement

Anyone who has seen my Facebook feed this week would know that I finished my final placement for my Bachelor of Nursing this week. This means that I no longer have to wear the Teal uniform of choice, I no longer have to practice under someone elses registration, and I no longer need to work for free. But despite all of the finality, and the opportunities that lies ahead, the journey to this point has been both enjoyable and enlightening. Every department had its own secrets to share, every shift had a lesson to be learnt, and patient a mystery to resolve.

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During my time studying to become a Nurse I have had placements in many different facilities and many different wards. My placements where in Aged Care, Community nursing, Acute nursing in a Surgical and Medical ward, Mental Health nursing in an Inpatient facility, another Surgical Placement, another Acute care Ward placement, Emergency Nursing, and Intensive Care Nursing. Each placement, and subsequently each ward, has had a profound impact on both my learning and clinical practice. The first placement in Aged care taught me compassion above all else; to treat every patient as a person and not a condition, to take solace in the small tasks for each person, and never be in a rush to be done with a patient. Community care showed me how easily a simple condition can become something far more sinister, and how people can be so accepting of the worsening of a condition under the guise of convenience. My first Acute nursing placement showed me the importance of time management and good communication. Mental health nursing firstly showed me that despite common misconceptions, it is not an easy option, and showed me the difficulty we face when our own mind fights against us. The Emergency placement showed me the wonders of critical care, the pace, the broad spectrum of ailments, the need to maintain nursing skills to the highest level. Intensive care taught me the importance of taking my time, the little details matter just as much as the large one, and the need to show compassion and tenderness to those who need it most. Every placement had something unique to share, I am blessed to have had these opportunities and I trust these experiences will serve me and my patients well in the future.

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38 weeks over 3 and half years, 190 shifts, 1520 hours, every single moment a new opportunity to learn, grow, and develop my skills and knowledge base. Looking back over my placements its hard to believe that so much time was spent in different wards, for so many shifts, with so much to come out of them. I have always had the mentality that you should endeavour to learn something new every day. It helps fight stagnation and keeps you growing as a person, a nurse, a father, or otherwise. Every shift may not have taught me about a medication, a disease process, a new technique, a new piece of equipment, or even a new practice, some days it was a different way to show compassion, a new way to engage with my patience, or even a new way to deliver bad news. I feel it is important to keep the practice of learning something new every day, and not just from fellow nurses, out doctors, or the patients, but from family members, the wards man, the kitchen staff, or the stores staff, each have invaluable information that could make your life a whole lot easier.

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Every patient is not just a human being who has befallen an illness or ailment, and they are most certainly more than just these. Each patient is a story, a journey, a life. Every patient deals with their ailments differently, they develop comorbidities and often take them in their stride; to see near life ending events as something trivial as they have survived them and moved on. We as nurses can never assume that two patients who have the same conditions will act the same. And for this I am grateful. Every patient also has a life of stories, stumbles, triumphs, and complications. These life events can not only help build a better picture of the patient you are currently treating but also give you insight into how others may develop their illnesses. We need to take the extra time to spend with our patients to collect these little gems as we go about our day.

All in all, the placement process has been enjoyable. I’m not going to lie, I am glad I will no longer be working for free. I am truly thankful for all the staff, patients, others involved in my placements and the learning they imparted onto me. I will do everything I can to ensure the information is used to the betterment of my patients.

Maintain the Rage

Luke Sondergeld

Advocacy

Advocacy is one of the most important and under utilised components of a Nurses job. It sits at the very core of our being, the reason behind every action, and heart behind every conversation with a Doctor. Recently, whilst caring for a patient, I didn’t exercise my right to advocate for them, and as such they have continued to be mis-managed. For confidentiality reasons I will not disclose particulars of the patient, but will instead refer to them as Jeff. I have come up with a nemonic of ABCDE to remind me of the components of Advocacy for the future, and I hope they will help you too.

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Always

As some of you are aware I am both an Enrolled Nurse, and a student Registered Nurse. I am also on my last placement before graduating at the end of the year. I felt that because Jeff was a patient of mine, whilst under supervision, as a student I couldn’t or shouldn’t raise my concerns and subsequently Advocate for them. I was wrong. As Nurses we should always feel empowered to Advocate for our patients. It doesn’t matter if you are a LPN, EEN, AIN, GRN, RN, CN, or NUM you should feel comfortable to stop what is happening and Advocate for your patient. I have been beating myself up since the event, and cannot seem to console myself regarding my inaction. Jeff continues to be, in my opinion, mismanaged because I, and others, feel that we cannot raise our voices and say STOP, this isn’t in the best interest for the patient. STOP, we need a different course of action. STOP, we are not caring for and treating this patient, we are treating our own conveniences. I wish I had spoken up, but now I know what a difference it could have made, and how lousy it feels when I don’t, I will never step down from Advocacy again and I will encourage others to do the same.

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Back Up

When Advocating for a patient we should remember we aren’t just individual Nurses, we are part of a team, and we are stronger together. That wasn’t supposed to sound like a chant for a Union, but there you go. If we don’t feel strong enough to confront a Doctor directly, enlist help from other Nurses in the team, bring in the Supervisor, the Shift Coordinator, the Clinical Educator, the Clinical Facilitator, or even the Nurse Unit Manager. Together you can approach the Doctor and Advocate appropriately, it will look less like an idea from a solo Nurse and more like a considered idea, and it is good to know that you are justified in your Advocacy when you have the assistance of another. This won’t come across as “Ganging Up” if done correctly, and could be the component you need to successfully Advocate for your patient.

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Considerate

As Nurses we pull some pretty long and random hours, with things like Late-Early shift, overtime, Double Shifts, and a myriad of other whacky ways the roster seems to wind up. Our job is physically demanding by being on our feet all day, lifting and rolling patients, performing care, and everything else we do in a shift. Our job is also emotionally and mentally draining with supporting the patients and their families, dosage calculations, evaluating observations, constantly assessing a patient, and somewhere in all of that is Advocacy. Now, we all know what we do is demanding and exhausting, we justify the extra coffee, the second bar of chocolate, or ignoring the phone on breaks because of it. We flay ourselves over jobs missed, or errors in judgement, and we feel terrible when things are late. Now, our Doctors may not be there for the hands on cares, the lifting and rolling, the supporting the patient during mobility, but they are carrying the burden. The Doctors are trying to manage a massive patient load, the medications, the investigations, the outcomes, the families, and the demands we as Nurses put on them. The Doctors are under the pump all the time. They can’t ignore the phone, their breaks are constantly cut short, they are the ones that get to explain to the patient and their family about a poor prognosis. They have a huge burden to carry. When we advocate for our patients we need to be Considerate and keep in mind these burdens. Don’t Advocate by telling them they are wrong and should be doing it a different way, or calling into question their education. Come along side of the Doctors and show them what you are seeing and suggest the alternative course of action.

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Don’t forget the Patient

We shouldn’t forget that the reason we advocate is for the best outcome for the patient, as such we shouldn’t forget to include them in the decision making process. It may be entirely necessary, and entirely justified to discuss your concerns with the patient prior to stepping up in front of the Doctor. Some patients, despite the best intentions you may have won’t want to take differing actions to what the Doctor has ordered. This is why it is important to discuss your concerns with the patient, or if the patient is unable to then a discussion with the next of kin may be appropriate. This seems simple, but can be just as difficult, if not more difficult to achieve. Discussing with a patient that the care that has been prescribed isn’t the best, and a different action would be better, can be seen as conniving, sinister, arrogant, or just plain rude. A polite tongue and respective tone when discussing this matter will need to be adopted, and under no circumstances should the Nurse belittle or bad mouth the Doctor, or professional prescribing the care. We are all a team, we need the Doctors just as much as we need them, nobody wants to be seen as “That Nurse” and as such we shouldn’t behave that way.

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Evidence

Whilst we should advocate for our patients, always, we need to make sure we have the evidence required to back up our claims. This can be something as simple of observations, blood work, an x-ray, comment made by family or friends of the patient, or statements made by the patient themselves. We may also have written evidence from Journals, textbooks, Research Articles, or recently attended workshops or conferences. It may be something as simple as showing the doing guide from MIMS or the product information leaflet enclosed with the medication. We as Nurses need to be prepared when confronting Doctors in relation to our patients, it may not be enough for us to simply say “I am not happy, we need to do something differently”. Being educated, well read, up to date, best practice using badasses we are we need to show the Doctors that we know what we are talking about, and that we need to be listened to.

These five components; Always, Back Up, Considerate, Don’t forget the Patient, and Evidence or ADCDE, will help you remember what needs to be considered when Advocating for your patient. Don’t end up where I did with Jeff. Don’t be afraid to stand up and be heard. Don’t think that you are just a Nurse. You are the patient Advocate, exercise the right, but do it properly.

Maintain the Rage

Luke Sondergeld

12 Hour Shifts

I have started my placement in the Intensive Care Unit (ICU) of one of the hospitals in my region. Like most ICUs they run on 12 hour shifts, specifically for the one I am placed at 0700 till 1930 and 1900 till 0700. On the surface this seems great, over 3 weeks you work 10 days and are still counted and paid as Full Time, you have 11 days off over the same period, there is no such thing as a late-early, and the likelihood of being asked to stay back is greatly diminished. Though all of these things are true, and I will expand on some in a moment, there have been some interesting issues develop along the way.

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The Roster

I have to admit, the idea of 12 hours shifts, 11 days off in 21, and never having to work a God for sake Late-Early again, is awfully appetising. I adore the fact that the days you work, in which you seldom get anything done anyway, are just a little longer. I do enjoy the possibility that you are handing over to the person you received handover from. On the surface it seems like the dream, but there is a catch. So far I have been doing nothing but day shifts, which involves getting ups at 0530 to get ready and leave the hour by 0630 to be at work ready to go by 0700. The day then proceeds thill 1930 when I depart, walk to my car and drive home, arriving somewhere between 1945 and 2000. So far in this day I have not seen my children or wife awake, on arrival only my Eldest and Wife are still awake. No biggie, spend some time with them, wind down then off to bed, to get up at 0530 and do it all again. As you can see, there isn’t a lot of family time going on. There is  a lot of just surviving. Working, eating, sleeping, working. When I first arrived to ICU the Facilitator made a remark about working 12 hours shifts and how you shouldn’t expect to get anything else done on those days as you are just doing what you need to do to get to the next shift. I scoffed when she first said it. Now that I am living through it, she isn’t far from the truth. You wouldn’t be able to engage in any drawn out, meaningful activity. Normally I eat my dinner with my wife, we talk about our respective days, she returns to her school work, I read for a while, then sleeping for the next day. It took me by surprise. So though on the surface the roster seems really good, just keep in mind, you are almost useless for 10 days out of 21.

Plan Your Sleep

Plan Your Sleep

Self Care

The need for self care is incredibly important while undertaking 12 hour shifts. You need to make sure you are adequately fed, a mistake I made on the first day, just catering for lunch and that was it, didn’t make that mistake again. Staying adequately hydrated, which I know as Nurses we are notoriously bad at but we need to make an effort to do it. Getting enough sleep, and I mean good sleep not naps on the couch or two or three small naps, I mean a good solid 8 hours, which when you do the math leaves you with 4 hours for EVERYTHING that isn’t Work and Sleep. Supporting the home front, for those of us that aren’t single and have a partner and maybe children, you need to make sure that they feel adequately loved and supported. It is all too easy for us to say that we are tired, and worked a long day, and were on our feet all day, but your partner has also worked all day, cooked, cleaned, organised the finances, or performed ALL the other homely duties that aren’t getting done because of the 12 hour shifts. You should also engage in a ‘Me Activity’ on your days off. This could be hiking, swimming, boating, painting, or stacking rocks, whatever your chosen ‘Me Activity’ is make sure you take the time to engage in it, it is all too easy to just work to live and live to work.

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The Shift

Talking about working 12 hour shifts could not be done without actually talking about, the shift. I can only talk on the Day shift presently but as I engage in Nights I will be sure to add my thoughts. But, the shift, putting aside the obvious thing which is it is 4 hours longer then a normal shift, is divided rather nicely into roughly 3 hour blocks. Each shift you have a single 20 minute break and two 30 minute breaks. They are usually taken around 1000 for the 20 minute, 1300 and 1700 for the 30 minutes. This gives you Morning Tea, Lunch, and if you wish an Early dinner, I tend to simply enjoy a coffee and the extended break time for my 1700 break. This break pattern helps divide up the day and ensure you aren’t too intently involved on the floor for too long without stepping aside and breathing for a moment. It allows for a little bit of the aforementioned Self Care with regard to diet and hydration, it also allows for a brief period of contact with loved ones to make sure they are adequately supported, and gives you a moment to switch off from the intensity that is ICU.

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As you can see there is a lot to consider with regard to the 12 hour shift, and Nurses have made entire careers around it. I would love to hear some of the stories from those out there that do live the 12 hours shift day by day and what secrets they would like to share with regard to surviving the shift, self care, and days off.

Maintain the Rage

Luke Sondergeld

Emergency Department

This week, and subsequently the week prior, saw me completing my two week placement in our local Emergency Department. Originally, I was merely excited to just get a glimpse of the chaos and mayhem of ED. Having now spent the two weeks in ED…. I WANT MORE!!!

Emergency Department

Emergency Department

A while ago I wrote a piece call Medical Nursing, whereby I reflected on the exposure to different sections of Nursing and how they impacted me. In the conclusion I stated I felt that I was more a Medical Nurse than a Surgical, namely due to the chaos and distant style of Nursing that it tends to be. I then surmised that a Medical Nurse is responsible for the growth and healing of a Patient and not just bandaging them up to get out of the bed. This is the same thought I had towards ED, prior to my placement. However, upon arrival I noticed a few things;

  • The chaos of ED is a finely balanced ballet of Nurses and Doctors
  • The pace is clearly defined by those Nurses and Doctors
  • ED isn’t all gunshot wounds, mass trauma, and gallons of blood
  • Bed blocked is a very real and serious danger
  • There is more care given to one patient in four hours then some receive in a week
  • Nurses and Doctors work together as equals, not superiors and subordinates
  • Everyone is learning, Nurses and Doctors alike
  • A litre of blood can pour out of someone’s nose
  • A baby being born is truly magical
  • Drugs, illegal drugs, are bad
  • Mental health is not an isolated issue, its part of the patient
  • Not everything is running around
  • No-ones opinion is invalid

Theses are just some of the things I noticed while working in ED, and all of these things showed me that its not an adrenaline junkie’s hot spot, and only suited to those mad few, it is a high intensity, knowledge pushing, crucible that produces some of the most well rounded and knowledgable Nurses and Doctors that anyone would have the pleasure to work with or have work on them.

Emergency Nursing

Emergency Nursing

With all of this being said, like some five year old in a candy store, I still have a six week placement in the Intensive Care Unit of the same hospital. I could fall madly and deeply in love with the 12 hours shifts, organised structure, and relative peace of ICU. Or I could simply be left longing for the high speed rush of ED.

Where will all of this take me, I don’t know. I will float like a leaf on the wind, and land were I will serve best. I have the capacity to be a great Nurse wherever I am, and I can take great joy in every section, if I do so chose. Only time will really tell. My career, based on my current retirement age, has the potential to be 38 years long. Making 40 years of Nursing in total. I have the time to be able to move around if I am not comfortable in a section. Or simply fall in love with one, study my Masters in that area, and strive and thrive in the environment.

Only time will tell.

Maintain the Rage

Luke Sondergeld

2nd Year

Well I thought the First Year went by quickly, it seems as if I blinked and the second has disappeared. I thank everyone for coming on this journey through depression, weight loss, nursing, parenting, and life as a whole. It has meant so much to me that you have decided to come along for the ride.

Second Birthday

 

Firstly, the numbers. In the past twelve months I have written 67 posts, starting with Quoth the Raven and ending with this one. I have written about my success, my stumbles along the road, and the treatments I went through to save me from myself.  I began to share about my struggle with weight, and the steps taken to change the image that was in the mirror before me.  I explored more of my own struggle, ideas behind death and the nursing implications, what it is to father someone who is not your biological child, and a pictorial view of the town I love so much. From these posts, and many more, we can sum up the year with some key numbers;

  • 64,659 Words Total
  • 696 Words per Post (average)
  • 139 Comments
  • 348 Likes
  • 6,288 Views, of which the top five countries were
    1. Australia
    2. United States
    3. Canada
    4. United Kingdom
    5. New Zealand / India

These are just the figures from the Maintain The Rage website and do not account for comments, likes and shares from Facebook, Twitter, LinkedIn, Tumblr, or Reddit.

When I started Maintain the Rage I had the intention of sharing what I had learnt, my tips and tricks, and general advice. I quickly realised that I would immediately be thrown into the Do these five things if you want to be rich, successful, and sexy category. I shifted to sharing about my life, not in an attempt to illicit pity or praise, but to show that you can do all the things you want to do, to juggle the different activities, work, school, family, and life, to show that even if your are struggling, thats ok. I hope that this has been a well received shift and that I have made the right choice. But judging by the reads and conversations with people in comments, direct messaging, and face to face contact, I am going to say it was the right move.

For the future of Maintain the Rage I am going to stay the course, I will continue to share my journey as a Parent of both a 1 year old, a 3 year old, and a 16 year old, my life as a Nurse, my journey through life with my Wife, my Scouting life, and my struggles and successes with depression and anxiety, and the victories and struggles through weight loss.

I thank everyone of you who have come on this journey with my and hope you have enjoyed and taken away something from the posts. I encourage all of you to ask me what you want to hear about, and what part of my life you are curious about. I also encourage you to share this blog with family and friends, not for mere likes or views, but so we can expand the community that Maintain the Rage has and continue to share together.

Thank you again,

Maintain the Rage

Luke Sondergeld

Point in the Road

We are all so focussed on where we are going; the next goal, the next promotion, the next holiday, even our next home. This forward focus is needed to ensure we don’t stagnate, but, at times, we focus so much on the future we lose sight of where we are, and those who are on the journey with us. As we travel down the road of life, we sometimes need to stop at a point in the road, look at how far we have come already, and refocus with a renewed energy.

Childhood Home

Childhood Home

Above is the picture of one of my childhood homes. I say one of as my father served in the Australian Army for just over 22 years and subsequently moved around a fair bit as a child. At this point in our lives, we were a single income family, being my fathers. Our family consisted of my Mum, Dad, myself and a newly born younger brother. My father was a Corporal but while living in the house we would see his promotion to Sergeant. We didn’t have a lot, as the income of a serving member back in the late 80’s and early 90’s was less than desirable, but that didn’t mean that our childhood was lacking; we spent every day doing some kind of activity to stretch our physical and mental selves. I start at this point in my life, which I reconstruct much from stories and photos, for this reflective journey both because I have some memory of this house and because we have moved back to Rockhampton, the city in which this house is located.

My Service

My Service

Fast forward a number of years and many things have happened. We would move to Sydney and spend nearly 9 years there before moving to Canberra and really planting roots. My parents would finally be in a financial position to buy their first home, at 31 and 34 years of age. This meant that my mother would have to return to full time work and thus my brother and I would need to be far more responsible. With afternoons spent completing addition chores, cooking meals (where I found my love of feeding people), and finishing homework, it would be the foundation of my self reliance.

School would be school, where I graduated from year 12 and immediately began working full time in Fast Food. Jobs would come and go, and eventually I would secure a job with Employment and Workplace relations. This job would then enable me to secure my first Home. The years would go by, and the waist would began to expand. In 2008 I decided to join the Navy, and at that point I weighed 149kg and I had to be under 100kg to enrol in the Navy. I gave myself twelve months to lose 49kg and by January 2009 I would sign the bottom line, literally, and begin my basic training.

Love

Love

During my service I would reconnect with an old friend, Alinta. We would date, engage and marry, inside of 12 months. I was still serving in the Navy, and as most Navy people do I went to sea, two weeks after our Marriage, for 6 months. When I came home, my boss told me to enjoy the 2 weeks off, we will be going away for 11 months in the next year.  Alinta and I both decided that life at sea, and being in the Navy was no longer going to work. In 2014 I discharged from the Navy, and set on new path to Ministry.

Our House

Our House

We would buy our home late 2014, move in and immediately begin making it ours. I would spend my time studying and working in the local Church.  We would be blessed with our first daughter December 2015. Unfortunately, I would be laid up for an extended period when my bowel decided to perforate in early 2016. This period was painful, restrictive, and all round unpleasant. It did however give me plenty of time to think over where I was on the road and what I doing. My time in bed, or on the couch, would reveal that vocational governmental ministry was not currently in my immediate future. What I did need was a skill that was actually useful in the real world, as there isn’t a huge call for people to drive warships outside of the Navy… who knew.

Life Changing Scar

Life Changing Scar

So after much thought I headed down the path to become a Nurse. Firstly completing my Diploma, so that I could work and earn money whilst studying to become an RN. I am now studying my Bachelor to become the Registered Nurse I wanted to be. The skills I learnt in the Diploma set me up, not just to work, but for further study. I have felt, so far, that I have learnt more during the Diploma than I have in the Bachelor. The Bachelor does cover some of the “higher” thinking processes, but nothing a good seasoned EEN wouldn’t know or be able to work out.

New Career

New Career

I can honestly say that I love my Job. I love Nursing. Even at 2 in the morning when a patient has finally opened their bowels after 4 days, I still love my job. I look at the rest of this year and think that I have soo much left to go with my study. I sometimes feel like it is insurmountable. But I stop and look back on the road travelled thus far, I think about all the decisions that have lead to this point, I think about all the people I encountered and how every little word and conversation has shaped who I am. After reflecting on the road that has been, the road ahead doesn’t seem so bad. There are only 18 weeks left in the Academic year. 10 of those weeks I will be on placement. I graduate on the 8th of December, and I WILL graduate.

The past 30 years have culminated to this point, every person and very decision. The past 20 years have shaped how I look at others, situations, and deal with emotions. The past 10 years have been a crucible in which I have developed my attitude, my ethics, my values and my beliefs. The past 10 years has also bought me my family, my wife, my son, and my two beautiful daughters. The road thus far has seen some twists and turns, some speed bumps and seeming road blocks, but the road ahead seems slightly less foggy and confused.

Maintain the Rage

Luke Sondergeld

Good Death

Over the past couple of weeks I have been reflecting on palliative care and what it is to experience a Good Death. I have had the honour of being a nurse to several patients in their final days and moments, and to my glee they have all experienced what I would call a Good Death. This also triggered thoughts surrounding my family losses in recent years, and the ones that are to come. More broadly this raised the discussion around assisted suicide and the moral, legal, and ethical issues surrounding the idea.

Some people will find it unusual or even confronting to read the fact that I had glee in my heart when dealing with someones death. Please realise that it warms my heart to see friends and family surrounding someone, who is comfortable, in no pain, well presented and cared for, all in their final moments on the planet. For me I define a good death by several factors. Firstly, comfort; the patient should be as comfortable as physically, emotionally, and spiritually possible. If this means Morphine infusions so be it, if it’s aromatherapy so be it, 12 pillows, a heater, their favourite blanket, if it can be arranged and not be a danger to them that’s what I will do. Secondly is pain; unfortunately most of us won’t meet the end of life without pain. My job as a nurse is to liaise with Doctors and ensure that the pain is either eliminated all together, or kept to an absolute minimum. Thirdly, well presented and cared for; the patient should have their hygiene needs met, new clothes as appropriate, hair attended, mouth cares attended, clean pad if appropriate, and generally look like someone has actually cared for them. Finally, family, and this can be a tricky one. Nobody can force family to be in attendance. Nobody can force family to be civil. We can facilitate an environment whereby the family don’t feel the need to clash, bicker, or argue with one another. The family of the patient should be able to say their goodbyes in a fashion that suits both them and the patient. Nothing will fill a person with regret quicker than not seeing a family member in their final moments, and having to apologise at the funeral.

Nan

Nan

A couple of years ago I lost my Nan and my Aunty within the same week. My Grandfather lost a Wife and his Only daughter. It was a rough week, and an emotional roller coaster. My Aunty suffered a massive brain haemorrhage and spent over a week in ICU before being declared brain dead. Within 24 hours of her passing she saved 6 lives as an organ donor. Please register to donate your organs here. My Nan was moved to palliate care after 4 days on a medical ward deteriorating. She spent 3 days on the ward before being called back to God. In those three days she was surrounded by family, memories, stories, and a whole gambit of emotion. She was prayed for, prayed over, and had the last rights read to her by the local chaplain. She was kept comfortable by some of the most attentive nurses I have ever met – one of the driving forces behind my choice to become a nurse. She was part of a going away party the night before she passed whereby her husband, sons and their family at pizza, drank beer, and reminisced over stories old, and not so old. There was laughter, there was tears, there was acceptance. We left Nan that evening and returned in the morning. That morning the Cheyne Stokes pattern kicked into high gear, we all knew it was close. We gathered around, and there was an absolute silence, and she slipped away. I led a prayer for her as she was taken back to be with God, and then the inevitable emotional release hit all of us like a ton of bricks. There was tears, and hugs, and silent nods of acceptance. My Nan passed without pain, well presented and cared for, surrounded by her family. She experienced a Good Death.

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In the effort to ensure that everyone has the opportunity for their Good Death, the conversation around Assisted Suicide or Euthanasia was bound to come to the front. My viewpoint is simple, everyone has the right to choose the way they want to die, how it looks, who is there, and what is involved. I am happy to facilitate all of that, just don’t ask me to push you over the edge. I can appreciate the fact that some people are in immense amounts of pain, and that their final days could be potentially agonising, though I am not convinced that a medical and pharmaceutical care plan could not deal with the pain. I also appreciate that some people won’t have a quality of life that they are accustomed to in their final days. I am not convinced that a well structured and considered Nursing care plan could make their final moments as dignified and for-filling as possible. I know that this subject is both currently controversial and emotionally charged, however it is something that needs to be discussed. It is also something that is unlikely to simply go away.

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With all of this said, the best way to ensure that the patient, a family member, or even yourself experiences a Good Death is to talk to your friends and family. If you want to be an organ donor, register and tell people so they know. Have an Advance Health Directive drafted so your wishes, should the terrible befall you, can be executed. Talk with your friends and family about your wishes and how you would like to be treated. Be informed of what is available in your region for palliation. Can you be palliated in your own home? Do you need to go to hospital? Would you need to travel to be palliated? These seemingly macabre things are considered as irrelevant or too distant to warrant discussion, but accidents can happen to anyone, or a sudden and fatal medical episode could befall you. Set yourself up properly for a Good Death.

Maintain The Rage

Luke Sondergeld

Wednesday Weigh Day 7

Welcome to the Seventh of a continuing series of posts called Wednesday Weigh Day. These posts will be a tracker for my progress through weight loss, hopefully, and a way to share my journey, and some of my recipes. With a current Daily Kilojoule goal of 5000Kj, to better tie in with my wife, who is also on the weight loss journey. I have been on the 5000Kj goal for a little over a fortnight now and have settled into the reduced intake reasonably well.

Weight at Start: 131.7kg

Goal Weight: 95kg

Weight Today: 118.7kg

Weight Loss this Week: 0.4kg

Total Weight Loss: 13.0kg

Amount till Goal Weight: 23.7kg

This week has been a bit of a holding pattern as far as food goes and also inability to take some snap shots. With work being busy, and University assignments and Residential School filling my timetable, and my wife having Parent Teacher interviews till 1900 at night. As such most of our food has been tried and true recipes like Chicken Fried “Rice”, Man Pie, Steak and Veg, or Chicken and Salad.

If you see a post on Facebook that involves a meal that hasn’t been covered here at Maintain the Rage, please message me, or comment below and I may be able to write a special post with the recipe.

Maintain the Rage

Luke Sondergeld

Schools Back

By the time you read this, the University semester has begun again. I will no longer have free time to indulge, sleep will cease to exist, and I will be semi-permenantly hunched over my computer. But on the bright side, it’s my final year, I am studying something that I love, and every moment I spend in a book is another skill or piece of information that I can use to Nurse better.

I want sleep

I want sleep

I am profoundly happy about the fact that this is my final year of study before becoming a Registered Nurse. A dream that I wasn’t sure I was going to be able to achieve. I am also happy that I could get the elective that I wanted, The Nurse as Educator. I firmly believe that every nurse, regardless of type or seniority, has the potential to learn, and not necessarily from someone higher than them. I also believe in continuing the education of the next generation of Nurses, or whatever you profession happens to be. To this end, I hope one day I can teach portions of the Diploma of Nursing course so that I can give back to a profession that has already given me so much.

The down side to all of this is, as with most things, time. In an average fortnight there are 224 waking hours, which assumes 8 house of sleep. I work eight out of fourteen days, totalling 68 hours, bringing us down to 156 hours. Study is expected to consume on average 80 hours per fortnight, bringing us to 76 hours. Deduct travel, showering, ironing, eating and prepping food, the time wasted lying in bed not sleeping, totalling 35 hours, we are down to 41 hours. Spread that over the course of the fortnight and that leaves you with a little under three hours a day to spend with the children, do chores, run children to extracurricular events, wind down, spend time with family, and other ancillary tasks. And that assumes all goes to plan.

coffee

Coffee

When I first embarked on this journey, at a time when I was bailed up having most of my abdomen sliced open, I knew that my study would put a strain on the family. I knew that I would be sacrificing time with the children, time with my wife, and time to myself, all in the interest of completing the required study to do a job that I am so passionate about. They say Nursing is a sacrifice. And it is, from the moment we begin studying, to working nights, weekends and other public holidays, coming home emotionally drained because of the different masks we wear for our patients, we come home physically exhausted from all of the walking, lifting, carrying, and other manual labour tasks. Nursing is not just a job. It’s a calling, something that gets placed upon your heart whereby you feel the overwhelming desire to serve people at their worst and most vulnerable. A profession I gladly serve.

Study Nursing

Study Nursing

For those who read this an are put off by the notion of study, don’t be. The journey may be rough and arduous, but is infinitely rewarding. If anyone is unsure of whether or not to embark on this journey I strongly encourage you to reach out to me, or someone else who has walked the journey ahead of you. Email, message, comment, Facebook stalk, I don’t mind, just reach out.

Maintain the Rage

Luke Sondergeld

Medical Nursing

I have been Nursing for about a year now, which isn’t a lot in the grand scheme of things but never the less, and I have had the pleasure of experiencing Mental Health Nursing in two different facilities, Medical Nursing in two seperate facilities, Aged Care Nursing, Community Nursing, and Surgical Nursing. Though this only scratches the surface of what nursing is available with; Oncology, Cardiac, Emergency, Intensive Care, Renal, Respiratory, Rural and Remote, and Midwifery just to name a few. I have recently been reviewing my career and what each section has taught me, showed me, and revealed to me about my nursing.

When I first started my career I was almost exclusively employed in the surgical ward of my Hospital. I thoroughly enjoyed the work. It was fast paced, I had a tonne to learn, the staff were great, and I was able to meet new patients almost every shift. This was amazing, for the most part, but I felt that something was missing. Occasionally I would float to Medical and Mental Health, and though this was great exposure I didn’t really get a chance to experience the whole ward and what it meant to Nurse in these sections. My time in surgical felt very much like a revolving door, every day saw the discharge of one patient just to be replaced by another, that patient would stay overnight then would be gone again. It was something that I never got used to, it was something that I never felt comfortable with, it wasn’t the way I liked to Nurse.

medic treating patient

My exposure to Mental Health Nursing is varied. On one hand I was floated to Mental Health at random times which was great for a small taste of Mental Health but I never really had the opportunity to perform all of the duties a permanent Mental Health Nurse would, and for very good reason. My placement for Mental Health showed me a whole new side of Mental Health Nursing involved with involuntary mental health orders, and forensic mental health orders. This changed the behaviour of the client drastically compared to that of a voluntary client. Following everything that happened mid last year I no longer float to the mental health ward, to which I am thankful.

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When I returned from leave I found myself permanently assigned to the medical ward, at first I was a little miffed, I had always considered myself a surgical nurse, but never the less I gave the new role my all. What I did not expect was the learning, the experience, the joy, and the mental exercise that I would get on a day to day basis. I began to see what one of my nurse-mates said which is surgical is like the sports jocks, and medical is more like science geeks. Surgical pushes you as a nurse to be constantly one step ahead, be organised, and know what the next step is. But when it comes to medical its noticing the little things, the comments made by the patients, the changes in behaviour, the myriad of medications, and the effect of medications, bowel status, and fluid intake has on the human body and behaviour.

person using black blood pressure monitor

This last week I found myself back in surgical again, and I began to realise something…. I am not a surgical nurse. I am a medical nurse. I love taking care of people, I love watching as someone improves, I love encouraging patients to do their best and stretch themselves. I never thought that I would find myself saying those words, I thought I would be the speed freak chasing the quickest nursing with the quickest turn around and the least amount of physical time with individual patients. I was so sorely wrong. So what does this mean for me in the future? Currently I will continue to enjoy my time on the Medical ward of my workplace. In the future, I still don’t know. It could be a full career on Medical Wards, Intensive care, maybe even palliative. Only time will tell.

Maintain The Rage

Luke Sondergeld

 

Setting Goals

Each year it is not uncommon for people to set New Years Resolutions, or goals for the proceeding year. Though I do not personally subscribe to the idea of a News Years Resolution, like January 1st is the only time of year you can set goals, I do subscribe to the notion that we should be constantly growing and moving forward. To that end I have three overarching goals for 2019, along with a slew of smaller ones, that I would like to see achieved.

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Goal 1

My first goal is probably going to be the hardest to achieve. I want to weigh 95kg before the year is out. Now some of you are probably thinking that should be a reasonably simple goal, that I should only have to shave 5-10 kilos and I will be done. Alas, no. To reach this goal, please note this is before Christmas and New Years befalls us, I need to shave 32kg from my frame. I need to lose the weight for my own health, the longer I carry this thick layer of visceral fat, the more and more likely I am to develop a serious cardiac issue. I also need to lose the weight for my kids, if I don’t shave the weight I won’t be able to run with them, hike with them, swim, jump, or play with them, and I can’t have that. That is not going to be an easy journey, however, it is a journey I have been on before. I know I can lose the weight, I just need to actually exercise, stop eating and drinking so much sugar, and cut down my portions from what I want to eat to what I actually need to eat. So Goal One, lose the weight.

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Goal 2

This one seems a bit of a no brainer but is here for a very valid reason. My second goal is to continue to Blog at least once a week. The reason this is a valid goal and not something  that is a given, is at times my depression outweighs my desire to share with everyone. Somedays I look at my computer and the only thing I feel I can contribute is a long paragraph of crying and some terrible pictures of me doing as much. Sharing with this community is as much for my benefit as anybody else’s, I feed off your reads, your comments, and your engagement. I love hearing about how a story I have written has impacted someone, or is changing the way we deal with ourselves and others. So this is why Blogging is my second goal for 2019.

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Goal 3

Again a goal that should not need to be written, but valid none the less. My final formal goal for 2019 is to Complete my Bachelor of Nursing. The reason this goal is so important is Nationally 25% of Nursing students drop out of the course, that is just the voluntary ones, then you have the failure rate of up to 40% on top of that. That is more than half of the students who begin the course will not see the end of it. In 2018 I had an interesting year (for those who are interested please read the Mental Health related posts) I managed to pass my written assessments, pass my exam (if only just), and I got through my clinical placements. It took a lot out of me to accomplish simply completing my second year, and that is I something I do not want to have to go through again. Hopefully, and God willing, I will be able to manage my depression and anxiety, study hard, and pass my Bachelor. This will the provide me with a better paying job, an expanded scope of practice, more opportunities, and a fantastic sense of accomplishment. So my final formal goal for 2019 is to complete my Bachelor of Nursing.

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Informally I would love to, accumulate, assemble and paint 2000pt of Tyranids, play more Warhammer with my friends, spend more time with the kids, lean in closer to God, attend Anchor as much as my rostering allows, continue to grown in my faith, serve the Church more, spend more time with Family. I find the informal goals to be the things we all ascribe to achieve, and for one reason or another we fall short. I am finding if you write your goals down, have them in front of you all the time, and stay focussed you can achieve great things.

Why not share your 3 goals for 2019 in the comments below, who knows you may find a Goal buddy for 2019.

Maintain the Rage

Luke Sondergeld

Just Do It

I was recently interviewed by the Australian Teachers Magazine for one of their upcoming Student Guides. I was humbled and privileged to be a part of something that could potentially impact on the next generation. Part of the process was an interview in which a variety of questions were asked regarding my educational journey, my journey to becoming a nurse, and it culminated with the final question which was If you could give just one piece of advice to a student considering further study, what would you say to them, without hesitation I answered with Just do it!

This experience led me to reflect on the journey through Nursing to this point, the people along the way, the learning opportunities, the teaching opportunities, and the people impacted along the way. Before I even began studying my Diploma I had friends and family who were either currently studying the Bachelor or have been in the industry for a number of years offering advice on how I should go about my study, areas of Nursing to pursue, or even anecdotes of encounters with different patients. Even during this early stage I began to notice that nursing was more of a harmonious collective then a series of individuals. As I progressed further with my study this notion didn’t falter, of course there are the odd few that are the exception to the rule, but for the most part Nurses here in Australia are a fairly accomodating and encouraging bunch.
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During the Diploma itself, I was with some 40 odd other students who came from a variety of backgrounds, and had a diverse range of skills. We had everything from the School Leaver to the Re-skilling Mum to the 30 something Career shifter. All of these different people made for a unique learning experience. We were at the University for three days a week, every week during the semester. This gave us all a lot of time to spend with one another. Friendships were formed, clicks began to emerge, but on the whole we worked as a class to get through the learning, practice the skills, and become better nurses accordingly.

These ladies and gentlemen and I would hone our nursing skills by using each other as patients, this gave us the unique opportunity to see what the care we were providing was like from the patient’s perspective. We practiced everything from bed making to hoisting to basic observations to administering medications via a mixture of routes. Some students came forward as natural leaders and teachers and subsequently lended themselves to assist the class when they were having difficulty. I formed a close friendship with two of the ladies in the class, Sarah and Michelle; we studied together, learnt together, and unwound together. I am thoroughly thankful for every single person in the class, without them I would not have strived to be the nurse I am today, I would not have the skills or the knowledge I have now. Ladies and Gentlemen I thank you.

As I entered the workforce I found that the same camaraderie that I found during my study continued into the profession. The nurses I work with every day have no issue taking the time out of their busy day to help out, and conversely know that if they need assistance for whatever reason I will be all to willing to provide it. I am currently on one of my placements for the Bachelor, it is in a facility I have never worked in before, and the staff have been great. They have taken the time to show me around, answer all my silly questions that arise in a new facility, and help me to stop thinking like an Enrolled Nurse and start thinking like a Registered Nurse. What I didn’t expect was the opportunity I had to share my knowledge. I was on shift when one of the patients required their Negative Pressure Wound Therapy, or Vac dressing, changed. None of the RNs on shift that day had changed one before, or it had been so long that they had all but forgotten. Given I work in an area that sees frequent vac dressings, as well as having  spent a large amount of time with one personally, I was able provide the information required.

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So why share this story? Sure its a nice feel good, heart warming piece, but what’s the point? The point behind this post is to encourage those who are considering taking up a career in Nursing to jump in and Just Do It. For those who are thinking of taking up an apprenticeship or traineeship, Just Do It. For those who are wondering whether or not they should study at TAFE or University and are concerned they might be too old, Just Do It. For those who considered study but thought to yourself I am not smart enough or I am no good at school, put the doubt aside, and Just Do It. No simpler message could I possibly impart.

Maintain The Rage

Luke Sondergeld

My Old Brain Back

Over the past couple of weeks since ECT I have been blessed by the almost complete removal of Suicidal Ideations, reduction in the feeling of depression, and the decrease in general negativity. With this all been said, as I have been back at work, endeavouring to be more proactive around the house with both chores and children, and participating in Bible study with my wife every evening. All in all things have been going pretty well, but there are a few things that have made me want my old brain back.

I like to think that I am quite good with my words, almost eloquent if you will, but over the past couple of weeks I have barely been able to string a sentence together without forgetting one of the key words. For example, when I was writing the introduction paragraph to this post, I completely forgot the word proactive. I sat here staring at my computer for several minutes trying to think of the word. Eventually I asked my wife, and we sat in our office going through possible words until something twigged. It isn’t always a difficult or foreign word that is forgotten. Yesterday I forgot dishwasherdrinkphone, and car. I know that we all have moments were we simply forget something, or our brains decide it’s on lunch, but when it happens with as much (like right now) regularity as it has done with me, I wish that I had my old sponge of a brain back, and the guys and girls from my Diploma of Nursing class will know what I mean.

right-to-forget

The other thing I have lost is my tenacity or drive. Previously I was beyond driven, I had so many things on the go at once sometimes I didn’t know how I got them all done. I was volunteering at Scouts, the Diploma of Nursing Society, the SRC, the SPARC, studying my Diploma, parenting, assembling painting and playing Warhammer, and working. By anyones standards I was busy. I know that to work at that level for too long can burn anyone out. There comes a point when you have to hit the breaks and slow down for a bit. I unfortunately didn’t do that. I decided that the only thing to do was keep going and try and pile more on. I have no doubt this lead to my brain applying the breaks for me. Now I work 8 days a fortnight, study my Bachelor of Nursing, parent, be a friend, a son, and assemble, paint, and play Warhammer. A far stretch from where I was six months ago. The issue I have is, I miss being busy, I miss achieving things, I miss making the area around me better. I have no drive, no tenacity, and no push to achieve almost anything. I find it distressing and depressing that I don’t have the same level of drive as I have had previously and I am scared that I won’t ever have it again.

A mindset that I have found to be creeping in is mediocrity. Too many times over the past couple of weeks I have uttered the words ‘Meh, that will do’ or ‘Ps get Degrees’. Anyone who knows me will know that is not an attitude I ascribe to. During my Diploma studies I strove be be the best that I could be, know as much as I could, and generally attempt to be all that I could be. This is the reason I was nominated for two awards, received a High Distinction in one of my first semester units of my Bachelor, and a Distinction average on the others. I always pushed harder and reached further. Now I can barely motivate myself to achieve the minimum I need to just achieve. I am sitting on a credit average this semester, may have just passed two essays, and have not undertaken any extra curricular activities, vice this blog. I do miss the thirst for knowledge, the little voice that yearned to know more, the attitude of nothing is good enough until you have done all that you can. Instead, I am left with an apathetic brain that can barely remember the word dishwasher, a far cry from where we were.

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How I actually go about cherry picking the best parts of my brain and behaviour from before treatment and then apply them to life now is still a mystery. Maybe the only way to have the level of tenacity and drive is to have the negatives that come with it, negative feat for a positive feat. Maybe I am now stuck with the brain as it is and I just have make the most of it. I find it distressing to think that I have voluntarily removed almost everything that made me, me. It is almost as if I have been changed from an A type personality to a B type. I know as many of you read this particular post you will be thinking of how much I still do, and how I am being too hard on myself. The reality is the one of the behavioural traits that carried over almost flawlessly was my ability to self analyse and subsequently tear myself to shreds. It’s not the healthiest trait, but it does help me improve, or at least identify fault. Where do I go from here? I honestly don’t know. I know I need to improve my drive, but not at the cost of my mental health. I know I need to push more, but not at the cost of those around me. One day I suppose I will find that balance, unfortunately today is not that day.

Maintain the Rage

Luke Sondergeld

Schools Out

This week saw the last exam for the semester, and the last contact day for University in 2018. Though I have enjoyed the learning and content covered this year, I am also looking forward to having some down time and enjoying time with the family, friends, hobbies, and other neglected facets of my life. The journey through 2018 has been an interesting one, with a new child, new mental health issues, and the challenges of continuing to juggle everything else.

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In March of this year, consequently the start of term, my wife gave birth to our third child, and second daughter. The normal strains that come with adding a new screaming bundle of joy into the house were of course prevalent and made work, study, and parenting interesting. I am supremely glad that my wife is the trooper and super Mum that she is. Without her ability to manage the house and children, normally at great personal sacrifice, I would not have been able to get thought the first semester of University, working 10 shifts a fortnight, and contributing were I could. Our daughter is  just over 6 months old and is an adorable happy ball of cuteness. Unfortunately, I cannot post any pictures of her as my wife and I agreed on no pictures of the children online. But take my word for it, she’s adorable.

As I have written about in many posts, my mental health took a sharp decline not long after my second daughter was born. I had thoughts of suicide, I was depressed, I was anxious, and I could barely function on any reasonable level. I sought professional help, I became medicated, and I began seeing a psychologist to talk through my emotions and diagnosis. Everything continued for a while, but alas did not improve. The decision was made between the psychiatrist and myself that ECT was the best way forward. So we began a course of 12 sessions, three times a week, until completed. I saw the course through and things had improved. Now, some weeks on, I have had struggles, but we get through it. Now, I am still medicated, still see the psychiatrist on a weekly to fortnightly basis, and see the psychologist when our schedules align.

Whilst the treatment happened, whilst my second daughter continued to grow and be awesome, I was studying. I managed to get through my first semester with reasonably good marks, one subject was a High Distinction, and I felt pretty chuffed. Unfortunately, one of the side effects of ECT is memory loss, and I have a rather large blank spot in my memory. It extends roughly from June through to the end of August. It is interesting to say the least, people will tell me stories of things that happened, that I was involved in, like rebuilding my mate’s back stairs, or cutting down and moving a ton of firewood. This had lead to the second semester being less fruitful when it has come to my grades, leading me to the expression Ps get Degrees. Its not pretty, its not how I like it, but its what I have to do to survive considering the circumstances.

27862164-school-s-out-for-summer-on-blackboardI will just be glad that over the University break, which runs from now till March 2019, I will be able to spend more time relaxing and doing the things I love doing. I am also glad that I will be able to have a recharge and hit the ground of 2019 running. I still have one more placement to go in just over a weeks time, stay tuned for the reflection, but otherwise, its work, family, and rest.

Maintain the Rage

Luke Sondergeld

Working through it

Anyone who has been following my social media on Facebook or Twitter, and those who have been reading my blog for longer than a week will know I have Depression and Anxiety disorder.  This has meant that I have had a course of ECT, been on a myriad different medications, and see a psychiatrist and psychologist on a regular basis. All of this is done with the hope that I can continue to exist with some sort of sense of “normality”. A part of that is I endeavour to continue to live my life as though my mental illness didn’t exist; I study, I parent, I work, and I try to be there for my friends. Sometimes things don’t always go to plan.

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So on a weekly basis I see my psychiatrist for a review of the week, not too dissimilar to what I do on here actually, identify any risks or significant changes in my mental state, and then come up with a plan for the week ahead. This week we discussed how the medication had been sitting, how much coffee and alcohol I have consumed, how my week had been travelling, what my thoughts had been like, how my motivation was, how my sleep was, and as always any thoughts of self harm or suicide. Most of the medication had been sitting with me quite well, no significant side effects, and all performing as they should. The only exception to this was the newly added Quetiapine. It was added to help with my anxiety attacks, and at this task it was performing adequately, the only side effect was it made me a little dopey and sleepy, but thats ok nothing an extra couple of coffees a day couldn’t fix right? The Doctor wasn’t too amused by the number of coffees I was having in a day. His suggestion was to completely eliminate coffee, well actually all caffeine, and to assist in this he changed when I take the Quetiapine. Instead of three times a day I take one large dose at night, it helps with sleep, stops the daytime nap attacks, and assists with eliminating caffeine. I may not eliminate caffeine completely, but I will cut down to one coffee a day. Small steps.

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The past couple of weeks have been intense on the study front. I have completed 26 quizzes, written 1500 words for a reflection on my mental health placement, and a series of small written tasks that are more time consuming than actually difficult. The workload this semester has been a little more intense than I had anticipated, compared to last semester, and in fact the diploma, this semester has required a lot of work in a surprisingly small period of time. The period of time may have been made smaller due to the fact that I had four weeks of ECT, a period of most of the semester in varying states of depression, and losing large portion of my memory that cover the semester and its content. This hasn’t stopped me from studying full time however. I intend to keep this momentum for the remainder of my Degree, thus finishing at the end of 2019. Not long now.

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The past two weeks have seen me on placement at a Mental Health facility. Though I thoroughly enjoyed my placement, the staff, the opportunity to learn, and the new experiences, there were some interesting situations that arose that may not have been an issue, if it wasn’t for my mental state. John was a consumer who was diagnosed with bipolar affective disorder, and was currently in the depressive phase. John was not an aggressive consumer, nor was he deliberately belligerent, or difficult. John was, typically, a polite consumer who was in the throws of the depressive phase of his condition and didn’t know how to deal with it. With this information at hand the conversation was easier to begin, and it made engaging with John possible. The conversation began with idle small talk about how he was going, what he had been up to and the like.  When he answered about how he was going this opened the conversation up to talking about his feelings, what was making him feel low, was there anything that made him feel joy, was there anything that provided an emotional response other than sadness or depression. By listening to John’s responses, asking open questions, being empathetic to what John said, and engaging with him on a personal level, I was able to draw out more from John, and John was able to see more of himself.  The result of this conversation with John saw the rapport together grow stronger, and the conversation to progress naturally and openly. John began to share his story of life prior to his admission, share on his lost loves, his family, his illness and struggles. It took nearly an hour of general conversation before John began to openly reply without the need to have every piece of information drawn out like blood from stone. He spoke about his illness and how it made him feel, how it skewed his view on things, and how it most likely affected his previous relationships. Personally I was affected by the openness and his story, how his illness has affected him, and how it continues to burden him. As someone who suffers with depression himself I found it both confronting and comforting hearing the story. I found the similarities and the emotions to be difficult to swallow at first, and to be honest it are still a little difficult to process. To think that my trains of thought could continue to develop to one day be admitted to an institution such as the one I was working. To have my thoughts and emotions assessed and probed by someone who was in my situation. That thought still lingers.

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My mental health has not had a more profound effect on anything as it has on my family, and my role as father. Thankfully there hasn’t been a direct action caused by my depression or anxiety that has bought harm or ill will to my children. The effect it has on my children is more closely related to apathy. My mood often places me in the position where I do not want to interact with my children, do necessary chores for the children, or otherwise do the necessary things I need to do as a father. This has weighed heavily on my heart. I feel terrible for not doing what I need to do for my children, but at the same token I have no energy or drive to complete the tasks either. I love my children, I want to be able to say I would do anything for them, and have it be true.

I have not been back to work for several weeks, this has been due to the original mental state, followed by ECT, and most recently I have been on placement. Today marks the first day I will actually be returning to work. I am both apprehensive and excited to be returning to work. Though I have no doubt about my physical ability to do my job, or my professional ability to carry out the tasks my job requires, my anxiety continues to whisper in my ear feeding ideas of inadequacies and shortcomings. The end of the shift will be the only true indicator of how the day will go. I just pray the day goes well.

As with most things surrounding my mental health, my friends have suffered through all this. I have bailed on events, forgotten almost everything that has happened or been said over the past month, and almost actively avoided interacting. Though my friends may not think I have been a lousy friend, it is certainly how I feel. My heart is to spend more time with my friends, give them the time they deserve, be there to support and help out when I can. I hate myself for not being the better friend, which causes my depression to take a dive, which leads me to generally being a worse friend, which leads to the loathing again. Thus the cycle continues.

Though the story above may seem to be now of woe and worry, it is not all doom and gloom. ECT has been a raging success, with my mood improving and suicidality decreasing, the medications have been working with varying degrees of success, my walk with God has helped me keep things real, the time I have spent with friends has been great, and I have managed to find time to spend on my hobby.  Things are still hard, I still have thoughts of being irrelevant or unnecessary, I spend most of my day trying to motivate myself to keep my mood up, I am still failing in more areas than I am succeeding, but I am doing everything I can to,

Maintain The Rage

Luke Sondergeld

The Week That Was

I have been wracking my brain trying to think about what this post was going to be about. I kept bouncing between my mental state, my placement, my family, my study, and everything else in between. I couldn’t sensibly decide on one topic to share with you all. So I have decided to share all of them. This weeks post will be The Week That Was.

THIS POST OPENLY DISCUSSES MENTAL HEALTH ISSUES AND MAY BE DISTRESSING TO SOME READERS. DISCRETION IS ADVISED

I start by updating everyone on my mental health. For those of you who follow along at my Twitter, @LukeSondergeld, or keep tabs on my Facebook, Luke Sondergeld, or the Maintain the Rage Facebook page, Maintain The Rage, you would know that things haven’t been going so well. I shared yesterday that I have been feeling a lot like I had done back in the middle of August. This is particularly distressing as that is also pre-ECT. The most distressing part of all it is the anxious and helpless thoughts that are returning, with no rhyme or reason. I feel as though I have been knocked to the ground and am constantly being kicked by circumstance. The most frustrating part of it all is, my life is pretty great. I have have an awesome wife, my kids are pretty great, I have a roof over my head (which I own), I have a car, a job, food in my belly, and I am not actively been persecuted, hunted, victimised, or belittled. I have no reason to feel the way I do. But I still seem to be coming back to it, over and over again. It is moments like these, in my darkest moments, I catch my mind wandering back to suicidal thoughts.

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Through all of this I have been on my clinical placement, ironically, for Mental Health. In the interest of keeping the workplace, the consumers, and the staff protected, I won’t mention where I have been doing the placement. The placement has been amazing. The staff have been great. The consumers have been challenging and accepting all at the same time. I have been allowed to do my job without being treated like a child, and my opinion, thought inexperienced, is still listened to and respected. I still have another weeks placement ahead of me which is going to be challenging and rewarding all at the same time.

The one thing that has been the constant, the rock, the shelter, has been my family, my friends, and those close to me. They have all been my greatest support though my depression, the most understanding when I am stuck behind my computer completing 26 Quizzes in a little over a week, forgiving when I loose my temper, and supportive when I am a blubbering mess or quivering wreck. To all those who I call family, and you know who you are, thank you and I love you.

To add a little salt to the wound I am still trying to complete my Bachelor of Nursing, hence the placement. This has also meant I have recently, as previously alluded too, been completing, and subsequently passing, 26 Quizzes on Pathophysiology. This week I still have one more to complete, which is some 60 questions and has 3 hours allotted to it. Additionally, I have a 1500 word reflection to write about a difficult behaviour, how I handled it, and what I learnt from it. Thankfully I am in the habit of writing and reflecting, so it should be too difficult.

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So that is the Week That Was; this week will see a return to my Psychiatrist for a review and a serious discussion about my headspace and what we are going to do, a return to my placement, more study which I hope to complete, and somewhere in there some peace and quiet. To those reading, and sharing, this post…

Maintain the Rage

Luke Sondergeld

First Fruits

This week I had the inordinate pleasure of attending the Badging Ceremony (Pinning for our American brethren) of a group of Nurses I mentored during their time at the University. I also had the honour of being the keynote speaker for the event, which was a new and exciting endeavour I hadn’t yet experienced.

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The night was beautifully set up by some of the students, you know who you are, and was primarily put together by those students. The funding for the event came from the Diploma of Nursing Society, which I created and Chair. The night was MC’d by a student with enough charisma to bring the house down, Charlie you did an excellent job, don’t ever change. The evening flowed amazingly with presentations commemorating this time together, speeches from the staff congratulating the students and from the students thanking the staff, and of course the presentation of the actual badges.

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The history of the pinning ceremony is long standing, the nursing pin has a long history, dating back more than 1,000 years to the 12th century crusades. During this violent time period, those who were devoted to caring for the injured and ill were given large Maltese crosses to wear on the battlefields. These crosses with equal-sized arms were large enough for all to see.

However, it’s the legacy of the famed Florence Nightingale hundreds of years later that has influenced modern-day nursing school pinning ceremonies. Hospitals recognized Nightingale’s impact on the field of healthcare—particularly nursing—and began creating pinning programs beginning in the mid-1880s. Initially, only those nurses with exceptional marks and practice received pins, but that later expanded to a larger audience—including all nurses devoted to the welfare and well-being of society.

By 1916, pinning ceremonies were common in the U.S. and England. Since then, colleges and universities have created their own pins as well as produced their own versions of the ceremony. While some have decided to forego the ceremony and pin altogether, many continue the time-honored tradition.

Usually a separate celebration from receiving a diploma, the pinning ceremony tends to be more intimate and involves new nursing graduates and their families as well as faculty members and other representatives from the school of nursing. Some ceremonies dictate that family members pin the new graduates, while others have nursing school faculty members place pins. Nevertheless, the pinning ceremony symbolizes the graduate’s achievement of completing the educational requirements and marks their transition into the profession.

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As a final thought on the night I though I would share a portion of the key note I delivered. This section was the conclusion, and more generalised in nature.

The average life span of a nurse is just 3.7 years. It is a tough and often thankless profession that demands nothing shy of perfection every single day. It requires you to often sacrifice yourself for the betterment of others. It requires you to have the knowledge of a Doctor without the pay to match. It is a profession where you will get covered in all varying forms of bodily fluids, handle the worst that comes out of a patient, and smile while you’re doing it.  It will require you to hold back your own tears as you comfort others. You will need to juggle dozens of things at a time, and still need to make sure they all fall into place. You will be pushed by the patients to breaking point, but still deliver care with a soft and welcoming hand. You will be the first thing a baby will see, and last thing an elder will see. You will hold peoples lives in your hand as they deteriorate following trauma, and you will smile when they rehabilitate. You will write more in a shift then most authors do in weeks, and decipher more scripts than an archaeologist. You are blessed to be a part of this profession, and the profession is lucky to have you.

As a final thought I leave you with this. Nursing is a profession that requires a high level of skill and dedication. Try and take something away from every shift. Whether it be a new technique, new skill, or even a new medication, learn something. And of course try and remember, if its wet and not yours wear gloves.

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To all of those who were pinned this week, I wish you all the very best in your endeavours. For those of you who are still on the journey I wish you the very best of luck. I know I am looking forward to my Badging at the completion of my Bachelor.

Maintain the Rage

Luke Sondergeld

QLD Training Awards

As anyone who follows my Twitter or Facebook would know, I was nominated for the Vocational Student of the Year award. The weekend just gone was the award ceremony for the finalists, and eventual winners. The night was amazing, and is completely available on Twitter under the official hashtags #QTACQ and #QTA2018, and all of my coverage is under #MaintainTheRage.

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The whole experience started a couple of months ago with a phone call congratulating me on my nomination for the award. I was then told I would need to write what would equate to an essay on myself and why I should be considered. This essay would filter out candidates to narrow the field to three. Following that a phone interview was conducted whereby they asked questions about study, life, extracurricular activities, aspirations and a myriad of other topics. This determined the winner. But it would be many months between the interview and the awards. The local paper wrote an article about my nomination, as did the University where I studied my Diploma and currently study my Bachelor. But before I knew it, the weekend was upon us.

I was accompanied on the night by my Mother and Father who have been a MASSIVE support since my discharge from the Navy, and subsequent training, and difficulties along the way. Not that they haven’t been supportive prior to this moment…. you know what I mean. Anyway there was nibbles, drinks, and networking going on everywhere. There where some 200 people in attendance that varied from 15 year old students to teaching staff to Dept of ESMTSD and the local MP. It was great to have Jay Laga’aia as the MC for the evening, he not only kept the night moving as it should, but gave some much needed comic relief to the room.

 

The food was pretty good, considering they were catering for the 200 of us, and some of us decided to be fussy and try and eat Keto for the night… It didn’t work, I failed and subsequently gouged myself on Carbs. I regret nothing. The entertainment was amazing, there was a local two piece band that was AMAZING, if you are ever in Mackay Queensland and you get a chance to check out Jessy J and the Ricochets, DO IT!

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Now the actual presentation was broken down into two main parts, the naming and  awarding of all the finalists by category. This was again broken in half by our main course, and followed by dessert. Then the naming and awarding of the actual winners of each category. Which was unexpectedly nerve racking. I was counting down the categories as they approached mine. I was trying to see if there was something common amongst the other winners to show a glimpse at what might come. Even when my category was up and Helen Huntly, PROVOST of CQUniversity, began her opening dialogue to draw out the suspense, I was convinced I wasn’t the winner. Then she said it. My name. I couldn’t believe it. It was like a dream. I looked up at the screen to see my name. I had done it. I had won the Regional Vocational Education Student of the Year Award. I was over the moon. I couldn’t stop shaking with the surge of adrenaline. I walked on stage and excitedly embraced Helen, and then thanked and shook hands with the other dignitaries on stage. Jay made some Darth Vader remarks and asked if I wanted to say a few words. Which I took the opportunity to. Because as you all know I hate speaking to crowds and always shy away from a chance to say something. The video of my announcement and speech is here for those interested.

 

So now I prepare for State finals. The process is almost exactly the same with the only exception being the night will be held in Brisbane QLD in September. I will try and keep everyone up to date with what is happening with the Award and any cool stuff that comes out it.

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This story wouldn’t be possible without the dedicated, understanding, patient, loving people I have around me;

  • Deb my Mother and check sum
  • Jim my Father and sounding board
  • Ashley my Brother
  • Bec my Sister-in-Law
  • Jess my Kiwi friend
  • Jess my Not Kiwi Friend
  • Adrian my good friend and Ninja Turtle
  • Chris my good friend and Xeno Scum
  • Joseph, Darby, and Ethne my children who give me a reason to get up in the morning
  • Alinta, my wife, the one person who single handedly holds my world together, catches the pieces that I drop, and ensures that I actually stop and breathe once in a while.

I love you all. You are the reason I can continue to Maintain my Rage. Without any of the above people, and numerous others I haven’t named, I would not have been able to even be nominated for such an award, or even do the things that I do, so Thank You.

Maintain the Rage

Luke Sondergeld

Nursing with Depression

Nursing is a tough gig by anyones standard, the demands put upon us to know medications, procedures, illnesses, conditions, symptoms, cultural traits and behaviours; be able to assess pain, nutrition, hydration, mental state, and to be able to perform our ever increasing mound of responsibilities while maintaining our smile, our professionalism and conducting our duties with aplomb. Then on top of all that add in a large dose of self doubt, insecurity, second guessing, negative self talk, fear, paranoia, anxiety, reluctance, demotivation, and malaise. That’s Nursing with Depression.

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I love my job. I don’t mean that in a cynical it’s nearly Friday kind of way, I genuinely love what I do. I am privy to people at their worst and get to help them through it. I get to see someone take the first steps on a new knee, or regain movement after a traumatic injury. I get to see people recover from the depths of despair, and see them cast off their demons. I love my job, but, I have deep perfectionist traits, and these traits often leave me feeling uneasy about what I do. If I am administering medication I like to know the reason for why the patient is on it, how long have they been taking it, do they receive the intended benefits, and have they spoken to someone if they have not. What I also tend to do, is beat myself up. I will be organising a patients medications, get to something I am unfamiliar with by name, look it up, realise it is the same as a drug I already know, then kick myself for not knowing, for the rest of the shift and sometimes further past that. This then leads me to kick myself about everything. Sometimes things that are even out of my control or ability. I have such a high expectation of myself that I will count failure where others count success. I have been told I need to see the silver lining in things, and for the most part they are right, but to my perfectionist side… silver is second place.

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The perfectionist it probably the reason for my burn out last year, my depression taking hold and the anxiety being as high as it was. The depression is the ongoing anchor around my waist. Most days I can get through with a reasonable level of positivity glued to my face and convince everyone I am ok. For the most part I succeed, but not every time. There are a few who I work with who know what is going on, to what extent, and understand the daily struggle. To everyone else, I am either well rested or exhausted. The depression manifests itself at work in the form of doorway syndrome, having to read the same thing anywhere from twice to six times, checking my watch three times and still not realising the time, feeling lethargic on the floor and feeling like I am walking through molasses. It takes some of the joy out of my job, the time spent with the patients, and the satisfaction from my work. It truly is hard to describe what is it like.

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Though the depression makes the day difficult, nothing is as debilitating as anxiety. Anxiety as a whole is terrible, I feel for every person who lives with anxiety. Trying to nurse with anxiety some days is down right impossible. There have been times on the ward I have had to leave a patient’s room to try and calm myself. I have had to steady my own hand as I’m giving an injection, not only to perform it correctly, but to give a modicum of hope to the patient that it was going to be fine and they needn’t be nervous. Thankfully it hasn’t stopped me from performing my job, yet, only delayed or slowed what I am doing. It has curbed my interactions with staff and patients. I find it difficult to talk about some subjects, especially those that I believe will cause people to think less of me, or that I am incompetent. But I suppose that all links back to the perfectionist side again.

This article is not designed to illicit sympathy or cause you to feel pity. This article is to show you that times can be tough, work could be rough, your anxiety is kicking you when you’re down, and depression won’t let you get back up again. It is to share with you my struggle, every single day. It is to show you that you are not alone, your journey is shared and we are stronger together.

Maintain the Rage

Luke Sondergeld

Murse Luke

After the past 18 months of study, placements and headaches, I have finally made it. I am working as an Enrolled Nurse. Though this is just the first step on a long road it is an important one, and one I am enjoying every step of the way.

My first week was interesting for numerous reasons, firstly, it felt oddly like placement to begin with. The facility I am working at has a robust policy surrounding skills and the management and assessment of them, so when a new nurse comes onboard they are observed by a senior nurse to ensure they are safe and proper. So my first set of medication rounds, my first injections, my first dressing change, my first ECG, my first admission, my first discharge and even my first progress note, where all checked to ensure I was safe and proper in my nursing.

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Secondly, I am still working my through my own Mental Health struggles, and the one thats being playing up for me is Anxiety. I am normally a confident and outgoing person, this has helped me in my day to day life as a student nurse, in the Military and generally as I have travelled through life, but when you have a little voice in the back of your head casting doubt over everything, things get difficult. I only had a couple of anxiety related attacks, one of which was with the aforementioned dressing change, I was reduced to shaking like a leaf and sweating profusely until I reassured myself that I can do it, calm myself down and cracked on. But generally I have had a seed of doubt, which has made my life harder. I have been doubting decisions, doubting knowledge, doubting my own ability. Which is super frustrating.

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Finally, I was hired as a Surgical Nurse, that is a nurse that is primarily on the surgical ward caring for people post-operatively, not in theatre, and I have spent the entire time thus far on the Medical ward. Now I am exceptionally grateful to even have a nursing job straight out of school let alone a full time one, but it is a little odd. And the work is a whole lot “heavier”, by which I mean, most pop the patients are over 80 and need assistance with Showering, toiling, walking and moving from the bed to the chair.

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It has been a great week, I have had no thoughts of suicide since starting work, my wife has commented on how she has her old husband back, and I am feeling like I am on a little bit more of an even keel. I am looking forward to the trials and tribulations, the fun and frivolity, and the tears and smiles that my work will bring.

Maintain The Rage

Luke Sondergeld

Back to the Grind

So as my medications begin to take a better effect and I can see improvement on the anxiety front, I am faced with returning to work and the beginning of University in a couple of day. The reality of how much work I have ahead of me is starting to hit home, and I would be lying if is said I wasn’t a little nervous.

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I begin my first ever job as a nurse today, Monday, on the Surgical Ward of a local private hospital. I am so excited to actually get in and get the job done, however, I am also a little nervous, and has been the centre of several anxiety episodes over the past week and a bit. I know that it centres around my own idea of how much I need to know, and the idea that I will never know enough to do my job. I also know that when I get on the floor and actually start doing my job I will fall into the groove and be fine.

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The other thing that is rapidly approaching is the starting of University. Though Orientation Week is technically this week, I am working so have completed an online orientation. I am nervous about starting University. Though I have completed three Diplomas I have never started or studied at the Bachelor level. I have no doubt I would be able to do the work, but through 40 hours a week onto of full time study, things get difficult. Then throw another baby in the mix at the same time.

My Mental Health is improving. The number of anxiety episodes has reduced, even if the generalised feeling of anxiety remains. I haven’t had any suicidal ideations this week, though my mood, motivation and patience have all been low. Medications continue to change, but in an expected way this time, with the addition of more Lithium to bring me up into the Therapeutic Index.

I am struggling to live day to day with my Depression and Anxiety but I am getting there, getting back to work and starting school again will help with that. My wife, as always, continues to be may rock. And I love her more for it every day. Stay tuned next week to here how the first week of Nursing went. Until then,

Maintain the Rage

Luke Sondergeld

Nursing Steps

For those who haven’t been keeping up with whats going on, I have completed my Acute Care Placement and subsequently my Diploma of Nursing. It was a great 5 weeks, there are daily Reflections to catch-up on, and a wonderful experience. Following on from that we all had our Badging/Pinning ceremony on Wednesday as a graduation of sorts. I was then lucky enough to be asked in for an Interview at one of the Local Private Hospitals.

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The badging ceremony was a nice end to this part of the journey, it also marks the first step on my nursing journey as complete. The Diploma, for me, was a step to my Bachelor, registration as an RN and further study. The Diploma had it challenges, but I loved every minute of it. I enjoyed the opportunities the University provided me, the opportunity to mentor other students, and the experiences I had with the students and instructors alike. As far as the next step on this journey, I have been accepted by CQUniversity to study my Bachelor in 2018, which should see its conclusion by Christmas 2019. Then onwards and upwards.

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I was lucky enough, as part of a class of 40 in a small town (just over 80,000 in total), there was going to be some serious competition for positions. Hillcrest Private Hospital, one of the facilities I applied for, called me in for an interview the day following my badging ceremony. It may very well have been the shortest interview I have ever attended. I am reasonably certain I was in and out in 6 minutes. I arrived, the interviewer disposed with the pleasantries, asked what I was fishing for to which I answered full time work on any day and any shift, she said she could offer that and asked when I could start. We went back and forward for a short period discussing an approximate date for starting and it was decided that the day after I receive my registration paperwork would be the best. So come on AHPRA!

I am relieved to have work next year, Full Time work at that, I am glad that this part of the journey is done and dusted and that I can take the next step. I hope you all continue to come along the journey with me.

Maintain the Rage

Luke Sondergeld

Five Acute Care Reflections

Over the past Five Weeks I have completed my Acute Care Placement for my Diploma of Nursing, to catch up on the day by day click here. Over that time I learnt may very valuable lessons, what many different drains can be used for, the effect of different wound care products, the differing cocktails of anaesthetics, and how diverse the multidisciplinary team really is. But given that most of that can be learnt from a book or educator I will leave those particular lessons to them. Instead, I will focus on the lessons that are picked up along the way, shared by other nurses and learnt from the patients themselves.

Time Management

We all get taught at some point during Nursing School the importance of Time Management. I have always been a fairly organised person by nature, so thought I would be ok by the time I hit the floor. Oh how I underestimated how much needs to be done, and how many interruptions to your time there will be. I would suggest that, especially as a junior nurse, come up with a time table to break up your time that suits you. I found that by the end of my placement one hour blocks were too broad, I needed 30 minute blocks to sort my time. So I would draw up the patients I was assigned with hourly columns and a diagonal line. The Left triangle would be the first 30 mins of the hour, and the right the last 30 mins of the hour. You will also need some sort of key that works for you. I used for medications, IV for anything intravenous, Dx for dressing changes or checks, Obs for any observations, BGL for any blood sugar checks, and would create others as I required them. This creates a quick reference of your night, makes handover a cinch, and means that if you get pulled away by the NUM, you can ask someone to cover the things you now about.

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Self Care

I know I have written about Self Care in my Aged Care Reflection and I feel it even more important to talk about it again after my Acute Care placement and the impacts of family, life, and the dreaded Late to Early swing. The temptation, and Lord knows I pulled this stunt too often, to simply try and live a normal life when you are on PM shift, getting off at 2300, getting home, writing for an hour, bathing and getting to bed at 0130, then getting back up at 0600 to be with the family, then proceed to stay up all day living life before heading to work by 1530. It sounds ok, till four days of only five hours sleep begins to take its toll. Sleep is key. Please ensure that you get the requisite amount of sleep. You may get away with little sleep in the short term, but Nursing is a life long career not a flash in the pan job.

Eat well, eat regularly and keep up the water. I know in the first week of placement, I wasn’t the best at keeping my fluid, and was terrible at skipping meals before or after shift. So I had to actively change the habit. I ensured that I had access to a bottle of water somewhere on the floor, as you will rarely have the opportunity to leave and get a drink, and made myself eat before and after shift. this will ensure your body will be able to deal with the coming shift, and recover from it after the fact.

Take time to yourself. I wrote two weeks ago on my Post Fall on Sword about how I was terrible at taking a moment to have time off for myself, my family or my friends. TAKE TIME AWAY FROM WORK AND SPEND TIME WITH YOUR FAMILY. I was going to be more subtle but decided that it wasn’t necessary, and would get the point across as well. The people around you will be the only ones to help you after a rubbish shift, they will be the ones that are there when you loose a child on the ward, they are the ones who will be your sounding board when the NUM rosters you for 16 days in a row then calls you on your first Sunday off in a month. Spend quality time with them, switch off from distractions and try to leave work at the door.

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Take your Time

As previously mentioned, there are a myriad of things that can drain your time during the shift. However, an extra five minutes during an admission, asking a couple of probing questions when taking observations, or simply making small talk when checking up on your patient could give you key information that would otherwise be missed. During my placement, and subsequent time in Surgical, there was a patient who was in having a hip replacement. During the admission it was discovered that they had recently completed a long haul flight six day prior. Now those two things on their own are concerning enough, however, 24 hours after the procedure the patient had a seizure, their O2 saturation were below 80% on 15L of O2, and things were looking grim. It would  later be discovered that during their time overseas they had consumed some bad seafood, had a diarrhetic episode and subsequently took six Imodium to stop it. This subsequently kept the bug inside the body and it festered away, which eventually caused the Septic Shock that the patient had suffered. Now, the nurse who admitted the patient did ask probing questions about the trip, the travel  and all other matters of questions. What was missed was when the patient stated they felt unwell on their day of travel home, the only question asked was How do you feel now? Which is only an issue in hindsight, however, for me it will stick forever the importance of asking probing questions of anything that is out of the ordinary.

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Be Personable

I spent the first 5 years of my working life, like most young Australians, in Hospitality. For most of that I was heavily involved in Wedding planning, coordinating and serving. This generally meant that for six months of the year I would plan, run and serve for over 400 weddings. As you can imagine it gets a little mundane, as each wedding, no matter how unique, is formulaic; people arrive, couple gets married, a whole bunch of photos are taken, everyone eats, there are some speeches, some people cry, some people get drunk, the couple leave, everyone stays way longer, then just before the wedding day becomes a wedding weekend everyone leaves. So after doing this 400 times you could say you would get over it. However, my boss at the time had been doing it for over 15 years. So just a few weddings. He told me that despite the fact that it may be my 400th wedding, for the couple it was their first, and hopefully only, and that stuck with me. Now, as a young practitioner, I take that lesson with me. For me it may be my 5th day on the ward, my 100th day, or heaven forbid my 1,000,000th day on the ward but for the patient it may be their first, and even if it is not the first time on the ward it may be the first time for this condition, treatment or procedure. Be a real person, talk to them about their lives, laugh where appropriate and don’t treat them like a number or another body in a bed. It is a simple lesson to listen to, but proves to be difficult to put into place when under the pump.

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No Dumb Questions

No matter how many times I hear it, no matter how many times I have tried to impart this little gem it still seems to be something that is missed. I know during my placements, my lab days at Nursing School, my study sessions with my friends, or simply asking old Dr Google, I asked a ton of questions. Some of them seemed a bit simple or dumb at the time but I soon realised that either I wasn’t the only one thinking it or it wasn’t such a stupid question at the end of it all. I recall after ECT, during my Mental Health shifts, I noticed that the consumers right eye was almost alway more blood shot then the left. I knew it was the side that the treatment runs through and assumed it was a side effect of the treatment, but asked the question anyway. It was a seemingly dumb question but raised an interesting problem, no-one know why, and more interestingly, most people hadn’t even noticed it previously. So this seemingly dumb question now moves into the realm are curiosity for many. I am still yet to actually find a reasonable answer other than because of the electricity, but I live in hope. The lesson is, NO DUMB QUESTIONS, with the sole exception of Who’s ID is this…

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Well there you have it, my Five lessons that I couldn’t learn in a classroom or book for my Acute Care placement. This brings me to the end of my journey as a Diploma Student, in a number of short weeks my registration will come in and I will be an Enrolled Nurse. Come March I will begin a new journey as a Bachelor Student as I study to become a Registered Nurse. I thank you all for coming on this journey with me far and I hope to see you all as the journey continues.

Maintain the Rage

Luke Sondergeld

Day 25

Day 25, my FINAL DAY of my Acute Care Placement, my final day in Theatre and my final day as an EN student. All in all, a momentous occasion. I saw my first set of Dental surgery, completed the last of the task book, enjoyed a nice lunch out provided by the facility and very un-ceremonously completed my placement.

The dental surgery was a fast paced, short, and reasonably simple procedure. The patients would come in, go under the anaesthetic, either have the teeth cut out, pulled out or cut into pieces, then wake up and go home. The set up and clean up were the simplest I have seen since scopes day, and the equipment list almost as short. The thing that did vary, was the method of keeping an airway. Instead of using a LMA, the anaesthetist used a Nasopharyngeal Airway. Otherwise it was a good consolidating list, though tragically cut short by my 1200 meeting with our facilitator.

The meeting was to finalise our books, sort out any last minute paperwork and hand back out locker keys. It was essentially a un-ceremonous finish to our placement. The facilitator thank us for our time and our efforts, we thanked them for their efforts and patients and we one to lunch. The facility provided us lunch at a local pub to say thank you and good bye. Two of the four NUMs attended, but had to depart early due to prior engagements, the rest of stayed for a short while then parted ways. In some ways it was a bit of a rushed end to something that had taken us so long to get to. But in other ways our Badging Ceremony we have on Wednesday is truly our finish and ceremony day.

Its been a journey, I am glad to have embarked on it. I hope you all have enjoyed reading the journey just as much as I have being on it.

Maintain the Rage

Luke Sondergeld

Day 24

Day 24 of my Acute Care Placement. My second last day at the facility, a return to the Operating Theatre and a series of new experiences. I had the privilege of sitting in on an abdominoplasty and bilateral brachioplasty first up this morning, then spent the afternoon in recovery while the three theatres were pushing out patients every 20 minutes.

The abdominoplasty and brachioplasty where both interesting in the fact that large amounts of tissue were being removed and the reconstruction of the body part following the removal. It was a time consuming procedure, both taking nearly two hours each. Most of the time was consumed by the suturing following the removal. I had the chance to handle some of the removed issue as we weighed it and disposed of it. It was oddly soft and felt like warm jelly. I remember thinking while I was holding the patient abdomen fat and skin that I wasn’t just holding useless tissue. Experiences, memories, meal, friends and family had made this fat and tissue. They where a part of the patient, and we held them in our hands. It was a surreal moment.

The afternoon in recovery was the cold shower to wake up from the surreal into reality. The patients were coming through thick and fast. The team and I were sending them back to the ward as quickly as they could be produced from theatre, and as quick a the ward could take them. It was nice to see the team of highly skilled nurses in recovery work. They are a well oiled team, with nerves of steel, an encyclopaedic knowledge and hearts of gold. Each one would care for their patient with skill, grace and poise. Tending to their needs as they arose, and anticipating the next step. It was almost inspiring to watch.

I realised today that my time with the facility is nearly at an end, and as such, my time as an Enrolled Nursing student also. I realised that I would soon be a part of this great family of nurses who dedicate their lives to caring for those in need, those who are hurting or at their worst. I am proud to stand with them, and I embrace the challenges that lie ahead in my career, my future study and beyond.

Maintain the Rage

Luke Sondergeld

Day 23

Day 23 of my Acute Care Placement, hump day of my last week, my second day in Theatre, and the day I had my final performance appraisal. Not a huge day according to the lists, with the exception of the Eye Surgeries, of which there where 27. But it was still a big day when you consider the implications of a potentially negative appraisal.

I was placed on the Scopes list this morning with a rotation through recovery in the afternoon. The Scopes list is exactly as it sounds, all of the Gastroscopies and Colonoscopies. It was biologically interesting to see the inside of someone in such close, HD detail. It was good to have the doctor explain what we were looking at and what they where looking for themselves. I have the opportunity to assist and take the samples and bottle them for analysis, a small task but enough to not be completely detached. The afternoon saw me hit recovery for the first time. It was both interesting and a change of pace. Recovery is a very one on one nursing situation, it requires attention to detail, a good knowledge base and quick reactions to physiological changes. I had the opportunity to see several cases coming out of theatre all the way through to handover to the ward. It was different, and I am glad for the experience. It was nice to actually be awake and remember what recovery is all about.

My final performance appraisal. I was a touch nervous. Not because I thought I am a terrible nurse, or can’t do the job, or anything along those line, but because I can come across as brazen, arrogant or disrespectful without intending to. In the appraisal you first make a self evaluation on a range of things, loosely based on the Nursing Standards, and give yourself a score of 1 (really bad) to 5 (excellent). I gave myself 3s almost across the board with a could 4s in areas I thought I did particularly well in. When I sat down with my facilitator, the first thing she said was You are a bit harsh on yourself aren’t you? That made me feel a little better from the word get go. The facilitator had rated me at 5s across the board. They believe that I am excelling at what I am doing, for the level I am at and just need to build the experience, by seeing different cases etc, over time. They said there hasn’t been a question asked of me where I haven’t been able to give the answer, or at least a viable way of finding the answer quickly. I was stoked.

With that behind me, registration and the final couple of days are all that is left. I am looking forward to my last two days in Theatre, I am uncertain what they will bring. But I am ready for the challenge.

Maintain the Rage

Luke Sondergeld

Day 22

Day 22 of my Acute Care Placement, and my first shift in the Operating Theatres of the facility. I was assigned one of the three theatres and given specific instructions of Blue is Bad, don’t touch blue. I was also left a little bit to my own devices as to what experience, what to get out of the day and who to follow around. I decided to make the most of it and get as close to the action as possible.

I had the pleasure of being on an orthopaedic list today, which consisted of three total knee replacements, a shoulder and a radius reduction. The list was short, the time was not, but man did it fly by. During the procedures the orthopaedic surgeon was kind enough to explain what he was doing, the rationale behind it, what we were looking at and what he was looking for. It was a great experience that I had not anticipated. Before I knew it we were closing up the second knee. I decided it would be a good time to see the same operation from the anaesthetists point of view. I teamed up with the anaesthetic nurse, and anaesthetist and started the process from entering to leaving. The anaesthetist explained what they were doing, the medication being used, what it was for, what they monitor for, the different equipment and why its used over other similar equipment. It was all in all a very enlightening experience.

The oddest part of the day was not the sounds or the sights, they were expected, but it was the smell. Specifically the diathermic device. It creates a smell that is somewhere between burnt hair, and over roasted pork. It fills the room whenever ti is used and at first is really off putting, as you realise someones flesh is being brunt just a little. But, after a while the smell becomes less intrusive and you get used to it.

The dynamic of the staff within the theatre was also interesting. Where other wards were quite clicky as a team, and worked with each other, even it was a medical vs surgical mentality, whereas surgical seems almost to be like a high school playground. Everyone is playing around but some quite nasty or demeaning things get thrown around very casually. There is backstabbing, snake like behaviour, and an almost selfish ideal shared by most. However, when it comes to the job, all bets are off and its all about the patient, but it didn’t seem to me to be the most harmonious working environment.

The first day was great, some big expectations to live up to for the next three. I would love to see an abdominoplasty, a couple of scopes, and the other odd and end surgeries the facility does. It would also be interesting to see if the different teams work differently to each other. Only time will tell.

Maintain the Rage,

Luke Sondergeld

Day 21

Day 21 of my Acute Care Placement, my last day on the Mental Health ward and my first exposure to Electro Convulsive Therapy (ECT). It was the first day on the ward that I felt truly in control, I knew what was expected and what to do fully. It is a shame that it has taken the four days t find my groove, but I am glad I found it in the end. I am also intrigued by ECT and TransCranial Magnetic Stimulation (TMS), both of which can be used to treat severe clinical depression, both use electricity but in different ways.

My day on the ward started differently to what it has the past couple of days, as I was tagging along for the ECT round this morning. It began at 0600 and started by meeting with the consumers participating in ECT, gaining their consent for the days treatment, discussing any concerns, completing paperwork and preparing them for the treatment. We then escorted them to Theatre, they where put under a light General Anaesthetic and there treatment was completed. For anyone who hasn’t seen an ECT or is curious click here. The treatment itself was slightly confronting, despite the fact that I knew what to expect, in that you are literally watching someone have an electrical signal pushed into their midbrain to cause a controlled seizure. I knew it was conducted safely, I knew the consumer would feel and remember none of it, but it was still confronting. In the recovery room I chatted to the consumers, both out of curiosity and to ensure they were waking appropriately, about the procedure and how they felt. Of the consumers that completed treatment today, they had no memory of the treatment, didn’t realise they had even gone through the procedure, and felt no ill effects from the treatment. Anecdotally, later in the afternoon the consumers that had completed treatment were the brightest and most conversant I have observed them to date. When asked how their mood was, they responded with Great, better then yesterday or similar. I was intrigued.

I had the opportunity to watch TMS a couple of days earlier, as a sort of precursor to ECT and for exposure, and it was definitely less confronting then ECT. To begin with the consumer that was being treated was awake, and the only thing that was involuntarily moving was their eyebrow, which at the time was directly beneath the magnet. I was able to converse with them while they were being treated, ask if they were uncomfortable, in any pain or felt unusual. Aside from the uncontrollable twitching of the eyebrow, there was no complaints. I was intrigued yet again. In later discussions with  one of the Clinical Nurses (CN) I learnt that ECT has about an 85% success rate versus TMS with a 50% success rate. So despite the gentle nature of TMS and the seeming barbaric nature of ECT, the results speak for themselves. If I were in the shoes of a consumer and being asked to select a treatment option, I think I would start on TMS before jumping into ECT. But, knowing that some of these consumers have fought depression for 30, 40 or even 50 years, I can appreciate and understand why they would jump to ECT, and continue with it.

I am thankful for my time in Mental Health, it has opened my eyes to a world that I didn’t think really existed. I know I entered Mental Health with expectations and assumptions, though to be honest I am still trying to work out exactly what they were. And I have left feeling educated, enlightened and better for it. Could I work in Mental Health, absolutely,  could I make a career out of it, entirely possible. Asked me that 7 days ago, and the answers may have been slightly different. Thank you to all the team, you know who you are.

Maintain the Rage

Luke Sondergeld

Day 20

Day 20 of my Acute Care Placement, my first AM shift and my second last shift in Mental Health. The day was certainly busier than the PM shifts have been of late, read day 18 and 19 to catch up, but still very different from the busy of Surgical or even Medical. I have started to see the report I have been developing with some of the consumers bearing fruit as I move around the Ward, they have begun to open up and actively talk with me about their issues, feelings, and psychosis.

I am still unsure about Mental Health, not a profession or study, but in myself. I know that the goal of Mental Health is to help consumers achieve their goals and learn coping mechanisms, stabilise their medications or enact treatment. However, I still feel like there is this massive grey area in the middle between admission issues and dischargeable acceptable goals. Though I am seeing benefit to the teaching of coping mechanisms, medication balancing and treatments as the consumers are brighter, their mood improves and they seem to able to deal with life pressures better. Though the consumers are still in a facility where they have almost everything done for them so it creates a false reality to begin with. But, I am not a psychologist or psychiatrist, so I will continue to nod and smile politely.

I am feeling more comfortable, not only in Mental Health, but with myself as a clinician. I am still asking a thousand questions a day, and will continue to into my old age, but I am more confident in my knowledge, decisions, and actions. I feel that the course and subsequent placements have actually almost adequately prepared me for what to expect. Will I still have issues, sure, will I still need time, definitely, I am still a junior clinician, I am still learning, and I am still developing, and its important to remember that.

I am thankful for my facility, its staff and all of those who I have worked with. I am particularly thankful to all the patients and consumers who were happy to allow me to practice my skills on them.

Next week will bring with it my last Mental Health shift and then four shifts in the Operating Theatre. It should be an interesting if not less intensive week then what I have been having.

Maintain the Rage

Luke Sondergeld

Day 19

Day 19 of my Acute Care placement, my second night on the Mental Health Ward, my last Afternoon shift of placement, and the start of my last Late-Early swing for placement. The afternoon was similar to yesterday, quiet, controlled, and so much different to what I have experienced thus far. The advantage I had tonight was the company of a 40 year veteran of Psychiatric Nursing as my RN for the shift.

I began the evening going through the charts, identifying the medication times, any physical observations that needed to be completed, additional notes left over from handover and any other nursing interventions that needed to be completed. Once I had the plan, we went around the ward and introduced ourselves to the consumer we would be looking after, had a discussion about what the different consumers habits, conditions and medication requirement were, then returned to the nurses station to attend paperwork. So far I have noticed that Mental Health is far more paperwork intensive then the other wards. Everything is document, re-documented and then have a progress note written about it. It is laborious and time consuming, but I am starting to realise that it is necessary.

I had the opportunity this afternoon to have a one on one chat with one of the consumers to assess their mental state, mood and general thoughts. Their diagnosis was OCD and Depression, and the conversation the we had very much pointed to that. What wasn’t documented well was the level of anxiety, it is centred around uncertainty with situation and the unease of their normal Psychiatrist being away. Their coping mechanism for OCD is currently to simply avoid, though there is no indication that the consumer has any other methods of dealing with their OCD. I felt comfortable conversing with them, I felt like to conversation was small talk loosely veiled over the questions I needed to have answered. The difficult part about the whole process is, Mental Health is all about report and relationship, I am in Mental Health for four shifts. Then I am gone. How much report can one build with a consumer in such a short time, specially when the level of exposure to mental health up to this point has been minimal.

I am enjoying my time in Mental Health because it is so different from what I have done previously. I can see why some people find it comfortable, appealing or suitably challenging enough for it to become a career. Do I think I am at that point, time will tell. I have two more shift, the first being at 0700 Friday, so maybe something will change, or I will become super aware of Mental Health and how I can fit into it. But for now, I think that the exposure I am getting is only sufficient enough to know roughly how the ward works.

Maintain the Rage

Luke Sondergeld

Day 18

Day 18 of my Acute Care Placement and my first shift on a Mental Health ward. I didn’t quite know what to expect from this afternoon. I didn’t quite know what my role was going to be. I knew that I was going to be dealing with complex and numerous medications, emotions that were on a knifes edge, and triggers from consumers (Mental Health Patients) that vary from noises, to visual cues, through to hallucinated triggers.

I like the back and white. I like when there is a problem, that there is a solution. That’s why I prefer Maths to English as a subject, and why I have an affinity for Medical and Surgical. If someone comes in and they are bleeding we stop it, if they have a broken leg we set it, if someone comes in with brain that isn’t doing what it is supposed to be doing… well thats where the grey comes in. And I don’t deal well with shades of grey. It is a hangup that I have to deal with, and even in my brief stint so far in Mental Health, I have begun the journey to overcome it. I understand that Mental health is a very different game, everyone is unique and their treatment is just as unique. No two depressions are the same, no two PTSDs are the same, and they aren’t treated the same.

Another thing I will have to get used to is the pace. Having just spent eight days on the Surgical Ward I have been used to achieving what needs to be achieved in a  polite and courteous manner and then moving on, with 20 other things happening at the same time.  Mental health is not like that at all. Though there are still things that need to be achieved, it is at a slower pace. It is a calm, quiet and sedate environment that allows for open communication and a report to be built between the consumers and the staff. I think with time, and proper tutelage, I could flourish in Mental Health, and with more and more Mental Illness being present on other wards, it will serve well in the future.

Tomorrow is a new day, a new outlook and a better equipped student who knows roughly what he is getting in for. I am thankful that the facility I am in allows the rotation of the student through the various areas, I am glad I have the opportunity to see Mental Health, outside of the placement environment I don’t think I would have voluntarily stepped foot inside the ward. Tomorrow will be a good day.

Maintain The Rage

Luke Sondergeld

Day 17

Day 17 of my Acute Care Placement and my last shift on the Surgical Ward. The ward was packed, and I mean not a bed spare, hot swapping patients within an hour of discharge, sending them onto other hospitals for rehabilitation. Proper busy. As a final shift, and pseudo send off from the ward, it was finishing on a high note.

I took three patients as my own, and between myself and the AIN made sure all the cares, observations and the like were completed. I then liaised with the RN to ensure I could complete the medications required, while still availing myself to the interesting learning opportunities on the ward as a whole. It was fun, I thoroughly enjoyed myself, not to mention I felt at home, I didn’t feel anxious, nervous, or out of control. I felt like I was another cog in a well oiled machine. It was nice.

Something thing of note, I completed my 20 hours of required Medication time tonight. Which doesn’t mean I stop being involved and trying to get every available subcutaneous, intramuscular injection or otherwise, but I am no longer burdened by this looming target that I have to reach, especially with my move to Mental health tomorrow and Theatre early next week.

I enjoyed my time in Surgical, I enjoyed the pace, the teamwork, the diversity, the structure and the process. I feel that from a time management perspective, Surgical would be a great ward to work in following graduation. However, I feel that for maximum exposure to different, unique and sometime complex health situations Medical won hands down. But having said all of that, my facility is only small, it only has the three wards and theatre, it doesn’t have an ICU, HDU, Oncology, Cardiac, Paediatrics, Neo Natal, Rehabilitation or Renal unit. Without exposure to all of these wards or units, I don’t feel I will ever truly be able to find my favourite place. And having said all of that, every ward, section or unit has its positives and negatives, all of them are potential learning outcomes and growth points, and thats what I love so much about Nursing, its diversity and the ability to grow and learn. A profession like no other.

Tomorrow afternoon will see my first Mental Health shift, I am a little apprehensive as I am not a massive fan of shades of grey. I like black and white, that leg is broken you need a cast, but if someones head is broken its not so easy. Of the four wards the facility has, I feel that Mental Health will push me the most, not because of its overt complexity, busy schedule or heavy physical demand, but because it is such a different style of nursing to what we are taught, and different from what I feel I am good at. A good lesson in self discovery shall be had.

Maintain The Rage

Luke Sondergeld

Day 16

Day 16 of my Acute Care Placement, and my second last day on the Surgical Ward. Not knowing what to expect from a Monday evening, I didn’t go in with any level of expectation, when I arrived I went through the list of names and beds, checked against the surgery list and endeavoured to plan out the evening as best I could. That was almost useless. Theatre by the end of my shift, was operating nearly four hours behind. Patients were only being seen at times we thought they would be returning. This made for a slow and disrupted afternoon.

I was allocated eight beds with one of the RNs and we set out to check charts, make notes about medications, check care plans, have a chat with the patients to identify habits and needs, and generally get our things organised. All in all the afternoon was going to be constant but nothing crazy. We set to our work. Having a very experienced RN with me for the afternoon made things very efficient, we worked well as a team and achieved what we needed to achieve in little time. This left us with ample time to assist those who had returned from theatre with getting comfortable, rearranging linen and lines, and generally tidying them up post-op.

My heartwarming moment of the day was seeing the patient previously written about in Days 14 and 15 up and walking about. They are so happy to be moving around, and eternally grateful with things like I wouldn’t be here if it wasn’t for you lot being said to almost every nurse on the ward. It was good to see such  positive result out of a potentially life threatening condition.

I did have, what I consider, to be the best compliment an EN student could be paid by another staff member, paid to me this shift. As we were packing up the files, handing over and generally debriefing the shift one of the RNs asked what I would be doing post graduation. I explained I was going to be studying my Bachelor and working as an EN. They then said Wow, I thought you were an RN student, you seem to know so much already. This sentiment was echoed by several of the other staff I was working with that night at the same time. I was chuffed, I’m not going to lie I think I even sat up a little straighter. It is so good to be told that you are on the right track, that you have the requisite knowledge or skills. I still feel that I don’t know enough, and in a way I pray I never do.

Tomorrow afternoon is my last afternoon on Surgical before moving over to Mental Health. A new ward and a new set of challenges.

Maintain The Rage

Luke Sondergeld

Day 15

Day 15, the end of the third week of my Acute Care Placement, and my first afternoon shift on the Surgical ward. I didn’t know quite what to expect from an afternoon shift on Surgical, however with an emptying ward, no new admissions, only two theatre cases and most of the patients being day three, I wasn’t anticipating a busy shift.

The shift began just as any other, with handover, it was nice to be on the receiving end of  a bedside handover for once. We then proceeded to the oddest part of the afternoon shift, after signing on 30 minutes prior, we go to afternoon tea, then return to allow the morning staff to leave. We completed our medications rounds, completed observations, changed wound dressings and planned out the afternoon and early evening. But even with all of the pressing, and not so pressing, cares completed we all still felt this unnerving and uneasy calm across the ward. We all checked out patients again o ensure they were all comfortable and didn’t require anything. We were going to be in a, I can say it now because the shift is over, quiet night. It almost seemed that we would have 10 minutes of work then 50 minutes of wandering around fussing over empty rooms, tidying up the ward, preparing the next shift and the next day, organising charts for the two surgical cases the following day, and generally cleaning up the ward. It was not time wasted as the staff took the opportunity to discuss some of the decisions that had been made with various patients, medications, procedures and honing of the critical thinking we all get hammered with in nursing school.

An interesting development with the patient mentioned in yesterdays post. The original diagnosis for the patient was a Pulmonary Embolism as the CTPA returned the possibility. However, following early blood cultures, and other blood results, it was later determined that he suffered from septic shock. The Doctor even went as far to say that if it wasn’t for the quick and thorough actions of the nursing staff yesterday that the patient may not be alive today. Chalk one up to the good guys. The current theory is, the patient travelled overseas and consumed some of the local water, had episodic diarrhoea which the patient took an exceptionally large dose of immodium for. The bacteria that caused the initial diarrhoea was then left in the body and eventually infected his bloodstream. The patient is now doing much better, though is still being closely monitored by both the Doctor and the Nurses.

I still have another two afternoon shifts in Surgical before shifting over to the Mental Health ward. But for now I am going to spend some much needed time with the family.

Maintain the Rage

Luke Sondergeld

Day 14

Day 14, for my Acute Care Placement and a return to the Surgical Ward, for what was is my last AM shift before a three day stint on the PM.  The ward was surprisingly empty, compared to the chaos that was yesterday. There were several discharges, a fair spread of second day orthopaedics and abdominoplasties, and a day two TURP. I would have the inordinate pleasure of being assigned the patients at the end of the passageway, the furthest point away from the Nurses Station.

The day began really well, I was with the RN with five patients, we checked on the patients, delivered their morning medications and analgesia, I assisted the RN with IV therapy and antibiotics as appropriate. The morning progressed, we went to morning tea and returned to assist with physiotherapy, post morning ablutions and showering. As I was assisting a patient into the shower, the Emergency buzzer was set off. I ensured my patient was safe and left them in the hands of their partner. I walked out of the room to find it was the patient next door. There were people everywhere. We alway talked about it in class that every man and his dog rocks up, but they weren’t kidding, Doctors, Nurses, Physios and even the Pharmacist rocked up. The situation was the patient was returning to bed following a shower and they began to convulse.  After taking observations it was noted their Oxygen Saturation was below 75% and was barely staying at that point on 15L of O2 with a Non-Rebreather mask. After settling the patient enough and stabilising the oxygen saturation on Nasal Prongs, a portable Xray of their chest was ordered to rule out a clot. A CT Pulmonary Angiogram was also ordered to determine the extent of any such clot.

The day progressed, we monitored the patient like a hawk, with observations being conducted several times an hour, the doctor visiting from time to time to write up orders and to check up on the patient. The day progressed and the patient remained reasonably stable, till about 1500 just after handover their BP crashed to 80/40. They were left in the very capable hands of the afternoon shift and the day was done. It was oddly exhilarating going through the whole process, the stabilisation, the investigation, the monitoring, the diagnosis, and the care of both the patient and the partner. I am thankful for not only my training received at CQUniversity but my time in the Navy that prepared me to deal with the situation and the people involved.

Tomorrow will be an interesting change moving to the PM shift on Surgical, but I am looking froward to the challenges that lie ahead.

Maintain the Rage

Luke Sondergeld

Day 13

Day 13, Hump Day for my Acute Care Placement and a return to the Surgical Ward, for what was promised to be a busy day. And it didn’t disappoint.  The ward was full, there where four patients on the waitlist for a bed and 90% of the patients on the ward were only One Day Post Op. I was assigned two patients at the end of the ward, and assisting the RN and EN with the other six, where possible.

I arrived this morning early to check over the days list and see what was happening, given we had been worded up by the admin staff that today was going to be a doozy. I was running over the list and almost immediately saw what they meant. It wasn’t the number of surgeries booked from the ward, which was only five, but the sheer number of IV antibiotics, drains, VTE prophylaxis, post operation medications, catheters, fluid balance charts, physiotherapist reviews and subsequently paperwork associated. Then onto handover, not much that was overly surprising but good to know we were due to discharge five patients before lunch, so we can fill the beds up again.

My two patients were great, one abdominoplasty and one total knee replacement, both first day post op, both busy in their own right, the other six were no easier. I set up my plan, I got organised and the first snag of the day, intravenous (IV) therapy, IV antibiotics and Schedule 8 (S8) medications. I needed two staff, at least one RN before I could even start my day, and even then I couldn’t really do any of it, even if I wanted to. I set out to help as best I could, I delivered the S8 medications with the RN, gave out my other oral medications with the facilitator, made beds, showered patients and helped the physio staff. I got done what I needed to get done, but I was busy trying to do it, and I was only made busier by having to find the staff I needed to be able to do the task I set out to do.

I felt today that I was doing nothing but disappointing my facilitator, not because of any massive error, or laziness, or misdemeanour, but just a feeling. When we were handing out medications they handed me the two cards I needed, I saw them pull them out of the cupboard, out of the box and hand them to me, I then dispensed the medication, checked the ID and 7 rights of the patient and moved on. After the fact I was asked if I checked the expiry date on the card I was handed, I did not. They pointed out I should have, which I totally agree with, and that even though someone else may have checked the expiry, in this case the facilitator, I shouldn’t rely on or trust that it is done correctly. Later in the afternoon when it came time for writing progress notes I went to the nurses station to write my patients noted only to find that the fastidious nurses that I was working with had already written them. The facilitator comes round to ask if I have written the notes, I explain what has transpired and they simply say Oh well, do them tomorrow then. I know that it was probably nothing, and I know that the facilitator wasn’t being mean, malicious or callous. I just think that the placement, my final placement, the study, the light at the end of the tunnel is all getting to me a bit and I am starting to see little things in people, mannerisms, and reading too much into them. Tomorrow I think I will try and relax and just care for the patients worry about the rest later.

Tomorrow is my last morning shift with Surgical before a swing onto the afternoon shift for Friday and Monday, then onto the Mental Health ward.

Maintain the Rage

Luke Sondergeld

Day 12

Day 12 of my Acute Care Placement and my return to Surgical Ward. After a wonderful, if not busy 8 days in Medical (Days 2, 3, 4, 5, 6, 7, 8 and 9). Today saw me be assigned a patient to be responsible for, a new admit, and a  support role for the RN on the ward. It was listed to be a busy day, with the return of an Orthopaedic Surgeon and a two patient wait list on top of the other admissions planned for the day.

Firstly, the patient I was assigned. I was looking forward to it. I paid attention to the intricacies in handover, I checked the chart to ensure there wasn’t anything I missed, planned out medications, the works. As I was sussing out my admit who was due in a little later in the day, the Doctors completed their rounds. I returned to my patient to see if they needed anything, take some observations and generally care for the patient. To find she was being unexpectedly discharged. Which threw my entire plan out the window. Instead, I organised an outpatients appointment, sorted her paperwork and that was it. Done and dusted by a little after 1000. Reminds me of an old Navy saying, remain flexible.

My admit, my first solo for surgical, arrived at around 1200, for a 1400 operation. I bought them in, went through the paperwork, weighed, observed, measured and prepped the patient. I thought I was doing really well. I had my paperwork checked by the RN who pointed out some minor things I missed and felt really chuffed. Till I saw how long it took. Just under an hour. In school I thought I was doing pretty well, my practice admits where down to under 20 minutes. I put it down to several things;

  1. Real patients don’t anticipate answers like nursing students
  2. I am still trying to work my way around the facilities paperwork, as it is significantly different from what we have learnt
  3. This patient was complex, not just because of their history, but because every time a question was asked it seemed to either contradict a piece of information, or reveal something new.

However, this is the real world, and I need to be able to shorted that time to under 30 minutes. Something to strive for.

The rest of the day seemed to disappear. I think I looked at the clock to actually check the time three times, not including for documentation, and it seemed to go something like; 0830 to 1145 to 1430 in two blinks.  I am thoroughly enjoying my placement and my time in Surgical.

I also had my mid-placement review with my facilitator. I was a little nervous. I didn’t quite know what to expect for my first acute placement. I sat down with the facilitator, we discussed the time I have had, what I have learned, and how everything is going. They then told me that I am doing really well, that’s a relief.  They told me that I have the knowledge, I have it squirrelled away in my brain, and I just need the experience to polish what I know, with some clinical time, to produce a great result. It was a nice little boost for the afternoon, and is a great encouragement to continue on this placement, and into the future.

A return to Surgical tomorrow, to deal with the 24 hours post op cares, should be an interesting day.

Maintain the Rage

Luke Sondergeld

Day 11

Day 11 of my Acute Care Placement and my return to Surgical Ward. After a wonderful, if not busy 8 days in Medical (Days 2, 3, 4, 5, 6, 7, 8 and 9). My day was less about assigned patients, as I was buddied with another EN, and more about getting things done, getting exposed to some new procedures and supporting the team.

The EN I was buddies with was great, they had recently been employed by the Facility following their placement with the facility some months prior. They were knowledgable, friendly, respectful and willing to educate on some local procedural things and Nursing tips in general. We worked well as a team, dividing and conquering where we could, and buddying up where appropriate. We admitted patients, discharged them, prepped for theatre, observed, documented and generally Nursed away the day, which seemed to evaporate again. They were a pleasure to work with, and look forward to spending time with them tomorrow.

I had the opportunity to remove a Jackson-Pratt drain from a patient, following their abdominoplasty. The procedure is simple enough, it involves releasing the vacuum from the drain, cutting the anchoring stitch, and removing the drain by pulling it out of the body. Simple enough. Only the Facility I am at perform the task differently. Instead of using the wound tray and tools inside to handle the drain, wound or otherwise, they add in Sterile gloves and a whole new series of steps. With normal gloves, you prepare the area, move your drains around and other dirty tasks. You wash and don new gloves, open your wound pack and clean the area with saline and swabs. You then de-glove, scrub up, and don sterile gloves, which you then use to hold the drain with a pair of forceps, cut the stitch, pull the drain, cover with gauze to ensure there is no leaking then bandage appropriately. Because this procedure was different to what I was expecting, I looked the right goose in front of the patient as I was almost coached through the procedure by my facilitator. Lesson learned, talk before the procedure to ensure there are no massive differences in technique.

I felt accomplished by the end of the day, despite the fact that I don’t know where the time between 0930 and 1430 went. Tomorrow promises to be not only a good day, but an even busier one, with one of the Surgeons returning from leave and taking up patients again. I am looking forward to the challenge.

Maintain the Rage

Luke Sondergeld

Day 10

Day 10 of my Acute Care Placement and my first day on the Surgical Ward. After a wonderful, if not busy 8 days in Medical (Days 2, 3, 4, 5, 6, 7, 8 and 9), I and the rest of the Students, have been rotated  to different Wards. It was also my first experience of a Late-to-Early swing, finishing at 2300 the night before and starting again at 0700. I am not going to lie, I was a little rough around the edges this morning and could have very easily gone back to bed. But, I persevered, arrived early and eager to do my best.

Handover was much the same as it is in Medical, except there are nearly twice as many patients, and thankfully twice as many staff. The turn around times are significantly shorter and the focus is less on diagnostics and treatment, and more on preparation and recovery, which was to be expected. There where all sorts of post operative patients, abdominoplasties, laparoscopic cholecystectomies, joint replacements, wound debridement and management. So many varied procedures, and subsequently varied post operative cares. The medication rounds tended to be easier, with most people being on analgesia and maybe a couple of medications from home, as apposed to medical which wasn’t unusual to see 15-20 medications for a single patient.

The wound care, however, more than makes up for it. Every single patient has some varying form of wound, from a couple of small openings from a laparoscopic procedure, to a long incision and wound from an abdominoplasty. Wound care is fascinating. Time consuming, but fascinating. I have aways loved wounds, their treatment, what can go wrong, the ways to remedy a deteriorating wound, it is all interesting and different. Most of the wound are fairly simple, a clean and new dressing every couple of days, and they are fine. Then there are the chronic wounds, skin grafts, and dehisced wounds. They are not so simple. I enjoy learning more and more about wounds and post operative care. Today was a really great insight into a ward that can at time be chaotic and task orientated.

Nursing is never dull. Ask any nurse and they will tell you there is always something that  pops up that you just can’t help but laugh and smile. Today I had a patient come out of their room, and quietly say she had a problem, several nurses who were standing close by all turned around as I asked what was wrong, their analytical minds already turning over in anticipation. They then, very bashfully, say I have lost my knickers out the window, can somebody help me. Professionally we all share in the chuckle and I go out the front of the facility to retrieve the patients undergarments. Thankfully their window was open so I could return them to the patient without having to carry them through the ward, for everyone to see. Never a dull moment.

I am thankful for a quieter day today, both because I am on a new ward, and because I was exceptionally tired. I am looking forward to the next seven days I have in surgical and the lessons I will learn.

Maintain the Rage

Luke Sondergeld

Day 9

Day 9 of my Acute Care Placement, my last night on the Medical Ward, and what a night. The night started much the same as any other, we had enough staff, we were in control, everything was running OK. Then an overflow surgical admission hit our floor, and a new medical admission, then the Theatre was ready for their new patient, and a patient was hypertensive with no action helping, Doctors came and went with their new orders, and the night somehow… vanished.

I arrived to the facility early, as I always do, looked over the patient list, had an informal chat with one of the other Nurses, caught up with the AM Student on the Medical Ward and awaited handover. Handover went well, nothing spectacularly out of the ordinary, most of the patients were the same and stable. Medication rounds, observations and the start of the evening ran smoothly. We went to dinner. Then everything changed. With what seemed like a small increase in workload, the ward slipped into a madhouse. Instead of the cool, calm and collected Nurses I had been working with, we were all now flat out and juggling patients, medications, admissions and transport. Which wouldn’t normally be a problem, but when so many tasks have to be completed by an RN and you only have one, things get busy. So the EN and myself set out to be as useful as physically possible. There were no longer assigned patients, just cares that needed to be attended.

The most frustrating thing about the whole ordeal, was my limited scope of practice.  I could see what needed to be done, I relayed them to my RN and EN counterparts, and I could do none of it without the RN. So I did what I could. I took the observations, I moved, rolled, assisted, changed, wiped, and emptied everything I could to take the burden off the other two. We worked well.

Overall the night may have been chaotic, and busy and non stop, but I loved it. It was exhilarating to see this well oiled machine of a hospital get into gear and just do. It is uplifting to know that I can do this Nursing thing, when I have the scope to do it. It is great to hear praises and thanks and well wishes from the other nurses on my effort, ability and future.

I am happy to be called a Nurse, and even happier to serve as one

Maintain the Rage

Luke Sondergeld

Day 8

Day 8 of my Acute Care Placement, and I’m still on the Medical Ward, though not for much longer. Today was one of those days where I should have gone back to bed and rolled out of the other side. I had to try hard to focus, and if I didn’t, I would forget what I was doing and miss a step. Today was also one of those shifts where you walk on the ward to almost chaos, staff are blurs, voices can be heard from everywhere and the paperwork is still sitting in the nurses station. I should have taken that as a hint that it was going to be an interesting shift. I did not.

Off shift, I noticed that I was having a bad memory and focus day when I would start chores and leave them half done, enter a room and forget why I was there, and when I had to check three times when I had to be on shift, when I have had the same start time all week. I tried to Caffeinate Up and push through, but that was only a stop gap measure. I was going to have to focus today. Thankfully, by the time my shift started I was ok, I forgot some minor things, nothing medication or cares related thankfully, but little things like forgetting to come back with that bottle of water, or not finishing a sentence. The end of my shift, however, I did let my mind wander again and I wrote the notes for a patient, in another patients chart… to my defence, they had the same last name, approximate age and file size, however it was a large enough mistake for me to forcibly switch back on and refocus.

Today was my first shift with four patients, and the RN only watching over me, without prompts or assistance. It went well, I felt like I was in control through the shift, I was still able to assist the EN with her load when she asked for it, or attend her patients calls when she was busy. I felt accomplished. The RN seemed to be pleased, and when I asked how I was doing she simply stated You’ll be fine, you are knowledgable, kind and personable. A good little boost for the middle of the shift.

The shift its self seems to dissolve away just as quickly as 2017 is seeming to be doing. We started at 1430 with handover, had a Ward Meeting at 1500, then hit the floor, before I know it, it was 1800. I had completed all the medications, observations, cares and what not that I was required, all the patients were happy, but time just trickled through my fingers. Additionally, every task on the shift seemed to take longer than anticipated. A simple assist to the bathroom becomes a 30 minutes evolution when the requests begin, and additional little tasks the patient has saved up for your next visit. However, the shift went well, everything was attended as appropriate, I handed over the patients I had at the end of my shift, with some additions from the RN on matters of Blood Results and other information handed over to her that I was unaware of.

I look forward to my last shift on the Medical Ward tomorrow, it will be sad to leave the patients I have come to know, and I will miss seeing their progress and eventual discharge. However, I will still receive news from my student friends who are rotating with me from other wards. So that is comforting.

Until tomorrow, Maintain the Rage

Luke Sondergeld

Day 7

Day 7 of my Acute Care Placement sees my Second Late shift on the Medical ward for my Facility. The staff are becoming more familiar as I work with nurses I have previously, the processes are beginning to become more streamlined as I continue to work with them, and even the Patients are beginning to become a little more familiar, as some of them are in for a long stay.

I am feeling more comfortable on the floor. I arrive early, just as I have always done, get myself sorted personally, grab a copy of the patient list, being identifying who is who and what has changed since my last shift, draw up my work table on the back of the sheet, note down the highlights of each patient like observations, medications and anything else that needs attention, then get ready for handover. I listen to the handover to pick up any new details that I don’t know, or isn’t clear in the chart, I listen for patterns in behaviours and observations, and I make more notes. I then get my patient allocation, which continues to be three with the addition of assisting the RN with her medications and cares, and helping any other staff out where possible. I am finally in my groove. I feel like if I could work within my scope as an EN, without the need to be shadowed constantly, I could comfortably look after three patients. Perhaps I will ask for more, though feel I am already unofficially doing it with the RN begin my shadow.

The patients are remembering who I am, and I them. I am identifying and acting upon their habits, behaviours, and trying to anticipate need vice reading to need. The patients feel comfortable with me as a Nurse and don’t see me so much as a student anymore. I have had my first rejection for care tonight however, a female client had a urinary bag attached to collect a sterile specimen, when she buzzed to have it checked and I arrived, she promptly asked for a female nurse. Now, it is completely her right to request any nurse she wishes, and I in no way took offence, but it was however notable. I find as a Six Foot Two male, that I have to be almost overtly kind and compassionate to compensate for my gender, height, and overall size. Most patients though, haven’t had a bother. I have performed two ECGs on females, inserted a catheter into a female patient, and the three patients I have been solely responsible for are all female. So on the whole, I feel that people are seeing me as a nurse, and not anything else, which is pleasing.

I did have a deep swallow moment today however. I have a patient who I cared for during my Aged Care Placement, they came in with lower limb cellulitis. On admission it was limited to the distal end of their left leg. Now it consumes most of their left leg and is beginning to develop on their right. This in its self was not the trigger for my deep swallow. What was the trigger, was the last time I saw something like this, was one week before my Nan passed. She had cellulitis in her lower legs, and was flow to Brisbane, she passed just over a week later. Now it wasn’t the cellulitis on its own that took her, there where a myriad of reasons behind that, but it did touch on a sore point, and I had to stop and compose myself before continuing on. Given the fact that nobody said anything, I am going to guess I got away with hiding it.

So for a reasonably quiet shift, it was a good reflective shift, it allowed me to look at my practice, my time management and my nursing cares. I am falling in love with this profession more and more every day, and am so grateful that I have the opportunity to be a part of it.

Maintain the Rage

Luke Sondergeld.

Day 6

Day 6 of my Acute Care Placement saw the return to the Medical ward, however, this time was the Afternoon shift, 1430 till 2300. The shift began with a in room handover of the all patients, and then oddly, 30 minutes after beginning the shift, afternoon tea. I was assigned three patients, two of whom were on contact precautions, and one with a Intravenous Antibiotics, which I am one allowed to monitor and report on, not actually hang and administer.

I am still puzzled by the choice of having afternoon tea so soon after the shift begins, and after watching the shift progress there are far better times to have a break, however, this is what the facility does, and who am I to argue.

The management of the patients went better then any shift previous, I had the medications rounds sorted, I checked the medications I was unsure of, I knew what was happening and when, and still had time to assist with the other two patients of the RN who was supervising me, and their medications and cares. All in the name of experience, help and education.

I feel more confident on the ward, I feel like I am getting to know the position, how it all works and who is who when it comes to complex cares. The part I am finding difficult is end of shift notes. I can complete the care plans, assist with the drafting, admissions, discharges, and the risk assessments that come with them. But when it comes to writing a few lines at the end of the shift to summarise what happened. Nothing. I draw a blank, I look over the observations, my notes, go over what happened, and struggle to squeeze out a sentence. I suppose in the end of it all, I am struggling because it seems pointless to write Patient existed, nothing happened in spite of constant checking. We as nurses fill out numerous different reports, plans and pathways on a patient, we document everything to the nth degree. And then right at the end we draw a little word picture, covering everything that is written on everything else. Even if something different happens, and you take an action, that is still documented elsewhere, and we still write about it. I know it is something I will have to get over, and get better at, but it still irks me.

This week sees me staying in Medical until Friday, at which point I move over to the Surgical Ward, and the busy times to had there.

Until tomorrow, Maintain the Rage

Luke Sondergeld

Day 5

Day 5 and the end to the first week of the Acute Care Placement, so much learnt and still so much to go. This week has seen so many polished skills, improvements on time management, patient care, and assessment ability. The facility and its staff have been extremely accomodating, patient, and nurturing towards not just myself but the other students as well. The staff afford every opportunity to be exposed to new procedures and give the students a go, often at the expense of efficiency, but never at the expense of patient care.

Today saw a return to the Medical ward for my last Early Shift in the ward, as I will be swapping to the Late Shift from Monday to finish my eight days in Medical. I assisted the RN today with a case load of six patients, two Discharges and three new admits. I monitored a blood transfusion of two units for a patient, completed medication rounds as normal, and completed two ECGs. All together it made for a busy day, but manageable, though having a great RN to work with made the job infinitely more manageable.

Other than the obvious learning previously mentioned, I had an interesting encounter with several of the patients today. Firstly, one of the new admits was a client from my Aged Care placement in 2016, which was kind of surreal. When I last saw the resident she was reasonably healthy, for someone of their age, and it was almost saddening to see them in an acute setting, knowing that their health was deteriorating. In a lot of ways it was a physical representation of the deterioration of the human body as we age, and how sometimes its the mind that lets go, and sometimes the body. It was uplifting to see that the resident was their upbeat, happy self, and that they where in good hands.

During the monitoring of the Blood Transfusion, I took the opportunity to chat to the patient and his wife while I was taking observations, to pass the time for all concerned and to distract them both from the procedure. While talking with them I found out that the wife was a retired RN, and the husband an Army Veteran. We talked about their various conditions, which turned out to be great learning opportunity, and while taking the observations I witnessed a mild fluid overloading, which was characterised by an increase in systolic blood pressure and relieved by passing urine and increasing movement.

Currently on the ward is a palliative patient, as there isn’t a designated ward in the facility. The patient has end stage bowel cancer, with a descended abdomen, fluid collection in the lower extremities, decreased input and subsequently decreased output. They are in the final stages with a subcutaneous infusion, and pressure area care being the only real nursing interventions being undertaken. As someone with an interest in palliation, I ensure I try to extend the comfort afforded to the patient to their family as well. It is something I firmly believe in and thankfully observe the other staff at the facility undertaking as well. Palliative care done right warms my heart.

All in all, a busy day, that was extremely rewarding, and though I feel exhausted, for placement reasons and non placement reasons, I feel invigorated at the same time. Every day I spend on the floor, is another reassurance that I am in the right place, and I am answering my calling.

Until Monday, Maintain the Rage

Luke Sondergeld

Day 4

Day 4 of my Acute Care Placement was an Introduction into routine, management and additional skills. I was given two Patients to by the NUM as my case load for the day, with the additional instruction Anything else interesting that comes up, which tickled my curiosity and intrigue just a little. The patients I had assigned weren’t overly difficult, but had large amounts of medications and high level personal cares. I also had the opportunity to complete a surgical admission, and see it through to handover at the theatre doors. I also had the opportunity to insert a Indwelling Catheter on a female patient for the first time.

Having a patient load of my own was a great opportunity, and a great learning opportunity. I took the time before I started to look over the medication charts to see when medications were due and make notes accordingly, I noted any cares requirements or additional tasks that needed to be completed by the end of my shift. For the most part I managed the day well, I was a little late with the 1400 medications as I was inserting the aforementioned catheter. But otherwise managed well. A great learning curve for the day, and a chance to push myself tomorrow and see if I can juggle the addition of another patient.

The Indwelling Catheter was a rare opportunity for my facility, as most are inserted in theatre, or patients come into the Medical ward with them already. I had supervision from our preceptor RN and had the other two students on shift with me to assist and observe. I was a little nervous heading into my first catheterisation and a female to boot. What made matters worse was the constant chorus from the other nurses about how hard this particular patient was, which in addition to females being harder in the first place, didn’t fill me with the most confidence that I would be able to nail this. However, I set myself up in the room, had my fellow students position and hold the legs slightly apart, and with some conferring with the RN inserted the catheter first time, collected the MSU I needed, inflated the balloon and exhaled deeply with overwhelming relief that I didn’t miss, or more importantly, put undue discomfort on the patient.

All in all, a great day. A good confidence boost for my time management, skills and procedure knowledge, and patient cares. I feel that in the past four days I have learnt more than in the proceeding four weeks. And I am exhilarated because of it. Each day brings with it a new sense of adventure, challenge, knowledge, growth and personal discovery. Definitely picked the right career here.

Looking forward to another great day tomorrow, Maintain the Rage,

Luke Sondergeld

Day 3

Day 3 of my Acute Care Placement saw a complete shift from yesterday, there were two RNs on Shift, plus the Nurse Unit Manager (NUM). It made life so much easier for skills, assessments, medications, procedures and patient care. I was free to do more with the patients as I had the supervision I needed to legally perform the tasks. I seem to be learning more and more everyday, which I expect to do for the rest of my career, and it seems that no matter how much I seem to learn, it still seems I don’t know enough.

Unlike yesterday, I started on the floor. We completed handover with the evening staff, then dove straight into the morning routine. Wakes, observations, showers and 0800 Medication Rounds. In School we discuss polypharmacy and its impact on patients, what it is and how it occurs. Today I witnessed polypharmacy and how much harder it can make your job. Two patients had over 12 medications, just in the 0800 medication round and nearly 20 different medications by the end of day. It stretched my mind to remember all of the classes of drugs and which ones I was giving out, what they were for and looking up the ones I hadn’t heard of before. It was time consuming and very rewarding, and I am eternally grateful for the very patient RN I had supervising me.

I was given two patients for the shift that were my responsibility, in some ways I felt I did quiet well, I stayed on top of observations, preparations for theatre, discharge preparation, medication administration and personal cares, but in other ways I felt I was inattentive. I am sure it was either my own mind wanting to give them my undivided attention, but as the ward was as busy as it was, and there were blood transfusions, Vac dressings, subcutaneous injections, and other complex or rare procedures to be completed and experienced, I felt I was abandoning my patients. But I know that if at any time I was being truly neglectful the RNs on duty would have curtly reminded me of my duties, or prompted for me to ask for assistance… read You have forgotten this would you like me to do it for you.

I completed my first Fleet Enema on a live patient, vice a latex manikin, which was both interesting and far less daunting then I expected. I am finding the more skills I perform on actual patients, injections, suppositories, assessments, or otherwise, the more I feel reassured that I am actually helping them and not infact inflicting discomfort, pain or general unpleasantness upon them. It is nice to know that what you are doing is having a positive impact.

I experienced my first interrupted meal as a Nurse, even if I am still a student. I was taking the opportunity to take a lunch break between 120 Medications and the afternoon activities prior to handover. I make it to the break room, make a coffee, finally get to the front of the microwave queue and then another staff member comes around the corner and says Medical just called and they are about to start the Blood Transfusion. The blood transfusion I have been waiting for all day. I take my lunch out of the fridge, place it and my coffee on top of the fridge, and race back to Medical. Some 2 hours following the procedure, the myriad of observations that need to be done following and the satisfaction that my Patient is not indeed having an acute reaction to the blood, I return to the lunch room…. Two hours later.

Outside of placement, after clocking off at 1530, I raced home to cook dinner for the family, showered and changed into another Uniform for Scouts and left again by 1730. I returned home, tired, sore and sweaty at 2030, where I now write about my day in my Blog for you the reader to enjoy, it may take a while to get used to regular 14 hour days.

All in all though, it was an amazing day. I learnt a ton about procedures, skills, medications, diseases and conditions, but I also learnt more about myself, my place in the world of Nursing and the same constant reassurance I receive knowing that I am where I am supposed to be.

Until tomorrow, Maintain the Rage

Luke Sondergeld

Day 2

Day 2 of my Acute Care placement saw me finally hit floor, after a brief 2 hour induction into ward routines, paperwork and documentation. The induction was good as it gave us all an understanding of the different paperwork and documentation requirements of this facility. The Medical ward, in which I am completing my first 8 shifts, was in a little bit of chaos as it was combined with the Surgical ward until early this morning, at which point all of the patients where returned to the Medical ward, with little to no handover and several new admits.

The induction was detailed and informative, it alleviated some of the tension and answered some unknowns. It was good to cover the different paperwork and have a chance to talk to the Registered Nurse (RN) about what it all actually meant, and to be able to see what the expectation was before hitting the floor. We covered off on Ward layouts, handovers, abbreviations, medications, conducted a simulated spirometry and discussed the expectation of managing our tool books and work hours. It was a informative and well structured morning, finished off with a spot of morning tea and a coffee, I felt good when I was introduced to the staff I would be working with for the day.

The ward staff where great, professional, well read, and hard working. The Wardsman had just completed his Assistant In Nursing (AIN) training and was filling that role for the day, which was a great help. The RN on duty for the Medical Ward was actually the Nurse Unit Manager (NUM) and her only offsider was one EN. This was going to make life interesting. I managed to sneak in an early Subcutaneous Injection while I still had the preceptor, and an insulin injection when the RN was available. Without the RN readily available doing any Medication Rounds was going to be difficult.

I assisted with cares, made beds, organised files, wrote notes, saw to patients needs, and generally completed the caring side of the nursing job. I had the opportunity to witness a Fleet Enema, preparation for surgery, completed a series of observations and shared a laugh with several of the patients as I went about my business.

I initially felt anxious as I arrived in the morning, by morning tea I was beginning to calm down as I had more information to go off, but lunchtime I was firing on all cylinders, but felt like I was driving around with the handbrake on as I didn’t have the supervision I needed to complete the tasks that I have been trained to do, and by the time I finished my shift I was ready to leave, debrief, reflect on practices and get ready for another day tomorrow.

I know days like today will happen, I know that staffing in Nursing isn’t always perfect, I know that sometimes I will be the only one available to do the job. But today didn’t need to be that day. I am not registered, I am not qualified and I don’t have the Scope to be able to do the things I know needed to be done. Hopefully tomorrow we will have the staff to be able to take the handbrake off and kick some goals.

Looking forward to another day tomorrow, Maintain the Rage,

Luke Sondergeld

Placement Rage

As regular readers will know I am coming to the end of my Diploma of Nursing studies, which culminates with a five week Acute Care placement, totally some 200 hours. As I did with my Aged Care placement and my Community Care placement, I will be documenting my thoughts, interactions and reflections on my experience. Unlike my last two placements, I will not be summarising after the fact, but in fact giving a daily summary of experiences, emotions and lessons learnt.

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Current Thoughts

I am looking forward to putting my accumulated knowledge to use, I am looking forward to the challenge that lies ahead. But, I would be lying if I didn’t say I was slightly apprehensive. I hope I never get to the day where I feel like I know enough, if you don’t think you know enough you will keep asking questions. I am not concerned with my clinical skills, and I am looking forward to learning and applying new ones.

I want to excel, which brings with it a certain level of apprehension as D-Day approaches, doubt creeps in and you begin to wonder if you are going to be good enough. If any of my class mates are reading this, they will be getting ready to echo back the same thing i have been saying to them for months, You will be fine, you know what you are doing, just breath, relax and dive in. And I have been reminding myself of these words, and the sense of irony certainly isn’t lost on me either.

The first day will set the tempo for the whole placement, Orientation Day. We are meeting up at a facility outside of the hospital to be inducted, trained and tested to ensure we are up to scratch before we hit the floor. With previous orientation sessions, the information was simple enough with the focus being on manual handling and general safety. This time however we will be conducting more complicated procedures, delivering medications and monitoring patients who are in a far less stable condition. But as my old Chief Bosun used to tell me, or rather yell at me, Pressure Makes Diamonds.

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Blogging Timetable

So the nitty gritty. I will be writing my daily reflection almost as soon as I get home. Therefore if I was to publish as soon as I wrote them, the posts would come out at all varying times, and no one would be able to keep up. So instead I will be releasing the posts the morning after my shift. That will mean the blog posts for the week will be published as;

  • Monday’s at 0600 (AEST) will be normal Maintain the Rage posts
  • Tuesday’s through Saturday’s at 0600 (AEST) will be Acute Care Reflections from the day previous
  • Sunday’s will remain the Sabbath and there will be no new posts

Placement Rage 3I thank everyone for their support of Maintain the Rage thus far, and I thank everyone for their words of encouragement going forward not only with my placement, but my Nursing Career in general.

Maintain The Rage

Luke Sondergeld

Planned Rage

Today I am taking the opportunity to share a little with what I am planning over the coming months, what it means for me personally and what it means for this blog. As with everything in our lives, planning is important, but we shouldn't lose site of the journey. For me this whole journey of becoming as Nurse has been wonderful, insightful and joyful. I am also aware that God decides I am needed elsewhere then I must go, that is after all how I wound up in Rockhampton in the first place.

Nursing

So for those of you who have been reading this blog for a while now know that I am due to graduate from my Diploma of Nursing course in December this year. This will mean that I am eligible to register as an Enrolled Nurse (EN). But there is one final hurdle to jump over, my final five week clinical placement in the Acute setting. This is going to be a great opportunity for learning and development. It is also going to be a great opportunity to hone my clinical skills in a real time environment, with patients that aren't my colleagues, with conditions that are actually manifesting not just described.

This both excites and scares me at the same time, it will be the first time in my life I will be actually qualified at something, and not just doing something. I know that I will have the base line knowledge required of me to fulfil my role as an EN, I know that I am compassionate enough to be the kind hand I need to be, I know I am efficient enough and manage my time well enough to juggle multiple patients. But I also know that I have so much more to learn, I could be more compassionate to my fellow man, I need to ensure I don't become too task orientated, too cold, too distant or too removed. I know I need to remember why I am being a nurse in the first place.

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The Blog

This year I will be completing Nanowrimo, a 50,000 word writing challenge that runs for the month of November. My final placement also runs for the month of November, and as part of my assessments I am required to write a reflective journal covering this period. I have negotiated with my instructors, and they have agreed, to allow me to combine the two. Thus, for the month of November, I will be writing a Daily blog post about my placement, what I am learning, reflecting on my clinical practice, my trials, my tribulations, and everything in between.

I see the weekly structure of the blog posts being something along the lines of;

  • Monday – Friday (or whatever my shift week becomes): Daily Reflection released within 12 hours of shift completion
  • Saturday (or first day off): Weekly Round Up
  • Sunday (or second day off): A different topic, like the ones being posted now (open to suggestions for content)

This will be an intense time of writing and learning so I thank you all in advance for your continued support.

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The Future

The future for myself is simply another two years of study towards my Bachelor of Nursing with CQUniversity. This gives me the ability to register as a Registered Nurse at the end of 2019. Given my registration as an EN, during those two years I will simultaneously be working as a Nurse, hopefully in a Medical/Surgical ward in one of the three hospitals here in Rockhamtpon, but we shall see what the future has in stall. Past 2019, only God really knows what's in stall, but perhaps a career in ED is my calling. Only time will tell, and opportunity to work in different wards may mean I find my passion elsewhere.

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As for the future of this Blog? I am considering a Podcast of the blog posts for those who are too busy to read, or would rather listen to my dulcet tones instead of reading them.

So there you have it, a brief look at what's to come in the coming months and years. If you have suggestions for what you would like to see, have an idea for a post, curious about a facet of my life I haven't mentioned then feel free to comment below.

Also, don't forget to click on the subscribe button so you can get all the updates and notifications of new blog posts.

Maintain the Rage,

Luke Sondergeld

Studious Student

In all endeavours we should attempt to excel past expectations and achieve the best we can achieve; for some of us that come easy, for others not so much. There are many stresses put upon us by others, and many more that are put on by ourselves. As a student I know there are expectations to retain knowledge, pre-read textbooks, complete assignments, study for exams, pass said exams, eat healthily, maintain the rage, maintain a work life balance, hold down a job, pay my fees, and somewhere in all that actually sleep. I know that a lot of people out there are going to think that the life of a student is easy, that compared to the real world there are no pressures, that how hard could it be to simply rock up and pay attention, and until I returned to study, I would have shared similar thoughts. But I have since seen the struggle of being a full time student, full time parent, part time employee, full time friend, and full time human being. The juggle is difficult, but I thought I would share some of the simple things that have helped make me a Studious Student and the habits that can be adopted to ensure that you too can be the best that you can be.

Studious Students Study

Pay attention and Study

The temptation to skip class, study in the evening, study in front of the TV, read only the sections of the textbook that you need to for the assignment and coast through is strong. But at the end of the day, you are paying a large sum of money (my course is totalling somewhere near $18,000 which doesn’t include textbooks) to be in class, absorb knowledge and pass. For my course, the Diploma of Nursing at CQUniversity, we have to attend three full time days per week, 0830 till 1600. During those days we have classes that are a mix between lectures and tutorials, clinical skill development, and content discussions with the instructors. In those classes it is not unusual to cover large volumes of textbooks, broad subject material and a ton of detail. The expectation is that you take the information from class, add another 40 hours per week in reading and studying to fill the blanks, and keep up with what happens in the rest of the week. If that sounds intense, that’s because it is. I began the course thinking the 40 hour reading and study on top of classwork was over exaggerated. By the end of the second week, I realised it wasn’t enough. I spend, on average, 50-60 hours reading textbooks, journal articles, news articles, research papers, and anything remotely related to the subjects at hand. All of this study now brings up the total hours spent on Schooling to 75 to 85 hours a week.  But it pays dividends, for every hour I work during the semester is three hours I don’t have to madly cram for an exam at the end, it saves me countless hours in research for assignments, and gives me the confidence and ability to answer correctly when the instructors ask something of me. It also means when I am on placement, I am confident in my own abilities and know my own limitations. So I implore you, pay attention in classes, take notes, read the textbooks. As I like to say to my other budding nurses, You are studying to save a life not pass an exam.

Studious Students Pay Attention

Read Broadly

The temptation as a student is to see a reading list that has been prescribed more as a set of guidelines, though the broader we read, and dare I say it, even outside of the prescribed reading, the better students and better graduates we become. I have purchased every book on my reading list (that was available), either Prescribed or Recommended, and I have collected over a dozen other books of use from book fairs, second hand stores and family. All of these books have been useful at one stage or another. I also read journal articles, health news, nursing news and magazines, blogs, Twitter feeds, converse with Nurses in the field, overseas and local professionals, I endeavour to gather as much information regarding our profession, how to conduct it and the latest and greatest procedures I can. This gives me a wide and varied base to draw from for exams and assignments. It means I am as up to date as I can be, and as a professional, ensures that I am maintaining my professional development habits which will serve me well in the future. My suggestion is read broadly and read often. Buses, trains, morning tea breaks, lunch, quiet times in the lounge room, relaxing in the bath, everywhere is a potential reading spot to absorb more knowledge.

Studious Students Concentrate

Don’t Cram

Anyone who is anyone has crammed at one stage or another, and if they say they haven’t, they lie. I have crammed for exams in the past and it serves to only have you pass in the short term but provides no long term information retention. During my time in the Navy we would be learning a new concept every week, with an exam on the Friday. It was expected that you pass the exam on the Friday so you could start a new subject on the Monday, if you failed however, you would resit the exam on the following Thursday, and still have the new exam on the Friday. Now you had two exams to study for. So cramming became a way of life, which was ok for passing exams and frying brains, but horrible for long term retention. The only way we retained the information was through constant drill and use. The information became so second nature, that I could almost step back onto the bridge of a Patrol Boat and not have too many dramas. However, in Nursing you are studying to use information one month, two months, three years or even a decade later. Cramming is no longer effective, and rigorous drill is ineffective as there is simply too much information to rote learn and reflex learn. So, slow, methodical learning through reading, writing, studying, revising, and reciting is the only viable way to retain the information long term. Now within all of this your individual learning style still applies. I am, for example, an aural learner with visual tendencies. Which basically means I learn best by listening, but can get away with reading. Some people are kinaesthetic, which means they learn through movement or by doing. The difficulty is going to be discovering what works best for you and going for it. I remember listening to a recording of a friend of mine, which ran for just over 45 minutes, with the rules for Navigation, droning on and on and on, and listened to it over a two day car trip incessantly in the interest of passing an exam on the other side. Which I did. So for me that worked.

Studious Students Don't Cram

So there we have it, a quick look at some tips and pitfalls of study and being a Studious Student. I am in no way the perfect student, but I have learnt over time some habits that have helped me. So I now pass them on to you. If you have other hints, tips or lessons learnt from your study, add them in the comments below, or connect with me on the connect page. Don’t forget to subscribe so you can get regular updates on what is happening on the blog.

Maintain the Rage

Luke Sondergeld

Five Community Care Reflections

To follow on from the Reflections of Aged Care and in the interest of continued Reflection so I can Maintain the Rage the following are lessons that I have learnt while on my Community Placement for my Diploma of Nursing. The lessons and revelations that I came to during my placement were; Community Care is not a lesser form of care, Discharge from Hospital doesn’t mean Healthy, Funding is a speed bump not a road block, D is for Danger, a little care goes a long way.

Community Care is not a lesser form of Care

After spending a week in the community setting I very quickly realised, it’s not a lesser form of care, less equiped or less skilled, if anything I found the opposite. The organisation I placed with had two Nurse Practitioners on staff, a myriad of Clinical Nurses and Registered nurses, and an Assistant in Nursing who ran the stores and supply chain. This was a well oiled machine of Healthcare. They were all completely professional, top of their game and the most caring people I think I have met on my journey so far. They work diligently to provide the best level of care they can, and if they can’t, they find someone who can. They didn’t know the meaning of the phrase ‘Too Hard’.  It completely changed my perception of what community care was, which I will admit, wasn’t a very positive one. I alway pictured nurses with a bag of observation equipment, some simple dressings and a box of drugs going from clients home to clients home dealing with  the Elderly and Disabled because they couldn’t make it to the General Practitioners. I could not have been more wrong. This particular organisation ran a clinic in the CBD, an after hours service, visits to the aged care facilities, at home palliation, home delivered clinical services and intra venous antibiotic therapy in the home. Nothing short of a real Hospital in the Home.

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Discharge from Hospital doesn’t mean Healthy

I also learnt that just because someone is released from Hospital that doesn’t mean they are on the mend, they are simply stable and well enough to be at home. This is the sad state of affairs in most countries, where the need for hospital beds is pushing quicker and quicker turn around times. Hospital beds are also becoming cost prohibitive, with the average night stay in Australia costing over $1,800. This has spurred the community health sector into overdrive, the need for advanced clinical skills in the home and community environment is at an all time high. With more people being discharged early, or avoiding hospital and seeking alternative arrangements. That’s were services like the one I conducted my placement with really come to the forefront. We as citizens of our respective countries need to be aware of this, as fathers, mothers, brother, sisters, and children of someone who may be discharged from hospital one day, we need to be aware of what services are available, and what help can be sought. We also need to be aware that the instructions that are given to you on discharge are there to, hopefully, keep you out of hospital. So do yourselves a big favour, especially those who are heading into healthcare, and learn what community services are available and what they can do for your patients on discharge.

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Funding is a Speed Bump not a Road Block

John Kander wrote a song for for his 1966 production Cabaret  which said “Money makes the World go Round”, and unfortunately it does. Healthcare is driven by two things, firstly patients needs, secondly how much those needs cost. Community care in Australia is funded either by the Government or Private Enterprise, and the private enterprises are usually not for profit organisations who receive funding from the Government. These agencies receive a certain amount of money per patient depending on complexity, time needed and a swag of other criteria. These criteria then govern how much the organisation receives to run that service, and what boundaries the organisation has to stay in, so as not to step outside of their appointed jurisdiction. This however does not stop the services from providing the care to the patient. What tends to occur is the service will refer to another community care organisation that has the jurisdiction to cover what is required. As far as the patient is concerned they still receive the right treatment, and the healthcare system get a smiley face sticker for doing the right thing, its a win win.

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D is for Danger

As anyone who has completed their first aid certificate in the past can tell you there is the the pneumonic of  DRS ABCD, where the first D is for Danger, to both the casualty and yourself, community care is a lot like that. Before entering someones home for the first time a risk assessment is conducted, this covers everything from number of people in the house, to pets, to access to the inside, to lighting, everything. The community nurse also has the right to arrive at a patients home and not enter and simply drive away if they believe there is a real threat to their safety, like the 75 kg hungry Rottweiler thats sitting in the front yard. This is paramount for the community nurse, because if they enter the property and the Rottweiler decides they’re lunch, you now have two patients at the residence not one. This lesson can be carried into the acute setting as well, if you have a belligerent patient who won’t settle and is throwing bed pans, grab a mate and tackle the room (not the patient) together.

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A little care goes a Long way

The short amount of time you get with each patient in their home doesn’t leave much room for error, but by providing a little care to the patients in the time you do see them can lift their spirits and help with recovery. Human contact, social activity and conversation are all great ways of battling depression, anxiety and promote good health. The simple act of being kind and caring during your visit could be enough for a patient to see the light at the end of the tunnel and really focus on their recovery, not their condition. Even in community palliation, the difference between openly and compassionately communicating with the client, and always walking on egg shells, can be the difference between what is considered a good death and a bad one. So in all walks of your health care life, care a little, share a little and take the time to be with the patient, not the task.

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My community care placement has taught me a lot, I made a swag of new professional contacts, saw first hand what the services can do for patients, learnt a lot of clinical skills and developed the ones I already had. Do you have a lesson learnt from one of your placements? Do you, or have you had a friend or family member receive care from a community health organisation? If so comment below, if you would like to share your story head to our Connect page so we can share it with everyone. Don’t forget to subscribe to receive email updates of new articles.

Five Aged Care Reflections

With my Community Care Placement beginning tomorrow I have been considering the lessons I leant from my Aged Care Placement I completed at the end of 2016. The placement was nothing like I had anticipated, I pictured the stereotypical residence scenario where most of the residents where mobile, ate in a large dining hall, played canasta for a large portion of the morning and slept away the afternoon, before retuning to the dining hall for an early evening meal. But this was not the case.

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Some ideas are formulated early

1.  Its their home you are just a visitor

The trap some young, inexperienced not necessarily just age young, Nurses and caring staff fall into is that you are at work, a building in which you arrive to every day, clock on, complete a series of tasks, clock off and go home. What you should remember is you are entering someones home, this is where they spend all their time, it’s not a dining hall it’s their dining room, it’s not a common room it’s their lounge room, and it’s not just the room their bed is in, that’s their bedroom, their sanctuary. To that end, you are not an employee who has the right to barge in and do what needs to be done, you are a guest in their home and need to act as such. Tasks should only be completed when they are fully explained, permission is given and in a manner that the resident/client/patient is comfortable with.

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Home Sweet Home

2.  Residents are People and not Tasks

This may seem like something obvious but when you get under the pump and time is short, the task that needs to be completed can seem to be the priority.  As previously mentioned, you are entering the residents home. Picture for a moment a stranger walking into your home; briefly introducing themselves, making your bed, demanding you get up and have a shower, dressing you hurriedly, giving you a small cup full of unknown colourful pills and demanding that you take them.  This is, unfortunately, how some residents are treated. Thankfully the placement I had, I didn’t see anything remotely like this behaviour, but there were times when some tasks where pushed with less than complete consideration given to the resident. So remember you are there to care for the resident/client/patient not complete a series of tasks, take the time to care.

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Task Task Task

3.  Refusal isn’t personal

As Nurses we are taught that residents/clients/patients have the right to refuse treatment, medication or procedures, this also extends to cares, showers, getting dressed and even getting out of bed. How many times have you woken up and just thought “I am not getting out of my pyjamas today, I am sitting on the couch, eating ice cream and watching “Sliding Doors”. This situation is no different for those in your care, they have the right to refuse anything, even having their cares completed by someone who isn’t you.  As a Male I had to be prepared for most of my female residents to refuse to have their cares completed by me. Thankfully this didn’t happen too often, but I did have one resident who absolutely refused to even have me in the room at all, it took nearly two weeks for her to get used to the fact that I was there to assist and allow me into the room, she did however always continue to refuse for me to shower her, dress her or in any way see her in a a state of undress, which is completely understandable. Refusal isn’t personal and as such shouldn’t be taken to heart, just discuss alternatives with your supervisor and move on.

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It’s not personal

4.  You can’t disconnect completely

We are all human, and as such we all develop some degree of human attachment. We are taught to be caring, and supportive, but not to be overly involved. Working in an Aged Care facility I had prepared myself for the inevitable reality of the environment. I am normally quite astute at separating myself from emotional attachments unless it’s necessary, like relationships, friendships and the like. I thought I was doing a great job of it too, I was still caring and supportive of the residents, I was compassionate to their needs, but wasn’t attached in a way that left me vulnerable. Until I met ‘Dave’ (not real name), Dave was a palliative patient who had served many years in a volunteer capacity, his children where only able to visit briefly every week, and he constantly questioned why he was still alive. I endeavoured to make him as comfortable as humanly possible, make sure that his every need was met, but inevitably he passed away a couple of weeks later.  It hit me harder that I expected. Though I was glad that he now had the release he was so desperate for, I still felt saddened by his passing, I knew this world had lost someone who truly cared about others, and placed them above himself. It is perfectly normal to feel saddened, but don’t let it consume you, often there is still plenty of work to be done, and many other residents/clients/patients who need your care as well.

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Don’t let is consume you

5.  Don’t forget to Care for yourself

Anyone who has flown before has been told to “Ensure you have secure your oxygen before helping others”, this extends to the care environment as well, you need to care for yourself before you care for others. If you have cheap, unsupportive shoes, you will get sore feet after standing on them for 8 hours. If you don’t eat properly during the day, you will get tired, lethargic and unwell. Here are a few things to consider to help you help yourself;

  1. Buy good supportive shoes, they may cost over $150 but will save your calves by lunchtime,
  2. Remember to actually stop and eat, we tend to be consumed by tasks and time runs away from us, plan to have a small break twice a day and a longer break for lunch. All this assumes your workplace allows this,
  3. Eat fruit, nuts, lean proteins and complex carbohydrates. Try and avoid the tendency to grab a quick slice of cake, handful of chocolates or other quick snack,
  4. Rehydrate, Rehydrate, Rehydrate! Remember to drink plenty of water during the day. It is not unusual to walk over 20,000 steps in a shift, couple that with the dry air conditioning of most facilities and you will quickly realise that your intake will have to be higher than normal, and
  5. Actually go to the bathroom, it only takes a minute. With all that water, and normal body processes you will need to go to the bathroom. Actually go, there are many health problems that can develop from urine retention over time, take the time to relieve yourself.
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Help yourself so you can help others

This is in no way all of the lessons learnt during my placements, and certainly not an exhaustive list of cares for yourself, but they are some of the most important. I am thoroughly looking forward to the next opportunity to serve the community and those in need. I anticipate there are going to be an inexhaustible list of new lessons learnt from this next placement, but as one of my Commanding Officers once told me “The day you stop learning is the day you become dangerous”, it was true then and remains true today.

Do you have lessons learnt from your nursing experiences? Do you have secret cares that you can’t go a day without? Write them in the comment section below, after all community is key to success.

The Australian Process

I thought it fair for any budding young Nurses, and for our Brothers and Sisters overseas, to discuss the general process for becoming a Nurse here in Australia. It should be noted that there is more than one way to skin a cat, so though I may only talk about the Bachelor of Nursing, there are other choices, but I will include the links to our Registration Authority the Australian Health Practitioner Regulation Authority (AHPRA).

The process in Australia depends on what type of Nurse, or carer, you wish to become, the following are the main classifications;

  • Personal Carer Assistant (PCA) or Assistant in Nursing (AIN) – These care workers are non-registered members of the team, they generally hold a Certificate 3 in their field and assist with the Activities of Daily Living (ADLs) and general duties around the facility or ward.
  • Enrolled Nurse (EN) – The first level of Registration, sometimes referred to as Endorsed Enrolled Nurses (EENs) or Division 2 Nurses. These Nurses deal with the care of the client, administer medications, conduct observations and assist the Registered Nurse with the construction of Care Plans.
  • Registered Nurse (RN) – The Registered Nurse, sometime referred to as a Division 1 Nurse. These Nurses conduct all the above duties of an EN with the overarching responsibility of the client, along with the extended scope to include Intravenous Therapy (IV) and a myriad of other Clinical Skills.
  • Midwives – The Midwife is a specialty that deals entirely with the Pregnant and Birthing activities.
  • Nurse Practitioner (NP) – A Nurse Practitioner is a highly specialised position, it is generally considered the “Nurses Doctor”, they have the ability to write scripts within their field and within specified parameters, have the ability to diagnose and complete care plans and treatment plans beyond that of a RN.
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The regulatory authority for all Health Professionals in Australia

The Education requirements of the above are, thankfully, reasonably straightforward. They do however change from time to time, AHPRA does have a search function to enable you to check that the course of study you are going to undertake will meet the requirements of your chosen Registration, currently though the study requirements are;

  • PCA or AIN – No formal requirements, however to be gainfully employed most employers will insist on a Certificate 3 in Aged Care, Personal Care or similar, depending on what field you are entering. This course takes about 6 months and finishes with a 3 Week unpaid placement.
  • EN – A Diploma of Nursing. This course takes 18 months and contains 3 placements totalling 10 Weeks unpaid placement.
  • RN – A Bachelor of Nursing, some Universities offer a Bachelor of Science (Nursing) and this is also acceptable, however check to ensure your Universities course is approved by AHPRA. This course takes 3 Years and contains a number of placements totalling 20 Weeks unpaid placement.
  • Midwife – There are several options open to Midwives, with either the Bachelor of Midwifery or a Graduate Certificate in Midwifery. There is a varied amount of placement that is required but averages around the 20 week mark.
  • NP – Either a Masters of Nursing or Masters of Clinical Nursing. This course takes between 18 months and 2 years, depending on institution, and as such the placement requirements vary as well. It should also be noted that generally to become a NP, you have to be nominated and supported for the position.

There are avenues at some Universities to complete a Diploma of Nursing and then transition to a Bachelor of Nursing with some of the study time and placement requirements taken off. I am, for example, currently studying my Diploma of Nursing with CQUniversity and intend on ‘rolling over’ into my Bachelor of Nursing in 2018. This process has been made easy with CQUniversity as they have a tailored program based around that exact pathway.

After completing the requisite study, the process continues with AHPRA and you file for Registration, completing forms, proving identity and the like. There is a Professional Development requirement every year depending on your level of registration and an annual review process. But thats the process for Australian Nurses, I hope this helps future Nurses understand what they are in for, and explains the process for our Overseas Brothers and Sisters in Arms. What’s the process for your Country, does it differ? Do you have questions? Post in the comments below.

Maintaining My Rage

The idea behind Maintain the Rage originated with Gough Whitlam, an Australian Prime Minister who famously said in 1975 “God save the Queen, because nothing can save the Governor General”. He would go onto to say “Maintain your rage and enthusiasm through the campaign for the election now to be held and until polling day.” in which Gough Whitlam conferred to the Australian People that they should keep their interest, their tenacity, their fire until the election campaign came to a end on polling day, to put an end to the nine term streak that the Australian Liberal party had wrought on the Country.

My sentiment towards Mr. Whitlam is not that of political support, but rather his passion, his drive and dare I say it his perspicacity. I endeavoured to harness these qualities and apply them to my own life. I adopted the saying “Maintain the Rage” as a sort of sign off for my posts to fellow Nursing Students, as a pick me up when something had gone awry, and as an encouragement to others to “Maintain their Rage”.

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My Broken Arm in early Semester 1 2017

I have been studying for my Diploma of Nursing since June 2016, there have been many times I needed to remind myself to Maintain my Rage.  My journey to Nursing needed plenty of reminding.  At the beginning of 2016 I had ruptured diverticulitis, for those not in the know a snappy Dr Google search will sort you out, which meant an extended stay in hospital and the need to use a Colostomy bag for a period of 6 months, again Dr Google.  During this time I had no less than eight ER visits, five of which required at least an overnight stay, two more operations bringing the total operating theatre time to 13 Hours and over 55cm of scar tissue on my abdomen.  Though this time was tough physically, mentally and emotionally, it did provide me with ample time to consider my journey and where I was headed.

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Some times in the Navy were easier than others

I reflected on my time so far, my goals, my ambition and their central theme, Service. I served in the Royal Australian Navy for five years as a Junior Officer, I served in Hospitality for over seven years, I served for over five years in my local church, I still serve as a Scout Leader for Warripari Scout Group here in QLD.  I began to reflect on what my purpose was, what it all had been leading to.  I have always had a fascination with the Medical field, but could never justify the 10 years of Medical School, besides most Doctors don’t spend enough time with the patients for my liking, and thats not what I wanted.  I then thought about all the Nurses who helped me during my times of need, the service they provided, their knowledge and prowess. Bingo, my purpose. I enrolled at CQUniversity for the mid year intake in their Diploma of Nursing Program, 18 Months, end of 2017 and I will be a Qualified Enrolled Nurse.  I had found the way to Maintain my Rage.

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Decision made

Now I do everything I can to Maintain my Rage, and to fuel the Rage in others. I serve on the Student Representative Council, the Student Participation and Retention Committee, and I am a strong advocate of leaving everywhere you go better than when you found it. I am spearheading a Peer Support Program for other Diploma Students so that they can be assisted with Maintaining their Rage, and getting through the course of their choice, I personally support and assist student who request assistance, and even some who don’t. Thats the kind of passion you need, the cause in life, the legacy in which you will leave behind.

So thats the overview of the story so far, this blog is not going to be selling a product, service, or ideal.  It will be stories and ideas from my life, that helped or hindered me, that help me Maintain My Rage.