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.

Placement Rage 1

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.

Placement Rage 2

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

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.