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

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.