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

Our Rage

I have decided to talk about my favourite subject, my Wife and our life together. But before I loose the male portion of my readership this isn’t going to be a love story with walks on the beach, champagne breakfast and how I was the perfect embodiment of Casanova. Instead this is going to be how my Wife and I stay together, keep it together and Maintain Our Rage. The three main concepts I wish to convey with regard to Our Rage are; Communication, Priorities, and Making Time.

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Communication

All good relationships, whether marriages, friendships or working relationships are based around solid, effective, two-way communication. Our marriage is no different. From the onset Alinta and I set out to communicate every idea, thought, question and issue. Other then the normal getting to know you questions, one of the first discussions we ever had was around the intent of our dating. A hard discussion, but one that ultimately set the tone for our relationship. Alinta shared that dating should be with the intent to determine suitability for marriage, and not some summer fling, thankfully I tend to agree with the notion and the matter was sorted. But the matter was still raised and we discussed it, something not too many people would have given similar situations.

Communicating, discussing, relating, talking, sharing, and listening are all part of the exchange of information in a relationship, and it extends beyond simply sharing of thoughts and ideas. My Wife and I made the decision very early in our relationship that we would never go to sleep angry, we would instead remain awake and discuss what is on our mind and come to an agreement, or at least understanding, before saying I Love You and going to sleep. This isn’t to say that there haven’t been many  sleepless night because of this rule, but it has meant the irritations, habits or disagreements cannot take strongholds within our relationship and rot it out from the inside.

Our marriage began with a six month separation due to work commitments whilst I was still serving in the Navy. This meant our normal sitting arm in arm on the couch conversations weren’t happening.  We missed the personal connection that comes with being in the same location, myself especially, but it didn’t stop us from communicating. We would spend hours on the phone at night taking about our days, reflecting on how different things made us feel, and delving deeper into our relationship through our words.

The most sage advice I ever received in regards to a relationship is Never stop talking. This isn’t to say that you should continue to talk AT your partner until they submit, or fill the air with so much talk and noise that your partner cannot think, but to never stop talking to each other, never stop sharing, never stop reflecting, never stop saying I Love You.

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Priorities

In my 30 Lessons Learnt by 30 I mentioned priorities and how they govern everything I do, how I organise my time, and ultimately what gets my energy first. The lit of priorities, in order are;

  1. God
  2. My Wife
  3. My Family
  4. My Employment and Education
  5. Myself

Now, some of you are going to be asking Why is God first? And it’s a valid question. God forms the focal point of our family, He determines what blessings we should or shouldn’t have, where we go in life, how large our family should be, everything. Our entire life is conducted through the lens of Is this what God has planned for us? To that end, my wife is  next on the list. I ensure that she is the first one to receive my attention when I get home, when I wake up in the morning, she is the last one to get my attention before going to sleep, she is the first (most of the time) to know when plans have changed and she is the first person I consult on anything to do with the rest of the list, including how I spend my me time. I would encourage everybody to organise their lives into a priority list, but don’t do it haphazardly. My priority list has been carefully considered and prayed over for a long time. It took a while for me to realise that I am at number 5 not number 3. And I am OK with that. You need to be ok with it too. This priority list also helps when it comes to decisions about time. Our lives all get busy from time to time, some a lot busier than others. By having my wife as the second on the list, when I get asked by my mates to come to the pub, or come hang out, I will either ask to bring my wife, or decline in favour of staying at home. Same goes with unwarranted overtime, excessive extracurricular activities and the like. I will either decline upfront, or at least consult with my wife to make sure she is going to be OK with the level of commitment I will need to put into something else. See back to Communication to understand why.

So my advice, set a list, put it aside, come back to in a week, think about the decisions you have made in the week. Did they fit into that priority list? What needs to Change? Make the necessary changes and do it again, and again and again until you have a list that works for you.

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Making Time

The need to take time extends to most facets of our lives, and taking time for those we love is no exception. Alinta and I, endeavour, to spend time as a couple, just the two of us, no kids, no distractions, no anything. That doesn’t always come to fruition but we try. Sometimes the us time is merely sitting next to each other at our desks and mutually ignoring one another while we work, study, blog or otherwise. Sometimes it is as simple as watching a movie together on the couch. Whatever the activity is we endeavour to make deliberate time for it.

As I mentioned previously, I personally endeavour to make sure that the first person I spend time with when I get home, is my wife. Without her our family unit doesn’t not have its united leadership. When we are out and about we endeavour to be sitting next to one another, walk with one another, hold each others hands, and all the other cliche things, that normally make people sick due to there sweetness, but we do endeavour to do these things. It is what helps us remain united and strong together.

So make time to spend with your loved ones, take a vacation together, get off early from work and surprise your loved one, small tokens of love and appreciation will always go further than singular large gifts. Time is our rarest commodity and the most cherished, share it once in a while.

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So to conclude we may only be on the early steps of the journey but we have enjoyed every minute of it. I look forward to the memories we will make together in the future and the times we will share. I look forward to the trial and tribulations, the good times and the bad, the sickness and the health, until death do us part.

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Maintain the Rage

Luke Sondergeld

Controlled Chaos

I have been requested by a good friend of mine, you know who you are, to write about how I keep everything in order, achieve what I do, structure my day and not fall into a heap by the end of it. I think its prudent to say that I have an amazing and incredibly understanding wife who puts up with more than she should, and for that and plenty more, I love her. But I have developed several key ideals and strategies that I employ everyday to ensure that I can maximise my time, achieve more, and seemly do 30 hours work in 24 hours. As those of you who have read my post Maintaining My Rage are aware I am a Member of the Student Representative Council (SRC) for CQUniversity, a member of the Student Participation and Retention Committee (SPARC), a Nursing Student, a Scout Leader, a Blogger, a stay at home Father and a Husband. Along with normal family and friend engagements and activities. A full plate by anyones standards.

‘Spare Time’

I would love to say that I am so super organised that I have enough spare time to paint, or play music or go to the theatre, but the truth is the ‘spare time’ that I do have I fill. Even the time I am sitting on my couch, a passenger in the car or waiting for my next engagement is filled with something. As a nursing student there is a lot to learn, and it isn’t all contained within the prescribed text books, so a lot of my spare time I am reading journal articles, new techniques, the latest research, or the coolest piece of technology that is going to change our world. If I’m not reading I’m writing, I send more emails between 6pm and midnight then almost any other time of day. My daughter is asleep, my son is asleep, my wife is usually sitting two meters away from me marking assignments or planning her next day, so I write. I inform the parents in the Scout Troop about the upcoming activities, I plan the next term, I organise regional events, I throw ideas to the Deputy Vice Chancellors of the University ways to improve the student experience, I draft policy, and I create change, in short, I don’t stop. My wife used to tell me to get off my phone, as she assumed I was emptily engaging in Social Media, she soon realised that I was always doing something, planning, reading or designing, so now she tells me to ‘Switch Off’, but who has time for that. It should also be noted that most nights I average 4-5 hours sleep, so that helps make some time available. So use your spare time wisely, yes you need rest and the 3Rs but don’t squander the time you have available to you.

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Not enough hours in the day?

Not Procrastinating

Which leads me to procrastinating, in all its forms; coffee, cleaning, odd jobs, sitting, chatting, wandering, napping, socialising, or any other activity that isn’t the one you should be focused on. I feel like every day I am asking my son what takes him so long to get ready in the morning, honestly, it can take nearly 45 minutes for him to shower and get dressed. Now that is some expert level procrastinating. If you are structured, no nonsense and can focus on completing your task well the first time, you will save yourself time in the long run. The is an old saying, If you want something done, give it to a busy person, and there is nothing but the truth in there. If you want to be efficient, “overload” your plate, you will find minutes in the day you didn’t even know existed. No time to read, audio book in the car; no time relax, use your laptop on the couch; not enough time to cook dinner in the afternoon, put a slow cooker meal on the morning before; no time for gym, get up earlier or walk to work. There is secret time all through the day. A great exercise is to document a week, every day and write down what jobs, chores, Facebook, activities, study or whatever else consumes your day. Write it down with a time started, and and time finished, and see where all the time in the day goes, where there is seemingly nothing, and fill it with something. Wait a week or two and do it again. And again and again. I am constantly, formally and informally, assessing my time and where I can and cannot possibly fit anything else in.

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Where does the time go?

Loving what I do

Christian Louboutin once said ‘If you do what you love, it is the best way to relax’, now I’m not normally one to quote a Fashion Designer as part of… well anything really, but he makes a great point, Work doesn’t feel like work if you enjoy it. If you enjoy your work, or extra curricular activities you can recharge from them, I know I feel a great amount of joy from helping others, a great sense of achievement when I see change for good, and it recharges me when I camp and sit around a fire. So for me SRC, SPARC, and Scouts are all rewarding and recharging activities. Sure, the emails, policy, planning, documentation, safety briefings and other mundane activities are a bore, but the rewards at the end are incentive enough for me. You may not be able to achieve the same level of enjoyment out of your activities, and you shouldn’t be discouraged by that, even if you can start by taking one positive, saving grace moment from each day, then after a week, make it two, then three and so on, before you know it everything is enjoyable.

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Sometimes it’s the small victories

Organising my Day, my Week, my Month and even my Year

Though it sounds like a really bad F*R*I*E*N*D*S parody, which was slightly intentional, but it is important to organise your day. I find that begins with breaking down your life into segments. For me I break it down into the following; short term – I work on the period over the next week, medium term – I work in school terms so thats my medium, and long term – the remainder of the year. From that I can split any day into 15 minute blocks and plan it out, travel, packing, meals, meetings, the works. My recommendation is to use a Day-to-a-View diary, this gives you the best coverage and space to plan your day and make notes, the size of the diary itself is whatever works for you. I also recommend finding one with a Monthly and Year planner in it, this helps with the ‘strategic planning’ of the year for big ticket items like camps, holidays, and ANNIVERSARIES! By planning out your day in 15 minute blocks and actually planing out things like travel and meals, you don’t feel like the day is rushed and you find more time to achieve the things you need to get done. This will sometimes mean you will need to rearrange activities to suit better, don’t be afraid of requesting meeting times to be convenient for you, try and avoid doubling back, or visiting the same place more than once if you can, and try and combine meetings at the same location onto the same day to save travelling and preparation time. By organising your day you will also know when to say No.

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Knowing when to say No

So you have mastered you spare time, you have all but eliminated procrastination, you have organised where and when you are going to sneeze, and yet you still don’t have time to fit everything in. Now it is important to know when to say No. This is the hardest skill to learn and the hardest thing to actually do. I am notorious for over filling my plate, double, triple or even quadruple booking myself because of my stubborn natured Yes response.  My suggestion is to alway have your diary near you, either physically on you, or in the car close by, this way when someone asks if you are free, you have a tangible and real idea of how much time you actually have. This also saves on that double booking problem. When to say no, is when you need to prioritise yourself. For me my priorities are;

  1. Family
  2. Work/School
  3. Scouts
  4. Extracurricular for Uni
  5. Myself

Now this may seem a little odd to some, but those are MY priorities, yours will be different, and I expect them to be. Once you have figured out your priorities, stick to them. If something in Number Four is going to impede on Number One time, say No. It is important to do this, it will help with your sanity, it will keep your life in balance, and also help you even handedly distribute your time. This should be caveated with, you have to go to work because you love to eat and have a roof over your head, so you obviously can say No just because your family exists and you would rather stay at home with your partner watching M*A*S*H reruns. Thats where communication comes in.

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Communicate, Communicate, Communicate

Almost every marriage counsellor on the face of the planet will tell you that the secret to any great marriage is Communication, unless you are Mark Gungor and then it’s sex AND communication. But this goes for any type of relationship, de facto, friendship, Father-Son, You and your cat, communication will keep everybody happy, and if not happy, at least informed. My wife and I sit down once a week, usually Sunday afternoons, and ‘sync diaries’ we will go through the next week or two, or if something big is in the medium to long term thats new we bring that up. This way we both know what the other is doing, I know when and what to cook for dinner, my wife knows when I am not going to be home and for how long, and most importantly we can make sure that one of us is home for our 18 month old daughter, remembering for us Family is number one. We communicate every hour of every day. We text when things change, when things don’t, when we run out of something, when we fill it up, when we leave, when we arrive and when we are having a struggle with the day. You need to make sure that you communicate, maybe not to the same level as my wife and I on the onset but do communicate. If you don’t know what your significant other is doing, at least in the broader sense, one of you hasn’t communicated enough, and that can include not asking the right questions. Now this isn’t meant to be a sleuthing exercise, you are not trying to micromanage each others lives, but if your not going to be home at 6pm for dinner let your wife know, if you want your husband to buy milk on the way home don’t assume he noticed, drop a text. This will go a very long way to ensuring that the day can run as smoothly as you have planned it, or at least give you a sounding board when it doesn’t.

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I hope this has at least given you a glimpse into how I juggle everything, and Maintain my Rage. If you have any tips, tricks or suggestions for how you manage your schedule write a comment in the section below. If you would like to hear about anything specific, just as this Blog article was requested, jump over to our connection page and fill out the form. I would love to hear from you.

Relocation beats Stagnation

Reading though my Twitter feed this morning and I saw a tweet from Nurse Mike about his recent move and it made me think about all the times I have relocated during my life and the reasons behind them, the opportunities that were made available and the lessons that I learnt about moving, packing, engaging and connecting. My father served in the Australian Army, so as a child I moved a number of times, I then joined the Australian Navy, and moved a whole lot more, following my departure from the Navy I moved from Perth Western Australia to my home now in Rockhampton Queensland, some 4,642 kilometres (2,884 miles for those playing in the USA) across the country. And through the 17 different moves that I have completed through 5 states I have learnt some invaluable lessons and tools around the actual moving process and settling into a new locale.

Pack into Boxes

This may seem like an obvious tip, but after helping move my friends over the years, and myself numerous times, whether across the street or across the country, the advantage to having EVERYTHING in a box is astronomical. When you do a short distance move the temptation is just to throw everything into the car, to not pack things into a box so you save the hassle of unpacking, try and move drawers full, clothes on hangers and I have even seen fishtanks full. The disadvantage of moving this way is you tend to do more trips to and from the new place as everything is an odd shape and in it most vulnerable form. When everything is in a box, almost everything is a square or rectangle making the move so much easier. Think of playing Tetris with nothing but square shapes, now play with six circles, two octagons, a dodecahedron and four triangles. A little harder now. Most boxes will fit in and around larger objects like tables or filing cabinets, funnily enough objects that are also square or rectangular.

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All those hours ‘practising’ weren’t for nothing

Unleash the inner Ikea

The temptation to leave all of that flat pack furniture assembled, including the bed, bookcases, and coffee table is immense. No body likes Allen keys, and nobody likes assembling furniture when the instructions either went the way of the Dodo or are written in Ancient Hebrew. There are some items that can make life easier, they include a hex shaped drill bit or screwdriver with hex bit attachments, it will save the ‘Ikea Hands’ by the end of the day and speed the whole job up. If you are slightly handy, and have an angle grinder, you can also make you own by cutting of the angled portion of the Allen key and using it in your drill. The reason for disassembling your furniture is two fold, firstly it removes unnecessary space from the back of the van or truck, and secondly lessens the possibility of damage by the item of furniture taking a load or falling when moving.

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Some things can stay as a flat pack

Clean and Sort before the move

Sometimes moves are unexpected, quick or unplanned, but that doesn’t mean that the time cannot be taken to clean furniture as it is moved, and things cannot be sorted prior to being packed. Remember if you pack it, you have to move it. So moving is a great time to perform a ‘spring clean’ and donate or throw out some of those things you have been hanging onto since Keating was in power. The advantage of cleaning your furniture before you move is you tend to enter a house that is reasonably clean, if you bring in clean furniture it saves having to ‘double clean’, that is both the house you left and the house you are entering. Think of a move as a Dirty Room and a Clean Room in a Hospital. By decluttering your belongings you have to move less, save space, give the less fortunate clothes for the winter and help others out with your donations.

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Good chance to clean out that ‘Spare Room’

Moving can be an Opportunity

Most of my moves have been a requirement of either my fathers or my work, but the ones we conducted voluntarily were for family and opportunity. When I left the Navy in 2014 the employment prospects in Perth were low for someone who was not a tradesman willing to work in the mines, Rockhampton however was still flush with opportunities of many varying types. Being a regional centre the health sector, education sector and Government sector were all short of staff. So my wife and I decided to make the move to be closer to family for support, and to increase employment prospects. It would take time to make the opportunities come to fruition by my wife secure full time employment with a local private school and I began working with a Government agency. Time would go on and circumstances changed, I took up the opportunity to study Nursing with CQUniversity and changed my careers direction, and stayed home to look after our youngest daughter. Without the move to Rockhampton neither opportunity would have presented itself for my wife or I. Sometimes you have to move, close one door, so another can open.

Connecting with the Community

One of the hardest things to do after a move is connect with the locals and find a new circle of friends, for some this comes easy and for others a little more difficult. It is important to connect with those in the region and build a sense of community, it will be good for your mental health in the long run. As Christians we found the ability to connect easy as we could connect through the local Church, that worked for us but doesn’t work for everyone. I would recommend making yourself available, check out the local groups who meet in the area. If you like playing boardgames connect with the local club, if its lawn bowls then go a watch some games and connect in, golf, tennis, scrabble, bingo, canasta, whatever the hobby or activity you enjoy find those of like mind and seek them out.

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Hard work, but it pays off

Moving can be hard work, connecting even harder, but if we step out and take the opportunities when they present themselves who knows what we can achieve. Do you have some other tips from what has been mentioned here? Stories of when you moved for a change or opportunity? Tells us about it in the comments sections below, or email me from the Connection page.