for the love of nursing

I survived another 36 hour shift, it wasn't pretty but here I am alive to tell you a story. Parts are sad, parts are not. The best part about working 3 - 12 hour shifts in a row is continuity of care for the patients. On Friday I was assigned 6 patients, some were discharged only to be replaced with someone else but for the most part throughout the weekend I had a "core" 4 that I took care of for 3 days. One is a spanish speaking woman who has been in the hospital for almost 3 weeks with congestive heart failure. One thing that amazes me about the human body is how each organ is dependant on another to work, they all have symbiotic relationships with others. Not one can stand alone without another and the heart is no exception. The heart and lungs and kidneys are all best friends. If one is out of wack, the rest follow suite. Her husband is very attentive to all her needs, bathes her, cleans her after using the bathroom, combs her hair and reads to her. She doesn't have the strength to do these things herself anymore and his love for her extends beyond traditional roles you and I would think of. I commented to him that I admired his devotion to his wife and he teared up, this was the love of his life I was speaking of, how else was he to act? Their relationship definitely moved me and "refilled" my kenosis tank so to speak.

One of my other patients was a young man, came to me from the ICU after ingesting some pills in an attempt to take his life. He also acted out in other ways that I am not able to talk about. When I met him he was very confused as to what landed him in the hospital and scared. I was nervous about telling him what happened, but as a patient in the hospital, he has rights. He had a right to know what happened and the plan of care for the remainder of his stay. He was dumbfounded as to why he would do such a thing. (I admit I was too) One of the protocols that my hospital has as do others is that when a patients comes in after trying to commit suicide an "emergency detention order" is obtained so that the patient cannot leave on his own accord, if he/she so chooses to try the police are brought in. This is for the safety of the patient (they still may or may not be in their right mind-considering they just tried to kill themselves, this is likely) and for the safety of anyone that may be involved in the patients life (girlfriend/boyfriend, family,etc....) Anyways, another part of obtaining an EDO is that a room at a psych facility needs to be available for when the pt is medically cleared to be transferred. This is where we ran into a snag over the weekend. I could not get an EDO for my patient due to the fact that no beds were available within a 100mile radius. My patient is asking to leave, insisting on leaving and I am throwing all my tactics to stall at him I can, "the doctor needs to evaluate you before you go", "you don't have a ride", "you don't have clothes", " whats your plan after you leave"....all the while I am getting assistance from a nurse at the local psych. center on how I can legally keep this guy here. I am scared he will hurt himself again, he has said things to warrant this. So she tells me the phone number of the judge that can I can possibly get to write a warrant to keep him at the hospital...its a long shot, but of course I am going to try. I called him, and explained the situation, telling him that between me and another nurse we've called over 20 facilities in Texas to see about availability. He said he cannot legally sign the warrant but was willing to help me out and make phone calls to people in higher places....and guess what? At 6:30pm I spoke to a Hospital that was willing to take my patient and approval was being made as I was leaving. My physician was on board and as a team this kid is going to get the help he needs ( I HOPE!). As exhausted as I am today, I am just so thankful that we could find a place and people were willing to help this kid. He probably doesn't care that all these efforts were being made, he was more concerned that he was missing his girlfriend but I will sleep easy
knowing I did all I could, we did all we could.

Nursing is so much more than handing out pills, doing dressing changes, starting IV's and preforming wound care. It's the leg work, its going the extra mile to be the change, the catalyst for something better, something more. I am so honored to be a part of it all.

valentines day

The picture doesn't do these valentines day cards justice but these are the valentines that sloan will be handing out Friday. She choose 4 different prints of scrap booking paper that were love/valentines day related. She traced them and I cut them with pinking sheers. The white label in the center is also cut with pinking sheers and says:

"you make my heart glow"

taped to the back across the heart is a glow stick (thank you heather for letting me know you get them at target). Then we hot glued glitter hearts to the ends. I found this idea when I googled "creative valentines day cards". So many to choose from but Sloan decided that this one was "way cool". Yay, I am cool, at least for one more day. Hope everyone feels the love this valentines day, I know I do.

Hospice

The word "hospice" comes from the Latin "hospitium" meaning guesthouse. It was originally described a place of shelter for weary and sick travelers returning from religious pilgrimages.



I wanted to write something about hospice, it's such an important part of what I do and what I care about and want to be a part of during my nursing career. Hospice is not only comfort care and providing dignity to the patient it's serving, but to the family as well. Its a support system, a shoulder to cry on, an ear to listen, and so much more. (not to mention its non for profit)

Recently, I was privileged to take care of a patient who was "healthy" for his standards. He had significant heart disease but was living at the highest quality he had. He came down with pneumonia and just succumbed the battle. After careful thought, the family decided to put him on hospice. I am always careful to show my enthusiasm for the choice of hospice, I know the benefits and all that hospice has to offer but for many families and patients even they only think "I'm dying, and soon.". The prerequisite for hospice care is less than 6 months to live after being diagnosed with an incurable disease. I have seen many people on hospice for more than 6 months though.

This gentleman lived for 4 days on hospice. He was comfortable, was provided quality care ( at least by me) and was given dignity, even after his last breath. At the time of his passing, his breathing changed from agonal to almost peaceful. His face, relaxed and content. His family was present and I truely believe that he knew they were all there. There is empirical evidence that states that hearing is the last sense to go before death. Often the patient will not acknowledge that they hear due to not having the ability but they hear the memories shared by the family, the "i love you's", the "i'm sorry's", the "its okay to go's". Sometimes that is all the patient needs to hear, permission to go.

The hardest part, that I wasn't expecting was calling the death. You auscultate for breath sounds, feel for a pulse in strategic locations and then note the time. You let the family grieve and they will, give them time to absorb what happened. As I left the room with tears in my eyes I realized what an amazing job I have. Its not the most glamorous part of the job, not my most favorite part of the job but it is amazing. Amazing in the sense that I am a part of someones last breath, last heart beat, last goodbye. Honored.

I know I will not remember each death, although I really do try to take in all the emotions and feelings that I have, to honor the death.