Friday, September 19, 2008

My First Clinical

Clinicals went well the other day, and most importantly, I know I'll never have another first clinical day ever!

I was oriented on the building some more, and it was kept fairly simple. I took some vital signs, had some conversation, did a small assessment of the skin, helped with a bath, and that kind of thing. I was so nervous about going in and talking to a patient and touching them for the first time, but it ended up not being a very big deal at all. My least favorite part of my clinical experience, believe it or not, was sitting around and talking about while my favorite part was actually getting up and doing it.

I royally screwed up my first care plan and I forgot to assess my patient's bowel sounds (very important because he has gastric ulcers). I didn't check my manual blood pressure reading with the automatic blood pressure manual to verify its accuracy (since the whole blood pressure cuff thing is new to me; even though I did pass my skills test on it). I know what to do, and what not to do when I go back next Wednesday, which I hope to do a full head-to-toe assessment on my patient and see if he has any, as of yet, undiscovered pressure ulcers which wouldn't be much of a surprise considering the particular facility I am doing my clinicals at.

My patient is a really cool guy and I'm happy he's my first one. He's in good spirits, nice, helpful, and even willing to allow my fellow students that are not assigned to him to poke and prod on him as well. He has an AV shunt in his arm, and it was my first experience listening through the stethoscope to such a sound. I compared it to sheet metal being moved and flexed to which my clinical instrcutor responded that she had never heard it described that way and I let her know that she definitely would've heard that comparison if she'd had more male nursing students! Feel the "thrill" and hear the "brewy" is what she called it.

I was distrubed by quite a number of things I've noticed which I think just aren't right. Most irritating of all, is that I think we can do a little better than hoisting our PVS patients into a geri chair and parking them about 2 feet from the threshold of their door. I mean is there any socialization? Stimulation? Just because someone can't do for themself, there's no reason in this world to park them wherever so you can meet the bare minimum for a federally required standard. There's no way to tell, at least for a nurse, how alert someone is, even if they are considered PVS, so why not find out from family members what kind of music she likes? Television shows? Movies? We're parking our elders in hallways because we assume they don't know what's going on. And that's wrong. I don't care if you think that meets the legal requirement; in no way, shape, or form, should that meet our ethical and moral standard. I'm here to help people; not take the easy road and do less work just because I know that a patient can't complain about my morally questionable behavior.

I hope I never become like the nurses that seem to have lost their caring for people; people near the end that need it most.

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