Fall Down Go Boom

The Art and Science of Nursing

2006-08-04T20:23:00.000-06:00

My great great aunt Mae was a nurse at the turn of the 19^th Century. Seven days a week, she hitched-up her horse and buggy to provide medical care and comfort in her rural community. When the local veterinarian was busy, she would also help care for local horses and cattle. Later, she became a psychiatric nurse, and even later a nurse educator. Nursing allowed her to travel, meet new people, and provide for independence that most women couldn’t attain in that time period. For her, nursing meant freedom and the ability to be her own person.

My great aunt Marge became a nurse in the late 1930s. She initially worked in a small country hospital. When World War II erupted, she moved to a bigger city to care for veterans on a medical ward. As she provided these brave men with physical care, she also performed assessments and interventions to help relieve their psychological pain. She felt that her calling at that time was to heal their damaged spirits. Though her career spanned many decades and various nursing specialties, it is this work that brought her the most joy and great professional pride.

When I decided on a career in nursing, I knew none of this. I had worked in healthcare settings since I was 15 years old, and always knew I wanted to work in a patient care environment. I readily learned the tasks I needed to perform whatever job I was assigned. But more than that, I could easily connect with my patients on a level deeper than I expected. Patients would open up to me. Even at the tender age of 16, I had elderly patients share their fears of death and dying with me – seeking comfort

Nurses are old and young, tall and short, skinny and wide. We come from all walks of life. Some choose to enter the nursing profession for job security, others to help those around them. Throughout our schooling, we are taught and tested on the science of nursing. Our primary focus is the ability to recall important facts, to think ahead of the current situation, and to understand interactions between the patient and the interventions we provide.

It is only when we begin direct patient care that we become aware of the art of nursing. The word art can be used to describe the results of a particular task as well as the knowledge and skill required to perform that task. Elusive, yet widely recognized, the art of nursing is our ability to connect with those around us. Like other more fashionable art forms, nursing can be dramatic, inspirational, comedic, relaxing, comforting, joyful, and even sad. Nursing is also creative, existential, and has a particular rhythm. This intangible connection can create an environment of healing, one that allows patients to fully participate in their own recovery process.

Nurses teach, support, communicate, medicate, and coordinate patient-care events. Nurses are patient advocates who provide comfort and hope to our patients and their families. The art of nursing is in play when we just ‘know’ what to do to meet a patient’s emotional needs: when to hold a patient’s hand, stroke their brow, crack a joke or even just sit and listen. Most of this is being accomplished simultaneously during each patient interaction.

The science of nursing allows us to care for our patient’s bodies; this is what we are tested on in the course of our careers. But it’s the art of nursing that calls me to the profession and allows each of us to touch and heal souls.

Computers and Life Events...

2006-06-13T08:34:00.000-06:00

I lost my user name and password. Now you'd think that customer support could help ... but they couldn't. It took me months to finally come up with the correct combination to access this account. *sigh* Frustration to the Nth degree.

But that isn't why I am here today.

I am sad.

A friend died this week. She was young and hitchhiking through Africa. As a vegan, she didn't believe in foreign chemicals in her system. This led to her demise as she was felled by cerebral malaria.

A few hours later I was informed that one of my Great Aunt's had died . She was in her 80s, and though unexpected, I was okay. THEN I heard she had taken her own life. That hit hard.

Elderly suicide is not uncommon. As a matter of fact, they are the age group most likely to succeed. Is it due to their knowledge? Their determination?

According to some sources, elders comprise 12% of our population, but make up 20% of all successful suicides. These numbers do not include "silent suicides" ... those elders who die from purposeful non-compliance with medical regimes, dehydration, or starvation.

Aren't there supposed to be signs? For some, there ARE signs: change in routine, social isolation, verbalizations, changes in self-grooming. For others, it is as simple as "putting affairs in order". How do we, as concerned friends and family know when some of these subtle signs are related to normal aging, grief, or suicidal ideation? The sad fact is that we miss these cues everyday; we attribute these events as 'normal aging'.

My Great Aunt had lost her husband a few months before. After his death she moved from the nursing home back to the assisted living they had lived in before his illness necessitated a higher level of care. She wasn't writing, but she was playing bingo and such. She was eating, grooming, and gave all the appearances of simply being a woman who was still grieving the loss of her husband... they HAD been together for about 60 years after all! Though the move took her further from her son's home, it brought her closer to the extended family network. She had frequent visitors, and was taken out and about town regularly.

When the signs are seen, the person can begin therapy, be placed on close watch, can be hospitalized if necessary. Loved one's can intervene.

In her case, no one suspected.

Her suicide note stated she missed her hubby. She also said if she was 'in her right mind' she might be able to get to the other side of her grief. After all, you don't live to a ripe old age without being able to process grief and other intense emotions. But because she 'wasn't in her right mind', she was simply done. She didn't want to hurt anyone, but she was done.

She then jumped off ther 3rd floor balcony. She died instantly.

What mind was she referring to? A mind and heart filled with grief? or her slowing mental processes? Or perhaps her increasing confusion? One of the saddest things to witness is the slow decline of a vibrant and intelligent person's mental cognition. She knew for several years she was becoming more confused. Her own mother was institutionalized for something similar for the last decade of her life. Could those memories, combined with her own grief, created a fear that she just didn't want to deal with anymore?

We'll never know now ... we can only guess her motivation.

I like to think her hubby caught her soul on the way down and held her in his arms again.

Love and aging ....

2006-04-24T21:47:00.000-06:00

We seem to forget about our elderly - especially those without family living in our communities. I live on a block of older homes, with older occupants, and I don't even know most of their names. I don't know if I'd notice if something happened behind their closed doors. A couple that came into our ER reminded me of this sad fact.

An elderly woman was brought in by EMS. The report stated she had fallen 3 days earlier. She was the caretaker for her 90-ish year old hubby - who had alzheimer's. She couldnt' reach the phone, he didn't have the cognitive capacity to recognize the need to call someone. So for 3 days and nights this confused man sat by his wife on the floor. No food, no water for either of them. Finally on that day, he went outside and flagged down a passing car. The driver of the car that DID stop, called PD to check on the house, and stayed with this obviously confused gentleman until the police arrived. When the police got to the house, the wife was barely conscious, and in the same spot in which she had fallen days before. EMS was dispatched and they were brought to our ER.

The hubby isn't one of those aggitated confused gents ... he had a lost affect, quite childlike actually. He stayed within a couple of feet of her constantly... stroking her brow, holding her hand. He never spoke to us. They were both previous patients of our system, and there was no data in our computers on next of kin. They were alone in this world - and had built their own little bubble of life. Their bubble contained just the two of them.

She not only had a broken hip, dehydration, rhabdomyolosis, and cardiac ischemia ....... she couldn't communicate well due to her extreme condition. Her urine was dark brown, her CKs heren't as high as we expected, but her BUN was 100. We didn't know if we'd be able to adequtely recover her kidney function.

In the meantime, her hubby just stayed there, a silent sentinel. Case Management was called, and were unable to find anyone to care for him at home. They were also unable to find alternative placement for him in the middle of the night. I called the CM, who was handling this from home, and was surprised to discover she hadn't called Adult Protective Services! She felt they couldn't help until Monday. I clarified that they are on call 24/7 and have access to emergency SNF beds throughout the state. I also let her know a report HAD to be made. If she didn't want to make it, I would.

Why is it we are so afraid of contacting authorities in neglect cases? Does it make a difference in our minds if the neglect is self inflicted? It seems to. APS has resources we don't. They aren't out to take away self determination. APS will provide as many FREE services as possible to help our mentally incompetent and eldery citizens to remain SAFELY in the community.

For this night, I talked our hospitalist into admitting the husband until we could safely place him somewhere. I spoke w/ the charge nurse on the inpatient SAC unit that the wife had orders to be admitted to - she agreed we needed to keep this couple in the same room - for both of their sakes. So, she moved patients around to create an open semi-private for this couple. When I wandered by hours later, they were both sleeping peacefully in the glow of their IV pumps.

BTW- the APS worker on call did check in and told us since the hubby was safe, they would come by in the morning to investigate and arrange emergency placement. He stated that there were available beds for the confused and demented in town, and that he just needed to meet the patient in order to determine which bed would be best. I felt good AND bad. I hated the idea of splitting these two up, but could he handle watching us resusitate her if she coded? After overnight rehydration, he would be well enough to leave ... Did he deserve to be in the confusing hospital environment and exposed to all the 'bugs' we have there? Ragrdless of the immediate situation, they needed help. And this was one way in which we could help them get the assistance they do desperately need.

If they hadn't been on ignore, if they'd had a support system of some sort, this could have simply been an elderly woman with a hip fracture. Instead, because of their isolation, this could be the end of a lifetime together.

Isn't that sad?

Guilt and such ...

2006-04-20T22:11:00.000-06:00

Today I decided to bite the bullet and begin my blog. I've been lurking in the land of medical blogs for months now ........ for some reason today it just felt right to dip my toes into the blogosphere. So far, no sharks.

I would love to have something amazingly intellectual, profound, or downright witty to share on this momentous occasion. Unfortunately, I don't. So hello internet-land .... did you hear that echo???

I've learned to watch where I step, professionally AND personally. Today I choose to find a little place in the world where I can simply dance on those obstacles I come across in my life.

What obstacles? Well, my health is improving after a prolonged illness directly attributable to being a patient at my own place of work. My hospital was once a pillar in the community - a place I was proud to work. Today, this has changed. We were bought (like so many hospitals in the US) by one of those large, faceless, soulless corporations. Patient care is in the toilet, the guilt of not being able to provide the care we know our patient's deserve is eating our souls. We feel beaten. The grass is no greener elsewhere, and we love our patients - so we stay and try our best to make do with what little we have.

Part of me thinks leaving in protest would help me ... but it would hurt our patients and my remaining peers more. So I stay. Tired, frustrated, and saddened by the lack of support. You know, I got into nursing to HELP people ... and most shifts lately, I don't feel like I've helped anyone. Yet, I stay. in my own way, that IS my protest. I stay, I say what I feel, and mean what I say. I try to support my peers to the best of my ability, and care for my patients as I would wish to be cared for.

Those silly suits in another state who SAY quality care is a top priority have decided this is a good time for an employee satisfaction survey. Oh dear! I can't believe their timing! So yes, I completed my survey and shared my concerns. I wasn't abusive, I voiced my opinions in the same manner I chart: factually. Why do I think this won't change a thing?

So today I again fell down ... and went boom... I wonder when I'll pick myself up?