The Small Things.

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I can’t believe how quickly the term is wrapping up. I’ve almost completed my 13 week stint in general medicine and I can definitely say there’s a drastic difference from that first week student nurse. I am not only more confident in my skills and assessments, but more aware of what is actually going on around me.

I must say i’ve got to see some pretty cool things this term, like watching an endoscopy and colonoscopy. I got to perform wound dressings on some pretty intense wounds and ulcers and pull out a catheter. I’ve learned how to hang mini bags and set up IV poles, flush saline locks, and administer injections subcutaneously and through and SQ port. I’ve got to see and help set up and take down a nocturnal cycler and see how a wound vacuum. I got to perform bladder scans and take my first VRE swabs and send them to the lab. But i’ve also seen the realities of healthcare, like budget restraints, poor communication between team members, and patients stuck in gridlock waiting to be placed in palliative or long-term care. I’ve seen death up close and how lonely and dreary dying in hospital can be. Seeing what the morgue looks like and putting a body in there was quite morbid to be honest, it was cold and white.

I’ve been pretty fortunate to have had some pretty awesome patients the past few weeks. I am also happy to say that the elderly lady I had the pleasure of taking care of and advocating for was discharged home and awaiting further care at a different facility. She’ll probably be one of my more memorable patients, but it was touching to see how much the help from the students meant to her, and how sad she was to go home and not have the same supports looking after her. I was lucky to follow up with her for two extra weeks and check in to see how she was doing. It was a relief to actually see that the nurses now had implemented into day a one to two hour move to her chair so she could enjoy looking out the window and eat her lunch with her family. Having her son come up to me and thank me for making this happen was touching, but to be honest, I shouldn’t have had to be thanked. It should have been followed up with by the nurses, physicians, and physiotherapists who are responsible for her care on a daily basis, not the student who comes in once a week.

One of the things that has captured my mind lately has been how isolating the hospital can be. The last few patients I have had the pleasure of taking care of all had their moments where I could tell how being alone for the majority of the day could impact their emotional well-being.

I think one of the things I wish hospitals had more funding to do would be to encourage more programs where volunteers can sit and chat with some of the patients, especially those with no family or friends. In an ideal world, it would be nice if volunteers could eat with some of the patients or even play some games to keep them company for a few hours a day. During one of my head to toe assessments, my patient broke down because of how scared they were about not knowing why she was having so much pain and having to be fed through and NG tube. It didn’t help their daughters were 6 hours away, they had no immediate family close by, and their friends rarely came by. To some extent, it can be hard to comfort patients, especially when as a medical team we don’t quite understand what’s causing the issues that originally got them admitted to the unit. I was fortunate to have a really awesome bedside nurse that day who took some time to teach me a few new skills, but also show the importance of compassion. Even though mornings are an incredibly busy time and we have to have charting vitals and medications administered by 9 am, watching her stop what she was doing and pull up a chair to hold my patients hand while they cried is something I hope I carry forward as a future nurse.

Needless to say, the support I received from many of the bedside nurses, both RNs, RPNs and clinical assistants has been awesome. As terrible as it sounds nursing at times is notorious for being a pretty catty profession, where often the weakest are eaten up not because of their patients but because of the people they work with. The stuff I have taught or invited to see is so important to helping not only me grow, but my peers as well. Our floor has been super friendly, and to be honest there is a part of me that is sad to wrap up this rotation since it’s often hard to find a team as rich. Compared to the unit I was on last term, it’s a drastic difference with nurses actually taking time to interact with us and teach us new skills.

To some extent, i’m lucky that as a second year nurse, I only get one patient to look after for the day (obviously i’m responsible to help my peers). I try my best to use a portion of my time to spend time with my patients, especially during meal times. I think sometimes as individuals we forget the cultural significance of eating with others during lunch or dinner. A lot of the loneliness peaked during these times, when I would see patients staring into an empty space and eating their meals alone whether in a chair or at the side of the bed. Their expressions would always pipe up when I would come sit on the side of the bed or stop by to chat with them while helping them open up some of the food containers. It always made me feel a bit better to keep them some company, but knowing that for a regular nurse to do something like that, when they have 3 to 4 other patients, it’s not usually possible.

I think my other favourite moment from clinical last week was the ability to fully understand how much performing personal hygiene can mean to someone. Since my patient had been admitted (2-3 days) to the unit, it did not look like they had brushed their teeth or took a shower. While it was difficult at times to interact with them because of their delirious state, when I offered them a toothbrush and found some toothpaste the look on their face was priceless. I was fortunate to be able to sit with them and keep them company while they ate (and making sure they didn’t fall). It was disheartening to know they had no friends or family who would come into visit them. It always makes me feel guilty to some degree and makes me want to try to give those patients a bit more attention. When I found lotion later on in the day, it was a real treat to see their face light up and thank me when I gave them a small hand massage and lathered nice smelling cream on their arms was touching. I think as human beings in general, we often forget how meaningful small actions can mean especially when people are at their most vulnerable or weakest period of their life.

One of the things i’ll miss going forward is how awesome my clinical grouped meshed together. It’s incredibly refreshing when we all start at the same level and how our personalities all flowed with one another. For people who aren’t in nursing there really is no way to explain what a nursing friendship is like or how important it is to keep our own sanity in check. I’m forever grateful to be able to have had the support I did from my peers when trying a new skill, boosting a patient, or even doing bed baths. It’s so incredibly important for nurses to feel not only physically supported in their work, but also emotionally and mentally supported. Never once during the term did I ever feel judged or made to feel like a burden, every favour I received I made sure to reciprocate because honestly team work really does make the dream work. I’ll finish off with this picture though, because in all honesty only nursing students (or PSW’s) would understand and it’s true!