When you enter nursing school, you're going to be told that you'll need to develop critical thinking skills. You'll have to learn to think like a nurse. At first, it may seem impossible to put all of the pieces together and there are bound to be some embarrassing moments where you feel like a dunce. The truth, despite how air-headed you may feel sometimes, is that after all of that studying, cramming, practicing, observing, and stressing you do in school- you slowly and surely begin to develop a "nurse's brain". The day you discover that truth will be nothing short of glorious.
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On the first day of clinical, my instructor told me that she was going to teach me to think like a nurse. Critical thinking may be the most valuable trait that any nurse can have and my instructor did this incredibly well.
I was with a elderly dementia patient that day. He wasn't my patient, but another student was having trouble communicating with him and had asked for my help. He had a hearing deficit and it took him about a full two minutes to respond to any questions, as if he were running them through him mind and formulating a proper response, which was usually only a one worded response- yes, no, covers, etc.
He was sweating under his covers and began to move his blankets off of himself. A few moments later, he was shivering and asking us to pull them back up. About ten minutes later he was sweating and pulling them off again. This went on a couple of times. I knew something was odd about this, but I could not place my finger on it.
When my instructor made her way into his room, I told her what he had been doing. She looked at him and immediately placed her hand against his forehead. "He has a fever.", she said. "Take his temp." And sure enough, he did.
I was in awe of how she came to that conclusion in 30 seconds flat. I was also bothered that I had not been able to figure it out. After all, I was looking at this patient for more than 30 minutes. I've had fevers before. How had that not even crossed my mind? I didn't have the skill yet to put it all together.
Fast forward 6 months, and I'm on the tele rotation. It's 7:30am and I step into my patient's room in the morning and perform vitals, and the head-to-toe. During the assessment, the patient states that she feels like she has to urinate. I can see that she had a foley. She has a history of bladder retention and states that this is not an unusal feeling for her. I'm getting her I+Os and her foley is empty. I immediately assume it was just emptied.
I stepped out of the room to document the assessment and when I go to put in I+Os, I notice that the last time anyone documented an output was 3 hours ago. I think, "But the foley's empty... Could they have emptied it and not doc'ed it?" Hmmmm.... Then WHAM!!!
It all makes sense. Patient c/o feeling of bladder fullness, foley's empty, last time charted 4am. I suspect this foley is kinked somehow. I pop up from my seat and return to the patient's room.
Me: "Do you still feel like you have to go?"
Pt: "Yeah.. I know that sounds crazy, but I kind of do."
Me: "I don't think it sounds crazy at all. Let me look at this foley again."
Inspecting the foley, gently wiggling and manipulating the line.
Foley: GUSH!!!
500cc of warm urine rush through the foley into the bag. I've never been so happy to see pee in all my life.
Pt: "That's much better. Thank you."
Me: "Sure thing."
Me on the inside: "YES!!! I AM the CHAMPION! Who figured that out all by her bad self?! TOYA did, that's who! (On stage at a podium). I'd like to thank God for being here, my mom for inspiring me, my instructor for educating me, and my brain for being AWESOME!!! I'd also like to thank all of my friends and family for believing in me! (Bowing and waving off stage.)
I felt INCREDIBLY blessed. I didn't run and tell it on the mountain and brag to my friends. I just sat down at the computer again, and went back to charting, with a smile on my face, shaking my head at how great God is. Where I was unsure that I could ever learn to be so observant and think so critically (and quickly), now I am confident that with time I have what it takes to be great at this, and I have to defer to GOD on this one. I wouldn't have even been standing in this position without him.
