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Have Nurse

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  1. Have Nurse

    It Never Occurred To Me.

    Thank you.
  2. Have Nurse

    It Never Occurred To Me.

    You are sooo right and what a blessing you were to him and the staff! Thank you for sharing that.
  3. Have Nurse

    It Never Occurred To Me.

    I appreciate your comments! Many thanks! Just an old war horse, that's me.
  4. Have Nurse

    It Never Occurred To Me.

    Thank you too. I too am a veteran and in spirit, he was my brother.
  5. Have Nurse

    It Never Occurred To Me.

    You are kind. Thank you for your words and encouragement.
  6. Have Nurse

    It Never Occurred To Me.

    We'll call him John. John was 7 feet 2 inches tall. At 65 years of age, he had long brownish-gray hair, that he wore in a clumsy ponytail. He suffered from morbid obesity which made it difficult to ambulate as evidenced by his shortness of breath. A Viet Nam veteran, homeless, was found wandering the streets with a very high blood glucose level. He claimed he didn't know he had diabetes, which was possible. John hadn't seen a doctor in years. He was polite and cooperative, up independently and ambulating in the halls when we met. He had a distinct strong body odor. His day nurse informed me earlier that "He won't take a shower." I wondered why. Remembering that there is a reason for every kind of behavior, I decided to mull it around a bit before broaching the subject. He shared with me stories of his military service, how he got to be homeless and how he found himself in the hospital. "I was married once," he began. "It lasted 20 years....but then...she got sick and I couldn't keep up with the bills. We lost our house, she died....and suddenly it was all gone." He was sitting on his bed. I had pulled up a chair. It wouldn't be long before I had to do rounds again for vitals and meds, but I sensed a wounded spirit in him. A burden not just on his body, but in his heart as well. The elevator doors down the hall opened. The smell of hot food wafted down the halls. "John, " I asked gently, "Is there anyone I can call for you? A friend? Anyone?" He shook his head sadly. "Supper trays are arriving. Will you eat?" I was worried that his blood sugar would take a dive if he didn't. He nodded. I smiled at him and retrieved the tray. I still hadn't asked him about his refusal to take a shower. He allowed the staff to change his towels and linens. As John ate his supper, I reviewed his chart again and noticed how many times the previous shifts had offered him hygiene assistance but he would politely refuse. I also noticed that no one had charted on asking him why. Looking at the Allergies section of the chart, I noted no issues with soap or laundry products. Was he afraid of water? How long had it been since he had a decent shower or bath? Our homeless communities have access to showers and facilities so I was coming up empty on this one. Since he was a veteran, I knew he could handle it if I was direct with him, but it would need to be tempered with respect. Off I went down the hall. I walked into his bathroom, turned on the shower, set up supplies and towels and brought in a clean fresh oversized gown and fresh robe. He glanced up in surprise. I smiled at him and pulled up the chair again. His eyes still had that hint of sadness, so I reached for his hand and said: "John, part of my duties as your nurse is to not only keep you safe and help you get better, but I owe you the honor of being truthful and to offer possible solutions when at all possible. The staff, as well as myself, have noticed that you have not been able to get a shower in during your stay. You are beginning to give off a very strong odor and I am concerned that along with your medical condition, that you may be setting yourself up unknowingly for infection. The odor comes from bacteria, which loves to grow in dark, moist areas." I took a breath. "There are places on your skin that you need to get clean." I wasn't prepared for his response. "Well, " he began slowly, "I want to take a shower. But I didn't want to embarrass the young ladies taking care of me.....I'm so big and I can't reach where I need to, and I didn't want to make those young girls uncomfortable." This man was a true gentleman. "John," I asked, " I would not be uncomfortable with assisting you. Will you allow me?" He nodded with relief. I smiled. "After you, Sir." Yep, there's a reason for every kind of behavior. And sometimes, it's just plain courtesy.
  7. Have Nurse

    Jake's Choice

    "He's had a few close calls this past week," I was told has I prepared to visit this man who lived out in the mountains. "He's a crotchety fella and not too keen to go to the E.D. so do what you can if anything goes wrong." "Great," I thought, "This should be interesting." We'll call him "Jake." Jake was a 76 year old man who suffered from COPD, Diabetes Mellitus and Peripheral Vascular Disease. He was also a fairly recent double bilateral amputee above the knees. His struggle with COPD left him on oxygen 24/7. However, he didn't always wear it, nor was he always compliant regarding his neb use. In short, he often sabotaged himself. Recently discharged from his surgery, he lived on a small farm up in the Maine mountains with his son, a developmentally disabled 22 year old, and his chickens and ponies. He wasn't one of my regulars. His Case Manager was out for the day and I was asked to see him on the weekend. I grabbed my supplies and headed out. Jake's place was about a 25 minute drive from town. When I arrived, I was amazed how long his driveway was. A dirt road off of another dirt road. "If it was dark out, I would have missed it." I told myself. I slowly backed my vehicle off to the side being mindful of the chickens who insisted on escorting me up the walk. I knocked and was greeted by Jake's son. "Dad's in here," he pointed to the living room. The T-V was blaring. Jake was seated at his kitchen table, in his wheelchair, baseball cap on his head. He looked tired and was having some difficulty breathing. "Hi, Jake," I introduced myself, opening my bag after tossing down a barrier and whipping out my hand sanitizer. "My name is Cynthia. I filling in today for your nurse. Let's check that oxygen level and get you more comfortable." I was concerned. His heart rate was high, skin was moist and his color was a bit gray. Even though he was a CO2 retainer, I cranked his O2 from 2.5 to 3.5 while I scrambled for a neb from his box. It can be dangerous to increase oxygen on a CO2 retainer as their body has compensated the lack of O2 for over a long period of time. Weaning them down too quickly can have deadly consequences. He denied chest pain. But Jake had standing orders to increase his oxygen for saturation parameters, but to wean him slowly as soon as we could back down to his normal rate of 2.5L per nasal cannula. Of course, we were to let the Physician know. I listened to Jake's lungs. Not knowing what his baseline was made it a bit tricky. I didn't like what I was hearing. His sats were still in the mid 80's. "Jake," I said, "If I can't get you stable quickly, I should send you in." He grabbed my arm. I winced. "No hospital!!!" He said emphatically, shaking his head forcefully. I glanced to his son, still sitting on the couch, watching T-V. He was oblivious to the distress, or maybe he was just use to it? I could see the idea of going to the Emergency Room was making him worse. "O.K., Jake," I relented. "You're the boss, but I am going to make sure you take your breathing treatments and I mean now. I cannot even begin to do your ordered dressing changes until I know you are breathing better. "I've got time, so what do you say?' He nodded, and took his nebulizer. I began to document, listened to his lungs again, documented some more. Much improved. He coughed up a lot of mucous. His sats increased to 92%. I began the process of slowly weaning him down over the next hour. I washed my hands again to set up the dressing for his bilateral stumps. The wounds themselves actually looked good but nutrition, blood and oxygen perfusion would play a big part in his healing process. I glanced at the kitchen, noting the dishes in the sink and the dirty stove. With Jake's permission, I did a quick visual of what was in his refrigerator. "Jake, what did you eat today for breakfast?" "I ate eggs and coffee." He stated. We had a discussion about food choices, the part that they play in building substrates for cells to mesh, etc. "I know that it takes a lot of energy for you to eat, and it's great that you are eating protein so it's fine to go slow, but please try to eat vegetables, fruits and whole grains and all of it if you can." "No one told me that!" I stayed silent because to keep good relations with clients and caregivers, there are times when one simply cannot rise to the bait. I am sure his caregivers went over this, as it was on his Care Plan. I reviewed the Care Plan with him instead. My visit with Jake was long. Between the education regarding his disease processes, the need to use his medications and oxygen appropriately, the monitoring for infection regarding his wounds, it took some time. But by nursing and God's grace, he was pulled back to his baseline. His dressings changed, his vitals stable, his color much improved, his discomfort abated, for now at least, I felt I could leave his house. As I said goodbye and thanked him for trusting me with his care, my gaze wandered to the window. The pastures so green, lilac fragrance in the air, the ponies scampering enjoying the summer breeze. For a while, all was well once again in Jake's world.....for now.
  8. Have Nurse

    What Did Joe See?

    Am sorry the poll is closed, actually, it's been open for weeks. Thank you for your thoughts on this! Best to you!
  9. Have Nurse

    When You are the Newby

    I've never been an A.D.O.N. before up until 2 and a half years ago, let alone work in a Convent. One of my duties for my job requirement is to be the Staff Developer for both the Nursing, and non-Nursing staff. Hmm. "What exactly does that entail?" I asked the H.R. Director. "It means that not only would you do the staff education, but New Employee Orientation as well." "Oh." I could just see myself cloned in my mind, madly dashing the halls, super-imposed with images of me standing up in a classroom lecturing, with a deluge of questions being hurled at me in various languages, and/or just plain silence. "Of course, you will also be supporting your Director." "Of course." My first month on the job was one of discovery and contrast. I decided that if I were to get to know the staff, I would need to take the time to meet with them and speak with them individually. We started with the Break Room. At lunch I would wander down, ask to sit with them and eat. They seemed a bit startled, but politely nodded consent. Once I introduced myself and began to ask them light-hearted questions and shared some things about myself with cordiality, the ice began to melt. Over time, I learned their stories and difficulties. If I was able to offer and outside resource, I would. Example: One of the Housekeeping staff was moving at a pace that was slower than usual, and she seemed a bit downcast. "Madia," (not her real name)I asked, "Are you feeling alright?" She just stared at the floor, moving her mop slowly. She began in broken English, "My landlord not fix air condition. I so tired from heat." It was 94 degrees outside, no breezes either. Madia's income supports her family in Ethiopia. She couldn't afford a portable air conditioner. I was appalled at her landlord's lack of response to her need. Did he think that just because she is from a country nearer to the equator, that she could just roll with it?! Madia had lived in Minnesota for years. Honestly there are some days that make a nurse just want to shake her head.... "Let me see if I can help, that is, if it's okay with you, Madia?" She looked at me hopefully. "Yes, please." Off to my office. After some online digging, I found a website and some phone numbers for her to call regarding Residents Rights in Minnesota, and some inexpensive fans she could purchase from Sears. We also had a mini-lesson on hydration and how it affects the body, particularly in her line of work so increased hydration is a must! She was very thankful and told her peers about our encounter. In her eyes, I honored her so she honored me. After that, at lunch time, they would often welcome me at their table. I marveled at some of the colorful food dishes that the Housekeeping staff would bring in. They were from South Africa so I was fascinated by the smells and colors of the various dishes. I reminded myself of the change I could see. At first, they were hesitant to come to classes. I hated complaining to their supervisors about mandatory attendance missed, but we had compliancy to worry about, in addition to being sure that everyone understands what they are doing for safety reasons. During the State required monthly training, for those not on a computer, we would meet in one large room and do our lessons. but we also took time at the end of the class to talk, or vent. I would make sure they had treats and water. But, even that was a lesson for yours truly, as I learned that this particular group did a lot of fasting and could only eat certain things. Guess who started reading labels? Still, we rolled with it and it was fun. Suddenly class attendance had grown and once they knew that I would take the time to re-word a phrase or a word such as: "Disclosure" or "Compliancy", they got it. I never let any of them fail. I might toss out a question to the group and if I got a blank look, or saw an expression that looked as though they wanted to answer, but just weren't sure if they had the correct one, they would hear me say: "This is learning. It's okay to try and it's okay if you say that you don't know." Their faces would brighten and an audible exhale would be heard. We moved on. I loved working with them because they showed a genuine desire to understand. It warmed my heart. Yes, sometimes it took longer to explain something due to the language barriers, but then acting a concept out, role playing, makes it fun and easier for all. You have to be flexible and you have to love people. At the end of the session, they know "What is said in this room, stays in this room." And, it has. Unless it is something that must be reported, such as someone wanting to hurt themselves or someone else, it stays in this room. They know that. Over the years both the Nursing staff and non-Nursing have learned that they can approach me in my office or in the hall, and know that I will stop and take the time to listen to them. They are much more open about speaking in class now. I made a deal with them: Normally the annual training is broken down into one presented subject a month. I would present two subjects. So, instead of having to finish in December, the same year, they would be done by August. It was great because with the holidays and special Feast Days and events in the fall and winter months, the Kitchen and Housekeeping staff could focus on their duties without the added stress of scrambling to attend mandatory training. Since then, the non-Nursing staff had done very well in staying current. The Nursing staff is another story. Sometimes it's a challenge when they get behind. I would have to alert the Director of Nursing and send out 1:1 communications via text messaging that they need to catch up. At first, some of the C.N.A.s couldn't understand why being "a bit behind" wasn't okay. "Because," I began, "If State audits our training records and sees that you have not completed the State requirements, not only can we be fined and penalized, but they can fine and penalize for every staff member who has not completed it within the time frame. That can add up to thousands of dollars. Do you really want that??" Indeed not, they would not betray the Sisters whom they love. When they get the picture, they assure me that they will "get on it this weekend." They usually do. I chase down the ones that don't. On the other hand, some staff are behind because they aren't comfortable n the computer. That's when we do some 1;1. As I stated earlier, I don't let anyone fail. No, I don't give the answers. I may re-word the question for them so they can process it better. We work together. We get it done. The point is, that when you take on a position that involves exposure to multiple disciplines as well as multiple cultures, you get creative and you learn to make yourself not only available but approachable. This is how trust is built. Help them get to know you, so that you may get to know them. You won't regret it.
  10. LOL! The "punchline" as you call it, lies in the last chapter. You have to read this journey to understand why.
  11. I'm not sure why you interpret it as a "complaint," as it is not. It's only the beginning of a story that had 8 more chapters. If you will note, the first Chapter is Part 1. Thanks for reading!
  12. Have Nurse

    What Did Joe See?

    They were: Matt Mark Luke John (Books) to Mary Mag. 28:1 16:9 24:10 20:18 Angel to the women 28:5 16:8 Sorry. I tried to line these references up but when they post they slip out of order for some reason. To the Emmaus Travelers 16:12 24:13
  13. Have Nurse

    What Did Joe See?

    I have slowly re-read many of the posts in response to "What Did Joe See?", and I marvel and wonder at the wonderful interactions and even some of the snarkey ones. Thank you for reading my story and offering your unique feedback. While we are all of us different in our walk toward eternity, I am glad to meet all of you and keep you in prayer. You are my brothers and sisters in Nursing. We draw strength from one another, and love too at times. We have a hard job and we need one another. We need to support one another. We offer guidance and expertise when it is asked for. We are grateful for it. Mothers' Day is always a tough one for me so this nursing family means a lot especially today. Hugs and warm fuzzies to all this special Sunday.
  14. Have Nurse

    What Did Joe See?

    Thank you. I needed that.
  15. Have Nurse

    What Did Joe See?

    It's been quite a ride hasn't it, Everyone? And from an earlier post from OldDude, we are all family here and unified by our nursing profession. I hope we can all continue to lift up one another.
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