chirstine

It is organisational policy where I work that artificial nails are verboten, for good reason. It gives me that shuddery, icky feeling to think about people working with them on. Brrrrrrrrrr!

hi everyone long time reader, little time poster, yada yada! i work in older people's health, we are basically a medical ward in a general public hospital that caters for 65+, and theoretically we are supposed to be an a, t&r ward - but we all know how much the official title matters, right? people are people, people get sick, and people need us to care for them. anyway, we've had a 'character' in the ward over the last couple of years - recidivist smoker, lives in tenous social circumstances, multiple medical problems, including severe pvd with consequences including a R) BKA. her mobility was shocking, and she was not able to stand for more than 10 seconds with the help of 2 assistants. it was acknowledged during the several times she was a patient on the ward that she was not an easy person to nurse, due to her social circumstances and her adamant and vocal nature. (euphemisms, i loves ye!) anyway, tonight, she was my patient. when i had left her last night, she had had an episode of malaena, and told everyone concerned, including medical staff, that she was DNR, and didn't want anything done. when i got to work today, i frankly did not expect her to be there. when i arrived at work, she had two iv lines going, and had received 40mg iv omeprazole, 2 units of FFP, 2 units of RBC and was due another unit of RBC. also she was having continuous fluids throughout this time. anyway - after the third unit of blood, she seemed to be holding her own. no further malaena, her colour looked far better than it had the night before, but i knew we were in the 'see saw'. in fact, the consultant asked me what i thought, and i heard the words ' circling the drain' come out of my mouth. i went to my dinner break, and when i got back to the ward i went in to visit her. she told me she felt sick, and then proceeded to spectacularly vomit bright red blood everywhere. i called in the other senior RN (her and i were the 'grown ups' on that night), and over the next half an hour, we stayed with her and soothed her as she continued to vomit large amounts of fresh blood, and continued to pass PR malaena. the on call house surgeon came, and our fantastic consultant arrived too. i stayed at my patient's head, and attended the ongoing (and frankly, terrifying) gouts of fresh blood issuing from her mouth, and the other RN and the consultant helped turn her, and make her comfortable. the end was inevitable, and as her respiratory distress increased, we gave her some morphine, which went a long way to soothing her. she knew she was dying, and yet was incredibly calm and resigned about it. she passed away, calmly, half an hour after she initially started vomiting. i felt privileged to have been there, and a part of this complex event. her family situation was complicated, to say the least, and even though we had spelled out her condition over the day, none of them wanted to be there. having known her for a while, and having cared for her over these last few years, the other RN and I felt some sort of, i don't know, completion? in caring for her whilst dying in such an unpleasant and graphic way. she knew who we were, and knew why we were all there, and knew what we were doing for her. this work is hard. but we are that certain type of person who does it for a reason. i am glad i was able to do this today. i felt proud to be with her, stroking her hair and soothing her as she transitioned from one state to the next, and i commend each and every one of us who does this difficult job. thanks for reading. chirst

I agree with a lot of what has been posted in this thread. I work in a geriatric assessment, treatment and rehab unit in a public hospital, where a lot of our job is assessing people for LTC, or receiving patients from LTC facilities for assessment of a higher level of care. Other wards in the hospital send us their patients, sometimes just on the criteria that they are 65+ years. We cover all medical specialities, including mental health. We deal with IV, PICC, ostomies, delirium,hoist transfers....you name it, it's there. And the opinion (I have found in general, anyway) is that what we do in our area isn't as good as the "real nursing" of acute areas. In fact, when nursing friends of mine found out I was doing my new grad experience in Older People's Health, they were outraged about how I "wouldn't get the clinical experience I need". Well, tonight I've nursed a man with necrotising faciitis, done a blood tranfusion for a new patient, done observations on all of my patients, communicated with family members, put five people to bed, supervised two new nurses in our area, helped with a man who needs restrained - all in a routine night. I have certainly felt the need to defend the area I work in to other nurses, particularly peers who are talking about the more "glamorous" areas like cardiac, ENT, ER etc. I have come to the realisation that I am lucky to be able to get to know my patients and make a difference in their lives, sometimes being the only person who can listen to them and advocate on their behalf. Care of the elderly is a demanding area and we need to be boosting ourselves up about choosing to work here. It's not a soft option, or an "out to pasture" area. Thanks for your posts - it's good to have some opinions and views to read that support my own thinking.

Hey - I'm chirstine (yes, I realise it looks like a typo, there's not - only a story.....) I"ve been nursing for just over two years - mainly based in geriatric Assessment, Treatment and Rehab. I work mostly 2.30pm - 11pm shifts, and was just curious as to what other nurses to do unwind particularly at this time of the night when most other people are a bed, seeking the land of nod. Personally, I come home , hopefully by 11.30pm, put my iPod on and feed the cats outside - sneaking a society frowned upon nicotine fix at the time. Then I come back inside, pour a glass of at least decent sauvignon blanc (because, I rationalise to myself I deserve it!) and say hello to the internet - a great pal no matter what the time! It allows my brain enough breathing space to cope with the shift during background neural processing while doing something that takes the rest of my mind off it. A couple more glasses of wine and I'm ready for my PJs, my lovely new bed and, I fear to admit, a Reader's Digest! (it's my secret delight!) Over this period of time (usually an hour and a half) I have thought about my shift and decompressed enough to be able to get into bed without fear that I will lie awake until 3am. I am pleased to have discovered allnurses and others points of view on various matters - thanks for listening and think you may well see me around a little more - and let us know what you do to unwind from work ( a little more kudos to the shiftworker, eh!) chirst

Well done you - that is holistic care! Boo sucks to nurses that say "that's not a nurse's job" - I work in geriatric Assessment , Treatment and Rehab, which in some ways is like a LTC facility - and we do all the showering, cleaning up, medications, lifting and everything else you can imagine. You are showing respect, care and thoughfulness for your residents and your staff, including your secretary, because you are a big enough person to recognise that they are part of your whole health-care delivery team. I hope you don't let the other nurses tarnish the good feeling you should have after the kind of work you do and the consideration you are showing others.