Aellyssa

hi, one of the hardest skills that a clinical instructor has to learn is patience. this means waiting whilst students practise slowly and keeping your hands behind your back. yes, they are slow and as the student above has stated, going through all the steps in their minds. they are nervous and no matter what we say or do, they are nervous having us watch them, even if they know we have to be there. believe me, they will get faster as they learn the meds and the nursing care required for them. i did my masters' thesis on nursing students' perceptions of clinical teaching and learning. what came out was the very concrete thinking and narrow focus of the students when they first do a skill. it is like a thumbnail photo for them, they don't see anything else around them. then as they become proficient at a skill, slowly they see a normal photo and finally the whole scene. pushing them to see the whole scene too fast causes them to become very anxious. one of the biggest criticisms about new graduates is their lack of time management skills, but i believe that is because of unfair comparisons with nurses of many years experience. it takes time to settle into a new place, find out all the overt and covert rules & politics of the area and give good nursing care. all i can say is be patient, encourage them to note all their meds in their address book and let them take their time. remember also that your body language has to also show patience. if the students detect your frustration, it will increase their anxiety and it will take longer. it's only been three days...... keep 'em coming & please pm me if you feel the need to. blessed be, aellyssa

hi rhonda, this article just came in to me today http://www.medscape.com/viewarticle/502535?src=mp it certainly advocates cognitive behavioural therapy as a good way to help you overcome this. blessed be, aellyssa

hi rhonda , depression is a world wide disease, it is estimated by 2020 it will be the 3rd biggest disease in the world! let no-one tell you that it is something you can just get over. i have just emerged out of an 8 year tunnel of depression and for me it is like walking into the light again. i am on 300mg of efexor and i won't be reducing it until i have had a year of feeling "normal" again. for those who have never been "clinically depressed" let me tell you what i was like at the worst. - i had no motivation to do anything. it's like i was paralysed, i literally couldn't get the e to do anything positive. - i didn't wash myself or care for myself - i wore the same clothes for weeks sometimes. - i nevr cleaned my house even when there was dog faeces around - i mainly lived on coke (drink) and cigarettes. - i played computer games all the time. - i threw all my bills in the corner and didn't look at them. - i just stayed in my home the results of this were almost losing my job and having my car repossessed for unpaid bills. make no mistake i knew what was happening but i just didn't care at all about it. didn't really care about me really. i merely existed. did i have 'suicidal ideation" no - that would take too much effort. what caused this? well i wasn't having a "annus horribilis" like rhonda has had, but i was working in a very toxic environment and was imho the victim of extensive & continuous workplace bullying. and like rhonda, i ruptured a disk in my back (rolling over in bed - alone) which certainly exacerbated it. plus i was and am peri-menopausal. there is also a history of depression in my family - my grandfather & great grandfather both committed suicide. the one thing i cared about and in fact were my saviours were my 2 dogs - keeshah & ubu - bedlington terriers. they loved me no matter what i was like. i always had food for them. and they, my psychiatrist and my anti-depressants pulled me through this. plus i had support of my union who helped me confront the toxic environment where i worked and others who were also the victims of workplace bullying took our thought to the powers that be. it took some time for things to change, but change they did. i am now as i was 8 years ago, engaging in my profession again, really enjoying teaching & researching again & have even joined an on-line dating service! rhonda, honey, it takes time & it takes patience & endurance. your depression has been truly exacerbated by all of the truly dreadful things that have happened to you and it seems continue to happen to you. i can't hug you from here in australia but i can tell you that i have been there, and like so many others have offered so can you pm me. may the goddess bless you in all of her aspects, blessed be, aellyssa

sorry vevina, didn't mean to be obtuse :imbar could also be cultural and idiomatic problems. (damn where is that kangaroo smiley?) i mean the word cost not in monetary terms but in personal cost. let me see if i can clarify it. when a patient sees a white uniform, they usually think that they can trust the person wearing it. that's good, they relax and help with their own healing. but when we as nurses put on a white uniform, it comes with all of the adverse effects of wearing a uniform. so the questions are: do we have to put up with all of the adverse effects of wearing a uniform because it (the white uniform) causes the patient to trust us? is the patients' trust = or > than our distaste for uniforms. do the patients' needs always come before our own? aellyssa

actually when i use the term uniforms, i don't mean white - i mean any type though white uniforms are the most stereotypical. as for scrubs, my gut reply is yes and worse anonymity. there are many uniforms these days that don't look like a stereotypical uniform, and i think that is a good thing. and just to play devil's advocate (i'm good at that) :chuckle , uniforms do engender trust and confidence in patients but i would ask at what cost to the nurses? aellyssa

hi, the suggestions here are great and very much with what i have done over the last 20 odd years. i would add: 1. praise in public, scold in private. 2. have an interruption phrase. i have always told my students that if i was supervising them doing a skill and i said to them i'll take over now, they were to step back and let me. this meant that they were compromising patient care in some way. when i had finished, i would take them aside somewhere private and discuss it with them. 3. document everything 4. have the students keep a small address book with them, when they find a med about which they have limited or no knowledge, they can put that in the book, look it up & add it in the book. that way they can keep an up to date knowledge base. 5. get the students to do a daily planner - so it helps with their time management - use it with them. 6. if you have a "weak student", try and get them allocated the same patient(s) on consecutive shifts, it allows you to assess them more easily and it helps (hopefully) boosts their confidence & competence 7. tell the students that you will always go into to bat for them. but that also means being scrupulously honest in any situation that arises. 8. have fun with your students as well as being their teacher. learning can be difficult but it should always be fun as well. 9. always remember the students' vulnerability. they will watch every nuance of your behaviour, and will read into it their own interpretation - often to their own detriment. 10. always tell the students if you don't know the answer but that you will investigate it to find out. you aren't the font of all knowledge and making up an answer to save face doesn't facilitate good learning. be a good role model. 11. always tell your students that there is no such thing as a stupid question. 12. finally, put people up not down. being a clinical teacher is the most frustrating and rewarding position in nursing education. i love it. aellyssa

this really comes out of the care for/ care about thread. i lecture in nursing, and one of the tenets i teach is, of course, professionalism and how we should all be able to nurse all people. but then i add a caveat - if there are some people whom you really detest and whom you have difficulty nursing, then you need to be aware of this and do something about it ie examine why you feel this way & try to change it or get someone else to care for them. i can think of some people who i would have extreme difficulty caring for because of their beliefs, political leanings &/or criminal activity. now i haven't met these people and my first act would be to get to know them first and try to nurse the person not the belief, ideology or criminal act. but there are some people whom i genuinely dislike despite all of this. as a feminist i have had difficulty caring for people who have raped, and abused women, as a family maiden aunt, i have had difficulty with child abusers and paedophiles. we are all human, with all that being human entails. we cannot like all people. this means that there will be people whom we have difficulty nursing. i also know the rhetoric about professionalism. professionalism promotes an ability to look after all people, regardless of their race, creed, religion, ideology or sexual preference. but, believe me patients are always aware of when the nurse likes or dislikes them - it shows in a myriad of ways that professionalism doesn't hide. please don't tell me that this doesn't happen in nursing. i have seen it - how "drug overdoses" are treated in er, the "drug addict", the "alcoholic", the woman having an elective abortion, the ethnic minorities, the gays etc. i am trying to be brutally honest here and confront some of the hidden demons in nursing. in australia it is often our indigenous people who are discriminated against, especially if they are from rural & remote settlements. it happens. i have difficulty nursing some aboriginal people, not because of their race, but because i don't know enough about their cultural mores and i have a collective guilt about how we have treated them especially with the stolen generation. so who have you had difficulty nursing because you disliked them and what did you do about it? aellyssa

ah uniforms. what do they do? they pros - identify you as a member of a group and thus foster a sense of belonging - free you from the the fashion police so you don't have to decide what to wear to go to work. - can take all the dirty work so that your real clothes don't have to. - instil a sense of discipline into you so that it tranfers into your work - allow you to develop a persona that is different from your own cons - try to mould you into a stereotype - often suppress thinking outside the square - used as a way to discipline nurses about what they look like rather than what they do - don't determine the quality of care that you give - identify you so you be abused & ridiculed & have other people's baggage about the profession thrown at you - can be used a shield against the world - allow you to develop a persona that is different from your own but do they enhance professionalism? professional people enhance professionalism imho - it is who & what they do that is important, not what they wear or what they look like. can you be a nurse without a uniform - definitely. can you not act like a nurse when in uniform - definitely. uniforms enhance conformity. despite all of the above, i do like military uniforms etc 'cos they are designed to look good. :chuckle i don't like what the military does and that's my personal bias. i also must confess that the first time i put on my nurse's uniform - i preened but mainly because i knew that i belonged. but generally i think that they are used as a tool of oppression. :angryfire aellyssa

Hi Mama Val, The Clinical Guidelines could tell you the most of how we treat it. The DASC Website is a fount of knowledge plus there seems to be a number of really good ATOD websites in Australia. I can't answer your query about the frequent fliers if I understand your term - ie those who come in frequently. That is a difficult one and I guess you would wonder why they were there. Diazepam perhaps. How do you handle it? Aellyssa

hi, let me make it quite clear where i am coming from. atod (alcohol, tobacco & other drugs) is a clinical interest of mine and an area in which i teach. one of the first things that i say to my students is that they are never to use the term alcoholic or drug addict(druggie) :angryfire . these terms are negative stereotypes and merely serve to stigmatise patients. for that matter i don't allow the students to use an "ic" word (ie asthmatic, diabetic) except as an adjective ie descriptive term. naming a person as an "ic" puts the disease first and not the person ie it is a person with a drug/etoh dependency problem, a patient with asthma etc. secondly etoh dependence is viewed by most people working in the area as a syndrome not as a disease, and therefore approaches to treatment may be different than in usa as we tend to move away from the bio-medical model. we also have a harm minimisation approach in our care for people who use atod. this means that we recognise that people will continue in their use and we seek to minimise the harm that they can do to themselves in their usage. of course, abstinence may be the final goal but unless the person wants to change they won't. furthermore many researchers in the field do not espouse the theory "of once a user, always a user' so the generally held view of a "recovering alcoholic" even after years of abstinence places them in a difficult situation as it takes away the person's autonomy. that is not to say it isn't true for some people, just not for all.we could debate this for hours with no true resolution. so what is alcohol withdrawal? etoh is a depressant of the cns. this means that it depresses neuronal activity. furthermore there is the issue of tolerance ie you need to drink more to get the same effect - thus the person drinks an increasing amount of etoh. thus the cns is depressed even more. in order to function, the cns sends more and more nervous impulses to counteract the etoh. thus there is neuronal hyperactivity. suddenly the person stops drinking. but the cns is still sending out heaps of impulses with nothing to stop it. it's like bursting a dam. it is this hyperexcitability that causes the clinical features of etoh withdrawal ie tremors, hallucinations and seizures. and yes, it can cause death. delerium tremens is the final and most life threatening stage of etoh withdrawal. it is nearly always complicated by co-morbidities such as cardiac conditions. it is not what most people call the dts. so how do you treat it? in adelaide, south australia - the drug and alcohol services council has issued guidelines to all hospitals, doctors and nurses. they can be accessed at http://www.dasc.sa.gov.au/resources/documents/atod_nursing_quick_clinical_reference.pdf basically it goes like this; 1. all patients have a drug & etoh assessment when they are admitted to hospital. 2. etoh intake is measured by standard drinks (10gm etoh). every pub has the standards for these up in their establishment. 3. if the person has a history of >80mg of etoh a day, then they are at risk of etoh withdrawal. 4. they are then observed using an etoh withdrawal chart with 1 hourly obs 5. if that score is >13 they are started on a regime of diazepam (to calm down the cns) 6. this continues until they reach a score below 13. hope this helps. cheers, aellyssa

hi, this is my first posting here so be gentle please :chuckle when i first started nursing (1970) i was told by my brother that i was committing intellectual suicide. now, of course, he realizes what a pompous ^%$#& he was and has since apologised profusely. remember also that at that time nursing education in oz was still in the apprenticeship model (ie in the hospitals). with its transfer into the tertiary sector - nursing began to gain a better academic reputation. but now the debate continues to rage (albeit less intensely) about how academic educated nurses aren't prepared as well "practically" as their former compatriots. and that is often taken over into the press - it always sells good copy. so in some way that is still causing nursing to be questioned more. i think that generally "society" (however you perceive it to be) views nursing positively, we are always in the top 3 as the most trusted and respected professions. however, that cannot be said imho from other strata in our society. i think that we get a "bad rap" in two ways from my experience. firstly, i believe that other academic disciplines still perceive us as not being acdemically rigorous enough and the "poor relation'. let me give you an example from the institution where i work. in oz, all universities have to meet a specific envelope of enrolments (a quota), if they do not meet that quota their funding gets cut. so if you under enrol in one discipline, you over enrol in another. the more students in one discipline means that the ter (tertiary admitting rating or score) is lowered. which some people equate with "dumber students" ie medicine has a higher ter. this happened in my university this year, and where did they top up their numbers - nursing. so instead of 210 students we enrolled 420. never mind that we didn't have staff or classes timetabled or that we didn't have a lecture theatre that takes that number of students. nor, might i add, did they consult with us about this. imho this shows a complete lack of professional courtesy and respect. secondly i don't think we get a lot of respect from our employers which in oz are mainly the federal & state governments . we are all aware of the burnout rate in nursing, yet we consistently have fewer employed nurses with a workload that is literally back breaking. it's all done in the name of economic rationalism but it seems the $ is mightier than the desire for good quality nursing care. finally just like some gays suffer from "internalised homophobia", i think that many nurses suffer from "internalised nurse phobia". how many times have you said or heard said "i'm just a nurse". there is no "just" about it, you worked long and hard to get where you are & should be proud of it. then of course there is the idea that "if you are that intelligent, why aren't you a doctor" i rest my case. sorry about the rave, as you can see, i feel pretty strongly about this cheers, aellyssa