The Less-Than-Glamorous Duties

NoCrumping · Feb 27, 2005

I was at my public library and found a Fundamentals of Nursing textbook. I sat down and flipped through it and I was thinking, "I could really do this . . . I can really see myself doing this with pride." But I'm still a little concerned about adjusting to the less-than-glamorous duties. I get a bit uncomfortable when I read about, for example, digital manipulation of an impacted stool. Or looking at some of the skin ulcers made my stomach churn a little bit.
How did you all adjust to these type of tasks? I'm sure some of you weren't at all affected by it, but what about those of you who were a bit more squeamish? How was the adjustment process?
~Miya~[/quote
HI Miya.... I never got used to it, and never will do it. Thats why I do neonatal icu.

begalli · Feb 27, 2005

How did you all adjust to these type of tasks?

Hi Miya,

I think the important thing to remember is that these things are not "tasks." These things are contributory to the well-being and healing of an individual, at times even life-saving. You will come to understand what it means to deal with ugly and nauseating side of nursing. Not that I haven't been/am nauseated by things I've seen, but I think it's when you understand that what you're doing is directly related to the outcome of a patient, then you begin to be able to tolerate or stomach the grossness. Some things some people just never get used to but they still realize the importance of what they're doing.

Also, I wouldn't say that nurses have "duties." That implies that there is some definite definition of the professional, well thought out plans and decisions nurses think out and make when executing patient care. Nursing is very dynamic. Even passing medication is something that has to be thought about on a patient by patient case. Assessing, for example, a skin wound takes a scrutinizing eye aware of the subtlies of healing or the signs of deeper or continuing problems. The term duties just doesn't seem to do this justice.

It actually kind of bothers me when the words, duties" and "tasks" are used to describe what nurses do, because nursing is so much more than these simple words can describe.

begalli · Feb 27, 2005

p.s. I wanted to say that I've been in nursing for about 7 years total and have not once had to dis-impact a patient. I have however seen pressure ulcers that make the best of 'em sick to their stomach.

sharann, BSN, RN · Feb 27, 2005

Miya,

All of us get sick from some aspect of nursing but we deal with it in our own way eventually. remeber, the patients dignity is what we strive to keep intact. I too have never disimpacted anyone but I have cleaned patients full of liquid stool from head to toe. The feeling of pride I feel when they are clean and have their dignity back is beyond words. I know that cleaning poop is not glamourous, but it IS healing. (I do have to turn my head to dry heave at times...happens to the best of us)

NurseFirst · Feb 27, 2005

Miya,
All of us get sick from some aspect of nursing but we deal with it in our own way eventually. remeber, the patients dignity is what we strive to keep intact. I too have never disimpacted anyone but I have cleaned patients full of liquid stool from head to toe. The feeling of pride I feel when they are clean and have their dignity back is beyond words. I know that cleaning poop is not glamourous, but it IS healing. (I do have to turn my head to dry heave at times...happens to the best of us)

I am still a student, however:

I almost did a fecal disimpaction. I was scheduled to do one, but everyone said they gave him a suppository first; I gave him one and disimpaction was decidedly not necessary. Another patient who I was taking care of had one scheduled, but I was working with a classmate who had missed doing it previously and had gotten disciplined, so did wanted to be sure and do it as a response to having missed it before.

FWIW -- fecal disimpaction used to be something only physicians did.

Begalli has hit it right on the head about not seeing these as tasks, but rather as something that needs to be done to assist our patients in and to health, that provides them with relief, comfort, and, as another poster said, dignity.

I'm not crazy about doing bedbaths, but one patient had deferred on having her bedbath. When she finally decided that she was ready, she was sitting on the edge of her bed. I said, "You've never had a bed bath, have you?" (She hadn't). I continued: "You are in for a treat!" I had her lay down and enjoyed giving her her bed bath, after which she felt tremendously better. I have had the opportunity to give morphine to patients with heart attacks when I was a paramedic (many moons ago); the change in how this patient felt after the bedbath was nearly as dramatic.

I've had a young patient who ended up having to have a exploratory lap because of bowel obstruction...how happy I would have been had she had any kind of bowel movement. A 15 mo. old I took care of was in for having a colostomy "takedown" (removed; the bowel was reconnected) which had been necessary because he had been born with an imperforate orifice and large intestine atresia (didn't go all the way through; was not connected to the orifice). What a dramatic success of medicine to reconnect this child's bowel, and each soiled diaper was a symbol of the triumph of medicine over nature's mistake!

It's actually been a surprise to me how I have actually been happy to perform some of these less desirable activities because of the difference it made in my patient's life, or how it has indicated that the patient was on their way to improved health and comfort.

NurseFirst

LadyFree28, BSN, LPN, RN · Feb 27, 2005

...You may have to digitally impact someone, give someone a milk-and molasses enema and clean them from head to toe...

...You may have to clean up a chemo patients vomit, clean them from head to toe...

...You may have to clean someone's tracheotomy, full of blood and spit...

...You may have to clean up someone's clots-and thta may be it.

Nurses have roles, not duties,

The only "duty" that I can see is for me to perform my job for the patient's beneift

...and if i need to gag afterwards, gag in privacy...

...and go out and perform my role to the optimal abitlity.

begalli · Feb 27, 2005

The only "duty" that I can see is for me to perform my job for the patient's beneift

Exactly, we have a legal duty to our patients.

miya · Feb 27, 2005

Sorry I used the words duty and task. Semantics. Trying to ask a specific and concise question. Thanks for the responses.

begalli · Feb 27, 2005

Sorry I used the words duty and task.

It's okay, just don't do it again!

KIDDING!!!!!!!!!!!!! I'm just kidding, please don't take this seriously!!!! I just wanted to respond and there's no reason to be sorry. :)

LilRedRN1973 · Feb 27, 2005

You may have to clean up a chemo patients vomit, clean them from head to toe...

And you may have to clean YOURSELF from head to toe. A travel nurse I was working with had a patient projective vomit and it landed all over her head, hair, face, and shoulders. She handled herself very professionally....finished quickly what she was doing with the patient, had another nurse in the pod keep an eye on him, ordered a pair of scrubs from OR, and went to shower up. I was very impressed because still being a student, I'm not sure I could have dealt with it that well.

There are many things you do in nursing that other people would never dream of doing. But I see it like this: you are doing those things because the patient is unable to do it for themselves. I put myself in that frame of mind when doing things I might have considered unpleasant when I first starting working in the ICU. I now know how much of a difference it makes. Yes, giving someone a milk and molasses enema and having the clean up the results is not one of my most favorite part of the job. BUT, the patient letting me know her abdomen feels 100% better is rewarding. It took 2 nurses and about 30 min to clean up the mess, but the patient was forever grateful and appreciative.

I also think you get used to it. I remember when I started in the ICU and had to clean up stool from a C.Diff patient. Oh boy....I thought right there and then I would NEVER be able to do this job. But you know? Doesn't bother me now (I've been there just over a year). I've seen skin ulcers that were big enough to fit a Coke can into on someone's coccyx. I've seen toes, feet, and legs that were rotting off. And much worse. You do get used to it and the smells that come along with it.

Maybe volunteer somewhere so you can get an idea of what nursing is REALLY about. Reading books just doesn't give you the sense of what this job is about. Heck, I'm not even a nurse yet.....I still have plenty to learn!!!

Melanie

MamaTheNurse, BSN, RN · Feb 27, 2005

what made anything like that tolerable to me was the gratitude from the patient and family and my own personal pride at having done something that made a difference in someone's life - the fact that I was getting paid for it was icing on the cake!!!!

however, that doesn't mean that I wasn't totally grossed out sometimes and actually had to leave a room quickly to keep from vomiting (when I was pregnant) - you just can't let the patient know - they are already feeling undignified enough, don't rub it in (put yourself in their shoes)