To not take for granted my role as a preceptor. But sometimes it can be just as tiring as if I was running my tail off for the entire shift. The mentee that I have had for the past 3 months has spoiled me because she is very sharp and catches on quickly. The one I had yesterday who has been in the program for the same length of time, is not up to par.
I need to recognize that not everyone learns in the same manner, so I must adjust my preceptorship techniques. The benefit of this young lady is her eagerness to learn and her receptiveness of constructive criticism.
I have also learned that I am one of those who have the string of DNA which predisposes me to a higher perception of sulfur compounds. In other words, I can smell the odor of asparagus in urine quicker than most.
In addition to these findings I learn how precious sleep is and how much I missed it. This is the first week in three months I have not had clinical. On Tuesday I slept until 3 p.m. But school work was not over, and I still have had a few late nights. Next week I'm going to spend quality time with my family.
Opening a new box of books for the next quarter is exciting as if it were Christmas. My midwifery and women's health texts have arrived and I'm excited to face the next chapter in my education
I invite everyone to share what they have learned this week and please remember to keep it nursing related.
Thank you! Still a few weeks away. Should have been done a long time ago, but at first my husband was resisting the notion that our son wasn't absolutely "normal". Then after I had the referral, I was dragging my feet for quite a while following up on the paperwork.
A dx won't change much really; he's been receiving speech & special needs services since he was 2 (he'll be 5 soon).
Thank you! Still a few weeks away. Should have been done a long time ago, but at first my husband was resisting the notion that our son wasn't absolutely "normal". Then after I had the referral, I was dragging my feet for quite a while following up on the paperwork.
A dx won't change much really; he's been receiving speech & special needs services since he was 2 (he'll be 5 soon).
That seems to be the way it goes. Same thing happened in my brother's kid.
I can see how it would make you feel better and worse. *hugs*
I learned that I am thought of by many of my nursing classmates and a teacher as not having much confidence, but thought of as very smart and good with time management. I try to pretend to have confidence but most of the time I forget. A teacher told me "You don't have to pretend. You are capable of doing anything you want" and I felt like that was a huge compliment but the feeling of confidence is so foreign to me and it feels weird when I do feel a little confident.
So since ixchel is AWOL this week, I'll start the weekly "I learnt" thread:
This week I learnt how much I've missed out on TV. My DVR is stuffed.
This week I have been short with everyone, including my mother. All my assignments and projects are due in the next week and I am frazzled. No excuse though.
This week I came to a realization that while a post-op follow up phone call is a good thing to make sure people are not having uncontrollable pain and uncontrollable nausea post-op, I feel a part of me die when I have to say at the end "We hope you can rate us an excellent".
Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
So since ixchel is AWOL this week, I'll start the weekly "I learnt" thread:
This week I learnt how much I've missed out on TV. My DVR is stuffed.
This week I have been short with everyone, including my mother. All my assignments and projects are due in the next week and I am frazzled. No excuse though.
This week I came to a realization that while a post-op follow up phone call is a good thing to make sure people are not having uncontrollable pain and uncontrollable nausea post-op, I feel a part of me die when I have to say at the end "We hope you can rate us an excellent".
Merged this with the current WILTW thread that was started yesterday in the General Nursing Student forum.
This thread is usually in the General Nursing forum.....so some folks might miss it here.
So, I actually want to continue the euthanasia discussion that was started in the previous WILTW thread, but I realize I will get more responses here, so...
I have absolutely participated in euthanasia, beyond the shadow of a doubt. Not at this job (I recently had someone die in a minute in a half at this job after being extubated, my current job is so high acuity the patients don't need any assistance and usually die within an hour), but at a previous job. I have had the endotracheal tube removed and received an order for 10mg IV Morphine, or 5mg IV Dilaudid, or something like that on a narcotics-naive patient, and I have absolutely given it. The patients were very near brain dead, and were obviously unable to consent. Family did not explicitly tell me to put the patient out of his or her misery, but I have given narcotics doses that I absolutely knew would kill the patient for good.
I have no idea where this falls in the ethics continuum. It obviously goes beyond the role of pain relief. It obviously stops spontaneous respirations and leads to death. But, at the same time, these patients were usually post-codes that were down for 20 minutes or so before being "resuscitated." They usually had fixed and blown pupils and their only responses to stimuli were to exhibit posturing, if they did anything at all. I would say with almost 99% certainty that they would die within an hour of being extubated. So, does pushing those large doses of IV narcs on an essentially dead patient qualify as killing a patient or not?
ICU is a very gray area sometimes. I would be interested to hear what you guys think. :)
As far as staying on topic... I learned a brand-new gastric bypass patient can indeed be stupid enough to eat multiple cheeseburgers, vomit, and rupture her fragile post-surgical stomach plus aspirate her stomach contents on top of that. Lady, really - those discharge instructions were given to you for a reason! Welcome to ICU, where you will live on the ventilator for a while yet due to your massive raging pneumonia from cheeseburger aspiration. I hope those cheeseburgers were worth it.
Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.
Thank you, TNButterfly. I meant to put Ixchel's name in the title but I utilized my speech to text option on my phone and ... I either said it wrong, don't know how to say it, or something it would not recognize it.
Spelling it out loud didn't help. (Came out I is See ache eel.)
No problem. We are actually trying to make the title of each week unique and containing a sneak peek of what is in the OP since we are featuring each weekly thread in the newsletter. A unique title will attract more readers.
So, I actually want to continue the euthanasia discussion that was started in the previous WILTW thread, but I realize I will get more responses here, so...
I have absolutely participated in euthanasia, beyond the shadow of a doubt. Not at this job (I recently had someone die in a minute in a half at this job after being extubated, my current job is so high acuity the patients don't need any assistance and usually die within an hour), but at a previous job. I have had the endotracheal tube removed and received an order for 10mg IV Morphine, or 5mg IV Dilaudid, or something like that on a narcotics-naive patient, and I have absolutely given it. The patients were very near brain dead, and were obviously unable to consent. Family did not explicitly tell me to put the patient out of his or her misery, but I have given narcotics doses that I absolutely knew would kill the patient for good.
.
Those are small doses really - even in a "narcotics naïve" patient. I've given it regularly in the ER for patients in pain and not dying. And if this patient had been sick for a long time, how do you know for sure she didn't have a history of having pain medication?
In all the pain classes I've attended, the focus is that giving Morphine or Dilaudid at end-of-life does not cause death.
That's the unfortunate image we as hospice nurses have to fight against. People think we go into homes and "kill with morphine".
I've given quite large amounts of both drugs and one woman right now is on a pretty large amount of Dilaudid and Methadone.
Patients, as well as doctors, worry about overdoses and the potential opioid side effect of decreased breathing. I answer concerns about overdosing and depressed breathing by explaining that when a medication gradually is increased with an eye on the patient's breathing rate, the body adjusts. Despite what many people believe, there is no ceiling or single maximum amount or dose of opioids that is automatically fatal..........In my book, The War on Pain, I tell the story of Dr. Ira Byock, a hospice physician in Missoula, Montana and author of Dying Well. Dr. Byock had a dying patient able to absorb monumental doses of opioids. The woman had kidney cancer and treating her pain forced him to exhaust the entire supply of injectable Dilaudid (hydromorphone) in all of Missoula's pharmacies and both hospitals in the city.
At her worst, the patient needed nine grams of morphine per hour (one-tenth of a gram will knock out mostly healthy adults). Therefore, an effective dose depends on the individual and the pain. Sometimes the pain accelerates not only because of increasing tolerance but also because the disease has worsened.. . (Dr. Scott Fishman)
Right now I'm so hot and fanning myself I need a fan but my hot blooded lover is freezing. NO fans. /majorpout.
I have a fan on my bedside table. For my hot flashes and also because I have tinnitus and simply must have some white noise going on in the room to fall asleep.
There is no way I'd be able to sleep without it and so far, my dh doesn't mind. At least he doesn't say so but I do notice if I'm called out for a hospice patient and he goes to bed before I get home, there is no fan going.
RainMom
1,117 Posts
Thank you! Still a few weeks away. Should have been done a long time ago, but at first my husband was resisting the notion that our son wasn't absolutely "normal". Then after I had the referral, I was dragging my feet for quite a while following up on the paperwork.
A dx won't change much really; he's been receiving speech & special needs services since he was 2 (he'll be 5 soon).