Decisions, Decisions, Decisions

It is a known fact among family and friends that I am an indecisive person. I easily become overwhelmed by all of the possibilities that I am considering in my head. Even when I do decide I am often still in conflict of whether or not the decisive result of my pros and cons list is the best option. I am not a push over however when given options I can weigh them out and evaluate what I think is best or what I really want to do, though sometimes just to appease the situation I will go along with things. Maybe I am not indecisive I just take time to assess situations and build up the courage to implement my actions. I think in this one paragraph alone, I have proved my inability to settle on a single conclusion. I believe that sometimes there is more than just one option or there are multiple decisions to be made that lead up to what ultimately will be done in one’s life. In other words although we would like to pin point the major decisions as being monumental in our lives there are actually a thousand everyday little decisions that lead up to that pivotal moment. The pivotal decision I would like to discuss is my selection of BYU as my college choice.

As stated earlier there were many decisions that led up to this point in my life. It was the decision to sacrifice those extra minutes of sleep in the morning to try and make it to early morning seminary (emphasis on the try however). It was my dedication to my high school education and desire to learn that influenced my standing GPA that BYU approved. It was the everyday decision to read my scriptures and building my relationship with my Heavenly Father. The last statement includes the most important aspects of my everyday decisions that have helped me decipher what needed to be done in my life. The interesting thing about making the decision to come to BYU was that at first I felt that I had no choice at all. I was unfortunately either wait listed or denied at all the other schools I had so eagerly applied to during my senior year. When I found out I was accepted to BYU I was excited, but had never actually planned on coming. I had a bad taste about BYU from previous family member experiences and had felt that it was not as prestigious  of a school as the others I had applied to.  I then set about making my pros and cons list and then I prayed about it. Today I am not entirely sure of how I went about receiving an answer but I know I did. It was one of peace; reassurance and everything just seemed to easily fall into place. Once I arrived at BYU I then had the choice to have an attitude adjustment and actually give the university a shot. It was shortly after arriving that I had to make the decision, which this time included a couple hundred options, what was I going to study. For some reason I know now that even though I feared if I really had any choice but to come to BYU, I realize that my selection in what to study was also prompted, but a decision made entirely of my own accord. I know I prepared for BYU in high school and then once I was here the opportunity to apply to the nursing program was why I had come.

Everyday is full of little decisions that help you decide your own destiny in life. It also encompasses realizing the benefits or complexities of all the alternatives. We have the choice to be proactive participants and decipher the options before us or merely just buy the book because of its cover but never really discover what it has inside for us. In my own life I know it takes time and quality consideration to come to a decision. Unfortunately for an indecisive person in a fast paced world I have had to learn quick thinking and to fully rely on trust in the Lord’s hand in things. This does not mean I am a floater in this life, no because I know there are priorities and contingencies to each decision we make. I know we cannot always control the outcomes of our decisions but we have to have courage and trust that in the Lord’s eyes all things will be for our good

D&C 122:  7 And if thou shouldst be cast into the pit or into the hands of mrderes, and the sentence of death passed upon thee; if thou be cast into the deep; if the billowing surge conspire against thee; if fierce winds become thine enemy; if the heavens gather blackness, and all the elements combine to hedge up the way; and above all, if the very jaws of hell shall gape open the mouth wide after thee, know thou, my son, that all these things shall give thee experience, and shall be for thy good.

Come together right now, over me

In understanding what is happening to our patients we have to not only see the bigger picture at hand but also all the small details that encompass and make up all that we are seeing. In clinical last week I worked not only with my patient who was experiencing pancreatitis but also a kidney transplant patient. Both patients provided opportunities for me to understand what exactly the pathophysiologies of their conditions were. After trying to understand the lab values by interpreting them and applying them to their present conditions or medications it all started to come together for me. I was prompted or taught by my nurse a lot as she challenged me to explain why things were occurring and why were performing certain treatments to correct them. It was exciting to understand the correlations between treatments and what was happening physiologically to the patients.
These experiences taught me the importance of studying the interactions of medications upon the body’s systems. I learned that with study and evaluation of what is going on in your lab values, they will make sense! I learned the importance of educating our patients’ so that they can adhere to their medication regimen and understand what to avoid if applicable.
I hope to continue to put the puzzle pieces together of what is occurring in my patients. I hope to take the time to really evaluate the systems of the body, what is occurring due to the present condition, and what the medications are doing that I will administer. I am excited that things are starting to fall into place but it also challenges me to learn more so that I can really understand what is happening physiologically to my patients’.

Both are edified.

In being in an academic setting I often seek knowledge primarily from my professors. In nursing, however knowledge must be shared and taught by all members of the team. This team includes the patient. This past week at clinicals I truly learned the meaning of your patient being the expert and your best source of information. In working with my patient I learned a valuable lesson of how to learn from and teach a patient. My patient was very knowledgeable about her current condition and knew exactly how her care was to be implemented. She was able to teach me about why things were done for her in a certain way and how to properly perform them. It was wonderful o have such a great coach who was patient enough with me to teach me. I then realized that some one along the way had done the same for her. Other nurses who had cared for her continually had provided care and had taught her along the way. These nurses had given care that was rue to nursing standards and had provided the correct teaching as well.
I learned that the patient may be our best resource of information but only if she understands how to care for herself and what her condition entails. My patient was able to teach me correctly because another nurse had taken the time to do so for her.
I hope as a future nurse to be able to take the time and really teach my patients about their conditions. After all it is their health that we are trying to treat. I think that teaching our patients will help empower them and allow them to be their own personal advocates for health. In my nursing career I hope to not only take the time to learn for myself but allow my patients to learn along with me. I hope to achieve this kind of understanding with my patients just as it states in D&C 50:22, “Wherefore, he that preacheth and he that receiveth, understand one another, and both are edified and rejoice together.”

Order, order in the court of life.

Into the wee small hours of the morning, when sleep was beckoning me I was still feverishly typing away, lab findings, pathophysiology of the diagnoses, and nursing care needed for my patient. All the while trying to understand what it all meant! I was exhausted the next morning from my late night of work of pre-assessment but was still eager to get started for my first day on the transplant floor. I was a nervous wreck at first and was unsure if my nurse’s lack of acknowledgement to me was a tell sign of how the day was going to pan out. Luckily, the nurse that I was following was wonderful and my patient was very compliant. It was a day full of new experiences as I implemented my skills into real patient care and not on mannequins (though I love Mr. Arm and Gretchen Allen) I was able to do my first assessment on my patient, who had just received surgery from a removal of a tumor from the junction of her esophagus and stomach, and administer lots of medications. I was able to give my first IV push and I could tell the patient’s husband when asked about them exactly what I was giving and why. It was very exhilarating but before I get a head of myself this was also a very humbling experience. I learned that I still have so much to learn and to be comfortable with before I can really implement my skills and knowledge as a nurse. As I followed my nurse through out the day I saw her interact with more difficult patients whose needs were not always physically demanding but emotionally. It was not always the patients themselves that were the most difficult but their family members instead were the challenge. I saw how she addressed the patient first since they were her first concern. She rationally explained things to the patients and their family members in a way that was respectful and calm. She did not show her frustration until she left the room but acted sincerely in her interactions with her patients. I also admired my nursing professor who helped me administer the medications. She was able to relate to the patients so easily and make them feel at ease. She helped me understand why I was giving the medications and reemphasized to me the importance of doing the six rights(Right medication, right dose, right route, right time, right patient, and documentation). I feel that I am gaining a better understanding of my skills and I am constantly becoming more comfortable as I am put to the challenge. It is funny how I have been noticing that the things that I fear the most are most often what I end up valuing the most. I think it is because I have to learn how to replace fear with faith. It is in this faith that I learn and eventually gain confidence not only in myself but in my God. It is frustrating at times when I try to really care for my patients and feel limited by my skills. I want to give them my whole self and really care for not only their physical but also psychological needs as well. I want to have a wholistic approach to my care which I feel is lacking right now because I am concentrating on mastering my skills. I was grateful today when I read a verse in Mosiah 4 that reassured me of what I was doing right now is necessary for success later, either that or I am trying to justify my inadequacies. Either way I found it beneficial for what I am trying to do today:
27) And see that all these things are done in wisdom and order for it is not requisite that a man should run faster than he has strength. And again, it is expedient that he should be diligent, that thereby he might win the prize; therefore, all things must be done in order.

Post Script: I know there are some of who are grammar savvy. I am in a research class right now where I need to improve upon my grammar skills, especially in regards to commas, semicolons, and dashes. If you feel so inclined to inform of incorrect grammar in my posts, please feel free to inform me. I obviously really need to master the usage of proper grammar, since I am in college and am still lacking!

Right there beside you

The design, core, and purpose of the OR is to perform surgical procedures in a sterile manner. I had the opportunity again this past week to observe and occasionally participate in these procedures. I was amazed again to see patient after patient be rolled in and out of a room with great care and efficiency by all the staff. What struck me most however, were those of a very gentle demeanor in the OR. They were those who treated the patients with the utmost respect and were able to speak very calmly to them as well. They treated the whole situation seriously and were not distracted by their outside lives but concentrated fully on patient care.

Located slightly on the outskirts of the OR core is the PACU. This is where patients are monitored and cared for as they emerge from the effects of anesthesia. This is where I discovered something about myself as a future nurse. As each patient was rolled in for care I was drawn to them and their status. I was intrigued by how the nurse was going to assess and care for them. I enjoyed talking to them and helping provide for their comfort. I found myself getting excited about their vitals returning to normal levels and them being able to be admitted to their rooms. I discovered that I really do enjoy one on one patient care.

In my experiences in the OR and PACU I discovered different ways to provide patient care. What I truly learned though was about how I want to be more involved in patient care. It is a small acquisition but it has helped me realize, even in the slightest, what direction I would like my nursing career to go.

I hope to treat all my patients with care and concern for their entire body as I witnessed in the OR. I also hope to maintain the same level of a reverence almost to sterility in the procedures I will have to perform, such as placing a catheter. I also hope to treat my patients in a calm, respectful manner and have my central focus be on them while I am at work. In learning more about what kind of nurse I hope to be, I am grateful for this experience to now know that I really do want to be by the patient’s bedside caring for them one on one.

"Snap- SHOTS" of last semester

Placing a "Bleb" Giving Em an IM injection, she looks a little scared! This is also where I hit this skinny girl's bone! No worries you cannot feel that when it happens to you!

Standing Strong

 8 This book of the law shall not depart out of thy mouth; but thou shalt meditate therein day and night, that thou mayest observe to do according to all that is written therein: for then thou shalt make thy way prosperous, and then thou shalt have good success.

  9 Have not I commanded thee? Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee whithersoever thou goest.

 Joshua 1:8-9

I happened upon this scripture as I was preparing for my efy(especially for youth, counselor position) interview since it is this year’s new theme. It struck a very strong chord with me and was what I needed to hear desperately at that time.  As I write this post I will tweak its meaning for it to more accurately apply to my nursing life.

Only two weeks down in school and I am drastically behind in my reading. I feel completely lost in my classes as they review over pathology with terms that sound so familiar but fail to fall into congruence of what they all really mean. Part of me feels so overwhelmed, with the 3 chapters of reading for one class, four for another, or two and lots of videos to watch somewhere in between, making the climb of K2 seem not as daunting! In wanting to give up and hopefully survive through the bare minimum, that is where the encouragement of verse number 8 comes in. My book(s) of law are now my very heavy new set of Pharmacology, Medical-surgical, Nursing-research, and so on. Right now nothing I read out of them is quite making sense or sticking but I guess it is not suppose to yet. Eventually I hope after doing my reading I will have success in finally at least understanding what my teacher is talking about in my three hour class on Tuesday. It may sound like I am complaining and maybe I am but then I have my experiences in the hospital where it all comes together and makes sense. It gives reason to all the studying and reminds of what I am really doing, learning the healer’s art.

OR:  Operating Room = Real life Grey’s Anatomy

I am not an advocate of that show , although I do watch it on occasion, for one it does not have a single nurse in it and if it did half of the problems they run into would not have happened! I do not watch it for the drama and the incredibly annoying characters but I watch it for its back drop, the OR. So for those of you who watch it you have an idea of where I spent an entire day this past week. This year my clinical are in IMC, Murray UT, which has been so nicely nicknamed the Death Star! Do not be alarmed this is not because of very poor statistical ratings discovered by JAHCO but because this hospital is a monstrosity and very confusing to navigate through!

IMC patient tower, a very small portion of the entire hospital!

A sample OR

In my first day in the OR I was able to follow a patient from preparing for surgery till right up after she would be admitted to the hospital. We will call her Elle Woods for HIPPA purposes. I was not very warmly greeted by my first RN of the day and felt quite uneasy about how the rest of the day might go. I met my patient Elle who was to have an ORIF of her left distal humerus translation being that she had a fracture in her bone above her elbow that needed to be closed by placing plates and screws into her bone. As the RN started to put in the IV in her arm for surgery trying to find her vein and causing great discomfort in Elle! In seeing her pain sympathy struck too strong with me and I thought I was going to pass out right then and there! I thought how in the heck am I going to make it through an entire surgery if I cannot even watch an IV being put in! As embarrassing as it was I sat down until I started to feel more stable and had said about a dozen prayers to get me through the day, since the banana I had eaten  at 5:30 was not cutting it!

As we made our way up into the OR we were greeted by our friendly OR circulating RN who flight attendant like directed us into the room. I had never imagined to meet such professional, yet relaxed, intelligent, cool people ever in my life in the OR. Yes these RNs and DR. were listening to 80’s rock while they were doing this surgery and cracking jokes to one another the whole time while still being very focused on the patient. They even asked me about who I was, I could tell that they really care about everyone that comes into their OR. It was amazing to see the care they went into to protect the patient who would not be moving for four hours during the surgery. They made went to great efforts to provide lots of padding everywhere, warmth( because it is absolutely FREEZING in the OR!), and the sterility of the procedure. I was able to move around a lot during the surgery and watch all of it! I was right by the anesthesiologist for a while and was able to watch him intubate her (put a tube down her throat so she could breathe) and could see her vocal chords! The Surgeon was amazing he told me everything he was doing and all the anatomy that went along with it. It was incredible! I even was able to see the fracture in the bone that he was trying to fix! After the surgery I followed Elle into the PACU (Post Anesthesia Care Unit) This is where they monitor patients coming out from anesthesia and start controlling their pain level. Elle was in a ton of pain when she woke up and reasonable so, after just having seen her entire upper arm cut open! The RN there was great in explaining all her monitoring and what meds she was giving to help relief any pain. Unfortunately for Elle nothing was working! So then this other MD came in and preformed a nerve block by finding her nerve with an ultrasound machine(compliments of GE) and then injecting around it to help block the pain radiating down her arm through her nerve plexus. The pain was finally relieved and Elle was able to be admitted to an official room to see her Mom again. By this time it was almost three o’clock and I had yet to eat anything and I successfully had not passed out yet either! I then went to see if I could catch anymore surgeries before I went home. I entered in where they were doing thyroidectomy. The RN there was also amazing and really funny. He made sure I could see everything going on and showed me everything possible of interest and all of it was! I also saw a 10 lbs goiter removed, adrenal glands the size of a football (which are normal the size of a small rubber ball), and how the pathology lab diagnosis different tissues that come to their lab! Overall it was an amazing day. When I came it was dark and when I left this other world(very much like Star Wars where their technology is astounding, and their light sabers are bovies that electrically severe tissue, which smells like burnt hair!) it was dark again but I will never be the same because of it! I have a huge appreciation for what surgeons know and do, orthopedics being my favorite ones so far. I am so thankful for all those who taught me so much on my first day and for how much I was able to see. I was able to stand strong the entire day and knew that God was with me the entire time pulling me through, along with all the patients in the 60 some surgeries that happened that day.

Accomplishments this week

1.      Placed a couple of IVs successfully

2.      Learned how to start an IV pump

3.      Did NOT pass out in the OR despite the empty stomach and quivering nerves!

4.      Somehow managed to get the efy position even though I showed up thirty minutes late to my interview because I had the wrong room and I had a dryer sheet stuck to my skirt!

5.      Finished Anderson Cooper’s book, very interesting and great perspective on fairly recent historical events.

6.      Was fortunate enough to be the confidant of several confidential reports and kept them

7. Learned that you have to park the direction  of traffic to avoid a parking ticket :(

Pictures to come soon!