Category Archives: Health

Nursing and Our Senses

As nurses, we are grateful for monitoring equipment. The equipment tells us what we need to know at the touch of a button. But, we also know that relying on these machines alone can take the skill out of nursing. In the absence of monitoring equipment, there is no need to panic. The human body possesses what we need to carry out a basic if not effective nursing, life-saving assessment/judgement should things go wrong – our senses! A nurse needs to be able to tell if something is ‘off’ just by using their senses. The following are some tips on how we can utilise these senses and act in a timely manner thus also being able to save lives.

1. The eyes.
There is no greater tool to a nurse than the eyes. You can tell a lot just by casting a quick glance at your patient. Straight away you can tell how critical they are just by observing their colour, the rhythm of their breathing, chest movement or lack of it, a bleeding wound, a swollen leg, urine colour and any other physical signs of distress you can think of. Once you’ve noticed an abnormality, you can proceed with caution.

2. The ears
If a patient is unstable, they will make abnormal sounds. Sounds that indicate something is wrong with, perhaps, their airways such as wheezing, gurgling, stridor and so on. At other times, there are no sounds at all, which would also indicate a complete airway obstruction in some cases. So, using your ears, you will be able to ascertain whether your patient is making the right kind of sounds. If it is not breathing, they may cry/scream, or try to tell you something. Gather the facts with your ears and from then on, you will be able to act accordingly.

3. The hands
If anything, nursing is a hands-on job. You cannot be a nurse and not get your hands dirty. When faced with a sticky situation, take the time to feel your patient. Feel their pulse, their breath and skin. Are they warm enough, too warm, cold or clammy. That alone can tell you all you need to know about your suffering patient.

4. Smell
There is a lot that a nurse can tell just by using their sense of smell. Be it the smell of your patient’s urine, an infected wound or stools. Once you’ve established something doesn’t smell right, a nurse is able to proceed with confidence.

5. Taste
In 1674, Thomas Willis described the taste of urine in diabetic patients as ‘wonderfully sweet as if it were imbued with honey or sugar.’ I know what you’re thinking. Yacky right? Well, not according to those who nursed in the olden days. Before technology was developed the way it has, doctors and nurses, in some parts, used to taste urine for infection. Thank goodness we do not have to do that anymore. We have advanced technology now and we are able to diagnose at the press of a button.

6. Trust your instinct
Nurses have an uncanny way of using their gut to determine if/when something is not quite right with their patients. This, in my view, is what makes a nurse a bit special. Nurses are able to achieve this because they are the ones who spend the most amount of time with the patient and offer hands-on care, so, they can tell when a characteristic is out of the ordinary, even without medical evidence at first. So if you’re a nurse like me and you get that feeling in the pit of your stomach, that something isn’t quite right, then it probably isn’t. Go with your gut and tell the doctor what you think and let them know what your concerns are. The worst thing that could happen is you’ll annoy the hell out of the on-call doctor who was getting ready to take a nap after a long day at work. Better to be safe than sorry!

Although machines have made nursing somewhat ‘easy’ these days, I reckon we were given all the tools, the machines we need to do a reasonably sound nursing assessment. Our eyes, ears, noses, mouths (okay maybe not so much now) and gut instinct provide us with all the information we need to prevent danger from occurring to our patient. Let’s use them. Done enough times, the confidence and skill you gain from practicing with your senses are indispensable. You will feel satisfied and glad and so will your patient!

Four New Trends in Nursing Homes

As Americans live longer, many of the traditional nursing homes of years past are transitioning to a person-centered model of care. As the Baby Boomer generation ages, they have clear ideas about the way they want to receive care. According to data from the Pew Research Center, 18 percent of Americans will be older than age 65 by 2020, compared to just 13 percent of Americans by 2010. In response to these preferences as well as to the rising cost of medical care, seniors are increasingly able to “age in place,” receiving nursing home level care in the privacy and comfort of their own home rather than in a facility setting. Read on to learn more about how nursing homes are changing, and how these changes will affect your loved ones who need care.

Increased Technology for Senior Care
The pervasive use of technology in most aspects of our lives is also reflected in senior care solutions. Modern nursing homes are increasingly introducing a range of smart technologies for residents, including wireless networks that allow seniors to access instant support from their care teams. Another popular option is the provision of smart computer systems that allow residents and caregivers to track medications, vital signs, and more.

Designated Memory Care
As Alzheimer’s disease and dementia progress, intensive individualized care is needed. Many nursing homes are designating specific units for these patients, with a focus on dignity, socialization, and 24-hour care and supervision. These units typically have either private or semi-private rooms. Certain communities are even designed specifically to harken back to days of yore, mirroring a patient’s past while he or she increasingly retreats into long-term memory as the disease progresses.

Aging in Place
Rather than relying on institutional models of care for aging adults, families are more likely to take steps that help seniors receive needed care at home. This often takes the form of multigenerational living, in which homes are expanded or modified to add space and facilities for aging family members. Home care services allow older adults to receive the individualized care they need outside of a nursing home setting. For many seniors, home care is a less expensive alternative to assisted living care and allows the availability of a nurse or aide to be tailored to the patient’s needs.

Co-operative Assisted Living
This care model allows a small group of seniors to live in a community setting with health care and other services available. This lower cost model combines the convenience and care of a nursing home setting with the shared amenities typically associated with a standard housing development. Residents share not only medical care facilities but also fitness and swimming facilities, rideshare, gardens, and other features. With this rise in cooperative living comes a trend for lifestyle-specific senior communities, such as those for LGBT or other special interest groups.

Whether your family member currently needs care or you’re planning for your own health care needs after retirement, today’s older adults have more options than ever when it comes to nursing home care.

Nursing Beyond Birth and Babies

I have been a perinatal nurse for over two years now. Most people tend to assume that everything that surrounds perinatal nursing is rewarding and miraculous. For the majority of the times, they are, but then there are those moments like the agony of pregnancy, the despair of childlessness or even the grief of death.

Having been assigned to triage, one fine day, it seemed just more busy than usual. I was checking patient after patient. However, by lunchtime, I had managed to clear all the beds and decided to grab a quick lunch. As I was about to leave, a patient walked through the doors followed by her family members.

As I followed this tiny patient onto the triage bed, I couldn’t even tell that she was pregnant. With a tensed voice she informed me that her due data was tomorrow but she hadn’t felt her baby move since the night before. Putting the baby monitor on her tiny pregnant tummy, I heard nothing. Instantly, I knew that the baby was no more alive inside her. But, I didn’t want to give up. I moved the monitor around the little belly over and over again, just hoping that I would get some indication of a baby’s heartbeat.

The mother knew. She held her husband’s hands and started sobbing softly. In between sobs, she wanted to see her mother who was waiting outside the triage room for her. Just as I approached her, she looked up at me and said, “The baby’s gone, right?” As a nurse, I really couldn’t say anything to her. Instead, I held her closely and led her to the triage room and told them that the doctor would be on his way shortly.

My heart pained for the parents who’d lost her first child, a grandmother who’s lost her first grand-child. The doctor arrived and pulled out the ultrasound machine to the patient’s bedside in order to visualize the still and silent heart of her baby. This time, the finality of the situation sunk in as everyone could see on the monitor that the baby’s heart was no longer beating. Everyone cried once again. And the only thing that I was grateful for was at that moment the mother had the support of her loved ones around her and that the remaining triage beds in the room was empty. It was never good to hear the cries of a mother who’d lost her baby.

It’s not an easy job for a nurse to help a patient with a full-term intrauterine foetal demise through labour. Most of us working in this area have been through this at some point of time. Whilst we know the extent of pain that the patient and her family goes through, we as nurses are equally physically and emotionally shattered. You cannot offer any comforting words to ease her pain or be able to provide any closure for her. All that is left is the emptiness after experiencing every pain and emotion that comes with labouring towards bringing her baby into this world.

We walk a fine line as nurses. We keep praying that she does not have to go home from hospital with a lower-uterine transverse scar as a daily permanent reminder of what she went through during labour.

To the patient, we are just momentary guides through one of the most painful times in their lives. They would not remember everything we said or everything we did. They would never know that we cried for them, alone in an empty room where we would not be seen. And while we see this many times in our way of work, I can truthfully say that I remember every single one of them.

And this is just to let all those mothers who did not get to bring their babies home that your nurse remembers you and will always appreciate that a part of you was left behind in that labour room.

Four Lessons You Might Learn From Working in Hospice Care

Most people try to avoid thinking about mortality, but death is an everyday reality for people who work in hospice care. The nurses and CNAs who work with hospice patients have a unique window into the many ways all people cope with the end of life. Working in a facility that provides hospice care can provide insights that are relevant to daily life. Here are just a few examples of things you might learn by working in this setting.

Possessions Don’t Matter
When you go into the bedroom of a person receiving end-of-life care, there may be only a few items in the room. If it’s an acute illness, there may be flowers and cards, but it’s not as though patients bring collections of toys or movies. Pictures are a big deal, but they may be displayed on a board and covered with tape. Over the course of our working careers, a lot of our income goes toward buying things that seem important only for a short time.

People Have a Lot to Teach
During the weeks of hospice care, there is time to get to know just a little bit about each patient. More than a few have fascinating life stories, and some of those with incredible stories seem to have very few visitors. Unfortunately, there aren’t many opportunities to strike up deep and meaningful conversations during daily conversations at the grocery store or in the elevator. Still, it’s worth remembering that the strangers around us have their stories to share. Whenever possible, it’s a good idea to pay attention to others and ask perceptive questions.

Happiness Is Made
Even in the rooms of a hospice care facility, there can be laughter, jokes, and even joy. You’ll meet some personalities who just refuse to be downtrodden by circumstances. There are others who have every advantage, and yet they seem only to project anger and self-pity. Unfortunate life events can be very unjust, and it’s very easy to be sad and turn that anger outward. Still, it’s important to choose to keep a positive outlook and look for the silver lining. Optimism can help you overcome obstacles and, more importantly, minimize your suffering in times of genuine hardship.

What You Are Doesn’t Matter
It’s very easy to see the triviality of careers at the end of a person’s life. Once a person is wearing a smock in a hospice care facility, the details of their jobs don’t seem to matter as much. A former judge or CEO could be one room over from a former cashier or sanitation worker. The things that define a person in one-on-one conversation have more to do with compassion, openness, and perception. When you stand next to the patient’s bed and engage with them, they don’t need you to be incredibly witty or smart. They want you to care and be open to connection, and it would be nice if we could approach others in life with this attitude.

A Day in the Life of a Surgical Nurse

Being a surgical nurse is very different from other specialties, because surgical nurses deal with patients who are asleep. Surgical nurses see the patients very briefly in pre-op and then take them back to the operating room where they will be put to sleep by either an Anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA).

Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those OR doors, (neither patients or other nurses ). It’s a completely different world in surgery and without the proper training, you’re not permitted to enter the surgical area.

Surgical nurses don’t change dressings; they usually don’t administer medications (except for local monitoring). They don’t answer call lights or deal much with patients families. So what the heck do they do?

Well, behind those surgical doors are some exceptionally trained nurses who deserve recognition and praise, which is something they rarely get.

They don’t see how a patient recovers. The patients are so high on Versed that they have amnesia after their whole surgical experience.

If they’re on day shift they arrive at the hospital or facility around 6:00 am to be ready to set up a case at 7:00 am. This gives them time to change into scrubs and read their schedule. The schedule is their fate for the next 8-12 hours. They look at the big board by the front desk to find out if they’re the scrub nurse that day, or the circulator. The main thing they’re looking for on the board is which surgeon they’ll be working with. This simple thing can make or break their day. There are both good and bad surgeons, just like any other slice of the population. “Please God, don’t let it be such and such.”

Surgeons can be friendly, but their skills may be horrible. Or they can be great Surgeons, but real jerks. Hopefully that day you will be assigned all the surgeons that are both friendly and good at what they do… but it isn’t likely.

If you’re assigned to be the circulating nurse, then you grab your scrub tech/nurse, and you both go to locate your first case cart of the day. This could be anywhere in the mess of other carts that have been filled with items needed for other cases. Hmmm, what a joy this is when you have a big ortho case and half of the instruments aren’t sterile and need to be flashed Better yet, half of the items on the preference sheet are missing.

You have to run and find them while your scrub nurse is opening the sterile field. When you return you “dance with your scrub nurse”. Not literally, but to “dance with your scrub nurse” actually means you help the scrub nurse tie her/his sterile gown. They can’t do this on their own, or it would render them unsterile, for reaching behind their back.

You then must count everything, including all the instruments, raytec, laps, needles, and blades. Remember all this is done between 6:30 am and 7:00 am. Heaven forbid you lose a lap or any of the above items. It’s a nightmare when you lose anything. I’ve been in cases where we were removing a lap sponge, a needle or an instrument; these cases are so much fun. During cases where the surgeon has previously left a sponge inside the patient, you definitely need a dab of wintergreen on your mask, or you are likely to puke your guts up! (and that’s putting it lightly). Anyway, once everything is counted, your scrub nurse is happy, your OR bed is sheeted and all the equipment is in the room, it’s time to go out and greet the patient.

You go to pre-op to introduce yourself to the patient and evaluate the chart. God only knows what crazy stuff you’ll find in there. The labs may be way off, and the surgery may be canceled. The patient may be allergic to latex, so the whole sterile field has to be broken down, because you’ve already placed a latex foley on there. You walk into the room and address the patient in as cool a manner as you can, (trying to remember that this patient is scared out of their wits) unless they have had Versed. Such a wonderful drug!

Anesthesia has usually seen and evaluated the patient before you arrive, and the patient has already been asked 3 or 4 times whether they’ve had anything to eat or drink since midnight. But when you ask the patient the same question, all of a sudden their answer changes. They tell you all they had was a doughnut and coffee for breakfast that morning! Okay, so now the case is abruptly canceled and you’re lucky enough to have the task of breaking the whole operating room down room down and starting over. One of numerous other scenarios may be that the patient is allergic to shellfish or peanuts, (which is the allergy de joure these days). Everyone and their mother has a peanut allergy. Or maybe, the patient is just allergic to their own snot!

Today the patient has none of these problems. They’re not obese nor pregnant, so there’ll be no need to pull out the Hercules bed. Hip hip hooray, the surgery will proceed. You begin wheeling her back to the OR after she’s had her “margarita in a vial”, (Versed), and before she tells everyone in the pre-op area every secret she has.

She goes on to talk your head silly all the way to the surgical suite, and she tells you how she’ll never forget how wonderful you are. In your mind you’re thinking Yeah, right, you won’t remember your own name when you wake up, let alone mine. After entering the OR you transfer the patient onto the table and find that she’s still wearing her underwear, (complete with latex banding), even though she told you she had a latex allergy… Awesome!

You assist the CRNA or Anesthesiologist to put her to sleep, (in a hurry, cause she is driving you nuts), with her “jabber, jabber won’t shut up”. CRNA or Anesthesiologist to put her to sleep, (in a hurry, cause she is driving you nuts), with her “jabber, jabber won’t shut up”.

Alas, she’s asleep, and all is quiet for a few minutes, until in bursts Doctor Friendly. He’s had a bad day doing rounds, and he’s been paged 54 times by his office staff, so he’s in a lovely mood, and you’re in for a lovely day.

Nothing on the preference card is right, and you spend your time running around searching for instruments, (dirty ones, which need to be flashed). This only pisses the surgeon off more and enhances your day further. The bovie isn’t working, and the Rad Tech has been called for a C-arm 10 times but is still MIA.

When everything begins to settle down and all the issues have been resolved you can relax for 5 minutes and sit quietly, hoping it stays that way. Finally the surgeon is closing and you begin counting. Laps and raytec first, followed by instruments, then needles. All are correct, (well except for one tiny needle) that is nowhere to be found. The scrub counts again. “No, still missing.” The surgeon is about to knock someone’s head off and freely verbalizes it. You run for the magnet on a stick to roll it on the floor and find the friggin needle. Finally, you find it next to the scrub nurse’s foot.

The patient is beginning to rouse, and you are finished with the case. You transfer the patient to post-op and give the PACU nurse report. Yay, it’s lunch time, and you’re exhausted, with only five more cases to go.

This is a day in the life of a surgical nurse. Many nurses in other specialties believe that surgical nurses really don’t do much or aren’t “real nurses”. While the surgical nurses role is very non-traditional, they work very hard and they’re an integral part of the nursing profession. Unfortunately, they don’t get to see the fruits of their labor. Once the surgery is over they never see that patient again and usually have no idea how well the patient did in their recovery. The patient doesn’t remember the great care they got from all the OR staff and for the patient’s sake, it’s probably just as well.

surgical Nurses are highly skilled at what they do and really deserve more respect from both surgeons and other nurses. So, the next time you meet a surgical nurse treat them right, you may be the next one to come through those mysterious double doors and onto that OR table.

8 Weird Things About Surgical Nurses That You Never Knew

1. If you aren’t in scrubs, we don’t want to see you come into the OR. We don’t like strangers; they scare us. We are extremely protective of our environment because sterile procedures are conducted in every operating room and your presence brings new strange germs that we don’t care for, so go back to your own department and leave us to be happy in our own familiar germs. If you feel like you’ve stepped into the territory of Appalachian mountain folks when you enter the OR, and all eyes are on you, you’re probably right!

2. Many of us sleep in our scrubs. No, not the same ones we worked in, but we enjoy the comfort our scrubs offer us, and we really don’t care if they’re sexy or cute, we feel at home in them.

3. We practice sterile technique at home. When we open a 2 liter of coke, we place the lid down upside down. We scrub our hands before we cook like we’re about to assist with surgery. Our countertops are spotless, and our dishes are darn-near sterile.

4. We will hate you for life if you dare reach over our food while we’re eating, (it’s the germ thing again). Which is why we have a problem eating out. The waitresses love to reach over food, and all we can think about is all the germs she is transferring to our meal. If you want to call us phobic, then the shoe fits. Buffet style restaurants blow our minds. There’s no way you’ll drag an OR nurse into one of these Petri dishes. People grabbing the same spoons over and over, coughing over the food and there’s that problem of reaching over food again. Yuck, just yuck!

5. I guess you could say we’re pretty weird about our shoes too. We don’t want our shoes in the house, and I usually leave mine at work. If we do bring them home, they stay in the garage. There are so many nasty germs on shoes that we can’t see, and you have no idea what kind of horrific nastiness we get into during a shift. If you did know you probably wouldn’t even want to touch us again.

6. OR nurses probably have the cleanest belly buttons in the world. Why? Well, part of our job is to clean navels prior to surgery. Many surgical procedures are performed laparoscopically, and the device used to inflate the abdomen is introduced through the navel. So, if the navel isn’t clean, all those nasty germs go right into the abdomen creating a great environment for infection.

You wouldn’t believe the things I’ve found in patient’s belly buttons. People may shower and bathe, but they lost the memo about cleaning this area. Please, folks, clean your belly buttons already.

7. We talk with our eyes. This may seem a bit weird to you, but we spend most of our shift with a mask covering our faces, so our eyes are the only way we can express ourselves. Most OR nurses learn to use their eyes to convey messages to other members of the surgical team. This practice runs over to our everyday life. Even when we don’t have masks on we express our feelings and opinions with our eyes, (and our eyebrows).

8. Ask us for a screwdriver or a pair of scissors and expect to get them slapped into your hand in a position that is optimal for immediate use without readjustment. We have learned to pass instruments that way, and it carries over to everyday life.

Here’s a bonus “weird things that you never knew about surgical nurses,” although this one is pretty guessable even by a lay person. We love blood and for the life of us, we can’t really figure out why anyone would pass out with the sight of it. The bloodier the case, the better. A good deep abdominal case that we can get our hands stuck into is our idea of fun.

When I have blood drawn, I watch the needle go in instead of turning my head away, and I love to watch the blood pouring into the vial. I wonder what Freud would say about this? Maybe we were all vampires in past lives. There’s no room for people who “dislike the sight of blood” in the OR. Be gone and let us roll in our weirdness.

Love us our hate us, we only want the best for our patients and the weirdness we have can always be explained. They say once an OR nurse, always an OR nurse, and I can certainly say this is true. You can call us weird, but I guarantee you that the minute you need emergency surgery, you’ll be glad weird surgical nurses exist!