Nursing graduates share significant clinical experiences
"The following exemplars offer a peek into the moments of life as a nursing student that shape and help inform who they become as professional nurses. The exemplar writing assignment is to "describe a significant moment in practice where the student had an impact on the patient or the patient had an impact on the student." One of the prompts is to "write about a time when you knew you had become a nurse". These stories from practice describe pain and pain relief, fear and courage, despair and hope and the search for health that defines the journey of all nurses and patients. The faculty of the Cedar Crest College Nursing Department are so proud of our students and all that they do in the name of healing. We hope you enjoy their stories."
~Professor Amy Edgar
These are the stories written by the July 2013 nursing graduates.
*please note that the names of all patients have been changed for confidentiality.
It was Friday, the first clinical day of my last medical/surgical course in nursing school. However, I was not reporting to a unit to perform patient care. My first day was my observational assignment at the long term acute care unit of a local hospital. As I walked into the building, I wondered if starting off as an observer might place me at a disadvantage at the beginning of this final Medical/Surgical rotation. In retrospect, I now know this experience was exactly what was necessary for me. I reoriented to a clinical day, interacted with patients who had long term, critical medical issues and connected empathetically with patients, one in particular.
C.K., male, age 64, had been admitted seven days ago with a tracheostomy for exacerbation of chronic obstructive pulmonary disease (COPD). He had no family connections and only one friend, who did not live in the area. He was nonverbal, but could mouth words with some success. He was described by some as “demanding” and that he “told stories”. I considered this information objectively, and as in any new encounter with a patient, I did not judge. After shadowing the nurse as she performed morning care for C.K., I stayed in the room and asked him if needed anything else. I felt some connection to him, possibly because C.K. reminded me of my deaf-mute, foster uncle, R., who had looked very much like C.K. R. passed away two years ago at age 75 so his memory was still fresh in my mind.
I was having a very difficult time interpreting his ‘mouthing’ but I finally understood that he wanted a pencil and paper. I found some scrap paper and a pencil, and he proceeded to write about the staff - ‘don’t trust staff’, ‘not helping me’, and ‘trust you – student nurse’. I didn’t react or ask him why he didn’t trust them, but just ‘listened’ to him as he wrote more about he felt about the staff - ‘don’t care about me’ and ‘treat me like a baby’. I silently sat and was simply there for him. I realize now that this experience paralleled the domain in Benner’s (1984) book, From Novice to Expert, “the Healing Relationship” and the competency, “Presencing: Being with a Patient”. No one had come to visit him since his admission, I was told, and just sitting with him showed I cared. The simple act of being present with him and gaining his trust prompted him to write more about why he went to the Hospital – ‘couldn’t breathe when I walk’. He wrote that he ‘missed food’ and using hand gestures, pointed to his belly and wrote, ‘tube food not good’. He wanted to have the trach removed which he expressed He was distracted by movement at the door, and coincidentally, the respiratory therapist walked in.
I observed as the therapist suctioned C.K., and then discussed the benefits of a Passy-Muir valve (PMV). He was very hesitant to try it since he had been on the vent for a week but permitted the therapist to place the PMV. He was okay for about three minutes, but then became quite anxious and uncomfortable and indicated he wanted it removed. The respiratory therapist had left a brochure about the PMV valve which I skimmed through as I left the room. I soon returned, moved a chair close to C.K.’s bed and started talking about the benefits of the PMV – he would be able to express himself more clearly, eat and swallow, and have less secretions. I realized intuitively that this encounter had developed into the perfect time for teaching. Benner discusses this domain in the Teaching-Coaching section of her book. The competency, “Timing: Capturing a Patient’s Readiness to Learn” describes seizing those specific moments as they arise. I was very fortunate that I did not have other duties required of me at the moment and could spend time with C.K. I read some testimonials by patients with PMVs about the profound changes it had made in their lives. Abruptly, C.K. picked up his pencil and wrote ‘no reading glasses’, ‘can’t read’. He also indicated by hand motions that he did not have his dentures or his watch. This problem appeared to be much more important to him right now than the PMV. If he had some reading glasses, he would be able to read the pamphlet himself, creating control and power over his condition and the ability to make an informed decision.
I wanted to investigate the absence of his personal items, so I looked through his chart again and discovered that nothing had been transported from the emergency department where he was first treated. So what could I do? I did not have the resources at this moment to help C.K., but I knew what I would do. The next day, I went to the dollar store and purchased a pair of reading glasses with his magnification level, +2.00 (I asked him). I sent them to him via interoffice mail since I work at a different site of the same institution. I also sent an e-mail to the case manager describing the situation and asked her to look into tracking down his dentures and watch. It meant everything to me because I knew I did what I could for this patient. He had no one else. I truly hope C.K. received the glasses and was able to make an informed decision using the Passy-Muir valve. I will not forget C.K. and how he empowered my life as well. Sometimes it really is the small things we do for our patients that count the most.