Blog #6: Acute Care Clinical

I am finally beginning to feel like an asset rather than a nuisance at our acute care clinical at Evergreen Hospital. The first week at Evergreen I felt very out of place and in the way. My first patient was very ill and I was not able to really participate in her care, other than vitals and assessments. I observed as the nurse attempted to place a nasogastric tube, but it was very difficult and painful for the patient. Even the charge nurse was unable to place the NG tube and both the patient and the nurses were very frustrated. The patient was so miserable that I did not want to interrupt her more than necessary, so I kept my visits to a minimum and did not start the Gordon's until the second day. At the end of the first day I went home feeling very discouraged. The second day however, was a great improvment. My patient recovered from her nausea and vomiting and was in very high spirits. I was able to giver her meds, ambulate with her, and use a number of therapeutic techniues such as opening the blinds and finding her book and making her warm tea. She was very conversational and alert when I completed the Gordon's Assessment and was very encouraging to me and my vocation as a nursing student.

This past week I was with a very complex patient who had been in the unit for 30 days. After a 30 day hospital stay, with full-contact precautions, she was sufffering repocussions of social isolation as well as her extensive list of medical diagnosis. I was happy to have so much time to dedicate to her, because she was very eager to have someone to talk with - it was sometimes difficult to leave her room in order to do charting and paperwork. Throughout the two days that I worked with her she talked about a number of things, from her television shows, her past, her family and her medical care. I was very involved in her care and was required to be in her room a great deal and I could see a trust-relationship beginning to develop.
Near the end of the second day of our working relationship I completed the final questions on the Gordon's Assessment. When I asked about her role-relationships and her spouse, she shook her head and began to cry. She described her very difficult situation with her husband to me and shared quite a bit of her story. As I finished completing her Gordon's I found out that she had a very impaired sense of self-esteem, little-to-no coping mechanisms or support systems, and was in an abusive relationship. I was somewhat overwhelmed by her sense of hopelessness and depression, and yet I was glad that she trusted me enough to share her struggles and fears with me. I did not have a profound answer to give her, yet I do believe that it was helpful for her to express these unmentioned fears and struggles and to receive compassion and interest.

After our conversation I looked through her chart and saw that a social-worker had been working with her and making arrangements regarding where she would live when she was discharged. The details she had told me were in accordance with the chart, and had been addressed by a social worker. I am very glad that nurses and social workers cooperate with patient's care, because I could not stomach the prospect of my patient returning to an abusive living situation, with no support system or family to help with her care or coping. I am glad that social workers are also invested in the health of patients and are trained to deal with situations.