Summer.....what Summer

So great plans and all that.  My summer was supposed to be quiet and serene, lots of time for getting through that pile of books in my study and do some writing, including updating this blog on a weekly basis.  What happened?  Life happened.  We spent the beginning and the end of the summer travelling to Barcelona, London, and later South Carolina and Colorado and thoroughly enjoyed all of it, especially Colorado, there is something about being in the mountains that speaks to my soul, restores me a little, we all need that every now and again, especially in a high burnout profession like Nursing.

I continued with community nursing which had its very busy weeks covering for staff who were gone on vacation.  I had both interesting, sweet and challenging patients and some very hostile relatives.  I continually tell myself, their aggression is not really about me, its more about the frustration of their situation.  For an elderly patient who is facing end of life issues, a helpless relative can feel powerless and this can come across as dissatisfaction of care to the health professional in the line of fire (literally!).  Even though I know all this after several "not so nice" rels this summer I admit to it all getting a little old, being shouted at and second guessed several times a week.  But we soldier on, the hands on care is still the most magical part of nursing for me.

I also continued with my online teaching commitments.  This summer I have been coaching a leadership class and thoroughly enjoying it.  These young BSN students see themselves as novices even though many of them have years of clinical experience.  But the online education experience is a wonderful medium to exchange powerful ideas, lively discussions, solve issues hypothetically through PowerPoint presentations and develop a base knowledge that will hopefully lead them onto successful leadership positions.  All I really have to do is facilitate and grade 60 papers every weekend (groan!), all done at home by the power of my laptop, my perfect kind of job.

Just when things got to August and looked like I may have a month of breathing space before my semester starts again for my traditional teaching job at a Philadelphia University we met this guy....

I really was uncertain about doing the dog thing after losing our beloved Golden Retriever in April.  However one particular weekend when I was missing him so acutely my husband put me in the car and took me to a pet adoption at a local pet store....and there we met Toby.  It was love at first sight.  An adorable choc lab/pointer mix.  Loves to snuggle, chew cell phones and TV remotes.  He is especially fond of the 3am pee followed by a snuggle in bed.  And so I am now walking the neighborhood at 7am/pm every day, chasing him around the house with my carpet shampooer (forgot how much work potty training is), trying to persuade him not to eat the cat daily ( I secretly think the cat quite enjoys it!).  Exhausted and enjoying every minute of him

Faculty meetings have begun, planning and organizing a new semester is ongoing, I am ready to roll with whatever fall brings me and looking forward to it.

How was your summer?

Global Nursing

I was recently in London and attended a conference titled, Nurse Led Clinics.  It was a fascinating day with many excellent speakers.  As an advanced practice nurse who runs her own company and loves being my own boss I was interested to see how this concept was being developed in the UK, my homeland but one I have not worked in as a health care professional for nearly 20 years.

It seems the National Health Care Service is moving in the same way (relatively speaking) as the US, in terms of need for accountability of costs, tendering of services - which means there is no reason why nurses, physical therapists and others cannot form their own groups and bid for contracts.  It is an exciting time of change in the UK.  However, I appreciate not being a part of the NHS anymore it is probably very frustrating to live with these changes.  What is refreshing is that the UK system is still a service based industry whereas the US health care system is very much profit driven, sometimes quality of care gets lost in both systems.

I see a two tier system developing in the UK, where many people now have private insurance through their employers and prefer to get their point of service care, elective surgery and treatment through the private route.  Does this make the free NHS suffer, not sure, have not had enough exposure to that lately to make a judgement.  However, it does not seem that much different to the US system where we have the medicare/medicaid population, the totally uninsured and the rest of the nation.  It certainly is a tiered system where there are different levels of quality care depending of what coverage you have.

It was not all work though, I thoroughly enjoyed Barcelona, especially the flamenco festival that was taking place right outside our hotel.  It was lovely to see London draped in Union Jacks in anticipation of the Queens Jubilee (God Bless her) and the Summer Olympics.

Now back to the reality of home.  Have started double duty in my community health class that I teach on line, balancing 50 students instead of the usual 30!!!  I just keep saying to myself "Angie, you got this, you so have this!!"  Community health work has slowed down a little this week for which I am grateful.  I have not taught this class since February so I am taking the extra time to catch up on readings and go through the syllabus in detail.

I feel like I am on a new summer schedule and it feels good, getting up late, lazy breakfast, check in with my students, do a few visits, wander around my beautiful yard dead heading and pruning and then back to check in with my students later on in the day.  I could get used to this, very satisfying.

Next trip is to South Carolina in July and potentially a trip to Colorado in August. Life is good, long may it continue.

End of One Thing, Beginning of Another

The spring semester has finally been completed.  I should not be shocked at how much I learn from the students, but I do and I hope they learn much from me not just about pediatrics but about the art of nursing.  I think I have said before I am not just interested in developing these young adults as nurses but also as people.  The time I have getting to know them, learning their stresses and their joys brings a great deal of satisfaction to my teaching experience.  Every group seems to have its own "personality".  This group was more nervous than previous ones but very personable and teachable, they made me smile and though some of them lacked confidence (unduly) in their clinical skills their people skills were excellent.  I was very pleased the way they reached out to the children and family on the floor.

One of the most difficult cases we had this semester and one many of them spoke of in their reflection paper was the admission of a child who had been severely abused and showed evidence of several old fractures.  The students were quick to judge the parents/caretakers of this child, and I too struggled with the pain this small child was enduring.  But it was a lesson in tolerance and practicing non-judgemental care to the whole family.  While child abuse for me will always be without question inexcusable we have to remind ourselves as practitioners that we do not know the whole story and we must suspend our strong emotions so they do not get in the way of the care we are called to give.  I am thankful for Social Workers and DHS who do the hard work in these situations.  Needless to say this child received a huge amount of attention by all students and staff while he was in our care, we managed to get a few smiles out of him.

The rest of the semester was uneventful, we had our fair share of asthma, bronchiolitis, pylonephritis, basic stuff but excellent to teach the fundamentals.  I am excited to have just found some wonderful 3D applications for my ipad of the kidney and lungs that will make great teaching tools next semester (thanks hubby)  Its always easier to visualize the anatomy and explain the disease process rather than just verbalize it.

Exams and evaluations are complete, even had my students over for a celebratory afternoon tea which I loved so I intend to do that again.  Whats next for me.

A summer of work but in a different way, I intend to teach two classes simultaneously online which will be busy but hopefully done from the sun trap called my deck.  Of course I will continue with my community nursing but the goal is to gradually scale back and do more teaching on line and in the traditional setting, we shall see what future opportunities bring.

At the moment we are having a sad time in my house, mourning the loss of my dear 13 year old Golden Retriever who we had since he was 8 weeks old and was as much an integral part of the family as the kids.  Medicating my grief with some travel, about to tag along on my husbands business trips to Barcelona, England and South Carolina to name but a few.  When the kids leave for college and the animals start dying we find ourselves in transition again, I want to embrace the change sometimes it just comes a bit quick!!!!!

Weekend On Call

About once a month I do the on call schedule for the nursing agency I contract with.  This weekend was my turn on call and it was horrific.  I spent the weekend looking at stinky butts and feet with no toes on!!

Enough said.......just wanted to get that off my chest.

Ageism and My Misconceptions

So, this week I started teaching a new online class on aging populations.  It is an extreme change for me after being so involved in pediatrics for the past 20 plus years.  However, following my return to community health I have seen a mainly an elderly population and have found I absolutely love this demographic.  Anyways, week ones topic was ageism, what is it, are we guilty of it and how do we deal with it.

First of all the students were required to take a self assessment survey to judge their baseline prejudices and knowledge of the elderly.  I took the survey myself, found not only did I hold many prejudices about the elderly but I also assumed to be true many myths and did not do as well as I thought I should....a little humbling moment for Angie.  For example, I am a huge offender of calling the elderly sweetie and honey.  Now I have to admit that on a busy day I sometimes do this if I cannot remember a patients name, but still it must stop, a person is a person (Happy Birthday Dr Seuss) and they deserve to be addressed correctly.  On first meeting I do try very hard to greet the new patient as Mr or Mrs So and So but after that all bets are off.....I will make a better effort.  

I assumed that pain was a natural symptom of aging, not so, pain is a symptom of disease and should always be assessed and evaluated.  Here I am Miss Self Righteous Pediatric Clinical Instructor preaching to my students every week that pain is what the patient says it is and all children should be assessed with the appropriate scale.  Going to do a better job on that one too!

I also incorrectly assumed that the elderly get more religious as they get older and deal with change better but apparently this is also not true.  When I think about it I am getting less enamoured with organized religion and less inclined to change my present situation because I have about as much I can handle right now so why should aging be a catalyst to liking religion or change anymore than you do when younger.

I can see how this course will challenge me on many levels but will only help me in my scope of practice.  The discussions are already lively and challenging, a good bunch of students.  Looking forward to the next 5 weeks of learning and facilitating all I can.

New Semester. New Challenges

Its January, its cold (not as cold as it could be) and class has started for the traditional setting and the online environment.  This semester I continue as clinical instructor for the pediatric module at Holy Family doing our clinicals at a busy inner city pediatric hospital.  I think as a faculty we well and truly overwhelmed these poor students the first two weeks of orientation, I know I had a headache by the end of it.  Finally last Thursday at 6.30am sharp (I had been there a while by then.....yawn!) we were all on the floor, ready for assignments, implementing the nursing process, using evaluation and critical thinking skills like it was second nature, and oh yes....mastering the dreaded paperwork!  It went well, again a lovely bunch of students, I already know I am going to enjoy them once they stop being so terrified and realize they know more than they think they do.  But its good to be cautious in a new situation like this.  We will work on and build skills as we go.

Comparing that with the online class I am teaching there is a world of difference and similarities with the two learning environments.  I am in week 4 of teaching a community health class called Vulnerable Populations, the syllabus is excellent (thank goodness I did not have to write it), the readings are wonderful, engaging and up to date, the online environment is a nightmare to navigate.  The first week I struggled to do such simple tasks as post my welcome letter, get to email, and grading papers gave me hives.....too many buttons to push.  Everything has to be done within the online world, it has been a sharp learning curve but now we are in week 4 I feel I am just beginning to get the hang of it.  I have already signed on to teach another class in February on Older Populations....it cant be that different from pediatrics ...right?  That being said, a student is a student, these students have an electronic relationship with me but I still think given a little effort you can build a sense of community.  I have tried to get involved with the discussion boards, answer questions and emails promptly and even put in that extra human-Angie touch.  These students struggle like every other student with balancing work, family, school...been there...done that.  Its hard, you give up a great deal, tv, a social life, food beyond frozen pizza.  However, online education means you can plan and write papers, participate in group discussion at any time of the day or night.  For example I graded papers this morning in my pajamas in bed while watching the Today Show.......that's a pretty good gig.

It is expensive with time though, I am online seven days a week, I am working as a community health nurse sometimes seven days a week.  But thank goodness I have a job that I love and my sweet dog just lies by my feet and keeps me company!!  Next week I am praying for snow (with no power cuts) so I don't have to go anywhere.

Dealing With The Difficult Patient

Amazing as it may sound not everyone is thrilled to see me when I knock on the door with my sunshine and promises of supernatural healing powers!!  Some people are grumpy, angry, weepy, unresponsive, talk too much, talk too little.  Some people have an agenda to get me in the middle of their family squabbles and of course pass judgement in their favor.  Some people expect me to stay for dinner, walk the dog, do the laundry and clean the bathroom.  Yep, I have been asked to do it all and seen so much dysfunction in the family group I almost think my family is normal (steady on, I said "almost).

I was once asked in an interview for a job how I dealt with difficult people and after I thought about it for a moment, I answered something like this.

I do not consider that I have difficult patients.  I have patients that have baggage like most of us, maybe their baggage is more focused because of an acute illness or the exacerbation of a chronic one.  People exhibit stress in so many different ways.  The way a person manifests stressed maybe directed at me, the nurse, because I am supposed to be there to fix the problem and don't I have a resource list the size of a telephone book!  I have learned to take a deep breath before answering and realize the negativity in the room is not about me and I should not take it personally.  This person has a problem that needs solving, and we can brainstorm together.  When I turn it around and show concern for a patients anxiety they usually calm down and we can discuss/identify the real problem at hand, be that financial, emotional, a pain response, a lack of acceptance of the health issue.  But sometimes a person does not calm down, then its time for a time out and I try and leave to protect everyone.

When I am in a patients house, carrying out care I tend to be chatty, some may say overly chatty!  I like to ask a lot of questions, why? because fact finding is a safety tool to find out more of a persons health status.  But I also ask lots of questions because I think peoples stories are just so interesting.  In the medicare population I serve I have met a survivor from Auschwitz, a lady (now 90) who immigrated on her own from Italy when she was 16, WW2 veterans and more recently veterans from Iraq and Afghanistan wars.  These boys are just a little older than my oldest son so the maternal feelings kick in very strongly.   One young man I a seeing right now, several times a week for wound care needs can be pleasant and sociable and then the next day can be as dark as a black hole, PTSD is a terrible thing.

Unfortunately, not everyone wants chatty Kathy in their ear when I am doing wound care or checking a BP, I have learned to be quiet when I need to.  Quietness can be an important therapeutic tool when dealing with "difficult patients".  It gives a person control of what to say and when.  Its hard as heck for me to shut up sometimes but it is valuable to hear what comes back.

Now, if I could just learn to do that at home!!!!!