Wednesday, August 30, 2006
book reports: Cutting Remarks, Nursing America, and Forensic Nurse
A selection of the health-care nonfiction I've read recently.
Cutting Remarks: Insights and Recollections of a Surgeon
by Sidney M. Schwab
Dr. Schwab is a well-known blogger who has written a book reflecting on his medical career. I checked out his book after I read someplace that he lives in Western Washington - which is a dumb reason to pick up a book, but I really enjoyed it, so I'm glad that the reason presented itself. There is a stereotype that all surgeons think they're God and are assholes to the nurses, the med students, etc... but either Dr. Schwab is an exception to the rule, or he's in deep denial. He writes about events in his career with a sense of wonder and humility. And he's had a lot of events, including a stint overseas during the Vietnam War. Best of all, the man is FUNNY. I really liked this book and am now a devoted reader of his blog, too!
Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital
by Sandy Balfour
I was excited to read this book based on the description - I haven't had any experience with the nitty-gritty of nursing in an inner-city hospital and so I'd like to learn about it. But while Balfour did a great job of portraying the personalities and convictions of the nurses he shadowed in Memphis, he shied away from the medical details. For example, I was intrigued by the burn unit nurse who said, "I love to clean a dirty burn!" but there was no following description of what she would actually DO. However, Balfour did hit on some very serious and pertinent issues in nursing in a public hospital, such as the constant budget strain, race relations, noncompliant patients, and the stress of working under all of those pressures and more.
Forensic Nurse: The New Role of the Nurse in Law Enforcement
by Serita Stevens
This book was informative, but I didn't think it was very well written. I did learn a lot about an area of nursing I had previously not been aware of - forensic nursing. Forensic nurses contribute to law enforcement by collecting evidence and testifying in court. For example, a forensic nurse might examine a rape victim and testify about the evidence that she found at trial. Or an FN might examine a child or vulnerable adult when abuse is suspected, or even examine a corpse for evidence of homicide. The case examples were very interesting and did a great job of clarifying the role of the forensic nurse. However, the book could have used a tighter edit - it was kind of repetitive and I was distracted by the "political" remarks that the author made. I don't mean political as in about government politics, I mean political as in airing complaints about different factions in the nursing community. I found that a bit jarring. Overall, though, this book is worth a skim if you're interested in learning more about the field of forensic nursing.
Cutting Remarks: Insights and Recollections of a Surgeon
by Sidney M. Schwab
Dr. Schwab is a well-known blogger who has written a book reflecting on his medical career. I checked out his book after I read someplace that he lives in Western Washington - which is a dumb reason to pick up a book, but I really enjoyed it, so I'm glad that the reason presented itself. There is a stereotype that all surgeons think they're God and are assholes to the nurses, the med students, etc... but either Dr. Schwab is an exception to the rule, or he's in deep denial. He writes about events in his career with a sense of wonder and humility. And he's had a lot of events, including a stint overseas during the Vietnam War. Best of all, the man is FUNNY. I really liked this book and am now a devoted reader of his blog, too!
Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital
by Sandy Balfour
I was excited to read this book based on the description - I haven't had any experience with the nitty-gritty of nursing in an inner-city hospital and so I'd like to learn about it. But while Balfour did a great job of portraying the personalities and convictions of the nurses he shadowed in Memphis, he shied away from the medical details. For example, I was intrigued by the burn unit nurse who said, "I love to clean a dirty burn!" but there was no following description of what she would actually DO. However, Balfour did hit on some very serious and pertinent issues in nursing in a public hospital, such as the constant budget strain, race relations, noncompliant patients, and the stress of working under all of those pressures and more.
Forensic Nurse: The New Role of the Nurse in Law Enforcement
by Serita Stevens
This book was informative, but I didn't think it was very well written. I did learn a lot about an area of nursing I had previously not been aware of - forensic nursing. Forensic nurses contribute to law enforcement by collecting evidence and testifying in court. For example, a forensic nurse might examine a rape victim and testify about the evidence that she found at trial. Or an FN might examine a child or vulnerable adult when abuse is suspected, or even examine a corpse for evidence of homicide. The case examples were very interesting and did a great job of clarifying the role of the forensic nurse. However, the book could have used a tighter edit - it was kind of repetitive and I was distracted by the "political" remarks that the author made. I don't mean political as in about government politics, I mean political as in airing complaints about different factions in the nursing community. I found that a bit jarring. Overall, though, this book is worth a skim if you're interested in learning more about the field of forensic nursing.
Labels: book reports, medical, nursing
Tuesday, August 29, 2006
book reports
I have a huge backlog of books that I've already read but haven't written up, and it occurs to me that I'm starting 9 months of school in a few weeks and I don't really see myself doing a lot of book reporting in that time... so prepare yourselves for a great deal of literary rambling. If book reports bore you, come back next month when I'll have interesting nursing stuff to talk about.
But before I turn back into my former lit major identity, I want to write some more about working with hospice patients. I know it's too early in my nursing student experience to declare what I want to do - but I really think I like working with people near the end of their lives. Putting that down in black & white sounds kind of morbid, but my most satisfying caregiving experiences have been with patients who are on hospice or about to die.
I've already written about Hospice Lady, who I think is just holding on because her children are going to come visit her soon. There was also Tired Lady, who went rapidly downhill and passed away peacefully in her sleep (my name for her refers to the fact that over the last week of her life, every time I asked her how she was feeling, she said "I'm just so tired." I think she was just done, you know?). I was one of her caregivers during that week and while it seemed obvious to me that she was going to die, her family and her doctor didn't seem to notice. Interestingly, her children called me every time she needed anything at all - help to the toilet, changing a soiled nightgown, eating some food (although they were successful in getting Tired Lady to come up with something that sounded good to eat), getting dressed, whatever. Of course I was glad to do all of it - but it was neat to have this moment of "aha! that's why I'm here! Her family is dealing with emotional stuff and baggage and can't just take care of her, so I will!"
And finally, the last couple days I took care of Bedridden Lady who was given less than a month to live... six months ago. She is basically unable to bear weight on her limbs and can barely speak, and spends most of her time in bed. I didn't do anything heroic while caring for her - I fed her and changed her and put lotion on her face and cleaned her mouth and put some moisture goo on her lips and opened the blinds when she gestured toward the window. And all I got in return was some smiles and a couple of "thank yous" - but that was more than enough.
I know a lot of people are creeped out by caring for patients who are near death - and even my husband has asked me if I'm setting myself up emotionally by getting attached to terminal patients. But I'm not. When Tired Lady passed away I felt relieved for her - she was just so tired, and now she can rest. And when Bedridden Lady and Hospice Lady pass on, I will be relieved for them, too. I will miss Hospice Lady but I know she's ready to die, and that death will not be a sad thing for her. And spending time with her near the end of her life has been a joy for me, and for her - I know because she tells me! It is really, really rewarding for me to be present with these people.
Who knows, I may end up feeling this excited about other areas of nursing as well. Which is why I won't make up my mind until I've been through all my clinical rotations... but I have to say, I'm really drawn toward hospice work.
But before I turn back into my former lit major identity, I want to write some more about working with hospice patients. I know it's too early in my nursing student experience to declare what I want to do - but I really think I like working with people near the end of their lives. Putting that down in black & white sounds kind of morbid, but my most satisfying caregiving experiences have been with patients who are on hospice or about to die.
I've already written about Hospice Lady, who I think is just holding on because her children are going to come visit her soon. There was also Tired Lady, who went rapidly downhill and passed away peacefully in her sleep (my name for her refers to the fact that over the last week of her life, every time I asked her how she was feeling, she said "I'm just so tired." I think she was just done, you know?). I was one of her caregivers during that week and while it seemed obvious to me that she was going to die, her family and her doctor didn't seem to notice. Interestingly, her children called me every time she needed anything at all - help to the toilet, changing a soiled nightgown, eating some food (although they were successful in getting Tired Lady to come up with something that sounded good to eat), getting dressed, whatever. Of course I was glad to do all of it - but it was neat to have this moment of "aha! that's why I'm here! Her family is dealing with emotional stuff and baggage and can't just take care of her, so I will!"
And finally, the last couple days I took care of Bedridden Lady who was given less than a month to live... six months ago. She is basically unable to bear weight on her limbs and can barely speak, and spends most of her time in bed. I didn't do anything heroic while caring for her - I fed her and changed her and put lotion on her face and cleaned her mouth and put some moisture goo on her lips and opened the blinds when she gestured toward the window. And all I got in return was some smiles and a couple of "thank yous" - but that was more than enough.
I know a lot of people are creeped out by caring for patients who are near death - and even my husband has asked me if I'm setting myself up emotionally by getting attached to terminal patients. But I'm not. When Tired Lady passed away I felt relieved for her - she was just so tired, and now she can rest. And when Bedridden Lady and Hospice Lady pass on, I will be relieved for them, too. I will miss Hospice Lady but I know she's ready to die, and that death will not be a sad thing for her. And spending time with her near the end of her life has been a joy for me, and for her - I know because she tells me! It is really, really rewarding for me to be present with these people.
Who knows, I may end up feeling this excited about other areas of nursing as well. Which is why I won't make up my mind until I've been through all my clinical rotations... but I have to say, I'm really drawn toward hospice work.
Labels: CNA, nursing, nursing school
Wednesday, July 12, 2006
hospice
One of my residents who is on hospice told me she was ready to die.
She is very weak and mostly incontinent, but is still able to get around a little in her wheelchair. She takes pleasure in spending time with people, passing out hugs and kisses in the dining room like a politician running for office. She has very little appetite but still eats a bit at each meal. She has some memory loss but is perfectly capable of holding a conversation and expressing herself appropriately.
Last weekend I worked the evening shift on the floor where this resident lives. And when I was getting her ready for bed, she told me she wanted to die. I took a deep breath and said, "you feel like you're ready?" and she said yes. I sat down and took her hand, and said "It sounds like you're tired of the way things are now." And she exclaimed, "Yes! I'm exhausted!" I told her I could understand why she might feel that way. She got very quiet for a few minutes and patted my arm and petted my hair (I have long hair and was wearing it in pigtails) - she seemed to find the touch reassuring. Then she said, "Maybe I just won't wake up tomorrow." And I agreed, "Maybe you won't. Or maybe you will, and either way, whatever happens will happen." She smiled. I asked her what I could do for her before she went to sleep - she wanted a drink of water, and a hug and a kiss, and then she smiled again and said, "And hit me over the head with a baseball bat!" I couldn't help but laugh... but pointed out that I wasn't going to do that. She said, "Well, I don't have a baseball bat anyway."
I sat with her for a little while longer just holding her hand. She told me after a few minutes that she would be able to sleep. So I kissed her goodnight again and went on my way.
How did I do handling this situation? I wanted to make it clear that it was okay for her to talk with me about dying, that I wasn't uncomfortable or creeped out. She seemed comfortable with my response.
She is very weak and mostly incontinent, but is still able to get around a little in her wheelchair. She takes pleasure in spending time with people, passing out hugs and kisses in the dining room like a politician running for office. She has very little appetite but still eats a bit at each meal. She has some memory loss but is perfectly capable of holding a conversation and expressing herself appropriately.
Last weekend I worked the evening shift on the floor where this resident lives. And when I was getting her ready for bed, she told me she wanted to die. I took a deep breath and said, "you feel like you're ready?" and she said yes. I sat down and took her hand, and said "It sounds like you're tired of the way things are now." And she exclaimed, "Yes! I'm exhausted!" I told her I could understand why she might feel that way. She got very quiet for a few minutes and patted my arm and petted my hair (I have long hair and was wearing it in pigtails) - she seemed to find the touch reassuring. Then she said, "Maybe I just won't wake up tomorrow." And I agreed, "Maybe you won't. Or maybe you will, and either way, whatever happens will happen." She smiled. I asked her what I could do for her before she went to sleep - she wanted a drink of water, and a hug and a kiss, and then she smiled again and said, "And hit me over the head with a baseball bat!" I couldn't help but laugh... but pointed out that I wasn't going to do that. She said, "Well, I don't have a baseball bat anyway."
I sat with her for a little while longer just holding her hand. She told me after a few minutes that she would be able to sleep. So I kissed her goodnight again and went on my way.
How did I do handling this situation? I wanted to make it clear that it was okay for her to talk with me about dying, that I wasn't uncomfortable or creeped out. She seemed comfortable with my response.
Labels: CNA, nursing, nursing school
Monday, June 19, 2006
not a CNA, not yet a nurse
Do you have Britney Spears in your head now? No? Then go back and read the title of this entry again.
Today was my first day training at the Old People Hotel. I've been away from the CNA role since April 1st, which really isn't that long. And I've had 10 weeks of nursing school, which really isn't that much. And yet I found today that I feel completely differently about the CNA job than I did in April.
The girl who trained me is actually one of my classmates from my CNA training class last fall, which was a nice surprise - it was nice to see a familiar face in a new setting. But I was very much struck by the attitude of "getting my work done" that all the CNAs showed - not that they are uncaring or abusive to the residents in any way. But instead of putting the residents' well-being first in their minds, they are more concentrated on finishing their tasks on time. That is such a contrast to the conditioning we've gotten in nursing school, where we are taught to be primarily concerned with the client's needs and preferences even if that makes our job harder. (Up to a point, obviously.)
I think I was probably somewhat this way before starting nursing school, although I'd like to think that I was more attuned to what my residents wanted and needed. I guess it was easier at The Home because the residents were for the most part more "with it." So it was easier for me to remember to respect their individuality, because they would remind me.
In any event, I'm pretty sure that what my nursing instructors would tell me to do is to model the behaviors that I believe to be correct. So I will model good teamwork, respectful treatment of residents, and personal responsibility. And I will earn my stardust ('cause you sure can't call a CNA's wage "money") and keep my head down until it's time to go back to school.
Also, I went to the gym and worked out after work - and then soaked in the hot tub for my aching feet. I am not used to be on my feet 8 hours a day anymore.
Today was my first day training at the Old People Hotel. I've been away from the CNA role since April 1st, which really isn't that long. And I've had 10 weeks of nursing school, which really isn't that much. And yet I found today that I feel completely differently about the CNA job than I did in April.
The girl who trained me is actually one of my classmates from my CNA training class last fall, which was a nice surprise - it was nice to see a familiar face in a new setting. But I was very much struck by the attitude of "getting my work done" that all the CNAs showed - not that they are uncaring or abusive to the residents in any way. But instead of putting the residents' well-being first in their minds, they are more concentrated on finishing their tasks on time. That is such a contrast to the conditioning we've gotten in nursing school, where we are taught to be primarily concerned with the client's needs and preferences even if that makes our job harder. (Up to a point, obviously.)
I think I was probably somewhat this way before starting nursing school, although I'd like to think that I was more attuned to what my residents wanted and needed. I guess it was easier at The Home because the residents were for the most part more "with it." So it was easier for me to remember to respect their individuality, because they would remind me.
In any event, I'm pretty sure that what my nursing instructors would tell me to do is to model the behaviors that I believe to be correct. So I will model good teamwork, respectful treatment of residents, and personal responsibility. And I will earn my stardust ('cause you sure can't call a CNA's wage "money") and keep my head down until it's time to go back to school.
Also, I went to the gym and worked out after work - and then soaked in the hot tub for my aching feet. I am not used to be on my feet 8 hours a day anymore.
Labels: CNA, nursing, nursing school
Friday, April 14, 2006
book report: Nurse; Nightingales
Nurse
by Peggy Anderson
I read this book while in a frenzy of nurse-book-reading last year. This was a tough read for me - while it was published in 1990, the author reminisces about her beginning years as a nurse in the early 1970s. Man, things were different then. Not only did she have to wear a ridiculous uniform, the (all male) doctors treated nurses like crap, and there weren't as many technological advancement to treat severely ill patients as there are today. The procedures and techniques she writes about are mostly obsolete today (like when she makes fun of other nurses for putting gloves on to do peri-care [that's butt-wiping for those of you not in the health care field]) - but the emotional experience of being a nurse has not changed. It's still tough to see your patients lose their battles with cancer or heart disease, it's still hard to get chewed out by a family members, and it's still rewarding when you realize that you've made a difference in someone's life.
I was chatting with the director of the nursing program yesterday about my reading habits, and she was pleased to hear that I'd read some of these not-so-recent nurse stories. She made the excellent point that some of the nurses who were trained in the 1960s or 1970s are still working in the field today, and knowing what their experiences were like may help me see things from their point of view.
Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale
by Gillian Gill
No nurse's historical background is complete without reading about Florence Nightingale. I personally didn't know much about her, just that she was considered the founder of nursing, and that she was known as the Lady with the Lamp.
The book begins with a detailed genealogy of Flo's parents and their families... which seemed boring to me but does have relevance later in Flo's life. One of the major familial themes has to do with the inheritance law in Great Britain at the time - since women could not own property in their own right, the ladies in the families were desparate to produce sons in order to preserve their own lifestyles. This sets the stage for Florence's mother's complete outrage when Florence refuses to marry. Florence had a sister, but no brothers, and so after the death of her father, her mother was out on her ear. Okay, not literally, but one of Flo's cousins inherited the family estate because Florence's mother could not legally inherit her husband's property.
Anyway, about the nursing stuff - it seems that Flo was always a very religious and very sensitive, guilt-ridden child. She decided quite early in childhood that she wanted to care for needy creatures, and took in countless pets. She also cared for her sister and her cousins (she was very close with many of her cousins) when they were ill, and seemed to take great pleasure in the act of caring. One theme that cropped up over and over in Flo's private writing was of her overwhelming guilt about some unnamed bad thing that she felt compelled to do over and over. I crassly interpreted that as masturbation, but the author believes that Florence had a deep tendency to daydream or fantasize, which took her away from the concerns of the material world, which caused her tremendous guilt.
Oh, right, the nursing stuff. Florence insisted on taking nurse's training, which caused her upperclass family no end of grief. At that time, nurses were either nuns (and the Nightingales were Protestant) or else they were "working girls" who were alleged to be drunken prostitutes and lousy patient advocates. Florence refused to back down and eventually her family gave in, reluctantly. After training, Florence immediately took on an activism role, advocating for sanitation, a healthy diet, and peaceful surrounding to help patients heal. During the Crimean War, British soldiers in Turkey were dying hand-over-fist, and with the help of her family's connection, Florence managed to get herself appointed to the hospital treating the wounded at Scutari. She loaded a ship with medical supplies that she convinced wealthy friends to donate, recruited a staff of women to train as nurses, and took off for Turkey. The Army's medical director was not impressed with Florence's demand that he give over operations of the hospital to her, but eventually changed his mind after she sad, mule-like, out on her boat in the harbor and refused to hand over the medical supplies.
Once she got inside the hospital, Florence insituted all kinds of changes. She insisted that each soldier needed his own bed with clean linens. She demanded that the dressings on the soldiers' wounds be changed regularly, and the wounds washed with soap and water and redressed with clean bandages. She insisted that the kitchen be sanitized, and that all the soldiers required a healthy diet to be able to heal. And most of all, she showed the wounded men that she cared, personally visiting each one of them. She got the name "The Lady of the Lamp" because she carried around a small lamp as she walked the wards at night visiting soldiers who couldn't sleep or needed comfort.
There's a lot more that Florence did to advance the profession of nursing. But since I'm not writing my own book on her, I'm going to stop there.
by Peggy Anderson
I read this book while in a frenzy of nurse-book-reading last year. This was a tough read for me - while it was published in 1990, the author reminisces about her beginning years as a nurse in the early 1970s. Man, things were different then. Not only did she have to wear a ridiculous uniform, the (all male) doctors treated nurses like crap, and there weren't as many technological advancement to treat severely ill patients as there are today. The procedures and techniques she writes about are mostly obsolete today (like when she makes fun of other nurses for putting gloves on to do peri-care [that's butt-wiping for those of you not in the health care field]) - but the emotional experience of being a nurse has not changed. It's still tough to see your patients lose their battles with cancer or heart disease, it's still hard to get chewed out by a family members, and it's still rewarding when you realize that you've made a difference in someone's life.
I was chatting with the director of the nursing program yesterday about my reading habits, and she was pleased to hear that I'd read some of these not-so-recent nurse stories. She made the excellent point that some of the nurses who were trained in the 1960s or 1970s are still working in the field today, and knowing what their experiences were like may help me see things from their point of view.
Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale
by Gillian Gill
No nurse's historical background is complete without reading about Florence Nightingale. I personally didn't know much about her, just that she was considered the founder of nursing, and that she was known as the Lady with the Lamp.
The book begins with a detailed genealogy of Flo's parents and their families... which seemed boring to me but does have relevance later in Flo's life. One of the major familial themes has to do with the inheritance law in Great Britain at the time - since women could not own property in their own right, the ladies in the families were desparate to produce sons in order to preserve their own lifestyles. This sets the stage for Florence's mother's complete outrage when Florence refuses to marry. Florence had a sister, but no brothers, and so after the death of her father, her mother was out on her ear. Okay, not literally, but one of Flo's cousins inherited the family estate because Florence's mother could not legally inherit her husband's property.
Anyway, about the nursing stuff - it seems that Flo was always a very religious and very sensitive, guilt-ridden child. She decided quite early in childhood that she wanted to care for needy creatures, and took in countless pets. She also cared for her sister and her cousins (she was very close with many of her cousins) when they were ill, and seemed to take great pleasure in the act of caring. One theme that cropped up over and over in Flo's private writing was of her overwhelming guilt about some unnamed bad thing that she felt compelled to do over and over. I crassly interpreted that as masturbation, but the author believes that Florence had a deep tendency to daydream or fantasize, which took her away from the concerns of the material world, which caused her tremendous guilt.
Oh, right, the nursing stuff. Florence insisted on taking nurse's training, which caused her upperclass family no end of grief. At that time, nurses were either nuns (and the Nightingales were Protestant) or else they were "working girls" who were alleged to be drunken prostitutes and lousy patient advocates. Florence refused to back down and eventually her family gave in, reluctantly. After training, Florence immediately took on an activism role, advocating for sanitation, a healthy diet, and peaceful surrounding to help patients heal. During the Crimean War, British soldiers in Turkey were dying hand-over-fist, and with the help of her family's connection, Florence managed to get herself appointed to the hospital treating the wounded at Scutari. She loaded a ship with medical supplies that she convinced wealthy friends to donate, recruited a staff of women to train as nurses, and took off for Turkey. The Army's medical director was not impressed with Florence's demand that he give over operations of the hospital to her, but eventually changed his mind after she sad, mule-like, out on her boat in the harbor and refused to hand over the medical supplies.
Once she got inside the hospital, Florence insituted all kinds of changes. She insisted that each soldier needed his own bed with clean linens. She demanded that the dressings on the soldiers' wounds be changed regularly, and the wounds washed with soap and water and redressed with clean bandages. She insisted that the kitchen be sanitized, and that all the soldiers required a healthy diet to be able to heal. And most of all, she showed the wounded men that she cared, personally visiting each one of them. She got the name "The Lady of the Lamp" because she carried around a small lamp as she walked the wards at night visiting soldiers who couldn't sleep or needed comfort.
There's a lot more that Florence did to advance the profession of nursing. But since I'm not writing my own book on her, I'm going to stop there.
Labels: book reports, nursing
