Friday, March 19, 2010

The Education of a Nurse

Since my time in the hospital recovering from heart failure I have been thinking of an incident that keeps coming back to the forefront of my mind. Of all the confusion, the multitude of activity, the gaggle of doctors and the swarm of nurses, this one small incident still seems to be something I think about from time to time.

Normally I would not have said much more about my enforced stay in the hospital for this is a blog on teachers and teaching and not about quiet wards for those returning to health. But this incident IS about teaching and perhaps that is why it craves attention.

As I have mentioned during my stay I was plugged into technology that was simply put, amazing. I had receptors/senders on much of me sending data to "Telebox Number 3" All sorts of people could review my essential signs and keep tabs on me although they might not be in the room at the time. You could take me to another room for tests or an operation and the data would click in steadily at "Telebox No. 3." I suppose it was some form of "Bluetooth" technology that allowed this wireless connection to the hospital world. Fascinating stuff when I was awake and able to focus on it.

One of the less desirable bits of technology was the use of a catheter which went directly into the bladder. If you don't mind, I will let you figure out how this is done. But the result is that the patient does not have to leave the bed. The RN (highest on the nursing continuum) would measure flow, amount, color, time and I have no idea what else but from my point of view it was uncomfortable and it limited me to the bed or nearby chair. To have this device removed was high on my list of priorities. I asked my RN how and when can I get this device removed? He checked with the supervising physician and was given an okay to relieve me of this further discomfort. Hot damn!

There is little chance for modesty in a hospital especially in the gowns that they have you wear. Opened at the back and at a length that would delight a runway model, they leave little to hide. But I had a male RN--I was cool. Until......he came in and asked if I would mind if the young lady following him around who was a student nursing intern could do the job of removing the catheter from my....... I remember thinking that this young lady was a student nurse--she was learning. And I believe in education and learning. As much as my embarrassment might be I consented to her doing the deed.

The RN told me that the nursing intern had done this several times in a class (not on a real person) and that the Professor of Nursing would be supervising. I could see Jennifer, the nursing intern studying small flip charts from my hospital room. She was very intent on reviewing the procedure. I was very nervous and tense.

Shortly afterwards, the young intern came in. She thanked me for allowing her to do this and it was obvious she was as tense about all this as I was. Then the Professor of Nursing, an older lady, came in and was on the cell phone saying, "I'll be right there." Then she told the intern what equipment was necessary and how to attach this new device necessary for the removal of the catheter. The young lady did everything correct and while the Nursing Professor watched she also answered another cell phone call. Busy lady that professor. My young intern did the job and removed the catheter--I was free! There is no question in my mind that both the nursing intern and I was quite relieved that the process was over and that she had done well. Some of my modesty was restored. I now could go to the bathroom with some degree of dignity. The intern thanked me and I remember telling her "I thought you did a good job--thank you from me." She smiled and left but didn't say anything--I suspect still tense. The nursing professor had left almost immediately after the task was completed. Remember this point--it is important to me in what follows and why I keep remembering this incident.

Some time later my regular RN showed up probably to give more medications or to measure some data about me. And dutifully behind him was the nursing intern I suspect looking a bit relieved. I asked her, "would you mind my critiquing what went on today? I would normally do that with my student teachers." She agreed but I made sure she understood that my comments were for learning, NOT criticism. I remember saying to her something like the following"
1) it would have been good to have all your supplies (devices, warm cloths) with you.
2) I think you might have told the patient (me) what you were going to do and what the result would be.
3) Maybe ask the patient if this was alright and were there any questions?
4) Do the procedure and dispose of equipment.
5) Ask the patient how he/she is doing? Feeling okay?
What I didn't say and wish that I had was, "What could I have done better for you as a patient?"

Jennifer listened to me and agreed that my comments indicated a more professional approach to all this procedure. She thanked me and I felt that she took the critique well and that we had a positive interaction. I also told her that I thought she was going to make an excellent nurse. I truly believe that--I know students well enough. Later on the RN came by and mentioned that Jennifer had said positive things our our conversation.

I wish to make a major point here. Had the nursing professor had told Jennifer to some if not all of those items I just mentioned in my critique we would have set her up for success. Success breeds success. Jennifer and I had a positive outcome regardless but some coaching from the professor, she could have been assure of success. We were lucky. You don't throw a student out in deep water without assistance. I think my follow up with her will assure her of positive values going into the next stressful situation. I also think the professor needed to follow up with "nice job, well done." The intern needed a pat on the back. Taking out the catheter is a psycho-motor task with some cognition thrown in. This situation at the end needed the affective domain stuff (values/feelings).

Now in defense of the nursing professor. Interns, student teachers and nursing interns are a high maintenance student. Five or six student teachers would be a teaching load for me but college administrators want to see class loads of thirty to sixty students. The state legislature wants to see how hard college professors are working and if they see that a prof has only five students they get upset. I do not know how many students this nursing professional had to supervise--probably more then she needed. Still I am concerned when we put our students into stressful situations and not give them the support that they deserve.

Remember, if you set your student up for success it will be easier in the long run. Look at yourself for a moment. What do you like to do? Whatever it may be you are probably good at it. You're happy with the outcome and you have the skills or knowledge to cope with the situation. Success begets, breeds, promotes, ensures success. Isn't that what we want? Successful students.

I wonder which of my professors put me on to this success behavior. I really would like to thank them for this important piece of learning. And thanks to all the teachers who are making sure their students learn something successfully.

No comments:

Post a Comment