Ra'Phils Blog

Name:
Location: Australia

I am a Registered Nurse with 2 children, both under 6 and a wonderful husband.

Sunday, June 26, 2005

It's Party Time

~
Seems like party time all round - Finishing my studies, daughter's birthday....

Yesterday, we had a birthday party for my daughter. She will be 5 next Wednesday, but as we are going away, and had previously promised her a party, we had it a few days early.

I sat her down for a talk on behaviour and how we would take her home and leave her friends to enjoy her party without her if she played up. She was very well behaved - no grumps, tried to play with everyone, and politely said thankyou for all of her gifts. YEAH!! We had it at an indoor playground which meant food was provided, the play equipment was provided and I didn't have to clean up any mess - and BOY what a mess!! The only thing we did wrong in the end, was we forgot to drive both cars to the location of the party, and that meant R couldn't play on after her party as we had to get her brother home for a much needed sleep.

We fly to Adelaide on Monday morning @ 6:00am. That is the plane is scheduled to fly out at 6:00am, which means we need to head to the airport at 5:00am, get the kids up at 4:30am and get up ourselves at 4:00am - ewwwwwww!!

See you in a week :-)
~

Wednesday, June 22, 2005

Last exam.......I hope!!

~
Last night, my husband tested me with 24 A4 pages of questions I had set......my memory was appalling, and I just kept drawing a blank. I couldn't believe I had already read all of this stuff a few times, but couldn't remember any of it. So I sat up late last night reading the answers to my questions again, and then again first thing this morning, and again just before the exam. In the end, I felt nothing was sinking in, and each time I read something, it was like reading it for the first time :-(.

I was just about having a Panic Attack before the exam - which was one of the conditions I was about to be examined on!!

Standing out the front of the examination room, one of the girls from my tutorial group told me she no longer knew what she really knew and what she didn't - nothing was sticking. So I knew I was not alone - but, she didn't have a job riding on passing this exam!! She had the option of a supplementary exam to fall on if she failed today.

Started the reading time of the exam, and as always, I started answering the multiple choice. Some I knew - some I guessed, so nothing unusual for an exam. As there were only 20 multiple choice, I was finished with time to spare, so I started reading the short answer questions.

Suddenly, it was like my brain exploded into gear and I couldn't read more than the first case study, as I already had too much information bursting at the seams to get out. So I did something I didn't usually do - I started writing my thoughts onto the scrap paper so I didn't lose anything while I kept reading. It was the longest 10minutes of reading time I have ever experienced, but it was only 10minutes, no longer.

Then I could finally start writing on the exam paper, and I ended up with a cramp in my wrist and fingers from holding the pen and wrist ridged while I was writing so much.

There were a few questions that I didn't answer too well, but on the whole, if I have not passed this exam - then I have totally missed the point of ALL of the questions!!

I'm going to be REGISTERED soon!! :-D
~

Monday, June 20, 2005

Today's Research Exam

~
Today I needed 23 marks out of 120 to pass the Research subject overall.

I went into today's exam feeling confident about doing well. When I came out, I was still sure I had passed the whole subject, but wasn't confident about how I have done in the exam. They gave us the 2003 exam as a guide, but that exam was easier than today's and the short answer questions on the 2003 exam were not along the same lines as today's at all. In fact, the one area I told my husband I have been having trouble with in this subject, turned out to be the main area for the short answer questions. I tried to 'wing it', but don't think I have accomplished that. The short answer questions were worth 67 marks, and the multiple choice 53. I do still think I gained enough to pass though - and that is all we have to do in the end.

People keep saying P's get Degrees!! I have never had just a P, so this may be a first :-).

No rest for the wicked though, I have to study for Wednesday's now :O!!!
~

Sunday, June 19, 2005

Quick break from studying.....

~
Had to take a quick break from studying to post this link It is a site with over 50 illusions. Just click on one of the illusions and a larger picture of the illusion shows up, including what to do and an explaination as to how it works. Very nifty.

The eyes that follow your mouse around while you are trying to chose which illusion to click on are a bit freaky though :O.

Thanks wohba.

Back to study......
~

Wednesday, June 15, 2005

Studying for exams!

~
It is that time of the year again. EXAMS!!

The study is going ok. I have been going through questions from the semester during the day for my Integrated Nursing Exam; and at night, have been trying to read for the Research Exam......trying. The thing is, just sitting down and reading, reading, reading about Research stuff is quite boring. But, I have to do it.

On another note, is has rained the past 2 nights here. Wow - not only is it unusual for it to rain at all, but right now is supposed to be our dry season. When they say dry season, they really mean DRY. It hasn't bucketed down, but has been a bit of rain to keep lawn looking green for a bit longer. Still T-shirt & shorts weather though :P.

We are heading away from 27th June to 5th July. I am looking forward to our trip for a couple of reasons. I want to catch up with family and friends; I want R and PAC to rediscover some of their relatives; and I want something to take my mind of my results which don't come out until 11th July. So, the trip will take up most of that waiting period.

R is very happy at the moment, as since I finished placement she has been allowed to sleep in and not go to daycare until 9:30am. It is about an hour later than I would have taken her while studying for exams, so I don't feel I am missing a great deal of study time. I have to keep reminding her that once I start work, she will be going early again. R's sleep-in is about 7:30am and PAC still wakes around 7am.

Back to study.....
~

Saturday, June 11, 2005

4th & 5th day, 2nd week MH placement

~
Imagine this:

You are 19, have never stayed in ANY hospital before and don't know anything about the Mental Health Act. You have seen a psychiatrist in the community for a few weeks and he suggests you coming into a MH hospital for a few days assessment to see if what you are experiencing is depression or bipolar. You agree, pack your own bags and come into hospital voluntarily, accompanied by your mother.

Once in the hospital, you spot some weird looking people and become a little frightened about the 'open ward' which you are staying. It becomes worse as you realise you are in a shared room, and your mother will not be able to stay with you. So you decide staying wasn't such a good idea after all, and tell the staff you will leave with your mother. That's fine, isn't it?? After-all, you did decide to come here all by your self - you can leave at any time can't you?? - WRONG!!

What happened to this girl last Thursday, was her nurse notified the doctor that she was planning to leave. So the doctor consulted with another psychiatrist, who agreed that something called "Assessment Documents" be put in place. Assessment documents are a temporary legal way of making a patient 'Involuntary' while assessment of their mental status is performed. A doctor and a nurse each complete a separate form, stating they believe the person should be kept for 24hrs to assess their mental status. Then the doctor went back to the girl to explain it to her.

How would you react to being told you coudn't leave a hospital you had voluntarily entered??

The girl started yelling and crying and trying to pick up her suitcase and walk out the door. She then made a mistake of threatening self-harm if they kept her in. Unfortunately, she wouldn't have realised that is the worst thing she could have done, was threaten to harm herself (or anyone for that matter). It just gave the doctor and nurse conviction that they had done the right thing.

So Security were called, and we waited outside while one of the male MH nurses went into her room and talked to her nicely about going to our secure unit. Because she had been threatening to run away and self harm, they were moving her into the locked section to make sure she couldn't go anywhere. Unfortunately, the locked section is full of crazy people - one in particular would not have been nice for her to meet at all. When he isn't flashing, he is trying to punch someone and usually ends up in the 'seclusion' room each night for a while. The seclusion room has a mattress, padded walls and nothing else.

The male MH nurse finally convinced the girl to go over to the locked section, and he would get a second oppinion on her assessment documents. So the girl had to endure being escorted by her mother, 2 nurses and 2 security men over to the locked MH unit. It is actually called Psychiatric Intensive Care Unit (PICU). They gave her a chance to calm down in there for a while, and when another person turned up, who was needing a bed in that unit more than the girl, they moved her back onto the open ward. By this time, the open ward had been locked down for the night - so she wasn't going anywhere anyway.

Poor girl - even if she does have Bipolar, that was a terrible experience for her to have, for her first time in any hospital.

On Friday, she was seen by a senior Psychiatrist (a consultant) who decided she would be better off at home, as she usually was not a danger to herself or others and did not wish to stay. That really was the best thing to do. It was one thing that she was willing to come in and be assessed for a few days, but once she changed her mind, it was only if she was a danger to herself or others that would mean she needed to stay.

*********************************************

Friday - last day of placement and last day being a nursing student on a ward!!

There was four of us on the morning shift on Friday. I can't say we did a real lot. A bit of running around for other nurses, a few beds, and chatted to a few patients. That was pretty much it. At 11:45am, we left for lunch and came back at 12:45pm to get ready for our psychosocial presentations at 1:00pm. This went off without a hitch, and we then had a group (14 students) debriefing at 2:00pm. Then I went to the university (which is next door to the hospital) and dropped off my clinical placement paperwork. All done!!

Now to study for exams!!
~

Thursday, June 09, 2005

2nd & 3rd Day, 2nd Week - MH Placement

~
Tuesday was an interesting one, as we had a lady who does have depression - there is no doubt about that, but she is also an attention seeker. How do we know this?? Because she would target Staff members, walk up to them and drop onto the floor in front of them - sometimes grabbing them on the way. She had done it at least four times, two of which to my preceptor, and then once I was walking along behind her and she looked behind, saw me there and started staggering down the hall as though about to fall. Then she did manage to fall down in front of the other student and was then unceremoniously hauled off to her bedroom by two nurses either side of her, holding her in a 'special' grip. She tried to lift her legs and fall again, while they had her in this hold, and a third nurse grabbed the top of her shorts from behind and basically gave her a wedgie all the way back to her room through holding her up by her shorts. That was the last time she did it on that shift. The next shift, she tried falling again in the hallway, and the nurses just left her on the floor and told her to get up when she was ready - she did. We would have done that, but for us, she always chose to fall in the doorway of the office and block the doorway with her body.

So most of Tuesday was spent dealing with that.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Wednesday, we had a couple of new admissions. One was an older male who thinks he has done something 13years ago which he is going to be murdered for soon. Because of this, he is very distrusting of all staff. This means he could potentially be dangerous if he feels his life is threatened by a staff member or visitor who (he may perceive to ) look at him differently. The other side of the coin, is that he seems to think he deserves this impending murder, so he is resigned to it. Now, some may argue that he may have actually committed this crime, and any parents of daughters may think he deserves to die if he did, but so far we have no proof he has done anything wrong. He also has a very long history of schizophrenia, and has been off his medication for some time, so the doctors want to wait until his thinking is clearer with medication before tackling this possible crime he may have committed.

Another admission was a male, around 30 with severe depression. This man just can not function, and my heart went out to his wife - who has just seen the man she loves plummet to monosyllable conversation, absolutely no smiles/laughter of any kind, not eating, and completely dependant on her to be told to even get out of bed in the morning. She is trying so hard to be supportive, but she also can't understand what has happened to this man. He used to play sports also, but now he barely gets dressed in the day and isn't the slightest bit interested in things he used to love. Now that is a textbook case of depression. I had seen it in previous hospital admissions for medical reasons, but this was the first time I have seen someone in such a state that I am positive his suicidal risk would have been rated as 'very high' (once his anti-depressants kick in, as he probably can't be bothered even with suicide right now).

A couple of admissions takes up a lot of the shift and we did have a third who believes in conspiracy theories and that we are all trying to poison him and the government has cameras in all buildings in every nook and cranny. He was interesting, but even the psychologist says he is plain mad!!

That was Wednesday - an interesting, sad and different shift.
~

Monday, June 06, 2005

1st Day, 2nd Week - Mental Health Placement

~
I saw ECT today. For those that don't know, that is electro-convulsive therapy. So now I am about to detail what happens - if you don't wish to know, please stop reading now:

The client comes into the room and lies down on the hospital bed. An anaesthetist, an anaesthetic nurse, a Doctor and a MH nurse greet them and takes their Blood Pressure, Oxygen Saturation, Pulse etc and makes sure they have emptied their bladder. The client then has an IV cannula put in and the Doctor puts the electrodes on while they are given gas/oxygen. Once they have taken enough gas/oxygen, they are given 2 anaesthetic drugs intravenously and by then they are under. Then the Doctor flicks a switch and they go into a seizure. The MH nurse times how long the seizure occurs visually, while the Doctor times how long the seizure occurs on the machine delivering the therapy.

Once they have finished their seizure, the anaesthetist starts bringing them out of sedation, and they are transferred to recovery. Then their Blood Pressure, Oxygen saturation, Pulse and consciousness levels are monitored every 10mins for the next 30mins, after which they are usually fully awake and able to eat a sandwhich.

That is ECT. Nothing like the old days, where the person was not anaethetised and they had the seizure fully awake.

There are many arguments for and against ECT, but for some people, it has worked wonders. One woman was catatonic - and after even her first ECT, she was moving about which was unheard of beforehand.

One person who received ECT today, the team were going to recommend they discontinue the treatment, as they had not improved at all, so it was a waste.

Last week, we had two clients go missing from the ward (ie, they absconded). Today, I stopped one more from occurring. I was sitting by the window, waiting with a client who was about to go into ECT, when I spotted one of the regular absconders in the carpark, ambling along - backpack on her back. So I alerted a couple of nurses, who went and brought her back :D.

That was Day 1, 2nd Week.
~

Friday, June 03, 2005

Day five - Mental Health Placement

~
K went home today. She was not happy about it, but the MH unit felt there was not anything they could do for her. They have given her the breathing techniques, set up supports and counsellors in the community - now the rest is up to her. She gave me a carnation before she left, which was very nice.

This evening was a bit haphazard. We admitted a new patient into the bed K had just vacated. In fact, this client had been sitting in the foyer for a few hours, waiting for K to leave and for us to redo her room. So it was quite interesting that one client had arrived hours before the other had left. But it was like that all over the ward. They were discharging a heap of clients and also had a heap of admissions waiting in the wings. So the night seemed to be full of paperwork for both the discharges and admissions.

My Husband and 2 children came for tea with me at work tonight. I only get 30mins, so that went VERY quickly. I think if we did that again, I would have him get tea beforehand, to save time getting it after my 30mins starts.

It was nice having tea with them, but R got a bit clingy towards the end, and PAC wanted to be held as we were walking back towards the MH unit. So I was holding PAC in one arm, and holding R's hand all the way back to the car. R then got upset that I wasn't coming home, and I think I got a taste of what it is like for the clients who have their children visit and leave :-(. But I still got to come home at the end of the night - they don't.

It was still interesting tonight, even with all of the paperwork.

End Day 5, now for the weekend.
~

Thursday, June 02, 2005

4th Day, Mental Health Placement

~
Hmmm, what can I say....

I had asked the PTSD woman (hereafter I will call K) about using her for my psychosocial history I have to do on a client. She said yes, so in I went today, armed with my questions I had to ask her.

When I first saw her, she was flat - VERY FLAT. K had been alone for most of the day thinking and when she starts thinking about her past, she becomes very depressed. She didn't want me to leave and didn't like the fact that she had a new nurse ie someone she didn't know, for that shift. I ended up sending her nurse down to meet her and fortunately, K accepted her. That seemed fine. I then alerted K's nurse (L) to the fact that K was having a shower, and that we had to limit her showers as she self-harmed when in the shower. That went ok - K did well, did not harm herself and got herself out - HUGE step forward.

Later, we had an abusive patient in the courtyard, who was upsetting the others, so I left to get help to remove the abusive patient. Well that was when the **** hit the fan. K let another patient upset her, went off and had a shower. I went looking for her and went to her room. I knocked on the shower door and asked if she was coming out shortly. Then I found L and let her know what was going on. L couldnt get to K straight away, so I went back and found K sitting on her floor, crying. She had a towel wrapped around herself and she admitted to me that she had self-harmed. I found L, and told her to go to K which she did, and then L went to get some Diazepam. (I hate Diazepam - so addictive, but /shrug). After we calmed K down, she showed me a letter she had written to the aborted baby, and explained she was going to bury it, hoping to bury her guilt about the abortion. The letter almost brought tears to my eyes, but I held it together. By this time, I had long decided to forget using her for my psychosocial history case-study.

L, K & I then spent time outside with K, and once the Diazepam kicked in, K became quite animated and easy to talk to. K then asked if we were going to do the interview soon, as she was still keen. Talk about my jaw dropping - I had thought she was in no condition to be bringing all of that stuff up, and here she was offering. So we went ahead and did it. She was very open, telling me about the abuse, rape, attempted suicides and self-harm leading up to her admission. We were talking for some time about her husband, family and other things. Finally, she decided to go into the courtyard for another smoke and I said my goodbye. I asked if she was ok (to be alone) and she stated she was fine.

One cigarette later, she was crying at the nurses station door, because she couldn't cope being alone :S. As one nurse put it, she has become a bit dependent on ME, as I spend a fair amount of time with her during the shift. She also asked when I would be back on (which is tomorrow night) and she was happy that L is going to be on in the morning.

So, the preliminary diagnosis for her is going to be depression, anxiety/panic disorder and possible dependent personality disorder. I would have to agree with all of those!! Especially being the recipient of the dependent personality part.

/Day 4
~

Wednesday, June 01, 2005

Day three - Mental Health Placement

~
Tonight I worked the late shift. That started at 2:30pm and finished at 11pm. It was a better day than yesterday, and by that I mean it wasn't as hectic. That meant, more time for the clients and more time to work out just what happens on a day-to-day basis in an Acute Inpatient Unit.

I talked more with the PTSD (raped at 19) woman. She opened up to me and showed me her writings about being raped, plus being sexually abused when she was 7 years old. 7 YEARS OLD!! Grrrr that makes my blood boil. We discussed the fact that she now has a 6yr old son and a 3yr old daughter (along with a 1yr old son) and how her past was affecting her present and future. We also discussed her obsession with the shower and how long it had been occurring, her anxiety attacks and her previous suicide attempts. In the end, I spent a long time with her, and missed helping with an admission they wanted me to be a part of. But I felt I couldn't leave this woman, who had opened up to me more than she had with the other staff that day. She had not shown any others what she had written about being sexually abused, so I did not want to just up and leave her.

I figured there will be plenty more admissions in the next week, that missing one tonight will not make that much difference in the end.

One thing I forgot to mention in the previous post, is that all staff carry alarms with them, which can be set-off in 2 different ways. If someone actually tries to remove the alarm from the wearer's clothing without removing it a certain way, that sets off the alarm. The second way is by pressing a button. The first way is good. If a person tells you to hand over the alarm, and tells you not to press the button, the wearer can remove the alarm the 'wrong' way and it goes off. It is a silent alarm too, it makes certain telephones around the hospital ring (and some staff wear the telephones). Those telephones then show up the number of the alarm which has been set-off and the location of the wearer.

The bad thing about this, is sometimes a person can accidentally set-off the alarm, (and we have been told a student usually does so) especially in the toilet if they remove the alarm and remove it incorrectly. So I expect the person who makes the alarm go off will be me :P

Anyway, that was day 3.
~