There are 10 discussion board postings by students. All I need is meaningful responses to the questions/comments posed by each student.

DB_Postings

There are  10 discussion board postings by students.  All I need is meaningful responses to the questions/comments  posed by each student.

1)Jami

We had a patient that was brought to the Emergency department from home. She was nonresponsive and they had to intubate her. She was transferred to the ICU unit where I was doing my clinical. She lives in the basement of her home and her grandson lives on the upper level. This lady was 77 years old and 600 lbs. She had been sitting on a heating blanket for a week, she had burns on her back, a stage 4 sore across her buttocks in the shape of an object, and a stage 3 across her Left hip in the shape of an object. Her vagina had sores. Lots of slough and eschar present. There were also maggots in her wounds to include her vagina. She had very poor hygiene and her hair was matted so bad that it had to be cut off right next to the scalp. Obviously this woman had not been checked on in at least a week or more. This was so bad that the couch had where she had been sitting had to be burned. Her children and of course the grandson were all around her crying and carrying on. I try not to sit in judgement on people, but where was this family for the 7 days she was sitting in her own urine and feces and burning her skin with the heating pad aquiring pressure sores and maggots. This lady had to go to surgery for debridement where they found the stage 4 and stage 3 sores. She was in so much pain! The doctor ordered a wound consult and Adult protective Services consult. I understand that the elderly are very hard to deal with sometimes. They are usually stubborn and set in their ways, but they still need to be looked after better than that. When she woke up and got extubated, it was obvious that she had somekind of cognitive deficit present. Whether dementia or Alzheimers, something was wrong with her. The family was very demanding, expecting us to do everything to help this lady. They were asking questions, getting mad when we did not cater to their every request, and just acting like they cared. I could not help but feel agitation towards them on the inside. Where was their love and affection days ago? Why were they not checking on her more often? The grandson did not even work, why did he not do a better job?  Why would APS allow this family to even be in this room with this lady? It was a sad situation knowing that this woman was doing so good in the hospital and would eventually go home again to the same situation. I really hope APS gets a handle on this situation. My question with this situation is, should this be treated like a child abuse suspicion case and the woman be separated from her family? Very rarely do I let my emotions get to me with the nursing job at hand, but this hit me hard.

2)Christine

There were not many times during my clinical experience that I felt I was looked down upon and treated like I was "less than" by the staff at the clinical facility but, there were a few. In one instance, a classmate and I had just taken a patient up to the floor from the ER. We were returning down the elevator, one of two that will fit the patient beds, with the now vacated bed to the ER when we stopped on one of the other floors. The elevators were small so the bed took up a majority of the space. When the doors opened there was a team of doctors with a patient on a bed. Being unfamiliar with the hospital and with the floors, we had no idea what was done on this floor or any idea where the team was headed. The lead doctor proceeded to yell at us to get off the elevator. He would not move and blocked the exit but demanded that we get out of the way. We were confused but compliant. He was unable to push the bed in to the elevator in time to make it before the doors closed. He got very upset with us and had to wait for the next elevator but never explained anything. We felt so angry because of this and frustrated with the lack of concern we had been shown. What do you think should be done in this situation?

3)Dilraj

 At the veterans affairs hospital, there is a client that is very disruptive on the unit. He suffered from a brain injury during his service. There is a daily occurrence that other vets come and complain about his disruptive behavior in the communal areas. One day a vet told the charge nurse and I that he was being disruptive and was threatening other vets with a butter knife. When the nurse and I got there she questioned him about his disruptive behavior and then slowly grabbed the butter knife out of his top shirt pocket. She then questioned him about the butter knife, but he denied using it to threaten other vets. She then allowed the client to stay in the communal area and told him to be more cooperative with the other vets. I didn`t understand why she wouldn`t take him back to Unit, because the other vets were asking her to. She then explained to me that the Vet suffered from a brain injury and he just wants to be able to socialize with other vets. She stated she doesn`t want to deny him of socialization. I was thinking how I would have probably handled the situation differently because I didn`t want the other vets to feel threatened. But I also understand why the nurse did what she decided to do. How would you handle this situation and what is your perspective on this issue?

4)Dilraj 2

During rotations, I have noticed some clients refuse treatment. I know that it is their right to refuse treatment, and we should follow their wishes. Some of the clients also have dementia, and sometimes cannot comprehend what is best for them. For example, there was a client who is refusing his wound dressing changes. His sister has been counseled by the staff and she states that she wants him to get the treatment because she doesn`t want him to lose his legs due to infection. She also spoke to her brother and he agreed with getting the dressing changes because he is scared of losing his leg. After that meeting, he still refused the dressing changes. How can one help the client in a situation like this?

5)Theresa

The VA facility I am completing my clinicals, my preceptor has a great holistic view in taking care of her nursing staff.  Every week she provides a meditation/tea time to create a time/atmosphere for her nursing staff to relax/destress from the demands of the nursing role.  During this time, she lays out her tea set, candles, aromatherapy scents and allows her staff 30 mins uninterrupted time to relax and have small talk with other coworkers.  I was able to participate in meditation/tea time and also see how the staff can benefit from this relaxation time.  Do any of you have experience whether at your workplace or clinical site in which a relaxation/meditation time is valued and provided for the staff?  Can you describe this time that is provided for the staff that you have experienced?

6)Theresa

 At the VA facility I am completing my clinicals, I had the opportunity to attend meetings with the nursing managers in which they discussed staffing shortages and daily staffing issues.  The nursing managers said many times the nursing staff has to work short because a few of the nursing assistants or nursing staff habitually call in sick or late causing an additional strain/extra workload into nursing staff that are present/responsible.  These unreliable nursing staff were hired as intermittents (on-call nursing staff) and are unable to be dismissed until a whole calendar.  These policies are built into the hiring/staffing VA system.  How do you think the VA can alter these hiring/staffing policies to relieve nursing strain/extra workload on the nursing staff?   

7)Amy

In a management meeting they were discussing the applicants that they have received for various positions.  Several nurse managers have said that they still need to fill jobs and have not been able to fill these positions for months.  Another person in management asked why they have not been filled and the response was that the applicants they have received are not good.  They had a discussion regarding they type of applicants and it was said that most are just not qualified or when they bring them in the person is not what they expected.  It was asked how do they get better applicants.  The responses was that no one wants to work there since the pay is extremely lower than other hospitals in the area, people tend to use the job as a stepping stone to get experience then move on to better paying job.  They said that the benefits are better than other places like; 5 weeks of vacation and 13 paid holidays a year.  One manager said that young people are after the money not the vacation since young people have kids and with low pay they would not be able to use the 5 weeks of vacation.  They were trying to think of ways to help them to get better applicants to apply for the positions.  What would be some things you look at when applying for a position? What could this facility  do to get people to apply and stay at the facility?  (I have to say that I have enjoyed myself at this facility, everyone is very nice and helpful.  It is a great place.)

8)Jamille

Towards the end of my clinical rotation, I have witnessed one of the most common conflicts in the nursing profession. I was assigned to this RN who had a not so good reputation not only in his permanent unit but also in the other units. He is known as being lazy and usually the nurses have a hard time looking for him throughout the shift. He let me do all the job while he was just sitting in the computer looking at cars. He never left his chair unless it was really important. He let me run all over the station to do all the stuff for the patients. The following week, I was assigned to another nurse and she even made a comment that that nurse was lazy and always hides in the rooms. His patients` family wanted to speak to him so the charge nurse paged him twice but never came. I never complained to him or to other nurses since I did not want to cause any conflicts in the station and I was only there for a couple of weeks. How would you have approached this situation?

9)Erin

One of the things that I have enjoyed about my clinical rotation is that I’ve gotten to be part of many meetings between managers and staff. I’ve been  A day last week the unit manager and my preceptor who is a Clinical Nurse Leader for the unit were discussing a the performance of a new staff nurse who was butting heads with some of the more experienced nurses on the floor. Some of the more experienced nurses may have only had an AND, but some of them had been nurses for over 30 years and the manager respected their experience. The new nurse has only a year’s experience, but has a master’s degree. His attitude toward the experienced nurses was that he knew everything he needed to know. This was unacceptable to the floor manager because she wants to have a culture of shared and growing knowledge among her nurses. The VA where I’m doing clinical hours at is a teaching hospital and she embraces that. They have many nursing schools, medical students and ROP students there to learn, and she explained that she doesn’t want the knowledge sharing and learning to stop with the students; she wants her staff to be strong because they can build upon each others skills.  In her meeting with the new nurse she expressed these sentiments to him. Suggest team-building strategies that would reinforce the team as a teaching/learning unit. Do you think that being a good teacher to your fellow staff warrants being assessed during yearly performance reviews? Should your ability to be a good team teacher/learner contribute hiring or firing even if you are a good nurse? Is this philosophy unique to this department?

10)Erin 2

I’m nearly done with my clinical hours, but I’m might face some of these same challenges once I go back to work; so I’ll consult with all of you fine people to gain some insight into the kind of self care you do to keep yourself emotionally and physically fit enough to keep up with a demanding career in nursing. Many of you are working while finishing your degree, and you can call what I do all day work, I just don’t get paid for it. While finishing my degree I have had two children and have essentially devoted myself to them. This last month I have been traveling 3 hours away to do my clinical hours and staying overnight so that I can do 3 days in a row. It’s been rigorous and I’ve had little time to myself after doing clinical hours, driving, homework and taking care of my family. What are some of the most effective and timesaving self-care tips you suggest for a person who is juggling many roles and experiencing role stress? I want to find balance in my life between my family, my career and my own needs.