Body language: a good lesson for new nurses and old nurses alike

In an earlier post I had mentioned the power of body language to influence our behavior and feelings. We have known for a long time that forcing our selves to smile makes us sound nicer on the telephone and can cheer us up. As a dog owner, I learned the equivalent of this with my dogs that you can hold their tail up when they are scared and that this cheers them up too. Our moods are incredibly responsive to our body's actions. It is counter intuitive in many ways, but biology often drives behavior.

I stumbled across this TED video and it made me think about how hard it is to teach communication to new nurses. I felt that I learned next to nothing in my nursing communication course except for how to prepare an SBAR (that will be for another post). I don't think the communication and confidence "thing" clicked until I started my job and realized I had other people's well being in my hands. I emulated my coworkers and quickly learned what did and didn't work.

There is very little, apart from life experiences, that can prepare you for the occasional dose of crazy patients, aggressive doctors, or bullying coworker nurses. I thought this video was a great reminder to how to not read only others, but to read ourselves in the great game of communication. Enjoy!

Whopper of lesson: withholding judgement

There are a lot of medical conditions that one does not have control over - genetics, environment, and life just happen. People live their lives as best they can and they get saddled with some disease process   that pose obstacles and challenges that we can't even wrap our heads around.

Then there are days when you want to holler some sort of Hippocratic quotation at your patients that seem to have gotten themselves into their predicament, such as these:

1. "Let food be thy medicine and medicine be thy food."
2. "Everything in excess is opposed to nature."
3. "Walking is man's best medicine."

The thing is though humans have a million foibles and it's actually surprising we don't make ourselves sicker or injure ourselves more often.... I am compassionate to the type 2 diabetics and the smokers - I love chocolate and coffee - who am I to point a finger on these addictions? 

These poor folks suffer enough without an additional serving of judgement. My job is to care for them and give them the best tools possible to help themselves. We all do the best we can and we are all in this together with our individual burdens to carry. If we can help each other, all the better.

As a new nurse I had this idealistic view that I would never be judgmental towards my patients. However, the idealistic view got a big whopping dose of reality recently. A handful of times now I have been the nurse for trauma patients that have been intoxicated and driving. It is harder than I imagined to to find a compassionate spot for these individuals when you know the passengers were perhaps life-flighted out of the area and that the patient you are caring for is the perpetrator of the accident and the least injured out of the bunch. 

My nursing assessment and skills are equal amongst all my patients, but these patients have challenged me to remain kind and warm without shutting them out for their behavior that landed them in a hospital bed. These experiences made me think back to some of my classmates that had done a nursing clinical in the prison system in Portland. They told me they made a point not to read deeply into their patients' charts until the end of the rotation, because they knew they could not reserve judgement otherwise if they knew the crimes their patients had committed. 

And so I have endeavored to immerse myself into the medical side of these patients and do my best to forget the trauma that brought them to my unit. I also plaster a smile onto my face because I know scientific research tells us that our body language tells our body what to feel, so by the end of my shift I have moved from a place of judgement to a place of kindness. 

Again, it's been a whopper of a lesson and probably one that will be relearned many, many more times.

Vineyard Lake Hike

Spring time has finally arrived to the Magic Valley and the weather is warming up. Greenery here is ephemeral and lasts for just a short time between the end of winter's bitter cold and the beginning of summer's infernal burn. Therefore, this month has been a chance to explore the area by foot a bit more. Today a  fellow nurse, who has become a friend and mentor, took Roxie and I to Vineyard Lake before the day got too hot. 

The lake is fed by a natural spring coming out of the ground and there are little rock fish and minnows that cavort in the waters. Apparently it is also a popular cliff diving area, although that seems like a dangerous idea with all the lava rock littering the landscape. 

~~~Enjoy~~~

Looking from one bank to the other

The spring comes out of this little canyon to feed the lake

Vineyard Lake from afar

spring feeding the lake

basalt everywhere

Equipment malfunction and the "calm" panic voice

This week I had the most bizarre thing happen with my IV pump. I was running heparin via IV - an anticoagulant medication used to treat clots or potential clots in patients at risk for pulmonary embolisms or strokes among other things. Often heparin is a once or twice a day injection, but this patient needed it IV due to their circumstances. 

At about 0500 I heard the IV beep telling me there was "air in the line." However frightening that sounds, it's really rare there is actually air in the line. The IV pumps are incredibly sensitive and even eensy-teenie-weenie bubbles that cannot cause harm to the patient will set it off- generally to the annoyance of everyone within a 5 mile radius. I went to look at it and jiggle the line that exits the bottom of the pump and noticed that it was wet!!!

I have now adopted my "everything is okay, I deal with type of stuff every single day" voice when in fact I have most likely never ever seen what I am witnessing actually happen EVER. I have to admit I'm not really sure where that tone of voice came from, because prior to being a nurse that tone never existed for me. I have never been a confident person, but wearing the scrubs seems to give me an alternate ego of Nurse Reese who will take care of you no matter what. I cannot even imitate myself in that voice when I'm out of scrubs!

Anyway, I calmly explained to the patient that I was going to clamp her IV and check the tubing. I unlocked the pump to visualize the tubing inside - again something I do actually do all the time. Instead, when I unlocked the pump the IV tubing fell into 2 pieces - it looked like it had been sliced in half with a pair of scissors! I thankfully reacted fast enough to grab the bag of heparin and turn it upside down before I had created too big of a heparin puddle on the floor. 

I grabbed all new tubing, primed the line, and set the patient back up on the medication and then asked a more experienced nurse to look at my severed tubing. The nurse said, "Huh, I've seen children chew through their IV lines, but I have never, ever seen that happen." Awesome.

In the midst of this I had called lab for a stat PTT draw (the lab that tells us how well the heparin is working - the goal is to be within a therapeutic range), called the pharmacist to tell them what the problem was and that I would notify them as soon as I had the lab results for further orders, and talked to the doctor who happened to wander in during the middle of all this for report. My fear was that the patient had not been receiving enough medication and therefore was at risk for a repeat medical incident. However, all is well that ends well because in fact her PTT was a little too high -even with the leaking tubing- and pharmacy had me turn off the medication all together.

I don't think it was until 0730 that my heart rate came back down to normal. However, no one else was the wiser ;)