Thinking sideways …

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There needs to be some way of adding creativity to the standard nursing curriculum. Evidence-based practice, rubrics, exams, and case studies abound in nursing school at all levels, and sometimes the process becomes the point, and the end becomes obscured. I believe that creative thinking should (must!) be encouraged in Registered Nurses both before and after graduation.

Creativity can be not only practice-expanding, it can also be fun. It’s easy to be too earnest and too serious about what we do. Inserting creativity into the structure of the classroom may not be easy, however. I would dread being given an assignment that “required” me to “be creative,” because my preferred style and type of creativity may not be yours. I would fear being judged on how I approached the assignment, and would try to make sure what I produced matched the rubric of the assignment – self-defeating, eh?

I use humour to communicate, and I find that humour is often lacking in my fellow nurses and nursing instructors. I once gave a group of nursing students I was precepting on a med-surg unit an assignment – they were each to write a limerick over the weekend that focused on any important lesson they  learned the previous week.

You’d be surprised at how many things you can rhyme with “bedpan.”

I get the, “But I’m not a creative person!” from some of my students, and I have to tell these folks that learning to be creative is a real thing. For some it comes naturally, others have to work at it, but everyone can do it.

Part of the secret is to find an avenue of creativity that you enjoy. I have one friend who sews stuffed toys. They are whimsical, colorful, and she gives them away to her own students and friends. They often reflect personal events or interests of the person she gifts them to. Another friend makes her own greeting cards, painting blanks and filling them with serious or silly thoughts. Many recipients frame them or keep them on their desks. I write and cartoon, and often translate my daily life as a nurse into humourous commentary on my blog – or into goofy pictures on my patient’s walls.

The very act of being creative changes the way you look at and process life. You think differently and act differently when you have an outlet for expressing yourself creatively. You start to look at the world not as a succession of problems and tasks, but as a collection of jumping-off points for creative expression. As with any other learning experience, your brain rewires itself, and then it learns to use these new neural pathways to solve old problems. New pathways that can be used to creatively move from Problem A to Solution B – pathways that might not have existed if you had never drawn that first cartoon on the whiteboard or written that first limerick – are the key reason reason to nurture your own and others’ creativity.

Think sideways.

When in doubt, …

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When in doubt, make a fool of yourself. There is a microscopically thin line between being brilliantly creative and acting like the most gigantic idiot on earth. So what the hell, leap. (Cynthia Heimel)

The only thing written on the 3×5 card I was allowed to bring to my Microbiology final.

Theory and Philosophy of Nursing …

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My own philosophy of nursing is evolving, and the process of identifying, expanding on, and encoding its elements has been an important part of my development as a professional Registered Nurse. I have observed patterns during my years of practice that repeat in predictable ways – repeat not because of the inter-connectedness of ephemeral energy fields, but because the human mind has evolved to act and interact with its environment in structured, recognizable ways. I recognize in myself some of these patterns of action/interaction, and introspection has been an important part of my nursing theory development. But humans do not exist apart from their environment, and just as medicine, nursing, and other health-scientists debate the roles of nature and nurture, so must a nursing theory take the effects of all into account.

Environment. Every human being is born into an environment. The environment can be defined as everything that surrounds and affects that human, from other humans to the inanimate rocks on her path. Each element in the person’s environment has an effect on that person, and the effects of the elements are determined by external (it’s cold) factors, internal (I can cope with cold) factors, and distance (it’s cold outside but I’m not there) factors.

Health. In my evolving understanding of the interactions of humans with their environments, I have been able to define and detect patterns of human health and existence that make me more proficient at providing nursing care to those who come to me for care. In my theorizing I have found that everything from human anxiety to Maslow’s hierarchy has a place.

Nursing practice. I am taking control of my vision of nursing, in part by formalizing my own theories of nursing, from the grand to the practical. I may never reach the end of my explorations, and will certainly never be satisfied with “what is” or “what was” as long as there is a “how come?” left. While the answer may indeed turn out to be 42, I still need to know why. The process is more important to me than the product, and by continuing to write, I believe that I will establish a solid foundation for my future professional practice.

Nursing Theory as Worldview: To Be Determined …

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It is difficult for me to choose a single grand nursing theory to wrap my practice around. After years of studying nursing theory, both as part of required coursework and as ongoing intellectual entertainment, I have yet to find a Nursing Grand Theory that comes close to fitting my own worldview. I have read the works of many of the Grand Dames of nursing theory, and from most I have gleaned useful concepts, ideas, and philosophies that have informed (and improved) my nursing practice. But I do not feel entirely comfortable with any one theory to the extent that I can base my entire practice on it. No one theory yet holds the answers for me.

While exploring, reading, and discussing nursing theory with fellow nursing students in the past, and in the present with a collegial group of nursing friends who are admitted theory geeks, I have been encouraged to analyze, encode, and verbalize my own views. To me, nursing theory is neither static nor immutable. Nursing theories, my own included, change, develop, and evolve, becoming (with luck and work) more useful, practical, and elegant as time passes.

A very good friend of mine is a nurse practitioner, nursing scholar and an unabashed Rogerian, and she believes that at the core I am one as well. She and I discuss pattern recognition whenever we get together, and that remains one area where I do feel that I recognize the intent and usefulness of Martha Rogers’ theorizing. I am unable, however, to buy into her many of her theoretical constructs, such as pandimensionality, unitary energy fields, and therapeutic touch. I place my faith in what I can see and feel, and my feet are firmly planted in three dimensions. A fourth all-encompassing dimension in which humans interact as energy-beings is one I can’t rationalize, and therefore I am unable to integrate that Rogers concept into my practice. In addition, while many nurses today have become expert in the use of physical therapeutic touch as a means to bond with and help their patients heal, Martha Rogers’ “laying on of the hands” to repattern a patient’s energy fields without touching that patient’s body is just too much of a stretch for this skeptic.

To be continued …

Not all it’s cracked up to be …

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Being the Director of Nursing for a psych facility is not the cush job it first appears to be.

  • 0625. Arrived at the facility. Met at the door by two NOC staff with their updates, complaints, and emergencies.
  • Five eloping patients tried to leave over 100 times during the day shift.
  • Four resident assistants reprimanded for leaving door alarms unarmed.
  • One computer meltdown finally fixed after four days with no connection.
  • One dying patient in pain and with sinking O2 sats assessed and comforted. Hospice notified but tells me “We’re pretty busy today, can you handle it?”
  • Two crisis family meetings.
  • Four missing syringes of morphine.
  • Nine calls to the VA and hospice to order more morphine.
  • One meeting with a parole officer, one meeting with an angry parolee.
  • Five calls to MDs to adjust meds.
  • One resident transported emergently to the ER for chest pain.
  • One solid beating of the DON (me) by an angry bipolar who wanted to leave the back yard. One pair of broken glasses.
  • One new exterior gate latch purchased and installed by the DON to prevent further back yard escapes.
  • One trip to Shopko for toilet paper, butt wipes, and gloves.
  • One extremely unsavoury coccyx wound repacking on a screaming resident.
  • One hemorrhoid tucking for a resident who’s spitting on me.
  • One call from and collaboration with an ER doc.
  • Nearly 400 meds found in a closet from 2010 logged in and destroyed.
  • Over 110 HIPAA act label violations found in a mailbox and remedied.
  • Two missing psychotropic med scrips tracked down and original orders refaxed to pharmacies.
  • Two wound care packages ordered.
  • Two staff fights refereed, the staff’s July schedule approved, and three more staff schedule disagreements handled.
  • Another 150 pages of protected patient information shredded.
  • 26 residents rounded on twice.
  • Multiple hugs administered.
  • Office chairs cleaned of resident urine twice.
  • Cellphone located in resident’s shoe.

1855 heading for home. Day 19 in a row without a day off. My cellphone rings before I even leave the driveway.

Get ’em up, move ’em out …

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As a Med-Surg nurse, you take the assignments they give you. Some days you win, other days you resign yourself to being amused. Today’s line-up of patients, one any med-surg nurse would envy –

  • “Toga Boy,” a 20-yo who refuses to wear clothes, whose current girlfriend sleeps in his bed and spoon feeds him, and who has spent the last three weeks wrapped in nothing but a sheet.
  • “The Dripper,” a 34-yo woman sporting an insulin drip, IV parenteral feeding drip, IV fluids drip, and patient-controlled narcotic drip.
  • “Mr. Demento,” a seriously demented 80-something who spent last night mooing at the staff. Today he’s arguing with me about the “tall wooden Indian ladies” in his room who are playing with shotgun shells and shotshell boxes and who are going to blow their fingers off unless I stop them.
  • “Hoss,” a 57-yo Hispanic guy who fell off either a horse or a house, we’re not sure, because all he says over and over is “Fell off hoss! Si!”

At least she’s not blaming the nurse …

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“I want to talk to my doctor, now!”

“Maureen, did you need something? Your doctor is in surgery right now, so it might be a while before he can get here. What can I help you with?”

“You can’t help! I’m having a side-effect from the damned surgery!”

“What’s happening? Can you tell me how you’re feeling? Has something changed?”

“My butt is swelling! My butt is much bigger than it was before surgery!”

“Let me look, maybe I can help.”

[RN checks patient’s butt. It’s exactly the same size it was before she left for her hip surgery.]

“Maureen, I don’t see any unusual swelling. Is your bottom feeling itchy? Maybe it’s just the dressing that feels irritating. Dr. Fitch will be looking at that and changing it in the morning. Does your bottom hurt more now than it did last time I was in?”

“I WANT HIM TO KNOW RIGHT NOW THAT THIS SURGERY IS MAKING MY BUTT LOOK BIGGER!”

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