Tuesday, October 16, 2012

holistic nursing and the surgical patient

A category 2 abdominal pain patient was brought into room 5 from the waiting room of my ER…She was an early 20 something who happened to be 17 weeks pregnant…she was complaining of diffuse belly pain, fever and nausea that had escalated over 48 hours.  I watched the tech wheel her by the nursing station to go into room 5.  She was petite in stature, and even smaller in appearance as she hunched forward guarding her stomach with her arms.  A very worried looking older woman accompanied her. 
I quickly exited out of my charting on the computer, grabbed her triage information and scanned it.  I went to the med room and collected an IV tray, saline, and a Doppler.  As I entered the room I quietly laid my equipment on the counter and walked to the stretcher.  Worried eyes looked at me from the face of this attractive young woman.  She sat on the stretcher in a semi-fowler position with her knees drawn up to her stomach.  She held the older woman’s hand and barely changed expression as a tear fell from her left eye. 
I outstretched my hand to her as I introduced myself to them both.  “My name is Bobbi and I will be your nurse tonight, I promise to take very good care of you and make you more comfortable as soon as possible.” 
“Thank you…and my name is ***** and this is my mother….I’m pregnant” she tearfully answered.
After she finished telling me about her abdominal pain I examined her, assessed her vital signs again and started an IV, drew blood and hung NS at 150/hr.  Using the Doppler I found her baby’s heart beat to be a bounding 176…this brought a fresh tirade of tears from both women as they visibly exhaled with relief that the baby was okay.  Her temp was 102, respiration's 22, heart rate 122 blood pressure 126/70, lungs were clear bilaterally with a room air sat 100%.  Her skin color was pale and very warm to touch.  She rated her pain 8/10.  She had positive bowel sounds all quads and was extremely tender to the slightest touch with positive rebound tenderness. 
As the next couple of hours went by with tests and the diagnosis of appendicitis ~ I carefully took care of this patient as we awaited her trip to the OR.  She was quiet but strong…she was childlike when the pain intensified and somewhat soothed by her mother’s reassurance.  I administered morphine often in small doses to alleviate her pain…I gave her cool cloths for her forehead, dimmed the lights and sat with her.  I offered her constant reassurance that her baby would be okay~ when my interventions for her and my other patients were completed,  I was able to give her a hand massage and Reiki as we waited. 
What I noticed, as did her mother, was that during the hand massage and during the Reiki treatment her pulse significantly lowered and her breathing slowed as her face relaxed.  The pain meds helped of course but the visible transformation of her facial and body features during the relaxation therapies was so obvious that her mother commented on it several times.  As I wheeled her to the OR she again asked me for reassurance of her baby’s safety…I gave this to her.  Before I left her in the care of the OR team she tearfully took my hand and thanked me for caring about her and her baby…she thanked me for the way I cared for her in the ER… “the touching therapy helped me so much…thank you…Can you come and take care of me when I’m in labor? She asked with a grin”…
Walking back down to the ER I felt so thankful that I was able to take care of this patient in her wholeness…body/mind/and spirit.  I have been blessed these last few years to have my nursing skills enhanced with the knowledge of holistic care and the learning of alternative therapies like hand massage and Reiki.  My BSN classes included a Reiki course to which I became a level 2 practitioner… I now have the awesome pleasure of teaching Nur. 101 and I’m able to pass on the teachings of holistic care with real life examples of what it looks like.  Being able to nurse someone holistically positively affects not only the patient but me as well… I have a very grateful heart.

Tuesday, October 2, 2012

past and present reunite

I could hear her crying and screaming in pain as I entered the ER for my evening shift.  The door to her room was closed but the bone chilling cries echoed out beneath the wooden door and filled the airspace of the nursing station.  I inquired of her... “She got here almost an hour ago and we cannot seem to get a handle on her pain…”  I looked at the board to see her name~  I knew her…  My heart raced and I felt a lump gather in my throat…I hadn’t seen her for almost 9 years now.  My mind sped back to a time that our paths had crossed. 
I was doing home health nursing then and she was a teenager with a newly diagnosed sarcoma…I was to care for her while she received treatments.  I was in her home several times a week for a several months…we bonded and I cared about her.  She knew my daughter~  I wanted her to live…I prayed for her day and night.  She was tough…strong and determined.  She had spirit and spunk far beyond her years…I wanted to take care of her… her case brought out the best in me but also that part of me that wanted to take over and do it all…  I struggled with my sense of ego and pride…I struggled to not let her into my heart…it was a losing battle.
Life changed for me and I took another job~  I left her in the hands of my co-workers and I cried for days…I battled with the feelings that I had abandoned her … I had crossed the line with her~ I knew that my feelings for her were deeper than they should have been.  I took on more of her care than I should have or at least more than was professional… when I left it broke my heart.  I did not know that it broke hers too….
I was pulled back to the present by the day nurse wanting to give me report…I would be getting this girl that so long ago claimed a piece of my heart…  I listened to the report and then went in to meet with her.  As I opened the door the crying and begging for pain relief hit me in the heart.  I looked at her and saw a grown woman whose pale face was contorted in pain. Tears soaked her face as she twisted and rithed on the stretcher.  “Please help me, I can’t stand this pain any longer…”  I left the room, went to the orders and saw she could have another dose of dilaudid now…I retrieved it from the med room and quickly returned to her. 
As I sat on the stool next to her bed and injected the pain medicine I prayed for relief for her.  Her mother sat close by holding her hand.  I introduced myself as I cared for her…she looked at me and started a fresh tirade of tears… “Oh my god, is it really you Bobbi?” 
“Yes it is” I replied with a smile. 
She reached across the stretcher and put her arms around my neck and pulled me close as she cried into my neck.  We stayed like this for several moments.  I let myself feel the heart wrenching feelings that I had let go so long ago.  “I think of you so often,” she said between sobs.  “you were the best nurse I have ever had…I measure everyone next to you.” 
I smiled and let the compliment enter my heart.  “I missed you terribly when you left,” she said.  I told her that I had missed her as well and so often had prayed for her.  I told her that I watched her in the newspaper and from afar at school…I told her that she was one of those patients that never left my heart. 
I managed to get her pain under control with meds, hand massage and presence…and we enjoyed catching up with one another.  She was admitted and I went home …  As I thought about the encounter I realized that as a young nurse I tried so hard not to let anyone into my heart for fear of being unprofessional… I knew she had entered my heart deeply and it scared me.  I always thought of her, prayed for her and worried for her, and struggled with the feelings that I had abandoned her…as I let myself feel the rush of emotions that occurred when we reunited I realized that I was wrong all those years ago… It wasn’t the fear of being unprofessional; it was the fear of not being able to help her that kept me bound…
Jean Watson’s theory of human caring talks about caring moments and allowing our hearts as nurses to be present with our patient’s heart.   I did not realize what was occurring way back then BUT I do know the power of presence now.  Being present with this patient gave her and I both healing that night in the ER… allowing myself to care for her all those years ago touched her and in return in touched me.  As we reunited and told one another the power and effect the other had on our lives…healing happened.  Watsons theory came alive for me that night in the ER and I will never be the same.