Rapport

Had another clinical yesterday--after the three tests I was pretty tired, but managed to make it through. At one point in my day, I caught a young unit secretary staring intently at my chest. I asked her what was up and she said, "I am going to have one of those some day," pointing to my student ID badge. Found out she has applied to my school's program and is dying to get in--she is all excited and stuff. Gave her a high five and tried to be excited for her, but this all happened during a really stressful moment, so I felt like one of those jaded nursing students/nurses/doctors we all run in to once in a while who are like, "Why would YOU ever go into NURSING?"

This happened at about 1900 last night. The day had been somewhat easy with head to toe assessments on mom and baby and computer charting.

At first, my young, post-section patient was very wary of me when I went into her room. I decided to make it my job to work on rapport with her, since we are learning about that in mental health and I am just figuring out what that is.

She was extremely quiet and watched me very closely throughout the day as I cared for her and her baby (soooooooo stinkin cute, that baby!). She was talking to the baby a lot, keeping I&O, had the baby all dressed in pink and was up and around the room changing diapers, etc. She had some visitors (various family members) at one point and I got them all interacting with the baby--stuck my pink stethescope in one heavily tatooed guy's ears and made him listen to baby's heart rate, respirations and bowels sounds. Soon, everyone in the room wanted to listen, and I noticed that the barriers were coming down. She even told me I was "doing a good job" at one point--I don't think she had felt really cared for prior to my coming around...

Went to dinner with pt doing ok. Came back and it was change of shift. PT had lost lots of blood during her section, so she needed a transfusion. Because she had spiked a temp, they had held off giving her one (???). So when I walked in the room, they had started transfusing her---she looked over at me, paniced, and said, "I am scared!"

"What's going on?" I asked.

She pointed to the bag of blood. "Are you scared of the blood?" Big tears and a nod of her head. "Aids?" I asked. She started crying. "Yeah, those bags have diseases," she explained. I asked her to take a couple breaths, then explained the process blood goes through when it is donated and how it is screened for disease. She started to mellow out.

Things got quiet, and then I heard the nurses reporting off on the patient in the doorway of the room. My patient's little ears perked up when she realized they were talking about her--and they were not very positive in what they said. Also, they got her age wrong, said she had an iffy prenatal history, said she was defiant, etc. She was looking at me and shaking her head over everything they said--so when her new nurse approached her, the girl was very upset and defensive.

"Why did you say that stuff--it isnt true?" she asked the new nurse.

The new nurse said nothing and went about her assessment. From that point, things went downhill, with my patient eventually asking to NOT be touched by the nurse and then to my patient asking me if she could change nurses (and I asked and was told "no way"--and my instructor was completely absent all day so I had NO feedback from her). I am not going to go into too much detail, but I DO think that the nurse was competent, but very brusque in her behavior (later my instructor called the nurse "all business"). She made an enemy of her patient to the point where the young girl would only answer questions from me. I felt very "in the middle" trying to get the job accomplished and trying to keep things peaceful between patient and nurse. I did ask the nurse to step outside the room withe me in order to clarify some stuff at one point, and the nurse thanked me later for handling it in that way. In other words, I didn't embarrass the nurse in front of the patient.

Pt was not doing well by the time I needed to leave--spiking a high temp, restless, agitated, rapid breathing, etc. I got her to close her eyes and rest after I encouraged her to call her mother to come up and be with her. The nurses thanked me for being "patient and so good with her" and for helping with communication, etc. Felt like I had maintained all relationships...for whatever that's worth.

At post conference found out--by checking patient's prenatal chart--that she had had great prenatal care, WAS older than what was being verbalized by the nurses(?) and had participated in a great program for pregnant teens. According to the chart, the girl was very serious about her pregnancy, had good support, and was taking care of herself. But I feel her treatment by the staff was really screwed up.

I don't like what I saw...but I DO like that I have some ability in some area. Yeah, I can't work the blood pressure machine half the time(stupid, stupid, stupid machine), but I can make clients feel comfortable and be empathetic, communicate well, and yes, establish rapport.

So tired today...must sleep! ;)

PS The new Change of Shift is up--Kim has done it again!