Week 8 as a level 4 nursing student

Well. It's official, my friends. I've made it halfway through this semester! Yessssssss!

I'm not sure if you could tell, but last week was pretty hard. In my assessment for one of my patients, I missed that there was a bit of necrosis on their foot until my friend (who had the same pt assignment after my shift was over) asked me about it. I felt so dumb and just couldn't get past something like that. I was so frustrated with myself for missing something I should've seen. I took the socks off and charted about a bit of a break on the OTHER side of the foot but completely overlooked the part that was actually necrotic. I look back on it now and we laugh, because it's a learning experience, isn't it? But believe you me, last weekend, I beat myself up pretty bad about it. It wasn't just the necrotic foot, it was that I plugged the NG tube with my poorly crushed meds on Thur, then the missed necrosis on BOTH days and that I thought my pt was having a heart attack on Fri morning. I haven't gone home wanting to cry that badly since level 1. In fact, I haven't felt so incompetent in a really long time. But as it always is, you're your own toughest critic, right? Don't get me wrong, I'm not discounting the fact that I should've seen it and caught on, but I am only human. Moreover, I'm still a student and still learning.

Last weekend was relaxing. I met up with two nursing friends on Sun to study for our midterm on Tue for PBL on campus, but beforehand, two of us went running around the track at school. It was so good, we ran 5 laps and talked about what crappy weeks we both had. Knowing that I wasn't alone really helped. We studied diabetes for about 4 hours on Sunday and then we had a bigger study session on Monday night, too. We did a bit of studying, had dinner together, then finished the rest of the content.

This week in clinical, I felt like a rockstar with the NG tube because I went through mishaps the previous week. I don't know if Julie purposely gave me that assignment as a test, but in retrospect, I am thinking...hey, I learned from my mistakes. And that's the beauty of learning, isn't it? To continually surpass your previous benchmarks, striving for improvement, and consistently honing on your existing skills. This week, I left clinical really happy. Why? Because I was able to actually talk with my two patients, to get to know them in depth. I've realized that's where my passion in nursing comes from - the past 3 semesters, I was able to really get to know my patients. This semester, I've become so task-oriented that I lost sight of it. I felt so fulfilled being able to have conversations with my patients about their lives, their families, and things they cared about. I've missed being able to connect with ppl.

This past week, I had my mid-term evaluation with my instructor. :) I think the thing that made me happiest to hear was that many nurses said they liked working with me and that they felt I was a really good team player. My instructor was saying she wanted me to go find her more often to go over research and whatnot. I kind of got the feeling she felt I avoided her at times, which is NOT THE CASE AT ALL!! I find her incredibly approachable and I've been trying to become more independent this entire semester, so I think I'm trying too hard to be independent. I just see this as the last semester with an instructor, so it's time I get used to not asking for answers, but she's totally right, it's different asking her for answers and proposing answers I've thought up myself (which I thought I did, but I guess I don't!) So that was a good point for me to hear. A bit disappointing, but something else to strive for, right?

Here's to an incredible latter half of the term.
I've had a pt with malaria! They were lovely. :)

Applied to volunteer at the Vancouver Friends for Life Society! I've been wanting to do this since level 2!! A whole year, I've waited!!!! Yes. The time has come to stop procrastinating for everything. I'm running in a half marathon in May, I'm volunteering at this society. I need to live in the now, not in what's to come, two, three years down the line. This is my now.

Weeks 5-7 as a level 4 nursing student

I know I've been neglecting this blog like nobody's business. I guess that goes to show how tough it's been the past 4 weeks. It's been so busy I don't even really have time to cry. I feel so overwhelmed with everything I don't know and everything I've been missing that I don't even know what to do, sometimes. I keep replying to the 'how was clinical?'s with a generic 'it was good.' because I don't have the energy to even talk about how busy school, work, St John, and life have been. I haven't been this tired for this consistent a period of time in....I don't even remember. I haven't struggled this much with nursing school ever. Stay positive, stay positive, I know. And I try. Believe you me, I try. Frontload, you say? This semester, it's been on a week-week basis. But it's ok, in hindsight, everything's 20/20. Once xmas arrives and I get together with all my friends (if they still remember me) and do our homemade gift exchange, I'll look back and laugh at my very haggard self.

Highlights:
- Knowing that what sucks for me is nothing compared to someone who's been diagnosed w kidney failure, on welfare, has a child to support, and lost their child 3 years ago.
- Knowing that my nursing friends are right where I am, and who care enough to take the time to remind me of that.
- Knowing that had my pt actually had an MI, I would have done all the right things (lol)
- Knowing that I have the ability to voice my own thoughts and rationales about why I would do things the way I do it and not just follow suit.
- Discovering that you CAN make improvements in just one day, with just one experience, and you can rock that NG tube
- Taking the time to talk to a pt and preventing them from having a fall (true story).
- Consistently realizing the need for being flexible
- Having great friends I can depend on, who know exactly what I'm going through, who I don't always have to be jolly around
- Realizing what my limitations are and being able to stand up and articulate what I can't do without feeling incompetent

I know the first part of this entry was really bleak and this post wasn't great in terms of pt experiences, but I'm on a professional practice paper writing hiatus at the moment and those articles aren't going to read themselves. Oh, and trust me when I say I will come out of this semester a champ.

Week 3 and 4 as a level 4 nursing student

In week 3, we started on days and I had one pt who was lovely, but I was also able to help out with so many pts those two days! It really felt good to be back and I was so excited to be back doing skills and working. My instructor's really laid-back but still expects us to deliver, so I really dig the style.

There was a pt vomiting blood on Fri and I was checking this pt's vital signs with my classmate. When I was checking the resp rate, I had counted for about 10 seconds and realized that there WAS no breathing. I motioned to my classmate to count with me and after about another 10 seconds, the look on our faces was pretty much the same. I knew, without words, that we were both thinking 'CODE BLUE'. It was like I was looking in a mirror, cuz I'm pretty sure that's how I looked, too. In my mind, I know I was thinking...'ok, what do I have to do? Is his airway open? Press the code button. Pull out the pillow, give two breaths....compressions....' One of the things I fear is calling a code unnecessarily...but I guess it's better to call a code than to not call one and have something even worse than embarrassment happen, right? Anyway, we made sure to do everything possible to wake him up by shaking him, grabbing his shoulder, and doing the sternal rub. After the sternal rub, he GASPED for air. Again, the look on our faces was like..."THANK GOD!!!!" Turns out it was sleep apnea, but MAN! That was intense. My heart was beating so hard and so fast...I don't think I can remember when the last time was that I felt so.....intense....but that's not even the right word for it. I'll have to think about that.

So this week, week 4, was a disaster and a half. We started at 1300 and finished at 2200. I was frantically trying to figure out what information I needed to know for my pts and their diagnoses. I was just not with it and couldn't figure out why. It was really frustrating for me, actually. Then I went home and was like....'ok. Tomorrow will be better. Tomorrow will be better.' and it KIND OF was, but still. I don't know why, but I just felt so blah. Next week will be better. This was just a weird week, I think. I'm still me, don't worry. :)

Week 2 as a level 4 student

This week was our first day back in the hospital in scrubs. We were shadowing a buddy nurse and had a three pt assignment but I didn't do many skills - just took out a saline lock :) Still, it was exciting to be able to do things and interact with pts and nurses again.

The highlight of this week was being able to connect with a pt who was a bit agitated in the beginning of my shift. He was at risk for choking, so his diet was modified to thickened fluids but could have water if supervised. After lunch, he asked for some water and I said he could have some if he took small sips, but he did have dementia, so maybe that's why he had a difficult time processing what I was saying. He ended up getting really frustrated with me and swore a few times. I was surprised that I wasn't taken aback by his outbursts and repeated what I had said firmly - not sure if that added anything to the situation at all. I gave him some and was hovering (unaware) by his side and by the suction just in case. It's funny because we talk about self-awareness, but I was so worried about him choking, that I guess my body language mimicked it because he said to me, 'relax, mate, why do you look so nervous?' I literally think I was standing with my shoulders up by my ears and my arms were like Mr Burns' from the Simpsons hahaha. I was impressed because that's another lesson learned from a pt - when in hospital, you don't want to feel any different from anyone else. You want a drink of water, something so simple to most, yet you need to be supervised. Worse yet, the person supervising you is hovering over you like you're a baby eating a grape (major choking hazard). Haha. Noone wants to feel that way. Does your mom/dad/boyfriend/girlfriend ever nag at you and watch you do something you feel perfectly competent in doing? How do you feel when that happens? A bit angry? A bit agitated? Food for thought.

Rest assured, my story has a happy ending! When I woke him to say goodbye at the end of my shift, he stirred and said 'thank you for being so kind to me.' That made my day worth it. It's all worth it.

Talking about becoming more 'emotionally intelligent' and tapping into my own emotions, I found myself feeling really unhappy yesterday. It wasn't that I was unhappy, exactly, but I felt like something was really bugging me. I couldn't put my finger on it. Part of it is being around negative ppl - I just can't take constant negativity. It totally messes with me. I think my feeling of 'unhappiness' yesterday was actually stress. Haha! It was because I was assigned a presentation on Tue for PBL and I have to present this upcoming Tue and I hadn't started yet. It was stress that I was feeling but couldn't really pinpoint until hours later. How do I not know what stress feels like....?

Ridiculous. So I made a to-do list and did some research in the hospital today. :) All better!

Learning and living and recovering from the long weekend....

WEEK 1 AS A LEVEL 4 NURSING STUDENT

Wellllllll, time has just flown by, hasn't it? I guess 3 weeks really is no time. I'm sure that will make me feel much better by the time week 7 of school hits. Hahaha!

So this week felt hectic, as usual. Luckily, my new planner has become my best friend. There was a lot of course reading to become acquainted with the guidelines and requirements.

I'm really excited about my classes - I feel like I can learn a lot about patho this semester in clinical AND PBL. It seems to me like I've learned to let the little things go. I can't quite put my finger on it, but in PBL when we were discussing group norms and presentation topics and dates, I felt a sense of zen which I hadn't felt at all before in PBL. I'm still trying to figure it out....it's not at all that I don't care about school anymore, because, hello, keener much? I think it's moreso that I'm trying to be more open and flexible to everything - Karen was right, there are a lot of things I can't control in life. I need to look and focus on what I can do, right? Is it really worth me becoming worked up over something small? On the grand scheme of things, something like calling vs texting is not a huge deal. I will always have my personal preferences, but I can only control what I do.

I'm super excited to be at SPH! Clinical rotations are on Thur/Fri and we get to do days and evenings! Evenings mean that we get off at 2200 meaning xmas lights!!! I'm so excited!!

Anyway, lots more to say, I'm sure, but I must attend to my Community Nursing discussion posting now! Until week 2, folks!

Bye bye Bangladesh and a little bit of Cassandra

Well, I’ve had my final Nurs 221 class this afternoon. I gotta say, it’s been an incredible journey. Sigh (I literally paused to take a breath there). Let’s see where to begin.

When I arrived in Bangladesh 7 weeks ago, I was nervous, intimidated, excited, apprehensive, shy (a bit), and slightly lost (literally and figuratively). When I was told that I was to teach the diagnostic lab tests of the Nurs 221 Med-Surg course, I was so scared. And worried. I looked over the content from previous years and realized that it was WAY beyond my own knowledge but was told that I could restructure the course with a nursing twist. The previous course was formulated by Med lab students who know so much about their lab tests (rightfully so). So I had a vision (partly poached from PBL). I went through the previous course material and wrote down what labs had been covered. Then I assigned the students 2 labs to look up each. They needed to put into a template (which I created for them) what the test was for, what the normal ranges were, what high/low levels indicated, and what some nursing interventions would be for high/low levels.

I gave them their assignment and gave them a week to do it (not unreasonable by BCIT standards). When I received them, I was so excited that everyone submitted their assignments on time! That sounds kind of ridiculous, right? It was kind of a personal accomplishment, that I was firm with them and said that I had very little tolerance for late submissions (it’s true and I hold myself to that as a student). Then I began editing them all and thought to myself, ‘Why am I doing this? Is it MY responsibility that THEIR assignments should have been done properly and coherently?’ Partly yes and mostly no. Because I began holding Saturday lab classes (they had a shortage of RNs to supervise them in the hospital), I was able to have them review and edit each other’s work. I was so thrilled when they came up to me and said, “Ma’am, I don’t understand what they are trying to say here.” Cuz I smiled, looked at them and said, ‘Me neither. You get to look up the answers now!’ They were able to feel the joys of being a teacher (and nurses are teachers), the trials and tribulations of delivering material in a comprehensive manner! This is learning! Don’t worry, I’m not ALL mean, I could tell when they were getting restless and we played some trivia games, too! Competitive students exist EVERYWHERE – I’m not the only one who gets riled up in trivia, fyi – clinical and PBL members, thank you very much. Haha.

So they all looked over each others work and made suggestions and corrected them. But, they all submitted them to me (so I have the master copy) but I’d already made comments on the document, so I sent it to them to look over. One thing you should know about me is that I don’t like giving answers out freely. I make you work for them. So my comments were more guiding questions to lead them to the answers. I will admit, this was slightly mean of me. I kept the master copy with all the answers and only gave suggestions and hints on the document for them to look over at home. It’s ‘mean’ but it will also help them in the long run. The more exposure you get to this information, the better it will stick! I don’t pride myself in being tough, ok? That’s not me. If you know me well (which you hopefully do by now), you will know that being mean to students makes me feel just as bad, if not worse, ok! But I only do it out of love and hope that they will learn!

They all presented, in partners, on 2 patho conditions and the labs you would use to diagnose this condition. That happened last week. I was pretty upset after last week. The amount of disrespect I saw from them towards each other really made me angry. I told them from the start that I have a zero tolerance policy on talking through someone else’s presentation and instead, they passed notes. And some were reading through their own presentation notes. I had to threaten them that I would be taking off marks before it got better. I ended up taking off 2 marks for note-passing and 5 marks for reading through your own notes. The presentation was out of 40. Slightly harsh, but I gave you fair warning before it started. I should not be wasting valuable class time teaching about the importance of respect. That is not part of adult learning. I definitely was pretty affected by that and felt like I was being tested. Like, how far can we push the new teacher before there are consequences? I do realize that students all over the world do that, but I guess it was the fact that my blatant ‘I can see you passing notes’ looks were ignored and continuance that bothered me.

This week, I wanted to incorporate PBL techniques – group process and discussion. We sat in a circle and discussed what the potential problems would be for every patho condition. From this, they need to submit a careplan around the potential problems and what their nursing interventions would be. I think I was unclear about this part of the assignment and I will have to make note of it when I leave all my documents behind. I’ll have to wait to see how the careplans are before I finalize my comments and make suggestions for the future Nurs 221 instructor.

You have no idea how excited I was to see them talk things out. I sat there with a smile I tried my best to conceal. I failed miserably. Lol. I was just so excited and proud of them! We talked about tactfully delivering alternate viewpoints, the importance of NOT being defensive, and solving differences EARLY instead of late (preventing passive aggressive behavior). Visions of PBL came screaming back at me. Now, I’m ready to leave (except not really because I feel like I haven’t had enough time here) and head to Taiwan to see my aunt, HK to see my grams and family, and finally, home to my momma bear, sister, and the Henster, and of course beloved friends.

These blogs are merely the tip of the iceberg. This journey has been so incredible and I feel like I’ve learned so much and given a part of myself away.
Luckily, ‘myself’ is like the liver – it regenerates. I’ll be back as a whole by the time I’m home in beautiful Vancouver, BC.

Love you all, see you in no time!
Cass Ma

The realities of nice-ness

So much has happened since I’ve last blogged that I can’t even remember where I left off. I literally have to refer back to my older posts to jog my mind.

In general, I try not to get swept up in the little things. I don’t normally become stressed out with assignments and a heavy workload, but moreso with interpersonal relationships. I know myself, and I know that part of myself well.

I was told right from the beginning that I could not be friends with the students but they could be friends with me. I’ve been trying really hard to make the diagnostic lab course make sense for nursing students, so I’ve been pushing them. I’ll admit it. But I’ve also tried really hard to make myself available for help – I come into the office pretty early and stay until late (by Bangladeshi standards) just in case a student is still here and needs to ask a question. These are the assignment guidelines, maybe you can tell me if it makes sense:

Each person is assigned 2 lab tests to look up what it does, the normal range, what high/low levels may indicate, and what nursing implications come from the high/low levels. For example if someone has a low hemoglobin level, this could indicate anemia, so as a nurse, we would monitor for shortness of breath, fatigue, weakness, resp rate and O2 sats. I assigned these a few weeks ago and when I received them, I was having a hard time editing them all. So I’ve started to teach an extra lab session on Saturdays because there is no RN to take them to the hospital, I’ve done some reviews on the head-to-toe assessment and then had them look over someone else’s work as an editing exercise. I did this so that they could see the importance of submitting a coherent assignment. I had made track changes in the documents they sent me, but I asked them to edit as well so they would have some practice in researching and appreciate the work that goes into marking. So I can appreciate that there may have been double the work done (students and I both had to do this) but it was the principle that I was going after. So I get it, the students are very flexible and have been, for the most part, cooperative.

I gave them the presentation assignment on July 5 and they had one week to prepare for it. In PBL, it’s pretty standard. They were put into partnerships and each set of partners were assigned two pathophysiological condition (ex. Coronary artery disease and myocardial infarction). They are to present on the patho briefly and talk about the labs that are associated with the condition. (ex. What tests would be ordered to test for CAD?) Then they had to talk about the nursing implications. Most of the labs had already been assigned previously, so most of the work (after they make revisions) has already been done. To try and make it fair, I prepared a presentation, too, on diabetes.

The problem I’m facing is that students are complaining about me giving too much work and I’ve been receiving a couple of flippant comments. It makes me feel really bad. But on that same note, I know that I have a rationale for assigning this. If you give an assignment without rhyme or reason, then why assign it? I have been trying really hard to tie it into nursing. It makes my heart really heavy. I am trying to rationalize it by saying that these aren’t my friends who are dissatisfied with me, and these aren’t my friends who are complaining about me. I am here to be their teacher, to enrich their learning experience. You can’t win them all. I can’t win them all. I’m having a really hard time trying to be assertive and friendly at the same time. I guess I need to realize and demonstrate that even though I am still a student, that I am teaching their class, that I am leading their class. I can’t be friends with everyone. Push me hard enough and disrespect me in my class one more time and I will have to take action. Respect is a two way street, right? My sister swears I’m too nice to ppl even though I don’t see it, but I guess I still am.
My time is running out here. I have 11 more days and 3 more in-class sessions with this group. I say that not meaning ‘I only have to put up with them for 3 more days’ but ‘I will overcome this within the next 3 classes’. Watch me. If I can make it this far, I can make it through.

I’ve taught my first aid classes to the faculty. My first class fell sub-par, in my opinion. I felt very pressured for time and did more talking than practical, so I felt it was very boring and grew tired of hearing my own voice. I had another class the second day and was so determined to make it better. I wrote out what I didn’t like and how I was going to make the second class better. Then, I executed my plan and found redemption. The second class was much more interactive, fun, and just…up to my liking. I threw in trivia, lots of demos and practical, humour and trust me, grown ups like trivia JUST AS MUCH AS CHILDREN! Hahaha. This class was also bigger and had more questions, though, so that may have also played a part. It was great and really rewarding.

I have to set up my class now, so I have to cut it short, but some of the most rewarding moments I’ve had here involve struggling/difficult students. I have realized that I am big on the concept of ‘tough-love’. The more you try to get away with laziness, the more assignments I give you. Works for some ppl, not for everyone, but this one particular student (story is too long to type here) was being less than hard-working so I gave him an assignment. He did it poorly so I made him redo it. My happiness lies in the fact that he was able to, with some guidance, give the right answer in front of his class based on the assignment I gave him. Did that make sense? Basically he was able to recall the hw he did and he smiled one of reward and triumph.

11 more days here to make it count.

Love you all, thinking of you all (seriously)
Cass Ma