musical directions for a nurse...

i found this just now from http://www.impactednurse.com/?p=793 , and love it:

Nursing, like music, is a science best served as art.
But unlike musicians, we often loose our way. We are not very good at finding our voice, or for that matter, in providing direction to our nursing kin on the subtitles of timbre and pace that flux and dance across our shift.

Is it any wonder that some wards end up resonating with dissonance and disharmony?
Lets have a look at some of the notations used to guide the musicians through their own score and transpose them into out own profession.

Anima Soul
Appassionato Passionately
Oh gosh, don’t just be a 9-5 nurse. Be a Beethoven. Be a Bono. Be a Miles Davis.
Look at what you have. Nursing can move and lift and heal. How many other professions can make the sort of differences to people that ours can. You know what I mean. Find your instrument and find your muse.
Nurse with bravura.
Bravura (With) boldness and spirit

Colla voce (lit. with the voice.) To follow the solo instrument or voice
There are times when you will have your own solos, and there are times when you must follow others. Whether it be senior staff, doctors, hospital policy, or patients wishes.
Appreciate the talents of your fellow musicians. Learn when to listen, and when to provide an expert accompaniment to the voice.

Dolore Grief, sorrow
Managing grief whether it be a patients or your own, is yet another skill you will need to play the piece well. The secret is, that it is no skill at all. As long as you are authentic the right music will come. And in its own time, the grief will fade.

Duo A duet
Dont forget to buddy. Two of you is far more powerful than one of you. Drawing up drugs, debriefing, planning care, performing interventions. Always look for the duet.

Legato . Smooth
Lento Slow
Smooth and slow, some of the best direction you will get. Even when the situation calls for rapid, urgent response the trick is to stay in the music. Smooth and slow will ultimately be much quicker and far more effective than hurried and rough.
The ability to remain focused and calm as others around you blow up in an uncontrolled crescendo, is one of the hallmarks of a great nurse. It is a skill like any other. And with practice it will improve. That’s what separates a great musician from a hack. Practice, practice, practice.

Lontano As from a distance
There is time for getting in real close, squeezing the juice out of every note. Pressing your cheek against the ink of the staves. But there are also times when it is important to maintain a little professional distancing from your work. There are instances when the best thing you can do for your patient is to remain off stage. Dont get caught up in their drama, even when its particularly…er…dramatic. By keeping some internal perspective, the correct course of action will be far more evident.
Of course, there are times when you need to maintain a very physical distance from the music. The orchestra can be a dangerous place. Exit stage left.

Lunga pausa A long pause
Perhaps one of the most powerful communication techniques there are. When talking to your patients or taking a history make sure you give them space to tell you what they want to say as well as what you want to hear.
If a patient is trying to tell you something important, or if your own gut feeling is that there is something else going on that for whatever reason has remained unspoken, wait till they have finished speaking and then leave a long attentive pause. If they don’t speak, remain with it. Just wait quietly.
Alternatively, ask them if there is anything else they need to say and then pause at the end of their reply.
Often this space will open a much deeper level of conversation, cutting through to the important stuff.
Its not easy to do, and shouldn’t be used all the time, but just as in a piece of music: the space between the notes can sometimes be more important than the notes themselves

Misterioso Mysterious
There are great mysteries within the hospital. They run quiet counterpoint, often far below the dense chords of science and technology that pulls at our attention with all its sharps and flats.
Being open to this mystery is an important part of the art of nursing. Listen carefully.

Obbligato Indispensable, cannot be omitted
There are things that you must do or must know that are indispensable. Know them and do them.

Prestissimo As fast as possible
This is the way you are going to have to eat your meals, ’cause there are twenty other things you need to be doing.
This is the way you are going to have to empty your maxed-out bladder, ’cause there are five patients all wanting a bedpan….now.
It has always been this way. It always will be.

Scherzando Playful

1. Nurse soft. Play hard.
2. Swap densities as required.

Senza Sordini Without mutes
Now, more than any other time in its history, nursing needs a voice. Speak up. Step up onto the rostrum and conduct.
Find your own drum and do not be afraid to hit it loudly with a big mallet if a strong beat is what is required. Gather your best players and go out into the world and show them your art.

Troppo . . Too much
Going Troppo is a real risk for nurses who fail to care for their instruments. You need to look after yourself and find your own balance point. Just like the strings of a violin, if the tension is too loose, everything sags, your work becomes sloppy. And it quikly effects the strings around you. But if you wind yourself too tighly, your sound becomes harsh and sctatchy, and at a very real risk of breaking.

Volti subito (v.s.) Turn the page quickly
You can never play the same sheet of music exactly the same twice. So, play the phrase and then move on. There is probably going to be something even more interesting just over the page.

surgical day care, palliative care rotations

i just found out it's daylight savings time, already! (that might explain how i slept in so late!) =) luckily chris is more on top of these things than i am...

i'm in the middle of my "community" clinicals, which has been like a vacation since we don't have to do our lengthy work-ups before we go. (for orth, surgical, medical, etc. we have to do a full patient work-up, which takes about 2 hours, then complete the bibs of all their medical diagnoses and highlight, which can take anywhere from 2 to 4 hours, do two care plans, which takes about 45 minutes to an hour each, and pull and highlight med cards for each med they're taking. if it's not in the nursing med deck, we have to make one. finding all the information is torture. so the weekend before clinicals (on monday and tuesdays) i do nothing but patient work-ups.

aaaand, if your patient leaves (either celestial discharge or goes home) before your two-day clinical rotation is up, you are lucky enough to get to do one of these for another patient. overnight. knock on wood, i've been lucky enough to not have to do this. (i try to pick patients who are obese and/or diabetic, because they seem to have longer hospital stays. so yes, i am greatly appreciating my two weeks of community clinical. :)

last week i went to the surgical day care at the community clinic and watched the ENT surgeon perform two tonsillectomies and two septoplasties. it was a pretty slow day, but i was happy to get to see something besides fifteen cataract surgeries in a row. the surgeon was awesome. "you can't see anything back there. get up here and take a look..." he explained what he was doing, and i enjoyed watching him with the patients. i was really impressed with the surgical tech. i thought the RN would be doing more, but she mostly did computer charting, away from the table. the surg tech however, seemed as if she could read the doctor's mind. she'd pick up an instrument and hold it out to him without him even asking for it. i'm sure she's probably assisted on so many of these cases she could probably do the surgery herself, but it was still impressive.

i heard several horror stories about people passing out in the OR, and i really did not want to be one of those people! one girl told me she passed out...right into the surgeon's sterile field. (she was a primary nurse on my ortho rotation). how embarrassing! i never eat breakfast (my stomach is not awake at 6am!) but i did eat three pieces of lunch meat, (very nutritious...) just to have something in my stomach. looking back i'm not sure if that was such a good idea. once the surgery started, my curiosity overtook my paranoia and i was fine. i like watching surgeries, but i don't think an OR nurse would be the job for me.

one thing that amazed me was watching the nurse anesthetist. he'd complete his assessments (about every 15 minutes) and then go back to his Sudoku puzzle. i didn't think it was that big of a deal really, because his machines would beep periodically if something was out of range. i started to wonder if he was really paying attention to his job though, when i noticed the patient's bag of LR was getting low. the nurse got a new bag and put it next to the old one so it'd be right there when his old one needed to be changed. i watched the bag drain from the "9" mark, to the very bottom, and decided i wouldn't say anything unless the bag was completely emptied. which...about five minutes later, the last drop had been squeezed out of the bag and the drip chamber was slowly draining. i asked the surgical tech if the bag was okay, and she looked at it, and told the CRNA to change it.

on tuesday i went back to the hospital to shadow the palliative care coordinator. i had no idea what to expect from this clinical, but i love the nurse who oversees it, Edie. I got to the hospice house at 8:30am, and we set off for rounds. she goes to the ICU, CCU, CICU, and PCU rounds, and is available for patients to speak with regarding hospice care, if their prognosis is poor, or for palliative care, if they have a chronic disease or condition. i don't think people really understand what the difference is between palliative and hospice care, and tend to freak out a little when someone comes into their room from palliative care.

I thought the ICU rounds were the best. the doctor truly seemed like he was the most organized, and arranged for multidisciplinary walking rounds. it was a crowd, but everyone was on the same page and knew what they had to do. it was the physician, the dietitian, Edie, the pharmacist, the chaplain, the respiratory therapist, speech pathologist, social worker, and two unit managers. i loved being on ICU, and still think that's where my calling is. being in the patients' rooms and actually seeing how much equipment they're hooked up to was a little daunting, but i really like the critical thinking aspect of it, trying to figure out what's going on, and how it's affecting other body systems.

once rounds were done, Edie had an appointment with a patient's wife. he wasn't doing well, and was being kept alive by the machines. his wife was in her mid-fifties, at the latest. two physicians were in the meeting, along with an RN, the chaplain, and Edie. she wanted to take her husband off life support on friday, when her family could be there. she seemed so calm, almost stoic for the first part of the meeting, and i started to wonder about her. halfway through the meeting she broke down, which was hard to watch. seeing other people cry always makes me tear up. she pulled herself together shortly, and we finished the meeting.

i asked Edie about her later on, because i was curious about her coping mechanisms and what Edie thought of them. she mentioned that she'd be worried if she hadn't broken down at some point during their conversations, but seeing that she had, and how well she pulled herself together made Edie think she was coping and not denying the whole ordeal.

it made me somber friday morning, writing my paper about these two clinical rotations for my instructor, and realizing that a couple blocks away, this woman was saying good-bye to her husband...