and I thought statistics was tough…

I am now up to my eyeballs in “nursing research”.  In my online class, we have small group discussions. One guy is obviously waaaaay ahead of the rest of us. Today he posted his answer to the question that will last the next 2 weeks….I, and probably the rest of the group have only just cracked the book/read the article.

My new vocabulary sounds something like this:

  • retrospective design, cohort design, prospective design, correlation design-so far so good
  • descriptive research, descriptive correlational research, univariate descriptive studies, prevelance studies, incidence studies- I’m fading quickly
  • counterfactual, blinding-single & double,pretest/postest, factorial design, crossover and quasi-experimental-help!!!
  • nonequivalent control group, propensity matching regression discontinuity design, rival hypotheses-shoot me now!

I am determined to crack this research nut and get at least a “C” in this class.

My hair is looking more and more like this guy…and it’s not because we share any intellectual similarities

Einstein-Letter-set-for-Auction-shows-scientist-challenging-the-idea-of-God-being-Chosen1

 

 

a different nursing perspective

As a critical care nurse I used to have some really sad patient stories. I cared for the patients myself and felt the pain of the patients and families very personally…sometimes too personally.

Now I have responsibility for the infection control issues on several different units, often with very high risk diagnosis such as oncology/bone marrow transplant, organ (liver, kidney, pancreas) transplant and neonates, often less than 750 grams ….

I read the medical records, try to meet the patients…put a face to name….celebrate when they go home…and grieve the bad outcomes.

As I move on with my education and take a more global influence over nursing practice at my hospital I still remain, at heart, an ADN (associate degree in nursing)-considered the lowest, most basic of nurses. In my escalating nursing role, I savor “reading” patients…I relish the time I have to ask questions and wait for their response unlike when I was a bedside nurse rushing around like a nut.

Instead of taking care of just one patient, I now “care” for many patients and I mentor the bedside nurses to “care” about their patients also.

welcome back

tracya-research nurse, is turning back into tracya-critical care nurse. officially 31st of march but i will be working lots of shifts in the hospital between now and then. there are a few reasons for that:

  1. money, moola, big bucks, dosh
  2. they are d.e.s.p.e.r.a.t.e for nurses
  3. it’s winter, cold, dark and there’s nothing better to do….

i worked my first regular shift in the new hospital yesterday-i am still shell shocked. i called last week to confirm which shift i was on and i asked the charge nurse-“how’s it going, over there?” she said-“you’ll find out when you get here…” not exactly a glowing report…

when i got there i had to trek from one end to the other through more doors, having to swipe through most of them, than i care to remember the place is huge!! luckily i found a familiar face who was coming in for the same shift as me…i asked her “so, how’s it going. over here?”…as we walked back to the unit (through 5 or 6 doors) she told be it was horrible and gave several examples of things that had happened….and as if on cure as we approached the door of our unit the porters were wheeling out a dead body…

we went to the coffee room and my old friend was having something to eat-he let me know that at 12pm he was only just having his morning break…another bad sign…

i asked the charge nurse if i could have a handover (on all the patients) because i hadn’t worked for so long and she said sure, but could i just go give a hand in bed 21 while she tried to get a bed for another patient….never got handover and never left bed 21…

the very short story is that it was chaos…okay so i was new and didn’t know where anything was but nobody else knew either!! my patient had to be intubated (put on the ventilator) but was unstable for the next three hours and had very low oxygen levels- i was comfortable with that part and really felt good as all my old skills came back but when i said to someone where is the bronchoscope?…i just got blank looks…ummm, it might be over there…it might be next to the crash trolley….where’s the crash trolley?…it’s around the corner just past the cupboard between the seminar room and bed 14….i didn’t have a clue and the whole unit is a maze-it seems like you could just go around in circles all day…

and of course it’s been divided up into the inside and the outside—kind of like the number 11-outer circle bus

except there was no map and the inside has no sunlight…there’s going to be a lot of despressed, stressed nurses in birmingham~~did i mention that we expanded from 14-15 beds to 20 beds and that we are using loads of outside agency nurses?

it’s weird to go from my cushy research job, preaching patient safety to the real patient world equivalent of walking over burning coals. at the end of the shift i saw the nurse that i walked in with-she asked me if she was wrong…i told her that her comments did not even come close to describe the horrors of the situation. i have a feeling the blog is going to become a lot more interesting over the next few months…..

i’m a real nurse again

it’s been nearly a year since i took this research job and despite the ups and downs, it’s been a real learning experience. this month though i decreased my hours on the project to 30 and am now working 7.5 hours a week in my old position as a critical care nurse on my old unit.

last week i worked a long day sunday, i didn’t have the sickest patients but i did start out with two patients, transfer one out, admit another patient in and then transfer the other one out making a total of three patients in one shift!! like i said they weren’t the sickest but it did test my time mangement and delegation skills.

this week i worked saturday night…i didn’t have the sickest patient again but there were at least 4 patients on the unit on the verge of a life threatening moment that the whole unit actually felt like a critical care unit. the 2 “crash trolley”(s) spent most of the night in one bedspace or another, the lights at one end of the unit never got turned down….. there were sporadic flurries of people rushing around, curtains being drawn and semi-frantic arm waving requests.

ahhh, just like the old days….

a reminder

when i work now, i am “agency” which means i make more money per hour and it generally gives them permission to give me crappy more challenging…long term patients or two patients, which is what they did sunday. i don’t really mind, i just get on with it. …it’s a reminder to me that i shouldn’t get to smug about my trips to london and my meetings with little sandwiches.

my first patient i kind of knew from the day before…a real friendly, chatterbox with a big but cheerful family. the interesting thing about him is that i was just confirming his date of birth with him…17 july 1945….mmmm, i said… oh dear right at the end of the war?

he went on to tell me that he was the baby of the family…he had 5 older brothers and 2 older sisters. he said they lived right here in south birmingham all through the war…i was just really humbled with the thought of raising all those kids during a war and still being hopeful or foolish enough to have another baby…

i know lots of people did it and lots of people are doing today but they must have been really incredible people to have produced such optimistic kids…but then maybe the only way from there~~~was up…

the other funny thing was i asked him what he did for work when he was younger….he rattled off a list of menial labor jobs but said he liked the bins the best…..loved the bins! it took me a minute to understand he meant he was a garbage collector. he said he started at 4:45am finished a 1pm and was in the pub at 1:15pm…that kind of lifestyle is what is missing in the young men today….it’s fine to hang out in the pub with your mates….after you’ve put in a days work!!!! anyway, trev was really funny and made me laugh…a lot!

i really needed that to offset my other heartbreakingly sad and difficult patient. i still can’t get my head around how this can happen but as far as i could find out from his notes, up until this past summer, 2009, he was a dairy farmer…he started to have leg/hip pain which increased rapidly over 4-6 weeks to the point his leg was giving out, he had falls, was on strong pain killers and wheelchair bound.

 in sept 2009, he was seen at the orthpedic hospital and after several attempts they were able to get scans which showed a “mass” extending from his leg up to his spleen, pressing on his IVC and other organs and nerves. they have been unable to get any definitive diagnosis and the truth is that it doesn’t matter because if it is growing so fast and intertwined and stuck to so many organs ~~~they have already labeled it “inoperable”

to say this man is miserable is the understatment of the year..and who can blame him? nothing was right for him and due to his size~~~i assume he was a fairly big guy even before we filled him with 10 liters of fluid…his left leg is twice as big as his right and takes one person just to lift it and another person to adjust the pillow.

i really tried to do what i could for him, he alternated between being fast asleep (thanks to the morphine) and being drowsily awake and telling me was sooooo uncomfortable and just wanted to shit…i did manage to hoist him into the chair for awhile.

the whole situation just makes me so angry…angry at our biology…and angry at the healthcare system because a nurse who used to work in palliative care suggested more effective ways of keeping him comfortable and angry that when he goes to the ward, the nurse will have more patients and less patience than me and will do even less for him…he certainly does not deserve that.

did i mention he was only 48 years old?

 

i’m just a girl who can’t say no

especially to extra shifts…it’s taking my doing more motto one step further. once i get in a working~making money frame of mind…i go into american work ethic mode.

a few people have asked me about the goals i referred to in a previous post. i have 4 main goals for this year~~~

  1. get my kitchen finished

  2. have matt come here for a visit

  3.  go to roses  graduation

  4.  be with my mom on her 75th birthday

i know i probably won’t be able to fit all those things in but extra money will help. so the result is that i am working one extra shift every weekend plus christmas eve and christmas night….

after january it will be near impossible to work extra since i am starting my MSc…with the exciting “qualitative research”~~~

did i mention i have been named on another study as a collaborator??? i’ll be working with the ethnographers in leicester~~~

on my day in newcastle with the senior research nurse, she was interviewed by the BBC about a study she published about noisy wards. besides her going red as we listened to her voice on the BBC…. i was really touched that her first comment was to say she needed to call her parents and tell them to listen….

my own feeling was that maybe this really could turn into the second best career choice i ever made~~~

london calling

i’m feeling much better today, better in most ways.

my tummy has settled and i woke up really energized, committed to doing lots of things. accomplished most….i wrote an email to my boss who is off for a few days in barcelona, explaining my concerns about my role as a research nurse.

i met my american friend julie, who is going through a really rough patch, for lunch. sometimes a big american hug is what we need.

made it home just in time for our weekly catch up teleconference.

my boss was not there…i really cringe at the way they (the london group) behave when he is not there. only the lead research nurse from newcastle defends his position. in my morning email asked him if i should be more assertive or just concentrate on the integrity of the data… his response…

The problem with the NPSA is that there are many ‘leads’ in contrast to conventional research where the CI has the final word.

 

Carry on with your plan below which is fine.

 

No need to be more assertive yet!

 

JB

i have been offered a task producing a monthly report…… i’m going to the london office next wednesday…..i’ll see what they really do down there…..

i’m working a nightshift saturday night….almost looking forward to it.

i miss my garden, my stained glass….where has my creativity gone???

 these people in london don’t have a clue about being a critical care nurse.