Commitment to Excellence

This week was a busy week, here are the highlights:

Photos: Commitment to Excellence Ceremony, my 1st day in Duke scrubs, class photo.

Commitment to Excellence Pledge: As a nurse, I commit myself to care for each person’s needs in a holistic way that is both individualized and compassionate.  I commit to serving both the individual, and the family, helping them attain and maintain optimal health and well-being.  I will be accepting and will not judge an individual’s values and beliefs.  I commit to working collaboratively with other members of the health care team to provide quality, evidence based care.

Yesterday, I attended a talk, by Dr. Rick Hodes who does spinal surgeries in Ethiopia for the last 29 years.  He talked about the Jewish concept, Tzedakah (charity/ moral and societal obligations) and how it applies to his work.  He said in the Jewish faith, there is the concept of giving back to the community, sometimes a portion of your income goes to charity, but for him, in his work, after the surgery, he ensures the patient has an income and skill to further their lives.  The concept of Tzedakah resonated with me.  Click the link of his name and read the story about two patients who walked 400 miles (8 days) to see him. 400 miles is something like walking from Boston to Washington, D.C.

I applied for our clinical placement assignments for the spring, 2nd semester to go to Tanzania, Africa and work with the Good Hope (an orphanage, mostly of children left behind from war).  It is a two-week global clinical immersion assignment and I am excited to learn about Global Health.  We are interviewed in a few weeks about our clinical site placements, it is not a guarantee I will be selected to go.  I am also excited to apply for the alternative spring break trip, that goes to Guatemala and works with maternity care in a village.  It will coincide with our 2nd semester Maternity and Pediatrics class work.  3rd semester, we can take an medical Spanish elective course.

I joined two clubs – Nurses Students without Borders and Duke Emergency Nursing Students.  I am excited about the Nursing Students without Borders club.  I looked up their previous activities, and they go out and service the community.  For example, a health fair focused on refugees and another with the Latino community.  I not yet sure if I will run for a Board/Leadership position in one of the clubs.

Other activities this week, I was offered a job that I did not apply for.  I applied to work with the Duke Outdoor Adventure community as a guide, but they interviewed me and decided they were not hiring for this position this semester.  Instead, they offered me a job working with their Adaptive Climbing program, which is a climbing program for people with disabilities in the Triangle Region (Raleigh, Durham, Chapel Hill).  I do not identify as a climber, but I accepted because I thought it would be good experience to learn to work with a population I have not yet worked with.  I also asked for the minimum commitment, so I will only be working, two hours every month.  For fall break, they might have a staff backpacking trip, but not confirmed yet.

In class, we had a presentation by Blind Industries, which is in Raleigh (30 minutes from Duke/Durham), and we will learn to work with blind patients in another of our clinical assignments this semester.  I learned from our brief introduction with them, to learn to ask the patient, would you like to take my arm?  (Usually the answer is yes, and you keep your arm straight, not bent, and they usually take your elbow.)  Would you prefer the right or left?  We were told just because you see someone with a walking cane or a dog, do not ask them if they need help.  Do not assume someone needs help, unless they are struggling.  We live in a sighted world and it is important to communicate tactily and verbally.  Blind people see, just with their fingers.  For example, if someone says to a blind person to sign on this line.  You could fold the paper, and crease it, so they could feel for where to sign on the line.

This week, I came to terms with the fact, this accelerated program feels like 4 years of work in 4 semesters.  We speak in the same terms.  We are in the 1st semester cohort, and next semester we become the 2nd semester cohort.  There will be a cohort behind us, starting in January.  We advance, similarly as you would consider a first year, sophomore, junior and senior.

I met my peer advisor who is a 3rd semester student and she said this semester is challenging semester because we have to be on campus every day and the volume of material is a lot.  She tried to help me set my priorities and come to terms with the idea I will personally not make it to the gym regularly this semester.  But, next semester when we switch to 2 full days on campus and full days of clinical assignments, I will be able to manage better.  She suggested, since my labs are in the afternoon, I use the mornings to do stuff other than studying, like laundry, etc.  I met my tutor, who also helped me with time management.  Next week, we’ll start studying pharmacology principles.  We started our discussion in class about how drugs enter the body and the effects they have – for example, if a drug is acidic, will it be absorbed in the stomach?  Now, I understand why Chemistry and Physiology were important pre-requiste classes.

Tonight, I’m going to the farm to meet my Community Support Agriculture (CSA) people.  I’m excited to meet the farmers (refugees) who are producing my food, and the other members.  This is my fun activity for this week.  Over the weekend, I have to go back to the lab to practice taking vital signs (temperature, respiration, pulse/heart rate, blood pressure) as we are tested on them in a simulation next week.  We have another simulation next week too, which is focused on therapeutic communication and motivational interviewing.  We get fake patients or rather real people pretending to be patients, where we spend twenty minutes in an office setting discussing a scenario (like losing weight, eating better) and we are filmed and then assessed.

Week 3 done.

Week 2 – more wellness

Life feels a little like Irma, preparing for the storm. I feel incredibly behind with the volume of work, acknowledging I will never be caught up. I’m really trying to just do enough to be present and prepared for the day which was challenging this week. Each of our ATI modules (prep for NCLEX – Boards) was 30 mins each and there were 5, with post tests. This is above the regular homework assignments.

Week 2 – By Sunday, I will have written two papers, (one very long paper on wellness – my definition of wellness, social determinants of health, family health history, etc… this is only part 1 of the paper and part 2 and 3 will be later in the semester). The other paper is a reflective essay after our assignment of observing a community support group (like AA). I attended Nar-anon which is a family/friend support group of addicts. It was very different than my expectations. If I have time I will start writing my third paper of the week, research on the past/history of palliative care/hospice nurses, current state and future.

Other work this week, I took another quiz and learned in lab – how to take blood pressure, find a radial and brachial pulse (all not well)… we get tested on this a little later. I am however proficient at motivational interviewing and therapeutic communication, which I practiced for more than 6 months as an HIV test counselor, so that skill came in handy, and was good preparation for nursing. I may not yet know how to use my hands but I know when and how to use my words. People with some sort of medical background excel at our lab check offs but I hear the playing field will even out next semester when we start memorizing drugs. Other cohorts also tell me this is the easiest semester so that frightens me.

I have not yet been to the gym. All my scheduled gym appointments were pushed off in my calendar. I recognize I will have no time and only trade offs. This Wednesday, I could either go to the gym after class, cook a few more meals for the week or study. I choose to make meals since I really appreciate my fridge turning into a grab and go Tupperware fest. I suppose I’ve been really good at my nutrition, in 23 days being in Durham – I have eaten out only twice and have made/packed every meal – breakfast, lunch, dinner. I suppose I did my own version of whole 30. My new rule for eating out is an interesting budget concept I read – no eating out unless it is social. No take out, no pizza, no Starbucks unless a friend wants to go do those things. My budget so far is on track to spend $2,000 (rent/utilities not included) for 4 months.

My self care plan (which is also part 2/3 of my wellness paper) is to spend 2 hours every week for myself. Since I no longer have archery – I need to find another outlet. This week, I went to see a terrible mainstream movie as my escape. Next week, I am taking a free art class at school about screen printing.

Week 1 – wellness

 

During our first week, we talked about the concept of wellness a lot.  Wellness is conscious, self-directed, an evolving process of achieving one’s potential.  Different than health, which is the absence of disease.

Wellness is multifaceted, with many dimensions.  Upon a self inventory, I could use more physical activity and have more relationships.  I’ve put in my calendar some gym classes to force the time into my schedule and will look for more ways to build community/relationships.  I invite you to take inventory of your wellness.

  • Emotional: coping with life, satisfying relationships (could be improved)
  • Financial: satisfaction with current and future financial situations (not ok, but coping until I graduate and become employed to pay back loans)
  • Environmental: good health, stimulating environments that support well-being (check)
  • Intellectual: finding ways to expand knowledge and skills (check)
  • Physical: recognizing need for physical activity, diet, sleep, and nutrition (diet, sleep, nutrition – ok, physical activity – lacking)
  • Social: sense of connection and well-developed support system (check)
  • Spiritual: expanding sense of purpose and meaning in life (check)
  • Occupational: personal satisfaction and enrichment derived from one’s work (check)

Josie King

After watching the video of Josie King, I felt heart-broken.  Josie King was an 18 month old burn patient who died at John Hopkins Children’s Hospital in 2001.  She died from dehydration but due to errors in a series of failed communications from her medical teams.  When her nurses, doctors, and health care units made a series of mistakes, this baby died from a preventable death.  Her story is the reason we learned today to chart and document.

Her mother settled for an undisclosed amount of money but no amount of money can heal her baby’s death.  Her mother went on to continue to tell Josie’s story to create better patient advocacy and safety at Hopkins and beyond.

Josie King’s story told by her mom, video by PBS

Hand washing 101

Did you know there is a proper way to wash your hands and we get graded on it?  Why is this not taught in grade school?  Our clinical instructor gave us a handout and said, here is the technique to wash your hands.  I said, the handout is great, it’s like IKEA instructions, for me, when reading it, I have a 50% chance of getting it right, but if you demo for me, I’m sure I can follow.  She then demo’ed for us, and said if you are washing your hands properly, it should take at least 15 seconds.  We then were given fake bacteria to put on our hands to wash off and taken into a dark room after with a special light to see if the bacteria was washed off.  I failed, in that I did not wash above my wrists.  I don’t think I’ve ever washed above my wrists.  We were not graded today but it was a helpful exercise.  We are not allowed to wear jewelry except a simple wedding band, if you have one, no nail polish (since it harbors bacteria) and nails should be short. We should wear watches with a second hand.  And if you have long hair it must be tied in a bun.  If it’s in a ponytail, it could either lean into something gross or a patient could pull your hair.  I think my learning style is learning by observation.  I’m glad there is a lot of that in nursing school.

http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

Also, I’m not sure I budgeted correctly, or when filling out my loans, I budgeted the very minimum I could to get by.  From August-December, minus living expenses (rent, utilities), I have $2,000 to spend from my loan money.  I am getting anxiety from that small number.  I’ve already wandered around the house to think of ways to sell things that I don’t really use and posted them online.  The key is to not spend money, and if I do, there has to be a balance of income or I need to make some money.  I bought a $50 Patho book off a 4th semester cohort, even though I already rented it for $40 this semester, but I wanted to buy it because we’ll use it in the next two semesters.  I’ll likely be able to sell it to another incoming student later, if the college continues to use the same edition/book, but that means I am down $90 and should figure out a way to make $90 to break even.  This is how I’ve always lived my life to make ends meet, but for the first time not working is causing me a lot of stress.  I’ve come down with a cold already, but I know it’s just from the stress of moving, financial aid and starting school.

1st day of school

Every Monday, I start class at 8 am with Homeostasis and Principles of Pharmacology.  It’s a tough way to start the week.  In 30 minutes, we reviewed key concepts that took two weeks to learn in my Physiology class at CCSF.  That’s not to say, it took a long time to learn these concepts in City College, I only mention it to demonstrate the accelerated pace of this program.  In each of our classes, we are given objectives (sort of like a to do list of the day), the list of the things we need to learn today, and commit them to memory.  Then, we are told to go home and quiz ourselves while answering the objectives.  For example, verbalize the steps used in performing hand hygiene.  We are quizzed weekly.

In Pharma, this week we are reviewing homeostasis (adaptions to physiologic demands or stress to maintain a steady state) and thermoregulation  (as it relates to my other class, Foundations: where we will learn how to take blood pressure and vital signs.

I find it interesting that the classes are mostly team taught.  In my Foundations class, there are three instructors and between them they have 98 years of nursing experience.  In Patho, we will be using the same texts for three semesters, so I now need to purchase the Patho book, which I had rented this semester thinking we were only going to use it one semester.  I asked some people in the cohorts ahead of me about books, and they said it depends on your learning style.  Some people don’t do the reading or don’t buy the books and rely on the powerpoints to learn the material.  They said it depends on your own learning style.  There is so much to do and they said they didn’t have the time to get to the books.  Others have said, they bought all the books and used them as reference.  All my books are over 3 inches thick and they are really heavy.  There is no reserve library reading, you are expected to have your own materials.  I think I’ll at least have really strong legs at the end of the semester biking my books to the library.  I haven’t decided on where to study yet.  I think it will be in the library because we are encouraged to have a study group or study buddies to practice and quiz each other.  I think I might like the Divinity library.  I’ve seen pictures and it looks beautiful.

Day 1 done, onto Day 2 – lab for 6 weeks in the afternoons, then we start clinicals from 7 am-3 pm on the lab days.  This semester is 12 weeks, classes M-F on campus.  Finals are the first week of December.

In my foundations class, we are to design and implement a self care plan too.  I won’t be able to do archery, as it is 30 minutes away from campus and I don’t have the funds for private lessons either.  I’ll have to find a new activity.  I signed up for free art classes like print screening and ceramics and have an interview next week for the Duke outdoor guiding program, but still looking for a new outlet for fun.

Durham Farmer’s Market

Durham Central Park is not a Central Park, it is more of a central spot to gather.  I went to the Farmer’s Market today and loved it.  I spoke with the farmer couple selling eggs.  I asked where was their farm?  They said, it’s about 30 miles south of Durham, just down the road past UNC.  They have 1000 chickens on their farm, all in different stages in life.  300 chickens lay eggs with an egg producing life span of 3 years.  I asked what they do with the chickens after they have finished their work cycle.  The farmer said, “well, we try to give them away.  We don’t eat or kill them.”

I bought some kind of weird spinach from another farmer.  He said it’s in season and looks like spinach and cooks like spinach but isn’t exactly spinach.  I bought a few handmade cards from a photographer who went to Columbia, South Carolina last week to shoot the solar eclipse.  I bought some other greens and a honeydew melon from another farmer.  Next week, I’ll go back to buy flowers, handmade soap, beeswax candles, and honey combs.  The person who makes the soap said it is a 3 hour process and it takes about 45 days to sit after she is done.  The honey person said he is able to make his candles with a mold.  I am excited to support local artisans and farmers, and know my food traveled no more than 30 miles.  There were also food trucks and two local bands playing on either side of the park.  It’s a nice way to spend Saturday morning.

In other news, I am further along with furnishing my home.  A new classmate donated new glassware to me.  I bought a nightstand from another student moving and received two dressers for free.  One dresser was advertised on the local neighborhood list serve.  I walked over two blocks to the person’s address and rang the doorbell.  I said, “I just saw your post about the dresser and I would like the dresser but I do not have a car.  Can you help me bring it back to my house?  I live on the next street over.”  He said, “sure, let me get my shoes.”  I lifted it and it was kind of heavy so I recommended we use his car.  I’m happy with the free dresser that was delivered.  It is not great quality but will do as a night stand.  The other dresser, I received from my previous Airbnb host.  She was kind enough to give it to me from her attic and helped me bring it home.  Lastly, I would like a large rug for my living room, but can live without it.  My home is settled enough to not be a distraction and I can begin classes on Monday.