Decreased Intracranial Adaptive Capacity

I used the student computer on lab on Friday afternoon to download and print some documents off of another instructors coarse website because my own computer didn't have the program she had used to create the documents. Several of the nursing students where working frantically on a paper they have due next week. The assignment was to perform a health assessment on a classmate and then create a nursing care plan based off of the 4 top priority nursing diagnoses. The longer I sat in that room the more questions they asked me.
Nurses cannot legally make medical diagnoses, however they can make what are called nursing diagnoses. Every year a group called NANDA (North American Nursing Diagnosis Association) has a conference to approve the next list of official nursing diagnoses. When I was in nursing school there were only 144, my has the list grown!
As I went through the lists I couldn't help but wonder what it would have been like at those conferences. Here a few new ones that kind of make me go Hmm...
Decreased Intracranial Adaptive Capacity
Impaired Adjustment
Diversional Activity Deficit
Ineffective denial
Acute Confusion
Ineffective Individual Coping
Knowledge deficit
Do they speak from experience? Sometimes you just gotta wonder...

Long, But Worth the Read

Yesterday as I was walking backing into the health sciences building I held the door for a girl coming in behind me. As I was walking up the stairs to the lab, the girl stopped me and asked where she the nursing offices where. She went on to explain that was alum of the nursing program and she needed to talk to one of the professors about a problem she had. As I walked with her down the hall she said "You work at UW don't you?"
I wasn't quite sure how she knew that but of course I said yes. Then she asked if she could tell me about her situation, I of course said yes to that too. The poor girl just fell apart as she began to tell me her story. She had just started a new job in an oncology (cancer care) ICU. A few weeks ago while she was still on orientation she had her first patient code (cardiac arrest). They where able to resuscitate the patient twice that day but the woman died two days later.
She went on to explain that at first she felt OK about what had happened, her co-workers and her manager had congratulated her on how she had handled the situation.
She didn't fall apart until a few days later... Just before her patient (who is extremely sick) had coded she had drawn a blood gas from and arterial line. After she had drawn the blood she noticed a very small bubble in the in the line. The preceptor told her to flush it anyway. To make a long story short the poor thing became convinced that she had killed her patient by giving her an air embolism. She had been tortured by this awful thought for two weeks while on a family vacation, she was about to go and tell her manager this.
We talked for about an hour. I tried to explain to her that it takes several milliliters of air to cause and air embolism, the amount of air in 2cm length or art line tubing isn't enough to cause anything. The patient was on the way out! The question I asked her was "Where did that thought come from?" No one had told her she had killed her patient or that she was a bad nurse or that she couldn't do it. Those condemning and untrue thoughts were coming from the devil, who else wants us to fail? Who wants to disable us with our own thoughts and keep us from being who we are called to be? We can't let ourselves go down that path. While people can and do make mistakes that they need to be accountable for, they cannot take false responsibility. One cannot also be overridden with guilt to the point where they can't move on and it affects productivity.
2 Corinthians 10:5 says:
We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.

Isaiah 55:8-12 says:
"For my thoughts are not your thoughts,
neither are your ways my ways,"
declares the LORD.

"As the heavens are higher than the earth,
so are my ways higher than your ways
and my thoughts than your thoughts.

As the rain and the snow
come down from heaven,
and do not return to it
without watering the earth
and making it bud and flourish,
so that it yields seed for the sower and bread for the eater,

so is my word that goes out from my mouth:
It will not return to me empty,
but will accomplish what I desire
and achieve the purpose for which I sent it.

You will go out in joy
and be led forth in peace;
the mountains and hills
will burst into song before you,
and all the trees of the field
will clap their hands.

As we were talking another professor came in and the three of us had the opportunity to pray these promises. I think we all needed to be reminded to take captive every thought and seek a higher understanding grounding ourselves in truth.


I can't take credit for this picture, it was taken my a person I met in Rwanda who worked for World Concern. The picture was actually taken in Pakistan.

Playing Dolls...

Last week our nursing students started what is lovingly known as "Boot Camp." Boot Camp is the concentrated time we spend in the skills lab learning basic patient assessment and other fundamental skills such as bed baths, bed making, hygiene cares,etc... Some of these skills are practiced on one another while others are practiced on mannequins. Last Friday I was helping the students practice bed baths when one of them said, "I feel like I'm a little girl playing dolls." Essentially that's exactly what we were doing. Little girls (and sometimes even boys) have been learning the art of how to physically care for others by "playing dolls" for centuries.
One group of students was practicing basic care on the pediatric mannequin when the they noticed that the arm was not securely attached. Needless to say we ended up with a traumatic amputation. I took little Jill (the name they chose for their "patient") into my office for some orthopaedic surgery. I was able to reattach the arm but unfortunately due to some missing parts Jill will have a slightly more limited range of motion in her right shoulder.
In my attempts to find some material for some upcoming class discussions I have been reading a wonderful book titled Fearfully and Wonderfully Made. It's by Dr. Paul Brand and Philip Yancey. Dr. Brand was a missionary doctor at a leprosy hospital in India. The book is written from his perspective and discusses the ingenious design of the human body and it's implications to what that means in the concept of community.
In one chapter Dr. Brand describes how he was able to learn more about the disease process of leprosy by studying the bones found in a 500 year old leper colony. He recalls a lecture he once attended by a famous anthropologist. In her lecture Dr. Mead claimed that the earliest sign of civilization is not a clay pot or tools. She claims that the earliest signs of civilization are healed bones! Such artifacts, she said, are never found in the remains of savage societies. The artifacts left behind by them are always evident of violence and destruction. A healed femur (such as the example she had when giving this lecture) showed that someone must have cared for the victim and provided for him (at personal sacrifice) during his time of recovery.
How fascinating, the concepts of caring and community truly are what make us "civilized."

On Monday when I came back into my office after making some copies I found Jill sitting at my desk!

One Week Down

So ends the first week of school... I'll say it went well, it really did. Classes are in full swing and the students have already had an "exam." On Thursday I gave a short "schpeal" about blood pressure, what it is, how the body regulates it, what affects it, etc... Friday I tested them on it. They each took turns taking a blood pressure on one another as I listened in with a double stethoscope. Apparently I make the students hypertensive! Their nervousness was never more obvious to me. In spite of this, they all did very well but I'm starting to wonder how things are going to be when we start breaking out the needles!

Let the School Year Begin!

It's that time of year again, school starts in just a few short days. The students have moved into the dorms and the parents have left. Teachers everywhere are making last minute preparations, hanging borders, making word walls, and expanding their classroom libraries.
I had the pleasure of visiting a "teacher store" with some elementary school teachers of mine. I also had the distinct pleasure of writing "Mrs. Baros" inside the covers of all sorts of exciting titles ranging from "Winnie the Pooh" to "Amelia Bedilia" to "The Boxcar Children."
Just last week "Mrs. Baros" helped me go through my classroom library which incidentally had much more boring titles like "Therapeutic Nursing Interventions" and "The Physicians Desk Reference." I must admit that I would rather be reading Encyclopedia Brown than writing my lecture on fluid and electrolytes.
Last Friday morning I had the distinct pleasure of leading the devotion time during the new student orientation. I was reading the passage in Exodus 17 where the Israelites are fighting the Amalekites in the valley while Moses stood on the hill holding his staff. As an illustration I had one of the students hold a box over her head as I read the scripture. After a few verses I would then add one of their text books to the box. Of course it didn't take long for her arms to get tired (as I can be long winded and each of those darn books weighs at least 6 pounds). Her classmates soon figured out that they could help her by holding her arms up. When I finished reading the chapter I asked a few questions about the application of this passage. They seemed to grasp the theme of encouraging one another in the Lord, baring each other's burdens, and standing firm in truth but when I asked them what was above their heads one of them quite seriously said "our assigned readings." Actually I was going for the whole "The Lord is my Banner" thing but...
Later that afternoon I weighed that box and found out that with all it's contents it was 52 pounds! I'll bet our students were wishing they were reading Amelia Bedelia or Encyclopedia Brown too.