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The Nursing Process (page 2)

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Updated on Dec 8, 2010

Nursing Notes

Making a Difference, One Patient at a Time, by Jolynn Sannicandro

My preceptor and I stood outside a room as she gave me the report on a patient who was admitted that morning. She explained to me that the patient was fresh out of surgery for a total laryngectomy and that the patient's voice box had been completely removed due to laryngeal cancer. My preceptor further identified my objectives for the morning, which included assessing the patient from head to toe, obtaining vital signs every four hours, monitoring output, suctioning the patient, changing the patient's feeding tubes, and providing wound care.

As my preceptor left to tend to another patient, I took a deep breath and walked into the patient's room. She was sitting in a chair with her feet elevated on a stool and a trachea collar attached to oxygen and humidified air. There were two drains located below the right and left clavicles, which appeared to be patent based on the accumulation of fluid. I grasped the stethoscope around my neck and proceeded to introduce myself. As I began my full body assessment, I observed other devices attached to the patient that I had learned about in lecture and seen in clinical practice, such as a catheter and a nasogastric tube. The catheter was properly placed by the nurse. It was taut against her thigh and below the bladder. The nasogastric tube was connected to a pump and there was formula flowing from the feeding bag through the tube and into the patient. The woman had a nervous but kind smile and warm eyes behind thick round glasses. The patient's fear for her own well-being was compounded by her awareness of my own self-doubt. This being only my second day at this hospital, I was still experiencing the butterflies that come with every unfamiliar and challenging experience. However, I placed my own apprehension aside and thought back to the nursing classes that had more than adequately prepared me for the current situation I was in, dealing with a patient who was scared and needed a medical professional who she could trust. I had no idea that this initial placing of trust would be the beginning of the kind of relationship that is at the heart of the nursing profession.

The patient remained under the hospital's care for several weeks. I was assigned this same patient every clinical rotation and began to grow closer to her. Although communicating was difficult because everything she wanted to say to me had to be written on a notepad, I was still able to read her emotionally by looking for nonverbal cues. As a nursing student I had been trained to become more aware of a patient's emotional state by observing for something as subtle as a slight change in a patient's facial expression.

I was also able to glimpse the life of the patient through her large, close-knit family, who visited her daily. I came to know the patient's family when they would visit her to play board games, watch her favorite soap opera, or share stories about their day. Throughout these visits I saw the interactions the family members had with the patient and quickly realized how important her family was to her.

One day after a visit by the family members I was checking the patient's vital signs; she tapped me on the shoulder to show me a note she had just written on her pad that said, "Do you think I will be out of here in a month to see my niece get married?" Taking her hand in mine I told her that I could not promise her when she would be discharged from the hospital, because I did not want to instill in her a false sense of hope. However, I assured her that the healthcare professionals and I would be there with her every step of the way on her journey toward recovery. With that, the patient gave me a smile and squeezed my hand.

After I assured the patient that I would be there for her, I made sure she continued to build her strength by walking around the floor with her, washing her hair, or just simply spending time with her when her family was not there. As I did these things, I could see before my own eyes that her health and morale were slowly improving. This pattern continued for several weeks before she was finally discharged from the hospital. On her last day, the day before her niece's wedding, she wrote me one last note that said, " I couldn't have done this without you; I love you." After giving her a hug and a kiss, I realized that moments like this are why I wake up early for clinical and spend long hours in the library. I truly felt, and her note confirmed, that I was an integral part of this woman's recovery. The experience I encountered with this patient showed me that this career allows me to touch the lives of people in ways that people in other fields will never get to experience.

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