How to age gracefully

"What is the secret to staying young?"

I ask this question of all my older and surprisingly independent patients. I have had some expected answers and some that shocked me. 

I thought I would compile a list (of the ones that I can remember). Because, let's face it... we all want to age gracefully.

• Stay active. Every single day
• Take time out from your job
• Drink a shot of Greek Brandy every night with dinner. I have also been told on several different occasions, a shot of liqueur, or a small glass of red wine every night helps too.
• Have lots of sex
• Remain positive
• Never stop learning
• Reduce stress in your life
• Eat healthy

I endevour to update this list as I meet more new and exciting elderly patients. I love sitting and chatting with them, and learning about their lives. A lot can be learnt from them!

Nurse KC

Graduate Year: How to stay ahead of the game

                                                                                     source: sketchymedicine.com

One thing I have learned from asking experienced nurses, is ways in which you can maximize your potential to learn new things, and stay afloat. And it all comes down to asking questions.

Whether the questions are:

• What is this diagnosis?
• What is this new medication?
• Are there any practice points I need to know for these?
• Are there any side effects?

It has been drilled into us at uni, to question everything that we come across. And it's so true! 

Whether you have time at work or at home, is so important to advance your nursing care, and expand on your knowledge.... it's not all about the fun complex medical procedures.

I'll give you an example...
Today I cared for a patient with Serotonin Syndrome. Before today, I had only dealt with Serotonin Syndrome in the community, so I had no idea how to manage a sub-acute patient with this condition. Luckily for me, an ICU nurse had been one step ahead and printed out a BMJ Best Practice article on this condition. It greatly helped in identifying the diagnostic approach, the classifications of Serotonin Syndrome, the investigations needed, and the criteria the patient meets to be diagnosed with the syndrome.  

Not only knowing the presentation of a medical condition, but also how it is treated can shape you nursing care to be more patient centered. Also, it greatly aids in the identification of warning signs that things aren't right for your patient, and the things that are expected.

Understanding the treatment plan the doctors are prescribing makes for a happy nurse!

Questioning everything has advanced me a lot further than than being 'just a grad nurse'.  With time, the 'common' diagnoses in the ward will become ingrained in my memory, and google will no longer be my best friend!

For those interested, here is a link to a basic rundown of Serotonin Syndrome.

You're welcome :)

Now, go forth and study your hearts out!

Nurse KC

ANZAC

Today is one of the most important days on the Australian and New Zealand calendars. ANZAC Day.

ANZAC day is annually commemorated to mark the day in which that Australian and New Zealand Army Corps landed at Gallipoli in 1915. Dawn services are held around the country to mark respects to those who fought for our freedom (unfortunately, this year I was unable to attend, due to work commitments). Veterans and family members march in parades, their shiny and prized medals gleaming brightly, pinned to their breast. This is an amazing experience for all involved. 

In true Aussie style, an annual AFL game between Essendon and Collingwood is played out at the MCG in front of a packed crowd. During World War 1, the VFL alone lost 94 players, including 17 in the chaos of Gallipoli - six on the first day! (abc.net.au)

I identify strongly with the connection to the Australian Defence Force. I am proud to have a grandfather who fought in World War 2, and my brother currently serves in the Army, and holds a rank of corporal.

So today I say thank you to the ANZAC's who paid the ultimate sacrifice to that we could live ours. Thank you to the ANZAC's who returned to teach us about the spirit of the ANZAC's. Thank you to the ADF for keeping our country safe. 

Lest we forget.

Nurse KC

Knowledge

I stumbled upon this post Dr. Grumpy recently uploaded about knowledge. I can relate to the Medical Student that was Dr. Grumpy and Haley. There have been so many times when I was a student, and now, when I look up to senior nurses and wonder just how they can remember that much, and how it seems like second nature to them.

While I roll around the ward with my P-plates on, I must look like a foal trying to walk for the first time. Although, I am getting better at my coordination of certain things... like taking blood and not being so cack-handed.

I know that it is experience and practice that makes perfect. So here is to all the practice I will get!

Have a read of the story Dr. Grumpy shared...

Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.
And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.
Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.
As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.
Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."
And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.
I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.
In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.
And, if they ask me if I ever feel like I don't know anything, I tell them "always."
Good luck, Haley!

Oat Bites

I found these Oat Bites on the Kristin Cavallari app that I have (yes, I am a huge fan of her... She "get's it", you know?). Anywho, I decided to give them a crack, and I am pleasantly surprised that they taste bloody amazing! And there are so many possibilities to make them healthier, or not so healthy (....chocolate and alcohol, anyone?)

Here is the recipe:

Ingredients:

1 cup rolled oats

2/3 cup unsweetened coconut flakes

1/2 cup cashew butter

1/2 cup chia seeds

1/2 cup cocoa nibs

3 tablespoon coconut oil, softened

1/3 cup honey or maple syrup

1/2 teaspoon vanilla powder

Directions:

1. Mix everything together in a medium bowl. 

2. Chill for 45 minutes.

3. Roll the mixture into balls and enjoy!

4. Store them in the fridge.

I bought the white chia seeds... only because the supermarket was sold out of the black chia seeds. I did have to hunt around for a whole foods store that sold cocoa nibs. And I substituted the vanilla powder for vanilla extract, because I had that in my cupboard. Next time I make these, I think I will make my own vanilla powder.

Let me know what you think of these! 

Nurse KC 

Photo: Kristin Cavallari app - Oat Bites

Fuel your fire!

All nurses will know how important it is to fuel their bodies with healthy, whole foods.
In light of this, I thought it would be appropriate to update my blog a little bit, and add this new section featuring holistic and healthy recipes that we can indulge in (and don't taste like cardboard).

In the cafeteria, I've seen time and time again health care professionals making poor food choices because they have been under prepared for the shifts they are working that week. And I know sometimes it's easier to chuck $20 in your wallet and stroll down, and eat your bucket of wedges and sour cream. Or, and I think this is daylight robbery, paying $8.50 for a salad! WHAT A JOKE! You can make the same thing for a fraction of the cost at home.

If you're like me, I need food that is going to keep me alert, and provide sustained energy between breaks. I am a person who gets HANGRY, and my concentration goes out the window if I don't eat good food (insert high sugar, high carb and high fat foods here....).

So if you have any super healthy and vitamin packed recipes, let me know! I'd love to try them and share them on my blog! 

Nurse KC

How I Got Into Nursing

I've been asked this question more times than I can count. I guess people love to hear a romantic tale of how I realised my dreams and blah blah blah...

I am not one who had a 'calling' to become a nurse. I've dreamed about becoming many different things growing up, and I think because of this, I never passionately followed one path. I was passionate about every dream I had. Police Officer, Forensic Detective, Doctor, Lawyer, Vet, Scientific Researcher, Scientific Researcher in the Army... These are all dreams I have had over the years.

When I was in Year 12 completing my V.C.E, we were required to decide our future... were we going to study at university, and what were we going to study? These decisions, at the time, I thought were going to rule my life for evermore. I know now that it is not the case. But when you're 18 and deciding your career, it's an incredibly daunting decision.  I was in love with Biology. Heck, I was top of the class! So with this decision alone, I decided that a Bachelor of Science was the way to follow my academic love. A lot of my friends gave me weird looks when I told them I was going to study science. I am not sure if they understood what it entailed, or the fact that I didn't fit the typical 'nerd' description, but it didn't alter my decision.

Throughout my science degree, I learned so much. So much of it has become applicable to my nursing. However, in my 2nd year of study, we were introduced to Human Anatomy and Physiology. This was the 'OMG' moment, and I fell in love. Immediately, I knew that my Science degree had lead me in a completely different direction. I started looking into transferring into other courses, specifically Biomedical Sciences, in an attempt to study medicine.  Once the glitz and glam wore off, and the harsh reality that transferring was going to cost me an extra year and a half of study, I decided against it. I looked into other options... Nursing and Post-graduate medicine. Nursing was soooooo much easier to get accepted into. And I think that's why I chose it. It fulfilled my love of learning about Human Anatomy and Physiology, while engaging in the hands on medical practice. I love helping people. It is truly rewarding.

Maybe I have a 'calling' to nursing and I haven't realised it, or maybe I have experienced enough of it to understand the joys. Either way, I am glad I chose nursing.

Medicine is always in the back of my mind. And because of this, I am giving my self 4 years to decide if I will follow this career path. Admittedly, it has it's pros and cons.... But I figure in 4 years, I will have had time to reflect and decide if it's what I really want to do.

Nurse KC

Baby Shower

Yesterday was one of my closest friends baby shower. She was absolutely glowing, with her comically large baby bump leading the way when she walks. 

A, her sister, and a good friend had gone to some extraordinary lengths to prepare for the day. We were treated to fun baby games, sparkling wine, and homemade gourmet food. It was truly a precursor for the loved life this baby is going to be born into. 

Of course, when buying presents for the baby shower, I couldn't stop at one. And I am a practical gift buyer, so I picked some very practical items off the gift registry: bottle and test cleaner, milk storage containers, and microwave steam sterilizer. Like I said, practical. I also couldn't help my self and also purchased some bibs, and some singlets that bubs will grow into over winter. Again, practical.  There was some amazingly gorgeous baby gifts that A and bubs received.

A's sister had prepared some fun baby games, and they were a hoot!

18 days and counting until this little bundle of joy is due to light up our worlds.

Fitbit

I

A few days ago I decided to purchase a FitBit Charge. Also, the fact they were on sale was the deciding factor. I've wanted one for a while. 

I think I will be pleasantly surprised to see how far I walk when I am at work. I know that I don't stop for the vast majority of the shift. 

Also, I know it will provide motivation to get off the couch in my days off and clock up my 10,000 steps. 

So far I am loving it. And it tracks my sleep... Don't know how,  but I think it's nifty. 

Quite a few nurses wear them at work, also. My only concern is getting gross stuff on it. I think I will have to be a little conscious of where I am putting my hands. 

Nurse KC

Unit Tour

In the interest of sharing, I thought I would give you guys a look at my unit. 

It is a 1 bedroom shoebox, to put it bluntly, but I have everything I need. I really hope to be in a house next year. 

All the furniture I have, has been accumulated over the last 10 years or so. So some of it is outdated. All of which, I hope to be able to slowly upgrade over the next couple of years. 

So without further ado...

This cube sits beside the front door, and keeps my keys safe. 

My amethyst cluster brings peace and calm (I hope!). But is also looks gorgeous. 

I have a collection of small nursing texts, and reference books here. Along with my magazines and wifi! Most important thing of all!

My couch. Super comfortable and is essentially a spare bed. I do wish it wasn't brown, but hey, that's what I was going with 4 years ago. 

Ah, my TV. What can I say? I don't watch TV much, so an upgrade is the furthest thing from my mind right now. This bad boy is about 10 years old, and still going strong. Weighs a light tonne. 

My cats scratching tree. She loves this thing. When the heater is on, she is spread out on the top level, soaking up the heat. So lazy. 

My dining room / study. I don't have room for a desk, so I study on my table. 

Nothing overly exciting on here. 

My clock my sister gave me for my birthday, and a little something I made from drift wood I picked up on the beach when I was living in Port Fairy. 

My little kitchen. 

Bathroom / laundry. 

Bedroom. Note the fitness gear hidden away under my bedside table. I think it's collecting dust. 

My Himalayan salt lamp, and my Bears of Hope teddy. In the glass bowl in front of him, I have some small crystals/rocks. 

Rose Quartz, fluoride, aquamarine, and amethyst. 

So that is a quick tour of my place. I hope to share some upgrades with you when I can. 

Nurse KC. 

Patient's Logic

I was helping another nurse look after a patient the other day... Lets name them B.

B was admitted for community acquired pneumonia and is a heavy smoker. B requires oxygen to maintain a normal oxygen saturation. However, B likes to take off the oxygen, complain they can't breathe properly, and LIGHT A CIGARETTE IN THE BATHROOM! When B was asked by the ANUM, B flat out denied smoking. Never mind that the other 3 patients in the room were not able to ambulate to the bathroom on their own, and the room now smells of fresh cigarette smoke... 

B also like to refuse any IV or oral fluids, then complains of a massive headache.

I love my patients, but people like that tend to elicit this internal response...

I swear, my poker face is getting so much better! 


Nurse KC

Quote of the day

The following comes to you from Dr. Grumpy

Dr. Grumpy: "Are you allergic to any medications?"
Mr. Fleming: "I can only take penicillin to use as an antibiotic. If I take it for any other reason I get a rash."

Graduation

Graduation day rolled around quickly! Before I knew it, I was gowning up with my class mates; ready to walk across the stage, and accept our long awaited degrees.  

While this is not the first time I have graduated from university, I still enjoyed it. The ceremony was relatively short in comparison to my first graduation, as Warrnambool is a smaller Deakin campus. 

We were treated to some live entertainment before the academic procession made their way through the theatre, lead by a piper. After a series of acknowledgements and speeches, the national anthem was sung. Candidates were lead out and we lined up, eager and nervous to accept our degrees.

One by one, we were called. Eventually, my name was called. "Kate Sarah Cumming, Bachelor of Nursing with Distinction". I couldn't help but smile big. I tapped my trencher and proceeded to accept my degree without falling over in my sky high heels.

My sister Claire was all smiles when we emerged in to the torrential rain and made the dash over to the refreshments tent, where we were treated to some delicious finger food, and a complementary glass of sparkling wine. I was quite hungry by this stage so, naturally, I helped my self to the food. I can't help it, it's who I am! 

Here we mingled for a short while, before making the drive back to Hamilton. 
I tend to be a quiet celebrator when it comes to my own achievements. So Mum, Claire, and I headed out for dinner in Hamilton and enjoyed each others company. 

I am yet to find a frame I like for my degree, so for now it sits in its plastic sleeve. I hope to find one soon and hang it proudly beside my Bachelor of Science. 



Nurse KC

Code Blue

Yep. It's exactly what you think. I called a code blue. 

Obviously, due to the sensitive nature of medical stories, I can't go into too much detail of what happened. But I will tell you this: it was a bloody shock! Having a patient collapse and turn blue is something that you cannot prepare for. No matter how many simulations you attend. What matters is how you react in that moment. 

Luckily, I didn't freak out. Instead I called out for help. LOUD. 
DRSABCD was the first thing that came to mind.  My patient remained unresponsive for what felt like an eternity. However they did regain consciousness, so no CPR was needed. The whirlwind of doctors and ICU nurses that followed was amazing. They were so thorough and procedural. I felt like a complete novice next to them. While I had no idea what to do in this situation, I stood at the end of the bed and watched. The other nurses were happy for me to do this as it was my first code. I ducked off to the drug room and collected the supplies the nurses needed. All the while my adrenaline was running in overdrive. 

My patient was later transferred to ICU and was diagnosed with bilateral pulmonary embolisms. They later returned to our ward after a few days in ICU. They are now recovering back on our ward. 
So what do you do if you find your self in a code blue situation(either first person or respondent)?  BREATHE! 

• Stop. And think. What is happening in front of you and what is the first thing you need to do?
• Send for help. The more people there; the more knowledge and the more help. 
• Clear the area of any excess furniture. 
• Close the curtains of all the other patients in the room (if shared room). 
• Offer help where appropriate. 
• There needs to be a scribe. Someone standing back, taking notes. Specifically: what happened, quotes from Drs and patient (if responsive), size, time, and location if IV cannula(s) are inserted, time and dose of any medications administered, who is present, time of death (if appropriate), and any other procedures that are performed in the patient. While you may not be the one to write what happened in the progress notes, it is a HUGE help to the nurse who does. Often their adrenaline is still running and their mind clouded. 
• Offer debrief to the nurse who called the code. They may need to vocalise how they are feeling

Codes are an inevitable part of medicine. And the only thing that is going to make you more competent at them, is practice.  So if you have the opportunity, jump in and lend a hand. 
Nurse KC

Nursing Tip: Managing Late - Early Shifts

Everywhere I have worked, we have had late - earlies. For those who don't know what I mean by this, let me give you a quick run down. On most wards, there are 3 shifts; morning (early), afternoon (late), and night. The times for these vary depending on how the ward is run. 

As a nurse, you will find your self working late-early more than you would like. On my ward, an early starts at 0700 through to 1530, a late runs from 1300 through to 2130, and a night runs from 2100 through to 0730. 

On my late - early shifts, I try to do the following:

• Have my lunch and dinner planned for both days. Healthy, balanced meals are absolutely essential working as a nurse. Sugar highs and lows are no ones friend.  Especially mine. (Ever heard of HANGRY? Yeah, that's me!)
• Have my scrubs ironed, and ready to go for both days. 
• I set my alarm for the same time every morning. And I get up. No snoozing! 
• The kettle is filled, ready to go. 
• I have my lunch box semi-packed with fruit, nuts and dried fruit, and some muesli bars. My favorite ones are the Carman Gourmet Protein Bars with Dark Chocolate and Cranberry. They are OMG-delicious. And a little treat with the chocolate. They fill me up and keep me full for a while. Which is a bonus!
• I do my makeup and hair while drinking my coffee/tea/milo. 
• I know I should eat more of a breakfast, however my appetite fluctuates in the morning. Sometimes I wake hungry, other times the smell of food is yuk. I listen to my body. At the very least I will eat a banana on the way to work. 
• Make sure you get to bed at a reasonable hour. Sleep is so important at maintaining functionality, and endurance to last a shift without brain fade. Then I finish a late, get home and fluff around (entertain my cat, have a shower etc) I can usually make it to bed by 2230 - 2245. Being able to block out light and noise is important. Also, ditch the technology. Blue light emitted from the screens of our phones and tablets reduces the melatonin in the brain -- the wake/sleep hormone.  So switch off at least 30 mins before bed. 
• Relaxing after work is something I struggled with as a student, and sometimes still do now... Especially after a whirl wind shift.  I dream about work, and it wakes me up throughout the night. Super annoying! However I find this happens when I haven't mentally checked everything off in my head BEFORE I leave the late shift. Everyone has their own routine to help them wind down. Alcohol is a common one. I'm the first to admit I love a glass of red. However alcohol affects your ability to get enough REM sleep -- these are the periods of sleep where you body actually sleeps. So avoid using alcohol as a sleeping agent. Also, beware of the caffeine content in tea. 

Preparation is key for late - earlies.  It might sound like a bit of an over kill,but it saves times and stress when your trying to find your shoes and keys in the morning. 
Like I said before, everyone has their own routine. What works for one may not work for another. It's all trial and error. 


Nurse KC

My First 8 Weeks As A Graduate Nurse.

My apologies for being absent of late. When I started my grad year, I knew it was going to be a big transition. Possibly the most challenging thing I will do in my career. And the last 8 weeks have been that and more!

Over the next few days (when I have a few days off) I plan to retrospectively fill you in on the details of my nursing thus far.

It has been an incredible experience. I feel that the title of 'nurse' is becoming more natural. When people ask me what I do, it doesn't feel so bizarre to say "I am a nurse". And I am proud to say it. I am learning more and more that people have positive stories to tell about the nurses in their lives, which makes me proud to be apart of this highly esteemed profession.
I plan to provide more tips on how to survive your first year out, specifically maintaining a work-life balance. To be honest, it sounded easier than what I though it would be...


Until tomorrow...


Nurse KC.