Wednesday 5 January 2022

Nursing Schools, Nursing Degree, Nursing Degree US, Nursing Job, Nursing Career

Fainting and nursing don’t sound like an optimal combo. Vasovagal syncope, in itself, is an awful feeling. Your heart rate and blood pressure drop suddenly, reducing the flow of blood to your brain. You get extremely lightheaded, your vision narrows, and you are overwhelmed with this clammy, nauseous feeling. Then, because you're in nursing school and supposed to be caring for a patient, not being the patient, tack on embarrassment to that lovely feeling.

All that said, I fainted in clinicals. It wasn’t fully lights out, luckily, I got to a chair and held on to consciousness, but still not a great feeling. For some reason, seeing gastric acid explode out of a gastronomy tube site didn’t sit well with me. All I could think was, “that should not be happening”. Then I began thinking about how leaking gastric fluid could affect this baby's sensitive skin, and how the site, raw and bloody, could easily get an infection. I began to wonder if the child was in any pain - Was he uncomfortable? Did it feel weird having a G-tube inside him? Thinking about it too much made my own stomach hurt and I was suddenly engulfed by that awful lightheaded feeling. I tried to remind myself that this child was okay, he was still smiling and his medical team could fix his tube. However, even with this in mind, my body was shutting down. I stepped away and took a seat but the dizzy spells, tunnel vision, and clammy sweat had already begun.

While the lightheadedness ultimately passed, I was left with the feeling of embarrassment. The nurses, doctors, and instructors around me were so kind, explaining that it happens and some things are just more triggering. The funny thing - everyone that helped me told me that it happens more often than people think or talk about. It’s actually a common occurrence. I decided gastrointestinal things may not be my forte, but when working at a hospital, it is ultimately very hard to avoid.

The next week, I was given a patient with VACTERL (Vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities), a nonrandom genetic association of birth defects that affect multiple anatomical structures. She was an adorable two-month-old with a variety of concerns including tethered cord, ventricular septal defect, and imperforate anus. With these concerns in mind, her care team had placed a nasogastric tube, a suprapubic catheter, AND an ostomy bag. With the past clinical in the back of my mind, seeing that she had an ostomy made me nervous, to say the least. Part of me hoped I could get away with just pushing the stool out of the bag to measure output, but another part of me wanted to challenge and expose myself to things I feared. In doing her assessment, I found that her ostomy bag was leaking and would need to be replaced. My fate was decided for me, it was time to face some fears.

My clinical instructor apologized profusely for giving me a patient with an ostomy knowing what happened last clinical when I worked with abdominal holes. However, I was honestly happy it happened because I knew, deep down, there was no way I could avoid G-tubes or ostomies forever. After helping me gather the supplies to change the ostomy and going over the procedure, she asked me whether I wanted to do it, to which I responded that I would help but wasn’t sure if I could do it. I was scared I might pass out again or mess up and hurt her tiny abdomen, so I felt very cautious about doing this procedure.

We began by tracing the stoma pattern and cutting out the areas where the stomas would be inserted. Then we began the process of removing the patient's leaking bag. My instructor gave me the adhesive remover wipe and I carefully peeled the bag off her body to reveal two bright, beefy red stomas. My patient had a temporary sigmoid colostomy due to her imperforate anus and therefore had one stoma that was made with the lower part of the colon through which stool passed through and one mucous fistula. 

Next, we cleaned the skin around the stoma by washing it with warm, soapy water. At first, I was worried about touching the stomas, but my instructor reassured me that they could be touched so I cleaned them as well. After the area around her stoma was clean and dry, my instructor directed me to wipe Stomahesive paste around the stomas. We then placed the new bag and left her swaddled with a warm pack so the bag would better adhere.

I had finished the ostomy replacement with no fainting! My instructor then congratulated me for doing most of the replacement by myself with some verbal instruction. I’m glad I was prompted to do most of the ostomy change, even though I was hesitant to do it because I was able to prove to myself that I could perform the procedure. While I still don’t love gastrointestinal procedures, I was able to face a fear and can now remind myself that with exposure and experience I will become more confident in my nursing skills and hopefully pass out less often.

That same day, I was also able to work with an NG tube (the original reason my instructor had assigned me to my patient). Not only did I administer medication and formula through the NG tube, but I was also able to place an NG tube into my patient! While I was nervous to place an NG tube because I had never placed one on a real person, it gave me confidence knowing that earlier that day I had changed an ostomy and that I had practiced NG tube placement in Sim Lab. I reminded myself that while I was nervous about making a mistake or potentially passing out, I would be depriving myself of a great experience if I yielded to my fears.

With this said, I gathered my supplies - an NG tube, a syringe, sterile water, tegaderm, duoderm, lubricant, pH strips, a pen, scissors, and her pacifier. After washing my hands, I decided which nostril to place the tube and then measured the distance to insert the tube by starting with the hole at the end of the tube at the tip of the nose, to the bottom of the ear lobe to the halfway mark between the breast bone and the naval. Once the tube was marked I measured and cut the duoderm and tegaderm. I cleaned and dried her face and then applied the duoderm onto her cheek next to the chosen nostril. Next, I lubricated the tube and positioned my patient so that her head was elevated 30-45 degrees with her pacifier.

Then came the part I was most nervous about - the insertion of the tube. While I was nervous, I reminded myself that with practice and clinical experiences these procedures would get more and more comfortable. I took a breath and inserted the lubricated tube into the chosen nostril. Using two hands I pushed the tube back and down the throat. Hitting the back of the throat and meeting some resistance scared me at first, but I mentally and physically pushed through and was able to insert the tube down until the marked point was at the entrance of the nostril. I then secured the tube across the duoderm by applying tegaderm on top and confirmed the proper tube placement by pulling up the fluid with the syringe and testing that the pH was between 1 and 5 which indicated the tube was in the stomach. 

Another nerve-racking procedure was done and I had been able to prove to myself that I could do it!

In both of these procedures, I was able to gain hands-on experiences and exposure to methods, as well as learn and grow as a future nurse. With this said, to get those experiences I had to let go of the fear of making a mistake or passing out. Entering clinicals with those fears would ultimately deprive me of the experiences I so fiercely want as a student nurse. Learning involves making mistakes or, in this case, having your body react in ways you're not expecting. While it may feel or seem embarrassing, it is through these experiences that one can identify their response, and then adjust and better prepare for future practice. 

Being a nursing student practicing skills on a real patient, especially a baby, can be scary and overwhelming. However, it’s crucial that I continue to be an active participant in my patients care and place myself in as many learning experiences as possible, even if they scare me, for these are the experiences that will ultimately help me grow into the confident and skilled nurse I hope to be.



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