By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.
By Ctd 2005, via Flickr
I’ve begun volunteering at a local free clinic. While it’s been rewarding and satisfying, it’s also been fraught with challenges I didn’t expect; I’ve only worked in an ICU, and the assessment skills specific to critical care don’t translate smoothly to the clinic setting. I’m out of my professional comfort zone, and I feel so inexperienced.
Here’s what I’m used to: By the time a patient is admitted to the ICU, they’ve already been “worked up” in the emergency room. Physicians have been assigned and a preliminary diagnosis is in place. The patients are connected to equipment that displays their vital data continuously, on monitors I can see from almost anywhere, and alarms are triggered by any alterations. I’ve got easy access to radiology reports and films, laboratory values, and microbiology reports. The nursing physical assessment is thorough and paramount; I know what I’m looking for, what I’m listening and feeling for, what certain smells indicate, and I trust my instincts. I’m accustomed to not only the forced intimacy that comes with the in-depth physical assessments of critical care, but the technology and data that supplement my assessments, as well.
At the clinic my nursing role is quite different. I sit at a desk. I am to determine the reason for each patient’s visit and take their vital signs. I ask how they’ve been and what’s changed since their last visit.
One gentleman, when I ask what medications he takes at home, fishes in his pocket and drops pills wrapped in toilet paper on the desk that separates us. I sit across from him, considering how to proceed, itching to take his hand and slide my fingers along his wrist to feel the pulse of his radial artery. I wonder about his breath sounds, what his feet look like, whether I’d be able start an IV on him, and what I’m missing. There are no same-day diagnostic reports to refer to and no dictated medical histories. All I have is the snapshot capture of his vital signs and what he wants me to know.
I’m used to knowing my patients from the inside, out. Here in the clinic, I hardly even touch anyone. I feel blind.
These are the challenges I’ve found: to create a picture of my patient with limited information and subtle clues; to listen to what someone tells me, hear what they don’t say, and know what to ask; and finally, to not lose my vision because I miss my familiar tools, but instead find a different way to see.
Thoughts After an INANE Editors Conference
August 16, 2011Begun almost 30 years ago, the group depends on the goodwill of its 200+ members, who volunteer for Web site operation, take turns organizing the annual meeting, and contribute when needed to support small expenses like mailings, Web site fees, etc.
It’s simple and it works. This year’s conference covered things editors of nursing journals find interesting—copyright, impact factor, ethics, and the like (see INANE’s blog, From the Editor’s Pen—“Cherry Ames” blogged from the conference!), plus a lot of great networking. (Full disclosure: the conference was sponsored by the specialty nursing journals of Lippincott Williams & Wilkins, AJN’s publisher.)
I’m always struck by the breadth and variety of nursing knowledge among the members of this group—there’s everything from skin and wound care and infusion practices to broader topics like oncology and home health. (Not to mention a few broad-based journals, like AJN, that cover all of nursing.) The editors of these journals are passionate about meeting the needs of their readers—for some association journals, this means meeting members’ needs while also trying to gain nonmember readers. It might seem easy to figure out what those needs are, but it’s not. Read the rest of this entry ?
Posted in Shawn Kennedy, AJN editor-in-chief, writing and nursing | Tagged Cherry Ames, editors, impact factor, Nursing, reader comments | 4 Comments »