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Like many other people, I was very disheartened when the news broke that sophomore clinicals were to be cancelled. It was always difficult to wake up at 5:30 am, and I was always a touch nervous about what the day would bring, but ultimately I left every clinical feeling a little more proud, a little more confident, and a little more knowledgeable.

When I think about the first day of clinical that I had, I realize how much I have improved. On the first day, my anxiety and nervousness was nearly palpable and I stood in the room feeling very much out of my comfort zone. These feelings did not go away by the second clinical, or even the third or the fourth. I don’t think those feelings have ever truly gone away, but I definitely feel much more confident and sure in my self when I walk into a patient’s room. This is for a couple different reasons. For one, I have gotten much better at performing a head to toe assessment. The questions and follow up questions come more naturally, as do the skills. I used to have to rely on the items listed in IHIS to ensure that I completed a thorough assessment, and even then I would leave the patient’s room only to find during documentation that there was a section I missed, resulting in my having to go back into the patient’s room. After recognizing this, I tried to pay special attention to what I was documenting and what I commonly missed so that I did not miss it again. After a couple clinicals, I was able to complete a full assessment without forgetting any parts, which was a big accomplishment for me. Another reason I feel more confident when entering a patient’s room is because  I have gotten better at communicating and interacting with patients. I think that I have gotten fairly skilled at establishing a good rapport with patients, and maintaining a positive and appropriate demeanor. I have also started to recognize more and more my own anxieties that I bring to situations, thus allowing me to control and regulate these emotions. Some specific communication highlights for me were comforting a patient during a very difficult treatment, and establishing a trusting enough relationship to elicit important health information from another. Connecting assessment findings to what we have learned in class and clinical has also been an area of improvement I have noticed. I love asking my clinical instructor questions so that I can learn all that I can during clinical.

Even though I have improved in making clinical connections, I would still like to continue building upon this skill. I anticipate part of this growth coming naturally just by continuing in class and clinicals, but I also know that applying knowledge takes diligent learning of that knowledge and practiced critical thinking. Another area that I would like to improve upon is communicating with other working nurses and PCAs. I find that I am intimidated by them during clinical, and most of the time they do not approach us students with guidance or opportunities. Therefore, I have tried to take it upon myself to ask questions and ask to be apart of opportunities. However, this is still a challenge for me. I just recently received a job offer to work as an SNA starting in the summer, and I am hoping that the additional interaction with healthcare workers will foster my confidence in posing questions and concerns to them. Another communication obstacle that I have yet to conquer is communicating with a more non-cooperative, challenging patient. So far though, I have not had a patient like this, and a result I have no experience navigating this type of interaction. Initiating this type of encounter is not something that I can control, but nevertheless I recognize it as an area of needed growth because I have yet to find out how I would handle such a situation.

For this assignment, I am watching The Good Doctor, a TV drama about a brilliant young man with autism named Shaun Murphy who becomes a doctor in a hospital where feelings about his presence and actions are mixed. In this episode, Shaun encounters a patient who reminds him of his younger brother who died in front of him when they were children. Shaun does his best to treat this patient like any other, but it is difficult. It only gets more difficult when the patient’s parents tell Shaun that their son had been diagnosed with osteosarcoma seven months prior, but they chose not to tell him. Shaun questions the parents’ choice, feeling connected to the patient and like he knows what is best for the patient and what he wants. He consults his colleagues and asks one for help in interacting with the parents and patient, as he anticipates a struggle in being able to keep the diagnosis from the son. After conversing more with the son about honesty and lying, Shaun finally breaks and tells him about his cancer diagnosis. For a moment there is a role reversal, as the patient notices Shaun become visibly upset and the patient consoles him. More and more Shaun sees his brother in the patient and becomes increasingly invested in his case. As a result, Shaun begins to obsess over all of the patient’s records, trying to search for an alternate answer other than a deadly cancer. He believes he has found a different diagnosis with a much better prognosis, but it requires a test that his supervisor is not willing to allow because it would give hope to the parents when ultimately the evidence points to osteosarcoma and death. Shaun then consults his mentor about performing the test but just not telling the parents what he is doing, an action which his mentor notes is a blatant ethics violation. His mentor, who has a close relationship with Shaun and knew his brother as well, gives him advice on how to carry out this unethical plan. Shaun is in the patient’s room ready to perform the procedure, clearly without getting informed consent, when the parents walk in and Shaun tells them about his suspicions. The parents become infuriated and shove Shaun out of the room, enraged that he told their son of his diagnosis against their wishes and that now he is refuting a diagnosis that they have been dealing with for months. After performing a surgery that revealed irrefutable evidence of cancer, the family has to deal with the re-diagnosis. When the son and Shaun are alone, the son thanks Shaun for all that he did, even though his parents hate Shaun, the son is thankful for having the truth come forth and Shaun trying his best. Their final conversation gives Shaun closure for his own brother’s death. While all of this was good and touching for a TV show, realistically Shaun was very out of line and far too close to the case, which unethically affected his actions and contraindicated the wishes of the patient’s family. The interactions seemed therapeutic for the son, but ultimately Shaun was acting selfishly under the guise of doing what was best for the patient; he was trying to save the patient since he couldn’t save his brother. The character of the son was made to be a strong, witty, mature young boy, so Shaun’s actions did not have negative implications for him necessarily, and in fact the closeness felt by both Shaun and the boy seemed to aid the patient in coping with his care. That being said, there were certainly many instances of role reversal in which the patient was giving advice and guidance to Shaun. In essence, Shaun seemed more worried about the situation than the patient and proceeded with his actions with regard to his own need for a happy ending, when the patient had already come to terms with his prognosis. The ones who felt the greatest burden of the ordeal were the patient’s parents, who were deprived the right to tell their son about his situation on their own terms, and who were also put through the emotional distress of Shaun’s deception and implications of false hope. Once again, the endearing relationship cultivated between the boy and Shaun made for great TV, but in reality, Shaun deprived the family of a therapeutic relationship and their rights as patients.

My clinical experience last week could have been a lesson straight out of class. I started off the day by getting report with my nurse from the patient’s previous nurse from the night shift. It was a depressing situation to hear about, a young man in the hospital for a number of severe medical issues. After she got through the important medical information, the nurse told me to be cautious when in the patient’s room, saying “He will tell you you’re pretty, just watch where his hands are and don’t get too close unless you have to.” Being that this was the first clinical day when I was to go into a patient’s room alone, I was already anxious, and her ominous warning only added to my anxiety. But I was happy for the heads-up because she was right. Throughout the day, my patient made very inappropriate comments and asking personal, probing questions. Some of the highlights included asking to be his girlfriend several times, talking about the “irony” of how us nurses see patients undressed but patients never get to see nurses undressed, and asking for my phone number. These among other comments posed an uncomfortable communication challenge. I did not want to anger a patient whom I had to care for for the next several hours, but I also wanted to maintain a professional boundary to protect myself.

Performing care on my patient that day thus involved a lot of situational awareness; I had to be aware of my own level of discomfort, the patient’s emotional needs, the patient’s medical needs, and how this all contributed to the care I delivered. I tried to handle my own discomfort by minimizing physical contact with the patient, without letting it get in the way of my assessment and care. As far as the inappropriate questions and comments go, I did my best to let the patient know I was listening, but also not encourage such behavior. Admittedly, I could have done better in some cases. Often I was not sure how to respond, and so I kept my answers short. For example, when the patient called me pretty as I got closer to him, I simply said thank you and made no further comment, and when he asked for my phone number I told him that I was not supposed to give that information to patients. Even though I could have done better, I was relatively pleased with the result. The patient became very comfortable with me as a friendly presence in the room and talked to me a great deal about his past, including his hometown, reckless childhood, and family. These conversations brought up many important topics to the patient’s care, such as deaths of close family members, health and lifestyle choices, and plans after discharge. I did my best to practice active listening when he was talking about heavy topics: neutral expression, nodding, eye contact, empathetic and reassuring responses, allowing silence but also asking open ended questions that could yield valuable information and allow for further discussion.

It was a challenge to try to formulate the best response to certain situations. I think my anxiety going into the situation contributed to my nervousness. Quite possibly I think it also led me to overthink situations. I was so concerned about responding perfectly every time that my mind scrambled at times, searching for a needle in a haystack of words. While the information we have learned in class most certainly saved me with this particular patient, I think I tried too hard to apply everything perfectly like a textbook. I am thankful for this experience because it was such a great learning opportunity; people are not textbook, which is easy to say in class but difficult (at least for me) to remember in practice. He was a real person with a unique situation, and while I think that he and I got a lot out of our therapeutic relationship, I believe it could have been further maximized. I learned that I need to put more focus on what specifically the patient is saying and then adapting the techniques and templates I have been taught to each specific situation, instead of trying to cut and paste a patient into a certain response. Overall, I am proud of how I handled the certain aspects of the situation and I think I had some really well-formulated and thought-out responses that created a comforting and trusting environment for the patient, but there is most certainly room for improvement.

Lane Ave Panera, 7:40 pm, Wednesday January 22nd:

As always with campus Panera, there are many young people here on their laptops. Some are in groups, some are alone, but almost all of them look stressed to some degree. One young girl just keeps staring at her computer screen with a slight frown on her face, eyes unwavering. Her legs are stretched out and she is leaned all the way back in the booth at which she sits. If it weren’t for the frown on her face, I would think she’s relaxed, but the body posture paired with the facial expression gives me the impression that she is stressed to the point of exhaustion. Now she has closed her laptop and seems to be on a phone call. She smiled for the first time since I’ve been here, and now she is getting ready to leave.

This brings my focus to another group of people on their laptops. Well, sort of. There are four of them sitting together, and scarcely do they look at their laptops. Instead they are conversing with each other, constantly smiling and laughing, using excited and lively inflection. If they are doing work, their non-verbals are telling me that it is either not that urgent to them, not that difficult, or it is enjoyable. Nevertheless, they seem to be enjoying each others’ company as I do not think they have stopped talking to each other for even a moment since I have been here.

Conversely, there is a boy and a girl working at a booth on what appears to be some kind of group work. I have not really seen them speak or look at each other since I’ve been here, which makes me think that they are either very focused or fairly unfamiliar with each other. The girl just asked the boy a question, and as he was explaining it, she began running her fingers through her hair and then he scrunched up his face. Perhaps they are stressed and confused about an assignment. They are back to working silently and they look very hard at work, eyes locked on screens, determined faces.

There is also a group of girls sitting in a booth, and one of them looks to be practicing some active listening. We will call her Girl 1. The girl across from her has been talking for a very long time. We will call her Girl 2. Girl 2 seems flustered and distraught about whatever she is talking about, based on the tone I can hear from where I am and the hand gestures I can see. Girl 1 was looking at her with a serious yet sincere expression as she was talking, and intermittently giving a reassuring nod and “mmhm”. Now their other friend, Girl 3, is talking, and Girl 1 is still listening and nodding, and I even heard her ask a clarification question. She seems like a very good listener.

It is very interesting what you can infer about people from watching how they communicate. The decoding I did might have been spot-on, or they may have been way off, but nevertheless it is what the communication methods told me. And as was mentioned in class, I found myself gathering much more information from the non-verbal information than the verbal.

My name is Lauren Hiller, and I am an anxious yet excited sophomore nursing student. I say excited because the prospect of being a nurse and applying what I know on a daily basis to improve the lives and health of others fills me with a bubbling sense of joy, but the process of acquiring that knowledge and getting to that point is enough to make a grown woman (me) cry. I did not begin this journey with the naive idea that it would be easy, but pushing myself has always been a bitter sweet characteristic I possess.

I grew up in Dublin, Ohio attending a school system that loved its students but also loved the high test scores they turned out. Competition and determination constantly brewed in the hallways, contributing to the students’ detriment and success. Detriment because of the stress, anxiety, and depression felt by many students, and success because despite it all, many of us were put on excellent academic tracks. Such an environment contributed to many of my bad days, but Dublin was also home to many of my best days. I found my love of science through rigorous yet exciting classes taught by great teachers, my knack and love for community service surrounding youth drug and alcohol prevention, and general affinity for interacting with people throughout the community from all walks of life. All of these factors contributed to my desire to become a nurse. That and the slow realization that my former dream of being a veterinarian had to stop due to my having allergies to just about every animal on the planet. Nevertheless, I have two dogs because nothing can stop my love for animals.  I think now that nursing was always the better option anyway, the one that was really meant for me. The hundreds of hours of community service I did showed me that my joy and energy comes from interacting with people, which of course as we have all been told many times by now is the “art” of nursing. I gave countless presentations, coordinated and led retreats for my peers, headed discussion groups, wrote and performed skits, and planned several events locally and around the country all for improving the health and well-being of young people. it all brought me so much joy and a sense of contribution and accomplishment. I used to think that I wanted to be a pediatric nurse, but the nature of my previous volunteer work along with a growing field has made me consider public health as an option that very well might interest me.

But nursing aside, there are other things that make me who I am. I come from a very loving and supportive family consisting of my mom Christine, my dad Steve, my sister Rachel, and the two dogs Tucker and Josie. My mom is a kindergarten teacher in Polaris, but she got her realtors license a few years ago that I hope she starts to pursue soon since her and I have always had a passion for house hunting and design (lots of HGTV). My dad recently got a job with the online school the American College of Education as a recruiter for their program that allows working nurses to get their masters degrees online for a relatively cheap price. Rachel is exactly fifteen months older than me, and she is in her third year at the University of Cincinnati in Interdisciplinary studies with the goal of going into public health, but she is also getting a minor in history. Tucker is my baby boy, a little white fluffy malti-poo who we’ve had for nine years. He is a constant ball of energy, but also loves snuggling with his family who he loves very much. Josie is my pretty girl who we have had for about seven years. She’s a sweet, smart, gentle rescue dog with the biggest heart and love for all people she meets. As for myself, art, music, and a few close friends help me keep my sanity as I go through school and life. Now for some random facts about myself. My favorite food is Cane’s and I can frequently be found at the one on High Street chowing down on more than my calories for the day. My idol when I was a child was Gabriella Montez from High School Musical, and I thought that if I believed hard enough I could quite literally metamorphasize into her like a butterfly. I absolutely cannot stand those long skinny waterslides where you lay on your back and go shooting down a dark tube because I feel lost and like I’m drowning. Similarly, I am terrified of the ocean, possibly related to watching Shark Week on the Discovery Channel many times when I was younger and a couple scary water-related incidences I have had over the years. Lastly, and on a more serious note, I like to think that I am a hard worker and I do not quit or give up often, so I promise I will work hard to succeed in Therapeutic Communications this semester. It seems like an extremely helpful and informative class and I look forward to being apart of it.