Wednesday, October 1, 2008

Having a Boring Student Rotation?


So you're bored with your Post Partum rotation. Well let this be your first lesson that nursing is not about YOU; it's about the patients and the excellent level of care you are giving them!

This rotation may not give you the adrenalin surge that you get in the ER or the ICU, but these patients are just as important. They need your help, understanding, education and caring. So rise to the occasion and meet this challenge.

Not every patient will present you with a specific set of tasks or procedures to perform. You need to figure out what kind of care they need. If nothing else... where are their knowledge deficits about their present condition?

The biggest problem with being "bored" is that you are likely to become complacent. These patients aren't "sick" but they are recovering from a tremendous effort their bodies have gone through in the last few hours or days. They need your care and guidance.

Here are just a few things to consider:
  • Have you assessed that fundus adequately? Is it firm or boggy?
  • Have you instructed the new mom in pushing fluids to replace the vast amount of fluids she lost during her labor and delivery?
  • Are you encouraging her to rest now and to understand what her body has gone through? Does she understand the recovery process, and the need for rest?
  • Is her nutritional intake adequate or is she desperately trying to lose all of the baby weight already?
  • Are her bowels working or is she going to go home severely constipated?
  • Have you instructed her in the need for protein and vitamin C for wound healing if she had an episiotomy or C-section?
  • Have you instructed her in the necessary food and fluid intake to produce milk?
  • Have you discussed breast engorgement, nipple soreness and how to avoid or treat sore or cracked nipples?
  • If she's not going to breast feed, does she understand about formula safety, i.e. not making eight ounces at a time and feeding from that bottle all day?
  • Have you discussed care of the baby including feeding, burping, and diapering?
  • Does the new mom know how to care for the cord and that it will dry up and fall off in a few days?
  • Does mom know to lay the baby on its back and not on its stomach?
  • Does she know how to dress the baby appropriately according to the weather or temperature?
  • If baby is jaundiced, do the parents understand the light therapy they'll receive at home?
  • Do they know how to clean their baby boy's circumcision, or under his foreskin if he's not circumcised?
  • Do they know how to clean their baby girl's bottom from front to back?
  • Do these new parents need some parenting classes or other community resources?
Have you reported your findings to your preceptor and documented carefully?

Post partum may not be your ideal niche, but understand that not everyday will be filled with excitement and challenging patients. There will be times when you are bored and times that you risk becoming complacent.

Don't ever assume that patients who aren't "sick" or don't appear to need much care have everything under control, or are doing "OK." Sometimes they turn out to be your most challenging patients because they catch you off guard and don't know it all and they don't even know enough to know that they don't know that they don't! Or they know just enough to get themselves into big trouble.

The biggest lesson you can learn from a boring rotation is that as a nurse you need to treat all patients with the same level of excellence regardless of their diagnosis, gender, race, or creed.

photo:Microsoft.com

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