I have now been doing my internship at Degraff Memorial Hospital, primarily in the skilled nursing facility, for roughly 2 months. It has been such a great experience thus far going in 2 -3 times a week and shadowing Lisa and Colleen along with Sally whom is also in the program with me. Until this point each day has been following and shadowing our supervisors around meeting the patients, co workers and doctors, and learning how to perform various tasks.
The first day we went in was just a general introduction, only lasting about 2 hours, we were given a tour of the facility, background about it and an overview of what they do and what can be expected. I started off the first two weeks ago doing grunt work, filing , cleaning, organizing, and getting everything in place while reading through applications to become firmiliar with how everything was ran. Slowly Lisa took Sally and i under her wing and brought us into the program, teaching us and explaining everything to us along the way. After the third we Sally and i were separated in a sense, according to our interests! She is now and has been working with the long term patients primarally under Lisa and i have been with the short term patients under Colleen.
She introduced me to her method of doing things and explaned their day to day routeens and goals.
The first couple weeks were no big deal until i came in one day and there was a patient sitting out in the hall constantly screaming for no obvious reason. i had no idea what to do or how to react, so i went into Lisa and Colleens Office and questioned it but they said she was suffering from severe demential and it occurs often and they have tried medicatins but do not want to drug them more than necessary because they have such a high importance of each and every patients quality of life that they werent going to just sedate them.
Interesting in this whole medication process i began to question everything i over heard from the nurses, i always felt that hospitals and especially nursing homes always drugged their patients way too much and i never felt that it was right or acceptable. But i have slowly began to realize that its not always the case, that Degraff especially only administers and little medications as possible, as long as the patient was comfortable. They even brough to my attention that they have a specialized pharmacist come in every week to make sure that everything the patients are recieving is necessary.
Every tuesday Sally and i get to sit through their doctors meetings. It took me a few weeks to be ableto attend due to my Class schedule but after the first one i absolutley loved it. they discuss each and every short term patient ( the ones that i work with) and how much they have progressed since their injury or surgery and what our plan is to help them reach their baseline and return home comfortably. It is so interesting to be able to follow these patients, helping them along they way, seeing them improve and knowing they are better and can go home!
I have slowly learned to read charts and plug information into the computer system but am not fully on my own just yet doing it. I shadow colleen often to to BIMS (Breaf interview of Mental Status) which is a form that is required by the state that needs to be filled out for each and every patient that comes in. although when reviewing it i find that it is almost uncomfortable , confusing and unnecessary questions to be asking all patients. they range from memory to do you want to commit suicide. I feel that it makes me and the patient feel uncomfortable especially because they are only there for rehab and therapy, Although i understand that medicne, especially anestesia often effect individules, more commonly older individules mental status i just think that these are not questions that should HAVE to be asked.
Last week for the first time i began the BIMS on my own, which was very nerve racking! I filled out their information, which i got from their chart, on forms and had to go into the new patients room introduce myself and start asking quesiton. My first one was with a gentleman that was in due to shortness of breath. which ended up actually being really cool because in my anatomy class the unit we were on was the cardiovascular system so during my "interview" with him iwas able to apply knowldege from classes to what he was going through so he better understood everythng that was going on and i better understood how it actually happens! he answered my questions very easily and i was able to asses him completely and positively! After him i had Colleens Grandma who had fallen and broke her hip. she was to be my first complete follow from start to finish which has worked out thus far very well. she is a 92 year old lady with 7 children and happier than can be! she is doing great and continuously attending therapy.
The only problem i have found is that Doing the BIMS with the short term patient is unfair, and although there are certain ways to answer questions i feel like i make it bias and pursuade them to answer a certain way without even noticing it! which brings me back to my psych classes. i dont purposly do it by any means but i find myself often giving too many cues to the correct answer or trying to make them feel more comfortable answering the question by shaking my head or something on accident. This is something that i def. need to work on in order to improve the Data we recieve and keep it as accurate as possible. Besides my interfearance i feel like asking a patient "do you have trouble falling asleep or staying asleep in the past two weeks" or "have you had little or no appitite" or "do you find little or no interest in doing things you normally would" are hard to ask my patients, because i feel that if i put myself in their position stuck in a hospital i would be miserable. usually there answers end up being ... "yes im in a hospital its hard to sleep and i constantly get woken up for blood tests ect." "or the food here sucks so i dont want to eat it " or " im stuck in a hospital or hospital bed all day long and obviously imtired and there is nothing to do ". These answers are all so understandable to me so i feel that it is unfair for the state to asses them negatively because it is only because they are sick or injured or in a hospital!
Last thursday Feb 24th, i decided to go with Sally to do the BIMS on one of her long term patients to see how it goes with them. The first two were fine, i just tend to find them very depressing because i feel bad that they are stuck there in a nursing home and i feel like nursing homes are just never a fun places even with the events taht are going on. We finally went to our last guy on the list for the day and it was an older gentleman that was with his wife. Everything was okay until we got to the last few question about him feeling guilty being there, and feeling like he has let people down and thinks he would bne better off dead. he proceeded to tell us that he has though about it alot and tried to come up with a plan to go through with this idea. it just absolutely broke my heart, seeing how upset he was and how upset his wife got during this discussion literally made me cry. Sally and i had no idea what to do or say, i let her be the more professional one and "take it away" which she most definitly did, she handled it so well and was able to talk him through it all. I dont know how she does it all the time with these long term patients because i never have to go through that. the most i get is that the patient is upset because she or he cant be home to take care of their spous or family.
Yesterday (March First)
I went in and met Lisa in the office befor our doctor disbatch meeting. we discussed updates of each patient and she informed me of anything going on. at 1 we went into the meeting and went through each patient separately. Now it all made mroe sense to me because i was firmilar with the patents and knew what they were talking about and what the conversations were concerning. it was interesting to hear the medical termonolgy thrown around and actually understand what was going on! we hadnt made much progress with our current patients so we only had 3 individules scheduled to return home which pushed me to do some research and figure out why the patients have not made progress. i was unable to find out much information besides that there healing process is just slow, which of course is hard to go around and update and tell the patients this when you know they just want to go home! but i did so and it went well. until i went on my own with my list from colleen to do some of the paper work and BIMS. My last patient of the day was super nice when i first walked in until i went through her forms to confirm that the information we had was correct. When it got into her address and finances and family status she got very upset with me and asked me why it was any of my buisness and why i care. i proceeded to tell her that we had to confirm the information to make sure that what we had on file was correct and it was part of my job and required not only by the hospital but the state and she was not very happy with this. i think some of it had to do with knowing that i was a young college student and having all her private information even though i assured her that it was all confidential and i am sworn to not say anything and would never . i cant blame her though because it is alot of personal questions and i was probably the 100th person in her room that day prying her for information, i suppose i would be a bit miserable too! but it def shocked me because she was my first patient that got upset over just confirming the information we had recieved about her.
3/3
Today i went in and was on my own again for the whole time, i was left a list of new addmittens and was eager to get to work. i began going through their charts to pull out as much information as i could before interviewing them and going over the information i had to make sure that everything on file was accurate and correct. I had a male and a female, the femal had a start next to it saying that she was "confused" to give me a heads up of what to expect. already that made me nervous and unsure of how the rest of the day was going to go. when i was all ready, i went on a wild goose hunt to find the lady and could not find her anywhere! all i knew was her name and that she was 90 years old , there because she had fallen when getting up to go to the bathroom. i gave up after that search and then went to find the man. He at first had family in so i didnt want to interrupt his vistitors and figured in the mean time i would go file some paperwork. i found that while filing i was getting to know people pretty well there and could put a face to the name although in doing so i found out that many patients left already! This was exciting to know they were better and able to return home but at the same time sad because i was getting to know them. That is the only downfall with working with the short term patients and only being there 2 days a week, i get to know them and then may not see them again! When i went back upstairs, his family had gone and i was able to do the interview! it went very well, he was super nice and loved life which just made me really think about my life and the way that i look at things. he had been in the hospital with several respiratory and cardiac problems for months and yet still was smiling and happy!
3/8
Today i went in and went directly to the discharge meeting, which is where we sit and mean with all the doctors, (p/t o/t nutritionists, surgeons, pharm. ect) and discuss every patients status individually , to see where they are at how they are doing and where to go from here! it was a good meeting, although not much had changed for many of the patients which made us all a little worried and unsure of how to handle it. we concluded for a few of them that they just had lack of desire to do the therapy necessary for them to return to complete independent functional status which is just heart breaking because you can only make someone want to do something so much the rest is their own will power. i wasnt firmiliar with any of the patients in this situation or else i think i would have personally gone myself to try and encourage them . Following the meeting i had to meet with two lovely ladies that just had left total knee replacements and just so happend to be roomates! when filling out their work i noticed i was no longer having to ask many questions! i was understanding the termonology and medications, which was super exciting! (L) TKR = left total knee replacement. i met with them and they were both very vibrant and happy ! they were the easiest interviews yet and i had fun doing it! not realizing it , a difficult interview takes about a half hour, i found myself in there room for an hour in a half and it was all just talking to them about anything and everything! i finally feel completely comfortable doing my tasks and being in the hospital which had definitly helped me to enjoy being there that much more!
3/10
When i went in today the vestbule was filled with flowers, the patients were all around buying them for loved ones before they went into the large dining hall to play bingo! i went into the office where i got my assignments for the day and got to work. we had two new admittens come in yesterday and two today so i had to get all their paperwork together and begin the interviews. thank god sally was there to help colleen and i out or else we would not have gotten through as much as we did! i found myself working faster than ever, knowing exactly where in their medical charts to look for all the information i needed. I also got to work on the computer inputting patients BIMS results, Cognition results and overall status. There is a new program to electronically complete these reults that automatically take them and send you triggered areas of concern to help us dig deeper into the problems if there were any. Once you click them it takes you through several steps on how to asses the individual, take action, and intervene! although i didnt have anything exciting pop up, colleen showed me a mock of what would have happend if i did. The state requires so much out of every patient even thoes that are only there for a week!. later when sally and i went back down to the office we found flowers with our names on them which was pretty exciting! the reason was that its social work appreciation month! woo little did we know we were in for a treat. Today was a short day because colleen had to leave early and i had studying to do so nothing to exciting happend but im sure come tuesday that will be a whole different story because we are supposed to get in several patients with all sorts of different reasons for admittance.
