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April 2020 CNSA - SACRAMENTO STATE CHAPTER VOLUME 36, ISSUE 2

Caregiver and Patient Dynamic

By Sharon Hill
2nd Semester

Her name stood out from the patient list as if in bold print. “CHELSEA” read in my mind like a friend’s name I had
seen a hundred times before.

“19,” was listed under her name on a line all by itself. Maybe that was why I felt the hair stand up at the base of my
neck. Nineteen feels like yesterday. The matter-of-fact narrative sent chills down my spine. I felt myself pull at the
hem of my sleeve, wrapping my fingers around my forearm without thinking. Her name and age range in my head.
She was admitted after my shift was coming to a close yesterday. While I was planning my to-do lists and after-
Lending a Helping Hand
noon snack, she was having one of the worst moments of her life. I hoped her life wouldn’t get worse than this. I
in the Expected and
looked over my shoulder and her chart was sitting on the rack to my left – an attempt to sum up her ‘case’, her
Unexpected
demons and the scars she bears in a 2-inch binder of disorganized papers and scribbled notes, the thickness drasti-
Page 2 cally less than those surrounding it, a tell of her age and a limited psychiatric history. I wondered how thick it
would get before she left this place. I wondered if she could imagine a day when she would leave this place. I read
her name on the spine of the book over again, a red sticker outlining the letters of her name with an urgency simi-
Therapeutic Chocolate lar to the one I felt as “19” bounced around in my thoughts again. Being only six years her senior, I can recall with
Milk and Small Victories precision how hard of a year nineteen was for me. I was trapped in a place in my mind and unable to see a way out.
in Pediatric Med-Surg I wondered if she had a sister, too; someone to touch her wounds and help her heal. Someone she can rely on to
Page 3 hold her hope for her when it is too much for her to carry on her own. I wondered if she could imagine living long
enough to see those cuts close and turn white with scar tissue, fading with time. Would she hide them with cuffs,
tugging at the ends when she wasn’t sure of herself? One day those marks might heal, dance in the sun atop her
Mental Health Matters: bare, carefree arms waving to a loud, happy song – behind her a road of struggle, fear and sadness. Would a
A Playroom of Emotions thought like healing seem like hope or torture to her right now?
Page 4 Thinking of Chelsea was a very personal experience and an opportunity to ask myself questions I hadn’t come
across in the med-surg setting… What do I have to offer to Chelsea? Chelsea wasn’t psychotic… she isn’t seeing
Hornets in Action figures in the day not really there, she isn’t lost in a mirage of confusion and disorientation, she isn’t hearing voices
that she laughed along with in hysterics. She is a lot like me. She doesn’t need to be sedated or reoriented, redi-
Page 5 rected to a logical thought. What kind of help does Chelsea need?

When I heard her case reviewed during shift-change report, I heard myself ask how we, as caregivers, offer some-
Important Upcoming one hope. This opportunity for self-exploration was not about Chelsea. It was about me exploring the dynamic be-
Dates tween caregiver and patient. These questions are about my role as a caregiver in my own mental health and about
Page 6 when and how my own mental health affects my role as a caregiver. What parts of us are useful in the therapeutic
relationship? What parts aren’t useful? When do we know how relatable to allow ourselves to be with patients like
Chelsea? Some patients are no different than the young girl standing behind us in the grocery store line, who we
might bend down to help pick up dropped change for and offer a compliment on her shoes. The creation of our
identity as nurses isn’t about creating a separate alter-ego that we slip on every day before our scrubs. It’s about
taking the parts of ourselves, our humanity, our kindness, empathy and passion and bridging it into a pool of
knowledge, expertise, skill and evidence. But then I think about Chelsea and it seems much harder than it sounded
before.

*Note: Name and Patient identifiers changed for this article.

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Lending a Helping Hand in the Expected and the Unexpected

By Danielle Baldwin
Undergraduate Co-Representative II
3rd Semester
Going into pediatrics has always been a dream of mine
and having the opportunity to be in the pediatric rota-
tion this semester has been a wonderful experience.
When I was 4 years old, I wanted to become a nurse.
Even into high school, I still desired this, having the deep
passion to specialize in pediatrics. In our younger years,
I think that one focuses more on the dream of being a
nurse rather than the variety of cases you will see every
day in the hospital setting. This pediatric rotation has
been a manifestation of all my dreams combined; in
some ways it has been the same as what I expected, and
in other ways, it has been very different.
For the parts that are the same, I knew that my heart
would be so excited and joyed to be there for each child and encourage them during their hospital stay. I knew that I
would try and do everything I could to support the family and the patient, and really hope to get at least one smile or
a high five from the patient during my shift, helping them cope through all that they’re going through.
For the parts that are different, seeing so many children with complex cases is more than I had expected on a regular
pediatric floor. It is expected in the ICU, but on the pediatric floor, there can still be complex cases that require much
management and careful observation, while paying attention to great detail to any subtle changes in the patient’s
status. For my ICU rotation, my patient had to go to MRI and then the Operating Room. Their condition was critical,
and it was important that their care was managed very carefully, as they had a spinal cord injury, and needed an in-
tervention to ensure that their neck was stable. The doctors decided to operate that day. Having the opportunity to
help with preparing the patient for transport and going with the nurse to the MRI and Operating Room is an inde-
scribable experience. The father thanked me for all I had done, and that moment was one that I will never forget and
is treasured in my heart. Supporting the family doesn’t have to be a lot of words, sometimes a gesture of getting
them a cup of water is enough. It can be so simple but mean more than words can describe. For my patients on the
pediatric floor, I have cared for many previously premature patients, toddlers, and one teenager. Each clinical day
has been an incredible learning experience, teaching me varied skills, all of which are helping to shape me into the
future nurse I will be soon.
These experiences only inspire me more to become a pediatric nurse, because although there can be many challeng-
es, I am privileged to have the opportunity to care for such precious children. It is truly amazing to have a job where
you are trusted immensely by the family, and that they feel comfortable and thankful that you’re there to care for
their child. Not only this, but we can be an inspiration for the patient and their family, and the way in which we act
can have a lifetime effect. May we find joy knowing that wherever we go as nurses, we can lend a helping hand, an
ear to hear, and a heart to listen.

*Note: Name and Patient identifiers changed for this article.

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Therapeutic Chocolate Milk and Small Victories in Pediatric Med-surg

By Jeremy Thompson
Community Health Director
3rd Semester
45 minutes. That’s how long it takes to feed a carton of chocolate milk to a
one year old via oral syringe. You might consider tucking that information
away for your time management later on, or maybe it’s a cool party trick to
have that as walking knowledge. I don’t know though… I’m a nursing stu-
dent with no time for parties and tricks (maybe the Poli-sci majors can
weigh in?).

So, how do you end up with a syringe of chocolate milk? Well it all starts
with a one-year old patient that is s/p palatoplasty. Oh, and RSV… Yeah RSV
was a factor too… Cleft palate surgeries are relatively straightforward, and
such a long stay is normally not indicated, so what’s the problem here? Well
this particular patient was falling off of their growth chart into failure to
thrive territory, with PO fluid intake being inadequate and the main barrier
to discharge at this point. In modern medicine, with our fancy interventions
and knowledge of nutrition, you’d think that there are better moves than,
“do you want chocolate milk?” But, when your patient has hardly had anything to eat or drink in a day and they’re in the
first percentile for their weight, the narrative turns into you and the mother positioned over a crying baby begging,
“please drink the chocolate milk!”

This is where empathy comes into play. After all, imagine you were laying in a hospital crib and your mother is shoving
something at your face, and there’s a stranger wearing droplet PPE, and you can’t communicate, and you have no higher
understanding of masks and syringes and hospitals because you are, in fact, a baby who doesn’t understand a whole lot
more than “I’m hungry” … I’m shuddering just thinking about it. After crying (the baby, not me), and several failed at-
tempts, my inner monologue was starting to look something like this:

Why isn’t this working? Chocolate milk is delicious. Peds is hard. Oof, I need a Mentos with this mask. Come on child, this is
for your own good. Wait, what would Florence do (WWFD)? Assess, ok… My assessment is that this isn’t working.

At this point, it was time to change up our game plan. Since there were two of us there, I encouraged the mother to sit her
baby up in her arms while I used my super cool nursing skills to “administer” the life-saving milk. It was slow going at
first. After all, this is a patient who for all intents and purposes is re-learning how to eat with her new palate, but once we
figured out the right rate, my inner monologue turned into:

It’s working! Refill the syringe! My hand is cramping, and it’s hot in this gown. Palms are weak and knees are heavy, some-
thing something something, spaghetti. Woohoo! Peds is actually kinda fun!

With trembling arms and a sense of relief washing over us, mom and I high five each other for this little win. What, if any-
thing, can be taken away from this otherwise funny story? Well for starters, as someone interested in adult critical care, I
was wrong to dread the “boring peds rotation.” Pediatric nursing has many of the same complex situations and skills
we’ve been learning in school so far with the added complications of irrational toddlerhood. Second, as students, we have
more time to give our patients and their families than the primary nurses we are working with, and they deserve that
time. In this instance, the patient actually had enough PO intake during my shift that the doctor ordered their discharge
at the end of the day! And finally, even with all our fancy nursing skills and knowledge, sometimes the patient simply
needs some chocolate milk.
 THE MONTHLY SHOT PAGE 4

By Jaymee Cruz
Monthly Shot Editor
4th Semester
A Playroom of Emotions
When you think about precepting in pediatrics, you picture toys, games, laughter, and pure joy. Children remind us every day
that we can find happiness in the little things. But what if you come across a child abuse case? Or an infant who has been in
the hospital for months struggling to achieve cancer remission? It takes a mental toll on you.

I had just watched a documentary on Netflix called, “The trials of Gabriel Fernandez.” It was a case of torture and murder of
an 8-year-old child committed by his mother and her boyfriend. never imagined I would be taking care of a toddler who was a
CPS case the next day. My heart broke when I heard the words, “possible child abuse and neglect” during report. All I could
think of at that moment was that if this child has never known love, I will shower this child with love and care as much as I
could. I know you shouldn’t have favorites when you are taking care of patients, but unlike the rest of my other patients, this
child had no family present at the bedside. His parents are both incarcerated, and all his siblings are in custody. He was alone
encaged in that crib waiving hello to every passerby hoping one of them would stop by and give him a little bit of their time. I
precepted for two consecutive days and got to know the child very well. He loved it when I sat him up in his little red wagon in
the nurse’s station. I would give him goldfish and milk to snack on while I kept up with my charting. He loved it when I read to
him before he took his afternoon nap. He got very excited and yelled out “Yes!” every time he saw me with his food tray. The
child life specialists gave me two tubes of bubbles because I told them he enjoyed them so much. I was basically his parent for
two days and as much as I tried not to, I fell in love with the sweet little child. The next day, he was medically cleared for dis-
charge. I was on my 30-minute break when the foster parent came to pick him up. I wasn’t able to say goodbye because ac-
cording to my preceptor, they were in a hurry. I was heartbroken, happy, and hopeful all at the same time. I hope he finds
love with his new family because I believe that every kid deserves to be in a nurturing home.

I went home that day thinking that as much as we try not to get attached to our patients, sometimes it is inevitable. Nurses go
above and beyond their duties, and as humans, we feel emotions too. What we have to do keep ourselves grounded is to take
a step back and remind ourselves that it is okay to feel, but at some point, we have to let go of those emotions. We should
give ourselves a break every now and then so that we can regain our composure. Reminding ourselves what inspired us to be
a nurse despite knowing that there are more difficult days is one way to replenish our mental health. I will keep pushing for-
ward because there will be always be another child who will need me. And when that time comes, I want to be the very best
version of myself so I can take care of them safely.
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Hornets in Action!

Pictured Above: Nursing student volunteers at the Foot Care Clinic

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Learn more about

Men in Nursing at
IMPORTANT UPCOMING
www.aamn.org/ DATES
Events:
Congratulations to the first semesters on Men In Nursing Meeting:
their White Coat Ceremony! April 24 (Friday) at 4:30 pm on Zoom
Zoom ID TBA

C.N.S.A. Meeting
April 10 (Friday) at 4:30pm on Zoom
Zoom ID TBA

Contact Info
California State University, Sacramento,
School of Nursing:
6000 J Street
Sacramento, CA 95819-6096
http://www.hhs.csus.edu/nrs
Phone: (916) 278-6525
Fax: (916) 278-6311

Monthly Shot Editor: Jaymee Cruz

Email: csus.cnsa.monthlyshot@gmail.com

Faculty Co-Advisors:
Dr. Denise Wall Parilo & Dr. Bridget
Parsh
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