Exemplar
A night to remember
Michelle Millane
PP: 167 - 168
Article Text
Night duty was another new experience for me as a newly registered nurse undertaking a graduate nurse program.
The neurological-neurosurgical ward I was working on had three registered nurses this shift. A senior registered nurse, very conservative and quiet in her ways, another graduate nurse on her second placement approximately six months into her twelve-month program and myself, a graduate of about three months experience (or inexperience as I was soon to label my expertise level).
The night was going smoothly-0200 observations, medications and pressure area care completed, we settled into the nurses' station and continued our usual night duty conversation. Some time during this conversation, a client nearby commenced snoring heavily. The snoring persisted and it was decided that someone should investigate. In doing so, I spoke to him gently, he opened his eyes, moved, mumbled and continued to sleep. I was happy and rejoined the others outside the bay.
This man, Mr Smith (not his real name) was admitted following a cerebrovascular accident. He was commenced on a heparin infusion and was responding well to treatment. His blood pressure was becoming normotensive, with the movement in his affected side being regained gradually. His APPT or coagulation levels were being monitored four to six hourly.
Having had the APPT checked late on the previous shift, the infusion rate of heparin had been adjusted and increased at 0200 hours as per medico orders. This snoring had commenced an hour to an hour and a half later.
At 0400 hours, my colleague (the other graduate nurse) proceeded into the bay to fill up the intravenous pediatric drip chamber with the appropriate volume of heparinised Solution. Mr Smith was still snoring. She touched him, spoke to him, intending to help him to change position to ease the snoring but could not wake or rouse him.
Upon further examination, he was found to be unresponsive, having pin-point pupils, tachycardia and was slumped in the bed. The events of the following hours seemed to happen in a blur. The night medical intern, having examined Mr Smith, further consulted the medical registrar. While this was occurring, my colleagues and I had began to discuss what had happened. My first reaction was self-blame. I should have noticed something was wrong when I initially went in to arouse him from snoring. Why hadn't I tried to rouse him adequately to make sure he was awake? Doubt about my ability was beginning to creep into my mind. Why hadn't I fully assessed the client properly?
I then accompanied Mr Smith whose condition was unchanged, to the radiology department for an emergency CT scan at 0500 hours. After forty-five minutes of filming, we returned to the ward where his son was waiting. He had been contacted by the medical staff and was obviously quite upset at the condition of his father. I then had the difficult task of both preparing Mr Smith for theatre and trying to comfort and provide an explanation for his son- an issue I was definitely not comfortable with at this early stage of my career.
I didn't panic but I felt ill at ease. I was feeling rushed because Mr Smith was for immediate theatre. He needed preparation, however his son also required attention and my colleagues were unable to help me as routine 0600 hours work needed to be completed. I was feeling for the son, one, because of his father's dramatically changed condition for the worse, and secondly Mr Smith had been incontinent and I was trying to maintain dignity on behalf of all parties.
The CT scan revealed a cerebral haemorrhage, and at 0700 I escorted Mr Smith to theatre, while handover to the morning staff was being conducted.
After completion of the shift, my graduate nurse colleague and I talked for a long time, not believing what had occurred, realising our lack of experience in the situation and wondering what the outcome would be. A question we kept asking ourselves was, 'Could we have prevented it?' Could we have stopped progression to the stage of necessary surgery if we had recognised the sign of deep snoring and related it to unconsciousness? Again, I began to blame myself and doubt my nursing skills when I thought of Mr Smith's future quality of life. In the months to come, I heard of Mr Smith. The surgery was relatively successful. Surgeons had also performed a tracheostomy and recovery was slow. However, after time, Mr Smith had the tracheostomy tube removed and intensive occupational and physiotherapy saw him back on his feet and eventually he walked out of the front door of the hospital unaided.
My colleague and I met in the corridors of the hospital not long after I had been given this information and 'Thank God' were two words I distinctly remember us saying to each other. Both of us were relieved at his recovery, also realising the immeasurable leap on our learning curves to becoming competent health professionals as a result of the situation with Mr Smith.
Ever since that night, I feel I am more attuned to those in my care, and more importantly attuned to my instincts to support my ever-increasing knowledge levels. In some situations I find that I still have an adrenaline rush, however the 'ill at ease' feeling has been transformed into a feeling of telling myself to look at the whole picture, analyse and rationalise, then take it one step at a time. I know that it's not always a calm approach, but it definitely isn't a frightened one of a self-doubting newly registered nurse doing night duty for the first time.
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