Clinical Journal 4/8/16
Today I was with the CNC. Most of the day was spent reading patient charts in her office. I noticed that most of the patients suffered from depression or anxiety on her unit. One patient did have an interesting chart however. He and his biological sister had been adopted, and he struggled with his behavior for years, but his background was unknown before the adoption. He was forcing his biological sister to have sex with him and was watching pornography. I asked the CNC why he wasn’t charged with sexual assault (since he was 17 and his sister was 10), and the CNC informed me that a lot of times the parents choose not to press charges when this happens because insurance won’t cover his treatment at the facility. I thought this was really sad because now his little sister will probably suffer from this trauma, and she will probably wind up at the treatment center herself. During the day there were two boys fighting during class and we had to go administer an emergency medication. When we got there one of the boys said “we both need shots.” This was interesting to see how calm he was, but was still asking for a shot. I was surprised that they administer the emergency medication even when the patient has calmed down and doesn’t necessarily need it. When the CNC was preparing the shot, one of the techs was instigating with one of the boys, and I thought that she was making matters worse. It seemed like she was trying to fire him back up after he had already calmed down. I also found it interesting that the two boys that had been fighting were placed on the same step together. At the end of the day we went to the ropes course. I enjoyed watching the girl being discharged do the eagle flight and make her speech. Her speech was very heartfelt, and you could tell that she truly cared about the other girls on her unit.
In this situation administering the emergency medication I felt like the medication wasn’t very necessary anymore. Both of the boys were sitting together and were acting very calm. They weren’t fighting anymore, so I wondered why the medication was still administered. I also wondered why no one told the tech to stop arguing and instigating with one of the boys. I feel if I had been the nurse I would have nicely suggested using a different technique because her yelling and fighting with him (even though he wasn’t fighting back) could not bring anything good in that situation. I learned that I would handle this particular situation with caution. I would analyze the need for the medication, and decide if it was still a necessity. The other nurse helping the CNC didn’t even ask the boys any questions about the situation until after she gave the medication. In that situation I would have first assessed everything, and then administered the medication if it was still needed.
This has taught me how to look at the whole situation, and how to act based on the information I am given. It has taught me that you shouldn’t just jump to medication when the patient starts acting up. I realize that other techniques can be used and can be effective instead of medication.
In my nursing practice, I want to improve on my assessing the situation. I know that assessing is the very first thing you do and is the most important thing you do. Today has made me realize that sometimes that is skipped over, or isn’t done thoroughly. I want to make sure in my future as a nurse that I am assessing everything before acting on the situation.
Today I felt like I utilized my nursing knowledge when I recognized the importance of assessments and what to understand and look for before acting on the situation.