Sundowning

There are few things that make me sadder than seeing a confused old man in a pair of these mits. The look of hopelessness and confusion in their eyes as they ask you why you are putting these on them is enough to make you want to cry. We use these to prevent patients from pulling out their IV's, foley's and other bodily tubes.

Patients who sundown can potentially win themselves a pair of these gloves. They remind me of the mittens Micky Mouse wears which makes them even more depressing.

I had never heard of sundowning before becoming a nurse, but as I understand it, it is dementia that kicks in abruptly in the afternoon/evening and then goes away again in the morning. You might recognize this phenomenon when suddenly that elderly patient who you've been having such nice conversations with all day is now calling you a tooth fairy (in the best of cases) or trying to break your fingers (in the worst).

End of Life

My patient this week was in his 9th decade -a WW II veteran from the Marine Corps who'd been all over the world. I got my first shot at shaving a patient with him, which was scary and also kind of funny. I didn't cut him, thank god, but he looked kind of like a mangy puppy after I finished. He was so happy though, he just kept telling me what a great job I'd done even though he had no idea what he looked like. 

I was so surprised at how lucid he was when I met him. I like how he called his hearing aids his "ears", his glasses his "eyes", and his oxygen cannula his "breathers."

Thinking about how he was reaching the end of his life made me a little sad. I don't think he's going to make it too much longer. Even though he's had a long life and a pretty good one judging by his spirit, it's still an end none-the-less. He'll have some time now to look over his life and think about everything he's done and seen, and when he's gone someone will have lost their dad, their husband, their buddy... It's like the end of an era. Makes ya feel a little melancholy...

Long Term Care

Last week I started the clinical portion of school at a long term care facility (read: nursing home). We'll only go a total of four days to our designated facility before my group and I head into acute care on an organ transplant floor.

Each student has been paired up with a resident at the nursing home who we'll work and write a clinical paper about at the end of our four days. I was happy when my resident immediately reminded me of my 94 year old grandmother. She's pretty funny and feisty and while I thought she was at least in her late 80's to early 90's, I found out on the second day that she was only 69! That's just a few years older than my mom, dad and aunts and uncles. Why do people age so differently, I wonder.


Being at this home has been a saddening experience to say the least. And not because we're working with elder patients, some of which have dementia or can't talk or feed themselves, and all of whom are incontinent... it's the fact that there is about one burnt out CNA (certified nurse assistant) per 8 residents who's lack of patience or desire to take the time to be a little more caring is all too evident. "Fortunately" for me, I'm at one of the "better" homes where residents just get left on the toilet for 30-45 minutes and rushed in and out of the shower as they cry for the CNA to be careful because they have dementia and are afraid they're going to fall or get hurt. I've heard horror stories from other students who are at different homes who've told me of a resident having her own urine wiped on her by a laughing CNA who left this incontinent person in her bed for three hours and then scolded her for peeing in it... Or others who've told me that the residents in the home where they've been placed are wheeled into the hallways where they spend their whole day staring at the back of the person in the wheelchair in front of them... And we've only been at these places for TWO days! Imagine spending years living or working in one of these homes.

So what have I learned? 1) I don't want myself or anyone I know to ever have to live in a nursing home 2) CNA's need to be paid more and their patient load needs to be drastically reduced.
I can't stop thinking about my resident who's only been at this home for one month but who's already developing a pressure ulcer on her butt from sitting in her wheelchair all day, everyday. It's entirely possible that she could end up dying from an infection resulting from that sore. It makes me feel guilty knowing that once I put in my last day with her on Thursday, I'll go on to something else, but she'll be right there until the end of her days.