Sunday, April 26, 2015

Mrs. Chase - A Proxy Patient for Practicing Procedures

Nearly every R.N. in the US and Canada received her basic training on the Chase Hospital Doll. For over 50 years, standard equipment in the nurse training hospitals throughout the world.

This was the copy from an ad placed in the American Journal of Nursing in 1965. It also touted the availability of a male and infant doll. Our school was in the possession of only a Mrs. Chase and I have never seen the other varieties.

Mrs. Chase was named after the lady who created her as an improvement over straw filled dolls that were used to teach basic nursing at the beginning of the 20th century. She hailed from Rhode Island and had vinyl skin which was stuffed with sawdust from a nearby furniture factory. She was 5  1/2 feet  tall and weighed about 80 lbs. thanks to the strategic placement of weights. Hook and loop fasteners  like those found on a gate served to attach arms to shoulders and hips to legs. Her elbows and knees were articulated with hinges very much like those found on cabinets. She was equipped with an anus, urethra, nostrils, and a tracheotomy stoma. She also had an assortment of sites for various injections.  Curiously, her mouth was sealed shut with pursed lips, perhaps as a measure to mute her screams and complaints. The main advantages over a real patient with Mrs. Chase was her availability and the safety issue - you did not have to worry about her sciatic nerve when giving an injection.

Our Mrs. Chase looked like she came off the battlefield. Her pleasant neutral expression in stark contradiction to what she had been through at the hands of novice nurses over the years.
Her vinyl skin was brittle and dry from all the alcohol sponge baths used to simulate treatments to break a fever. Her faux anus stretched out to the size of a donut hole from all the invasive enemas. When new, Mrs Chase had a fluid reservoir that held about 2 quarts of enema solution which was drained through an abdominal port upon completion of the procedure. Ours leaked so we never had a chance to instill rectal solutions. We had to wait for the real McCoy to experience this delight.

She also had a tracheotomy stoma that we learned to clean and care for. Trach tubes had an inner and outer canula. The silver inner canula was removed and cleaned with hydrogen peroxide. Mrs. Chase also had an urethra for practice catheterization. Over the years it had been so dilated that the procedure was akin to inserting a pencil in the Holland Tunnel.

Injection techniques such as hypodermoclysis were done on Mrs. Chase  (I'm thinking about doing a post on this old hydration technique later.)  Anyhow, IM injections were also practiced and landmarking techniques which were probably the most important part of the procedure had to be mastered later. Mrs. Chase had a 2-3 inch diameter round hole chopped out of her right butt cheek at the injection site. It was filled with a replaceable foam rubber insert. You really could not miss. Just stab away to your hearts content. I remember when our instructors got their hands on a cache of expired BiCillin LA and wanted to demonstrate how much pressure it takes to inject such a viscous substance. It turned Mrs. Chase's buttock into a whitish, gooey mess, but at least there were no shrieks or complaints that were so common when giving this to a real person. This photo gives a really nice view of the injection site and at the very bottom her anus is visible along with the bilateral hooks to secure her legs.

We learned all varieties of bed making with Mrs. Chase: Occupied top to bottom, Occupied side to side, Post-op with the sheets carefully fan folded on the opposite side of entry, and unoccupied. We had no fitted sheets and the corners had to be mitered at exactly 45 degree angles. There was one other bedmaking tip we learned.  When there was a dead on arrival expected in the ER, lay the morgue shroud down on the treatment table last to prevent struggling to get it under the patient later.

We also learned transfer techniques, bed to chair, chair to bed, and litter to bed. My favorite one person transfer technique was the "demon drop." For this, Mrs. Chase was pulled to the edge of the bed with the chair in alignment and pulled laterally until gravity dropped her into the chair. We devised another technique called the "guided missile" that really defies description, but was very effective.

Nice illustration of Mrs. Chase elevating for a transfer. Look out below!

A nurse was so impressed with Mrs. Chase that she penned this poem found in an old nursing school yearbook:

                   Mrs. Chase

In the classroom you've been our faithful guide
So your fame in nursing will ever abide
Your history is one we can no longer hide
For we're designed to spread it far and wide
Though we've bathed and pummeled you with treatments galore
And turned you until you must have been sore
You never spoke or an angry look you wore
As we practiced the nursing you made us adore.

You've been touched and observed to teach detection
Of the signs and symptoms of mankinds' infections
You've had purposeful ails and many injections
That we gave you with heartened affection

You are dearly loved by all those in white
And students speak of you day and night.


Thursday, April 16, 2015

A New Book, Becoming Nursey by Kati Kleber RN

Nursing books of yesteryear were dull, uninspiring, and in a way judgmental and preachy. They were all navy blue and looked very plain. Our pediatric text often concluded a description of some dread disease with the statement "These children rarely become useful citizens." That line always gave me the creeps as a student and years later, still bothers me. I don't know who is qualified to make judgments like this. I suspect someone with a special combination of arrogance and ignorance.

It really is great to see how much times have changed.  Becoming Nursey, a new book by Kati Kleber is very informative and uplifting.

It really is heartwarming to see a young nurse so passionate about bedside nursing. We were all bedside nurses in my day. Today it seems so many young  "nurses"  opt for nurse entrepreneur, computer nurse,  insurance company nurse, and a number of other non patient contact positions just to escape the bedside which is where the heart and sole of nursing lives. I am sure Kati could have succeeded in any of these endeavors, but chose bedside nursing.

I think this choice can be a difficult path to follow and she offers many valuable tips and insights that are helpful. Bedside nursing is where the long term rewards are. Forty years from now you won't care what kind of smartphone you had, but the care you invested in your patients and what your patients returned to you will remain etched in your consciousness  providing a sense of peace and fulfillment that does not exist in non bedside nursing positions. Kati's new book can help your spirit thrive at the bedside.

Reading this book did bring to mind some situations that I could have been more accommodating and understanding with new nurses. It's hard to be really supportive when feeling time pressured or some imminent disaster is brewing. I don't think older nurses are necessarily mean hearted, but the stress of the job can cause a gruff exterior at times. In my heart, I always admired young nurses and thought their job was much more difficult than mine.

If you are thinking about nursing as a career this book is a good window to living as a nurse. I wish there was something as uplifting when I was younger. It used to be a trial by fire mentality and it is nice to see times change.

Nursing texts are necessary and I have spent many happy hours with them. This book is a great read because it goes beyond what is covered in a textbook in that it reveals the spirit of nursing. I feel certain that Florence Nightingale would have purchased this book if it had been available in her time.

Wednesday, April 8, 2015

Profiles in Nursing Administratiion

Nursing administration involved a simple hierarchy in my day. It went from head nurse to supervisor to director of nursing. There were no nurse managers or nurse executives. Nevertheless,  I bet some of these supervisor personality archetypes are recognizable to whippersnapperrns. Knowledge and procedures advance, but over time human nature is more fixed.

Head nurses were really in a challenging position- responsible for patient care and keeping the unit running smoothly. You had to be really good clinically to survive. The supervisor level is where most of the incompetence reigned and here is a sampling of the finest examples.

The Sister Supervisor  This supervisor came from a religious background and judged events as either good or evil without any grey areas. Suffering on the part of patients or staff under her was a good thing because it guaranteed salvation. She made sure there was plenty of misery for all. I actually worked with one of these characters and she thought open draining wounds were a sign of evil exiting a patient's body. Thankfully, with the corporatization of health care and the Sisters not reproducing, this type is nearly extinct.

The Supervisor in Absentia    One of my favorite types. This one is frequently MIA. She attends every in - hospital meeting and every seminar outside the hospital. Frequently a unique blend of arrogance and ignorance. I was at a critical care seminar with one of these birds and she was able to point out p-waves and QRS complexes on an arterial line waveform. I did not have the guts to tell that it was  not an EKG waveform that she was "interpreting."  Things would be different today!  The only thing preventing her causing any real damage is her absence from the clinical area.

The Paula Revere   Frequently seen galloping down the halls yelling out,  "JCAH is coming in 8 months,  JCAH is coming in 8 months"  Always on the alert for coming disasters and mishaps. Terrible clinical skills and intuition. Told a nurse pushing a crash cart to slow down- "You're making too much noise with that thing.'  Usually skinny and hyperactive and prone to OCD behaviors.

The Barbie Doll. She looks like an escapee from a cosmetics testing lab. Her lifelong dream was to enter nursing and marry a prominent physician, preferably a plastic surgeon so she could get a mammary augmentation at no cost. Makes frequent calls to physicians when there is no good clinical rationale. Once called a doc at 3AM to get a straight cath order on a patient with a Foley. Cannot pass a mirror without pausing to self-admire. This was the type of student nurse to write elaborate, flowery care plans that were a work of art. Unfortunately her disheveled patient was stuck in a huge pile of poop that she failed to notice for hours. Everything looks great on paper though.

The Overseer   This supervisor thinks of the hospital as her plantation and those under her supervision as slaves.  She makes frequent references to "My nurses" and "My operating rooms."
I worked with one of these characters and it was best to just play along. "Them there lights sure be bright this morning,  Miss Rita." was a frequent comment. Little instrument handling tricks served to amuse her. In the neuro room I taught myself how to load 2 Raney clips at a time. She sure 'nuff be proud of my nimble slave fingers.

The Retro Grouch   This supervisor was caught in a time warp. Her favorite line was I'm old school and then would proceed to harangue and harass you to no end for your new fangled ways. Thought every piece of equipment should be reused. Once proposed that one time use endotracheal tubes could be repurposed for retention enemas, "The cuff is the perfect caliber for an enema." This supervisor could also sharpen needles and surgical instruments by hand using a whet stone and was critical of anyone lacking this skill.

The Office Sitter This supervisor never leaves her office. Foodstuffs and personnel enter but she never leaves her domain. She decided to get progressive and announces an "open door" policy from 3PM to 3:30PM on the third Tuesday of every month. It's strange how this coincides with the time all nurses are getting report.

It is possible to have a hybrid supervisor. I once had a Barbie Doll - Overseer. She was one of the all time most nightmarish supervisors I have ever encountered. Luckily for me she left to become a drug sales person.