Magazine article American Nurse Today

Interdisciplinary Rounds in the Acute Care Setting: A Powerful Tool for Student Nurses

Magazine article American Nurse Today

Interdisciplinary Rounds in the Acute Care Setting: A Powerful Tool for Student Nurses

Article excerpt

My colleague shook his head skeptically as he said, "I'm not sure the students know what nurses actually do." The fall semester was coming to a close, which often prompts faculty members to wax philosophical about our nursing students. Despite hours of lecture and intensive work in the skills lab and on hospital rotations, we can never be sure that all students have gained an appreciable understanding of what being a nurse means--clinically, intellectually, and emotionally. Our university graduates hundreds of new nurses every year, many of them second-degree students. The program is built for speed--in 15 months our prospective nurses must be ready to sit for the NCLEX licensing exam. Apart from my colleague's worries about emotional and intellectual preparation, I wonder if 15 months is enough time for students to understand the complicated culture of the US hospital system. The week after my colleague shook his head, a chance assignment opened a door for exploring how the use of interdisciplinary rounds can help prepare students for the work ahead.

The assignment

On the last day of the students' hospital rotation, I assigned two second-degree freshmen to take care of a 73-year-old man who was actively dying. Mr. S. had complications from a previous hip surgery that included a postoperative infection, Vancomycin-resistant enterocci in his urine, and respiratory failure. A past medical history included hepatitis C and chronic obstructive pulmonary disease. I had reservations about assigning the patient to relatively inexperienced students and was not at all confident they were ready to handle this involved case, let alone manage an end-of-life experience. Only a few weeks ago they were working in jobs light years from nursing; one young woman came from the public relations world and the other from a job as a sales associate at a large chain department store. The night nurse, who appeared tired and overwhelmed, whispered that Mr. S. would probably die on our shift. When I learned he had no family or visitors, my decision was made. I could not bear the idea of a patient dying alone.

My goals for the students that morning were to provide comfort, monitor vital signs and intake/output, be responsible for his general care and, possibly, observe postmortem care. The patient's code status was do not resuscitate, with no plan for hospice care. The RN case manager was wringing her hands, trying to chase down the attending to write an order for hospice care. Complicating the situation was the fact that Mr. S. had been placed on the orthopedics floor, and the nurses wanted to transfer Mr. S. to a medical unit.

Nervously, the students tied filmy blue gowns around their waists, struggled into plastic gloves, and approached our patient. His eyes were dry and staring as we entered the room. A bag of normal saline dripped into a vein keeping him hydrated, along with several piggybacked antibiotics to treat the infections overwhelming his body; a Venturi mask covered his face pushing air into lungs that no longer worked on their own. We were told he was responsive to pain only.

We talked to Mr. S. as we cleaned and bathed his face, body, and wounds. We adjusted his breathing mask, placing cotton gauze under strategic areas to prevent the plastic ties from biting into fragile skin. We put saline drops into dry eyes, massaged hands and feet with moisturizer, and applied barrier cream to a reddened sacrum. The students took vital signs. His temperature was 94.6 F degrees, and we rushed to cover him with extra blankets. We turned and positioned him carefully, relieving stress on a body that could no longer move on its own. Mr. S. had been a professional musician, so we turned the radio to a classical music station. As the notes of a piano concerto begin, we snipped and replaced wristbands that had grown tight around his swollen arms. We reattached sequential compression devices, which had been lying on the floor, to the patient's legs. …

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