Clinic

I have really enjoyed, and felt intimidated by, learning skills that require me to use my hands, not just my head. We've had to make an occupied bed, clean dentures, take blood pressure (that's so hard!), and we're way behind. There are a total of 24 skills we have to know for the practical part of the NAC exam, and they all have lots of steps. The actual book the state publishes that supposedly contains all the information is dreadful. A given skill will contain some number of steps, but their division is arbitrary--some are separated, some chunked, some skipped--and their directives are often unclear. Step 4 says, in useful, clear, commands, "Raise the side rail on the working side and move to the other side of the bed." Step 5 will say, "Patient is covered with clean top sheet, bath sheet and/or soiled top sheet has been removed." When? Before which step? Doing what before or after? The book is full of these. And we've just finished our 3rd week of class, next week has a holiday, so we have only 8 more classes in which to learn to do all these skills. Eep!

Our lab is old, and full of old, no-longer-standard equipment. Betty grumbles about it and it's pretty funny to hear her. We have about 10 beds in the lab, and at least 4 of them have side-rails that extend the length of the bed. Nowadays, no healthcare facilities have these, since leaving them both up is a form of physical restraint, which, like chemical restraint, only occurs under physicians' orders, and only when it is considered a way of protecting a patient (not staff) from harm, if no other methods work. Facilities now have beds with 4 side-rails, two at the top half of the bed, two at the bottom half, and only one half is left up at a time.

We practice skills like feeding or making an occupied bed in 3's: one do-er, one patient/resident, and someone to read the misleading and infuriating steps out of the NAC book. Therefore, the 4 or 5 fragile and expensive mannekins in the lab are in our way, we have to stack them on top of each other, where they lie, foley catheters askew and limbs partially detached, looking ghoulish and abused. The first day Judy saw us do it, she commented that it looked like Auschwitz. Incidentally, for this purpose we use one of the over-long-side-rails beds one of the now-verboten rails of which is permanently and unhelpfully stuck in the up position.

Unlike in the classroom, where there are books and a lecturer involved, I feel hapless in clinic, which is good, because it is humbling and means I'm not a "seminar pariah"--each of us is useless at some things, skilled at others, and all of us, even Betty, don't perform skills in exactly the same order as they're written in the pamphlet. And all of us need extra help figuring out how to measure blood pressure. Betty is taking extra time this week and next to do FORTY-FIVE MINUTE tutorials with every pair of students in our class willing to take the time to do that with her. That is a _lot_ of extra hours for her. She's really, really, dedicated. And often impatient with me, and I don't even mind, which is funny.