LEARNING THE BASICS

I am very excited about the increase in those of you viewing this blog. As I began to write this exploration of one career, I felt that my focus was to be on NURSING PRACTICE. I want to leave a legacy, for those who were interested, that told my story. You will find that I do repeat some parts of the story for clarification, and expand the story to refresh memory, and refer to previous entries.   There have been so many changes in health care and in nursing in the over sixty years of my career.   I have found that my colleagues, role models, mentors and others who taught me important lessons are a major part of my memories and I wanted to publically acknowledge their contributions to me and to others.   I will continue to talk about these people as I talk about my journey as well as the funny and sometimes pathetic stories of my classmates, co-workers, bosses and health care leaders. Sometimes I will be very critical, negative, or judgmental.   Having developed a sincere respect for history from my Professor husband, Ralph W. Greenlaw, Jr.,I know I have earned the right to report my observations. It is more than true that WE MUST EXAMINE and ANALYZE OUR COLLECTIVE OR PERSONAL PAST in order to move forward with improvement.  This account is indeed a combination of a personal narrative and a discussion of practice and its development as I know it.

Years of uniforms...Ours are back center. The 50's

The first semester of our sophomore year was spent doing the very basics of nursing both in the laboratory in Hanes House and on our assigned patient ward.  We were finally dressed in our starched aprons and blue student uniforms. Our caps were starched and with the help of white bobby pins attached to our heads. We learned every single little detail of care. Making an unoccupied bed was done with a very specific method that emphasized two important things. You were to maximize efficiency and protect your body.  To be as fast as possible was important because in a few short weeks we would carry an assignment of 10-12 patients in a morning for bath, bed, and the treatments we knew. All before we left at 11 to get to class or eat lunch. We would not be doing medications until we had mastered pharmacology. 

My bed making with HILDA TAYLOR was such a gift.  I already knew how to do hospital corners, flip a quarter on the sheets to make sure they were tight enough and how to put a pillow case on. There were class members who had not even ever made their own bed and I felt so bad for them in their struggle.

Oh the simplicity of the
beds of the fifties!!

Some bed-making rules: 

Never go back and forth from one side of the bed to the other. You start at the side of the bed furthest from the door, strip linen to the middle of the bed, make the side you are on, go to the other side remove the dirty linen and put in the hamper, complete the bed and then put on clean pillow cases.   Make sure that the bed is tight, especially the draw sheet. 

No piece of linen is ever used if it hits the floor. It should not touch your uniform.

Pillow cases were put on with your hands only.  Never mind putting the pillow under your chin like when you were home.

The bed was always in the UP position so that you did not have to bend.

The absolutely accuracy of these rules was so important and I expect that most of us still make a bed the way we learned in 1954.

I am very appalled today when I watch nurses and nursing assistants making a bed. I was a patient not so long ago at Duke for four surgeries followed by three weeks of rehabilitation three times, which translated in close to 90 days of watching from a patient point of view.  I observed many beds being made and not one single person made it so that the really basic principles were followed. Rarely did the bed get raised from a low position to be made with ease.  I asked how they had learned to do the very basics of nursing and bed making.  I am sorry to report that they learned by watching videos, maybe reading a procedure manual but not one admitted that they had an extracting instructor like my HILDA TAYLOR OR LOIS KNOWLES to guide them and give them the gift of being able to do something very well as second nature.  As a student, I thought if I heard the criticism that I was not using good BODY MECHANICS another time I would cry.  I know that many of my problems today relate back to the use of my back and I so wished I had learned that better.

Making an occupied bed was so much more complicated but required the same exacting procedure coupled with the comfort and safety of the patient.  Bed rails were critical and you just didn’t make a bed with a patient in it without them being up.  So many safety issues were critical and I believe if we had forgotten to do what we should, we would have been quickly booted. About half the time, care givers would make my occupied bed without raising the side rail.  Of course I became a real pain to them when I corrected this practice.

We mastered the beds, the feeding of patients, and cleaning the areas, as we moved past the beginning of our clinical rotation.

As a nurse surveyor for Joint Commission, many many years later, I had a most fascinating interview  on a nursing unit. It made me understand how lost the basics have become.   In order to ascertain how a nursing unit had approached improving the quality of care, we asked that they do a presentation for us.  A wonderfully bright nurse in a California hospital was given the chore as presenter. They had state of the art EVERYTHING. She explained that they had researched the airline industry to find some direction as to how to approach improving PATIENT SATISFACTION.  They were in a bit of difficulty with their numbers from their data collection.  They found that one of the big customer satisfiers was the warm washcloth given to travelers before meals (this was when they actually did this on airlines.)  The nursing staff had decided to give warm wash cloths before each meal to their patients.  I ALMOST LOST IT!   It took all the control I had to ask the nurse for their procedure book.  I asked her to find the procedure she used to give meal care.  She began to read and I let her continue until she and her committee were totally red-faced.  They had, in essence, not even met their minimal standard of care. They had long before dropped the practice of mouth care and hand washing before meals from their procedure.  There are so many reasons that adherence to basic hygiene is critical. I often worry that if current JOINT COMISSION SURVEYORS were taught the same way how can they truly assess practice? 

As we were being groomed for professional practice, I remember DEAN ANN JACOBANSKY giving a lecture regarding our emerging roles.  She made such a valid point.  If we did not learn these basic things, if we did not learn to do them automatically through practice and understanding then we could not move to applying the complex skills that we would later learn and use as an integral part of our practice.