On Being a Primary Health Nurse

Today, I am finally waiting for graduation. It’s been a long journey towards where we are today, and I congratulate all of my friends from high school who are going to march during their commencement exercises this year.

In every story, there is a climax, and now I stand at the denouement. Getting here wasn’t a walk in the park, but it was worth it.

I had the privilege to be a student nurse performing primary health nursing, staff nursing, and head nursing at a tertiary level hospital for the months of January to March 2012. To just define some terms here, primary health nursing is being the all-around nurse for a client that you serve. It means that you’re in charge of providing direct care to that client, as well as coordinating everything that happens to the client. While primary health nursing is being a 24/7 nurse to a client, staff nursing is providing direct care to a client for the shift only, focusing on acute problems that you encounter during the shift. Finally, head nursing is, well, being the boss of the ward. Not only do you ensure quality patient care, you’re also responsible for ward management and personnel development’ I guess it’s the pinnacle of the clinical duty nurse. I’ll be writing about my experiences as a primary health nurse, since I think it enscapulates everything that can define my hospital experience.

I spent the first 4 weeks as a primary health nurse in the ward. A word to describe my experience during this time is “intense”. Everything I did was intense: taking life-threatening cases, planning intensely for care, executing intense care. Everything I learned for the past few years I did in a day. But what was really intense was the emotional experience of becoming close to my clients and to the families there. Being a nurse isn’t all about giving medicines and making patients comfortable; I learned that it was deeper than that. Some people say that while their nurses pass by their lives for a minute, the impact that they leave carries through eternity. The same is true for someone like me: there are clients who pass by my life who I will never forget.

I took care of a client with Ovarian Cancer that had metastasized (spread) from the primary site. She was very friendly to me, and very accommodating to my novice-ness. She said that she is happy to be part of my life as a student, and that she wished to help me learn as much as I can. I provided her with the best care that I can. During the first two weeks of caring for her, I noted edema (swelling) of her lower limbs, which was progressing upward. I studied her case, and found how ascending edema, despite all the treatment that we could give her, was not a good prognostic sign. Despite this, she was a fighter, and said that she wanted to live.

At my third week of caring for her, she had some issues with her daughter. The daughter left and never came back. I don’t know how, but that broke her will to live. The friendly woman had a blank stare on her face. When I held her hand, she did not grasp back as she usually did before. Her will was broken. I painfully saw how her condition deteriorated. When her swelling reached her neck, she was unable to speak. We had to insert a tube through her nose just to feed her. Then she would go in and out of consciousness. She was dying. She was put on a “Do Not Resuscitate” order by her relatives.

At my fifth week of caring for her, I was the student head nurse of the ward then, and I was not handling her directly. I remember it clearly: I was at the station when her caregiver approached me and said: “Sir, parang hirap huminga si ——” I quickly went to the station with my partner, who was the student staff nurse at the time, and assessed her.

Heart Sounds = very faint, barely perceptible.
Pulses = absent.
Pupillary reflex reaction = pupils were fixed, dilated.
Respiratory rate = 3 per minute.

She was gasping. I heard the “death rattle”. I knew it was the time. I told the caregivers to call the rest of the family. I referred the client to the resident on duty. I went back to her, held her hand, and I whispered: “Nandito lang po ako Tita ——. Hindi ko po kayo malilimutan. Maraming salamat po.” She passed away at 11:35 AM, February 23, 2012.

I helped my staff nurse perform post-mortem care. After all, she was my client, and though I was not her primary health nurse anymore, I felt bound to pay my last respects to this woman who touched my life.

I finished the shift professionally. After the shift, I visited my client’s room, and found her relatives there. I approached them, and expressed my condolences. I told them how much the client meant to me, and how I will never forget her. Then, I just found myself crying in front of the client’s relatives. They cried with me.

“Tsk, naiiyak din tuloy ako sa iyo!”
“Eh, sorry po, hindi ko po mapigilan.”

I guess the greatest challenge I faced then wasn’t all those papers, those long sleepless nights, nor those moments of doubt. The greatest challenge was staring Death in the eye and welcoming him as a friend. I saw patients on their deathbeds, and a passing thought comes that one day, I too will be looked upon by a student nurse.

Before all this, I was adamant to Death not coming near any of my clients. My favorite motto for the shift was: “Itatawid ko ang pasyente.” Not on my watch, I would bright-eyedly say. My ideal. When my professor pointed out to me: “Yes, this is what you want for the patient… but is this what the patient wants?” I thought to myself, what peace can be found in being connected to all sorts of tubes and lines and being unable to move by yourself, a prisoner in your body? What peace is there in being unable to decide for yourself, as you have no way to speak or express your feelings? I realized how Death, though a bitter truth, is the bridge to peace.

Besides considerably honing my knowledge and my skills, I guess the lesson I’ve learnt from my experiences in primary health nursing is that the classroom can only teach you so much. The attitude of being a professional in dire situations… and keeping your humanity, is taught by life itself.

Insights for March 16, 2012

Today was my last day as a staff nurse in —–. Even until my last day, I did my best to grab all the opportunities presented to me to learn more about what I can do as a staff nurse in the ward. As I also had experience in head nursing, I was also able to assist in facilitating the return of excess medical supplies clients for discharge were not able to use during their stay. I was still able to provide care to 7 clients today, albeit for only half the shift. I appreciated how the staff were very supportive of Ms. Rozario and I as we were about to leave for exam today. They told us to do our best, and to make them proud. When I look back to my first day here in the ward, I am reminded on what I was before all of this, and now that I look at this final day as a staff nurse, I realize how far I’ve gone. Becoming a nurse really isn’t something that can happen overnight. If it takes a village to raise a good child, it takes a set of determined faculty, a great head nurse, and a group of excellent staff to become the best nurse that one can be. I will miss —–, and I will always treasure the experiences I have gained from my clients and my colleagues there.

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