Monthly Archives: November 2017

Critical Care at 33,000 Feet

As a part of the 50th anniversary of the BYU College of Nursing, a book was compiled called “The Healer’s Art: 50 stories for 50 years.” It has been 15 years since this book was first published and these stories were shared. We plan to regularly post selections from this book to help each of us remember and cherish the experiences of nursing and learning the Healer’s art. 

Critical Care at 33,000 Feet

Elaine Bond

On a return flight home from the Middle East, our plane was somewhere over the Atlantic. My fellow passengers were a varied ethnic group, mostly Arab, many East Indian, some Europeans, and a few Americans. Most of us had been on board for over nine hours, from our Amman, Jordan embarkation site and were tired and somewhat crotchety. Other passengers joined us during a refueling stop in Shannon, Ireland. We were about two hours out of Shannon when an overhead announcement asked if there was a doctor or a nurse aboard. I could tell by the tone of voice this was no ordinary request.

With my Critical Care senses kicking in, I pushed my call light, stood up, and started toward the front of the plane. A flight attendant hurriedly escorted me to the bulkhead, where a row of portable cribs hung, filled with babies, in front of their mothers’ seats. Another flight attendant handed me a large seven month old baby, Mohammed, who was in obvious distress. My senses were reeling, as I performed my initial assessment. Even as I noted he was seizing and not breathing, the smell of diarrhea and vomit assailed me, and the feel of hot, soiled clothing met my touch. Luckily, I could see his heart was still beating, as his pulse pounded in his throat.

As I stood in the aisle, surrounded by the baby’s young mother, Amal, and other concerned passengers, I tried to block out the confusion so I could function. “Baby, baby, are you all right?” I mechanically asked, extending his neck to assure an adequate airway. When he began to gasp for air, I quickly took stock of the surroundings and determined how to eliminate some of the confusion and get enough space in which to work. Since the plane was not full, I asked the flight attendants to move the other mothers and their babies to new seats. Amal hovered over me, worrying about her son, frantically asking questions in Arabic which I could not answer. Another nurse (Mary Peterson) arrived, saw someone was in charge, and began to return to her seat. Since my background is with adults, and though she was not a pediatric nurse either, I asked her to stay, knowing two heads were better than one, since we needed at least two pairs of hands and someone to communicate.

Mohammed drifted in and out of consciousness, sometimes able to focus on my face, alternating between no respirations and rapid respirations around 50 breaths per minute, with a heart rate of 160 to 180 beats per minute, sometimes seizing and sometimes lying limp. We unbundled him from his blankets and outer clothing. Now at least, we could see more easily whether he was breathing. He was clammy to the touch, leaving me wondering about his underlying problem. I knew he must be dehydrated due to the vomiting and diarrhea. Was he also hyperthermic? Did he have an infection? It was difficult to tell. My limited Arabic, “Marhaba, Kaef Halak? (hello: how are you?) was inadequate for the occasion.

One flight attendant served as a translator and brought the aircraft’s small first aid kit to us. Oh, for my emergency supplies and sterile gloves locked carefully away in the hold below! The first aid kit had a fever scan thermometer inside and we quickly checked Mohammed’s temperature. It was somewhere around 39 degrees, but we did not know whether it was accurate. A nearby grandmother handed us a rectal thermometer, which gave us a more precise reading of 41.2 degrees. We quickly asked for and received a container of ice, which we placed in strategic locations around Mohammed’s body, as we were getting his history from his mother.

She had taken him to see a doctor the day before the flight, when he would not nurse as usual, following several bouts of vomiting and diarrhea. The doctor had given her some acetaminophen suppositories to control his fever and Pedialyte to provide fluid, calories and electrolytes. Mohammed had not resumed nursing, would not drink the Pedialyte from a bottle, and Amal had not known what to do with the suppositories.

Since she had the Pedialyte and suppositories with her, we administered a suppository and mixed Pedialyte in a bottle to try to give him, should he become conscious enough to try to suck. We continued to cool him with cold wet cloths filled with ice. Because he was so dehydrated, his veins were so small. I could not have started an IV, even if I had the equipment and fluids.

Sometime during the confusion, the airplane’s co-pilot came to ask us what we needed to do. I said, “We have two choices: return to Shannon, Ireland or land at the first available airport in North America. This baby will not live until we reach JFK airport in New York.” After conferring with the captain and radioing for additional instructions, the co-pilot returned and reported we had passed the point-of-no-return and must continue forward.

The next two hours were a blur as we sped over the Atlantic to our new destination, racing against time. We continued to cool Mohammed, worrying that we would cool him too rapidly, or that we couldn’t cool him enough. His temperature slowly dropped; down to 39.9 degrees, then 39.4, on to 38.9, down to 38, then into the 37s. We removed the ice and wet cloths and placed him in a clean dry blanket.

The flight attendant brought us a small, partially full oxygen cylinder with an adult face mask. We had to estimate the flow of oxygen and I had to help others understand we couldn’t place the mask completely over Mohammed’s face; we didn’t know how much flow we had and we incurred the risk of having him rebreathe his own carbon dioxide. He soon regained some color in his face and his capillary refill time returned to normal.

He seemed to be awake and we tried to give him the Pedialyte, but he was too weak to swallow. His dark eyes were huge as he tried to fathom what was going on around him. We gave him to his mother to hold, hoping it would provide some comfort and a sense of security for both of them. She was very frightened– on her way to a foreign land to meet her husband, unable to speak the local language, and not knowing whether her baby would be dead or alive in the next minute.

I didn’t pay attention to how hot it was in the plane: I thought I was hot because I was working so fast and because of the stress of the moment. However, the heat came back to haunt us later.

The pilot, co-pilot, and chief flight attendant gave regular updates to the passengers about our diversion to Gander, New Foundland, and about Mohammed’s condition. From what I could hear and see, the passengers were understanding and quiet. The mothers and grandmothers in our vicinity gave words of encouragement to Amal and to us, which the flight attendant translated for us. I suggested some Muslim, Hindu, and Christian prayers might be in order as well! The pilot was able to locate Mohammed’s father in New York and get him on a plane to Gander to meet us.

At last, we landed in Gander, where there was an ambulance waiting for us. We hustled Mohammed into the ambulance where they could get an IV started, get some fluid into him, and give him the correct amount of oxygen.

While I was helping with paperwork, both for the ambulance and the emigration officials, one of the flight attendants came to me reporting an elderly male patient was not responding well and asked if I would look at him. When I got to the man, he was slumped in his seat, grey, totally unresponsive, chin on his chest and not breathing! As I lifted his head, I thought, “Oh no! This cannot happen twice on the same plane!” He began breathing and his color began to improve. His initial blood pressure was 60/40 mm Hg and his pulse was 30 beats a minute. I tried to analyze whether his rate was really that slow or whether he was in bigeminy or trigeminy. I could only feel a pulse every second or third beat.

Getting an adult into Trendelenburg in a cramped airplane is no small task! However, Nurse Peterson was creative in getting people out of enough center seats so she could get space for him to lie down. Once again, we needed an interpreter and a spokesman for the gentleman, who was East Indian. We discovered he had taken his Beta Blocker (Atenolol) shortly before the problem arose for Mohammed. Our analysis told us the heat in the plane and the excitement of the emergency landing had exacerbated his normal response; he vasodilated and bradied down.

His blood pressure slowly equalized and his heart rate returned to normal. As he became more alert, he was able to converse with us. He refused to get off the plane and said his daughter could take him to a doctor when we got to New York. Nurse Peterson stayed with him as I finished the paperwork for Mohammed so the ambulance could leave. We periodically checked on the gentleman during our flight to JFK and he experienced no further difficulty.

As I walked off  the plane, five hours late, I thought, “This is just like any routine day in ICU. When the shift starts, you have no idea what care you will need to provide. When a trauma patient arrives, you stabilize, assess, stabilize more, assess more, send the patient off to surgery, deal with psychosocial concerns, get an interpreter for families, save lives, then walk out the door. No one out there can possibly understand the drama behind the work we do. You smile when your significant other asks how your day went, and you answer, ‘It was just a routine critical care day.’ ”

 

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Blood, Sweat, and Tears: What Happens When Nursing Meets Rugby

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Nursing student Ali Smith goes in for a hard tackle during a BYU Women’s Rugby match against University of California

 

 

 

 

 

By Jonathan Schroeder

For four and a half years, Ali Smith lived what some people might call a double life. By day, Smith was a smiling, gentle-mannered nursing student in one of the most demanding academic programs at BYU. Few would have guessed that by nightfall, Smith’s smiling face would be covered in the blood, sweat, and tears of one of BYU’s most aggressive contact sports.

Smith has been a member of the BYU Women’s Rugby team ever since her very first semester at BYU; a journey that transformed her from an inexperienced benchwarmer to veteran starter in a National Title game. Now a capstone student in the nursing program, Smith has had to take a step away from the rugby pitch to focus on her clinicals. However, she says that the lessons she learned from rugby have helped her become a better nurse.

Smith first joined the BYU Women’s Rugby team as a freshman — long before she submitted her application to the nursing program. Although she had never played rugby before, Smith quickly fell in love with the sport.

“Rugby is a very physical game, but it’s also a very mental game. There are days in practice where you can get really beat up and you’ll ask yourself “Why am I doing this?” You just got beat up for two hours and now you have to go home and do homework for the next three hours! But I really wanted to become better and be the best; whether it was perfecting my pass or perfecting my tackling form. And it was totally worth it!”

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Ali Smith sprints for a try. A try is the rugby equivalent of a touchdown in football.

Starting in late September and going through the month of May, the BYU Women’s Rugby team practices for 2+ hours every Monday, Wednesday, and Friday. This is in addition to strength and conditioning sessions (every Tuesday and Thursday) and games on Saturdays. Despite this huge time commitment, Smith says it wasn’t uncommon for her to stay late after practice to work on passing or kicking with her teammates.

“I love the team dynamic of rugby,” Smith shares. “It’s such a neat experience when you’re able to get into a groove with the people you’re playing with; making good passes and making plays happen. You just get the sense that you’re part of something that’s bigger than you.”

After several semesters on the rugby team, Smith decided to expand her horizons even further. She applied, and was accepted, to the BYU College of Nursing. Suddenly Smith’s already busy schedule became much more demanding.

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Ali Smith with her Nursing peers at the Intermountain Healthcare Complex

“It never felt like I was ‘done’,” Smith explains. “I was constantly doing something. If I wasn’t studying for a test, I was thinking about a play I could use on the field. If I wasn’t in class or doing homework, I was on a run or on the pitch.”

But having a crazy schedule did have its benefits. Between strength training, midterms, practices, and clinicals, Smith says she developed excellent time management skills.

“When I was in class, I was focused on that class. When I was in rugby, I was focused on playing rugby. I didn’t have extra time in my day to practice rugby or give to my classes, so I needed to make every moment count. Most days I didn’t have 5 hours to study for a test; I only had 2-3 hours before I had to go to practice. But for me, that extra focus was a huge blessing because it helped me get everything done and be more productive. It helped me develop self-discipline; I couldn’t just put off my homework till later because I knew I wouldn’t have that time.”

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Once Smith entered the nursing program, she noticed that many of the principles she learned on the rugby pitch could also help her on the hospital floor.

“On the rugby team, I learned to be very encouraging and complimentary towards my teammates; especially when they performed well. They need to know that I’m there for them.”

“Sometimes you are in a game where the player who plays your position on the opposing team is really, really good, and you’re just having an off day,” Smith explains. “But because you have a team, they can help make up for what you’re lacking. I’ve seen that a lot in the hospital. There have been days where things have gotten really crazy and you think “There’s no way I can get to both of these patients at the same time” and just then another nurse will offer to help get meds for your patient. That really makes a huge difference. When you’re on a team, sometimes you can only do so much, but because you have that team dynamic things can still run as smoothly and efficiently as possible.”

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Ali Smith and her teammates, prior to a BYU Women’s Rugby match

This team dynamic is part of what makes the BYU Women’s Rugby team one of the top programs in the nation. The team has only lost three home games in ten years of collegiate competition. Last May, they won a tough semi-final match to earn a place in the National Championship Title game against the 10-time defending champions.

“I felt a lot of pressure walking onto the pitch of that national championship game,” Smith reflects. “I never thought that I would get there or be that good. But our team performed really well. And even though we didn’t win the match, it was still a whirlwind of an experience. To play in that game and represent BYU in that national title game was such an honor.”

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The BYU Women’s Rugby team after the 2016 National Championship match. BYU placed second in the tournament, after suffering a narrow loss to Penn State, 15-5.

Even though Smith may not have another chance to represent BYU on the rugby pitch, she says she’s extremely grateful for the experience and how it’s impacted her future nursing career.

“In a hospital, sometimes people are in critical condition counting under you to perform in really stressful, high-pressure situations. So just like how in rugby you train so we can play in those high-level games; in nursing we learn and gain skills and become good at what we do so that in that moment when someone needs you, you’re ready for it and you’re able to perform under pressure. I think that having experienced that on the rugby pitch, I’m better prepared to handle whatever stressful situation I may encounter as a nurse.”

 

New Visiting Scholar

The BYU College of Nursing is hosting a visiting nursing scholar from China.

Dr. Fen Yang is from Wuhan City in China’s Hubei Province. She will be at BYU through April. During that time, she hopes to complete research on evidence nursing and community management of chronic disease.

“The reason I chose to study nursing is that I want to help people,” she says. “Nursing is a great occupation; patients can feel more comfortable because of nurses.”

While Yang was studying to obtain her doctorate, she met a man affiliated with BYU who helped her extensively with her studies. He told her good things about the university, including the kind disposition of the students and teachers. She also is intrigued by the clinical simulation conducted by the BYU College of Nursing.

“I am curious about it, so I am here,” she says.

Already Yang is coming to love the clean air and water of Utah Valley, as well as the educational climate that favors student independent learning. She also notes differences in nursing practices between the United States and China. In China, nurses focus more on disease care while American nurses focus more on patient interaction and have a larger amount of responsibility.

Her hobbies include walking, bike riding, and reading.

From Fighting Forest Fires to Working Clinicals: Michael Scott’s Story

When entering a burning building, remember that the hose is your lifeline. Crawl while advancing hand-on-hand or else you could twist the hose and get lost. When Chief says get out, you get out because the building could be about to collapse.

Such as some of the memories of nursing student Michael Scott’s time as a firefighter in New Hampshire. The job brought a mix of excitement and pressure, all of which helped Scott in his journey to studying nursing at BYU.

Starting first as a volunteer firefighter in high school, Scott realized how much he enjoyed the team atmosphere and the inherent service to the community that the job entailed. Each week offered plenty of opportunities to get the adrenaline flowing while responding to a variety of calls.

“I loved it,” he says. “I think it depends on your personality. I liked getting woken up in the middle of the night, and it was exciting to head to the scene or head to the engine.”

Scott became a certified firefighter and dedicated the next five years to the profession. The lifestyle was one in which everything could change in the blink of an eye.

“I’m not sure what a normal day would be because all calls are so different,” he says. “We were trained to be able to get all of our gear on in a minute. It was fun. You were really relaxed one minute, and the next minute you were sprinting, putting your clothes on, and heading out.”

Not everything was exactly what he had pictured.

“When I joined, I’d always pictured fires,” he says. “But most of the calls I got were for motor vehicle collisions and suicides.”

Scott found that he liked responding to many of the medical emergencies; he soon became certified as a firefighter EMT and worked closely with injured victims.

“The medical calls required a little bit more of me in general; I couldn’t just be in autopilot,” he says. “I actually liked that—I liked going to those calls and doing my best to help out and to make the people there feel important.”

As much as he enjoyed working as an EMT, something continued to trouble him.

“One of the things I noticed is that we would have repeat patients for cardiac arrest and other issues that are fixed by education, but as EMTs we don’t get to do that,” he says. “I’d always go home and I wished that I’d had a little bit more time to try to help that patient.”

During his EMT training, he had watched nurses in a local hospital. The nurses’ ability to help patients make productive health decisions and analyze their lifestyles affected him deeply.

“That’s what I really felt like saved the patient,” he says. “[EMTs] brought them back, but a lot of those patients just died later just because they didn’t make changes they needed to make. The things that the nurses would teach them those made a real difference. I liked that.”

Wanting to be more involved in helping patients prevent future health problems, Scott decided to study healthcare at BYU, eventually gravitating to nursing.

One thing he enjoys about BYU’s atmosphere is the Gospel-oriented atmosphere, particularly in the Nursing College.

On a few occasions at the firehouse, coworkers ribbed Scott for holding to his standards. He remembers that shortly thereafter the team responded to a devastating car accident in which a teenager had been thrown through the windshield. Scott had worked to stabilize the youth’s head, which was bent at an unnatural angel.

The team tried to load the teen on a backboard, but he adamantly refused to be strapped down. Realizing the extreme danger that the teenager was in, Scott tried explaining to him that even though his movement would be limited, the restraints would keep him from becoming permanently paralyzed. In that moment, he had some important realizations that influenced why he came to BYU.

“In healthcare and in eternity, living within certain restrictions can mean we trade a few moments of restraint for a lifetime of mobility,” he says. “The Brigham Young University nursing program includes principles for eternity in caring for people in a mortal state.”

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Fast forward to the present. Scott is a successful student and a proud father. As a student nurse, he is learning the skills that he saw nurses use to help patients back in New Hampshire, and he is excited to make a difference in the lives of others.

“The most traumatic part of being an EMT was when we weren’t able to save someone and having family watching and basically trying to figure out if we’re going to be able to save their family member,” he says. “As a nurse, I’ll have the opportunity to intervene a lot of times before that point. I’ll be able to decrease the number of goodbyes that family members have to make to their loved ones.”