So today was the first day of clinical for my Heart Smart Apprentices (our new nurse tech program). Basically, I asked for one patient for each but asked that they be total care. This means that they had to have a bedbath, be fed, toileted, etc.

They were so timid...hardly able to take vital signs. After 21 years, I find it hard to remember that level of timidity and innocence. Made total care bedbaths a bit of a treat.

TMI alert.....

You see, men of a certain age and older are seldom circumcized. It came into vogue in the late 40's to 50's so if you are older...well you just don't look the same. So basically, that involves one more step in hygiene, retracting to wash and rinse and then repositioning the foreskin. Problem is...folks forget to reposition cause things look more "normal" after the retraction. Well, two of our patients had been left in this way. Further problem is that if left back the foreskin swells into a doughnut shape that can actually compromise circulation there. Exquisitely tender, swollen skin has to be gently but methodically repositioned or it will continue to swell until it cracks or causes necrosis. True to form...the swelling dissipates rapidly after the procedure but you have to get there and the getting there is the real trick.

So, needless to say...these new nurses of various personal experience levels and no professional experience had no idea what they were looking at. So, I did that portion of the bath and coaxed things back in place. Just as with any procedure and pathology, I took them to the station and explained what happened and what had to be done and if that had failed what the result would have been (bedside circumcision). Add to the experience that one gentleman was quite demented post stroke and combative during his bath and you can imagine how tricky that was!

Well, after today they know a whole lot more about this and many other things. By the end of the day, they were growing in confidence and understanding. They were even more aware of the care with which we must practice our profession. They were secure enough to laugh at their reactions and look forward to the new experiences to come.

And you all thought I was naive...I just have different bases of knowledge.