I have realised as I’ve reviewed my previous blog posts that they tend to be quite personal. This post started as a very non-personal post but then, as I rolled ideas around my mind, I was reminded of times when the language used by Healthcare Professionals (HCP) had profound effects on me; some of these were positive and some negative but all forever imprinted in my memory and all influenced my experience of particular situations so, once again, this post will include my own experiences!
Late summer is a very bad time for me as in August 2013 my beautiful husband left me and our 3 sons and disappeared for 3 hauntingly long, soul crushing days when he made a serious attempt on his life only saved by the fact he was a pretty clean living fella with a nice healthy liver which did its job and chucked the massive paracetamol/ibuprofen overdose out of his body causing permanent liver damage but leaving him alive. This is not a post about mental health or suicide so the details of the lead up to this are not relevant here but suffice to say those 3 days were the worst of my life. I envisioned having to tell our 3 young sons their daddy was never coming home and having to raise my boys without my best friend and soul mate by my side. I imagined trying to support my in-laws with the grief of a second child having already buried their daughter…..they were the darkest 3 days of my life. The reason I am sharing this is to demonstrate the importance of the language we use as HCP.
By day 3 of this nightmare I was fully expecting a suicide note to turn up in the post, instead I got a phone call from a nurse from an emergency department in a hospital ‘down south’. She rang to tell me my husband had turned up and was being treated for the overdose he had taken. Now, the past 3 days had pretty much broken me but I did not break down in tears on the phone for many reasons, one of them being I was a practising counsellor at the time and was familiar with the language of attempted suicide and depression and I heard the news in a seemingly calm way. I then came off the phone and broke down both physically and emotionally.
My husband informed me, during a conversation much much later when we were debriefing during one of hundreds of conversations we had about that time that the nurse told him she thought I was “very clinical and a bit cold considering what she had just told me”. This stayed with me and continues to. I felt judged and misrepresented. I wanted to ring her and tell her that the reaction she heard was the result of 3 days without food and very little sleep, the reaction of a desperate wife and mother clinging to the only version of herself which was solid (the counsellor). I doubt that this particular nurse would even remember that conversation a week later never mind 4 years later, but I remember it and my husband remembers it. He didn’t need to hear his wife had been clinical; he had no idea what sort of reception he was going to receive when we finally spoke to each other but what he needed to hear was that I had been informed and was ready to talk to him when he felt ready (which is actually exactly what I had said).
In situations of high emotion if you don’t know what to say, stick to the facts. Do not include your opinion and do not pass judgement.
So, onto another example of poor communication and the use of language.
During and after the traumatic delivery of my eldest son (for the midwives amongst us he was an undiagnosed malpresentation and a 36 hour induced labour ended with a rush to theatre for a trial forceps then emergency c-section). Things midwives said to me included:
“what do you mean you aren’t getting the sensation to push, everyone gets the sensation to push” (not true, however I believed I was weird and not a ‘proper woman’ as I wasn’t ‘doing it’ right)
“you aren’t trying hard enough” (I used quite a lot of bad language at this point)
“Please try to push harder we need to see more maternal effort” (I cried)
“Well, if you had pushed that baby out you’d have broken his neck” (Yes, yes this was actually said to me – his ear was the presenting part so it was probably true but I did not need to hear it)
“We took bets that you wouldn’t deliver him naturally” (so many things wrong with this sentence I do not know where to begin!)
So….therein ends a couple of examples of the poor language used to me personally during interactions with hcp (I have lots of examples from friends but I won’t share them as they are their stories!)
I now want to share some good examples of when HCP have used language in a positive way and how these have also stayed with me.
Following the above traumatic delivery my community midwife (who I respected so much she is a major reason I wanted to be a midwife and who I now know as a colleague) said to me “none of this was your fault. You did nothing wrong and nothing you did could have changed the outcome” (she knew I had wanted a homebirth with candles and words of love not theatre lights and words of terror). These words alone gave me permission to let myself off the hook for not being good enough to have a ‘normal’ birth.
*side note* Please be mindful of using the word normal it can be very damaging. In terms of delivery I feel ‘vaginal delivery’ is enough without the word normal in front of it, its unnecessary.
When my middle son broke his wrist and I waited 24 hours to take him to a&e because I thought it was just a ‘bit bruised’ I felt like the worst mother in the world and told anybody who would listen how awful I was and how could possibly I leave him 24 hours in pain poor little soul etc etc. A lovely radiographer took me to one side and whispered in my ear “I am a radiographer, my son broke his ankle and it took me 24 hours to bring him in; I thought he was just moaning”! Brilliant! Still makes me smile and instead of coming out of that situation feeling awful I came out feeling forgiven (although the middle boy still mentions it when he is wanting sympathy!)
All my sons have been in hospital for one reason or another most of which were when they were babies and the language used when communicating with me as a terrified mother has mostly been lovely and comforting (we will ignore the paediatrician who told me I would not be ‘allowed’ in the room when my 8 week old son was having a cannula sited in his head as we mothers tend to get ‘hysterical’ AND the paediatrician who looked at the 90ml bottle of breastmilk it had taken me AGES to express and said “is that all you’ve managed?”……we shall ignore them!!!!).
But this is what I want to leave you with (and something I remind myself of when working with women and their families)…
We may not remember all the people we work with and support or all the things we say but they remember us and they remember what we have said.
…………………….Years and years later.
Ask your friends and family about the midwife who delivered their babies….ask them what she was like (my Nana,at aged 95, could still remember the midwife telling her to stop screaming when she was delivering my 11lb mother as she may disturb the neighbours!).
Ask your friends and relatives about their GP and the things they have said to them over the years, or the nurse who looked after them when they had their tonsils out when they were 7 years old (“eat the cornflakes or your mummy won’t be able to come and see you” ….I realise I have not had great experiences with HCP!!!!); ask them about the student midwife who took them to one side when their wife was haemorrhaging post delivery and explained who all the scary people who had just rushed into the room were and what they were doing; ask them about the consultant who told them there was nothing more they could do for their beloved dad; ask them about the importance of language and words.
Also, don’t lose sight of the influence of non-verbal communication: our body language speaks VOLUMES. Being clinically good is fundamental to being an effective HCP but being kind and respectful ensures the experience of the people we care for is remembered for the right reasons not the wrong reasons.
What we say matters. It MATTERS. If we are having a bad day and we are a bit too blunt with our language or we are too harassed to sit down and explain a procedure or we are tired and turn a blind eye to somebody you know is on the verge of tears and needs a friendly ear…..these things matter. Of course we have bad days but share these with your colleagues and friends; try really really hard to not let this influence the experience of the people we care for as they are mostly vulnerable and usually scared.
Thank you x
July 23rd marks International #hellomynameis day. The #hellomynameis campaign was started by Dr Kate Granger MBE, a lady who set up a campaign in August 2013 using social media after receiving treatment in hospital for terminal cancer and realising that not all of the staff helping to support her introduced themselves. The campaign has raised awareness about the importance of healthcare professionals telling service users their name and role to help improve communication and increase the quality of patient care. The 23rd of July sadly marks the anniversary of Kate’s passing, though her husband Chris Pointon continues to travel the world delivering talks about Kate’s story and how we as healthcare professionals can improve people’s experiences of being cared for.
Hello, my name is Abbie and I am a student mental health nurse. As I am a couple of weeks away from the end of my first year I have had lots of contact with service users on practice placements so I’ve been able to get a flavour of how much of a difference introductions can make from a professional perspective. From a personal perspective when I’ve been treated myself and accompanying loved ones to the hospital or the doctors I’ve witnessed professionals assessing not just the physical health but also the personal thoughts and feelings (mental health assessments are very thorough – see here) of people without telling them their name. Not doing so can put up a barrier to communication as the service user may feel awkward and uncomfortable with disclosing very sensitive information that they may previously have never shared with anybody before to a nameless stranger. A simple introduction can make the service user feel more valued and willing to talk about things like what they’ve been experiencing and what they wish to gain from treatment, which helps professionals deliver person-centred care that is tailored to each individual’s needs. Kate’s #hellomynameis campaign strives to improve patient experiences and aligns with the 6 Cs, values underpinning effective nursing practice that were set out in Compassion in Practice: Evidencing the Impact (2016).
Some University of Manchester students find themselves on placement within the Tameside and Glossop Integrated Care NHS Foundation Trust, which is where a number of nurses dubbed ‘Kate Granger nurses’ are the first in the UK to have been appointed. Kate Granger nurses will wear special identifiable badges and aim to encourage staff members in the trust to demonstrate effective communication and uphold the standards of compassionate care that Kate and her husband Chris have spent years campaigning for.
Searching #hellomynameis online brings up a wealth of posts showing healthcare professionals and service users pledging their support for the campaign. Visit the campaign’s website to see what events Kate’s husband is attending and find out more about how you can get involved.
I write this not to highlight the negatives of our current NHS in crisis, but to address how we can collaboratively work together to save our glorious institution.
I don’t need to talk about our failing health service, I don’t need to talk about the millions of pounds needed from the money tree to keep our beloved institution a float. I don’t need to talk about what the NHS means to Britain and its people, I don’t need to talk about the pressures, the constraints we as healthcare professionals all face.
What we need to talk about is how we can change the future. I don’t think I’m wrong in saying this is without question the hardest time ever to train to be a nurse or midwife.
We’ve lost our bursary, some of us have lost our passion, our dreams of delivering the care we want to. Who do we thank for this? Is it a question of politics? Or has our health service just reached a tremendous plateau of increased life expectancy, a rise in population, increased complex care which have become a potent mix given the current economic climate.
How do we adapt?
Collaboration that’s how!
Collaboration– “A purposeful relationship in which all parties strategically choose to cooperate in order to achieve shared or overlapping objectives.”
I love this definition, it epitomises what I believe is at the heart of what we all signed up for; whether you are a student midwife or student nurse we all have overlapping goals, we all CARE.
We all want to deliver the best care possible whereby it be to a baby on neonatal unit, an Alzheimer’s patient, a child, a patient on a high dependency unit, a labouring woman, they all deserve the same amount of care and compassion.
We are governed by the code (NMC 2015), we all follow the code, are regulated by the code, we all follow the same overlapping objectives -care, compassion and empathy.
As a whole we are truely invincible. We have the power to stand up and fight. We have the power to change OUR NHS !!!
Let’s get to know one another, the roles we represent, the care we provide and how we can support each other. Once we are fully united then I believe we have the power to transform and adapt to the future of our glorious glorious service.
A really common occurrence, particularly for students in their first year in practice, is the feeling or impression that you are taking up the role of a Healthcare Assistant (HCA or Nursing Assistant or Auxiliary as they used to be called).
If this is you do not panic!!
An important point I feel it is essential to make is that a lot of the tasks that fall to HCAs in modern units are vitally important to that person’s Nursing care and are highly educational, need-to-know jobs. For example, washing patients or doing observations. The opportunity to wash patients gives you an invaluable period of protected time with that patient to really form a strong therapeutic relationship and hear what it is that is truly affecting or worrying them that day – use this time well! Also you get to see your patient’s skin from head to toe and make observations about their condition or their ability. You get to share some amazing moments with patients for example if they haven’t been able to walk to the shower for some time, being able to facilitate this really empowering event is really very moving. Some patients may have thought they would never be able to get back to that fitness!
Equally when there is a crisis and the senior nurses come to the fore – the first intervention more often than not – is a full set of observations. Being so used to doing them you can put a BP cuff round a patients arm in your sleep means you can do it quickly in a crisis and that builds your confidence when those events happen.
All that said and done – never forget the vital part of what makes Student Nurses different to HCAs. We are here to learn. You are Supernumerary. You may want to help out with the routine tasks of the ward’s running, and that is a really wonderful trait to have and please never lose that – but don’t feel obligated.
I think all Student Nurses develop their own little ways of making sure they get treated as they should be and have access to all the best educational opportunities our wonderful placements afford. As always, with any issue in practice, your first port of call should be your mentor. Some of the best mentors I have ever worked with had a really simple but effective way of making sure I got the best out of my day by taking 2/3 minutes in the morning after handover to set goals for each day.
I know it sounds straightforward, but if you say “I would really like to complete the medication round with you today” and your mentor hears and acknowledges it, the likelihood is, it will happen! If daily chats isn’t possible, aim for a weekly goal, “I was hoping that this week I could do a wound dressing/remove a catheter/remove a cannula/ observe the ward round”. Communication is absolutely key to achieving what you want out of each placement and making sure your mentor is aware of your goals and can properly support you to achieve them.
PEF and all-round Superstar Tracy Claydon uses the alias of “Beryl the Toxic Auxiliary” to discuss the tricky situation that can arise in practice of HCAs who will sometimes excessively delegate tasks to student nurses (often with a scowl on their face). The best way to handle this issue is to proactively set your own tasks – before Beryl can delegate all the obs or turns to you! Maybe try having more of a discussion when jobs are being delegated, such as “OK if I do these obs, can you check turns before I do the meds round with my mentor?” or try taking your own patient(s), obviously under the supervision of your mentor but having the responsibility of that patient you will be busy providing all their care, doing all their documentation etc.
A thought provoking guest blog, second year CYP student nurse Kate Plant shares her experiences and insights into palliative care from her DILP summer placement…
Before starting my nursing degree, I volunteered as a Sibling Support Worker at my local Children’s Hospice. So, I already had some idea about how special these places are. But it was not until I undertook my Elective Placement there that I realised how rewarding a nursing role, in the provision of Palliative Care, can be.
The first thing I noticed was the difference in pace, compared to my previous placements. I was used to dashing around on hospital wards and barely having a moment to drink. So, when I was offered a cup of tea on my first day (half an hour into my shift) I was completely taken aback. But, obviously, there were more significant differences than having the time to quench my thirst. A patient would be allocated both a nurse and a care support worker, on a 2:1 basis, due to the complexity of the patient’s needs. This 2:1 care gave nurses time to listen and understand what really matters to the patient and their family. There was no rushing around. The environment was relaxed. Families would allow a nurse and other staff members to enter their lives in very difficult circumstances and build strong relationships with them. This is where the satisfaction came in.
In addition, I have by no means observed doctors, nurses and care support workers work together as well as within palliative care. There was no division but instead, a sense of unity. This enabled a pleasant atmosphere to bloom within a setting which, stereotypically, has connotations of being constantly surrounded by upsetting situations. All staff members were part of a team, encouraging a family atmosphere so families were as comfortable and happy as possible. Staff were able to take away a families’ everyday stresses so children and their families could treasure the remaining time they have together as a family, however long this may be.
The thing that struck me the most was the parent’s enormous strength to keep a pleasant face for their terminally-ill child and their other children, in one of the hardest times they can ever face. A parent’s strength is aided through their ability to effectively plan, with help from compassionate and empathetic staff members, any wishes they have in the care their child receives before death. This includes preferred place of care, spiritual and cultural wishes and anticipatory symptom management planning. With such a wide array of resources available at the hospice (including sensory rooms, adapted garden swings, music rooms, parent bedrooms, bereavement rooms – the list could go on and on) these wishes were almost always met.
Last year, the ‘Together for Short Lives’ charity reported a national shortage of children’s palliative care nurses which is negatively impacting on the care provided to children and families. I truly believe if other students and qualified nurses were to gain a deeper understanding and/or even experience how rewarding roles in Palliative Care can be, this could help bridge the care gap. After all, you’ll never regret making a difference in the quality of care a child or young person received, during their last moments of life.
I have never been good at receiving complaints. Before I started my nursing degree, I worked as a waitress for 5 years. It was not uncommon to deal with customer complaints on a daily basis, and I would always just say “I’m really sorry about that. I’ll speak to my manager” which was always a fail safe. 98% of the time, the customer didn’t want to speak to me anyway!
But that changed when I started my nursing. Suddenly, whilst trying to make small talk with patients, I was being confronted with complaints about care they had received in the past or at that very moment. I couldn’t get away with my usual spiel because care complaints are more specific, more personal. You have to say something, and sorry doesn’t quite cut it.
I remember, very vividly, the first time I saw a nurse deal with a complaint efficiently. The patient in question was raising her concerns about the referral system for district nurse visits after a stay in hospital. Her care had been delayed due to this. The nurse I was working with listened to her very carefully, occasionally (when appropriate) asked for more detail and did not seem flustered at all. She then thanked the patient, said she would follow this up but urged her to voice her complaint at PALS.
PALS stands for Patient Advice and Liaison Service. It is confidential, and designed to provide support for patients, relatives and carers.
I was amazed at how calmly the whole situation went. Although the patient was upset initially, she was clearly at ease by the end of the visit, and I felt it was due to her being able to voice her opinion. And she was actively encouraged to talk about her concerns as it helps the NHS grow as an organisation! And it inspired me!
Since this event, I feel as though I have been inundated with patient complaints. Sometimes I feel as if there is a secret sign on my head that says please voice your thoughts at me!. I have now had endless practice at being calm and friendly, with some situations leading to me having to be a little firm (I will not be shouted at). I find that listening a lot, speaking barely at all, seems to work. Asking them to expand, answering questions when needed, and most importantly not denying their claims. It is extremely important, I think, to acknowledge that not every care interaction is perfect or goes to plan. We must embrace feedback, negative or not! Whether it comes from a staff member, a patient or a relative; complaints should be listened to!
Always speak to your mentor or a staff member about a patient’s complaints.