Working with the MDT

I am currently based on an acute respiratory ward and am having the time of my life working with the huge multidisciplinary team (MDT).

Why is the MDT important?
In both primary and secondary health care settings there is an emphasis placed on great interdisciplinary working in delivering effective treatment in a timely manner. If this team is not built on trust, effective communication and a good working relationship then they can act as barriers in delivering effective treatment and care. With the demand in the health services increasing, the need and pressures for interagency teamwork is also increasing.

What does this mean for you?
You, as a future registered nurse will be the backbone of the team. Yes you! The nurse seems to have six arms, a brain the size of a watermelon and apparently a bladder like a camel. You will be the key element in linking all the members of the teams together. You have the most patient contact. It is imperative that you develop your communication skills in order to be the driving force in increasing the collaboration between different team members. Are you excited yet?

What does it mean for you as a student nurse?
It is never too early to start working with the MDT now. I know it is daunting; I still hyper-ventilate when a consultant/doctor asks me a question about a patient I am looking after. AND I am a third year! I still panic when I answer the phone and it is the bed manager asking me what our status is. When the dietician changes the nutrition plan and hands over to me because the nurse is occupied. When the physiotherapists, occupational therapist, social worker and all the rest of the MDT ask me any question. I always think I will give a wrong answer or information that may have changed since I last on shift. So yes, I understand we have all been there.

What can you do to overcome these issues?
On my current placement, I have had the chance to put my MDT skills to practice. On my first day, members of the team were introduced to me. I became acquainted with them by having a casual conversation, this eased my anxiety and I became familiar with them. I was asked multiple times to pass on messages, to ask for a drug to be prescribed, to find out the plan for patient X and by the time I knew it my anxieties soon faded away. I began asking the MDT questions regarding their role in the care for my patient, I asked questions regarding my patients care and even requested to be present when they did their assessments.

What can you take away from this post?
1. Ask to be present when the MDT’s are carrying out their assessments because you will understand more about their role and know your patients capabilities. Did you know you can even spend a WHOLE day with them? YES! Spoke = spending a day with a member of the MDT to understand their roles.
2. Your trust and respect will increase with regards to their contribution to getting your patient discharged safely. Furthermore, you will be able to appreciate the pressures they are also under to meet the same objective as you are.
3. Finally, you will lose any anxieties or awkwardness you may have with approaching your team members. Always begin: Hi, my name is Shayma (obviously you would say your name not mine Hopefully unless you are too anxious 🙂 )

I for one have overcome my barriers and anxieties. And if in doubt, fake confidence and hide your anxiety until you make it, we all do it at one point!
That’s it from me, Good luck working with the MDT and please share your experiences with us!

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Healthy Eating-YES you can!

Since starting Nursing I feel I have been unintentionally gaining unwanted weight and with each academic year I promise myself this year will be different. And we all know how New Year resolutions turns out (sad, but true). I use to be great at meal prepping and avoiding junk food. After my night shifts and the ridiculous long hours I started to feel tired, stressed and would skip meals or ate whatever was easiest at the time (most of the time it was junk food *sigh*). I stopped cooking (which I love to do), I did not stick to my usual routine of eating (big breakfast, medium lunch and smaller dinner), instead I would skip all meals and eat one large meal when I got home at 9PM (yes, very unhealthy eating at that time) and that meal could sometimes be just toast (once i ate 8 pieces of toast within a 24 hour period *ashamed*). Then in the morning I would be so HANGRY (hungry & angry) because I want to eat but don’t have time to eat. At times I would come home from a long day, knowing I have a 04:30am start the next day I would make a decision: to eat, to shower, to sleep? and most of the time it was to sleep.

But this September I decided enough was enough and did something about it. These are my five tips to eating healthy/better and working a 12 hour shift (night shifts are the worst for eating properly- its so easy to eat nonsense, especially when staff bring in quick food to munch on).

#1 MAKE LUNCH: During first year I use to cook lovely delicious healthy meals and bring in nutritious snacks and occasionally a cheeky chocolate bar. I bought a new lunch box, wrote out a meal plan for the week and stuck to it. (most of my time is spent thinking about what to eat). Plus I get to use my half hour (if that) to actually sit and eat properly rather then going to a shop to get a sandwich (that I do not want) and eat quickly in ten minutes.

#2 ALWAYS MAKE LUNCH THE NIGHT BEFORE: you will never wake up early (earlier rather) to make your lunch. I have lied to my self more than I can count, I’d rather sleep then eat (as we have already established :-p). You are always to tired before work to cook anyway. I suppose for night shifts it is a little easier.

#3 DRINK WATER: I keep a 1 litre of water with me all the time. I am continuously drinking. This not only keeps you hydrated but also stops you from snacking on biscuits/chocolates.  To be honest, water is my answer to everything! It reduces my headaches, my cravings and keeps me focused. Not to mention how great water is for your skin. It keeps you less stressed through the day as you are hydrated and makes you feel full (so you don’t get HANGRY).

#4  NEVER SKIP MEALS: As I have mentioned I have a huge tendency to do that. It is easy to skip meals when you are in a busy working environment. Make time to eat, you owe that to yourself. If you can not got for a lunch break, keep fruits, granola bars with you and munch on them as you write your nursing notes. If you skip meals, you go home hungry and feel you can eat your whole fridge.

#5 AVOID JUNK: Easier said than done, I know. But if you remove junk from your household and do not buy them when you are out then you will avoid the excess sugar and fat. I’ve started to buy lots of fresh fruit and veg, from continuously eating such food you can change your cravings and habits. I really believe that the more your eat healthy the more your body wants healthy food. Once I was addicted to carrots and hummus, I would keep a bag of carrot sticks and a pot of hummus with me all the time because I craved it.

Bottom line. You can eat healthy whilst being a nurse. Bring healthy snacks with you to munch throughout the day. Try to have your lunch halfway through your shift (I know that can be difficult). When patients give the staff chocolates to say thank you, be careful with your hand because it will have a mind of its own and you will end up eating one to many! I truly believe that a healthy nurse is an efficient nurse, it will allow you to be always on your ‘A game’ and you will feel great!

Please share any tips you have to eating better on a 12 hour shift.

 

Reflection: A Dignified Death

Death is often not spoken about in our communities and so when it hits home, we don’t know how to react. I have witnessed many deaths since the start of my nursing career and I really can’t say that it gets easier. Nurses whom I have worked with would say, you reacted as best as you could or that after so many deaths you just know how to deal with it.

I remember last year, I was looking after two dementia patients in a hospital setting and within a week they both died due to rapid deterioration. I grew fond of these two individuals and so I was deeply saddened when I heard the news of their death. Towards the end of their lives, both became distressed and would not keep their clothes on. One had to be sedated for long periods of time as she would be aggressive towards myself, the staff and other patients. I did not feel that these two had a dignified death and was sad to see them in such as state. No one spoke to me about how I felt or had any sort of discussion with me about the death of patients. I left to handle it on my own. During the next few weeks, I thought hard about death and attempted to handle it my way.

Moving on to my community placement. We visited a gentleman who has been battling cancer for some time now. He came to the end of his battle, where the doctors have said he has only a few days left. I had visited him four times during my placement and have seen him deteriorating. I was quite saddened by this case because I grew fond of him and his wife, they were a lovely young couple that loved travelling and had more things to to together. During his last days, we saw that he was growing more anxious, and could no longer get out of bed and was in a lot of pain. He told his wife not to call the ambulance and that he if it was time, he wants to pass away in his house listening  to his favourite songs. He had made a playlist of his songs and his wife put the CD in. We came to visit as his pain was unbearable, we inserted a syringe driver to deliver pain relief slowly. And also to support his wife, letting them know what happens next. We made preparations for his death, the ambulance are not to be called. The palliative team in the community will be available for them.When we left, I was feeling sad. But what made the situation better was that this gentleman was happy as someone who as about to die can be. He was going to pass away in his home. With his wife beside him. Listening to his favourite music. I thought he was going to die with dignity, without pain and in his own bed. Of all the deaths I had encountered so far, I felt this was the most dignified.

What I learnt from these experiences was that communication was key in delivering the best care for a palliative patient. This results in them keeping their dignity and dying with comfort. In hospital I found this to be difficult as people seem to be busy and rushing. What I want you to take from my reflection: listen to what the patient wants when they are coming to the end of their lives, they still have a right to choose whether they should die in a hospital bed or in their home.

 

From Ward to Community

I was really nervous at the start of my community placement with the district nurses as I had heard some horror stories from peers. The night before I could not sleep, I lay in bed with a hot water bottle for hours thinking about the challenges the placement would bring. What kept me awake was that I would have to go visit people I their houses, which I did not feel comfortable doing.

06:30am alarm went off, time to get up, get ready and head out. Once I got to the clinic, I was early so the doors were locked. I ended up standing outside in the freezing cold for 15-20 minutes. Once inside, I went to the reception, they walked me to meet the team I will be working with for the next 12 weeks. Once I entered the district nurses office, the two sisters welcomed me, knew my name which made me think that they were expecting me (brownie point for them). I was given a tour of the office, shown where all the files were kept as I would be expected to get them when they are asked for. I was welcomed to the team, what I really liked about the team was when they said I was welcomed to the tea and coffee, once you are welcomed to their collection of tea you are initiated and part of the family. This made me genuinely smile, I was going to like it here, and the team were all lovely and had a great sense of humour. I waited for the nurse to arrive as she had started at 08:00am and was doing her early visits. Once the nurse arrived, after paper work we headed out to a care home to visit 6 patients at 09:30.

On our way to the residential home, the nurse informed me of the patients we were going to see and what our role was in their care. We got to the home, went upstairs to see our patients. The tasks we were doing were pressure ulcer checks, injections, dressing changes and assessing the overall health of the patients. These tasks took the whole morning. Once we got back in the car, we head back to the office for lunch.

Next at 13:30- the team of 7 district nurses come sit together and discuss the morning visits, they talked about any issues, what afternoon visits are left, new patients, the aim is to update the whole team- all while have a cup of tea and biscuits. After more paperwork, I worked with a different nurse and we went to visit patient homes. What I found strange about these visits was that we had a code to get the key to their house let ourselves in to carry out tasks such as insulin injections. I was astonished; my idea of what I was going to do in community was totally different. After the afternoon visits, back in the office for more paper work. Then home for 17:00.

On my way home, I was thinking WOW! What a great day. You see, I have been on three ward placements all have been busy and hectic. Working with the district nurses allowed me to get to know the patients history, I was able to get a holistic idea of the person’s situation. We were in their home, their private space. Even though we were there for only 15/20minutes, that was probably the only social contact that person got that day. I found myself changing my views about working in the community; I always thought that I’d like to work in ward; fast and busy, lots to do. But now I am not too sure.

So, remember don’t judge a placement before you have met the team and give it a chance.

Advice from a Newly Qualified Nurse

Today I am delighted to bring you some advice from a newly qualified nurse, who also graduated from The University of Manchester

To all my fellow nursing students… the toughest students around! I have recently qualified as a staff nurse in October (scary right ) and currently work on a diabetic specialist ward- the first job I applied for as I went through general trust recruitment and would recommend this to any of you who aren’t sure what area you would like to work I in yet. I thought I would pass on my experience as a Manchester student and as a newly qualified staff nurse 🙂

First of all I am going to bullet point any learning experiences or notes I have for all of you rather than put it in a long winded paragraph as frankly we all have to read enough rambling on of other people whilst at uni, especially if you are currently writing your dissertation, you may never want to read again!

Student Life: -Don’t give up!

1-It is a very hard but very rewarding career. At times I felt like quitting with the stress of placement, uni work and trying to hold down a part time job. You are all doing so well to have made it this far, and we are all here to help and support you. On a side note please ignore all the nurses on placement who say:”why on earth have you picked to do nursing ” or my favourite ” oo you should have been a doctor, that’s much better money”.

2-In reference to part time work – I worked at a roster aunt long hours at weekend for my first and second years and it was just too much ! I would advise to join nhsp as a HCA as soon as you have done 6 weeks in a hospital setting . If like me nhsp keeps crashing for you and is taking 6 months to get an interview consider agency HCA who I joined with for my last year – if anyone wants any information on that I will leave my email 🙂

3-Do your work in plenty of time ! Especially your dissertation, I left mine till the last minute and boy was it stressful . Also a tip for assignments, the reference app thing on Microsoft word is very good.

4-If you are a complete newbie, invest in comfy shoes,your feet will ache after long shifts on your feet all day and please don’t wash your tunic and pants together, they go a very odd colour haha.

5- whilst on placement attend all of the training sessions you can by booking onto them at the education centre, they make up your hours which is good, especially if you aren’t to keen on your placement. I also found it handy to carry a small notepad in my pocket to jot useful things down whilst on placement.

Moving on… Newly qualified:

1- I am not going to lie, it is scary as anything when you first qualify, when someone shouts nurse, you look down and it’s you ! It is normal to doubt your capabilities, question if your cut out for this or why on earth have I decided to do this? ITS OK & VERY VERY NORMAL. Every nurse you see on the ward has all been there , you are going from little to full blown responsibly and that’s scary however the nurses in my experience are all so supportive and understanding. They know you are new to the job and don’t expect as soon as your graduation cap comes off , super nurse to bound through the doors, and any nurse who tries to put you down for not knowing something because your newly qualified, shame on them , no one knows everything there ever is to know about nursing and on a side note, revaluation is coming around, we have had 3 years worth of cross referencing and reflection for our portfolios, so the tables will soon turn 🙂 I would recommend getting a job where there is a preceptorship programme as that’s what I wish I had done differently.

2- Stand your ground: if there is something you are not sure of or not happy with, just ask or even question a doctor as to why he’s doing such a thing, no one is going to think your stupid and you would rather be safe than sorry (we all make mistakes, even doctors!) At the end of the day no one can make you do anything you don’t want to, it’s your pin on the line. Have confidence in your own judgement , most of the time you will be right 🙂

Good luck in your training , which ever stage you may be in, you will all make fantastic nurses and hope to work with you in the future.

If anyone has any questions they would like to ask about anything this is my emailracheljanemoore@hotmail.com

All the best , keep up the good work:)

Rach

A Day in a life of a Hospice Nurse

Today I am delighted to bring you a guest blog post from a Hospice Nurse.

After qualifying as a children’s nurse about 2 years ago I worked on a neonatal intensive care ward. Although palliative care was an integral part of the role, I felt that I wasn’t using my specialist paediatric skills so decided to apply for a nursing role at Haven House.

I was lucky enough to be successful and a few months later, I can honestly say I love my job. The encouragement from staff and the hands-on-experience has already helped me progress and develop as a nurse.

The work here varies on a day-to-day basis which makes my job really interesting. At the start of a shift all staff receive a handover from the nurses on the previous care shift. We discuss all aspects of individual care and then a lead nurse allocates each child to a nurse and one of our fantastic health care support workers. This ensures continuity of care and gives everyone a sense of security throughout the day.

Depending on the care plan we bath or shower each child in our luxurious sensory bath that has lights and music. Most of our children attend school, so if it is a weekday we ensure they are dressed, fed and ready for school by 8am. This can sometimes be a challenge but good team work and staff management helps ensure we are usually on time. Haven House has fantastic complementary therapies for children and families to benefit from such as therapeutic yoga and music therapy. When children attend these sessions we usually have the pleasure of providing day care to them as well as attending the therapy session. We also have paperwork, care plans, documentation, audits, research and meetings to attend so it soon comes round to 3:45pm again. The beeping sound of a vehicle in reverse informs us that the school bus has arrived! Each child’s detailed care plan informs staff on shift how, when and exactly what to feed them. After a snack or feed its playtime. Many of our children can’t eat solid foods so are fed through a tube in their stomach.

Next, the children have some down time. Haven House has a sensory room with an interactive floor and walls. Music and lights, sensory toys and games and books for all ages are available in the activity room. Our lovely play co-ordinator ensures there are always activities and crafts set for children to immerse themselves into, whatever the weather. We often spend time in our wonderful grounds or our cinema room – the children love this as it often gives them a feel of family time and time to develop interpersonal relationships with staff and other children. Breaks in play time have to be had when children need changing, medicines or a feed.

Dinner time can’t come soon enough and we either have food ordered in or we whip up a healthy meal ourselves for the children who can eat. After dinner we have a good tidy up and then take the children to their bedrooms to get them prepared for the evening. It’s bath time or showers for those who require them according to their care plan or based on how actively engrossed they were with their messy play and crafts during playtime! Medications are given throughout the day at specific times to each child based on their individual prescriptions.

Once the children are washed, they are dressed in their pyjamas, teeth brushed and settled into their rooms. It’s either story time or a bedtime programme to help children wind down. At 9:45pm the handover process begins again with a fresh team of staff ready for the night shift. I can honestly say it’s a complete privilege to do my job every day. Our children have complex and rare life-limiting conditions and require a great deal of care and attention. I draw my strength from the knowledge that parents and carers look after them on a daily basis without any complaints. Their strength becomes our strength and this translates into brilliant care for each child at Haven House.

Despite the long hours, intensive work and heavy case-loads; I wouldn’t exchange the job satisfaction that nursing gives me for anything else in the world.

Muryum Khan, Pediatric Nurse.

World Cancer Day 2016

Today is WORLD CANCER DAY, I write you an experience I had coming into contact with a patient who was diagnosed with cancer. I hope it may inspire some of you to choose the oncology path, will keep it short and sweet.

Nurses who have chosen the path of oncology have my utmost respect. For those who are thinking “what is she babbling on about oncology?” well an oncology nurse is someone who provides care for patients who are suffering from cancer as well as monitoring those who are at risk of developing cancer. These nurses become part of the person’s life, see them throughout this difficult and distressing time and not only are they there for the patients but are also there for the family.

To protect his right to confidentiality, let’s call him, Mr Andrews, he was 82 years old. During my shift I was asked to monitor Mr Andrews, whilst I was recording his observations the doctor came in with the results of his biopsy. As a first year student, I thought this would be a great learning experience, so I stayed and listened. The doctor informed Mr Andrews that unfortunately his cancer had returned, it was aggressive and all they could do was hope for the best after more chemo-radiotherapy. After the doctor had finished his chat with Mr Andrews and left, I wanted to know what was going on in Mr Andrews head. I asked him, how he was feeling and if he wanted me to call anyone. He took my hand and remained in silence for a long time. I wasn’t sure what my role was in this situation and what I was supposed to do. So I sat with him, in silence. After a while, he said that he didn’t want any more treatment. He was done. He had 82 good years, a loving family and now it was time for him to go. I wasn’t sure how to respond, so I asked why he felt that way. He responded by saying the staff that had previously took care of him were absolute “angels”, they stood by him when he was in agony and crying with pain. He had seen so much in those 82 years. He felt, cancer coming back was nature’s way of telling him, enough. He didn’t want that last few months of his life to be spent suffering from side-effects. He wanted to go home, see his grandchildren and be at peace on his own terms.

At the end of my shift, I was thinking about Mr Andrews and tried to gather all my thoughts together. He had cancer. Again. He was dying. It cannot be cured. He was not sad. He was not shocked by the results. He was not in much pain. He had a loving family. He wanted to die with dignity. With his family around him. He was loved by many. It was his choice. After that, all I could think was how brave he was, he fought the cancer twice already and third time round he decided enough was enough. He was a happy man and he wanted to end life like that. I should be okay with that.

In short, caring for patients who are suffering from cancer requires you to listen attentively. Respect their choices and support them from the moment they come into contact with you. You having a presence, holding their hand, smiling, bringing them a cup of tea, all the little things one may think is a simple task leads to you making their last moments be at peace. You make a difference, even if you sit in silence holding their hand.

Why don’t you save a life today and hop on over to Cancer Research UK and make a donation to transform the lives of people who are currently suffering from cancer: http://www.cancerresearchuk.org

Further Reading:

  1. Rieger PT, Yarbro CH. Role of the Oncology Nurse. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.Available from: http://www.ncbi.nlm.nih.gov/books/NBK13570/
  2. Cancer.Net. (2015).Types of Oncologist.Available: http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists. Last accessed 04 Feb 2016.