Community Matrons; the role we need

I bet you’re thinking, what is a community matron? It sounds very official and a bit scary…but you couldn’t be more wrong!

Within the community healthcare team, there are a wide range of roles. I am currently based with the district nurses (can you tell I love community yet) and I wanted to see how it all fits together. I had never heard of the community matron role, until I met my placement’s local one. She gave me a really fabulous explanation of her job, and I spent two days with her!

Community Matron’s are the Advanced Nurse Practitioners in community. They work alongside the GP’s, District Nurses, Social Workers, Occupational Therapists, Physios etc. to ensure that more vulnerable patients living in the community do not end up in hospital needlessly. Using their amazing medical/psychological/social care assessment skills, they are able to provide support for patients with chronic conditions such as *COPD or heart failure. This is an absolutely fantastic, and much needed role, within the community. They provide extra support to all the healthcare professionals in community.

Whilst working with the community matron, I got a really good idea of what there job is. It’s a very diverse job! One patient we met, the wife was concerned about her husband’s medication. As the main carer, she felt as if not all the medication was necessary and did not understand the need for them. We were able to sit down and have a long discussion about the home environment, how they are coping, and of course review the medication. At the end of our visit, the patient’s wife thanked us profusely for helping her understand. She was much calmer, and felt as if her questions had been answered. One hour made a huge difference to herself and her husband!

Another example was an elderly lady who had *COPD and recently had a chest infection. The community matron ensures that this lady, as well as many other patients with long-term conditions, always have antibiotics in the house, and teaches them to recognize signs of a chest infection. This means the infection is dealt with quickly, it encourages self-care, and reduces the potential stress on GP and A&E services! During our visit, the matron taught me how to listen to chest sounds and undertook basic observations. This is to keep an eye on the chronic conditions her patients suffer from.

This is only a small insight into the work of community matrons, and I could easily sing their praises all day! Personally, this is what integrated care should look like.

I would wholly encourage anyone, no matter what stage in your training, to get a spoke with a community matron.

 

 

 

*Chronic Obstructive Pulmonary Disorder

Behind closed doors: a student nurse in general practice

When I first considered nursing as a career, it wasn’t the adrenaline-filled excitement of A&E or intensive care that attracted me; neither was it intricate technical knowledge of theatre nursing or the busy variety of working on a ward. From the outset, community-based or practice nursing had always been my ambition. Maybe I’m slightly odd, but I love chronic conditions and the idea of helping people to manage those has always been appealing. I was also attracted by the autonomy of practice nursing and opportunity to work towards advanced nursing skills like prescribing…and I can’t lie, the lack of nights or weekends didn’t seem too bad either.

Research online suggested that I would need at least two years experience, preferably in A&E, or even a masters degree before moving into general practice. I wasn’t put off, but as a mature student it felt like there were a lot of hurdles to overcome before I could realise my ambition of becoming a practice nurse. I didn’t think for a moment that I’d spend time as a student nurse in general practice – so when I tentatively checked our placement allocations earlier this year, I was over the moon to find out that I’d been placed in a GP surgery nearby.

My mentor and the whole nursing team at the surgery couldn’t have been more welcoming. I discovered that I was their first nursing student and that the surgery is leading a project locally to encourage more GP surgeries to offer placements to student nurses. Like other areas of nursing, there have been difficulties recruiting practice nurses for a number of years, partly down to current practice nurses reaching retirement age, alongside fewer newly-qualified or experienced nurses choosing practice nursing as a career. As such, surgeries like the one I was placed at want to promote general practice as an attractive place to work; they see placements for student nurses during their training as a key part of that strategy.

Over the 12 week placement I got a real insight in the role of the practice nurse. My mentor, who was also a prescriber, led on the management of chronic conditions like hypertension, asthma and COPD, which encompasses advanced assessment skills, prescribing and lifestyle advice. This was on top of bloods, smear tests, contraception advice and of course, lots of injections; a workload shared with another skilled nurse who also took care of all child immunisations and travel vaccinations. They both worked closely with an experienced care support worker who took care of ECGs and spirometry, among many other things. Meanwhile, an Advanced Nurse Practitioner also based at the surgery leads on emergency consultations, seeing everything from chest infections to mental health crises. It was fantastic to see the varied role of the nurse in general practice and just how valued they were by patients.

The first few weeks of my placement were spent observing however as the placement progressed I was encouraged by my mentor to start leading consultations under her supervision. This was nerve wracking at first, but my confidence soon grew. I was eventually given my own clinics to run, taking on straight-forward asthma reviews and blood-pressure checks. It was fantastic having my own room and calling patients in from the waiting room. I loved talking to people about their health, explaining how their medication works and making a plan together that we hoped would help them better manage their condition. The most rewarding part was seeing patients return. One man said his life had been transformed by a steroid inhaler I had encouraged him to start using, saying that he no longer felt breathless or worried about his asthma. The opportunity to get to know your patients and equip them with the tools and knowledge to improve their health and quality of life, has to be one of the best parts of practice nursing.

The pressures on GP surgeries were clear to see, as they are in many other parts of the NHS, however my time in general practice revealed just how crucial practice nurses are in supporting the everyday health needs of individuals. Practice nurses are highly-skilled practitioners in their own right who make a valuable contribution alongside GPs and the rest of the team in a surgery. Hopefully more GP surgeries will start taking on student nurses during their training so that more can gain experience in this often-overlooked area of nursing. Of course it’s not everyone’s cup of tea, but I loved my time in general practice and feel that student and newly-qualified nurses have so much to offer to this area.

We would love to hear your views on nursing in general practice – is it a career path you would consider as a newly-qualified nurse? Share your thoughts below!

The joy of community nursing

Community is often painted as marmite- you either love it or you hate it. But is that strictly true? Surely there is something about every placement that can be enjoyable, and not so enjoyable!  I will first admit that my heart lies in community. I knew within the first few days of my placement in first year that I wanted to work in the community. So I thought I’d make a little list about why it’s just so amazing. 

You have to expect the unexpected! You aren’t in the relatively controlled environment of the hospital, you’re in a patient’s home/room. Anything can happen, even trying to stop the pet dog from jumping on the bed during catheterisation!

It really is community based nursing. No matter what area you work in, you’ll know the people, their attitudes and the roads like the back of your hand. It’s really refreshing to be moving around constantly instead of endlessly walking around a ward or clinic.

Improvisation is key! Can’t find the correct wound dressing? Come across a new skin tear? Can’t access the patient’s house? Better make it up! I’ve seen some amazingly ingenious solutions which I’ve then stored in case I ever come across it again. It’s one of the best ways of learning!

Community nurses can be a lifeline. Many patients you will visit in the community are elderly, some of which are very isolated from society due to mobility issues, lack of family or the fact that they live in rural locations. Often, community nurses are the only people they interact with in the day, and they appreciate their presence immensely!

The patient-nurse relationship is very different! As soon as you enter someone’s home, you are entering their territory and you follow their rules. I feel that this allows patients to have a larger role in care decision-making. It is what holistic nursing is all about.

Community nursing is not for everyone, but never underestimate it’s ability to build up your skills!

If you’ve had a community placement, and you’re feeling creative, why not write us a blog post? Simply send us an email at enhancingplacement@gmail.com. We always welcome new content!

Hello from the other side…

We’re delighted to share this guest blog from Lizzie, a fourth year Bachelor of Nursing and Midwifery student from the University of Queensland, Australia. Lizzie shares her incredible experience on exchange at the University of Manchester where she is completing her final nursing placement in A&E at Manchester Royal Infirmary:

“Hello… Can you open your eyes please… What’s your name? Do you know where you are?

My name’s is Lizzie, I’m the student nurse looking after you. How can I help?”

Welcome to the adrenaline packed, electrifying, exhausting and incredibly humbling world of Accident and Emergency. I’m one of two UQ final year Bachelor of Nursing/ Midwifery student’s fortunate enough to have the incredible opportunity to go on Exchange to the University of Manchester, and complete my final Nursing Undergraduate Placement in A+E at the Manchester Royal Infirmary.

Lizzie 1

I can’t believe in just under three weeks I’ll be finished my nursing degree! When I was little I always dreamt of being able to help people with my hands, my heart and my brain. I actually have come to feel so at home in the hospital – nursing has fit me like a glove. I love to learn, I’m a people person, but most of all I feel such a sense of satisfaction when I know I’ve made a difference. That’s why I’m excited, and proud to (almost) be a nurse.

I’ve been in the UK for 3 months now. Words can’t describe some of the things I have seen, how much I have grown personally and professionally, and how much I love it here – but I’ll give it my best.

Lizzie 2

A+E is a never-ending puzzle. In comes a person with a list of symptoms, and (in the time constraints of the National Health Service’s 4-hour max wait times) you assess, stabilise, gain a history, conduct tests, perform interventions, monitor for the impact of these interventions, and then either refer them to a specialty or (hopefully) send them home. The true skill comes in managing many patients simultaneously – yet still treating, valuing and respecting each as an individual.

While every shift is an adventure – here are some of my highlights:

In A+E when there is a really critical person about to come in we get pre-alerted by a call from the Ambulance service to a “Red Phone”. The Nurse in charge takes the call, and then alerts the department over the loud-speaker – “Red Standby, Adult Major Trauma – ETA 5mins”.

One of these “Red Standbys” was a motorbike vs car head on collision, resulting in fractures to the patient’s femur, hip, wrist, and back… I got to look after and stabilize the patient, and follow them through to the Orthopedic Trauma Operating Theatre. The surgeons and theatre nurses were so kind, they not only talked me through the 3 operations, but they even let me scrub in so I could stand right next to the surgeon as he used metal rods, plates and pins to reconstruct the patient’s broken bones.

I have been actively involved in eight cardiac arrests (one was on my first day – but that’s another story). I’ve helped wheel a patient down the hallway while they were actively receiving CPR, and get them to the “Cath-Lab” where under X-ray guidance surgeons were able to guide a wire up the patient’s femoral artery, and use a stent to reopen the diseased blood vessels of the heart, and save his life.

Lizzie 3

I have been blessed with a plethora of opportunities to learn – just over a week ago I traveled to Chorley to complete a simulation training day in “Out of Hospital Emergencies” with the Paramedics and Army Reserve. I’ve worked with an advanced practice nurse running a Community Clinic for Chronic Diseases, and have done home visits with a GP for the day – visiting some of the sickest home-bound patients.

Just yesterday I got to ride in an ambulance for the first time as we transferred a patient to a specialist hospital for neurosurgery. The patient was critical, so we traveled on “blue lights”. The paramedic crew were amazingly skilled, calm and good at balancing as we tore down the highway.

Manchester is a beautiful city to explore, and the rest of the UK is so close that I’ve being doing my best to see as much as can on my days off. So far I’ve day-tripped to the Lakes District, spent a weekend in Bath visiting the Roman baths and Stonehenge, seen some stunning castles in Wales, and travelled to Dublin for St. Patrick’s Day!

Lizzie 4

There are some exciting opportunities on the horizon – in my final week as a student nurse I’ll be attending a conference in London and on shift with the London Ambulance Service.

I have been so lucky to have worked as part of an incredibly supportive team and mentored by inspiring nurses and doctors. I won’t sugar coat it – I have seen some heartbreaking things (as is the nature of Accident and Emergency), but I wouldn’t change a thing. I’ve found my calling – caring for people when they are most vulnerable. Be that at the beginning (as a student midwife) or at the end (as a student nurse), it’s my privilege to love, support and provide dignity. Not as a healthcare professional, but as one human being caring for another human being.

I have learned there is never a situation in which a non-judgmental ear, a hand to hold, and kindness won’t help.

I’ve realised how precious every moment is.

Be Resilient, Stay Brilliant

Student nursing takes many different skills: patience, compassion, dedication, the ability to plaster a smile on your face for 12 hours even when you’re exhausted, and more. But there is one skill I never thought would be so useful; resilience!

Resilience is when you’ve made a simple mistake and you can feel the embarrassment creeping up, but you carry on caring and learning. It’s what makes you keep going when someone doubts your ability. It is what you use to take in constructive (but sometimes not!) criticism on an essay, a presentation or an act of care. Resilience is the ability to bounce back!

I didn’t realize how important resilience was until I was having an incredibly busy day on my last placement on an acute medical ward. Myself and my mentor had ended up with a few very poorly patients, an astonishing amount of paperwork, delayed transport for a patient and some awkward available beds mix ups. To help out, I offered to call a unit an explain that patient they were transferring to us needed to be delayed slightly, due to late transport. I was greeted with what I describe as understandable anger and frustration. I spoke as calmly as possible, explaining that we were sorting the situation and that the patient would not be delayed much longer. The nurse I spoke to continued to berate me on the phone, and eventually hung up.

Luckily, within 10 minutes, we had managed to sort the entire situation out. No more angry phone calls for the day! I spoke to my mentor about what had happened, and she reassured me that it was just a tough situation and not to take it to heart. I still get slightly annoyed when I think back, but I have to remind myself that we are all just looking out for our patients. Sometimes that comes across in different ways! I think if I was a qualified nurse, I would have had a better understanding of how to deal with the situation. But I know for sure that I will not forget this phone call.

Remember; if you have experienced a situation like mine, please talk to someone about it! Whether it is your mentor, a fellow student, the PEF, your AA, friend, family dog etc. Difficult situations should be discussed, and you are allowed to vent. I can highly recommend writing a reflection about it!

Have you had any moments of resilience? Let us know in the comments, or on Facebook/Twitter. Or, if you’re feeling creative, write us a blog post!

 

 

 

 

 

 

 

Miscarriage & Midwifing

Before continuing to read this please note it may be triggering for those who have experience of baby loss…..please bear this in mind and take care of yourselves before reading further. This is an incredibly personal post so please note all experiences are based on my experience of miscarriage.

I recognize I am a person who processes life events by writing about them. I realized quite soon after my miscarriage that I would need to write about it to help me grieve but now the time has come I don’t really know where to start. I do know I want to reflect on my experience as a student midwife grieving over my lost baby and how I felt/feel.

I started this blog post by doing a quick search for research and other blogs written by midwives who had experienced baby loss but the area is quite sparse. I was surprised by this as midwifery is dominated by women and as miscarriage effects 200,000 couples each year and 1 in 4 pregnancies end in miscarriage (Tommys.org.uk) the chances are a lot of midwives are touched by miscarriage.

I feel like midwives losing babies is a subject not really talked about. Maybe it is discussed among colleagues, friends and peers but my experience is it all feels a little taboo…..like if I talk about it I may be judged as not being able to do my job or might fall apart when taking care of pregnant women….I can’t really verbalise my feelings regarding this other than this was my personal experience of miscarriage as a student midwife. I felt like I needed to just carry on as taking time off may be perceived as a sign of weakness (this is not something I was told by anybody but it was how I felt). This degree is relentless…if I took time off I may never go back so I felt I needed to be ok…to show resilience, put my head down and ‘power through’.

I started my midwifery degree with 3 school age children and felt my family was complete. Both my lovely husband and I were both told, for various reasons, our individual fertility was irreparably damaged so as a couple our chances of conceiving were zilch….which was fine! After a particularly gruelling schedule of placement, exams, essay deadlines, family pressures etc I felt ill…..really ill. More than tired ill and more than stressed ill…I felt dreadful. I have been pregnant 3 times so I recognise the signs. I returned home after my first exam and did a pregnancy test……which was positive!!! I was stunned! Being a StMw (Student Midwife) the first thing I did was calculate my EDD (estimated due date)……our baby was due on our 13th wedding anniversary…..surely this was a sign that the little miracle bean growing inside me was meant to be?

After the shock settled for both me and my husband we started to get excited….this was a door that was firmly closed, bolted, locked and double padlocked! We had been given a chance! I knew the stats….I am 41 for goodness sake! I recited the stats to my husband to try to keep us grounded in the reality that this pregnancy was unlikely to continue but we had got pregnant against the odds so surely I would be ok?!

I went through a whole array of emotions and my thoughts were racing:

I wouldn’t graduate with my cohort which was gutting BUT I would have a much wanted baby…. which was wonderful!

We had no money…..no answer to that really except we would manage!

We are OLD – our youngest is 7 so we would be starting again when all our friends had similar aged children to ours….we didn’t care, we love babies and children!

….and many many more random thoughts…but most of all we were thrilled and, as all couples who are pregnant with a longed for child do, we made plans. We planned when we would tell people, when I would leave uni, when I would return, how I would cope with the pressures of a full on degree when pregnant in my 40’s, who would do my booking as I know all the community midwives in my area? Would people judge us as irresponsible and foolish? The odds of having a healthy baby were not in our favour so would family/ friends/ fellow midwives judge us for getting pregnant especially given all my husband’s health issues and my ever depressing age?! Do you know what?….we didn’t care! We felt so happy and blessed!

I grew our baby for 10 days….10 remarkable, wonderful days when I felt fertile and hopeful and excited. 10 days of hope and dreams and of improving stats (I found an app that showed the likelihood of me miscarrying reducing by the day)…I fell in love.

We were going away for a few days to end my 3 sons’ fortnight holiday from school. I had 2 exams and an essay deadline during this fortnight so the boys had been bribed to tolerate my emotional absence and grumpiness with promises of having 100% mummy for 4 days at the end of their holiday. On the Friday morning we were going away I started to bleed. By Sunday night it was pretty much all over. The hcg line on the pregnancy test had gone from a strong line to a faded line only visible when held up to the light. I was inconsolable and angry….why let me get pregnant for this to happen? I felt my body had let me down. I felt foolish for hoping….this was an incredibly early miscarriage and in a cold, clinical light I could accept that my very efficient body had dealt with a non-viable pregnancy quickly and with little fuss; but this knowledge did little to stop my heart from breaking.

I called my local EPU (early pregnancy unit) on the Monday morning we were leaving our mini break to confirm what I already knew. The very lovely, kind sounding nurse confirmed I was likely miscarrying and informed me to repeat the pregnancy test a week later to ensure all the ‘products of conception’ had gone and to ring immediately if I started to haemorrhage, have severe pain or pass large clots. My pregnancy was all but over. When we returned home I found the pregnancy test with the strong hcg positive line and I sobbed; that proved our baby had been real, albeit momentarily.

I was on placement in the community the next day and was also scheduled to attend a 20 week ultrasound anomaly scan with one of my caseholding couples.

Would I be ok?

Part of me felt silly for being so upset…this was very early (I was about 6 weeks) and people lose babies at all stages of pregnancy how dare I be so upset about such an early loss? But I was…it was the loss of hope and loss of a future we had dreamed of and imagined. The loss of us being parents to 4 children and being a family of 6 ….or more! We had joked it may be twins (my age and a family history of twins increased this possibility).

I was a counsellor before training as a midwife and during my 15 years as a practising counsellor I experienced major personal life traumas but, with increased support from my supervisor I maintained my practice throughout. I know I am able to acknowledge my own feelings whilst also allowing the space within myself to empathise and be present for others in a professional capacity. For this reason I felt I would be okay to attend placement but remain mindful and aware of my own emotions whilst staying grounded in my role as ‘student midwife’. I have always felt it is my role as a professional to empathise not identify. Allow an individual to experience their own situation without inflicting my personal feelings and experience on them.

I sat in the 20 week ultrasound scan with one of my caseholding couples and I was genuinely excited for them. Their baby looked healthy and they were told they were likely having a baby girl. I was thrilled for them and felt emotional and privileged at being able to experience such a lovely, personal moment. I went home after finishing the rest of my shift and felt ok but the poignancy of the situation was not lost on me as I could still feel my body dealing with the loss of my baby.

So what can we do as midwives?

…….Baby loss is a fact of life…the stats prove this. The stats don’t show the women and their partners behind that loss. The stats don’t show how many midwives experience baby loss. The stats don’t give you the tools to manage that loss. I have coping mechanisms thanks to my previous career but I am not made of stone…..what I found hard was not a 20 week ultrasound scan but an 8 week booking appointment when I would have been 8 weeks pregnant and it would have been around the time of my own booking appointment. I didn’t fall apart and I was (I believe) fully present for the couple during that booking appointment but did I go and have a cry on the toilet after it?…. Yes I did.

What needs to change?

……I am not sure……more talking amongst midwives of their own experiences of baby loss (hence this blog…..very few people knew I was pregnant so I feel quite exposed writing this but I am trying, in my own small way, to challenge the perceived taboo) and an acknowledgement that miscarriages, even very early ones like mine, leave a footprint. Our wedding anniversary will come and go and we will acknowledge our baby existed for however short that amount of time was.

Miscarriage is discussed in a very clinical way with terms like ‘products of conception’, ’tissue’ and ‘chemical pregnancy’ but I needed to talk about my ‘baby’ and ‘hope’. I needed to talk about how I felt about my 3 beautiful sons not having the chance to meet their baby brother or sister. I needed to sob & sob and not feel guilty for crying over somebody who only existed for a short space of time. I am not a Christian or a particularly spiritual person but our baby existed to me & my husband and we need time to be sad. My husband was quite pragmatic until we did the final (negative) pregnancy test …until that point he must have been carrying some hope (I was not; the test for me was a relief that my body had dealt with everything and I didn’t need to go to hospital and have any medical procedures) and he cried. I was shocked…..I am embarrassed that I was shocked as I feel like I should know better but I was genuinely surprised he was so upset. Fathers need acknowledgement within baby loss too and they tend to grieve differently. My experience as a counsellor is it seems to take longer for men to acknowledge loss and therefore grieve. This is worth bearing in mind when supporting families with loss.

If you are working with women and their partners following baby loss, please acknowledge the loss; acknowledge the sadness and grief. Being told “well it was very early” is unhelpful as it undermines a couple’s grief, we needed permission to be sad not platitudes in an aim to ‘cheer us up’.  Being told “well at least you can get pregnant” is also unhelpful as that does not acknowledge the loss of this pregnancy and this baby which is what we were experiencing. What helped me was my amazing trio of fellow Student Midwives who were my friends. They were not clinical or ‘midwifey’ they were my friends and gave me permission to grieve.

Thank you for reading.

 

 

Tops Tips for Staying Cool

As you have probably noticed, we’re currently experiencing a bit of a heatwave at the moment! This may mean ice cream and sunbathing for some, but for us student nurses it isn’t much fun! From stuffy uniforms and buses hotter than hell, to rushing around Image result for warm weatherensuring patients are hydrated whilst being dehydrated yourself.

So what the the top tips for staying cool in a heatwave?

  1. Sun cream!! Especially if you’re on community or commute via walking/cycling.
  2. Keep hydrated***. It’s obvious, and we all harp on about it, but the day will drag more and the heat will hit you harder if you don’t keep drinking cold water or juice. Make sure you have a bottle or jug nearby to remind you, or drink with your Image result for patient drinking waterpatients so you both get the benefit!
  3. Don’t over-exert yourself. You are the most important person to take care of in your life! Make sure you take regular little breaks for drinks + a sit down. I know it can be hard, but you’re no use to your patients if you aren’t on top form!
  4. Change into your uniform when you get to placement. It prevents you starting your shift in a sweaty mess, and allows your body to cool down on your way home.
  5.  Avoid too much caffeine. I know this sounds barbaric (I can’t survive a shift without coffee) but caffeine is a diuretic. That means you’re going to the toilet more, which leads to more water loss. Try not to overdo the coffee intake!
  6. Try and get some sleep! Nothing is going to make a hot day longer + harder than lack of sleep. If you need a fan, get one! I know I couldn’t cope without mine.
  7. ***Know the signs. Dehydration can be bad news, whether its staff or patients. Make sure you know the signs (headache, dry mouth, not urinating a lot) and keep an eye out. Let someone know if you or a patient is suffering.

Have you been coping with the heat? Send us any tips/tricks via email, Facebook or Twitter !