My day with the Health Visitors

As an adult student nurse, I don’t encounter many babies/children, so I was keen to try something a bit different. So when I found out that the Health Visitors were just down the corridor of my placement’s main office base, I soon popped my head in to organise a spoke! I had an absolutely wonderful day with the team! Not only did it help me understand the workings of the Community Multi-Disciplinary Team, but its exposure to another field of nursing! Plus, my current district nursing placement is largely based around treating patients, so observing some preventative public health care was great. Oh, and I got to play with some adorable children- I love being a student nurse!

Each Health Visitor is a qualified nurse (adult, child, mental health or learning disability!) or midwife, and their role is based around family care. By leading the delivery of the Healthy Child Programme, they ensure that expectant mothers and new babies up to the age of 5 get the best start in life! They visit families in their homes, GP clinics, Nurseries and Sure Start Centres. It’s an incredibly varied job.

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A tiny grasp for baby, a huge step for development!

My day with the Health Visitors started with a visit to a local SureStart centre, where the local ‘Baby Clinic’ is held. This is where one year old’s attend and the health visitors evaluate their progress. Its not as scary as it sounds, I promise!! They look for certain markers in a baby’s development and then, if needed, can give the parents pointers on how to help their child. For example, by the age of one they should be ‘babbling’ (repeating words they’ve learnt, usually nonsense), pulling themselves to stand and using furniture to wobble around on two feet, and using a pincer hand gesture. We had two lovely little babies visit us, both of which showed these developmental markers but at different stages. Each child, of course, is different and they have started to develop their personalities at this point. Our first baby was very outgoing and had his older sister to make him confident enough to play around and show us how well he was doing. The second child was a bit more shy, and preferred the company of her mum. However, after I showed her the wonder of some bells on a stick, she did everything we asked of her.

Alongside looking for the developmental markers, Health Visitors are also looking at the bigger picture. Their aim is to ensure that the family is happy, healthy and safe. How do you do this? Use a good old pyramid of course!

health visitor bible

Who doesn’t like a pyramid?

The Safeguarding and promoting welfare pyramid is designed to help pinpoint the areas which children should have. So, for example, if the Health Visitor detects that the child doesn’t seem like they have enough stimulation for the child to grow and enjoy themselves, that would question the parenting capacity. It’s useful for identifying a variety of factors that may be affecting a child’s development, as it’s never usually just one thing. Anything that is identified as missing can be worked on, via the Health Visitors, Social Workers or Family Support Workers.

If you want to learn more about Health Visitors, NHS England has a load of information about their role and how to become one! Or, if the chance arises, go and spend time with some!

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Healthy body, Healthy Mind

If there is something I used to find more boring than eating healthily, it’s people talking about it. But my attitudes have changed now that I’m a responsible adult (haha). Being on placement is pretty tough, especially if you haven’t worked in that environment before. I’ve done 13-hour waitressing shifts before but after an 8-hour student nurse shift, I’m shattered! During my first placement, I didn’t pay attention to how much sleep I needed or what I ate. Totally the wrong thing to do! I’m not saying being a student nurse needs you to turn into a health guru with your own cute Instagram account called LoveKaleForLife, but being that little bit healthier can help. So that means avoiding cheap takeaways when you get home from placement, no matter how tempting it is. Unless its treat yourself day!

Getting enough sleep seems like a pretty obvious tip on how to survive placement, but you’d be surprised on how difficult it can be- especially if you live in halls! I’ve had few incidences, and heard a lot from other nurses. And when that karaoke at 3am on the floor below you starts up, your precious sleep can suffer a bit. Earplugs might be a good investment if you can’t handle that. Luckily I lived above a nightclub for 3 months, so the sound of drunk screams is like a weird lullaby.

Food is another MEGA important aspect. Making sure you eat a decent and healthy meal three times a day makes it easier to get through your shifts. I found out the hard way that just a fruit bar for breakfast is just going to give you the rumbliest stomach ever. And stomach rumbles aren’t easy to conceal, trust me. It’s a bit unerving for patients when you’re packing an infected abdominal wound and your nurse looks hungry enough to dig in!!  Whether it’s a packed lunch (couscous for dayyyyys) or something you buy when you’re on placement, get yourself ‘mealed up’!

Finally, remember that your life isn’t just about placement. You need time for other things! I like to walk my dog as both exercise and downtime. I know it’s hard not to jump straight into bed with Netflix and crisps (which I have done on many occasions), but try it out! I’m not suggesting you run a marathon (unless that’s your thing), but exercise can help you release stress and aid your sleep. And who doesn’t like sleep???

 

 

 

Wounds, Wonderful Wounds!

I’ve now entered my third week of district nursing and let me tell you, it’s been an adventure. I realized on my first morning that wounds are the majority of the case load-which is perfect! I’ve wanted some hands on wound care experience for ages, and I’m a bit of a gore fan. All the nurses have also been very helpful in letting me get stuck in with the goriest of wounds, and the patients seem to be pretty happy with letting me do that too! After all, its not everyday that you see someone’s foot tendon exposed..

Thanks to this exposure to wound care, I’ve started to appreciate how nursing is an art and a science. The science comes from knowing your stuff. You need to be able to look at a wound  explain how well its healing, and what it looks like. It might be granulated, which means the wound is all red but dry. So the next stage is for the wound to epithelialize, where new skin grows back from the edges inwards.  And then there’s sloughy (pronounced sluth-e) wounds. This makes the wound look all white/yellow, caused by dead epithelial cells and white blood cells. Slough often makes a wound look quite bad. When I first saw one, I was a bit shocked that the nurse wasn’t overly worried!

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Granulated finger wound

The art comes from the practical side; dressing the wound. A lot of patients I’ve seen require their wounds to be packed, as it’s a cavity. This is to aid the healing process, and draw out the nasty stuff. I’ve packed a few wounds now, and its slightly scary but really interesting. The skill comes in ensuring you don’t pack it in too much, as you’ll be pulling it out next time!! (like unwrapping a surprise you weren’t sure you asked for).

And then there’s bandaging. From blue-line to bi-layer, it must make district nurses insanely good at wrapping presents! They can look at a wound and bandage it perfectly. I tried, believe me. I’m not very crafty, but with practice its doable! 

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Fashionable hats and pro-bandaging techniques

If you’ve had some interesting wounds on your placements or have any questions about district nursing, comment on our Facebook page or email us at enhancingplacement@gmail.com. 

 

 

 

 

 

 

Week 2 – DILP Questions Answered!

At the end of my second week working in a Sri Lankan hospital I am pretty exhausted. It’s been a really full on week; my first ever in A&E and it’s been absolutely invaluable. I’ve observed lots of amazing Nursing and care but can’t seem to keep myself from thinking “Oh, that’s not how we do it in England” every time something surprises me.

IMG_7797.JPGAfter last week’s post a few of you had some questions about the DILP and how myself and others went about it. Since I have organized my placement independently I referred to my friends currently working in Andhupura who have gone through Work the World for their DILP about their experiences too. They explaned that they chose Andhupura because it seemed to have a richer culture compared to Kandy and was near the beaches of Trincomalee which is one of Sri Lanka’s best preserved pieces of coast-line with clear blue waters and lots of snorkeling opportunities.

Firstly and often most crucially going abroad for this placement is an expensive undertaking. Going through an agency condenses all the costs however into one lump sum you pay directly to them to organize accommodation, flights etc. this can be paid in installments or in one go but the deadline is a couple of months before you fly. It has been known for people to fundraise to pay for their DILP but none of the lovely Ladies in Andhupura did but we were told by the DILP unit lead to expect to pay around £3000 through an Agency so fund raising may be a very good option.

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Our ECG machine – complete with metal suction cups

Since I organized mine independently it cost a lot less, around £1500 for flights, accommodation, visa’s, insurance and the cost of living whilst I’m here. Although recommending someone to go it alone abroad is much like recommending someone to do a home birth without alerting a midwife. It can be super rewarding and great but if something goes wrong – it can be really disastrous.

Work the World have been really wonderful with all the students who worked with them, really helpful and easy to contact which made the whole process very straightforward and stress-free. Also the students (who come from all over and include OTs and Medics) with Work the World all stay near to eachother which is nice to have a little support hub of people all going through the same thing.

People were curious about time off and whether or not we have the ability to actually experience the country and the culture whilst working 37.5 hours a week. We were unanimous in our answer of YES!! 7.5 hours a day with early starts does mean it’s not advisable to be staying up late every night having cocktails at a beach bar but there is always the weekends for that!

I’ve been working 8 hour shifts (excl. breaks) 7-3.30 each day which leaves me a big chunk of the afternoon to do as I please. With a coupe of 12 hour night shifts thrown in I’m finishing placement in 6 weeks (30 days) as opposed to the 7 weeks (33 working days excl. bank holidays) allocated by the university. This means I’ll have a week at the end of my placement exclusively for free time.

I’m lucky enough to be able to stay on for a while after placement is done to travel around the island a bit and holiday with my family and boyfriend which is a really nice goal to aim for when I’m missing home.

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“Difficulty walking, slurring speech, brain stem stroke”

The language barrier can be frustrating at times but all medical terms are spoken and written in English so you can spot quite easily what each case is about. Most of the Nurses I’ve encountered have a good grasp of English so if you ask questions, they will try their hardest to explain. The best thing about working abroad is the independence. You are relying on your Nursing instincts and knowledge, I’ve learnt a lot from my mentors and patients but I have taught them a lot as well. I’ve introduced a new standardized handover tool, which has been saving hours of staff time. I’ve been screenshot-ing and explaining tools such as the Bristol Stool Chart and the SBAR in an effort in increase the use of evidence based assessment tools. The staff are really keen to learn as am I which makes for a really engaging and exciting atmosphere in the ward.

Again any more questions you have about working abroad, working independently or the DILP in general please do comment on our Facebook page or email us at enhancingplacement@gmail.com

Padding out your Portfolio

As a student nurse, you are expected to keep a portfolio/professional profile to remember all the amazing things you’ve done, and it’s a good way to show why an employer should hire you.

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My portfolio baby (complete with an unfortunate stain)

Alongside lots of other things like reflections (see Natasha’s blog post), certificates are a good thing to show how great a student nurse you are. Certificates in your portfolio are the equivalent of gold stars on a chart. You’ve really earned them, and they look pretty.

You can get these wonderful holy grails by attending workshops, training events, and educational lectures through university or placement. For example, a few weeks ago I attended the clinical skills event organized by the HEAL society (Healthcare Alliance). And it was amazing!

Alongside with healthcare related students, we learnt skills such as a swallow assessment, how to use an Ophthalmoscope, Neonatal resus, how and why crushing tablets is necessary, and I got to interact with a simulation man! These activities were chosen because they are quite specialized activities, which you might not normally get the chance to learn about. So events like these give you the chance to get that practice in! Plus, most of them were taught by fellow students (speech & language therapists, ophthalmologists, medical students, nurses and midwives!), and peer education is always great! The free pizza was also a bonus..

It’s super easy to get involved with this kind of stuff- you just have to keep an eye out! Most of the events are advertised through your university email, but they can also pop up through word of mouth. So idle chit-chat with your course mates might just lead to some professional development!

Surviving Extended Semester

You’ve done it, you’ve made it through exams, A&P is over and you’re still standing. Everyone is packing up to go home, Parklife and Pangaea are on BUT; you are a student nurse…

Pangaea is an excellent way to blow off steam and show your creative side making a banging costume

Pangaea is an excellent way to blow off steam and show your creative side making a banging costume

Before you panic, don’t worry, this doesn’t mean that you can’t go out and blow off some steam with your peers before they go off on sunny holidays. Whilst they’re still there it is essential you make the most of it. Block placement is an amazing opportunity and your first real taster of life as a full-time Nurse, you work a 37.5 hour week and in my case these hours could only be made on weekdays so Social activities were strictly a weekend venture.

It’s a 9 week placement which sounds like forever, 315 hours total, it is daunting but I say this with complete honesty that it completely flies by. Once you get into the swing of your new placement its such a breeze, you go in, you learn, you experience such amazing and interesting things and meet such vibrant characters and help people when they are feeling their most vulnerable. You may get home exhausted but then Netflix is always there for you.

It is tough seeing your friends from other courses posting photos on Instagram of their tanned legs on some beach in Greece, when you’re spending your evenings washing your uniform, making your packed lunches and binge watching Nurse Jackie. But each day on placement you will learn something or experience something new so use this time to REFLECT.

Even Mulan struggled with reflections

Even Mulan struggled with reflections

By reflect I don’t mean gaze out of your window staring into the middle distance and contemplating how much fun it was pulling out 30 staples from a patient’s abdomen. I mean put pen to paper and get some thoughts down about your day in practice. Everything goes in your Portfolio and is valuable to help document your progression through the course and is really helpful to consolidate in your head what it is that has happened in that day.

Think of it as a more professional diary. If you don’t like what you’ve written, don’t put it in the portfolio but even the process of taking your experience and working through the Gibbs reflective cycle can be really rewarding and entertaining. Also the more reflections you have he more you can show off to your AA and just look generally impressive to everyone and keeping yourself busy when you get home makes each day go faster than the last and before you know it you’ll be posting those photos on Instagram and enjoying a well-deserved rest.

My greatest struggle during placement in the community: ANTT

The one thing I found most difficult when working with the district nurses was understanding how to manage cleanliness and sterile fields when dressing wounds. You may very well hear a range of different view points about what is acceptable practice for Aseptic Non-Touch Technique (ANTT) in the community. On my first day, the nurses felt compelled to drill into me the idea that we were working in someone’s home and that ideal ANTT procedures are not always possible. I imagine most university students are as uncomfortable as I was having just come from clinical skills demonstrations that offer a perfect situation for ANTT.

Disposable_nitrile_gloveHowever, often the practice I saw was unnecessarily hurried and avoided maintaining proper ANTT because of time constraints rather than an established lack of opportunity. Some homes we visited were rather cluttered and very dirty and the lack of a reasonably clean surface to set the sterile field on was a challenge. Even so, there was often a tendency to forget to keep the sterile gloves sterile by not reaching in one’s pocket to get out a pair of scissors (when a fresh pair of sterile scissors should have been used). Some DNs would explain that even though they were using a sterile dressing pack, that the procedure was a ‘dirty’ procedure that did not require they maintain the sterility of the gloves. But practice and opinions differed so greatly from nurse to nurse and patient to patient that it became very difficult to get a sense of what was good practice and what was poor practice. By the end of my first week I had seen the same patient three times and observed three relatively different ways of approaching the ANTT needed for that patient’s wound dressing. Some DNs went to great lengths to explain their motives and others became angry when questioned about their choices during the ANTT procedure.

All I can recommend is that, if you start to feel uncomfortable about how ANTT is being used, read, read and read some more about ANTT. Get a very clear idea in your head about what it is for and why we do it. If you understand WHY we use ANTT, then chances are you’ll be able to evaluate the situation for yourself and come to your own conclusion about whether the patient was kept safe from infection during the procedure.

I feel that unfortunately, working on one’s own day in and day out can lead to poor practice creeping in. When no one’s watching, I worry that there is a tendency to let standards gradually slide and forget why you were using ANTT in the first place. Some DNs have thanked me and told me that they are glad to have students along because knowing a student is watching reminds them to make certain their practice is of a high standard and that student questions make them reflect on their own actions. Other DNs have told me that they think I am rudely questioning their practice that that I should remember my place as a student.  Be prepared to encounter both attitudes from practitioners, but never stop thinking about what is and is not good practice.