International #hellomynameis Day

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.

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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).

6csSome 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.

 

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.

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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.

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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.

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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!

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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.

Pressure Sores 101

One of the most common nursing buzzwords- pressure sores (AKA pressure ulcers). They can be developed by anyone, and in a wide range of places on the body. As nurses (student or not!) it is our responsibility to report, treat and prevent them.

What is a pressure sore?

A pressure sore is an area of skin that has been deprived of oxygen, due to continuous pressure. This prevents the area of skin getting enough blood, causing the skin to “blanch” (become white due to lack of blood flow). This can then develop into varying degrees of tissue damage; ranging from grade 1 to 4 depending on the severity (NHS Stop the Pressure, 2009).

Grade 1-  skin is intact but blanching, may be some heat/oedema as well 

Grade 2- partial thickness skin loss, looks like an abrasion or a blister. 

Grade 3- full thickness skin loss, some fat may be visible. Possible ‘undermining’ or ‘tracking’ as there is usually depth, depending on the location. This depth can sometimes be covered by slough, which needs to be removed before proper grading can take place. 

Grade 4- full thickness tissue loss, with exposed bone or tendon. There tends to be undermining or tracking, depending on the location. 

Where do they crop up?

Areas that have a hard bony prominence are at risk of pressure sores. This is because they have the least amount of skin protecting itself.

What factors lead to a higher risk of pressure sores?

There are many factors that increase the risk of pressure sores:

  • poor circulation – this could be caused by kidney problems, heart diseases or diabetes.
  • reduced/no mobility- it doesn’t have to be long term! even short term loss of mobility (e.g. after an operation) leads to a pressure ulcer risk.
  • friction- this is where good practice comes in. People who transfer frequently between bed-hoist-chair or just bed-chair, and being moved up/down a bed are at risk. This is why we use slide sheets!

How can they be treated?

  • regular re-positioning/ turns are vital! This helps distribute the pressure, and reduce the risk of the pressure sore from getting worse. You must assess whether the patient is able to do this themselves, or if they require help. Asking the patient (if they have capacity) is always best.
  • pressure relieving devices such as airflow mattresses or pressure cushions can be obtained through physiotherapists, occupational therapists, some trusts require nurses to send the referrals (depends on the area).

  • regular cleaning of the area. Special washes can be used such barrier creams or sprays like ‘Sorbaderm’. This is especially useful for pressure sores on the buttocks/sacrum as they are subjected to lots of moisture.
  • dressings! There are a wide range of dressings which can be used on pressure sores, those that have foam are good for extra protection.

 

How can they be prevented?

Similar to the above treatment! Encourage your patient to mobilize frequently (if possible) and explain the reasons why. Those who are at risk will be identified by their Waterlow Score (10+). If in the community and the patient has carers/relatives helping with their care, speak to them and ask them to update you on any concerns re: pressure sores. Completing bodymaps whenever a new patient arrives and update it regularly is also important. This allows you to assess the patient’s skin integrity, and keep an eye on any possible developments.

 

If you have any ideas for another ‘101 guide’, please get in contact via facebook, twitter or email us on enhancingplacement@gmail.com.

 

 

“The doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.

Commentary: “If you need anything just use the Buzzer…”

Firstly, I would like to say thank you to Tasha for her thoughts on call buttons. I think this is a very important topic in terms of understanding patient need and attainable levels of comfort.

There is a reasonable amount of research out there exploring patients’ perceptions of the ‘busy nurse’ and how this changes their willingness to ask for support as well as what they value in nurse-patient communication (see McCabe, 2004 for an excellent introduction).

I think it is always worth keeping in mind that what may seem trivial to us might be something that is far from trivial to our patients. Taking your slightly colder water jug scenario – to a mobile individual who can get up to get their own water whenever they want and who feels relatively in good health it may be rather trivial to want colder water. But to a patient who may be feeling nauseous, overheated, uncomfortable and is currently bed bound – that cold water may mean a great deal. I realise that it was a comment made in jest but I also think you hit on something: patients are in an unfamiliar and ultimately uncomfortable environment and this discomfort will manifest itself in different fashions and lead to different patient responses.

Hospital stays take patients out of their own environment and place them in close proximity with other patients at a time when some or none of them may be feeling particularly well. Then to add insult to injury we ask them to do things such as have personal conversations about their care and condition or use a commode with nothing but a thin curtain between them and a dozen other individuals. As much as we try to preserve the dignity of our patients and attend to making their experience positive, I can’t help but think how excruciating I would find being admitted to hospital myself. Add to that the fear of upsetting a nurse who has labelled me as calling ‘unnecessarily’ for an ‘outrageous reason’ when my world has been reduced to revolving around the next mealtime, managing my pain and whether I need the toilet or not.

Of course there will be times when we realise we are dealing with a patient who is calling for an element of attention rather than just water. But maybe that attention is just as important in terms of the nursing care that we can provide. Have I reassured my patient sufficiently? Have I answered all their questions? Have I promised to do things previously and then forgotten and hence lost some of their trust in me as their nurse? Have I fully taken their immediate psychological health into consideration as one of my nursing goals for their care?

I would say that there are things we can do during our not-so-busy moments such as making a point of checking in on them rather than waiting for a call button to ring. That little bit of extra support may alleviate some of their concerns and decrease their use of the call button – thus leaving us in a position where we can trust that if the button goes off we know it will be something more serious.

McCabe, C. (2004) Nurse-patient communication: an exploration of patients’ experiences. Journal of Clinical Nursing, 13(1):41-49.