Relatively speaking…

Although – thank goodness – not everyone will have had the opportunity to experience being the relative of someone in hospital, it definitely helped me learn a great deal about speaking with the relatives of my patients.

I am also very grateful to my mentor at the time for helping me to extract the learning out of my experiences on the other side of the nurse-relative relationship. Without her prompts to reflect on how my time as a relative had changed my perspective on nursing, I may have let valuable opportunities for understanding and growth go by the wayside.

talking

Immediate family, carers, distant relatives, friends – some people may find communicating with them extremely daunting at first.

I was very nervous on my first placement. What if I say something I shouldn’t or give incorrect information? What if they are unhappy about a student helping to care for their loved one? What if they ask me tonnes of questions I don’t know the answers to? What if, what if, what if…

I know it sounds corny, but I always remember this line from the crime drama Cracker.

“People say nothing…cos they’re frightened of saying the wrong thing. But it’s better to say the wrong thing than nothing at all.”

Now of course this doesn’t apply for absolutely everything, but on the whole, I feel you’re more likely to do damage by staying quiet than you are by trying to engage with relatives.

It gets better. The more comfortable you are in your environment the better you will feel about speaking with confidence. Focussing on listening, rather than talking, makes conversations flow so much more easily. And although that might seem obvious, when you’re nervous and uncomfortable it is simple to accidentally keep talking when you should be listening.


I have a few take home messages from my experiences as a relative caring for a family member who was in intensive care after a major emergency operation:

  • Introduce yourself clearly, make certain your name badge is visible. Try to say your name at least twice.

I tend to say, ‘Hello, my name is Heather. I’m a student nurse and I’m helping to look after ___ today.’ At the end of the conversation I make sure I say my name again and touch my name badge to draw attention to it, ‘So, yes, I’m Heather and if you have any (more) questions I’ll be around.’ It can be a bit awkward saying your own name over and over, but as a relative you can feel quite rude not knowing nurses’ names but many don’t make it easy for relatives. Wearing your name badge/card on a lower pocket, turned backwards because you don’t like the picture of yourself or not wearing it at all can be hugely irritating to relatives who want to start a conversation. Remember, they will have other things on their minds and remembering a raft of new names will be the last thing on their to-do list so don’t make it any more difficult for them.

  • Ask, ask and ask again if the relatives have any questions.

It can be very upsetting not understanding what is going on. What is this tube or that tube for? How are they eating? When will they walk again? What will their life be like in 1 week, 2 weeks, 3 months? Although some of these questions can be answered and others cannot, letting people ask them and doing the best you can to answer gently and honestly will help. And don’t just ask once and assume they’ll never have any questions again. Ask when they come in, ask when they’re leaving and ask every time they visit. Don’t just assume they’ll get your attention if they want to ask something. I spent a great deal of time battling silently with myself thinking, ‘I want to ask (y) but it seems rather trivial and I already asked about (x) but I hadn’t thought of asking about (y) until just now and I don’t want to be a bother as I know they’re busy but…’.

  • Make yourself available.

Stay close, make eye contact every once in a while and don’t be afraid to interrupt and just check if they have any questions or need anything. You don’t need to hover right over them, but some nurses have a tendency to completely disappear during visiting times which can be very disconcerting for relatives. I’ve also watched nurses expertly avoid eye contact with relatives when they were walking past to avoid engaging.

  • Everything revolves around making certain that relatives feel they can trust you to do the best for their family member.

It’s very easy to start to worry that things about your relative aren’t being noticed and that their care is being communicated poorly throughout the team. From the point of view of a relative I can tell you that care can appear very fragmented. A different nurse on every shift, different doctors stopping to chat with patients, different physio teams coming every day. When you’re trying to talk to your relative about the care they are receiving and they have no idea who anyone is because no one has introduced themselves properly or informed you or your relative about any plans for their care, you start to lose trust in the healthcare team. When this happens, your first port of call is usually a nurse on shift. If that nurse is no where to be seen or avoiding eye contact with their name badge turned backwards, it makes everything feel even more poorly managed and inaccessible.

Advertisements

Incontinence IPL – So good I just couldn’t hold it in!

Last week I attended an amazing IPL (Inter Professional Learning) seminar all about continence issues across the age span. First I’d like to highly recommend going to as many IPLs as you can as they offer a really useful insight into specialist areas of nursing, you may not realise you have a particular interest in. Continence may not be a topic that particularly grabs you but having spent a fair few hours on a gastro ward I have experienced up close what its impact on a patient can be.

All the goodies

All the goodies

The continence specialist nurse who spoke (let’s call her Liz for confidentiality’s sake) truly was a specialist. She brought a whole table-full of gadgets and aids available through the Trust to help patients both in community and in hospital with continence needs. It isn’t uncommon for continence issues to arise following a hospital stay as patients catheterised for a prolonged period of time can have depleted control of their urethral sphincter. This has led to a worrying culture of nurses in hospital and community thinking that incontinence is just a symptom of old age. THIS IS NOT THE CASE. If a patient is losing control of their bladder or bowels there are things that can be done or services we can provide, like consultations with specialist nurses such as Liz.

There are dozens of conditions that can lead to continence issues and they don’t just affect the elderly!! Stress incontinence or urge incontinence can affect anyone at any age, for example urinary incontinence is quite common directly following vaginal birth especially traumatic births involving use of forceps or indeed vaginal tearing (this however should not last longer than a day or two).

Did you know a large pad can absorb 500ml of liquid in under 10 seconds?

Did you know a large pad can absorb 500ml of liquid in under 10 seconds?

The best solution we have to continence issues is to try and avoid them ever existing. Pelvic floor exercises for example only take a minute or so and can be done anytime, anywhere. In fact I’m doing them now as I write this post. Strengthening your pelvic floor allows better control of your bladder and a better sex life – according to Liz. Taking good care of your bladder and bowels with a healthy diet, plenty of fluids and regular strengthening should be far more commonplace than it is because, believe me, you’ll miss them when they’re gone.

Carers; the only people who know more than Surgeons… but don’t tell the Surgeons that

Regardless of which field you are in you will come across a Carer in some capacity, even if sometimes they don’t realize it themselves. These Carers might be parents, daughters, sons, lawyers or accountants and occasionally they’ll be professional full-time Carers. Despite their occupation or relation to the patient, they should be regarded as the experts they truly are.

Their specialist subject is your patient and they could be the most valuable resource you have into how best to proceed with that patient’s care. A really common and incorrect belief is that Carers are only present with patient’s with Learning Disabilities. THIS IS NOT TRUE. Often people with Carers will have full mental faculties but require assistance in one particular area for example. More often than not, this is the area which requires treatment.

For example elderly patients often struggle with Stoma care; the task of its maintenance often falls to a family member or spouse. So when you ask the patient “Has your stoma always been this active?” and they nod along, not wanting to make a fuss, have a look at their Carer or relatives!

Equally with wound dressings, bowel movements, bladder control or memory loss particularly, a patient is often unaware of any changes if they have someone looking after them.

A Carer or relative can be a treasure trove of vital information that will lead to both an easier shift for you and a better outcome for the patient.

If they say they have complete continence, yet their significant other is looking doubtful ASK, it will save more than just a clean set of sheets in the long run.