Enabling quality of life in very difficult circumstances, by Kate Plant

19964730_1773600412654889_568888045_nA thought provoking guest blog, second year CYP student nurse Kate Plant shares her experiences and insights into palliative care from her DILP summer placement…


Before starting my nursing degree, I volunteered as a Sibling Support Worker at my local Children’s Hospice. So, I already had some idea about how special these places are. But it was not until I undertook my Elective Placement there that I realised how rewarding a nursing role, in the provision of Palliative Care, can be.

The first thing I noticed was the difference in pace, compared to my previous placements. I was used to dashing around on hospital wards and barely having a moment to drink. So, when I was offered a cup of tea on my first day (half an hour into my shift) I was completely taken aback. But, obviously, there were more significant differences than having the time to quench my thirst. A patient would be allocated both a nurse and a care support worker, on a 2:1 basis, due to the complexity of the patient’s needs. This 2:1 care gave nurses time to listen and understand what really matters to the patient and their family. There was no rushing around. The environment was relaxed. Families would allow a nurse and other staff members to enter their lives in very difficult circumstances and build strong relationships with them. This is where the satisfaction came in.

CYPIn addition, I have by no means observed doctors, nurses and care support workers work together as well as within palliative care. There was no division but instead, a sense of unity. This enabled a pleasant atmosphere to bloom within a setting which, stereotypically, has connotations of being constantly surrounded by upsetting situations. All staff members were part of a team, encouraging a family atmosphere so families were as comfortable and happy as possible. Staff were able to take away a families’ everyday stresses so children and their families could treasure the remaining time they have together as a family, however long this may be.

The thing that struck me the most was the parent’s enormous strength to keep a pleasant face for their terminally-ill child and their other children, in one of the hardest times they can ever face. A parent’s strength is aided through their ability to effectively plan, with help from compassionate and empathetic staff members, any wishes they have in the care their child receives before death. This includes preferred place of care, spiritual and cultural wishes and anticipatory symptom management planning.  With such a wide array of resources available at the hospice (including sensory rooms, adapted garden swings, music rooms, parent bedrooms, bereavement rooms – the list could go on and on) these wishes were almost always met.

TOGETHER_LIVES_RESIZE_800_450_90_s_c1_c_cLast year, the ‘Together for Short Lives’ charity reported a national shortage of children’s palliative care nurses which is negatively impacting on the care provided to children and families. I truly believe if other students and qualified nurses were to gain a deeper understanding and/or even experience how rewarding roles in Palliative Care can be, this could help bridge the care gap. After all, you’ll never regret making a difference in the quality of care a child or young person received, during their last moments of life.

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Suicide is everyone’s business

There were 6, 122 registered suicides in the UK in 2014 (ONS, 2016).

Today is National Suicide Prevention Day. This got me thinking about my experiences of suicide attempts in placement and what I have learned, which I wanted to share with you.

I am a student children’s nurse… I know, suicide in children’s nursing?! Yes, children and young people take their own lives. Notice I didn’t say ‘commit suicide’? Well-spotted. This was intentional. Now, it’s not easy to break our language habits, but I’ve found that a good start in communicating with people who have attempted suicide (or any vulnerable person, or, well… people) is to think carefully about what I’m saying. The word ‘commit’ is commonly used in reference to criminal activity, which ties it to negativity, so I prefer not to use that word. I recognise I used the word ‘attempt’ above. Is this word associated with failure? I don’t know. I’m still learning.

During my time on placement, I have observed how well staff respond to these children and young people in a clinical sense, and how they are still learning how to provide emotional and psychological support.

My first experience was with a young person with diabetes who intentionally missed insulin doses and miscalculated insulin doses in an effort to end her life. The nurses were open about their discomfort in communicating with her. I respected their honesty and, from this point, made it my objective to build my knowledge of communicating compassion in these situations. I started by sitting and talking with her. More importantly, I listened.

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Fast forward a few months and I am with a girl who has taken an overdose on the ward. This was an emergency. The charge nurse raised his voice and forcefully asked what she had taken. She stayed silent. Another student and I took a different approach. She held her hand and I asked people to stand back.

We introduced ourselves, explained she wasn’t in trouble and that we cared about her.

Somehow, we got to a point where we were singing and dancing to Justin Bieber in her bay, with the curtains closed enough to give her some privacy and open enough for staff to monitor. We listened to her and gave her our time. She disclosed to us what she had taken and she was treated. She was referred to CAMHS (Child and Adolescent Mental Health Service). She thanked us sincerely.

Following this incident, I asked staff which they felt was the best approach, given it was an emergency. Opinion was divided. What do you think?

I could write on and on about suicide prevention, but for now I have listed some of my top tips:

  • Refrain from judgement. If you can admit to yourself that you can be a little judgemental, that shows great level of self-awareness and highlights an area of self-development. For now, try to disguise your judgement. Think about how eye-rolling, tutting and slumping your shoulders whilst turning your back (yes, I have observed these in practice) could make somebody feel – Remember the first standard of the Code ‘treat people with kindness, respect and compassion’
  • Actively listen. Show you’re listening; make eye contact, nod with understanding…
  • Sometimes there are no ‘right’ words, but think about how your language could make someone feel.
  • Don’t be afraid to ask. ‘Are you feeling suicidal?’ ‘Would you like to talk?’ ‘Is there anything I might be able to do to help?’…
  • Don’t make promises you cannot keep. If you feel someone is at risk, make it clear you will need to share information confidentially with appropriate colleagues/services.
  • Know who to refer to and what support is available. You are a student, so at this stage it would be your mentor you would raise concerns with, but learn trust safeguarding policies and national and local services. Here are some resources to get you started:

SamaritansMindStamp Out SuicideMaytree, Male-specific: The Calm Zone,

Young People: Papyrus, Children: Childline

  • Be open to learning ways to help vulnerable people who are considering suicide. One small action you make could save somebody’s life. Keep learning. Keep reflecting. As always, I recommend Twitter as a useful starting point:

#WSPD16 #WorldSuicidePreventionDay #ItsOkayToTalk #TalkThroughTheTaboo

Suicide is everyone’s business and you can make a difference.

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.

pincer grasp

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!

What a difference a year makes…..a message to those starting uni in September

This time last year I was 2 weeks away from packing up my beautiful little counselling room and walking away from a career which I had worked in, enjoyed and become competent in for 15 years and I COULDN’T WAIT!

office-1Don’t get me wrong I loved….LOVED being a therapist and in some ways it defined me but I had pondered long and hard about the decision to change careers and it had been an exhausting slog getting to the stage where I felt confident to finally end my practice and leap into this new world of placements, essays, exams, university life, uniforms, night shifts, long days, hospitals, babies, women, families, doctors, midwives, HCAs, colleagues, blood, faeces, vomit, paperwork, paperwork, paperwork and STRESS but I was ready I WAS READY TO GO …or at least I thought I was!

What would I say to me this time last year:

“read everything you want to read which isn’t midwifery related because in a year you will feel guilty every time you pick up a non-midwifery related magazine/book”

“knit what you need to knit, sew that skirt and dress you’ve been desperate to get on with and RUN for hours in the evening when the kids are in bed whilst you still can as that time will swiftly become ‘study time'”

“play with your sons, read with your sons, cwtch them at bedtime and in the mornings before school because these are times you won’t be around for and you will be intoxicated with guilt for all the times you could’ve done this and didn’t. Enjoy taking them to school and picking them up as this will soon become a treat not a chore”

“go and visit your parents and explain to them that the next three years are going to be tough and you will work weekends and when you aren’t working weekends you will be studying over weekends as you have worked all week and yes, this is dreadful as dementia is slowly taking your dad away but drink him in now, absorb him and how he is in 2015 as 2016 will bring a bit less of him”

“go out with your husband-he’s a good, decent man and over the next 12 months he is going to prove time and time again that he can and will step up and be both parents to your sons and keep the kids fed, the house clean, the washing basket empty and the animals fed and you sane(ish) despite you doubting his ability to do any of these things at this moment in time”

“invest in the right people. You have amazing friends in your life, some will still be around this time next year and some won’t-friendships have seasons but you will meet the MOST amazing friends on this course and, along with a couple of decent friends already in your life, they will hold you and wipe your tears and tell you that you can do this despite you truly believing, in your soul, you have made a massive mistake. The friends you make over the next couple of months will be your ticket to making it through the next 3 years and hopefully the rest of your career because your midwife sisters are the ONLYpeople who truly understand what it takes to make it through this career choice. It is HARD but MY GOD it’s worth it”

“and most of all EMBRACE every opportunity….you are going to be scared at times, really scared; you’ve been really scared in your life before and you’ve managed to get through it but this will be a different fear; this is a fear of failure, a fear of actually causing harm because you don’t know what you’re doing, a fear or letting your family down, a fear of letting yourself down but don’t let the fear get in the way of being in the moment and experiencing every opportunity that comes your way because this job you are training for, this career, this vocation is a gift and a privilege and NOTHING that precious comes without a price”

Would I have heeded any of this advice….NAH! I was too excited but it’s nice to look back on and reflect!

To those about to start university-yes you’ll have doubts and you will probably cry and wonder if you’ve done the right thing at points over the next 12 months (& beyond I would guess!) but always force yourself to go and do your next shift as you just never know what might happen on that shift that confirms you’ve done the right thing! Plus-if you need support its there don’t be alone in your worry.

 

Learning Curve

Your first placement as a student nurse is meant to give a taster of what your career could be. It’s designed to inspire, help you find your feet and learn some of the basic skills. So what happens if that’s not the case?

There is a known fact amongst student nurses/midwives that everybody has a bad placement, whether that means it’s too intense, not what you expected, or not as exciting as you hoped.

For me, it was very much not what I expected. I was placed on an outpatients’ department. It was incredibly diverse in that I worked alongside many different healthcare professionals and was able to observe a wide range of clinics- which all helped my A&P knowledge a lot! But apart from that, I felt a bit shortchanged. Whilst all my colleagues and friends were off being thrown in at the deep end, I was endlessly calling patients in and observing doctors’ clinics. This wasn’t exactly the way I saw my first experience as a student nurse panning out, and I felt completely hopeless. Fellow students and staff would give me a look of sympathy and tell me it gets better when I told them where I was. I would dread going there, because I wasn’t being challenged. I felt that my time wasn’t being spent in the best way possible.

The best thing to do in a situation like this is to make the most of it. It’s hard, I know. You think “what could I possibly get out of this” but you’d be surprised! A placement like this is a great chance to brush up your knowledge, and it’s fabulous for reflective accounts! I have spent countless hours observing every moment in a consultation, thinking about what went well, what could have been better, and how I could improve that when I am put in a similar situation. You’ll also spend a lot of time talking to patients, which can make all the difference to them. A memorable patient for me was a young woman with a rather excitable young child came into the clinic. I played with the child (using only a curtain, which I’m quite proud of) whilst she discussed her medical problem. When she left, she thanked me so graciously that I knew I’d done her a huge favour. Its moments like that I have to remember that nursing isn’t all exciting stuff and clinical skills. Sometimes it’s about those moments when you make someone’s life just a little bit easier.

 

Note: if you ever feel unsure about your placement, no matter what the problem, talk to somebody! Whether that be your mentor, PEF, friend, AA or another member of staff. Someone can help.

Receiving cars…. receiving babies..

Receiving cars to receiving babies…. its a funny old life

 

cars

During the last few days on my delivery suite placement I’ve started to experience a strange surreal feeling. Last week I was stood in theatre observing a beautiful c section birth and I zoned out momentarily.

I zoned out to my previous life, I zoned out to my customer service 9 to 5, I zoned out to reports, targets, receiving keys, checking cars, answering phones.  ! BANG ! Back in the room! I’m here!!! I did it!!! I’m stood in theatre as a student midwife experiencing the start of someone’s life, experiencing the wonder of what we can create, experiencing something that is so so precious!!! Being able to share this wonder with families, from all corners of life.

 

recieving cars

The night before every shift I have a funny mix of excitement and anxiety, I pull up to the car park and sit there momentarily wondering what the day will bring, I used to have the same feelings in my old life but the difference is I get to see the most amazing things ever! I get to support women when they need support the most, I get to develop friendships with families nervous and scared waiting for what is to come, I get to work with midwives, the most underrated profession.  A profession that deals with everything you can think of. How lucky am I!

So I ask myself, was it worth it?, the studying, nights of worrying about my applications, getting that dreaded ‘something has changed’ from UCAS on my email, the endless preparation for interviews, maths tests, essays, english tests, group interviews, one to one interviews, the cycle goes on and on!!  Yes it is worth it, never give up, I thought I was too old and past my prime to start this amazing journey, with 3 children, a house to run and the general everyday rubbish that comes with responsibility I thought I didn’t have a chance, the lovely ladies I met at interviews out shone this ageing lady with a little tribe, by luck or miracle I was offered a chance and I took it.  This time last year I was on cloud nine, I remember finding out in work I had got in, I started crying, blubbering in the office, everyone looking bemused at me!!  I drove home that night in disbelief,really me???????????!!!!

shocked face

 

So do i miss my old life?

Receiving cars or receiving babies…..

No contest!!!!!

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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.