Student midwife information services-From an educational and practical perspective

I seem to live, breath, eat and sleep midwifery!  Last thing before bed and the first thing I do in the morning is read the latest updates from Elsevier, Midwifery Journal, RCM, MIDIRS the list goes on!!!

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No amount of reading can ever be enough as a STMW.  As students we are adult learners, responsible for our own learning, expected to keep up to date with current research, information and clinical guidance.  There is so much to midwifery, I never truly appreciated the enormity of my vocation before starting my journey.

Information services are invaluable for our learning.   I am subscribed to many different learning tools and organisations.  One information service I find particularity invaluable is MIDIRS.

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‘Our Mission:
To be the leading international information resource relating to childbirth and infancy, disseminating this information as widely as possible to assist in the improvement of maternity care’ (MIDIRS 2016)

MIDIRS is an information and resource service for midwives and student midwives, keeping in touch with the latest up to date midwifery knowledge and research, hot topics and articles in midwifery as well as having an in-depth database of research.

‘MIDIRS – or the Midwives Information and Resource Service – is a not-for-profit educational charity providing effective information resources that help maternity health care professionals or students succeed in their professional development and studies.’ (MIDIRS 2016)

Publishing a journal/digest quarterly of the latest research studies and news so you can always rely on the fact the information in the journal is current and reliable information you can use in your studies.

Upon starting my degree I went out and bought umpteen midwifery textbooks, although my course requires me to use this literature, journal and database use is seen as extremely favourable by the university as it shows initiative, breadth and depth of knowledge and passion.  I strongly recommend any midwifery student or nursing student to use current databases and journals to keep up to date with your subject area, I find these invaluable to my practice, learning outcomes and knowledge as a STMW.

 

 

 

 

 

 

 

Call the Midwife- I need a pinard!!!

Pinard’s- Funny horn like instruments that remind me of a trumpet.

Pinard’s- what are they? Pinard’s- why call it that?

These are the questions I first asked myself as a fresh 1st year shuffling through my clinical skills book. They want evidence of antenatal assessment using a PINARD!! 😇

Once I got into antenatal clinic I was introduced to the pinard, ahhhhhh I thought…. Call the midwife!!!! I reminisced back to the series, scenes of the nuns and midwives using these funny shaped horns , pressing into a woman’s bump to hear the baby’s heart beat. Ohhhh!!!!  So what is a pinard and how does it work?

The pinard was once called a fetostethoscope, before the days of the doppler or sonic-aid, midwives would use the pinard to listen for the FH- fetal heart. It was named a “pinard” after French obstetrician Adolphe Pinard.  A pioneer in perinatal and antenatal care, he specialisesed in palpation and fetal activity. In 1895 he invented the “pinard”.

I love the pinard- I see it as a right of passage, an essential authentic midwifery tool that has been replaced by technology.

 

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It amazes me how the midwives of the past used these simple yet effective stethoscopes to keep track of fetal development.

Nothing beats the feeling of actually finding the heart beat of a baby in clinic, I adore discovering the fetal position, listening to the fetal heart and with technological advancements women are now able to hear their baby’s heart too, the sound of a fetal heart is so soothing and it is lovely to see the women comforted by their babies ‘thud thuds’.

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I do however wish the pinard was used as frequently as a sonic-aid, it is a piece of midwifery history that I believe is just as important.  I took my pinard-

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(My pretty pink pinard!! 🙂

to antenatal clinic this week, determined to practice the art!!  When I heard a beautiful beat I was elated!!!  Safe to say I will be taking my pretty pink pinard with me on placement next week, determined to keep this historical practice part of my future practice.

I recommend visiting Sara Wickhams blog about pinard use, Pinard Wisdom – Tips and Tricks from Midwives (Part 1), fascinating read into pinard use.

 

 

5 things I’ve learnt on my first placement 

That’s it – we survived our first placement! One step closer to that blue uniform. I’ve spent the last ten weeks on an elderly rehabilitation ward where the patients are quite poorly, needing help to wash, dress, eat and get to the toilet. I’ve had good days and bad, and it’s been physically and mentally challenging at times. Looking back, I thought I’d share some of the key things I’ve learnt so far:

1. Nursing is messy 256px-research-suggests-women-who-have-a-heart-attack-wait-longer-than-men--221603

…and the bodily fluids are only the half of it! It’s complicated and unpredictable and sometimes it feels impossible to use all the theory we’ve been taught at Uni in practice. There’s no ‘one-size-fits-all’ approach and I’ve had to constantly adjust and adapt to match the needs of each patient, who are all individuals with their own character, ideas and worries. No two days are ever the same, that’s for sure!

2. Healthcare assistants are our best friends

On my first day someone asked me to get a bedpan from the sluice. I literally had no idea what they meant or what I should be looking for – I think I walked round the ward for a good five minutes before I finally plucked up the courage to ask. I had to start from scratch and it was the healthcare assistants on our ward that really helped teach me the core elements of care. I especially loved seeing the way they relate to patients; singing a familiar song to a distressed patient with dementia or taking the time to paint someones nails. They have become invaluable allies and I owe a lot to their patience and encouragement.

3. It’s the little things that count

It’s so easy to get caught up in the long lists of jobs that need to be completed and forget what really matters to the patient. Whether it’s spending time combing someones hair or fetching a fresh jug of cold water, those small acts are what make people feel cared for.

4. Fake it ’til you make it

There have been few nerve-racking moments over the last few weeks; my first bed bath, giving an injection, doing a drug round – but patients can smell fear and I think when I’m anxious, they feel worried and uncomfortable too. Even when I’m nervous and my heart is going 100 miles an hour I now try my best to at least appear calm and in control. Hopefully one day it’ll all be second nature – but for now, I’m just going to have to fake it!

5. It’s down to me to make the most of every placement 

On a busy ward, you can’t spend every minute with your mentor or another nurse but as a result, you sometimes feel like you’re missing out on learning proper ‘nursey’ things. I’ve learnt to ask lots of questions and always have an ear out for anything going on – ‘what’s that? did someone say catheter?’ It can be tempting to watch procedures but one nurse told me not to hesitate and get stuck in – patients are usually understanding that things might take a little longer and can give just as much encouragement.

I hope everyone has enjoyed their first placement and we would love to hear about things you’ve learnt over the past ten weeks – feel free to post on our Facebook page.

Trauma Talk

Witnessing a distressing or traumatic event is something you expect when you start a nursing degree. I remember when we did our Basic Life Support for clinical skills many moons ago, and the teacher made a point of saying “when you need to use this”. I’ve been taught CPR before, and the instructors have always said if. Suddenly realising that you may be the only person to help in a traumatic situation is kind of terrifying.

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I had my first experience a few weeks ago. I was on an optional training course at my placement, learning alongside students and Health Care Assistants. On our way to the next talk, one of the group members collapsed, had a fit and sustained a pretty nasty head injury. Fortunately, there was a qualified nurse on hand and soon enough there was loads of help arriving too (watching 3 doctors run towards you, stethoscopes at the ready, is like being on a TV show). I just stood and watched, and felt completely out of my depth. In theory, I knew exactly what to do. Call for help, avoid getting too close until he’d finished fitting, compress the head wound and maintain his airway- but I was terrified. I like to think that if I was the only person there who could help, I would have done those things on auto-pilot. But being an observer is different, especially since I’ve never seen anything like it.

Once the casualty was taken to A&E, the nurse who was teaching us took myself and another student nurse aside, and asked us if we were okay. She told us that she’d check on him later and update us tomorrow. I felt better after that, plus I still had adrenaline in my system and it was fantastic to see how everyone worked together. But as soon as I finished my shift and I called my dad, it started to feel more real. I suddenly felt really spaced out and didn’t want to go into detail with my friends once I got home. I couldn’t believe that it had actually happened. Luckily everyone was super understanding and gave me my space. My housemate even made me dinner!

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I’m very lucky to live with someone who can make amazing food. 

Everyone listened wonderfully and were really supportive. The next day I was informed that he was doing better, and that was the best news.

The way that people dealt with that situation, and how immediately supportive people were gives me a lot of hope for the future. Nursing is a demanding career, and you will have bad days. But having colleagues, fellow students, lectures/advisers at uni,  family, friends, partners, maybe even a dog to listen to you is amazing. Just keep it strictly confidential! Its these people who you make you strong enough to carry on and get to experience the good days too!

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.

Clinical Skills – From the Horse’s Mouth

Written by David Turner – Clinical Skills Lecturer

The clinical skills teaching facility, Clinical Skills and Simulation Centre (CSSC), has recently been extended to include additional teaching rooms, a home environment room and simulation suite, this is in addition to the existing two principal clinical skills rooms that reflect the hospital ward environment. The CSSC is designed to provide the student with a safe, realistic and pleasant learning environment, and is equipped with all the latest resources required for training pre and post registration nursing and midwifery students in a range of clinical skill, including state of the art simulation training equipment.

The Bachelor of Nursing Programme provides clinical skills teaching in a range of mandatory and core clinical skills. A blended learning approach incorporating a practical session taught in the clinical skills laboratories and/or an online component (accessed in Blackboard) is adopted for each clinical skill.

In addition to gaining exposure to a range of clinical skills the students have the opportunity to develop confidence, interpersonal and team working skills in a safe environment, complimenting clinical skills teaching and experience gained during clinical practice placements.

The clinical skills are delivered over three years; the online Core Skills Framework (CSF) has to be completed prior to commencement of the students first practice placement. The practical component of the CSF: Basic Life Support, Moving and Handling and Infection Prevention and Control, are also delivered prior to the students first practice placement. It is also mandatory that certain Core Skills are updated in years two and three.

Other skills are taught across fields in the first year of the programme; in the second and third years field specific skills are taught with the exception of Enhanced Life Support (incorporating Basic Life Support update) and Moving and handling of People update, these are taught across fields in the second year of the programme.

A range of teaching methods are utilised during training sessions including demonstration, supervised practice, peer supervision and simulation. We are constantly striving to enhance the student experience; recent developments include a dedicated team of staff delivering clinical skills and appointment of a clinical skills technician to optimise the facilitation of clinical skills, resources and the learning environment.

Another recent addition is the online resource Clinicalskills.net that has more than 200 peer-reviewed clinical skills procedures, all in a highly illustrated step-by-step format with links to further published guidance. A link to Clinicalskills.net can be found in Blackboard, Clinical Skills and Core Skills Framework, My community. One way students can use Clinicalskills.net is to prepare for a procedure they are likely to be exposed to in practice, they can print out the procedures and have it available in their practice placements.

We are also currently evaluating a trial of drop in sessions for certain clinical skills, however, I am sure you can appreciate this presents many challenges that are not straight forward to overcome and will limit what drop in sessions we can provide in the future.

David Turner

Lecturer – Clinical Skills

What is a [blank] ward like?: Post 2 – Community Nursing

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Mater Misericordiae Hospital, Brisbane 1914

The first thing I wanted to know when I saw my placement allocation was what on earth being ‘in the community’ might entail. I knew that we would be caring for patients in their homes, but beyond that…

What kind of things would I get to see/do?

What sort of nursing goes on?

What is the day-to-day like?

In this series of posts, I will briefly describe the kind of activities I encountered on each of my placements so far.  Although all placements will have a slightly different set-up and slightly different ways of doing things, hopefully this will give you a better mental image of what you will be walking into on your first placement day.

District Nursing:

My second placement was with the district nurses (DNs) in a relatively deprived area of Greater Manchester. The DNs were based in offices at the back of a local GP surgery. They met here in the mornings before going out to people’s homes and returned here in the afternoons to complete paperwork and get ready for the next day.

 

The patients we saw to primarily needed wounds redressing. Some were short term patients who had surgical wounds that would need the ‘clips’ or metal staples removed in 7-10 days after their surgery. Sometimes these patients ended up becoming longer term cases if there were complications with their wound healing. Other patients were long term/permanent and these often had non-healing venous leg ulcers that needed regular redressing. We also saw patients who were prescribed insulin for their diabetes and needed continuous support with administering the subcutaneous injection. Other less common visits I experienced included post-surgical prophylactic low-molecular weight heparin injections for prevention of venous thromboembolism, line flushing for central lines used to administer chemotherapy, cancer patient comfort visits/check-ups and end of life palliative care for syringe driver maintenance.

 

Our days consisted of meeting at the GP surgery in the morning around 08:30-09:00. If you’ve previously been on a ward that might seem like a late start for nursing, but the DNs would usually make a few visits to regular patients needing insulin on their way into work from home. Once in the office, they would pick up their list of patients for the day that had been allocated the previous afternoon. After reading through the list to see what their day would entail, the DNs would pick up any materials they needed from the store room (e.g. sterile field wound dressing packs, specific dressings they suspected they might want for a particular patient). Then, considering the location of each of the visits, they would decide who to see first, second etc and set off for their first visit around 09:30.

 

Once at a patients home, the DNs would enter and ask for the patient’s notes file that was kept in their home. If the nurse was familiar with the patient and vice versa, they would probably be comfortable with what they were there to do, quickly check the patient notes and get on with the task. If they hadn’t met the patient or perhaps the patient’s status had recently changed, the DNs would take a moment to discuss this with the patient and decide on the best way to approach the visit. Some visits took 5 minutes (e.g. injections), some took 30-45 minutes (e.g. extensive leg wound dressings or cancer care visits).

 

Some days the DNs would have 5-7 patients to visit. Other days there would be 10-15 visits. This depended on patient need, any unscheduled visits (e.g. a patient rings in to say that their dressing has fallen off or they are worried about something and need to see a nurse) and the estimated length of each visit.

 

Once the last patient of the day had been seen, the DNs would return to the GP surgery offices to complete paperwork before finishing. This included filling in patient visit details on the computer, checking emails, responding to any phone calls that had arrived while they were out, obtaining/writing any prescriptions for dressings necessary and faxing this information to the pharmacy.

 

Sometimes, the DNs would have ‘clinic appointments’ in the afternoon at the GP surgery. These were for patients who were transitioning from being housebound to being more mobile but who still needed nursing attention for say wound dressings. Asking the patient to come into the surgery, where possible, encouraged them to mobilise and become more independent. It also meant that the nurses could save on travel time and complete their paperwork in between waiting for patients to arrive for their clinic appointments.

 

Again, every community team is slightly different, but in general, these are the kinds of activities that will be going on around you. As always – be sure to get involved as much as possible!

 

See here for a blog post on the use of Aspetic Non-Touch Technique (ANTT) within the community.