Finding your feet in third year: a lesson from A&E

*Disclaimer: this post includes description of a traumatic situation which some may find distressing* 

When I started 3rd year, I was excited! I had a fantastic end to second year, and I truly felt ready to enter my final year of my degree. But with that excitement came the endless worrying about jobs, dissertation, and work for other modules. When placement began, I realised I felt like a complete novice again! Despite only having two months off over summer, I felt like I couldn’t remember how to do anything on placement (clinically speaking). I was even putting on blood pressure cuffs the wrong way. Everyone asked me what year I was in, and saying “I’m in third year, but I don’t know what I’m doing” every time was ruining my confidence.

It wasn’t until my 5th shift when I finally started to feel less on edge. I was working in resus (for the most critically ill patients in a&e), and we had an man with chest pain and fluctuating consciousness. Since he was in a bad way, a few anaesthesiologists from ICU came to set up mechanical ventilation for the patient. It was really fantastic to see everyone working together almost seamlessly, and including me in their decision making. I was given little jobs such as getting supplies or checking the observations but it was all I could really help with at the time. After a very long trip to CT, it was clear our patient was deteriorating. As soon as he was back in resus, our patient went into cardiac arrest. The nurse I was working with asked if I had done CPR before, and if I wanted to get involved. To my own surprise, I agreed. I have been learning CPR for well over 5 years now, so I knew that I could help in some way. Each person did 2 minutes of CPR, whilst keeping an eye on the defib heart monitor. Due to the patient being on a hospital bed, we all had to stand on a stool in order to reach, which I found really bizarre!

I wish I could accurately describe the feeling of trying to save someone’s life, but I can’t. There was so much adrenaline rushing around me, but all I kept thinking about was how I was currently involved in the worst day of someone’s life.

During CPR, the doctors confirmed (through an echo-cardiogram) that there was nothing left we could do. Myself and the nurse went to work on ensuring our patient was at peace, and ready to be seen by his family. They were in shock and declined, which I understand. And our day went on. I had a debrief with the nurse, and a HCA who had also performed CPR for the first time, which was lovely. We spoke about how CPR is so different from how it is often portrayed. I had never thought about the fact that you won’t be able to reach a patient without standing on a stool, or how someone must time each session of CPR.

Despite being a high-pressure and sad situation, it helped me a lot. I did something I had never done, but had extensively prepared for. If you feel like you are back at square one, despite being a third year, I challenge you to think about what you do on placement. I think there is a tendency to see progression as acquiring new skills, but sometimes its about putting our current skills to use in a new situation.

 

 

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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