Handling complaints: what I never learnt as a waitress

I have never been good at receiving complaints. Before I started my nursing degree, I worked as a waitress for 5 years. It was not uncommon to deal with customer complaints on a daily basis, and I would always just say “I’m really sorry about that. I’ll speak to my manager” which was always a fail safe. 98% of the time, the customer didn’t want to speak to me anyway!

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Accurate picture of me listening to customer complaints

But that changed when I started my nursing. Suddenly, whilst trying to make small talk with patients, I was being confronted with complaints about care they had received in the past or at that very moment. I couldn’t get away with my usual spiel because care complaints are more specific, more personal. You have to say something, and sorry doesn’t quite cut it.

I remember, very vividly, the first time I saw a nurse deal with a complaint efficiently. The patient in question was raising her concerns about the referral system for district nurse visits after a stay in hospital. Her care had been delayed due to this. The nurse I was working with listened to her very carefully, occasionally (when appropriate) asked for more detail and did not seem flustered at all. She then thanked the patient, said she would follow this up but urged her to voice her complaint at PALS.

PALS stands for Patient Advice and Liaison Service. It is confidential, and designed to provide support for patients, relatives and carers.

I was amazed at how calmly the whole situation went. Although the patient was upset initially, she was clearly at ease by the end of the visit, and I felt it was due to her being able to voice her opinion. And she was actively encouraged to talk about her concerns as Image result for complaintsit helps the NHS grow as an organisation! And it inspired me!

Since this event, I feel as though I have been inundated with patient complaints. Sometimes I feel as if there is a secret sign on my head that says please voice your thoughts at me!. I have now had endless practice at being calm and friendly, with some situations leading to me having to be a little firm (I will not be shouted at). I find that listening a lot, speaking barely at all, seems to work. Asking them to expand, answering questions when needed, and most importantly not denying their claims. It is extremely important, I think, to acknowledge that not every care interaction is perfect or goes to plan. We must embrace feedback, negative or not! Whether it comes from a staff member, a patient or a relative; complaints should be listened to!

Always speak to your mentor or a staff member about a patient’s complaints. 

Community Matrons; the role we need

I bet you’re thinking, what is a community matron? It sounds very official and a bit scary…but you couldn’t be more wrong!

Within the community healthcare team, there are a wide range of roles. I am currently based with the district nurses (can you tell I love community yet) and I wanted to see how it all fits together. I had never heard of the community matron role, until I met my placement’s local one. She gave me a really fabulous explanation of her job, and I spent two days with her!

Community Matron’s are the Advanced Nurse Practitioners in community. They work alongside the GP’s, District Nurses, Social Workers, Occupational Therapists, Physios etc. to ensure that more vulnerable patients living in the community do not end up in hospital needlessly. Using their amazing medical/psychological/social care assessment skills, they are able to provide support for patients with chronic conditions such as *COPD or heart failure. This is an absolutely fantastic, and much needed role, within the community. They provide extra support to all the healthcare professionals in community.

Whilst working with the community matron, I got a really good idea of what there job is. It’s a very diverse job! One patient we met, the wife was concerned about her husband’s medication. As the main carer, she felt as if not all the medication was necessary and did not understand the need for them. We were able to sit down and have a long discussion about the home environment, how they are coping, and of course review the medication. At the end of our visit, the patient’s wife thanked us profusely for helping her understand. She was much calmer, and felt as if her questions had been answered. One hour made a huge difference to herself and her husband!

Another example was an elderly lady who had *COPD and recently had a chest infection. The community matron ensures that this lady, as well as many other patients with long-term conditions, always have antibiotics in the house, and teaches them to recognize signs of a chest infection. This means the infection is dealt with quickly, it encourages self-care, and reduces the potential stress on GP and A&E services! During our visit, the matron taught me how to listen to chest sounds and undertook basic observations. This is to keep an eye on the chronic conditions her patients suffer from.

This is only a small insight into the work of community matrons, and I could easily sing their praises all day! Personally, this is what integrated care should look like.

I would wholly encourage anyone, no matter what stage in your training, to get a spoke with a community matron.

 

 

 

*Chronic Obstructive Pulmonary Disorder

The joy of community nursing

Community is often painted as marmite- you either love it or you hate it. But is that strictly true? Surely there is something about every placement that can be enjoyable, and not so enjoyable!  I will first admit that my heart lies in community. I knew within the first few days of my placement in first year that I wanted to work in the community. So I thought I’d make a little list about why it’s just so amazing. 

You have to expect the unexpected! You aren’t in the relatively controlled environment of the hospital, you’re in a patient’s home/room. Anything can happen, even trying to stop the pet dog from jumping on the bed during catheterisation!

It really is community based nursing. No matter what area you work in, you’ll know the people, their attitudes and the roads like the back of your hand. It’s really refreshing to be moving around constantly instead of endlessly walking around a ward or clinic.

Improvisation is key! Can’t find the correct wound dressing? Come across a new skin tear? Can’t access the patient’s house? Better make it up! I’ve seen some amazingly ingenious solutions which I’ve then stored in case I ever come across it again. It’s one of the best ways of learning!

Community nurses can be a lifeline. Many patients you will visit in the community are elderly, some of which are very isolated from society due to mobility issues, lack of family or the fact that they live in rural locations. Often, community nurses are the only people they interact with in the day, and they appreciate their presence immensely!

The patient-nurse relationship is very different! As soon as you enter someone’s home, you are entering their territory and you follow their rules. I feel that this allows patients to have a larger role in care decision-making. It is what holistic nursing is all about.

Community nursing is not for everyone, but never underestimate it’s ability to build up your skills!

If you’ve had a community placement, and you’re feeling creative, why not write us a blog post? Simply send us an email at enhancingplacement@gmail.com. We always welcome new content!

Mysterious midwife? Vs obstetric nurse

So at the end of this week I will have finished my nine week community placement and I am absolutely gutted! 😩

Community to me IS midwifery- community encompasses the entire midwifery continuum. From booking to postpartum the community midwife is highly skilled in all areas of midwifery. For those who are unaware of what a community midwife does an average day from personal experience is a full antenatal clinic dealing with a wide range of medical, social issues, recognising safeguarding problems- including domestic violence, mental health problems, poverty amongst many many more.

Postnatal home visits, parent education, meetings with multidisciplinary agencies, phone calls from colleagues, anxious women, the hospital…. the list goes on!!!!!!!

One of the most beautiful amazing things we get to advocate in community is homebirth. Indeed research tells us that giving birth in the comfort of your own home with your family, partner, home comforts round you increases oxytocin- the hormone of love, childbirth, bonding and feeding which will therefore lead to positive outcomes. Of course some women are not suitable and we throughly risk assess all women in our care at booking to determine plan of care for delivery, providing the woman with the most upto date evidence based practice.

Of late, being an avid tweeter I have become increasingly alarmed by a small but growing consensus of people who believe midwifery has no place in contemporary society. These people believe it to be an ideology, a fantasy, a dream concept. I was very disturbed to read one post attacking midwives for our quest to promote normal birth as being for our own selfish gains. Believing that promotion of normal birth, home delivery to be nothing more than a ridiculous ideology that no longer features in a medicalised world.

This is the very reason why I feel midwifery is not just underrepresented but STILL in 2017 the average joes’ knowledge of childbirth and maternity is so poor that it is very easy to whip up so much negative hype- particularly on the back of terrible tragedies such as morecombe bay.

Why is childbirth seen as such a mysterious entity??? Why compared to most industrialised countries do we have abysmal breastfeeding rates?

Who do we blame for the increasing trend towards the medicalisation of child birth and the entire maternity care package?

Its somewhat of a wicked problem but all I know is the role of the midwife is to show care and compassion, to recognise deviations from the norm and REFER!!, promote normal pregnancy and labour. To be a midwife you need to care, care about the woman you are looking after, the baby in utero. Our strive for normality in childbirth proves how much we care! We want the very best outcome for the gorgeous ladies and babies we look after.

So please help spread the word-……..Midwifery is a vocation not a cult!!!!

An Interview with Ian Wilson – Mental Health Lecturer

word-cloud-ianIan Wilson, Honourary Teaching Fellow in the Mental Health Field has given us an early christmas present in the form of this amazing, honest interview about his specialist field – Mental Health, specifically discussing his work in the community with dually diagnosed service users (those with mental health and substance misuse diagnoses). This is a truly insightful piece with some wonderful tips and advice for all fields of Nursing.

ENJOY!!…

 

What do you enjoy most about working in the community?

I enjoy the autonomy of community work. I enjoy being truly collaborative with my service users and colleagues. I enjoy the flexibility and responsiveness that community work offers workers and their clients. I enjoy the equalization of the ‘power balance’ between professionals and service users that community work offers.

What do you enjoy most about working with the university?

Regular contact with students is undoubtedly the most rewarding part of my university job. I welcome the enthusiasm, creativity, professionalism and dedication to mental health nursing that I see students frequently displaying. Because of this student contact I am reassured about the future of my profession and reassured about the future of mental health services.

What do you think is the biggest challenge facing Mental Health Nurses today?

I believe that we MUST maintain and nurture our own professional identity as mental health nurses. We have a unique perspective and a unique therapeutic trust. Both of these things are a huge privilege. We must ensure that this is not diluted.

Even as Student Nurses we can sometimes neglect our own mental health, especially with dissertations looming, what advice would you give students struggling with university stress?

I manage my own stress through regular exercise. I also have a group of friends who I can trust. Some of them are nurses, most of them aren’t. I have different groups of friends for different aspects of my life; my ‘football’ friends; my ‘music’ friends; my ‘work’ friends; friends I’ve known for 40 years or more, friends who have only recently entered my life. I rely on them all for support and encouragement.

How has your role as a Mental health Nurse changed since you registered?

I commenced my career as an inpatient staff nurse (two years). I then moved into community mental health nursing and I’ve done that for 20 + years. During that time my roles have changed and my responsibilities have increased. However, my core values have changed surprisingly little. I would still recognize myself from 25 years ago!

What qualities make a great Mental Health Nurse?

Empathy, unconditional positive regard, honesty, therapeutic optimism, positivity, self-reflection, a genuine interest in other people’s lives, open mindedness, a sense of humour, resilience, resourcefulness, self-reliance.

What made you choose to work with those suffering from drug and alcohol misuse?

I have both personal and professional reasons for working with dually-diagnosed (both mental health & substance misuse) service users. Additionally, I find service users with ‘dual’ problems resourceful, resilient, insightful and challenging. This keeps me going!

f3766f876d143ea85bd35fb7b63cabaf731c5493-3-1.jpgWhat piece of advice would you give Mental Health Student Nurses today?

Take every opportunity that comes your way to promote non-stigmatising attitudes towards mental health service users. Promote acceptance and respect among your colleagues. Use evidence based practice wherever possible. Have confidence to stand up against poor practice whenever you encounter it. Always push to improve services and your own skills and knowledge as a nurse.

From your experience working with service users who smoke cannabis, have you seen a therapeutic effect from taking it as a method of self-medicating and not just for recreational use?

Yes. For instance, a man with bi-polar illness has been using cannabis to regulate his mood. He has been actively attempting to reduce his cannabis use but as soon as he starts to reduce, he experiences a relapse into distressing elevated mood. His answer to this currently is to attempt to grow his own cannabis, which, he hopes, will be high in cannabidiols (anti-psychotic and sedating) rather than high in THC (very psychosis inducing). He is proving to be partially successful. However, in my experience this is unusual. Most of the service users I’ve worked with for many years do not get a good therapeutic effect from cannabis. Quite the opposite in fact. For almost all service users with psychotic illnesses cannabis can be a disaster for their mental health prognosis.

What impact do you think there would be on mental health services if cannabis was to be decriminalised or legalised in the UK?

Taking cannabis misuse out of the legal system and into the healthcare system would enable those people who have problems with cannabis misuse to seek appropriate help and treatment. It would also remove it from the control of organized crime.

From your experience what role does excessive alcohol consumption play in the development of mental health disorders?

This is a complex and multi-dimensional issue. Demographically, 50% of people entering alcohol treatment services have a severe depressive illness. 20% of people have a psychotic disorder (Weaver et al 2003). Whether this is a consequence of drinking excessively, or whether drinking excessively is a causative factor in the development of illnesses is, of course, usually too complex to fully determine.

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Legal Highs come in all sorts of forms and can be bought on the high street

With the rise of “legal highs” and previously uncommon substances of abuse (such as ketamine) in Greater Manchester, has their been a notable shift in conditions patients suffer with as the popular drugs of choice have changed?

I believe that there is now no doubt that many of the newer substances, such as synthetic cannabinoids and highly potent stimulants such as PMA and methadrone are potentially far more dangerous to both physical and mental health. Synthetic cannabinoids, especially, appear to be very dangerous and unpredictable. However, their use, among mental health service users and people in general seems to be increasing year by year.

If you could give child/adult field nurses a few key points to convey to patients they may encounter that they believe might be struggling with drug or alcohol abuse what would they be?

  • Be honest but non-judgmental about peoples’ lifestyle choices
  • Encourage service users to discuss issues of substance misuse in an open and honest manner
  • Listen to what they tell you and find ways of reflecting back what they’ve said
  • Express empathy about their situation in relation to substance misuse. Be especially empathic about the difficulty their substance misuse is causing them and how it may be preventing them to achieve their goals
  • Seek permission to offer information which is neutral, up-to-date, and presented in an accessible form. Check out carefully what they make of this information
  • If they don’t want to change their current patterns of substance misuse, carry on discussing the issue in an open and honest manner, avoid arguing or persuading; offer harm reduction tips
  • Keep the door open to possible intervention in the future

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.

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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!

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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!

Putting the Super in Supernumerary 

When I started my nursing degree, I was prepared to be a quiet observer. During my first placement, I did exactly that. I listened, learned, and did what was asked of me. I wasn’t exactly useful to the team, but they liked having me around. Now on my second placement with district nurses, this has changed drastically. I feel useful. There is a slight superstitious joke that I have healing powers, since a lot of patients that I visit (with different nurses) have lovely healed wounds. But maybe it’s that whoever takes me gets an extra of mileage to claim back whilst I’m in the car…
Anyway, because of this popularity, I’m starting to see how valuable students are to placements. This week I’ve been helping recreate the caseload map. Due to my computer skills (always knew that ICT GCSE would come in handy), I was being HELPFUL.

my amazing map

Caseload map, still needs work doing. It’s bigger than me.

Students are also useful for those more time-consuming patients. We have a lot of patients who need a two layer bandage on each leg, often due to oedema and ulcers. Now since a two-layer bandage requires a reasonable amount of time and effort, it’s always handy to have a second person. I recently visited a man who required two-layer bandaging on both legs, and had a suspected gangrenous toe! It was good that I was there as the nurse I was helping could take time to phone the relevant people, whilst I finished the bandaging and took notes. It makes the visits more efficient!

I’ve also noticed that I am often the eyes and ears, both in the office and with patients. So I will pick up something which one nurse might not have remembered, or wasn’t there during that visit. So I’ll often pipe up during handover saying “oh that patient needs a new sharps bin!”. It’s not groundbreaking or life saving stuff but it helps.

Although sometimes it can be frustrating because you are ‘just a student’, remember that this is such a valuable time. Not only are we learning hands on, but our education comes from how much you are willing to get stuck in with! Be brave, bring your skills to the table and you’ll get more out of every placement you go to.