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!

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!

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.

Wounds, Wonderful Wounds!

I’ve now entered my third week of district nursing and let me tell you, it’s been an adventure. I realized on my first morning that wounds are the majority of the case load-which is perfect! I’ve wanted some hands on wound care experience for ages, and I’m a bit of a gore fan. All the nurses have also been very helpful in letting me get stuck in with the goriest of wounds, and the patients seem to be pretty happy with letting me do that too! After all, its not everyday that you see someone’s foot tendon exposed..

Thanks to this exposure to wound care, I’ve started to appreciate how nursing is an art and a science. The science comes from knowing your stuff. You need to be able to look at a wound  explain how well its healing, and what it looks like. It might be granulated, which means the wound is all red but dry. So the next stage is for the wound to epithelialize, where new skin grows back from the edges inwards.  And then there’s sloughy (pronounced sluth-e) wounds. This makes the wound look all white/yellow, caused by dead epithelial cells and white blood cells. Slough often makes a wound look quite bad. When I first saw one, I was a bit shocked that the nurse wasn’t overly worried!

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Granulated finger wound

The art comes from the practical side; dressing the wound. A lot of patients I’ve seen require their wounds to be packed, as it’s a cavity. This is to aid the healing process, and draw out the nasty stuff. I’ve packed a few wounds now, and its slightly scary but really interesting. The skill comes in ensuring you don’t pack it in too much, as you’ll be pulling it out next time!! (like unwrapping a surprise you weren’t sure you asked for).

And then there’s bandaging. From blue-line to bi-layer, it must make district nurses insanely good at wrapping presents! They can look at a wound and bandage it perfectly. I tried, believe me. I’m not very crafty, but with practice its doable! 

bandaging

Fashionable hats and pro-bandaging techniques

If you’ve had some interesting wounds on your placements or have any questions about district nursing, comment on our Facebook page or email us at enhancingplacement@gmail.com. 

 

 

 

 

 

 

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.

 

 

Silence the doubts….I’ve done the right thing, haven’t I?!

I’ve decided I am NEVER taking a holiday again until this degree is finished as it seems the ‘powering through’ method of coping was doing me JUST FINE! It wasn’t until I stopped after a particularly lengthy period  in between holiday breaks that I started to process how hard this degree is and then how hard the career I have chosen is and THEN the  “WHAT HAVE I DONE???” panic set in!!!

dont-panic-1067044_960_720 There I am lying in bed pretending to be mellow and sleeping the night before returning to university after a two week break and I am flooded with thoughts. Is there a worse time to start thinking and overthinking than 2am when the rest of the world is asleep and you are lying next to somebody who has previously slept through AN EXPLOSION  (i.e sleeps like the dead)?! There are few things more disheartening than trying to sleep next to somebody who breathes heavy, snores and responds to none of my ‘polite’ requests to SHUT UP! I share this level of detail as its pertinent to how my mind spiraled from ‘well that was a nice two week break’ to ‘I have LOVED being at home SO MUCH I need to be a stay at home mother and somehow find the money, patience and personality that is the person who can be a stay at home parent’ (disclaimer: nothing wrong with being a stay at home parent I have the utmost respect for anybody who can stay at home its a very hard 24/7 job but its just not for me)
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I wont bore you with further details of my psyche and the thoughts I manage to conjure up when ‘insomniated‘ but they are wild and illogical at best. Was the whole decision I had made completely wrong and I needed to leave the course and somehow return to my old career? Picture me lying next to a snoring fella, clammy with terror that i had ruined our lives and our children’s lives by making the WRONG decision …..and so it went on….and on….and on. Until I gave up, got up and indulged in some highbrow tv viewing (Real Housewives of Cheshire..don’t judge me I was stressed!)

So i started back to uni, sleep deprived, full of doubt and pretty much decision made to have a ‘serious discussion’ with my husband when I returned home as i had made a dreadful error and we needed to plan what I can do …I mean I must be the only person who was having doubts and was questioning my passion and drive…mustn’t I? And then I spoke to my pal on the way to uni and she made me feel better by hearing me without judging me. And then I had lectures which were all about everything I LOVE about midwifery; the holistic approach to care, the signposting of  women to services which can support them, using our eyes and ears as our best tools…THIS was why I wanted to be a midwife and I did a silent ‘thank you’ to the universe for sending me this message at a time when doubt and fear were in abundance. AND THEN I went back out on the community and I remembered why I love midwifery and being ‘with woman’ ……to care and to listen and to see and to support.

I realized then that my doubts weren’t a sign that I should leave the course and be a stay at home parent or that I need to rethink my decisions but they were (dare I say it!) ….normal. Like a lot of people who have sacrificed so much to follow their passion whatever it is…I have invested SO much already into needing to ALWAYS love midwifery and ALWAYS be passionate for learning and ALWAYS be excited to go on placement (even it means leaving my children and not seeing them for days) that I had effectively set myself up to fail! How can I possibly ALWAYS (such an absolute statement) ALWAYS feel that strongly when there are times when I am tired or my kids are ill and I have to leave them or they have a special assembly I am missing or I simply want to stay at home and knit..on these days it is harder but these days are also in the minority and having come through the other side of this particularly massive doubting session I am CERTAIN I have made the right decision! Moral of the story….be kind to myself whatever is going on in my overactive mind as ‘this too shall pass’ and if I can’t sleep it is probably wiser to have a warm drink and meditate instead of watching trash tv!