My day with the Health Visitors

As an adult student nurse, I don’t encounter many babies/children, so I was keen to try something a bit different. So when I found out that the Health Visitors were just down the corridor of my placement’s main office base, I soon popped my head in to organise a spoke! I had an absolutely wonderful day with the team! Not only did it help me understand the workings of the Community Multi-Disciplinary Team, but its exposure to another field of nursing! Plus, my current district nursing placement is largely based around treating patients, so observing some preventative public health care was great. Oh, and I got to play with some adorable children- I love being a student nurse!

Each Health Visitor is a qualified nurse (adult, child, mental health or learning disability!) or midwife, and their role is based around family care. By leading the delivery of the Healthy Child Programme, they ensure that expectant mothers and new babies up to the age of 5 get the best start in life! They visit families in their homes, GP clinics, Nurseries and Sure Start Centres. It’s an incredibly varied job.

pincer grasp

A tiny grasp for baby, a huge step for development!

My day with the Health Visitors started with a visit to a local SureStart centre, where the local ‘Baby Clinic’ is held. This is where one year old’s attend and the health visitors evaluate their progress. Its not as scary as it sounds, I promise!! They look for certain markers in a baby’s development and then, if needed, can give the parents pointers on how to help their child. For example, by the age of one they should be ‘babbling’ (repeating words they’ve learnt, usually nonsense), pulling themselves to stand and using furniture to wobble around on two feet, and using a pincer hand gesture. We had two lovely little babies visit us, both of which showed these developmental markers but at different stages. Each child, of course, is different and they have started to develop their personalities at this point. Our first baby was very outgoing and had his older sister to make him confident enough to play around and show us how well he was doing. The second child was a bit more shy, and preferred the company of her mum. However, after I showed her the wonder of some bells on a stick, she did everything we asked of her.

Alongside looking for the developmental markers, Health Visitors are also looking at the bigger picture. Their aim is to ensure that the family is happy, healthy and safe. How do you do this? Use a good old pyramid of course!

health visitor bible

Who doesn’t like a pyramid?

The Safeguarding and promoting welfare pyramid is designed to help pinpoint the areas which children should have. So, for example, if the Health Visitor detects that the child doesn’t seem like they have enough stimulation for the child to grow and enjoy themselves, that would question the parenting capacity. It’s useful for identifying a variety of factors that may be affecting a child’s development, as it’s never usually just one thing. Anything that is identified as missing can be worked on, via the Health Visitors, Social Workers or Family Support Workers.

If you want to learn more about Health Visitors, NHS England has a load of information about their role and how to become one! Or, if the chance arises, go and spend time with some!

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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.

Healthy body, Healthy Mind

If there is something I used to find more boring than eating healthily, it’s people talking about it. But my attitudes have changed now that I’m a responsible adult (haha). Being on placement is pretty tough, especially if you haven’t worked in that environment before. I’ve done 13-hour waitressing shifts before but after an 8-hour student nurse shift, I’m shattered! During my first placement, I didn’t pay attention to how much sleep I needed or what I ate. Totally the wrong thing to do! I’m not saying being a student nurse needs you to turn into a health guru with your own cute Instagram account called LoveKaleForLife, but being that little bit healthier can help. So that means avoiding cheap takeaways when you get home from placement, no matter how tempting it is. Unless its treat yourself day!

Getting enough sleep seems like a pretty obvious tip on how to survive placement, but you’d be surprised on how difficult it can be- especially if you live in halls! I’ve had few incidences, and heard a lot from other nurses. And when that karaoke at 3am on the floor below you starts up, your precious sleep can suffer a bit. Earplugs might be a good investment if you can’t handle that. Luckily I lived above a nightclub for 3 months, so the sound of drunk screams is like a weird lullaby.

Food is another MEGA important aspect. Making sure you eat a decent and healthy meal three times a day makes it easier to get through your shifts. I found out the hard way that just a fruit bar for breakfast is just going to give you the rumbliest stomach ever. And stomach rumbles aren’t easy to conceal, trust me. It’s a bit unerving for patients when you’re packing an infected abdominal wound and your nurse looks hungry enough to dig in!!  Whether it’s a packed lunch (couscous for dayyyyys) or something you buy when you’re on placement, get yourself ‘mealed up’!

Finally, remember that your life isn’t just about placement. You need time for other things! I like to walk my dog as both exercise and downtime. I know it’s hard not to jump straight into bed with Netflix and crisps (which I have done on many occasions), but try it out! I’m not suggesting you run a marathon (unless that’s your thing), but exercise can help you release stress and aid your sleep. And who doesn’t like sleep???

 

 

 

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!

Finger_with_granulation_tissue

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. 

 

 

 

 

 

 

From Ward to Community

I was really nervous at the start of my community placement with the district nurses as I had heard some horror stories from peers. The night before I could not sleep, I lay in bed with a hot water bottle for hours thinking about the challenges the placement would bring. What kept me awake was that I would have to go visit people I their houses, which I did not feel comfortable doing.

06:30am alarm went off, time to get up, get ready and head out. Once I got to the clinic, I was early so the doors were locked. I ended up standing outside in the freezing cold for 15-20 minutes. Once inside, I went to the reception, they walked me to meet the team I will be working with for the next 12 weeks. Once I entered the district nurses office, the two sisters welcomed me, knew my name which made me think that they were expecting me (brownie point for them). I was given a tour of the office, shown where all the files were kept as I would be expected to get them when they are asked for. I was welcomed to the team, what I really liked about the team was when they said I was welcomed to the tea and coffee, once you are welcomed to their collection of tea you are initiated and part of the family. This made me genuinely smile, I was going to like it here, and the team were all lovely and had a great sense of humour. I waited for the nurse to arrive as she had started at 08:00am and was doing her early visits. Once the nurse arrived, after paper work we headed out to a care home to visit 6 patients at 09:30.

On our way to the residential home, the nurse informed me of the patients we were going to see and what our role was in their care. We got to the home, went upstairs to see our patients. The tasks we were doing were pressure ulcer checks, injections, dressing changes and assessing the overall health of the patients. These tasks took the whole morning. Once we got back in the car, we head back to the office for lunch.

Next at 13:30- the team of 7 district nurses come sit together and discuss the morning visits, they talked about any issues, what afternoon visits are left, new patients, the aim is to update the whole team- all while have a cup of tea and biscuits. After more paperwork, I worked with a different nurse and we went to visit patient homes. What I found strange about these visits was that we had a code to get the key to their house let ourselves in to carry out tasks such as insulin injections. I was astonished; my idea of what I was going to do in community was totally different. After the afternoon visits, back in the office for more paper work. Then home for 17:00.

On my way home, I was thinking WOW! What a great day. You see, I have been on three ward placements all have been busy and hectic. Working with the district nurses allowed me to get to know the patients history, I was able to get a holistic idea of the person’s situation. We were in their home, their private space. Even though we were there for only 15/20minutes, that was probably the only social contact that person got that day. I found myself changing my views about working in the community; I always thought that I’d like to work in ward; fast and busy, lots to do. But now I am not too sure.

So, remember don’t judge a placement before you have met the team and give it a chance.