Mind your language!

I have realised as I’ve reviewed my previous blog posts that they tend to be quite personal. This post started as a very non-personal post but then, as I rolled ideas around my mind, I was reminded of times when the language used by Healthcare Professionals (HCP) had profound effects on me; some of these were positive and some negative but all forever imprinted in my memory and all influenced my experience of particular situations so, once again, this post will include my own experiences!

Late summer is a very bad time for me as in August 2013 my beautiful husband left me and our 3 sons and disappeared for 3 hauntingly long, soul crushing days when he made a serious attempt on his life only saved by the fact he was a pretty clean living fella with a nice healthy liver which did its job and chucked the massive paracetamol/ibuprofen overdose out of his body causing permanent liver damage but leaving him alive. This is not a post about mental health or suicide so the details of the lead up to this are not relevant here but suffice to say those 3 days were the worst of my life. I envisioned having to tell our 3 young sons their daddy was never coming home and having to raise my boys without my best friend and soul mate by my side. I imagined trying to support my in-laws with the grief of a second child having already buried their daughter…..they were the darkest 3 days of my life. The reason I am sharing this is to demonstrate the importance of the language we use as HCP.

By day 3 of this nightmare I was fully expecting a suicide note to turn up in the post, instead I got a phone call from a nurse from an emergency department in a hospital ‘down south’. She rang to tell me my husband had turned up and was being treated for the overdose he had taken. Now, the past 3 days had pretty much broken me but I did not break down in tears on the phone for many reasons, one of them being I was a practising counsellor at the time and was familiar with the language of attempted suicide and depression and I heard the news in a seemingly calm way. I then came off the phone and broke down both physically and emotionally.

My husband informed me, during a conversation much much later when we were debriefing during one of hundreds of conversations we had about that time that the nurse told him she thought I was “very clinical and a bit cold considering what she had just told me”. This stayed with me and continues to. I felt judged and misrepresented. I wanted to ring her and tell her that the reaction she heard was the result of 3 days without food and very little sleep, the reaction of a desperate wife and mother clinging to the only version of herself which was solid (the counsellor). I doubt that this particular nurse would even remember that conversation  a week later never mind 4 years later, but I remember it and my husband remembers it. He didn’t need to hear his wife had been clinical; he had no idea what sort of reception he was going to receive when we finally spoke to each other but what he needed to hear was that I had been informed and was ready to talk to him when he felt ready (which is actually exactly what I had said).

In situations of high emotion if you don’t know what to say, stick to the facts. Do not include your opinion and do not pass judgement.

So, onto another example of poor communication and the use of language.

During and after the traumatic delivery of my eldest son (for the midwives amongst us he was an undiagnosed malpresentation and a 36 hour induced labour ended with a rush to theatre for a trial forceps then emergency c-section). Things midwives said to me included:

During labour:

“what do you mean you aren’t getting the sensation to push, everyone gets the sensation to push” (not true, however I believed I was weird and not a ‘proper woman’ as I wasn’t ‘doing it’ right)

“you aren’t trying hard enough” (I used quite a lot of bad language at this point)

“Please try to push harder we need to see more maternal effort” (I cried)

post delivery:

Well, if you had pushed that baby out you’d have broken his neck” (Yes, yes this was actually said to me – his ear was the presenting part so it was probably true but I did not need to hear it)

“We took bets that you wouldn’t deliver him naturally” (so many things wrong with this sentence I do not know where to begin!)

So….therein ends a couple of examples of the poor language used to me personally during interactions with hcp (I have lots of examples from friends but I won’t share them as they are their stories!)

I now want to share some good examples of when HCP have used language in a positive way and how these have also stayed with me.

Following the above traumatic delivery my community midwife (who I respected so much she is a major reason I wanted to be a midwife and who I now know as a colleague) said to me “none of this was your fault. You did nothing wrong and nothing you did could have changed the outcome” (she knew I had wanted a homebirth with candles and words of love not theatre lights and words of terror). These words alone gave me permission to let myself off the hook for not being good enough to have a ‘normal’  birth.

*side note*  Please be mindful of using the word normal it can be very damaging. In terms of delivery I feel ‘vaginal delivery’ is enough without the word normal in front of it, its unnecessary. 

When my middle son broke his wrist and I waited 24 hours to take him to a&e because I thought it was just a ‘bit bruised’ I felt like the worst mother in the world and told anybody who would listen how awful I was and how could possibly I leave him 24 hours in pain poor little soul etc etc. A lovely radiographer took me to one side and whispered in my ear “I am a radiographer, my son broke his ankle and it took me 24 hours to bring him in; I thought he was just moaning”! Brilliant! Still makes me smile and instead of coming out of that situation feeling awful I came out feeling forgiven (although the middle boy still mentions it when he is wanting sympathy!)

All my sons have been in hospital for one reason or another most of which were when they were babies and the language used when communicating with me as a terrified mother has mostly been lovely and comforting (we will ignore the paediatrician who told me I would not be ‘allowed’ in the room when my 8 week old son was having a cannula sited in his head as we mothers tend to get ‘hysterical’ AND the paediatrician who looked at the 90ml bottle of breastmilk it had taken me AGES to express and said “is that all you’ve managed?”……we shall ignore them!!!!).

But this is what I want to leave you with (and something I remind myself of when working with women and their families)…

We may not remember all the people we work with and support or all the things we say but they remember us and they remember what we have said.

…………………….Years and years later.

Ask your friends and family about the midwife who delivered their babies….ask them what she was like (my Nana,at aged 95, could still remember the midwife telling her to stop screaming when she was delivering my 11lb mother as she may disturb the neighbours!).

Ask your friends and relatives about their GP and the things they have said to them over the years,  or the nurse who looked after them when they had their tonsils out when they were 7 years old (“eat the cornflakes or your mummy won’t be able to come and see you” ….I realise I have not had great experiences with HCP!!!!); ask them about the student midwife who took them to one side when their wife was haemorrhaging post delivery and explained who all the scary people who had just rushed into the room were and what they were doing; ask them about the consultant who told them there was nothing more they could do for their beloved dad; ask them about the importance of language and words.

Also, don’t lose sight of the influence of non-verbal communication: our body language speaks VOLUMES. Being clinically good is fundamental to being an effective HCP but being kind and respectful ensures the experience of the people we care for is remembered for the right reasons not the wrong reasons.

What we say matters. It MATTERS. If we are having a bad day and we are a bit too blunt with our language or we are too harassed to sit down and explain a procedure or we are tired and turn a blind eye to somebody you know is on the verge of tears and needs a friendly ear…..these things matter. Of course we have bad days but share these with your colleagues and friends; try really really hard to not let this influence the experience of the people we care for as they are mostly vulnerable and usually scared.

Thank you x

 

 

 

Hello from the other side…

We’re delighted to share this guest blog from Lizzie, a fourth year Bachelor of Nursing and Midwifery student from the University of Queensland, Australia. Lizzie shares her incredible experience on exchange at the University of Manchester where she is completing her final nursing placement in A&E at Manchester Royal Infirmary:

“Hello… Can you open your eyes please… What’s your name? Do you know where you are?

My name’s is Lizzie, I’m the student nurse looking after you. How can I help?”

Welcome to the adrenaline packed, electrifying, exhausting and incredibly humbling world of Accident and Emergency. I’m one of two UQ final year Bachelor of Nursing/ Midwifery student’s fortunate enough to have the incredible opportunity to go on Exchange to the University of Manchester, and complete my final Nursing Undergraduate Placement in A+E at the Manchester Royal Infirmary.

Lizzie 1

I can’t believe in just under three weeks I’ll be finished my nursing degree! When I was little I always dreamt of being able to help people with my hands, my heart and my brain. I actually have come to feel so at home in the hospital – nursing has fit me like a glove. I love to learn, I’m a people person, but most of all I feel such a sense of satisfaction when I know I’ve made a difference. That’s why I’m excited, and proud to (almost) be a nurse.

I’ve been in the UK for 3 months now. Words can’t describe some of the things I have seen, how much I have grown personally and professionally, and how much I love it here – but I’ll give it my best.

Lizzie 2

A+E is a never-ending puzzle. In comes a person with a list of symptoms, and (in the time constraints of the National Health Service’s 4-hour max wait times) you assess, stabilise, gain a history, conduct tests, perform interventions, monitor for the impact of these interventions, and then either refer them to a specialty or (hopefully) send them home. The true skill comes in managing many patients simultaneously – yet still treating, valuing and respecting each as an individual.

While every shift is an adventure – here are some of my highlights:

In A+E when there is a really critical person about to come in we get pre-alerted by a call from the Ambulance service to a “Red Phone”. The Nurse in charge takes the call, and then alerts the department over the loud-speaker – “Red Standby, Adult Major Trauma – ETA 5mins”.

One of these “Red Standbys” was a motorbike vs car head on collision, resulting in fractures to the patient’s femur, hip, wrist, and back… I got to look after and stabilize the patient, and follow them through to the Orthopedic Trauma Operating Theatre. The surgeons and theatre nurses were so kind, they not only talked me through the 3 operations, but they even let me scrub in so I could stand right next to the surgeon as he used metal rods, plates and pins to reconstruct the patient’s broken bones.

I have been actively involved in eight cardiac arrests (one was on my first day – but that’s another story). I’ve helped wheel a patient down the hallway while they were actively receiving CPR, and get them to the “Cath-Lab” where under X-ray guidance surgeons were able to guide a wire up the patient’s femoral artery, and use a stent to reopen the diseased blood vessels of the heart, and save his life.

Lizzie 3

I have been blessed with a plethora of opportunities to learn – just over a week ago I traveled to Chorley to complete a simulation training day in “Out of Hospital Emergencies” with the Paramedics and Army Reserve. I’ve worked with an advanced practice nurse running a Community Clinic for Chronic Diseases, and have done home visits with a GP for the day – visiting some of the sickest home-bound patients.

Just yesterday I got to ride in an ambulance for the first time as we transferred a patient to a specialist hospital for neurosurgery. The patient was critical, so we traveled on “blue lights”. The paramedic crew were amazingly skilled, calm and good at balancing as we tore down the highway.

Manchester is a beautiful city to explore, and the rest of the UK is so close that I’ve being doing my best to see as much as can on my days off. So far I’ve day-tripped to the Lakes District, spent a weekend in Bath visiting the Roman baths and Stonehenge, seen some stunning castles in Wales, and travelled to Dublin for St. Patrick’s Day!

Lizzie 4

There are some exciting opportunities on the horizon – in my final week as a student nurse I’ll be attending a conference in London and on shift with the London Ambulance Service.

I have been so lucky to have worked as part of an incredibly supportive team and mentored by inspiring nurses and doctors. I won’t sugar coat it – I have seen some heartbreaking things (as is the nature of Accident and Emergency), but I wouldn’t change a thing. I’ve found my calling – caring for people when they are most vulnerable. Be that at the beginning (as a student midwife) or at the end (as a student nurse), it’s my privilege to love, support and provide dignity. Not as a healthcare professional, but as one human being caring for another human being.

I have learned there is never a situation in which a non-judgmental ear, a hand to hold, and kindness won’t help.

I’ve realised how precious every moment is.

Tips for first year Student Midwives….

CONGRATULATIONS! YOU MADE IT!!! YOU ARE STUDENT MIDWIVES!

How are you all finding semester 1? Terrifying? Is life sciences sucking the life out of you? Have some lectures left you running for the hills crying into your pints at the SU? Have you actually got over the shock of being a student midwife yet and now the reality of being a student midwife is kicking in?

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Ok…so as a second year the horrors of that first semester are still fresh enough in my mind that I get goosebumps at the thought of how I felt this time last year but I am also sat here having survived so feel it may be a good idea to share how I got through it! I will add that maybe not everyone finds this first semester as a student midwife hard but I did and a lot of my cohort did so here are some tips that got me through to semester 2 in one piece and nearly sane!

  1. Don’t look too far aheadby this I do not mean do not plan…planning is GOOD (see point 2!) but do not look at your timetable for 4 weeks time and think ‘how can I possibly manage to do ALL THAT WORK?” . Think about what you need to do today and what you need ready for tomorrow. Have an awareness of assignments whilst you are reading stuff but don’t be consumed by it! One day at a time…your knowledge is building up one brick at a time so if you look too far ahead you will overwhelm yourself and you cannot possibly know what you do not know so just be with what you need to do now, today.
  2. PLAN –  you need to be organised! USE the time allocated to you for Guided independent study and independent study. If the timetable says 3 hours do 3 hours! It sounds silly but this will help you ensure you are doing the right level of work. I have a list of studying to do which I add to and cross things off as necessary! It helps me sleep at night not worrying I may be missing something i need to be doing!images-1
  3. Do not over think it (at this stage!)  At the moment you are bombarded with information and, lets face it, you’ve been accepted onto a highly competitive midwifery degree because you LOVE it and want to read and research EVERYTHING around it but you WON’T HAVE TIME! This was a downfall for me! More than once drafts would be returned to me as ‘too complicated’, ‘too complex’ etc because I didn’t want to just read and write about a nice straightforward pregnancy I wanted to research why a perfectly straightforward pregnancy and labour could result in a retained placenta WHY??? Goddamn it!!!! This is not the time for that level of ‘reading around the subject’-read what you have been told to read at this stage as you will have little time to read around the subjects if you want to get through the massive amount of material you need to get through and your FIRST YEAR is focusing on normality do not confuse yourselves by needing to know about the complex stuff….yet! Imagine your knowledge is being built and you need to embed the foundations nice and solidly before branching out further into the more complex stuff!
  4. Use everybody who offers support we are not just being nice we want to help you! Your AA, your PASS leaders, your mentors, midwives on your placement, your lecturers, your PEFs, your ward managers, your PEERS! They are all there as support – support each other! Knowing you are not alone in the struggle is such a bonding experience! Tell people if you are finding something so hard you are questioning your decision to train as a midwife! Take time to check out within yourself how you are feeling and reach out when you are struggling-learning to reflect on your experiences is important on  a lot of levels so the sooner you start the better!
  5. Be kind….to yourselves and others– please be kind to yourselves! Give yourself time off; spend time with your family and friends! Do non-midwifery related stuff! It is EASY to be consumed by this degree but self care is fundamental to resilience and good health so start as you mean to go on! Sleep well, eat well and invest in ‘you’ time it will benefit everybody around you especially you! Look at your cohort-are some people struggling? Reach out to them-this is not a competition we really can ALL succeed but its much nicer if we all help each other along rather than revel when people fall! We are training in a compassionate profession this starts with how we treat each other!
  6. Attend revision lectures – that is it really! Attend them-they are important!
  7. Use social media sparingly– so you did well and got 110% on your first assignment….AMAZING!!! Well done! Please consider why you would put this on Facebook! It’s super you’ve done well and you should be proud of yourself but tell your folks, tell your friends, shout it from the rooftop but jusocial-medast ask yourself why you are sharing that somewhere so publicly when you know others in your cohort are going to read it and maybe might not have managed to get such a great result! We all have areas we are strong in and areas we are not so strong in-support each other and celebrate successes but be mindful of how your fabulous result may make somebody feel who only managed 35% this time.
  8. Enjoy it! You will be frantic at times and wonder how you are ever going to get through your life sciences exam as well as hand in your poster assignment draft, get that presentation ready, complete your placement documentation plus have any kind of extra curricular life! But enjoy being a first year student midwife! Take time to stand on the 4th floor of uni place looking down Oxford Road at the buildings and the hustle & bustle and remind yourself you are a student at MANCHESTER a highly prestigious university! Go to the library and breathe in the smell of ALL THOSE BOOKS embracing how far you have already come and that YOU GOT CHOSEN! Do not be so consumed by panic that you lose sight of why you want to be a midwife. Oh….and learn to scan read! An essential skill!!!