PEF’s corner: Lisa Brown, MHSC

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At a recent PEF forum we asked some of your friendly neighbourhood PEFs some short interview questions to help you get to know them better and pass on any wise words of wisdom! First in this series is Lisa Brown, PEF and OT at Manchester Mental Health and Social Care Trust, Thanks Lisa!

 


What is your background in Nursing? 
I don’t have one! I am an Occupational Therapist by professional background and have worked on acute mental health wards since I qualified in 2005. I currently work 2 days a week as a PEF and have done since April 2015 and 1 day a week as an OT.

What do you enjoy most about your role as a PEF?
I really enjoy getting the students feedback from placements and helping students get the most out of their placements. I’ve also enjoyed implementing inter-professional learning sessions in our trust so that students from different professions can learn to work together better in practice.

What is the most challenging part of being a PEF?
The most challenging aspect tends to be the administrative / organisational issues, ensuring we have enough good quality placements available and enough educators to accommodate the students.

What does Occupational Therapy mean to you?
Occupational therapy to me means helping people to help themselves. I enjoy finding out an individual’s story and tapping into their interests and values to enable them to live more independently and achieve their goals.

One piece of advice you would give yourself as a student…
Take full advantage of all your placement opportunities , ask lots of questions and ask if you can take the lead in things – I often waited to be asked and missed out to some extent by not taking the initiative.

How can students get in touch with you?
I am available by email via the form below. You can also follow our trust twitter account @PEFMMHSCT for updates or my personal account @OT_LisaB for general musings on mental health, occupational therapy and education.

Please use the form below to contact the author of this post with your comments and questions:

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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!

DoLS – What does it even mean?

Having a DoLS or “Deprivation of Liberty Safeguard” in place means that staff at the patient’s place of treatment, have the legal ability to prevent them from leaving when it is deemed they lack the mental capacity to decide for themselves.

The reason these safeguards exist is for the greater good of the patient, although the process of a DoLS allows the patient or their family members to challenge the decision if they feel it’s unnecessary. It’s vital this is discussed with friends and family so everyone is on the same page and working towards the same goal of ensuring the patient’s well being and safety. DoLS can be revoked when/if a patient improves and it is really important to let loved ones know when/why/if an order such as this is being put in place.

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Infarcts of the brain caused by Vascular dementia can cause drastic personality changes and memory loss

I had a recent experience involving a patient who was suffering from vascular dementia, where it was stated in handover that he had a DoLS in place. He was a very calm man most of the time and although he was very confused at times, he was aware that he had dementia and lots of things were now decided for him by staff and his wife to protect his best interests. Day after day I would hear it in handover “This gentleman is under a DoLS, as he has requested to leave many times and doesn’t understand that he would be vulnerable”. Because he was so confused, no one doubted or questioned it, especially as it would be hazardous for him to go outside alone, not just socially but physically.

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We battle off dozens of bacterial strains every day without even realising thanks to our white blood cells

This gentleman was originally admitted to treat his leukaemia, following chemo his white cell count was severely depleted so his immune system was really low which would make him very poorly if he came into contact with even the common cold.

After about 2 weeks of being handed over has having a DoLS, we discovered that in fact, no such order had been put in place. It was requested, but the site team whose responsibility it was to actually fill out the paperwork, never did it. So we had, all the while been telling this chap, he wasn’t allowed to leave and his wife and his doctors had agreed this is what’s best for him, when in fact legally, he had every right to leave.

What I learnt from this experience was how essential good communication skills are. I think this is something we all take for granted too often in this profession. I know when I started I was very confident in my communication and thought having a unit on it was pretty silly but there were two big lapses of communication here that went unnoticed for days. Firstly it must have been handed over that we had applied for a DoLS and it subsequently got distorted into we had a DoLS – poor/rushed handovers happen all too often and this was the result. And secondly, the Multidisciplinary communication must have failed or else the site team would have followed through with the directives given to them. Luckily, we swiftly got the order correctly applied to this man and his family was very understanding, but when it comes to legal statements such as a DoLS or a DNAR as soon-to-be registered Nurses, it’s vital we know the information we are acting on is reliable and sound and as a student it’s crucial we learn to question things like this. If there is no evidence in the patient’s notes or medical information – do not act on word of mouth, one day it’ll be your PIN on the line and you want to be confident with every move you make.

Age UK has produced a really helpful fact sheet about DoLS – read it here

If you have the clap and you spread it around, is it called applause? – My day with Manchester Sexual Health Services

As it’s national STI day today I decided to do my bit for breaking down the taboos of talking about sexual health openly as if we can’t do it as emerging practitioners, how can we expect our patients to?

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Just incase you weren’t sure this thumbs up signifies that we support safe sex

I was lucky enough to have a spoke day placement with the Manchester Sexual Health Services and it was one of the most insightful days I’ve had in practice. I spent the day in a CASH clinic (Contraception and sexual health) and encountered all sorts of patients for all sorts of reasons. HOWEVER this wasn’t my first visit to this exact center…

As a responsible, sexually active adult I had attended one of their clinics previously for contraception and a general MOT. So when I realized I’d be on the other side of the table this time I was rather sheepish. Eventually I told the Nurse practitioner who was my mentor for the day about our previous meeting and we both had a big laugh about it.

However my visit to the CASH clinic was rather more jolly than a few of the patients we saw that day. For example I encountered a Mother of a young child who had come to find out that she had contracted Chlamydia – an extremely frighteningly common STI that often presents as symptomless (which is the scariest part, it’s like an invisible ghost). However she hadn’t had any new partners since her previous test, which was carried out when she was pregnant, as STIs can be passed on to baby during vaginal delivery so all women are screened. This therefore brought about the upsetting notion that it was her long-term partner and father of her child who had contracted and then passed on the infection to her.

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Oh hey there CHLAMYDIA nice of you to show your face!!

Treatment for Chlamydia is extremely simple and so easy to access, just 2 tablets taken at the same time and two weeks hence you’ve got a clean bill of health! That is unless you are re-infected during the time the medication is taking effect so condoms all round for that time. Gonorrhoea is equally as terrifying as it has no symptoms in up to 50% of all infected women and 1 in 10 men. Gonorrhoea is equally as easily treated, although an injection is necessary, it is one dose of antibiotics and the infection should subside.

Both Chlamydia and Gonorrhoea can go on to cause severe and long-lasting negative health effects such as infant-blindness or infertility so services such as CASH are essential to provide free, non-judgemental advice and screening as well as a safe and respectful place to receive treatment. Speaking to the Nurses at the clinic you can really tell how seriously they take each patient and their circumstances. But the thing that surprised me most is how pleased they were to see each and every patient. In other clinics if your walk in is full to bursting with people queuing out of the door, that’s not a good thing. At CASH it was a positive “Great, the more people we can deliver good health education to about safe sex and the more people we can successfully test and if needs be treat”.

This should be the attitude of all Nurses in all areas I now believe.

Having a full bay of patients means the maximum amount of people as possible are benefitting from your care and services and the bigger impact on the community you can have through your work as a nurse.

CASH services have definitely got the right idea and were a great example of a highly functional and cohesive multi-disciplinary team of HCAs, GPs and Nurses that I believe every student nurse could learn something from.

And you also get a goodie bag full of condoms!!

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And who doesn’t like free gifts?

Guest Blog: Cardiac Catheter Lab

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Coronary Angiogram

For my first placement of second year I was placed in a cardiac catheter Laboratory, an acute surgical department which performed cardiac interventions such as angiograms, angioplasties and pacemaker insertions, with use of radiological imaging.

As a student, I found it was a really positive placement for me for a number of reasons: Firstly the attitude of the staff towards me and my learning helped tremendously, my mentor, nurses, radiographers; physiologists all took an active interest in my learning, explaining procedures to me and going out of their way to impart their knowledge to me. Furthermore they treated me like one of the team, which as a student is such a confidence boost because it shows that people trust in your abilities and in turn I felt compelled to actively participate in the team in my role as a student.

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A Normal Adult ECG

Working in the lab also opened up opportunities to work with other members of the MDT, for example I spent the day working with the cardiac physiologists learning how to do an ECG and how to analyse it, also spoking with the cardiac rehab team and the cardiac liaison team which deals with emergencies that go through the Cath lab. These professionals have so much knowledge and experience to impart and it has given a much more rounded experience.

Written by Lewis Cameron