#hellomynameis Kate

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Kate Granger, the founder of the amazing campaign ‘#hellomynameis’, wonderful doctor and cancer patient, died this week. Throughout her treatment, she spoke up and informed healthcare professionals how they could improve their practice by doing something simple; introducing themselves. A simple introduction, she believed, could go a long way. The patient needs to feel like a person, not just a list of symptoms. This is the exactly what patient-centered care is all about; Kate hit the nail on the head, we need to change our behaviour.

When I first came into contact with this campaign, I thought “gosh how could anybody forget to introduce themselves?” but it happens, and I’ll put my hands up and say there has been a moment when the patient has had to ask me! But it does make all the difference because it is the beginning of a professional-therapeutic relationship, and the patient needs to be able to trust their caregiver. It makes me smile when patients are happy to say “Kate, can I just ask you a question?” Or “Kate can you just do this?”.  It makes the situation a little bit more normal, less formal and that helps people relax.

What we need to learn from Kate’s work is that speaking up is the best way to kickstart change. If you see something, or think that something could work better- do not be afraid to speak up. Even if you just mention it to your mentor, write it in a reflection to show to your academic adviser, maybe even a blog post…. it can do a world of good. It might not turn into a nationwide social media campaign, but the smallest changes can make the biggest difference. For example, Natasha (one of our lovely bloggers) has been using her knowledge, and spreading it amongst the staff in the Sri Lankan hospital where she completed her DILP placement. You can read that blog post here as it’s a good example of what I’m trying to get across.

The #hellomynameis campaign is still going strong, and I don’t think it will be slowing down anytime soon! Kate’s family and supporters are keen to keep her amazing work going, and I for one will happily get more involved. You can get involved on Twitter or just through the website.

Rest in peace Kate, thank-you for inspiring us.

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DILP Week 5 – Teaching and Learning in Maternity ft Muetzel

Well the outrageous fact that next week is my FINAL WEEK is madness. Right now I’m sitting pretty at 208 hours (40 to go) but it almost feels like a dream: I’m so full of questions about the culture and the way of working out here so I feel like I’m always engaged in some sort of discussion, which makes each day really rush by.

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Shout out to my amazing Nursing Therapeutics Seminar Lead – you know who you are!!!

After one such discussion with the ward Matron, she said she felt the staff could improve their communication and social skills with patients, creating more of a rapport (this took a while to figure out as she speaks rather broken English). So I briefly explained Muetzel’s model of the therapeutic relationship, which is based around Partnership, Intimacy and Reciprocity. She was so interested I ended up making a couple of posters and giving talks to staff members in little groups over the course of the week. It was a really rewarding experience for me to see these Nurses taking on this academic knowledge and applying it, almost immediately, to practice.

It was also wonderful for me to realize how much I’ve learnt during these last 2 years at UoM. Lots of what I was teaching hasn’t come up in exams and I haven’t been fastidiously revising it, but it was still there in my brain, informing how I interact with patients and being able to pass this on was such a great feeling.

All my questions though did make for a slightly awkward discussion with a consultant this week when I asked why it was the normal procedure in Sri Lanka to give Episiotomies, no matter the size of the baby: “Because Sri Lankan women are far more petite than Western women” Fair enough, I thought (the average height of a Sri Lankan woman is 4ft11) but that wasn’t what he was getting at… Gesturing with his surgical scissors he added; “For example this woman’s vagina is far smaller than yours would be”. THANKS DOCTOR. I almost died of embarrassment.

My questions haven’t all had such uncomfortable endings though. For instance I’ve become fascinated by the many superstitions and traditions deeply woven into everyday Sri Lankan life. One very common belief is that the exact time of a person’s birth is holds great importance over the course of their life.

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Its a bit of a cross between buddhism with a big emphasis on horoscopes, couples are often matched based on Birthdays

It is always noted to the minute and this information is taken to a spiritualist (Tamil or Buddhist astronomer) who produces a big document/graph thing that contains key dates to be wary of and dates of good fortune. These can be days or years. During the times of misfortune the family can offset this bad energy by giving alms, doing charitable work or attending the temple more regularly. Equally there is some level or risk management that is involved. For example if someone is predicted a bad 2016 because they were born at 4.33 instead of 4.34 then even if it made sense with every other facet of their life, big dates such as having a baby or getting married would be delayed until they were back in good favors.

I personally would not respond well to such strict time frames but I was far too curious to know what my prophecies would be. So, luckily, I was able to take a short 20-minute stroll from my apartment to the hospital where I was born, 20 years, 6 months and 5 days ago. After a quick 5 minute trip to the records room a nurse produced a huge leather-bound book, identical to the one I have been writing baby’s birth records in for the last two weeks. Except in this one, “Baby Girl Wragg” made an appearance! Thanks to this hand-written entry I am now armed with my birth time and am setting a meeting to speak to a tamil astrologer to find out how things are going for me! Hopefully 2017 with my dissertation looming, will be a very very lucky year for me or else I’ll just have to find a Buddhist temple somewhere near Stretford.

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Baby Girl Wragg OG Sri Lankan

Supporting Patients with a Learning Difficulty

 

Between 25 and 40% of people with learning disabilities also suffer from mental health problems, with dementia and schizophrenia showing a higher prevalence. Standards of care for those with an identified learning disability have been under the spotlight since appalling levels of care were highlighted in the media relating to a specialist care home – somewhere that should have been a safe haven for those in need of support. Questions were raised about in-patient services for those with a combination of a learning difficulty and a mental illness who presented with behaviours that were challenging and what care options should be provided. It must be highlighted that not everyone presenting with these combination of diagnoses will present with challenging behaviours. Everyone is different but we all deserve the same level of care.

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In placement as a mental health student I have observed patients being brought onto a general mental health acute ward who have a diagnosed learning difficulty. I have seen both good and poor practice observed. I have seen staff gain a real understanding of a patient’s condition and how the patient see’s and understands the world. I have seen other patients on ward stand up for and support a patient with learning difficulties and sadly seen others exacerbate the patients current mental state. Knowing how to support and care for the patient as an individual in this situation is crucial as well as manage the others in your care in the same way.

Learn more about the patient’s condition just as you would a standard mental health patient. Asking the patient directly can also be a great way to gain understanding of they view their situation. Asking a carer or family for advice, again in the same manner you would with other admissions helps to promote equality and improves the care you can provide. Find out if they have any extra physical or communication needs that need support as it can help relieve some stress and anxiety about settling into the new environment.

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Providing an individualised person centred approach to care during an admission is vital. The Royal College of Psychiatrists (2013) recognise the complexities involved in service provision of this kind and confirm the importance that communication between a multi-disciplinary team plays. Some hospitals have a learning disability liaison nurse so it’s worthwhile finding this out too. It maybe that a learning difficulty is undiagnosed in a patient as cognitive impairment is often found in those with schizophrenia; the consultant should be able to provide support on this when made aware. Either way, care provision should be treated with the same respect, care and dignity as it is to all.

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Reference:

The Royal College of Psychiatrists (2013). People with learning disability. London: Royal College of Psychiatrists

 

 

Remembering our Red Cross roots

We’re all familiar with the famous red cross emblazoned across old-fashioned nurses uniforms and  fancy dress costumes, but links to that famous symbol and the nursing profession go waaay back.RedCrossNursen.jpg

Today marks World Red Cross Red Crescent Day, the birthday of founder, Henry Dunant, who set up the International Committee of the Red Cross (ICRC) in Geneva over 150 years ago after witnessing horrific scenes during the Battle of Solferino in Italy, where thousands of soldiers, on both sides, were left to die on the battlefield.

He founded the movement on seven fundamental principles – humanity, impartiality, neutrality, independence, voluntary service, unity and universality  – of which all Red Cross societies around the world still base their work today.

I can’t help but think those principles apply just as much to nursing – in fact, Henry Dunant says that it was the work of Florence Nightingale in the Crimea that inspired him. It’s pretty amazing to think that the heroic efforts and ideas of a nurse inspired the largest humanitarian movement in the world!

During the first World War, thousands of nurses were needed at home and on the front line to care for soldiers wounded in battle. Under the banner of the Red Cross, trained nurses were sent to military hospitals across Europe, while at home, they recruited thousands of volunteers – known as Voluntary Aid Detachments or VADs – to help run all kinds of vital services including new auxiliary hospitals being set up around the country, often in stately homes like Dunham Massey in Cheshire. By 1918, there were over 90,000 Red Cross VADs, both men and women.

These volunteers, many of whom might not have ever thought of nursing, were suddenly thrust into a strange and scary world, learning to treat horrific wounds that had never been seen before, most of which was way beyond their experience or comfort zone. Sound familiar?

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Like now, there was a huge emphasis on training but exam questions were a little different, like: ‘How do you make peptonised beef-tea?’ or ‘How would you prepare a linseed meal poultice, an ice poultice, and a mustard poultice? What are the indications for their use?’ Their version of pharmacology and drug calculations!

Some Red Cross VADs, like Vera Brittain, joined trained nurses in hospitals on the front to care for British and German soldiers alike. Vera Brittain famously wrote about her experiences in her biography A Testament of Youth, published some years after she returned from a military hospital in France, heartbroken having lost her brother and her beloved husband. It’s definitely worth a read – or the film is on Netflix, if you’re looking for a study break!

Red Cross nurses became a familiar sight during World Wars I and II, but they were still needed after war had ended. While the NHS was finding it’s feet, Red Cross nurses and VADs continued to run hospitals around the country – and the link with the NHS still continues today, with Red Cross volunteers offering support to patients when they return form hospital as part of the their support at home services.

Anyway – history lesson over, I promise! I just wanted to take a moment to remember all the Red Cross nurses before us – as the next generation of nurses, we owe so much to their courage and determination.

Was one of your family a VAD? The British Red Cross have an online archive of thousands of VAD record cards, so you can find your own little piece of Red Cross history.

Learning Curve

Your first placement as a student nurse is meant to give a taster of what your career could be. It’s designed to inspire, help you find your feet and learn some of the basic skills. So what happens if that’s not the case?

There is a known fact amongst student nurses/midwives that everybody has a bad placement, whether that means it’s too intense, not what you expected, or not as exciting as you hoped.

For me, it was very much not what I expected. I was placed on an outpatients’ department. It was incredibly diverse in that I worked alongside many different healthcare professionals and was able to observe a wide range of clinics- which all helped my A&P knowledge a lot! But apart from that, I felt a bit shortchanged. Whilst all my colleagues and friends were off being thrown in at the deep end, I was endlessly calling patients in and observing doctors’ clinics. This wasn’t exactly the way I saw my first experience as a student nurse panning out, and I felt completely hopeless. Fellow students and staff would give me a look of sympathy and tell me it gets better when I told them where I was. I would dread going there, because I wasn’t being challenged. I felt that my time wasn’t being spent in the best way possible.

The best thing to do in a situation like this is to make the most of it. It’s hard, I know. You think “what could I possibly get out of this” but you’d be surprised! A placement like this is a great chance to brush up your knowledge, and it’s fabulous for reflective accounts! I have spent countless hours observing every moment in a consultation, thinking about what went well, what could have been better, and how I could improve that when I am put in a similar situation. You’ll also spend a lot of time talking to patients, which can make all the difference to them. A memorable patient for me was a young woman with a rather excitable young child came into the clinic. I played with the child (using only a curtain, which I’m quite proud of) whilst she discussed her medical problem. When she left, she thanked me so graciously that I knew I’d done her a huge favour. Its moments like that I have to remember that nursing isn’t all exciting stuff and clinical skills. Sometimes it’s about those moments when you make someone’s life just a little bit easier.

 

Note: if you ever feel unsure about your placement, no matter what the problem, talk to somebody! Whether that be your mentor, PEF, friend, AA or another member of staff. Someone can help.

5 things I’ve learnt on my first placement 

That’s it – we survived our first placement! One step closer to that blue uniform. I’ve spent the last ten weeks on an elderly rehabilitation ward where the patients are quite poorly, needing help to wash, dress, eat and get to the toilet. I’ve had good days and bad, and it’s been physically and mentally challenging at times. Looking back, I thought I’d share some of the key things I’ve learnt so far:

1. Nursing is messy 256px-research-suggests-women-who-have-a-heart-attack-wait-longer-than-men--221603

…and the bodily fluids are only the half of it! It’s complicated and unpredictable and sometimes it feels impossible to use all the theory we’ve been taught at Uni in practice. There’s no ‘one-size-fits-all’ approach and I’ve had to constantly adjust and adapt to match the needs of each patient, who are all individuals with their own character, ideas and worries. No two days are ever the same, that’s for sure!

2. Healthcare assistants are our best friends

On my first day someone asked me to get a bedpan from the sluice. I literally had no idea what they meant or what I should be looking for – I think I walked round the ward for a good five minutes before I finally plucked up the courage to ask. I had to start from scratch and it was the healthcare assistants on our ward that really helped teach me the core elements of care. I especially loved seeing the way they relate to patients; singing a familiar song to a distressed patient with dementia or taking the time to paint someones nails. They have become invaluable allies and I owe a lot to their patience and encouragement.

3. It’s the little things that count

It’s so easy to get caught up in the long lists of jobs that need to be completed and forget what really matters to the patient. Whether it’s spending time combing someones hair or fetching a fresh jug of cold water, those small acts are what make people feel cared for.

4. Fake it ’til you make it

There have been few nerve-racking moments over the last few weeks; my first bed bath, giving an injection, doing a drug round – but patients can smell fear and I think when I’m anxious, they feel worried and uncomfortable too. Even when I’m nervous and my heart is going 100 miles an hour I now try my best to at least appear calm and in control. Hopefully one day it’ll all be second nature – but for now, I’m just going to have to fake it!

5. It’s down to me to make the most of every placement 

On a busy ward, you can’t spend every minute with your mentor or another nurse but as a result, you sometimes feel like you’re missing out on learning proper ‘nursey’ things. I’ve learnt to ask lots of questions and always have an ear out for anything going on – ‘what’s that? did someone say catheter?’ It can be tempting to watch procedures but one nurse told me not to hesitate and get stuck in – patients are usually understanding that things might take a little longer and can give just as much encouragement.

I hope everyone has enjoyed their first placement and we would love to hear about things you’ve learnt over the past ten weeks – feel free to post on our Facebook page.

Writing in Patient Notes

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Documenting patient care can be a daunting task.

  • What did I do today?
  • Do I really need to write all of this down?
  • Is what I’m writing making any sense to someone else reading it?
  • Have I kept any personal judgements out of the notes? (e.g. patient is friendly)
  • Did I use ambiguous terms like ‘ok’, ‘good/bad’, ‘high/low’ without giving more specific information? (e.g. ‘pulse low’ versus ‘pulse low (39)’)
  • What are the things that other members of the Multidisciplinary Team (MDT) need to know about the care I gave my patient today? (e.g. how much is too much information?)

Document as you go along or in one large paragraph at the end of the shift

It is considered good practice to write about care as it happens so that you are less likely to forget or incorrectly document any care that has been provided. In practice, however, you may find it difficult to set aside time to write in bits and pieces throughout the day. Most nurses tend to record important clinical decisions, test results, scores etc. on their handover sheet as they go and then document it all in one sitting later on in the shift. You will gradually find what you are comfortable with and what works for you on your ward. Just remember that documenting care accurately is very important. You will often hear staff say that documentation is your safeguard against lawsuits or the NMC questioning your practice. I prefer to consider the patient’s situation first and say that accurate documentation benefits your patient immensely by keeping them safe. If the rest of the team is up-to-date with what care the patient has already received, what stage they are at with mobility, continence, wounds etc. then other staff will be better equipped to plan their own further interventions.

Different types of documentation systems

You’ll see lots of different systems for documenting patient care. Every ward/district/trust does it slightly differently.

Among the possibilities you will see are:

  • preprinted care plans that just require a signature and may have a free text set of blank lines on the back to note anything out of the ordinary,
  • reams of blank line sheets just on their own – usually called ‘continuation sheets‘ – where all the care is documented in paragraph style,
  • separate styles of continuation sheets for nurses and medical staff where doctors, physiotherapists (physios), occupational therapists (OTs), etc. will document their patient visits on one type of sheet with blank lines and nurses will use another slightly different type with blank lines,
  • places where all staff write on the same sheet with blank lines and nurse, doctor and OT notes will all be mixed up together with or without preprinted care plans.

Writing in preprinted care plans can seem easier as there is a defined structure that prompts you to provide the pertinent information. It can also be frustrating when you have something to add that doesn’t quite fit in any of the care plans as they are often rather specific. Some nurses will tell you that they ignore the small areas for free text on the preprinted care plans and simply rewrite everything in a main continuation sheet of nursing notes. Again, you will find what works best for you and your workplace. There are arguments for and against any method as well as arguments for and against an NHS wide standardisation and a ward specific way of documenting. This is ongoing and you’re likely to see as much change in your job once qualified as you have done during your training!

Keeping it accurate, concise and comprehensive but relevant

Easier said than done, right? You know what you have accomplished on the shift, but to condense everything down into a smallish paragraph can be tricky. It is definitely a good idea to start getting a pattern to what you write which will help you avoid missing out any care given. I have seen people who write chronologically, some who write according to body systems (e.g. anything to do with respiratory first, then anything to do with cardiovascular, then renal etc.) and those who have their own set pattern.

Documentation Example

This is an example of how you might consider setting out your notes. It would be written in paragraph form, not bullet points as gaps should not be left on lines to prevent additions to your writing after you have signed it. You will find this is something nurses stick to but medical staff do not.

  • Written retrospectively
  • Patient care taken over at 07:30.
  • Initial observations completed, EWS = 1 due to low systolic (93/51). Monitored over next hour and currently EWS=0.
  • Patient reports no pain/nausea.
  • No shortness of breath. SpO2 and respiratory rate within range. Patient on nasal spec (2L O2).
  • Patient required some assistance x1 with wash this morning.
  • All pressure areas intact, SKIN Bundle completed.
  • Passing urine but bowels not opened as of 13:30.
  • Diet and fluids taken.
  • Anti-hypertensives and diuretic withheld due to low systolic, all other medications administered as prescribed. Patient encouraged to drink fluids. Medical staff informed.
  • Patient mobilising independently with frame – advised to request support if required.
  • TED stocking (large) removed and reapplied after 30 minute rest.
  • Surgical wound (right knee) dressing dry and intact. No signs of inflammation/infection.
  • Recent test results: Hb 132, Urine dip = NAD, MRSA negative
  • Section 2 sent
  • All care explained, patient fully capable of expressing needs.
  • Water and call button in reach.
  • Patient reports comfortable, no concerns at present.

The majority of this is pertinent to most patients. Some will be shorter if, for example, their EWS=0 you would just put ‘Initial observations completed, EWS=0.’ Or if they were on room air instead of nasal cannulae you could say ‘No shortness of breath. SpO2 and respiratory rate within range on room air.’ It is difficult to avoid repeating documentation, for example, I have not included VIP scores for a cannula as this more than likely will have its own separate sheet. Feel free to include it yourself. You will also no doubt think of something else I could have included and this is the nature of documentation. I guarantee you that as soon as you write the final line and sign your name you’ll remember something else to include and end up adding one more line at the end and signing all over again.

What is important?

Well everything and nothing really. Different healthcare professionals will tell you that they only want to hear about x, y, and z when others want a, b, and c. The best you can do is present the information in an organised fashion that clearly and concisely states the contact you have had with your patient. The information should also help staff to notice developing patterns. For example, if a patient has not opened their bowels for a few days and you notice this reading through the last entry, you may wish to discuss this with the medical team to see if an appropriate laxative can be prescribed. Or if a patient continually reports severe pain first thing in the morning, understanding why this is the case and discussing possible changes to their available breakthrough analgesia would benefit the patient greatly.

Remember this is a learning process and no one size fits all. Keep the safety and quality of your patient’s care at the forefront of your mind at all times and you will be fine.