What can nursing give to me?

Becoming a student nurse can consume you. With placement and academic work mixed together, it can often feel like all you do is nursing! On top of that, we often focus on what you can do for nursing. But what about what nursing can offer for you?

Recently, I’ve opened my eyes and seen the reciprocity within nursing. It started with my Nursing Therapeutic module, where we’ve been learning about Muetzels model who says that a therapeutic relationship between a patient and their nurse requires three components. These include: partnership, intimacy and reciprocity. Since we explored how a therapeutic relationship could benefit both the patient and the nurse, I thought maybe nurses get more out of their career choice than I thought?

Confidence! Going into placement takes guts. You are literally throwing yourself into new situations with new people everyday, and that takes a certain amount of confidence. Speaking to the wider MDT use to fill me with dread, but now I basically chasing them around for questions. This has reflected into my personal confidence A LOT. I am more sure of myself, and what I want to get out of situations.

unknown-2Time management. I thought I was organised before I came to uni. I was wrong. I feel I’ve reached a higher-level, as uni has forced me to gain the ability to spread out my work so I’m not over-exerting myself. It’s a VERY good skill, as it’s very easy to become burnt out. Spreading out work helps you fit in the other important stuff that isn’t necessarily related to nursing/uni but is absolutely vital! Get yourself a fab diary and a calendar life will become easier.

Problem-solving. I recently attended an inter-professional workshop with our lovely midwives all about the health needs of refugees. Once we were put into teams, it was like somnurses and midwiveseone lit a spark! Suddenly, adult nurses + midwives + child nurses + mental health nurses were able to outline all these potential solutions to the fictional family we were ‘caring for’. We were more than able to use our combined knowledge to solve the situation with ease!

Honesty. Before uni, I would often be told to do something at work/school and just nod endlessly until they told me to go and do it. What would happen? I would have literally no idea what I was meant to be doing. You can’t really do that in nursing, so you end up asking more questions and understanding where you need support. This not only shows honesty, but it shows a lot of maturity as well.

This is not an exhaustive list by any means, but its great to reflect back on how you’ve grown. I would urge any of you to do the same! Not only is it a useful skill for interviews, but it really helps with realising why this degree is so worth it.

What has nursing given to you? Comment, tell us on facebook/twitter or send us an email!

“The doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.

Student Nurse Advocate

images.jpegAdvocating for patients, in my opinion, is one of our most privileged roles and one we should take very seriously. I have often found, our position as Student Nurses affords us a certain advantage when it comes to patient’s openness right from day 1. Because we are often very hands-on, we know our patients very intimately and they feel more able to open-up to us about smaller concerns they may not feel were important enough to raise with their doctor or consultant for example. This carries a responsibility for us to make sure we take all patient’s concerns seriously and act on/escalate anything that, using our theoretical knowledge, may be of importance to their care. This also takes a pinch of courage to have confidence in your instincts and “back yourself” as we say on the Rugby pitch.

Last week while assisting a patient with his wash (which is often a time when I learn the most about a patient) he told me he hadn’t slept well that evening as he had visited the bathroom over 10 times in the night. This patient was due for discharge in the coming days so this was concerning for me. As an elderly gentleman with hypertension, heart disease and other comorbidities, he was at risk of Falls and if he is going up and down to the bathroom so regularly, especially in the night, he may sustain a serious injury such as a fractured neck of femur. I looked through his drug kardex and found he was on very high doses of furosemide, a loop diuretic that is often prescribed to patients with Heart failure to prevent oedema.Renal_Diuretics.gif

I asked the patient if he was happy for me to discuss this with his doctors and a specialist continence nurse to see if something could be done to help either reduce this frequency or make provisions for his discharge so he isn’t at an increased falls risk, he agreed and I approached his doctor.

This encounter wasn’t entirely successful. When I proposed reducing his diuretics to the doctor, initially his response was “Do you want him to die of heart failure?” – in front of the patient…

keep-calm-and-back-yourself-4Not exactly the response I was hoping for, but I explained my concerns from a Nursing point of view and emphasised I am aware that his furosemide was prescribed for a reason and it is entirely his decision, I just wanted to advocate my patient’s best interests.

This exchange I felt didn’t end on a particularly positive note, so later in the day I apologised to the doctor saying “I didn’t mean to question his treatment I just wouldn’t feel comfortable if I didn’t make you aware of his concerns to see if we could work together towards a solution”. The doctor was much more amicable and smiled and said he understood and would consider what could be done.

Not long after this, the same doctor stopped me and said he had written a letter to the patient’s GP to recommend reducing his diuretics in the community and observe his response. He felt changing his medications the day before discharge might impact on his fitness for discharge. He also suggested trialling Oxybutynin. When I recognised Oxybutynin as an anti-muscarinic (which would improve his feelings of urgency), his face lit up. I have a feeling, he may not have expected me to possess such knowledge.

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So many speech bubbles but 1 shared goal – patient’s wellbeing

Only upon writing this have I realised just how many units of study went into this encounter; Communications, Anatomy and Physiology, Pharmacology, Applied Pharmacology, Nursing Therapeutics, Recovery focused care and Medicines Management all informed my actions in this case. Reflecting on this scenario I am really pleased with the outcomes we achieved. Not only was the gentleman’s GP made aware of our concerns and recommendations but I managed to speak to the Trust’s continence specialist nurse and get her recommendations for interim provisions to help the patient transition into community. I fed all this back to the patient who was visibly relieved and so grateful we had pursued his concerns and formulated an action plan he understood and would work for him.

Advocating for patients is a vital part of the Nursing role and we can see advocacy in the NMC code in various different guises (see 3.4, 4.1, 8.6, 8.7 & 9.3).

#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.

DILP Week 3 – A&E lessons learnt

This last week has absolutely flown by!! I’ve kept myself very busy both in and out of placement which has been tiring but so rewarding!

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Scans following the admission of a lady with drowsiness and weakness following loss of consciousness

I can now run triage efficiently and effectively on my own and have been working with some really great nurses for the last two weeks who have taught me a bit of singhalese in between tasks. Key phrases you need to know as a tourist e.g. What’s your date of birth? What is your pain scoring between 0-10? Etc.

I’ve managed to get all the nurses to ask the patient for pain scores now which is a really vital thing. I only realised they weren’t asking properly when a woman who couldn’t speak with the pain in her abdomen or open her eyes fully had a 5/10 for pain written on her triage documents.. I’m in no way saying this is the only time I’ve come across falsified pain scores, unfortunately. It wasn’t at all rare to see Ward rounding forms where all patients conveniently had a pain score of 0 on my first placement in the UK. It wasn’t the case of course but writing this down meant less paperwork and less hassling the already over worked doctors. So it was sort of left unsaid and when I did rounding a and was accurate with pain scores it was met with a general groan from the staff because they had to chase up altering patients analgesia.

Pain is such a vital symptom to understand – this should be evident by the fact that all of our hospitals have a devoted “Pain Team” of specialist nurses that are like ache whisperers.

Changes in pain, not just the score but the type or the frequency can be the biggest clue you get about what’s going on with your patient and if their records aren’t accurately reflecting this evolution of their pain then we have failed that patient. For example, a headache.

It can be cause my 101 different things but if the patient is complaining of a sharp throbbing headache associated with noise or lights and also has a rash on their abdomen.. This could be meningitis. This patient might require urgent interventions. Equally, they might be having an allergic reaction or be dehydrated. However, without going into the details, we are pretty much running blind.

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This is not where anyone wants to be is it?? 

Literally 3 hours ago as I write this a woman who originally came in suffering from loose stools for 4 days arrested! She started coughing up frothy pink sputum then her heart failed, I was lucky enough to assist in giving chest compressions and ambu-bagging her to keep oxygen pumping around her system.

I had no idea what to expect from the other staff members in such a high-pressure situation but the respect and trust they showed me was pretty moving.

Having the doctors from CCU direct their questions at me about the patient, as a humble Nursing Student, was really empowering. I’m also very pleased to say that the patient’s vitals were stable when she left our care to recover in CCU.

Experiences like that today just remind me how privileged I am to be able to not only be a Nurse but to have this opportunity to travel half way across the world and still be respected, trusted and appreciated for all the hard work I have put into the degree so far. Nursing has always been a great passion of mine and it’s a truly wonderful thing when you can see that that passion exists in Nurses across the world who will work tirelessly next to you for the good of each patient that needs our care.

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.

Padding out your Portfolio

As a student nurse, you are expected to keep a portfolio/professional profile to remember all the amazing things you’ve done, and it’s a good way to show why an employer should hire you.

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My portfolio baby (complete with an unfortunate stain)

Alongside lots of other things like reflections (see Natasha’s blog post), certificates are a good thing to show how great a student nurse you are. Certificates in your portfolio are the equivalent of gold stars on a chart. You’ve really earned them, and they look pretty.

You can get these wonderful holy grails by attending workshops, training events, and educational lectures through university or placement. For example, a few weeks ago I attended the clinical skills event organized by the HEAL society (Healthcare Alliance). And it was amazing!

Alongside with healthcare related students, we learnt skills such as a swallow assessment, how to use an Ophthalmoscope, Neonatal resus, how and why crushing tablets is necessary, and I got to interact with a simulation man! These activities were chosen because they are quite specialized activities, which you might not normally get the chance to learn about. So events like these give you the chance to get that practice in! Plus, most of them were taught by fellow students (speech & language therapists, ophthalmologists, medical students, nurses and midwives!), and peer education is always great! The free pizza was also a bonus..

It’s super easy to get involved with this kind of stuff- you just have to keep an eye out! Most of the events are advertised through your university email, but they can also pop up through word of mouth. So idle chit-chat with your course mates might just lead to some professional development!