Community Matrons; the role we need

I bet you’re thinking, what is a community matron? It sounds very official and a bit scary…but you couldn’t be more wrong!

Within the community healthcare team, there are a wide range of roles. I am currently based with the district nurses (can you tell I love community yet) and I wanted to see how it all fits together. I had never heard of the community matron role, until I met my placement’s local one. She gave me a really fabulous explanation of her job, and I spent two days with her!

Community Matron’s are the Advanced Nurse Practitioners in community. They work alongside the GP’s, District Nurses, Social Workers, Occupational Therapists, Physios etc. to ensure that more vulnerable patients living in the community do not end up in hospital needlessly. Using their amazing medical/psychological/social care assessment skills, they are able to provide support for patients with chronic conditions such as *COPD or heart failure. This is an absolutely fantastic, and much needed role, within the community. They provide extra support to all the healthcare professionals in community.

Whilst working with the community matron, I got a really good idea of what there job is. It’s a very diverse job! One patient we met, the wife was concerned about her husband’s medication. As the main carer, she felt as if not all the medication was necessary and did not understand the need for them. We were able to sit down and have a long discussion about the home environment, how they are coping, and of course review the medication. At the end of our visit, the patient’s wife thanked us profusely for helping her understand. She was much calmer, and felt as if her questions had been answered. One hour made a huge difference to herself and her husband!

Another example was an elderly lady who had *COPD and recently had a chest infection. The community matron ensures that this lady, as well as many other patients with long-term conditions, always have antibiotics in the house, and teaches them to recognize signs of a chest infection. This means the infection is dealt with quickly, it encourages self-care, and reduces the potential stress on GP and A&E services! During our visit, the matron taught me how to listen to chest sounds and undertook basic observations. This is to keep an eye on the chronic conditions her patients suffer from.

This is only a small insight into the work of community matrons, and I could easily sing their praises all day! Personally, this is what integrated care should look like.

I would wholly encourage anyone, no matter what stage in your training, to get a spoke with a community matron.

 

 

 

*Chronic Obstructive Pulmonary Disorder

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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!

High risk women and the importance of continuity of midwifery care

  So this week I’ve enjoyed working within the birth centre at my trust. The birth centre is midwifery led care for low risk women.  This unit only has midwives, there are no doctors, no CTG monitoring,  no medical equipment just relaxing rooms with lava lamps, pools, tea and coffee making facilities, a calm safe place to give birth. The women who are able to use these facilities ’ will have had the pleasure of MLC- midwifery led care throughout their pregnancy, enjoying the continuity of midwifery.  Whilst enjoying my first day me and my mentor got called to go to a heart and lungs ward to see a woman who was extremely anxious about her baby. At 36 weeks she was to have a C- Section at the advice of her  medical team and Consultant Obstetrician. The woman had cystic fibrosis and due to the long term use of steroids to treat her condition she had also developed gestational diabetes.  Once we got to the ward the nurses informed us of how anxious she was about birth, attachment and bonding, feeding, all the anxieties a low risk woman would have. They had been unable to calm her worries.  Throughout her entire pregnancy the woman had not seen one MW apart from the booking appointment at 12 weeks. This was because she was “high risk”. Being high risk she automatically qualified for Consultant led care .  All she had seen were her CF doctors and a Consultant Obstetrician. All the woman wanted and craved was midwifery care, she wanted to discuss her pregnancy, her pending motherhood, her feelings and thoughts of what was to come. Seeing a midwife made her pregnancy seem real putting her anxieties to rest. As midwives we are in a unique position, our role ultimately is to listen to the women we care for. Doctors obviously have to listen but from a medicalised point of view. Anatomy and physiology is always at the forefront of their mind.  It was rewarding to see how our chat had helped the woman, the relief on her face was plain to see, she opened up to us, spoke about her greatest fears, I found the whole experience so hugely rewarding. This is why I came into midwifery- to make a difference, to listen to women, to support them at their most vulnerable, to make them believe they can do it, they can birth, they can get through pregnancy, they are amazing! listening This experience got me thinking- High risk women need continuity of midwifery just as much as low risk women do, in fact in many ways potentially they are in greater need.  This woman had been medicalised her entire life and craved for the normality of pregnancy.  It is so important these women are not forgotten about. Yes absolutely high risk conditions must be monitored by obstetric means during pregnancy, intrapartum and post natal but midwifery offers a unique form of care that is just as important. why  

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?

Spokes – Its a State of Mind!

I attended the 10th annual ‘Mental Health Student Nurse Conference’ held by the University of Manchester yesterday. This was a great event organised by staff here at the University where students got a chance to debate the 6Cs with a panel of professionals. Workshops were held to focus on specific areas such as OCD or Dementia. We were also lucky enough to have a presentation from State of Mind. They are an award winning charity that challenges attitudes and stigma and helps to raise awareness of mental health within the Rugby profession and community groups. The guys were truly inspirational. Lead by a mental health nurse the guest speakers, all of whom were ex-professional rugby players, told us their experiences of mental health following life changing injuries sustained in the sport they love. Click on the link to the charities website to find out more of the fantastic work they do at both professional and amateur level. state-of-mind-logo I am writing about this to show how creative mental health work can be. Using this charity as a starting point, you can be as creative with your spokes as is relative when on placement. Look outside the box and see what amazing things mental health nurses are involved with out there.  Link up to your portfolio requirements as well and discuss possibilities with your mentor to help discover other ideas for learning opportunities. Physical health plays a large part in mental health both as a cause and an intervention. Use your spokes to come up with ideas or suggestions to help improve the care of those being looked after on your placement.  Discuss ideas with your colleagues, peers and AA and bounce ideas around.  Attending conferences and events in and around the university and NHS trusts can help spark your imagination and develop your skills and knowledge in just what mental health nursing incorporates.

Surgical Placements

I’m three weeks in to my DILP block placement of second year and thought I’d write a few words on placements at surgical theatres as they have a completely different atmosphere and routine to a ward environment. The role of the nurse within theatres covers three main areas; scrub, anaesthetics and recovery. While I’m here I have been given two mentors; one who mainly works as a scrub nurse and the other who covers anaesthetics and recovery, this really helps to get the most out of each mentors expertise in a specialist area.

For me the main difference has been that for most of the time the patient is in your care they are unconscious! Care of the anaesthetised patient is an important skill to learn but the dynamic between the nurse and the patient definitely changes when they can’t reply to you! This is why it’s so important to advocate for the patient when they can’t speak up for themselves. Of course it’s also crucial that you gain consent from the patient before their procedure to ask them if it’s okay for you to be there. Many patients are more than happy for you to be involved in their care to aid your learning but don’t take it personally if a patient would prefer if you weren’t present for their surgery.

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Key topics I’ve covered with my scrub mentor are ANTT; one of the scrub nurse’s main responsibilities is to maintain the sterile field around the patient and the instruments used, theatres now use the WHO surgical safety checklist to ensure patients safety during surgery, particularly for instrument counts and checking the patient identity. Scrubbing in and gowning up will mean you can stand within the sterile field and you will be able to get a better view what’s going on- it can really help you brush up on your anatomy and physiology, especially as real organs aren’t as neat and colour coded as in your textbook!

Anaesthetics and recovery is a fantastic place to brush up on BLS skills, particularly airway management. The nurses and ODPs (Operating Department Practitioners) use an ABCD approach to focus their care and it’s also a great environment to learn more about pharmacology related to anaesthetic and analgesic drugs.

Some spoke ideas related to this area could be to follow the patient’s journey from their admission to discharge; spending time on the ward inpatients are transferred from prior to surgery and in critical care following their initial post op care in the theatre recovery area. Follow up clinics, related specialist areas and other aspects of their care surrounding surgery also make interesting spokes related to a surgical hub placement.

If you have a surgical placement or are spending time in theatres on a spoke, make the most of your time there and enjoy not having to wear your uniform! Once you’ve tried scrubs on, you won’t ever want to wear your uniform again- especially in summer!

The Importance of being a Mentee

On my previous placement I was on a busy gastro ward that was understaffed and had a constantly changing off-duty (The schedule of nurse’s hours which is released weekly) and an unfortunately timed annual-leave meant I spent more than half my time on the ward without a mentor. I found this both a help and a hindrance in equal measure.

My Mentor’s absence meant that I was a “free agent”, I could help any nurse at any time, I could move between the 3 bays on the 28-bed ward as opposed to being attached to one, I was always asking for jobs that I could do or nurses would offer to teach me new skills if there was an opportunity. I ended up “doing more” than other girls on my placement because I was far more available than if I was more associated directly with a mentor and I loved being kept busy for my whole shift.

However being on my new placement has allowed me to see more clearly the negative aspects of this lack of a clear and constant mentor. I spend my hours between a mixture of clinics and a day surgery ward, specialising in Ophthalmics and Maxillofacial conditions and traumas so each case varies from the next and we move around the hospital quite a bit. My new Mentor (let’s call her Ann for confidentialities sake) really took the time to get to know me in my first shift both personally and professionally which allowed her to get a good feel for my strengths and weaknesses and what I could learn from this new placement. She introduced me to all the staff, showed me round the ward and explained what her working week is usually like and what her duties were.

Since this initial meeting Ann has been constantly feeding back to me about my progression, offering any available opportunities to me like spokes for example (these are days spent in different areas of practice or in extra-curricular educational training organised by your trust). This open dialogue between us has allowed me to learn so much more from her as a one-on-one basis that I didn’t really experience in my previous placement. This placement is much quieter than my last ward so getting acclimatised to this different aspect of nursing has been tricky for me, as I prefer a ward-based layout, but Ann has made me feel so welcome and supported it shows what a difference a good mentor can make and she is a prime example of what a great mentor is.