Be Resilient, Stay Brilliant

Student nursing takes many different skills: patience, compassion, dedication, the ability to plaster a smile on your face for 12 hours even when you’re exhausted, and more. But there is one skill I never thought would be so useful; resilience!

Resilience is when you’ve made a simple mistake and you can feel the embarrassment creeping up, but you carry on caring and learning. It’s what makes you keep going when someone doubts your ability. It is what you use to take in constructive (but sometimes not!) criticism on an essay, a presentation or an act of care. Resilience is the ability to bounce back!

I didn’t realize how important resilience was until I was having an incredibly busy day on my last placement on an acute medical ward. Myself and my mentor had ended up with a few very poorly patients, an astonishing amount of paperwork, delayed transport for a patient and some awkward available beds mix ups. To help out, I offered to call a unit an explain that patient they were transferring to us needed to be delayed slightly, due to late transport. I was greeted with what I describe as understandable anger and frustration. I spoke as calmly as possible, explaining that we were sorting the situation and that the patient would not be delayed much longer. The nurse I spoke to continued to berate me on the phone, and eventually hung up.

Luckily, within 10 minutes, we had managed to sort the entire situation out. No more angry phone calls for the day! I spoke to my mentor about what had happened, and she reassured me that it was just a tough situation and not to take it to heart. I still get slightly annoyed when I think back, but I have to remind myself that we are all just looking out for our patients. Sometimes that comes across in different ways! I think if I was a qualified nurse, I would have had a better understanding of how to deal with the situation. But I know for sure that I will not forget this phone call.

Remember; if you have experienced a situation like mine, please talk to someone about it! Whether it is your mentor, a fellow student, the PEF, your AA, friend, family dog etc. Difficult situations should be discussed, and you are allowed to vent. I can highly recommend writing a reflection about it!

Have you had any moments of resilience? Let us know in the comments, or on Facebook/Twitter. Or, if you’re feeling creative, write us a blog post!

 

 

 

 

 

 

 

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

Life on a Mental Health Mixed Acute Ward

It’s a roller coaster ride

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Some people like them some people don’t but life on an acute ward is often up and down. Some days are busy some days are – dare I say the word…. Quiet!

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But no two days are the same, which for some people is what attracts them to work the acute life.

Acute wards in mental health are designed to be a place for assessment and or treatment for people experiencing a severe episode of mental illness. Admissions can come at any time in the 24 hour period and with varying degrees on urgency.

Some patients are informal and choose to be admitted as they may recognise they are unwell, others are brought in on a 136 section from police custody due to concerns for their welfare or that of others. All will need risk assessing and care plans put into action straight away.

On top of the new admissions there are the often another 20 or so patients on the team-upward (depending on the size of the units). These patient’s presentations may vary day to day depending on how their treatment is going and how they feel it is going. Whilst mentally unwell, patients may have little or no regards for others on the ward so balancing out everyone’s needs can be hard. Team work is essential.

Some patients may be restless all night so keeping the disturbance for others to a minimum is another challenge. Flexibility and thinking on your feet for solutions is another necessity for a mental health nurse.

However there is nothing more rewarding than escorting a discharged patient calmly off the ward knowing they are now thinking  and feeling a lot more clearly and will hopefully be able to manage their illness out in the community and regain their place as part of  their family or community.

As a student nurse a mental health ward is one of the best places to really understand what someone experiencing a mental health illness can be like. Every kind of illness could be admitted, from depressive or manic behaviour, thought disorders and post-partum psychosis to severe self-harm and aggressive behaviours. To match the variety of illnesses you may encounter there are the medications to match.

The medication trolley will be your nemesis as a student nurse. Trying to remember your anti-depressants from your mood stabilisers and your anti-psychotics becomes stressful as you are under the watchful eye of your mentor as well as the patient themselves. You probably won’t remember them all so don’t try too.

Always ask if you are unsure – the patient is an expert in their own medication usually as well so there is no harm in asking them if they are stable in their presentation to assist you. This also helps to check the patients understanding of what they are taking their medication for; which is part of the NMC Code.

Talking to the patients can seem daunting at first but just being around canbe helpful for some as a piece of mind that someone is there is they need them. As a student nurse you may often find during your shift you have more free time than the qualified nurses so you can become extra support and provide more vital one to one time with a patient. Just don’t forget to document it afterwards.

Love it or loathe it acute wards can throw anything at you at any time of your shift they really are a roller coaster!

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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.

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  

We need to talk

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Approaching the end of my first placement, I’m finally feeling a bit less like a headless chicken. I know my way around a bed bath, I’m comfortable with a host of bodily fluids and have mastered the art of the perfectly positioned bedpan. I understand the rhythm of the ward and I’m more familiar with the paperwork and observations…well, I’m getting there.

However, what still keeps me up at night is that difficult question I didn’t answer well or that awkward moment of verbal diarrhoea when I should have just SHUT UP and listened.

We all know communication is important – but a recent report from Marie Curie explains that good communication is more than a ‘soft skill’, a ‘nice-to-have’ bonus once we’ve taken care of everything else. It says that good communication is an integral part of a person’s care and can have a direct impact on their recovery – whether it’s making sure a patient understands why they must take their medication, involving a patient in a decision or simply giving someone reassurance to ease anxieties.

On my ward I’ve noticed that as student nurses, we can play a special and unique role. Patients seem happier stopping us and asking questions or confiding their concerns and we can enjoy the privilege of a bit more time to stop and talk. Those few extra moments aren’t idle chat, they’re a key part of that patient’s treatment. They help them feel cared for, more human, especially when staying in hospital for long periods, away from everything familiar.

I found our recent communication module really valuable, though it could be easy to question why we need to be taught communication – we all know how to communicate, right? Marie Curie’s report argues that communication can and must be taught if we are to improve care – my time in practice so far has taught me that communication is probably the most important skill I’m going to develop.

Words stick, probably more than actions, so I want to be equally confident in communicating with patients as I hope to be in dealing with their physical needs.

It’s a work in progress and I know it’ll take time to develop my own, natural style of communicating with patients – I still find myself trotting out cliches or borrowing phrases from other staff that I think worked well. Recently I’ve been looking for opportunities to simply sit and talk to patients, and it’s paying off – I feel a little bit more confident after every shift. I’ve realised that patients don’t expect us to have all the answers; often, it’s just being there that counts.

Oops, my mistake!

I won’t lie, my first placement has been hard. I’m on a busy ward looking after elderly patients and most days I return home in a zombie-like state wondering whether I’m strong enough, physically and emotionally, to be a nurse. It’s a rollercoaster of emotions ranging from fear to blind panic, confusion to joy.

I’ve also made plenty of mistakes – though one in particular still fills me with dread. Shortly after arriving on a busy late shift, the senior nurse I was shadowing asked me to do the observations for a bay of patients. I picked up the iPad and wheeled the trolly over to the first patient in the bay.

15083417861_fa0698290d_bIt took me a little while to find her pulse, which was very faint, and I ended up taking her blood pressure three times to get an accurate reading. This made me anxious and I could feel my face burning up, conscious that I was taking far too long. When I got the reading, I took the remaining observations and saved the results on Patient Track before quickly moving on to the next patient. What I failed to spot was that my first patient was scoring a ‘3’ meaning that I should have alerted a senior nurse or doctor, so that she could be monitored more closely.

Later that night, I was heading to the linen cupboard when a nurse called me aside. She asked me why I hadn’t reported that the patient was scoring a three. I was horrified and admitted my mistake straight away. She was kind and told me not to worry, saying that the doctor was now with the patient who thankfully seemed to be fine – but I felt so guilty, worried that I’d put her in danger by not spotting something so obvious.

It feels horrible to make a mistake, especially one that could put someones life at risk. In my previous job, a colleague often used to say ‘it’s not life or death’ when something went wrong. It wasn’t then, but now it often pops into my mind, because as a nurse it could be!

When I got home that night, more exhausted then ever, I decided not to let it get to me. I’m sure this will be the first of many mistakes. In fact, I realised that I’m better off embracing failure – nursing is a complex, messy and confusing business, so it would be naive to think I could waltz in Florence Nightingale-style and do things perfectly first time round. Mistakes are often the best way to learn and there’s nothing quite like that feeling in the pit of your stomach for making you remember something – I know for sure that I’ll be checking and DOUBLE-checking the scores next time I do obs!

I think the trick is having the willingness to own up when something has gone wrong and do our best to make sure it doesn’t happen again – but hey, there’s no guarantee. We’re only human, after all.