What do you think?

"You are a member of the ward team that has to decide which patient is to be put in to a side room, but you need to debate and discuss the reasons for and against for each patient..."

It is not every day that you are in the position to make such a decision, one that could potentially be critical for your patient. As student nurses you are often involved in the decision making but the sole responsibility is always left to someone who is qualified and more senior within the team. Occasionally bed managers make the decision for you, but that is a whole different blog post!

"Mr Smith is a 53yr old gentleman who has had an open and closed*. The Surgical team have discovered that is tumor is now at a stage where it is inoperable. He is drifting in and out of consciousness and reaching the end stages of his life. Mr Smiths family are extensive and would like to be with him as often as they can..."

Do you think a dying man should be left to die in dignity in a side room, surrounded by his family and away from the prying eyes of other patients.

OR

"Mr Kemp is a 24yr old gentleman who has ulcerative colitis. He is in hospital because he is due to have elective surgery. He is currently anaemic and is suffering from terrible diarrhoea which is making him self conscious. The smell is offensive and asking for a comode or bed pan all the time is a little embarrasing..."

Could this young man be saved the embarrasment of having to run to the toilet every few minutes. After all hospitals are not places for young people.

OR

" Mr Jones has recently had surgery. Swabs were taken from his wound site and the results have come back positive for MRSA..."

Surely infection control procedures should be followed in order to protect patients from infecting MRSA.

The decision is yours!

I bet I know what your thinking. You instantly chose the dying patient, yes?

Every patient has the right to die with dignity surrounded by the people they love in a comfortable environment, right? Well of course they do. So why not send them home or to a hospice. Hospitals are places for the acutely ill and patients who no longer require 24hr care can be reffered on to other care providers. This does not mean that I advocate pushing dying patients out the door, it is not that at all, but in an ideal world we would love to put everyone in to a side room who deserved to be in there. However, we can not provide that type of service.

The young guy who was quite unwell. Yes, he is young. So what? Age does not play any kind of part in the overall care that a patient recieves. Yes, age is considered in alot of treatments (e.g. contraindications of surgery, drug dosages etc) but saying that he deserves a side room because having diarrhoea is embarrasing for a 24yr old guy is not good enough. Turn the tables a bit, if he was 84 would your opinion be different? I guess you would just give him a bed pan because why not he's lived his life. What if the patient was an 84yr old female? Would your opinion change again?

Some illnesses come hand in hand with some pretty nasty and horrible symptoms. Diarrhoea, vomiting, flatus, oozing, seeping, incontinece, dribbling, sweating.. and the list goes on. All of those things are embarrasing, they all lower the patients self esteem. This is something we do need to take in to consideration but to put someone in to a side room to maintain their street credability is not good enough.

Last but not least, MRSA. This could either be aquired from the patients home before being admitted, or it can be hospital aquired. In this instance it was hospital aquired and at the wound site. Isolating this patient is paramount. He does not require an armed guard but do be sensible.

I could sit here for hours and tell you my opinion on the subject matter, but I guess we all have a different take on things.

What do you think?

Welcome to 2010...

I am on my knee's in front of a patient, dabbing at the large cut on his eyebrow.

'Did you black out at any point? Do you have a headache? How much alcohol have you had to drink this evening?...'

My interrogation carried on whilst all around me were the bodies of wounded strangers. They were sitting in chairs, laying on stretchers and a few were wandering around aimlessly.

Some bright spark decided that throwing glass bottles into the air whilst in the middle of a crowd would be a fun game. The bottles returned to earth crashing into anyone that stood in their way. Slicing into faces, arms, torso's, feet.

I found myself zoning out, blocking out the noise and urgency of other patients whilst I made sure I did a good job on the one sat in front of me. I patched him up and sent him on his way. As i returned to the masses the noise gradually became louder, the crying and whaling of other patients became increasingly unbearable. I had come out of my 'zoned out' state and walked back into reality.

Who will I treat next? Shall I go for the unconscious, unresponsive teenager or the multiple facial trauma? or how about the suspected spinal fracture?

Yes, you guessed it. I chose the suspected axial burst fracture! Wahey! I get to play with some toys, puff out my chest and play with the big boys. hehe.

She was sat in a chair with a nurse holding her head, I retrieved our kit and applied a hard collar. The plan was to slide the long board behind the chair and tilt the chair down until she was flat on her back, on the board, on the floor. I am pleased to say that it went rather smoothly, I had hold of her head whilst the Dr cleared her. She was assessed and we were happy to send her on her merry way, without the added accessory of the spinal board of course!

By this point Big Ben had chimed, fireworks had gone off and it was finally 2010. I did not see midnight but I did see a very nice splatter of second hand kebab that night.

Happy New Year.

Bah Humbug

I know its a bit late but I wish you all a Merry Christmas and a Happy New Year!

Christmas and New year was a busy time for me. I spent some time over Christmas volunteering for Crisis Christmas (Crisis.org.uk) It was an enlightening experience to say the least.

I spent time with people who I would not usually socialise with in any other circumstance. I ate dinner and drank tea with people who could tell you stories that would make your toes curl, but I loved every minute of it. I was seen as an equal despite there being very clear and obvious differences.

My first job of the shift was to stand on the front gate and welcome in the guests, do a quick pat down for alcohol and weapons, if all was clear, send them inside. This sounds easy enough right? Think again!

One particularly loud lady approached the entrance to the centre, I'm guessing because of her extrovert nature the other girls on the gate did not want to search her so dispersed, leaving me on my own. I proceeded to pat her down, after all what's the worst that could happen?

'Do you have anything on you that could harm me or other guests?' I said calmly.

'Are you accusing me of being a druggie?....that's so typical of people like you... you come down here trying to save the world and you think because i slur my words I'm a druggie so I'm going to prick you? ... well you can f**k off!....'

To say I was slightly taken aback would be an understatement. She carried on with her speech for 5 minutes whilst I stood back and let her get it off her chest. She began to calm down and let her friend do all the talking, I approached her (with caution!) and apologised.

'Thank you, I'm sorry I shouted. Its just I'm always labelled you know?'

Sadly, I think we all understand the implications of labelling and stereotypes. Only this time I will take it a little bit more seriously.