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.

Lost

Through the small window in the door I can see her laying in bed like a little kitten snuggled up amongst the blankets. Only her head sticks out the top, slightly sunken in the pile of pillows she is resting on.

I let myself in to her sanctuary and place the jug of water I'm delivering on to her side table.

"Who's there?" She squeaks.

"It's only me Sylvia, I just came to replace your jug of water"

"Oh well that's all right then"

As I make my way around the bed to meet her gaze I am greeted with a toothy grin and a wink.

"Where have you been? I have been waiting for you. Just look at the mess they have made, look!"

I peer down to the bottom of the bed where she is pointing. Her covers are ruffled up past her ankles so her feet poke out of the end like sticks. The bandages on either foot have been cut down the middle and spread so that the odd ends lay either side of her feet, exposing the rotting flesh beneath.

--------------------------------------

This lady was admitted after a fall which left her with an open fracture to her ankle. As a result of poor vascular return she has gangrene in both feet. She has ulcers all over her feet and some of her toes have turned black.

--------------------------------------

"Why are my toes black?"

Tears have begun to well up in her eyes and something inside of me tightens. I sit myself down in the chair beside her bed, placing one hand on top of hers. She weeps silently turning her face away from me. How much differently can I explain to her, what has already been explained many times before?

"I miss my mother you know. I miss her terribly"

I nod and smile in the right places as I listen to the unfolding story. It is a tragic tale of how much she loved and adored her mother, how beautiful and caring she was. They shared a loving relationship until one day, Sylvia was 15, and upon arriving home from school her mother was not there. There was a note left behind, from a stranger, telling her to make her way to the local hospital.

Sylvia arrived at the hospital flushed with anxiety not knowing what to expect. She was greeted by the matron who led her to a quiet room. Sylvia was told that her mother had suffered a stroke, she was looked after as best they could but she didn't make it.

"Your mum must be so proud of you being here, looking after old cry babies like me"

Suddenly I can feel a lump in my throat and my lungs can't find the air. My heart starts to pound and I am overwhelmed by a strong feeling of loss. Rationally I know that I have not lost anything, but listening to this story has stripped me of my professionalism and made me vulnerable.

I have to get out of the room.

I mop Sylvia's tears, stroke her hair and give her a few squirts of her favourite perfume. She gives me that heart piercing smile and I make my way out of the room.

I look at the clock and ask to be relieved for my break. I make my way to the changing rooms where I sob uncontrollably. I grieve for Sylvia's mother and all the things they was not able to share together.

I then write a text to my own mother.

'Hope you are having a good day, I will see you later, I love you xx'

Gerry Will Fix It

I turned over the television only to find a rather interesting program.

"Can Gerry Robinson Fix Dementia Care Homes?"

This program was right up my street. It highlighted many important points about what we are lacking as a nation. We lack compassion, empathy, realism, enthusiasm, motivation.... I don't think I need to add any more to the list, you get the idea!

Although I am studying Adult Nursing, what some know as general nursing, I do have a keen interest in mental health. Especially with Dementia patients. In my opinion, this programme touched on some important issues and opened up our eyes to the ongoing problems that face care homes across the UK.

There is a lot to be said about one-to-one care for dementia patients and I believe that patients benefit from such close care from their carers. For example; I spent time on the ward with just one patient. She had Alzheimer's and she was pretty far advanced. Just having me around her had a marked improvement in her behaviour. She had previously pulled out her catheter, left the room and was wandering. With me around, she was eating all her meals and enjoying them, having conversations about the weather and things she liked and disliked.

It breaks my heart to see patients admitted to care homes and just left there with no stimuli.

Let's not let this happen any more. Tune in next week for the second part.

Dreams

For the past week I have found it extremely difficult to sleep and when I do my mind decides to take me deep into weird and wonderful dreams. Some have reoccurred but on the whole I get a fantastic vivid new episode every evening.

My latest one.

I am in my Nan's flat, surrounded by most of my family (On our annual get together I suspect). I am then stood there trying to steady my nan, she is wobbling all over the place. I can't seem to catch her in time and she crashes into the door banging her head fairly hard. She recovers momentarily but then she collapses in front of me.

I immediately call out to her, lean over her and shake her. No response.

My family all look at me, my mum and aunt already in tears. I pick her up, in my dream she is weightless, and I take her to the sofa. I check her over but she just lays there motionless, not giving off any signs of life. In my mind I am willing her to move, I am thinking over what to do next but I am also conscious that it is a dream and what ever I do wont work.

The next thing I know, I am transported to another place as I make my way to my nan's kitchen. I don't recognise the place, its dark and woody. I think I am outside and I am also on my own. I try and wake myself up, 'wake up, wake up...'.

Soon enough I am awake and I am slightly disorientated to the time and place, its dark and I am overcome with emotion. I hope my Nan is ok.

This has now happened two nights in a row. I don't know if some outside force is trying to warn me about something or not?

NOISE

When I first came across this article I recoiled in horror - http://news.bbc.co.uk/1/hi/health/8387836.stm

In an ideal world we would all like hospitals to be quiet tranquil places, offering us a place of sanctuary when we are recovering from an illness. You should be able to have your privacy and dignity maintained and get rest as and when you require it. For those of us who have had the pleasure of staying in hospital, or for the few of us who work there, you know that this is not what happens in reality!

I am somewhat disgusted to know that there are people out there who are putting figures on what should be acceptable noise levels in places where this is just not achievable.

"patients should not be exposed to noise above 35 decibels or a loud whisper..."

So what you are trying to say is that of all the million and one things I need to do for my patients, I am going to struggle to do them if I am required to speak quieter than 35 decibels? I do hope that none of may patients are hard of hearing!

What about the patient with dementia who is wailing at the top of her voice as she hobbles down the corridor? Or the 'quiet top' bin lids which are no longer quiet which have failed to be repaired by the domestic staff? Not to mention the gaggle of student medics who are gathered at the nursing station gossiping.

It is not realistic. It is not achievable. It is not going to happen!

Answers

What do you do if you have missed the opportunity of a lifetime because you were too blind to notice just how much it meant to you at the time?

Answers on a postcard

Faith

I enter the room and immediately I can hear the classic wheeze of an asthmatic. He sits in a chair looking up at me craving relief from his inability to breath out. It kicks in fairly quickly that I am the one to provide that relief, so with introductions over I put him on a nebuliser and continue my assessment.

I look to my crew mate to get some vitals as I continue with the treatment. He responds well to the Neb and I get a little more history out of him. He was on his way home driving down the motorway when he began to feel breathless so pulled into the services. He wound down his window in the vain attempt at making things a little easier but some fresh air provided no relief so he summoned the help of a shop worker who then called us.

He has been asthmatic almost all of his life and has been hospitalised before after a particularly bad attack. *Cripes* i thought, best get the RSI ready! (Just in case of course). I consider all the possibilities so that I am keeping my options for treatment open, and I think its time to bundle the patient into the truck and get him off to hospital.

My crew mate agree's so gives me a smile and a nod.

-----------------------------------------------------------------------------------------------------

'Right, you can stop there'

*Phew* the scenario is over and I can stop trembling now. I take a look around at my team, one playing the role of the casualty and the other playing the role of my crew mate. They both give me the thumbs up. I then take a look at the assessor.

'Well done. You were calm throughout and you explored every possibility and narrowed it down'

I was chuffed with this critique. I had been nervous all weekend about whether or not I could make the grade. I was one of the least experienced members of the group so I thought I didn't stand a chance of passing.

I came away from that course having learnt that I CAN do it. I know what I am doing, I just need to apply myself and have a little faith in my abilities. I also learnt; in the wise words of a very funny northern chap -

"If it isn't going to kill you or make you pregnant, then what have you got to worry about?"

GP = Ghastly Practice

As of this morning mother has been signed off work for another week. She's not a happy bunny. After the MI in august she was off of work until the new school year and more recently she has been off for a week with Laryngitis. However, this has progressed into a serious chest infection warranting heavy antibiotics. The GP has been most unhelpful by just writing up a sick note and telling her he hopes she feels better soon.

My question is; Does it rely on training and experience as to the kind of treatment you receive?

I know that GP's are not masters of the universe and do not know everything, but I know from my own training that if you complete a full assessment and you listen to your patient, then you can't go far wrong. This works for any health profession. Nurse's, Doctor's, Ambulance personal etc. Cracking out a book to check so that you can be 100% sure would not be a problem. When I was 7 I had an inner ear abscess, my GP pulled out his encyclopaedia and confirmed his diagnosis was correct. I thought this was great, it proved that he was not going to second guess himself.

Do these quick spin GP's just see patients for 10 minutes at a time, with only enough time to only discuss one problem to then write up a prescription and wish them well until next time? It takes the average member of the public around 3 days to acquire an appointment to then be told about what you can and can not talk about with your Dr. Your made to feel like a time waster if your problem is deamed as trivial so you wait another 6months until your limbs are hanging off before you make another appearance at the surgery.

Most of the time you go in to find that you are not seeing your regular GP and instead you have an over zealous locum smiling and nodding at your every word, whilst incessantly staring at the computer screen. Maybe this is a new way of assessing patients that I just haven't heard of yet?

From my own personal experience I was diagnosed with Chondromalacia patella using a two year old MRI scan. The GP I saw know's I am a student nurse so threw the symptoms back at me asking for my opinion. She was some what disgruntled when I told her that if I knew what the problem was then I would not be sat in front of her! I had the scan when I was 18 so now two years on my symptoms are worse, the pain is sometimes unbearable and I have the added fear that if the problem has worsened it could potentially ruin my career.

I know that I should be offered another scan so that the Orthopaedics can reassess and I can either be treated conservatively or with much heavier treatments such as a knee wash out or key hole surgery.

Than again, what do I know, i'm only a student!