Wednesday, August 19, 2015

The End...?

There. Three years of work whittled down into three lever-arch files ready to collect dust on a shelf for an indeterminate amount of years..

The end of an era. I’ve absolutely loved being a student nurse. I’ve loved the experiences I’ve had, the friends I’ve made, the people I’ve met and the sense of pride and achievement at so many steps along the way. However, it’s been a hectic, stressful and chaotic three years. I have written over 20,000 words in 9 assignments on a wide variety of subjects, sat 8 exams, spent nearly 60 weeks on placement in 7 different areas, attended countless rep meetings and open days. I’ve helped to organise a conference (or two) and a week-long death café. I’ve been to Leeds, London, Manchester, Liverpool and Edinburgh on various occasions for various extra-curricular activities. In my spare time I've also had a car crash, endured the most horrible bereavement, and of course - had the pleasure and responsibility of looking after my lovely family (including a post-operative husband at one point!). 

It’s been hard, hard work. I definitely took on more than I had to, but I don’t regret a second of it. I’ve been determined to do well from the start and keeping that momentum going for three whole years has been, at times, exhausting. There have been so many tears and tantrums (usually in the week before an assignment deadline). Times that I’ve said “I can’t do it”…but having that sense of determination meant that “I can’t” was always closely followed by “…but I WILL!”. 

And I did!
 
I’ve just completed my final placement. Twelve long forty-hour weeks. I was on placement when I got my final assignment grade in July. The feelings of happiness, pride and relief at not having to write another assignment were overwhelming that day. That was the moment I thought “I’ve done it!” I couldn’t stop grinning like an idiot all day, but then burst into tears watching a mildly sad film later that night - complete emotional overload. So, I had thought that I’d probably feel the same on leaving work after that final shift – but strangely, it felt like any other day. Part of me wonders if that’s because it hasn’t all sunk in yet, but I think it’s partly because I’m not as sad to finish as I thought I would be. 

This last placement has shown me that I’m ready to move on. This is the first time since starting my degree that I’ve felt held back. At the start of placement I was told “don’t think of yourself as a student now, think of yourself as a staff nurse”. I found this very difficult to do when still treated as a student. Managing your own patients is hard when most of them are nil by mouth and their medications are all IV and explaining that you need to get a “proper nurse” to flush their cannula to stop the pump bleeping or to give them some pain relief. You’re restricted by the routines, and your mentors’ “way of doing things” because although they want you to be independent – you’re still reliant on them to agree to any decisions you make and countersign everything you write. And often, to other professionals, the student uniform is like a Harry Potter style invisibility cloak. Regardless of the fact that you’ve looked after that patient for the last three days and know everything about their care, you’ll still have doctors, physio’s, dieticians etc., asking to speak to the staff nurse – or worse, speaking to the staff nurse without any interaction with you at all so that you miss important information about their care. One patient actually remarked, “It’s a shame you have to wear that uniform and be called a student, considering all the work you do.” And though I’ve always been proud to wear my student nurse uniform, I felt inclined to agree.

In a few weeks it will all be confirmed in black and white, and I’ll have my official qualification, and I have a job to go to that I’m really looking forward to. I’m slightly terrified too, obviously. The sudden responsibility; that first solo drug round; that first, terrible time the crash alarm is raised and I’m expected to know what to do, and all those other scary scenarios to be in. But then there’s the other things, the good things. Things like… getting PAID! (OK, so that’s not very dedicated of me, but it’s a practicality that means a hell of lot after three years of financial nightmares.) There’s being able to finally be your own person and doing things the way you want to do them. I’m looking forward to finding out what sort of nurse I can be when I’m left to my own devices. I’m looking forward to meeting new people, making new friends, learning new things and all the new experiences of new job. 

The other day, a nurse I was working with asked me what my future plans were and what area of nursing did I want to work in. I really struggled to answer. Up until now, this has been the goal - finish degree, get a job - and that’s all in hand. So what is next? Well, firstly I want to spend some time with my family. Yesterday, I watched my daughter playing out on our neighbours’ bike…without stabilisers! When did that happen?! How did I miss that? I feel like I’ve missed so many things - sports days, parents’ evenings, family gatherings, seeing friends. I’ve got a lot of making up to do. I would like to do a masters’ degree at some point, but other than that I’ll just see where life takes me. For now, I just want to spend time being the best mum, wife, friend and nurse that I can be - and I'm looking forward to having the time to do that without worrying about assignment deadlines or directed study or pre-reading for lectures.

So all in all, finishing my nursing degree is not the sad ending I thought it would be, but instead it's a proud achievement and the start of an exciting, happy new beginning :)







Friday, April 17, 2015

To my best friend


A quick note...

I wasn't sure whether to publish this or not. It  seems a bit too personal... and I doubt anyone else would want to read it. But then I thought, "this is MY blog, and I need to write this. For me."

So here it is.

 

I’ve tried to write this all week, but found it difficult to find the words. And I had to write it because you're the only person I could, or would, tell. I’m not very good at talking about me – to most people anyway – but to you I could. Though I mostly didn’t have to, because you’d just know. Whatever happened, whatever was said, I never had to explain myself because you always just understood. I don’t wear my heart on my sleeve - if I’m sad or scared or annoyed or angry, I don’t usually tell people about how I feel. But you already knew. I was going to say that the one thing you didn’t know was what an enormous part of my life you were – but you did know. Of course you did.
We worked together, our kids went to the same school – same class even for a while, and we lived within staggering distance of each other’s houses. Not forgetting that you were my honorary bridesmaid and honorary godmother to my daughter – we never let small things like me not having any bridesmaids and Emma not being Christened get in the way of those. She’ll always be “your iccle Emma”. She loved you too.
 
 Not that we were joined at the hip, we didn’t always see each other as much as we wanted to. But you...we...were just always there. I could be silly with you, get on my soapbox with you (though you were usually on it first), have a rant with you - we did love a good rant. We did serious too...sometimes...


It’s just so bloody hard to lose your best friend. It feels like "bereavement" is something that's reserved for direct relatives, if you know what I mean. Blood is thicker than water and all that. I feel like I’m having to make people understand that “best friend” is just as painful, if not more sometimes. It almost feels like I'm not worthy of this amount of grief, because we were "just, only friends". No matter that you were more like my extended family than my actual extended family. 
This isn't the first time I’ve done the whole bereavement thing. You’d think it’d get easier. But my previous experiences of this horrible sadness that comes with grief have never been accompanied with this sickening feeling of loneliness and isolation that I’ve got now. And that’s because at those times before - I always had you...and now I don't.

Northern Lights (Golden Compass) (Phillip Pullman, 1995) probably wasn’t your cup of tea, but if you read it (I know you didn't) – cutting children from their dæmon. That’s how it feels. Like someone’s taken a great big knife and sliced a massive piece of my life off.

When I stay up till silly o’clock in the morning, there’s no Facebook messenger conversations anymore, because you were the only other person in the world to be daft enough to still be up. I miss those conversations terribly. I still wait for your comments on my Facebook statuses. No more calling in for coffee when I drive past your house, and I drive past it a lot. You were the first person I thought of to tell all my things to - even the silliest, most trivial things - because I couldn’t help but smile knowing what your reaction would be – good or bad. There’s no-one to tell those things to now. I told you more than I tell my husband. When I graduate, I’ll be sad because you’re not there getting all soppy and pathetic….for all of a minute before we start throwing sarcastic insults at each other. When I finally move house, I’ll have to get excited about obsessive colour co-ordination and accessories and soft furnishings all on my own...

...but that’s me being selfish. That’s me being sad for me. Which doesn’t compare with how sad I am for you. It seems so cruel that someone who loved life as much as you should die so soon. I’ve cried so much for you, for the future you wanted but couldn’t have. I think of how tired you were, and how much it hurt you to live with the knowledge you were having to leave your children before you’d finished helping them grow up. I know how much pain it caused you – I felt it. And I honestly don’t think you’d have made it as long as you did if it weren’t for your love for them. You had so much love for all your family and they did for you too. In way that made even harder to bear. I can't begin to imagine what they're going through right now. 

Now I hug my children that little bit tighter because you remind me just how lucky we are to be together. In fact you’ve taught me a lot. From now on, when I moan that life’s too hard – I’ll think of you and be grateful for everything I have. When I think I’m struggling, I’ll think of you and I’ll know that it’s nothing compared to what you did – and you did it all with a smile. I’m so very proud of you.

Also from now on, I will put extra tinsel on my Christmas tree and I will always chop carrots into round, circular slices. Because I know how much you hated those things. Hehehe. (I can hear you giggling at the very notion of me actually preparing fresh vegetables.) Every Christmas Eve (work permitting) I will still go shopping at 6am in a silly hat and then go forcoffee at McDonalds after and I’ll drink a toast to you…



I could write more, I could write forever, about you and how wonderful I think you were/are/whatever. But you already knew that, right?
If I could send you a Facebook message right now, I’d say:
Need to clean this bloody house – I seem to keep getting dust in my eyes or something. Cos I’m absolutely, definitely NOT crying.
...
Love you Lady D Xxx
And you’d say:
Love you too Dotty Xxx
...
Thank fook for facebook cos I’d never be able to tell you to your face :’) <3<3<3
And I’d say:
I know :’)

Saturday, February 14, 2015

Labels are for Jam Jars


I had a little conversation on Twitter today with @cookieskitty and @lulaperula about putting a person first and not defining someone by their medical condition – such as “a diabetic” or “an asthmatic”, for example. It reminded me of a blog post I read by @everydayupdwns where he talks about how subtle use of language can have quite a dramatic effect on attitude (read it here: http://www.everydayupsanddowns.co.uk/2014/03/why-i-decided-to-stop-being-diabetic.html?m=1 ).
We should really give some thought to the language we use in healthcare. How we describe someone - in handover for instance – will create the perception of that person for others, and that perception will either be a positive or negative one. I’ve heard people who need support with mobility described as “a double” many times, which gives an impression of hard work and a drain on staffing resources. I’ve heard people described as being “very demented” rather than a person who has “mid-late stage dementia”. Not very positive or accurate terminology, is it? Labels are for jam jars - people are so much more interesting and complicated than a single medical or physical condition.
Anyway, I wanted to share with you my experience on placement yesterday. I was working in recovery and took the handover from a staff nurse for a patient who had just had a procedure. I was told his name, which procedure he’d had and how successful the procedure was. I was told that this gentleman had been very anxious about his procedure, that it had been rather painful for him and that he would therefore need a bit of extra support from staff in recovery. I was told that he had had no sedation or pain relief (at his request) and therefore could get dressed and have something to eat and drink as soon as he was ready, with which he may need some assistance. I was told that his relative was ready to take him home and was waiting in the waiting room. That was pretty much it. That was the handover. It was a handover the same as any other might be. From that handover, I knew all I needed to know to support this gentleman and I went about my work as per usual.
At no point was it mentioned that the gentleman had a learning disability - nor was it necessary.
Nursing without labels – just as it should be :)


Update:
Following some wonderful debate on Twitter, I just wanted to point out that of course conditions (medical or otherwise) must be raised/flagged/documented/handed-over in order to give the right care, support and treatment. My point is that there is no need to label a person as a condition. Person centred care is about putting the person first. People are not diabetics, schizophrenics, asthmatics, dyslexics, ostomates, lepers, etc. These are labels. People are people who may or may not have conditions for which they may or may not require treatment and/or support.



Saturday, January 24, 2015

Just a Student Nurse

There’s no doubt about it, being a student nurse is hard work. My degree is made up of ten(ish) week blocks of placement twice a year, another twenty-odd weeks of theory in uni and seven weeks of annual leave – most of which is spent working on assignments, coursework and revision. A nursing degree requires 40 hours of study or placement a week in order to achieve the grades and experience needed to pass, though I’m sure many of us do more than that (certainly feels like it anyway).

I’m currently three weeks into my penultimate placement. Only seven months until I qualify, so the pressure is on. I feel like I should know everything. But after a variety of placements and previous care work experience - not to mention the enormous amount of nurse-related information that my brain has had to process over the last two and a bit years - I still feel like I know nothing. Every placement is like starting a new job. I'm feeling like the new girl (again) on my first day of school. I have no idea who anyone is, where anything is or what do with it when I find it. I’m suddenly faced with scarily expensive, complicated, technical equipment and procedures that I can’t even pronounce let alone explain to an anxious patient. The paperwork is either different for each procedure, or the same for different procedures. It’s so confusing! Worse still, I’m wearing scrubs in this placement which means I look the same as the rest of the staff – the only thing that distinguishes me as a student is my little badge that nobody looks at. Patients and relatives (and doctors) see the uniform and ask you all sorts of questions that they expect you to be able to answer – so I’ve become rather adept at the skill of maintaining an air of professionalism and hiding the “rabbit caught in the headlights” look of horror, which is what I’m actually feeling most of the time.

And I’ve heard myself say it. Those apologetic, excusing words of low self-efficacy:
"I’m just a student"

And that’s how it feels. Among the experienced nurses and healthcare assistants who breeze through their work like it's second nature, I certainly feel like I’m “just a student” - an inconvenient mistake-maker that holds people up and doesn’t have a clue.
"Just a student nurse."

In this context, The Oxford English Dictionary describes “just” as being an adverb to mean “simply”, “only”, “no more than”. And on looking it up for the purposes of this blog post, I was rather saddened to also see this definition: “to the exclusion of everyone/everything else, and no one else, and nothing else”.

"Just a student nurse…and no one else, and nothing else."

Yep. That’s the feeling. So sad, but true.

But it’s not true, is it?

I bet you’ve heard “I’m just…” many, many times in care environments, and I dare say you’ve said it yourself at some point. “I’m just a junior doctor”, “I’m only a cleaner”, “I’m only a nurse”, “I’m just a care assistant”. But why do we give ourselves so little credit? It’s true that over-confidence is something to be avoided at all costs – this is where mistakes happen and problems occur. It’s no good being a student nurse and thinking that you are qualified enough to carry out tasks or make decisions that are completely beyond your capabilities. And it’s also true that there are some people that we work with – and that includes patients, families, carers and other staff members – that have attitudes towards us that make us feel that we are unimportant and incompetent. But mostly it’s ourselves that make us feel that way.

It’s easier to lose confidence than it is to build it in my experience. One innocent mistake can make you question your competence in everything you do. “Am I good enough?” is a common anxiety amongst student nurses. Now in my final year, I often wonder if I am indeed good enough to be a nurse. I know I have the right attitude and commitment, but am I really good enough at doing the actual job to be a proper nurse working on a ward in a few months’ time? It doesn’t feel like it. An “I can’t do this” attitude is not a good one to have, you'll start to believe it the more you think it.

Whilst I mostly feel like I’m floundering in a sea of information-overload on this placement, when I actually reflect on the last three weeks I realize that I’m not as rubbish as I think I am. There was the lady that gave me a hug as she was leaving and thanked me for all the support I’d given her. There was the nurse who requested my presence in recovery because she needed my help on a very busy day. I was a “help” not a “hindrance”. There was the chap who told my mentor (without provocation I might add) how impressed he was with my professionalism and that I’d done a really good job at explaining things to him and made him feel at ease. When one nurse said, “a student shouldn’t be doing that,” another replied with, “actually, she’s a third year and perfectly capable, and knows exactly what she’s doing”. When I look at what I’ve actually been doing these last few weeks, I realize that I’ve hardly worked alongside another nurse at all. I've mostly worked autonomously doing tasks that are designated to nurses. Real, qualified, experienced nurses.
When I compare my first year self to my current third year self, I can see the progress I have made. Not just in terms of the clinical skills I can now do, but the confidence I so often think I don’t have. In my first year, I was so much quieter on placement. I’d generally go about my business politely and speak when I was spoken to or when I needed to ask a question. Everything was so new and strange that I wouldn’t have said boo to a goose (I still wouldn’t actually - geese are not birds you want to upset). I certainly wouldn’t be teasing consultants about the fact that I only ever see them in the staff room when there’s cake in there, or asking doctors questions about the procedures they were doing. I wouldn’t be sharing my ideas with the ward sister or be quite so honest about how I felt about my experience on their ward. I wouldn’t be chatting away to radiologists about their jobs and what they did and how they did them and how they worked with other health professionals. I wouldn’t be initiating conversations with medical students about their courses and their hopes and dreams for the future. I wouldn’t be actively seeking out opportunities to learn new things on placement and making them happen. I wouldn’t spend more time outside of my box more than I spend inside it. I do all that now.

Self-awareness is so important for healthcare professionals. There are lots of times when we feel we don’t know what we’re doing. But we need to look objectively at ourselves and see what we actually can do. We also need to know our limitations and recognize that asking for help is not a weakness, but a very sensible way to develop our knowledge and skills. Be realistic with yourself. Think about how you can do things better, focus on the things you need to learn, but never forget to give yourself a pat on the back for all those things you do well - and there will be lots of things that you do well!
Everyone in healthcare is important. To make a great team, we must all respect each other’s roles as being important and valuable. Never accept that someone else is more important that you, or believe that you are more important than others. Equality is not just for audit purposes, it's for us too.

The truth is that I’m very nearly a qualified nurse. I wouldn’t have progressed to my final year with good grades had I not been competent and capable. I am not “just a student nurse”, but a caring, motivated, intelligent woman with 17 years’ experience of working in care. I am not “just” anything.

So my dear fellow students, never say you are “just a student”. Say, “I am a student nurse,” and say it with pride. Being a student is no humble vocation, or an excuse - it is a worthy and valued role. Don’t believe you are “only”, “simply”, or “merely” anything. You are a complex individual with experience, knowledge and ideas, and you are the future of healthcare. Things that you think you cannot do, are only the things you haven’t learned yet. You can do whatever you set your mind to, as long as you accept that you may need to ask for some help along the way. You will never stop learning and you know much more than you think you do. You will touch the lives of countless patients, families, carers and other members of staff during your time as a student, and you will be remembered. You are not just a supernumerary observer, you are part of the team. Whether you’re at the beginning, middle or end of your training, there’s a reason you are there. You earned it. You are good enough. You deserve your place in the world.

Above all else, believe in yourself - because (believe it or not) there are others who believe in you.


Many thanks to David Foord ( @DGFoord ) for making me think about being more than "just" something :)

Tuesday, January 13, 2015

What's in a Name?

"What's in a name? That which we call a rose, by any other name would smell as sweet."
William Shakespeare

This idea behind by this quote seems pretty straight forward on the face of it. Look a bit deeper though, and it actually throws up a whole heap of questions - particularly when you read it in the context in which it was written (i.e. Romeo and Juliet). I'll leave you to analyse the literary works of Shakespeare at your own leisure, should you wish to do so - but to the question "What's in a name?", I personally would answer, "Quite a lot, actually".

Being called Dorcas, I probably think about names more than the “average Joe” (pardon the pun). My name is very much mine. I've grown up with it, and it's part of my life. Having an unusual name, for me, has meant that throughout my life I have always immediately entered a conversation about it whenever I meet someone new - so it’s a good ice-breaker if nothing else. Giving someone my name is more of a chore than you might think - I say my name and then immediately spell it out, whether I’m asked to or not. I’m quite used to saying “Delta Oscar Romeo Charlie Alpha Sierra” on the phone and I’m always ready with an answer to, “No, your first name” or, “That’s unusual isn’t it?” or, “Where does that come from?” or, "I've never heard that name before". I'm usually less prepared for someone who acknowledges and accepts my name without question. I honestly believe that my life would have been different had I been given a different name.
Dorcas Gazelle

If you’re wondering, “Dorcas” is Greek (δορκας). It means gazelle – there’s a species of gazelle called a Dorcas gazelle. My parents aren’t Greek, I don’t think they’ve ever even been to Greece, but there you go. I’ve never had a satisfactory answer for why this name was chosen for me, but it was a something to do with a character in a book that my dad read. In the Bible, Dorcas is the Greek translation of the Aramaic name Tabitha. She was the lady who was risen from the dead by St Peter because lots of people were upset when she died because she did a lot of nice things to help homeless people. “Dorcas” was the name of the lead character in Lark Rise to Candleford (BBC); one of the Seven Brides for Seven Brothers (a 1954 film directed by Stanley Donen); one of the Nomes in the Nome/Bromeliad Trilogy by Terry Pratchett; a witch mentioned in Harry Potter and the Order of the Phoenix (J.K.Rowling); a girl tried for witchcraft during the Salem witch trials; but not to my knowledge, and contrary to the belief of many people I meet, a character in any of the Dickens novels (happy to be corrected on this).
I dare say I know more about my unusual name than most people with relatively common names know about theirs.

But regardless of what your name is, it’s important. It’s an enormous part of your identity. So why are names so often not used?
It’s a couple of weeks into placement and already I’m hearing, “If I get called ‘the student’ one more time I’m going to scream!”...or words to that effect. But how many times on hospital wards have you heard patients being referred to as "bed 3" or “the neck of femur” or “the nephrostomy in bay 4”? They’re not names, they do not pertain to people. They’re a description of a medical condition or a bed number…. A bed? A piece of furniture?! Is that what our patients are? Now, of course, there are many places where this doesn't happen - which is great - but it still happens enough to be an issue. It's one of those things that's "just always been done that way". 


When I hear the bed number thing being used, I can’t help but think of my dad. He has one of those senses of humour that means he's not scared of embarrassing his grown-up daughter and so when his number is called at the blood clinic, for example, he will delight in saying loudly,

“I am not a number, I am a free man!”

This, for those readers not au fait with 1960’s cult television dramas, is a quote from The Prisoner. The Prisoner was all a bit surreal, but it's basically about a bloke who is captured and taken to a prison-like village where people try to extract information from him via methods such as drugs and identity theft and mind control. No-one in "the village" is allowed a name and instead everyone is assigned a number. 


Scary concept, eh?

And here’s why the whole bed number thing is so terribly wrong. Not using someone’s name dehumanises them. They become, in your mind, that bed number or that medical condition rather than the individual and whole human being that they are. Using a person’s name is Rule One of holistic person-centred care.
It's not quicker or more efficient to use a bed number/condition to refer to a patient. People move beds and people go to different wards. People get discharged and new people get admitted. Bed 2 could be host to many people (not all at once, obviously) throughout the course of one day. If you don’t use people’s names, how on earth would you know you were with the right person?


It's not OK if you only use bed numbers/medical conditions when discussing care with other members of staff – even if you obviously don’t say it when talking to the patient. It’s not ok because for a start, those curtains around beds are actually not soundproof so it’s quite likely that a patient – possibly the person you’re talking about - will hear you and feel like you don’t know or care who they are, and that they’re an inconvenience that doesn’t merit investing the time to learn the name of.


And it doesn't help with confidentiality either. Discussing somebody's embarrassing gynae problem on a ward  will not become confidential if you say "bed 2" instead of "Miss Bloggs" - it only takes the busybody in bed 3 to overhear and read the name above bed 2 to know exactly who you're talking about.


Finally - most importantly - it’s about the whole culture of it. It doesn’t matter where you use non person-centred terminology, it’s that fact that you do that’s the problem. Person-centredness is a complete mind-set, not a thing to do only when you’re face to face with a patient. To deliver best quality care you have to think about the person as a person whether you’re talking to them, about them or writing their notes. Using their name is not difficult.
Then there’s #HelloMyNameIs… Dr Kate Granger started this campaign when she became a patient herself. She noticed that many health professionals didn’t introduce themselves when they met her to deliver care or treatment, so she started the #HelloMyNameIs… campaign to change this (if you haven’t already, find out about it here: www.hellomynameis.org). I was lucky enough to hear Dr Granger speak at an event a few weeks ago. The #HelloMyNameIs… campaign was inevitably mentioned as it is one of her most prevailing achievements among many, many other great things. One thing I’ve noticed is that whenever this campaign is introduced, it always seems to be said that it’s sad that it’s needed at all. This is very true. Introducing yourself to someone who you have just met is simple, basic manners and it is indeed sad that these pleasantries are so often overlooked. However, lamenting its necessity will not change anything, engaging with the concept will.


Coming from a colourful and diverse world of learning disability services, it was a rather a shock to the system to be thrown into a sterile, clinical hospital setting on placement in my first year. It was an alien environment to me and I did what I was told as I had no idea what I was supposed to be doing. I remember being told to write in the notes “patient admitted to ward”, “patient alert and orientated”, “patient sleeping” etc. Every time I wrote “patient” it felt wrong and went against everything I’d ever learned about being person-centred. I remember looking around the bay I was working in. Each identical bed was occupied by a grey-haired, elderly gentleman – each one wearing one of those ghastly hospital gowns that camouflaged them into the curtains - and all looked identical to each other. There were no distinguishing features between them other than the name above each bed. Their name. Their own, unique, individual name.
To call someone by their name is a small but significant acknowledgement of who they are. To be called by name is to be taken notice of, to retain a sense of self and to be given a sense of purpose and being - rather than an invisible “thing” in a crowd of many, or something to cross-off on a to-do list.
To use the name of the person you are caring for is just so obvious and easy. To introduce yourself to the person you are caring for is also obvious and easy.
Small things can make a big difference. So, if you work on one of those wards that writes “patient” in the notes, or calls people by their bed number or medical condition – please, please, please, do one small thing: use the name of the patient you’re caring for. When you talk to them, when you write in their notes and when you discuss their care with other health professionals. Lead by example. Before long you’ll notice others doing it too. It's a quite a small step, but it's in a very bright direction.
PS. If healthcare staff could kindly remember to extend the courtesy of using people's names to nursing students as well, we’d all be very grateful ;)

Thursday, December 11, 2014

From Student Nurse to Patient (and back again).


As a student, I find experiential learning the most beneficial. Lectures and journals and books are great for knowledge building, but it’s only when you use that knowledge in practice that it starts to sink in (and finally make sense). And it’s not just professional experience either – I’ve had an awful lot of personal and life experiences that help me to identify with patients and the people I care for. However, one thing that I’ve not much experience of is being a patient. Until now.

Let me start by saying that I’ve not got anything scary or life threatening and it doesn’t make me poorly - but it is something that affects me on a daily basis and, as far I’m concerned, needs sorting. So, having already diagnosed myself with a fairly rare condition (as you do) I told my GP and was referred to a consultant. Now, being a student nurse/caremaker extraordinaire you’d expect me to go to that appointment firing on all my 6Cs cylinders and be the super-nurse patient who’d already read all the journals and knew exactly what was going on. I’m so used to hospitals and healthcare now that I wouldn’t be phased at all… right? Wrong.

That first appointment was awful. Having spent half an hour playing musical waiting areas in the outpatients department, I was eventually called into the room. I was now feeling rather apprehensive. What if I’m wrong? What if he thinks I’m being silly? I felt a bit silly now. What if (worst case scenario) he says there’s nothing wrong with me? Cue minor panic attack…

The very first thing I noticed was the amount of strange, metal, medieval-looking instruments of torture strewn across a table. Slightly unnerving to say the least. The consultant then gestured towards the three (yes, three!) nurses in the room saying “don’t worry about them”, and asked me to take a seat – which was next to the table of torture tools and resulted in me sitting with my back to the three nurses. I have no idea why there needed to be three nurses in the room. They didn’t seem to be doing anything - apart from sitting behind me, making me feel nervous, possibly sharpening those “things” on the table… The thing is, they could have been doing anything - because I couldn’t see them. Then the consultant asked me, “what can I do for you?”. That is an awful question to ask a nervous person. Surely my referral from the GP contains all that information? How on earth do I know what a consultant can do? He has my notes, he can read what’s going on – but no, he instead has to ask me a question that I have no idea how to answer. Obviously, it’s usually best to start from the beginning, but in my flustered state I think I started somewhere in the middle, didn’t quite get to the end and didn’t mention the beginning at all. It all came out in a disorganised babble and I’m surprised he understood a word I said. And that was that. I was told I needed a CT scan and to just go home and expect the appointment letter through the post. Oh and on my way out, I had to go get a blood test – no idea why. Seemed completely unrelated to anything at all.

I came out of that appointment feeling very disappointed and actually quite upset. I’d waited for so long for that appointment and I felt I’d screwed it up, like I hadn’t explained myself very well at all - I kept thinking of things I should have said.

The CT scan came and went and I waited another four weeks for another appointment – this too is very annoying. 8 weeks between consultant appointments with a CT scan slap bang in the middle with no word of what’s going on or what to expect. In an age of electronic communication and instant messaging, waiting for appointment letters via snailmail is tedious. I’m a very impatient patient. Anyway, I finally got my appointment - this was the important one, this was the one I really wanted. This was diagnosis time. I was ready. There was no way I’d let myself feel like I did last time. I knew exactly how this one was going to go. I was going to this appointment with my nurse head on. I was going to make sure I competently communicated to get my point across and ask questions and demand answers. So did I? Did I heck as like. It was exactly the same. I’ve still no idea what the blood test was for (I’m assuming it was OK) and I didn’t even get to see my CT scan picture. I was quite looking forward to seeing a selfie of my brain. I got the diagnosis I was after, but told that I shouldn’t bother to look it up. (I should mention at this point that I had neglected to tell the consultant that I am a student nurse, or that I had read all the relevant medical journals and learned the pathophysiology of my condition before I’d even been to see my GP six months previously.) So now I have to wait for another appointment to see another specialist at another hospital who might or might not do anything to resolve it. So I came home frustrated, disappointed and upset once again.

That is my patient experience so far. But I am a student nurse, and after two and a bit years I’m finally getting to grips with the art of reflection. There’s always something to learn from every situation, and I’ve certainly learned some things about what it’s like to be a patient. Not what the text books say it’s like, but how it actually feels. Now I’ve experienced it and I’ve felt it and I don’t like it.

Being a patient is intimidating. No matter how much you know, you still feel like you know nothing. You are way below the bar of the doctor, consultant, nurse or other health professional delivering your care in terms of knowledge. Partly because they have information about you that you don’t – i.e. your medical notes/test results. Knowing that someone knows something about you that you don’t know is disturbing and makes you feel uneasy. This contributes to that balance of power being tipped in their favour.

Power and empowerment: When you feel intimidated, the feelings of powerlessness and helplessness comes with it. Hospitals and doctors surgeries and dentist surgeries are intimidating places. The buildings, the uniforms, the funny smells, the big words used by the doctors, the instruments of torture that are present in the room, the not knowing – these are all intimidating things. It’s very difficult to empower yourself when you feel like this. Power is something that needs to be given to you by those who already have some. Simply asking abyss-wide open questions doesn’t empower people - there’s much more to it than that. I think it requires great skill to unintimidate people, and it’s a skill that is often overlooked.

Environment: The environment matters. Where you ask someone to sit, who is in the room, where you put the tools of your trade when you’re not using them. It all matters. It’s difficult to change a hospital’s layout or décor or equipment, but you can change how you use it. You can make a room more compatible with a positive experience just by changing where you ask people to sit, how the other professionals in the room engage with the patient. If they don’t need to engage, then do they need to be there? If they do need to be there, then they need to part of the consultation – not some bystander making the patient feel uncomfortable and not understanding the reason for their presence. Do you really need to have scissors and forceps and other spikey things out on display? No you don’t. Put them away.

Experience: A person’s medical condition is not just a set of signs and symptoms and diagnostic test results. That is of paramount importance obviously, but what’s equally important is what those signs and symptoms and diagnoses means to the patient. Do they know what it means? How does it make them feel? How does it affect them in their day to day life? Do they want to know more? And patients shouldn’t be told not to bother to look things up – they should be given all the information they need so that they don’t feel the need to.

 

This is all "just" person centred care. It’s all very basic, but we often forget how these little details matter, how the little things can alter a person’s experience of healthcare for better or worse.  This is all stuff we learn in uni – but it’s not until you experience some things for yourself that you appreciate their impact. The theory’s great, and very important, but if I’ve learned anything it’s that your own experiences (and the experiences of others) are as valuable to your role as any qualification, theory, nursing model or clinical skill.

 

By the way, if you’re wondering, I’ve got Superior Semi-circular Canal Dehiscence Syndrome. Do feel free to look it up – it’s really quite interesting ;)