Another triade

Support Workers. I'm not going to make a blanket generalisation about them as - what's the point? Generalisations are rubbish.

The handful of individuals I'm thinking of our representative only themselves, not some group they belong to. They are, however, support workers. And that information is relevant for the conversation.

The same SW who sneered at me for not offering up my chair this morning (see earlier post) I will refer to as miseryguts. She is politely referred to as 'old school'. A bit like the BNP are referred to as 'a bit old fashioned', in my opinion.

She's the sort of SW who makes sure the patients are out of bed as early as possible, whether they like it or not. This is not for their own good, but to make the beds. Which seems selfish to me given it could probably wait a while, especially when it comes to bad sleepers or lethargic patients, but whatever.

Today I overheard miseryguts and another SW in the staff room talking about how they hadn't received enough help through the day, particularly from another student. Students, let's not forget, are studying nursing. The nurse in question insisted they needed the student's help, and nurse's orders are paramount, surely?

I'm all for helping out with tasks traditionally assigned to SWs, but they take a backseat to important nursing duties. That's why we were made supernumerary in the first place and why I may, in some cases, refuse to leave one job for another.

I think I can handle the sneering, bitching wrath of miseryguts.

A new week...

Today one of the support workers who doesn't like me (yes, it does happen, from time to time) accused me of not being chivalrous. Before I could get annoyed, another member of staff spoke up for me saying it was 'all for equality'. I could've kissed her, even though the support worker said that was 'bullshit'. Ha.

A good day, anyway. I removed another set of surgical staples, recieving an 11/10 from the patient in question. I feel well pleased about that, as I've never taken them out of a stomach before. Good experience.

I also did most of the paperwork today, which was useful experience since the other ward-bases students don't do any. Start early in your training, I say.

I have a very unique patient I'm considering doing a case study on. They're a 60-something year old, ex-stand up comic suffering from confusion and hallucinations with only a limited time left to live. Between the pain and illusions, the patient is very cheery with a highly positive outlook on their future. It's actually quite awe-inspiring, really.

Domination!

The world of nursing is pretty genderfucked. Don't get me wrong - I like it, but it's - as Jimmy Greaves once said (about something completely different): "It's a funny old game."

I like to think of adult nursing as a mini-matriarchy. Obviously, within the health service adult nursing is but a small part. A lot of medicine, like the world in general, is a patriarchal sort of gig. Which makes the little, woman-dominated island of adult nursing quite unique. A lot of older men that I know couldn't cope with living outside of a patriarchy, in my opinion. I'm something of an exception, I'm happy to say. One of my bosses, after the entire staff poked a bit of gender-based fun at me (which a softer human being could have wrongly mistook for bullying), told me: "We're all bitches here, sorry."

I told her I'd get used to it.

And I will. It's quite strange, to spend half of my time in one little world and the rest in one that is quite different. But I suspect it must be quite different for the female students.

The idea of Female-Solidarity is a hazy one in pop culture, and although the ethos behind it is lovely it often falls prey to backstabbing within the traditional patriarchy of British society. On the ward, it seems to be worse. In a sense there are no real male figures for anyone to play for or play off, and so you're really down to the bare bones. In fact, being a man within the system makes you into something of an impartial observer, which is fun. I'm sure if the staff I'd met were single, closer to my age, etc. I might end up taking up a different role of 'eye candy' (which wouldn't be a completely horrible fate) but right now I'm happy to observe proceedings. It's fun.

One day that turns into two...

So, I'm working quietly along yesterday... Well. That's a lie. I was working very hard, and effectively.

You see, yesterday (on my early shift) a bank nurse had cancelled and NHS:Professionals (yeah, right) didn't let us know. So the Ward Manager sort of took over the bank shift, which left us one nurse down, effectively. I jumped in the bay to give a little assistance.

Before yesterday I didn't really know the WM. Ward Managers, by the way, are Charge Nurses (I refuse to use the highly sexist 'S' word) but a little bit more concerned with running the ward than the patients. It's a necessary job thanks to the buearocrification of the NHS, and I previously thought that perhaps our WM was good at that much had lost touch with actual nursing.

I was happy to be wrong on this occasion. On top of being just a tiny bit fit, she is an awesome nurse and a very good teacher - at least the way I like to be taught. She pushed me as much as I like to be pushed, but was always aware of what I was doing and whether it was going to go wrong, with a helpful push in the right direction.

Then, delightfully for me, she was shocked at my apparently immaturity (year and semester -wise), giving me another ego-filling 'I thought you were a third year' treatment. Happy, I was.

She complimented my assertive nature, and we had a discussion about how it's necessary within a ward.

Anyway, after building up a rapport and then realising after the early shift they'd be understaffed again, I volunteered to stay onto a full day, working under her valuable guidance.

And the day was a busy one. Good god. Four admissions into our bay alone, as well as doctors, EWS (Early Warning Scores; a piece of evidence-based practice used to alert nurses to deteriorating patient vital signs) going through the danger barriers and angry patients. And all this fuelled by chocolates and black tea.

It was lots of fun, but I was happy to see my bed. I wrote a list, before I got to sleep, of all the things I performed in the long day (which spans from 7am to 9pm). I'll place the list here, as not to forget:

- I prepared, spiked and started (including programming of the feeding machine) a bag of TPN. TPN is short for Total Parentenal Nutrition. This is basically a specially prepared and medicated solution that goes straight into a patient's veins, especially useful if their bowels are totally inflamed or they have had some kind of resection/removal.

- I mixed granulated feed (the name of which I've forgotten) with sterile water (soaking myself in the process, woo) and then set it up to be fed through a distal feeding tube.

- I practised non-sterile dressing. This occasion was useful as it allowed a patient to be discharged quite quickly. If they had waited for a registered nurse, not a supernumerary like myself, they would've been there another hour.

- I had plenty of fun talking to Doctors, who always seem a bit shocked when a student nurse speaks to them. I'm not arsey, like. I'm polite, but assertive. One patient was on a EWS of 3, which involves intervention from a medic within 30 minutes. This one I spoke to was sort of "I have to do next door..." but I, and the WM I was under, were nicely insistent.

- I removed my first cannula. I'd witnessed it once before, and I'm being taught on a very fun 'See one, do one, teach one' ethic. I performed this one under the supervision of a lovely support worker, who advised me of two tips: Hold cotton wool over the site with the cannula still on. And then pull it out, not up. It went well, in my eyes.

- I witnessed my first ECG, which didn't go to well. The machine that serves most of the hospital looks like something out of Life on Mars, so I wasn't surprised. Still, very interesting. One day I might know what the results mean, too.

- I talked my first patient through a discharge summary. This isn't rocket science, but it is a test of communication skills. And a vital step, even if a patient does want to be discharged ASAP.

- I learnt that I didn't know everything about Tinzaparin. I thought I was pretty good at injecting if, but there is always room to improve. For example, I now know the bubble should go in after the liquid to help with dispersal. I'm also supposed to go in vertically for the most desirable effect.

- Two more juicy bits of information. Supplements should, apparently, never been taken with meals as they are just that - supplemental. Additionally, mouth wash is never given with hot drinks as the drinks ruin any after effect the wash has by... well. Washing it out.

- She also helped me adapt my naive writing style as to protect myself and the NHS. Using seemingly innocuous words like 'stable' won't stand up if you ever have to go to court ("What does stable mean?!" the lawyer would scream "Is your idea of stable the same as someone elses?" Etc.). So vagueness is out. Additionally, you have to write everything as the patient's advocate. It can never even seem to look like you've forced the patient to do anything they wouldn't usually do. No decent nurse would ever do this, but some writing could make it seem like they did, which is dangerous.

The WM complimented me on a good day, calling me 'excellent' (which did my ego no harm). Thursday morning and I would be called 'our wonderful student'. I'm clearly aiming to be the poster boy of male student nursing.

So. Wednesday over. Sleep. And what do you know, but Thursday crept around the door. Getting up was not easy, but worth it.

Another hard day. I stayed in the same bay, despite the fact that I'd be working with a nurse I didn't really know. However, she's newly qualified and they're generally fresh and interesting to work with. She was no exception to this rule.

My patient who had been scoring a high EWS hadn't improved much overnight, so we had to keep a close eye on him. Not close enough, unfortunately, as he soiled himself quite explosively. I haven't actually performed much patient cleaning on this ward, and didn't really get a chance as the nurse I was under did most of the work. Which was, really, fair play as she wanted to get him washed and back to bed as quickly as possible.

The other gents in the bay were generally, okay. One old fellah (he lived through WWII) was experiencing lots of pain, which was sad, but I helped facilitate all necessary tests for him and his EWS was low, so not a huge amount to worry about.

One of my favourite patients might have been fast tracked to going home - they live a long way away from this hospital, so that should be awesome. It occurred through a bit of luck, which patients within the NHS could do with more of.

I had an awkward scenario with a patient off in a side room. Previously, I'd had quite a good relationship with him. Today I went in to explain something to him, but we agreed to postpone it until he'd finished eating. He had major GI problems, so any eating he does is very valuable.

Anyway, his wife turns up. And I reason 'He wanted five minutes, so I'll wait until they're up and let her in.' It was out of visiting hours, so I was by-the-book in the right and my gut told me I was, too.

He shouted at me soon after, to which I was a bit disheartened. I was tempted to not see him again on the shift, but thought that was hardly finding a solution to the problem. So I had a chat with him. He told me his wife worked long hours, was very busy and so couldn't make normal visiting hours. I apologised, telling him I'd know such facts for the future, and we ended in some kind of resolution. So I was happy.

One thing I could've done better was caring for a young patient with a history or mental problems. I didn't spend much time with them, however they were lucky enough to have a 24-hour carer and were relatively independent, in a side room and stuff, so I'm not sure I could've done much more. No point blaming myself if I couldn't.

My final act of the day, which ran almost an hour over my scripted hours, involved escorting a patient I'd never met down to an outpatient appointment. The patient was older than me, and rather nervous around people they didn't know. I successfully chatted with them, making them feel at ease, and trying to calm them down when it turned out we'd waited an hour to be told it was the wrong doctor someone had booked them in to see. Good grief. I wheeled them back up and said my cheery goodbye.

Not before the ladies from one of our bays gave me a birthday card (it's my birthday tomorrow). I felt a bit lost for words, which is rare.

Another Reflection

I made my first real boo-boo this placement today (and yes, boo-boo is a technical term).

I'm enthuastic and tenacious. I like to learn and like to challenge myself. When I was asked by a member of the nursing staff (not my, or a, mentor) asked me to do a sterile redress on a wound. I knew it'd be my first time, but thought I had the knowledge and theory to do it.

I didn't, really. Thankfully, a registered nurse looked over my shoulder, told me what I did wrong and pointed me in the right direction.

Am I upset? Of course not. Getting things wrong is part of growing, and noone suffered because of it. Furthermore, I shall do it better next time.

What else did I do today?

I did my first admission (well, the maximum a student nurse can do of one without the input/moniker of a registered nurse). I helped with the discharge of a difficult patient (I know we're not supposed to use that term, but he was a difficult patient). It was somewhat of a challenge, but it was nice to see him go. For his sake (he was something of a homebird) more than mine.

Monday

Another good day on Placement.

Today, amongst other useful things, I removed my first drain.

For people unaware of medical terminology, a drain is a tube inserted, during surgery, used to drain (surprisingly) blood or other undesirable fluids from a wound or abdominal cavity. Once the drain is no longer needed, it is removed.

Removal is a simple, but by no means easy, procedure. The drain works by a negative pressure principle. It is later secured by a stitch through the skin of the abdomen.

To remove a drain (and this is not a guide of any sort) you have to firstly calm the patient and let them know what's going to happen. After that, you need to instruct them to take three deep breaths - which in itself is not a small task, as the drain can often cause breathlessness. On the third, you let them know, you will remove the drain.

Before this, of course, you have to use a scalpel or surgical blade to sever the stitch. Then test the drain will move out with a bit of give.

After that, all that's left to do is ask the patient to take the three breathes and pull. In a perfect world, one I was privy to today, the drain will slide out with a sort of 'plop'. There may be fluid discharge, there may not be. From then, like a bottle of coke that's been shaken up too much, you have to slam some gauze over the wound in case it leaks.

Hold it for a while, maybe swapping the gauze. Clean the wound, dress it and you're done.

Although later check ups may be necessary.

I was amused. My mentor literally showed me it once and then asked me to do it. I was confident, and it went well. That, in my book, is an excellent way to learn. There's no accounting for taste, of course.

I almost got a chance to remove my second set of surgical staples, but time ran out. There'll be plenty of time for that in the future, though. I fear the day I get bored of such interesting procedures.

Happiness

I'm hungover and irritatingly cheerful, it's fun.

I went home this weekend. 'Home' in the sense of my hometown, where my family still resides. I had a few drinks, had a few laughs, gave my nephew his birthday present. It's going to irritate his mum after a week or two, but I don't care. We had quite a lovely conversation, which originally started with me testing his memory.

"What do I do in [my current city]?" I asked

"You're a nurse."

"And is that cool?" I queried, to the Spiderman-loving 4 year old.

"Yes."

It's official.

So yes. I currently quite like life. It's a bit good. And I have my second week ahead. Things can only get better, methinks.

My Plan

I've discovered what I've been doing right recently in my plan for being a good student nurse:

1) Act clever, showing you've read around and aren't dim.
2) Make sure to do some work with the support workers, to make sure it's clear you'll muck in and aren't "two posh to wash".

With an optional point of:

3) Stay late after shift once helping, to help point 2 bed in.

All points to successful shifts, in my book.

Question: How do you make a happy student nurse happier?

Answer: Let him leave early.

Placement is great. I was let off early and now have a day off tomorrow. Well, I've got to go into Uni, but that's as good as a day off.

What new things did I do today? Well.

I helped fill in an admission pack, which is new for me.
I watched ANTT and then spiked a bag of dextrose, using an IVAC, helping to set it up.
I listened to a patient's worries, which is a huge part of the job, no matter how wrong they can be.
I went to the blood bank (no vampire jokes) and realised how they work down there.
More vaguely, I've familiarised myself more with the ward and discovered that late shifts are easier than mornings, but mornings are more interesting.

I'm pleased, but tired. And full of cold. But it could be worse.

I have the best present for my newphew and I'll hopefully get to see him this weekend. Woo.

Girls once more...

Sometimes, I like my women like I like my vices. Addictive and very bad for me.

The recent gal I've met is amazing. But it's going to get messy, I fear. Still, as a very lovely songwriter once stated:

"I'd rather have your heart broken by you,
Than never broken at all..."

First Day

Like the awkward second series, the first day on placement is always a tough one.

My mentor - not a good sign - wasn't in, so I joined up with a lovely, if slightly chaotic, newly registered nurse. She just sort of assumed I knew how to do more than I did, which is a good way to learn. I have the balls to speak up when there's something I don't know how to do, and at the same time I get to learn.

The main problem is that you're placed into a new ward and entirely new situation. Surgical nursing is a lot more chaotic than what I'm used to. Ontop of that, I know few of the staff and fewer of the patients.

Suffice to say a competent YearOneSemesterOne placement nursing student does not make a competent YearOneSemesterTwo nursing student. It is still, nevertheless, fun to work and learn. Once I managed to shake this fatigue.

Get me back into the swing of things, someone.

I witnessed and helped in a few completely new things today, though. I witnessed a vac-dressing, which is basically special dressing and pieces of foam sealed onto the skin and closed up by removing all of the air using a funky machine. The wound has to be pretty darned grizzly to need this sort of dressing, but it was fun to see.

I had my first experience of speaking to several departments through one day, got to experiment with ANTT (anti-septic no touch technique) and dress a wound for the first time ever. Plus I got to know some of the patients, which is clearly vital.

A good day. But I need to get my mojo back.

Pre-Placement-Progress

Yes, it's that time again. When all Diploma nurses get ready to go into the social hibernation that is known as Practice Placement.

I'm excited, but I may end up writing here a lot less reguarly. That'd be an achievement. In best case scenario I'll be using this blog for my reflective diary.

But I am excited. Working in GI Surgery, which should be a hoot, if a little unglam. I am currently reading up on disorders to make sure I don't go in completely clueless on my first day. Monday, that is.

Not that I frequent CH...

But Dr. Crippen's recent post caught my eye:

Now the Home Secretary is taking statutory powers not only to suspend habeus corpus but to stop coroners’ courts sitting with juries. She is likely to exercise these powers in the case of terrorist deaths.

Why would the government not want a jury to decide the Jean Charles de Menezes case?

Another assault on civil liberties by a government which seems to not want to re-build the trust from the citizens it supposedly represents.

If it ain't broke, Jacqui Smith, don't break it.

Unless a broken judicial system would let you do more of the things you want to do, obviously.

Issues

About fucking time...

The link above is to a story about the government THINKING OF (but not actually doing, something which Labour gobshites are awfully talented at) setting up at least one men's refuge for male victims of forced marriage. In this case they would be of mostly Pakistani origin.

Meg Mann - a humourous name, at the time of writing before a cup of tea - states:

"Generally people expect men to be able to look after themselves, to manage situations, so men subject to domestic violence, men subject to forced marriage are likely to find it much, much more difficult."

This is debatable, but as a broad brush generalisation it could be more right than wrong. She then goes on to say, because of this, "there could be" a need for a male shelter. Only could?

That's a mean word. A word to spoil a party.

Surely if she's describing it as a problem for the citizens of this fair country then, as the government of this country, she should be acting to solve this problem. Call me an old romantic, but I thought that's what we paid them for.

The issue of forced marriage is a horrid one for anyone, and I'm glad the plight of some men is at least being mentioned in the media as most of the few cases I ever see portrayed by the media are that of women being forced.

The whole story, however, isn't really enough publicity for the seldom touched upon subject of abuse of men within relationships. Despite the fact that the 01/02 Crime Survey reported 19% of domestic violence incidents were reported to have male victims and latest statistics report this trend to have at least continued. And even this source, the British Crime Survey, reports that a large slice of domestic violence incidents go unreported. Tie this in with Meg Mann's view and the problem could be a whole lot larger than it seems.

And, to me, the worst part is probably the lack of publicity and apparent support. The Refuge organisation homepage contains five mentions of the term 'woman/women' but not one mention of the term man. Oh no - wait. One. In a none too helpful fashion.

Refuge do a very important job on strained resources. But I can't help but worry that if men under threat went to the website of Refuge, one of the most published anti-domestic violence groups in the country, and found no sign of help (or even acknowledgement that domestic violence committed against men is a problem) they may lose confidence in their search for much needed help.

On the other side of the coin, Mankind also do a difficult job using a small amount of resources, but it doesn't help that their website is, firstly, not as swish as the Refuge one, and secondly, half inoperative due to a refit. Not a great message to send out.

Domestic violence is an issue the government needs to do more on, on all fronts. The majority of victims of domestic violence are women. But I don't think this justifies a lack of information for the almost one fifth of men who are victims of domestic violence.

Poetry

I sat through a lecture recently entitled 'Quality Assurance within the NHS' full of buzz words and rubbish political non-facts. So I wrote this:

Doctors apparently were once abusers,
That's why patients are now called service users,
Have to now use words like 'quality assurance',
People feel they're owed from National Insurance.

People don't worry about what they will miss,
All in the name of customer service,
The idea of health choice a rose tined illusion,
A privately funded, spin doctored delusion.

Sat through lectures full of buzz words,
I find myself feeling strangely scared,
For patients - not clients - and myself,
Health ruled from a box file on the top shelf.

But I feel there's no point in worry,
Just get on with work (not in a hurry),
Countdown the days 'til it's all sound off,
Fragmented care ran by the son of a toff.

They like to call it P-F-I,
Privatisation for "the sake of the little guy",
I know about this you were never asked,
Even though you're overly taxed.

It's to "hit targets, cut waiting times",
more like to fund stakeholder's fine wines,
And to keep the economy strong,
Who cares if the care's gone all wrong?