Thursday, 22 May 2008

Mixed Bag

As is becoming the style of the time I will give a brief outlook of the important parts of the day.

Terminal Patients

The patient I looked after through their hypo (see previous posts) suffering from End Stage Heart Failure was discharged today. Although they were in my area, I spent little time with them today. They are depressed about pending doom - which is hard to deal with as a student nurse. We're taught to emphasise with patients, but I'd feel like a right fuckwit if I did what I've been 'taught'.

"I'm dying, I'm not going to be alive much longer..."

Do you answer:

A) "I can imagine..." - *NO*. I cannot. And saying anything like that would be insulting.
B) "That must be terrible..." Obviously! Doi.
C) "How do you feel about that?" This is the most viable option, but I'm aware the patient doesn't want to talk about it anymore. They are already in denial most of the time, as are the family.

The family were around today and the patient had meetings with specialists of all kinds, which was lucky. But it's a tricky situation I hope to deal with at some point.

'I'm dying...'

Another patient who may or may not be dying, this time. For once, I'm going to actually reveal some patient details without infringing anonymity as the story makes little sense without them. MrBelligerent is a man who believes in an archaic religion (take your pick which one) which believes it is a sin/wrong/whatever for a woman to see a man naked. This being said, MrBelligerent has not had a shower or shave for three days and has complained to his family that there is noone suitable to help him out.

[NB. One of my huge hates (not pet, pure hate) within the NHS and nursing is one simple fact. If, for example, an ECG has to be done on a woman, some of the leads need to go under the left breast. This, it is often said or hinted in my experience, makes men unsuitable to perform ECGs on women if there is a female alternative. No such prejudice exists for installation or removal of catheters in male patients. Therefore, I almost kicked up a fuss about this blatent piece of sexism VS. patient choice but decided it wasn't worth the paperwork)

One of the reason reasons for him not getting a shower is that, unless he is on oxygen, he desaturates very quickly on room air. Desaturation is the process by which the blood begins to carry less oxygen, which can make the lungs and heart work harder which can make someone very out of breath. MrBelligerent is not good at keeping his oxygen on normally, but in the shower we imagined this would be worse.

The support workers mithered me to help him shower, even though is diuretic infusion was due at the time. My mentor caved in and I helped him into the bathroom. He is not too steady on his feet, and yet he proceeded to stand up to shave, rather than sit down. This shave was the most brutal act of hair removal I have ever seen, I must mention. It also started with him removing his oxygen.

"If you don't keep this on, you're going to get breathless," I politely remind him.

He swatted me away with a grunt, and so I let him keep it off. He collapsed into his chair for a shower, moaning about being out of breath. I try to help him with the oxygen, but he is struggling with it, trying to get it off, trying to put a different bit in his nose and grumbling constantly. After about a minute under water he insists is 'cold' (which was quite hot, in my opinion) he gets up, soaking wet and soapy, demands a towel and waddles back to his chair to dry off in the main ward. I'd had enough by this point, my polite enquiries being met with angry noises, and left him to his own devices.

It turns out the patient is quite confused. Talking in the middle of the night in a number of languages, complaining of random things, confusion over location. Although I've looked after the patient for a few days now, and he has been generally fine, if grumpy. There's no mention of confusion on handover, and nothing I can see from his history to suggest it. Go figure, as the Americans say.

Doctors on beds and other such unsporting behaviour

I hate to fall into a stereotype and repeat what various people think. But Doctors flouting the rules on ward is starting to get to me. Some wards feature protected meal times. Usually from 12-1pm. Within this time *noone* is supposed to disturb the patients. It is also the time when some consultants like to start their ward rounds. Well done.

If initiatives are going to be placed on ward, and presumably agreed with different departments, Doctors should actually agree to them. The two of my patients who the consultant was disturbing today were desperate to see their doctor, so I didn't shout at the consultant or any of the henchmen or henchwomen. I know, student nurse shouting at consultants is quite a funny image. But I want to get some practice in before I'm a staff nurse shouting at them.

When they come in at a disallowed time, you may also expect them to ahdere to other rules. Like not sitting on beds. They don't. When I want to talk to a patient on their eye level, I crouch. Or I sit on the floor. These things are allowed by infection control rules. Doctors apparently like to flout these as well.

And furthermore, stealing chocolates addressed to 'the nurses' is certainly unsporting behaviour. Doctors do a very important job and we'd be lost without them, don't get me wrong. But they could do a few things to stop annoying me. Especially given the amount of errands I run and favours I do for them, personally.

It'd be nice.


BenefitScroungingScum said...

Sounds a bit of a frustrating day. My pet hate when it comes to ECG's is being shouted at for asking for a gown. Unacceptable it seems. Along with the polite request not to have to sit naked above the waist in an open room in full sight of whoever chooses to wander in and out whilst waiting for the technician. I mean, I've got nice enough tits, but it usually takes alcohol for me to sit around showing them off to anyone and everyone (one of the reasons I don't drink!)

OFMN said...

Most of the nurses or other such workers I know worth their salt know how to arrange a gown or pyjamas in a perfect tit-covering arrangement.

There is seriously nothing worse than a patient asking for something quite reasonable and a healthcare worker huffing and puffing about it. They seem to think hospitals would be perfect without the patients.