Didn't Want To Be A Doctor

Still Alive (x2)

2009-08-02T01:50:00.000-07:00

Yes. I'm still alive and - better than being alive - I'm still a nurse! For now.

I'm currently in the middle of a placement which has had ups and downs, although the first two weeks involved working with the finest Band 6 I've studied under, who also loved how I do things, told me to ignore ICU's criticism and keep on being proactive.

I might end up back in surgery in the future, actually. Scrub is certainly enjoyable.

Anyway, more later. Sunday looks to have a little sun in it, which I might actually enjoy, given half a chance.

New Placement

2009-07-07T10:35:00.000-07:00

So, I started my surgical placement yesterday. I actually ended up working a little scrub today, before the procedure became quite out of control and ruined. I was pretty good, though. Used some initiative, thought things through.

Scrubbing up and working with the as-sterile-as-possible area is quite terrifying, I freely admit. Although I'm getting better and am determined to make my clinical skills spotless this time around!

I've also moved out, which is a bit of a nightmare.

I'll write more soon!

Still Alive

2009-06-04T04:02:00.000-07:00

Yes, I'm still alive. And still a student nurse, just about.

I was just signing on to wade into the debate on feminism and The Apprentice and whether the firing of Deborah was part of the patriarchal backlash.

It was first brought up by Jane Moore, a self-confessed feminist . Ignoring her, this very valid arguement that some behaviour in socially acceptable in men and unacceptable in women. This is a valid point in several debates, given we live under patriarchy and all.

The theory would carry more weight if there was a man left in the last five contenders who was abrupt, rude, ruthless and in-your-face. But there wasn't. In fact, most of men cut from this cloth were weeded out early on, so rather than take a solely feminist tack, it might be best to look at other factors. Woman or not, Deborah does rub people up the wrong way. Even her references didn't like her, y'know?

Anyway. It's a funny old thing. The 'business world' is still ran by white men who like to employ white men. Women are discriminated against particularly for various bollocks-reasons. Bolloc-easons if you will.

I actually like Deborah and I think she should've won the whole thing. Rudeness aside, she'd be a good person to work with. First off: she'd be too busy stabbing you in the front to stab you in the back and that's something I love. She has a can-do attitude and a love for business that made most of the other candidates look dull and passionless in comparison. But was it a matter of the style in which she rubbed people up the wrong way that lost her the deal in the end. And I'm not sure a man would've survived if he acted the same.

Vindication

2009-05-01T02:15:00.000-07:00

Almost.

As well as confusion from my personal tutor, my peers have all turned out to be perplexed as to *why* I was failed by my last placement. That's a total bonus.

And half a week in University got me back into the swing of things. Action plans will abound, soon, and my next placement will be quite utterly useful. My skill and talent will actually be appreciated, according to my peers and my gut.

More soon.

I'm not alone.

2009-04-27T03:22:00.001-07:00

That is to say I am not the only one who is confused in respect to my recent placement failure. I have just got back from seeing my personal tutor who was very understanding, and quite perplexed to the noted criticisms levelled against me. A visit to the ward might be in order, although I wouldn't go with them. I'd prefer not to see that place again for a long time, although it appears it might remain a weight around my neck for longer than I thought.

My tutor half suggested I should try handing in a PMC form in respect to the fact that a) no mid-term plan was completed, partly joined with b) I was given no targets to aim for in these things I supposedly hadn't made enough progress in. There is the issue that the ward didn't contact the University (until too late) and certainly didn't speak to my personal tutor. This is a bit contentious, though, as this is also my responsibility. I could argue I didn't think there was a massive problem at mid-term, but that is equally dodgy.

I don't think I will. A PMC would be a drawn out process with but a slim chance of success. I'd rather save a PMC for an occasion which really deserves and warrants one. Instead, my personal tutor and I have agreed I should be proactive. I'm going to put together action plans and PDPs in relation to the things I am supposedly not proficient in. My personal tutor is going to take them back to ICU and make sure they actually pin down some issues instead of making vague, wishy-washy judgements, and then I'll move on to my next placement with these improvements to be made.

My chin is firmly in the up position. I don't think I'll fail to retrieve any of the 5/20 areas I still "have difficulty" with, and these action plans and PDPs will make doubly sure of that.

Failure et al.

2009-04-26T11:33:00.000-07:00

As the title suggests, my performance has been evaluated and has been awarded a failing mark. And I'm miffed, pretty much.

If I have failed this placement then it is only fair to reason it has failed me, too.

I'm irritated about the feedback given, more than anything. I have not worked with my mentor very much. Less than once a week in real terms, so that's less than a tenth of my time on the ward. My mentor aimed second hand anecdotes as reasons as not to pass me. Not only were these anecdotes second hand, they were recycled, mostly, from the past 'little chat' which now, the way she phrases it in my paperwork today, was more of a disciplinary meeting. Little did I know.

To say I spoke to relatives about a complex procedure and gave them the wrong idea sounds terrible, but it's not as simple as it sounds. For example: The nurse I was working with had already discussed the procedure (the removal of a JP drain from the patient's head) earlier in the day. I went out to fetch the relatives from the waiting room, and they asked me whether the drain was out. I told them yes, since I'd took it out, and explained what I did. A week later, when my mentor told me this wasn't on, I said I would stop doing it. Which I did. My lips were sealed to next of kin and friends alike. Yet I was still taken to the cleaners with it at my final meetings.

Another occasion, on which I asked a doctor to prescribe our patient some potassium due to a dip in the patient's potassium levels, after discussing this with the nurse I was working with (who was there when I asked) was brought up. Again, I thought I was being useful but the ward didn't think so. That's fine. I didn't do it again.

I don't mind making mistakes, or being taken to heel because of them. I learn from my mistakes and don't do them again. If I do this, and am still criticised for them... what's the point in changing?

Although it was said that I was clearly keen and a hard worker, I was essentially told I should've been doing /less/. It wasn't documented how I helped various members of staff pin down violent patients when I should've been doing less. I wasn't even thanked much at the time for helping out. But that's as maybe...

I was told that, although my skills in basic care have progressed, they haven't progressed enough. There was no quantitative level indicated, so I'm not sure where I should've been. It was implied, for example, that I should've been quicker doing my drugs. I know people on the unit who, working on their own, perform their drug administration at slower rates than I did. This is ignoring the fact that I have to wait for two nurses to check the drugs, which often takes a while. I don't mind being told I should be more efficient with it, but if speed was the problem, there should've been goals set and targets to reach, in my opinion. And I'm not at all convinced not being very quick on the draw when it comes to NG meds counts as unsafe practice. Ditto for my time management skills. They've progressed, but not enough: how much is enough? Especially when there are a lot of things I, myself, cannot do on a shift.

The thrust of her criticism was also pretty flawed in my opinion. I was told I was too keen to do things and get involved in things I may not have a huge amount of experience in half way through my placement, so I adjusted my practice to be less forward. I get told at the end of my placement that I'm too cautious and taking too long to do things, like give meds. Seems contradictory to me...

A major part of the criticism revolved around my mentor not feeling I practised safely. One event in particular, actually, in which I gave closed, tracheal suction to a patient. At the time I was not aware I was breaking any rules. I had, in fact, been taught the technique by one of my associate mentors. I was innocent and foolish enough to think this meant I could... do it.

Another example of this: Bottom bags of catheters, when full, need to be emptied. With my associate mentors (who I spent the other 9/10ths of my time with) I was doing this quite simply by turning the tap and emptying them into a cardboard receptacle to be disposed of. I did this with my mentor, and was looked down on for not using an alcowipe on the exit port, which is apparently trust policy. I witnessed one of my associate mentors doing it the former way, no wipe, after this telling off. I informed her of policy and she just laughed.

Similarly, one of my associate mentors criticised me one day when I was leading the planning with a patient because I didn't listen to the patient's chest, via stethoscope, at the start of the shift. She said this would be a good exercise in getting used to chest sounds, linking what physios said to actual sounds in your head. 'Good idea!' I thought, and have started to do it when I get a spare minute.

Today, my mentor pulls me up on it. She says I'm not trained to do it, that I wouldn't know what I was looking for and basically implied I was being pointless. When she asked who advised me to do it, I took a little amusement in telling her it was one of her own nurses. Just a little.

I could bring up other examples of this, as it happened a lot. In hindsight I think I should've been less diplomatic and, when given a telling off for doing something I'd learnt from someone else, just pointed the finger.

The bottom line is: I should've kept my head down, spoke when spoken to and generally been a gutless whelp. If anyone was to ask me how to get through ICU, that's what I'd advise. Sticking your head above the parapet is not appreciated. As it has been in all my other placements. And I don't think I'm going to change what I do, overly, in the next placement I have. I have to get retrieval marks now, for the 5/20 areas which I still have 'difficulty' with. I can do that.

I could go on about how the feedback was unjust, but I'll be doing that to my personal tutor tomorrow. As well as planning my future acts to make up for this slight dip. My mentor has already contacted Uni with her concerns and to get guidance on what to do. I have my turn to speak to the institution tomorrow, it seems. And I'm positive about it. My chin is utterly up.

I'll end this ranty post with the point that, near the end of the interview, my mentor said: "If you were on any other ward, you probably would've passed..." which, to me, demonstrates a sense of arrogance or disregard for other clinical environments (Probably why some people don't like ICU staff, I'd venture). This mentor hadn't read my first placement of this year, never mind the other three, all of which I've passed. Quite a pertinent point to end on.

ICU is different to anywhere else in a hospital. This doesn't make it better, in any sense. There's no qualitative judgement to be made in that case. Student nurses can't be as involved as they can be in a normal ward. That's par for the course. And I ruffled a few feathers as I adapted to life on ICU. They act as if you're supposed to be an observer and yet complain when you don't make any progress within seven weeks. Or they did to me. Maybe I just didn't /get it/. 7 weeks isn't a long time, in my opinion, and I think I made some progress. I will take on board some of the ideas levelled against me, and attempt to improve. I am in no way saying I had a flawless placement. But that's their fault, as well as mine.

Penultimate Shift

2009-04-25T05:27:00.000-07:00

It was two days ago. I'm late, so sue me.

And due to a toothache I'm not feeling recovered at all. But I'll trundle on.

It was a good shift. A shift which started with one Level 2 patient and ended with a different 2/3 patient. The story of the latter was somewhat sad, although I'll find out tomorrow just how sad it turned out.

The patient had a medical history as long as my arm, for starters, and was no spring chicken. These two things set off warning bells, in my head, at least. This patient was brought into A&E and then into ICU due to a quite tenacious case of community-acquired pneumonia. Placed on CPAP for a long, long time. CPAP basically comprises of a spaceman-style facemask. Something you are basically strapped into. You might get a break once every four hours, if your oxygen levels are up to it, but generally you're stuck in it. And it's like hanging your head out of a car window at 70MPH (although without the risk of it being knocked off comically by a signpost). Trapped in, blown at. And you can't drink, eat or talk to any useful degree. Not pleasant.

On the plus side, it is very, very effective. The patient was improving. There had been fears the patient would have to be sedated and intubated if their condition worsened, which was entirely possible. The doctors were optimistic (this is, as previously mentioned, rare). The nursing day was going well. We were on top of things, would you believe! And then, of course, something happened.

After having a few visitors, the patient decided they'd had enough of the mask. We spent a little while trying to convince this patient that keeping the mask on, as difficult and awful as it can be for the whole day, would be the best thing to do. As a compromise, my mentor decided to step him down to a normal face mask on high, high flow oxygen.

And we watched. The patient seemed happier, the family were a lot more worried, but the consultant said we'd see how it went. And within a half hour their saturations were holding well, blood gases weren't terrible. My shift ended then and so I'll see, on Sunday, how it panned out. Well, it goes without saying, I hope.

My First Ambulance Placement

2009-04-21T13:54:00.000-07:00

Indeed, on Monday I spent a day with the Ambulance services, touring around this fair (unnamed) county. It was enjoyable. I put some effort in, where I was allowed, and (unlike in ICU) it was appreciated!

The crew were tip-top. They were both technicians, which (to paraphrase them) meant if we were sent to any RTAs or the like we were pretty much fucked. Technicians are somewhere below Paramedics. They can't give out strong medication, etc. But one of the technicians I was working with had passed all the exams and was just waiting for a 'medic spot to open up. It's all about the money, as usual.

Anyway. Despite this excellent book and the attached blog and the warnings thereof, we received no pointless calls! All day! I was almost shocked.

We went to a couple of falls of old people who were frail enough to require a trip to hospital. We attended one patient whose shoulder had popped out of joint, for the 35th time, and was in intense amounts of pain.

Could someone from A&E tell me why such a patient wasn't given morphine when the patient was brought in? Weird, I thought.

We attended an old dear with dementia who had been found half collapsed in the street. The police gave them some water as we turned up. The patient's offspring also arrived, someone with the patience of a saint. This elderly patient gave us various stories and wives' tales during our little check up. This patient also refused to go to hospital, despite appearing in massive amounts of pain, at points. There was a large amount of paperwork to fill in for someone who a) declined a trip to hospital and b) didn't appear to have capacity to make such a decision. The offspring signed it off, we put them both in their car, and waved them off.

That is a whole different kettle of fish. Although the old dear received some help at home, it didn't seem like enough from what we could gleam. And it's funny, but not shocking, to think of paramedics dealing with the fallout from shit government policy.

It was a good day. I gained awareness and a bit more of the love I've lost on ICU. For helping people, etc.

Good news..

2009-04-17T13:50:00.000-07:00

... and the bad news.

More feedback from my day calling the shots.

Positive:

Improvements in mouth care, eye care, ANTT, dressing changes.

My planning began well, especially given there are only some things I can plan for. It was my second long day and my first ever day planning a day for a patient. I kept an eye on infusions, which is something I haven't been too good at before. I planned for turns and the like in advance.

Negative:

I think too 'medically' and need to take a step back from this.

My planning became less effective as the day went on and our patient deteriorated.

I was too rigid and set towards set times, when working on ICU involves doing some things early, some things later, not necessarily on the hour.

Basic cares still need improvement.

I need to not talk to doctors without speaking with nurses first.

---

These are the views of my associate mentor. I'll talk about how I feel re: them later, but just wanted to get them down. It is the end of my last two long days in a row, I'm teary and generally irritable. I'm conciously accentuating the positive and eliminating the negative, as the song goes, and will reflect again soon.

Progress, though, is important! It should be noted I also directed all medical questions from the family to someone else, which is more progress.

Right now, though, I hate this placement and parts of me hate nursing because of it.

I do need some sleep, though.

Positivity!

2009-04-16T13:42:00.000-07:00

So yeah, I'm bouncing back.

I had a good shift today. My removal of another central line was good, if a little methodical. My planning was more than adequate. I worked more things through than I usually do. And! I even managed to keep my mouth shut to various people and played the good little student nurse.

I'm happy. This placement is up and down and today is an up.

My associate mentor said she's going to e-mail my main mentor informing her of my solid progress. At the same time, working with her tomorrow, she plans to give more authority for planning and implementing to me tomorrow. Which I'm looking forward to, big-time!

Negative Feedback

2009-04-13T13:50:00.000-07:00

Indeed, I received some less than positive feedback today.

It was delivered nicely. Almost apologetically. I'm worried, but I would've been *very* worried if it was delivered in a stern sort of way.

Anyway. For almost two years now, I've been pretty up on my A&P. And my time with cardiac rehabilitation had me talking, at an easy to understand level, with patients and their relatives. It's a trend I have continues, since my last mentors seem to like it.

However, this is not how it's seen on ICU. There have been some queries and complaints made about me overstepping my bounds and doing this too much, which has been pointed out to me. I don't think, with two weeks left, this is a failing thing.

Personally, I think it's better to be keen than not interested. Obviously, if my behaviour would've become dangerous to patients, then it would've been too much. I was warned, for example, for giving internal suction when my mentor wasn't really watching. Someone has trained me, though, and I have done it before. More than once. So is this my fault?

Either way, I'm reining in my exuberance. It's a fine line to walk, and I'm not entirely happy with my progress, but it is progress.

And my patient today was very happy with my nursing. So I must be doing something right.

Interesting times.

2009-04-07T08:55:00.000-07:00

As the old Chinese curse goes, this is not always a nice thing to say.

It's Tuesday, right? My days are all off kilter. Tuesday. I like Tuesdays! I'll get to them later.

Monday was the aforementioned interesting. Sunday, as you may or may not remember, involved me following a patient with some neurological problems into surgery. I was with this patient again for the whole of Monday. From a nursing perspective, my mentor was very good in letting me plan out the day and - for an hour - we stuck to it. Then the doctors arrived and announced the necessary (if fucking irritating) plan of letting this patient off sedation.

For those not educated in the fine arts of critical care, this involves turning off the sedation and waiting for the patient to react, which is often by coughing and choking. With this ability to protect one's airway, the ET tube can be pulled out and replaced by a face mask ('weaning'). Patients are generally confused when 'waking up' from sedation, which is usually fine. It lasts for a little while and they settle down. Sometimes you have to be firm with them in order to keep the face mask on them and oxygen going into them, essentially life preserving treatment (the idea of taking someone from ventilation down to simply breathing room air is not often a good one for patients in ICU).

This patient had quite the chequered history. I am mentioning no names or no real details here, therefore am not breaking confidentiality I rush to remind readers. The patient was involved with the police. The patient had a history of drug and alcohol abuse, the former of which meant we needed visors, to start with. The patient was agitated on the cessation of sedation (try saying that ten times fast). This continued and continued until we couldn't keep a mask on this patient with just two nursing staff and one doctor. We, with effort, swapped them to nasal specs (those tubes which pop up each nostril) and the patient seemed to relent at pulling at them.

This was the beginning of problems. The patient was also riddled with lines used for feeding, medication and monitoring and the patient decided to turn their wrath on these lines next. This reaction is not uncommon, as the feeling of intrusions into the body isn't very nice. However, they're all vital so, short of sitting on the patient, I managed to keep them in for a bit.

By now, the patient was swearing, shouting, digging nails in and generally being abusive to us. This is not uncommon, but is hardly helpful. The doctor had left by now, leaving myself and my mentor to try and keep the patient from from hurting themselves.

This is a big issue within nursing. You can talk about the right to autonomy as much as you like in the class room, but should someone be autonomous in causing themselves large amounts of damage in (and out) of a hospital bed?

Anyway. An hour after this and the patient is still agitated, still physically and verbally aggressive. My mentor and I (after consulting the information at hand as well as the patient family, who simply laughed off the aggression as something apparently hilarious) decided the patient was actually quite orientated and just a bit of a nasty. The patient began, from then on, to verbally and physically refuse cares. During this drawn out period we were punched at, kicked at (he missed, just about, with one on each), bitten at, swore at and successfully scratched on more than one occasion. With the help of another nurse we managed to pin the patient down for long enough to change his trousers, clean up his entire body (the patient had had a bowel movement and spread it all over themselves, their catheter and their femoral central line. Faeces staying around this area? To call that simply 'an infection risk' would be like calling Nick Griffin 'a bit old fashioned'.

During this time, we were shockingly nice. Vocally and in general. My mentor continued to give the patient pain relief, despite being told - in no uncertain terms - to 'fuck offffff!'. We continued to put our bodies into the line of fire to keep the patient in bed and generally safe. We removed all the lines as quickly as possible and were generally worn out by the end of the shift.

We weren't, for the record, allowed to place 'boxing gloves' (i.e. the act of bandaging the hands) on the patient. The coordinator said, because there were two of us (I'm not supposed to be in the numbers, remember), we weren't allowed. I viewed this, as well as the whole lack of staff and support as a shocking let down for us. As did my mentor and the nurse who helped us, and we all filed incident reports after shift. Otherwise nothing'll get done. Nothing will get done regardless, but at least we tried!

More on this later.

It's not brain surgery...

2009-04-05T13:11:00.000-07:00

Actually it is. What I saw, today.

It started off as a normal long day of a shift. My associate mentor is still off, so I was placed with a Band 5/6 and set about working. Or trying to. Despite the fact that Annoying-Band-7 told us our patient was ready to be moved into a side ward due to an infection, he really wasn't. In fact, the night nurse had no idea he was moving.

That put us back about two hours, with a patient who was already quite sick. Sedated, ventilated and bed bound. With a history as long as your arm and a very poor prognosis. A history of strange behaviour and substance abuse. After a day of helping provide care to this quite Level 3 patient, of which I was mostly successful, and then got to go and watch him in surgery.

I got to scrub up, which was more than interesting as an experience, and then I got to watch the worrying experience of cutting open a head, drilling through the skull and taking out flaps. It was... an eye opening experience. Which, given what was happening to the patient, was probably quite a luck event. I'd rather have my eyes opened than my skull...

Another two long days down and out.

2009-04-03T13:54:00.001-07:00

And I'm tired. The random nurse I spent the PM working under let me off an hour early, for which I was thankful. Tired but happy, I got home in one piece and drank some tea. Only then was I ready to write this.

It was a good day. Hilariously, none of my mentors were around to see it. But I planned well, I pushed on with my essential skills (a trachy-dressing, with some assistance and minor mistakes) as well as planning the day and going through with my plans. Management-tastic. A good day.

I have the day off tomorrow, in which I'm shopping for more of my packed lunch and going the bookies. Not in that order. And then I'm going to curl up, cat-like, and sleep.

"The breach" indeed!

2009-04-02T13:56:00.000-07:00

What a day. 15 hours today and 15 tomorrow. I'm only coming online whilst I eat my supper, which is much needed after such a day.

It's really my fault, in a sense. I started the morning with the physios, spoked, as it were. I thought that'd make for a quiet shift.

Idiot.

I joined up with my mentor soon after and helped look after an old dear with dementia and a broken, operated-on hip. The patient was, as it can be termed: "pleasantly confused". If you didn't mind telling the patient, once every three minutes, that they were in hospital: they were a ball.

Then lunch. Lunch included my interim interview, in which my mentor let me know my ability to provide basic care wasn't proceeding along as much as my knowledge and ability to fit into the team. I was annoyed/upset at first, but then I figured: a) I have over half my placement to work on it and b) ICU sets trends essential care. It'd be silly if I thought I was up to their standards already, especially since I haven't been in a ward all year.

So, onwards and upwards. From 2PM upwards, I had a new nurse to work with (who worked me like a dog) in the admission of a patient. This is something, as previously blogged, I haven't had a chance to do. I took a big part in this, and it was a busy one.

The scary part was when we were changing this patient's sheets, later, and turning the patient, too. I took charge of changing the sheets, cleaning up the patient, whilst two nurses held the patient, mid-roll. When rolling a patient, the ventilator generally starts to alarm as breathing is interrupted. Very quickly, however, we realised the patient was going blue. Not just blue. Grey! I shit you not, straight to grey. So the nurses reacted quickly, bagged them, insisted the patient wasn't going to let themselves down so easily, and brought him back from the breach. Amusingly, once the patient was sorted out, a Band 6/7 came in to shout at us for talking whilst moving a patient. We were not talking about going out and getting pissed, or reciting Hitler's speeches. We were just chatting. Yet, apparently, you have to be robots.

After that, I finished most of the paperwork, which was an experience in itself, and handed over to the night staff. Exhausted, the nurse I was working with told me I'd performed really well and let me go. Hopefully she's checked all that paperwork, because I was, rather adorably, muddling through. I feel good, though!

Back into breach once more.

2009-04-01T02:19:00.000-07:00

This is my last day off. I'm celebrating with gingerbread right now, whilst later on I plan to go out and learn some more dancing the NMC wouldn't approve of.

This post got me thinking on mentors. Mentors, like it or not, build new nurses. University certainly doesn't. University teaches abstract ethics which are applied to theoretical situations (if you're lucky) and informs how to lift boxes and place them down correctly. The fact that we had many sessions on this and only one on how to move a patient? Pretty sad. Anyway. I'll hop off my soapbox for a bit and get on with the issue.

I recently commented on the above blog post in relation to the idea that mentors are overworked and struggle to teach students under their guidance due to this shortage of staff and large workload. I don't mean to say this is bollocks, but it sort of is. Let me elaborate:

I have had many mentors. Well. Five actual mentors so far, and probably about fifteen more who I have worked under due to staff shortages, etc. I have had good and indifferent mentors. Noone I would honestly view as deliberately *bad*, which is certainly a good omen for nursing education, but there have been some who simply aren't that bothered. Like they tolerate you following them, trying to soak up knowledge like some hungry piece of floating plankton, but aren't willing to help.

Were these types overworked? Maybe. But, in the cases I have experienced, they seemed more apathetic. These are the types of people I always guess might sell half of their human rights and civil liberties for a free parking space and this attitude can seep into patient care. Thus: I don't agree with their politics or professionalism. One of my favourite tutors always tells us that, although students should challenge actual bad and dangerous practice, it's more about leading by example with best practice, candor and professionalism. And that's what I try to do.

So, there are the not-so-good mentors. What about the good ones? The inspirational ones? They're worth waiting for, certainly. I'd say, to become part of this elite group, one needs to be knowledgeable and on-the-ball. One needs to be able to say *why* they're doing something (as a good student should always ask). A good mentor also needs to treat a student like an adult. Older, younger: doesn't matter. A nurse I worked with recently spent a lot of the night asking if I was happy with the treatment we were giving. Whether I said yes or no, she'd ask me why. This is proactive and works with me, big-time.

The mentor's job, however, is not to drag a student along. My comments are sort of sullied by the fact that I'm one of those killed cat (read: curious) types who is always asking questions. And to do things, too, or join in on other procedures. I am driven by many things, but one of the driving forces is a sense of disgust and dismay at those nursing students who lean against the nursing station all fucking day, scratching their arses and whining about nothing interesting happening. If a mentor is faced with someone so lazy, disinterested and unsuited to nursing, it must be a challenge.

As a final point, the clinical environment the mentor is based in is important. Standard medical wards are often understaffed and a good student nurse can, under supervision, end up with responsibility for a couple of beds (drugs not included) which is excellent experience. A critical care ward, on the other hand, involves a lot less of that type of responsibility. The student might be more hands-off and student and mentor must be a bit patient (no pun intended).

In conclusion, I refuse to accept that poor mentoring can be blamed on overwork alone. Overwork plays a role, but so does the character and skillset of the mentor, the type of clinical environment as well as the history of student nurses they've worked with.

More Placement Thinking

2009-03-23T09:13:00.000-07:00

I had these really current and up to date posts typed up in draft form and thought Blogger saved them for me. I was wrong. So I'll be quick, instead.

I am in the middle of a mini-week off. I spent four nights in work, adapting temporarily to the life of a vampire nurse. Stealing pinpricks of blood and walking around silently.

It was a mixed week in the end. There were a few less than hum drum moments in which I thought nursing wasn't for me after all, and there were more than a few moments in which my faith in the profession was reinvigorated. The nurses I was working directly under, one my main mentor, one a complete random, were helpful in this. They told me how I was fitting in with the team well and coming off as competent, to say the least, which helps.

All a bit vague, I realise and apologise.

To be honest, I think I thought ICU was going to be a more intense experience than it has been. Maybe I'm getting off easy. Or maybe I'm emotionally hardier than I thought.

That's being 25 for you...

I'll get back here with more specific things soon. Right now, I'm enjoying a mini-week off, due to the glory of how my shifts are arranged. Time off is almost as important as time on, after all...

Second Week, ICU and bedpans.

2009-03-22T14:20:00.000-07:00

This post isn't really about bedpans. It's just better if these things come in threes.

Although, come to think of it, my patient today (my third one, something I'll touch on in a bit) did think the bedpan/bowl I was holding with a hat. We decided it'd pass for formal wear if it was painted black.

Well, sort of we. They are a funny one.

I post today for various reasons. My mentor gave me a few hints of things to reflect on, and I will choose to reflect on here, in my trademark glib manner before putting pen to paper and going all serious and shit.

The long and short? A Band 7 spoke to my associate mentor, and I, like we were pieces of shit on their boot. Backstory:

We started the day in a side ward, with one patient who had been placed there with a suspicion of C. diff, although by the time we came on shift she had quite formed stools, so we were happy. This patient was a bit... mobile around the bed. And unresponsive to commands, but generally well. Quickly as possible, we did all the transfer stuff for a step down to NeuroHDU.

This was all the more rushed as there was a patient in surgery, awaiting the bed we were clearing. Excited, I was going to see an admission and discharge on one day! This stuff is important so you're not completely clueless, really.

The fly in the ointment was a logistical one*. There was a member of the nursing team close to finishing their supervised placement who it was said would take point on the admission. My actual mentor said I could still be there, though, and that was agreed by all the staff on the floor to be a good idea.

However, Band 7 comes along and - with one of those laughs you want to swap, in your head, for the sound of rancid, jagged nails down a blackboard - gives this: "I didn't realise you had a student with you!" (When she hadn't actually popped out from behind the nurse's station since start of the shift). They proceeded to tell us their brilliant plan involving my associate mentor supervising the admission and the new nurse doing it. We kinda looked at each other and said: 'That's what's happening, yes, we thought.' They proceeded to say how that meant three people would be far too much. We replied with what we'd all discussed on the floor and they said, I shit you not: "This is *my* plan. Two of you."

Enough said. Moron.

A patient I wasn't looking after, someone who has been in ICU for a while and is making some progress, decided to pull out their tracheostomy tube today and refuse to let it stay back in. It brought up an interesting ethical dilemma, as I discussed with my mentor. Patient autonomy is important, naturally, and yet there's an issue as to whether a patient can make an informed choice on below 85% oxygen saturation, something which was happening. The patient had been in ICU for over a week, too, and there's also the issue of ICU-created psychosis, which is more common than I'd thought. My third patient today had it, but - as mentioned - they are a bit of a funny one, either way. I reckon, with the ability to breathe and talk, they would probably be a bit odd. In a nice way.

The medics, in this case, decided to remove of the trachy-tube and replace it with a trachy-mask, even with the risk of desaturation and respiratory distress. They also removed their arterial line in an effort to make them feel less tied to a machine. It was very difficult the patient grievance when they could not actually talk. The patient was was mouthing something about having waited 5 days for something, but it was unclear. An accelerated step down from trachy-mask to uncuffed tube to fenestrated tube would end up with the patient being able to articulate, verbally. Only then would someone be able to decide if his ability to stop such treatment was an informed choice. And I think, ethically and professionally, the medics made the right choice.

The patient was uncooperative to the nurse, but I don't think the nurse in this case was very understanding. They displayed what I thought was a short fuse and seemed bereft of empathy. I go onto nights tomorrow so it'll be interesting to see how the patient in question is doing then, either way.

*Logistical flies in ointments are the worst kind.

ICU, one week down.

2009-03-14T12:45:00.000-07:00

Indeed, my first week of placement on ICU is finished. Sadly!

I'm enjoying it, thus far. It's difficult, y'see, in a challenging, rather than dangerous and horrible, way. As a taste, for the first day, I witnessed back-to-back tracheotomies and helped on the second, which was not entirely by-the-book. You'd think holding a tube would be pretty easy, but it's really not. The doctors were awesome, though, talking me through all the curves.

I'm a bit tired, after two Long Days in a row. Suffice to say, I've learnt a lot already. I like my mentors (associate ones) and I like the staff I've met.

The first patient I had, in shaky writing (since they were one of the trachee'd patients), expressed disbelief it was only my first day. It was sweet.

Sexual Health

2009-02-26T14:19:00.000-08:00

Teenage Pregnancy: up.

Sexually Transmitted Infections: High.

School Nurses: Low.

Sex and Relationship Education: Low.

It's not fucking rocket science, New Labour!

I'll get to a decent post soon, but this has annoyed me.

Been long enough, I know.

2009-02-08T09:20:00.001-08:00

I've been busy!

News:

I had an exam last week, which was entertaining. I feel good about it, as exams go, and so am not too worried. A few people on the course didn't even answer all 5 questions, which is worrying, if you ask me. It was about a MI patient, and MIs are going to be more common when we qualify.

More News:

My next placement is on ICU. I am terrified and excited all at the same time. On top of that, I am one of six students who will be working there for various periods. Means I'll have to be on top of my game. Which I fucking love.

More later.

Men

2009-01-20T00:44:00.000-08:00

The BBC today are running two articles on men and childcare.

Which is a nice change. However, the first of these articles highlights two major problems related to sexism. Firstly, people working in the childcare sector are massively underpaid, especially when they are reasonably skilled workers. This is linked to the fact that the majority of these workers are women and women are massively underpaid in a patriarchal system, but also linked to the idea of 'value' for the 'role', I suppose. Secondly, pushing for men to go into the jobs and actually providing encouragement is a massive job, not something one slips into a statement from an organisation. Paternity time has increased under the Labour government, which I'm vaguely thankful for, but until a more equal scheme comes into play in which mother and father can divvy out a pool of parent-time between them, I don't see how men are going to be actively encouraged into such a job, or indeed encouraged to care. Sad, really.

Back to the salt mines.

2009-01-14T09:36:00.000-08:00

Christmas and New Year are over, 2009 is so far treating me well. I had a mock exam on Wednesday, which went relatively smoothly, although it formed a warning. The warning: Examiners talk bollocks. When I read the mock answers, I mean. I will have to bear this in mind.

But no, obviously I'm still alive. Not much to say, but I'm sure I will do once this new term starts rolling along.

I was going to comment on how much I dislike non-socialist feminism today, but am too happy to moan. I'm sure I'll wax lyrical some other time.

Moron

2008-12-23T01:44:00.000-08:00

Fact: Richard Branson is figurehead of Virgin Health, a private health concern.

Fact: Richard Branson's daughter, who works in the same company (why help every patient when you can just help the rich ones who can afford it?) has recently been in the news in a positive light.

Fact: Richard Branson is advising the NHS.

All three of these facts resolve themselves into an big, fat truth, unfortunately. In the above story, There are two moronic, but quite funny, facts to pick up from the story. Firstly, Beardie complains government ministers mess around with health policy too much before... yes. Saying how he wants to fiddle with health policy. His grand scheme is to test (presumably by swab x3) every single person who works in the health service for MRSA. Not only would this be massively time consuming (compared to, I don't know, maybe HAND WASHING) it would also put a huge strain on the resources of microbiology. Saying that, perhaps Beardie would put the contracts out to tender. Perhaps Virgin Health would get them...

His second - most hilarious - point is that the health service could learn a lot from the airline and train industries. I don't know a huge amount about the airline industry, but - as any fule does know (or Private Eye reader, for that matter) Beardie makes large bags of cash from Virgin Trains. Most of this cash doesn't come from actually running the trains. It comes from contract negotiation and gobbling up appetising subsidies. Maybe that is his point, then. Perhaps the health service should be sold off to private concerns (at a snip, for them) and continue with massive problems in the infrastructure (whilst all the separate companies complain that beds aren't actually their problem) remaining unaddressed whilst the companies still grow fat off of massive public subsidies. Once they had their finger in this pie, they could justify increases in the cost of subcutaneous injections by whining about the price of oil, leaves on the lines of their delivery trains (private, of course) and, of course, the state of the economy!

Cunt.

Term Over.

2008-12-20T02:12:00.000-08:00

Yes, indeed. Hark! The herald angels have thought it fit to see me through to the end of a term with my sanity intact. Or something like that.

Huzzah!

I've felt the past, compacted week has been something of a waste of time. Except for swapping experiences about placement, which only took about an hour, it was pretty benign. Two lectures were made worse by either: a lecturer not knowing how to use a computer properly, or a computer malfunction. One of these sessions basically involved watching 'Inside I'm Dancing' and reflecting on it. Which was certainly strange as a University experience.

Another involved debating nursing in relation to abuse of the vulnerable. To fence this into a 2 hour session seems a bit harsh, since it's a massive problem. Abuse by carers, professionals, other patients. Horrid subject matter, of course, but something that must be faced. By the end of it the lecturer, who is self-admittedly "old school" (but I like her), said she had faith in us as the subject got us all so upset. She said she still loved nursing after decades in the trade, and if that wasn't an indication of how burn outs don't always happen, nothing was. Useful session, perhaps, but over too soon.

And now it's the Christmas break. Eating, drinking, being merry and of course studying. I'll have to work on accomplishing all four.

The Right to Choose

2008-12-16T04:09:00.000-08:00

It's not rocket science.

I've just came back from my morning lecture with an extended break, so thought I'd hit a few points that are on my mind. I'll go onto the ever contentious issue of abortion soon. A quick couple before, though.

The AM lecture was unfortunately cut short, but I'm quite glad. The course has tried to make a session on the massive problem of domestic violence into half a session, which I think is plain offensive. It would've been the arse end of the session, too, which is when most of the morons I sit in lecture theatres with are itching to stop learning and go for their second overpriced cup of coffee of the day. They don't have any money, obviously.

Staying on the point of the sections of my year group who don't seem to care much for the learning part of learning, I was quite amused to be sat in front of a row of girls (actually quite young, in respect to the average age of someone on my course) who talked all the way through the lecture. And I mean talk. Not whisper. And it's not even a big lecture theatre. It amused me more than it disturbed me, to tell the truth, as I can actually multi-task. But I feel bad for the lecturer (a person I quite like) who shouldn't really have to work with the behaviour generally reserved for a group of Year 11 girls sat at the back of a R.E. class. I've made a mental note to sit closer to the front, just in case. Anyway, the girls were shouted at (in hushed tones) by other colleagues, to much cringing and looking away. Funny old world, certainly. This afternoon's session is ran by someone with much more strength of character, shall we say? It should be interesting.

During the AM session, though, an idea came up. Can a nurse be an advocate if a patient is partaking in something they do not agree with? Should they feel guilty if they don't? The side of the room featuring me has to say a nurse shouldn't feel guilty, and we moved onto abortion. Boy, did I end up biting my tongue.

If someone doesn't agree with abortion on 'moral' grounds, or out of some other personal opinion, then fine. Feel free. But once, /especially/ as a nurse, you start to press your own opinions onto someone, onto someone's choices and treatments, you're so wrong it's untrue. I think smoking is a silly idea. Not a 'sin', or against the view of some great deity who may or may not existed, just silly. I do not, however, state clearly that I think someone should be denied treatment because of this choice (which will harm them and do very little good, so is almost against my stance on the 4 pillars of ethical practice) they've made. If someone has had an Myocardial Infarct and subsequently needed a CABG (a 'bypass') to repair it and yet continues smoking I would not deny them treatment, or deny them (in the above case) my advocacy. Nurses don't get to choose who they help in this country, and that's a good thing. Murderer, paedophile, terrorist - nurses should not be casting judgement which will influence their care and treatment on any patients who come their way.

EDIT: It was sad to see and hear most of the anti-choicers bringing out familiar old anecdotes from the Nadine Dorries school of fearmongering. Dead babies, floating in toilets and in kidney dishes, or maybe still alive, gasping for air. Same old biased bullshit, which does in no way reflect the wide range of cases, issues and types of abortion. And portrays abortion, as well as the woman who make such a choice, in a negative, prejudiced light. I was sad, but not surprised. Fear is a powerful tool.

My stance on abortion is similar to my standpoint on most life choices. Noone else matters except the person making the choice. I don't care if, in this example, a baby could survive outside the womb at 2 weeks. That's immaterial. It's the woman in questions right to choose. Not rocket science. The fact that I've met several student nurses who seem to think this isn't the case is downright wrong. Advocates, as it states we should be in the Code, nevermind ethical practice, they are not.

Update: Cretins

2008-12-15T08:39:00.000-08:00

I have been told, officially, to not speaking to a colleague "as if they're stupid". This, as the previous post will back up, is incredibly difficult when they are, in fact, stupid. Call me old fashioned.

Basically, we were having a debate about blood pressure and it all boiled over (ho ho). A theoretical patient had a blood pressure of 80/60 and someone was implying that this was a sign of cardiogenic shock. I said his was bollocks (in a more polite way) as I've met patients who are quite lucid and /not/ in CGS with such blood pressures. Someone argued with me, which was a bad idea. I asked them, point blank: "What is hypertension?". I probably used the term 'high blood pressure', since they do not like big words. For which the above accusation was levelled.

I don't really care, anymore. The tutor backed up the opinion of a colleague and I - that is to say that such a blood pressure is not indicative of cardiogenic shock. I argued he had a history of hypertension and was medicated for it, which agreed with the above opinion. But, voracious as I was, I made few friends. M'bothered, am I? Not really.

These people I learn with, the people who don't want to hear big words, are one of the reasons nursing doesn't advance as it could and should do. Their attitude adds to negative views towards nurses, in my opinion, which is something along the lines of what this idiot believes. On top of this, I don't think it's my role to dumb down my own learning to a level in which I don't learn. This is the same group who I, being the only one with cardiology experience last year, offered supplementary sessions to. Out of the kindness of my heart, no less! Funny old world.

Cretinous...

2008-12-15T04:40:00.000-08:00

... fuckwits. I worry about nurse education quite constantly, honestly. I have just finished a placement which, at times, may have been boring, but there was no shortage of learning opportunities. The staff themselves were constantly engaged in their own learning, as well as mine. Now I'm back to Uni? Ick.

In the past, student nurses I know have complained about the use of big words. A qualified nurse I worked with said working on a coronary unit involved "too much thinking". I shit you not.

I have just got out of a session (something I have to go back to) in which people I should respect espoused the idea that a Mentor (that is to say, a registered nurse who is guiding your learning on a ward) should teach you basic A&P if you're too pig ignorant to go out and learn it yourself. Sweet. Mentors are supposed to do this in between being overworked, overhoured and underpaid, apparently. Forget about independent learning, forget about guided learning. This is learning-on-a-plate. And here's me thinking that should've been left back in primary school.

N.B. A mentor should certainly assess your knowledge on a subject, and work from there. But if your knowledge is low, that is neither his/her fault, not is it his/her core responsibility to teach you what you don't know. My best ever mentor figure would ask me what a drug did. If I didn't know, I'd ask. She was fully prepared to answer, but would first tell me: "You know where the BNF is..." which is exactly the ways things should be done. My cretinous colleagues don't seem to realise this.

Absent

2008-12-09T14:11:00.000-08:00

With Leave, as opposed to the other kind.

I went home to see my family, specifically my nephews. For the second time in a month my youngest ended up giving me a 24-hour vomit and malaise bug. Wrapping arms around the toilet at 4am on Sunday? Not fun.

As NHS doctrine dictates, I have to stay off until 48-hours have elapsed since the last symptoms. Since then, I've got better and then got bored. I should've done more studying today, when I've felt a lot better (thanks for asking) but didn't. I won't lose myself any sleep over it.

It's good, though, in a roundabout way, to be sick. I'm not sure nurses would be good at their jobs if they didn't have reasonably frequent reminders of how shitty symptoms can make you feel, as well as the repercussions. I originally got into nursing due to the fact I was ill when I was young. The reason I almost got into child nursing.

So, looking on the bright side, it's not all bad!

Health Promotion in Action

2008-12-03T08:44:00.000-08:00

I've had an optimistic couple of days on the Health Promotion front. It's fun. This might have something to do with the fact that I finished before 1pm on each, but let's not be cynical.

On Tuesday I spent the morning with the team's Occupational Therapist (OT). Now, from the outset I'm pretty biased. I bloody love Occupational Therapy. I love the primary idea. It can be really basic, or really clever, and when it is facilitated well it can really improve people's lives. The OT I was with is very talented and experienced and we had a good chat about the ins and outs of OT within cardiology. We then went out - in the bloody snow, and I was already soaked through - to help a patient fit a bath seat. One of these zany electric things with suckers and whirring gears. That went smoothly, we had a chat and she expressed gratitude that we'd been able to help. A good visit, all in all.

Today I went to a real community setting, a church hall no less! Exercise classes for people post-MI go on there, at personal expense to the attendees. I'll vent on that later. The leader for the group was one of the most cheery, positive people I've ever met, which obviously helps things. Both groups knew each other, and on further questioning some of them had been attending for 12 years or more! No wonder, then. The exercise was pretty light, but given some of them were in their 80s that's no surprise. It is, rather cleverly, arranged into three levels, which makes it plenty accessible. Level One is quite sated, whilst Level Three generally uses whole body moves. It was an excellent learning opportunity, really. I got to speak to the leader about the classes and the reasons attendees value them, and then I got to check this out by speaking to the people themselves. They were all lovely, and told me the classes were both enjoyable and useful.

The major bee in my bonnet is the fact that they have to pay. These classes are bi-weekly, for an hour and a half each. One member of staff is required. The classes are in a church hall. I'm not seeing how they could be massively expensive. The classes are uber-useful. Not only do they allow people to exercise, warding off further MIs and other linked problems, but they encourage people to exercise outside of class. More importantly, the classes double up as a support group. People with similar problems getting together. Level Ones can find similar people to do the circuit with. If Level One A is a bit further down the road to recovery than Level One B they can talk about it. They get bloody enthusiastic about finding out about their conditions, which is one of the most important parts of Health Promotion!

And yet the PCT refuses to fund it. Good job, you cretinous fuckwits.

Concern

2008-11-27T23:56:00.000-08:00

Is it going to take an epidemic to change things?

The above news story is quite saddening, as a nurse, a scientist and a person. Some very scared people once believed this man and his (at best) inconclusive piece of research. I'm not going to go too deeply into the specifics, but when everyone - including the research team at the time - said the issue (the link between autism and the MMR vaccine) needed further research and one person says: "No, it's conclusive" surely this hints at something. Then link it to the possible conflict of interests and you should have a doctor stripped of legitimacy.

Unfortunately, Wakefield used an oldie-but-goodie within medical/quackery circles. If you tug on the emotional heart strings hard enough, with an air of threat about you, logic goes out the window. People can't think sensibly, act irrationally. In this case they continue to give reverence to this debunked research.

Until this research and the fallout from it, measles was well under control in this country. Now, as the leading story reports, it has shot up. Because it has not been a problem for a decade or two, people have forgotten how horrible measles can be. Make no mistake: measles can kill. It does, and has in this country already for the first time in over a decade.

I hope Wakefield is happy with himself. I feel sorry for the scared parents, but in the same sense I don't consider ignorance an excuse in any situation. Especially when it could lead to misery, sickness and death. It's a bloody shame.

Going somewhere else

2008-11-27T04:31:00.000-08:00

My course gives me a chance to venture into other clinical areas whilst on placement. They usually have to be connected and you need to justify why you'd want to do it. Thus: "Because this placement is boring," or "Because there's a staff nurse on there who's well fit" don't really cut it. In the same sense, it makes little sense to want to spend time in Orthopaedics if you're on a Cardiology placement, and so on.

My current placement, as previously detailed, is not the most exciting, in my opinion. As is prempting this, my mentors are somewhat pushing me out of the aeroplane to attend as many of these sidecar placements as possible. Problem is I don't really like them.

I turn up, introduce myself and firstly see if the people you're going to be watching and working with for the duration are much bothered. You find some to be gloriously friendly and helpful, some... not so much. Most of the time, I can pick up the vague impression I'm somewhat in the way of a day's work, really. One of the main reasons for my dislike. I prefer to be working, rather than standing around looking pretty.

Now, I hear you say - you can be observing! Yes, of course, and I do. But there's only so much you can learn from observing what happens to one or two patients. For example, I was observing echocardiograms today, which are very cool. I find them interesting, the technician was lovely and I understand the results of them more. But watching two can only do so much. Now, for example, if one of my patients was going down for one I would be happy to watch that single scan on it's own as part of the patient journey through the diagnostic pathways. But watching two scans of people I don't know from Adam? I don't find it particularly useful in itself. I do like EEGs, though. It's the same concept as doing that scan on a baby, but more interesting. You get to see the heart in all it's glory, the movements it's making and the rate it's moving at. A skilled technician then takes live feeds from different angles, recording them on a handy computer. The size of the chambers is looked at, as well as how much they're inflating and deflating. More importantly, one can observe all four valves, to see if they're leaking (regurgitation) or any other defects. Not only can one observe the heart in greyscale, it is also possible to bring in some colour. Specifically, it allows a technician to observe force moving away from the probe (usually in red) and towards the probe (usually blue) and anything in between. This is important to check if any blood is moving the wrong way, i.e. back through a valve. This is a bit naughty. There's also this awesome effect when you catch a decent glimpse of the Aortic Arch with both colours going in and out of each other. Fun. I like echocardiograms, then, yes. They're non-invasive, and a bit sci-fi. Only the former point is relevant to most patients, I'm sure.

I also witnessed a modified stress test, without the exercise component. Instead, the technicians administer a drug intravenously which makes the heart put a little more elbow grease in than normal, pumping effectively harder. This chemical is used in patients for whom even a gentle walk on the treadmill would be too much. The old and the very ill, in other words. The middle ground between these two absolutes (a full on exercise test and the chemical) is a more sedate time on the treadmill. The scores received are they modified, I believe, by another handy computer. The chemical test is pretty simple. A patient just lies there as it works it's magic. Reassurance is obviously key, as the chemical can cause an increase in temperature and - since it's a potent vasodilator - can lead to a drop in blood pressure, as well as the associated symptoms - dizziness, nausea and the like. The patient I witnessed was fine for the duration of the test, sat up well and just felt 'a bit funny'. Before sitting up, however, they are injected with a radioactive dye. The patient is then given a lovely meal involving milk and a (preferably fatty) sandwich. The Nuclear Medicine Department is not emulating the witch out of Hansel and Gretel, oh no. Instead, the idea is to activate the Liver and Gall Bladder, get them moving and, by proxy, move any radioactive dye that may have accumulated in either outwards. That way, there is more chance to recieve a better picture of the myocardium when the patient is being sent up for a Gamma Camera test.

The Gamma Camera test is pretty dull, from a patient perspective. It basically involves lying there are two cameras cycle around you, in jerky movements, to take a decent set of pictures of the heart. 20-20 style, although the cameras are arranged at angles of 72, 90 or 180 degrees to each other. So hardly like a human head. The gent in charge was nice enough to talk me through what the scans mean, so I can write it down here before I forget. The GCT is useful for a few reasons. The most important one is thus: Two sets of images are taken on two different ocassions. One after a stress test, so the pictures are of a heart working hard, and the other when the heart is at rest. This is the clever bit. If both pictures show nice swathes of white and red, therefore lots of perfusion of blood to the heart muscle, it's all good. If there are 'holes' in the stress test when compared to the rest test, then it is a strong indication of ischemia. That is to say, the heart is struggling to pump blood to itself when under increased exertion. If both rest and stress pictures are holey, this implies (but does not confirm) an infarct has taken place and most, if not all, of the non-perfusing tissue is dead.*

These are the tests I witnessed. I will now be able to speak of them to patients in a much more informed manner, which is a good thing, but I can't help feel a bit at a loss when it comes to time spent. I left before the afternoon began, as I didn't think there was much more to see. I, instead, will read about the above to increase my knowledge on the subjects. Additionally, I can't help looking forward to my next placement back on an actual ward, doing what I consider more valuable work.

* A different nuclear method, a Thallium test, can later give an idea how much of this tissue is fully dead, and how much of it is in hibernation.

Nazi Nursing

2008-11-24T00:37:00.000-08:00

This is all at once saddening and maddening.

The four pillars of ethical practice and the views of far right, racist, nationalist politics do not mirror each other. In fact, they clash quite massively with each other. This idea that one could treat every person with dignity, respect and acknowledge their autonomy is somewhat ruined if, underneath, you want to unlawfully throw them out of the country for having skin that isn't white.

This is typical behaviour from the NMC. I am a constant critic of the lack of political opinions and stance from nurses in general, who seem to play the angel/martyr card as a get-out clause. But this is typical hands-off work by the NMC.

Political freedom is one thing. The freedom to believe in things which go directly against all nursing (and, to a point, the NHS) stands for is completely different. I believe in socialism, partly, and I definitely believe in trade unions. This political belief does not throw around slogans such as 'Rights for Whites' or does not involve violence and intimidation against it's opponents. It does not advocate hate or any other inequality. There's a fucking difference. No pity for fascists, no quarter for fascists. Just call me old fashioned.

Paternalism for Prostitutes

2008-11-19T11:25:00.000-08:00

It's lovely to see that, even from women within the snake pit of national politics, patriarchal, paternalistic bullshit is still alive and well.

A sex worker on Channel4 News was not the first person I heard express dismay that the government commission - in its quest to make the world safer for sex workers - did not really talk to... sex workers. Shome mistake, surely?

Well, not really. It simply turns out that the idea of 'We Know Best' still reigns supreme. The ministers went on a tour of different countries to see how they handle the issue of sex workers. In Holland it's legal, as many anecdotes from just as many young men who go there for a dirty weekend will elude to. In Sweden it's completely illegal, etc.

The government chose to copy Finland with this new legislation. Legislation which has, to be polite, had a limited effect in that country. Legislation that sends out mixed messages. It doesn't appear to much protect the women it is designed to protect (and the personal opinions of sex workers I've read backs up this idea) and yet it - like most anti-prostitute legislation - force many sex workers underground.

People involved in the sex trade should be supported, in my opinion, and this new bureaucratic mess will certainly not do much to that end. KGM basically had DoubleH admitting she wanted prostitution completely banned, in theory. What else could be expected from a woman with such a goal?

Angriogram Duty

2008-11-19T09:47:00.000-08:00

Today I have been observing angiograms, which is nowhere near as exciting as I thought it'd be. I got to wear scrubs which I'm sure some people might find exciting, but the (heeled - why?!) clogs that went with them were utterly irritating.

Not much to report, really. I'd already witnessed a nephrostomy back in the day, so it was pretty much the same thing.

The radiographers were snotty, the nurses were nice and the main consultant I observed was very helpful, talking me through and asking me questions (woo) on the scans the unit performed that day. Other than that, things were quite dull.

A massive ball was dropped, though. A rather rotund patient got all the way to the table before it became clear they would be too heavy for the mechanisms. So, at the eleventh hour, the whole procedure had to be scrapped. The patient was surprisingly good about it, but quite a mistake to be made.

On that note, another overweight patient was being scanned when the consultant noticed a quite horrific note in the patient file from a surgeon back in 1981. I paraphrase:

"Patient is embarrassingly overweight, with plump, reddened cheeks and presenting stinking of alcohol but appeared clinically sober."

It went on. How things have changed... I hope.

Anyway, I'm quite bored of my placement. And have yet 3 and a half weeks to go. Nil desperandum.

The Last Week

2008-11-16T03:33:00.000-08:00

So, I spent some half days doing (what I know feel is) the same old Health Promotion business. Home visits with interesting people with interesting problems, which are very fun, really. But it's hard to ignore the fact that you're reading them the same check-list, over and over. The skill there, and the skills the people I work with really have, is keeping the procedure nice and fresh.

I spent Thursday and Friday on the Heart Care Unit, which was fucking awesomely out of this world. Critical Care really is my cup of tea, if this hasn't been made clear through my usual ramblings. And given my previous experience in Cardiology, it was a comparatively good deep end to dive back into. I had worried, over the Summer holidays and my current placement (involving few clinical skills) that I would be clinically void. Worse still, I feared I'd lost my edge communicating with and providing care for critically and acutely ill patients. But I haven't! That's exciting.

I had some really good experiences. I worked with the same senior staff nurse for both shifts, who was both a great nurse and a superb teacher. I impressed her with my knowledge, enthusiasm and willingness to get involved - another three things I'm glad haven't waned.

Yes, HCU was very good for me. Given I have an exam coming up about managing care for someone who has just suffered a cardiac event, it was a valuable education experience. The HCU in my current hospital is quite well staffed, which is excellent to see, and there is a more proportional population of men in the nursing side of things, a fact that fills me with optimism. Other than that, it simply reminded me of how much I *LOVE* the core.

This isn't to say it was easy. There were patients who had lots of things going on in their lives, and needed high levels of support on every level - social, spiritual, psychological and medical. This is one of the hardest parts of working in acute and critical care, but it's also one of the most important ones that I'm eager to learn more about, no matter how difficult.

This week I have to try and sort out some spoke placements, which is fucking awkward, especially when it comes to sorting them in other hospitals who are not 100% connected to my place of learning. I can't help but feel my current placement is eager to ship me off for as many away days as possible, which seems a bit besides the point, but we'll see. This week isn't all doom and gloom, though - oh no! Firstly, I'm going out on the tiles tonight to see one of my favourite ever bands. Second, I get to attend and observe some angiograms on Wednesday, which will be lots of educational fun. I look forward to it.

It's been a while.

2008-11-16T03:09:00.000-08:00

So, yeah. Apologies for the lack of Mother and Baby conclusion. Although, truth be told it wasn't that interesting. I spent some time on the midwife-led delivery unit, and saw absolutely nothing, alas. A couple of baby examinations, that's about it. Not much that eluded to education and experience, but that's the way it goes, sometimes.

Dr. Crippen has been chronicling re: midwives/"madwives" recently, and it's certainly an interesting debate. Especially the comments.

I'd say the education of student nurses is quite biased towards midwives, in my experience. We share a council, obviously, which might effect things. But generally I don't mind them. They do a difficult job under often difficult conditions. Dr. Crippen has a big ying against Independent Midwives, with some good reasons, but it's not all that clear cut. It's not baddies VS. goodies or anything so simplistic.

The thing which I dislike is the view of the - ahem - feminists over at TheFWord. To state, quite simply, "we decide what is anti-feminist" is hilarious. Their arguments on 'medical rape' are also quite amusing. I seldom agree full on with Dr. Crippen, but his point rings true: Their arguments rely on eliciting emotion, overriding logic and good sense. They speak as if the waters are always clear in modern medicine and midwifery, and like decisions are typically easy to make. I am in no way condoning patriarchal, paternalistic, top-down care or anyone. That's bollocks. What isn't bollocks are the 4 pillars of ethical practice. 'Feminists' over at the F-word state that people in the medical and nursing professions aren't God, which is certainly correct. However, as any fule knows, sometimes judgement calls have to be made. Beneficence can overrule the three remaining principles. Worse still, in the case of pregnancy there are two lives to consider. Doctors, midwives and nurses have to make calls on these issues, often in split seconds, and I believe such decisions are a million miles away from the coffee table debates that concern these 'feminists'.

Mother and Baby Day Three

2008-11-05T08:26:00.000-08:00

Third day down. Today was my first day spent with the community midwifery team, which was interesting. There were a quite a few women who didn't attend clinics or who weren't in when we called, which was educational in it's own way. Midwifery is difficult. I sat with the whole team, elements of which I will be working with for the rest of the week, as they had what is locally known as a 'natter'. There was a bit of bitchiness as well, but this is common in my experience of women grouped together.

The latter part of the day involved another clinic, a bit more well attended this time. Bizarrely, there was myself, the midwife I was with and two medical students. I'm sure some patients would be intimidated. But most were fine with it. The medical students (the female of the pair was actually quite doc-hot) were quite cute in asking if they could discuss issues related to the patient in their tutor groups. I just give them the respect of anonymity and get on with it, personally.

Pretty standard stuff, all in all. My midwife-of-the-day told me the story of a 16 year old pregnant girl who had had to give birth in hiding from her family due to death threats. Lovely world we live in, eh? Apparently the mother had been able to reconcile, but the rest of the male side of the family refused to. The baby is probably going to be put up for adoption. Shame.

Tomorrow I have elected to spend a late shift up on the Birth Unit. This is a midwife-led part of the hospital, reserved for normal births in which few to no complications are anticipated. There are no doctors involved primarily, which is a bonus. Far too many people think doctors are skilled at delivering babies, when it's really midwives who know the score in 'normal' births. I don't like late shifts, and I don't want to ruin my 100% awesome record at helping in births, but on the optimistic side I could end up keeping the record alive and helping out another little person come into the world problem-free. I'm not sure if my hand can take the squeezing from another stressed mother, but it's worth the risk.

Top Up Fees Are Rubbish

2008-11-04T12:27:00.000-08:00

The government are planning on relaxing the rules on 'top ups' within the NHS. This is a stupid idea.

Let's forget about the inequity I've blogged on previously. These are more philisophical, I suppose.

Drug Companies are not good people. They're out to make money and they do it well. Given you have to speculate to accumulate companies spend more money on advertising than they do on research. Convenient, eh?

Making money and good ethics are seldom partners. If you want to sell things, you push them on people. If you want to sell pricey drugs which NICE have not yet certified as value-for-money, then what do you do? Advertise. Prey on people in very bad parts of their lives. Bad Karma from the Big Pharma. Although drug companies are not allowed to advertise directly to patients, as they are in the US of A and are restricted in advertising directly to GPs, the internet is a virulent tool. Such companies find other days of advertising their wares, and suddenly people are informed of treatments that their GP or other doctor didn't tell them about. They feel betrayed, even though the health care professionals were only trying to stay true to the four pillars of medical ethics:

# Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
# Non-maleficence - "first, do no harm" (primum non nocere).
# Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
# Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

Drug companies are not pinned down by such pesky ideas. They can promise people pretty much the Earth, with some presentational caveats (i.e. spin). Such freedom must be quite liberating. But is free market economics the way for the NHS to go? I think not.

Mother and Baby Day Two

2008-11-04T08:22:00.000-08:00

Day Two turned out nowhere near as educationally exciting as Day One, I must say. Hence a shorter post.

From the outset, though, I got to see the mother, father and baby I made friends with yesterday. The two who could speak were very grateful, to which I had to play all modest (which I've learnt to do quite well, with practice) and honestly thank them for letting me play such a role in a massive experience in their lives. The mother expressed amazement when she found out it was my first birth, but her general happiness made the whole thing worth while. I didn't get to provide care for her and the baby on the ward, unfortunately, but seeing them was enough.

So. Post-Natal. A bit boring, really. It was interesting to see which kind of checks are done on both mother and baby on a daily basis, but not a day's worth of interesting. I got the strange privilege of feeling some contracting uterus' (externally, I should add) but other than that it was pretty procedural.

A note now about midwives. I have worked with two groups over two days, so this is in no way a big time judgement - just thoughts on blog-paper. A lot of the midwives I've met act as if they've seen it all, which a few might have. But sometimes this perceived expertise can come off as inconsiderate. For example, a mother was desperate to get home (for various reasons) but her baby still needed further tests. In this case, the midwives were worried about the baby's bilirubin levels. Too high can lead to jaundice which can, worse case scenario, lead to brain damage. This is a bad thing. But some of the midwives involved, out of earshot of the mother, were highly critical of her need to get home ahead of the needs of the baby. I can understand where they're coming from, but they were actually quite harsh about the whole thing when part of the problem could've been the distress of a new mother. This was not the only time something similar happened on the shift, and I personally felt it wasn't really empathetic practice. However, I'm just a student nurse, not a midwife, and so have no idea of the full picture.

An interesting day, then. I'm sitting here waiting on a call from the community midwives (who, I gather, are a completely different kettle of fish) to inform me of where to meet and what to do tomorrow. Interesting times continue.

Mother and Baby Day One

2008-11-03T06:48:00.000-08:00

I have previously mentioned how I thought my Mother and Baby sub-placement, a week around and about the maternity and midwifery hotspots of the current Trust I'm working in, might be a waste of time. I feared this, and had images of me just stood prone not allowed to do anything, being both a man and a student on the wards for one day each. However, like most placements, it turns out it's what you make of the experience.

Today was an early shift up on the labour ward. After arriving in the wrong ward and rushing over the right one just in time, I was quickly assigned to a midwife and a pregnant woman, whose labour was in the earlyish stages, because I was more likely to see something there. Obviously, I will be keeping things ever vague to protect anonymity, but on asking the lady was glad to have me there, which is a lovely liberal attitude to hold in this day and age. I would it difficult to interact at first - asking if someone is alright when they're clearly not is just a silly idea. Generally, because her partner was unable to get onto the ward until later on, she was grateful for the support, if a bit standoffish since she didn't know me as of yet. And I was annoyed at myself for standing around very much in the style of a lemon for a bit, but then I remembered this was a total and utterly new thing for me. Maternity and midwifery is unlike standard nursing, and that's a lot to take. The midwife I was working under was equally lovely, and answered my myriad questions well, guiding me and talking to me about the issues involved. I think she was something of a (very skilled) rookie, having asked her superior for advice on a few occasions, but second opinions are important.

From starting at about 8am, the woman was in something of a state already, but still very calm, considering. She had requested no pain relief, and was simply annoyed at being linked up to machines. Things began to drag for her from there, as contractions slowly but surely gathered in pace and pain. I had found my nursing mojo and had been chatting to her by now, in between shadowing and helping the midwife. Some time later, due to somewhat suspicious clinical presentation, the midwife advised the woman to lie on the bed so we could track the heart rate of the baby and some other things more clearly. And this is when it began to kick off.

Pain and distress, although the woman was bloody well brave about it all, requesting no pain relief until much, much later down the line. The husband arrived soon, which helped, and gave us time to make some decisions. The midwife finally decided that, although it'd make the contractions hurt a bit more, a hormone delivered by IV would make them more consistent and prompt a smooth labour. The patient agreed and so off we went. Things accelerated from there - not quickly enough for the woman who was tired, in pain and generally fed up (but still immensely brave and doing everything right). I was crouched by the bed by this point, opposite her partner, having my hand squeezed in the vice-like grip only pregnant women manage to bring into play. After picking up on the things the midwife had been telling her, I took over the role of pregnancy cheerleader, helping her with her very light pain relief and the breathing she needed to be doing to 'breathe through the pain'. Once you've been an actor and learnt how to effectively improvise, this bit flows quite easily off the tongue.

Now, whereas she had not been near the 10cm of dilation necessary for delivery for the morning, the early afternoon was to herald some changes. She was the kind of woman whose status could change quite quickly and so I had half an eye on the tracing machine and the other one and a half on her, encouraging her along.

The one bad moment of the day came when a doctor came to examine her. To cut a long story short, he wanted to look and she was very sensitive. There was a point when he was inside her when she was screaming at him to wait, and I'm aware than sometimes we in the medical profession do things patients don't like and these things need to be done, in this case to assess the safety and health of the baby, but when you're being told to stop you really should. Just go away and document the patient said no, y'know? Anyway, I was close to actually speaking up when he stopped and got out of the way (and the room). Leaving the midwife, the husband, the woman and I.

From there things got really crazy from my standpoint of utter inexperience. After spending the past hour telling this lovely woman who was desperate to push NOT to push and to keep breathing, now she'd hit suitable dilation that she SHOULD push. I'm surprised she didn't smack us upside our collective heads, but she did excessively well in the push on. She was very concerned for most of the time before that the baby's head was nowhere to be seen (in the literal sense) but that soon changed. Cheered on by yours truly, primarily, the father more of the strong, silent type and the midwife busy getting things ready for what could be a quick crescendo, she pushed like a bloody trooper, and soon this beautiful little person was coming out of her. Just the head, then the face. The hard bit over, this baby was all out and the midwife was clamping off the cord, placing him right on his mother's chest. Silent at first, he soon piped up with some skin to skin contact and after a quick dry with the towel, and the woman was so relieved it's untrue. Smiles all around, despite the crying out of the lovely set of lungs of the newest person in the room. The father, elated, snapped some pictures and cuddled with the pair. The harder work over, I helped the midwife retrieve the placenta, which seemed relatively painless, and it was over. Just under an hour before the end of seemingly the longest shift I'd ever been on, and I was let go by the team, mission successful. And I felt good. The baby was absolutely beautiful, perfect even. The mother and father thanked me, to which I had to say it right back. It meant a lot to me to be involved in that special experience of their lives. I said goodbye to the baby, having a go in his father's arms after some very valuable skin2skin contact, and made my merry way home. A day of good work, indeed!

Earlier in the shift, the midwife asked me I'd considered midwifery. I said yes, but was put off by the job opportunities and difficulty getting onto the course. Asked the same question at the end of the day, the answer was still a resounding yes. I LOVE the core, even the midwifery one. They're not nurses and don't much like being associated with them, and I can see why. Their work is a world apart.

Less Excitement

2008-10-30T13:36:00.000-07:00

What a difference a few days make. Well, not that much of a difference, truth be told.

My feelings are still mostly positive, but mixed. I very much like talking to patients, and can do so with confidence since I've the experience in cardiology. One of the downsides of the basis of the placement is the constant talks given to the patients. The talks are vital, but I just end up observing, which is dull. The same with exercise classes, which I'm pretty much pointless in, other than helping checking some pulses and blood pressures.

The former part of the job is very interesting, though. My mentor apologises that the interview/assessment part of the job is very much asking the same questions over-and-over. But she is very wise in the sense that she leaves half an hour to an hour for any one-on-one time with patients, which gives them a chance to talk through any problems. And that's all some patients need - a few open-ended questions and a listening ear - especially in community. That's where I could see getting the satisfaction out of working in the community, personally.

So yes, mixed experience. Tomorrow I spend the day with the dietician. An important role when it comes to cardiac rehab. There's a home visit involved, which will certainly be interesting, to say the least. And it sounds as if I might get off early, which will be lovely. As I get to go and dance.

I'm still waiting for some new shoes to be delivered. I have a suspicion my accommodation office are hoarding packages downstairs, since they should've been here by now. Such lack of shoes really are my biggest problem right now. It's fun.

Not my first first day.

2008-10-28T11:17:00.000-07:00

I'm excited.

My new mentor, who I unfortunately won't be spending all my time with given the nature of community nursing, is great. She's only recently qualified, which means she has an idea about what student nurses mean and is generally lovely. The team itself seems sound, too, which is always good news.

The ideas involved in community nursing are certainly interesting, and there are lots of new challenges to face. In the real world, people are nowhere near as compliant as they are in a hospital bed, dressed in their pyjamas. I'm looking forward to learning how nurses work in such environments.

I attended an exercise class this afternoon, followed by a talk on healthy eating. I sat and chatted with the clients, as they should possibly be called within this environment, and it was lots of fun. Interesting, too.

I'd generally forgotten how much I love nursing in general. It's sad that university makes one forget one's love of the core.

Long time no type...

2008-10-27T10:19:00.000-07:00

Yes, I'm alive. Like Flash Gordon, sort of thing.

Anyway, what's been going on? Well, I start my community placement tomorrow which will be very interesting. I spent the day in PCT mandatory training, which was a glorious waste of time but completely expected.

I feel quite nonplussed about the prospect of community care. I know - and am constantly told - that care is going to move much more into the community over the next few years and beyond, as per government "choice" policy. But I love ward work, and would like to stay in it. My mine, however, is wedged open and am looking forward to being surprised. This placement might make a community nurse out of me, yet!

Either way, I'll keep this blog of mine informed. In the casual, cuss-ridden learning diary sense it exists as, anyway.

Nursing and Poledancing

2008-10-07T09:57:00.000-07:00

As (I think) previously mentioned, I pole dance in my spare time. I used to, anyway, and am just getting back into it with my highly talented teacher. I have performed (for fun, not cash) in the past and enjoy it very much. During a discussion on the dreaded NMC and professional conduct both in and out of work, I got to wondering whether anyone could have a problem with this. Pole dancing doesn't involve stripping or anything morally rude. And it's challenging physical activity. I just wonder whether the NMC would see it differently, if I was somehow or for some reason reported for it.

Funny old world, innit?

Suffice to say, for this reason and others I'm heading to join Unison. The RCN do very little for nurses, student or no, so I would rather be part of of one that does. Sounds simple, and is. I like it that way. Unison backed my dear old mum to the hilt when the government were trying to screw her over in employment, so I have faith.

The Second Year then...

2008-10-06T08:14:00.000-07:00

It's a long time coming, but it's time to procrastinate about the second year of this wonderful Diploma I'm on. As previously mentioned, this module is split into two. The first module is all about Health Promotion, which means I struggle to stay awake during lectures and seminars and get into all sorts of trouble.

I have a few problems with this concept of Health Promotion. Don't get me wrong, it's important. Nurses should be nursing people before they get sick (even if this idea is not something I personally want to follow up in my career) for the first time or any concurrent occasions. No mean feat, but it is a noble goal. My main problem, however, is the idea that nurses have to work closely in line with local policies and government white papers they have little control over. Maybe it's just the socialist in me, but I'm against being used as a tool of the government. And we could debate how regular, hospital-based staff nurses are the foils of HMG, but those involved in Health Promotion are - in my opinion - more so.

Apart from that, the lion's share of health promotion theory is all too Humanist for my tastes. I'm a Freudian with lashings of Cognitive, Behavioural and ginger beer, thus generally lack faith in anything Carl Rogers would adore. Not that it is not without certain value to certain groups of people, it's just of little interest to me.

Speaking of which, the second module this term revolves around nursing people with acute and critical illness. This is where my passion lies, blatantly. This is where a nurse needs to be skilled both technically and personally (i.e. around and about people). To say it's cutting edge stuff is perhaps a bit insensitive, but it's true. It's where I would like to be.

My responses to each module have been quite predictable. I'm excited and interested in acute and critical care, seminars in which we speak and debate the technical skills and - more importantly - how they relate to patient care. There is this underlying, excellent reminder to keep your centre in mind. Don't go requesting a CT scan until you've had a chat with the patient (if possible) about how they're feeling. If a patient feels unwell, don't jump straight for the DinaMap until you've looked the patient over with your eyes and experience.

Health promotion seminars drone on about government initiative after government initiative which, if you look into it, haven't made much of a difference anyway (although we never get to debate this in seminar). "Saving Lives: Our Healthier Nation" for example has been recognised as not reaching it's aims. This is government-speak to say it failed. But instead of doing something radical, another document was producing, full of management speak and, as a respected colleague of mine has pointed out fancy collections of letters that are "just words". Words, of course, backed up with bureaucracy. This time, however, the ideas are constantly backed up with the idea of "choice". "Choice" being a byword for privatisation through the back door, another issue we don't get to debate. My anti-capitalist leanings aside, we spend very little time talking of nursing in the read world and instead speak in abstract, disconnected terms. I assume the essay I have to write on an issue related to health promotion will have to be full of such terms, too.

My next placement is within a cardiac rehabilitation environment, which should certainly be an experience. I shall, of course, end up doing my health promotion essay about issues pertaining to coronary heart disease. This is an easy option, but why make it hard for myself? The essay itself is pretty yawnsworthy. Discuss health promotion related to a certain issue, including primary, secondary and tertiary care/prevention. Given our other assessed piece of work is about CHD, I think it's wise to do it about that. If a little boring.

Anyway, the second year: a mix of beastliness (in the good sense) and boredom, so far. The jury is still out. I might like Health Promotion once I get into placement and see it in action, but for now I am more excited about my upcoming critical placement.

Troublemaker

2008-09-30T04:53:00.000-07:00

I've always had a strong respect for authority and figures of said thing. I was brought up by a strict patriarch which I'm sure has contributed to this, but society in general ("back in my day" etc. Ha) is approving of structure and the like. That's fine. When I was younger my respect perhaps bordered on the unhealthy, but only for a little while. As I've grown up and gained a massive sense of self-awareness this respect has been altered. Figures of authority can still gain a large amount of reverence and respect from me, if there is some shown in return. Maybe I've been listening to too much Rage Against the Machine, but I don't follow authority blindly anymore.

Whereas there are currently subjects and lecturers I enjoy, engage with and certainly respect, there are definite bits I do not. One of the male lecturers at my University is highly approachable, likeable, professional and academic. This is the sort of nurse I want to be in the future hence: respect. He speaks about physiology with a level of expertise I haven't seen in other lecturers, but still reminds us that the patient is key. Other lecturers are less engaging in this sense, and so my respect ebbs away.

This can land me in hot water.

I am a doodler, and a multi-tasker. I can read or draw and listen at the same time. Especially like, as in the lecture this morning, the same basic information was being used as a 4x2 to smash us over the head with. If I hear the words Immunisation and Primary Prevention reminded to me one more time I may scream. Anyway, after this quite brutal piece of non-independent learning, the lecturer gave us a 35 minutes break (we'd been in for 45 so far). Then we came back to do the old presentation-lather-rinse-repeat. Not interesting, and not innovative. To me, anyway.

To cut a long story short, I was asked for the inevitable 'word after class'. I was told that reading during a seminar and presentations was rude. For once, I backed down and emulated apology, saying I'd try to pay more attention next time. Invigorated by such victory, the lecturer asked me how I would've felt if they read a newspaper during my presentation. The truth is: I'd be pretty nonplussed (in fact, the lecturer said they would've read the Daily Mail which would've been rude but for several other reasons), but I couldn't be arsed with an arguement. The lecturer argued the book I was reading (Essential Endocrinology) wasn't even relevant. I was tempted to retort that endocrinology is vital in the areas of diabetes and reproduction we were discussing from a Health Promotion point of view, but felt pretty hungry. Happy with perceived victory, the lecturer left and I realised I've made one more antagonist. Amusingly so.

Sadly, I don't really care. I'm a damn good student nurse. My essays are passable even when I put in little effort, my presentation skills are second-to-none and - to put an utterly self-indulgent point on it - I'm only doing this diploma for the free money.

These acts keep me amused, which in itself is pathetic. Like I told the lecturer about something completely different: "I'm trying to cut down, honest,".

But I'm intellectually unstimulated. And have to tow the line of looking interested in students who have previously asked, despite supposedly having done a week's research about Coronary Heart Disease: "What's ischemia?" So I modify my behaviour, bit by bit. I know now that sitting in front at a seminar, especially with this particular lecturer, I will now feign interest whilst secretly playing Empire Strikes Back in my mind, akin to Homer Simpson. I can live with it.

Quickie

2008-09-24T08:57:00.000-07:00

I think this would be a good idea. If there's one thing that annoys me, it's overmedication of the population propped up with a lack of proper education. Why am I on these pills? What good and bad things do they do? When are they not working? These are questions people should have answers to, about themselves or their offspring.

Of course, this costs more money than simply packaging and distributing the pills does. So it's not taken up. Shocking, I know.

I'm fine, by the way. The first week is a bit hectic. Expect a larger post about the start of the second year soon.

Health and Gender, Inflexibility

2008-09-17T08:18:00.000-07:00

Stories like this one are now, thankfully (in a roundabout way), quite common in the media. This overriding idea that conditions of ill health, and more importantly the people suffering from them, do not always conform to the written symptoms and law.

There is an arguement that parts of medicine are stuck in quite rigid 20th century thinking. The recent advent of circadian theory in relation to drug administration, especially chemotherapy for cancer patients, highlighted the fact that different individuals will feel the effects of certain medication better at specific times of day. Conversely, they will weather side effects with less stress. As the link above points out, there is this idea that young women may not exhibit the usual symptoms of Autism the books harp on about and therefore might slip under the radar. Harking back to a previous article, older books and sources on eating disorders may place little importance on the possibility of male sufferers.

The overall point is: people should be treated as individuals within the discipline of medicine. Which is kinda what modern nursing has been harping on about for a good while now, and rightly so. Obviously, there is little chance each patient (especially within the NHS) could have a personal retinue of doctors, nurses and allied health professionals studying their case 24/7, at the patient's beck and call. That's just silly. There has to be a middle ground somewhere between the two ideas, and in my experience there are some healthcare professionals who would rather tick boxes than open their minds. This idea of uniform treatment sometimes drives me crazy. Doctors who, despite the fact a patient might not be scheduled for surgery until 4pm on the next days list, don't think to alter a patient's Nil By Mouth setup and starve them from 6pm the day before like everyone else. Little things like that get to me, sometimes. On the other hand, I love it when I see some eyes open, questions asked and even far off possibilities explored. More of that, please.

Watered Down Megan's Law

2008-09-15T11:44:00.000-07:00

I don't like it. One bit.

I am now old enough to count myself amongst the people who remember paedo-steria of the late '90s and early '00s. Many things came out of it, but the Brass Eye special was the only good one.

The new idea, if you haven't read the story yet, involves giving people the ability to find out if anyone (for anyone, read: men) in their lives have any history of child abuse/domestic abuse which would endanger children.

Why don't I agree? I could trot out the old arguement of how these kind of laws drive people with a history of child abuse underground. I could, and it does. But that's done. It gets to me because it goes against the idea of Justice in this country. The whole idea of going to prison and the like is based around the idea of rehabilitation. Rehabilitation links in to giving people a second chance, a chance to change. In this new pilot scheme, anyone who thinks a man might be a bit of a wrong 'un can check up on them and their past. And if there is anything there and this information comes out, their second chance of a life could be ruined. Again and again, in fact. I am in no way apologising for paedophiles, child abusers or any kind of criminals for that matter. However, this idea of possible persecution stinks of mob rule, and frankly makes me sick to my stomach.

Male Health Issues

2008-09-12T14:13:00.000-07:00

Times are a'changin'. As this article shows. This article (and the issues therein) is not a shot out of the blue. Eating disorders have been on the rise in British men for years now, throwing into confusion some of the reasoning behind some psychological explanations behind bulimia and anorexia nervosa. It's the 21st century, for better or worse, and despite how I personally often feel that the link between men and their body images is often giggled at, ignored or even dismissed by society at large, it is becoming more important.

As I've also previously discussed, I think any cynicism towards John Prescott's admission of suffering from some form of bulimia was in poor taste (no pun intended. It's a minefield, this satire malarkey...) Seriously, though, eating disorders in men should not be snickered at like poor jokes in a poorer sitcom. I, personally, am sometimes unhappy with my own body image and so I'm pretty confident I could relate and care for a man suffering from similar anxiety and upset. I wonder if other student nurses, outside of my demographic, could say the same..

You can put lipstick on a pig...

2008-09-10T14:01:00.000-07:00

... but it's still an anti-abortion, ignorant, nepotist and dishonest pig.

Haha. Seriously, though. I love this new Palin debate. She's an idiot and yet a brilliant idea. Anything said by anyone against her or the right-wing of the Republicans automatically gets lumped in with the rest of the 'left wing conspiracy' that has apparently been dragged out of some dusty wardrobe to be targeted against poor Governor Palin. And Americans will fall for it, as they typically do. Two terms of George Bush speak volumes of how a large section of Americans like tough-talking, somewhat bellicose leaders.

It's a sex debate, it's a race debate, however you like to spin it. And boy do those right-wingers like their spin, as evidenced by the adverts and supposed outrage of today. But the prejudice angle is something of a phoney war, since both candidates don't really push the interests of their demographic groups, per se. It helps, for example, that unlike Hilary Clinton (to a point) Palin stands for policies and ideas traditionally backed by men and patriarchy. That is to say - guns, anti-abortion, pride in the army, against sex education, etc. The fact that white women are apparently flocking to back her and the Republicans is quite pitiful. These are the issues that the Democrats are trying to tackle the Republicans on, and yet the messages are being twisted by the Repubs. They know very well that the comment was about financial policy, and yet use it to their advantage. All's fair in love and war? Unfortunately, this platitude isn't black and white. Whilst the right-wingers use quite open comments to their own advantage, the issues of racism go under the radar, implicit even.

Maestro

2008-09-09T13:59:00.000-07:00

I'm slightly upset, on a quick note, that Goldie did not win the recent BBC2 series of Maestro. Although both finalists had music in their backgrounds, Sue Perkins (talented as she certainly was) had been lucky enough to be taught Piano to some Grade level when she was younger. This, unfortunately, costs money which some people don't have and stinks, debatably, of possible classism. Shame, really, since conducting and classical music is quite fun.

Anyway, where's all the nursing, you ask? I've been reading on and off all summer and will review the books and material soon. Especially when University starts again in two weeks time.

Freerunning

2008-09-03T14:26:00.000-07:00

I like freerunning. Bunch of guys got together, started fucking around and jumping off of walls. It soon evolved into racing around big cities, using functional environments designed by other people for fun. With tonnes of risk, for fun. Excellent.

So tonight there is a freerunning tournament in London. Someone has built a cushioned course within a big warehouse and people are going to watch. I'm not a freerunner, but as an admirer I'm quite upset. No longer are these people invading and gloriously misusing cityscapes at great risk, but are coming together like competitive but performing monkeys. The warehouse is owned by someone else, rented out. The equipment is also owned by someone else and must be paid for by someone. It's selling out, plain and simple. Wait until Nike start sponsoring the special shoes. And when the stars, who started off their own backs, have to turn to the camera and say "Don't do this at home, kids," even though it's how they started.

I am a somewhat prolific graffiti artist, and this happens within the street art community. It's annoying and against some of the founding principles. Perhaps this is just another stage of the evolution of both forms, but it doesn't mean I have to like it.

Fiona's Story

2008-09-01T08:06:00.000-07:00

In a move to annoy Male Rights Activists everywhere (like they need more excuses) the BBC have made and broadcast a drama programme about the story of a woman (Fiona, obviously) whose husband is discovered to be guilty of accessing child pornography. It's an interesting, if a little overdone, angle - the suffering female one, I mean.

From an actor's point of view (me being a red brick, classically trained actor and all. Heh) the role of Fiona is a doozy. Challenging, deep, limelight. Some people like that sorta thing. The whole idea is that Fiona is the greater, deeper victim and is being punished for essentially being good. Well, that's how I read it, anyways.

Being the protagonist, the story is obviously told from Fiona's point of view and it revels in the upsides and fails to avoid the associated pitfalls. Whereas the actress is more than capable, the directing falls a bit short. There are too many string quartet rising and falling in the quiet bits, were actors just look at each other/out into space and little else.

The story is a hybrid of standard slow-paced Brit thriller and American twist-drama. It's done well, but the process gets a bit old. Let me set the typical scene: Fiona thinks she knows something, and makes this assumption known. Suddenly someone or something comes down from the heavens to affect a big change and she is both shocked and saddened at the new turn of events. These events generally rely on her husband or someone else close to the plot revealing something. The shocks all lead to Fiona feeling more and more isolated. From her friends, children and obviously her husband. The crux of the drama is the family, and therefore Fiona-the-Mother plays a massive role. Again, I can't help but feel this idea, no matter how well performed, has been done. Not to death, perhaps, but done all the same.

But this leaves one big problem for me, personally. In the recent (and most excellent) BBC Drama Criminal Justice the protagonist was essentially painted as an innocent victim - like Fiona, in this case. But he was still a bit of a cunt. And you felt that. All the characters - none of them were particularly nice. And yet in Fiona's Story, she is righteous and everyone else is wrong, basically.

This unfortunately leads to the supporting cast being made up of two-dimensional characters. The actor who plays the husband is superb, but the character is a walking stereotype. Two-faced bastard, charmer one second, monster the next, all in all. And this process goes for the majority of the supporting cast, unfortunately. They trot out the generally heard of opinions of paedophilia, as if almost attempting to convey a balanced view.

The issue of paedophilia is tackled very well, it should be said. It is often the elephant in the living room, literally, being such a taboo subject. The 90 minutes does not draw too much on the controversial background, or too little, in fact.

All in all, for a one-off feature it is quite passable. I compare it to Criminal Justice, which had five episodes to tackle it's plot so this comparison is perhaps unfavourable. Regardless, I can't help but feel some of the ideas and themes have been done before and will be again. The forlorn female lead is by not means original, but Fiona's Story was never advertised as revolutionary.

Reflections of Drunken Adventures

2008-08-26T04:06:00.000-07:00

5 day-long ones, even. I will switch to copy typing my notes:

I have, this end-August Bank Holiday weekend, discovered I am not suited to festivals. The main reasons can be summed up quite succinctly. Firstly? I don't like camping. Second? I don't like the festival music scene

[I didn't know this before heading off, of course. It's all about discovery - Ed.]

I scribble, rather than type, in one of the tiny notebooks I try to keep secreted about my person. To elaborate:

Camping is plain not my scene. I don't get a kick out of tents: either 'living' or sleeping in them. Although my cheap [8 squids] tent has been nothing but dependeable. And there's a great deal to say in favour of waking up in a piece of vaguely idyllic countryside every morning. Even if you were woken by an insistent sun turning your tent into a greenhouse. Great place to live, but I seriously do not want to live here. Like I have been doing [for 4 days]. Although I'm impressed with how well I've managed, living with insects and small arachnids as a matter of course is not sustainable. So yes, camping is not really my (sleeping) bag.

But festival life is much more disagreeable. Music-wise there is obviously a large variety, but it's a lot more impersonal compared to the small, local gigs I prefer. On that note, the epic magnitude of the event seems to bring out the worst in people. I will highlight but a few strong, reoccurring incidents:

* Men whacking their cocks out in the middle of a field and pissing into any nearby recepticle. This was, where possible, often followed by the apparently ever popular see-how-far-I-can-throw-this-cup-into-a-crowd-of-dancers-it'll-be-well-funny-even-though-loads-of-people-have-already-done-it-this-song.

* People with more money than sense and less sense than amoebas. Concequences of this being people passed out off theiir faces on a random substance and/or dressed in as much overpriced tack and merchandise as possible.

* People who will up music venues standing still. Now, I can't talk as I sit on the extreme end of the spectrum. I'd bop to a funeral dirge if it had a good beat. However, I would do so out of the way of people who wanted to be all stoic. I would not fight my way into a prime position to act like a slack-jawed yokel or concentrate on waving my large, pointless flag.

I am a self-confessed music snob, and proud of it. And I don't think my opinions are right, but they're mine which means they're pretty fucking good. I have no respect for people whom, during one of the two live gigs Rage Against the Machine will do this year (if not forever more) in this country, fail to dance. Or people who come to the bar. Or, even, sit down and watch. This is a paradigm busting, massive headliner of a band. If you weren't fully arsed about getting involved, I don't want to know you. And I am happy to rip you off for drinks, as a sign of that total non-respect.

I prefer smaller gigs, where the bands aren't stick figures and where I am not surrounded by thousands of people who barely care about the music. I was working behind one of the main bars for Queens of the Stone Age and then Rage Against the Machine, but I showed more enthusiasm than most people who had actually paid to come and see them. And that, more than anything, is why festivals don't do it for me.

Paxman Rides Again...

2008-08-25T11:33:00.001-07:00

This story warmed me greatly as I was stuck at Leeds Festival, away from all idea of civilisation.

Paxman really does not give one solitary shit, which is highly respectable. And, given his background, is always careful to qualify his remarks which is vital.

MF shows the typical head-in-the-sand mentality associated with the feminine agenda in the media. That and, of course, misdirection. She points out Johnothon Ross, Ian Hislop, Paul Merton and Paxman himself. Essentially Paxman was talking about people in high up jobs within media, rather than personalities, and MF could come back with no real retort to this point, preferring instead to trot out the old platitudes. Women are oppressed in certain arenas, there's no doubt about that. But men face troubles, too, which is something MF and her ilk seem pretty hesitant to accept as a possibility.

I will be blogging my five days at Leeds Festival soon. Right now, I haven't slept in 28 hours. Priorities, priorities.

The Olympics

2008-08-19T02:17:00.000-07:00

I don't like the Olympics. Period, really. That's not to say I dislike them very much, I just have a very strong lack of opinion for them. I probably don't like more the way in which the Olympics are viewed more than anything. I am vaguely miffed that winning a few medals in a four-yearly event can inspire national pride when the few actual good things we do cannot, but that's neither here nor there. And say what you like about football, but at least it's accessible. Some of the sports we're winning medals in are hardly something a bunch of kids can run out and get involved in. Sailing - expensive. Cycling - given mums and dads are worried almost full time about the welfare about their kids, they may be hesitant to let them go out and race around the surrounding roads on bikes. Obviously, the case of Mr. Foy (bought a old BMX, went out and won stuff, etc.) is tabloid inspirational, but it's not that clear cut, is it? Swimming - thanks to the past two governments, most of our indoor and outdoor pools have been gotten rid of anyway, as frequently pointed out in Private Eye. At least kids can still, more of less, go out with a ball and have a kick about.

The things which irk me about the current Olympics are the fact that the IOC are a bunch of impotent bastards when it comes to China's blatant promise breaking (although the mischief caused by Channel4 News has almost been worth putting up with the massive human rights abuses. See those IOCers squirm... ) and that the British success just adds weight to the 2012 Olympics, which have already run massively over budget and sucked up mounds of funds they weren't supposed to. I'm all for sports: partaking in them can promote well-bring; self esteem; happiness and sometimes even self-worth. But, in an Olympic context especially, they're not the be all and end all. As an ex-actor and still sometime-artist, I despair at the cash that will be snatched away from these disciplines to fill the Olympic void.

Panorama 18/08/08

2008-08-18T12:42:00.000-07:00

Panorama today is about The so-called Post Code Lottery. And, by proxy, the good old NHS. Obviously, in this case, it is anti-NHS.

I've said it before and will say it again. I don't like bureaucracy. I hate it with a passion, in fact. Especially within healthcare. But, I don't necessarily agree with the programme. Whereas I think it's harsh that someone in one area of a city can get a certain treatment whilst another person elsewhere can not, this is not a black and white situation. It's local decision making at work.

Now, despite the fact that Panorama has been dumbed down a bit, it's still a good investigative journal. But today, I can't help but feel it's being rather tabloid. It takes headlines and blows them up. It takes young people with their lives ahead of them and turns on the waterworks and violins. It picks TV-OK examples and tries to warm - or chill, in this respect - the cockles of the heart. It's a bit of a cheap shot at a complicated issue.

NICE exists and is a necessary evil. And, although the people who work for NICE are not fully paid, you couldn't pay me to do their job. As any textbook will tell you, the NHS is a funny old game. Finite pot of money VS. masses and masses of problems. NICE try to make that work, somehow. But obviously, it filters down the system. And there are traps, sieves and gutters until it gets down to the people who matter: the patients. These traps, sieves and gutters actually count as the much trumpeted local-decision-making.

See, back in the day there was once a land of central decision making. And then people wanted to dissolve power to local authorities. And the-powers-that-be did so. And then, this happens.

I don't know what the perfect outcome is. Some people will complain if you give too much power to consultants, like Panorama suggested should happen. Some people will complain if you give too much money to mandarins. Some if you give it to politicians. The bottom line of this day and age seems to be: Your life is worth about £30,000 a year. And that's just economics. Medicine is economics, like it or not, and the NHS will never suit everyone.

Imagine if...

2008-08-13T09:20:00.000-07:00

... we lived in a universe where the idea contained within this story could work out soon.

Any hope of a treatment for HIV/AIDs should be gripped with both hands, clearly (even if the more cynical among us would point out it would make Big Pharma even richer than they already are). The science behind it is, from a geekish point of view, fascinating and could even help make people ill with different diseases and disorders better, too. Hope does, indeed, spring eternal. Come on, science. Do it for the good guys...

More Rape Based News

2008-08-12T05:56:00.000-07:00

Like the title says, more news. Anyone watching any sort of extended news broadcast today would've seen this story.

A rape victim who was told her compensation would be cut because she had been drinking before the attack has had the decision overturned.

I do so hate sounding like a bastard, but I do have a slight problem with the context of the story. I don't want to get into the rights and wrongs of compensation for crimes. This idea that: 'Well, we - the police - were not really around at the time of the crime, which is our fault, so here's some money to make up for it.' *

I have a number of thoughts about this case (only this one, as I don't know much more about the other 14). The story mentions the woman in question had been drinking 'excessively'. Whether this is over the typical 3 drink limit to make a binge, or whether it is actually excessive is not something I know, but it is at least hinted she may have had more than a swift half. Now, to say having a few drinks means the woman in question was 'asking for it' is fucking Neanderthal thinking and shouldn't be given the time of day, however; I'd be curious to see how 'excessive' alcohol consumption reflects on other compensation cases. For example, if someone had a few two many drinks and left their front door unlocked and only to have their home completely burgled, would they be penalised for that? Obviously these are completely different crimes, but legislation has to deal with this idea on an equitable basis. Consuming alcohol involves giving up a measure of control with your own consent. And although going out on the streets on a Saturday night may prove otherwise, this is not something to be taken lightly. There are plenty of risks attached in taking such a choice and unfortunately there are plenty of people to take advantage of people who take said risks.

I'm not really making any definitive conclusions or points, just noodling. But we have two people and one of this pair do something that makes them more vunerable and less in control of a situation, should that make a difference in how they're dealt with by the courts? I'm not sure.

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

* Obviously, I'm being glib. Things are more complicated than this, but the point still stands, no matter how lighthearted it may be.

Book Review

2008-08-05T12:51:00.000-07:00

It is my adorably optimistic aim to read a book a week over these 8 weeks off. On average, since some weeks won't involve anything near a book.

Last week I finished:

TRANSCULTURAL CONCEPTS In Nursing Care: Second Edition (1995)by Margaret M. Andrews and Joyceen S. Boyle, J.B. Lippincott Company: Philadelphia

On the plus side I received this book as a gift, which means it's all mine. That gives me the option to underline, note and scribble endlessly in it, which is one of my guiltishly geeky pleasures.

So, what's it like? Well, it was a gift. I would not have bought this book, personally. It's old (most of the sources are from the 80s, making their reliability and relevance questionable) and American, which means it refers to processes and - more importantly - cultures and sub-cultures which are not very prevalent in this country. I am, for example, unfortunately not going to meet many Native Americans in my neck of the woods. Whereas I am statistically more likely to look after men and women of Arab descent, a culture not greatly covered in the book.

So it has it's down sides. Generally, if taken with a pinch of NHS salt the book is an interesting and valuable insight into the ideas behind transcultural nursing and does provide a few relevant examples that prove useful. Did you know, for example, that people of Asian descent find blowing one's nose to be rude, and consider sniffling more polite? Interesting stuff.

Would I recommend this book? To check out from the library, certainly, but not to buy. There may also be a later edition or even a British analogue out there which would be a much more sensible idea. Most certainly better than a kick in the teeth, though.

Magicoreligious Madness

2008-07-30T03:51:00.000-07:00

The recent story of the Sikh girl who won the right to wear a piece of jewellery in opposition to school rules was always going to get a comment out of me.

As evident by the prominent link to a certain Church on my blog front, I don't hold religion is particularly high regard. Not to say I don't have faith, which I do, or I don't see a point in believing in something or than deterministic, reductionist science. I don't consider faith the be all and end all of existence in the same sense that science does not explain everything, however some people on either side of this invisible border between the two continue to have irritating effects on society. A society which is, apparently, looked after by a secular government.

The school in question was running a 'No Jewellery' policy. This in itself is not uncommon from schools I have both attended and worked in. I gather such policies are conducted for several reasons. Firstly, jewellery can cause jealous and envy, which have further follow on and side effects. Secondly, jewellery can cause problems with local health and safety policies (hoop earrings being pulled out - not pretty). Thirdly, some schools employ a uniform policy in an attempt to make children feel smart and equal to each other. Accessories put a dint into this, unfortunately. I don't agree with taking away people's individuality ala uniform policy, but it is a rule in many schools and was in this one, for (debatably) good reason. Rules are rules, and - made to be broken or not - are enforced, and should be if that's what the school board has agreed. Furthermore, the student in question signed a contract saying she would abide by said rules. I'm sure it wasn't a blood-legal document, but still an agreement.

Thus, she was breaking school rules. And anyone breaking rules is usually reprimanded. She continued to break the rules, she continued to be reprimanded. Until she went into the Court system and received what could be described as special dispensation to break the rules of the school. This special dispensation happened because what she was breaking the rules wearing is an accessory of magicoreligious importance. Despite the fact that it is going against the grain of all three of the above points of the rule.

This is particularly annoying. Schoolchildren comprise a diverse mix of cultures and subcultures who are different in physical appearance and psychological standpoint and belief, including any spiritual or magicoreligious standing. For some children, music is king. It's the most important thing in their lives. Listening to it, reading about it, following the tenets set out by the leading stars. And yet they are not allowed to express this through accessories on uniforms. Piercings and eyeliner, for one example, are disallowed. Yet a Sikh bangle has been given special dispensation (thankfully, the Fundamentalist 'SilverRingThing' was thrown out of the courts last year. I almost had a little party in celebration).

So, the crux of the matter is: where do we draw the line? This is not a secular society, so one belief should not receive more privileges than an other. Clearly, Sikhism has existed for a much longer duration and has a larger following than some Gothic music subculture, as hinted at in the example above. But does that automatically make it more important? What about a young black child who is celebrating his or her ethnic or racial links or roots by wearing a certain accessory to their uniform? Is this aspect of colonialism and it's aftermath less or more important than a religion. Where is the line drawn?

My standpoint is that mentioned above. As long as Britain remains a secular country then religion should not get any leg-ups. There are many schoolchildren who believe in fashions or trends just as vehemently as a religion, and yet they're not allowed to express themselves within the gates of a school. Their treatment shouldn't be so unfair.

New Laws

2008-07-29T11:49:00.000-07:00

New laws, championed by Harriet Harmann and pushed by the British Law System, are attempting to liberalise the laws surrounding murder.

To be perfectly honest, I haven't researched this topic in an intense manner, but I have listened to various viewpoints and I am, perhaps unsurprisingly, against such a change. There are already bits and pieces within the law to allow defences like self defence to be used in the case or murder. And judges are, or should be, more than capable at managing these laws effectively.

The history of governments (and I know the supporters say this rule change has nothing to do with government, but that's bollocks) meddling with laws are dodgy at best. The recent decision to mess with anonymous witness schemes within murder trails hasn't helped one bit, now, has it?

Now, of course, we live in a "democracy". But there are plenty of people who haven't been voted into any seat of power who make decisions. And these men and women are the ones who annoy me most. That's an aside, I know, but a necessary one.

Anyway, what else is wrong with this law? I don't particularly like the wording. "Seriously wronged"? That could be taken in so many ways it's not even funny. Especially when you bring cultural, social and magicoreligious reasons. That's got trouble written through it like a stick of Blackpool rock.

Aside from that, the way in which the media is reporting the law is considerably biased towards to women suffering abuse. This is undoubtedly a problem, but just because female/male-on-male is statistically lower than the media published male-on-female domestic abuse doesn't mean it's any less important. And when one of the founders of a rather large Women's Refuge is criticising the government for gender bias and being both naive and short sighted, something's gotta be wrong.

Joined Up Thinking

2008-07-23T14:37:00.001-07:00

This article made me giggle. The following paragraph in particular:

The areas that the audit has looked at include leadership (only four out of 35 British National Governing Bodies of sport has a female chief executive), media coverage (there is more than 50 times as much coverage in the media for men's sport than there is for women's, with only two per cent of articles and one per cent of images devoted to elite female athletes and women's sport) and investment in sport, which looks at the split in funding of men's and women's sports.

The concept of equal funding is a good and relevant one. The idea of somehow trying to influence the genders of sports leaders stinks of positive discrimination from the outset, but we'll see. My main problem is with the media point. Linking sexism to media coverage is spurious at best, bollocks at worst. Sport is a business. From the selling of equipment to the screening of matches/exhibitions on television, it's all about the money. Consumerism and shareholders etc.

Now, I could walk down a high street and run a quick survey on how much window space is given to male clothing vs. female clothing. I daresay the ratio would lie quite heavily in the female front. Are men being deprived of opportunities to express themselves through fashion? Perhaps. Why are these shops selling predominantly female clothing? Because it will make them more money. The 16-40 year old demographic probably spend more money on clothes than anyone. That's just capitalist good sense.

Open the back pages of a newspaper and you will probably be greeted with information (depending on the time of year) about football, rugby, cricket. Maybe some horseracing. Different times of the year will mean there is more coverage of certain sports. Cycling during Tour De France. Athletics during the Olympics or other big Championships. These subjects are clearly of interest of sports fans, otherwise they wouldn't get past the editor. Where does the big money lie in sport? Generally, lots of money is bet on horseracing, football and greyhounds. These fans, betting or not, also pay good money to watch their sports. Lots of people watch rubgy and cricket, additionally, and pay for the privilege. Greyhounds aside, the stars of these sports are all male. If the interest is in predominantly male sports, the money will go there, including in the media. This is simple consumerism, and I don't see how it relates directly to sexism in the sense they mean. If it does, then I hope to see a commission set up to tackle the discrepancies between male and female clothing choices on the average high street, too.

Just a quick one...

2008-07-23T05:25:00.000-07:00

... about a fucking important subject. I cannot convey how delighted I am at the sight of more publicity for prostate cancer. Like cancer of the bowels, cancer of the prostate is not glamorous. There are no large-scale marathons of men in blue t-shirts running around to make money for the cause. Hell, ask a man in the street where his prostate is and he might reply like an American looking for Afghanistan on a globe. Despite the fact that Bob Monkhouse campaigned against the killer (from beyond the grave, to boot, bless him), not many - and not nearly enough - people know about this vicious strain of cancer. Or knew about it until the new stories of this new possible treatment for it came around. Now it has made it's way into the media spotlight, it's possible some men might actually think about getting themselves checked out for this horrible, despicable condition. And that, in my book, is a silver lining.

The Second Year

2008-07-23T05:02:00.000-07:00

We had our first briefing for the second year and goddamn I am excited about it. Despite the fact that there's still going to be lots of happy-clappy-client Mental Health input (I'd say no offence to any Mental Branch readers, but there's no nice way to phrase my contempt for the way Anytown University handles our other branch exposure).

Firstly, we're no longer within Common Foundation learning, which means things are going to get more hardcore from now on. Welcome to big school.

Secondly, the assessments actually sound quite fun. One presentation, which should be a good giggle, and one unseen problem-solving-trigger-type exam. Varied, I like it.

The modules are a mix of exciting and twee. The twee one is all about Health Promotion, which is certainly interesting at points, but similarly quite wet and happy-clappy throughout. I'm not taking anything away from the role of the nurse as a health promoter, but I have a feeling the module is going to be similar to past ones. We'll see. The sister module is about acute and critical nursing, which is what I go to school for. The clinical skills classes should actually be interesting, the sessions are all about relevant skillsets and situations. Yes, we're actually going to be faced with theoretical clinical situations and instructed on relevant care and issues surrounding them. Something sorely lacking in the last few modules.

We have two weeks, one in placement, about Mother and Baby. Given I was close to being a midwife or child brancher, this will be very interesting, especially from a gender discrimination point of view. I think we're also due two days to drive around in an ambulance, which has me quite chomping at the bit.

I'm excited. But, to be prepared, this summer is going to involve a whole lot of reading. Given I'm going to be poor, that shouldn't be a problem. Woop.

Stating the Blinking Obvious (tm)

2008-07-22T08:38:00.001-07:00

I am convinced that one day, in Anytown University somewhere I will accidentally walk into the wrong class. This hypothetical classroom is filled with old women. There is a quite normal person stood in front of them, unable to use the PowerPoint presentation they should be trained to use. Each old woman has an egg placed in front of her, and is being taught to suck it.

What has prompted this extended metaphor, you ask? Today we had a semi-lecture (which is like a lecture, but not in the safe, anonymous environment of a real lecture theatre where one can sleep/read/otherwise not pay attention. The seminar was about the important of spirituality in patient/client life. Firstly, given the guest speaker was from a hospice, I thought it might be stealth religion talk. But no, nothing so insipid.

It turns out that spirituality means... well... everything. Pretty stupid fucking definition, really. The importance of everything to the patient/client. Everything is, by definition, the be all and end all. This glorious definition kicked off a close to 2-hour extravaganza in which we were told many things.

Newsflash!: Some patients need a bit of company, and to be listened to.

Breaking News!: Nurses should be considerate.

I know. Revelations. Well, actually: no. These are things we were bombarded with through our first module. And ever since, really.

I'm not being funny, but if you don't know the basic parts of the nursing skillbase after three placements, you've either had a sheltered year or are as empathic as a plank of wood.

The whole pointless session was topped off by another repition of the poem by the Crabby Old Woman. For the non-nurses out there (it seems like the law of the land that students or workers of this caste called nursing must have it thrust in their faces every three months by my reckoning) this poem can be found: here. It's far too passée for me to copy and paste it onto my lovely blog. The context of the poem is obviously a sad one, but one reading is painfully sufficient.

Yes, I am being cynical. But I'm being clinical, too. In ages gone by, maybe nurses had time to sit all day with patients having a chin wag. The guest speaker was a hospice nurse, which meant they had this added time outside of a clinical environment. Modern, ward-based nurses don't have this luxury. On top of that, modern nurses are shouldered with delicious clinical skills and responsibility. Not to mention overworked. I appreciated the sentiment from twee and wet lecturers that we should never forget the patient in the job, but in a way it's quite offensive. If was ever close to being a box ticker of a nurse I'd get out of the job sharpish. The concept of forgetting that a person is a person is so arse-backwards, the fact that I'm being pre-emptively accused of it is insulting.

Venus and Mars etc.

2008-07-18T07:36:00.000-07:00

There are number of interesting articles in this week's NewScientist relating to all kinds of prejudice.

The first, smaller article is based around stereotypes. To cut the very detailed search down to an easy to digest tidbit, researchers simulated a situation were test subjects were left out of a three person game. The subjects had their brain scanned and were questioned afterwards. The group consisted of 12 white males and 13 black males, mostly college students. The two other people playing within the computer simulation were shown as white. The results were markedly different. The white gents involved in the study generally thought the exclusion was for some personal reason, which activated certain bits in their brains. The black gents generally attributed the exclusion to racism and this conclusion activated different, lesser parts of the brain, leading the researchers to speculate that it is less painful, therefore 'easier', to take rejection or negativity if one attributes it to a generalisation than if one thinks it is individual and personal. Interesting concept, and a lovely link up of sociology and brain scans, I thought.

There is also an extensive feature on the unexplored difference between genders on a biological level. The article aims to bring to bear the idea that men and women might actually, neurologically be wired very differently. Reception of pain is explored at length using the anatomy of the male and female brains to illustrate how different sections appear to be activated in each gender. This could explain why men and women are effected by analgesia in different ways, which is fascinating in itself. The article brings up another more important point, which revolves around how rats involved in pain tests are almost certainly male. Given women feel pain much more harshly, this seems to be a huge dropped ball by scientists in related fields and could, tentatively, be linked into the idea that females come second in healthcare, generally. The fact that they could be being treated by analgesia which somewhere in it's phases of testing was biased towards the opposite gender is, in the words of one researched, 'scandalous'.

Lots of things to think over, though.

I wasn't having a good few days recently. My 'good' ear, i.e. the one which is seldom infected, has started to give me the distinct impression that there is some kind of mucus build up inside (lovely...). Another infection, perhaps, but at least it lacks pain. On top of that, lectures aside I've had very little going on. Just staring at these four walls, which makes me a very dull boy.

I'm a big advocate of actually going out, getting the blood pumping and being active when you start to feel glum. So I went out on my bike into town, bough aforementioned copy of NewScientist and did a bit of window shopping with limited retail therapy. The object of my affection was a new, expensive trumpet book, which is all about learning through jazz. Oh yes. I then cashed in a Nero loyalty card - which pissed off the shop guy and made me feel even more gleeful - and got caffienated. I listened to music, drummed my fingers and generally indulged my science geek side and have felt much better ever since, especially considering how moody I was this morning.

My ear is still quite annoying, though. And against my better judgement (I disagree with over prescription of antibiotics within the NHS, especially when I'm not in any pain per se) I might go to the walk-in tomorrow. Joy of joys.

But yeah, funny day. I feel better for kick starting a good mood within myself. My fun weekend has been cancelled, however, so I might be stuck between these four walls for another weekend. If I'm lucky, I might be able to take in some of the current Jazz festival which would just keep these good vibes going. I might even be able to groove this glugging right out of my ear!

Stay tuned.

Lectures

2008-07-16T08:38:00.000-07:00

The title of this post may be lectures, but sometimes I wonder whether most of my fellow nursing students agree with the term. The amount of whispering, gossiping and eating that goes on puts me under the impression they think it's some kind of hybrid of a sewing circle or picnic. And a drop-in sewing-picnic at that, given most can barely be bothered to arrive on time. Now, don't get me wrong, there can be lots of reasons for accidental lateness, but if you're late day in and day out you should sort out your fucking scheduling.

I shouldn't gripe. These people have less knowledge than me, unless they can listen, eat, learn and talk at the same time. And their poor time management means I'm more likely to get work ahead of them. Still, it is highly irritating.

News

2008-07-16T08:22:00.000-07:00

News Stories have always interested me. Stories relating to nursing and sexism, or - ye goddes! - both even more so.

This story caught my eye today, the byline of which reads:

Male nurse 'abused' 23 patients

This got me to thinking whether this was a common theme within the BBC. I have previously illustrated my annoyance with female soldiers being singled out and how this surely sets back the course of equality in several senses. So I went trawling through achieves to see how this has been dealt with by the BBC in the past.

These links all illustrate the BBC's previous lack of byline discrimination. The byline contains the description 'Nurse' and doesn't specify gender.

So why the seemingly sudden change? It's curious. I know the man from the first article is quite the funny looking arse-hat, but the byline itself surprised me, especially since it's not a practice the BBC have previously seemed to engage in. Oh well.

Diary Summaries Year One

2008-07-16T03:18:00.000-07:00

As part of my 'get-my-fucking-act-together-and-organise' routine, whilst waiting for a pointless biology lecture I can not get away with skipping over I've completed my diary summaries for the first year. Read and enjoy: or not, as they're quite dull. I'm really only pasting them here as an online back-up.

Diary Summary: Semester One

My first placement saw me based on a neurorehabilitation ward. Being rehabilitation based, the ward saw the same patients for long periods of time. The placement gave me extensive experience of the workings of an MDT, most of whom were attached permanently to the ward. This gave me valuable insights into the roles of the Occupational Therapist, Physiotherapist, Psychologist and Social Worker. I attended two MDT meetings and became aware of the evidence based practice and clinical governance that would be used within them.

From a nursing point of view, the placement gave me solid experience of essential cares, especially to bedbound patients. The nature of the ward meant I developed my skills in building up relationships with patients on a day-to-day basis. These two basic skill sets would be vital for my further placements. I was also taught more advanced skills, like Neurological Observations and how to effectively tally a Glasgow Coma Scale, skills that would also prove useful in later placements.

Due to the nature of the injuries and conditions of the ward's patients, I was able to complete several sections of my Exposures booklets on this placement. I passed my communication OCSE. I gained an insight into the often complicated area of acquired brain injury, too.

Diary Summary: Semester Two

My second placement saw me based within a surgical ward specialising in gastroenterology. This seemed an ideal second placement as, unlike the former ward, patient turnover was generally quick. Unlike the previous ward, the was less input from a MDT and more input from the nursing team.

From a nursing point of view, the placement encouraged the development of skills relating and communicating with patients who I would only meet for short periods of time. This was a valuable experience that taught me the value of different ways and methods of communication, and posed quite the challenge. From a clinical point of view, there were more things to witness and start to learn: the removal of surgical slips, chest drains and catheters, for example. It was on this ward that I experienced my first patient death. And I worked my first three nights of my training.

Like the previous ward, this placement allowed me to complete more of my first year paperwork, including my Administration of Medicines booklet. I attended special sessions on new techniques and equipment used in NG feeding and special sessions on gastric banding and bypassing for bariatric patients. Otherwise, my time on the ward developed my knowledge of the GI tract and it''s role and function in daily life.

Diary Summary: Semester Three

My final first year placement saw me on a acute medical ward. The balance of MDT and nursing input was more equal in this environment, and there was a mix of long term and short stay patients.

From a nursing point of view, there were further opportunities to learn more about essential care. Given the ward received predominantly cardiac patients, they often needed help mobilising or washing. There was less to do and learn from a clinical point of view compared to previous placements, although I did receive more practice in preparing and administering IV solutions. These would often be diuretic solutions, therefore I also learnt quite a lot about the action and results of these.

I finished up my paperwork for the first year. The context of the ward helped me develop my understanding of the heart, it's A&P and the impact heart conditions have and will have on the growing, ageing British population.

Back to reality

2008-07-15T10:12:00.000-07:00

Paperwork has hit me like a steam train. I forgot just how much stuff was due to be printed, completed and triple signed by the end of term.

I have quite a varied palette of talents, but ultra-organisation is not really one of them. But to keep up with the quick pace and massive amounts of paperwork, I've bought a hole punch and lots of folders to sort things through. And I am quite stubbornly determined to not fold (no paper pun intended) but to keep this up. It's not enough to be good, you have to strive to be even better.

Other than that, I miss my last ward. Just the general concept of working is easily missed. I miss working with people. But it's still fun and useful to get out in the real world and meet real, non-sick people. Reminds you what it's all about, in a sense.

In other news, I went back to my hometown for a sibling wedding. I have... family issues, to say the least. So it was not the most comfortable weekend I've ever spent, but it had it's up points. Some old mates, outside of marital affairs, reminded me of why I like them and why I like being me. That certainly made the trip worthwhile.

Male Rights Activists

2008-07-09T12:24:00.000-07:00

Male Rights Activists (MRAs) are a group of people who, surprisingly, campaign for male rights. Shockingly, you may or may not think, I am not one. I've been doing a bit of reading about the entire subject which is, admittedly, quite interesting if a bit on the biased side.

Well, I don't count myself as a MRA, anyway, which is the most important point, isn't it?

I think any large scale movement is doomed to failure. It all too easily gets wrapped up in paperwork, rhetoric and dogma. Large scale movements are seldom local, and therefore fail to cater for specific problems faced by individuals. Too much navel gazing for my liking.

I'm my own person. As originally stated when setting up this blog, I'm interested in the trials to be faced as a young, attractive and confident man training to be a nurse in 2007. Obviously, this will encompass gender issues, and I wouldn't have it any other way, but this doesn't automatically make me want to fly the MRA banner. I'm my own person, with my own individual issues, and - sharing them on here and with my nearest and dearest aside - that's how they'll stay, really. The idea of male rights VS. female rights sounds far too much like a Good/Evil VS. Good/Evil prize fight for my liking anyway.

The R Word

2008-07-09T03:40:00.000-07:00

Another month, another government initiative regarding rape (Committed against women, obviously, since men can't be rape victims).

Rape is a quite singular, abhorrent crime. But it is a difficult one, something I have spoke of before and will no doubt speak of again. Despite some pop cultural themes, rape seldom occurs in dark alleys or wind-swept parks. A woman is more likely to be raped by someone she knows, a partner, ex-partner or 'friend' or some kind.

That said, there is a link between the accused and victim. This link can cloud cases and make them difficult to follow, and make prosecution even harder. A hypothetical case could go something like this, and forgive the simplicity for the moment: Jill accuses Jack of rape. Jack denies any rape occurred. Police investigate the surrounding case, interview people etc. and it turns out Jack and Jill were in a relationship at the time. Relationships are pretty private, so it is Jill's word set against Jack's.

I feel for Inspector Knacker, at this point. Rape is not a clear cut crime, like theft or assault, for example. If Jill accused Jack of stealing some material goods, and he denied such theft, the police finding such goods in Jack's house would count as evidence. There is no such clear cut evidence for rape. If Jack and Jill were in a relationship at the time, much vaunted DNA evidence is pretty moot. Although bruising and other injuries could count as something more of a smoking gun (bruising on the wrists, for example, insinuating some sort of forced holding/restraint), some of these injuries are not clear cut proof, either. Vaginal tearing, for example, can occur during consensual sex, too.

This paints a grim picture of any possible rape prosecution. I support the idea of placing more emphasis on solving cases of rape, and specialist squads are not a terrible idea. Some organisations blame Inspector Knacker for not taking rape seriously. These squads/teams could help reinstall a little faith in the system, and encourage more rape victims to come forward. But I can't help feel this is yet another policy in a long list of ideas which are never fully funded, followed up and backed up. Which is a damned shame.

Edit: Mark Easton makes some great points here, including statistics. He ends on the idea that policing alone can't change conviction rates and even attitudes towards rape, and I couldn't agree with him more. Considering rape within marriage was only made into a crime recently, the country - not just Inspector Knacker - should be ashamed of itself.

Edit ii: Interestingly enough, Mark Easton points out that rape is counted as:

"the penetration of the vagina or anus without consent and penetration of the mouth by a penis without consent."

Why rape against males still doesn't exist in a legal concept, I have no idea in that respect.

The Glass Ceiling Cracks

2008-07-05T01:34:00.000-07:00

He's a nurse, he's a man and he's an action figure. And just to make sure it's clear, he's labelled 'Male Nurse'. Oh yes. These times, they are a'changin'. Ha.

On reflection...

2008-07-04T11:43:00.000-07:00

So that's it. My time on my Third Ward is over. And, as ever, I'm a little bit teary. So, what's happened? Some friends became enemies, some enemies became friends, in the words of Stewie Griffin. Thus it's time for a little epilogue.

I've met some people who I now respect. That's a good thing. People have been lovely to me today, with nurses and patients bidding me a fond adieu and even the doctors popped by to say goodbye and wish me well. I've impressed some people, and I've made some people happy. That's what I go to school for, so to speak.

10 weeks has been a long time, even if it has felt as if it's passed quickly. Despite the fact the ward was nowhere near as quickly paced as my Second Ward, I'm still in some desperate need of R&R. And going back to University certainly counts as that.

So, in a Crystal Maze sense, Richard O'Brian is telling me that my time is up in this zone. Time to go through some old, plastic tunnels into a new one.

I always liked the Medieval Zone, myself. Although, in healthcare, this might be an unfortunately pertinent metaphor.

Last Shift #3

2008-07-04T03:04:00.000-07:00

So, this shift coming up (a late, which is ever so annoying to wait for) is my last one on my current ward. Reflections?

Well, the ward is understaffed, plagued by staff sickness and not amazingly managed. On top of that, it is on the bottom rung on many priorities of departments and bed managers. I believe this makes it a less than positive place to work, nevermind learn.

All in all, I wish my second placement could've been swapped with this one. There was much more left for me to do in a possible three weeks last time, whereas on the current ward 7 weeks would've been more than enough time to experience all there was to do. Additionally, I worked a lot more closely with my mentor last time, which is a way of working more conductive to me, learning-wise.

The ward I'm on currently isn't bad, but it isn't a whirlygig of learning fun, either. Shame, really.

Hate Crimes

2008-07-03T08:05:00.000-07:00

Is the current era a bit dramatic, do you think?

I was reading, within the massive organ of investigative journalism that is The Metro, that Stonewall, a pro-homosexual group, has recently found that hate crimes against homosexuals is relatively common. I can't remember the figures, but they were something like 1 in 3 people have suffered a hate crime due to their preference of sexual partner.

The day after this article, a man wrote in shrugging off the study, suggesting that some of these 'hate crimes' could simply be a little bit of name calling. And that name calling occurs in many walks of life, for many reasons (although I assume all these reported 'hate crimes' involved some kind of homophobic slur). A cavalcade of letters followed the day after, lambasting the guy for voicing his opinion.

It got me thinking about this day and age. By now, you may have picked up my general dislike for the term 'hate crime'. It's too emotive for me, personally. Not clinical enough, like many other crime titles. Grevious Bodily Harm is quite descriptive. A Bloody Good Kicking is less so.

Today a patient made a joke about me being a good nurse "for a boy". This is clearly discriminating against me due to my gender. And this is not unusual. Some kind of similar comment is made probably once weekly. Is this a hate crime?

I'm pretty impervious to such jokes. And they are jokes. Light-hearted, if a little ill-considered. And I rebel against most gender stereotypes anyway, so I don't mind. But someone else might mind, and to this someone else such jocular gesticulation could count as a hate crime. To them, I mean. So is hate crime in the eye of the beholder? Where do the boundaries lie?

I personally agree with the first letter writer. There are degrees of jokes/insults. I'm from a regional background which takes a lot of stick for various reasons, but I wouldn't cry 'hate crime!' when someone did an impression of my accent or insinuated something about my character.

But I suppose someone else might.

Once again, it might be a case of me being white-middle-to-lower-class-reasonably-educated-male-trash. We're kinda overlooked by positive discrimination/affirmative action*. If the entire hiring process of nurses changes overnight to admit male candidates until the make-up of the nursing core is more representative of the general population, I'll take this point back. But I won't be popping down the bookies to put any money on that happening just yet.

*Note: Isn't the term AFFIRMATIVE ACTION awesome? It's so American. So much so you can imagine a high-kicking film of the same name. Not a good one, but a film all the same. You know what I mean. It might have Steven Segal in or something.

Pink Arms

2008-07-02T08:26:00.001-07:00

Yes, I am currently half-man half-lobster, it's fun. And at least a conversation starter.

Not a large post today. Two things to reflect on, really. Firstly: what a fucking chaotic day. You know one of those days in which you just plain don't get a chance to sit down to yourself? Well, I tell a lie. I grabbed my 15 minutes to eat my sandwiches far too late. What cause chaos? I'm still not sure, but I'll try to chronicle the main events:

* A&E needed to transfer a patient up to HCU
* HCU was full, so needed to transfer a patient to us
* We only had two male beds free, and the patient to be transferred was female
* Thus, we swapped two men from a four-bedded bay into a double room. The women who were in this room were then moved into the four-bedded bay, leaving space for the woman coming up.

That's the simple explanation. Beds and cabinets have to be moved, causing a sort of slow, painful ballet in the hallways. This was not helped by the fact that one of the men, a very peculiar chap, had covered his sheets in something that sounds like 'sheet' but I will call faeces for the technical term. The whole move was a bit of a clit ache. And it got me thinking about the framing situation. A Staff Nurse told me that when something like this had happened before and the bed wasn't freed up in quick time that A&E had placed a critical incident report in.

The balance issue annoys me. Simply put: because of one patient, four have their mornings put out of whack. Washes had to wait, medicines were delayed and there was general distress caused by the move. These patients didn't get a say in it, the bed manager did. Just seems a bit silly to me.

So yes, my personal bay is now a female bay. Which leaves us with only one male bay, which can cause problems. E.g. some male support assistants not wanting to wash female patients and vice versa. The new female bay is actually quite effort intensive. And the two women who were first moved in argue quite frequently. And not like Odd-Couple-Hilarious-Arguments. More bitchy ones.

The older of the two ladies wanted a shower and was happy for me to help her out, which was nice. Although very few women refuse to have male staff members assist with hygiene, I have received my fair share of grudging looks in my time. In fact, she was more worried I'd not want to look at her, which was sweet of her, really.

I still (in the nicest possible way) blag my way around washes, really, having been given no formal instruction. I just ask what the person wants to do and get on with it, insisting they shout at me if anything is not to their liking. This old dear hadn't had a wash in a week, I heard. And that's sad, but I'm not sure of her history in hospital, so can't really comment. And, for once, won't. She was very grateful to have some shampoo rubbed into her scalp, and we got on - despite the pouring water - like a house on fire. It was a nice moment in a crazy day were there was little time to do anything but run around doing favours for my recently returned mentor. Anyway, she's lovely. And it's good to actually look after some women primarily, for once. It's easy, as a male student nurse, to be farmed off to look after male patients, sadly.

Summer in the City

2008-07-01T11:44:00.000-07:00

Hot damn. Looking out at the rain now, I find it hard to believe where my sun burn came from today.

I'm tired. The long day took more out of me than I thought. I spent the day reading, playing games and having fun. Whilst fully hydrated, too. Good news.

Right, my expanded review of yesterday.

The New Class

As mentioned, my bay is now inhabited by men with varied, including mental health, non-cardiac disorders. Parkinson's, possible Dementia, a sub-dural haematoma. Allsorts of stuff, and it was quite a shock to be plunged back into. Not that I am under any illusion that I will always get (or want) 'easy' (and by that I mean self-caring, independent and jolly) patients, but it was a seachange. I coped, though.

Teary Oedema

One of the patients in my team (but not in my bay, recently) is a lovely old dear. Bit hard of hearing, suffering from Congestive Cardiac Failure. This means her heart cannot pump effectively, which means fluid can build up around various parts of her body. In her case, she has fluid (oedema) around her lungs, and in the tissue around her legs. This makes it hard for her to walk, and keeps her very short of breath. Because of these things, she buzzes the nursing staff and uses a commode next to her bed.

Generally, she wants to stay independent and I'm happy to encourage that. However, yesterday she was attached to a pair of drips. On transfering on her own she sat on one, and couldn't reach her buzzer. I found her in a right state, crying: so I paniced. Shit - had she ripped her canulla out? Was she in intense amounts of pain?

No. But more importantly she was upset. She told me she felt 'like a fool' for doing it, which I immediately chided her for. But I was quick to comfort her, just talking and being there for her. Chiding was not the order of the day, but comforting worked a lot better. I sat on the floor, chatting with her for a while before going to find her nurse. I think it turned out alright, in the end.

Death

Morbid title, non? One of my newer patients came to us on the palliative pathway, which was something new to deal with. It was something I blagged it, really, just chatting with him and providing cares as he needed them. I chatted man stuff, as much as possible, about women and work and stuff. His discharge was due on Tuesday, going home to spend time with his family and - frankly - die.

On Monday, once he'd pulled me aside and asked, I went down to CT with him twice. These scans seemed completely unnecessary, since he was no longer for active treatment, to me, and seeing him stuck on a trolley in the middle of an NHS corridor was quite sad. Two hours later we were back on ward. He was sitting up in bed, surrounded by his family, smiling. And suddenly I thought: that's it. Morbid or not, that's the way he wanted to die. And it's a good one, you ask me.

Edit: The man from the above section used the old line that, when asked if he had any allergies he'd joke: "Women." The old ones are the best ones. I was talking to him at length about it and, with a tear in his eye, he told me: "Not the wife. She's the only one I'm not allergic to." God, it made me feel better about birds, who have not been my favourite demographic in recent days. The female population may be generally silly, but it's good to know there are exceptions. I'd forgotten about them for a little while, but it was a sweet reminder from a sweet gentleman.

A long, long day

2008-06-30T14:14:00.000-07:00

My sorta-mentor asked me to work a full day instead of an early, and I was glad to oblige. Today was full of stuff. I mean, y'know, crammed. And I'm a bit dead-ed. So I'll keep this late night session brief.

I looked after a teary woman full of odema, a man who has but a few days to live, my favourite ever patient and my personal bay which has turned from a lovely exercise into Saved By The Bell: The New Class. Hard work, and without that classic comedy atmosphere.

I worked hard, sweated hard and am exhausted. But god-damn I love the 'core.

Do when in a good mood.

2008-06-26T09:57:00.000-07:00

I'm pleased. Despite the fact that Final Fantasy Tactics A2: DS doesn't come out until tomorrow. I'm also amused by recent news articles.

Firstly, can't women wear ties? Enough said.

Secondly, the whole positive discrimination part of the Equalities Act being put through it's paces today. Highly amusing. Don't get me wrong, a lot of the Act is a good idea. Equal pay, for example, or lack of, is a fucking joke. The law shouldn't really mess with the policies of private companies, but the fact that some government jobs don't pay men and women equally is just a bit stupid. If the government kicks it's gender-pay-issues into touch, private enterprise might follow. The whole issue should be sorted out, if not for red tape. This much I agree with.

The idea of using positive discrimination to try and sort of these issues is unworkable false economy at best. The whole concept seems to revolve around: 'If two identically qualified candidates were up for the job, and performed identically at interview the employer could pick a woman/person from a ethnic minority if it'd make things more equal'. What the latter bit refers to, I hazard to think. I suppose they mean that if an area was populated by 60% Asians of Pakistani descent then someone who was of similar origin would get the nod to be police chief, or whatever.

The whole first part of this fictional scenario will never happen. Two candidates will never be identical, so surely the point of the legislation is to use ethnic background and sex to 'smooth out' any 'inequality'. But surely, this idea that someone got a job because of their biological background instead of their talent doesn't help anyone. In fact, does it not undermine the whole fight for equality?

Two wrongs don't make a right, as the saying goes.

Now, given around half the people in hospitals at any time are male, does it mean men will be fast tracked into nursing posts? I'm massively talented and don't really need a cheating opportunity from the government, but even so in two years, I certainly hope so.

Edit: It seems that this positive discrimination will operate before interview. So if there's a pile of similar CVs of people with identical experience then employers could pick the female and ethnic ones over white and/or male ones to fill any sort of quota supposedly towards equality. So what happens if you pick people on evidence of their CV and biological background and find they all interview terribly? Do another round of admission to interview without the filters on? Interesting idea.

Don't blog in a bad mood..

2008-06-25T12:37:00.000-07:00

So I let myself simmer down. Then I invited my bestest friend around for a cup of char and a pot of laugh-filled bitching. Once girls, work and the world at large had taken a bit of a bashing, I felt better.

And after explaining, at length, how bribing people without putting a bid in on eBay doesn't work I've decided to chronicle trials and tribulations of the day.

I was shouted at earlier, which is something I'm used to. The Charge Nurse was annoyed that I'd undermined their orders. Whereas I was concerned with the four beds I was looking after (this Charge Nurse had asked me to care for them, after all), the Charge Nurse was looking at things from a more global level. It was a stern telling off, but I'm pretty thick skinned. It wasn't a lot more fuel to the funeral pyre of my foul mood.

What was surprising is that the Charge Nurse apologised not once, but twice! The first one seemed like a bit of an afterthought, like when someone bumps into you in the street and apologises, despite the fact they knew they would anyway. The second time seemed more heartfelt. The Charge Nurse told me I was wrong, but there was no need to respond to me as they did. I don't think I was wrong, but perhaps they had a more realistic set of priorities. And I perhaps shouldn't have undermined their orders, but, as I told them, I was being obtuse and standing up for my patients. And I'd do it again.

What made me more upset was further evidence of my skill stagnation (I'm aware it's a bit rich to talk about this as a first year, but it's a problem). I got to change a dressing today, and people endeavoured to try and make me feel quite stupid in the process. A common theme on this ward. The bottom line is: this is the first dressing I've done in three months, so I'm totally out of practice. And without practice, I can't learn anymore or at least get back to my previous stupendous level.

This is a recurring problem on this ward, and makes me feel quite excited to get off of it. With no new skills to be learned, I'm just going through the motions. And just talking about that edges me back to the previous foulness. So I'm going to stop.

Magna Carta

2008-06-24T11:19:00.000-07:00

This old, lovely document has had a lot of publicity around the idea of 42 days detention and how it should be respected. The news, though, of how law lords have ruled that anonymous witnesses can no longer be used within trials is a very linked problem.

And an interesting one, philosophically. On one hand, the idea the accused should be able to know who is accusing them of a crime is enshrined in English law. No matter how nasty they are. On the other hand, witness protection is important, too. Not just in gang warfare, as is something concentrated on in the current news stories, but in cases of rape, child abuse and other sexual assaults (remember, men can't be raped, legally).

The Magna Carta is important. The issue is: is it black and white? Some of these people, rapists and gang members and other such scumbags, are nasty people who deserve, at least, to be in prison. And surely we should try our best to get them there. But can we compromise morals to do this, or is that just as bad as 42 days?

I'm in a bad mood...

2008-06-24T08:58:00.000-07:00

... so I sharn't bore you with the details of why.

Suffice to say I spent my last hour of work doing the work of support workers, half of which couldn't be arsed to do what they're paid for - after turning up late - and the other half who couldn't be bothered to turn up at the start of their shift.

If student nurses (I won't use the s-word. It's already obvious) weren't there, who'd pick up the slack?

The age-old issue.

Consent

2008-06-22T12:09:00.000-07:00

Just a quick one, since it's Sunday.

Dr. Crippen's theoretical post about 'medical rape' got me thinking.

Consent is a funny issue with lots of people in the sphere of healthcare. I try to see it as a bit of a black and white issue, as it's easier.

The situation is thus:

You are a hospital doctor, working in obstetrics. You are called to the Labour Ward by the midwifes. Ms Smith is a 29 year old barrister and is in labour. Her partner, aged 32, and also a barrister, is with her. It is her first baby and she is towards the end of the labour which has been uneventful but a little longer than expected. She declined an epidural. She has, at her own request, had only “gas and air” for analgesia. She has been fully dilated for nearly an hour. She was pushing well at first but, suddenly, she is very tired, and she can no longer push effectively. The foetal heart rate has dropped suddenly and precipitously. The baby’s head is on the perineum, but Ms Smith cannot push it out.

The baby must be delivered quickly. You tell Ms Smith that she needs to have some help, that you need to do a forceps delivery. She is close tears and exhausted. She agrees. “Yes, please, just deliver my baby as quickly as possible.” Ms Smith is put up in the stirrups. You infiltrate some local anaesthetic, put the forceps on the baby’s head without difficultly and are about to do what the obstetricians (not the patient) would call a “simple lift out”. You start to apply gentle traction on the forceps. The baby’s head begins to move easily. At this point, Ms Smith starts to scream, “No, no, no, stop, take those bloody things out of me now.” Ms Smith’s partner mops her brow. She continues to scream, “Take those bloody things out of me”. You ignore her request saying “it won’t take a minute” and continue to increase traction on the forceps. Ms Smith screams more and keeps saying “take them out, take them out.” Twenty seconds later, the baby’s head is born, and you remove the forceps. Ms Smith stops screaming. The rest of the birth continues without problems. The on-call paediatrician is present. The baby has a low Apgar at one minute but then pinks up very quickly and is handed to the mother alive and well.

In my comment on DC's site, I mention how I'm not sure what'd happen if the Doc would've removed the forceps at the moment the pregnant refused. For example, if this would've caused damage to baby and/or mother than the doctor is in an ethically screwed area. On one hand, s/he does something for the best: to sort out a problem and keep both parties as healthy as possible whilst running the risk of being called a rapist. On the other, s/he takes notice of the patient and lives with the consequences. This could, essentially, go against ethics or morals. To do no harm, and to do good, specifically.

Even so, I'd go with the latter option. There might not be a court in the land who could try and prosecute a doctor for doing what s/he thought was right, i.e. delivering the baby, however in this new consumer-obsessed world of 'choice' and the like, the latter choice would be the one for me. As long as you've explained what you want to do (before doing it) and then, once the patient has asked you to stop, explained what the consequences of not doing/completing the procedure, I don't see the problem in stopping. If the patient complains about it in the future, you could just play the old 'respecting your wishes card'.

Brilliant.

Another Friday...

2008-06-20T08:53:00.000-07:00

But today is payday!

Huzzah!

I get to buy earphones that don't sound like shit, get a haircut, chewing gum. All sorts of stuff. It makes me happy.

Not much on today. I took my usual four patients and looked after them competently. I made up an iloprost, which involves Antiseptic Non-Touch Technique, whilst watched by a Charge Nurse, which was a sternish test. All good fun.

I look forward to the weekend. There are more things to buy, more fun to be had. Although I might just kick back and relaxxxxx.

Junior Doctors

2008-06-19T08:25:00.000-07:00

Today, I had a quite distressed patient's spouse come to me. This spouse almost broke down in saying how depressed their love one was, at not knowing what was going on, what their fate was or if they were going to be around for much longer. I had some vague knowledge that the patient was having all kinds of scans and bloods done, so it was just a depressing waiting game of diagnosis. I told this, more sensitively, to the spouse who expressed great relief in actually hearing something from someone, and asked if I'd say such to the patient. Being not entirely clear, I told said spouse I'd try to find the nurse in charge or at least get my facts straight beforehand, but I'd be happy to try.

Whereas I try to know everything pertinent about the people I look after, this patient was not particularly one I knew lots about. Their nurse was in a hefty handover session, so wouldn't be around for a bit. I looked through their notes, and found the House Officer assigned to the patient. The HO was hesitant to tell me... well... anything. Ward Rounds were four hours away with the big consultant type and so the HO repeated for me to wait until then. I revealed the spouse might not be around at that time, to a muted reaction. Eventually I recieved permission to at least have an informal word with the patient, now my facts were clearer. Which I did.

The patient expressed dismay. They referred to doctors as 'Gods walking around the hospital'. Finding myself in the rare position of having to defend doctors, I replied that medics are not all knowing and all powerful. They have to wait for blood results, for scans to come through, etc. My arguments, I'd like to think, were compelling, but the patient was mostly unmoved (although their spouse was very grateful, so the talk was not for naught).

The HO said that they would go and have a word 'at some point', but with ward rounds on the horizon I doubted it'd happen (my shift ended before rounds began, unfortunately).

I'm, as Hot Third Year seldom lets me forget, a mere first year. But my talk with this patient helped, at least a tiny bit. I wondered why the doctor couldn't go and have a big word, before rounds. I'm not saying the junior doctor should've went and made unrealistic promises, or lied, or anything like that! Rather give him a little more information about the tests and results, stuff like that.

The HO I'm thinking of is, to be honest, wet. Lovely, intelligent but a bit of a wet squib. I was with this HO and another patient earlier, where the HO was consenting the patient for two rather uncomfortable procedures. Now, don't get me wrong, I'm aware that noone in healthcare should make promises they can't keep, on pain of suing, but the whole thing was a bit doom and gloom. The procedures are Gastrointestinal-based, which means I have some knowledge of them, and have watched doctors consent patients for them before. The procedures are quite... well. Everyday. The risks are pretty minimal, and if I was a doctor I'd be pressing this point home a bit more, as I've seen other (more senior) doctors do. Inspiring a bit of confidence, without making unrealistic promises. This HO left the patient a bit... uninspired.

So I got to thinking. Is being wet, mild mannered, quiet and subservient like some evolutionary response to working under certain consultants? Does it make life easier, or does it make you more likely to be promoted or have good things said about you? I am not for one second criticising junior doctors, let it be known. 'Wet' is not a criticism and although I suppose a lack of charisma counts as one, it's not meant as a barb. The ability to inspire confidence is certainly one learnt through experience, but it is also something some people are talented with just through their use of words. Naturally, almost.

I'm sure a lot of junior doctors grow in confidence as they grow in experience, and make terrific Senior House Officers and beyond. It seems a shame, however, that the role of HO, the medic the patients see more than any other, is home to quiet types, when some patients could do with someone with a bit more... pep.

Ten Thousand Men?

2008-06-18T12:02:00.000-07:00

If you haven't heard today, perhaps you've been hiding under a rock for the past 24 hours, I don't know... But if you haven't heard, a female soldier died in Afghanistan today. Four men died, and scores have died previously, but the media sees fit to mention this gender-based tid bit again and again and again.

How we're supposed to get anywhere near to equality when this fact is repeated over and over, I have no idea.

Unlucky for those four soldiers who died today. Males get second billing on the death front.

Update: Does the media view each death equally? See this story and make your own mind up.

Swings and Roundabouts

2008-06-17T11:36:00.000-07:00

Today started off really well. I got to work with the Ward Manager who was happy to give me four patients to personally look after. Responsibility is something of a drug, sometimes, and I was drove on by this new challenge. The patients in the bay arguably like me a lot, so it seemed like a good day. Two of the patients caused a little trouble with insulin-based hilarity, but nothing we couldn't handle. Still, there's no such thing as a perfect day.

Doctors, chest pain and upset

One of the patients in my bay has been in hospital for a long time, awaiting a CABG (a heart bypass, essentially). Noone was really sure why the patient is in. The patient seldom scores anything on EWS and previously managed their own condition outside of a hospital setting. I pressed for weekend leave yesterday, which was accepted. Today, however, a consultant decided the patient was fine to leave and have their CABG done as an outpatient. The nurse in charge refused to give this news, much to the annoyance of one of our HOs (House Officer, not gangsta-type ho). The nurse in charge says that this is a medical issue, and leaves it at that. The patient is told, and is elated.
Obviously, this good news would be too lovely to happen without a hitch.

After telling the patient that they could go, the HO then decided to ask them about chest pain. I wasn't there, but apparently the patient admitted to having slight chest pain frequently, although it went away with medication. Ho went off to speak to said consultant. Guess what? Discharge denied.

There was some debate about this issue within the nursing team, inspired by yours truly. I frequently jump in on ward rounds and, considering the patient's history of cardiac problems, they are never quizzed about chest pain. I argue that it's a bit stupid of the doctors to give such news without having all the information, as well as the fact that they never quiz him about such pain on rounds. The nursing team ask patients about pain three times a day, and until now the patient has always denied any. Senior nurses argued that the patient was a grown human being and should've reported said pain off their own back. This, anyone in nursing may realise, is a big problem in itself.

Now, don't get me wrong. The patient isn't in the right 100%. But some more, let's say, old fashioned types can be hesitant to admit anything that they (or they fear others, perhaps?) could see as weakness. Doctors should be aware of this. Whereas one (including me) could argue the patient has lied to the nurses about experiencing chest pain, at least the nurses asked. The doctors did not. This - on top of the fact the doctors revealed the news of a discharge without getting all the pertinent information - puts them slightly more at fault. I was upset, but have cheered up a little bit since. The saddest part is that the patient is not only in a terrible mood, but has admitted that they will never tell the truth about chest pain again as they believe it'll keep them in hospital more. This breakdown of trust between the patient and the MDT is probably the worst fallout I could think of.

Burning everyone out, even the young?

Hot Third Year, a sometime reader of his organ, is the latest in a long list of people on my current ward suffering with burnout. The sad thing about said ward is that it makes people feel deskilled. For an idealistic young first year like myself, it's fine. But for people who are actually good at their jobs, it can be a motherbastard at sucking away confidence and love of the job. There are good days and bad days, clearly, but I know, for example, Hot Third Year had one of the latter today. I'm too inexperienced to have been onto one of those bad days, yet, but I'm not looking forward to them.

As of today, I'm feeling a lot better. As observant readers may observe, I'm home excessively early from working a long day. Getting let out early is lots of fun. And despite the challenges today, I feel psyched still. On the whole, I looked after my four assigned patients as competently and well as could be expected. Hell, more so, even. I've even put a couple of spoke placements in the pipeline. Productive, eh? To paraphrase Sgt. Apone:

Another glorious day in the 'Core! Day in the Nursing Core's like a day on the farm: every meal's a banquet; every paycheck a fortune; everyformation a parada - I love the core!

Good days

2008-06-16T09:29:00.000-07:00

A short one today. Post, not shift.

I try to keep the interest of my patients in the forefront of things all day, clearly. Part of this involves trying to jump in on ward rounds to translate (usually later, as to not irritate or undermine any doctors) the medical speak for them. This is reasonably important and makes me feel happy, like I'm accomplishing something. Always a bonus.

I was sad to find that, despite me handing it over, writing it on handover and telling people face-to-face that noone had enquired into the possibility of weekend leave for one of my patients (they don't belong to me, but they're under my team juristiction so I group them as 'mine'). When I first brought it up with a support worker within conversation, they were pretty negative about the whole thing, betting the patient wouldn't be allowed to go home. This, though, is no reason not to at least broach the subject.

Happily, I did this morning and said patient, who is still waiting for various tests, will be allowed to go home this coming weekend. The patient was happy, so I was. Another tiny, but important, victory.

Nurse Promotion

2008-06-13T08:50:00.001-07:00

It has recently been pointed out that this blog is, for the majority, pretty down on nursing. Mostly because it's my only anonymous outlet to whine about shit, so my bad days probably seep through more than the good days.

But, despite the flak and fire that I have to put up with, I still love what I do. I wouldn't want to do anything else, now, as the thrill of actually helping people is the kind of satisfaction that can't be beat.

I set up this account to talk about issues around being a male, student adult nurse in 2007 and there are a lot of problems that I, personally, face, but that doesn't mean there aren't rewards. If there were no rewards, believe you me I would not - like some nurses I've met - be still training. I'd go make thousands selling some miscellaneous, unnecessary shite to stupid people.

I love what I do, and that all-encompassing passion works in mysterious ways. I'm glad I get annoyed at the crap that goes on, as it shows I still care. But, I should be careful to highlight the awesome bits, too, of which there are - thankfully - many. Too many nurses say, sometimes precisely, 'Don't be a nurse'. I say - if you think you can stand the challenges and want to do something you'll actually give a shit about, do.

So, I haven't failed...

2008-06-13T07:09:00.000-07:00

Bonus, right?

Well, obviously. One essay got a spanking 65% (not bad for zero effort) whilst one got a sort of 'Pretty terrible with sparks of brilliance' review of 49%. Both passes, which is good since I blagged them with little preparation. But points to consider:

- Firstly, I hate the stupid concept of, whilst being an academic, having to explain every little technical term. Wards around the country use the Early Warning Score. It's a piece of evidence based practice. So why should I have to explain what it is? If you end up explaining every little thing in an essay you won't get any debating done.

e.g.

"Jane was a human being. A human being is a carbon-based lifeform from planet Earth. Earth is the third planet from the Sun. 'The Sun' is the term used by humans for the star their planet orbits. A star is..." etc. I jest, but there's a serious point in there. Where does this process start and stop? The answer is debatable, but one thing is clear. Some markets like everything explained, some are less draconian.

- Secondly, I was always taught that introductions were something to get out of the way, lest too much labour be spent. And yet in both of these essays I've been told mine are too short. So, it seems this University wants me to labour the point. Fine.

- Finally, I have no complaint that some of my references didn't match my bibliography perfectly. That's easily improved.

Anyway, I aim to be much more organised in the future. And I'm excessively good at learning from my mistakes, my next essay is going to blow some socks off. It's decided.

I almost failed my course and all I got was this lousy t-shirt...

2008-06-12T02:43:00.001-07:00

So, yeah. Busy week.

On Tuesday I was told my paperwork was due in on Thursday. That's today. As previously discussed, my current ward has staffing issues. Which means, on Wednesday I had to flutter my eyelashes a bit to get this anywhere near finished. So I worked a whole day Wednesday to meet one of my mentors (I have about seven, thanks to said staffing issues) who was coming in on a night. I begged her to finish the important bits overnight so I could hand it in and be done with it. I got up at 6 this morning to pedal all the way there to pick it up. I had to wait an hour to have it signed off by one of the Charge Nurses. I pedalled all the way back, scanned it, got it signed off and handed it in. Phew.

Except for the sheer amount of pencil I've used, and the fact it's a rush job, it counts as a pass. I'm eternally thankful for said fortune.

Ontop of that, I was supposed to pick up essay feedback a month ago that I forgot about. I've sorted picking it up from the big cheese of the University tomorrow. Hopefully I'm going to get through that with the minimum of interrogation. I might pass, too. That'd be nice. But the resits are at the end of next month, which I'll certainly pass, worse case scenario.

The only other issue today: I found someone's practice placement book today and, after e-mailing them to tell them where it was, had a peek. They've done lots more spoke placements (in other parts of the hospital) than me and have dressed things up more. I mean, they've wrote this big blurb about watching cathertisation happen, as an example. Now, I've saw bits and pieces and took a catheter out myself, I just haven't tarted it up for my book. And insecurities aside, I'm predominantly happy. I'm still a good student nurse, impressing third years I work with, so I can't be doing that bad. A couple more spokes, and I'll quest to get some more skills on ward. Good to go.

Now, I might sleep.

Friday, I'm not in love.

2008-06-06T09:32:00.000-07:00

So, two shifts later. I spent a hungover late Thursday shift, with little sympathy from staff or patients.

I decided to bash through an early on Friday, which this mood of mine is the end of. I had a busy shift, in bits. One bedfast patient caught a lot of time from various members of the nursing and student teams, soaking effort up like a sponge. This patient should really be in either rehab (they are, according to rehab teams, not rehab-able) or a home. Not an acute medical bed.

I spent most of the rest of the shift (which I should've spent working with my actual mentor) was wasted down in Ear, Nose and Throat with one of my patients. I've made this jape again and will make it. Our time down there was like a Bob Monkhouse show. Joke, after joke, after joke (Geddit??). Firstly, despite booking the porters in time, they didn't arrive, hence why I had to take the patient down. Then two reception desks were closed, leading us on a merry dance. Then ENT had no idea what we were there for, so I had to explain what was already in the notes. We waited an hour before they came back, asking us more questions about why we were there. Finally, after a while more of uncomfortable waiting, the patient was dealt with.

This is not the first time I've waited forever in ENT. If they know there are always delays, why schedule the appointments so close together? Dolts.

I got back, roped into helping to change that bedfast patient. Just to prove my skills are still immense, I also ran the blood sugars of the patient who I'd pushed and pulled down to ENT for those hours. They were also a diabetic, which is another reason waiting two hours somewhere with no suitable food might be a fucking stupid idea. It was high, so I suggested DGN give the patient ActRapid, which is treatment for high blood sugars. DGN looked at me, stating that ActRapid was only to be used if the blood sugar (BM) was over a score of 20. With an enviably level of humility, I informed her that this patient was to have a lesser dose of ActRapid if the BMs were over 16, which they were. Good to know I was still on the ball after all that.

In other news, my paperwork has almost been started. 5 weeks into the placement. Not a big surprise. In fact, I'll be more surprised when someone actually gets my paperwork done on time within these 3 years. When or if.

Co-Payments

2008-06-04T08:20:00.002-07:00

Unity responded to DK's quite naive post about co-payments with his usual meticulous fisking, and I've commented but I'd like to expand upon my comment (below) a bit:

Excellent post, as ever. Good to know there are medics willing to make a shitload of cash from people’s misery. Some things never change.

And that’s the bottom line, whoever has a problem with co-payment. If any of you have worked in healthcare, you’d probably see the problem more clearly. Imagine you have two patients with similar diagnoses. One is part of the affluent middle-class, one has a more working-class background. Both have paid NI all their lives. Both are informed of these random, maybe-effective drugs that could prolong their lives, but only one can afford the treatment. What do you say to the patient who cannot? ‘Tough shit’?

The NHS is free and equal to all. It's not, but it's supposed to be. The consumerist society we live in mirrors the free market economy model, which implies that you can have what you like if you have enough cash. This should not automatically transfer to the NHS. The National Health Service was designed to be, above all, fair*.

If you can buy add-ons, providing you have the money, then how is that fair? It pisses me right off. And, like the new news that private 'managers' are going to be brought in to improve the efficiency of 'failing' hospitals (that is to say hit more crappy targets), this is one more step to a private health service. It might piss me off, but it's the poor of the country who're going to get pissed on.

Anyway, good day. Started in a bad mood, kept my shape, kept my character, threw down some awesome nursing manoeuvres, and now I'm in a splendid mood. And I'm going out on the piss, which is even more exciting. I'm working my first late tomorrow, possibly hungover, so we'll see how that goes. Quietly, I'll guess.

But now, of course, I have quite likely jinxed it. Woo.

* People will use the term 'equitable', but ignore it. Far too open to interpretation.

In other news...

2008-06-03T13:11:00.000-07:00

We now have three patients taking up acute medical beds who have no acute medical problems. Hurrah!

Not.

This is a serious problem on my current ward. We seem to be used as something of a hold over place. Someone finishes with a cardiology procedure and can't be discharged. For social reasons, for example. So they get sent to us to twiddle their thumbs. It's fucking irritating.

Otherwise, we have two patients who deserve to be in a specialised rehab unit or in a nursing home. But both refuse to accept the patients, so we're stuck with them, with nothing else we can do. Nice one.

Homophobia Vs. Old Fashion

2008-06-03T09:21:00.000-07:00

One of my patients, who I quite like for the record, is quite annoyingly homophobic. This could be chalked up to 'old fashioned', but that's bullshit. Prejudices shouldn't be allowed just because someone's a bit old. Their homophobia comprises of insulting me for occassionally placing a hand on my hip, asking if I go out in the gay district (which I do, since it's quite popular) and saying 'Hello, sailor'. I shit you not. Anyway, I'm not going to make an issue of it just now, but it's pretty annoying.

Additionally, I realised I was in a bad mood today. But it's a good sorta bad mood, because I - rationally - know I'm going through it. I realised when I kinda almost shouted at Year1Semester1 student nurse. In all fairness, they did fuck up yesterday and, in messing with a machine in my bay were messing around with the whole nursing team system - which is in place, for better or worse. Anyway, I was being slightly irrational but also doing the right thing. I told them to go away, anyway, as they very well might've made a mistake.

I don't really like Year1Sem1 much. They're a bit like me when I first started, except without the character. A bit bland, all told. They live in the same block as me, but I'm not really excited about making them into a new friend. That says enough.

Anyway, here's hoping my mood improves.

Back in the saddle

2008-06-02T09:23:00.000-07:00

First day back after the weekend is always a toughie, it seems. But today wasn't so bad, for me, as a person. The day started terribly, with one Staff Nurse missing and no replacement, so my mentor was busy with 1 and a 1/2 a shift's worth of patients. I got on with the obs, and the old reliable 'basic patient care'. I do a lot of this anyway, but we were also down one Support Worker so there were tonnes of gaps to be filled. Patients were more worried about where their next cup of tea was coming from. Sweet, in a naive sorta way.

My main duties revolved around showering and shaving my blind gentleman patient. He's a dear, all in all, and it was good to spend some time with him, even if said time did involve me wet through my shoes. He actually got quite upset when he spoke about people dissing the NHS for getting such bad press when he thought all the staff he'd met, which was a tiny bit harrowing. But we survived, I got some valuable experience shaving someone else (which is *not* easy) and he was happy, in the end.

We have three student nurses, including myself, as of today. One is on their first ever placement, but is reasonably skilled, whilst the other is on their last ever placement and only started today so I have yet to get a bead on. She, as she is a she, is reasonably hot and I've been doing my best to show myself as the amazing human being I am. I could do with a date, just to keep myself in practice, to be honest. She asked me what the ward was like and, being an honest kinda chap, took her to one side and told her, quite simply, that we don't do anything exciting and it's full of bank staff. She was a bit frowny, but I reasoned it'd be pretty stress free and therefore allow her an easy end to the year. I'm an awesome diplomat.

Moving on, there was an issue linked to my previous issues about not forcing people to eat, today. That issue is... not starving people, too!

We had a situation, more down to low staffing levels and the YearOneSemesterOne student, in which a worried patient had refused to stay Nil-By-Mouth. This patient had something to eat, and then accidentally got sent down to the X-Ray they were being kept NBM for. For those not in the know, the X-Ray Department get pissy if people have had something to eat, and told the patient's nurse this down the phone. The patient's nurse wasn't really in on the loop, having been in handover, and it sounds like the X-Ray receptionist was being a fucking arsehead about the issue. The medics also seemed unamused.

These people are not nurses, clearly.

Just because someone - a doctor or an X-Ray operator, in this case - wants a patient to be Nil-By-Mouth for x-amount of time, it doesn't meant they have to be. You cannot, as a nurse, starve someone for 'their own good' without a bloody good reason. They're individual people, and can do what they like as long as they know it'll screw up their treatment. If, as in this case, a patient demanded food then you can't keep it from them. It goes against the code, to do no harm, for starters...