Health Promotion in Action

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

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.

The Last Week

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.

Less Excitement

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.

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.

The Second Year then...

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.