Inspiration

Beside a friends bed is this sign, and you can’t deny it speaks the ultimate truth.

Sometimes days are hard, sometimes it is hard to motivate yourself. Sometimes you have a realisation that you need to pick yourself up and get on with. My friend who has this beside her bed is a pretty incredible woman; she’s 23, studying international development at Goldsmiths and along with two other passionate women set up a charity in Haiti called EduHaitian. Well if she can get up and change the world each day, then what is stopping me.

But if I truly need a whack of inspiration then I just need to look at a photo of Mike. Mike is the child I sponsor through EduHaitian, he is a cheeky, vivacious chap who is set upon his goal of studying to become a doctor. I wish I could bottle his drive, his passion for life gives me a boost when I need it.

Finally there are two incredible young women who for me epitomise inspiration.

Olguine and Darline are sponsored through EduHaitian and completed their secondary school studies this year. They have saved up enough to contribute significantly to their university degrees by making the school clothes for the children who are sponsored by EduHaitian. This means that these incredible two young women will be studying Nursing and it is their determination that has gotten them to this point.

I am incredibly lucky; I study at a well regarded uni and the government contributes significantly to my degree. These two women have paid for their education since they began, as in Haiti education is a privilege not a right. They are my inspiration, and they make me recognise just how lucky I am.

So if you are having a day when all you want to do is sloth, procrastinate over that essay and complain about how hard your life is, take 5 minutes and contemplate the story of Olguine and Darline, two women who are truly making a difference with their passion and dedication to the world of nursing.

Perhaps it’s time we learnt from women like this, we opened our ears to their experiences and allow them be our constant and daily motivation.

Certain wounds make you shudder

A patient was admitted into our ward yesterday.

He has grade 4 pressure ulcers on his buttocks.

For anyone that hasn’t seen a grade 4 before it is effectively a big hole, filled with sloughly necrotic tissue where his buttocks should be. Despite having numerous lectures on pressure sores, nothing prepares you for the moment you first see one. It truly looks agonizing!

Our skin is there to protect us, it’s a barrier to the outside world, and when it breaks down to that extent it cannot do the functions that are expected of it.

In a grade 4 pressure sore there is usually lots of dead tissue and in his wound there was a lot of leakage of fluid and sloughly flesh.

He is at serious risk of infection as the wound could affect other areas of his body via his blood circulation causing blood poisoning (septacaemia).

He was in an extraordinary amount of pain, and he had to be turned regularly meaning that his sleep was interrupted throughout the night which doesn’t help the wound healing.

He developed these sores at home. He has come into hospital when they are in an appalling condition, now it is about management of his wounds rather than prevention. A pressure ulcer can develop very quickly but it can take several months of permanent bed rest to heal. In some cases it may even require surgery in addition to a long period of bed rest.

I find it scary how many people must fly under the radar in a similar condition. His sole carer is his wife, who is elderly herself.

In 2001, around 6 million people provided unpaid care in the UK. There are over 3 million people aged 50+ providing unpaid care in the UK, providing in effect more than £15 million in care each year. Over 47,000 are aged 85+, 11,750 of these very aged carers provide 50 or more hours care per week. I feel that is an astronomical figure.

Now for a photo… eyes averted if you don’t like gruesome pictures, but this is what a grade 4 looks like. Now think about if you had that on your bottom and the constant pain you would be in, terrifying isn’t it?

Stats from Age UK and Carers UK

Real Life

My friend almost died last night.

That’s an terrifying phrase for me to put to paper but that is what happened.

When you have a uniform on nothing phases you, when I have a a uniform I can cope. It’s a completely different scenario when someone you know is in a dangerous situation.

I’d been out, celebrating a sporting win in an extremely drunken fashion. The night had ended, we had piled back to mine and were sitting scoffing pizza in our makeshift den.

Then the door opened. A friend had run from the club to mine. She had run because she was having an anaphylactic attack.

Immediately we all sobered up and my housemates and I tried to calm her down. She gets them regularly, they are unexplained. They haven’t yet found a reason for them.

She managed to choke down some piriton, her face was extremely swollen so we could see this was a trial for her. I sat on one side of her and my housemate Ben sat on the other. My other housemate Matt sat on a chair reasoning with her to call an ambulance because she kept asking us not too. I tried to keep her breathing slow and steady. But it was clear to all of us that she was deteriorating. I tried to discreetly pass my phone to Matt to call the ambulance but she got upset. We made the decision and Matt left the room. She grasped her EpiPen and rammed it into her thigh. Then she lay back. We tried to keep her breathing steady. It was raspy, unsteady and unsettling.

Then she stopped breathing.

Ben reached into her mouth and cleared her tongue out of the way so she could breathe.

I lent over and opened her eyes and we both remained talking to her.

Suddenly she sat up and gasped.

Paramedics arrived.  Astoundingly her blood oxygen levels were  only 77%.

She was taken into the van and then they shut the doors on us. No-one moved, the van didn’t move. Then one of the paramedics ran inside to grab the defib. Once he was back in the van he shut the doors. Then the waiting began.

It could of been 2 minutes, it could of been 10, but for those indeterminable minutes the back of the van did not open. They did not drive away and we could see a steady rocking movement in the van.

All we could do was wait, our hearts were in our mouths. We huddled together and muttered mantras, willing that door to open. Because if that door opened then she would be safe, she would be steady enough for them to drive to the hospital. But right now they needed two of them, and a defib. Your imagination goes into overdrive, and the reality was unfortunately what we were imagining.  Our friend was in a serious condition, not breathing and being shocked back to life.

The relief when that door opened and a paramedic ushered my friend Ben in to join them to hospital was unreal.

I can’t place it into words, but I’m sure you could imagine it.

At no point did anyone panic. Everyone remained calm throughout. At no point did I feel like the situation was out of control and it is for that reason I am so thankful that I live in a healthcare household, my housemates are medics.

She made a full recovery and was almost flattened with hugs when she walked back though the doors of our house a couple of days later.

Just keep walking

Today I walked, and walked and walked and walked and walked.

Today I shadowed a site practitioner.

When you are on the ward you are focused on your patients, and I’m not yet far enough through my training to be considering the leadership side. That apparently comes in year three, when according to my university structure I am deemed competent enough.

Sometimes you forget that your ward is not the sole one operating in the hospital, that there are actually heaps of other ones and patients constantly streaming in through A&E.

The site practitioners role is to manage patient flow from A&E to MAU and SAU. But not only that, they also manage transfer between wards and help solve any transport issues.

They also have a lot of targets to hit, priority is to ensure that no patient on A&E overstays that magical 4 hour figure.

They firefight, they listen to moans and groans and field the politics between wards.

The chap I was following did this all with a smile on his face, remembered every staff members name who he bumped into and did not stop (bar bed flow meetings) for 8 hours. Phew!

Insightful to see the back work that goes into keeping the hospital functioning.

It’s freshers fair tomorrow, will we convince the new nurses to join the NEW nursing society. I hope so! In other news, very much enjoying having 3 days off!

An opportunity to say goodbye

I wonder if you will always remember your first death? I hope I will never become immune or numb to it. Although you don’t have a personal relationship with your patients, you develop a therapeutic one. Part of developing a therapeutic relationship with your patients is that you do feel a sense of loss when they pass.

I had a very poorly lady in the morning, her family had stayed with her throughout the night. In a sense I knew she wasn’t going to last my shift, I discussed it with a colleague on my break, I had a sense of foreboding. Shortly after I returned she passed away. Her family were accepting, and it felt very natural. People die. At some point our lives come to an end and hopefully we will be able to look back and say we have led a happy and fulfilled life.

It’s morbid but it does get you thinking about how you would like to go, I always thought I would pass in an adrenaline rush, doing something exhilarating. But on further reflection, I see now that there is nothing more beautiful than passing peacefully surrounded by those you love.

Patients are still patients despite the fact they have passed away.

Last offices mark the care transition between life and death and as a nurse you have the opportunity to experience closure when you perform last offices. Prior to the family saying their goodbyes, we went and ensured she was presentable. We closed her eyes and fetched a flower. I suppose it was our last gift to her. It’s not a practice that I think regularly occurs anymore, in fact my mentor said ours is the last ward in the hospital that still places a flower next to the patient. We asked the family if they were happy for us to do so, and they said they advised they were grateful for this gesture. Once the family had said their goodbyes, I had the opportunity to do so. I went and opened a window, no-one prompted me, but my colleague nodded her approval. Everyone has their own rituals when performing last offices. You are showing your respect to someone, by cleansing them and ensuring they are comfortable. We shrouded her and she looked peaceful.

That is the image that will stay with me. A woman who looked at peace, who was clearly loved by those she was close to.

She has donated her body for medical research to a university, it was part of her living will, and in a sense it felt right that as a student I performed her last offices. She has already taught me a lot and I’m sure in time others will benefit from her decision through learning.

A peaceful lady who in her passing taught me about respect and compassion and primarily about dignity.

Rest in peace and thank you.

Small steps

Sometimes you have a day when the last thing you want to do is crawl out of your warm bed at 6am in preparation of a 7am shift. You might be tired, you’ve worked long days that week and you have frankly hit a hump. Your apathetic and you slouch into handover with such a face of drudgery that your colleagues question if you are well. Everyone has them. Sometimes you feel like you need to witness a miracle to bring you back on course, to convince you that shift work is worthwhile and you are heading on a path towards a career where you can live up to expectation of a nurse who embodies the 6Cs.

But miracles are few and far between and in reality rehabilitation is a slow and steady process. From shift to shift you don’t see dramatic differences and sometimes it can be disheartening working with such poorly people, because, and it is a very simple need, you want people to get better swiftly.

Inspiration doesn’t have to come in the form of miracles though. My inspiration came today, not within nursing but when I spent the day with the occupational therapists and physiotherapists.

Today I remembered the reason I undertook this course. Today I witnessed my own understanding of a miracle, and a number of them. I was reminded that every small step forward is a huge step towards rehabilitation and towards getting better. I was also reminded about patient focus and the importance of individualized patient care. The necessity of getting to know your patients. The OTs and the physios get to know the patients back story, everyone I worked with knew a hobby or a like about the patient which was an instant conversation starter. The type of information that is not written in a patient’s medical notes, the information that you can only discover from talking to an individual.

When I began my placement I met a patient who had a stroke just before I started. He was dysphasic with left sided weakness, was bed bound and was frustrated with his situation which meant he would lash out occasionally. Today we took him on a home visit, he walked with the use of a wheelchair and had a grin on his face which would light up a room. It was emotional, and truly a beautiful thing to witness. In that visit I learnt a lot about the patient despite the fact he couldn’t talk, I learnt about his life through the explanation of loved ones. I saw where he lived, photos of his family and how cared for and loved he is.

By squeezing my hands for a yes, I managed to speak with a patient who couldn’t vocalize or open her eyes. She could follow commands and raised her arms when asked. She could hear us. It reminded me that you have to think outside the box when it comes to communication, and that everyone has a way to communicate, even if it is not immediately obvious.

Later, I witnessed a young patient who had a stroke earlier in the week walk for the first time on the parallel bars. The exuberance on her face was something to behold.

Today I was reminded why nursing is such a rewarding career. I was reminded that I really should be thankful for my own health. I was reminded that providing exemplary care is not just being competent and compassionate but also about getting to know your patient as a person.

Today was an incredible day.

Caremaker

So yours truly is now officially a Caremaker. If you haven’t heard the term before that may be because we are quite a new phenomenon (maybe phenomenon is an extreme descriptive term, but no harm in aiming high). Being given the title Caremaker means that I can stand up and call myself an ambassador for the 6C’s.

For those of you who like me struggle to read upside down these are; Care, Compassion, Competence, Communication, Courage and Commitment.

It’s effectively an NHS initiative inspired by the ‘spirit’ of the London 2012 Olympics and as the website describes they will ‘learn from the way Games Makers were recruited, trained and valued and  instilling the spirit of energy and enthusiasm they created’

From snooping twitter and the tags #6C’s #Caremaker and #proud they appear to have recruited exactly that. A further 120 Caremakers to add to the original 50 who are extremely excited to be involved.

I’m obviously thrilled, it’s an achievement to be picked as a Caremaker,  and I’m looking forward to meeting the others in the pack. It will be great to be surrounded by inspired people, positive attitudes can’t help but rub off on others so I am looking forward to help the vision of the Caremakers achieve it’s aim.

I’m already receiving emails about upcoming conferences and I have claimed myself a rather snuggly hoodie which I am pretty pleased with. Lets see where being a Caremaker will take me, whatever happens I look forward to the ride.

Greys Anatomy

I’m a student in healthcare and i have never watched greys anatomy.

Since I’m now living in hospital accommodation I have a lot of time to spare. Does that mean I should now switch on my tele and tune into Greys?

Would this be an error, would I just be watching drivel or would I actually enjoy it?

Still in two minds.

Nb. Have now spelt Greys right, shows how much I know

You know you live with nurses when your conversation around the dinner table revolves around the colour of faeces and who got the most vomit on their shoes today. Delightful.