Ok so I could comfortably blog about some of the things I have experienced this week. I could use pseudonames and insert false information that is irrelevent to the main story in order to protect the Identity of the people I could blog about. As dull as it sounds my key experiences this week have all involved patients who deserve better than that. So no exciting stories for you all this week.
I'm moving house tomorrow. I've been shotgunning a combination of late and early shifts which means I am exhausted and in a pretty foul mood. I've just got one more shift(a late) before my two days off where I can rest, relax....and move house.
Thursday, 19 June 2008
Sunday, 15 June 2008
On time
How is it that I, the supernumerary, student nurse am always the last person to leave when the shift I am on finishes?
My shift yesterday had ended, my colleagues on that shift had all left the ward. I stayed behind to make sure that one or two urine samples were bottles, documented and sent for testing. I wanted to make sure a patient who was off her head on zomorph wasnt going to pull out her cannulas and ng tube. Whilst checking on her she vomited rather impressively.
None of this bothered me. I'd sooner come home and get a good nights rest knowing I had done everything I should have done at work than come home and stayed awake all night thinking 'damn I forgot to do X or check Y". I may only be a student but the level of autonomy I am given does come with a certain amount of responsibility. Especially when those who are meant to be supervising me have left the ward.
My shift yesterday had ended, my colleagues on that shift had all left the ward. I stayed behind to make sure that one or two urine samples were bottles, documented and sent for testing. I wanted to make sure a patient who was off her head on zomorph wasnt going to pull out her cannulas and ng tube. Whilst checking on her she vomited rather impressively.
None of this bothered me. I'd sooner come home and get a good nights rest knowing I had done everything I should have done at work than come home and stayed awake all night thinking 'damn I forgot to do X or check Y". I may only be a student but the level of autonomy I am given does come with a certain amount of responsibility. Especially when those who are meant to be supervising me have left the ward.
Friday, 13 June 2008
Proposal
I am in the process of writing up the plans for a little experiment. I have written a script that generates 10 mathmatical sums(+) using two digit numbers. The user is timed answering these questions. Thats not all, the user performs two normal runs of this script with 30mins in between and then starts drinking one pint in between each round of questions. The script records how many correct answers the user inputs and how long the user takes. My hypothesis is that there will be a peak efficiency level some time after the user starts drinking. I am factoring into this the knowledge that after the first hour the body metabolises one unit of alcohol per hour.
This experiment is largely inspired by Randal Munroe of xkcd both in a comment he made regarding rubix cubes during a talk at MIT. and this strip.
Heres a copy of my largely inefficient script (but it still works)
puts "Enter Contestant Name -"
name = gets.to_s.chomp
puts "Current Units Consumed?"
units = gets.chomp.to_i
count = 0
score = 0
time = Time.now
start = time.to_i
while count != 10 do
first = rand(99)
second = rand(99)
puts first.to_s + " + " + second.to_s + " = "
result = gets.to_i
if result == first.to_i+second.to_i
then score = score.succ
end
count = count.succ
end
final = score.to_s + "/10"
puts final
time = Time.now
finish = time.to_i
speed = finish - start
File.open(name, "a+") { |f|
f << units.to_s + " Units Consumed - " + final.to_s + " in " +
speed.to_s + " Seconds"
f << "\n"
}
This experiment is largely inspired by Randal Munroe of xkcd both in a comment he made regarding rubix cubes during a talk at MIT. and this strip.
Heres a copy of my largely inefficient script (but it still works)
puts "Enter Contestant Name -"
name = gets.to_s.chomp
puts "Current Units Consumed?"
units = gets.chomp.to_i
count = 0
score = 0
time = Time.now
start = time.to_i
while count != 10 do
first = rand(99)
second = rand(99)
puts first.to_s + " + " + second.to_s + " = "
result = gets.to_i
if result == first.to_i+second.to_i
then score = score.succ
end
count = count.succ
end
final = score.to_s + "/10"
puts final
time = Time.now
finish = time.to_i
speed = finish - start
File.open(name, "a+") { |f|
f << units.to_s + " Units Consumed - " + final.to_s + " in " +
speed.to_s + " Seconds"
f << "\n"
}
Wednesday, 11 June 2008
Food
It may not be the most glamorous part of the job but ensuring a patients dietry requirements are met and delivered in the most appropriate way has an important and direct effect on a patients wellbeing.
My ward has a variety of dietry requirements - diabetics, clear fluids only, high protein diets, vegetarians and even a vegan. Each day we fill out the patients menus for the next three meals. When we do this we write the patients dietry requirements into the 'dietry requirements' box. This means the kitchen who look at these menu's and create a tray of appropriate food know patient x has requirement x.
One of my patients is on thin fluids only. He has an NG tube in for feeding. This is a tube up the nose down into the stomach through which substances similar in description to gruel are pumped into the stomach. The patient can take thin fluids orally as well. This means he cant even have soup, however he is allowed ice cream if he allows it to melt. Today I nearly served him what the kitchen sent up for him....a large slice of pie. This wasnt too bad because even if I had allowed the food to get as far as the patients bedside he knows that he can not eat this.
Now imagine we have a patient with vascular dementia, or some other condition preventing them understanding or communicating when something isnt right. Say this patient is diabetic and we have requested a sugar free dessert. I cant tell if a desert has sugar in just by sight. This still isnt as bad as it could be. Now say this patient is vegetarian and we have requested quorn mince in his shepheards pie....still not bad enough? Say the patient has a fatal alergy to lemons....
We put a huge amount of faith in the kitchen. We have to believe what we are serving is what they say it is. And they are wrong on a meal to meal basis. The fact that the nurses dont allow incorrect food to get as far as the patients mouths is still bad enough to warrent a clinical incident report in my books!
My ward has a variety of dietry requirements - diabetics, clear fluids only, high protein diets, vegetarians and even a vegan. Each day we fill out the patients menus for the next three meals. When we do this we write the patients dietry requirements into the 'dietry requirements' box. This means the kitchen who look at these menu's and create a tray of appropriate food know patient x has requirement x.
One of my patients is on thin fluids only. He has an NG tube in for feeding. This is a tube up the nose down into the stomach through which substances similar in description to gruel are pumped into the stomach. The patient can take thin fluids orally as well. This means he cant even have soup, however he is allowed ice cream if he allows it to melt. Today I nearly served him what the kitchen sent up for him....a large slice of pie. This wasnt too bad because even if I had allowed the food to get as far as the patients bedside he knows that he can not eat this.
Now imagine we have a patient with vascular dementia, or some other condition preventing them understanding or communicating when something isnt right. Say this patient is diabetic and we have requested a sugar free dessert. I cant tell if a desert has sugar in just by sight. This still isnt as bad as it could be. Now say this patient is vegetarian and we have requested quorn mince in his shepheards pie....still not bad enough? Say the patient has a fatal alergy to lemons....
We put a huge amount of faith in the kitchen. We have to believe what we are serving is what they say it is. And they are wrong on a meal to meal basis. The fact that the nurses dont allow incorrect food to get as far as the patients mouths is still bad enough to warrent a clinical incident report in my books!
Tuesday, 10 June 2008
Governance
I wasnt planning to write this post for some time. However as the topic has arisen on various other blogs I thought I would follow suit.
My first real job in care was in a dementia nursing home. There I saw some of the worst care practice of my life so far. Patients needs, Moving and Handling Policy, Infection Control Policy, and many other important aspects of care went right out of the window. Even in my relatively unskilled months I immediately knew this practice wasnt right.
Recently allegations regarding a care home owner who was sexually abusing his residents were verified. I could spin off hundreds of other stories focusing on the poor practice in care homes. I wont do that, instead I intend to contrast it with the superb care practice in hospitals.
When a patient is admitted to a ward their care needs are fully assessed, as well as their personal needs. The nursing and care staff do their best to make the patient feel safe and comfortable and I've not heard of one incident locally that suggests patients have been taken advantage of in any way.
The only difference between care homes and hospitals is, in hospitals you've got lots and lots of people watching you're every move. Everything is documented, if the hospital legal advisers get so much as a wiff of poor practice you'll be out of a job. This doesnt happen in care homes, there are doors to close and limited(and mostly similar minded) staff to witness you're actions.
My question is this, if there was no governance in hospitals or if it was as limited as it is in care homes, would hospital care diminish to the same state?
My first real job in care was in a dementia nursing home. There I saw some of the worst care practice of my life so far. Patients needs, Moving and Handling Policy, Infection Control Policy, and many other important aspects of care went right out of the window. Even in my relatively unskilled months I immediately knew this practice wasnt right.
Recently allegations regarding a care home owner who was sexually abusing his residents were verified. I could spin off hundreds of other stories focusing on the poor practice in care homes. I wont do that, instead I intend to contrast it with the superb care practice in hospitals.
When a patient is admitted to a ward their care needs are fully assessed, as well as their personal needs. The nursing and care staff do their best to make the patient feel safe and comfortable and I've not heard of one incident locally that suggests patients have been taken advantage of in any way.
The only difference between care homes and hospitals is, in hospitals you've got lots and lots of people watching you're every move. Everything is documented, if the hospital legal advisers get so much as a wiff of poor practice you'll be out of a job. This doesnt happen in care homes, there are doors to close and limited(and mostly similar minded) staff to witness you're actions.
My question is this, if there was no governance in hospitals or if it was as limited as it is in care homes, would hospital care diminish to the same state?
Monday, 9 June 2008
First Week
Yesterday was the first shift I've really enjoyed on my new ward. One of the newly qualified nurses took me under her wing. I got a chance to bond with my mentor. It was good.
The icing on the cake was a ....discussion I had with the son of a patient. His mother was in a two person bay with another lady. This bay was directly opposite our isolation rooms(rooms for patients with conditions that require barrier nursing). He saw myself and an HCA running in and out of an isolation room, every time we changed our gloves and aprons(as per infection control policy). He approached me and suggested that this is where all the NHS money gets wasted, if we didnt use to many gloves and aprons his mother could be afforded her own private room. I pointed out to him that if i didnt use the gloves and aprons and then went to his mother she would indeed have a private room because she'd catch C. Diff or MRSA. This seems to turn his anger into embarrasment but he still rufused to be wrong and as he walked back into his mothers bay he uttered 'right, well just watch how much you waste'. It was a good moment.
Its public misconceptions like this that really annoy me. Mainly becuase they are fuelled almost entirely by the media. I intend to explore this in more detail at some other time.
For now I'm sat at home, its a nice day outside. I'm enjoying a day where I dont have to be my 'professional self'. This means I can swear, drink, laugh heartily, run about, and just be me. Its nice.
The icing on the cake was a ....discussion I had with the son of a patient. His mother was in a two person bay with another lady. This bay was directly opposite our isolation rooms(rooms for patients with conditions that require barrier nursing). He saw myself and an HCA running in and out of an isolation room, every time we changed our gloves and aprons(as per infection control policy). He approached me and suggested that this is where all the NHS money gets wasted, if we didnt use to many gloves and aprons his mother could be afforded her own private room. I pointed out to him that if i didnt use the gloves and aprons and then went to his mother she would indeed have a private room because she'd catch C. Diff or MRSA. This seems to turn his anger into embarrasment but he still rufused to be wrong and as he walked back into his mothers bay he uttered 'right, well just watch how much you waste'. It was a good moment.
Its public misconceptions like this that really annoy me. Mainly becuase they are fuelled almost entirely by the media. I intend to explore this in more detail at some other time.
For now I'm sat at home, its a nice day outside. I'm enjoying a day where I dont have to be my 'professional self'. This means I can swear, drink, laugh heartily, run about, and just be me. Its nice.
Thursday, 5 June 2008
First Day
My new ward is really nice. The people I'm working with seem very close and friendly. This is definitely an environment I can happily spend the next three months in. I was a little amused that the only full time mentor I have has an equal(or lower) level of qualification than myself. She is a healthcare assistant. Fortunately for me shes a very experienced HCA. We may have the same textbook knowledge but in the world of healthcare experience means a hell of a lot more. My primary mentor is a sister and shes currently on annual leave. My secondary mentor is only a part-timer.
Most of the patients on this ward(acute repiratory medical) are not in fact suffering from respiratory conditions. This is a common in the NHS. At any one time you wont find a specialist ward with enough patients for that specialty. However more generic wards usually find themselves full. My last ward was an elective orthopaedic surgical ward. The patient turnover was insanely quick because the NHS is trying to cut its waiting lists down. This means getting a patient in, operated on and discharged as quickly as possible. The ward managed to do this without negating patient care. Towards the end of my stay there about a quarter of the patients were not orthopaedic, they were vascular.
A solution to his is not to expand the wards that are always over flowing, because there are no consistancies in which wards need more beds. One month there may be too many cardiac patients, the next month there may be very few cardiac patients but too many urological patients. This is why wards like 'Elderly Acute Care' have been created. If the patient is not in direct need of very specialist supervision then they can be placed on this ward where the staff are of mixed disciplinary backgrounds. One bay in this ward may have patients for urology, cardiology, neurology and pulmonology. The idea is a good one.
I hope my ward gets a few more respiratory patients soon, not that cellulitis, and hep C arent facinating but I was hoping experience in acute respiratory care would serve me well in my critical care future.
I cant believe how out of shape I am. Since the end of my last placement on March 14th I have put on 13kg and have gone from a 34" waist to a 36. I spent most of yesterday sweating. Fortunatley I wasnt the only one. It was a hot day and apparently the ward was very busy. However what this ward is calling busy was a moderately quiet day on my last ward. This was a surprise.
Most of the patients on this ward(acute repiratory medical) are not in fact suffering from respiratory conditions. This is a common in the NHS. At any one time you wont find a specialist ward with enough patients for that specialty. However more generic wards usually find themselves full. My last ward was an elective orthopaedic surgical ward. The patient turnover was insanely quick because the NHS is trying to cut its waiting lists down. This means getting a patient in, operated on and discharged as quickly as possible. The ward managed to do this without negating patient care. Towards the end of my stay there about a quarter of the patients were not orthopaedic, they were vascular.
A solution to his is not to expand the wards that are always over flowing, because there are no consistancies in which wards need more beds. One month there may be too many cardiac patients, the next month there may be very few cardiac patients but too many urological patients. This is why wards like 'Elderly Acute Care' have been created. If the patient is not in direct need of very specialist supervision then they can be placed on this ward where the staff are of mixed disciplinary backgrounds. One bay in this ward may have patients for urology, cardiology, neurology and pulmonology. The idea is a good one.
I hope my ward gets a few more respiratory patients soon, not that cellulitis, and hep C arent facinating but I was hoping experience in acute respiratory care would serve me well in my critical care future.
I cant believe how out of shape I am. Since the end of my last placement on March 14th I have put on 13kg and have gone from a 34" waist to a 36. I spent most of yesterday sweating. Fortunatley I wasnt the only one. It was a hot day and apparently the ward was very busy. However what this ward is calling busy was a moderately quiet day on my last ward. This was a surprise.
Tuesday, 3 June 2008
Placement Two
Tomorrow morning I start a new placement on my new ward. This placement is on an Acute Medical Respiratory ward. This is much more my style. My last placement was incredible however the specialty really wasnt for me. Orthopaedic Surgical Elective? well I think orthopaedics is just carpentry. I have based this on the drills, hammers, chizels and nails they use. Surgical wards really dont interest me too much either. Surgery is more anatomy than physiology. As much as I love anatomy I find physiology far more interesting. This is where I am hoping this placement will interest me. Medical wards focus on non-surgical care and thus take a much greater consideration of the bodies mechanical, chemical and electrical processes(physiology).
In theory I was meant to start today, however two of my mentors are on leave and the remaining one is only part time so they rota'd me as a day off today giving me a chance to relax after yesterdays exam. This placement is considerably longer than the two months I worked on my last ward. I'll be there until the 19th of August. Somewhere in there I have a week or two off.
Given my previous ward experience was on a laid back, elective surgical ward I am a little concerned that I'll be unprepared for the intensity of an understaffed acute ward. Especially given in times of medical emergency my mind falls back to its training which does not include my new role as "student nurse". Whilst mthis role should protect me from having to do anything other than observe in a medical emergency, my enthusiasm and apparent aptitude for those situations usually leaves people forgetting I am just a student.
As soon as I finish this placement I have four weeks in lectures then I start my next placement. I have no idea where that will be but it will only be a couple of weeks long.
Hopefully this placement will give me lots to learn, experience and blog about .... whilst abiding the rules of the Nursing and Midwifery Council Code of Professional Conduct(2008) in regards to confidentiality of course.
Wish Me Luck
In theory I was meant to start today, however two of my mentors are on leave and the remaining one is only part time so they rota'd me as a day off today giving me a chance to relax after yesterdays exam. This placement is considerably longer than the two months I worked on my last ward. I'll be there until the 19th of August. Somewhere in there I have a week or two off.
Given my previous ward experience was on a laid back, elective surgical ward I am a little concerned that I'll be unprepared for the intensity of an understaffed acute ward. Especially given in times of medical emergency my mind falls back to its training which does not include my new role as "student nurse". Whilst mthis role should protect me from having to do anything other than observe in a medical emergency, my enthusiasm and apparent aptitude for those situations usually leaves people forgetting I am just a student.
As soon as I finish this placement I have four weeks in lectures then I start my next placement. I have no idea where that will be but it will only be a couple of weeks long.
Hopefully this placement will give me lots to learn, experience and blog about .... whilst abiding the rules of the Nursing and Midwifery Council Code of Professional Conduct(2008) in regards to confidentiality of course.
Wish Me Luck
Sunday, 1 June 2008
Careful
It appears one of my favourite bloggers, An A&E (ER to those of you in the colonies) nurse here in the UK, has been outed. She has been writing about one or two subjects that are grey areas in nursing. Our professional bodies clearly think so. She has been threatened with being sacked or struck off the professional register.
Those of you out there who blog about your professions that dont have a professional governing body are lucky. Professional ethics should apply 24 hours a day 7 days a week. Drunk or Sober. Despite the day, week or month you've had. Our professions can kick the crap out of our spirit but we still have to present our every outward expression with a mind to how our actions may be interpreted by a politically minded group designated to judge us.
Ok rant over. I would now ask you ladies and gents a favour. I know I rant, I have a hard time controlling myself. However if any of you deem my words on here inappropriate in regards to my profession I would appreciate you warning me.
Those of you out there who blog about your professions that dont have a professional governing body are lucky. Professional ethics should apply 24 hours a day 7 days a week. Drunk or Sober. Despite the day, week or month you've had. Our professions can kick the crap out of our spirit but we still have to present our every outward expression with a mind to how our actions may be interpreted by a politically minded group designated to judge us.
Ok rant over. I would now ask you ladies and gents a favour. I know I rant, I have a hard time controlling myself. However if any of you deem my words on here inappropriate in regards to my profession I would appreciate you warning me.
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