Social

In all fields of nursing there is a term that induces intense headaches. "Social Discharge". Perhaps the patient has been declared medically fit, perhaps they came in with a minor complaint that could have been resolved by a GP but some social concerns were flagged by the nurse in A&E. For example the patent may live alone and be dishevelled, unwashed and by all appearances unable to look after themselves.

Whatever the reason at some point a nurse, usually a ward nurse will have to start the social services referral process. First you fill out a "Section2" when you first identify the patient may have care needs on discharge, this is filled out before the patient is medically fit for discharge just so social services have the patient on their books and are roughly aware of what the patient may require with this you have to fill out a box entitled "Estimated Date of Discharge". Can you imagine how hard it is to guess when a patient may be ready to go home when they first present to you?

Next up the "Section 5". This is a joint work between the nursing and medical team saying the patient is medically fit. On this form you suggest what care the patient may require, residential home, nursing home, home care, caters coming into the home up to four times per day. This then gets faxed off.

That was the easy part. Now you have to get together in a room with a social worker, physiotherapist, occupational therapist, nurse, doctor, dietician, speech and language therapist and a case worker whose job it is to co-ordinate proceedings. The purpose of getting all these highly paid, highly experienced professionals in the same room is to decide who pays for this patients post discharge care. If their care needs are severe everything will be funded by the primary care trust(pct). This never happens. Of their care needs don't meet the pct requirements it's down to social services. Social Services funding is means tested. If the patient has more than £12000 worth of combined assets then the patient is required to partially find their own care.

So after completing and faxing over twenty forms and then attending this meeting which can take hours. Bare in mind a ward nurse attending this meeting has twelve patients on the ward not being looked after as well as they could be for the duration of this meeting because the nurse "holding the fort" has twelve patients of their own. What is the inevitable outcome of all this? The patient isn't suitable for state funded care and will have to stay in hospital until the family have made private arrangements.

I was sat in that meeting for two and a half bloody hours! I am a high dependency nurse my job is to care for two very sick patients. When they are more clinically stable they go to the wards. I'm lucky in that my job very rarely involves discharges and social meetings.

Specialist Care

I hate this, I am sat at my desk looking at a patient recently sent to me from one of our cystic fibrosis wards.

Because we have wards staffed with nurses who are highly skilled and experienced in CF care I very rarely get to work with this kind of patient. Also because we are a high dependency unit I very rarely have to provide end of life(palliative) care. This patient is flirty-four, this is by far the oldest CF patient I have even heard of. She has been moved Into my care for end of life nursing.

It's not that I don't want palliative patients however my knowledge of her condition is textbook only, I fully admit I lack the skill and intuition that CF nurses have.

As a result my end of life care for this lady will be merely adequate, any dying patient deserves more than that.

Precious Patients

Every now and then we get patients in who are for one reason or another incredibly demanding. Some have spent years in expensive care homes with lots of well paid nurses and careers to cater to their every whim. These patients then come into hospital and expect the same treatment. Patent when the buzz you for the hundredth time to do something they are quite capable of, like moving a small object in arms reach to a new location still within arms reach they don't bother with words like "please" or "thank you".

It's hard to blame these patients it's how they have learned to live in their nursing homes. However you have two patients under your care as a high dependency nurse. By the time this precious patient is feeling better they have fallen back into their routine. However if you have one of these buzzer happy patients trying to monopolise your attention while waiting for a bed on the wards or a space back in their nursing home and a very sick patient who requires half hourly observations, multiple back to back IV's including inotropes and panic control on their relatives it becomes very difficult.

I am still trying to find a way to effectively help these demanding patients understand I am not the hired help without offending them. Sometimes you just have to be blunt with these patients so you can prioritise your time and ensure the sick patient receives the best treatment possible.

Stress

Well this year hasnt quite gone to plan so far. The prognosis for my eye condition has deteriorated considerably and shortly after receiving this news my wife suffered a traumatic miscarriage which almost cost her her life. She took three weeks off work to rest and recover, I did not, I threw myself into my work. I am not writing this for any kind of sympathy or shock reaction. I am writing this because my stress reaction interested me and I felt this was worth exploring.

Three weeks working fifteen hour shifts and single-mindedly ensuring my wife had everything she needed to get through this left me exhausted, lighter and sick. However I didnt feel stressed, over the years I appear to have build a complex mechanism for dealing with stress that operates entirely sub-conciously. I was fully aware that everything I had been through should cause me to feel stressed, a normal human being should feel stressed by these circumstances. I didnt feel stressed however all the symptoms were there, sleep loss, loss of appetite, my blood work showed evidence that my body was pumping out increased levels of adrenaline for a longer period than normal. I found I couldnt concentrate at work and then I became sick,

Which leads us to this post. My boss has insisted I take a few days off, he has been genuinely concerned about me and I suspect he has experienced a similar situation in his recent life. So I am sat at home, resting up and blogging to try and organise my mind.

I had never considered before the possibility that a person could be highly symptomatic of acute stress without actually feeling stressed.

Also normally I would not blog about anything this personal however the anonymity required for my nursing posts has afforded me to a freedom to bare all to complete strangers without fear or expectation. I have mentioned the cathartic application of blogging before however I am starting to wonder if it has a therapeutic application.