Hippocrates Got Lost

New Year, New Rules

2012-01-02T13:18:00.002Z

As always I feel a sense of hope when starting a new year. What will I learn or discover in the coming twelve months, How will my life be altered, who will I meet and what stories will I have to tell come december?

I know this year will be filled with work, because every year since I turned sixteen has. Where will my career lead me this year? My plan is to stay where I am for at least another sixteen months(which will take me to the two year mark). I always intended to move on from this post at two years....or when the learning curve no longer satisfies me. Fortunately I am quite happy learning and developing my skills at the moment so in all probability I will remain on a specialist high care unit for a while longer.

I have two holidays planned, One for my birthday I want to return home to cornwall, however this will be my wifes first trip to my home county and I wanted to experience something new with her so we are going to Mevigissey on the south coast of cornwall, a place I have never been before(to my recollection). It looks beautiful. We are renting a cottage in March, hopefully this will avoid the masses of tourists that flood the streets of cornwall every year. If anyone has been there I would appreciate some feedback. My second holiday is my yearly fellwalking trip to the lake district. We may go twice, the first time I'll take my wife and one of my friends, as my wife dislikes fellwalking but enjoys the view and the solitude with a good book. This will allow me to safely tick a few more fells off my list. The second time I shall just take my wife and we can enjoy a cosy week perhaps just before winter when there is benefit to snuggling up by a fire.

Many of my friends and family have expressed an expectation that children are the next immediate step to my marriage, Whilst if my wife fell pregnant I would by no means be upset I am currently enjoying being a young newly-wed with the finances and time to see more of the world. However time changes many a plan so who knows how many members of my family there may be come December.

Unfortunatley there are also some expected deaths in my family this year, I hope that when these wonderful people pass it is in comfort and peace. They are stout methodists so I also hope they find some comfort in their peace and find whatever it is they are looking for beyond this life.

I feel I have ended this brief post(hopefully the first of many for the year) on a sad note. However it would be niave to expect the new year to bring only happy things. I just hope that the good outweighs the bad for myself, my friends, family and whatever readership I have retained on this blog.

Happy New Year Everyone

Perfect Moments

2011-11-13T08:53:00.001Z

Life has been so hectic recently, When I am not at work I'm thinking about work. Financial and other such issues work their way into my head too.

Not so now.. Its a beautiful sunday morning. I am sat with my cup of freshly brewed coffee, the beans I bought from salisbury market yesterday(a wonderful Gautamalan dark roast). My wife has just left for work but we spent a great day together yesterday, and I am listening to song light folk music.

This may not be your idea of perfect, dear reader. However my advise to you is this go into the world today and seek out your perfect moment. Find it, sit in it, take a deep breath and smile. This is what life is, a series of perfect moments interconnected with unimportant worldly matters.

This Weeks End

2011-11-11T10:00:00.001Z

This has been a rough week. I have worked far too many shifts, most of which have involved heated clashes and extreme differences of opinion in appropriate patient care with other professionals. It has been a week of fatigue, anger and frustration.

Fortunately I now have six days off(just part of my offduty, I worked the first four days at fifteen hours a piece of this week and next week all my shifts are at the end of the week). This would be a much more welcome piece of information if I were not broke. I am being paid well enough, I am very careful with my money and dont really go in for luxuries, I am a very practical person. So why is it my wages are lasting less and less each month? I've noticed no obvious increase in any of my bills or normal expenses. I am still managing to cover all my outgoings but it it a little troubling,

I guess this will be just another month of work and staying at home. It could be worse I guess....

Just Business

2011-11-06T19:03:00.001Z

The following is based on a conversation I was having at work the other day with a few of my medical and nursing colleagues.

We are all feeling a little disenchanted with healthcare at the moment, More and more the focus is being shifted from patient care onto costs and public ratings. If you look in the stock cupboard of any ward in my hospital, on the shelves beneath the boxes containing all the equipment we use on an hourly basis, are labels telling us how much each item has cost the hospital.

Pharmaceutical companies spend hundreds of millions researching and trialing new drugs, and if the drug works really well they pub a massive price tag on it. In some cases this prices the NHS out. We cant afford to buy drugs with high efficacy ratings. I know drug companies have to recoup their investments but once they have done that and start making a substantial profit they still dont drop the prices, so my patients are receiving treatments that whilst still largely effective are not the best on the market.

My hospital recently had a status upgrade, we are now a foundation trust, this means that we receive a slightly increased budget from the Department of Health, but more importantly we get to say how we spend our money. In a normal trust the DoH give you x amount and say you have to spend 10% on this department and 4% on this department. So this financial liberty is a great first step in ensuring we can provide better care......right? I mean we can personalise our budget so departments like sexual health can be downsized as in this area there is an unnecessary abundance of sexual health clinics, the hospital should not be required to provide another, superfluous service. Cutting off the fat should be a good thing.....RIGHT?!. Apparently not, my hospital has just spent over £320,000 on the name change, literally just adding "foundation" into its name on all the signs and headed note paper. £320,000 is how much it would cost to hire thirteen new staff nurses for a year. However clearly the name change is more important. I am sure there is some legal issue requiring the immediate name change however it just annoys me when I am struggling on a ward that has to rely in agency staff of questionable skill and training on a daily basis. Even the best agency nurse wont work at full efficiency on a ward that is not her own.

The nature of healthcare and medical progression is such that it is now possible to offer individually tailored treatments for most ailments. Something like asthma, you can now manufacture drugs in a lab based on an individual patients precise unique physiology, offering a treatment so good its almost a cure. We cant afford that, so when I get a brittle asthmatic in, a normal every day human being whos caught a cold, and she asks me if there is anything else I can do to stop her suffering(and having lungs so inflammed the body is screaming for more oxygen would be my definition of suffering) and I tell her "the salbutamol, aminophyline and magnesium are the treatments we give all our asthmatic patients, you'll be feeling better again in a few days". How can I keep a straight face knowing there are drugs out there that could have her home the next day, or even prevent the acute episode to start with, but they are too expensive for the NHS.

Most Doctors and Nurses get into the job because we want to help people(its sure as hell not for the money or the high quality of life health work provides). Unfortunately our bosses are keen to remind us a hospital is a business.

Energy Drinks

2011-07-28T09:21:00.000+01:00

I was just reading a facinating case study about a patient who was admitted to an emergency department in London. The patient presented with repeated unexplained fits, he was unconscious, tachycardic(fast pulse) at 160 with an irregular rhythm. His oxygen saturations were 52% on air(should be over ninety, anything less than eighty is extremely worrying). All this paints the picture of a patient in a lot of trouble. He had a past medical history of heroin and cocaine abuse however was in a halfway house following a successful rehabilitation process. His toxin screen and drug tests all came back negative but his blood ph was extremely acidic at 6.2 (I wasnt even aware this was compatible with life).

It turns out he had drunk a mug of coffee and six cans of red bull in the space of four hours. This had taxed his heart, brain and lungs.

My sister drinks loads of energy drinks more or less constantly. I cant help but wonder what effect these drinks are having on her and where they may lead.

Tragedy

2011-07-24T09:34:00.000+01:00

This comment started as my facebook status however one of my contacts(at the time very drunk) posted some incredibly inappropriate comments in reply so I felt I should move the original statement here and invite any who could present a sensible comment to do so.

Any loss of life is a tragedy however the fact Amy Winehouse is getting more media coverage than the ninety-five dead in Oslo and the twenty(potentially up to fifty) victims of that nurse in manchester suggess we have some serious priority problems in this country.

I will admit to having taken issue with Amy Winehouse in the past on the basis that anyone who has celebrity status has a responsibility as a role model. Amy influenced a new generation of teenage drunk junkies.However was she like that before she became famous? I refuse to believe anyone becomes addicted to anything willingly, some trigger usually provides the push. Her passing so young is very sad. I would not normally hazard a guess at cause of death before it has been officially released but I feel it is a safe bet that it is something drink or drug related.

On the other side of the coin, the near one hundred dead in Oslo were the victims of a randomised attack by an extremist. The victims gunned down at the youth camp made no choices that could have forseeably resulted in their deaths, they were just in the wrong place at the wrong time. As far as the bombing goes I have to admit my heart stopped when I heard a developed country had been bombed. Whilst the act was horrendous I am very glad the "terrorist" was a Norweign national and thus an internal issue. We all know the result of the last bombing on a developed western country by an eastern power.

Rebecca Leighton a twenty-seven year old nurse has been charged with deliberately contaminating bags and ampules of saline with insulin. We use saline for everything, mixing IV powders into liquids to be injected, we add drugs to bags of saline for long duration infusion and we very frequently give saline bags on their own as they are designed to quickly hydrate our patients. Where I work almost every patient has a bag of saline going up constantly. What sickens me is that all of our patients are vulnerable, they have placed their faith in us as nurses and the thought of someone abusing the trust has sent shockwaves throughout the nursing world. There are no good reasons insulin would be introduced into saline unless for immediate use. I just hope that this does not effect how safe my patients feel in my care, I work really hard to build and maintain the crucial patient-nurse trust. And once again these were victims of the actions of another.

All three cases are tragic however I do feel hundreds of innocents dying superceeds the potential suicide or accidental overdose of a girl who knew which path she was on and where it would ultimately end.

New Job

2011-06-28T11:30:00.000+01:00

As the title suggests this post was intended to be about my new job. I am now a Medical High Dependency Nurse(sort of semi-specialising in respiratory high care). I love my new job I am encouraged to think about my patients. I am now equipped with training(and the beginings of experience) that allow me to assess, analyse and intervene with highly unstable patients. This is much more my environment. The move was made largely thanks to my wifes constant nagging(I was miserable and disinclined to do anything about it) but also something Sage said that went along the lines of "ask yourself two questions, why are you miserable and is the cause likely to change" the answer to both was no so I moved.

Due to the highly sensitive nature of most of my cases at the moment I dont really feel comfortable posting about them(maybe later). Fortunately I have other material. Last night (27/06/11) a new series aired on channel four. Sirens is a dark comedy based loosely around the works of Brian Kellet(Tom Reynolds). I admit at times the combination of dry wit and blunt please the masses comedy grated on my nerves a bit however I found it very entertaining, worryingly accurate of the mind-set of most healthcare workers and carrying an interesting and important message.

Without giving too much away, three ambulance techs go through a particularly traumatic call-out, this episode follows them through the post-trauma reaction. Adrenaline had flooded their systems creating a euphoric high, they then become very restless and then they experience an adrenal crash. This is summed up in the title of the episode "Up, Horny, Down". The EMT most directly linked to the traumatic event declares he can defy his biology and control this reaction. He spends the next twenty-four hours trying not to given in to these adrenal responses. As it turns out his efforts are just another defence mechanism, allowing him to distract himself.

This hit home rather. On a day to day basis most healthcare assistants, nurses, doctors, emergency medical technicians and paramedics see and do things that the human body is instinctively progamed to avoid. Yet time after time we throw ourselves towards these situations. All healthcare professionals are more than well acquainted with the "Up, Horny, Down". In addition to this it doesnt take long for any new healthcare professional to discover their own defence mechanisms that allow them to move on following a traumatic event and deal with the adrenal response. Mostly this does involve learning how to distract yourself.

The constant exposure to this sequence of events is incredibly unhealthy and against every biological urge. We just keep dealing with it and there are surprisingly few mental health issues related to healthcare work(except the slightly higher than average alcoholism rate). I cant help wondering that long term effect this system will have on me, my wife and my friends.

Married! The Finale

2011-06-14T10:14:00.000+01:00

So far I had gotten through the ceremony and my speech without slipping up. I was fully aware that my only three duties that day were the ceremony, the speech and the first dance.

The latter was causing me come concern. I had been receiving dance lessons in order to respectably pull off my first dance. I am not exaggerating when I say I am completely unable to dance, its never been a requirment in any training or education I have received, added to this while all my peers were informally learning to dance by going to nightclubs I always opted for a nice warm pub.

The DJ called for myself and my wife to take to the floor for our first dance. Lonestar - Amazed started and we started our.....routine. It was going perfectly and I was rather proud of myself for not placing my size fourteens on either my wifes dress or her tiny feet. We were about thirty seconds from the end of the song. I was nearly done! ....then disaster struck, the audio cut out. The DJ was terribly embarressed but promised to sort it out swiftly. At which point five of my friends sprung into action - A sound engineer, an electronics engineer, a network engineer, a functioning genius and most importantly a pub landlord who had his own mixing desk in the boot of his car. Within five minutes we were set back up. We restarted our first dance and completed it well. So I managed to get two first dances. This situation didnt bother me, everything elese was going so smoothly that this just added a little character to the evening. Myself and my wife then took our own mothers to the dance floor and everyone else joined us. Halfway through the first song one of my best men did something that really impressed me, He cut in for a dance with my mother. Good Man!

The rest of the evening passed without event, the hog roast was stunning, the DJ sang various incredible tributes to the ratpack and then did the rounds performing magic tricks. I wasnt expecting magic! The night ended with a few songs tailored for my enjoyment - Kansas, Boston, etc

All in all it was a perfect day. We got to celebrate the most important day of our lives with those we love, ate well and got to party well afterwards. We liked the hotel so much I ended up booking hte honeymoon suite for another night and spending the following day in the spa.

|The day after we set off for the lake district where we spent a week doing absolutely nothing and loving every second of it. Now we are just waiting for the official honeymoon in september......

Married part Two

2011-06-12T10:48:00.000+01:00

Waking up the morning of my wedding I had a bath(with bubbles) and prepared a cereal breakfast for my best man(still my guest, rules of hospitality always apply!). Unsurprisingly I had no appetite. We donned our suits and he, having trouble with his cravatte offered me assistance with mine "they are tricky buggers to put on, let me sort yours out".

Later that day, just before the ceremony I had my chat with the registrars, during which I explained that I was legally and physically fit to marry under the laws of the united kingdom. One question that amused me as all anachronisms do - "are you free born and a citizen of the United Kingdom?". Fortunately in this day and age I was not born a slave......strange question!

Shortly after this I was stood in the hall, the majority of my guests sat before me and my best men stood beside me. At this point I should stress that the temperature when leaving my house was twenty-eight degrees, that was at half past nine, it was now midday, as people piled into the small room the temperature steadily climbed to what was apparently my melting point. On occasion a guest would arrive late, the music would stop as the door opened, when realising it wasn't my bride the music restarted. After the fifth time this happened my nerves were shot. Eventually the bridal party arrived at the door, headed by our reluctant page boy.

When I caught sight of my near-wife I became breathless, as she walked towards me and stopped beside me I became aware of the registrar saying something. I still have no idea what it was, my entire universe was focused on how incredible the woman beside me looked. I know it sounds cliche and because of the cliche I thought I was equipped to deal with the situation.....I wasnt.

Before the ceremony formally started my best men took their seats and a very dear friend stood. She was shaking uncontrollably in front of seventy odd people. However her voice rang out beautifully as she delivered our chosen reading. Shakespeares sonnet 116, I know its well used but I like it and the friend delivering it has a voice of pure fragile beauty perfectly suited for this one task.

"Let me not to the marriage of true minds
Admit impediments. Love is not love
Which alters when it alteration finds,
Or bends with the remover to remove:
O no! it is an ever-fixed mark
That looks on tempests and is never shaken;
It is the star to every wandering bark,
Whose worth's unknown, although his height be taken.
Love's not Time's fool, though rosy lips and cheeks
Within his bending sickle's compass come:
Love alters not with his brief hours and weeks,
But bears it out even to the edge of doom.
If this be error and upon me proved,
I never writ, nor no man ever loved."

She delivered this not just in pure, clean, crystal clear english. But also in perfect Iambic pentameter. No small feat when suffering severe stage fright.

The rest of the ceremony took place with ....minimal tears. Once it was all done we all retreated to the lawn for photos. At which point my wife told me that my cravatt was the wrong way around(thank you best man). A small point which NO-ONE else picked up on but which she is clearly never going to let me forget. A great number of photographs were taken in various places. Bubbles were used in the place of confettii as we were in the New Forest and it seems they get a bit shirty about people throwing loads of paper around. We then formed a recieving line and greeted all of our guests into the hall for the wedding breakfast(a massive lunch). My brain was struggling to keep up with the ettiquette as person after person appeared in front of me (do I know this person well enough to hug? is a handshake appropriate.....AHHHH!). After more hugs, kisses and handshakes than I care to remember we were introduced to the room as "Ladies and Gentlemen, please be upstanding for the new Mr and Mrs ******". We were then walked into the room and to our seats via the long route. Orders for the starters were taken and these incredible little plates were placed in front of us, I chose the salmon....it was a good choice. When main course food was ready we were taken up by the staff, they asked us what we wanted and collected it on a plate, and carried it with us back to our seats(I could get used to this). At this point we were all fairly well plied with wine and it was obvious in the room it was having good effect as a social lubricant. The guests then went up for food, surprisingly for both families not one person complained about the food(it was that good). After a number of speaches(my best mans going down in infamy). We exited the room and everyone was given time to relax before the reception. I took this time to investigate my room and have a shower. As it turns out my room was bigger than my house and I got a little lost inside it. The shower was much needed. I got back into my suit and found myself at the bar with a double straight GlenMorangie(my favourite whiskey).

I sedately socialised with friends and family and greated friends as they arrived for the reception.

This is a good place to end part two.

Lessons from this part - Never trust another man to dress you. Your best mans speech will almost always beat yours, In extreme times of dire need your family may behave themselves.

Married! part One

2011-06-10T15:22:00.000+01:00

Breaking News: I have fallen from the noble bacheolar ranks.

After years of planning, saving and a surprising amount of stress I got myself married on June 4th at Careys Manor in Brockenhurst. For those who dont know the manor its a very large manor house/four star hotel in the middle of the new forest.

The night before the wedding my wife stayed at the hotel and enjoyed their spa facilities. I stayed at home with my best man and enjoyed a bottle of wine with some friends. Whilst my wife was being pampered I was recieving regular phone calls from people we entrusted with small but vital tasks. Things like taking my MP3player and speakers and switching the music from Einaudi which was playing whilst people were milling around to Jason Maraz which my wife chose to walk down the aisle to. This small task just involved pressing a button and I had previously felt bad that this was the only task I had given one of my closest friends. However this friend has a gift for overcomplicating things and had decided my speakers were too weedy for the task so he had acquired some very large "monitors"(to my lack of knowledge they are little more than just speakers) with a mixing desk, ripped my music and attached all this to a laptop. I get a phone call at 2200 the night before I am to get married saying he cant get this system working and appears to have lost the music I gave him in the first place. Some people just have a gift for overcomplicating the simplest of tasks. I strongly suspect this issue would not have arisen had this friend not fallen under the influence of another, an electronics engineer of our aquaintence. Fortunately My friend from glasgow had just arrived(following a ten hour drive down) and he was staying in a B&B near Careys Manor. We threw my stereo and a second mp3player in the back of his car. At which point friend A called back saying he "thinks" he's sorted it. We left my kit in the back of the scottsmans car anyway.

I have to confess with slight shame and embaressment myself and my best man were unsure of how to put cufflinks on.....we had to consult youtube. This was his suggestion and it was a good one, This is why I chose him as best man. He didnt have all the answers but he knew where to get them.

The night before the wedding was hot, very hot and stuffy. I probably wouldnt have slept through my nerves anyway, however I could definitely have been more comfortable, I dont do a good job tolorating the heat at the best of times. Its funny though, my nerves were entirely focused on administration. People have been hasing me for about a year now "are you nervous". I have been with the new Mrs Asklepius for five years, known her for a lot longer, I had no nerves about marrying her, frankly if I was to have any doubts I would have felt them years ago. However given the sheer number of people we were relying on for this enormous organisational feat I was worried about it all falling apart.

As it turns out things couldnt have gone more smoothly. From the second I arrived the Manors wedding facilitator sat me down at the bar with a complimentary pint of guinness(which I've just realised I didnt drink). She told me to relax and mingle with my emerging guests and she would fetch me when the registrars arrived for my pre-wedding chat.

This is probably the best place to end part one of my wedding day.

The lessons to be learned from this section - Always have a backup plan no matter how much you trust the person performing the small vital tasks. At no point on your wedding morning will you be sat still long enough to enjoy a pint, If in doubt.....youtube will probably have the answer.

I'm really back this time.

2011-06-10T14:58:00.000+01:00

After many false starts I decided to leave this blog until I had more time and some new experiences to tell you all about. The last few months have probably been the most active of my life. I have(I hope correctly) set my next five posts up to time release so this blog should be increasingly active. I also have drafts for at least ten more based on notes I have been making for the last three months.

A little indicator of what has been going on in my life - I am now married! I have a new job, I have discovered various new ales and my reading list is finally getting smaller after years of books being added at a greater rate than I can read.

Hopefully at least some of this will provide passable reading to anyone still keeping an eye on this blog.

Balance

2011-02-19T18:05:00.000Z

Its taken several months of soul destroying work. Dragging myself out of bed every morning with no real incentive past the desire not to be beaten. Going into work and coming home feeling aweful. But I have finally found a balance. The negative aspects of my work are still present but I have somehow found myself happy again recently. I am not taking my work too seriously(past the life or death decision making). My plan is still to leave this ward as soon as I have reached the one year mark. One years experience is invaluable in nursing and it is the stage at which newly qualified nurses are expected to move on to new areas in order to expand their field of experience.

I have discovered one or two new hobbies. Astronomy being the first. Following several hours in a dark field a month ago with a friend and an expensive camera I suddenly realised how mind blowing some aspects of astronomy can be. With the naked eye you can actually see other galaxies, entire clusters of solar systems with light that has taken hundreds of thousands of years to reach us. Many of the stars visible may be long gone. unc

I have also started working on my family tree with the use of various local records and internet sources. Fortunately I have a fairly uncommon surname ....infact most of the surnames in my family tree range from uncommon to rare. Theres a lot of interesting stuff in there and I have dug up a few photos of my family from many generations back and I have even found a hand written letter, written by my great-great-great-great-grandmother. Between the spelling and the handwriting its taken me nearly a month to decipher it.

I've also managed to find my great-grandfathers world war two RAF dogtags. The trouble is I am still fairly new to this so I cant figure out where I can search for records with just a surname and service number.

In addition to this I've also rediscovered my geeky side. I've spent a week off fixing laptops, PCs and coding in perl. Its been incredibly therapeutic. Although I have to admit one of the laptops is bothering me. I'm still not entirely sure what was wrong with it, or how I managed to fix it.....but its working now. This is a perfect example of how my mind works I am never satisfied with a solution if I dont have a complete understanding of the problem.

Viney!

2011-01-06T12:50:00.001Z

I've had a week off and as. Result I have been calm and relaxed. So this morning I've tuned into Jeremy Vine just to experience a healthy amount of rage and frustration. One idiot caller in particular phoned stating that "the NHS is in ruins because all these cheap foreigners are taking english nurses jobs". Tuis made me wince. Its people as ill informed as this that keep the bnp going.

So I thought I'd shoot holes in this statement here.

1. every healthcare professional in the NHS is being paid on a banded system. I am a staff nurse so I am in pay band five. I am on Exactly the same pay as every other staff nurse in the country regardless of race, gender or eye colour.

2. There is no shortage of nursing jobs in this country. Infact both trusts I have worked at have declared crisis because they can't fill all the nursing posts they have.

3. The reason nurses from places like the Philippines appear to get more jobs than english nurses is because the level of training in the philippines is far better than the standard of training here. Most philippino nurses graduate with education and experience that takes an english qualified nurse ten years to catch up with. Also all of the phillipino nurses I've worked with have worked harder than anyone else whilst english trained nurses have spent more time complaining.

This caller really annoyed me and I think its because hers was the voice of the vox populi. Ill informed, ready to blame everyone but herself, but violently prepared to voice her opinion. In some small way I can see a comparison between people like this and a certain German political movement in the 1920/30s.

There we go. Another rant over. I hope everyone had a great Christmas and new year.
Sent from my BlackBerry® wireless device

Christmas

2010-12-23T13:44:00.000Z

I have a couple of days off now before my fourteen hour shift christmas day. Myself and my fiancee are currently on the A34 on our way to Cheltenham where two of her friends are getting married tomorrow. I have recently discovered how to post by emailing from my phone. Empowered by the spirit of adventure I thought I'd use this system for posting today and I've even tried to add a picture of my first activity when I get to Cheltenham. Although I'm not sure of I can add pictures this way.

I'm glad to have the day off. My body is still aching from my shift yesterday. My ward is the only ward in our division that isn't closed to admissions due to diarrhoea and vomiting. This means that when ICU needs to move a few patients out to make room for the very sick all of their high care patients are coming to us. Every patient I cared for yesterday was very sick. I am very proud of myself, I did not bow to the pressure of my superiors to work faster and spend less time with each patient. I took my time, prioritised and yes I did forego my breaks and I even left an hour late but everyone one of my patients became stable largely due to my actions. I even found the time to feed two patients and acquire some mouthwash for one patient who has developed very painful mouth ulcers which are limiting her nutritional intake.

Having spoken to the other newly qualified nurses on the ward we are all equally displeased and have even gone as far as saying we are wasting our days off panicing about our next day at work and who we might be working with. The knowledge I am not alone in feeling this way has helped me considerably. I am enjoying the acuity and the patient groups. Who I work with and the lack of support are obstacles to be disregarded until such a time as they can be overcome.

I wish all of my readers a very happy Christmas. Eat well, drink to the upper range of your limits and most importantly be safe.
Sent from my BlackBerry® wireless device

Vintage Whine

2010-12-20T12:39:00.000Z

So it turns out that I'm not enjoying being qualified. I am enjoying the job, just not where I am doing it. I am entirely unsupported and the team I'm working in consists of people who don't know or like each other. Not exactly a friendly environment. I have to admit I am currently living day off to day off.

I was trying to hold off posting until things picked up however all evidence suggests this won't happen so here I am submitting another whiney post.

Sent from my BlackBerry® wireless device

Qualified

2010-10-18T09:27:00.003+01:00

Yep, the title says it all. I am now a qualified nurse. I have completed my course and been given an entry on the Nursing and Midwifery Council(NMC) register. I have started a job as a Staff Nurse on a general ward at a local hospital. The last few weeks have been filled with a sense of blinding terror and headaches induced by all the new paperwork in this new hospital. As soon as I qualified I felt I had forgotten everything I had learned over the last three and a bit years. Fortunately this doesnt appear to be the case.

I have enrolled on a preceptorship program. This effectively gets my post-qualification education off to a good start. Including things like respiratory and cardiac study days. I also have a semi-experienced nurse on my ward who is there to assist my development. Its all very cool.

I have been working on my ward for three weeks now and I have to admit I am only just starting to find me feet. During this supernumerary period I am supervised in everything I do. This is accompanied by phrases like "You dont have to do it this way but its how I do it" from the senior nurses which of course oblige me to "do it their way" whilst they are supervising me. I finally started finding my feet when we were too understaffed to allow me any supervision so I could do it all my way.

I have to admit there is a large part of me that regrets not going straight to A&E but I still believe its essential to my core development to get experience in a specialty area first. I am however missing my highly acute patients, we have had one or two on my ward but most of the patients have fairly high care needs but few medical or acuity needs. As is true on a lot of wards in a lot of hospitals many of my patients are in with us for a "social sort out", they have complex or increasing social care needs and need a bed with us whilst social services work their magic. I fully appreciate the importance of this system for the patients however I believe there should be special wards designed just for this purpose so social patients arent taking up acute care beds on wards with staff with specialty training and experience.

There we go. My first post back, my first post as a qualified nurse ending in a micro-rant.

Politics

2010-05-03T21:52:00.002+01:00

I'm currently on a break from university. This time is intended to allow us to apply for jobs and prepare ourselves for life in the real world. Many people have asked me what it feels like to almost be a qualified nurse. To this I tend to explain that if I were a blacksmith having completed an apprenticeship I would be considered a journeyman blacksmith. The journeyman is someone who has fully learned the core of their trade but is far from being a master. I am soon to be a journeyman nurse.

Whilst I am waiting to start my final placement I have been getting rather interested in the political situation. Over the last two weeks I have found my self at one point or another supporting each of the three main parties. After weeks of seeing the pro's and con's of each of the parties I have come to the following conclusion. I really dont care who is in power, all I really want is for tomorrow to be more or less the same as yesterday. Where there are sick people there will always be nurses. so I will always have a job(a job I love), I have a mortgage, a gorgeous fiance and a very mischievious cat. My world is a near perfect place. In the coming years there are things which may further enrich my life. By and large nothing that truly matters to me will be effected should any one of the party leaders become prime minister.

Time off.....AGAIN!

2010-04-05T11:41:00.002+01:00

I am approaching the end of my course, qualification awaits. All I have to do is pass this final placement. Which given the proficiencies I have to demonstrate shouldnt be a problem. These a proficiencies that frankly any third year student nurse should have been proving for over a year now.

The trouble is I am currently on a very very long easter break from this placement. Eight weeks!. Most people seem to enjoy a bit of time off. I love the odd day doing nothing. However there are no bank shifts going at my hospital due toa combination of closing wards and everyone else being off and wanting work. My personal problem is that when I am left without work for a prolonged period I always seem to find a way to very expertly derail my life. This usually involves a combination of boredom and either over-exercise or over-drinking. Whilst alcohol doesnt cause me to make as big a fool out of myself as it seems to most people. It does trigger a massive personality change in which I become a complete and utter bastard. Fortunately for me I am marrying a girl who knows how to handle this. Generally with strong words or a series of increasingly painful slaps around the back of the head.

I just get sooooo bored when I have no work to do.

Note to my Patients

2010-03-31T19:32:00.003+01:00

Dear Patients

When you come to my Accident and Emergency department complaining of chest pain and I ask if you have any history of heart problems could you please tell me the truth. When you say "No" I assume you havent had those two myocardial infarctions you will later tell the doctor about. It doesnt matter that they were "only minor" when you lie to me it scraps whatever credibility I may have as a student nurse with the doctors. When a patient is diabetic we know to double the number of cream cakes they say they have eatten today, when they are smokers we know to treble the number of cigarettes they claim to have smoked, and with alcoholics its always a factor of four. This should not be the case with heart attacks.

When you do things like this it makes me angry, and there is only one way my professional armour allows me to deal with that anger. So when you lie to me and make it look like I cant take an accurate history do not become upset when I become extremely sarcastic. Please remember when you lie to me, that although I may not have a fancy stethoscope around my neck my fraying patience is the one controlling your oxygen supply.

Yours ever so sincerely

Disgruntled Student Nurse

Dark Place

2010-03-31T19:17:00.003+01:00

I was going to write about a shift I worked recently which was woefully understaffed. I was going to write about issues concerning patient and staff safety. I was going to let off steam regarding the complete absence of the most fundamental of ward equipment on this ward. I could go on.

In fact I did write about the above, I even posted it. Then I deleted it. Its rare that I am left to feel this helpless. No serious harm came to anyone during the shift. So it would not be considered a priority. Infact we hit all our targets. I considered writing an incident report about this shift but the people who read incident reports are the people who put myself and my colleagues in that situation. They are also the people I was shouting at all day to no effect. When a patient or member of staff gets hurt the incidents will be noted by those high enough up the chain of command to change things. I just hope that it doesnt take a death.

My First - Arrest

2010-03-23T17:41:00.002Z

Technically this wasnt my first arrest, but it was my first arrest working on A&E and as a student nurse this meant I had a greater potential to effect the outcome of this arrest.

I was working in A&E resus with my mentor, and the red phone(commonly called the bat phone) rang. This phone is only dialed by ambulance crews telling us they are bringing a majors or resus patient. We took the details of the patient as follows -

44 Year old. Male. In cardiac arrest on arrival. Non-shockable rhythm. Resuscitation started on arrival. Four previous MI's. High BMI. ETA 4 minutes.

There were other details but the purpose of this post they were irrelevant. I started preparing the space we would bring hte patient into. Turning on the AED(defib). Making sure the cardiac monitor, blood pressure and pulse oximeter cables were all untanlged and the machine they were all connected to was on. I cracked open a high flow o2 mask and started it on 15L. Whilst I was doing this my mentor was beeping the crash team. We then gowned and gloved up. I made sure the board was clear and the board markers were working. Scribing is vital to clear, fluid resus attempts. Just before the ambulance crew came running through the emergency doors and the crash team came running down the corridor, my mentor looked at me, smiled, told me to take a deep open breath and remember this "No matter what happens, even if you do everything wrong, this man is dead, nothing you do can make the situation any worse for him". I still dont fully understand why but his words have come to my mind during every arrest I have attended since and they have kept me calm.

The resusciation attempt wasnt as hard as I was expecting, I stayed calm, and there was very little thought involved. My mentor took charge of everyone present, even the doctors. My body reacted to the voice of command and I found everything else was muscle memory and instinct. The patient did not survive however a study performed in london a few years ago suggested that when it comes to pre-hospital arrests, even if the crew arrive quickly and a first aider starts cpr as soon as the arrestee drops there is still only a 1 in 185 chance that the patient will survive to be discharged from hospital. I would imagine the odds are a lot worse for people who arrest with a non-shockable rhythm(Asystole or PEA). The hard part is thanks to all these medical drama's on tv every patients relatives expect you to raise the dead.

My First - Death

2010-03-13T16:27:00.002Z

I am back on placement, my final placement. After this I qualify and become a real nurse. The strange thing is I have spent the last two and a half years rocking every placement, walking around MY hospital with a confidence I have never really felt before(and in most of the situations i've been in over the last three years an outward confidence I didnt really feel). I have been dying to qualify, raring to go. Now I am nearly there I am petrified. I think it was Socrates who suggested something along the lines of - the more you learn the more you come to realise you know nothing.

Now I'm nearing the end of what has been a strange combination of the longest and shortest three years of my life I cant help but look back at the defining moments of my training. In this case the first patient who died under my care. This happened in my first year on my first placement, an elective orthopaedic ward. The patient was only on the ward due to lack of beds on the trauma orthopaedic ward. He had come in following an RTC, he had been stablised in A&E and went into surgery to repair numberous fractures and ruptured vessels. When they had finished with him he was transfered to my ward and remained unstable, his blood pressure constantly dropping, pulse rising and dropping with an irregular rhythm and the patient hadnt been conscious since A&E and a DNR order was signed by his NOK with his permission on presentation to A&E. I was working the night shift about a month into the placement, one of the other nurses had checked on him twenty minutes previously. I went in to check on him largely because there was nothing else to do. He was dead, my first dead patient. He looked just the same, I'd heard all these stories about how people change in death but I had to check for a pulse and watch for breathing to make sure. I walked out of the room and told the nurse. She knew he was taking his last breaths when she'd been in earlier, she just shrugged it off. Then it hit me, the shame that all I was thinking about was how hard his death was for me, the anger at her indifference to the fact someone had just died less than ten feet from where we stood(which I now understand is a defence mechanism and one that I use myself).

Two years on I've worked in A&E, I've worked on many acute medical wards and I have had many patients die under my care. The only way you can survive the reality of acute nursing is to distance yourself from the deaths, and make sure you did everything you could so you know there was nothing more you could have done and their death wasnt your fault.

Making and Appointment

2010-02-26T09:00:00.002Z

A few months ago I phoned up my GP surgery to make an appointment for my fiancé. The receptionist not for the first time asked me what the appointment was for. Receptionists are not doctors or nurses, and whilst many of them do a very good job deal with the more idiotic elements of the community on a daily basis they have no right or reason to ask why you are making an appointment. Certainly in my surgery the information does not reach the doctor before you see them, they can not suggest you see a nurse or not make the appointment instead, they do nothing with the information. I had a choice, I could explain this to her in a calm and non-confrontational manner or I could take the childish option......

Me: "The patient is a 24 year old female presenting with pyrexia with haemoptysis and epistaxis with intermitted hypertension and tachycardia. No previous relevent medical history or history of recent trauma. Whats your Diagnosis doctor?"

Receptionist: "I'm not a doctor, I'm just a receptionist"

Me: "They train receptionists to diagnose?"

Receptionist: "No I..."

Me: "to triage patient appointments allowing more acutely unwell patients a chance to obtain an appointment?"

Receptionist: "No its first come first ser..."

Me: "Ah so you pass on the relevent information to the doctor so they are prepared for a patient before they arrive?"

Impressively Resilient Receptionist: "No we dont note the information anywhere we arent allowed to write in patient notes or their electronic records...."

Me: "So what times her appointment?"

I dont feel good about the above conversation but I had recenly taken my fill of GP Surgery Receptionists on my community placement who were just asking patients what they were seeing a doctor for out of pure curiousity or "incase the information became useful later". To be fair the last few times I have phoned my GP surgery the receptionists have been very curteous and not asked me for any confidential information, they have simpley done what they are paid to do.

Mid-Staffordshire NHS Trust

2010-02-24T17:25:00.003Z

Many of you have probably already heard about the investigations and subsequent report that has suggested that several hundred more patients than predicted died in the Stafford Hospital emergency department between 2005 and 2008. The report also indicates that staff were uncaring and more focused on saving money than treating patients.

Whilst I do not in any way condone the treatment of these patients I dont blame the nurses or doctors at this trust. They became EXACTLY what the NHS is training us to be. If a patient comes in to A&E we have a four hour breach target. So if the patient is still present on the department four hours after first being seen by a triage nurse the department recieves a fine to its next budget. You have four hours to fully investigate a patient .It can take longer to get blood test results back or find a radiographer to take an xray for you. Add to this the fact you see a lot of the same patients every week who "cry wolf" if you have to save time and money for your department(money that may well be used to pay you) the temptation may be to discharge the same old patients without a complete investigation(I promise you that will be the time they are actually ill).

You then have cost limits on treatment, if a patient needs a dressing we are told to use the cheapest dressings available that are not likely to get the trust or practitioner sued for malpractice. For example if you have a deep pre-tibial lasceration(a deep cut to your shin) we will have to chose a non adhesive layer to prevent the top layer of gauze sticking to the wound bed, realistically there are three options -

1. Release - A sort of thin gauze covered in some kind of oil to prevent it sticking. The oily layer dries within a few hours and the release then becomes stuck to the wound bed, to remove you have to soak the dressing in saline and if you are very very lucky you wont reopen the wound. Very Cheap.

2. Atraumen - A greasy mesh that stays non-adhesive for about three days(at which point the wound should be assessed anyway), doesnt do a bad job. Moderately Expensive.

3. Mepitel - A silicone based mesh that I have never known to dry out while covering a wound, can be used for upto about 18 depending on trust policy. Primarily designed for burns but still incredibly effective as a general non-adhesive, can also be used to draw a wound together in the absence of steri-strips. Does an unparalleled job. Fairly Expensive.

In my trust we are told never to use mepitel and we can only use atraumen if a senior doctor has signed off on it. There is a similar system for anti-emetics(anti sickness drugs) we give cyclizine because its cheap, although it does make patients very light headed and dizzy. I would personally refuse anything except donperidone which does the same job but without the unpleasant and very common side effects.

Fortunately the hospital I work in completely ignores the targets set by people so far up the chain of command they dont even know what a hospital looks like. If we feel a patient is less likely to develop an infection because we have used mepitel we use mepitel, if a patient is clearly distressed by their nausea we will not give them cyclizine, knowing that the secondary effects of cyclizine will distress them further. And I can honestly say I have never discharged a patient without ensuring they have some help in place. Even if I dont believe what they say is wrong with them and they came to us instead of their GP I will phone their gp and make an appointment for them knowing I havent just left them out on their own.

What has happened in Staffordshire is tragic but it is the result of government and NHS target setting and the threat of penalties to any trusts that dont meet these unrealistic targets generated by people who either have no clinical experience or had it so long ago operating theaters floors were still covered in sawdust. The new chief executive of this trust has already proven a massive improvement in care since hiring close to 200 extra nurses.

As a side note if I were to become ill this is now the trust I would want to go to. Given the scrutiny this trust is under it will probably be demonstrating exceptional standards of care for some time, whereas many other hospitals which receive good marks have probably grown complacent.

State of Relax

2010-02-17T14:45:00.002Z

Immediately after my post the other day explaining my recent writers block in regards to one of my assignments I sat down and wrote over a thousand words. Some of the best I have ever put into an assignment, I really am rather pleased. Whilst the assignment still has a few hundred words to go I am taking some time to relax. Between work, social and family obligations recently I hadnt realised how badly I need to just stop and do nothing.

I'm currently on the healthcare worker diet. This is an involuntary diet all healthcare professionals are on it involves getting up at 0630 every morning, this time being far too early for me to eat(even toast this early makes me feel sick). Dragging myself into work for a strong cup of low quality black coffee(so strong it could easily be mistaken for gravy). Working for eight or fourteen hours without a chance to have a break or even go to the toilet. Leaving work an hour and a half late because the ward is understaffed and you feel somehow obligated to help pick up the slack. By the time you get home you just about have the energy to fall into a hot shower. You drink a huge quantity of water because you have been sweating all day and not had a chance to drink any water. By the time you have consumed an adequate quantity of water you no longer feel hungry, knowing you should eat something you grab a piece of toast and fall into bed, ready to repeat the process in seven hours time.

Thanks to this process I have gone from a starting weight of 106kg(when I started my course) to 86kg. So its not all bad, although my professional opinion is the healthcare worker diet is extremely dangerous.

Obligation

2010-02-16T14:34:00.001Z

I recently came across a fairly interesting dilema at work, and I truely feel sorry for the doctor who has to sort this one out.

A patient is diagnosed with a disease. Its genetic so there is a good chance the condition will manifest in at least one of his five children or one of his parents(who are both still alive). I cant divulge exactly which disease this patient had but lets pretend its Huntingdons a very nasty, incurable and degenerative neurological disorder. Now here is the kicker, he doesnt want anyone to know, he doesnt want his wife, his parents, his children to know and thus he is preventing any of them being screened. Our obligation is to the patient, and he can rely on confidentiality in this case. Our legal obligation would take priority if this was a very infectious bacterial infection, we would have to trace everyone who came in contact with the patient and screen them. However this is not infectious, the patients family already either have it or they dont the dice have been thrown. So we say nothing.

Now what if the patients son was in RAF Squadron, flying planes with high yeild payloads for a living and he didnt realise he had a condition which severely impairs motor function as a primary symptom. Do we not have an obligation to the greater good then to inform the patients son?

I understand the importance of confidentiality. I also understand that this patient had just recieved the worst news of his life and probably wanted to prevent any of his family worrying about him, he may even have been clear headed enough to realise that if his children didnt know they couldnt get tested and those those of them who surely had this condition could be spared feeling what he was feeling now. Its information that you cant take back, once you tell someone they are going to die in one of the most horrific ways imaginable(and there is no way to sugar coat it) you cant untell them. His children were only young, whilst the condition could strike at any time maybe he was just trying to buy them a few more years of innocence?

In the interests of balance(I have been told I always assume the best in people) maybe he was just a coward who didnt want to face his own fate and thought that by hiding it he could avoid it no matter what the cost to those around him.

What would you do in this situation? would you respect the patients right to confidentiality? or would you inform his family?

Assignments Assignments Assignments

2010-02-16T09:58:00.003Z

For the last week I've spent several hours a day sat in front of a blank word processing window with the learning outcomes for an assignment due in on friday in my hands. Fortunately its only 1500 words which I could crack out in a few hours however I cant seem to find the motivation to start. I'm not procrastinating, I sit down every day with the intention of writing, I dont get distracted I just cant seem to find the words to start. I'm exhausted and this is a really boring assignment. "A critical reflection of placement three of the interprofessional learning unit"(IPLU). I'm sure you've heard me rant about the futility of this module before however for once, in this third year it has proven constructive.

Our group was made up of a med student, four nursing students(two adult branch like myself), a social work student, a physiotherepy student and two radiotherapy students (one diagnostic one theraputic). We were assigned a task, to audit the correct and safe use of the hospitals Venous ThromboEmbolysm(VTE) (things like pulmonary embolisms and deep vein thrombosis) risk assessment forms. These forms came as standard in the nursing admission packs so in theory all patients admitted to the hospital should have been risk assessed for VTE and any procautionary measures put in place. We had to take samples from different wards, two medical, two surgical, two orthopaedic, reviewing ten patient notes per ward. We were looking for completed risk assessments, patient age, gender and cause of admission so we could identify which groups were being overlooked(not that any should have been). Once we had collected and analysed our data we had to compile a ten thousand word report covering our methods and findings and at the end of the two weeks we were to give a twenty minute presentation to the relevent members of staff.

The work was facinating not in the least because my father died of a pulmonary embolism ruled as medical negligence at the age of twenty-seven. I found this as a refreshing opportunity to reaquiant myself with a leadership role, a role rarely suitable for a student nurse, although we are encouraged to take some leadership responsibilities on clinical placement.

So why am I having such a hard time writing this assignment? the criteria have drained all the fun out of it, I am not to mention the subject matter just the groups interactions and my role in achieving the final objective. I find it hard to write about myself in a critical light at the best of times, I go with the flow of self-loathing and low self-esteem. Another reason I might not be getting this assignment done is because I am sat here, writing this.....which is far more enjoyable and more than a little cathartic after a week of writers block.

MMR Problems....Again

2010-01-31T11:51:00.002Z

For those of you who havent already heard about this. Dr Andrew Wakefield is the Canadian trained British physician who published a report in 1998 'proving' a link between the Measles Mumps and Rhubella triple vaccine and various bowel disorders and even autism. His 'results' are now being questioned, and not just by those of us who know enough to identify shoddy research when we see it. Almost miraculously his research is now being questioned by the vox populi. The optimist in me wants to believe this indicates a massive step forward in the general intelligence of the masses.

The first issue with this chaps research I wish to raise is that he recieved fifty thousand pounds(a substantial amount even for a doctor) from a legal agency supporting patents of children with health conditions they would like to link to the MMR vaccine. I cant think of any reasons he would take the money that would allow him to remain unbias(an essential stance for any level of research). Interestingly the article makes a fairly small point of it. He also tried to patent a potential alternative to the MMR vaccine, had this gone through he would have been a very wealthy man, however success in this matter required the standing MMR vaccine to be discredited.

However the largest issue from my perspective is that this man presented his findings as fact when there was insufficient evidence to even found a credible theory, infact there was overwhelming contradictory evidence. As a result the number of parents vaccinating their children went from around 91% before his report to 70% following it. As a result there has been a massive resurgance of mumps(which can be fatal). I admit its largely the patents fault for not vaccinating their children but what choice did they have when the 'experts' told them it was too dangerous. I also dont understand why this increase has gone unreported by the media when so much fuss has been made over a few cases of swine flu. In my honest opinion I feel this 'doctor' and his colleagues should be charged with manslaughter.

Great Shift

2010-01-26T16:27:00.002Z

I had a wonderful shift as a bank healthcare assistant on an emergency medical assessment unit(EMAU) today. This shift has come in the middle of a series of horrifically busy and understaffed shifts. Today we were busy(the busiest ward in the hospital) and understaffed as well. The key difference was who I was working with. My recent bad shifts have been working with people who panic, they get stressed and it paralyses them. I honestly found someone crying at the fact our linin cupboard had run out of organge pajamas so she would have to dress her patients in the green or pink ones. When one person on a shift gets overly stressed the rest of staff on that shift feel it and get stressed too. Fortunately working on A&E has taught me how to stay calm when others are freaking out however eventually it does get to me too.

Todays shift was busy, I had fourteen patients to myself as did the other three healthcare assistants(its a big ward). However I spent more time on this shift laughing than any other time in my recent memory. We kept each other calm and focused. There was one point where another HCA was feeling a bit shakey about being told to take the obs of a patient she knew was close to death(I recently posted on a similar matter). I uttered something along the lines of "Our job is to play the game, and if we get really really good at it we can change some of the smaller rules". It was just an off the cuff and hopefully supportive sentiment which had the desired effect however it wasnt until I had said it that I realised it was true. The best incentive for ambition in healthcare is the ability to tweek the minor rules regarding patient care(the big rules will never be dictated by anyone with a clinical education).

I'm currently aching but still smiling, Today wasnt just about the much needed money for me, I really enjoyed my shift.

The Bell Tolls

2010-01-18T12:11:00.004Z

Her bones are clearly visible through her yellow tinted skin. She has a cannula in each arm both have tissued, her veins having shut down hours before. Her last set of observations tell me her systolic blood pressure was sixty-seven, barely compatible with life. She has been on the liverpool care pathway for two days. She is Dying.

Despite all this my patient was incredibly lucid. She was aware of what was going on around her and could answer all of our questions appropriately. This is why, when I was asked to take a set of observations on her I refused. She is on the pathway for the dying with twenty-four hours left on it all of her previous vital observations and physical observations suggest it will be much sooner than that. I refuse to tug a blood pressure cuff onto her arm, inflate it to a painful level and drag it off again when the results will be of no use to anyone. I still cant believe the nurse asked me to do that to my patient.

Standard Shift

2010-01-16T18:30:00.004Z

I step onto the ward at 0645, typically early. I stand staring down the long corridor leading to the nurses station. Doors to the right leading to small two or four bed bays, doors on the left leading to isoluation cubicles. I close my eyes the same as I do every time I start a shift listening for the indicators of the kind of shift I have ahead of me, somewhere down the corridor I hear the loud, shrill screaming of a ninety year old dementia patient on a loop screaming for her mother. Down towards the nurses station where all the six bed bays are I hear numerous buzzers going and the sounds of staff members actively trying to prioritise tasks. The smell which once was very prominent to me now barely noticable that of thirty unwell patients. All this speaks of the end of their busy night shift and the begining of a fairly standard early shift.

Eight hours later I am stood in the same place looking back down the same corridor, sweat still obvious on my skin, my head throbbing and my hands shaking because I havent had anything to drink since the start of my shift and I havent eaten in almost twenty-four hours. My knees and back also throb, my bodies way of complaining at the unnatural positions I have to adpot in order to do my job. A smile creeps across my face as I realise despite all this I have achieved a lot today, my patients are all clean, well fed and settled. I take a deep breath, aching and maloderous I go home.

Growing Up

2010-01-15T19:48:00.002Z

Recently I have been mulling over fond memories of my later childhood. Spending whole nights playing various computer games with my friends, exchanging witticisms over irc. Sunny summer days spent sitting on the grass in a nearby towns park just relaxing. I used know exactly when my favourite authors next book was due out.

Now my life is all sixty hour weeks, assignments, wedding plans, mortgage payments. As far as my favourite author goes even if he hadnt died I'm certain I wouldnt be able to name any of his recent books. As for my friends, I see very few people from those days. I suppose this is just what growing up is and I am certain there are stresses and problems from those times that I am not remembering.

There is nothing in my life currently I would want to be without, I am in a really good place. However I wouldnt mind a touch of the carefree days of youth entering my life again just for a while.

Snow

2010-01-15T01:37:00.004Z

I had promised myself I wouldnt blog on the tedious matter of the snow. However it is directly effecting my work so its hard to avoid.

Personally I love the snow, I have a degenerative eye condition called retinitis pigmentosa(RP) which makes me as good as blind at night. However the is now this nice reflective white stuff everywhere meaning I can safely walk around at night now(and I love night time). Also as I have size 14(UK) feet and always wear my magnum boots I have no problems with slipping.

Professionally I am concerned about the strain this is putting on the local hospitals. The larger of the two local acute hospitals was completely out of beds for several days recently forcing ambulances to divert to a much smaller and already strained hospital(where I work). My hospital has reopened a ward to try and take some the strain. This ward is entirely staffed on a day to day basis by bank staff, there are no permanent staff on this ward at all. I have got plenty of shifts booked there as a healthcare assistant (the money is good) however it cant be good for patient care to have different staff on every shift throughout their admission.

A&E departments are swamped by fractures(mostly elderly) and the ambulance service is overwhelmed by people who are perfectly able to get to their gp's office but have decided that an ambulance is a much warmer way to get a paracetamol prescription for their headache.I honestly believe these people should be fined, I am certain that the income generated by these fines would pay for a lot more paramedics, nurses and even a doctor or two.

Cynic

2009-12-06T22:29:00.003Z

As far as I am aware it is impossible to work in healthcare without eventually becoming a cynic. Here are a few of our more regular experiences.

Drunks who have fallen into the gutter and as a result are covered in minor abrasions and have suffered a possible head trauma. Observe them for four hours, take blood, hook up to a big bag of sober-up-juice(saline) take GCS every half hour, listen to them explain how they only had one pint.

Women who have been beaten(and occasionally raped) by their spouses, several broken ribs, lacerations to the face and possible skull and limb fractures. X-Rays to all effected areas, GCS every half hour, ECG to rule out cardiac damage as a result of thorasic trauma, listening to them explain how they either fell down some stairs or how their spouse is a good man and wouldnt have done it if they hadnt set him off.

Parents who when faced with a child suffering a high temperature, vomiting and diaorrhea decide that they dont need a doctor, they need homeopathic herbs and spices. By the time the child reaches us they are massively dehydrated with a blood pressure so low it can barely push blood around their body and a pulse so fast that the chambers of the heart barely have time to fill. Listening to them explaining how medicines are poisons and pollute the body and soul*.

Parents who are themselves vegans or vegetarians and are forcing such a diet on their infants, as a result the infant is now in the lowest survivable body mass index and will probably suffer permanent damage to all their bodily systems.

As a result of this I think its understandable that I have become a little more pragmatic and cynical. I still treat every patient with respect and ensure whatever dignity they have left is maintained. I perform tests both based on what they tell me and what I suspect to be the truth knowing that the day I refuse to believe a patient is the day I am wrong. It also appears that I can be a cynic and an optomist.

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*The comedian Tim Minchin has an eternal place in my memory for this line - "Alternative medicine is either not proved to work or proved not to work, do you know what they call alternative medicine that is proved to work..............medicine".

Bank

2009-11-25T13:37:00.002Z

I have been working bank shifts as a healthcare assistant in my trust. Just to earn a little extra money. At first it was liberating having next to no responsibility. All you have to do is worry about washes, feeds and obs, everything else is the nurses job. This soon became quite frustrating a patient becomes breathless or starts desaturating and as a student nurse I would shove them on oxygen. I cant do this as an HCA I have to ask the nurse. A patient complains of chest pain I cant just put them on high flow o2, do an ecg and show it to a doctor, I have to wait until a nurse appears so I can ask her if its ok.

I was in a bed space yesterday with a nurse and the patient starts vomiting large quantities of blood, the nurse asked me to get a doctor or another nurse in there as quickly as possible. I go out to the nurses station where the doctors are discussing their rounds and I shout, "we have a problem with a patient, we need help NOW!" everyone, every last one of the doctors and nurses in sight said "find someone else, i'm busy". So i go back to the bedspace and hit the resus alarm, this gets some fairly immediate attention. Despite the fact this tactic worked in the face of overwhelming stupidity I spend the next two hours being shouted at for misuse of the alarm and making the senior sister look like an idiot.

When I'm qualified and running a ward if I EVER see a member of staff ignoring an urgent call for help I will see to it that even if I cant fire them the only favourable option available to them will be to quit.

The patient survived, just about.

Oh Dear!

2009-11-15T10:15:00.002Z

In the course of research for an assignment I discovered that the most common sources of heparin come from porcine(pig) intestinal tracts. This normally wouldnt bother me, most of the medications I administer (or occasionally take myself) come from animal sources. However we use a modified version of heparin, enoxaparin as prophalaxis and treatment for blood clots in whats probably 70% of the patients in my hospital. Its very commonly used.

My problem is that I had no idea it was procine based, most of the staff I work with had no idea it was porcine based. I have certainly had jewish patients in the past. I must have at some point administered enoxaparin to them. Normally I give little consideration to religious elements of care, I appreciate they are important but I prioritise the body over the soul, I let the hospital chaplains worry about that. However this is a fairly heafty rule in the jewish belief structure we are unwittingly breaking.

Busy, Oh So Busy!

2009-11-15T10:11:00.002Z

In the last month or so I've moved house, passed the placement from hell and been working in all the free time I have to pay the bills. I think things are settling down now but sometimes its hard to tell. I had intended to write up a load of posts and time release them. I'm guessing i've lost a large portion of my reader-base but hey, thats not why I started doing this.

Swine Flu

2009-09-18T07:44:00.002+01:00

In 2007 over five thousand infants and elderly people died from "human" influenza. The every day, run of the mill flu. This statistic is actually a vast improvement on the previous years, largely thanks to the greater use of the flu vaccine in vulnerable people. Why is this not reported in the news every year? because it happens every year and thus it is not news. However a few hundred people die from a virus that is almost indistinguishable and certainly no more fatal and the media use exercise their ability to cause mass hysteria. Whilst these deaths were indeed deeply tragic the majority of them came from nations with undeveloped healthcare systems where the general populous live in third world conditions. In the nations with more developed healthcare systems, including the UK, most diagnosed cases took place largely due to clinical and professional assumption. Currently one in every two hundred "confirmed" cases of H1N1 have been laboratory confirmed and they are symptomatically identical to the "human" flu.

The Department of Health current risk catagories for this "pandemic" is word for word identical to that of the yearly flu risk publication. The very young, the very old, and anyone with a chronic condition. Chronic Condition is a very broad term for any disorder or disease that can not be cured. This however does not mean it is fatal and can not be managed. This could be something as reletively harmless(if well managed) as Diabetes or a rapidly deteriorating disease like Motor Neurone Disease(MND). Several chronic conditions will not effect a patients vulnerability to influenza, however many conditions like Systemic Lupus Erythematosus(SLE) and other auto immune conditions require treatments that will effect a patients immune system(immunosurpressants mainly).

My arguement is not that swine flu is not a serious condition(it certainly can be). It is that it is no more serious than the annual flu and all this media and public hysteria may well draw attention away from the seriousness of the annual flu, many may not get vaccinated this year(or only get covered for swine flu) and a massive unnecessary loss of life may ensue.

Patient: Abdominal Wound

2009-08-27T18:28:00.002+01:00

Bob, normally healthy 23 year old male presenting with abdominal stab wound. Unconscious, Pulse 150, BP 60/30, Resps 27. Appears diaphoretic and ashen.

This is a patient we saw(minus a few identifying facts) in A&E. I thought I would outline how we treated him.

He was clearly in hypovolemic shock. His blood pressure was incredibly low so his heart couldnt pump the oxygenated blood to his cells. To attempt to compensate for this his pulse increased. We start getting concerned when a patients pulse exceeds their systolic blood pressure, its a sign of acute shock. In order to keep pace with the heart and oxygenate the increasing blood flow(increasing at first) his breathing became shallow and rapid. However long before this he would have passed out, Its not clear weather this is another one of the bodies failsafes or just coinsidence but an important step in immediate treatment of shock is to lay the patient down, preferably with their feet up so as much blood as possible is flowing to the brain. His blood vessels would contract in order to attempt to compensate for the plumetting blood pressure this would have caused the ashen appearance.

Going back to basics.

Airway/Breathing - the patient had a patent airway but his oxygen intake from the shallow breaths was insufficient so we placed him on highflow oxygen(15litres via non-rebreathe mask).
Circulation - We applied a heavy dressing and applied as much pressure as we could in order to slow down the blood loss. We obtained venus access. This was particularly difficult as he was peripherally shut down. We then pumped as much saline and gelofusin into his veins as possible increasing his circulating blood volume and taking blood for typing. Short term its important to increase the circulating volume with anything we have at our disposal, it will increase the blood pressure and hopefully decrease resp and pulse rates. Long term however the lack of red blood cells will cause hypoxia(among other things) despite the high flow oxygen. At this point several units of blood for transfusion appeared and he was deemed stable enough to risk surgery to repair the damage caused by the knife.

All this happened in a very short period of time, the patient survived(surprisingly).

Downtime

2009-08-23T20:15:00.004+01:00

Its been an insane week. Many stressful situations which are thankfully now resolved. So I am now sat in my living room, alone(my fiance is on nights). Drinking a blended whiskey(I am normally a single malt man but this isnt a bad one). With my entire music collection on random(thats a lot of music). So I thought in the interests of pure laziness and at the risk of a massive blow to my standing amongst my loyal readers I would post bellow ever song that comes on. In bold you'll see any excuse I wish to make. May the comments begin!

Iron Maiden - Face in the Sand
Deep Purple - Black Night
Dreamevil - Book of Heavy Metal
Queen - Mad the Swine
Nirvana - Opinion (I have no idea how this got on here)
Luke Kelly - The Town I loved So Well
Corrib Folk - Wish it was Sunday
Anastacia - Secrets(I have no idea how this got here either)
Johnny Cash - The Wall
Hammerfall - Take the Black(Nothing like hammerfall for destressing)
Iron Maiden - Seventh Son of a Seventh Son(Parts of this song sound very Greek)
Van Halen - Running with the Devil
Toad the Wet Sprocket - Somethings Always Wrong(I love this song)
Savatage - Handful of Rain(My usual drinking song with a good video)
Ludovico Einaudi - I due Fiumi
Thin Lizzy - Jailbreak
Bad Company - Bad Company
Iron Maiden - Intro:Churchills Speech(One of histories greatest speeches)
Sonny Rhodes - Firefly Theme
Skyclad - Spinning Jenny(A truely Filthy Song!)
Elexorian - Dryads and Trolls(Hillarious lego video available on youtube)
Plain White T's - Every Second Counts
Skyclad - Any Old Irony?
Tyr - Ormurin Langi
Bon Jovi - Wanted Dead or Alive ("Bon Jovi Rocks....On Occasion")
Amateur Transplants - Anaesthetists Hymn(Medical Spoof Band, Highly Recommended)
Thirteen Senses - Into the Fire
Bruce Dickinson - Inertia
Free - Wishing Well (One of my Favourites)
Lynard Skynard - Freebird(This was my fathers song)
Iron Maiden - The Trooper
Kansas - Fair Exchange
Led Zepplin - Immigrant Song
Kenny Rodgers - The Gambler

Ok I'm going to end it there, that wasnt nearly as bad as I was expecting.

Broken Squirrels

2009-08-17T16:58:00.002+01:00

Shortly after returning from the lake district recently I was sat in my local with a friend and we were discussing the complexity of reintroducing red squirrels to the south. The concept is referred to in ecological circles as humpty dumpty communities. The intruder greys came in and won dominance over the red squirrel. It seems the solution is simple, remove the grey squirrel and reintroduce the red squirrel but it is far from that simple. A species often has different requirements to establish themselves in an environment. A certain insect or plant which has long since died out may be required in abundance to allow the red to reach the necessary numbers in the initial stages in order to survive in an environment long term. Many people say they prefer the red squirrel but ultimately evolution has led to the rise of the grey squirrel and as much as many would like to see a predominantly red england again, what right do we have to tamper with the progression of nature?

The grey squirrel is larger, more aggressive and more of their progeny are likely to survive infancy. This clearly placed them at an advantage over the more timid, less hardy red squirrels.

This concept is best explained by Olivia Judson(one of my heroes). Whilst I was in the lakes I asked my fiance(a northern lass) why the grey squirrels dont seem to have penetrated the lake district(loads of red squirrels and I've never seen a grey in the lake district). Her reply made me laugh "we're better shots than you".

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I am aware that some of my readers are avid gardeners and I would like to ask for any tips when it comes to battling white fly on my pepper plants. Every year about 75% of my plants are ruined by the little buggers.

My Return

2009-08-14T08:44:00.002+01:00

I have returned. I decided to take a little bit of time away from blogging(and the computer) whilst I was on my A&E placement just so I could keep focused. That placement is now over and I am really going to miss it. When I qualify I fully intend to find a job either in that A&E department or to one in a local hospital.

Now down to the business of the day. As many of you will have heard President Obama is presenting the idea of a government funded healthcare system(a bit like our own) in the US. This has been met with fairly aggressive opposition and frankly more than a little sniping at our system in order to discredit it. The problem is, as I see it. most if not all hospitals, pharmaceutical companies, etc in the US are businesses, they have many investors who will suddenly lose a lot of money if free healthcare finds a place. The current system mean thats most americans only have access to healthcare if they can afford it, leaving those that cant in a pretty sorry state. There are of course a few very badly funded, understaffed, underequipped services trying to cater to the needs of those who cant afford the care they need but it is wholly insufficient.

The problem here is how do you introduce a state funded system that will rival big businesses in an entirely capitalist society?

Shorthand

2009-05-04T00:06:00.003+01:00

Pt biba following RTC. 3xPCW around R 4-5 IC spaces. ?# R NOF as S+R of limb and dec ROM. GCS 12. MEWS of 5 due to rr 22, pr 114 and systolic bp 98. 15l o2 via non-rebreathe, maintaining sats 89%. ECG done and shown to dr. IV morphine administered as per prescription chart. CXR, Abdo XR and Hip XR ordered. Pt a/w tx ESAU.

This patient was an absolute wreck, I was helping work on him. Later that shift I found this nursing note written by a charge nurse also working on that patient. I can understand everything written there but I feel nursing notes should be a little clearer. The translation is as follows -

Patient brought in by ambulance. Three penetrating chest wounds around the right fourth and fifth intercoastal spaces. Query fractured right neck of femor as there is shortening and rotation of the limb and decreased range of motion. Glasgow coma scale of 12. Modified Early Warning System score of 5 due to resp rate of 22, pulse rate of 114 and systolic blood pressure of 98mmol. Patient on 15 litres of Oxygen via non-rebreathe mask and maintaining oxygen saturation of 89%. Electrocardiograph done and shown to doctor. Intravenous morphine administered as per prescription chart. Chest X-Ray, Abdominal X-Ray and Hip X-Ray requested. Patient awaiting transfer to emergency surgical assessment unit.

A&E: Day Four

2009-04-25T00:32:00.003+01:00

My fourth shift started with my primary mentor in majors, we had a couple of chest pains(?MI) and a headache with left sided vision impairment and limb weakness. All very pleasant patients. And then I got asked to take a set of obs on a patient in resus because they were rammed in there and didnt have the time to juggle everything. Seven hours later I left resus.....

It was incredible, juggling obs, drawing meds and just generally identifying jobs that needed doing and doing them before the qualified staff realised they needed to be done. At the end of my shift I got a chance to chat with two of my patients in resus(they were on half hourly obs and nothing else in there needed doing). One lady in her late eighties came in with chest pain(i'm told she was a little bit in love with me). I find that a lot of elderly patients get spoken down to. as though they have no right to know exactly what is happening to them as long as their progeny have been filled in. I do not agree with this, as long as the patient is competant and willing to know, they have every right to know whats going on with them. This also seems to help me form nurse-patient bonds. This patient was very stable when I went off duty.

Another patient was a lady probably in her late fourties, overdose of paracetamol. her fifteenth suicide attempt in the last twelve months. This told me several things. The patient felt rewarded by the attention her suicide attempts acheieved, the patient shouldnt have been in a position to make a second suicide attempt, let alone a fifteenth. She should have been sectioned under the mental health act. As a result I felt obliged to give her my most professional behavior, I did everything by the textbook, with no more than the professionally required level of warmth. Its a shame, the patient was such an intelligent person and she was wasting her life by trying to end it.

On the other hand we all over our stories and people dont end up like that unless a series of events has guided her path there. To be honest I had no idea what to do non-medically that would be in her best interests. I am sure she will survive to discharge and in all probability make another attempt, who knows one day she may accidentally succeed.

There was another patient who died under circumstances that really effected me but it is probabilty disrespectful to recount the events of his failed resuscitation on a public blog. Needless to say there are some parts of the job I will never enjoy.

However I have had another great day, largely thanks to the staff I have been working with. I am more than ready for my two days off now and a bit of sleep.

A&E: Day Three

2009-04-24T09:21:00.002+01:00

Today has been the best(and most exhausting) day in my two years of training. I was working on resus. I lost count of how many chest pain patients we saw. We also had a few stroke patients. Normally my hospital thrombolyses(injects an agent to break down clots) about eight people a month. Today we did this to six patients. They have to meet a very specific criteria to be eligable. It was all very exciting. While we didnt have any actual arrests in resus all of our patients were very ill. We also had two patients with very impressive breaks (one elbow, one wrist) who were sedated and had their breaks manipulated (pulled into a more stable position and cast) both of these patients were admitted as they would require surgery.

Something that strikes me as very different here is that the doctors actually get stuck in with general nursing duties, a doctor helped me transfer a patient to the ward. She also later on helped me roll a patient so I could get a bed pan under her. This would never happen on the wards. The nurses in A&E are all so laid back and relaxed, someone could walk through the doors in flames and they would probably yawn before putting the flames out. There is no such thing as a rush in A&E. I like this approach, calm and sure.

A&E: Day Two

2009-04-24T09:12:00.003+01:00

Back on majors again today, and loving it. A couple of old ladies collapse query cause. This means taking a full set of basic tests - ECG, Pulse, Blood Pressure, O2 Saturation, Resp Rate, Temperature. And blood tests including - Full Blood Count(FBC), Microcultures and Sensitivities(MC&S), Blood Glucose Levels, etc. Because its easy enough treating the injuries sustained in the fall but the cause could be very sinister. In this case on patient was admitted with fast atrial fibrilation(Fast AF) and the other wise discharged as the fall was caused by a raging urinary tract infection(UTI, very well known for knocking little old ladies off their feet and making them a little crazy at the same time).

We also had a couple dementia patients who didnt stay with us long, they were admitted for a social sort out. Not really our job but the ward nurses are very used to this sort of thing.

All in all another awesome shift, Roll on Tomorrow!

A&E: Day One

2009-04-24T09:00:00.003+01:00

Sorry for my lack of posts recently I've been putting a bit of time into preparation for my new placement. I am now spending eight weeks on Accident and Emergency. This is very much where I want to be career wise.

For my first day I was working majors. This is where patients go if they have a serious injury or illness and will probably require inpatient admission. My first patient was a known alcoholic in his mid-fourties who was found in the middle of a road unconcious with some very nasty grazes down his arm. Grazes dont sound that bad however he was losing about a pint of serous fluid(clear body fluid) every few minutes. He had taken most of the layers of skin off his. Obviously the key here was to dress the wound and get as much saline into him as humanly possible, we also gave him various vitamins to ease the effects of the alcohol withdrawl. All in all a really good first patient.

We also had a couple of road-traffic collisions(RTC's) one of whom was triple-immobilised by the ambulance crew(neck colar, head blocks and straps all over hte body). We had to get an x-ray of his c-spine before we could remove any of this. This shouldnt be too hard but we are fairly sure he dislocated his shoulder as well so it was damn near impossible to get a clear picture of the last cervical(that spelling doesnt look right but my brain is melting so it will do) vertibrae.

All in all an exciting first day.

Chaplains

2009-04-08T10:49:00.005+01:00

The National Secular Society are suggesting that the chruch should fund Chaplains in UK hospitals. This would save the NHS £40,000,000 per year.

I am far from a religious person. I believe there is something bigger and more powerful in this universe than I can understand. I have no idea if its some kind of intelligent entity designing the universe to some kind of plan. I seriously doubt it but thats just me. But I have seen the effect these chaplains can have on my patients lives. They are a crucial part of a lot of patients care. It is important to appreciate that most hospital inpatients in a general hospital will be elderly. They are from a generation which has led them to go to church every week. It is important for them to feel their God(s) havent abandoned them when they are ill or dying. A few months ago I had a patient who was incredibly ill, she was dying and frankly we couldnt explain why she was still alive. She was in an incredible amount of pain and understandibly terrified, until she saw our chaplain. After a bit of a chat and a couple of prayers this patient faced her imminent death without any noticable fear. It was incredible. This is the basis of my opinion that faith is a beautiful thing, it can lead you to do things that you are not capable of and it can bring you peace. I dont necessarily mean faith in God(s), faith in yourself, faith in science, etc. The problem is religion is political. You are told to believe like this, or worship like that otherwise you are going to be punished.

As I said I am far from a religious person but as a student nurse I cant help but recognise the significance of Holistic Care(caring for the whole. physical, emotional, spiritual, etc). I am deeply worried that if the job of financing these chaplains goes to the church they will be subject to the churchs politics the same as any other priest, vicar, etc. And this may well effect the emotional wellbeing of my patients.

Productive Ward

2009-04-03T17:41:00.003+01:00

Many trusts seem to be adopting a fairly interesting new system known as Productive Ward. This is where for one shift on a regular basis a nurse is taken off of his/her clinical duties and sits down and trys to think of ways to make the ward more productive. Something as simple as moving the commodes nearer the door in the sluice room so that it takes a fraction of a second less time to get the commode to the patient(which apparently adds up).

A ward in bath has made the news because rather than having the one set of keys for the drugs trolley floating around different members of staff depending on who used them last they keys are now locked up in a safe and every member of staff is given a key for the safe. The benefit here is that they can now avoid a very regular occurrence on all wards - a member of staff has gone home with the keys in their pocket and has now got to be dragged back in because none of the patients can get their medications. I would strongly argue that the downside of this system is that when they keys are floating they are always in the possession of a member of staff, someone relevant always knows where they are. If they are in a safe they are unobserved for long periods of time, added to which there are now keys for the safe all over the place. This seems far less secure and potentially very dangerous.

All in all the productive ward scheme seems to be keeping peoples attention on the importance of ward efficiency however I am not certain that the changes made are really making a difference. Another drawback is the nurse working a productive ward shift has to do it on the ward. If you are a nurse on your ward you are going to get roped into checking IV's, answering buzzers, and generally chipping in during those day to day crisis moments on the ward(which frankly I would prefer). This wouldnt be too bad if most wards didnt insist that a nurse in a productive ward shift has to wear plain clothes(no uniform).

However it does make you think how much time and energy is wasted at work through tiny inefficiencies. It does all accumulate.

On a side note I recommend you guys take a look at This Site. Its full of little educational flash games. My favourite is the blood typing game.

Hang Over

2009-04-01T21:59:00.003+01:00

Last friday it was my birthday. To celebrate surviving another of our earths rotations around the sun I traveled to the far off city of York. By far my favourite city in the UK despite the distance. One of the many many reasons I love this city is that pubs and more importantly varied ale is plentiful. So on the afternoon of March 27th I started drinking. I got absolutely riddled. This obviously led to a hangover.

The key symptoms of a hangover(at least for me) are - Headache, Photo-Sensitivity, Nausea, lethargy and Weakness. And in my a rather bizzare desire for a pint of hot, thick gravy. Most of this can be explained by the simple fact alcohol is a diuretic, it causes you to urinate. This means you are losing water......in this case lots of water. When you are dehydrated you get a headache, you're blood pressure drops which also explains feeling weak and lethargic. The Nausea is a combination of the Ph effects of alcohol and the dehydration.

In a perfect world I would hook myself up to an IV of saline, or even better something with a few electrolytes in to reverse the effects of the dehydration. I would also take a Proton Pump Inhibitor(PPI) to settle my stomach Ph. PPI's are commonly given to people high risk for gastric ulcers, usually because they are on a medication which can errode the gastric lining(asprin and ibruprofren are key offenders here).

As I had none of this on me I considered taking an approach I have used with a moderate amount of success in the past. A good seven hours sleep and about a pint of black coffee so strong the spoon dissolves. However in the name of science what I tried was something my fiance recommended, being from yorkshire stock and having been a student I believed she was a leading mind on the subject of hangovers. So I drank a bottle of Iron Bru. Honestly I cant explain why it worked so well or so quickly outside of suggested witchcraft. Its clearly designed to rehydrate and boost electrolytes. But I was feeling absolutely fine five minutes after drinking it. It Was a miracle!

So I was wondering dear readers. What do you do for a hangover? How well does it work?

I thought I might start ending my posts with a bit of information on what I am up to -
Reading: Terry Pratchett - Last Continent.
Listening To: Bad Company - Bad Company, Mark Knopfler - Sailing to Philidelphia.
Watching: Poldark.
Drinking: The Aforementioned Black Coffee.
Eating: Nothing I'm in a Diet.

I should mention that none of the above should be used to try and estimate my age. :P I'm only 23. I just have taste.

Sickening

2009-03-18T07:21:00.002Z

READ THIS!

When I first read this I couldnt believe it. I know there are a great number of chav's, football hooligans and various other bottom feeders out there but this is just insanely low. I want to put emphasis on the fact that SECONDS in emergency care can make a difference.

Admittedly this is from the daily mail, but I have substantiated it via other means.

Its Just Sick

Right Place

2009-03-17T17:40:00.003Z

I have no problem with religion....well no problem that I can apply to this post. People can believe what they want, when they want as long as they keep it away from me. Faith, Religion and God even have a place in modern medicine, that place is in the waiting room.

There are more than a few people on my course (a very science heavy course) who are creationists, and believe that the universe was created 5000 years ago and the fossils are just a test of faith. There are other inappropriate beliefs going around the nursing and medical degrees at my university. At the end of the day this really scares me. If I have a patient under my care I use my knowledge of science, my understanding of the human body and my faith in my own abilities to treat them. Anyone who does the same is fine in my books, if they want to talk to their god(s) about it once they have dealt with the patient that is also fine. At some point there is going to be a scientologist applying for a medical or nursing degree, as this is a minority faith any university would be obliged to accept them. For those of you who arent familiar with this faith there are a number of ideas that I have no right to take exception to, what I do take exception to is the fact that they dont recognise a number of very common conditions. As far as they are concerned for example Autism isnt a real condition.

There is a time and a place for Religion, that place is not in the operating theatre or the ward, that place is the waiting room, or at home. If you are practising as a healthcare professional you are a scientist, to be anything else is negligent.

Catch 22

2009-03-16T14:40:00.003Z

A patients blood pressure dropping can indicate nearly anything, couple this with raising tachycardia(Increased Pulse Rate) and pyrexia(Raised Temperature) and you probably have a patient suffering sepsis. Until the antibiotics sort out the sepsis(assuming a surgical pathway hasnt been taken) you have to deal with the patients blood pressure. it needs to be raised to a point where the whole body is receiving enough blood regularly. The popular method of doing this is hanging saline regularly as well as another IV fluid called gellofusin. The idea is that at least you are keeping the circulating volume up even if the actual contents is a little diluted when it comes to oxygen bearing red blood cells.

A common result of cardiac incidents, or general poor cardiac function is the collection of fluid in the preferies(Oedema), and usually this fluid makes its way onto the lungs. This is pretty easily resolved with a nice little diuretic we use called Furosemide. This causes any excess fluid in the body to be passed through the kidneys, into the bladder and given the condition of most of my patients straight into their cathater bag.

So what the hell do you do when you have a patient who has a plumeting blood pressure and is overloaded to the point where their lungs are severely comprimised?

The doctors caring for this patient decided to try and maintain a balancing act, putting enough fluid in to keep her blood pressure compatible with life whilst putting enough furosemide in to stop her drowning. Not an easy thing to do and I dont envy them.

IPLU

2009-03-12T13:40:00.002Z

So tomorrow is the last day of my InterProfessional Learning Unit for this year. Myself and a group of medical students, ot students, pharmacy students and other nursing students have been auditing some bits and bobs on a neonatal unit. Its been fun but I really miss being a real student nurse so I'm glad this is nearly over.

One thing I haev learned from this unit is that neonatal care scares the hell out of me. I'm an adult branch nursing student. Adults and big, smelly and in general foolish. They are far less fragile than neonates(usually). In general if a neonate is sick enough to be admitted to a ward they are probably balancing on a knife edge. Adults get admitted for everything from a social sort out to the sniffles.

I also have a hard time connecting with paedeatrics and neonatal nurses. In my experiences adult nurses bond with the use of dark humour and grim satire. Paeds nurses are all happy and bubbly. Its probably hard to apply dark humour to critically ill babies.

After tomorrow I get to spend a few days in the lake district. to relax, recoup and drink heavily. Then i'm back and spending a few months in my local A&E department. I am really looking forward to this however I suspect my only duties are going to be taking obs. I cant imagine there is a lot in A&E students are allowed to do.

Two Patients

2009-02-26T21:18:00.002Z

Patient One

18 Year Old Male.
No Medical History, Normally very healthy.
Very fit and active.
Presented to A&E with acute abdominal pain.
Diagnosed with appendicitis with immediate risk put on the next mornings surgical list.
Patients family are hypochondriacs and overly dramatic panic mongers.
Patient goes into theatres for a perfectly routine procedure.

Patient Two

87 Year Old Male.
Repeated relapses of cancer over the last 20 years.
Chronic Obstructive Pulmonary Disease.
Not very active and in pretty rough shape at the best of times.
Patient admitted with increasing Shortness of breath due to infection.
Infection not responding to antibiotics.
Deterioration indicates that patient meets the criteria for the liverpool care pathway(will be dead within 72 hours).
Very upbeat, has had a hard life and accepts everything that is happening.

I have treated patients similar to both of these although neither of these patients is exactly like any one patient I have treated. Now heres the challenge for any of you poor readers, Tell me what I will find if I go back in three weeks to see these patients. And tell me why I will find what I do.

Sleep

2009-02-26T04:25:00.002Z

Its 0425.
Every muscle in my body is aching.
I can barely find the energy to sit up in my chair.
My mind has slipped into an energy sparing melancholia.
I should be fast asleep.

But I'm not. I've spent the last five hours staring at my bedroom ceiling, unable to sleep despite the new depths of fatigue I am currently exploring. I've been back in lectures for a while. Thus the lack of posts, I havent had anything of worth to blog about. Given how exhausted I've been when on placement I decided to take some time off working as a bank carer as well. Finally get some time to just be a student. Unfortunately this is how my body always reacts when I go a prolonged period without work. The lecturers arent challenging(for anyone) at the moment, and despite the fact I am still being very active for some reason I just cant seem to function unless I am working myself to the point of sickness.

In the past I have tried everything through medications, herbal remedies and alcohol (not at the same time) to correct this purpose-deprived insomnia but nothing touches it. So I thought I would throw it out to all you guys, what wierd and wonderful tactics/potions/tricks do you guys use to treat insomnia. Anyone who comes up with something that actually works will earn my undying gratitude.

Mythology: Vampires

2009-02-17T11:38:00.003Z

Most cultures have superstitions involving beings more or less similar to what we call vampires. In this post I intend to offer a possible medical explanation for these creatures. A condition known as Porferia is caused by a malformation of an enzyme in haem. Haem is a crucial element in our blood and allows our red blood cells to bind to oxygen. The condition can easily be fatal without a treatment, a suppliment of artifical haem. Lets break down the "signs" of vampirism.

Drinking Blood
The folklore states that vampires need to drink blood in order to survive. This is technically a solution for porferia suffers, Ingesting large amounts of human blood would provide the required elements to suppliment low haem levels. However most of the ingested blood would be immediately broken down and unusable in the stomach.

Sensitivity to Sunlight
Three types of porphyria are associated with a sensitivity to light, which can be as extreme as sever sunburn at minor exposure. Most sunscreens are totally non-effective.

Complexion
Most legends suggest that vampires are very pale in complexion. Maybe because the legends state they dont get out much during the day? Most people suffering from porpyria are very pale in complexion as a result of barely functioning red blood cells.

Despite all this there are a few bits where the legends dont match up to the medical condition. As far as medical science is aware porphyria suffers cant fly. Also the legends all seem to give vampires a far eastern european accent. Porphyria is one of surprisingly few condtions that dont seem to effect any ethnic group more or less.

This connection has been suggested in the past by many academics one of the better works was a paper writen by a biochemist named David Dolphin in 1985. These suggestions are deeply contravercial as it adds an additional stigma unto suffers of what is in reality a very natural and saddening condition.

Failure

2009-01-28T11:29:00.003Z

In this profession you standardise you're level of success or failure based on how many patients are alive when you leave the ward. If you have worked a shift and none(or in critical care very few) of your patients have died then you mentally tick that off as a successful shift.

Many wards at any one time have patients who are palliative, they are dying and there is nothing that can be done medically to prevent this. Fortunately there are care pathways(protocols) in place for any patients who meet very specific criteria. This takes a lot of the difficult decisions out of the hands of doctors, nurses and the patients family. The standard care pathway in my trust is the Liverpool Care Pathway. Once a patient has started on this care pathway their treatment is purely for comfort. Analgesics, Anti-emetics, etc are administered
more or less constantly via a syringe driver. A device that slowly injects medications over a given period so rather than a patient getting a dose of morphine for their pain at 1300 and needing another dose at 1500, the driver releases the same dose into the body constantly over x amount of hours. This not only means the patient is constantly receiving pain and sickness relief but the nurse doesnt have to wake the patient up every three hours to administer the drug.

Once a patient is on the LCP and non-essential medications are discontinued(pretty much anything they wont die immediately if you take them off) and their observations are either ceased or taken only once a day as it is an uncomfortable thing to do to a patient but absolutely necessary for a patient who has a chance of recovery. In patients with no chance of recovery whats the point of waking them up at 0500 every morning to take their blood pressure, pulse, oxygen levels, etc. On a regular basis the patient is assessed for pain, agitation, nausea,
breathlessness, etc and if there is any variance on these then the medication the patient is on is adjusted so that they are as comfortable as possible.

This phrase always made me laugh "as comfortable as possible". The patient is dying, they are scared, exhausted, probably in pain. What we make the patient isnt anywhere near comfortable. And to add to the discomfort we take them off fluids and food and of course they are bed bound so they will be cathatarised. Ethically is this the right thing to do? they are dying and food, fluids, etc will prolong this however do we want their last hours to be spent, thirsty and hungry?

And back to my original point when you leave the ward and one of these patients has died how do decide if it was a success or a failure on your part?

Back

2009-01-13T14:43:00.002Z

I have returned. My abscence over the last month has been down to two things. Firstly I finished my third placement and thus didnt have a huge amount to talk about and secondly I spent a good couple of weeks over the christmas period in a state that some refer to as being 'bladdered'. But now I have returned and though I am not back on placement I am back to working (to earn money so I can afford to stay on my course).

I'll start with an old familiar topic just to ease my return. HIV and Population control.

Everyone knows what Human Immunodeficiency Virus is, admittedly the general populous have a very misguided interpretation of what it is and who it effects. The potential target group for this virus is EVERYBODY! not just homosexuals and drug addicts. Now we've cleared that little misunderstanding up lets move on.

There is a very similar virus that effects monkeys, Its called Simean Immunodifficiency Virus(SIV). Studies have suggested that the earliest outbreaks of this virus occured in africa. This isnt terribly shocking considering the earliest species of simean have been found in africa. Now, several thousand years after the first suggested outbreaks of this virus there are many native monkeys in africa which show absolutely zero uptake on this virus. They are either immune or resistant to the point where you might as well call it immunity. However if you expose for example an asian monkey to SIV they will almost certainly contract it with ease.

This leads us to beleive that there were monkies in africa which were both vulnerable and immune to SIV, the virus killed off all of the vulnerable monkies leaving behind just those which were immune, this immunity was passed on from generation to generation and from that point SIV was almost removed from africa. Should this also be the case for humans and there are those out there with an immunity to HIV(and there is no evidence that this is the case) then HIV could just be another one of mother natures population limiters.

In bacteria there are various principles of growth. Give a bacterium x amount of nutrients in a petris dish and expose it to the perfect amount of heat to promote growth and at first they spread at an incredible rate....then they slow as food becomes limited and excreted toxins start to build up, but at this point they are still in a state of population growth. They then stop, an equal amount of bacteria are dying due to lack of nutrition or exposure to toxins than are being created through further growth. And finally the culture starts to die, there are too little nutrients available and far too much toxic exposure. They have grown to their deaths.

Mankind is doing something similar, although we are still in a state of exponential growth. But the cause of all this 'global warming concern' is that we are facing the inevitable. In this history of this planet we have had an insane number of ice ages, then the ice melts(entirely) so even the polar caps are water, leaving only the highest of land above water. This has never really been a problem before because what few humans there were on the planet could fit into the visible land masses. Unfortunately now with 6,700,000,000 people on this planet we dont have any space to allow the entire species to survive a perfectly normal interglacial period. This period of defrosting is happening not because of us or our 'carbon footprint' but becuase it is meant to happen as it has always happened. Admittedly our effect on the environment may have expediated the defrosting but not by a huge amount.

There we go, Rant over. Have you all missed me?

Drinking it In

2008-12-07T11:44:00.002Z

Every shift I turn up at work half an hour early. I grab a cup of coffee and sit in plain view of the ward. Its the only time you get a chance to do this. Once you start working you have the blinkers on and you cant really get a feel for whats happening on the rest of the ward. So i sit, and I watch, I watch where the carers are focusing the most attention (even if they dont realise it themselves) I assess which patients will need two for assistance with a wash and which will need one. I note the noisey dementia patient who was probably screaming all night and make sure that is the last bay I go to so the others in there can get some rest once I have moved her to a cubicle.

I sit there and let it wash over me. And I have to say, its an incredible feeling. I am definitely an acute ward nurse. The ward is my home, and whilst I have the highest respect for scrub nurses I could never be one, I dont have it in me, and as far as community goes? I dont have the stamina to see hundreds of patients who all need wound dressings every week. I love wound dressing but not in that quantity.

On equal note I dont think I could be a surgical nurse for all of my career. This is more down to preference I am a medically minded person. I love the intricies of renal failure and the challenges of COPD.

I am an acute medical ward nurse.

Laughter

2008-12-06T12:05:00.003Z

Yesterday we saw one the patients the entire ward had grown very fond of die. Thankfully it was very quick and painless. The mood of every member of staff on duty, from the sisters to the domestics dropped. Later than shift we had a quiet moment, someone (one of the class clowns) cracked a barely amusing, entirely inoffensive joke. The resulting laughter from everyone lasted several minutes and washed away the low moods. It was just the catalyst we needed to release it all.

Unfortunately in this job you dont really have time to stop and think about the bad things. A patient you cared about dies, you have to keep going because if you dont other patients will. The job doesnt stop to let you heal. In some ways I am grateful for that because if I stopped to think about every patient on any one ward who died I would probably end up killing myself.

The Job doesnt stop, so we cant either.

Three Patients

2008-12-05T10:45:00.002Z

Well i'm back to fighting strength, which is good. I'm also doing really well on this placement....so I'm told. I have to admit that I am going to miss it. My time with them finishes on the 12th but I have four shifts to make up so it might be a little later than that. Its been a good placement and I've regained all the confidence I lost on my last placement. I am also enjoying being a student nurse on placement with no assignments hanging over my head.

Yesterday we had a patient who went for a liver biopsy, when he came back he hadnt had the biopsy and had an acitic drain inserted(a tube inserted to drain large collections of fluid). The bag this was draining into was only 500mls. after the first two hours of emptying this bag every half and hour I decided to attach a 1.5 litre bag. To my amazement the fluid was draining even faster, it appears as long as there is space it will drain incredibly fast. This fluid loss obviously had to be compensated for so we were hanging bags of FFP(Frozen Fresh Plasma) and towards the end of my shift we had to clamp off the drain and hang bags of saline. All in all the man lost almost 10kg in a few hours. This cant be healthy! but he said he felt great and the doctors didnt seem concerned.

We have another patient who was doing so well, he's been with us for months and was medically fit for discharge until he contracted the D+V the ward was closed with, he finally got over that and seems to be in decline again. His blood pressure is in his boots, he's tachycardic, and very pyrexial. All of which leads me to believe he's septic despite the high doses of antibiotics he's on. This is an example of a patient you cant help but get attached to and at 90 years old I am not sure he'll see discharge this time.

Patient number three had the entire staff of my ward in tears yesterday(myself included). He is dying, he is very much at peace with his fate, he has at best a few weeks left and just wants to die in hospital so his family dont walk into his room one morning and find him dead. He had written a poem to his wife that is by far the most beautiful thing I have ever read.

So theres my three patients, the healthy, the declining and the dying.

Highs and Lows

2008-11-28T11:11:00.002Z

Yesterday I got to run my own bay, with six acutely ill patients. There was no one watching my back, I had my own healthcare assistant and I was responsible for getting one of the qualified nurses to administer drugs when I asked them. If I didnt ask the patient didnt get. It was huge for me, I didnt screw up, it all came off without a hitch and was a massive step for my training.

Unfortauntely today I am feeling rough, very rough. My ward is still infected with norovirus and I was hoping the fact I had only just gotten over this virus meant I had a greater resistance. Unfortunately Virii have a habit of mutating so the immune system cant recognise it and you just end up getting reinfected.

Also given I have just reread this post It appears I'm not thinking too clearly either.

The Songs We Sing

2008-11-24T21:13:00.002Z

I have mentioned before that there are certain songs that would lend themselves to the soundtrack of ward life. I thought I'd list a few of these based on the activities involved -

Performing CPR - Triumph - Fight the Good Fight

Having 1000 demands made on you at once - David Grey - Please Forgive Me

Trying to convince a dementia patient we arent stealing their blood Fountains of Wayne - Hey Julie

Trying to keep a mobile dementia patient from leaving the ward unnoticed
- Thin Lizzy - Jailbreak

Trying to get a doctor to canulate a patient at 0300 - Manowar -Fight until we die

Starting a Shift on a crisp, cold afternoon - Butthole Surfers - Dracula from Houston

A Moment of complete warm fuzzy teamwork - Iron Maiden - Children of the Damned

The end of a shift - Show me the way to go home

Noro Novo

2008-11-24T20:54:00.002Z

I've spent the last week off sick due to a pesky little virus called the norovirus. The basic symptoms of this virus are D+V. When I got back to work yesterday and my ward is closed to all admissions and discharge due to this virus. 25 of our 27 patients have it. One week may not sound like a huge amount of time to have off sick but thats only the amount of time it took before I was no longer infectious. The 72 hours starvation and massive dehydrated have taken their toll. I've lost 10kg in 6 days and still feel week as a kitten. Now I am reletively fit normally and its hit me this hard. Imagine how its hitting the elderly and recently post operative on my gastro ward. Additionally all the nursing staff are having to work harder under more stress because they are massively understaffed and this is making them more vulnerable to the virus.

The patient who originally had the virus died shortly after she was admitted to the ward, in the space of two hours she manged to infect enough people to start this. The interesting thing is this virus is ancient, its been around since hte begining of recording history (that or virii very similar to it) and its learned to adapt and survive everything the human body can throw at it

I'm not saying we should all be in awe of this virus but I am. Its defied the basic principles of evolution - Survival of the fittest, and its not evil, its not a life form going about its dark purposes, its just an entity that is doing what all living things do, finding means to replicate, the damage it does to the environment that supports it is completely accidental.

It has been stated that the only thing that exists beyond good and evil is death which does not discriminate, does not seek the good or evil, it strikes all without thought or intention. I would argue that life also its beyond good and evil, the struggle to survive against any and all odds without intention or inclination towards either good nor evil.

The Rain

2008-11-12T02:08:00.004Z

As a gastro medical/surgical ward, my ward sees a lot of alcoholics. Many of these are frequent flyers. Many bloggers from the ambulance service tell you about the trouble drunks give them on a regular basis. So I thought I would give you a little insight into what happens when those drunks actually get admitted to hospital.

Michelle(obviously a pseudoname) has wrecked her body with drink. Her brain barely functions and she often just sits and stares at the wall, saliva streaming out of her mouth and pooling in her lap. She is perfectly mobile and can answer direct questions. Her liver barely filters out the everyday toxins that wouldnt cause a healthly liver any problems. These toxins occasionally accumulate and attack her brain further. She has been a regular on and off the ward for almost a decade. Every time she comes in, we stablise her with a regimin of vitamin supplements and iv fluids and discharge her. The doctors insist their tests show she is mentally fit enough to look after herself, so they release her back to her home which has no electricity, no heating, and no water because the complexities of paying bills is a little beyond her level of comprehension. That night shes found roaming the streets of her town, naked in the pouring rain. Shes brought back into A&E, they send her back to us and the cycle starts again.

Now section three of the mental health act states that any patient who is deemed a danger to themselves or others should be placed into an appropriate mental facility where they can at best be rehabilitated, at worst protected from themselves. However the medical team in their infinite wisdom suggest that this women isnt a danger to herself. Their tests prove it.

On this ward I am learning how truely frustrating this job can be. We are working ourselves to the bone in order to save people who dont want to save themselves. But we still do it, with the same vigor we show patients who havent brought their conditions on themselves.

Wow

2008-11-06T18:33:00.003Z

Unbelievably one of the patients who had a GCS of 4 and was indeed on the liverpool care pathway came around. After two days being completely unresponsive with no pupil reactions she was sat up eating soup and chatting about her grand children. I have never seen anything like it.

New Ward

2008-11-03T09:54:00.002Z

So I'm settled on my new ward. Gastro Medical and Surgical. Its an interesting place to be. I've experienced a surgical ward on my first placement, and a medical on my second. Caring for both sets of patients in the same place is interesting.

Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.

The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.

I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.

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*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.

**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.

Suits

2008-10-27T09:07:00.002Z

One of the key issues with working in healthcare is you spend most of your time covered in sick peoples bodily fluids. Obviously this is just part of the job and it doesnt really bother you. However when you get out of the hospital you cant help but feel the need to clean thouroughly and get into some very clean cut, neat clothes.

In short I honestly need more reasons to go out wearing suits. Unfortunately there are only so many weddings you can go to. I dont know if this is just because I have come from a job where you spend most of your time in suits/neat uniforms.

BLS BS!

2008-10-22T17:10:00.003+01:00

As a student nurse I am required to sit through three hours of bls training every year. As a member of St John Ambulance I tend to keep my skills sharp much more regularly than that. Unfortunately the two sometimes conflict.

During my Basic Life Support training yesterday the nurse stated emphatically that should you have a patient with a possible spinal injury and they vomit into their mouths you are not to do anything. In short you sit back and watch the patient suffocate. In St John we are taught that Airway, Breathing and Circulation come first, as long as those are secure you can start taking care of other injuries. In this situation with sja or any other first aid organisation it would be appropriate to put the patient in the recovery position (in the absence of a suction unit) regardless of the risk caused by a possible spinal injury. The rationale is that if you move them the MIGHT die or suffer paralysis, if you dont move them they WILL die.

After taking some pains to explain my moral objections to the former concept being taught as protocol for 'healthcare professionals' I went above the trainers head to her boss. who supported my arguement. Unfortunately the trainer had already drummed this faulty concept into five groups before us.

One a more positive note I went to see my new ward today. Its a gastro medical and surgical ward and I'll only be there for six weeks. The ward seems wonderful, the staff were very friendly and welcoming and whilst the specialty is not a real passion of mine I still find it fairly interesting. I think this is just the placement I need after the mess with my last one.

Back to Work

2008-10-07T10:47:00.003+01:00

Due to all the hassle regarding my last placement I requested my exit forms from my academic tutor. She said "No", she was point blanc refusing to let me leave. So I attended a crisis meeting where it was agreed I'd spend a further week on the ward and my mentors would no leave my sight. This worked well and I got all my proficiencies signed off. Unfortunately me handing my documentation in late was an immediate fail ....or so I thought. As my academic tutor was so determined not to loose me she arranged for all my paperwork to....go away. It was very nice. Even had I completed the placement normally there would be a mountain of paperwork for me to sign but shes taken care of all of it. She also felt that I needed something to bolster my resolve. Something to hold on to and help me through the harder times. She told me I am guarenteed a placement in A&E in my third year. The day we accept the offer to start the course at the university they have the whole three years of placements mapped out. Its nearly impossible to change their plans and we are not allowed to know where our placements are other than the next one. So she bent a few rules but It has helped. I get my dream placement at the perfect time.

So I'm in a fairly good mood. The university are bending over backwards to ensure I stay (which I may be taking advantage of a bit). However I have two assignments due in soon so I am currently sat in the library trying my hardest not to start them. I have been fairly socially active with the other memebers of my course recently and some of them raised a point that my 'intellect is very intimidating' my immediate reaction to this was to laugh. Then I realised I have a fairly broad knowledge of most things, but very little in depth knowledge of anything. I know enough to know I dont know anything but the range and variety of my knowledge must present very differently to how I thought it did. I found this information very unsettling.

My first assignment is on Long Term Conditions. I had chosen Chronic Lymphocytic Leukemia but my academic tutor suggested this might be showing off a little. So I have decided to write one on COPD. I am still planning on writing the same assignment on CLL but I wont submit it. I find the condition facinating and writing this assignment will cause me to efficiently explore the medical and social implications. Is it sad that I do things like that?

Explaining All

2008-09-26T08:38:00.002+01:00

So all of my fellow nursing students are in lectures. I'm on placement and in lectures. This is exhausting me. As so many people keep asking me why this is I thought I'd just post it on here and direct them all to it. Makes my life a little easier.

In order to pass a placement you have to have certain proficiencies signed off by your mentor who is responsible for guiding your education on the ward. I got through 11 weeks of the placement, there were two more to go and my mentor came up to me and said 'I cant sign your proficiencies off....I've never been behind a curtain with you and a patient'. She was quite correct, she just set me tasks and I got on with it either myself or with another nurse. Two weeks was not enough time to be observed doing all of the required things, she'd effectively failed me on this placement. She had never seen me do a damn thing. I explained that I felt it was unfair I was being punished for this and removed myself from the ward pending a chat with my academic tutor. My academic tutor got me into negotiations with the ward and I am back. Making up time sort of. However I could not be granted an extension on the handing in of my documentation for this ward because the university do not condone having a student in full time lectures and full time work at the same time(however unofficially this was the deal that was cut for me). This is why I am exhausted. And it seems I've failed the placement regardless of weather my proficiencies are signed. Where this leaves me I have no idea.

Understaffed

2008-09-17T19:25:00.002+01:00

My ward is Acute Medical Respiratory. Due to the critical nature of most of our patients Our standard compliment is Four trained Nurses and Three healthcare assistants.

One shift recently there were two trained and one healthcare assistant(and myself but i'm 'supernumerary'). The ward sister got so pissed off with the EMAU sending us critical patients with our limited staff level and no warning that she locked the doors to the ward. The next morning there was only one trained on. These shifts were hell, I was doing things a student nurse shouldnt be doing without supervision. However we got through the shifts with no problems and I realised I always feel closer to my colleagues when we are massively understaffed. The nurse I worked with both shifts was wonderful, we communicated volumes through a simple glance at each other, I knew what she was going to need before she needed it and she knew what I was thinking. Its a level of teamwork I have not experienced in some time.

Sometimes in this job its the people you are working with that makes it worth doing.

Lack of Posts

2008-09-15T09:55:00.003+01:00

I've not really been around for a while, this means I've not written or read many blog posts. There are two very good reasons for this, firstly the insane hours student nurses have to work. and I am now Engaged. This means my time is even less my own ;).

Priorities

2008-09-15T09:38:00.002+01:00

I'm going to ease up on the nursing posts for a while as between my ward and my university I'm having enough of it. Fortunately I have been on duty with St John Ambulance a few times recently and have several infuriating stories I can relay.

Patient approaches me with a sever limp. He complains of a chronic pain in his knee and is barely able to pressure bare on that leg. I dont carry nor am allowed to dispense the medication for the condition he says is causing the pain and the strongest analgesics I can administer are paracetamol which are barely going to touch this. I decide its in the best interests of my patient to radio for one of the three on site doctors so they can deliver some more appropriate pain relief. The casualty gets bored of waiting after half an hour and returns to his business (a stall at the event) and notifies me where he will be when the doctor arrives*.

The doctor arrives at my first aid post and I outline the situation. We have a long debate which turns into an argument. He does not believe that analgesia has a place in first aid. I pointed out that from the patients inhibited ability to walk he will likely fall over and suffer a worse injury. The analgesics may allow him to walk a little more steadily and thus reduce the risk of a fall. After a little more exploration of this concept the doctor gets bored of me and gives in, he administered some prescription meds, I filled out the paperwork and the patient was not brought to our attention again that day (which suggests to me he did not suffer a further injury).

Interestingly a year ago I would probably have agreed with the doctor, analgesia has no place in the field. Its interesting how my new role as 'student nurse' has shifted my attention onto patient care standards.

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*this may seem like a slightly silly thing to do if the patient is in real pain, however many stall owners at this event put every penny they have into representing their businesses there, whilst he was away from his stall his livelihood was in peril.

Worthy Cause

2008-08-25T09:32:00.003+01:00

Whilst I accept few people actually read this I feel it is necessary to point some attention at an organisation which is becoming increasingly important in Hampshire.

The Hampshire and Isle of Wight Air Ambulance Take catagory A calls all over hampshire and nine times out of ten are able to get their casualties to hospital quicker than a road ambulance. However unlike the Hampshire Ambulance Service(on the roads) the Air Ambulance Receives NO government funding and operates entirely on voluntary funding.

Take a look at the site.

Basics

2008-08-25T09:17:00.002+01:00

Any regular readers will know that I occasionally rant about the importance of not forgetting the basics.

D - Danger to yourself, the patient or bystanders.
R - Responsiveness of the patient.

A - Airway is clear?
B - Patient is Breathing?
C - Circulation is adequate?
D - The Patient has a disability?

In a healthcare service which is full of cool toys, allowing us to test, probe and prod a patient it is sometimes easy to forget the above come first.

I was once faced with a patient who had a potential spinal injury. We had immobilised as best we could but we only had our first aid kits on us and we were awaiting the arrival of one of our nice, fully kitted out ambulances(including a spinal board). They were still three minutes away when the inconsiderate patient decided it was time to stop breathing. Now you have a choice. I moved the patient into a position where I could start resuscitation. This meant comprimising his spine. Guarentee of Death trumps chance of getting paralysed.

This was a fairly easy decision however similar situations can occur with greater stakes. My advice is, and always will be, REMEMBER THE BASICS.

Rant

2008-08-18T15:52:00.002+01:00

Firstly I had some very good news today. I am now a second year nursing student. YAY!

Unfortunately karma is an evil bitch. Half of one of my back teeth broke off. This feels and looks bad. So I phoned the dentist for an emergency appointment. The Following conversation took place -

Receptionist: We have an emergency appointment a week tomorrow.
Me: How is it an emergency appointment if its in eight days?!
Receptionist: Well you dont sound like you're in much pain.
Me: I'm glad to see the NHS train you in the art of triage, however if I want someones opinion on fonts and margins I will ask you, if I want someones assessment on my tooth, I WANT TO SEE A DENTIST.

The result being I have an emergency appointment in eight days time. Wooo!

Update

2008-08-14T16:31:00.002+01:00

Unfortunately one or two personal and academic problems have prevented me blogging too much of late and to be honest as I'm on a break from the wards I probably wouldnt have much of interest to say anyway.

During my time off I have thrown myself back into St John Ambulance. Which despite being an organisation with a poor reputation, which is mostly down to most of its senior members spending their time acting like catty teenage girls, has nurtured me. Before I joined I had no interest in healthcare, I didnt know enough to even think about it. After an incident whilst looking after my sister I asked my neighbour, who is the Divisional Superintendant of a local division, if he could take me down so I could learn some first aid. The confidence and the skills the organisation has given me is something I am grateful for. Most of this gratitude is aimed at this one man who introduced me to sja, and thus the world of healthcare.

You may ask why I would think anyone would find this interesting? Frankly I dont. There are three people I can honestly say have drastically effected the person I am today. The above man is one of them. The other two are teachers.

During secondary school(year 9 I think) I was bored. Very bored. I'm not saying I was terribly bright but in comparison to half of my year I was einstein himself. So I stopped paying attention in class, My grades slipped and I spent most of year 10 in the bottom set. It was during year 10 that my german teacher told me that if I even got an F in GCSE german It would be a miracle. This woman was the least professional teacher I had ever met. Fortunately at the end of year 10 she decided she didnt want to teach german any more and moved on to IT and Drama. So we had a new German Teacher. Mrs Hogg. This woman single handedly got my arse in gear, she took a student who was facing near impossible odds at passing and I ended up getting a C, had I been in the higher set I would have gotten an A. She didnt just motivate me towards german though, She opened my eyes and I ended up getting very pleasing grades for my GCSE's. Mrs Hogg died last month.

Whilst my eyes had been opened thanks to Mrs Hogg, I started paying attention in all my classes. This included Biology. Any of you who know me, know that Biology is my first love. This wasnt always so. Mrs Clarke is largely responsible for this. She tought the subject with such passion and vigor that I couldnt help but fall in love with it. I can still remember the first day I started listening in one of her classes and Biology suddenly made sense. Without this teacher my natural aptitude for biology may never have been realised and I would be almost utterly without passion and cause.

So to these people I thank you.

Human Rights

2008-08-08T10:13:00.002+01:00

Something I want to explore over the next year or so are the ethical issues tied up in nursing convicts. Especially those who have committed crimes which outrage the modern British morality.

According to the Nursing and Midwifery Council code of professional conduct(NMC, 2008). A key responsibility of nurses is to be their patients advocate. We apply professional knowledge and experience to act as our patients voice. In theory this requires impartiality, but it is impossible to know someone well enough to express their wishes and still be impartial. So if a patient is a rapist, murderer or paedophile this should not change the level of care they receive. Now factor into this the simple truth that nurses are human, and have been raised as most people in this country with a certain morality. Will power alone should be enough to ensure the patient receives professional and adequate clinical care, however it can not influence our interactions or preconceptions about this patient. As a professional you will not let your patient suffer neglect. It is your duty to treat and aid anyone who is in need. However a large part of nursing care is in the patient-nurse bond.

I would also like to ask those of you poor sods who actually read this blog. If you have twenty-eight patients and one is a recently convicted paedophile in need of high care, Would this effect the magnitude of resources you divert from other patients in order to care for this convict?

Rules and Doctors

2008-08-01T11:00:00.002+01:00

Recent EU regulations are limiting the amount of hours doctors can work. Currently doctors are not allowed to work more than 52 hours a week, this is soon to go down to 48. You may cheer this change as a means of improving patient safety. I believe the european working time directive poses a much greater threat to standards of care. This directive means that there are fewer doctors available on wards at any one time. The NHS cant afford to hire more doctors to pick up the slack. As a result more than half of scotlands hospitals are in the process of closing. This also means that other professionals have to work harder. Nurse Specialists are suffering massively increasing loads of patients, and general ward nurses who do perform some tricky procedures are still working up to 80 hour weeks in order to cover understaffing. How is this not a risk to patient safty?

Resistance

2008-07-28T08:02:00.002+01:00

In 1928 a Scotsman discovered the strange effects of a specific fungi. Along with a German and an Australian this fungi was turned into a drug. On March 14th 1942 the first patient was treated with this drug.

The drug was of course Penicillin, the Scotsman Sir Alexander Flemming, the German Ernest Boris Chain, and the Australian was Baron Florey. These men made potentially the greatest contribution to modern medicine. The bacteriostatic and bacteriocidal effects of penicillin were noted long before 1928, however these men did more than just make some mildly interested notes and move on. They developed this drug. However I would suggest their achievement will only be temporary.

Since the 50's almost everyone in the western world has come in contact with penicillin. A hundred years ago if you had a minor infection you would have a fever, a headache, maybe some localised pain. You would put your feet up for a few days and your body would take care of the infection. Your immune system would be better for it as it would create markers to prevent that same bacteria having such an effect again. My generation is given pencillin and other anti-bacterial drugs for almost any complaint. Our immune systems are weaker which means we are getting sick more often. But it gets worse, our bodies are becoming resistant to the penicillin, the constant exposure is causing our immune systems to neutralise these drugs before they can have a theraputic effect. Also as I'm sure you are all aware bacteria are surviving one dose of antibiotics and what they grow back into are resistant to that anti-biotic(MRSA is the big one everyone has heard of). Once the effects of these drugs are completely useless our bodies will have a hard time even fighting a simple streptococcus infection.

We are now sending antibiotic drugs across the world to third world nations. Into jungles to near untouched tribes of humans, to places a strong immune system is vital.

Dealing

2008-07-19T11:01:00.002+01:00

In hospitals there are certain things that you simply learn to deal with. Death and Illness are the obvious. The more annoying are the co-workers who get away with doing zero work. The medical team that NEVER respond to their bleepers, even when you fast bleep them. The SHO who sticks a giant needle into a patient with an insanely high INR and then blames his subordinates when the patient bleeds everywhere.

Honestly the deterioration and death that are commonplace in hospitals are actually much easier to deal with than the politics you find on the wards. I know every workplace has its fair share of politics, however of all the places I have worked I have never come across it in such high doses as I have in hospitals.

Even as a student nurse your superiors dont give you any support in learning to deal with these issues. You sink or swim, with luck you'll have your own support structures in place, partners, friends, other student nurses. I honestly dont know how I'd have survived my first year as a student nurse had it not been for these people. I cant help but wonder, of the three hundred people still on my course, there must be some who have no support structures in place, what effect is all this having on them?

Movies

2008-07-16T09:48:00.002+01:00

Its only since I have started working on this placement that I have noticed the accuracy in television programmes like scrubs and house. The medicine in them is generally way off, but in regards to life in a hospital. Even some of the more unrealistic plot lines come to pass in a real hospital. The hospital benefactor becoming a patient, the dementia patient making a break for it and being found hours later down the local pub, the old woman who attacks any nurses in range with her walking frame, the two patients in their late seventies being caught having sex in a side room, the doctors with funny beeper tones and occasionally the odd medical mystery.

If you listen really, really, really hard whilst on the ward you can almost hear the backing music which I'm sure alternates between the benny hill theme and how to save a life by the fray.

Patients 2

2008-07-15T11:46:00.002+01:00

During my shift yesterday one of the nurses called me to the nurses station. She informed me that our Emergency Medical Assessment Unit which is sort of like a buffer after A&E where the patients get sorted to the appropriate wards, has a patient for us. A female in her eighties, she had a fall(as old ladies do) and sustained no injury. She had asthma which was well under control with the use of her salbutamol inhaler and there were no other obvious medical or psychological abnormalities. I asked why this patient wasnt checked out in A&E and sent home. The nurse assumed that there must be more to the patient than her notes led us to believe.

The nurse was wrong. What we had was a lady in her eighties who was fully mobile and self caring with no apparent medical problems besides her asthma....what we had was a patient who was in better condition relative to her age than any of the staff on the ward.

She is a lovely lady and i'm glad we werent sent another high care patient. However her being in hospital despite more than adequate social means for discharge and no medical treatments to be performed is costing in the realm of £900 a week to the tax payer. She doesnt want to be in hospital as shes going to miss her weekly cards evening with the ladies from her church group. Why was she admitted? why is she still on the ward?

On another note one of my favourite patients died yesterday. I know its unethical to have favourites but you cant help it, you treat all patients the same but you do become fond of some more than others. This upset me as I was certain he was going to be one of the ones who walked out of the place. I was holding it together up until his daughter told me she was grateful to me for taking such good care of him and that he really enjoyed spending time with me. I didnt cry but my voice broke rather spectacularly.

Patients

2008-07-13T11:06:00.002+01:00

My ward is acute respiratory medical. By and large most of what our mission statement covers is COPD. Each of the nurses on this ward has had years of experience and training in respiratory care. The doctors on the ward are specialising in acute respiratory medicine. Our respiratory patients can rest assured that they are in the hands of experienced, highly trained specialists.

Only seven of our twenty seven beds are occupied by patients with any manner of respiratory complaint. I admitted a patient last week who was in due to central chest pain, elevated troponin level and a vast history of myocardial infarctions(heart attacks). All these things indicate the patient was both high risk for an MI and in all likelihood had probably had a minor one prior to admission.

The first thought that ran through my mind when I read this patients
emergency medical assessment unit(EMAU) report was that there cant be any spare beds on our cardiac ward. This I have come to accept, patients go where the beds are, not where the specialists are.

I later had cause to phone our cardiac ward regarding another patient. It turns out that they had five spare beds. Somewhere along the line the powers that be decided that this high risk cardiac patient didnt deserve to be on the cardiac ward.

I know all nurses recieve the same basic training. And this patient was at least admitted to an acute medical ward. Fortunately the nursing intervention for cardiac arrest and respiratory arrest is the same. Had this patient been high risk vascular patient, or a neuro patient then they would not have received the best possible level of care. Which is what the NHS claims to strive for. Most bed managers have been promoted from the clinical ranks and know more or less what they are doing. They tend to be unsuccessful due to the enormity of their task and lack of support from their clinical colleagues who become less co-operative after the bed manager has sent their surgical ward a patient with pylonephritis.

Sick

2008-07-11T11:25:00.003+01:00

I'm sick. This is not good as it means I have to make up some placement hours at a later date. However it is unmistakably my bodies way of retaliating to the high stress, low sleep and food, dehydration that comes with being a student nurse on a massively understaffed Acute Medical ward.

For the first time in my life in care work, yesterday we still hadnt completed all of the patients washes by the end of the early shift. All of the meals were handed out up to two hours late. We had two carers taken away from us by the bleep holder due to the fact the ward had 'two student nurses' on duty. The shift was chaos, however I tip my hat to the ward sister who was on yesterday, she ensured that all of the patients received their medications on time, all of the patients were sent for their tests as the doctors ordered. She delegated tasks incredibly.

For now I've got three scrubs box sets, a large bar of chocolate, and a huge bean bag. I've just got to hope i'm fit for work tomorrow.

Hospital

2008-07-10T17:09:00.002+01:00

I've had a few manic shifts recently. Those shifts where you are flat out rushed off your feet for the entire shift but when you look back you cant remember a single thing you have done. All of my interactions from putting a patient on a bed pan, to removing a patients cannula have mattered to the patient involved.

The truth is when you are truely, insanely busy in the hospital, you go on autopilot. You talk to the patient whilst your removing their wound drain, listen to them talk about their pet cat and you respond in a warm way. But you arent remembering any of this. And if the removal goes as it should there is no reason to remember it past adding a note to your handover sheet.

This doesnt bother me. You do what needs to be done and then you move on to the next task that needs to be done. Despite all this there is a place in the back of your mind that the hospital has infected. No matter where you are or what you are doing a small part of your brain is thinking about the ward, about a patient who was deteriorating when you left your last shift, who wont be there when your next shift starts, the MRSA screening you forgot or didnt have time to swab a patient for. The trick is making this part of your mind as small as possible

Today I got to insert my first NG(nasal gastric) Tube. This is a tube that goes up the nose, down the throat and into the stomach. Its used to aid a patient who isnt safe to take food orally(usually if they aspirate). This may not sound too impressive to any qualfied nurses who read this, as inserting them is so mundane by the time you qualify that they usually find a student to do it for them. However I am fairly sure it is the longest object I am legally allowed to insert into my patients.

Once the tube is in place you draw back some of the fluid from its end point and drop it onto litmus paper to ensure you have reached the stomach and found stomach acid. You then flush the tube with about 50mls of water to ensure it is clear and ready for food. You then connect a pack of high nutrition liquid to tube. This gets connected to a pump to ensure that you are feeding at the prescribed rate.

Its all fun. Despite how exhausted I am I have had two good shifts. I've learned a lot and had a lot of opportunities to make a difference in patients worlds. I suspect my shift tomorrow wont go so well. The cumulative fatigue was having a noticable effect on my performance today. I've got two more early shifts ahead of me and then a day off.

Life

2008-07-08T09:52:00.002+01:00

In the interests of confidentiality all names herein are pseudonames. Should anyone be interested this conforms with the Nursing and Midwifery Council Code of Professional Conduct(2008) in regards to Confidentiality.

I get a phone call last night. Its a Charlotte, a friend of mine, shes hyperventilating. She informs me that her boyfriend Sam has drunkenly punched a car and run off.

There are three reasons Charlotte called me -
1. She knows I'm a student nurse, and a more than experienced first aider.
2. She knows we are close as shes just left the pub we are at.
3. She knows my girlfriend is with me and that she is a qualified nurse(this trumps student and first aider).

So I leave my girlfriend to take care of Charlotte and I run off in the direction Sam ran. When I finally find him he is on the floor, more out of intoxication than blood loss. There is a fairly impressive amount of blood issuing from his hand. I call and ambulance and then notify Charlotte of our location. All the time attempting to keep Sam sat with his back to a wall so that he doesnt fall down and crack his head, and keeping his hand elevated(not easy and this chap isnt terribly co-operative when sober, let alone when he's been drinking for 9 hours).

Charlotte arrives with my girlfriend driven by Denise, a friend of ours(also a first aider).

The ambulance crew arrive in less than eight minutes. Despite how clear I made it to control that this wasnt a high priority call as Sam was 100% stable. They clean up Sam and fill out the paperwork to get us into A&E and call the police who formally arrest Sam for criminal damage but immediately release him on bail in order to have his hand checked out at A&E.

Denise drives myself and Sam to A&E. Where he is seen promptly by the triage nurse, then the radiographers in xray. We spent some time waiting for the House Officer to review Sam but eventually decided that there was no real damage and that his hand only required irrigating to remove any small fragments of glass left. So we left with a letter for his GP.

2100-0200 this is how I spend my time.

I have to admit that given how poorly my new ward is treating me I did need this night to remind myself that I am damn good at what I do and that I belong in critical care.

Defence

2008-07-06T10:19:00.002+01:00

The human body is full of defence mechanisms. Billions of years of evolution has led to a species that is designed to survive a huge amount. I suspect this is largely due to the individuals need to pass on their genes(something they cant do if they are dead)

You are in a car accident, adrenaline hits the vascular system causing vessels to constrict which limits bleeding. The heart beats faster, breathing increases in depth and rate allowing oxygen to get to the muscles. This allows you to get away from the danger and survive long enough to reach hospital. This is not such an uncommon scenario. Unfortunately when you get to hospital the first question you are asked is usually 'where does it hurt?' and the adrenaline is numbing the more significantly injured areas. The risk comes when the adrenaline is no longer being secreted and patients go from stood up talking calmly to dead on the floor in the space of seconds.

You lose a loved one in this same crash. Your mind decides how to process the loss. It could repress it, it could compartmentalise the feelings or it could allow you to grieve and release them. The immediate best option is chosen to allow the individual to survive as strongly as possible.

Drained

2008-06-19T08:17:00.003+01:00

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.

On time

2008-06-15T11:45:00.002+01:00

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.

Proposal

2008-06-13T11:21:00.002+01:00

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"
}

Food

2008-06-11T18:22:00.002+01:00

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!

Governance

2008-06-10T09:03:00.002+01:00

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?

First Week

2008-06-09T10:22:00.002+01:00

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.

First Day

2008-06-05T15:51:00.002+01:00

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.

Placement Two

2008-06-03T19:00:00.002+01:00

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

Careful

2008-06-01T18:46:00.003+01:00

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.

Self-Check

2008-05-30T12:02:00.003+01:00

Every Morning when I wake up the first thoughts that go through my head are usually a system of reality checks -

Who Am I?...........Richard
Where Am I?.........Bed
Who Am I With?......Naomi

This process usually takes a split second, unless I've not slept well or had been drinking the night before. One Day I am half expecting my brain to throw me the wrong answers to these questions for a laugh.

There are additional secondary questions that relate to remaining bladder capacity and current body position.