A Long Overdue Catch-up

Well...I hang my head in shame since it's been around 7 months since I last posted but I have had a tonne going on, and still have really so this will be very brief.

I'm currently on my second placement of second year in the biggest hospital in the area. I'm based on an outpatients department that specialises in plastics so it's absolutely fascinating! I'm loving the experience but not so much the travel and parking situation. I'll (hopefully!) write a more in depth post about the placement soon. My last placement was with the District Nurses, which I enjoyed but I'm not sure it's for me. I think I'm more of a 'hospital nurse'.

I've handed in an essay and completed a VIVA (spoken exam) and an anatomy and physiology exam. I managed to get 82% for my VIVA which I was over the moon with, especially given the circumstance of what's been happening recently. I'm waiting for the results for the other 2 which we should have in the next month.

So the reason (other than being manically busy) that I haven't posted in a while is because...I'm pregnant. We're expecting a baby boy on 10th December, in 3 short months. It has absolutely flown over so far and trying to balance everything has been a bit of a challenge to say the least. I can imagine the next few months will pose the most challenges but I'm ready to face them head on :) I know it's going to be difficult to complete my training with a young child at home but I'm going to do my very best. I intend on stepping off just before he's due, taking 6 months out and then going back in the Summer to complete second year and then straight on into third year. It makes me tired just thinking about it!

Unfortunately my partner's Nana, who brought him up also passed away recently so it's been difficult moving on from that, especially with us expecting our first child. I'm sure she's watching over our growing baby.

I'll try and post again soon. Hope everyone is well :)

Taboo subject? Under-age sex and sexual health.

Bit of a random post really but one of the experiences I had during my 2 week spoke placement in a sexual health clinic really got me thinking. (Everything I say here will be protecting the person's identity in line with the NMC Code.)

There were 2 girls who came in for a joint appointment. They were both 15. One of the girls/young ladies (I find it weird calling her girl when she was sexually active), let's call her "Eleanor", came in to ask to have her contraceptive implant removed. The nurse asked why she wanted to have it removed and "Eleanor" said that she 'just didn't like it'. She seemed unsure as to why but was adamant that she wanted it taken out. She was offered contraceptive pills, the depot injection and the coil as alternatives but she refused all of them saying that she just knew she wouldn't like them. Obviously the nurse has a duty to provide care and can advise but not force someone into making a decision, so if "Eleanor" wanted the implant removed and no alternative contraception that was up to her. The nurse explained the risks of this but "Eleanor" said she knew and she'd be careful and "probably" use condoms. Her friend, let's call her "Sally", said that she would never use condoms as she always forgot them. After another 10 minutes of discussion, "Eleanor" reluctantly accepted contraceptive patches (a brilliant invention in my eyes) and had her implant removed. The nurse explained how to use them but honestly I don't know whether she will. 

After leaving the room, the nurse explained that it's quite a common thing to happen. She said she was almost 99% sure that "Eleanor" would be coming back for either emergency contraception or a pregnancy test pretty soon. What a sad thing that is. The nurse explained that she had been meeting with her "Eleanor" since she was 12. 12! Yes, 12! I find it amazing that this young lady attended sexual health clinics and think that many others should take a leaf from her book to stay safe and healthy...I'm just flabbergasted that they need to. I don't know if I'm just naive but how many people are actually mature enough to make such a huge decision to have sex when they're 12 years old? I most certainly wasn't. I was too busy living out my childhood, playing kerbsies, riding my bike, playing netball, meeting with friends...you know, just being a normal young nearly-teen. The thought would never have crossed my mind. Is it a generational thing perhaps? Are children being pushed into adulthood by the media and peer pressure? It really does make me sad to think that children are no longer children. 

My First Week of Final Nursing Placement - Year One

So here marks the end of my first week back on placement and what a week it has been. Journaling is a new thing for me so please do bear with me. I start to record my positive areas and also areas for development mid-week and intend on carrying this on throughout my training as I'm finding it very helpful, not only in my development in my training but also as evidence for my progression criteria for my nursing assessment file.

Day 1 - Early shift

Today was my first day back to this placement since September. I spent most of the day readjusting to the ward environment again. It started out quite relaxed, teamed up with my co-mentor (brilliant lady!) who let me tag around with her pretty much all day, assisting patients, completing and organising patient notes, calculating IV doses, giving medications out, checking vital obs, etc. I keep forgetting but I'm going to get myself a tongue depressor to write common IV calculations on as a pocket guide. A lot of nurses/students say they did this and it was helpful.

Day 2 - Early shift

Today I was very much floating around all over the ward - no easy task when there are 27 patients and several nurses asking you to help them out. For most of the day I took vital obs and ensured patients were comfortable, documenting all the time. I went in to check on one patient who was on a monitored bed and had been doing quite well. His respiratory rate was up in the 30s (normal is between 12-20!), pulse over 120 bpm, oxygen SATs 85%, temp over 38oC and BP barely readable. He wasn't very responsive and was pale and clammy so I immediately got the nurse who had another nurse in the room in less than a minute and a doctor to review as well. I remember just standing there thinking, 'Oh God! What will I do when I'm the nurse?! Will I know what to do?". Nursing is scary.

I also accompanied a patient to a CT scan as she was very nervous. The nurse in charge of that side of the ward didn't seem overly impressed really but I wouldn't have forgiven myself if I'd let her go by herself, shaking and terrified.

Day 3 - Early shift

Today was my first day with my mentor since returning to the ward. I helped to serve the breakfasts for patients and then assisted patients to wash and get dressed. Following this my mentor explained that she wanted me to look after the patients in the 4 bedded bay section of the ward, where 3 of the beds were being used. This was quite a task since I'd never done it before and I was quite nervous. My mentor explained the importance of problem solving and managing time - 2 big things I need to work on. I had to ensure all tasks were completed for each patient - vital obs, any planned scans/xrays, record care rounding, document nursing notes from the morning and any new plans from seeing the consultant, ensure patients were pain-free and comfortable, assist to the toilet, support with nutritional intake, contact family to bring in more clothes, contact a care home to discuss patient history and ongoing needs, diffuse a situation with an agitated patient, monitor the condition of a patient who appeared more weary than the previous day, completed an ECG, talk to family members and friends of patients and refer to qualified staff where I couldn't help with a query. I found all of this very challenging to say the least alongside caring for one of the patients who had become increasingly agitated and wanted to continuously move around despite feeling sick and being very unsteady on her feet.

Whilst the ward had a meeting, I was also asked to ensure the safety and comfort of 2 other patients just outside of the bay, and although it was difficult to juggle, I managed and learnt the importance of prioritising tasks. I now see (from a more restricted view of course) why nurses are always so busy! I still have so much to learn.

Positives:

+ Managing numerous tasks

+ Staying positive all day despite how challenging it was.

+ Completed a full SBAR handover sheet for a patient leaving the ward which I'd never done before on my own.

+ Liased with other professionals including Nurses, Pharmacist, Physiotherapist, Occupational Therapist, Care Home Manager, Consultant and Dr (F2). 

Areas for Development:

- Time management

- Prioritisation skills

- Delegation skills

- Try not to get side-tracked

Day 4 - Late shift

Today I was asked to look after the 4 bedded bay again. In early PM there were only 3 patients but a new lady was brought up, meaning all beds were full. 3 of the ladies had dementia/delerium.

I admitted the new patient to the ward, ensuring she was as comfortable as possible and completing all documentation. This process was quite difficult as the lady had quite an advanced level of dementia and was very anxious about being in an unfamiliar place with very unfamiliar people around. One of her daughters helped to answer some questions given that she was unable to give sound answers due to her illness. All the while the patient was trying to go home.

I think I managed my time more effectively today, allowing equal time for each of my 4 patients and completing all vital obs and documentation. I went with my mentor to administer medications and gave some subcutaneous injections which I still feel a bit weird about. One person was difficult to inject due to having a very tight and swollen abdomen. The next 2 that I did felt much easier but I still cringe thinking I'm going to hurt them, which I know is ridiculous since it's a needle and is never a comfortable thing to have. I'm hoping this improves with more practice. I haven't given any intramuscular injections yet - I hate to think how nervous I'd be doing that!

I spoke to several family members regarding their loved one's condition and answered any questions I could. If I couldn't help, I directed them to a qualified member of staff.

With the help of my mentor I was able to diffuse a situation with the new lady from my bay who was very distressed. Her daughters were trying their best to keep her calm and seated but because they were stressed I think it wound their mother up too. She stood up and tried to exit the ward, saying she was going home and wouldn't be told to stay. Seeing my mentor's expertise was quite inspiring. She knew exactly what to say and how to say it. I just followed her lead and we worked together to calm the lady down quite quickly actually. When I got home I researched different techniques to calm escalating situations, particularly for those patients with dementia. There is quite a lot of good advice out there about maintaining a calm environment but when you're in a hospital setting, how calm can it actually be? It must be so awful for patients like this.

Throughout the day I also found myself delegating tasks so that I could complete the work I'd been asked to do rather than being sidetracked by 1,000,000 other things, which believe me is so easy to do! My mentor and I discussed the importance of completing tasks and not getting sidetracked. I asked for assistance from HCAs who were more than happy to help rather than me  struggling and missing things out.

Finally, I completed part of a handover sheet for the nightshift staff about the new patients on the ward who I had been caring for. My mentor also asked me to update the sheets for some other patients too but I got sidetracked and only got half done. Boo! It's so, so, so hard to get everything done, even with the best will in the world and being run off your feet and asking for help. The information was passed on in the end by the way, but verbally rather than being printed on the sheet ;)

Positives:

+ Managed time better

+ Completed all paper work (except some info on the handover briefing sheet!)

+ Completed most of a handover briefing sheet

+ Delegated tasks

+ Spent equal time on all patients in my bay

+ Diffused a situation effectively

Areas for Development:

- Still getting sidetracked - stay on task!

- More practice/confidence with injections

- Understand fully why a patient is in hospital and their journey to getting better and home

- Research: INR and Warfarin, PPI and Lansoprazole, injection technique and techniques to calm patients in   distressing situations, especially those with dementia.

Day 5 - Late shift

Today was my last shift of the week and I was shattered to say the least. My mentor and I were on a different part of the ward to the previous couple of days so I wasn't looking after the 4 bedded bay.

I carried out what felt like 100 sets of vital obs which, although they get a bit samey are...well, vital, as the title suggests. They  let you know how the patient is doing and if/how they are responding to treatment. My ward cares for a lot of people with COPD so it's really important to keep a check on their oxygen saturation levels too.

I also admitted 2 new patients to the ward, completing all necessary paperwork (reams and reams!).

Providing care for one particular patient was pretty difficult for me. He had been admitted with end stage MS and was extremely poorly. He was being fed through a tube in his stomach (called a PEG), had a colostomy and a catheter bag, could only respond to voice and had extremely limited speech and movement. For those who haven't read one of my earliest posts where I explain this, my Mam has MS so seeing this was a bit close to home for me. I know that MS affects people in different ways and that my Mam's MS is a fair distance from this patient's at the moment, but it caught me nonetheless. This could happen to my Mam one day. I have absolutely no idea how I will deal with this when it comes to it or if it will happen like this. It's just such an awful disease. Distancing myself personally from this was quite a difficult thing to do but I need to do it!

My mentor showed myself and a newly qualified nurse how to set up a PEG feed drip. I've fed a lady through a PEG before but it had always just been manual for her - flushing it with water through a syringe (with no push), then pouring in the feed and then finally flushing it again with water. It was always very interesting when the lady coughed. I'm sure you can imagine what happened! A nice shower of Jevity (that's the name of the feed) for me, haha! Anyway, I digress. My mentor also showed me how to completely change a colostomy bag. I've emptied an ileostomy bag before and it was just a matter of disposing of the contents and then closing it back up again, but this one had to be completely removed and replaced. It was very strange seeing how it all works and has lead me to several hours on YouTube trying to make sense of it. My partner definitely didn't appreciate me talking about it over dinner, that's for sure, hehe!

I found my time working alongside the newly qualified staff on the ward extremely helpful today. They were always asking if I was OK or if I needed help or advice which gives me so much hope for when I qualify in 2 short years. I can't wait to be able to offer the same support when I'm a Staff Nurse.

I also found that after this week I feel much more settled as part of the team on the ward. I've been on this ward for a total of 9 weeks now (spread out over the year) and due to nerves and finding my feet I've held my personality back a little bit since I've been mostly trying to keep my head above water. But today I was able to work alongside people, feeling like I was helping and not hindering, join in conversations and not hesitating for a second if I needed some help/advice. Team work is so important in such a stressful environment.

I had my initial interview (placement documentation) with my mentor today to discuss what my targets are for this placement and to go over my progression criteria that I need to meet by the end of the 6 weeks. I've got 6 more to get signed off which I'm well on the way to getting but find completing the evidence so tedious. My mentor said that she's happy with the amount of progress I've made and highlighted the importance of approaching her if I was struggling with anything. She's an absolute gem :) I really think that although I have to travel to get to my placement, I have hit lucky with this one. I get such a variety of experiences, a great team and a fab mentor. I doubt I'll be this lucky throughout my training so I am definitely making the most of it for now. 

So here are my targets for final placement of first year:

1) Identify a group of patients at the beginning of each shift to be responsible for, including all care, documentation, treatment and discharge planning.

2) Widen knowledge of drugs commonly used on the ward

3) Identify and be aware of the signs of the deteriorating patient and be involved in implementing the escalation of care

4) Attend Rapid Access Cardiac Clinic with Nurse Specialist

A lovely way to round off my last shift of my first week back was when a patient's family came to find me to thank me for all I had done and for helping their Mam so much during her time on the ward. Such a lovely feeling :)

Positives:

+ More confidence with admissions process

+ Learnt how to set up a PEG feed and change a colostomy bag

+ Great to hear I'm making good progress

+ Improving delegation skills

+ Feel part of the team

Areas for Development:

- Distance from personal/professional situations 

A long overdue catch-up: What I've been up to, nursing placements, Bank HCA job and almost finished first year.

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I must say I have been extremely busy (usual excuse) and have a lot of catching up to do in the blogging world. So over the last 3 months (oops!) I finished my second placement and had 2 spokes, which are kind of like tasters in different areas of nursing. I've also had an essay, a Workshop and 2 exams, as well as copious amounts of placement documentation and research. I then started a Bank HCA job and of course trying to fit my life around all of this has been a challenge in itself. I'll fill you in on placements and my new job in this post and then I'll write a separate one about the assessments I've had as this post is already going to be rather lengthy!

Hub 2 - Medical Ward

Let's start with my second main (Hub) placement. I go back there again on Monday and am so nervous. The last time I was there was 27th September :O Getting back into the routine is going to be fun, but I just can't wait to get onto a ward and nurse again. Anyway, on that placement I was given more responsibility and began to administer medication (supervised of course). I also provided fundamental care in a much more confident way,  assisted with more medical procedures, took swabs, removed what felt like 100 venflons, carried out vital obs, completed admissions, helped with discharges, attended ultrasounds, CT scans and Xrays with patients, referred patients to other professionals (physio, occ health, dietician, etc.) and arranged patient transport. I've almost certainly missed out the other 1000 things I did. I swear, I'd get home after a shift and just stare blankly at a wall for an hour from exhaustion. Placement is blumin hard work both physically and mentally.  

Spoke 1 - Mental Health

My first 2 week spoke placement was in a rehabilitation home for people with mental health problems. I must say I was nervous about going as I just didn't know what to expect. I went for a visit prior to the commencement of the placement so that I could get my shifts and find out a little bit about the place but they didn't really tell me much and seemed a bit irritated by yet another student, bearing in mind I was their 4th of 5 students in an 8 week period. They were probably very fed up. During the first week I was a little reserved as I didn't know how to make myself useful. There seemed to be a lot of tea drinking and sitting around which when you're used to a hospital ward can be a bit of a shock to the system. I was constantly asking if I could help or do something and it took me a little while to realise that the main point was therapeutic presence. A lot of the residents simply loved having someone there to sit with and have a little chat, and by the second week I loved it too. I learnt how to knit and crochet and now have a bit of a penchant for it if I'm honest. I am clearly a granny at heart :D I thoroughly enjoyed supporting people with the things they loved doing such as nipping to the shops, cooking tea, going to exercise classes, baking, going to social events and for little walks. The whole experience totally opened my eyes to the reality that 99% of nursing is about just being with someone and helping them to be them again. I don't think that MH nursing is for me but I really did learn a lot from it and hope to learn more in the future. Some of the nurses and healthcare staff who worked here were the best I've seen. I hope to be like them when I qualify.

Spoke 2 - Health Visiting/School Nursing/Sexual Health

My second 2 week spoke placement was spent with health visitors and school nurses and I absolutely loved it. After the short time I spent there I think I might actually want to specialise in school nursing in the future. It felt so natural for me. My mentor was fantastic and gave me every opportunity possible. I spent an afternoon with the sexual health nurse in her clinic and seen some very interesting things. I also spent a day with the sexual health team in a high school to educate teenagers on the risks of STDs and hand out testing kits, as well as little treats for having taken a test (something that they never had when I was young!). They got free cinema tickets, headphones or undercrackers. I then spent a couple of mornings in schools observing inoculations which were really interesting. It was a very strange feeling to be back in a school environment and I felt very uncomfortable at first but it was nice to be seen in a different way, not as a student teacher but as a student nurse. I held the hands of those who were afraid, handed tissues to those who had meltdowns and distracted them from the injections. It was a really interesting experience even though it was a simple as giving injections. In my final week I attended a child safety meeting with a whole host of other professionals, from nursery nurses to social workers. It was a pretty stressful environment and really opens your eyes to the vast role of the nurse...and the importance of quality, accurate paperwork. Aside from all of these things I went along to lots of home visits with the health visitor which made me ridiculously broody. All of the cute little babbas and nervous/excited parents made it such a lovely experience. I loved being in the community and dealing with people in different settings. People are so different when they're not wearing hospital gowns! Unfortunately I ended up missing 2 days of the placement due to spending some time in hospital but did everything I could to get back given that it was a 1 time only placement that couldn't be made up. That's another story though and I'm fine now :) My report for this placement was glowing and my mentor said that I'd make an exceptional nurse. Yeah! :)

HCA Bank Job

As I said in a previous post I gained a job at a private hospital as a Bank HCA and had my first shift yesterday. It took them so long to organise a shift that I honestly thought it would never happen! But regardless I went and it was OK. It was a very quiet shift, not much going on. I've got another one tomorrow morning and I've been told it's usually manic so I'm looking forward to that. I also have an interview for an NHS Bank HCA post on Monday as I thought it would be really beneficial to gain more experience in an NHS based hospital too. I hope I get it!

Final placement - Hub 3 - Medical Ward

So like I said above I return to placement on Monday morning and couldn't be more excited about all of things I'm going to get to see and do. I've really missed it. The Ward Manager runs her own cardiac clinic and has asked me to spend the day with her when I go back which I am ridiculously excited about. She knows everything there is to know about the heart and it's a particular area of interest for me due to my sister's very unusual condition so I'll be taking a tonne from it I'm sure :) My mentor also said that she's going to increase my level of responsibility when I return (after I've settled back in of course) so that I'll be looking after a whole section of my own patients, eep! I'm so excited for this but unbelievably nervous also. This is going to be my final placement as a first year student nurse. Next year I'll be a second year nurse and feel so unprepared for that title.

How did you other student nurses find the transition from year 1 to year 2? 

My First Patient

We had a task in one of the Care, Compassion and Communication sessions at university where we had to write a poem about an aspect of our placement experience so far. I've had a bit of a shaky year so far so I think this task hit me a little bit. I was fine writing the poem, I quite enjoyed it actually and found I slept better that night than I had in a while. Maybe I needed to get some things off my chest. When we attended the session people volunteered to read their poems to the class and I was one of those, feeling quite proud of what I'd produced and all. So I started reading it, and then felt the tears coming. I felt such a fool. My whole class seeing me so vulnerable and fall apart - I was so embarrassed. I managed to finish the poem and everyone was absolutely lovely (of course) but I hated the fact that they'd seen that side of me. Hated the fact that they were probably all thinking, "Look how soft she is", "She'll never survive nursing", "She's not resilient". But how wrong I was. My class is just amazing, every one of them clearly felt it too and I knew I wasn't alone. Nursing and working with vulnerable people has a profound effect on you. It's hard not to feel it and I think in that moment I realised that it's not about maintaining a hard shell all of the time. You can't wear armour all of the time. That release was exactly what I needed and I am so grateful now that I had it. I've found it pretty difficult to reflect on things in the structured manner that the university advise but I think I've found a method that really helps me - poetry. (I never thought I'd be saying those words!) 

Anyway, here is my poem about the very first patient I looked after on my very first placement - someone I will never forget.

My First Patient

Your first day on the ward, a strange place to be,

your proud smile says, "You don't need to look after me!".

You chat to all your neighbours in your bay,

Offering them a hand, you brighten up their day.

Your wife brings you flowers all the way from your farm,

a little piece of home for you to look back on.

Your home is your work place, your passion so true,

you talk with such fondness, with stories of the view.

I wish that you could see it now and be there just once more,

I'm sorry that you're confined here behind the hospital doors.

Your family, they pray for you and hope you'll be home soon,

they're missing you an awful lot, they're here most afternoons.

Days go by and your strength wanes,

it's difficult to fight through that much pain.

You accept our help, our comfort and support,

we provide care and compassion, with your needs in our thoughts.

I don't show you that I'm sad to see you get so weak,

I still sit by your bedside where we always speak.

The words we share become less and less,

I can see you fading, I must confess.

Your heart beats its last and your chest fails to rise,

you fade away so peacefully as you close your eyes.

You've gone to a better place now, a place without the pain,

with your family and loved ones, your spirit will remain.

I've known you such a short time, but have learnt a lot,

you are such an inspiration and will never be forgot.

And although it's sad that you're no longer here,   

I look back in happiness and not in fear.

Trying to have a life outside of Nursing

This is a tad random but a rant I feel might maintain the little sanity I have left. 

This course is incredibly intense. It takes over your life, changes your outlook on life itself and those around you both close and far. It uses all of your time, preventing you from bringing in money thus cancelling out most of your social life. Doing this later in life when others have their careers already and are beginning to settle down means your schedules become very difficult to match up especially when life's little complications rear their ugly heads.

People always said before I started this course that no one other than fellow/previous healthcare students would understand what it feels like and I always laughed and thought...really?! The truth is, well, that. It is difficult for other people to understand that you don't have spare time or money to go for dinner, drinks or lovely social activity like you used to. That and the fact that I was stupid enough to enter into yet more studying when I STILL have debt to pay off, which in itself is a balancing act. It's a pretty stressful ride. There are also the people who snort when you say you're a student, thinking that you get more days off than you do on...wrong. I work full time hours (37.5hrs a week) on a heavy ward, do everything I can to do well and please my mentor, stay alert for every learning opportunity, travel miiiiiiles every day, go home and do uni work or research for placement, do all of my house work, try to have a life and also find time for sleep. It's blumin difficult, and I don't have kids like many of my fellow students. I seriously don't understand how they do it. People - nursing students work very hard!

Spending time with friends and family is very important to me and although it is  something I'd never be willing to give up, trying to find a balance seems impossible! If anyone has any tips I'd be grateful...

More Nursing Practicals - Urinary Catheterisation

So before Christmas I spent some time back at university attending some not so exciting lectures and seminars. Dotted amongst these were a couple of practical sessions, which I really enjoy as they are obviously things I can take into practice and feel I learn the most from them.

The most recent practical session was urinary catheterisation in both men and women, although they spoke more about the anatomy of women when performing a catheterisation than men, which I found a bit bizarre. Having not performed an actual catheterisation on a person yet, I'm more daunted by performing one on a man than a woman, and I don't think that's just because I'm a woman. I've seen one performed on a man and it was extremely uncomfortable to watch never mind do it myself. The memory makes me wince. We practiced a couple of times on models and it was impossible with the lubricant and stiff rubber models. I think we spent more time giggling about it mind! I really just hope that it's easier to catheterise a human than one of those ridiculous models.

Our tutors said that we should aim to perform a catheterisation on both genders during our last placement of the year, which I start on Monday btw! ARGH! My nerves are literally jangling at the thought of it all.

Here is a pretty handy dandy link that shows you how to perform a catheterisation for those interested: http://www.hpsc.ie/hpsc/A-

Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Posters/File,12911,en.pdf

If you've performed one before, what helped you gain confidence with it? Any tips? :)