Well I must apologise for dropping of the face of the planet recently, or at least the blogging planet. I went away for a couple of weeks, which was a nice break from work, and have just been so busy with work. It's usually on my way home form work that I think about blogging, but then I'm just too tired to do it and have a tendancy to either do nothinf on my days off or cram loads in.
I'd been intending to write today or tomorrow anyway, but I received an email from a reader today which was a good nudge towards getting writing. I'll write a proper update in the next couple of days, we've had some interesting mental health cases recently (well every day to be honest!) that I think I will write about.
Wednesday, March 05, 2008
Monday, January 21, 2008
Donation and Compensation
Organ dontation, to opt in or to opt out, that is the question.
I am on the regiser as an organ donor, I'm also a blood donor between piercings, tattoos and foreign travel. Clearly I am a pro-dontation so I don't doubt this affects my opinion on the subject.
Personally I would be happy to see the introduction of an 'opt out' system of presumed consent. We need to increase the number of tissue and organ donors in the UK as we currently cannot meet the demand. I think that there are many people who would be happy to donate but just never get around to making that decision and registering. Where as, if an opt out system were in place, I expect those who do not wish to do not would feel quite strongly about this and be motivated to opt-out. I also feel that organ donation should be in the hands of the individual, not the relatives.
However there are problems with presumed consent. Is it informed consent, as is required for consent for other medical procedures, and how can we ensure it is informed consent? Making the material available for the individual to read does not necessarily mean they will (though personally I feel that's their choice).
How easy will it be to opt out and will that wish be respected. As with all things there is the risk of abuse. What if a person chooses to op out in the last moments of their life, can this be verbal withdrawal of consent, must it be written? What about children? Would the responsibilty lie with thier parents, and at what point would they be able to make their own decision?
Those are jsut a few of the issues that spring to mind and clearly it's an ethical minefield. (Life would be a lot easier without ethics I often think!) However I think it's worth considering the issue fully. On first thought I'm compeltely in support of the system. When I think further on it I see the difficulties that may arise. However ultimately I am in favour of it.
Suing hospitals for compensation is my next port of call. It's the recent story with Lesley Ash being awarded £5million that has prompted this and I've been considering for a while what I wanted to say about it.
*deletes all the heartless things she wrote*
Undoubteldy Lesley has suffered and I don't deny that there was negligence on the part of the hospital however it is an absolutely atrocious anount of money for one person to be awarded. Ultimately it feels rather like revenge on her part. But more importantly the part that bothers me is people taking much-needed money away from a FREE healthcare system. At the end of the day money doesn't bring back the dead, won't make you walk again but it will make a difference to patient care.
I'm not saying the hospital shouldn't be held accountable in some way, and change should be implemented, but compensation is only good for one thing, satisfying the greed of the individual. (I know that in some circumstances a person may be unable to work as a result of negligence, they may therefore be unable to keep up with rent etc, but that is a very different situation to suing for £5million, more money than you could ever need, even then it feels wrong to be taking money away from the service.)
People make mistakes. Nurses make mistakes. Doctors make mistakes. Surgeons make mistakes. This is human error and generally speaking not malicious, we are doing our best in an over-worked, under-staffed, and under-appreciated system. The NHS is a FREE healthcare service, and whilst we should be striving to maintian high standards of care, people should spend more time being grateful for what we've got and less time working out how much money they can get out of it.
Please feel free to comment on this. I know I'm being rather opinionated, possibly narrowminded and almost certainly heartless, but nursing and the NHS is something I feel passionately about.
I am on the regiser as an organ donor, I'm also a blood donor between piercings, tattoos and foreign travel. Clearly I am a pro-dontation so I don't doubt this affects my opinion on the subject.
Personally I would be happy to see the introduction of an 'opt out' system of presumed consent. We need to increase the number of tissue and organ donors in the UK as we currently cannot meet the demand. I think that there are many people who would be happy to donate but just never get around to making that decision and registering. Where as, if an opt out system were in place, I expect those who do not wish to do not would feel quite strongly about this and be motivated to opt-out. I also feel that organ donation should be in the hands of the individual, not the relatives.
However there are problems with presumed consent. Is it informed consent, as is required for consent for other medical procedures, and how can we ensure it is informed consent? Making the material available for the individual to read does not necessarily mean they will (though personally I feel that's their choice).
How easy will it be to opt out and will that wish be respected. As with all things there is the risk of abuse. What if a person chooses to op out in the last moments of their life, can this be verbal withdrawal of consent, must it be written? What about children? Would the responsibilty lie with thier parents, and at what point would they be able to make their own decision?
Those are jsut a few of the issues that spring to mind and clearly it's an ethical minefield. (Life would be a lot easier without ethics I often think!) However I think it's worth considering the issue fully. On first thought I'm compeltely in support of the system. When I think further on it I see the difficulties that may arise. However ultimately I am in favour of it.
Suing hospitals for compensation is my next port of call. It's the recent story with Lesley Ash being awarded £5million that has prompted this and I've been considering for a while what I wanted to say about it.
*deletes all the heartless things she wrote*
Undoubteldy Lesley has suffered and I don't deny that there was negligence on the part of the hospital however it is an absolutely atrocious anount of money for one person to be awarded. Ultimately it feels rather like revenge on her part. But more importantly the part that bothers me is people taking much-needed money away from a FREE healthcare system. At the end of the day money doesn't bring back the dead, won't make you walk again but it will make a difference to patient care.
I'm not saying the hospital shouldn't be held accountable in some way, and change should be implemented, but compensation is only good for one thing, satisfying the greed of the individual. (I know that in some circumstances a person may be unable to work as a result of negligence, they may therefore be unable to keep up with rent etc, but that is a very different situation to suing for £5million, more money than you could ever need, even then it feels wrong to be taking money away from the service.)
People make mistakes. Nurses make mistakes. Doctors make mistakes. Surgeons make mistakes. This is human error and generally speaking not malicious, we are doing our best in an over-worked, under-staffed, and under-appreciated system. The NHS is a FREE healthcare service, and whilst we should be striving to maintian high standards of care, people should spend more time being grateful for what we've got and less time working out how much money they can get out of it.
Please feel free to comment on this. I know I'm being rather opinionated, possibly narrowminded and almost certainly heartless, but nursing and the NHS is something I feel passionately about.
Thursday, January 17, 2008
Suicidal
A few months ago I was working a night shift and I was allocated the care of an 11 year old boy who was currently in A&E awaiting the arrival of an RMN. The reason for admission was that he was suicidal and had made attempts on his life that day.
We didn't really feel that our ward was the most appropriate place for this young man, usually we try to put these children into cubicles for some privacy and peace and quiet, unforutnatly the only cubicles on our ward are too far away from the nurses station and out of sight to be able to closely observe him. We decided to allocate him in our second bay in a bed opposite the nurses station. Not ideal as there were 4 other young children in that bay.
I tried to ready the bed space removing an items which could be used to harm himself, not an easy talk considering every bed space has a suction unit with lengths of plastic tubing and the child next door was an on IV infusion with long power cables coming out of his machine and plugging into the socket right next to this child's bed. I made the space as safe as possible, got a not-too-comfy chair for the RMN, pulled back the curtains and waited for the call.
When I got downstairs to the A&E department I was told that he was with his mother and the RMN in a room just out in the corridor. Then ursing staff weren't able to give me a very good history as he had been seen by the on-call psychiatry team almost immediately and they had had little to do with him. The story was that the boy had twice that day tried to run out in front of a car but had been stopped on both occasions. His mother had brought him into hospital because she was concnered abotu this and his recent behaviour. He has recently lsot a friend, and relative a little while ago and he dad was currently in prison.
I took the paperwork and joined the young man, his mother and RMN in the side room. I introduced myself and explained I was there to take him up to the ward. At this point he completely refused to come with me, said he wanted to go home, that he didn't need to come into hospital, that his mother had tricked him there.
So began an hour of negotiation. I explained to him that he wasn't in any trouble, but that his mum had been worried about him and that's why she had brought him in, and that we just wanted to keep an eye on him overnight.
He told me that he was fine, there was nothing wrong and that he didn't need to be there. Now his mother joined in, at times being constructive and helpful and at other times frustration getting the better of her and she would lose her temper with him.
She tried being the authorative parent, saying she had made the decision as his parent that he needed to be there and he would do as he was told. She tried explaining that she was concerned about him and about what he had done today. She got angry and told him how he was upsetting her.
I watched a lot of this, intervened when I felt it would be helpful, tried to placate mum when she got angry. Simon (not his real name) became increasingly frustrated, saying that he wouldn't do it again, that he didn't need to be here, said no one would believe him when he said he was okay. He slammed his fists into his lap, got up and banged his fists against the wall then sat in the corner of the room.
I tried to explain that it wasn't that we didn't believe him or thought he was lying, but because of what happened to day it was my job to make sure that he was okay, and that whilst he might feel okay at the moment and feeling one particular way sometimes this can change and we needed to make sure he was safe overnight.
Between angry outbursts and protestation he would become withdrawn and tearful refusing to make eyecontact with anyone in the room and not registering when someone spoke to him.
Every now and then the RMN would chime in with helpful comments such as "You're wasting time down here" and an inappropriate moments (e.g. mid conversation) "Let's go up to bed". I did my best to ignore this and manage to refrain from telling her to be quiet or giving her the "evil eye".
Simon was convinced that his uncle was going to come in and take him away, he kept telling us this and his mother explained that this wasn't the case and that his uncle would say he had to stay.
Almost an hour after arriving in the department I left the room to give him a few moments with his family (oh an the lovely RMN) whilst I had a discussion with the A&E nursing staff.
"You're still here?!"
"Yes, and I can see what you mean about the RMN" (They earler had described her a bit "odd")
"You know she came out of the room before you arrived asking for us to sedate him as he was upset?"
"I'd probably need sedating if I had her looking after me."
Although the child was upset, it was "normal" upset in my eyes, I would probably feel exactly the same way in his situation. He wasn't violent or aggressive, jsut very frustrated and did calm down. I felt that I had been making progress with him and that he was becoming more resigned to being admitted, however I now didn't feel the bedspace we'd allocated him was appropriate and that he needed a more private space.
We contacted the bed manager and reallocated him to a cubicle on our adolscent ward close to the nurses station. Although he was below the age the unit would usually accept we felt it would be better for him and they would be able to provide better care there.
I went back to explain to Simon and his family that he would be going to a different ward with a nice private room of his own where he could get a better night's sleep. His uncle had by now arrived and was whispering in his ear, he didn't stop when I entered the room or after I stood there for a few moment (which I found a little odd). I said goodbye to Simon without a glance or acknowledgement that I had spoken and hoped on my way upstairs that I hadn't traumatised the child too much.
He was admitted to the adolscent unit next door where I was told he had a good night's sleep, was seen by CAMHS the next morning and discharged. I don't know if he had any follow-up in the community.
We didn't really feel that our ward was the most appropriate place for this young man, usually we try to put these children into cubicles for some privacy and peace and quiet, unforutnatly the only cubicles on our ward are too far away from the nurses station and out of sight to be able to closely observe him. We decided to allocate him in our second bay in a bed opposite the nurses station. Not ideal as there were 4 other young children in that bay.
I tried to ready the bed space removing an items which could be used to harm himself, not an easy talk considering every bed space has a suction unit with lengths of plastic tubing and the child next door was an on IV infusion with long power cables coming out of his machine and plugging into the socket right next to this child's bed. I made the space as safe as possible, got a not-too-comfy chair for the RMN, pulled back the curtains and waited for the call.
When I got downstairs to the A&E department I was told that he was with his mother and the RMN in a room just out in the corridor. Then ursing staff weren't able to give me a very good history as he had been seen by the on-call psychiatry team almost immediately and they had had little to do with him. The story was that the boy had twice that day tried to run out in front of a car but had been stopped on both occasions. His mother had brought him into hospital because she was concnered abotu this and his recent behaviour. He has recently lsot a friend, and relative a little while ago and he dad was currently in prison.
I took the paperwork and joined the young man, his mother and RMN in the side room. I introduced myself and explained I was there to take him up to the ward. At this point he completely refused to come with me, said he wanted to go home, that he didn't need to come into hospital, that his mother had tricked him there.
So began an hour of negotiation. I explained to him that he wasn't in any trouble, but that his mum had been worried about him and that's why she had brought him in, and that we just wanted to keep an eye on him overnight.
He told me that he was fine, there was nothing wrong and that he didn't need to be there. Now his mother joined in, at times being constructive and helpful and at other times frustration getting the better of her and she would lose her temper with him.
She tried being the authorative parent, saying she had made the decision as his parent that he needed to be there and he would do as he was told. She tried explaining that she was concerned about him and about what he had done today. She got angry and told him how he was upsetting her.
I watched a lot of this, intervened when I felt it would be helpful, tried to placate mum when she got angry. Simon (not his real name) became increasingly frustrated, saying that he wouldn't do it again, that he didn't need to be here, said no one would believe him when he said he was okay. He slammed his fists into his lap, got up and banged his fists against the wall then sat in the corner of the room.
I tried to explain that it wasn't that we didn't believe him or thought he was lying, but because of what happened to day it was my job to make sure that he was okay, and that whilst he might feel okay at the moment and feeling one particular way sometimes this can change and we needed to make sure he was safe overnight.
Between angry outbursts and protestation he would become withdrawn and tearful refusing to make eyecontact with anyone in the room and not registering when someone spoke to him.
Every now and then the RMN would chime in with helpful comments such as "You're wasting time down here" and an inappropriate moments (e.g. mid conversation) "Let's go up to bed". I did my best to ignore this and manage to refrain from telling her to be quiet or giving her the "evil eye".
Simon was convinced that his uncle was going to come in and take him away, he kept telling us this and his mother explained that this wasn't the case and that his uncle would say he had to stay.
Almost an hour after arriving in the department I left the room to give him a few moments with his family (oh an the lovely RMN) whilst I had a discussion with the A&E nursing staff.
"You're still here?!"
"Yes, and I can see what you mean about the RMN" (They earler had described her a bit "odd")
"You know she came out of the room before you arrived asking for us to sedate him as he was upset?"
"I'd probably need sedating if I had her looking after me."
Although the child was upset, it was "normal" upset in my eyes, I would probably feel exactly the same way in his situation. He wasn't violent or aggressive, jsut very frustrated and did calm down. I felt that I had been making progress with him and that he was becoming more resigned to being admitted, however I now didn't feel the bedspace we'd allocated him was appropriate and that he needed a more private space.
We contacted the bed manager and reallocated him to a cubicle on our adolscent ward close to the nurses station. Although he was below the age the unit would usually accept we felt it would be better for him and they would be able to provide better care there.
I went back to explain to Simon and his family that he would be going to a different ward with a nice private room of his own where he could get a better night's sleep. His uncle had by now arrived and was whispering in his ear, he didn't stop when I entered the room or after I stood there for a few moment (which I found a little odd). I said goodbye to Simon without a glance or acknowledgement that I had spoken and hoped on my way upstairs that I hadn't traumatised the child too much.
He was admitted to the adolscent unit next door where I was told he had a good night's sleep, was seen by CAMHS the next morning and discharged. I don't know if he had any follow-up in the community.
Monday, January 14, 2008
Steep learning curve
Once again I cannot believe how long it has been since my last post. The weeks and months seem to be flying by me at the moment, and work is keeping me busy.
So a catch up before the main focus of this post. I worked Christmas Eve and Christmas day and all in all it wasn't so bad. Everyone was in good spirits, we had several Father Christmas' visit and we got half the unit on home leave for the day.
I had a very welcome three day break in Cornwall over the New Year which left me feeling refreshed and ready to work.
Last week I started on a new ward. It is an adolescent unit. I have so far worked for long days there and it is the reason for my post title.
The first two days were spent looking after a teenager who had been involved in a gang-related fight. It is a whole different world to the one I grew up and live in, though not unfamiliar because of the kids my mother works with.
He would swing from being polite and well mannered to being angry and refusing to cooperate. On several occasions he left the unit unaccompanied which is against our rules as we are unable to ensure their safety if they do that. Despite reprimands, explanations and assurances he wouldn't do it again he did. He would also try some of the most unbelievable lies to get permission to leave the ward, and then would become angry when we wouldn't let him. He was never verbally abusive to me and I never felt threatened by him, I actually quite liked him. Soon his anger would blow over and he would be cooperative again, now allowing us to do his antibiotic. I made him a hot chocolate and got him a packet of biscuits after one particularly difficult argument and as I sat watching him dunk his biscuits I realised that despite the bravado he is little more than a boy. He has had a really difficult home life, has been excluded from several schools, is now involved with a gang, I'm fairly sure carries a knife and is in trouble with the police, he also has some degree of mental health problems and anger issues. He is not accepting the help he is being offered and it's really sad to think where this young man may end up, because beneath that hard outer shell he is a nice boy.
On my third and fourth days I looked after a young woman who has had many previous admissions for confusion post seizures, and she has been non compliant with her medication. We had a registered mental nurse (RMN) (which makes me giggle) to watch over her, which makes my job a lot easier. Initially I didn't have a lot to do with her and was busy with three other patients but as the afternoon wore on I became more concerned about her behaviour which didn't seem like confusion you may have post-seizure but a lot more like psychosis. I was told she has presented like this before but it still didn't seem right to me. She had delusional thoughts; that she was a witch was the most common. She was having auditory, visual and tactile hallucinations; people calling her name, a man trying to strangle her. She was convinced she was dying and would not believe any reassurances that she wasn't and didn't have cancer, AIDS, wasn't having a heat attack. She became increasingly distressed and said she wanted to kill herself.
Although she had been seen by CAMHS and psych in A&E there wasn't really any plan for her, and fortunately at this point we had a brilliant psychiatric doctor come and review her. She straight away recognised our concerns and finally someone seemed to be taking this more seriously. She prescribed a very small dose of Lorazepam to try and help with her anxiety as she was highly agitated and distressed. This was given quite late in the day and the night staff reported it really helped calm her and she went to bed.
The following day we had more members of the mental health MDT assess her and the decision was made to transfer her to an adolescent mental health unit for assessment and observation. Unfortunately my patient didn't want to go and with her parents permission she was sectioned under Part 2 (I believe) of the mental health act - a process that I had not encountered before and took several hours, needing two different doctors to assess her and signs a document and the the Approved Social Worker to complete the last part.
We then had to wait over an hour for transport. When they were scheduled to arrive my patient was ready and had been persuaded and accepted the move to another hospital. Unfortunately the hour and fifteen minutes we spent waiting for transport saw her agitation increase and once again she refused to go. I was concerned she was going to try and leave the unit and was becoming a little aggressive, but we managed to persuade her back to her bed (having wandered up and down the adjacent children's wards with her) and when transport actually arrived (and I made them get rid of the trolley they wanted to strap her to!) she actually went quite peaceably.
So as my title suggests those four days were a very steep learning curve for me. At this point I would like to thank MMW for her blog. The knowledge and insight I have gained from reading it really did help me with the care of a patient that was totally outside my realm of professional experience.
So a catch up before the main focus of this post. I worked Christmas Eve and Christmas day and all in all it wasn't so bad. Everyone was in good spirits, we had several Father Christmas' visit and we got half the unit on home leave for the day.
I had a very welcome three day break in Cornwall over the New Year which left me feeling refreshed and ready to work.
Last week I started on a new ward. It is an adolescent unit. I have so far worked for long days there and it is the reason for my post title.
The first two days were spent looking after a teenager who had been involved in a gang-related fight. It is a whole different world to the one I grew up and live in, though not unfamiliar because of the kids my mother works with.
He would swing from being polite and well mannered to being angry and refusing to cooperate. On several occasions he left the unit unaccompanied which is against our rules as we are unable to ensure their safety if they do that. Despite reprimands, explanations and assurances he wouldn't do it again he did. He would also try some of the most unbelievable lies to get permission to leave the ward, and then would become angry when we wouldn't let him. He was never verbally abusive to me and I never felt threatened by him, I actually quite liked him. Soon his anger would blow over and he would be cooperative again, now allowing us to do his antibiotic. I made him a hot chocolate and got him a packet of biscuits after one particularly difficult argument and as I sat watching him dunk his biscuits I realised that despite the bravado he is little more than a boy. He has had a really difficult home life, has been excluded from several schools, is now involved with a gang, I'm fairly sure carries a knife and is in trouble with the police, he also has some degree of mental health problems and anger issues. He is not accepting the help he is being offered and it's really sad to think where this young man may end up, because beneath that hard outer shell he is a nice boy.
On my third and fourth days I looked after a young woman who has had many previous admissions for confusion post seizures, and she has been non compliant with her medication. We had a registered mental nurse (RMN) (which makes me giggle) to watch over her, which makes my job a lot easier. Initially I didn't have a lot to do with her and was busy with three other patients but as the afternoon wore on I became more concerned about her behaviour which didn't seem like confusion you may have post-seizure but a lot more like psychosis. I was told she has presented like this before but it still didn't seem right to me. She had delusional thoughts; that she was a witch was the most common. She was having auditory, visual and tactile hallucinations; people calling her name, a man trying to strangle her. She was convinced she was dying and would not believe any reassurances that she wasn't and didn't have cancer, AIDS, wasn't having a heat attack. She became increasingly distressed and said she wanted to kill herself.
Although she had been seen by CAMHS and psych in A&E there wasn't really any plan for her, and fortunately at this point we had a brilliant psychiatric doctor come and review her. She straight away recognised our concerns and finally someone seemed to be taking this more seriously. She prescribed a very small dose of Lorazepam to try and help with her anxiety as she was highly agitated and distressed. This was given quite late in the day and the night staff reported it really helped calm her and she went to bed.
The following day we had more members of the mental health MDT assess her and the decision was made to transfer her to an adolescent mental health unit for assessment and observation. Unfortunately my patient didn't want to go and with her parents permission she was sectioned under Part 2 (I believe) of the mental health act - a process that I had not encountered before and took several hours, needing two different doctors to assess her and signs a document and the the Approved Social Worker to complete the last part.
We then had to wait over an hour for transport. When they were scheduled to arrive my patient was ready and had been persuaded and accepted the move to another hospital. Unfortunately the hour and fifteen minutes we spent waiting for transport saw her agitation increase and once again she refused to go. I was concerned she was going to try and leave the unit and was becoming a little aggressive, but we managed to persuade her back to her bed (having wandered up and down the adjacent children's wards with her) and when transport actually arrived (and I made them get rid of the trolley they wanted to strap her to!) she actually went quite peaceably.
So as my title suggests those four days were a very steep learning curve for me. At this point I would like to thank MMW for her blog. The knowledge and insight I have gained from reading it really did help me with the care of a patient that was totally outside my realm of professional experience.
Tuesday, December 18, 2007
False Economy
False Economy. A phrase that I've seen used a lot recently, one I've used myself. It means something that initially is cheaper but works out to be more expensive in the long term. It's something I feel can really be applied to nursing, I was going to say particularly the ward I work on that the moment but I have seen in on many wards.
Staffing. We are under staffed. We regularly have shifts where on 4 of 6 slots are filled. Sometimes as little as 3, and on a good day 5. The last couple of shifts I worked were fully staffed, a rarity, and it was wonderful. We don't have enough staff, but they won't employ more full time nurses. This however is a false economy, because with all the shifts being filled by bank and agency it would have been cheaper and far less stressful to employ another full time staff member or two.
I can't believe how many days have passed since I last posted. Time is flying by and Christmas is nearly upon us. Unfortunatly I have to work Christmas day this year, which I have to admit I'm very disapointed about, however you gotta do what you gotta do and we'll just have to try and make the day special for all the patients.
I wanted to draw your attention to a charity my hospital is involved with. Facing the World.
F A C I N G T H E W O R L D is a children's charity. It has been set up some of the UK’s leading craniofacial surgeons so that children in desperate need, living without hope in the world’s poorest countries, can have access to the very best surgery that can transform their faces and radically change their quality of life.
If you only look at two things on that website please look at the short film linked on the main page, it's in the bottom blue box with the dial up or broadband link. I would also reccomend that you go to the Case Studies page. I think what this charity does is amazing, and it is one of the few charities that has really moved me.
Staffing. We are under staffed. We regularly have shifts where on 4 of 6 slots are filled. Sometimes as little as 3, and on a good day 5. The last couple of shifts I worked were fully staffed, a rarity, and it was wonderful. We don't have enough staff, but they won't employ more full time nurses. This however is a false economy, because with all the shifts being filled by bank and agency it would have been cheaper and far less stressful to employ another full time staff member or two.
I can't believe how many days have passed since I last posted. Time is flying by and Christmas is nearly upon us. Unfortunatly I have to work Christmas day this year, which I have to admit I'm very disapointed about, however you gotta do what you gotta do and we'll just have to try and make the day special for all the patients.
I wanted to draw your attention to a charity my hospital is involved with. Facing the World.
F A C I N G T H E W O R L D is a children's charity. It has been set up some of the UK’s leading craniofacial surgeons so that children in desperate need, living without hope in the world’s poorest countries, can have access to the very best surgery that can transform their faces and radically change their quality of life.
If you only look at two things on that website please look at the short film linked on the main page, it's in the bottom blue box with the dial up or broadband link. I would also reccomend that you go to the Case Studies page. I think what this charity does is amazing, and it is one of the few charities that has really moved me.
Wednesday, December 05, 2007
'Tis the season
The Bronch season.
Bronchiolitis is a common respiratory infection that affects young babies and children. Their bronchioles (smallest airways) become infected by a virus,becoming inflamed and causing a build up of mucus. Some babies become very unwell with this condition and this can mean admission to hospital.
Initially it presents as a common cold which then worsens and affects their breathing. They develop rapid breathing, a rasping cough and a raised heart rate.
In some children these symptoms worse and they have increased difficulty in breathing. They have a rapid respiration rate, will be using their accessory muscles to aid their breathing, this can be very tiring and lead to exhaustion, in this case they will need support in hospital. They may also struggle to feed as they find they become too breathless.
Treatment. We give oxygen. We sometimes give inhalers, though these don't always work well. CPAP - a form of non-invasive ventiliation to assist breathing. IV fluids to correct/prevent dehydration. Nasogastric tube feeding until we can reesatblish breast or bottle feeding.
I hate Bronch season with a passion. Bronch's are incredibly hard work.
a) They may be on oxygen. Hopefully you get a set of nasal prongs in and hopefully get them stuck down and then hopefully they won't keep trying to pull them out. If they're on oxygen they require hourly observations and being on a sats monitor.
b) Sats monitors are a great tool for nurses. They allow us to continously monitor the childs heart rate adn oxygen level. When there's a good trace. Which there usually isn't because the child is kicking it's foot around and doesn't like have the plaster attached. You will also notice that monitors increase parental anxiety. They become number watches, obsessed with the heart rate and oxygen levels, but they lack the experience to intepret the machine and it's readings, to knwo when it's accurate and when to be concerned. They require more reassurance and will frequently buzz for you worried that their child's oxygen level has dropped. Of course there is the opposite extreme. The parent who has seen you silence the machine before and think it's okay for them to do the same, not realising that you're also making an assessment when you do that. You then pop along an hou later to discover the child's oxygen levels are too low. Sometimes they even turn it off without telling you, because the alarm was annoying them.
c) NG feeding. This may be a continous feed or a bolus feed. Blous feeds take a considerable amount of time on an already busy shift. If they're very unwell we have to reduce their feed because the expanding stomach restricts the lungs ability to inflate, and if they're really very unwell we may stop feeds altogether and rely on IV fluids for hydration and the occasional comfort feed. This leads to d)
d) Irritable. Bronch babies, when they are unwell, are some of the most irritable and unsettled children I have come across. They feel rubbish, they're tired phsycally from the effort of breathing, will probably not be sleeping well and they're hungry. They are some of the hardest babies to settle, a nightmare for the parents and in turn for the nruses when the parents are at their wits end and asking you for a solution (or jsut ignoring thier child)
Where I'm working we put Bronch's into double bays. They're infectious, but with the number of Bronchs we have we double them up as they both have the same illness. Unfortuantly we so often seem to have one sick one and one slightly better one. Sick baby and mum keeps slightly better baby and mum up all night, causing frustration for everybody. Then slightly better baby goes home, and sick baby becomes slightly better baby and we get a new sick baby in and it begins again.
Hospital is the worst place to get a good night's restful sleep!
Bronchiolitis is a common respiratory infection that affects young babies and children. Their bronchioles (smallest airways) become infected by a virus,becoming inflamed and causing a build up of mucus. Some babies become very unwell with this condition and this can mean admission to hospital.
Initially it presents as a common cold which then worsens and affects their breathing. They develop rapid breathing, a rasping cough and a raised heart rate.
In some children these symptoms worse and they have increased difficulty in breathing. They have a rapid respiration rate, will be using their accessory muscles to aid their breathing, this can be very tiring and lead to exhaustion, in this case they will need support in hospital. They may also struggle to feed as they find they become too breathless.
Treatment. We give oxygen. We sometimes give inhalers, though these don't always work well. CPAP - a form of non-invasive ventiliation to assist breathing. IV fluids to correct/prevent dehydration. Nasogastric tube feeding until we can reesatblish breast or bottle feeding.
I hate Bronch season with a passion. Bronch's are incredibly hard work.
a) They may be on oxygen. Hopefully you get a set of nasal prongs in and hopefully get them stuck down and then hopefully they won't keep trying to pull them out. If they're on oxygen they require hourly observations and being on a sats monitor.
b) Sats monitors are a great tool for nurses. They allow us to continously monitor the childs heart rate adn oxygen level. When there's a good trace. Which there usually isn't because the child is kicking it's foot around and doesn't like have the plaster attached. You will also notice that monitors increase parental anxiety. They become number watches, obsessed with the heart rate and oxygen levels, but they lack the experience to intepret the machine and it's readings, to knwo when it's accurate and when to be concerned. They require more reassurance and will frequently buzz for you worried that their child's oxygen level has dropped. Of course there is the opposite extreme. The parent who has seen you silence the machine before and think it's okay for them to do the same, not realising that you're also making an assessment when you do that. You then pop along an hou later to discover the child's oxygen levels are too low. Sometimes they even turn it off without telling you, because the alarm was annoying them.
c) NG feeding. This may be a continous feed or a bolus feed. Blous feeds take a considerable amount of time on an already busy shift. If they're very unwell we have to reduce their feed because the expanding stomach restricts the lungs ability to inflate, and if they're really very unwell we may stop feeds altogether and rely on IV fluids for hydration and the occasional comfort feed. This leads to d)
d) Irritable. Bronch babies, when they are unwell, are some of the most irritable and unsettled children I have come across. They feel rubbish, they're tired phsycally from the effort of breathing, will probably not be sleeping well and they're hungry. They are some of the hardest babies to settle, a nightmare for the parents and in turn for the nruses when the parents are at their wits end and asking you for a solution (or jsut ignoring thier child)
Where I'm working we put Bronch's into double bays. They're infectious, but with the number of Bronchs we have we double them up as they both have the same illness. Unfortuantly we so often seem to have one sick one and one slightly better one. Sick baby and mum keeps slightly better baby and mum up all night, causing frustration for everybody. Then slightly better baby goes home, and sick baby becomes slightly better baby and we get a new sick baby in and it begins again.
Hospital is the worst place to get a good night's restful sleep!
Tuesday, December 04, 2007
Structure
Well after MMW's suggestion I'm writing a post on the structure of nursing. This is based on the heirachy where I work now, though I think it will be fairly similar all over - it certainly was similar where I trained.
So, there are three types of nurse you'll come across on the ward.
Staff Nurse, someone employed permanently by the hospital - that's me.
Bank Nurse, someone who has signed up to the hospitals internal nursing agency - that can also be me - usually someone who already works in the hospital and wants extra shifts.
Agency Nurse, someone who works for an external nursing agency. Sometimes they're good, often not too bad but slightly more a hinderance than a help, and occasionally absolutely awful.
Why would someone want to work for an agency? Agency nurses get paid higher rates than Staff or Bank nurses, (Bank nurses earn slightly more than Staff Nurses) - the ward waits as late as possible before "putting the shift out to agency" in the hope someone cheaper will agree to do it.
Less responsibility.
Agency nursing is flexible; you can work which shifts you choose.
However the downsides to Agency nursing:
Shifts may not always be available when you want them
Depending on where you work you will be unappreciated and looked down upon, you also run the risk of being given the difficult patients or those no one else wants to look after - I don't believe this is true of where I work now, I think we treat our agency nures fairly well, that's why we have some regulars who keep coming back to us.
On the ward I work on we have 20 beds, this closes to 15 over the weekend. On week days we (hopefully) have 6 staff, on week nights 4 staff, and on weekend days 4 staff and weekend nights 3 staff. At night you can expect to care for 5 patients, if fully staffed. On days 3-4, if fully staffed.
Some of the patients we have require a lot of nursing intervention, 1:3 may not sound like a lot but depending on the patient the workload can be very heavy, and day shifts are always busier than nights. That being said, nursing 5 patients overnight can also keep you very busy. We have a lot of jobs that are supposed to happen on the hour, an example of the hourly jobs you may have to do for 5 patients overnight could be: 3 pump readings, 3 sets of observations, 1 set of inhalers (on some hours rising to 2), giving a feed hourly or two hourly, plus on various hours on top of that IV antibiotics (which I'm not yet trained to do), observations for other patients, medications. I often find that I'll have just finished my hourly jobs just in time to start the next hour.
However, I have trailed off the topic for this post. Sorry for that rather boring interlude! Back to structure.
Band 5 - This is a Staff Nurse, generally speaking, in their first 5 years of nursing, after this point to progress through the pay scale you would have to move up a Band. You have lower and upper Band 5's, which represent the old D and E grades, basically those with more or less experience. These lettered grades were removed with Agenda For Change, but we still refer to them.
Band 6 - This is a Senior Staff Nurse, in some places they may be called a Junior Sister or Charge Nurse. They have more responsibility than us lowly Band 5's, which is one reason why some nurses choose not to move onto Band 6 despite reaching a cap in their pay. Where I work we currently have 5 Band 6's, two of which are very part time (2-4 shifts a month).
Band 7 - This would be the ward Sister, or where I work Ward Manager. The Ward Manager is similar in role to Sister but as far as I can work out is less clinical and more office based. We have one Ward Manager.
We have recently had a Modern Matron come into post, in the last few weeks, this is a very new position for us and I'm guessing it is a Band 8 position. He previous was a Ward Manager, and now manages the whole of children's unit with Ward Manager's in each ward.
Now, that is our basic structure for ward Staff Nurses and Managers, but there are a couple more "important" roles. During the day we have a Paeditric Bed Manager, and you've guessed is he manages the Paeditric Beds. He keeps tabs on all the beds and cubicles available across the unit and the demand for them in A&E. Any child admitted during the day needs to go through him, and he makes the decision about where to allocate them. At night this role is filled by the Site Manager, who has the unenviable job of being Site Manager/Bed Manager for the whole of the hospital. They need to keep track of the admissions, discharged, allocations and transfers as well as any staffing issues that may arise. Our last key person is the Senior Nurse (not to be confused with Senior Staff Nurse). This person carries The Bleep, and their responsibility is staffing; if someone calls in sick they have to speak to the Senior Nurse, they have to be aware of staffing across the unit and make decisions about where to send nurses to cover if we're short staffed. This is usually a Band 6 or above nurse, though some of our more experienced Band 5's will also do it. This is also on top of thier normal patient workload as staff nurse that day or night. Oh, and we have a shift co-ordinator in charge of every shift, this can be almost anybody who's been there at least a few months!
So that's how it all works. Kind of! I know this was probably a bit of a long winded and boring post, but I think understanding what goes on "behind the scenes" will make my blog make more sense!
So, there are three types of nurse you'll come across on the ward.
Staff Nurse, someone employed permanently by the hospital - that's me.
Bank Nurse, someone who has signed up to the hospitals internal nursing agency - that can also be me - usually someone who already works in the hospital and wants extra shifts.
Agency Nurse, someone who works for an external nursing agency. Sometimes they're good, often not too bad but slightly more a hinderance than a help, and occasionally absolutely awful.
Why would someone want to work for an agency? Agency nurses get paid higher rates than Staff or Bank nurses, (Bank nurses earn slightly more than Staff Nurses) - the ward waits as late as possible before "putting the shift out to agency" in the hope someone cheaper will agree to do it.
Less responsibility.
Agency nursing is flexible; you can work which shifts you choose.
However the downsides to Agency nursing:
Shifts may not always be available when you want them
Depending on where you work you will be unappreciated and looked down upon, you also run the risk of being given the difficult patients or those no one else wants to look after - I don't believe this is true of where I work now, I think we treat our agency nures fairly well, that's why we have some regulars who keep coming back to us.
On the ward I work on we have 20 beds, this closes to 15 over the weekend. On week days we (hopefully) have 6 staff, on week nights 4 staff, and on weekend days 4 staff and weekend nights 3 staff. At night you can expect to care for 5 patients, if fully staffed. On days 3-4, if fully staffed.
Some of the patients we have require a lot of nursing intervention, 1:3 may not sound like a lot but depending on the patient the workload can be very heavy, and day shifts are always busier than nights. That being said, nursing 5 patients overnight can also keep you very busy. We have a lot of jobs that are supposed to happen on the hour, an example of the hourly jobs you may have to do for 5 patients overnight could be: 3 pump readings, 3 sets of observations, 1 set of inhalers (on some hours rising to 2), giving a feed hourly or two hourly, plus on various hours on top of that IV antibiotics (which I'm not yet trained to do), observations for other patients, medications. I often find that I'll have just finished my hourly jobs just in time to start the next hour.
However, I have trailed off the topic for this post. Sorry for that rather boring interlude! Back to structure.
Band 5 - This is a Staff Nurse, generally speaking, in their first 5 years of nursing, after this point to progress through the pay scale you would have to move up a Band. You have lower and upper Band 5's, which represent the old D and E grades, basically those with more or less experience. These lettered grades were removed with Agenda For Change, but we still refer to them.
Band 6 - This is a Senior Staff Nurse, in some places they may be called a Junior Sister or Charge Nurse. They have more responsibility than us lowly Band 5's, which is one reason why some nurses choose not to move onto Band 6 despite reaching a cap in their pay. Where I work we currently have 5 Band 6's, two of which are very part time (2-4 shifts a month).
Band 7 - This would be the ward Sister, or where I work Ward Manager. The Ward Manager is similar in role to Sister but as far as I can work out is less clinical and more office based. We have one Ward Manager.
We have recently had a Modern Matron come into post, in the last few weeks, this is a very new position for us and I'm guessing it is a Band 8 position. He previous was a Ward Manager, and now manages the whole of children's unit with Ward Manager's in each ward.
Now, that is our basic structure for ward Staff Nurses and Managers, but there are a couple more "important" roles. During the day we have a Paeditric Bed Manager, and you've guessed is he manages the Paeditric Beds. He keeps tabs on all the beds and cubicles available across the unit and the demand for them in A&E. Any child admitted during the day needs to go through him, and he makes the decision about where to allocate them. At night this role is filled by the Site Manager, who has the unenviable job of being Site Manager/Bed Manager for the whole of the hospital. They need to keep track of the admissions, discharged, allocations and transfers as well as any staffing issues that may arise. Our last key person is the Senior Nurse (not to be confused with Senior Staff Nurse). This person carries The Bleep, and their responsibility is staffing; if someone calls in sick they have to speak to the Senior Nurse, they have to be aware of staffing across the unit and make decisions about where to send nurses to cover if we're short staffed. This is usually a Band 6 or above nurse, though some of our more experienced Band 5's will also do it. This is also on top of thier normal patient workload as staff nurse that day or night. Oh, and we have a shift co-ordinator in charge of every shift, this can be almost anybody who's been there at least a few months!
So that's how it all works. Kind of! I know this was probably a bit of a long winded and boring post, but I think understanding what goes on "behind the scenes" will make my blog make more sense!
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