People and suitcases

On monday I travelled up to Nat's. I had a big (and very heavy) suitcase with me. At Elephant and Castle station there are some stairs and I was strugging down them with my suitcase in one hand and leaning on the hand rail for support. Three people were coming up not using the handrail for support, and instead of moving around me expected me to struggle around them. How ignorant are people? Because I'm a polite person I moved around them, but next time I think I'll just stand still and see what they do. Instead I just muttered things about inconsiderate and ignorant people.

I dislike using pubic transport when I have a big bag, aside form it being inconvenient I don't like being in people's way, but as I don't drive I haven't got a lot of choice.

Looking good.

I saw my ethics lecturer this morning, after she kept me waiting for an hour, and she read through my essay and told me it was good! There are just a few small changes I need to make. So, I'm quite happy about that, though I won't celebrate until it's been marked because from past experience I know what the marker says about the draft may be entirely different to what they say to the submitted essay.

A productive day

I went into work today to get the last few things in my skills schedule signed off. I thought it would be horribly difficult knowing what my mentor has been like in the past when it has come to signing things, but actually it was smooth and fairly painless. It's a relief to have the Schedule out of the way and ready to submit next module.

I finished off my ethics essay tonight, I think it might actually be a load of rubbish, but I'm seeing a lecturer about it tomorrow and I guess she'll give me a clue.

I'e been quite stressed this weekend, having to get my schedule sorted and finish that essay, but also I'm going to Nat's tomorrow, we're going to a funeral on tuesday and then I'm staying there until friday when we fly out to Gambia for a week with some friends. So I've had a lot of packing and organising to do on top of my university work.

On the brightside, my parents being the Christmas lovers that they are have put up our Christmas tree, it looks beautiful as ever, and the kitten loves it.

Assignment grumbling

I'm currently writing a (bad) ethics essay. This is an essay that I have really struggled with, not because I lack in ethics(!) but we have received little teaching in university on ethical theory and principles which adds to the difficulty in writing this essay and the way in which we are expected to write is not the way we behave in real life. The decisions we make in practice are guided by ethics and by the standards laid out by the nursing and midwifery council, but we do not have the time to stand around critically analysing and discussing each decision we make applying relevent ethical theory (such as deontology or utlitiarinism) and principles (benificence, non-malificence etc). Many of these theories and principles are second nature to some degree, nonmalficence the principle that we shall no do harm for example. I don't know that I would go as far as to say this essay is a waste of time and will have no relvence to practice, it will, but the relevence is from the research I have done into restraint and policy, not because I have applied a consequential theory to the scenario or looked at the level of autonomy the patient has.

I know, I'm just moaning. But as with many of our assignments it doesn't seem to be about furthering our development but more about showing the university we can say all the right things in the right way. What you write in an essay does not reflect your ability to be a good nurse, it's jsut learning to talk that talk.

One of the things I struggled with in the course is how little my opinion is valued in terms of assignments. We have had to write many essays on various topics throughout the course and my opinion is worthless in them if I cannot back up what I say with a reference. I understand the need for evidence based practice, and I'm not denying that there needs to be sound a knowledge base in what we write but it is disheartening to know that my opinion is only worth something if someone has said it already. Where is the room for new ideas? All the references I use, someone had to come up with them in first place.

My week - an overview

This week has been pretty good. I worked three shifts. The first was out on the ward, as opposed to HDU, on a night shift. We are so undersaffed and underresourced and with the forthcomin gclosure of the ward the staff have had enough. The highlight of my night shift was being womited on by a baby who just would not stop crying, with a pretty useless father who seemed to feel it was the nurses job to do everything for his daughter, he'd just lie in bed when she cried or come and get us and point out that she's crying. Well.. yes.. and what do you think we're going to do that you can't do better as her father?

Yesterday I worked with B and she's a star, really helped me get some of my skills schedule signed off. Once again understaffed, I think it's helpful for them when I'm working as I can (fairly competently) take my own patients easing the staff load slightly. Highlight of that shift? (I typed shit then by mistake, Freudian slip?) Hmm. I did my first subcut injection and it's about time really. Hardly news worthy I know, but I had a sense of fulfilment doing it - I quite like doing injections, maybe I'm abit of a sadist.

Today I worked with my mentor. I don't think I've mentioned him before. He has been the most challenging mentor I have had I think, for reasons I won't go into here/now. But I have learned a lot of patience on this placement, and a lot about how not to treat people and patients. I was really hoping I'd find some way to get out of it as it was my last shift, however I didn't and I survived and it wasn't entirely horrendous. The highlight of today was being told by one of the senior sisters that I've "got what it takes to go far in nursing", that she's seen me in practice and that if they could offer me a job in April they would do, with the forthcoming closure and reshuffle they won't be able to, it's good to know though.

Oh, and I did a really good blood gas today, not a big deal at all I know but I feel like I always fuck them up and have to get someone else to do them, so it felt good. It really does make a difference having a supportive and encouraging person working with you when you're not feeling confident (it also helps that it was a compliant 9 year old and not a kicking, screaming babe).

Oh, and having done my durgs assessment last module I'm allowed to be a second checker. I like it, it's fun, but I also feel like I'm helpful and contributing.

I should really go back and check my typing, but I'm tired and can't be bothered so I apologise for any mistakes, if you begin to read this blog on a regular basis though I'm sure you'll get used to them.

Acronyms and Danger

Recently on a comments thread of a blog I have been following, the topic of hospital acronyms came up. It made me think about the little things I've not learned during my 2.5 year's training. TTA/TTOs. I know what they are - medication the patient takes home, but I've never really been sure what they stand for - that's not something they teach in university, (thanks to those who enlightened me on that thread).

Something else, incredibly stupid that in my third year I'm still a little hazy about, is the medical heirachy. When I'm asked to bleep the doctors for a particular task I'm never quite sure which one they mean, SHO, reg, consultant? I tend to go for the nice ones who'll either give me what I want or point me in the direction of someone who can. I was discussing this recently with a fellow third year who said she also is never quite sure - clearly a gap in our training!

Blogging. It's dangerous. I started reading Random Reality's blog because it came up in the Metro and looked like interesting reading. From reading his Blog I've moved onto NeeNaw's and Diagnosis N.F.I, from their Blogs I've started reading Mr Man's Wife and from there I've started glancing through about 5 different others! It's a wonderful way to avoid writing my essays, and the bonus is I can kid myself that it's all relevent to my training!

Diploma vs. Degree

I'm due to qualify in April, I wasn't really looking forward to it for several reasons.
a) I've got so much work to do between now and then I just want to give up and sleep through the winter
b) I'm not entirely sure I'm ready to be a staff nurse. Don't misunderstand me, I actually think I'm good at what I do (a rarity for me) and have the potential to be a good staff nurse I'm just not sure I feel ready to go out there and do it yet
c) I actually have to find a job

I'm so close to finishing it seems almost impossible yet I know, despite a,b and c, it will be a relief in some ways. So why am I now considering doing an extra year?

I've trained on a 3 year Diploma course, Degree or Diploma I exit the programme as a registered nurse child branch. I left school with just AS Levels, when I decided I wanted to do nursing a Diploma was the best option, I could have done an extra year at school to get onto a degree programme but the funding is better on the Diploma and it seemed like the best idea at the time. Afterall, I don't need a degree to be a good nurse.

During my training I realised that I want to get the degree at some point, I had thought CPD modules later when I'd qualified would be a good idea. However, my university runs a "top up" course full time for a year starting the month after I qualify. I'm planning on applying for it, my (ever supportive and loving) parents will help support me for another year and it seems better than trying to to it later when I may have other commitments like a mortgage or a family.

Why do I want a degree? Well there's definitely an issue of pride. Employability, well either way I'd be a registered nurse but in these cash strapped times who would a ward rather employ; a diploma nurse who wants to be sponsered to degree or someone who already has a degree? If faced with two applicants, a good diploma nurse and a not-so-good degree nurse I don't believe having the diploma would disavantage, however being on an even pegging in terms of "goodness" greater qualification has to be a bonus. If I leave nursing having a degree, regardless of it's relevence, will be looked on positively. If I want to go on to do more study, which I think I will, having the degree now will make it easier to access other courses. Finally, it is not going to disadvantage me doing an extra year of study and having more qualifications.

Do I really want to do an extra year? I was looking forward to these essays being the last I would have to write for the foreseeable future, I don't relish the idea of further study now. But I feel it would be better to get out of the way whilst I can. With regards to a,b and c...
a) doesnt' really change, I've always fancied hibernation as a life choice.
b) I would have another year to feel ready to be a grown up, maybe I won't feel ready then either but I certainly will have more experience under the safety net of being a student (though realistically I'll have a PIN and seeing as I don't seem to be counted as supernumery now I can't see that I will be then).
c) Perhaps the job climate will have changed by then.

The other downside is that on the Diploma course my tuition fees were paid and I received a nice bursary, this I will not get for the extra year and I anticipate the fees being quite high, I'll have to take out a loan (I've not needed to thus far) and be poor for a year whilst my friends go out and work and earn the millions nursing has to offer.However, at just 21 I have my whole life ahead of me, one extra year is nothing in the grand scheme of things.

Of course, all this is subject to my application and acceptance onto the programme however as one of their current students I think it unlikely I wouldn't be. So I'm now trying to mentally prepare myself for another year of essay writing and new found poverty.

If you read this far you deserve a cookie.

Doom and gloom

We have a careers day on thursday, which has now become a careers half day as there aren't any jobs. I personally find this amusing, but then I have an odd sense of humour.

Only one Trust agreed to have a stand at the fair, everyone else cancelled as the job situation in the local area is so dire. I've also been told by several different people in the last week how restrictive training to be a paediatric nurse will be, so apparently it's all doom and gloom that I have to look firward to in April. Apparently I should have trained as an adult nurse, but the thing is I don't really like adults so that would have been a drawback!

Obesity

So one of my biggest issues at the moment is obesity in children. In the last few weeks I have come across several very obese children on the ward. I personally feel that if an adult wants to be obese, fine they can make that choice for themselves but they should not be making it for their children.

Obesity is such a well publicised issue along with healthy eating that parents can no longer plead ignorance. But what motivates a parent to over feed and poorly feed their child to the point of obesisty? And I'm not talking a little bit chubby, I am talking clinically obese. For example, a 15 year old, 1.5m tall weighing in at 110kg. A 5 year old, 45kg (yes he was tall for his age, but he wasn't *that* tall). This 5 year was due to have minor surgery, the anaethetist was talking of cancelling the operation because obtaining venous access was very difficult due to his excess fat. Fortunatly venous access was obtained and the operation went ahead. I wonder though if the cancellation would have "taught the parents a lesson"? It's not about punishment and unfortunatly it would result in the child's care suffering but clearly the parents are not paying attention to their child's health needs and what will it take for them to realise it is a problem? They obviously didn't feel it was a problem; the 2 McDonalds, a packet of crisps and a packet of maltesers the night before clearly indicated this, as did the claim that they didn't feel he ate very much.

The child's diet and weight bordered on being neglectful or abusive as my collegaues have suggested, but these were clearly very loving parents, they just wanted to make their child happy. I think something has gone very wrong in our society, material things and food are all too often used as demonstrations of affection. I regularly see it in my work, parents not knowing any other way to show thier child love other than by buying them things and giving into their every whim whether it's good for their health or not. I wonder if they truly realise the damage they're doing to their children.

I'm trying not to jump on the obesity band wagon, but I've recently realised what an issue it's becoming and it is a difficult one to address. In many cases I think it is the result of parenting that the child has become obese and it's difficult to tackle as not all parents are compliant. I also feel that at times there is a hesitency to raise the issue on the part of healthcare staff; being fat has very negative connotations in this society and it's hard to turn round to a parent and tell them not only is their child fat (we try to come up with nice words for it) but that it's their responsibility - no parent likes to be criticised. It's an issue that needs to be dealt with very sensitively and it is easy to criticise, as I'm sure you've realised through reading this. I'm not sure what the answer is but I think we need to provide education for these parents, hard facts about what the consequences of childhood obesity are, but also a supportive and nurturing environment to help them to change their child's lifestyle.

I added some new links, for those of you interested in what we're doing in Iraq there's a site that attempts to keep a record of the casualitise to date. I've also added links to 3 blogs which I'm following with interest, I hope I've not broken any Blogging etiquette in linking.

Beautiful, wonderful

So, yesterday I got to pass my first NG tube, beautiful.
I got all my paperwork finished and signed, wonderful.

I realised just how soon I'll be qualifying and becoming an all grown up staff nurse. Although when on placement I'm working full time I'm always aware that I have a finish date and am counting down to it. I'm going to have to get my head around the fact that this is going to be my life come April/May. Assuming I can find a job.

Door buzzers and lumbar punctures

Most wards have a buzzer entry system, particualrly children's wards, we're not supposed to let complete strangers come say hello to the kiddies.


Me: Hello soandso ward, can I help you?
Person: Open door please
Me: Who are you here to see?
Person: Door open please
Me: Yes, but who are you here to see?
Person: Bed 5
Me: Which patient?

At this point there's usually a name mumbled, often Mohammed (we usually have at least 3 on the ward at any one time) and I let the person in now I'm more convinced they're not an axe murderer.

These conversations get me every time though. If there's a buzzer outside a locked door I think it's a safe assumption the person using it wants to gain access, yet I frequently get that response as though I'm a slighty dense person who's not quite realised what the bell is for.

On other matters, I saw my first lumbar puncture today, I'm not sure how I've managed to get half way through my third year without seeing one (or, come to it, passing a NG* tube on someone other than myself). It was quite good, I was the "catcher" for the CSF. I only managed knocked the needle out of the sterile field so the doctor had to plug it with his thumb between sample bottles, I didn't spill any though so I'm fairly happy! We learn through mistakes and and the doctor was very nice about it.

The poor kid also had a plastic container taped to his head which I realised protected his scalp cannula. Not seen one of those before, cool if a little odd looking.

* I noticed when reading the page about NG tubes that it suggests that injecting air down the tube and listening for air entry into the stomach as being reccomeneded practice for confirming the position of an NG tube. I just wanted to say that that is not the case and is not something we do in practice any longer. The article mentions aspirating and testing with pH paper, this is the reccomended practice. Just thought I'd bore you with that, I've got lots more info about testing NG tube placement if anyone happened to be interested! ;p