Almost There....

Hi everyone!
I have just finished my 5th week of placement. One more week to go and that is my second placement completed. It has been a rollercoaster of a placement.
Some weeks i have felt i have learnt a lot and i have gone home feeling positive and like i cannot wait to get back there.  On the other hand, there have been days where i have felt as useful as a chocolate fireguard.  Some days all i have done is clinical observations and that is more or less it.  I know clinical observations are vitally important and help to assess the patient's status, however, it is a little disheartening when you feel like you should be learning more.
i didnt set out to write a somewhat negative sounding post, however, i thought i best be honest as this is the nature of the course.  Not all placements and experiences will be to your liking.  I have, on the other hand, learnt what type of nurse i want to be and what i would not like to be like a few years down the line after qualifying.
I have been told that i will not need to learn certain skills as i am a learning disability nurse or that i wont be working with children. I have had to correct those people as children have learning disabilities too, and they too need specialised care. It does not mean that we will always experience this, but as a learning disability nurse to be, i find it saddening that there are people out there who still have that idea that learning disability nurses do not need to know many clinical skills.
Of course we do! Our patients are often unwell, can be more prone to infection and can have multiple diagnoses. It is therefore our job as learning disability nurses to set these people straight.
I have found that learning disability nurses are very passionate and that we can make a difference.  Recently, there has been a new campaign launched by learning disability nursing students at a university in regards to having that collaborative approach between nurses and their patients.  If you havent seen their video, watch here. 
This is more evidence of how, even as a student, you can make a difference.

The Nursing Times Award nominations are now out, and they take place soon. So remember, to nominate anyone you feel has made a difference to your education, to your learning experience and to the world of learning disabilities.
There are so many positives when it comes to nursing, that i will certainly not let a negative experience be negative.  You learn from that, you come away feeling different, knowing new things and having gone through that experience. That in turn will aid you in your path to becoming a qualified learning disability nurse. Anything that can help you, is always a good thing.  A lot of nursing now, student days and beyond, is about self reflection. So use that experience, good or bad, reflect back on, ask what you learnt, what can you do differently next time, how has it helped you as a person, how has it helped you as a nurse, and move on from that.
for each placement and each person you converse with will change you. And for that, those experiences are invaluable.

Night Shift......

This week I have had the lovely luck of having night duties.  I have personally been dreading them as I have been very lucky and not had to do night shifts in a good few years! 

But as a requirement in first year we are meant to do 3 nights on duty. So I have done my fill this week. It is weird going from day duty to night duty in several ways I suppose. It is difficult when your body clock is used to waking up early in the morning  (naturally even on my days off I wake up early now!).  It has also been hard in the respect the ward I am on I havent had to do a lot compared to days during the night.  It is children and generally, they sleep! We would have one or two admissions during the night from A&E.  Otherwise, it is making sure the observations are done, medications are administered and that everyone is comfortable. Occasionally we will have a child who is sick and a bed needs changing, or bottles need made for that 3am feed! So night duties have a very different pace in comparison to day duties.  You're very mindful of tip-toeing around and whispering every where you go. You are also very aware of the smallest sounds so you can tell when someone is moving or feeling restless and unwell. Depending on what the patient has been admitted for and if they have a parent staying with them, it can have an effect on their sleeping pattern. Some children find it hard to sleep in foreign surroundings but on a whole as they're not well, they tend to sleep when they can.  It is difficult when you are trying to do a set of observations at 4am and you unfortunately have to disturb them! Putting probes in their ears or tempadots under their arms is not the nicest of ways to be woken up for them.  Luckily, most tend to drift back off after that! 

I have found doing night duty to be useful though.  It has allowed me to sit and talk to my mentor and go through the various processes on the ward in detail, getting to know the paperwork and how this translates onto the computer system. I have been able to discuss my upcoming essay and get ideas of how I can use what I have learnt in my work.  I have helped to prepare and set up drips and learn about IVAC's (the pump system) and I have had chance to see how the admissions from Accident and Emergency happen.  I have been able to read up on patient's notes and I have been able to gain more experience with the younger patients.  I have been sterilising bottles, I have been assisting in feeding the babies on the ward, I have been doing their observations.  I have also had the opportunity to be able to visit the surrounding childrens wards to see what they are like and the difference in them.  On the ward I am, it is mainly surgical so we see a lot of day surgeries and other surgeries.  We see a wide variety of patients and it has been an amazing placement thus far.

Night duty can be difficult, however, I have been able to have a break time where we get to sleep for an hour or so.  You are a little more refreshed and each nurse takes it in turns so there is always someone staffing the ward.  I have found if you don't get away on time or even a little early, you hit all the rush hour traffic. That can be difficult when you are so tired you just want to jump into bed! 

It is incredible how much you learn within 6 weeks of placement.  You are able to gain so much experience and put into use everything you learn during your university class time. 

Although I was not looking forward to doing night duty I found them an invaluable learning experience.  You experience what happens when most people are not there.  The staffing levels are less as there are no day surgeries and admissions, there is such a reduction in noise in comparison to the daytime too! You also see the patients and their families in a very different light.  During the day, patients and their carers tend to go through the motions of being there. They are feeling scared, ill, unsure, yet with all the routine and hustle and bustle around the ward, these emotions seem to be hidden a lot more.  When it comes to the night duty, everything is a lot calmer and a lot quieter.  I have found it is these times when it is invaluable to the parents to just sit down and talk to them even for five minutes.  It takes their mind off why they are there a little and provides a much needed distraction.  A small conversation can be worth everything to them.  I have sat down with them, got to know my patients and their carers / parents.  I have been able to learn more about them, I have been able to pass my knowledge on to them and more importantly it allows them to know that although it may be busy at times and it may be difficult for them, there is always somebody about to be a listening ear or a shoulder to cry on.  In hospitals, you see people at their best moments and their worst.  It is emotionally turbulent for them and it is draining.  By being there and talking to them, you are providing a service they may not have asked for, but more than likely needed.  

On the other side of that, it allows you to pick up on things not necessarily mentioned when they are admitted and a history was being taken.  As well as this, you are also mindful that your patient is the child, regardless.  And although it may be difficult and some parents and carers may seem lovely people, and may genuinely be so, your priority is that patient.  So if you pick up on anything untoward, worrying or a little off then this needs to be reported.  With children, social services, health visitors and child protection can be involved. Some may already be in contact with the family, some may not.  It is always important that you remember the child comes first, and if there is anything that may need to be investigated then this will be up to the various agencies to decide.  As a nurse working with paediatric patients, safeguarding is fundamental to your care.  As with any person who is vulnerable, whether they are a child or an adult, they need and deserve to be protected.  This all needs to be done in line with the NMC Code of Conduct, various laws and legislation while remaining impartial and keeping matters confidential.  

Overall, I enjoyed night duty more than I thought I would! It has been a long week though and I have struggled to get anything else done as I have slept on and off for the majority of the days.  I have also felt drained and all mixed up, however, I am glad I have done it.  It has been a great learning experience, and everything helps for not only during your university experience, but beyond qualifying too. 

So while it may seem lovely to be able to have a little cuddle off a baby once in a while or to play with those children to provide a little distraction, it is important to remember your role as a nurse is multifaceted.  And it wouldn't be the rewarding job it is if it was one-dimensional. 

Strengthening The Commitment

This week I attended a conference ran by RCN in collaboration with local trust networks for learning disability nurses and students, or rather, a nurse of learning disabilities (I'll get back to that later). 

The conference was promoted by the RCN and our university made us aware of it and that students were permitted to attend.  There are some conferences that are post-registration only so this was nice to be able to attend and get a taste of what conferences are all about within the nursing world.  It was also a very good opportunity to be able to meet other learning disability nurses and hear stories about how they gone down the career pathway that they have chosen and what lead them there.  It was also good to hear of so many opportunities afforded to us as learning disability nurses.  The nurse of learning disabilities, rather than a learning disability nurse, is about championing ourselves as nurses first. It was noted by several speakers that even today, in 2015, we still face challenges as learning disability nurses. I believe this has to stop.  If other health professionals do not recognise us as highly skilled nurses, then when are others going to recognise that those with learning disabilities need specialised care from those learning disability nurses? This does not bode well for those with learning disabilities.  It is about liaising with other nurses from other fields, and for us to recognise just because a job does not have 'learning disability nurse' in the title, it does not mean we are not qualified for that role.  I spoke to several sponsors at the conference as well as listening to the guest speakers.  And it was even noted by others that there was a real buzz in the air, a very vibrant and passionate atmosphere.  It is not about different fields putting each other down or believing that one is better than the other, but working together to make a better future for our patients.  It is about collaborating, putting that message across to our patients, their families and carers, that we as health professionals are there to work together to put their health and wellbeing first.  

From hearing from Professor Owen Barr (co-author of Oxford Handbook of Learning and Intellectual Disabilities) to hearing from board members and carers, the conference really highlighted that there is such a network of learning disability nurses out there. It also enabled others to see the progress they have made in their careers and just how much they still enjoy what they do, even 40 years after qualifying!  If anything, I believe that is something most people hope for. That even ten, twenty, thirty years down the line, you still have that passion, that enthusiasm and that job satisfaction within your role.  

The conference was all about Strengthening The Commitment, a UK wide review of modernising and recognising Learning Disability Nursing. It is about looking at the challenges we face as health professionals, not just learning disability nurses, but right across the board from top down and bottom up.  It is about how we can overcome the challenges we might face and improving healthcare for people with learning disabilities.  Taken from the report I have linked above for you, "it reflects a four-country commitment to gathering and considering evidence on the current and future contribution of learning disabilities nursing. At the heart of the review is the commitment to supporting people with learning disabilities, their families and carers to achieve and maintain good health."

It all starts with You.  As a student, regardless of field, it is important to recognise the skills and attributes that all nurses have.  Working together, helping each other when we ask and where we may need guidance, will all help to improving health care for those people with learning disabilities. As I have said before in previous posts and I will say again, People with learning disabilities are living longer and often have multiple complex health needs.  These needs must be met.  These needs ought to be fulfilled. And that individual deserves to live a long and fulfilling life, just like any one of us.  For those that don't understand people with learning disabilities, their needs or how to communicate. Ask. There are always people willing to help. 

This Week I Learnt...

So what did I learn this week? 

I once again was able to go into theatre, although this was my longest surgery yet! I was in there for 4 hours. Yes, four! 

The surgery was unbelievable though. It was a surgery that the surgeons had never done before as it was something they had never come across before.  This was a very special patient indeed! The surgery was amazing though.  They had it on a screen so I was able to watch so I didn't interfere too much with the surgeons. There were five scrubbed in surgeons plus one theatre nurse.  So at some points it was a little hard to get close enough to see as there were many hands and heads in the way! So the screen came in useful at some points.  Once again, the surgeons were great in answering questions and explaining what was happening.  The patients scans and x-rays were also up on a computer screen for reference.  This enabled me to see what the surgeons had noted and why the decision had been made for the route the surgery was going in.  It was an orthopaedic surgery, of which I hadn't yet seen. So I was able to see the various layers of tissue, the skin, subcutaneous layers, the adipose tissue, muscle, tendons, ligaments and bone.  Utterly fascinating.  As it was such a delicate surgery, the surgeons were orthopaedic and plastic surgeons. So the different levels of knowledge in the room was vast.  The anaesthetists was also helpful in explaining the fluids they were giving the patient due to length of the surgery and potential for blood loss.  They also explained what they look for on the monitors and how important it is for them to know all about the different drugs that are available, their contra-indications and how to calculate doses in paediatric patients.  Constant monitoring is vital in any surgery, so it is important for them to be vigilant and know their stuff! 

Unfortunately I cannot say too much about the surgery due to how rare the surgery actually was.  I have researched on the internet and there is very little about this patients condition.  So due to the rarity and the chance for identification I will be withholding those details. The patient and their family consented to me viewing the surgery and asked how I had found it afterwards.  They were very helpful in explaining and only to happy for people to learn more.  It definitely helps when you come across people like that as it does make your journey for learning a little easier.  

I was also able to get a little mathematics practice in this week too.  I had my mentor assisting me with drug calculations on the ward and then making up some questions for me to enable to work out medication doses in the children.  As a learning disability nurse, we can work with adults or children.  I have yet to decide what path I want to go down.  So it is even more important that I understand childrens and adults calculations! Fluid intake and output is measured, and in babies their nappies are weighed. This, along with blood tests, allows us to know how well that child may be and have an understanding of their fluid and nutritional intake.  

I have managed to get copies of fluid balance charts, growth charts and PEWS charts. So I am hoping to use these to not only assist in my own knowledge, but to also use them in my essay writing and use them for reference.  I have also learnt that if you don't always ask, then you may not always take advantage of that learning situation available to you. You are responsible for your own learning and that means you need to take advantage of what is available to you on placement while you can. As you may not have those available to you again. Placements go so quick and it may be the only time you are supernumerary and are able to take advantage of all available to you. 

Theatres, Surgeries and Paediatrics

This week, I have finished my second week in my children's placement. It has been so interesting and once again I feel I have learnt so much. My mentor has been great in allowing me to experience different things in my placement. This week I have been assisting in admitting patients and discharging them. I have been able to follow patients through, from admission, preparation for surgery, anaesthesia, the surgery, recovery, return to the ward and then discharge. Seeing the patient's journey has been incredible. However, it has been hard getting used to having such a short period of time with the patients. I have worked in the community a lot, and it is something I enjoy. I like getting to know the patients / clients / service users and building up that relationship. So having patients come in and leave within a matter of hours takes some getting used to! 

This week I have spent time in the theatres being able to watch some paediatric surgeries. I have seen dental extractions, ear, nose and throat surgeries and finally an appendectomy. I have loved it! I was warned that they have had several nursing students faint in theatres and that often its because some people have not eaten. So I was able to grab a bite to eat, then away down to theatres. My mentor contacted the surgeon to see if it was okay that I observe, and permission was gained from the child's parents. I was then shown where to change into my scrubs and then clean up ready for theatre. I was told to not touch anything blue or green, as these were sterile and would compromise the surgery.

In each surgery I observed the patient going under the anesthetic. With children this is very daunting for them. If they go under scared and upset, then they can have a tendency to then come back round upset too. The children were placed under via mask and then injection. Depending on the child they would find it easier with one or the other first.  Once they were placed under, their airway was supported and they had a endotracheal tube or laryngeal mask.  A laryngoscope may be used for placement of a endotracheal tube.  Airway management is the responsibility of the anaesthetist. 

Airway management:

Endotracheal tube

Laryngoscope

Oropharyngeal airway

Laryngeal mask

My first surgery was a tonsillectomy and adenoidectomy. I was able to look down the viewfinder of the microscope as the surgeon was operating as he explained what he was doing and what I was seeing. Utterly fascinating! I was fortunate to see them removing ear wax from a child's ears and then removing the adenoids and tonsils.  This is a great surgery and was somewhat straightforward. Of course not all surgeries like this are straightforward.  The surgeon informed me that although it looked simple, it can be the case where it is the exact opposite.  Never be afraid to ask questions, the surgeon was so helpful and was more than happy to answer questions. 

Enlarged tonsils.

My second surgery was dental extractions where children were having teeth removed. Although this sounds like it could be a simple trip to the dentist it was far from that. One child had some teeth removed and a gap left where the incoming tooth could move into. Then another child had to have their hard palate cut back and to the side of the maxillary labial frenum (that piece of muscle under your top lip at the front of your top teeth) cut to gain access to the cavity beneath the nose at the roof of the mouth. This was a longer and more complicated surgery but was good to see how this was done and the knowledge of the dental surgeon. Again the surgeon was able to explain each stage to me and show me what was involved. 

My third surgery was an appendectomy. This was a little longer than the first two surgeries and a little more intricate and so interesting! Not recommended if you are somewhat squeamish.  I watched as the cut was made after they had felt to see where the appendix would be. The child twitched so was put further under anaesthetic. This can be due to nerves and the body not being fully relaxed due to the adrenaline that will be surging through the body beforehand with the nervousness the patient will be feeling. 

Once the cut was made, the layers of tissue, and the peritoneum were cauterised, then the appendix was located. Once this was located its blood supply was tied off. This was then removed and checked before being placed in a specimen pot to be sent to pathology.  The various layers were then sutured back together. Suctioning was used at various points and the area washed with saline to ensure it was clean.  The overall incision was a couple of inches and the surgery will have improved the quality of life for the patient.  It was remarkable to watch. I don't however recommend if you can get queasy! Especially at the smell of the cauterising of flesh, that is something you will remember! 

Once the surgeries were complete I was able to watch the patient being brought round from the anaesthesia. The nurses in the recovery room monitor the patient, note the patient's observations and ensure everything is as it should be.  The patient will not be sent there if the anaesthetist is not happy.  Once the patient comes round and everything is okay, then the patient's family are called in. Everything is recorded and even the machines monitoring the patient will give a print off for the patient's records. It is so important with anything now that it is all documented. As they say, if it isn't written down it didn't happen! 

If you get the chance on a placement, I do recommend asking if you are able to, observing some surgeries.  They are incredible and just reaffirms how amazing and intricate the human body is.  And underneath it all, we are all the same.