Placement 4

I have now completed two weeks of placement and I have really enjoyed it so far! 

I have been on night duty these two weeks so I have also been able to learn the layout of the building and familiarise myself with the stock room and the various health and safety checks etc that happen every day.  

I have also had time to read through the client's care plans and admission files to learn how the nurses admit and discharge patients and what it is that is needed.  This has allowed me to begin my care plans that I am needed to do, as my mentor on placement assesses these before they sign me off for the placement. 

I have also been able to set the child's enteral feeds up and run these through their pumps.  Many children tend to use the Kangaroo Joey pumps.  

Giving Set

Kangaroo Joey Pump

These are fairly easy to set up and some children will have these in a special backpack so it can be connected and running while they are out and about or in school. 

Many of the children will have their enteral feeds in the morning as well as school, and each school has a school nurse (that is also often learning disability trained) to set these up, oversee administration of any medication through their PEG tube or Mic-key button. 

A Mic-key button can be different sizes for the size of the child and these are assessed and changed on a regular basis as the child is still growing.  

A PEG tube fitting.

Positioning in a child.

                            A Mic-key button                                        A Mic-key button in a young child.

The locking system when attaching a giving tube.

I have pushed bolus feeds and bolus hydration through their Mic-key buttons as well as their medications.  Most medications are liquid, but some need to be dispersed in sterile water.  For the dispersible tablets, my mentor taught me to try and place the tablets within the syringe (by taking the plunger out).  Place the plunger back in as far down as it will go, then place the syringe within the sterile water and draw this up. Instead of placing the tablets in a medicine pot, dispersing the tablets in there and drawing up, it means you don't lose any of the medication from transferring from pot to syringe. Very clever idea and saves some time too!

I have also been fortunate to carry out my first female catheterisation on a young child too.  This young girl has intermittent catheterisation so it was not an indwelling one that I carried out.  The procedure to do so was quick and painless for the child.  

An intermittent one is similar to self catheterisation where you only insert the small catheter and the urine flows into a toilet bowl, pad or kidney dish for example.  As this was a child whom also had a learning disability, this procedure is carried out by the nurses. 

An indwelling catheter procedure would be similar to this;

There are plenty of videos available on YouTube and you will do this in practical classes within university too. A male catheterisation is much easier than a females, so try and get the practice if and where you can! 

I will be writing up my care plans this week (I have a draft of one done!). My mentor will be able to go through these with me and then I will be able to finalise these for my final week where I have my assessment with my mentor.  

So thus far, it has been a valuable learning experience.  I am hoping I am able to go into the schools soon and out with the children when I on my day duty. 

Hopefully I shall keep you informed! 

And don't forget, learning disability nursing is amazing.  All ages, all abilities and best of all, the greatest patients! 

The Struggles of Being A Learning Disability Nurse

I've completed my first placement and my first week back in lectures. 

We have had a tutorial where we have reflected on our placement and had chance to talk to fellow students about who was able to experience what in placement. 

It has been good to have that opportunity to do so. It has also allowed us to see the difference in placement areas and the different experiences that each of us had during our six weeks in placement. 

It did come up in discussion how some of us had struggled and had faced negativity towards the branch in which we are studying. 

It is disheartening that even today, in 2015, that we are still facing negative attitudes and opposition in studying learning disability nursing. I have even received some emails from readers of this blog in regards to this as well.  I had a interesting conversation in regards to a student's placement and how they had faced some nurses asking why they had chosen to do learning disability nursing and if they thought they would be able to succeed in finding a job after they graduate.

As I have previously stated, learning disability nursing is still seen as a small niche of nursing.  However, with the population living longer, reproducing later on in life and living riskier lives, we are all experiencing a different level of health and disease than we ever previously have in our modern day world. As you may have noticed, the Ebola outbreak has been onoing for a while now and this has taken many lives.  We are still not yet able to say if the vaccines they are trialling will even work.  It is hard to even say what may happen if the vaccines do not work.  There are also many more people suffering from conditions such as dementia and multiple sclerosis.  This is because we as a population, are living longer. Why do I mention this? Simple.  People with learning disabilities are living longer and are needing more specialised care.  The population of people with learning disabilities is ever increasing and is not going to diminish any time soon. So why are they excluded as a group almost in society? We forever see articles and media focusing on the ageing population and how elderly people may feel segregated and need care and help from those around them.  Why do we never see those with learning disabilities in the media like this? Why do we never see many people with learning disabilities in the spotlight? Perhaps those with learning disabilities are not aware. But maybe it is those around them who may not fight as much for them as for their elderly grandparents.  It has been, and may always be, a common societal view that the elderly are frail and need care and respect. We think of teenagers differently, we think of middle aged men differently.  It is these stereotypes that need fighting on a daily basis.

As a side note, I never experienced any negativity on my placement.  The nurses were very skilled, they were lovely and so very supportive.  They applauded me for doing learning disability nursing, however there was 2 nurses that even admitted if they could go back they would do adult as they like the hospital setting and many of those patients were being resettled into the community. In my placement I couldn't fault the nurses for this.  I personally would like to do community care and manage my own caseload. I would like to go on to do district nursing so I am able to do that extra training in catheter care, wound care etc.  I am not fully settled on that as I am leaving my mind wide open for the experiences I am yet to have in my nursing degree. 

It has been pointed out to me that there is a blog on the Mencap website of another student learning disability nurse facing negativity and opposition.  As I am unaware of where she is based this is difficult to comment on.  On the other hand, I can give my experience. 

On my placement I was able to give medication.  Once you qualify, it is almost expected of you to do this. This is why some universities have maths and english exams before they will even interview you. Medication calculations are important.  I was able to do PEG feeds, I was able to clean and dress the site. I was able to do body mapping charts. I gave injections. I was able to enemas. I completed case notes. All of this can be considered clinical care. Not one of my peers faced any opposition or comments in this, from other student nurses on other branches or people on placement.  Learning disability nurses are becoming more recognised and valued for their skills. 

It is becoming apparent that slowly but surely, it is being recognised that people with learning disabilities need that specialised care.  We need learning disability nurses to fight for those people with learning disabilities. We need people with awareness to make this known.  And I say we as a learning disability student nurse, we as people with learning disabilities, we as health care professionals and most of all, we as people.  I have always seen learning disability nursing as an amalgamation of all 4 branches.  In learning disabilities, you can work with pregnant women and their families, you can work with the newborn they just had that has been noted may have a learning disability.  You may work with children and assisting them in assessment and development.  You can work with teenagers, struggling with regular teenage problems or just trying to explain the process of puberty.  You may work those trying to move away from home and seeking help and support. You may work with those wanting to have a family. You may work with those going through significant trauma in their lives.  You may work with the elderly learning disability population.  You may work with those needing palliative care. You may work with those going through a bereavement.

See where I am going....? 

Learning disability nursing is not and will not be stuck to one area. You are working with people. People change, people develop. And most of all, people are people. Nothing is guaranteed.  Nothing is set in stone.  People with learning disabilities may just go through all the phases in life that the rest of the population go through.  It is all dependent on them, their needs, their assessment, their decisions and their wants.  So please never let someone tell you you cannot.  Learning disability nurses can do clinical skills. We can take blood, we can do I.V's, we can do B.P's, we can do dressings. All it needs is a bit of training.  Nursing is a career that you are always learning and are always adapting.  So if you want to do whatever it is within learning disability nursing, why can't you? Do well at university. Qualify. Find a nice job and a nice, supportive employer. Go on training courses. Never stop learning. And never stop fighting for and raising awareness of people with learning disabilities. Because odds are, they don't have the voice or the platform to do so. You do.