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. 

And so placement begins...

So I have completed my first week of placement and it has gone so quick!

I had a mad dash into town to go and buy some shoes and I've been wearing them in around the house. I did want some trainers as they're usually a lot more comfortable but needles can easily go through them.

And it is in our portfolios to wear black sensible smart shoes for placement. 

Ironic thing is a lot of learning disability is in the community so I don't even know if I will be wearing them much! 

I rang up my placement again on the Friday before hand just to ensure I had everything right in my mind about how to get there, where to park, if they charge for parking and if I'm needed to wear uniform. 

I have to wear mine so at least I'm getting my money's worth! We had to pay £160 for our uniform so it's always good when you can wear it. 

For our off duty the staff have been really flexible and so helpful as they know students can live anywhere and may not be in close proximity to the hospital. They have asked us what we prefer to work and if we want to do nights etc.  It does state that by NMC guidelines we have to do so many nights each year of the course.  In first year we have to do at least 3. So I am aiming to do that this placement.  That way I can see what happens at night and enable me to hopefully get some work done!  It also means that if I don't get chance to next placement or the one after, that I am covered! 

In my placement I am actually in a hospital so I am really enjoying that. Of all the years I've worked with learning disabilities I have never yet worked in a hospital. It has always been in the community which is what I love to do. But this placement has certainly opened my eyes.

My very first day we had an emergency situation so that was certainly interesting. I have dealt with challenging behaviour, done my first set of observations independently and unobserved. I then recorded this using a NEWS chart. I have done my first bm (blood sugar test) and given my first few insulin injections. I have also been to the dentist this week with a patient and I have had the chance to speak to many nurses who are more than happy to help.  Ive also done my first set of administering drugs under observation and I have learnt a lot! 

It has been exciting and exhilarating having done so much in one week.

My task for the weekend is to learn about the drugs we administer in this ward and how each one works etc. 

I am also aiming to learn about a few others things as we have new patients coming in all the time.  

It has been a whirlwind of a week and my mentor has been really helpful. I have managed to observe an ECG (electrocardiogram) being done, I have been able to get to know the patients and to understand how a learning disability hospital setting operates. It is definitely the most rewarding aspect of nursing, being able to converse with your patients and respond.  Especially if their communication skills are limited. This is where it counts in getting to know your patients.

My advice for the week? 

Be enthusiastic and get involved wherever you can. Most places you will go on placement will have had students before. And if the patients don't mind, observe every chance you get. Everything on placement will help you learn, no matter how small you think it may be.  And all that will help throughout university and into your future career. 

Week 4

So another week is over and done with!

It is so shocking sometimes how quick the week seems to go. 

I have completed another weeks work and trying to get my group together for our group presentation that's due in 2 weeks.

It is worrying that no one is going to do the work but you need to remember you are all there for the same thing and that you all want the marks. 

This week we have covered our clinical observations and practiced them in our practical classes. If there is anything I can recommend, learn the average values for your clinical observations. For example, what is the typical blood pressure for an adult, what is the normal temperature range for a child, what is the typical respiration rate for adults compared to children?

And if possible practice your clinical observations and gain confidence in doing so. I have found that St John Ambulance have been so good in this and helping me when it comes to first aid and talking to patients. It's not just knowing what to do, or what the average ranges should be, but how to talk to your patients and how to keep them reassured and have confidence in you as a health practitioner. 

Being able to converse with your patients and have them reassured that yes, you are a student, but you are trying your best to become the best nurse you can be. 

This is especially important in learning disabilities. People with learning disabilities may not give you more than one chance to take their temperature or their blood pressure. They may not fully understand why that blood pressure cuff is getting tight on their arm. So you have to find ways around this. It may not always work or may not always be successful, but if you can understand why and how your patients may feel then you are one step closer to becoming that proficient and professional nurse. 

All I can say is that it may be hard going in your first year, especially the first semester, but it is so worth it.

I'm due to go on placement in the next few weeks and I'm on a ward. I am really looking forward to it and I cannot wait to look back and reflect and see how this will have an influence on me as a person and as a nursing student.