Critically Funny

Understanding CPR is a crucial part of the nurse's knowledge. But have you ever attempted resuscitation and found it to be side-splittingly funny?

So far, the highlight of this semester has been the practice of caring for the critically ill patient. But we were not let loose in ITU, HDU or indeed theatres to hone our skills. In fact, we were not required to go anywhere near a real person. The genius of modern technology has meant we can practice critical nursing care from the comfort of the classroom.

Enter "Danny"; an advanced piece of technological equipment designed to increase one's confidence and management ability of the critically ill patient. Gone are the days of standing over a limbless plastic dummy. Danny not only has all four limbs but also presents with radial/carotid pulses, his chest moves as he breathes, and - best of all - he speaks, therefore causing a group of third year nursing students to get the giggles. It certainly didn't help when Danny explained, "I don't feel very well. I think I've got a rash" in a Yorkshire accent!

Who knew CPR could be so entertaining?!

Semester 5 Placements

Following an interesting lecture on Perioperative Care, many of us rushed home today to see if the postman had delivered the details of our next placements. There, in my mailbox, was the brown A5 envelope from the University, the contained information mapping out the next six months of my nursing life. As I ripped open the envelope, I thought of all the places I might end up; the Burns Unit, Oncology, Theatres...

But no.

I get sent to Eye Casualty and Trauma & Orthopaedics. Six months of conjunctivitis and hip replacements.

Ok, so I'm being somewhat cynical. I would be fibbing if I said I wasn't disappointed with my placements, but I'm sure these will both be enjoyable. I don't have a great deal of interest in ophthalmology, emergency or otherwise, although as I learn more about it I'm sure I'll begin to enjoy it. T&O is one of those departments where a lot happens - RTA patients and the likes - and there are a wide range of departments I can attend for Insight Visits, but I've worked in this area before. However, I'm going to look on the bright side and not be too envious of whoever landed the Burns Unit for their placement.

So, be mindful that from January to April 2008, I shall be discussing muppets who have managed to poke themselves in the eye, and grown men falling out of trees...

Eating my Words...

Ok, so I may have recently suggested that the NHS may not be ready for the obesity crisis threatening to hit the UK over the next 25 years. Maybe I spoke a tad too soon...

East Midlands Ambulance staff are doing us proud, thanks to some jolly expensive equipment. All hail the "bariatric ambulance"; a larger version of our well-known vehicles but fitted with greater capacity, suspension and hydraulics. Costing a whopping £100,000 each, they are equipped to carry patients weighing up to 55 stone (349kg). Four are currently in service around the East Midlands; Nottingham, Derby, Lincoln and Leicester.

While these are clearly very helpful pieces of equipment, let's hope the underlying issue of obesity continues to be fiercely tackled, rather than the effects of it being worked around.

On a completely different note, a Year 11 pupil at a school in Nottingham received an interesting birthday surprise from him parents this week. They ordered a singing telegram, but instead a stripogram dressed as a police woman turned up and performed in front of the entire class! Ooops.

I ♥ NHS

Calling all those who love the NHS! We've got a fight on our hands...

Today, the "I Love the NHS" march took place in London. Around 7000 doctors, nurses and members of the public marched their socks off to campaign against the privatisation of the service, and hats off to them. A huge chunk of the NHS has already been privatised under the Conservative and Labour governments - hospital services such as catering, laundry and maintenance are often carried out by private companies. As well as this, some of the big management positions have been filled over the years by people who have nothing to do with the NHS - the government have invited tops dogs in 'Tarmac' and 'Sainsbury's' to name a few, to manage a considerable portion of the NHS, with a considerable salary. Now the Conservatives are saying there should be more competition in health care.

Why do we need competitiveness in health care? Surely, if you're ill, you're ill. Choosing heath care is not like choosing between Sony and Panasonic, is it?! Sometimes I do wonder whether our politician's cerebral hemispheres have been misplaced...

It clearly looks like the NHS is in for a bumpy ride over the next few years, with administrators thinking they know best, private companies getting excited about how many pounds sterling they can milk out of the service, and the government thinking this is all beneficial to the UK population. Time to roll up our sleeves and get the rolling pins out!

Help! I'm a Patient, Get me Out of Here!

Imagine you're told you'll have to stay in hospital during the Christmas period.

Rather than sitting around with distant relatives you hardly know, drinking goodness knows what and eating enough in one meal to feed the village, you're stuck in hospital with nothing but Patientline to bring an element of Christmas cheer to your bedside. Problem is, one day's worth of TV costs a small fortune and programming is going downhill these days anyway. What's on? 'The Great Escape' again, along with as many Disney films and sitcom repeats as can be squeezed into the schedule. Perhaps Christmas in hospital won't be so bad after all. Think again...

One NHS Trust in Hampshire have decided to ditch the tinsel and various other bits of shiny clutter "to tackle infections" such as MRSA and Clostridium Difficile. But before you loose heart and feel that the NHS have cancelled Christmas this year, fear not! Management at the Trust have explained that the lack of decorations will be replaced by lots of "treats" for the patients. And their idea of "treats"?

"We've already had offers of handmade chocolates and luxurious Christmas cakes from top hotels and we're inviting the local panto dame and cast to come in too as well as choristers and carol singers."

The chocolate and cake is no doubt a nice touch, but if patients are too unwell to go home for Christmas, will they be well enough to gobble up posh nosh? What about the patients who are nil by mouth? And as for the panto dame and cast...

... would you want this lot turning up by your bed when you're in pain, feel queasy and are in a new pair of horrendous Christmas pyjamas bought for you by your great aunt? Me neither.

I bet that tinsel sounds appealing now, doesn't it?!

Hurrah for Public Services

Yesterday I was very impressed with our local coppers who visited my appartment, laden with Smart Water and bags full of stickers, personal alarms and leaflets. Why?

Last month a delightful human being decided to break into my car. Nothing was stolen (clearly, the naughty vandal didn't have need for a notepad, Nissan cover-up paint or a can of 'Magicool'). The front door had been damaged, so the Police Forensics team came out and dusted for finger prints. They didn't find any, but made a right mess of my car in the process! I then received a courtesy phone call a few weeks later from the police and thought that would be the end of it. But yesterday two Community Officers came over just to check I was ok. How nice is that?

It was somewhat embarrassing that when they arrived, I was in my pyjamas on the sofa feeling sorry for myself watching nonsense on TV. I did find it rather amusing that when the police man took his hat off, it was obviously too tight as there was a red mark across his forehead!

Our public services don't receive enough recognition - the news only ever report from a negative perspective. So a big thank you to all those lovely coppers out there.

Even Nurses Get Ill

I feel like I should write this post phonetically so that you can appreciate the horrendous cold I'm currently suffering from. But, rather than throw myself a pity party and spend the day on my sofa with a DVD and hot lemon drink, I trecked into University for the beginning of Year 3. And what a good day it was. It was great to catch up with old friends, not have to wear our uniforms, and play "spot the first year" (all first years spend around the first month wearing their ID badges before they realise there's not much point, and so don't bother).

One of the first things we were told in our introductory lecture was "you can't mess around in the third year like you could in years one and two". Mess around?! Since when was that an option?! I've clearly been working hard to no avail!

However, we did have a great lecture on oncology. My teacher's-pet-pre-reading payed off as our lecturer didn't actually explain the biology of cancer. Good job I have a basic understanding of all those damaged oncogenes throwing a wobbly. The only problem now is that my brain is overly focused on critical care and I keep wondering if this cold of mine is something slightly more dramatic. What if I start presenting with haemoptysis? Could this pounding headache behind my eyes be something more sinister? Am I beginning to sound like a really annoying hypercondriach?! Fortunately, tomorrow is a day of "Independent Learning" and while I don't wish to remain in bed for the entire day, at least I can have a lie-in.

I really fancy a cup of tea, but as there's no one here to pander to my every need, I shall have to slump to the kitchen and make it myself. Who takes care of the nurse when she/he is poorly?!

The Beginning of the End

I'm now on a home-run - tomorrow my third and final year begins. Finally, I can see the light at the end of the tunnel!

This semester is focused on Trauma, Critical Care and Oncology. The timetable looks fantastic and I can't wait to get into it. Fingers crossed that my placement in January will be on the Burns Unit...

Rather than lots of unnecessary and irrelevant assignments, our learning this semester will be tested courtesy of two exams; a written one and an OSCE (Objective Structured Clinical Examination). The OSCE will probably be the worst bit due to the sheer embarrassment of having to kneel over a plastic dummy shouting "can you hear me? Are you ok?" and then calling out "I need some help over here!". Talk about feeling daft!

That aside, it's exciting to think that this time next year I shall be a qualified RN. Christine Beasley's job is just getting closer and closer to within my reach... ;)

So, I'm now going to be a right swat and do a bit of reading before having a reasonably early night. Here's hoping for a great third year.

Mad Hatter's Tea Party

It seems that not a day goes by without some kind of directive or commission being set up within the NHS with the promise that this one really could work. Yet again today, the NHS resembles something of Alice in Wonderland's Mad Hatter's tea party, as we "all change" and welcome in the Quality Care Commission. Their mission - should they choose to accept it - is to tackle hospital super-bugs (queue the A-Team theme music). So how will they achieve this?

My guess is that a barrage of suited-and-booted administrators with clip boards and free pens from Medical Reps will descend upon our hospitals (and other areas of health care) and tick/cross lots of boxes. And if there are too many crosses? They have the power to:

• close wards/units/areas


• hand out fines


• issue warnings

Hygiene has become a big issue in the cleanliness of hospitals, mainly due to recent outbreaks of Clostridium Difficile and MRSA. But are doctors and nurses to blame, as one government bloke told the ITV news earlier today?

Tell him to come here and say that!

While I'm sure many doctors and nurses could be better at handwashing, the government seem to forget all these visitors and managers trapsing their germs in and out. If you ask them to "please move for a moment" because vomit needs mopping up from the floor, they look at you as if you've just kicked a puppy and often flatly refuse. Do we really need the "He-man's" and "She-ra's" of the administrative world to swoop in handing out detentions or whatever? Can't we just get on with the job we're training to do?

Without wishing to sound like a political activist, I can't help thinking that had the NHS been managed properly since it's creation without continuous change, we might not be in this pickle...

Change Changes Things

During our semester on Care in the Community earlier this year, we were taught that if we had any problems moving obese patients (e.g. out of the bath) we should call the Fire Brigade as they're more equipped (and probably have less potential of nail breakage!) to move said patient. Tomorrow, the government are set to release a commissioned report - Foresight. One claim expected in the report is that within 25 years, half of the UK population will be obese (a BMI of 30+). That's a pretty scary statistic, isn't it? Just think how much our society would have to change to cater for this.

It would appear that fireman in Wales are one step ahead of the game and have begun using a 28 stone dummy in training.

While we obviously have annual mandatory manual handling updates to enable hospital staff to efficiently care for all patients, when it comes to obese patients there are probably about three pieces of helpful equipment in the entire NHS! Ok, so that's a little cynical - I think our Trust has one "extra large" bed. But that won't be enough if half the UK population become obese. We'll need bigger wards to put the bigger beds in; wider doors to get the bigger beds through, etc.

Does it make me a cantankerous, disillusioned old woman to assume that the NHS won't be ready for this?!

More concerning than this, of course, is the nation's health. In 2006, it was reported that 25% of UK adults were obese, costing the NHS 3.7 billion a year. Obesity causes more harm than smoking, poverty or alcohol (see here). While the government have been making funds available for public health, ministers didn't see fit to ring-fence it. In other words, the money has been given to help the health service tackle obesity, but it doesn't have to be spent specifically on this. Perhaps it disappeared into that black administration-shaped hole... ;)

So, fellow colleagues, it's down to us to set a good example to the nation.
I'll just have a quick cup of tea and a delicious slice of cake first...

Maths Rules O.K.

I have a maths exam tomorrow morning, so am currently finishing some reading about fractions, decimals, and all things complicated. It's not too difficult if I concentrate and refrain from panicking, but I think it's fair to say that's not always the case...

Here's one of the more tricky ones:

A vial of drug is diluted with water to make a liquid containing 0.155g of drug in 1ml. The doctor prescribes 3.1g. How many ml do you give?

I'm sticking with Calvin on this;

HIV versus Theology

Having recently spent time with many HIV-positive patients, I was interested to watch Stephen Fry's HIV and Me. Did you know it's been estimated that 63,500 people in the UK are HIV-positive, yet around one third of these don't realise? That's rather frightening. Surely in this day and age, HIV should be preventable?

I'm currently working on an assignment concerning young people and sexual behaviour when on holiday, and the statistics make you want to bang their heads together!

• Annually, over 1.5million new episodes of STIs (including HIV) are diagnosed within the UK. This is a 15% increase from 2001.
• Between 2000-2002, 69% of heterosexual men acquired HIV whilst abroad.
• In one study of medical students, it was found that less than half who had engaged in sexual activity with a casual partner(s) whilst on holiday had used protection.
• Chlamydia is increasingly on the up, particularly among females under 20.

The sexual health of adolescents in the UK is very poor due to risky sexual behaviour, but why is this? It seems there is a certain amount of apathy when it comes to STIs and many of the patients we have seen haven't learnt from previous infections - they come back to the clinic time and time again.

I met with an HIV Specialist Nurse last week who told me that one of her major problems when working with HIV-positive patients in the community was African pastors. HIV-positive patients have to maintain a strict routine with anti-HIV treatment. Non-compliance will cause the virus to become immune to the specific drug. I live in an area with a reasonably high African population, and so there are many African churches around. The HIV Specialist Nurse has found many of these pastors tell their congregations not to take anti-HIV treatment because God will heal them instead.

This is dangerous ground, and dangerous theology too. Could the pastor be held to account by the law if/when members of his congregation contract an AIDs-defining illness due to a lack of medication?

I believe God can heal. I believe He is a good God who loves to bless His people. So should all HIV-positive people forgo medication and await God's "zapping" powers to restore them to full health? There are several issues with this:

• Firstly, it is impossible to know if you're cured of HIV. There are no tests to indicate this. It is possible to have an undetectable viral load, meaning the person is well and the level of HIV in the blood is low. But it would be impossible to know if the person had been healed.
• Secondly, we are very fortunate in this country to have a selection of anti-HIV treatment - many countries do not have these. So should we see the advance of medical science as a positive, God-endorsed thing and encourage their use?
• Does the taking of anti-HIV medication suggest a lack of faith in God?

Ultimately, it's down to the individual. Either way, us nurses are to respect and support patients in their decisions without judgement or intimidation, but with compassion and empathy.

Trichomonas Vaginalis

Here's an interesing flagellate parasite I have learnt about over the course of my GU Medicine placement. It causes Trichomoniasis, most commonly found in women engaging in sexual activity, and can live in the vagina, urethra and bladder. Men can also have TV, but the parasite is very rarely seen in them.

Here's the delightful parasite itself:

Nice, eh? When looking at it under a microscope you can see the thread-like flagellum moving around enabling it to "swim". I guess it's almost like having nits, but in a different area. Not nice to imagine something moving around in your body, is it?!

Patients with TV present with the following symptoms (if any):

• vaginal discharge (thin, often yellow/frothy and offensive)
  
• vulvovaginal pain/irritation


• dysuria


• dyspareunia


• vulval, vaginal and cervical mucosa is red
  

Fortunately, TV is fairly straightforward to get rid of: Metronidazole 400mg bd for five days. It's important that the patient doesn't drink alcohol for the duration of the course (and 48 hours after completing the course) as this can cause sickness. Also, the patient must not have sexual intercourse until a satisfactory follow-up appointment has been carried out. Any partners should also be treated, including men as they can pass the parasite on to other women.

We diagnose TV by looking for the parasite on a wet vaginal slide under a microscope. It tends to look something like this:

Among the epithelial cells, polys and/or "clue" cells, TV can be seen due to it's flagellum flapping about. We also look for TV on dry vaginal slides, by gram staining them (to be written about in a future post):

So there we have it. A short guide to trichomonias vaginalis.

Tea and Sympathy

Gosh, I can't believe it's been so long since I last posted on here. It's been a hectic four weeks in GU Medicine, not because the clinic's been busy but because of all the paper work I've had to do for the University (two assignments and 62 proficiencies - grrr!).

Today I felt very "nursey" as I spent a chunk of this afternoon being an advocate for one of our female patients. She came in for a check-up and as she presented with symptoms, a full screen was carried out. The male doctor (Mr X) showed her into the treatment room, and then I went in to set the equipment up.

The patient was lovely and very chatty. She was a bit nervous and ended up bursing into tears because she was so worried about what nasty infection she may have picked up. I sat with her for a while and we talked it through. I was actually quite surprised that I knew so much about herpes - I've obviously been listening to my mentor! She calmed down a bit, and felt that if she had contracted herpes, it wasn't the end of the world. Before I left the room she asked if she could have a female doctor instead of Mr X, and also said that she wasn't too happy with him as he'd been rather unprofessional during the consultation.

I took this information to my mentor and then attempted to find the female doctor on clinic (Mrs Y).

When I arrived back at the treatment room, two doctors were waiting to speak to me; Mr X and Mrs Y. My mentor had obviously spoken to them, and they wanted to know what was going on. Mr X couldn't understand why the patient would prefer to have a female doctor for the examination (men! No sensitivity whatsoever!). He also kept asking, "why is she so upset? Why was she crying?" He had started to get on my nerves at this point by being so insensitive so I quite firmly told him that the thought of having an infection was rather frightening for her - gosh, it would be for any of us. I think when you end up working in a specific area you forget how daunting it is for people who don't. All of us at the clinic are used to telling patients they've got chlamydia or warts, it's part of our job. But that doesn't mean the patients are used to hearing it. So Mr X really irritated me!

The patient had also informed me that during the consultation, Mr X had received a personal call on his mobile phone. Yes, you've guessed it, he answered it. He did ask the patient if she minded, but she was hardly going to say no, was she? He did get a bit of a telling off about that. He's got a pager; there's no need for him to have his mobile too.

Anyway, rant over! We all felt a bit better after having a delicious cup of tea.

Genitourinary Medicine

Endoscopy is now a thing of the past as I move on to pastures new. For the next four weeks I shall be enjoying the challenges set for me at the Genitourinary Medicine Clinic at the local hospital (sexual health). Unfortunately for the purposes of my blog, confidentiality in this department is such that I am unable to discuss a brief description of the patients diagnosis/prognosis. However, I shall no doubt learn some interesting things, information of which I shall divulge within the limits of the confidentiality policy I signed this morning.

Today was certainly interesting as I got to grips with how the GUM clinic operates, and also what herpes simplex happens to look like...

Needless to say, I was somewhat shocked to discover one of the lads in my youth group on an NHS poster advertising the wearing of condoms! I have a feeling it's going to be an eye-opening four weeks!

Complimentary Gentleman

It's been rather a while since I was last approached by an intoxicated middle-aged man. I was beginning to think they had all started hounding someone else, but no! Whilst walking through town a very unstable gentleman swaggered over and placed himself right in front of me. I wasn't entirely sure what to do, so smiled and said hi. His response?

"You have nice hair" - and then he carried on walking.

Always nice to meet a man who can give a reasonable compliment!

A Slight Blip

I'm now back on the Endoscopy Unit, and it's been a fantastic week. Perhaps it's because the assignments are now done and so I can concentrate on the job in hand.

I received some results last week from two assignments. Unfortunately, I failed my Literature Review so I am no longer on the BSc pathway. I'm gutted and was quite upset at first. A few months ago I spoke to the BSc course leader as I wanted to leave the pathway and stick with the advanced diploma. Her response was "so you want to be just a diploma nurse?" - nice. When I read my result it felt like my entire nursing career had collapsed in a heap - how was I ever going to get into government without a nursing degree? Surely I'd have to remain a D grade forever...

Fortunately I've now managed to snap myself out of my little pity-party thanks to the Lead Nurse in Endoscopy. I chatted it through with her, and she was so encouraging. The only difference between the degree and diploma course is one module in research. And I hate doing research! Completing that module doesn't make me any more employable. It just means I can write a research project.

I have to say, having thought about it I'm quite relieved. A year-long research project on tap water v sterile saline doesn't fill me with excitement! Plus, I can really work hard on my placements and portfolio now.

Isn't it amazing that no matter what grades, qualifications and skills we have, God can use us anyway? If God wants me in or around government, it'll happen, not because I've got a degree in nursing but because that's where God's placed me. What a relief! Hurrah for Jeremiah 29:11-12.

Checking In

Well, it's certainly been a while since I've posted anything here. There are two reasons for this. Firstly, life has been rather hectic what with completing assignments and moving house. And secondly, I've had no access to the internet as the BT man still hasn't come over to set the phone line up in my new flat. But things are looking up. My work is done, and the BT man is due to visit at the end of this week between 8am-1pm (we'll see...).

I am now enjoying two weeks of annual leave, baking breakfast muffins, getting my groove on at the gym and catching up with old friends.

Once I return after annual leave, I shall have two weeks left on Endoscopy, and then it's a four week placement in the Genitourinary Medicine Clinic. Lots of inflamed skin, discharge and nervous teenagers. Lovely. I'm not sure which is worse - having a tube inserted into the anus, or having a double gloved finger poked around that region. More interesting stories to follow shortly...

Pressing On...

I'm now back at work following my week of leave. This week consists of two days of lectures, and three study days, so it's not quite a full working week!

I'm now working on a Care Delivery assignment, discussing a few elements of care relating to Endoscopy. It's actually quite tricky - if I was on a ward I could write about continence, wound care or bed-baths. I've had to be somewhat more thoughtful about this and have settled on sedation/pain relief and psychological support, two big care delivery issues for Endoscopy nurses.

So, I shall brew myself a lovely cup of decaffienated, organic, fair trade tea and enjoy it with a Mr Kipling chocolate slice whilst reading through the large pile of literature I've collected. I'm pleased to say that currently, I feel inspired and empowered in my nurse education. Long may it continue.

In the Wee Small Hours of the Morning

I daren't report what time it is (although the post will obviously reveal it anyway!). My flatmates are fast asleep, as the sensible majority of the UK probably are, and it's looking dark and dreary outside my window. Even the birds have packed up for the night. Why am I still up? The joys of nursing education, of course!

In about 11 hours time I shall be submitting two assignments to the Assessment Clerk, both of which are something of a work in progress. It's not too horrendous - my Literature Review just needs proof-reading and the assignment I'm currently on is almost ready to be typed.

I can assure you that I am not usually this disorganised. Often my work is left until a couple of weeks before the due date, but that is because I'm the type of person who works better under pressure. This is a little too close for comfort, however. On a bit of a positive note, it would appear that I am not the only member of my cohort up at such an unforgiving hour. A good friend called shortly after two a.m. and was panicking about her assignments. It was good to discuss them, and I think it helped lighten the stress we were both feeling!

So why have so many of us managed to get ourselves into this position? Without wishing to place all the blame at the University's feet (aherm), we could have planned our work more effectively. That aside, it is obviously the University's fault! ;) Is it worth mentioning again that whilst on placement we have had three assignments to write, along with competencies to complete? Not forgetting those of us crazy enough to lap up the extra 4000 word Lit Review for the BSc pathway.

I'm still able to sit here and smile. I'm not entirely sure how :)

"D'oh"

The Department of Health recently cracked a hilarious joke during an interview with the BBC:

"The government has been committed to ensuring NHS staff are better paid and the pay award for health professionals in England is a fair award reflecting the balance between the right level of pay and the need to be vigilant against the threats of inflation."

(Incidentally, I'd be interested to know what this spokesman's salary is!) See the full article here

So midwives are joining us in having the hump about pay, and rightly so. Industrial action is on the cards but, because we're a caring bunch, walking out on our patients isn't an option. Instead we'll just make a racket, send lots of bits of signed paper to No. 10 and perhaps ask some more footballers to donate their wages.

According to a BBC article on nursing pay the RCN surveyed 2,300 nurses about industrial action, three quarters of whom agreed to action which would not cause harm to patients. I dread to think what the other quarter were thinking of doing...

I Shall Prevail!

It's a new day, and what a wonderful day it is, despite the horrendous weather. Apparently sales of fruit and ice-cream have plummeted for this time of year, whereas sales of soup and other canned conveniences have increased. Perhaps we're being denied a summer this year.

I'm currently sitting at my desk working hard on my Literature Review and I actually feel like I'm getting somewhere, hence I felt it ok to have a break from RCTs and contribute towards my blog. Having spent the morning typing away, I am now well over half way to completing this 4000 word document on sterile saline v tap water in the cleaning of acute and chronic wounds. So in my current inspired state I feel somewhat intelligent, and I'm not even wearing my glasses.

Perhaps it's all the mugs of tea I have consumed today. Thank goodness for delicious cups of tea. Mmmm...

At the Limit

Yesterday I had an appointment with my GP, and she has signed me off for at least one week due to stress and anxiety. Having recieved a letter from my GP, I then went to see the Head of Year as I wasn't entirely sure what I should do next. She was very nice and asked why I'd been signed off. Her response was "oh dear. Is there anything we can do to support you?"

Typical.

I've spent the last year at least trying to get some support from various tutors at the University, and they've all palmed me off onto the University Counselling Service - fat lot of good they were. I went to them for tools to manage my stress and anxiety, but all I learnt was that I am resentful of my younger sister, hence why I used to trap her underneath her duvet when she was little which has now resulted in her being claustrophobic. From what I remember, it was just a game that went a little too far, and we're actually quite close. So not much help then!

My Head of Year then asked if I was on the BSc pathway, and when she learnt that I was, a look of understanding flooded through her face. It would appear that many of us on the BSc pathway are struggling with the workload. She did ask whether leaving the BSc and simply doing the Diploma would be a sensible move for me which again, was a bit of a joke. I had a discussion with the Lead Tutors of the BSc a few months ago. I explained that I struggled with anxiety and didn't feel continuing on the BSc pathway would be helpful. Their reply was "but do you want to be just a diploma nurse? You won't be able to get into Nurse Management without a degree". Ouch.

Anyway, rant over. I'm now spending my seven days off working on assignments, exercising and having some relaxation time. Hopefully things will improve. I just find it really irritating that it had to get to this point. Grrrr!

Oesophageal Manometry

I think it's safe to say that Endoscopy nursing is not my forte. Yesterday one of my sole achievements was the removal of a particularly large moth from the recovery area - twice - admid screaming nurses. An interesting use of ten mintues, and rather a shame I didn't have my camera handy.

However, I was able to spend the morning with the Clinical Nurse Specialist, assisting her with Oesophageal Manometry tests. It was quite interesting; pulling tubes slowly out of patient's stomachs and through their noses to measure the pressure of the lower oesophageal sphincter. These patients had symptoms such as heartburn, indigestion and dysphagia.

A little 92 year old lady was referred for the test, which we felt a little unfair as it isn't a nice procedure to have. But she was wonderful - a very complient patient who just got on with it. In comparison, we had a thirty-something male patient who, when we attempted to insert the tube through his nose and into his oesophegus, kept shouting "NO! NO!" and kicked his legs about. As you can imagine, our appointment with him was rather a long one...

In the Dark Depths of the Mortuary

The novelty of working in Endoscopy is beginning to wear off, so I was pleased to discover that I was able to view some post-mortems today. Depending on what they have, they don't tend to allow observers.

It was interesting, yet quite sad. Four bodies were bought in: two were suicides, one was a sudden death and the other was an organ donation. Sadly, the first three were all young men - mid thirties. The two suicide cases were both due to asphyxiation by hanging. One gentleman had been found in a park. He had a wife and five children in his home country. The other was discovered in his flat by an Estate Agent showing around prospective buyers (I think we can assume they didn't put an offer in). It was so sad to see that there are people who are so desperate, they take their own lives. Just think what these men could have achieved if only someone had been there to support and encourage them.

The sudden death gentleman had visited his GP with a severe headache. An ambulance had been called and he was admitted to ICU with drains fitted to either side of his brain. He died shortly after. The post-mortem found a large cyst smack bang in the middle of his brain, about the size of a large grape. His brain was red and swollen, and it was obvious to see that it had been pressing heavily against his skull.

The fourth body was of an elderly lady who had a CVA. As a result, she suffered from dysphagia. Her family had consented for her brain to be used in medical research. It was actually really interesting to see the side of the brain that had been affected: it was pale and watery-looking.

So it was a fascinating morning, and one which caused me to think about the value of each individual life. At some stage, these people had had passions, hobbies, desires, ambitions, and for the three gentleman, these will never be realised.

Step into the NHS

Oh dear. I have just discovered, courtesy of a new NHS website, that I am in completely the wrong career:

Step Into The NHS gives you the option of taking a personality quiz to find out which job best suits you in the health service. Alas, nursing doesn't even feature in my top five! I ended up with HR Professional, Medical Secretary, Help Desk Advisor, Director of Finance and Audit Facilitator.

Incidentally, upon answering "I don't really care" to each question, the following jobs were recommended: Medical Physicist, Respiratory Physiologist, Cardiac Physiologist, Pharmacist, Audiologist.

Interesting...

Ouch!

This kind of tale is usually reserved for those in A&E departments only, so it was all the more interesting for us to be involved...

The patient arrived in A&E this morning following a very silly mistake. A couple of days ago whilst masturbating, this patient decided to enhance the experience by placing a complimentary bottle of shampoo into his anus. Yep, you've guessed it - it got stuck. Thinking it may be dislodged by a few bowel movements, he tried to forget about it. But today he obviously realised it wasn't going to shift, so faced the embarrassment and made his way to the hospital.

Upon removal of the said item, the patient was referred up to us for a flexible sigmoidoscopy due to a pr bleed. Needless to say, he decided against sedation and made his way out of the hospital as quickly as possible!

One Rule for Doctors, Another for the Rest of Us

Now just when was it that the GMC, BMA and DH decided that doctors were exempt from following local and national hospital policy? Today I met "the Professor" - a medic so advanced in his understanding of the GI tract that policies and procedures are to be laughed at. He came onto the Unit to perform one Gastroscopy on a patient whom he happened to know well; a Labour member and former squash partner.

Bearing in mind that this procedure can be a little messy (mucas and saliva are brought up, along with anything else harboured in the stomach), the Professor decided that donning a plastic apron and gloves was not necessary. Apparently he never wears them. So much for Infection Control measures.

But that's not the worst thing that happened in the procedure. Even the snide, medical questions he threw at me, the "trainee", were not the worst thing. Whilst poking the scope around the patient's duodenum, the Professor's mobile telephone started to ring. I expected a slight look of embarrassment but no, he answered it! Scope in one hand, mobile telephone in the other. And it wasn't even a work-related call!

Had I been the patient, the Professor would have recieved a stearn word once the procedure was over. The CNO-wannabe in me came out when discussing the situation with my mentor once he'd left. "He's like that all the time", she said.

Isn't it good to know that so many NHS employees shine with professionalism?

A Typical Patient Journey

Imagine the following:

You have abdominal pain and have lost weight recently. You don't worry too much - you'd been trying to loose weight anyway and perhaps last night's dodgy curry is responsible for the aches and pains - but it doesn't get better. In fact, things get worse. Your back passage starts bleeding and you feel constipated.

So you go to your GP. He prescribes a bottle of lactulose and sends you on your way.

Not much happens. A few bouts of diarrhoea perhaps, but the bleeding is continuing and you still have abdominal pain. By now you've lost a bit more weight too. So it's back to the GP and this time he refers you to the hospital for a Colonoscopy.

The appointment letter finally arrives for your appointment! At last, this could all be sorted out! You book the time off work, read the Information Leaflet sent in the post and get that delicious bowel prep down your gullet. As you head for the hospital you feel nervous: you're not sure what to expect and suddenly the thought of going into work is actually appealing. But you know it's for the best.

You arrive at Endoscopy and the paperwork is completed. You are first on the afternoon list which starts in 15 minutes, so not long to wait. You're given an attractive gown to wear but struggle to tie it up so have to ask the nurse which is a little embarrassing, particularly as your bottom is far from inconspicuous. You grab a copy of some tacky magazine, sit down and wait...

Fourty minutes later, you've perused the entire collection of the Unit's naff magazines and are starting to get a little twitchy.

This must be a pretty horrendous journey to go through. And the ironic thing about it? The Consultant responsible for this list doesn't turn up because he's sunning himself at some five star beach resort abroad and has forgotten to cancel his list. So we have a waiting room full of patients to be seen, and no Consultant. This leaves us nurses no choice but to do the most humiliating thing possible in hospital politics - we have to beg another Consultant/Dr to do the list instead. Fortunately we find a Consultant to do it, but it's too late - we've sunk to an all new low!

Uniform Health Hazard!

Another busy day in Endoscopy except today, I nearly punctured my lung. How? It's all courtesy of the new company the University are using to provide our uniforms.

I have recently ordered two new uniforms - dresses - due to the hot weather we were supposed to be having this season! They arrived yesterday and I decided to sport one of my new dresses on the Unit today. Problem is, whoever made it needs shooting as they clearly have no concept of what nursing entails. Not only would it be more practical as a tent (and it's a size 10!), but my pens keep falling out of the top pockets because they're so flipping large! Everytime I bent over slightly, the contents of my pocket fell out into a heap on the floor. Large pockets on the waist are fine, but not top pockets. My punctured lung almost occurred due to the largeness of these top pockets - my scissors ended up under my armpit and poking my side for the vast majority of the day. Ouch!

Another amusing moment of today was when one of our female patients started flirting with one of the doctors. He's a little, Greek man with a cheeky smile and a glint in his eye. One of this female patient's best chat-up lines was probably "well doctor, great things come in small packages..."

Eugh, please!

How Rude!

A busy morning in Endoscopy today, particularly as some assessors came in to make sure the Unit is meeting the Key Skills Framework. The cleaners have been in to buff the floor, trollies are sparkling, and some staff members have even had hair cuts!

It's been a tough morning though. My mentor and I assisted the Nurse Practitioner with her list of patients requiring a Flexible Sigmoidoscopy. This is usually a fairly quick list but today we examined several unwell patients. One was thought to have quite a serious rectal cancer, another was in a great deal of pain, and another required lots of banding for haemorrhoids. Then the rude patient popped up...

He was pacing around the waiting area in his gown and dressing gown. I went over to introduce myself and apologised for the delay in his appointment. I informed him that the Nurse Practitioner would be with him shortly (surely it's ok to have a toilet break? Evidently not). This wasn't good enough.

"I've been abandoned here for over an hour! It's not good enough. This is dreadful service. When am I going to be seen?"

I did want to tell him the extent of what we'd seen that morning - the massive cancer growth in an elderly gentleman's rectal passage - serious things which cause the procedure to take longer. There are many patients in much worse health than him. Instead, I explained again that the Nurse Practitioner would be with him shortly to complete the consent form and begin the procedure. I did consider telling him that she was actually having a wee but I'm not convinced that she would have thanked me for that! I was snarled at, but remained polite and ended our conversation. As soon as the Nurse Practitioner approached he was sweet as pie. Grrr!

It's interesting how the other three patients who were actually unwell were lovely and very polite, whereas this chap who, incidentally, had nothing wrong, was jolly rude. That seems to be the way it goes in hospitals; the sicker the patient, the more appreciative and thankful they are.

One of the Hardest Parts of the Job

A patient was brought up to Endoscopy today to have a PEG (percutaneous endoscopic gastrostomy) feed fitted. He is unable to swallow for himself and is currently being fed through an NG tube. However, due to his circumstances the Consultant felt it would be more appropriate for him to have a PEG.

The patient is a University student from another area of the country, bought here because his parents live locally. Several weeks ago he fell 9ft and landed on concrete. Obviously, he suffered massive head injuries. Currently he is responsive when spoken to, is able to look around the room and although he can move all four limbs, his mobility is severely limited. He is unable to speak.

By his bed on the ward he has photographs of his Uni friends and his housemates. It broke my heart to see how unwell he was. It's at times like this that you wish you had some magic cure to put everything right. But the best I could do for him was to protect his dignity - clean his face after the procedure, change and straighten out his bedding, and try to place him in a comfortable position. All the negative elements of the job completely fade away when you meet a patient who is really in need of your care.

Smiles all 'round

It's my first week on placement on the Endoscopy Unit and so far, things are going well. The staff are very friendly which makes all the difference.

Yesterday I observed an Endoscopic Retrograde Cholangiopancreatography (ERCP). Actually, that's rather an understatement - I observed five in a row and assisted where I could. It's a lengthy procedure made all the more uncomfortable by the lead aprons we had to wear. So as you can imagine, we were somewhat irritated when the Consultant popped out and returned for the last patient, late, and with a coffee in hand. We were all gasping for a drink at this point, so imagine our joy when the Consultant accidentally knocked his coffee over right in the path of his laptop!

Ok, so that's a little mean but hey - it made the patient smile.

Procrastination rules O.K.

I feel I should be a little more stressed considering my workload. However, this afternoon I took something of a lengthy break from studying and decided to get "snap-happy"! The subject? A couple of my plants. Pictures taken include the following:

There we have it - a few hours of procrastination, and now it's back to work!

Separating the Wheat from the Chaff

Arrrggghhh!

Today I feel completely uninspired with nursing. I have five assignments to do:

- A 4000 word literature review which is fine, although my tutor seems to have disappeared from the face of the planet. Helpful.

- Three assignments which are all fairly good, but they can't be started until I begin my next placement. That means on top of completing 60-odd placement competencies I have these flippin' assignments to do!

- An exciting poster presentation plus supporting assignment as I missed a placement at the beginning of this year due to surgery. This is the work to go with the placement, and I can't go through to the third year until I complete it. It would have been helpful to know this back in January. What good is it telling me three months before the end of the year?! At the time of writing, I am currently waiting to be given an assessment date.

The work is fine and I have no problem with doing it. What I do have a problem with is the lack of support from the tutors. They just don't seem interested. Trying to arrange a tutorial is like banging your head against a brick wall!

Regardless of all the trials and tribulations that go with this course, I do enjoy it and look forward to becoming a registered nurse. I don't think the path to registration should be easy, but I do think we should be better supported. So many people have left our cohort due to all sorts of reasons; finance and lack of support being big ones. Perhaps this is the University's/NHS's way of separating the wheat from the chaff. Problem is, it seems to be the "wheat" who are leaving...

I used to have a fantastic job at John Lewis; great hours, great pay and a very good discount. I could buy Radley bags at a great price! Instead, I have chosen to sacrifice myself on the alter of the nation's health.

I think I'd rather have a new Radley bag :)

The Curse of the Drunkard

What is it with me? Do I have some kind of aura that specifically attracts inebriated, middle-aged men? Since starting my nurse training I have encountered more worryingly drunk men than I care to remember. I always seem to find them alone, often by the side of the road or in some other place which could prove dangerous, and when I least expect it. Today was no exception.

Whilst waiting at the station for a train, I noticed a gentleman "wobbling" around on the platform. He held himself up against the wall and looked as if he was struggling to breath. Not something I like to see, particularly as my mind heads straight for cardiac/respiratory arrest! A few people looked at him for a while and then walked on. I felt that as a responsible student nurse (and as I had about half an hour to wait until my train was due to arrive) I thought I'd better make sure he was ok.

Of course, other than being intoxicated, the gentleman was fine. Whilst breathing his alcohol-fuelled breath in my face, he explained that he was on his way to Manchester. He told me a great deal about his time in the army, had the sheer ordacity to drink some of my cappuccino in an attempt to sober up (which he then spat out - what a waste!) and explained again that he was on his way to Manchester. He then grabbed me and kissed me on the forehead, all while trying not to fall smack-bang into a brick wall. Oh, and did I know that he was on his way to Manchester?

What should one do upon finding a person in such a state? The last drunken gentleman I found (apparently christened "Shauny-Boy") was trying to jump in front of the traffic so I had no option but to dial 999 for some muscular assistance! But if I was working in A&E, what would I do with some drunk bloke bought in simply because there wasn't anywhere else to take him? Sedate him and hook him up to some fluids? Go off shift?! Answers on a postcard...

The Blog Begins

My first post as a "blogger"! Having become engrossed in the blogs of others, I felt it time to start my own. It probably would have been better to start blogging at the beginning of my nurse training, but clearly I wasn't on the ball. So, almost two years into my training, I have now decided to get on with it.

And what an eventful two years it has been. I have been punched in the face by a patient whilst on my Mental Health placement, assisted in a post-mortem and fainted twice during a shift in Maternity (babies? Eugh!). I've been mentored by an interesting selection of registered nurses including one who felt it appropriate to tell me all the gritty details of her affair (not a conversation to use as Reflective Discussion evidence, obviously), and one who landed me with the task of teaching 6 classes of 12 year old kids how to put condoms on a plastic penis. The wearing of beer-goggles was an optional extra. Who knows what fun I shall partake in on my next placement?

Until then, I shall trudge on with this semester's five assignments so lovingly set by the University.

It's ok; I didn't want a social life anyway...