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!