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.