So, the first half of my adult nursing placement is over, officially, today. I’ve been ward-based for a month now, learning the ins and outs of how to be a good nurse. I have a mentor who is lovely, a team of incredible nurses who always find the time to stop and help, and a ballet of the most incredible, overworked, underpaid and certainly under-appreciated healthcare assistants this country has ever seen, helping the entire ward run smoothly. Seriously, I have no idea how difficult training would be if the HCAs weren’t there to help with the day-to-day running and management of each and every patient.
So, what have I experienced?
Firstly, I think it’s important to understand that unlike some other nursing students, I don’t have years of healthcare experience behind me. Sure, I’ve been in an administrative and management role in highly private clinics offering elective treatments, but no hands-on experience to note. So, I was tasked with learning literally everything from scratch. How to make a bed. How to take blood pressure. How to record NEWS (national early warning scores – basically when someone is at risk of deteriorating) and when to escalate. How to complete two-hourly care rounds. How to help someone who has dementia feel comfortable. How to give someone a bedbath.
Literally starting from scratch.
I’ve had a few memorable patients, too. Below are a few experiences. Please familiarise yourself with our disclaimer when reading. Oh, and why the coffee? I’ve never been so reliant on tea breaks (as few as they are) in my time on Earth. They are my lifeblood.
The one with the footballer
He was obsessed with a footballer and in his mind, he was somewhere else, he wasn’t at hospital. He could be aggressive and follow people around pulling back curtains when other patients were toileting and being washed. He just needed the right mental health care, something we simply couldn’t provide with seven other patients to look after (at the very least). Some days he’d be lucid, and he’d know he wasn’t at home and he was interesting to talk to. Other days, nothing was going to reassure him, his eyes looked scared.
Student nurses are supernumerary, meaning we aren’t counted as a member of staff. We will be required to spend time off-ward, so the nurse in charge is to view students as not part of the team’s numbers. But it was clear this gentleman needed one-on-one care, specialised care. So just days into my training, I was helping a long-suffering HCA manage the ward, taking some of her workload off her plate by allowing her to sit with the man, so we could both give all patients the level of care they needed, while still looking after this man.
It shouldn’t have happened, but I wasn’t going to sit there and demand my objectives were met when the HCA and nurse combined didn’t have time to even wash/dress half the patients for the day. His mental health was deteriorating day by day, but with mental health staff unable to take him with his physical complaints, he was trapped. He wasn’t getting the mental health care he needed from us, and if he was moved he wouldn’t get the physical care he needed from them.
Eventually, he was moved to a new ward, and I can only hope he’s given the care and treatment needed.
The dying, yellow man
He knew something was wrong, he could see it painting his skin a peculiar shade of yellow. He was on Vitamin K drips constantly, and needed to be kept on a food and fluid chart. This meant every time he went to the bathroom and every sip of water he took was noted and recorded. He apologised for the times he couldn’t stand up and walk to the bathroom, being scooted along in a chair. He apologised, needlessly, for so much. We knew he was unwell so no apologies were needed, but as he’d been active in life just weeks before, he wasn’t used to being cared for.
He had a smell. A very strange, very strong smell. I can’t describe it in any way, even though it clung to my lungs for days after he left. The closest I could suggest is that it’s similar to perhaps gone-off nail varnish remover, or a sweet smell. A sharp, clinging smell that nauseated my stomach. I was told it’s the smell of someone who is dying.
The one who died in the bay
The senior sister in charge of the ward is an incredibly compassionate woman and I’ve learnt a lot about dignity from her especially. When she knows someone isn’t likely to last the night, beds will be reshuffled so the family and patient can have privacy in a side room rather than in a four-bedded bay. That way, when the time comes for all to say their goodbyes, the family can take as much time as they need to grieve alone.
But, in some cases, it’s just not possible. Perhaps there’s barrier nursing (to prevent the spread of infection) in place and patients can’t be moved. Maybe there’s more than one dying patient. In that case, the curtains will be pulled around the patient’s bed in the bay, and left until morning. Then, the patient will be gently bathed and cleaned, nurses talking to the deceased just as though they were alive, and wrapped in a white shroud ready to be moved off the ward. This can all happen without patients in the next bed being aware, though of course sometimes they will know they’re sleeping next to someone whose journey on Earth has ended.
The super-strength elderly lady
There are HCAs and then there are Special HCAs. The latter will look after a patient one-on-one caring for their needs, just like witht he Footballer above. One lady was incredibly serene and mellow throughout the day. She was lovely. We talked about her being on the trains, and how she worked as a clerk at a solicitor’s office. We talked about her mum, and how worried she’d be that she’d stayed out all night (not knowing, of course, her mother was long dead, and the patient herself was in her late eighties with grandchildren of her own) and I reassured her briefly that we’d let her know where she was, playing into her mind’s fantasy.
The patient’s daughter came to visit and she complimented us all on how calmer she seemed here than at her home. And when she left, all hell broke loose. The patient gained an incredible energy we hadn’t seen all day, ripping the sheets off her bed, overpowering the sHCA, swearing and saying the foulest things. But, this is dementia. This is the deteriration of someone’s mind, their sense of language and time, their hold of emotions and their composure. It was difficult seeing how this serene, beautiful woman’s mind changed so dramatically out of fear and frustration. And us having to bear the brunt of her reaction.
The person under guard
One day I arrived on shift to see two guards sitting in one of our side rooms, with a patient. The patient was an inmate at a prison in the UK, and had come in via emergency ambulance. The prisoner was deemed a high flight risk, and so two guards worked shifts with two other guards to sit and wait. And wait. And wait. I briefly spoke to them and they had no idea what to do or how to help. Really, it wasn’t their job. Just like it wasn’t ours to worry about the patient’s incarceration and the reason they saw themselves banged up.
I was hesitant at first when I learned why the patient had been imprisoned. But that’s secondary to the fact they needed care, and it was our job to ensure they got it. My own personal sense of right and wrong, of justice, had to be put on the backburner as I served the patient with a smile, just as I did the frail old lady in the room next door, and the young boy with suspected appendicitis.
The highly explosive smoker
This lady suffered from smoking-related complications leaving her lungs (basically) not able to grab the oxygen breathed in to send to the rest of the body, but as she had full mental capacity, she decided that she didn’t want to stop smoking. Fair enough. Just as I would refuse certain treatments even if it meant death, just as some people refuse to be organ donors or to accept organs, just as some refuse chemotherapy for cancer, she decided that smoking was a part of her life and therefore her health was going to come second. This was her choice. But the most difficult part was the risk she was willing to put everyone else under. Smoking around oxygen tanks can literally cause a devastating explosion, yet she was willing to take the risk, and risk everyone else’s lives. All for one measly fag. For one more breath of toxic smoke that will eventually see her suffocate on air itself. That’s right. She’ll be breathing in, but her lungs will be so damaged they won’t be able to remove poisonous carbon dioxide from her blood. But how do you reason with someone who has their own course of life planned they way they want it? You can’t. You just respect it.
So, what have I learnt? Respect. Compassion. Professionalism. To question what’s happening, and why it’s happening. To question the doctors and consultants and the myriad of other professionals helping our patients and their families. To not judge a book by the cover, to se each person as their own being, and to treat each person with the respect the deserve, even if you don’t agree with their choices, and even if they live a life you wouldn’t choose to.
Image via Shutterstock
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