Importance of family-centred care

Whilst I’m holed up in bed recovering from the flu, I thought I’d share with you all the poem I wrote and analysed for my latest assignment. Following a nurse talking to various patients and family members, the poem considers nursing communication in the context of children and family-centred care; a concept which results in many positive outcomes. My current placement has further reinforced the importance of family centred care on the wellbeing of the child, highlighted some of the challenges presented by caring for more than the child alone and shown me the immensely amazing work that children’s nurses do every day.

Here goes…

Meeting for the first time, into the realm of the unknown
You’re quiet, and I can only realise the things that you have shown
I need to know all about you, I don’t want to assume
Not sure how to approach you all, it’s all a bit too soon

You sit on the end of the bed; silent, listening closely
I spoke to your parents who answered for you, mostly
I turned to you to ask you how you felt
It was apparent you wanted to answer the questions for yourself

It’s difficult and I can’t always find the words
It’s important that I listen to you but that your child’s needs are heard
If time was infinite, I’d hold your hand and dry your tears
Show you everything you need to do and how, for all the coming years

You began to cry, scream, kick and swear,
I reassured you, calmed you down; let you know I was there
I know you’re worried about this scary, new place
But a joke was all it took, then the anger flooded from your face

It’s not always easy, explaining the things you’ll need to do
Sometimes you don’t understand, still disbelieving facts which are true
I explained everything in detail, as simply as I could
You said it all confused you, but of course that you would

Waving their arms, screeching, hurling abuse
I had to say ‘take a seat, this is inappropriate and just no use’
The time came eventually when they began to see reason
So consumed by emotions and struggling to overcome them

Your parents were concerned about you being left alone
Whilst you were afraid you’d miss school and be forgotten at home
I sat by your side, listened to all of your cares
Told you a problem is often halved when it’s shared

Constantly aware of the tone of my voice and the words that I use
Ensuring my facial expressions are right and that I’ve polished my shoes
Sometimes my mind is elsewhere, but it’s never intended
Always thinking about the day that’s passed long after it’s ended

Time flies away caring for you and those you hold dear
Giving advice and instruction, helping you all confront your fears
I help you appreciate your worth and release any tension
Raise everyone’s spirits and encourage emotion

Establishing the information you already know
You’re still raw, reeling from the emotional blow
How do I approach this and can it be made easier?
You feel alone, but we’re together… we all want to help her

Struggling to let me know what’s wrong, but why?
Frustrated, tense, cautious and incredibly shy
Pointing at the cupboard for something, but what?
Irritably attacking the sides of your cot

Struggling to find the time to engage with you actively
Not wanting to ignore your views just because you’re having difficulty
Attempting to involve you in each step of the process
Using objects, symbols, pictures and photographs

Constantly reminded that no one child is the same
Always adapting my approach and the way I behave
Language and touch tailored to each child’s needs
Individualising care for each talk, play and feed

When I look at you I see a child, but so much more
I see a whole family that place you at their core
A brother and sister that miss you to talk to
A father and mother that would do anything for you

With all of these people you’ll agree, it makes it quite tough
To focus on you through times that are rough
Communicating effectively, concerned and kind
Supporting you all is never far from my mind.

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The importance of listening

I was doing observations on a 7 week old baby admitted onto the ward yesterday and found his parents to be very reluctant to contribute, quite stand offish and short with me. They’d previously been into A&E in a city about half an hour away by car to the hospital they were in now and hadn’t been told that there was a possibility that they’d have to stay over. They also don’t drive and have had to use public transport which takes considerably longer. They’d had lots of bad experiences with the NHS spanning years on lots of levels, in lots of different places. They were understandably worried about their baby, and had been told a different story by each person that they’d spoken to.

After results came back to confirm that he was RSV+, Mum and Dad were both quite panicked. Sometimes I find that parents get upset and worry excessively when a name of an illness is given without being explained to the full story about the illness. After taking baby’s observations, I spoke to the couple at length about their reasons for having little confidence in the NHS and it all made sense as to why they were quite reserved initially after being admitted to the ward. I got the staff nurse to come and speak to them honestly about the baby’s condition and explain the ins and outs so they understood. I gave them an RSV information pack for them to read over and reassured them that yes, it was quite common and that, yes, they’d be taken good care of on this ward. I built up a good relationship and rapport with the couple by understanding the reasons behind their lack of confidence in the NHS and their unwillingness at staying the night which broke down so many barriers.

It’s nice as a student nurse to have the opportunity and the time to sit with parents and talk with them about their child and their child’s care and to understand their situations. After I’d got the couple food and drink, sorted out some baby-grows, milk and nappies for the baby (they’d not been made aware they may stay over so they didn’t bring enough with them for the night and next day), made the bed and spent time supporting them, they truly thanked me, and thanked me especially for ‘listening’. I think the key to understanding and caring to the best of your ability is to take the time to listen to and be genuinely interested in what patients are saying to you and not to just think that they’re having a bad day. There is so much more to a person than what you see, and they’re full of experiences and views generally shaped on what they’ve been exposed to before.

As a student nurse, I often feel limited in my technical abilities, but there really are things that you can do that will make a difference. The couple I met I assume are not the only patients that feel this way, and by taking the time to listen and to help, each of us can really make a small difference every single day. If each one of us took the time to do this, the problems people experience would be reduced significantly.

Student Survival Skills – Care Skills for Nurses

 

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The student survival skills series claims to help nursing students understand theory and practice, refine their skills and to gain confidence and this book does just that. If you’re anything like me, you like concise and easy to reach information, but don’t want to miss out on anything crucial either. This book has found the perfect balance of information. Detailing information of essential nursing practices such as; compassion, performing personal care, patient safety and nutrition hydration care makes it a really handy little book to have to refer to.

I’ve generally always steered away from huge textbooks and having to trawl my way through endless information to find what I’m looking for at that particular time. Well, student nurses, worry no more! The book is well sign posted with clear learning outcomes in every chapter to keep you on track and is very easy on the eye too! As we all know, reading about something and seeing it for real is never quite the same, but the use of real images and charts really is the next best thing. I’ve been tending to do some further reading of certain things I’m seeing in placement and this book has proved an invaluable support. As one example, my mentor performed an aseptic procedure the other day, and although I knew what this meant, reading the SSS book provided me with the need-to-know theory behind the practice, with an example aseptic and aseptic non-touch technique competency framework. It then went on to give examples of situations where we use these techniques, drew attention to relevant D.O.H campaigns and tested my knowledge of what I’d learnt. Following the process set up in the book really ensured that I knew the subject in detail. The activities used in each chapter ask questions that make you think in a lot of depth about clinical situations that would at first-glance seem quite straightforward. There are also questions in pink boxes that frequently pop up to get you to think about something before the book goes on to explain about it – fantastic active learning that bodes well with how I try to learn best. Moreover, the colours used in the book for certain things are fantastic and ensure you keep on track. I get easily bored reading books with normal black ink and nothing eye-catching, but this book was particularly good with colourful images and ‘key points’ boxes being in a block colour to draw attention to them and to summarise the knowledge the chapter has provided you with.

Receiving this book just before starting my first placement has been particularly helpful, and it has, as it promised to do, increased my confidence and competence in clinical practice. The fact that it provides advice based on student-nurse knowledge and reflects NMC standards assures me that the information given is appropriate but essential and detailed. It’ll be a great help to glance over at any stage of the course and will be a much-loved book of mine, I’m sure!

I’m learning

The night before my first shift had been quite restless, and I awoke at 5am having had a nightmare that my uniform wasn’t cleaned, that I’d lost my shoes and that I was late. That would have been quite an eventful start to my first placement, but the reality was that there was no need to have worried so much. My first day was a whirlwhind of meeting people, spending time with my mentor, finding my way around the ward, handover, abbreviations and illnesses I’d heard of but wasn’t sure about in detail. Despite this, I didn’t once feel overwhelmed and constantly felt supported and relaxed knowing I was in good hands. It’s like starting a new year at school, or a new job, and as anyone knows, you always worry whether the people you’ll meet will like you and sometimes vice versa. Quickly, I realised this was another ridiculous thing to be worried about as I’d genuinely never been somewhere I’d felt more welcome or with such a group of lovely people that excelled at everything they do.

I used to assume that there was a huge hierarchy on a ward and quite a divide between doctors and nurses, but again, how wrong could I be? It’s like one big team that are happy to include and teach anyone their knowledge, with their focus always on the wellbeing of the child and their family. The ward wasn’t manically busy on my first few days, which I agreed was nice as it helped me to settle into how the ward works and become accustomed to the systems that are in place. I’ve had time to talk to the ward manager, the matron, sisters, staff nurses, doctors and HCAs and all have incredible yet different knowledge to impart, a font that all student nurses should take advantage of whenever they can!

I feel fortunate to have my first placement in a general children’s ward, where some of my peers are on specialist wards, as only 3 shifts in, I’ve been exposed to all manner of illnesses, and am confident that I’ll have a wealth of knowledge to take away with me at the end of my 5 weeks. It’s nice as a student nurse who’d never had any clinical experience before my degree to finally put all the assumptions to rest and to see what it’s really like out there in the big, bad world! Many of you will think this is silly, but as I’d never even really been in hospital myself, I sat in handover confused at what TTO meant, but I soon was saying it myself, and it was the same with many other medical abbreviations, too. My mentor has told me that there is no such thing as a silly question, which I sometimes disagree with, but I urge everyone to just ask if there’s something you don’t understand. I have, and my wealth of knowledge has already improved significantly… something which will expand even further over the course of the placement. I’ve learnt to relax and not to worry if you’re not sure what something means or how a procedure works, and I have to say to myself that all of the nurses I watch in awe were one day in the same boat as me, and that everyone feels helpless to start off with.

So far, I’ve become familiar with the assessment sheets and the ward admission pack and have observed nurses go through the admission process with a child and their parents. I’ve witnessed the process of admitting a child onto the ward from A & E. If my mentor is doing paperwork or updating her knowledge (something which never stops), I’ve spoken to parents about their children’s illnesses and they’re often the most knowledgeable, living with something everyday and understanding better than anyone what is ‘normal’ for their child and what their child likes or dislikes. The ward sister allowed me to sit with a staff nurse updating her knowledge on breast feeding, an experience which substantially increased my knowledge on something I’d previously known little about. I’ve taken a child in foster care down to surgery to have some teeth extracted and reassured his foster father whilst talking to him at length about the development of the child since coming into his care. I’ve seen how the ward’s Family Liaison Officer provides yet another facet of support to parents through the difficult time where their child is in hospital. I’ve watched a nurse adopt effective communication skills whilst administering medication to a distressed child with leukaemia, getting him to do ‘chicken arms’ to improve blood flow and to listen to the machine that ‘makes the same sounds as something from Star Wars’. I’ve seen how parents and children alike are so thankful for the care that they receive from nurses full of empathy and knowledge. I’ve seen a teenager admitted to the ward after an overdose, and sat by her bedside, talking about the things she liked to do, her favourite book and her best friends, seeing a smile come to her face and remembering that it’s often the little things that help so much. I’ve seen the difference that a few cups of coffee at regular intervals can make to parents of a child with complex care needs frequently residing on the ward. There’s still so much I have yet to learn, but I’m learning so much, every day, and I’m thankful for every ‘little’ thing.

‘Bucket List’, first placement nerves and tweeting nurses

When I was younger, I used to look at people’s blogs with jealousy and wonder why anyone would ever want to read my memoirs, but it wasn’t until starting my degree that I realised there were so many positive reasons behind starting one. This year, I made myself a 2014 ‘Bucket List’. I’ve listed about 30 things that I aim to achieve that I know will make my year so much more enjoyable. One of my aims was to start a blog to allow me to reflect on my course and life as a whole… so here we are! Anyone that knows me will probably argue that it’s a glorified form of procrastination – something at which I excel! I’m genuinely hoping that my list will give me a lot to be proud of on New Year’s Eve, where I would normally look back with regret, thinking there was so much more I could’ve done.

It’s January now, and when I started at University back in September, I remembered telling my fellow student nurses that we would have so long to prepare ourselves for our first clinical placements, but now it’s drawing so close that I’m starting to get slightly nervous. As with anyone, I’m questioning whether or not the people I meet will like me or whether or not I’ll do anything wrong, and it’s daunting, it really is, but I’m also extremely excited to be putting everything I’ve learnt so far into practice, and to meet people that will help and inspire me to be the best I can be every day. I’m also looking forward to writing about the things that I’ll encounter and using that experience to reflect and improve everything I do.

The kindness of the wonderful ’nursing family’ on Twitter is overwhelming, and reminds me that there is so much good in social networking, despite it’s general press. The wealth of knowledge that is available to student nurses in (generally) under 140 characters (although I tend to babble and send 4 or 5 tweets at a time) is amazing, and it’s so nice to be able to learn from those that have gone through it all already and are now making waves in the nursing world. It also makes me less nervous knowing that I’m not alone in this journey, and that I’ve got support down so many different avenues – something which I think will be extremely useful – especially when I have an assignment meltdown like I am doing at the moment. I would urge all nursing students to follow some of the wonderful nurses and fellow students on Twitter and to get involved- you have nothing to lose, yet so much to gain!

I took a while earlier worrying about what my blog name would, because there’s so many witty ones out there, ‘At your cervix’ being a particular favourite. I actually decided really quickly, ending up opting for ‘nursepraylove’ as a nod to one of my favourite books ‘Eat, Pray, Love’ by Elizabeth Gilbert, but not just because it’s my favourite book. The witty and intelligent story chronicles one woman’s extremely self-aware journey around the world until she finds balance and love in her life. Although only a small way through the journey I’m embarking on with nursing, I’m starting to better understand the concept and importance of balance in your life more than ever before and that’s something I want to hold on to with this blog.

Now, back to that assignment I’ve been neglecting… or maybe I’ll just enjoy the ‘dolce far niente’ for a while (can you guess what another one of my aims was?)