At the beginning of 2006 I wrote a post about what it means to be a nurse in the UK in 2006. Over the ensuing months there has been much discussion on both sides of the Atlantic about what nursing means, and about what patients should be able to expect from their health care providers. As role boundaries blur and nurses and other health care professionals take on tasks formally the domain of doctors sometimes we need to take a step back and ask what our patients really need from us and how we can make sure we are up to the job of providing that special something that makes us who we are.
My theme then for this week’s edition of Change of Shift is about trying to pin down the key skills of nurses and others who provide care for patients in whichever health care setting, wherever that takes place in the world today. This is not about trying to take on that extra role, about giving the most high tech care (though some of our contributors deal with such technical equipment on a daily basis) but instead it is about identifying what is really important for patents and their relatives and indeed the bit that gives us that feeling we have made a difference when we leave the bedside and head off home to our families.
Assessment of our patients needs is in my opinion one of the key areas of the role of all health care workers, and our ability to suss out exactly what is going on for that person is what helps us to be able to plan care and make sure patients get the treatment they need. Nursing Student, DK at Four Year Mission finds out that perhaps there is no such thing as a ‘normal patient’ when it comes to assessment, well that has certainly been his experience so far, but he has already discovered that those patients that might be termed ‘difficult’ are often the ones who need us to advocate for them. Assessing the mental state of patients is the challenge for Beth from Pixel RN who discovers that those who seem calm and co-operative while ventilated can become confused and unhappy afterwards.
The way we communicate with our patients, their relatives and each other is not just a problem for those dealing with people in the intensive care setting, but really is key to the work of us all. As OncRN tells us, some nurses have difficulty in filtering the information they share, where and with whom they share it, she suggests we all need to learn how to filter that information. Susan Palwick, a volunteer hospital chaplain from Rickerty Contrivances of Doing Good says that sometimes the sounds of the ED can be worse than the smells (hard to believe I know), and tells us how massage might be a way of helping to calm the screamers (can’t imagine that happening on the NHS with the current financial problems!)
The problem for Crystal from Aunt Pickle is how to tell her patients the things she needs to communicate with them, and writes a series of letters to try to help them see their perceptions and expectations from her point of view. This is something I have found useful in the past, writing a letter (but not necessarily sending it) to a patient or difficult colleague is a great way of learning how we can better communicate, not to mention getting some things off our chest about our real feelings! The reactions and expectations of people whose relatives have just moved into a nursing home and how we deal with them are a source concern for Patti Green from Nursing Assistants.net, something which had led to some interesting discussions on the site’s discussion board.
It is communication of a different kind that has John Crippen of NHS Blog doc angry (a not uncommon occurrence as regular readers of his blog will know). Manager jargon contained in a letter from an NHS Ambulance Trust appears to be suggesting that patients will be telephone triaged by ‘ambulance clinicians’ (whoever they are) in an attempt to cut down unnecessary Accident and Emergency visits. As John says, patients might be better off calling a taxi than putting their lives in the hands of yet another quacktitioner! Speaking in code is a pet hate of my own and in my own post of that name on Life in the NHS wonder why we do it quite so much. This is not to say that I can not be heard doing it myself, but at least I have insight! Speaking of which, Nurse Ratched points out how many letters people seem to have after their names these days which are pretty much an alphabet soup, with one thing and another it is definately getting complicated for us older nurses!
Knowing what to observe in our patients and how to do it are to Nurse Chic from Code Pink one of the key skills a neonatal nurse can have, she is not alone because she quotes Florence Nightingale “The most important practical lesson that can be given to nurses is to teach them what to observe”. As she told a student who wondered why she wanted to do this kind of work, she loves babies, and that must definitely help as actually liking what you do and who you do it for is key to professional fulfilment. A quick plug too for November as Prematurity Awareness Month, did you know that 1 in 8 of all babies in the US is born prematurely? I have no reason to suspect that statistic is different elsewhere in the western world.
Team working is one of those things that all of us need but some of us try to do without, as we attempt to be that person who is all things to all people. Kim, founder of Change of Shift, from Emergiblog however is grateful that others know better and go that extra mile to care for her as I am sure she does for them. Team working also helps us to develop the commitment that is needed to juggle work and home life. Jo from Coffee and Conversation in a Smoky room tells of her life as a busy medical / surgical nurse which she balances with spending time with her daughter. She tells us that she only works 8 hour shifts when many have to work 12 but her schedule is as busy as any I have seen in a long time and made me worn out just reading it!
For all nurses, providing basic nursing care should be something they feel proud to be able to do, Hannah from Milliner’s Dream is a woman of many hats but tells us how important it is to be able to make a difference. High tech equipment and medications are vital to a patient’s recovery but there is no substitute for basic care. You must however expect the unexpected when it comes to patient care, Jenn from Jenn’s Journal tells us about the first patient in her care to die an unexpected death and the equally unexpected but welcome news of life given to others through organ donation.
Finally, Susan Yox points us to an inspiring post on Medscape by Julie about the battle she has been fighting on the way to hopefully winning her own war with Cancer. As far as I see it, our role is to do everything we can to care for our patients and their families so that they in turn have the will and energy to face the challenge of their illness in whatever way they need to. Maybe that is the essence of Health care in 2006!
Well thats it for this edition of Change of Shift, thanks to Kim for giving me this, my first opportunity to do this job, I really hope you have enjoyed reading the contributions as much as I did. The next edition will be on 30th November over at Fat Doctor.