6 C’ing my way through Nursing – Compassion

I recently had surgery and interestingly, during my last placement I cared for people who had the exact same surgery that I’ve just had. So naturally, I went to my pre-op thinking that I knew everything that I would need to know. On the day of my surgery, I knew in my head the exact order in which things would need to happen…admission, WHO safety checklist, consent, TED stockings, no jewellery etc.. multiplied by 3. Then sleep. Then wake up. Then recovery. Home.

It wasn’t that simple. I was in pain – did I want to press the call bell? No, I didn’t want the nurses to think I was making it up and that I was a trouble maker. I couldn’t get comfortable. I wanted another pillow. I wanted an orangey drink because I hadn’t drank or eaten for hours and water was just not going down too well with me. I was hungry but didn’t want soup because my hands were shaking and I was worried that I would spill it all over myself. I ate it anyway. I needed the toilet but didn’t want to cause a fuss and have to unplug oxygen, BP cuff, cardiac monitor, pulse oximeter etc.. off me to then have to plug it all back on so I held it in until I could no longer hold it in any more. My lips were dry and I wanted lip balm which I didn’t have so I just licked and licked them until they got sore. I was cold and wanted to put my own pyjamas on. My hair was a mess and I wanted it in a bun on the top of my head and out of the way but with all the various things I had plugged onto me I couldn’t get to my hair so I just sat there looking like a hairy monster. Not that it mattered much because I also couldn’t see anything – my glasses were in my bag.

When I eventually got home (after a longer than expected stay in hospital due to a reaction to anti-sickness meds) I had no idea what to do with my medication, or when I would have my follow up, or how long to rest for. I had no clue. I had been told all of this before my discharge but retained none of it.

I thought I knew what to expect. But I really didn’t. I thought that I knew what patients that I had previously cared for had gone through. Not really!

Here is the definition of compassion:

6-7-2012-2-26-45-pm

Honestly, I’m worried now. Would I have known what it was like to have this surgery when I was on placement I think I would have been much more attentive to patients. Not that I neglected them but now I’m not so sure that I was able to really empathise at the time. I’m not sure that I would have been able to alleviate their suffering just like the definition says without knowing what it was! I can’t possibly have every procedure and intervention known to man in order to know what it feels like for patients, so how can I be completely compassionate without really understanding?

These are rhetorical questions of course. I’m not sure I will ever be able to fully understand. But I can try. I believe that now I know what kind of questions to ask post-surgical patients and this is where communication is key. Maybe I can even apply them to all patients. I think it’s definitely work in progress but I’m grateful for the very personal experience and I hope that it will make me a much better and compassionate nurse in the long term.

6 C’ing my way through Nursing – Competence

I say competence but really I mean incompetence. That’s how I feel today. I feel pretty pants.

Yesterday was entirely different. Yesterday I attended a COPD simulation session at my Trust and actually did pretty well – I managed to remember hellomyname is….I did my ABCDE assessments and incorporated all of my 6Cs into my care. I even managed to squeeze a brief intervention in there and encourage smoking cessation to my ‘patient’. I was pretty chuffed. Yesterday I went home from placement thinking that I could really do this nursing thing. After all my doubts and tribulations, I believed in myself. Yesterday I felt pretty competent.

Today however I feel the opposite.

Today, I took our a cannula for a patient who I knew was going home. Said patient proceeded to leave the ward without their discharge documentation and take out medication. She wasn’t my patient, I was just trying to do the nurses looking after her a favour and take it out so they had less to do. I don’t know if the patient took the removal of the cannula as a sign that she could go home. I don’t know if its my fault. I don’t know if that makes me incompetent but it feels that way.

Today, I took a shivering patient’s temperature (36.8), just like I always do, by holding one of those fancy infrared thermometers against their forehead and said patient proceeded to then spike a temperature (37.9) half hour later. The patient’s partner told the nurse in charge I had held the thermometer about 2 feet away from the patient. I’m sure that these thermometers do not work at a distance, and I’m even more sure that it wouldn’t have recorded a normal body temperature at all held so far away. But still, I don’t know if it was my fault. I don’t know if I did something wrong. I don’t know if that makes me incompetent but it feels that way.

Today, I also had my mid-placement review. All my competencies signed off except one. I should be happy I suppose. That leaves me the next 3.5 weeks to focus on one competency. Care of an acutely ill patient. The only problem is that it is not getting signed off not on the basis I haven’t been involved, but on the basis that the placement area itself doesn’t really care for acutely ill patients (elective day case) and therefore I’m unlike to experience it in the next 3 weeks. There was no attempt to get me to explain how I could care for such a patient. There was no attempt to run through my COPD simulation yesterday which covered exactly that. I had no chance to explain all my previous acute placement, for example A&E, which have given me more experience in acutely ill patients that almost any other areas of care. I know that I have the knowledge I need for the level that I’m at. I just feel like I won’t be given the chance to prove it. don’t know what it all means, but it doesn’t feel great. It makes me feel incompetent.

I wonder if competence and confidence are always so closely linked that it is near impossible to seperate them. I wonder if today I have lost my confidence and that’s why I feel so incompetent. Or I wonder if I really am not as competent as I think and my ego has taken a bit of a hit. I really don’t know.

But is confidence always a good thing? I don’t know if I would rather have days like today when I sit back and really reflect in my own competence and doubt or always be confident and self-assured.

I have met nurses and students who are super confident, who do not accept any form of critique and who appear slapdash, but they come across as always knowing what they are doing. Is that better or worse than having occasional self doubt? I think the answer, as with anything, is that everything should be in moderation. The good comes with the bad and vice versa. I just wish the lows didn’t have such a demoralising impact on me. It’s a vicious circle isn’t it? I’m not sure where I am in this bo – but today I really feel like I’m in the ‘Need Help’ Category.

I hope next week will be better, I hope that I will be able to feel confident and competent again.

6 C’ing my way through Nursing – Communication

Next post in the 6 Cs series!

Communication – one of those buzz words. Found in every job specification, every soft skills workshop and every CV. But really, sometimes I wonder if we always have the time to communicate properly, or even, if we sometimes remember that not everyone knows what we are talking about.

For example, this week I got some new inhalers for my newly diagnosed asthma. It’s not very well controlled at the moment and they have been trying me with all sorts of things. It turns out that I shouldn’t really be taking my Ventolin/Salbutamol (blue/rescue/reliever) inhaler more than 3 times per week if I am also taking Clenil (brown/steroid/longer acting) inhaler. No one told me that. I remember asking how often I could use my blue inhaler and my other GP said as often as I needed it. So I did. I didn’t realise that ‘often’ was limited to three times per week. This is what I thought it meant:

often
ˈɒf(ə)n,ˈɒft(ə)n/
adverb
adverb: often; comparative adverb: oftener; superlative adverb: oftenest
  1. frequently; many times.
    “he often goes for long walks by himself”
    synonyms: frequently, many times, many a time, on many/numerous occasions, a lot, in many cases/instances, repeatedly, again and again, time and again, time and time again, time after time, over and over, over and over again, {day in, day out}, {week in, week out}, all the time, regularly, recurrently, continually, usually, habitually, commonly, generally, ordinarily, as often as not; More

    informallots;
    literaryoft, oft-times
    “he often asked after you”
    antonyms: seldom, rarely, never

Perhaps not then! So…  cue a very surprised GP and even more surprised moi when I explained how often I used my inhalers. Now I have a pink one – to replace the brown one but not the blue. I have no idea why and I can’t remember if my GP told me. I just know that I very obediently picked up and paid for my prescription without really asking anything.

I’m surprised at myself really. I think I’m quite assertive and I don’t really see myself as needing any sort of extra assistance or support with my meds.  I normally ask a lot of questions and don’t really accept the status quo if I don’t understand it. But it does make me realise how much we all trust and rely on ‘experts’ without question.

During placement I ask any questions that I don’t know the answers to and when it comes to patients I try to gauge the patient’s understanding and knowledge and explain things in their own terms as much as possible. But now that I am the patient and ‘on the other side’ I’m double guessing myself – am I really communicating as well as I could and should be? Are my patients going away from hospital as confused as I am about my asthma inhalers?

I have no doubt that my GP believed that he was being truly helpful; looking after me and ensuring I had the right inhalers to help me. Just like I do not think for a second that a lack of information or communication is ever intentional. I don’t think people intentionally withhold or hide information on purpose. Or do they?

But, I can’t remember if my GP asked me if I had any questions when I got my new inhalers. Nor did he show me how to use them – a bit of a faux pas seeing that it was a completely new type that I had never ever seen before (thank you YouTube for showing me the way). But then again, I’m not sure I would have known what to ask, and I don’t know if I would have asked even if I did now.

Of course, I know communication is not just verbal. It also includes body language, tone, eye contact and gestures. But I wonder, is communication between the health professional and patient really about exchanging information (in whichever format that may be)? Or instead (or in addition to) is it an exchange of power? That’s what they say, isn’t it? Information is power.

Do we, as health professionals, not communicate properly or hold on to information for fear that the patient will run away with it and we will no longer be in control?

Or perhaps we are worried that they will no longer needs us? We need them! Otherwise we wouldn’t have a job!

Do we not willingly communicate for fear that we will not understand the response?

Or that we will not have the time or resources to deal with the response or questions that our own communication and information triggers?

The above reads like a bit of a riddle and I suppose communication in itself is a bit of a mine field. Most of us think we have the necessary skills to communicate adequately. I think I do. Sort of. Though I have to be honest and admit that the more I write this blog the more unsure I am that I’m getting my point across and communicating effectively! So I will leave it there..until next time!

Here is a quick picture that made me smile! I thought it was apt 🙂

wee non

 

 

6 C’ing my way through nursing – Courage

As I mentioned in my previous entry. I want to write about each of the 6Cs (have a look at my ‘6 C’ing my way through nursing’ entry if you want to know more!)

I wanted my first entry to be about Courage – for no other reason than a couple of events this week have really made me reflect on why people do certain things, and in turn, why I do the things that I do. Worth pointing out that in my view (and you may disagree here) there is a very distinct difference between being courageous and being reckless – though I accept that different people see things very differently. Nonetheless, I like to think I am the former and not the latter. So here goes….

When I resigned from my previous job, people said I was making a rash decision; a whim they called it. Those who knew me little were surprised at my new career choice. Those who know me best reacted with “about time” comments and those people were simply full of admiration. How many people do you know who are stuck in a rut? It may be work, it may be the house they live in, it may be a relationship, it may be financial worries or all of the above! It may even be you – reading this now – who is feeling like that..and how many people have the courage to make change happen? How many of all those people have the courage to change their circumstances? As it stands, I have met a lot of nurses and student nurses who have found that courage. Every single one of the people I have cared for are courageous people. They have courage to carry on; to keep trying; to keep smiling.

Take Dr Kate Granger, she’s a GP diagnosed with a very rare and terminal cancer. I have been very lucky to have met her, and can honestly say I have never met anyone so honest, open and courageous…unafraid to fight for what she believes in. She has fought tooth and nail for our NHS and to raise awareness of the value of person centred care and she has continued to do in the little time she has left. She has talked openly about her experiences in hospital as a patient and offered much valuable feedback on how we can improve further. Not as a means to devalue the NHS but in order to make it even better than it already is. This includes her ‘Hello, my name is’ campaign – encouraging all health workers to introduce themselves to patients as a matter of course. She’s a boat rocker and one of the very bravest.

Then, take the Daily Mail <sigh>….. I really wish I could remain objective when writing about such a sensationalist paper. This week, it published a story about Dr Granger’s campaigning. They didn’t really listen, they didn’t understand and without any consideration to Dr Granger turned HER story into one of disappointment and despair – Kate Granger is nothing like that. She is positive, encouraging and ambitious and the Daily Mail have broken her heart…but she has picked it back up, and has vowed to continue all her hard graft. What an inspirational lady.

What do you think? Who is courageous or who is reckless? Does it depend?

The thing with courage is that people think that a heroic act is needed in order to be courageous. I’m not sure I believe that. I take courage as I take risk. I weigh up cost vs benefit. Most of all do this in our daily lives anyway. To have a salad or a pizza. To drive or take the bus. To hang the washing out when its cloudy or not. To drive those extra 5 miles with the petrol warning light on or not. They are all decision that we make daily and risks that we take each and every day. They are all rational and calculated risks for which we accept the consequences. In my eyes, courage encompasses the ability to accept responsibility for the consequences of our actions – possibly to the benefit of others and not ourselves – and to do it regardless, much like Dr Granger does each and every day.

How would you define courage? Dictionaries not allowed.

Sometimes I wonder how people like Dr Granger do it. Where do they find the strength? I aim for the same bravery or course. Whether I will get there it remains to be seen! I don’t often say no to a new opportunity or to a challenge. If you have never seen the ‘Yes Man’ with Jim Carrey I would certainly encourage you to. I may have mentioned this in previous blogs but its a great film and incredibly inspiring. It is only because of this ethos that I have taken advantage of opportunities as much as I have. I don’t wait for other people to try things out first. I don’t wait for encouragement or coaxing. I like breaking down barriers and I’m not afraid of a little hard work to make it happen. I have to admit that  recent experiences would suggest that hard work and success offend people, and they get really angry. I’m not very sure why but it makes no difference to me whatsoever. I truly believe that THERE ARE people out there with no agenda. I work hard because it’s the way I am made and to ask me to do something less than my best would go against everything that I believe in.

Because of this, I spend a lot of time reflecting on things that I have done and said and I try to rationalise all outcomes. I get happy, I upset, I pick myself up and I carry on. I do that almost constantly because I am so self aware that I analyse almost every single one of my moves. I am my biggest critic, as most people are. But I try to not give myself a hard time if I am wrong even if it takes a lot of effort and energy to let things go. This is incredibly difficult to put into practice – but I do try!

I understand that when I write this blog and publish it to the Universe that I make myself vulnerable by opening up myself and my thoughts and inviting feedback. I understand that the power of the internet means that whilst I open up to all my readers, that in turn my readers are able to hide behind an internet persona without consequence. The internet, or the freedom of press and speech (see the Daily Mail for example) gives people courage to perhaps do and say things that they would not otherwise do or say in ‘real life’. I know it certainly gives me courage to write things I would normally reserve for my ‘Dear Diary’ moments. In spite of that, I continue to do what I do, I continue to publish blog entries.

I don’t really want to apologise for the long entry. I feel that it is important that we are all self aware of our actions and whether you are in a caring profession or not, consider the 6Cs in every day life. In the context of this post perhaps you could consider, are you courageous or reckless? Does it depend? And if so, what on?

 “Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.”  Winston Churchill

“Courage is grace under pressure” Ernest Hemingway

 

6 C’ing my way through nursing

The title of this blog entry is probably a little cryptic, so let me explain.

Back in 2012 (before I started my nursing course) in light of some of the most horrendous scandals to hit the NHS, the Chief Nursing Officer of England (Jane Cummings) set a 3 year vision and strategy that would include 6 specific action areas to ultimately deliver  and implement Compassion in Practice (CiP) at all levels of our National Health Service. These areas are:

  1. Action area one: Helping people to stay independent, maximise well-being and improving health outcomes
  2. Action area two: Working with people to provide a positive experience of care
  3. Action area three: Delivering high quality care and measuring the impact
  4. Action area four: Building and strengthening leadership
  5. Action area five: Ensuring we have the right staff, with the right skills, in the right place
  6. Action area six: Supporting positive staff experience

I’m sure everyone will agree that all of the above are vital if the NHS is to meet the expectations of the very people which rely on it, . But…they are a little wordy aren’t they? They don’t really roll off the tip of your tongue. So to help with that, the 6 Cs were created – the 6 Cs encompass the ethos of the Compassion in Practice strategy and cover:

  1. Care
  2. Compassion
  3. Communication
  4. Competence
  5. Commitment
  6. Courage

Again, I’m sure you will agree that they above qualities are essential in Nursing and Care staff. Nonetheless, there are people out who are not quite convinced that the 6Cs and the CiP vision will make any sort of impact. Some people believe that the 6C’s are a gimmick, and that nursing staff should not need to be reminded of the 6Cs to do their jobs….and to a certain extent, they are perhaps correct. Health professionals should not need to be reminded that they are in fact in caring professions. However, there are many examples out there of a lack of compassion, as we are frequently reminded of by the media, so something needs to change. My view is that something is better than nothing and I am an avid fan of making change happen and not simply sitting down and complaining about it.

The 6Cs act as a prompt, as a reflection model and as a really really good reminder of what Nurses are fantastically good at. They should be used to celebrate achievements, to show how there is no other profession quite as unique and rewarding as nursing, and to remind us all of why we do what we do (whether qualified or not). They are not – in my view – a tool to metaphorically beat people up with nor are they a framework on which to blame bad practice or culture.

So, in light of that, I want to dedicate a blog entry to each of those 6 Cs and I want to start this blog with Courage – keep your eyes pealed for it!