Nursing Specialty

Paediatric Oncology Nursing.

Thursday, September 2nd, 2010 by niknak30

The ward I work on is predominantly a children’s medical/ isolation ward but the majority of our patients these days are oncology patients that require isolation for one reason or another. So, it got me thinking about what it is that I like about nursing children with cancer?

child_in_hospital_175

Seems almost wrong to enjoy looking after children and their families who are dealing with the most terrible diseases, having treatment that makes them so so sick and often seeing them pass away. That said, the number who pass away gets less and less with all the advancements in treatment so thankfully there is still more good than bad in paediatric oncology.

So, what is it I enjoy?

Well, I really enjoy the continuity of care that we get by looking after long term patients, seeing them come from diagnosis right through until the end of treatment. I like that the families get to know us as much as we get to know them . I think it helps them to know that we know their children and it helps the kids because they know us.

The children being treated go through so much, lumbar punctures, chemo, blood and platelet transfusions, blood tests, nausea, vomiting , yet they on the whole tolerate these things with so much strength and they always try to smile whenever they can. The parents work out ways to explain the procedures, they might collect bravery beads, we might make sticker charts but every day we see these children they are just doing what needs to be done to get through.

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I love the warm fuzzy feeling you get from knowing that in some small way you may have made a difference in the life of a child and their family. Holding a hand, letting a parent cry on your shoulder, laughing about something silly at a time when life seems hopeless, being honest when you say “it will hurt a bit”, listening when someone needs you to even if you don’t really have the time.

smile

All these things add up and they mean as much to me as I hope they do to the children I care for.

Image credit: monkeyc, union of youth.

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Allegations on Aged Care Abuse – Malicious and Incorrect

Monday, June 14th, 2010 by shoils

No doubt you have all heard the hype that has been in the paper the last few weeks about our aged care facilities in Sydney (which I leave unnamed).

The allegations from this woman’s diary are serious and make it clear that we in aged Aged Carecare do nothing but neglect our residents. When reading the article I couldn’t help but feel enraged at this woman.

How dare she? For her 15 minutes of fame she has not only hurt the facility that she has been volunteering at but ruined a whole industry that is struggling already.

Many of the things that I read seemed to be a little far-fetched and I know are not the truth (as I know one of the facilities she was volunteering at).

Her allegations that she was told to keep things from the family and told that if a family asks about something to simply say “that is confidential” could not be further from the truth.

By law NOK/Guardians and any power of attorney have the right to see and get information from the facility in regards to their relative or client. Anyone who is not legally looking after the person of course can’t. But this goes for anywhere doesn’t it?

When I ring the hospital after sending a resident for acute care,  9 times out of 10, I am told that information is not allowed to be given to me in regards to the health status of my resident even though I am ringing on behalf of the nursing home and we are the primary carers of the person (not to mention that I am the care manager of the facility).

She complains that she was feeding and transferring residents without qualifications. Well I find this also hard to believe.

In aged care we are very much governed by legislation and I know that one of the facilities that she was volunteering in she was specifically told NOT to do any tasks that are specialised such as feeding and transferring, yet she was caught doing them and asked to please refrain from doing so as it is a danger to the residents.

This person entered these aged care facilities with the intention to catch them out — not to help. If she was hearing people calling out into the corridor and the staff were engaged with helping other residents why did she not simply get them that blanket? Or give them their bedside phone to make the phone call etc?

When you enter a nursing home you will hear residents calling out into the corridor, particularly if they have dementia and don’t know how to use the call bell or they have no concept of time and they may have only just rang the call bell and what feels an hour to them may only be a few moments thus complaining that the buzzer is not answered for hours and they never get what they need. But the reality is the nurses were busy taking someone to the toilet and as soon as they are done they will attend to that resident’s needs.

What is the most upsetting about this whole thing is that this lady is not a professional.

She has no idea about aged care she is purely making assumptions on the small snippet she has witnessed. Food does get cold, when you are serving more than 10 people at the same time and you have to feed the majority, unless you have a staff patient ratio of 1:2 – this can’t be helped.

It is against food and safety regulations to re-heat food in aged care facilities. So what would she like the catering department to do? Serve food resident by resident?

She passes comment on what the staff say during their “smoke break.” Well I don’t know where to begin to state how wrong this is.

Staff’s mealtime and break times are there for staff to de-brief, state whatever it is they feel like whether it be right or wrong, whether is be PC or not. If they said what she states they said (which is hear say in any case) is it not a person’s rights to do or say as they wish on their break away from their residents?

Nurses swap patients all the time, and say things about their patients particularly if they are difficult ones. That is how we let off steam and that is how we get emotional support from our colleagues.

I could go on and on rebutting everything this woman disclosed but I guess it would be useless the damage that this woman has done to our industry is too great.

Spot checks are taking place all through the aged care industry, unannounced visits have already started and will continue now for the rest of the year I suspect. You know what I say to that…… BRING IT ON!!!

The place she complained about had a 3 day accreditation and investigation and they found nothing.

Are you telling me that all the residents lied? If people understood the whole investigative processes of the department they would understand that not only are staff interviewed, but residents, relatives, visitors are all interviewed in fact who ever walks through the front door is interviewed.

Documentation is checked and so is achieved documentation. It is quite hard to pull the wool over the department’s eyes.

The department is trained to spot BS a mile away, and when an unsubstantiated complaint is made. I have done the assessors course so I am well aware of the processes. Whilst once upon a time neglect ran rampant throughout the aged care industry, now it is not the case we are a very heavily regulated industry and welcome these regulations to ensure our elderly get the very best they deserve.

Even if someone was to be nursed 1 on 1 they still might end up in a wet pad or calling out at any one time, this is human nature and life. The question that should be asked is…. Is this happening all the time? Does this person have deteriorated skin, or shows signs of neglect?

It has taken decades to try to get rid of the stigma of aged care and get the wider community to understand that aged care these days is not the end of the road full of neglect, but a place where the elderly can get their life back and enjoy the time they have left.

With one sharp swift of the pen this woman has taken us back to square one. She has stopped aged care facilities in trusting volunteers and thus as a result many will close their doors on volunteers from now on and who gets hurt in the end?

The elderly who so love having volunteers come in to be with them. I hope this woman is happy that she has caused more harm than good. All for the price of 15 minutes of fame.

What do you think about this whole saga? How did you feel when you read what she wrote? Did you believe this to be true or did you feel enraged at her story?

Image source (http://www.fotosearch.com/CSP126/k1264445/)

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Paediatric Nursing – it has so much to offer

Saturday, June 5th, 2010 by niknak30

nik and pepper 2In my group of friends at university when I was studying nursing, I was one of the few who knew that Paediatrics was where I was heading. I didn’t know what area of Paediatrics but I knew that my nursing career was headed in the direction of looking after sick children. In fact, in my year 12 year book I even said that it was where I wanted to be in 10 years time.

I was lucky enough after a 12 month new grad (nurse transition) program that had no paediatrics in it to get a job at a children’s hospital. I cried when I was offered the position!

People often say to me that it takes a special person to look after sick children and yes I guess that is true but as I always say, I get so much more from the job than I could ever give to it.

There is something unique about looking after children for so many reasons

  1. children are so brutally honest….. if you are fat, thin, tall, funny or even sick, a sick child will tell you in the bluntest manner. I am always amused when a child tells me I have a big bottom…. they are telling the truth, and the look on their parents face is worth it every time. Total embarrassment. I always giggle!
  2. as the nurse, we see sick children at their worst but also parents at their worst. Being able to be a part of that is something very special because more often than not we see that turn around into a celebration and it is great to be there for that.
  3. we get to go fun things at  work and it is accepted. Whether it be dress up in costume, wear pigtails in your hair, sing or dance or be sillynik. We are often celebrating a fundraiser, a special day or a hospital event and we always get involved and do it. It’s a great part of the job.
  4. A hospitalised child is often the worst experience  that will effect their family and often we have 16 children in that situation in our ward alone. It is wonderful to be able to help these families to deal with the trauma of that. Their child may be in for something simple or perhaps a long road of visits but being there is something quite rewarding. Knowing that you make the smallest difference is one of the reasons we go to work every day.
  5. adolescents will give you a challenging day just as much as a baby but getting to combine a little of both in each and every work day is truly rewarding

Would I recommend a job in the field of paediatrics?

I could not speak more highly of it as a career. You still get to chose between medical, surgical, intensive care, recovery, theatre, emergency or community but you also get to be involved in the lives of people who appreciate what we do in more ways than they could ever express. Helping a child return home to their families really does give you that warm fuzzy feeling.

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Nurses, are We confusing Dementia with Hearing Deficits?

Thursday, May 20th, 2010 by shoils

For the past month I have been trying to organise one of our residents to attend hydrotherapy with a private physio company. Mr X got approval from DVA (Department of Veteran Affairs) and was considered a good candidate for such hearing aidtherapy. This decision was made by the practice manager over the phone after I had spoken with her at length about Mr X. I finally got him an appointment for an assessment at the hydrotherapy place, sent him off, and after an hour he was sent back.

I then received a phone call from one of the physio therapists, in a very distressed and angry tone she proceeded to tell me how Mr X was not a candidate for hydrotherapy. He was demented, confused and didn’t answer any of the questions she had asked him. She couldn’t see how we thought he was a suitable candidate, he had arrived in a wheelchair and was unable to get up on his own. I let the physio have her say and then calmly told her that Mr X in fact was not demented or confused, he is able weight bare and walk with assistance from 1 staff and a frame. This in itself makes him a candidate for hydrotherapy….. no?

When thinking back later that day it dawned on me that the reason she must have thought he was demented and couldn’t answer her was probably because he couldn’t hear her properly. This confusion happens more than we care to think about. Many residents are branded as demented, confused, depressed, and as having behavioural problems simply because they cannot hear properly.

How many times have we seen a diagnosis of dementia on a discharge summery yet there are no tests to substantiate this diagnosis? They arrive to the nursing home, we do our assessments, pick up the fact that they can’t hear properly, get an audiologist visit, arrange for hearing aids and all of a sudden the resident is a different person.

It makes me angry to think that people like this physio are so quick to judge elderly people. They don’t take the time to stop and think that maybe there is something else causing this communication barrier other than dementia. Elderly people are misdiagnosed all too often and it is because people cannot be bothered to look at the whole picture. The rate of elderly people being diagnosed with depression is unbelievably high. GP’s start them on anti-depressants and then staff wonder why the medications aren’t working.

Did it ever occur to anyone that maybe the resident is not depressed?

Did the GP bother to check the resident’s ears?

Could it be that there is a wax build up in the ears? Or the resident requires hearing aids?

What has happened to the concept of holistic care and comprehensive assessments of our patients? Or is it that the elderly don’t deserve our time.

The statement of “I just don’t have the time” just doesn’t cut it, we are all pressed for time these days but if we just spend that little bit of time assessing the elderly properly then we will save time and money in the long run.

Have you experienced an incident like this?

Have you suffered the same frustrations where one of your patients has been misdiagnosed purely because someone was quick to assume or didn’t have the “time” to find out what really is going on?

Tell us your story, and maybe, just maybe, we might change the culture of medical/allied health staff dismissing the simpler things that make all the difference to our treasured elderly people.

Photo source (http://www.fotosearch.com/photos-images/hearing-aid.html)

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Arrested Development

Wednesday, May 19th, 2010 by niknak30

It’s a sound that rings through your ears and your heart momentarily stops.  You think to yourself “OMG, is it real?” No matter what time of day, no matter what you are doing, you are always on alert for THAT sound….. the one that makes your heart race, jump to attention and head in whatever direction it is coming from.

alert lamp

alert lamp

Fortunately for me, working in a Children’s Hospital, more often than not the arrest buzzer is set off by mistake because a parent has leaned on it, pushed it thinking it was the regular nurse call bell or because a sibling has wondered what that red light does when you push it!   However, on those days when the arrest buzzer goes off and it’s for real, not only do we deal with whatever situation we find whether it be a respiratory arrest, seizure or other emergency, the shrill cry of a scared parent often follows.

In fact, not only does the adrenalin kick in and we do whatever is required to help the child in question, we are also instantly aware that a child’s mother, father, relative etc who is at the bedside wants to know how we can fix this.  As in any area of nursing, we do all that we can and then we help the parents in any way possible before we then look after ourselves.

Looking after the nurses after a situation where resuscitation is required cannot not effect you in one way or another.  Some people go for a cigarette, some people need to talk then and there, some choose to discuss it at home and others need a more formal debriefing of a situation to know that regardless of the outcome, we did the best we could.

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Cardiac Arrest – the first time I saw it happen!

Thursday, May 6th, 2010 by patience

CCC_InTraumaThe first time I saw a patient have an arrest was when I was 17 years old. It was 1975 and I was a 1st year nurse with all of 6 months experience in the care of sick people.

I was working on night duty in a nephrology/oncology ward. The ward was divided into 3 sections and I was in-charge of one of them under the supervision of an RN. My section was the least acute, but still it seems ridiculous to think back and remember that hospital management thought it perfectly okay to leave a 17 year-old in charge of 12 fairly sick patients. But so it was and we didn’t think anything of it at the time.

This particular night was my 5th on night duty and I knew all my patients pretty well. There was one gentleman in particular that I had connected with – as we nurses often do. This man was in renal failure and quite unwell. He would spend most of his nights awake, so I would often sit with him and we would quietly chat and share jokes while the other patients slept fitfully. I liked him and he liked me.

Well it was about 6am on this chilly winter morning and I was looking forward to the dawn and the end of my shift. I was doing my usual 6am rounds, checking the all-important fluid balances and doing observations. The patients were rousing sleepily about me.

As I headed towards my favourite patient I could immediately see that something wasn’t right. He was lying on his back and I could hear gurgling noises coming from him! I moved quickly and the first thing I did was roll him onto his side and grab the suction equipment as I thought he was choking. But as I started to suction I realised that he was arresting. With a hot and frightened rush of adrenaline and with shaking hands I grabbed his buzzer and buzzed 3 times. The ward emergency signal.

My favourite patient was a big man and I was a rather petit teenager, but at that moment I seemed to have added strength and with some effort I rolled him onto his back. With a racing heart and sweaty palms I realised that the CPR was up to me and so I started it, all the while silently hoping the RN would answer the emergency buzzer as quickly as possible.

Time seemed to stand still and I seemed to move in slow motion while I initiated CPR. I remember feeling hot and cold flushes as I desperately tried to remember all I had been taught. I hadn’t even seen an arrest before let alone be the nurse to find someone having an arrest and be the one to begin CPR! Fortunately I remembered what I was supposed to do, and even though time seemed to drag, the RN and the other nurse were with me within a very short time. The code was called, the RN took over, the resus team arrived and I faded into the background to finish my shift, shattered and shaking. I went home feeling as if I been in a car crash!

When I returned to work that night I found out that my favourite patient didn’t survive his arrest and I felt as if I had let him down and hadn’t done a good enough job in trying to resusitate him. Fortunately, even though debriefing wasn’t something that was commonly done, the RN was able to reassure me that he had been a very sick man and that I had done exactly as I should have. And that was the end of it.

I saw and participated in quite a few more arrests after that one and I have to admit that I never got used to them and found them all a nerve-wracking experience. However, all those subsequent arrests have faded from my memory, but the arrest of my favourite patient is as clear today as it was 35 years ago.

My memories aren’t just because of my fear and anxiety over participating in my first medical emergency though that of course is a big part of it.

It was also because a patient I had connected to died and I couldn’t help him. This particular experience really brought home to me what nursing is all about. It’s the sort of experience that made some of the 17 year-olds I worked with hand in their resignations!

For me it gave me a deeper understanding of what nursing is all about.

Nursing is about connecting with people, caring for them, helping them and saying good bye. And the goodbyes can be either  happy and sad.

So that was my first arrest! how about yours?

photo courtesy of www.hospital.com

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Does ACFI truly capture how long we spend with each resident and pay enough?

Tuesday, May 4th, 2010 by shoils

Those of us that work in aged care appreciate and share the frustration and hurdles we have to deal with when it comes to the new funding tool ACFI (aged care funding instrument).elderly

When we first changed from RCS to ACFI many of us were sceptical and saw that we were going to lose a lot of much needed dollars to look after our resident, but were happy that the documentation required was going to be sliced and thus give us more time for direct resident care.  We were all told to give it a chance and told that in the long run we would see that the system change was for the better not worse.

Now that ACFI has been up and running for 2 years we still are having issues with trying to reflect the true needs of the resident and the amount of time it takes to care for them and thus getting the correct amount of funding.

Let me give you 2 examples that I have come across where because of the assessment and the fact that they do not correctly capture the needs of the resident I am not being adequately funded for either resident.

I have a resident, he has dementia, he is diagnosed with dementia, he is soooo confused, but for some reason his short term memory is excellent, he has a history of absconding and falls +++.

When I conducted the PASS (the cognitive skills assessment) on him, the final total score indicated he did not have any cognitive deficit (much to my surprise) so we could not claim anything. There is no section in the behaviour management section for absconding residents (which requires many hours of supervision) and because he is quite mobile despite his unsteady gait the funding is low. Our nurses spend a lot of their day providing supervision, assisting and helping him and yet he is classified as low care. The assessments do not capture the correct picture of him.

Another resident I have is classified as high care for some things as we need to provide full assistance for all of his personal hygiene but he is very mentally alert and he is very fussy about everything. To give him a shower takes 45 minutes because he likes things in particular order and done a certain way.

There is no assessment in ACFI to capture this. He takes a lot of staff time wanting to talk about issues in the home and discuss things that are going on during the day. He comes to the nurse’s station and talks to staff taking up a lot of their time and once again there is no assessment to capture this. We cannot put it down as intrusive behaviour as it isn’t. He is coming to us to talk for a reason this does not classify as a behaviour.

So what are Aged Care nurses to do?

This story is common across the board and we cannot get it through to the government that they are not funding us adequately and that their assessments are not true indicators of how things are. I do not believe that it is because staff is not efficient enough, or working smart enough. The government needs to understand that we are dealing with people and more to the point elderly people that are not always acutely ill and just lying in a bed. It does not take 10 minutes to attend to them, and then we move on to the next one.

The assessments need to reflect the real issues that nurses battle and that effect their time management.  I don’t understand why they don’t get nursing home staff to help develop their assessments and not people that once upon a time used to work in Aged Care.

What do you think about the ACFI tool? What are your stories and frustrations surrounding government funding?

image source (http://www.fotosearch.com.au/photos-images/elderly.html)

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Murder in Chatswood

Thursday, April 29th, 2010 by shoils

I am sure everyone has by now heard about the murder that occurred in Chatswood on the 27.4.10.

stalker

This murder took place around the corner from my workplace (that is a scary thought in its self) but reports state that the murder may have been by the victim’s patient.

The report doesn’t say that she works in the mental health field but it does say that they suspect that it was one of her mental health outpatients.

It is very worrying to think that the patients we look after, whether we work in mental health or not, can get a hold of where we live, who our family members are and our personal details. How does this happen? How is it that our personal details are so accessible to the people that we look after?

I have a very close friend that works at Long Bay as a mental health nurse. She once told me that they are not to bring in their mobile phones to ensure their security and to keep as little detail of their personal life out of the facility. This may make it harder for her patients to track her down in the outside world but in reality all they need to know is her full name and they can track down her address, phone number, and who her family is. It is not hard.

When I was in training I did a placement at Rozelle Acute Mental Health Hospital and one of the nurses there told me about how she had to move house because one of her patients stalked her when he was discharged.

According to law our work place is not allowed to disclose any personal details to anyone, including fellow work mates but in today’s day and age is this enough?  When this law was passed we didn’t have internet and whilst back then this may have been enough to protect nurses from patients or their relatives from finding us but now it is all too easy to look someone up on the internet and find all of their details. So how are we supposed to protect ourselves? Would it be wrong if nurses remained anonymous at work? Or, we use nick names instead of our real names?  And our  name badges have our selected names on it instead of our real names?

How are we to protect ourselves from patients finding us and causing emotional/physical  harm?

Do you have any suggestions? Have you experienced a scary situation with a patient or their relative? Please share your stories or Ideas.

Image source (http://www.fotosearch.com.au/photos-images/stalking.html)

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Malnutrition Allegations in Aged Care (Part 2 of 2)

Wednesday, April 14th, 2010 by shoils

man on scales This is the second part of this article. Please go to Part 1 if you have missed it.

The DAA suggests that we catch the problem early and monitor food intake in our residents. Every facility, no matter which provider they belong to, should have some kind of a food intake monitoring form. If you are concerned with intake you don’t need a GP or dietician approval to start one of these, you simply state in the residents notes that you are concerned about nutritional intake and you want to start investigating, thus you are commencing a food intake form. This is where who ever is the person to feed this resident/pt needs to be diligent in documenting exactly what he/she ate for that meal. All 3 shifts must do this for however many days the form stipulates.  Then, when you have evidence that intake has in fact decreased you can raise your concern with the GP or dietician. They will be pleasantly surprised that you have already completed the form and have the data waiting for them. Then you can start other investigations like find out if they are in pain, are no longer able to eat on their own, have problems swallowing, are becoming depressed, decreased cognitive ability etc.

The other way you know if someone is getting malnutrition is by regularly weighing them. They may have a great appetite but may not be absorbing  anything. At our facility we weigh people monthly and have a special obs form that it goes into and I as the care manager type it onto a special excel program that our IT department developed, and it  shows me if someone is starting to become malnutritioned. When I can see someone is starting to lose weight, according the amount of weight the person has lost I am to follow certain directives to try and reverse the malnutrition process. You don’t need a fancy system however to tell you there is a problem, all you have to do is weigh them and write it down somewhere in their file, if there is a weight loss do some investigating, consult their GP and their family maybe they have an explanation, or have noticed something that you haven’t.  There are also a huge range of great products now that help boost protein and caloric intake which I am sure you provider already has or can easily order, and these days they come in lots of different flavours that your residents will love.

You may not be able to stop everyone from becoming malnutritioned, but you can reduce the numbers with very small simple steps. Simple observations in behaviour, intake, and surroundings will prove very useful in aiding you to look after our frail and aged.

How do you feel about the statistics of malnutrition in our elderly? How have you helped a person from becoming malnutritioned? Have you witnessed some poor practices that have resulted in malnutrition?

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Infant Mental Health

Wednesday, March 31st, 2010 by patience

baby playingI have been really busy over the last few weeks going from community group to community group talking about the mental health of babies. Suddenly, it seems as if the word has got out that babies really do have an emotional life and parents want to know about it.

When I finished my Masters’ degree in Infant Mental Health four years ago, there wasn’t a nursing job to be found that required the qualification of Infant Mental Health. Now, it seems that things are changing fast and this mental health nursing specialty is finally coming in from the cold. Positions are appearing more and more frequently, especially with the new state policy directions in perinatal mental health. Read the rest of this entry »

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Posted in Nursing - Midwifery | 2 Comments »

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