On the receiving end of nursing

The last few months have been difficult, if I am completely honest. This difficulty has come to ahead recently following the death of two relatives. Its has given me great opportunity to reflect on being a relative of a patient as opposed to delivering care as a nurse. Today, I will write only about the story as
a person involved in receiving nursing care in hospital.

My Aunts Story

Cared for at Churchill Hospital (Oxford University Hospitals NHS trust)

My Aunt was 58 years old and was first diagnosed with breast cancer in 2006, not long after I had left home to attend nursing school in London. Initially she had a breast lump that she had found, but delayed  an appointment with the GP as she was going through a painful break-up with her partner. When my aunt finally did see a doctor she was referred to an oncologist and in a nutshell underwent a bilateral mastectomy. According to the surgeon, it was approximately the size of a tennis ball at that point and they had also found another golf ball sized tumour in her other breast. Following the operation, my aunt went through an aggressive regime of chemo-radiotherapy. She suffered hot flushes, fatigue, lost her hair and her skin went very pale. She slept a lot during the day and the hot flushes were so bad that you could feel the heat radiating from her head, her eating became irregular but she kept her motivation to beat the cancer. She remained positive throughout and to this day, I may not have been especially close to her but I have great respect for the positive attitude, spirit and bravery she had during her treatment. It astounded me that she could still laugh and be positive in a situation that could defeat most people. Eventually sometime after the treatment, my aunt went into remission, the earliest I remember this being the case was after I qualified, sometime in 2009 and sure enough my aunt built up strength to start rebuilding her life, but this had many mishaps along the way. She was monitored closely after she completed chemo-radiotherapy and her consultant at the hospital was sincerely attentive, kind, thoughtful and full of compassion, in short a model of a doctor who took good care of my Aunt through her whole illness not just as a doctor, but whom my aunt came to regard as a trusted friend.

Sometime around summer 2012, my aunt began to suffer neck and back pain, almost to the point where she couldn't get up or walk for long periods of time. As before, she delayed seeing her GP due to work and social commitments. She began to vomit severely, she lost weight and became very weak, to the point my paternal grandmother began to care for her. After becoming so ill, she was admitted to hospital where her condition gradually deteriorated and my Gran had to helplessly watch. The consultant who had cared for my aunt during her whole illness attended her and my aunt underwent MRI and CT scans and had a multitude of other investigations. A long story short, my aunt had metastatic spine and stomach cancer that had spread to her lungs, bone and brain. I had the news told to me directly by the consultant's house officer, who again was a model of compassion, kindness and sympathy. I believe she will surely make a fine consultant physician one day in the future...without a doubt I cannot fault her care. The nurses who cared for my aunt on the ward, also deserve high praise. The were kind to my aunt and held genuine high standards in their care delivery. They communicated with her and my family, did their utmost to manage her pain and endlessly encouraged her to eat and drink, and they didn't hesitate went she needed help. I was especially glad that in particular one nurse was a friend of mine, who I had done my nurse training with in London, the familiar face was a certain comfort.

The ward arranged transfer of my Aunt to a hospice nearby where again, my aunt was cared for exceptionally well. I'm very glad of this and made it a point to thank the matron and all the staff on the oncology ward for their hard work...words cannot express my gratitude adequately. My Aunt was cared for in a wonderful environment, where we could visit anytime, we could bring the family pet dog and my aunt was given all the pain relief and anti-sickness she could need. Alcohol and her favourite foods was also available to her and she was helped to take her first bath in a while, which she described as "Amazing". My aunt wanted for nothing.

She died early in the morning around 8am on January 2nd 2013, she was on her own, but I take comfort in that she was not alone because she was in the best hospice I know. I will always be grateful to the staff at the hospital and the hospice for their first class care. They made a horrid situation a little more bearable, if anyone can say the same about the care I give them, I will be a very happy nurse.


My Grandma's Story

Cared for at James Cooke University Hospital in Middlesborough

My (Maternal) Grandma was 83, and lived with my Grandfather in a small village in the north Yorkshire dales. One day in May 2012, my Grandparents were driving home from the supermarket during a very warm day after some lunch. My Grandfather unfortunately suffered a sudden cardiac dysrythmia and blacked out at the wheel of the car. According to hospital staff, my grandparents car collided with a tree, span out of control across the road and collided with another oncoming car. They were both airlifted to the regional trauma centre at James Cooke University Hospital in Middlesborough.

Sadly, My Grandma suffered the most significant injuries. As soon as I received the message about the accident from my mother I contacted the A&E department directly from home. I spoke to the sister, and she confirmed that my grandparents were there and then kindly explained a little of their injuries before handing my call to the registrar caring for my grandma. She had suffered bilateral fractured femurs, a fractured tibia, a colles fracture on the left wrist, a possible vertebral neck injury and a lacerated kidney and liver. Sufficed to say, the situation did not look good, but all the staff took time out of their very busy day to calmly and kindly explain the situation to me without once making me feel as if I was causing them extra work, they made me feel confident in their care.

Following orthopaedic and renal review my grandma was admitted to ITU and prepared for emergency orthopaedic trauma surgery to repair her legs. She spent 3 weeks on the intensive care unit where the one to one nursing care was superb, they had all her needs under control and the nurses were calming and personable when it came to dealing with me and my family. Nothing was too much trouble. they communicated with us at every opportunity. provision was also easily made for my grandfather (who was on a nearby cardiology ward) to visit whenever he wanted. It may not be directly relevant, but I noticed the staff's hygiene to be of an excellent standard whenever I came to visit my grandma.

After about 3-4 weeks my Grandma was transferred to a trauma ward, where even though the nurses were busy, they always had a smile on their faces and a positive attitude towards their role. My Grandma was well fed, given physiotherapy to help her begin to get up, she was helped to wash and thanks to their wonderful care, left hospital and went to a rehabilitation unit without a mark on her skin!

During her admission, my grandma's doctors discovered a a suspicious lesion on her head CT scan, more specifically a lesion on the frontal lobe of her brain, which after extensive consultation with neurosurgeons turned out to be a meningioma. The decision was made to observe my Grandma's condition but it would be unnecessarily cruel to put her through invasive neurosurgery following her significant injuries, her age and frailty being a major influence.

Sometime after her admission to the rehab unit my Grandma became increasingly disorientated and withdrawn, her memory deteriorated but nevertheless she was at a stage where she was fit enough to be discharged. After a monumental effort on the part of the staff at the rehabilitation unit and my parents, my grandmother was discharged to my parents house on 31st October, where my parents and Grandfather tirelessly cared for her with the help of some carers and one particularly kind district nurse, who I had known when she was a student during a placement on a ward I had worked on, once upon a time.

Sadly my Grandma's memory deteriorated further and my family were unable to cope with her care needs at home and she was again admitted to another hospital in December, where she was cared for during investigation into her decline in general health. When I met with the staff, the ward sister was a kind and gentle woman, with the patient listening skills of a saint, I was made to feel welcomed by all the nurses who never allowed care of patients to suffer despite their difficult working conditions, I was never made to feel a nuisance and was treated with care myself. Eventually, my Grandma's conditioned deteriorated to a point where her treatment had become futile, but the care remained at a high standard. I was kindly visited by an American doctor who had initially assessed my Grandma on admission. She took the time to talk to me and just ensure Grandma was warm and pain free and just generally see how she was. She held my Grandma in high esteem, she also took the time to ensure we were cared for and she was there right until the very end. Grandma died on January 3rd 2013 in hospital of a frontal meningioma with significant intracranial oedema. Even at the end, the nurses searched for me, trying to contact me to come to the ward, and finally they found me and I was sent to the ward by my senior staff nurse on duty. Her efforts to reach me despite not knowing where to begin the search, ought to be commended, for no other reason she will always have a special place in my heart.

I've not simply wrote this because I want to make my fellow nurses look good in light of bad publicity, I have genuinely had an exceptional experience of nursing and medical care of my relatives. I will forever sing their praises and cannot fault them. I will ferociously defend them against bad word simply because they gave us a wonderful experience that gives me faith in being a nurse. Despite all the negative publicity nurses and the NHS receive, I was always be their number one fan...I just happen to be a nurse too

Keep doing what you do my fellow nurses, you've made me proud!

The game of consequences

Considering consequences is something that plays a pivotal part in a nurses decision making on a day to day basis, that is not news to us as a profession. Sadly, I have come to think about the consequences of our actions in light of the tragedy that has befallen us as nurses in losing one of our own in such unfortunate circumstances. My heart goes out to the family of Jacintha Saldanha, I wish them well in recovering from this horrible situation.

The situation did however make me think about considering the consequences of our actions. The fact is, if we as nurses do not stop to think about our course of action and the likely possible outcomes based on passed experiences, it could lead to people suffering and a scenario from which we can't go back. When I think about my past experiences, I think about the things that I would have done differently. Itq doesn't matter how much I try to imagine the things I would do differently, I made a mistake and it isn't the first time and it won't be the last. The differences is, I stopped to consider my actions at the time and after and I learnt from it. It is when people don't stop to think, that the outcome can be disastrous.

I happened to watch an interview with the two radio DJ's, involved in the hoax call to the King Edward VII Hospital on an Australian news channel, and although the two DJ's sounded genuinely sorry for what happened, the words "We didn't think" really hit home and I just couldn't get this phrase out of my head when it comes to the idea of consequences. Seriously, what does this interview have to do with nursing?

Whenever I have heard about serious mistakes or errors in practise that has resulted in harm or severe consequence to our patients the common theme I seem to notice is the lack of thinking prior to taking some action. In the end the two DJ's also said they were sorry and it was not what they planned. I don't doubt they are sorry but all it demonstrated to me was the lack of insight into possible consequences for the people on the receiving end of the joke.

We as nurses learn that making a mistake is an inevitable part of practise and that we are humans, not robots. There does come a point however when our patients would question whether we had really considered something prior to taking action if the outcome is dire or considered preventable. Cases such as those going to professional competence and conduct hearing at the NMC are full of cases where nurses did not stop and think, the exact same thing as these two DJ's .

All that aside, I also noticed that despite the practical job not going to plan, these to DJ's continued with the prank, it was meant to be fun, it was done everyday, they thought they would be hung up on, the outcome wasn't thought about, they were doing their job and when it came to the decision of airing the practical joke on national radio...the decision was out of their hands. I also might add, that these were their own words, uttered from their own mouths at interview.

It was like an epiphany, it was like so many stories in nursing where things had gone unintentionally wrong, the likeness what strikingly similar and I thought, surely there is a lesson nurses can take from this? The most obvious being, even when a situation seems normal, day to day practise, we still need to stop and think and make sure we are absolutely sure of our confidence in what we are doing before we pursue it, otherwise we may end up uttering the words to an NMC investigation panel "I didn't think"

Sadly, these two radio DJ's are finding out the hard way the consequences of not stopping to think. It has had the most tragic of outcomes, that in my opinion could have been avoided. Unfortunately for them, like many nurses who went wrong because they didn't think, they have to live with those consequences for the rest of their lives. Just something to think about.