Our NHS – Enhancing Patient Experience #7

In the late 80’s I signed up for Enrolled Nurse Training. Over the next two years quite a lot of our time will be spent experiencing what it is like to be a patient:

Spoon feeding & being given drinks; the inevitable bandaging (at which I couldn’t be anything but ace thanks to my Mummified Red Cross friends & family), being hoisted (certainly taught me how much trust you need & why some patients are so scared: especially if they are a bit confused or fragile).inject orange Injecting oranges with water (yes really!).

Bringing in our swimming costumes so that we could be blanket bathed & have the bedding changed, even on one occasion being “blinded” & “deafened”, then having small bean bags strapped to joints so that we could experience what it was like to have arthritis.

We learned how to do base-line Obs (Blood Pressure, Pulse, and temperature & respiration rate) on each other: technological innovations which sped the process up had yet to arrive so that when we did get out on the Coal Face we actually had to look at & interact with people. We learned to “take” a pulse with our fingers &  could feel if it was regular or not, thready or strong. We could watch the rise & fall of a patient’s chest & see how easily they were breathing & came to understand the significance of what we were observing. And spending this time could give us scores of other useful information we might not get by asking. Yes it might have taken longer to do, but in the long-run potential problems could be identified much faster in my opinion.

There were of course LIMITS. You can’t have major surgery, be defibrillated, catheterised & the like just so you know what your patients are going through.

We were also during our pre qualified phase, exposed to a variety of different specialities to help us gain experience, knowledge & skill. Perhaps the most valuable of these was time spent in Theatres. I don’t know what my peers thought about all of this, at 27 I was the “oldie” in our set, but for me these experiences were very grounding (not a word I would have used then!). So much so that when I got set loose on “real” patients, I took far more care than I might otherwise have done.

As Pupil Nurses (Enrolled level) we didn’t get to spend much time in general or orthopaedic Theatres, but the School of Nursing still made sure that we had exposure to the “big” surgery: hip replacements, laparotomies (investigative abdominal procedures).  This was priceless. It helped us to understand why, when presented with someone with a big scar on their hip & sunset bruising aplenty needed pain-killers before they moved. It gave us some appreciation & insight into the reality that people had been sliced open, stretched, had internal organs manhandled while unconscious & medicated up to the eye-balls felt like pants post-operatively.

I did however, get to spend a “block” in Urology, which was a real revelation: thick tubes inserted into urethras (the tube which attaches to our bladder), the removal of bladders & kidneys, all further exposed me to the reality that surgery is invasive & that afterwards you are going to be in pain! Patient’s worry about “bursting” internal stitches could be reassured that the sutures used to stitch them back together were stronger than fishing lines used for Marlin & Sharks and would stay put!

Times change & that isn’t necessarily a bad thing, but I do wonder about what goes on today, I had been told some time ago that Student’s no longer have to do a block in Theatre & if this is the case, it’s a big shame.

I don’t want to sound like one of those Dinosaur Nurses who stomp about saying “In My Day it was Better” because not all of it was, however, I do want ask Nurse educators & staff what happens these days to enhance some sense of understanding of those patient experiences which I think it would be reasonable for them to share.

To illustrate: While I was at St Trinians for my surgery, I had a conversation with one of the team about the Pre-Op drinks which patients are expected to drink. drink My preferred method was just to glug them down because I didn’t find them at all pleasant. The person in question replied “yes, I know some women like them & others really struggle…”. “Have you ever tried one yourself?” I inquired. “No I haven’t & I’m not sure I would want to…”

The Dinomap machine used for taking base-line obs these days along with the aural thermometer could easily be experienced. Give me a good old-fashioned Sphygnamometer any day, the vice like grip of this chilling machine is excruciating – all the more so when the nurse doing the task fails to use the correct size cuff & ends up squeezing your arm in an effort to stop the cuff from detaching itself. Not only is this very painful, it also means that the reading (if you can get one) will be inaccurate!

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Similarly, the “screwing in” of the temperature (thermometer) reader into one’s ear-hole, when just awoken is dreadful, as Dave P concurs. When it’s accompanied by repeated shaking of the probe & the words “I think the battery must need replacing” prior to being reinserted & screwed in a little harder in the vain hope that this will  somehow help the situation! It won’t. All it does is remove ear-wax & borders on torture.

So what am I getting at? Well I suppose it’s to say that if exposure to these types of experiences isn’t readily made, is it any wonder that some nurses may be perceived as lacking in “empathy” or compassion?

I would like all nurses working in surgery as part of their induction  to see at least one major procedure early in their career.

Pretending-to-sleep1Then spend four hours on a bed, with a drip taped to their hand(not in it), a catheter tube(not inserted!)strapped to their leg with a nearly full bag (with water), an oxygen mask on their face (not on 02) & a couple of bags of sugar wrapped in cling film secured on their abdomen (to recreate that post op feeling).

In addition a Dinomap cuff left on their arm for “convenience” sake & a faulty Sats monitor alarming away & then leave them to their own devices to drink, eat a hospital meal & move in the bed.

Oh yes & finally, give them the nurse buzzer for two hours before putting it out of reach for the last two.

Holly xx

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