One Down!

So that’s it, placement is finished!

I’ve really loved it. Over the last few weeks honestly it feels like I’ve properly thrown myself into it, and really enjoyed everything that I've been doing. It’s gone so quickly, and I won't pretend it’s been easy- trying to juggle a family life and placement as well as writing an essay and making sure that was in on time- but it’s definitely been worth it. It’s 100% made me realise I've chosen the right career path. 

I’ve done so many different things and met some really interesting and lovely people. My mentor has been absolutely fantastic, and the other nurses that I was working with were lovely as well. I feel so lucky that they were such a lovely bunch of people, and they made me feel completely comfortable and able to be myself around them. I was quite pleased as well that my mentor said my communication skills with patients was really good as well, but I honestly think that comes from years of working in a bar and talking to every kind of person! We’ve had some really interesting and varied patients, which has been really good as I’ve been able to experience a lot within quite a short placement. I think I've grown in confidence as well, I feel like I’m able to talk comfortably to patients now and I don’t feel so awkward and nervous about it. I like community nursing a lot more than I thought I would. 

I’ve found out I’m not as squeamish as I thought I would be as well. 

There’s been so many interesting patients. We had one wound which had to be packed daily. Originally it was thought it was an abscess which the patient had had lanced, but it turned out to be a fungating tumour. We had asked plastics to reassess them and they had taken biopsies, and the medical diagnosis was non-Hodgkin’s lymphoma. The patient had deteriorated over the 3 weeks we were seeing them, and we had to phone an ambulance on our last call to have them taken to hospital. So it was good to see why accurate nursing notes are important to keep as it means that when different nurses visit patients, then they can see if there’s anything unusual going on. 

I’ve been able to give some injections as well which was good as I was quite nervous about that for some reason! They were mainly tinzaparin ones as I had built a relationship with that patient, so she was comfortable with me giving them. I’ve learnt a lot about wound-care as well and the different types of dressings/packing, and why it’s used, which I know is going to come in useful over the next few years. I also got to see male, female, and suprapubic catheters being changed, and did a number of palliative support visits as well as helping set up syringe drivers. We also did one bereavement visit after a palliative patient had passed away. I was a bit nervous about that call because I didn’t really know what to expect, but I think the family were prepared for it, and they were happy that he was comfortable in his last few days more than anything. 

Over the last few weeks I’ve really familiarised myself with all of the paperwork required for community nursing, which has involved a lot of different care plans, initial patient assessments, patient notes, skin bundles, nutrition pathway documents, syringe driver documents, and risk assessments. It’s been good because I’ve been quite confident in filling these out as well, and even got together a few new patient notes folders myself. My mentor was really helpful in showing me how to fill them all out correctly and got me to do it for a number of patients as well, which I definitely think boosted my confidence. She also showed me how they order patients equipment as well, like the EHOB cushions and other pressure relieving equipment. It’s a little bit like online shopping ha!

I think what has surprised me most is that my mentor trusted me with a lot. I’m really grateful for this and it gave me confidence in my own ability. She would ask my opinion on things (I’m sure she already knew but I feel like it was to build me up) and trusted me to prepare dressing packs for patients we were visiting the next day, as well as doing a lot of complicated dressings myself. She also got me to phone GP surgeries and patients about prescriptions and things. It might not seem like a big deal, but it feels like it to me. We had quite a complicated patient about half way through the placement as well, they had Huntington’s disease and really struggled to communicate, and his condition had recently deteriorated quite a lot. A family member of his had LPA, and he was being referred for a capacity assessment and CHC, as he was not engaging with care and it was becoming detrimental to his health. It was really interesting to see the entire process of this, and it was good to develop a relationship with the patient, as his communication needs we’re a lot different to other patients I had met, so I feel like I definitely learnt something. I got to sit in on the CHC meeting with my mentor as well, as they were trying to move the patient into a suitable placement instead of having him live alone. This was along with family members, a social worker, and a Huntington’s specialist nurse. It was a really good experience and seeing how different teams come together for the good of one patient was really eye opening. 

I’ve managed to get quite a lot of my competencies signed off, which has been great as we don’t find out what our next placement is until mid-August, but it takes a lot of the pressure off as well. I managed to get my dignity essay finished as well, which is great, I just did a bit every evening and managed to finish it the week before the deadline. 

So, all in all it’s been really good. 

I got my mentor and the other nurses a card and some chocolate when I left because they genuinely were really lovely to me. 

Exams Exams Exams

 Exams, and all the things that come with it. 

That’s pretty much what the last few weeks has been about. Placement is creeping closer and closer, and this week we finished our last exam until afterwards. It’s been a while because honestly the last few weeks has been a bit mental, personally and academically. Calum’s been super stressed and tired, he’s been working so many hours trying to make us a bit of money, whilst looking after Alys, as well as trying to do all the leftover DIY jobs in the house and get the garden sorted for summer so it’s safe for her to play in. I’ve been trying to help as much as I can, which is hard when I’m in uni on weekdays, I don’t get home til after 4, I give the baby her tea as he goes to work at 5, entertain her for a few hours, do bedtime, and by the time I get to eat my tea and get on with stuff it’s gone 9pm. There’s just not enough time in the day, and I worry that he’s unhappy with it all. She’s been teething like a monster as well which has made things (bedtime!) a lot more difficult. Thank god for calpol!

Aside from that, my best friend just had a baby she didn't even know she was pregnant with until 4 days before she went into labour, so it's all been a bit chaotic. Luckily the baby is okay- she was born at what they think was 35 weeks- she's a bit small but she's doing good. It's mad though because she's the same size Alys was when she was born, and she was full term! The mum's doing okay, it's obviously a bit of a shock and I said to her that I think the stress of finding out she was 8 months pregnant (no bump or anything!!) probably sent her into early labour. It's a good thing I kept all those baby clothes!

 AND

 Alys's godparents also had their baby as well, although she was actually planned, and they had to spend 3 days in NICU as baby got stuck on her way out and had some trouble breathing. They both look like they're getting on well with it though, although I have been sharing more PND mental health things on my facebook- it's really hard to be a new mum especially as there's so much pressure and people telling you to 'enjoy it'. Honestly if anyone says that to me if I have another one, I'll probably snap. There's not much enjoyable about raging hormones, sore nipples, sleep deprivation and stitches in your vagina!! 

So many babies around at the moment. Sometimes it makes me feel guilty about not really enjoying having Alys at first. I really struggled with my feelings and everything, and I know Calum did as well, and that whole first 4 months of hers is just a blur of trying to get through it. I was lucky that I managed to speak to people about it, and I think my love for her came gradually instead of in a 'rush'. Couldn't be without her now. 

So, anyway, we had the handwashing exam (which I passed!) as well as the MCQ, the recognising the sick patient practical, and the safe medicate exam. 

The MCQ wasn’t actually as bad as I thought, although some of the girls were really anxious about it and kind of overanalysed it afterwards. I guess that’s just human nature, but to be honest I said to them before we went in that you only actually have to get 14/30 right to pass. I think they probably think I don’t care about some things, or don’t get nervous, but the reality of it is that stressing about it isn’t going to make you do any better. I’ve reached a stage in my life now where I just try and take things as they come- if you can’t do anything to change the situation then there’s no point worrying about it. But maybe that’s just me. I care about what I’m doing without a doubt, but I know there’s no point letting it effect my mental health, that’s not good for anyone. I think the one I found the worst was RSP, but that was mainly because I hate the idea of roleplaying- I can talk for England in real life but ask me to pretend and it’s so far out of my comfort zone ha! 

The exams went well to be honest: I got 93% in the MCQ, passed handwashing and RSP practical, and got 100% in the SafeMedicate one. I probably should be more proud of myself really. I think a lot of people put stuff on Facebook and things, but I’ve never really been one for bragging about grades and all that. I think sometimes it can feel like a bit of a competition- who did better than who- but I hate that and I’m just happy to pass. Let’s face it, in 10 years’ time nobody is going to be asking what marks we got on an MCQ exam in the 1^styear, are they?!

But I will admit it does make me feel a bit more like I’m doing the right thing. The mum-guilt is real. 

So now all that’s over and done with we’re back to full on lectures until the end of this week, when we have a reading week before placement. I’m still anxious about that to be honest, it’s like the first day of a new job all over again, except this time I probably have more to worry about than just spilling a pint of carling! A few of the lectures in this module have been really interesting though, although I did find one or two of the mental health lectures really hard to sit through. It sounds ridiculous because I really would love to raise awareness about mental health post-baby (for men and women) but one of the people we had in to talk to us took me back to when I was a lot younger and really not very well at all. I guess it was a bit triggering in a way, hearing her talk about attempted suicide and everything to do with it, I spent a lot of my younger years in a really dark place and on a lot of medication, speaking to a lot of people and generally thinking I wasn’t good enough for anything. I mean, I’ve been better for years now aside from the too-common post-natal blip, but I wouldn’t really count that as I was aware of how I was feeling and went to see my GP straight away once the intrusive thoughts started. But there was something about sitting and listening to the talk that really reminded me of how I was, and it took me back to my very poorly 19-year-old self. 

We’ve also done a few smaller group work seminar-type things which have been helpful. I think it’s because I enjoy more of a discussion about things instead of being talked at all the time- which most of the first module was. I know it was because we had to take in a lot of info starting the course, but I feel like I get more out of smaller groups and being able to talk about it, and I know most of the other girls feel the same. 

I did start feeling bad this week though because I think I talk too much, or ask too many questions, but I think I probably just have to remind myself that we’re here to learn, and honestly these sessions would be really awkward if we all just sat there in silence! 

We found out our placements and I’m with one of the Community Nurses.

I’m really happy about this to be honest. I mean, I’m a little worried about being in a car all day with the same person, it’s such an intimate space and it’ll kill me if I don’t have someone who can hold a conversation. I appreciate we’re there to do other things and not just socialise, but it makes the whole situation a little bit easier really if the person you’re spending most of the day with has a sense of humour! I think I’m just a little worried as well because I’ve never done anything like this before. A lot of the other people in my cohort have care experience or already work in the hospital in some manner, whereas I’m just used to pulling pints and telling off drunk people! It sure is going to be a massive change, but I think that’s why I’m glad I haven’t been thrown straight into being on a ward, it’s not as much of a baptism of fire. It’s good as well because I’ll get to meet a lot of different people, but also see how nursing works in a setting other than the hospital, and what the NHS does for people who have care in their own homes. I think it’s probably a completely different experience to being on a ward. 

It’s been a good few weeks though, as well as a busy one. I’ve just got to wait for my placement mentor to ring me back to arrange the first shift- hopefully Monday- so then I know what time I’m starting as well. I think it’ll all seem a bit more real as it gets closer. 

My life after uni this week has been this: 

Easter Time and Exam Revision

Easter Holidays and the rest...

It’s currently the Easter holidays- we’ve got 2 weeks off before exams start in May, which is quite nice as it means I can fit in some much-needed family time before things start to get crazy before placement. I have to admit it’s really hard to try and juggle the whole family/university thing. I feel extraordinarily guilty that Calum takes care of the baby all day, he’s super stressed trying to do the work for his master’s degree and works nights as well. He doesn’t complain or mention anything to me, but I know he’s really feeling it. We’ve made a lot of sacrifices for me to be able to do this, I just hope it all works out. It’s been nice to spend time with Cal and Alys though, his dad came to visit for a weekend as well, so we went to Folly Farm with him and his sister- who’s actually studying at UWTSD as well. The baby really enjoyed it, and the weather held out for the day- so it was sunny at least!

So, exams are getting closer, me and the girls had a study day this week where we all practiced for our RSP exam. It was nice actually to see them outside of uni, we probably did more chatting than actual practicing in the end. We’ve got the handwashing exam and the MCQ all within two weeks when we get back as well. The handwashing should be okay, it’s probably the shortest exam I’ll ever do, I’ve just got to remember to avoid touching the basin or taps so I don’t have to start the whole thing again or fail. We had a bit of a revision session on the MCQ whilst we did the study day as well, it’s only a few subjects we need to know really, so I’m just going to try and go through it the best I can over the next few weeks. 

It’ll be nice to get back to lectures to be honest, after Easter there’s about 2 weeks of limbo around the exams, and I much prefer having structure to my weeks so I can plan when I’m doing things. It doesn’t help that we’re absolutely skint as well, but hopefully getting the bursary at the end of the month will help with that aspect of it all. 

Anyway, not much to report as it’s not term time! 

End Goals and the Basics

Basic Life Support, Manual Handling, Clinical Observations, and Bone.

That’s what we’ve done the past week or so. It’s been a short week, which is- I am led to believe- a rarity when it comes to this course. I’ve been quite glad of this to be honest, it’s been nice to have some down time with the baby: I feel like I’ve been missing out on quite a bit with her. She’s started walking this week, and I’m so glad I didn’t miss it. 

But let’s not get into the whole mum-guilt aspect of what I’m doing. I refuse to open that can of worms until I’m at least a few glasses of wine in. 

So- CPR. That’s basically what BLS is- for the first year at least. It was quite interesting actually, the practice suite we were in had these fancy CPR dummies where they tell you if you’re doing it right. It’s a far cry from the ‘annie’ dummies I trained on as a lifeguard when I was sixteen! 

It’s really tiring! I can see why you need a whole team of people to continue longer than two minutes. The average cardiac arrest lasts about 30 minutes, or until a doctor calls time, and we replicated this in teams of four- ten minutes in we were all sweating. My hands were actually bruised from it! It’s quite daunting really, thinking that now- even as a student- if something happened in the street we have a duty of care to act as we have the training. We have our first MCQ exam in May and there are elements of BLS within it, so I think I’m definitely going to have to revise the whole ‘DRSABCD’ process so I know it properly. 

Manual handling was something I haven’t done before. To be honest, there’s no real way to make it exciting- but the training has to be done before we are allowed out into clinical practice. Anyone working in the NHS in Wales- student or not- has to have their Manual Handling Passport signed off before they can start work. It’s good really, because, in theory it means that everyone is trained to the same standards. Although I am sure out in practice there are instances where ‘shortcuts’ are taken, as is usually the case with things like this. Fingers crossed it doesn’t happen, mainly because I’m imagining it would be daunting to say, ‘this isn’t the right way to do something’ to people who are actually qualified whilst I’m only a student. 

What is interesting though are the ingenious ways there are to move people who can’t move themselves! All sorts of hoists and machinery!

I learnt how to manually take blood pressure.

Honestly it is about as faffy as it looks when someone else does it for you. The concept, when explained, is actually fairly simple. The reality is not- especially when your patient has an awkwardly placed brachial pulse! It’s definitely something I’m really going to have to get used to, I’m ordering a sphygmomanometer online so at least then I can practise at home. We have an exam on that in the second week of May. It’s only a formative exam so if you do get something wrong you can do it again until you get it right, which is a bit reassuring I guess. They just want you to know how to do it, even though mostly in the hospital it’s all automatic machines. 

What I have really enjoyed so far is the nitty-gritty learning about the human body. It’s so fascinating, all the microbiology and anatomy. I understood a little bit before from the access course- but we’ve looked at viruses and different types of bacteria that live in different areas of your body, and what it can do if it gets into the wrong areas of your body. We did a class in the anatomy lab, which was about the skeleton and the structure of bone- we actually got to hold and feel real human bones, which had come from people who had donated their bodies to science after they died. It was kind of weird to be honest, thinking that these were actually inside of someone. Three of the skulls that we got to examine were from children- a one year old, a stillborn baby at full term, and a foetus. That was bizarre. We were told usually these smaller skeletons were usually donated by families who worked in science and medicine, as they help towards research. It’s quite sad really, but it’s also such a nice thing that these families donated them, as it enables people to learn about them. 

I’ve been thinking about our first placement as well. I’m quite nervous, I’ve never done anything like it before and it’s daunting. For my first placement, I’m actually hoping to get a community placement or something like that. The end goal is to work with women before and after childbirth- not as a midwife as I don't want to deliver babies, but after everything I went through with Alys I feel really strongly about honest communication about the mental effects of having a baby and everything else that comes with it. I think it would be a nice ease into clinical placement and what’s required. The main reason I did adult nursing first is because my health visitor and midwife both told me to, they said it’s better to go through and do adult first, and then do a short course after in paediatrics. 

I know there’s going to be placements I don’t enjoy as much as I should, and things I’m going to have to do that aren’t nice, I just have to think about the end goal.