Practice team blog
All posts from: November 2011
Patients should be as safe in hospital at the weekend as they are during the week. And from a nursing point of view we need to avoid that ‘nothing happens at the weekend’ feeling that patients can get.
It is important to maintain quality of care every day of the week. For example, patients who are being helped to get dressed should not be left in their pyjamas at the weekend or left in bed rather than being sat out in the chair.
It can be tempting for a mood of ‘it’s only the weekend’ to become part of the culture of care. Patients may not be having surgical procedures or going for X-rays during the weekend but they can still progress and develop from the nursing care that they receive.
It can be hard to keep up energy levels at the weekend as well as during the week. I remember it sometimes being hard to maintain the momentum during the weekend. It does require that wards and units be sufficiently well-staffed to avoid patients experiencing the equivalent of being held in a holding bay for 48 hours, waiting for care to ignite again first thing on Monday morning.
Weekends can be difficult for patients - particularly if they do not have visitors. The care that nurses offer can help patients to make progress in their recovery, whatever the day of the week it is.
Without even thinking I replied “washing patients’ feet!” Perhaps an odd answer but for me, somehow, it sums up what nursing is all about.
I remember busy shifts when decisions were made to only wash faces, backs and bottoms - getting the essential parts clean because the ward was so busy. It is easy to miss the feet off the list yet so many patients, particularly older people, cannot reach their own to wash them - even when they are well.
I often hear the word ‘basic’ used to describe core elements of nursing work and I worry about what this implies. To me, it suggests something simple and easy. Yet washing and dressing people, changing sheets when someone is critically ill in bed, giving a patient a drink or something to eat - these are all fundamental to comfort and recovery.
As we know, if you get these tasks wrong, everything else will invariably also be wrong. Patients have to be viewed as people and nursing cannot be broken down into small tasks where no one person has a complete overview of what is going on.
So, back to feet.
One of the greatest pleasures for me was to fill a bowl with warm water, put it on the floor and put my patients’ feet into it. Sometimes you could physically see the stress and anxiety drain from a patient’s face as they wriggled their feet in the water. Stopping for a few minutes before drying and moisturising the skin just gave us a little bit of valuable time to talk, for me to find out how they were feeling and what they were worried about.
Unlike other interventions - doing an IV or filling in an assessment - washing feet really is an act of kindness. It takes a little bit of time, but it shows that it matters to you that your patient feels clean, comfortable and ultimately, cared about. It is a lovely thing to do.
How ironic that one in four student nurses who responded to our survey had difficulty in getting a flu jab.
The NHS is running a huge Flu Fighter campaign, calling for all staff to get vaccinated to protect themselves and their patients this winter, yet students on placement - and their patients - are being denied the same protection.
But it’s not just the short-term implications we should be concerned about here. The students’ situation could be a sign of worse things to come if the NHS fragments more - which looks like an odds-on certainty unless the Health Bill changes radically before it becomes law.
Students who experienced difficulty in getting the flu jab were caught in a Catch 22-style situation, in which their clinical placement trusts told them to go to their GP for the jab, whilst their GPs sent them back to the trusts. Some finally opted to pay for themselves.
Like so much in life, it all came down to money. The trust occupational health departments would not vaccinate the students because they weren’t employees, while the GP practices said the students did not fit the criteria that would gain them payment from the PCT.
If the health service can’t organise free flu jabs for people coming into close contact with its patients and in its facilities, what will happen when a range of private providers come into the mix and budgetary responsibility for particular patients is unclear? Will they be shuttled back and forth between providers who deny responsibility for their care? I only hope that someone will actually provide the care they need while the accounts departments argue over who pays the bill.
When one of my nursing friends was on nights she used to have a sleep in one of the ward baths during her break.
We still laugh about it today as a piece of typically mad behaviour. But maybe it was not so mad after all.
In this week’s practice articles there is a discussion about research on the benefits of napping at night during night shift work.
The results suggest that restorative napping may be helpful in improving energy, mood and decision-making.
All nurses will be familiar with the struggle of staying alert and energised during a long and sometimes interminable night shift. Whenever the clocks go forward I always give a thought to the poor night staff who are having to work an extra hour.
As a newly qualified staff nurse I remember doing a pattern of nights that was seven nights on and six days off.
As the nights went on I would feel more and more exhausted and cut off from the world - living in a special night shift bubble where nothing happened other than me desperately trying to stay asleep when all my flatmates were awake and daring to talk.
In those days I had a duvet cover with a paisley pattern and sometimes during my night shift, when a wave of tiredness would hit, I could see the pattern before my eyes. I imagine that a restorative nap during the night would have helped to clear that pattern from my eyes and enabled me to function at a more optimal level.
Restorative napping could be the way forward - but let’s find a better place to have a kip than the ward bath.