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Why nurses should keep an open mind and never assume they know most

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A nurses intuition and experience in invaluable but, says Ben Bowers, it is not always enough

Dealing with clients every day, we get used to seeing, predicting and expecting certain patterns in human behaviour.

It comes as no shock when we encounter individuals who are coming to terms with a substantial loss in terms of health and well-being, and present as angry with themselves and the world.

Equally, nurses become adept at looking past the best attempts of the older person who keeps changing the subject to try to hide their growing cognitive deficits and deteriorating ability to cope.

However, as I have learnt, we must not presume we know what is happening by certain signs and experience alone.

After working in the community for a few years, I had an encounter that challenged my preconceptions. I was called by a concerned hospital nurse who had just realised that a patient discharged home four days earlier had not had his planned carer visits re-established to make sure he received his medication. I was asked to visit him urgently as he had just been put on more tablets to control his diabetes.

Apparently, he had been confused while in hospital and his blood sugars had been very high before he started the additional medication.

I went straight to his house. He lived in a wealthy area. It was clear from the disrepair of his property compared with the well-kept homes of his neighbours that he was not able or willing to maintain his property.

After several minutes of knocking, the man slowly opened the door. He had several days’ worth of stubble and his speech was slurred. As I introduced myself, the man looked over my shoulder and stared into the distance. Slowly he returned his gaze to me, smiled and apologised for not paying attention as he was watching a peacock chasing a cat down the street.

I wondered just how many hypoglycaemic tablets this poor man had taken to become so confused, so decided I should check his blood sugar then arrange an urgent medical review. As I went to close the front door, to my astonishment I also saw an aggressive peacock chasing a cat through his garden. It turned out that the man’s blood sugar reading was very reasonable and he had all his wits about him. He was managing his medication to some extent without supervision.

As practitioners, we get used to using all our senses to assess situations and rely on our experiences to build up a picture of what warning signs to expect in similar situations.

Arguably, we progress from novices to experts through reflecting on the experiences and situations in which we find ourselves, then alter our practice and gradually move on to the next stage.

However, as my encounter shows, regardless of our experiences and apparent signs, we must remember to stop and question just what exactly is happening in any situation.

Regardless of the clinical setting, every person we see is an individual with a unique set of circumstances. If we jump to what appear to be reasonable conclusions without taking the time to talk to a person and understand them, we risk miscalculating the support each individual needs. We might also miss spotting the occasional aggressive peacock.

Ben Bowers is a community nurse in Cambridge

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