International placements and conferences and excitement, oh my!

I’ve been a bit quiet on here recently but for good reason: sitting on several super-exciting things which I wanted to save posting about until I had confirmation that they were definitely going to happen… which I now have!

The first exciting thing I’m facing is that in September, I will be attending my first academic conference, but not just as a delegate – the conference has accepted a paper put forward by two of my lecturers about a research project they’re leading and which I’m involved with (and will assist in writing up). My trip to the conference, the International Network for Psychiatric Nursing Research, is being funded by the School of Nursing at University of Salford, which I’m so massively grateful for – I will, of course, write up the experience for both here and (probably) the School’s own blog.

The second piece of news (and, I hope the NPNR won’t mind me saying, a little more exciting…) is that in June, I applied for an international placement through the Erasmus scheme, to study and work with service users in the Netherlands for three months at the beginning of my third year. This is me at the moment I found out my abstract was successful, and that I’d been offered an interview:

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…sadly there was no handy photographer nearby at the moment I found out the interview had been successful as well, so you’ll just have to trust me that I looked even happier (if you can believe it possible!)

I have the beginnings of a blog post about the process of applying for my placement in my mind, for future students, and I’m vaguely planning on doing a series of video blogs whilst out there, just to spice things up a bit (if I can get over how odd I think my voice sounds recorded – although I’m assured by science and other people alike that what it’s no different to what I sound like everyday!)

Curating @NursingSUni

This was written for the Nursing at Salford University blog, about my week curating the school Twitter account, @NursingSUni.

I was really excited to have the opportunity to curate the Nursing at Salford Twitter account for a week last month. I’ve been using Twitter since 2008 to keep in touch with friends, and using it as part of my nursing education since shortly after I started my degree just over a year ago.

The excitement turned into nerves the first time I logged on but they quickly dissipated – those following the account were very friendly and welcoming of a new curator, and in the end I actually felt quite disappointed that I didn’t have much time to spend on Twitter during the week: I was on a clinical placement, and therefore mostly unable to tweet between 9-5 for five days of the week I was curator!

I did pop on during my lunch break each day, and thanks to a lengthy commute, I had plenty of time to tweet away whilst travelling, and then over the weekend I was able to engage some more. I was also wonderfully supported by @levylass during the week, who made sure there was activity whilst I wasn’t able to use Twitter, but I did feel like I missed out somewhat being away from my phone and laptop for almost 40 hours!

One thing I would say for future curators is that whilst I wouldn’t recommend against curating whilst in clinical practice – because it could be so interesting for the account’s followers to see what students and HCPs are getting up to (without breaking confidentiality rules and the NMC Code, of course) – but I would suggest that before doing a week of curation on placement, it might be a good idea to choose a week when you’re less busy!

There were plenty of good parts to curating the account for me, though – I was able to participate in some really wonderful discussions, and saw tweets from accounts that I didn’t follow personally (although I did end up following some of them as a result) and it was amazing to be able to put ideas and discussion topics out there, and see people engaging with things I was saying – the account is much higher profile than mine was, and I got a lot of interaction from people, which was a real confidence booster.

I would really like to curate the account again in future, perhaps at a time when I’m less busy, though!

My debut at Congress

I’m currently at my very first RCN Congress, having managed to wrangle my calendar such that I could attend lectures on Monday, Tuesday and Wednesday morning, rush across to Liverpool for the AGM and today’s voting, and spending Saturday in the library, wrapping my head around the role of the pancreas and insulin. (Fitting in coffee where I can, of course.)

I had planned on not throwing myself into the spotlight at this Congress, I was just going to observe this year, but I was talking to people last night and nobody was saying what I was thinking and it just sort of… happened. My speech, in the end, was a first draft that I’d practised once (just to make sure I wouldn’t run out of time) – so I’m kind of blown away by the response it got: one nurse told me she hadn’t realised what students have to deal with and promised to be kinder in future, a couple of HCAs thanked me for reminding people of the lower-paid staff in the NHS, and 4 people have told me I should stand for RCN Student Council. (I said absolutely not, too busy and I prefer being grassroots anyway.)

The room was enormous, and I was looking at over 400 future colleagues, possibly managers (and as a friend commented upon seeing the photo below, I looked a bit deer-in-headlights!) – but I only stumbled over my words once, and now the adrenaline’s worn off and I can think straight again, I feel very glad I went up there and did it, because it taught me that it’s possible to get up there and say something inspiring, from the heart, without having to practice for hours, and I will be less scared in future, I hope!

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If you weren’t at Congress, you can watch the debate online (it was resolution no. 22) and the text is below:

I am currently a second year student, and whilst I can hope that in two years I will take home something like a Band 5 salary, well above the Living Wage, that is not why I am standing here.

I am here as a student and an HCA. A placement week is 37.5 hours, and this summer I will be juggling that with revision for an exam and commutes of up to 2 hours each way. When not on placement, I study up to 40 hours a week, in lectures, doing coursework, and reading. I schedule time to sit and watch a film on my calendar, so that I remember to take a break.

I’m going to be terribly un-British now, Congress, and talk about my income.

Being a student nurse is undoubtedly a full-time job, for which I am given a bursary and a student loan that combined, provide me with £128 per week, or £3.41 per hour. I would not be here today were it not for the kindness of my mum, who doesn’t ask me to pay rent.

I can supplement my bursary and loan, when I have time, with shifts as a bank HCA, but between my limited time, and cost-saving measures including not using bank staff whenever possible, I was paid for more training than actual shifts last year.

We are the Royal College of Nursing, but we are not all Band 5 and above.

When you Google “What is a living wage?” the answer is “a wage which is high enough to maintain a normal standard of living”.

I ask you, Congress, when our purpose for being is to help people to live the best lives they can… do we not deserve the same?

Medication Paranoia

This poem was written by a patient I met on my last placement. I asked them and their named nurse if I could share it here and with my peers, and they both agreed.

Medication Paranoia

Waves of paranoia
In the membranes of my mind
My thoughts ain’t thinking clearly
And the words is hard to find.

You don’t know the way I feel
cos it’s purely drug induced.
I don’t need more medication
For the pain to be reduced.

I wouldn’t call it a pain in fact
More a brain disorder.
My body is affected
When my brain gives it an order.

It’s not a normal feeling
And it doesn’t come and go.
It stays with me
Injected by a needle don’t you know.

You say to me “what’s wrong?”
When I try to speak my mind
And all I say is gone astray
Like patches of mankind.

Will I regain the gift I had
When talking to my friends?
The natural me that longs to be
A poet til the end.

Dual diagnosis

I spent a week on this placement working with a dual diagnosis nurse (DDN), as my mentor wasn’t around for a few days and being most of the way through my optional module Substance Misuse & Self-Harm, I thought it would be a really great and relevant experience, and it was! I kept a reflective diary so I could discuss what I got up to with my mentor during my interim review, and write about the highlights of the week.

Completing detox
This morning got off to a great start; the first thing on the DDN’s to-do list was to see a patient she had been working on methadone detox with, and see if they had managed to complete the detox. The patient had taken their final dose of Lofexidine (used to soften the effects of opiate withdrawal) the day before, and the patient needed to be assessed for presence of methadone still in their system, and opiate withdrawal symptoms.

Happily, the results were exactly what the nurse was hoping for, and we got to tell the patient that they’d successfully completed detox. They’re now going to be prescribed Naltrexone, as a safeguard against mistakes – this blocks opiate receptors, and mean that if the patient does go back to either heroin or methadone in the coming weeks or months, they won’t get a high from it, which will make it feel like a very expensive waste of time, and hopefully mean they only do it once! The patient was so happy and positive when they were told that they’d completed detox, their smile pretty much lit up the room – it was wonderful.

Helping patients choose to detox
The DDN had been discussing the possibility of the first patient becoming a peer mentor and talking about his experience of tapering down and finally detoxing off methadone to other patients, because it’s all well and good for the nurse to stand there and say “detoxing will be good for you!” but it really helps to have someone who’s actually experienced it themselves to say “it is going to be difficult, but I felt like it was worth it” to those future detox patients who are really on the fence about trying it.

The patient had his first opportunity to give that a try later on in the week, when the DDN asked them to talk to another patient who had been considering detox, and when she had some 1-1 time with the second patient, they said that they’d spoken to the patient who’d successfully completed detox and thought they might want to give it a go, which she was delighted about. The second patient’s situation was slightly different, in that they were taking more methadone than the patient she’d just been working with, so he needed some reassurance that it wouldn’t be hell-on-earth, but she successfully persuaded him to give it a try, reasoning that on the hospital ward, having daily check-ups with her and the whole nursing team looking out for them, it would be a more bearable experience than his last DIY attempt at home, without the help of Lofexidine!

Drug and Alcohol Awareness
The DDN runs a weekly group on the ward discussing different things to do with drug and alcohol awareness, to try and help persuade patients to make more informed choices about the substances they use: whilst on the ward, they theoretically have much less access to any kind of substance, but of course, some patients going on leave are able to acquire certain things which they bring back either secreted in cavities that don’t get routinely searched, or perhaps left on the grounds of the hospital for collection by someone who is permitted unescorted smoke breaks around the grounds, after which searches rarely happen.

The bigger problem she’s fighting at the moment is one of “legal highs”, or “new psychoactive substances” – things like Black Mamba, a synthetic cannabis that’s sold as pot-pourri, and looks a lot like it but doesn’t smell of anything, and is sprayed with a chemical manufactured to resemble THC (the active ingredient is cannabis). I didn’t know very much about “legal highs” at all before the week I was working with her, and it was really interesting to find out everything I did:

  • “Legal highs” are legal only on the basis that the person providing the packet believes the buyer is not purchasing it for the purpose of getting high, which is why they’re labelled with things like “pot pourri” and “not for human consumption. However, this means that on hospital wards, they’re very much strongnot/strong legal, because the staff all know exactly why the patients have it! This means the staff are meant to do everything they can to stop “legal highs” coming onto the ward.
  • Preventing “legal highs” getting onto the ward is made really difficult by several things:
    • The patients get to order takeaway on a weekly basis, and the nursing staff are fairly sure that legal highs make it onto the ward, wrapped in plastic and buried inside the trays of food. They haven’t yet found concrete evidence of this, so they can’t ban the patients from having takeaway, and even if the patients were told they had to order from a specific place, it probably wouldn’t change anything, as if one takeaway is doing it… they’re probably not alone.
    • The staff are also fairly sure that “legal highs” are delivered by taxi drivers… specifically, the taxi company that is owned by a local drug dealer (which just do happens to be the taxi company that is authorised by the NHS Trust for use). But again, they have no concrete evidence, and because it’s the taxi company the NHS have authorised… they have no choice but to order taxis from that company. Incidentally, the same person who owns that taxi company also owns several takeaways…
    • The patients know they can do certain things to get the “legal highs” past the nursing staff when they return to the ward, either secreting it in a flower pot outdoors for a less-suspected individual to collect later, or inserting it into a particular body part that nurses have to have an excellent reason to search! This means that things still get onto the ward even when the person coming in is checked over thoroughly before leaving the airlock between the ward and the great outdoors.
  • They’re extremely popular not because they’re legal (particularly as, as I established earlier, they’re not legal in hospitals!) but because they don’t show up on urine screenings – so unless the packets are found, nursing staff theoretically have no hard proof that the patient has taken anything – unless they have a really adverse reaction to whatever they’ve taken.
  • Adverse reactions are really common. We know this from the many stories in the media of young people taking synthetic cocaine and having heart attacks, people dying from meow-meow when it was actually “legal, and various other situations – but as well as these critical illnesses, I heard stories of the nurses holding patients up because their legs wouldn’t work anymore, of patients projectile vomiting and days of pain afterwards from pulled muscles in their abdomens, and one patient described how one thing they’d taken – they didn’t even know what it was – made them feel like they were falling through a floor, constantly, for 18 hours.
  • All of these side effects differ from person to person, and even from use to use, as to stay ahead of the law, the manufacturers have to keep changing their quantities, recipes and chemicals that they use to make the differently labelled packages, so what someone takes one week and has a good experience with could put them in hospital next time.

I also learned that you can generate a spark to light cigarettes using (amongst other things) shower gel and an electric wall socket – a massive fire risk! – and this led to one of the patients on an adjacent ward only being allowed to have electricity on in their bedroom supervised.

The whole week was absolutely fascinating and gave me a real insight into some of the work a DDN does. It isn’t all easy (and often quite unpleasant, as you might imagine from the descriptions of what “legal highs” do to people) but… I think I had my first “this is what I really want to do when I qualify” moment whilst working with her :)

A Sane New World

Last week, I was invited by my local branch of Mind to go and see Ruby Wax’s new show about mental health, Sane New World, at my local theatre. I was quite excited, having seen her TED talk, Whats so funny about mental illness?, about 18 months ago. In that talk, she tore stigma apart with humour in a way that I found really impressive, and I was hoping that Sane New World would be equally amusing and insightful.

Within minutes, I realised I was wrong. Somewhere around the point where, tacked onto the end of an explanation of how our busy lives coping with the ongoing nature of the 21st century, of nearly always having a connection to email and telephone conversations, she threw in a line about how psychotic people wanted to kill her.

This is a thing that’s annoyed me for a long time. Recently, watching an episode of Castle with my partner, I had to pause the show to fume about how often people with a form of mental illness (often, but not always, psychosis) are portrayed as criminals, usually criminals who hurt, maim and kill other “sane” and “normal” people.

And it’s bad enough when TV shows force it down our throats that people with mental illness are dangerous, beings to be feared, but I can’t see the general public ever believing that the stereotypes we’re led to believe are not entirely factually accurate, when they hear it from Ruby Wax, the self-described poster girl for mental health. No, really:

Ruby Wax's Twitter bio: Poster girl for mental health, writer, performer comedian.

As the performance went on, I sat mostly stoic-faced, more amused by the scathing comments muttered quietly by the lady next to me; Ruby did say some quite interesting things at times, but I found myself struggling to be amused by her humour. The second half of the performance was a Q&A session between Ruby and her audience; I managed to resist putting my hand up to ask her what good she thought she was doing to the cause of reducing stigma with her jokes that doubled up as stereotyping remarks, although I was sorely tempted.

I must admit, amidst all this, that I was pleased when a question about medication came up, and Ruby fell firmly on the side of medication being an acceptable treatment option for many, whilst admitting that for some it does not work – my own stance on medication. Her line “If medication worked, nobody would ever relapse.” filled me with dread at first, but she went on to point out that medication can in fact be the difference between someone getting out of bed to attend therapy, or staying there and never getting better. I suppose this was predictable given her comparison of physical and mental illness (and that one of the most common arguments from people fighting stigma is that we don’t tell diabetics or cancer patients to avoid insulin or chemotherapy, so mental illness should be no different in that regard.)

But perhaps her wording choice wasn’t the best: I am more inclined to believe that medication does work, but isn’t foolproof; sometimes, something big happens and our dose is too low to prevent the straw on the metaphorical camel’s back from breaking; perhaps people become tolerant and relapse because of that. Clearly, though, for some, medication works (even if it doesn’t for others).

But when the people who are meant to be fighting stigma stand on a stage and make cracks about people with psychotic illnesses, I find it hard to see that they’re helping the cause, not hindering it. And it’s great when musicians give an interview, explaining they admitted themselves to the Priory to get clean or to iron out their depressive moods, and it was a life changing experience that they wish they hadn’t waited so long to do…

Except most people can’t do that. NHS patients face waiting lists for therapy of multiple years in some places. When people are facing losing their homes because the bedroom tax means they cant afford their rent anymore… is the Priory really an option?

I honestly have no problem at all with celebrities fighting stigma – actually, in some regards, they can be the best people to do it, because who better than those that society place on a pedestal to stand up and say “I have a mental illness and I am a person you admire; we aren’t ALL bad!” to show the world that depression need not be a death sentence?

But perhaps some of our spokespeople for mental health could look at what theyre saying and how they’re saying it, consider how realistic their opportunities are to the average taxpayer, and if maybe what they’re saying isn’t actually doing more harm than good.

On Happiness

It came to my attention that today, March 20th, has been declared by the United Nations as the International Day of Happiness.

I’m going to rewind a little here; just over 15 years in fact. I was 11 years old and at a roller disco party organised for the top students of Year 7 as a Christmas treat. I can picture the room still; it was a dark room and we were sat along two long benches either side of a table covered in party food, and the owner of the skating rink had asked us to listen to her for a few minutes before we started eating. That’s quite a big ask of a bunch of 11 year olds who have just knackered themselves skating around for two hours, but somehow we managed it. I honestly don’t remember much of what this woman said – more clear in my mind is the plate of Party Rings that were right in front of me! – but I do remember that she went round the table asking us tell her what we wanted to be when we grew up.

Nearly everybody had a different answer; we were a bunch of aspiring doctors, pharmacists and a wolf trainer. I was the last to answer, and said “teacher”. The woman looked around the room after I spoke, and said “Nobody had the right answer.” and I remember feeling confused at that; how could there be a wrong answer to what we wanted to do when we were older? She added: “None of you want to be happy.”

For the next few years, my career dream changed several times, from librarian, to pro cyclist, to photographer, to curator, to civil servant/local politician, to paramedic, and finally nurse… but through most of those years, my overarching goal was to be happy – particularly as I battled through anxiety and depression through my late teens and early twenties.

Until one day in 2008, when I choked through tears to my best friend: “I just want to be happy like everybody else. Why is that so much to ask?” and he paused for a moment before replying:

“Why do you think everybody else is happy?”

At first I was too stunned to reply. Then I started waffling about depression and anxiety, and how nobody else seemed to feel as low as I did, how if you’re not depressed then you must be happy… right?

He paused again, before saying he couldn’t imagine being happy all the time because it would be so exhausting, and actually how it would be more accurate to say that he was mostly just okay – sometimes happy, but mostly just okay. He added that not wanting to be depressed was a fair goal, that there was nothing wrong with that wish, but that expecting myself to be Happy, always and forever, was expecting too much of myself.

It’s important to note that at the time, I was taking a fairly high dose of a very old antidepressant, from the tricyclic family of drugs, and although it levelled out my depressive moods and significantly improved my anxiety, I lost the ability to laugh – and to this day, whenever the idea of me taking medication again comes up, I simply say to my friends “Can you imagine a Katie who doesn’t laugh?” – and they all admit that they can’t. (I’m very pro-antidepressants despite this; I simply don’t want to go back to them myself, unless I desperately need them.) – and I am not alone in this experience: the latest issue of Psychiatry Research includes a paper titled Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants which notably asked study participants about the “numbing” effect that many people experience (full text available via Science Direct).

I thought about what he said for a while, and realised he was right, that I could well be chasing the impossible and, just like that, I began to feel better, as the stress of reaching for something I had thought had existed but perhaps didn’t began to melt away.

On the first day of my last placement, as I sat through the handover from the night staff, one word kept being repeated that I hadn’t heard before: “euthymic”. At the end of the handover, I quietly asked my mentor what the word meant, and he described it as “the mood that’s not either depressed or happy, just ‘normal’”.

If laymen and nurses alike can recognise that actually, there is an in-between for mental health, if “average mood” even has its own clinical name – why are we touting happiness as “a fundamental human goal”? (UN International Day of Happiness publication, 2014.)

Don’t get me wrong, I don’t think there’s anything wrong with creating more happiness generally, and I recognise that a degree of good mood leads to greater mental wellbeing and resilience to depression and anxiety – and yes, the document does admit that “it may not be possible to be happy all the time” and that it’s “pointless” to compare ourselves to others as my friend pointed out those years ago, that instead we should strive to be the best we can be – but equally, the UN Secretary General said of the goal I once had: “It deep-seated yearning shared by all members of the human family. It should be denied to no-one and available to all.”

World happiness is a laudable goal, absolutely, and I wouldn’t go as far as to say that there’s something inherently wrong with seeking greater happiness, but I have to question the value (and indeed ethics) of pressing upon people that being happy is the ultimate goal in life, when chasing happiness in itself can in itself cause so much stress and unhappiness – particularly given the many people who take the mind-numbing antidepressants already mentioned.

Compassion in Practice

I got an email this morning, congratulating me on being accepted as a Care Maker – a voluntary role working as an ambassador for compassion and caring in the NHS, in recognition of my efforts to promote the 6Cs, inspire the nursing community, and promote compassion and caring. I was absolutely delighted, of course, though that I found out this week is ironic in a way, as something I’ve been thinking about that happened on placement the weekend just gone is really affecting me emotionally.

On Sunday evening, I spent some 1-1 time with a patient, to discuss their various symptoms so that I could complete a Brief Psychiatric Rating Scale for their file. As I was listening to them describe their beliefs and thoughts about their admission to the unit, I began to realise that I had no idea how to help them, and the more I thought about it over the next few days, the more upset I became.

This particular patient is extremely delusional; they have fixated beliefs about the world around them, with evidence to back it up that, on the face of it, is completely ridiculous – and yet mostly impossible to argue against. On the few occasions I was able to point out a flaw in their reasoning, they had a counter-argument that I couldn’t defend. The patient asked me: “Can you prove to me that I’m mentally ill? When you can prove that, I’ll take your medicines.”

But we can’t. Their beliefs are actually almost convincing. They stopped taking their medication (which was mandatory under a Community Treatment Order) because they became so convinced by their truth that they are not mentally ill, the logical extension of which is that, if someone is not mentally ill, they don’t need treatment for such. The CTO got revoked when the patient’s care co-ordinator realised that although the patient was no longer fully compliant (attending the depot clinic, but not taking oral medication) and they’re now under a Section 3, which permits the MDT to detain them for treatment. At some point, the patient will either have to accept medication, or have it administered to them against their will, possibly under restraint. That thought saddens me.

And worse, I feel sure that if we manage to administer enough medication to this patient that they start to recover, eventually they may consent to further treatment, and sometime after that, they may be discharged, potentially under a CTO. Which, don’t get me wrong, is potentially great, but if it’s happened before, it can happen again: the patient somehow becomes non-concordant with their meds, they become unwell again, which distresses those around them, and they find themselves back on an acute ward, asking questions like “Why am I here, when I wasn’t doing anybody any harm?”

At first, I was just upset because I came into this career wanting to help people recover from mental health issues. Not completely, necessarily, but at least help them to start on that path. And I know that I can’t help everyone – my own personal experience, whilst a part of what makes me special, won’t be useful to all patients – but this was the first time it had occurred to me that a patient could present such a difficult case that even a consultant who’s been practising longer than I’ve been alive is stumped for ideas.

On Monday morning, I asked my mentor if I could have a chat with him about it, but our shifts only intersected by an hour, and handover took too long, and then someone came to visit him, so he told me he would talk to me the next day, as he was going to be supernumerary and would easily find time for me. But when I arrived, I found that he’d had to alter his shifts because his childcare had gone up the spout, and again, we only had an hour, and a long handover, and then his shift was over.

Of the two nurses on duty for my shift, one is a bit too lighthearted to have a serious conversation with, and the other was snowed under with work and I knew it would be pointless even asking her. Two shifts without someone to talk to when something is troubling you is a long time to dwell. I hid in the darkened sluice and cried, twice.

Here’s the thing: I don’t want to be a superhero. I know there will be people I can’t help during my career, and I can deal with that, because I know that for each of those patients I can’t help, there will be many more I can. I know that sometimes, like now, discharge won’t be goodbye, but goodbye-for-now. That’s OK.

It isn’t not being able to help people that upsets me. I’m just scared that it will never get easier. And I know that nobody will berate me for feeling emotional at knowing we can’t help this patient, that this is part of why we do so much practice and (at least theoretically) have supervision time to discuss the aspects we’re finding difficult. I don’t expect to be able to cope already.

But I am scared that it will never get easier, that it will build up and up and up, and that my emotional resilience is not strong enough. I am scared that I will not be able to cope with the sheer number of patients I will fail during my career, and I am scared of the effect that may have on those who form my support network.

Logically, I know it should get easier. I know that each time it happens, it should bother me less.

And that scares me, too: what if it does get easier, but becoming hardened to it changes me? Makes me lose my compassion and all the wonderful things that make me who I am?

My partner tried to reassure me; I had to carefully tell him, “I don’t think anyone but a nurse with years and years of experience can reassure me on this”. And then I added: “and even they may not be able to, because they’re not me.”

How does anyone know if I can cope, until I don’t?

And so, the day that I become an ambassador for compassion in care, I find myself doubting that I can (or should) do this job, if I can cope with the tougher aspects of it without changing my core, changing the person I am, the things I love about myself.

Above all else, right now, I am scared because I don’t know if I can do this without either losing my compassion, or being so compassionate that it overwhelms and breaks me.

“Compassion hurts. When you feel connected to everything, you also feel responsible for everything. And you cannot turn away. Your destiny is bound with the destinies of others. You must either learn to carry the Universe or be crushed by it. You must grow strong enough to love the world, yet empty enough to sit down at the same table with its worst horrors.” – Andrew Boyd

Religion and Culture in Hospital

This is quite a difficult post to write, because as humans, something we’re really bad at is saying “I messed up”. It’s hard to do, and even harder knowing that my lecturers, peers, and even potential future employers could read this – but then, reflecting upon our experiences and learning from our mistakes (and the mistakes of others) is a large part of our professional education – and this story reminds me once again, how the patients and service users we interact with are actually the most valuable learning resource we have.

It was 3am, and one of the patients came to the office. She looked absolutely exhausted, and she said to me, “I wondered if a female could check my room.”

My initial reaction was one of confusion. “Why? Is there something wrong with it?”

“No,” she said. “I just want a female to check it because I can’t sleep with my scarf on.”

And then I saw her properly. Her name, her accent, her headscarf. Her lack of sleep, because with hairpins and swathes of fabric around her head, getting comfortable on the pillow was a task in itself – but she couldn’t take it off, because her beliefs dictated that no man may see her uncovered head.

We had asked her religion when we filled in her admission paperwork and updated the NCRS, but nobody had really thought about what that meant for her in the hospital.

I immediately said that we would do our best, explaining that sometimes it wouldn’t be possible but that as long as a female other than myself (as a student, I’m not permitted to carry out observations unsupervised), we would ensure that a female checked her bedroom and reported back to the person on obs duty.

I got thinking. Dietary requirements we do OK with, because we specifically ask people if there is anything don’t do or don’t eat, and how their food has to be prepare, and we arrange interpreters for those whose native language isn’t English, so we do alright really but I began to wonder what we were missing.

The nearest prayer room to my ward is a five minute walk away, in a different building to the mental health unit and across a car park. Our ward has 22 bedrooms, five bathrooms, two offices, a therapeutic activity room, a staff room and a dining room, and absolutely none of them are suitable for prayer, with exception perhaps of the patients own bedroom, if we can place them in a room that faces Mecca when they arrive. If we can’t, what then? Uprooting patients who have got settled and turned their bedroom into their space is generally something we try to avoid.

And language isn’t the only thing that needs to be interpreted: I remember witnessing a mental state assessment during my first placement where an Islamic man was asked if he ever had thoughts that life was not worth living, and he replied”I sometimes feel that way, but life, it is sacred.”.

The nurse conducting the assessment jotted down that religion is a protective factor for him, and moved on.

But let’s take a moment just to think about what that person is going through. They feel their life is not worth living, that the world would be a better place without them, or that they have taken all that life can throw at them and cannot cope anymore… and they are out of control. Life is sacred, suicide is an unforgivable sin, and they are trapped, in a terrible world of pain and sadness, unable to get out, and unable to see a way it could possibly get better.

And we say “OK” and write down that they won’t kill themselves because of their religion. As a child, I was always told not to read between the lines; now, communication is as much about what the person isn’t saying as what the are.

On the face of it, we do OK. We get food and communication mostly right, and we let people wear head coverings and carry rosaries and decorate their personal space with illustrations of their deity and symbols if that’s what they want to do. We do OK,

but surely – surely we can do better?

That Was The Year That Was

New Year’s Eve: where has the year gone?

I still vividly remember rolling over on the morning of January 28th, scrolling bleary-eyed through the notifications my phone had received overnight, including an email with the subject line “Salford University Offer”.

Attending a job interview two days later, to join the temporary staffing bank of the Trust I would get placed with, in which I was so brimming with enthusiasm and confidence that I was accepted. (Then, walking onto a ward 11 months later as a student, and finding that one half of the group mentoring team had been on the interview panel!)

The haze of paperwork and finance applications and sinking myself into The Student Nurse Handbook that was February and early March.

Walking into the lecture theatre on March 18th, excited and nervous all at once; going home that night, far less nervous and far more excited.

Sitting through anatomy lectures, wondering if it would ever make sense, revising hard and getting 85% on my exam – the first time I’ve scored so highly in anything since my GCSEs. Writing my first essay, about the communication barriers between nurses and people with Asperger’s syndrome, and getting another top mark, and then my second exam, my introduction to the mental health field, that netted me another top mark and a year average of 84%.

Being welcomed onto the team at Student Nursing Times.

October and November: Thorpe Park. A battle that is still not won, but is dormant at least, and more importantly, made me some fantastic connections and new friends.

Yesterday, one of the staff nurses told me I wasn’t allowed to be off duty for three days: “How will we manage without you?!” and I flushed with pride and accomplishment. If 2014 is anything like as positive as this year has been for both my personal and professional development, I will be very lucky, and very happy.

Whatever 2013 has brought you, good or bad, I hope that 2014 surprises you with how awesome and wonderful it is.