Outside the Box

When we think of Nursing, or for those outside the field, Nurses, we tend to think of Hospitals, Doctors Surgeries, and Aged Care Homes. But, as my recent furor with the job  market will attest, there are plenty of unknown opportunities. I was unaware that some Schools still employ Nurses, there is the Prison system which employs on site Nurses, the Meat Works employs Nurses as I will bear witness to, along with some Mine Sites, Cattle Stations, and of course the Military. My advice to you, as the potential Graduate Nurse, or Re-Deploying Nurse are the following three things; Look Wide, Ask Everyone, Talk to People.

Nursing Imagery

Nursing Imagery

Look Wide

As I have hinted towards already there is a large and varied workforce in which to select from when it comes to Nursing. Each one has its own pros and cons, and you as the Nurse will have to weight those up for yourself. For example, I would trade salary for time with family and availability to volunteer. So a Monday to Friday, Dayshift, or at least rotating roster were you can plan more than two weeks ahead, was worth more to me than an extra couple of dollars an hour. To this end, when you have decided what you want out of the job look everywhere, even places you wouldn’t expect. Look outside of Seek, Job Search, or the local Paper, jobs these days are also advertised on LinkedIn, Company Websites, or even FaceBook. Look in places that you would not have normally considered like Schools, Meat Works, the Military. Apply for EVERYTHING as you may not be successful your first few interviews, regardless of experience.

Dreaded Job Hunt

Dreaded Job Hunt

Ask Everyone

Don’t be afraid to ask around, ask those in the field, ask your friends, ask your acquaintances, or do what I did and ask FaceBook. Whatever your tactic for this particular portion is, be ruthless. Don’t be afraid to ask people you haven’t spoken to in a while, don’t be afraid to ask people if there is a job at their workplace, ask if they have heard anything, ask if they know someone who knows someone who might know about a job. The point being ASK EVERYONE!

Social Callout

Social Callout

Talk to People

While I was looking for a Registered Nurses Job one of the things I took it upon myself to do was to email EVERY SINGLE GP Clinic in my Hometown, Rockhampton. I must have sent out 30 emails to all of the Practice Managers with my Resume and a Written Reference. Some wrote back to me fairly quickly with a Dear John email stating they didn’t have any positions at the time. I had two interviews, and a call back for a third after I accepted my job at Teys. I also applied to the Three Hospitals Nursing Pool, and directly to several of the wards. None of these places were advertising for Nurses, none of them were asking for my application, and most of them at least wrote back to me in some form or another. As I mentioned in Ask Everyone, most of the Nursing jobs secured, especially in a small town such as mine, will be by who you know. With a little bit of what you know as well. The job I ended up with wasn’t advertised, was a suggestion by a mate of mine, and started with an unsolicited email to the HR manager of Teys. So Talk to People, it may land you the job you didn’t even know existed.

Never Know Who Will Have the Job

Never Know Who Will Have the Job

These are three quick and helpful hints to assist you with your Job Hunt, whether it’s for a Graduate Position, a Re-Deployment, First Enrolled Nurse Job, or Re-Entering the Workforce after a sabbatical. Don’t be afraid to pick up the phone, drop an email, post on Social Media, or do the classic walk around with your Resume. When it comes to Employment it may not come easy, you may have to work for it, but it will all be worth it once you are working in the best profession in the World.

Maintain the Rage

Luke Sondergeld

 

Weight Loss Since January 1: 5kg

Final Placement

Anyone who has seen my Facebook feed this week would know that I finished my final placement for my Bachelor of Nursing this week. This means that I no longer have to wear the Teal uniform of choice, I no longer have to practice under someone elses registration, and I no longer need to work for free. But despite all of the finality, and the opportunities that lies ahead, the journey to this point has been both enjoyable and enlightening. Every department had its own secrets to share, every shift had a lesson to be learnt, and patient a mystery to resolve.

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During my time studying to become a Nurse I have had placements in many different facilities and many different wards. My placements where in Aged Care, Community nursing, Acute nursing in a Surgical and Medical ward, Mental Health nursing in an Inpatient facility, another Surgical Placement, another Acute care Ward placement, Emergency Nursing, and Intensive Care Nursing. Each placement, and subsequently each ward, has had a profound impact on both my learning and clinical practice. The first placement in Aged care taught me compassion above all else; to treat every patient as a person and not a condition, to take solace in the small tasks for each person, and never be in a rush to be done with a patient. Community care showed me how easily a simple condition can become something far more sinister, and how people can be so accepting of the worsening of a condition under the guise of convenience. My first Acute nursing placement showed me the importance of time management and good communication. Mental health nursing firstly showed me that despite common misconceptions, it is not an easy option, and showed me the difficulty we face when our own mind fights against us. The Emergency placement showed me the wonders of critical care, the pace, the broad spectrum of ailments, the need to maintain nursing skills to the highest level. Intensive care taught me the importance of taking my time, the little details matter just as much as the large one, and the need to show compassion and tenderness to those who need it most. Every placement had something unique to share, I am blessed to have had these opportunities and I trust these experiences will serve me and my patients well in the future.

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38 weeks over 3 and half years, 190 shifts, 1520 hours, every single moment a new opportunity to learn, grow, and develop my skills and knowledge base. Looking back over my placements its hard to believe that so much time was spent in different wards, for so many shifts, with so much to come out of them. I have always had the mentality that you should endeavour to learn something new every day. It helps fight stagnation and keeps you growing as a person, a nurse, a father, or otherwise. Every shift may not have taught me about a medication, a disease process, a new technique, a new piece of equipment, or even a new practice, some days it was a different way to show compassion, a new way to engage with my patience, or even a new way to deliver bad news. I feel it is important to keep the practice of learning something new every day, and not just from fellow nurses, out doctors, or the patients, but from family members, the wards man, the kitchen staff, or the stores staff, each have invaluable information that could make your life a whole lot easier.

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Every patient is not just a human being who has befallen an illness or ailment, and they are most certainly more than just these. Each patient is a story, a journey, a life. Every patient deals with their ailments differently, they develop comorbidities and often take them in their stride; to see near life ending events as something trivial as they have survived them and moved on. We as nurses can never assume that two patients who have the same conditions will act the same. And for this I am grateful. Every patient also has a life of stories, stumbles, triumphs, and complications. These life events can not only help build a better picture of the patient you are currently treating but also give you insight into how others may develop their illnesses. We need to take the extra time to spend with our patients to collect these little gems as we go about our day.

All in all, the placement process has been enjoyable. I’m not going to lie, I am glad I will no longer be working for free. I am truly thankful for all the staff, patients, others involved in my placements and the learning they imparted onto me. I will do everything I can to ensure the information is used to the betterment of my patients.

Maintain the Rage

Luke Sondergeld

Advocacy

Advocacy is one of the most important and under utilised components of a Nurses job. It sits at the very core of our being, the reason behind every action, and heart behind every conversation with a Doctor. Recently, whilst caring for a patient, I didn’t exercise my right to advocate for them, and as such they have continued to be mis-managed. For confidentiality reasons I will not disclose particulars of the patient, but will instead refer to them as Jeff. I have come up with a nemonic of ABCDE to remind me of the components of Advocacy for the future, and I hope they will help you too.

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Always

As some of you are aware I am both an Enrolled Nurse, and a student Registered Nurse. I am also on my last placement before graduating at the end of the year. I felt that because Jeff was a patient of mine, whilst under supervision, as a student I couldn’t or shouldn’t raise my concerns and subsequently Advocate for them. I was wrong. As Nurses we should always feel empowered to Advocate for our patients. It doesn’t matter if you are a LPN, EEN, AIN, GRN, RN, CN, or NUM you should feel comfortable to stop what is happening and Advocate for your patient. I have been beating myself up since the event, and cannot seem to console myself regarding my inaction. Jeff continues to be, in my opinion, mismanaged because I, and others, feel that we cannot raise our voices and say STOP, this isn’t in the best interest for the patient. STOP, we need a different course of action. STOP, we are not caring for and treating this patient, we are treating our own conveniences. I wish I had spoken up, but now I know what a difference it could have made, and how lousy it feels when I don’t, I will never step down from Advocacy again and I will encourage others to do the same.

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Back Up

When Advocating for a patient we should remember we aren’t just individual Nurses, we are part of a team, and we are stronger together. That wasn’t supposed to sound like a chant for a Union, but there you go. If we don’t feel strong enough to confront a Doctor directly, enlist help from other Nurses in the team, bring in the Supervisor, the Shift Coordinator, the Clinical Educator, the Clinical Facilitator, or even the Nurse Unit Manager. Together you can approach the Doctor and Advocate appropriately, it will look less like an idea from a solo Nurse and more like a considered idea, and it is good to know that you are justified in your Advocacy when you have the assistance of another. This won’t come across as “Ganging Up” if done correctly, and could be the component you need to successfully Advocate for your patient.

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Considerate

As Nurses we pull some pretty long and random hours, with things like Late-Early shift, overtime, Double Shifts, and a myriad of other whacky ways the roster seems to wind up. Our job is physically demanding by being on our feet all day, lifting and rolling patients, performing care, and everything else we do in a shift. Our job is also emotionally and mentally draining with supporting the patients and their families, dosage calculations, evaluating observations, constantly assessing a patient, and somewhere in all of that is Advocacy. Now, we all know what we do is demanding and exhausting, we justify the extra coffee, the second bar of chocolate, or ignoring the phone on breaks because of it. We flay ourselves over jobs missed, or errors in judgement, and we feel terrible when things are late. Now, our Doctors may not be there for the hands on cares, the lifting and rolling, the supporting the patient during mobility, but they are carrying the burden. The Doctors are trying to manage a massive patient load, the medications, the investigations, the outcomes, the families, and the demands we as Nurses put on them. The Doctors are under the pump all the time. They can’t ignore the phone, their breaks are constantly cut short, they are the ones that get to explain to the patient and their family about a poor prognosis. They have a huge burden to carry. When we advocate for our patients we need to be Considerate and keep in mind these burdens. Don’t Advocate by telling them they are wrong and should be doing it a different way, or calling into question their education. Come along side of the Doctors and show them what you are seeing and suggest the alternative course of action.

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Don’t forget the Patient

We shouldn’t forget that the reason we advocate is for the best outcome for the patient, as such we shouldn’t forget to include them in the decision making process. It may be entirely necessary, and entirely justified to discuss your concerns with the patient prior to stepping up in front of the Doctor. Some patients, despite the best intentions you may have won’t want to take differing actions to what the Doctor has ordered. This is why it is important to discuss your concerns with the patient, or if the patient is unable to then a discussion with the next of kin may be appropriate. This seems simple, but can be just as difficult, if not more difficult to achieve. Discussing with a patient that the care that has been prescribed isn’t the best, and a different action would be better, can be seen as conniving, sinister, arrogant, or just plain rude. A polite tongue and respective tone when discussing this matter will need to be adopted, and under no circumstances should the Nurse belittle or bad mouth the Doctor, or professional prescribing the care. We are all a team, we need the Doctors just as much as we need them, nobody wants to be seen as “That Nurse” and as such we shouldn’t behave that way.

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Evidence

Whilst we should advocate for our patients, always, we need to make sure we have the evidence required to back up our claims. This can be something as simple of observations, blood work, an x-ray, comment made by family or friends of the patient, or statements made by the patient themselves. We may also have written evidence from Journals, textbooks, Research Articles, or recently attended workshops or conferences. It may be something as simple as showing the doing guide from MIMS or the product information leaflet enclosed with the medication. We as Nurses need to be prepared when confronting Doctors in relation to our patients, it may not be enough for us to simply say “I am not happy, we need to do something differently”. Being educated, well read, up to date, best practice using badasses we are we need to show the Doctors that we know what we are talking about, and that we need to be listened to.

These five components; Always, Back Up, Considerate, Don’t forget the Patient, and Evidence or ADCDE, will help you remember what needs to be considered when Advocating for your patient. Don’t end up where I did with Jeff. Don’t be afraid to stand up and be heard. Don’t think that you are just a Nurse. You are the patient Advocate, exercise the right, but do it properly.

Maintain the Rage

Luke Sondergeld

12 Hour Shifts

I have started my placement in the Intensive Care Unit (ICU) of one of the hospitals in my region. Like most ICUs they run on 12 hour shifts, specifically for the one I am placed at 0700 till 1930 and 1900 till 0700. On the surface this seems great, over 3 weeks you work 10 days and are still counted and paid as Full Time, you have 11 days off over the same period, there is no such thing as a late-early, and the likelihood of being asked to stay back is greatly diminished. Though all of these things are true, and I will expand on some in a moment, there have been some interesting issues develop along the way.

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The Roster

I have to admit, the idea of 12 hours shifts, 11 days off in 21, and never having to work a God for sake Late-Early again, is awfully appetising. I adore the fact that the days you work, in which you seldom get anything done anyway, are just a little longer. I do enjoy the possibility that you are handing over to the person you received handover from. On the surface it seems like the dream, but there is a catch. So far I have been doing nothing but day shifts, which involves getting ups at 0530 to get ready and leave the hour by 0630 to be at work ready to go by 0700. The day then proceeds thill 1930 when I depart, walk to my car and drive home, arriving somewhere between 1945 and 2000. So far in this day I have not seen my children or wife awake, on arrival only my Eldest and Wife are still awake. No biggie, spend some time with them, wind down then off to bed, to get up at 0530 and do it all again. As you can see, there isn’t a lot of family time going on. There is  a lot of just surviving. Working, eating, sleeping, working. When I first arrived to ICU the Facilitator made a remark about working 12 hours shifts and how you shouldn’t expect to get anything else done on those days as you are just doing what you need to do to get to the next shift. I scoffed when she first said it. Now that I am living through it, she isn’t far from the truth. You wouldn’t be able to engage in any drawn out, meaningful activity. Normally I eat my dinner with my wife, we talk about our respective days, she returns to her school work, I read for a while, then sleeping for the next day. It took me by surprise. So though on the surface the roster seems really good, just keep in mind, you are almost useless for 10 days out of 21.

Plan Your Sleep

Plan Your Sleep

Self Care

The need for self care is incredibly important while undertaking 12 hour shifts. You need to make sure you are adequately fed, a mistake I made on the first day, just catering for lunch and that was it, didn’t make that mistake again. Staying adequately hydrated, which I know as Nurses we are notoriously bad at but we need to make an effort to do it. Getting enough sleep, and I mean good sleep not naps on the couch or two or three small naps, I mean a good solid 8 hours, which when you do the math leaves you with 4 hours for EVERYTHING that isn’t Work and Sleep. Supporting the home front, for those of us that aren’t single and have a partner and maybe children, you need to make sure that they feel adequately loved and supported. It is all too easy for us to say that we are tired, and worked a long day, and were on our feet all day, but your partner has also worked all day, cooked, cleaned, organised the finances, or performed ALL the other homely duties that aren’t getting done because of the 12 hour shifts. You should also engage in a ‘Me Activity’ on your days off. This could be hiking, swimming, boating, painting, or stacking rocks, whatever your chosen ‘Me Activity’ is make sure you take the time to engage in it, it is all too easy to just work to live and live to work.

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The Shift

Talking about working 12 hour shifts could not be done without actually talking about, the shift. I can only talk on the Day shift presently but as I engage in Nights I will be sure to add my thoughts. But, the shift, putting aside the obvious thing which is it is 4 hours longer then a normal shift, is divided rather nicely into roughly 3 hour blocks. Each shift you have a single 20 minute break and two 30 minute breaks. They are usually taken around 1000 for the 20 minute, 1300 and 1700 for the 30 minutes. This gives you Morning Tea, Lunch, and if you wish an Early dinner, I tend to simply enjoy a coffee and the extended break time for my 1700 break. This break pattern helps divide up the day and ensure you aren’t too intently involved on the floor for too long without stepping aside and breathing for a moment. It allows for a little bit of the aforementioned Self Care with regard to diet and hydration, it also allows for a brief period of contact with loved ones to make sure they are adequately supported, and gives you a moment to switch off from the intensity that is ICU.

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As you can see there is a lot to consider with regard to the 12 hour shift, and Nurses have made entire careers around it. I would love to hear some of the stories from those out there that do live the 12 hours shift day by day and what secrets they would like to share with regard to surviving the shift, self care, and days off.

Maintain the Rage

Luke Sondergeld

Emergency Department

This week, and subsequently the week prior, saw me completing my two week placement in our local Emergency Department. Originally, I was merely excited to just get a glimpse of the chaos and mayhem of ED. Having now spent the two weeks in ED…. I WANT MORE!!!

Emergency Department

Emergency Department

A while ago I wrote a piece call Medical Nursing, whereby I reflected on the exposure to different sections of Nursing and how they impacted me. In the conclusion I stated I felt that I was more a Medical Nurse than a Surgical, namely due to the chaos and distant style of Nursing that it tends to be. I then surmised that a Medical Nurse is responsible for the growth and healing of a Patient and not just bandaging them up to get out of the bed. This is the same thought I had towards ED, prior to my placement. However, upon arrival I noticed a few things;

  • The chaos of ED is a finely balanced ballet of Nurses and Doctors
  • The pace is clearly defined by those Nurses and Doctors
  • ED isn’t all gunshot wounds, mass trauma, and gallons of blood
  • Bed blocked is a very real and serious danger
  • There is more care given to one patient in four hours then some receive in a week
  • Nurses and Doctors work together as equals, not superiors and subordinates
  • Everyone is learning, Nurses and Doctors alike
  • A litre of blood can pour out of someone’s nose
  • A baby being born is truly magical
  • Drugs, illegal drugs, are bad
  • Mental health is not an isolated issue, its part of the patient
  • Not everything is running around
  • No-ones opinion is invalid

Theses are just some of the things I noticed while working in ED, and all of these things showed me that its not an adrenaline junkie’s hot spot, and only suited to those mad few, it is a high intensity, knowledge pushing, crucible that produces some of the most well rounded and knowledgable Nurses and Doctors that anyone would have the pleasure to work with or have work on them.

Emergency Nursing

Emergency Nursing

With all of this being said, like some five year old in a candy store, I still have a six week placement in the Intensive Care Unit of the same hospital. I could fall madly and deeply in love with the 12 hours shifts, organised structure, and relative peace of ICU. Or I could simply be left longing for the high speed rush of ED.

Where will all of this take me, I don’t know. I will float like a leaf on the wind, and land were I will serve best. I have the capacity to be a great Nurse wherever I am, and I can take great joy in every section, if I do so chose. Only time will really tell. My career, based on my current retirement age, has the potential to be 38 years long. Making 40 years of Nursing in total. I have the time to be able to move around if I am not comfortable in a section. Or simply fall in love with one, study my Masters in that area, and strive and thrive in the environment.

Only time will tell.

Maintain the Rage

Luke Sondergeld

Dear Wife

Dear Wife,

I know you hate these public displays of emotion, especially affection. They cause you to feel anxious, shy, and force you to become a little more recluse. I know that what we feel is between Us and God. I know that everything I am going to say here is of no surprise. And it shouldn’t be. This should be nothing more than an overly public confirmation of everything you already know. But I am going to share it anyway.

While I am writing this you are baking treats for our children and trying to pry out of me what I am writing. I am doing my level best, and failing, at trying to hide it from you. You tell me that somedays I am a brick wall, and this is true. But even still you manage to leave your mark, and it doesn’t go un-noticed. I know some days it seems like I am not present, I’m sucked into my phone, or zoned out on TV, or even simply staring off into space. You try to engage with me, I give simple one and two word answers and seemingly get annouyed when I have to answer anything more. All in all, a wall. However, every conversation, every comment, every question, is graffiti on that wall. It is something that I will see, and feel, and show forever. Every conversation is cherished. Every moment together is precious.

Graffiti on the Wall

Graffiti on the Wall

You could very well be the most loving, kind, good hearted person I know. You not only see the silver lining in almost every situation, you see the good in every person, and every action. There are days were I feel like I am the worst human being, not worth anything, and generally useless. You always take the time to life me up, encourage me, show me what I am, what I am capable of, and the worth that you and God sees. I love your selflessness, your drive, and your inability to do something half arsed. You kill yourself over a computer, planning, researching, replanning, organising, building, and scripting every class you teach. Every classes script is uniquely written for each student. You endeavour to make sure that every single person in that classroom has the very best shot at learning, and growing. It is that that level of dedication and self sacrifice I strive to even get even half way towards, so that I can be the best nurse, the best father, the best husband that I can be.

Self Sacrifice

Self Sacrifice

My love for you grows every day. Every day I get the opportunity to wake up next to you, fall asleep listening to your faint gremlin like snore, every time I come home to your embrace, even hear your voice on your voicemail. I am so incredibly lucky to have you in my life, let alone have you as my wife, the mother of our 3 beautiful children, my confidant, my sounding board, my common sense, my anchor in the storm, my shield, my shoulder to cry on, and my warm body to curl up with. Every day I think I couldn’t love you more, and every day I am exceedingly delighted to be proven wrong.

If not for you I would not have come to know Christ in the very real and intimate way we should. I would probably have wound up miserable in the middle of the ocean somewhere pining for my next drink in one moment, while struggling with my direction and sense of self in the next. You showed me what was possible, the love that He can provide. You showed me how much closer we could be with Him in our lives. You nurtured me through my stupid questions, and encouraged me to lean in. You are the physical embodiment of what Jesus Christ has asked of us. You are kind, love others, you share the word at every possibility, and you live your life like it is the only bible someone might read. You are amazing.

I Love You - I Know

I Love You – I Know

If by now you can still stomach me being open for just a few word longer I will conclude. Alinta, you are the kindest, sweetest, nicest, most loving person I have ever had the pleasure of crossing paths with. You take me at my faults and use them to help me grow. You soften my often hasty, and rash decisions, but you still allow me to lead or decide as necessary. You are the love of my life, and I just wanted you to know that.

Love you Always

Luke Sondergeld

Good Death

Over the past couple of weeks I have been reflecting on palliative care and what it is to experience a Good Death. I have had the honour of being a nurse to several patients in their final days and moments, and to my glee they have all experienced what I would call a Good Death. This also triggered thoughts surrounding my family losses in recent years, and the ones that are to come. More broadly this raised the discussion around assisted suicide and the moral, legal, and ethical issues surrounding the idea.

Some people will find it unusual or even confronting to read the fact that I had glee in my heart when dealing with someones death. Please realise that it warms my heart to see friends and family surrounding someone, who is comfortable, in no pain, well presented and cared for, all in their final moments on the planet. For me I define a good death by several factors. Firstly, comfort; the patient should be as comfortable as physically, emotionally, and spiritually possible. If this means Morphine infusions so be it, if it’s aromatherapy so be it, 12 pillows, a heater, their favourite blanket, if it can be arranged and not be a danger to them that’s what I will do. Secondly is pain; unfortunately most of us won’t meet the end of life without pain. My job as a nurse is to liaise with Doctors and ensure that the pain is either eliminated all together, or kept to an absolute minimum. Thirdly, well presented and cared for; the patient should have their hygiene needs met, new clothes as appropriate, hair attended, mouth cares attended, clean pad if appropriate, and generally look like someone has actually cared for them. Finally, family, and this can be a tricky one. Nobody can force family to be in attendance. Nobody can force family to be civil. We can facilitate an environment whereby the family don’t feel the need to clash, bicker, or argue with one another. The family of the patient should be able to say their goodbyes in a fashion that suits both them and the patient. Nothing will fill a person with regret quicker than not seeing a family member in their final moments, and having to apologise at the funeral.

Nan

Nan

A couple of years ago I lost my Nan and my Aunty within the same week. My Grandfather lost a Wife and his Only daughter. It was a rough week, and an emotional roller coaster. My Aunty suffered a massive brain haemorrhage and spent over a week in ICU before being declared brain dead. Within 24 hours of her passing she saved 6 lives as an organ donor. Please register to donate your organs here. My Nan was moved to palliate care after 4 days on a medical ward deteriorating. She spent 3 days on the ward before being called back to God. In those three days she was surrounded by family, memories, stories, and a whole gambit of emotion. She was prayed for, prayed over, and had the last rights read to her by the local chaplain. She was kept comfortable by some of the most attentive nurses I have ever met – one of the driving forces behind my choice to become a nurse. She was part of a going away party the night before she passed whereby her husband, sons and their family at pizza, drank beer, and reminisced over stories old, and not so old. There was laughter, there was tears, there was acceptance. We left Nan that evening and returned in the morning. That morning the Cheyne Stokes pattern kicked into high gear, we all knew it was close. We gathered around, and there was an absolute silence, and she slipped away. I led a prayer for her as she was taken back to be with God, and then the inevitable emotional release hit all of us like a ton of bricks. There was tears, and hugs, and silent nods of acceptance. My Nan passed without pain, well presented and cared for, surrounded by her family. She experienced a Good Death.

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In the effort to ensure that everyone has the opportunity for their Good Death, the conversation around Assisted Suicide or Euthanasia was bound to come to the front. My viewpoint is simple, everyone has the right to choose the way they want to die, how it looks, who is there, and what is involved. I am happy to facilitate all of that, just don’t ask me to push you over the edge. I can appreciate the fact that some people are in immense amounts of pain, and that their final days could be potentially agonising, though I am not convinced that a medical and pharmaceutical care plan could not deal with the pain. I also appreciate that some people won’t have a quality of life that they are accustomed to in their final days. I am not convinced that a well structured and considered Nursing care plan could make their final moments as dignified and for-filling as possible. I know that this subject is both currently controversial and emotionally charged, however it is something that needs to be discussed. It is also something that is unlikely to simply go away.

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With all of this said, the best way to ensure that the patient, a family member, or even yourself experiences a Good Death is to talk to your friends and family. If you want to be an organ donor, register and tell people so they know. Have an Advance Health Directive drafted so your wishes, should the terrible befall you, can be executed. Talk with your friends and family about your wishes and how you would like to be treated. Be informed of what is available in your region for palliation. Can you be palliated in your own home? Do you need to go to hospital? Would you need to travel to be palliated? These seemingly macabre things are considered as irrelevant or too distant to warrant discussion, but accidents can happen to anyone, or a sudden and fatal medical episode could befall you. Set yourself up properly for a Good Death.

Maintain The Rage

Luke Sondergeld

Medical Nursing

I have been Nursing for about a year now, which isn’t a lot in the grand scheme of things but never the less, and I have had the pleasure of experiencing Mental Health Nursing in two different facilities, Medical Nursing in two seperate facilities, Aged Care Nursing, Community Nursing, and Surgical Nursing. Though this only scratches the surface of what nursing is available with; Oncology, Cardiac, Emergency, Intensive Care, Renal, Respiratory, Rural and Remote, and Midwifery just to name a few. I have recently been reviewing my career and what each section has taught me, showed me, and revealed to me about my nursing.

When I first started my career I was almost exclusively employed in the surgical ward of my Hospital. I thoroughly enjoyed the work. It was fast paced, I had a tonne to learn, the staff were great, and I was able to meet new patients almost every shift. This was amazing, for the most part, but I felt that something was missing. Occasionally I would float to Medical and Mental Health, and though this was great exposure I didn’t really get a chance to experience the whole ward and what it meant to Nurse in these sections. My time in surgical felt very much like a revolving door, every day saw the discharge of one patient just to be replaced by another, that patient would stay overnight then would be gone again. It was something that I never got used to, it was something that I never felt comfortable with, it wasn’t the way I liked to Nurse.

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My exposure to Mental Health Nursing is varied. On one hand I was floated to Mental Health at random times which was great for a small taste of Mental Health but I never really had the opportunity to perform all of the duties a permanent Mental Health Nurse would, and for very good reason. My placement for Mental Health showed me a whole new side of Mental Health Nursing involved with involuntary mental health orders, and forensic mental health orders. This changed the behaviour of the client drastically compared to that of a voluntary client. Following everything that happened mid last year I no longer float to the mental health ward, to which I am thankful.

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When I returned from leave I found myself permanently assigned to the medical ward, at first I was a little miffed, I had always considered myself a surgical nurse, but never the less I gave the new role my all. What I did not expect was the learning, the experience, the joy, and the mental exercise that I would get on a day to day basis. I began to see what one of my nurse-mates said which is surgical is like the sports jocks, and medical is more like science geeks. Surgical pushes you as a nurse to be constantly one step ahead, be organised, and know what the next step is. But when it comes to medical its noticing the little things, the comments made by the patients, the changes in behaviour, the myriad of medications, and the effect of medications, bowel status, and fluid intake has on the human body and behaviour.

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This last week I found myself back in surgical again, and I began to realise something…. I am not a surgical nurse. I am a medical nurse. I love taking care of people, I love watching as someone improves, I love encouraging patients to do their best and stretch themselves. I never thought that I would find myself saying those words, I thought I would be the speed freak chasing the quickest nursing with the quickest turn around and the least amount of physical time with individual patients. I was so sorely wrong. So what does this mean for me in the future? Currently I will continue to enjoy my time on the Medical ward of my workplace. In the future, I still don’t know. It could be a full career on Medical Wards, Intensive care, maybe even palliative. Only time will tell.

Maintain The Rage

Luke Sondergeld

 

Schools Out

This week saw the last exam for the semester, and the last contact day for University in 2018. Though I have enjoyed the learning and content covered this year, I am also looking forward to having some down time and enjoying time with the family, friends, hobbies, and other neglected facets of my life. The journey through 2018 has been an interesting one, with a new child, new mental health issues, and the challenges of continuing to juggle everything else.

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In March of this year, consequently the start of term, my wife gave birth to our third child, and second daughter. The normal strains that come with adding a new screaming bundle of joy into the house were of course prevalent and made work, study, and parenting interesting. I am supremely glad that my wife is the trooper and super Mum that she is. Without her ability to manage the house and children, normally at great personal sacrifice, I would not have been able to get thought the first semester of University, working 10 shifts a fortnight, and contributing were I could. Our daughter is  just over 6 months old and is an adorable happy ball of cuteness. Unfortunately, I cannot post any pictures of her as my wife and I agreed on no pictures of the children online. But take my word for it, she’s adorable.

As I have written about in many posts, my mental health took a sharp decline not long after my second daughter was born. I had thoughts of suicide, I was depressed, I was anxious, and I could barely function on any reasonable level. I sought professional help, I became medicated, and I began seeing a psychologist to talk through my emotions and diagnosis. Everything continued for a while, but alas did not improve. The decision was made between the psychiatrist and myself that ECT was the best way forward. So we began a course of 12 sessions, three times a week, until completed. I saw the course through and things had improved. Now, some weeks on, I have had struggles, but we get through it. Now, I am still medicated, still see the psychiatrist on a weekly to fortnightly basis, and see the psychologist when our schedules align.

Whilst the treatment happened, whilst my second daughter continued to grow and be awesome, I was studying. I managed to get through my first semester with reasonably good marks, one subject was a High Distinction, and I felt pretty chuffed. Unfortunately, one of the side effects of ECT is memory loss, and I have a rather large blank spot in my memory. It extends roughly from June through to the end of August. It is interesting to say the least, people will tell me stories of things that happened, that I was involved in, like rebuilding my mate’s back stairs, or cutting down and moving a ton of firewood. This had lead to the second semester being less fruitful when it has come to my grades, leading me to the expression Ps get Degrees. Its not pretty, its not how I like it, but its what I have to do to survive considering the circumstances.

27862164-school-s-out-for-summer-on-blackboardI will just be glad that over the University break, which runs from now till March 2019, I will be able to spend more time relaxing and doing the things I love doing. I am also glad that I will be able to have a recharge and hit the ground of 2019 running. I still have one more placement to go in just over a weeks time, stay tuned for the reflection, but otherwise, its work, family, and rest.

Maintain the Rage

Luke Sondergeld

Five Acute Care Reflections

Over the past Five Weeks I have completed my Acute Care Placement for my Diploma of Nursing, to catch up on the day by day click here. Over that time I learnt may very valuable lessons, what many different drains can be used for, the effect of different wound care products, the differing cocktails of anaesthetics, and how diverse the multidisciplinary team really is. But given that most of that can be learnt from a book or educator I will leave those particular lessons to them. Instead, I will focus on the lessons that are picked up along the way, shared by other nurses and learnt from the patients themselves.

Time Management

We all get taught at some point during Nursing School the importance of Time Management. I have always been a fairly organised person by nature, so thought I would be ok by the time I hit the floor. Oh how I underestimated how much needs to be done, and how many interruptions to your time there will be. I would suggest that, especially as a junior nurse, come up with a time table to break up your time that suits you. I found that by the end of my placement one hour blocks were too broad, I needed 30 minute blocks to sort my time. So I would draw up the patients I was assigned with hourly columns and a diagonal line. The Left triangle would be the first 30 mins of the hour, and the right the last 30 mins of the hour. You will also need some sort of key that works for you. I used for medications, IV for anything intravenous, Dx for dressing changes or checks, Obs for any observations, BGL for any blood sugar checks, and would create others as I required them. This creates a quick reference of your night, makes handover a cinch, and means that if you get pulled away by the NUM, you can ask someone to cover the things you now about.

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Self Care

I know I have written about Self Care in my Aged Care Reflection and I feel it even more important to talk about it again after my Acute Care placement and the impacts of family, life, and the dreaded Late to Early swing. The temptation, and Lord knows I pulled this stunt too often, to simply try and live a normal life when you are on PM shift, getting off at 2300, getting home, writing for an hour, bathing and getting to bed at 0130, then getting back up at 0600 to be with the family, then proceed to stay up all day living life before heading to work by 1530. It sounds ok, till four days of only five hours sleep begins to take its toll. Sleep is key. Please ensure that you get the requisite amount of sleep. You may get away with little sleep in the short term, but Nursing is a life long career not a flash in the pan job.

Eat well, eat regularly and keep up the water. I know in the first week of placement, I wasn’t the best at keeping my fluid, and was terrible at skipping meals before or after shift. So I had to actively change the habit. I ensured that I had access to a bottle of water somewhere on the floor, as you will rarely have the opportunity to leave and get a drink, and made myself eat before and after shift. this will ensure your body will be able to deal with the coming shift, and recover from it after the fact.

Take time to yourself. I wrote two weeks ago on my Post Fall on Sword about how I was terrible at taking a moment to have time off for myself, my family or my friends. TAKE TIME AWAY FROM WORK AND SPEND TIME WITH YOUR FAMILY. I was going to be more subtle but decided that it wasn’t necessary, and would get the point across as well. The people around you will be the only ones to help you after a rubbish shift, they will be the ones that are there when you loose a child on the ward, they are the ones who will be your sounding board when the NUM rosters you for 16 days in a row then calls you on your first Sunday off in a month. Spend quality time with them, switch off from distractions and try to leave work at the door.

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Take your Time

As previously mentioned, there are a myriad of things that can drain your time during the shift. However, an extra five minutes during an admission, asking a couple of probing questions when taking observations, or simply making small talk when checking up on your patient could give you key information that would otherwise be missed. During my placement, and subsequent time in Surgical, there was a patient who was in having a hip replacement. During the admission it was discovered that they had recently completed a long haul flight six day prior. Now those two things on their own are concerning enough, however, 24 hours after the procedure the patient had a seizure, their O2 saturation were below 80% on 15L of O2, and things were looking grim. It would  later be discovered that during their time overseas they had consumed some bad seafood, had a diarrhetic episode and subsequently took six Imodium to stop it. This subsequently kept the bug inside the body and it festered away, which eventually caused the Septic Shock that the patient had suffered. Now, the nurse who admitted the patient did ask probing questions about the trip, the travel  and all other matters of questions. What was missed was when the patient stated they felt unwell on their day of travel home, the only question asked was How do you feel now? Which is only an issue in hindsight, however, for me it will stick forever the importance of asking probing questions of anything that is out of the ordinary.

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Be Personable

I spent the first 5 years of my working life, like most young Australians, in Hospitality. For most of that I was heavily involved in Wedding planning, coordinating and serving. This generally meant that for six months of the year I would plan, run and serve for over 400 weddings. As you can imagine it gets a little mundane, as each wedding, no matter how unique, is formulaic; people arrive, couple gets married, a whole bunch of photos are taken, everyone eats, there are some speeches, some people cry, some people get drunk, the couple leave, everyone stays way longer, then just before the wedding day becomes a wedding weekend everyone leaves. So after doing this 400 times you could say you would get over it. However, my boss at the time had been doing it for over 15 years. So just a few weddings. He told me that despite the fact that it may be my 400th wedding, for the couple it was their first, and hopefully only, and that stuck with me. Now, as a young practitioner, I take that lesson with me. For me it may be my 5th day on the ward, my 100th day, or heaven forbid my 1,000,000th day on the ward but for the patient it may be their first, and even if it is not the first time on the ward it may be the first time for this condition, treatment or procedure. Be a real person, talk to them about their lives, laugh where appropriate and don’t treat them like a number or another body in a bed. It is a simple lesson to listen to, but proves to be difficult to put into place when under the pump.

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No Dumb Questions

No matter how many times I hear it, no matter how many times I have tried to impart this little gem it still seems to be something that is missed. I know during my placements, my lab days at Nursing School, my study sessions with my friends, or simply asking old Dr Google, I asked a ton of questions. Some of them seemed a bit simple or dumb at the time but I soon realised that either I wasn’t the only one thinking it or it wasn’t such a stupid question at the end of it all. I recall after ECT, during my Mental Health shifts, I noticed that the consumers right eye was almost alway more blood shot then the left. I knew it was the side that the treatment runs through and assumed it was a side effect of the treatment, but asked the question anyway. It was a seemingly dumb question but raised an interesting problem, no-one know why, and more interestingly, most people hadn’t even noticed it previously. So this seemingly dumb question now moves into the realm are curiosity for many. I am still yet to actually find a reasonable answer other than because of the electricity, but I live in hope. The lesson is, NO DUMB QUESTIONS, with the sole exception of Who’s ID is this…

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Well there you have it, my Five lessons that I couldn’t learn in a classroom or book for my Acute Care placement. This brings me to the end of my journey as a Diploma Student, in a number of short weeks my registration will come in and I will be an Enrolled Nurse. Come March I will begin a new journey as a Bachelor Student as I study to become a Registered Nurse. I thank you all for coming on this journey with me far and I hope to see you all as the journey continues.

Maintain the Rage

Luke Sondergeld

Day 1

Day 1 saw us all complete the Mandatory Training for the facility with a number of other staff. The day ran for approximately 9 ½ hours and covered everything from Emergency situations, CPR, Manual Handling, Infection Control, Aggressive Behaviour Management, Electrical Safety, WH&S and an overview of Company, which included a brief talk from the Facility CEO.

Though the day may not have been clinically interesting, as most of the material was fairly standard, although good for a refresher, it was interesting to hear about the company, its values and its culture. The company has a great culture of supported, safe, client centred care. They believe in their employees and treasure their skills, experiences and opinions. The policies and procedures of the facility are often sent out to the staff to ask for feedback, input and commentary. It serves any workplace well to have input from the people who are actually using the polices to test them first.

From day one the facility has set an excellent tone for professionalism, courtesy, input, support, and mentorship. All of these values and ideals are ones that I not only appreciate, but attempt to emulate as a leader, mentor and employee.

My previous apprehensive feelings have been mostly alleviated by the attitudes of the staff and their attitudes towards education and students. I look forward to my coming eight shifts in the Medical ward, and the lessons that will be learnt.

Until tomorrow, Maintain the Rage

Luke Sondergeld

Placement Rage

As regular readers will know I am coming to the end of my Diploma of Nursing studies, which culminates with a five week Acute Care placement, totally some 200 hours. As I did with my Aged Care placement and my Community Care placement, I will be documenting my thoughts, interactions and reflections on my experience. Unlike my last two placements, I will not be summarising after the fact, but in fact giving a daily summary of experiences, emotions and lessons learnt.

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Current Thoughts

I am looking forward to putting my accumulated knowledge to use, I am looking forward to the challenge that lies ahead. But, I would be lying if I didn’t say I was slightly apprehensive. I hope I never get to the day where I feel like I know enough, if you don’t think you know enough you will keep asking questions. I am not concerned with my clinical skills, and I am looking forward to learning and applying new ones.

I want to excel, which brings with it a certain level of apprehension as D-Day approaches, doubt creeps in and you begin to wonder if you are going to be good enough. If any of my class mates are reading this, they will be getting ready to echo back the same thing i have been saying to them for months, You will be fine, you know what you are doing, just breath, relax and dive in. And I have been reminding myself of these words, and the sense of irony certainly isn’t lost on me either.

The first day will set the tempo for the whole placement, Orientation Day. We are meeting up at a facility outside of the hospital to be inducted, trained and tested to ensure we are up to scratch before we hit the floor. With previous orientation sessions, the information was simple enough with the focus being on manual handling and general safety. This time however we will be conducting more complicated procedures, delivering medications and monitoring patients who are in a far less stable condition. But as my old Chief Bosun used to tell me, or rather yell at me, Pressure Makes Diamonds.

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Blogging Timetable

So the nitty gritty. I will be writing my daily reflection almost as soon as I get home. Therefore if I was to publish as soon as I wrote them, the posts would come out at all varying times, and no one would be able to keep up. So instead I will be releasing the posts the morning after my shift. That will mean the blog posts for the week will be published as;

  • Monday’s at 0600 (AEST) will be normal Maintain the Rage posts
  • Tuesday’s through Saturday’s at 0600 (AEST) will be Acute Care Reflections from the day previous
  • Sunday’s will remain the Sabbath and there will be no new posts

Placement Rage 3I thank everyone for their support of Maintain the Rage thus far, and I thank everyone for their words of encouragement going forward not only with my placement, but my Nursing Career in general.

Maintain The Rage

Luke Sondergeld

Studious Student

In all endeavours we should attempt to excel past expectations and achieve the best we can achieve; for some of us that come easy, for others not so much. There are many stresses put upon us by others, and many more that are put on by ourselves. As a student I know there are expectations to retain knowledge, pre-read textbooks, complete assignments, study for exams, pass said exams, eat healthily, maintain the rage, maintain a work life balance, hold down a job, pay my fees, and somewhere in all that actually sleep. I know that a lot of people out there are going to think that the life of a student is easy, that compared to the real world there are no pressures, that how hard could it be to simply rock up and pay attention, and until I returned to study, I would have shared similar thoughts. But I have since seen the struggle of being a full time student, full time parent, part time employee, full time friend, and full time human being. The juggle is difficult, but I thought I would share some of the simple things that have helped make me a Studious Student and the habits that can be adopted to ensure that you too can be the best that you can be.

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Pay attention and Study

The temptation to skip class, study in the evening, study in front of the TV, read only the sections of the textbook that you need to for the assignment and coast through is strong. But at the end of the day, you are paying a large sum of money (my course is totalling somewhere near $18,000 which doesn’t include textbooks) to be in class, absorb knowledge and pass. For my course, the Diploma of Nursing at CQUniversity, we have to attend three full time days per week, 0830 till 1600. During those days we have classes that are a mix between lectures and tutorials, clinical skill development, and content discussions with the instructors. In those classes it is not unusual to cover large volumes of textbooks, broad subject material and a ton of detail. The expectation is that you take the information from class, add another 40 hours per week in reading and studying to fill the blanks, and keep up with what happens in the rest of the week. If that sounds intense, that’s because it is. I began the course thinking the 40 hour reading and study on top of classwork was over exaggerated. By the end of the second week, I realised it wasn’t enough. I spend, on average, 50-60 hours reading textbooks, journal articles, news articles, research papers, and anything remotely related to the subjects at hand. All of this study now brings up the total hours spent on Schooling to 75 to 85 hours a week.  But it pays dividends, for every hour I work during the semester is three hours I don’t have to madly cram for an exam at the end, it saves me countless hours in research for assignments, and gives me the confidence and ability to answer correctly when the instructors ask something of me. It also means when I am on placement, I am confident in my own abilities and know my own limitations. So I implore you, pay attention in classes, take notes, read the textbooks. As I like to say to my other budding nurses, You are studying to save a life not pass an exam.

Studious Students Pay Attention

Read Broadly

The temptation as a student is to see a reading list that has been prescribed more as a set of guidelines, though the broader we read, and dare I say it, even outside of the prescribed reading, the better students and better graduates we become. I have purchased every book on my reading list (that was available), either Prescribed or Recommended, and I have collected over a dozen other books of use from book fairs, second hand stores and family. All of these books have been useful at one stage or another. I also read journal articles, health news, nursing news and magazines, blogs, Twitter feeds, converse with Nurses in the field, overseas and local professionals, I endeavour to gather as much information regarding our profession, how to conduct it and the latest and greatest procedures I can. This gives me a wide and varied base to draw from for exams and assignments. It means I am as up to date as I can be, and as a professional, ensures that I am maintaining my professional development habits which will serve me well in the future. My suggestion is read broadly and read often. Buses, trains, morning tea breaks, lunch, quiet times in the lounge room, relaxing in the bath, everywhere is a potential reading spot to absorb more knowledge.

Studious Students Concentrate

Don’t Cram

Anyone who is anyone has crammed at one stage or another, and if they say they haven’t, they lie. I have crammed for exams in the past and it serves to only have you pass in the short term but provides no long term information retention. During my time in the Navy we would be learning a new concept every week, with an exam on the Friday. It was expected that you pass the exam on the Friday so you could start a new subject on the Monday, if you failed however, you would resit the exam on the following Thursday, and still have the new exam on the Friday. Now you had two exams to study for. So cramming became a way of life, which was ok for passing exams and frying brains, but horrible for long term retention. The only way we retained the information was through constant drill and use. The information became so second nature, that I could almost step back onto the bridge of a Patrol Boat and not have too many dramas. However, in Nursing you are studying to use information one month, two months, three years or even a decade later. Cramming is no longer effective, and rigorous drill is ineffective as there is simply too much information to rote learn and reflex learn. So, slow, methodical learning through reading, writing, studying, revising, and reciting is the only viable way to retain the information long term. Now within all of this your individual learning style still applies. I am, for example, an aural learner with visual tendencies. Which basically means I learn best by listening, but can get away with reading. Some people are kinaesthetic, which means they learn through movement or by doing. The difficulty is going to be discovering what works best for you and going for it. I remember listening to a recording of a friend of mine, which ran for just over 45 minutes, with the rules for Navigation, droning on and on and on, and listened to it over a two day car trip incessantly in the interest of passing an exam on the other side. Which I did. So for me that worked.

Studious Students Don't Cram

So there we have it, a quick look at some tips and pitfalls of study and being a Studious Student. I am in no way the perfect student, but I have learnt over time some habits that have helped me. So I now pass them on to you. If you have other hints, tips or lessons learnt from your study, add them in the comments below, or connect with me on the connect page. Don’t forget to subscribe so you can get regular updates on what is happening on the blog.

Maintain the Rage

Luke Sondergeld

Five Community Care Reflections

To follow on from the Reflections of Aged Care and in the interest of continued Reflection so I can Maintain the Rage the following are lessons that I have learnt while on my Community Placement for my Diploma of Nursing. The lessons and revelations that I came to during my placement were; Community Care is not a lesser form of care, Discharge from Hospital doesn’t mean Healthy, Funding is a speed bump not a road block, D is for Danger, a little care goes a long way.

Community Care is not a lesser form of Care

After spending a week in the community setting I very quickly realised, it’s not a lesser form of care, less equiped or less skilled, if anything I found the opposite. The organisation I placed with had two Nurse Practitioners on staff, a myriad of Clinical Nurses and Registered nurses, and an Assistant in Nursing who ran the stores and supply chain. This was a well oiled machine of Healthcare. They were all completely professional, top of their game and the most caring people I think I have met on my journey so far. They work diligently to provide the best level of care they can, and if they can’t, they find someone who can. They didn’t know the meaning of the phrase ‘Too Hard’.  It completely changed my perception of what community care was, which I will admit, wasn’t a very positive one. I alway pictured nurses with a bag of observation equipment, some simple dressings and a box of drugs going from clients home to clients home dealing with  the Elderly and Disabled because they couldn’t make it to the General Practitioners. I could not have been more wrong. This particular organisation ran a clinic in the CBD, an after hours service, visits to the aged care facilities, at home palliation, home delivered clinical services and intra venous antibiotic therapy in the home. Nothing short of a real Hospital in the Home.

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Discharge from Hospital doesn’t mean Healthy

I also learnt that just because someone is released from Hospital that doesn’t mean they are on the mend, they are simply stable and well enough to be at home. This is the sad state of affairs in most countries, where the need for hospital beds is pushing quicker and quicker turn around times. Hospital beds are also becoming cost prohibitive, with the average night stay in Australia costing over $1,800. This has spurred the community health sector into overdrive, the need for advanced clinical skills in the home and community environment is at an all time high. With more people being discharged early, or avoiding hospital and seeking alternative arrangements. That’s were services like the one I conducted my placement with really come to the forefront. We as citizens of our respective countries need to be aware of this, as fathers, mothers, brother, sisters, and children of someone who may be discharged from hospital one day, we need to be aware of what services are available, and what help can be sought. We also need to be aware that the instructions that are given to you on discharge are there to, hopefully, keep you out of hospital. So do yourselves a big favour, especially those who are heading into healthcare, and learn what community services are available and what they can do for your patients on discharge.

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Funding is a Speed Bump not a Road Block

John Kander wrote a song for for his 1966 production Cabaret  which said “Money makes the World go Round”, and unfortunately it does. Healthcare is driven by two things, firstly patients needs, secondly how much those needs cost. Community care in Australia is funded either by the Government or Private Enterprise, and the private enterprises are usually not for profit organisations who receive funding from the Government. These agencies receive a certain amount of money per patient depending on complexity, time needed and a swag of other criteria. These criteria then govern how much the organisation receives to run that service, and what boundaries the organisation has to stay in, so as not to step outside of their appointed jurisdiction. This however does not stop the services from providing the care to the patient. What tends to occur is the service will refer to another community care organisation that has the jurisdiction to cover what is required. As far as the patient is concerned they still receive the right treatment, and the healthcare system get a smiley face sticker for doing the right thing, its a win win.

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D is for Danger

As anyone who has completed their first aid certificate in the past can tell you there is the the pneumonic of  DRS ABCD, where the first D is for Danger, to both the casualty and yourself, community care is a lot like that. Before entering someones home for the first time a risk assessment is conducted, this covers everything from number of people in the house, to pets, to access to the inside, to lighting, everything. The community nurse also has the right to arrive at a patients home and not enter and simply drive away if they believe there is a real threat to their safety, like the 75 kg hungry Rottweiler thats sitting in the front yard. This is paramount for the community nurse, because if they enter the property and the Rottweiler decides they’re lunch, you now have two patients at the residence not one. This lesson can be carried into the acute setting as well, if you have a belligerent patient who won’t settle and is throwing bed pans, grab a mate and tackle the room (not the patient) together.

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A little care goes a Long way

The short amount of time you get with each patient in their home doesn’t leave much room for error, but by providing a little care to the patients in the time you do see them can lift their spirits and help with recovery. Human contact, social activity and conversation are all great ways of battling depression, anxiety and promote good health. The simple act of being kind and caring during your visit could be enough for a patient to see the light at the end of the tunnel and really focus on their recovery, not their condition. Even in community palliation, the difference between openly and compassionately communicating with the client, and always walking on egg shells, can be the difference between what is considered a good death and a bad one. So in all walks of your health care life, care a little, share a little and take the time to be with the patient, not the task.

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My community care placement has taught me a lot, I made a swag of new professional contacts, saw first hand what the services can do for patients, learnt a lot of clinical skills and developed the ones I already had. Do you have a lesson learnt from one of your placements? Do you, or have you had a friend or family member receive care from a community health organisation? If so comment below, if you would like to share your story head to our Connect page so we can share it with everyone. Don’t forget to subscribe to receive email updates of new articles.

Five Aged Care Reflections

With my Community Care Placement beginning tomorrow I have been considering the lessons I leant from my Aged Care Placement I completed at the end of 2016. The placement was nothing like I had anticipated, I pictured the stereotypical residence scenario where most of the residents where mobile, ate in a large dining hall, played canasta for a large portion of the morning and slept away the afternoon, before retuning to the dining hall for an early evening meal. But this was not the case.

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Some ideas are formulated early

1.  Its their home you are just a visitor

The trap some young, inexperienced not necessarily just age young, Nurses and caring staff fall into is that you are at work, a building in which you arrive to every day, clock on, complete a series of tasks, clock off and go home. What you should remember is you are entering someones home, this is where they spend all their time, it’s not a dining hall it’s their dining room, it’s not a common room it’s their lounge room, and it’s not just the room their bed is in, that’s their bedroom, their sanctuary. To that end, you are not an employee who has the right to barge in and do what needs to be done, you are a guest in their home and need to act as such. Tasks should only be completed when they are fully explained, permission is given and in a manner that the resident/client/patient is comfortable with.

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Home Sweet Home

2.  Residents are People and not Tasks

This may seem like something obvious but when you get under the pump and time is short, the task that needs to be completed can seem to be the priority.  As previously mentioned, you are entering the residents home. Picture for a moment a stranger walking into your home; briefly introducing themselves, making your bed, demanding you get up and have a shower, dressing you hurriedly, giving you a small cup full of unknown colourful pills and demanding that you take them.  This is, unfortunately, how some residents are treated. Thankfully the placement I had, I didn’t see anything remotely like this behaviour, but there were times when some tasks where pushed with less than complete consideration given to the resident. So remember you are there to care for the resident/client/patient not complete a series of tasks, take the time to care.

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Task Task Task

3.  Refusal isn’t personal

As Nurses we are taught that residents/clients/patients have the right to refuse treatment, medication or procedures, this also extends to cares, showers, getting dressed and even getting out of bed. How many times have you woken up and just thought “I am not getting out of my pyjamas today, I am sitting on the couch, eating ice cream and watching “Sliding Doors”. This situation is no different for those in your care, they have the right to refuse anything, even having their cares completed by someone who isn’t you.  As a Male I had to be prepared for most of my female residents to refuse to have their cares completed by me. Thankfully this didn’t happen too often, but I did have one resident who absolutely refused to even have me in the room at all, it took nearly two weeks for her to get used to the fact that I was there to assist and allow me into the room, she did however always continue to refuse for me to shower her, dress her or in any way see her in a a state of undress, which is completely understandable. Refusal isn’t personal and as such shouldn’t be taken to heart, just discuss alternatives with your supervisor and move on.

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It’s not personal

4.  You can’t disconnect completely

We are all human, and as such we all develop some degree of human attachment. We are taught to be caring, and supportive, but not to be overly involved. Working in an Aged Care facility I had prepared myself for the inevitable reality of the environment. I am normally quite astute at separating myself from emotional attachments unless it’s necessary, like relationships, friendships and the like. I thought I was doing a great job of it too, I was still caring and supportive of the residents, I was compassionate to their needs, but wasn’t attached in a way that left me vulnerable. Until I met ‘Dave’ (not real name), Dave was a palliative patient who had served many years in a volunteer capacity, his children where only able to visit briefly every week, and he constantly questioned why he was still alive. I endeavoured to make him as comfortable as humanly possible, make sure that his every need was met, but inevitably he passed away a couple of weeks later.  It hit me harder that I expected. Though I was glad that he now had the release he was so desperate for, I still felt saddened by his passing, I knew this world had lost someone who truly cared about others, and placed them above himself. It is perfectly normal to feel saddened, but don’t let it consume you, often there is still plenty of work to be done, and many other residents/clients/patients who need your care as well.

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Don’t let is consume you

5.  Don’t forget to Care for yourself

Anyone who has flown before has been told to “Ensure you have secure your oxygen before helping others”, this extends to the care environment as well, you need to care for yourself before you care for others. If you have cheap, unsupportive shoes, you will get sore feet after standing on them for 8 hours. If you don’t eat properly during the day, you will get tired, lethargic and unwell. Here are a few things to consider to help you help yourself;

  1. Buy good supportive shoes, they may cost over $150 but will save your calves by lunchtime,
  2. Remember to actually stop and eat, we tend to be consumed by tasks and time runs away from us, plan to have a small break twice a day and a longer break for lunch. All this assumes your workplace allows this,
  3. Eat fruit, nuts, lean proteins and complex carbohydrates. Try and avoid the tendency to grab a quick slice of cake, handful of chocolates or other quick snack,
  4. Rehydrate, Rehydrate, Rehydrate! Remember to drink plenty of water during the day. It is not unusual to walk over 20,000 steps in a shift, couple that with the dry air conditioning of most facilities and you will quickly realise that your intake will have to be higher than normal, and
  5. Actually go to the bathroom, it only takes a minute. With all that water, and normal body processes you will need to go to the bathroom. Actually go, there are many health problems that can develop from urine retention over time, take the time to relieve yourself.
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Help yourself so you can help others

This is in no way all of the lessons learnt during my placements, and certainly not an exhaustive list of cares for yourself, but they are some of the most important. I am thoroughly looking forward to the next opportunity to serve the community and those in need. I anticipate there are going to be an inexhaustible list of new lessons learnt from this next placement, but as one of my Commanding Officers once told me “The day you stop learning is the day you become dangerous”, it was true then and remains true today.

Do you have lessons learnt from your nursing experiences? Do you have secret cares that you can’t go a day without? Write them in the comment section below, after all community is key to success.