Another week over

Apologies if this blog is a bit more medically than my others, it’s just been a really good week to reflect on in terms of practice.

This week at work has included lots of interesting and different clinical skills as well as some scenarios that were very thought-provoking. While I’ve still seen a fair few pressure ulcers and skin tears this week, it has been good to do some things other than wound care, which does make up the bulk of the team’s case load. Two things I’ve seen quite a lot of this week are PICC line care and male catheterisation. Both are skills that I’m not actually able to do until I qualify because of regulations. So, while this placement is also observational only, it definitely means I’ve had to take a bit of a back seat during those visits. This doesn’t mean though I just have to sit in silence and watch, as my mentor has been really good at explaining the procedures to me and explaining exactly what’s happening and why. Before this placement, I’d only ever seen a PICC line once in practice so it has been especially useful to get to see multiple visits to people for PICC line care. PICC (or Peripherally inserted central catheter) lines are mainly used for long-term intravenous medication administration, and are often used in cancer care to administer chemotherapy. The procedure for looking after the lines has to be done in a strict aseptic way in order to avoid introducing bugs into the line which could cause the patient to get an infection. Being able to perform PICC line care in the community is usually a real benefit to patients as it means they don’t have to go to the hospital each week so saves time and resources there, however it can bring its own risks. If the line was to be dislodged while the dressing was being changed then it means patients in Shetland have to be sent over to the mainland, usually Aberdeen, to get it reinserted. This therefore means patients can have a lot of anxiety during our visits as they are worried about complications and things going wrong. This is where my dual training is really useful as I will be able to offer more support to those patients to ensure their mental health isn’t being affected by this anxiety and also offering general emotional support during a patient’s journey with cancer or other long-term conditions. PICC line care can also be a bit of a complicated process. This led me to have a really interesting discussion with my mentor as she has a little prompt sheet that she uses to help remind her of all the steps she needs to do for PICC line care as it is a relatively new skill to her. I’d never really thought of a qualified nurse using prompt cards, but I think it’s an excellent idea, especially for a new skill. Although I guess it is a balance, as you should obviously know how to do the skill well enough to be able to practice effectively, but for a longer more complex procedure I guess it’s that bit of reassurance to know that you’ve done it all perfectly is good for your own peace of mind.

Another area of nursing that community nurses do quite a lot of is palliative care. Many of the patients I have seen this week have been receiving palliative care, however it’s been interesting to see the range of patients that fit into this category. Some of the patients appear very stable, and we only really saw them just to touch base and have a catch-up. While with others you can see the deterioration in their condition from one day to the next, where at the beginning of the week they could walk and by the end of the week they are bed bound and might not move from there again. I’ve been privy to some rather tough conversations between patients and their nurses and doctors about how ‘bad’ days with their illness will become more frequent and will start to join together as things start to near the end. I guess our job is to just ease the lows and celebrate the highs, and ensure the patient can be nursed where they want to be looked after and help them to accomplish anything they want to do if and while they still can. I’ve been really touched by a couple of patients that I’ve met up here, mainly because of how helpless they feel due to their conditions. It just makes you want to sit and talk with them all day, and show them that even though they aren’t as able as they used to be, there’s still plenty they are capable of. Empowerment is so key. Now this doesn’t mean telling a bed-bound patient that they’re capable of climbing Mount Everest if they put their mind to it, because that would be unreasonable and unfair. But it does mean promoting a patient to be as independent as possible, and showing them what they are still capable of in their current condition.

Now after this very thought-provoking week, it’ll be good to get out and relax this weekend. I am going to be returning to Yell to meet my family friend who helped me to organise this placement and so I’ll get to see a bit more of what Yell has to offer, and I’m sure there’ll be plenty of photos to follow!