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#Hellomynameis… in BSL?

*This post was inspired by a fellow student’s blog, Luke. Read it, it’s quite good!*

“What’s in a name? That which we call a rose
By any other name would smell as sweet.”

Romeo and Juliet (II, ii, 1-2)

I don’t consider myself a classical literature enthusiast, but this quote really strikes a cord. Juliet is telling Romeo that regardless of his name, it is the person behind it that she loves. He is more than his name, an identity that has been given to him but does not define him as a person. But despite what Juliet may think, you can gain a significant amount of information from a name.

Hello, my name is Nur Milenkovic. I’m a student nurse.

When I introduce myself to my patients and their families, they gather several tidbits of information about me, and some assumptions.

  1. I have an Americanized accent (this prompts a guessing game of where are you from?)
  2. I am a student nurse
  3. I am a foreigner
  4. If they speak Arabic, they know half of my heritage (“Do you know what Nur means?”)
  5. If they have heard of Balkan last names, they know the other half.
  6. Depending on intonation and body language, they know my current mood
  7. They know how to call for me, and make me take responsibility for my actions.

That’s quite a lot from just saying hello.

Recently, there has been a flurry of activity in relation to Hello My Name Is…, which was set up by Kate Granger in a successful campaign designed to improve the communication between healthcare staff and the patients that they care for.

I’m a doctor, but also a terminally ill cancer patient. During a hospital stay in August 2013 with post-operative sepsis, I made the stark observation that many staff looking after me did not introduce themselves before delivering my care. It felt incredibly wrong that such a basic step in communication was missing. After ranting at my husband during one evening visiting time he encouraged me to “stop whinging and do something!” Kate Granger, hellomynameis.org.uk

Communication is one of the 6Cs of nursing, yet is often forgotten in the flurry of activity that occurs in a care setting. How can you deliver person-centered care if you do not even take the time to build that therapeutic relationship? Throughout the first year of my course, we were told again and again that is was important it was to introduce yourself when you first meet your patients. It all seemed like common sense at the time, but it wasn’t until I was on my first ward experience that I understood why it was drilled into us from day one: people coming and going, busy staff, and organised chaos. The staff simply forget (I’ve done it too, over the phone when talking to the parent of a patient… “Hello, is this so-and-s0’s Mum? You asked me to ring you when your son woke up.” Oops).

Patients would wander down the hallway, with a bit of a confused look on their face. When I go up to them and ask if they need anything, they said they are looking for their nurse, the one with brown hair in a bun – that could be anyone. The extra time it would take to find the nurse could have been avoided if they been told clearly who their nurse was first thing in the morning. They wouldn’t have been waiting for an additional 10-15 minutes, which can be a very long time for a parent with a screaming child.

Wait, but what are the 6Cs of nursing, I imagine hearing non-nurses ask. Well, here they are: Compassion, competence, commitment, communication, care, and courage. I will let you figure out why each is vital in a nursing profession, but I will tell you that you need all six to provide holistic care to a patient.

I firmly believe it is not just about common courtesy, but it runs much deeper. Introductions are about making a human connection between one human being who is suffering and vulnerable, and another human being who wishes to help. They begin therapeutic relationships and can instantly build trust in difficult circumstances. In my mind #hellomynameis is the first rung on the ladder to providing truly person-centred, compassionate care. – Kate Granger, hellomynameis.org.uk

The activity that has been occurring on various social media in relation to #Hellomynameis (Twitter especially) has revolved predominantly around being able to introduce yourself to patients who may be hard of hearing/deaf. So in honour of that, I thought I would help those of you who may not have see it yet, and add a few additional ones (because, why not?)

*The following signs are all right handed, and performed in order from left to right

Hello, My name is…

bsl-alphabet-rh

I’m a nurse (I couldn’t figure out student nurse)

How are you?

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You may need to look up the responses here, otherwise you won’t know how they actually feel!

Although patients who require me to adjustment the way I introduce myself may not get quite as much information about me from my introduction as those who are able to hear, they will at least know who and what I am (and that I need to learn BSL properly).

So who am I? (Spiderman reference, anyone?)

Hello, my name is Nur Milenkovic. I am a student nurse.

A nurse for Halloween?

I love October.

For many many reasons. It’s my birthday month, Halloween, it is acceptable to wear the baggiest hoodies, Halloween, nature turns orange, yellow, and red. Oh and did I mention Halloween?

It has never been huge celebration in the countries I lived growing up, but having had the fortune of going to international schools – who’s student population was predominantly american – I was introduced to this fascinating tradition. Although I struggle to watch horror movies, I absolutely love the scary and gory costumes that people come up with for Halloween. I have never been too fond of commercial Halloween costumes, especially ones geared towards women and young girls, with adult costumes verging on the scandalous and girls being dressed in pastel Disney gowns. But hey, each to their own right? I just prefer going as a blood-soaked zombie.

This year is the fist time, since I was 13 (I think), that I will have the opportunity to dress up and go out in public in costume. My first instinct was – you probably guessed – something that would give me the excuse to go as extreme as my skills will let me. So, after a quick google search of popular costumes, to the surprise of no one, Nurse was one of them. Awesome! It’s taken over the rest of my life, why not actually dress as a scary version of myself? And there is  whole spectrum of what a commercial nurse’s costume can look like, just look at this one Buzzfeed video!

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Silent Hill inspired nurse    cc Nathan Rupert

But then I started to doubt the idea. Would this break the NMC Code of Conduct? What if someone I’ve met during placement recognizes me and is offended? Is it appropriate for me to dress as a “horror” version of my chosen profession? Can this negatively affect my future career prospects? I had absolutely no idea, and I felt a sudden sense of dread. Am I never going to be able to enjoy the things I used to without the fear or it leading to repercussions later on in my nursing career?

I’ve mentioned in a previous post about my view of the image nurses have, but it is a concept that seems to almost haunt me. The internet portrayal of nurses is fairly decent, with 70% of websites showing nurses as educated professionals. They are also shown as having specialized skills and knowledge. However, when it comes to portray them as health authorities, the image starts to falter. A study has shown that how the public stereotypes the profession can have effects on the nursing practice, and their self-concept. Does my Halloween costume then influence or perpetrate these stereotypes?

I decided to try and find the answers online, but there wasn’t much. I found one forum thread where fellow nurses were wondering if it was unprofessional to dress up for Halloween while on shift. Although not quite applicable in my situation as I am going to a Halloween party, it gave me some food for thought. The general consensus was that it

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cc Tim Letscher

strongly depended on the work environment – school nurses were almost expected to dress up, A&E or ICU nurses less so mainly to avoid having to share serious moments with patients and their family in a silly getup. So if it is based strongly on context, then it should be fine for me to do so if it is specifically on Halloween, and for a themed party.

Despite the reassurance of this realization, and the confirmation from a fellow student that they dressed as a nurse last year, I am still a little apprehensive. I don’t want to encourage the stereotyping of any profession. When I was looking for inspiration, I realized that most nurse costumes had kept the nursing cap in some shape or form. I’m not sure if this is simply because it makes it more recognizable (you know, despite the massive red cross on the apron and the syringe), or because it is one of those lingering stereotypes.

But does there come a point where you just have to accept that it is part of a costume? The same way fangs and cape are the go-to for a vampire costume? Has it become part of a character, or should insist that it is a profession and should be treated so? What about other professions that have been turned into costumes, such as the police or firefighters? There does seem to be a very fine line that can be easily crossed when it comes to costumes. Personally, I think professions are up for grabs – it’s always fun to pretend to be someone else. As long as it is done in a respectful way (e.g dressing up as Prince does not give you the excuse to paint your face dark, the outfit, wig, and facial hair should be clue enough).

So, despite the stereotypes and popularity of a promiscuous nurse, I think I would like to maintain the professional image even when covered in fake blood. It turns out, it’s cheaper to order an actual tunic and discount (yet still functional) stethoscope off the internet than a commercial costume.

 

I’m terrified of my new GP practice.

I had to register with a GP practice today…

As long as I can remember, I have always had the same GP back home. My family registered with the practice when we moved to Belgium and I had never needed to see anyone else unless it was for a more detailed examination, such as allergy tests. That practice was based in the bottom half of a house. You walked through the front door, a bathroom on the right, a small waiting room through the door on the left. On the walls of the hallway, pexels-photostock pictures of pebbles or something of that nature – you know the ones you find at Ikea or the pound shop? When you walk into the waiting room, there is a small table in the corner with a pile of magazines, several relatively comfy chairs to choose from. The walls also had generic pictures of flowers, and some posters and leaflets relating to healthcare (vaccinations, promotion of health services, etc.). Opposite the entrance door is the door to the consultation room, a brightly lit and secure environment. a desk towards the front, an examination bed and sphygmomanometer (blood pressure machine), scales, and the like towards the back. The walls had cabinets stocked with medical goodies, with those 3D posters placed strategically around the room.

It’s a tiny GP practice, family run I think. The two consultants, a man and woman, that alternate the days they work – so depending on who you felt more comfortable with, you went on those days. They would have drop in clinics from 7:00 til 12:00 almost every, and appointments the rest of the day. No reception, no nursing staff. It was kept neat, simple, and soothing. You either booked online or called in for an appointment – or woke up at 5:00 to try and make it to the drop in sessions first. Although I don’t remember signing up, I do know that every time you went, whether it was a drop in or scheduled appointment, you would wait in the waiting room, and the consultant would come to the room and call you in. You would sit at the desk, discuss your concerns, complete your appointment, then they would walk you to the front door and shake your hand goodbye when you leave.

My new GP here could not be more polar opposite.pexels-photo-1I received a call from someone named “Jen”, telling me that they received my online application to the practice and would need to come in just to complete two more questions and prove my identity and address – all pretty standard stuff. She told me when she worked, and to ask for her when I come in, no appointment required. Great, I have time tomorrow so I’ll drop in then before heading off to university. Upon my arrival, I notice that there are A4 sheets of paper with a notice stuck to the front door, stating that drop-in clinics were no longer a thing. Okay, but I was told over the phone to come in whenever. I ignore the notice and walk in.

 

That first notice should have been a warning for the chaos that greeted me inside. I could not tell you what colour the walls were originally, if they were painted or papered. Well, actually, they were papered – to an inch of their life – with notices, posters, and health promotion campaigns. It was so overwhelming that I forgot I was a student nurse and panicked at the fact that I was at the GP. Suddenly, I wanted to spend as little time there as possible. To the right was a door (also covered in notices, something about your weight and asking the reception for details – like what, does my coat make me look fat?). In front of me was a desk, presumably, with a counter. It was hard to say, there were so many stacks of paper on it. A clear plastic pot, which looked like the leftover packaging of a cookie tin, holding 5 miserable looking pens, had the words “Pl se Re u n Pens, THANK YOU” scrawled on it in ballpoint. The strangest looking machine was positioned in front of the counter, with a chair. I assumed it may have been a ticket dispenser as it had buttons, the time, and a bizarre circular opening with cloth bag inside.

It took me a couple of minutes to get used to my surroundings, by which time the two receptionists at the desk noticed my presence and asked me what I was here for. I told them that I was here for Jen. After asking me my name about 5 times, they finally found my online application and asked me to sit down and complete the outstanding questions. For a second I was confused, as the only chair I had seen up til now had an elderly lady sat in it. The realization, that the onslaught of chaos from the walls had given me tunnel vision, suddenly dawned on me as I heard a cough from the left side of the room. In an almost tv-trope manner, I turned slowly to notice the waiting room, with about ten people sitting, staring at me. I don’t blame them, I was the only part of that room not covered in A4 notices! I grabbed a pen and hurried over to the only available seat, next to a dirty looking children’s play table. I tried to concentrate on the documents in my hand, but I could almost feel the stares on me.

questionnaire-clipart-6Finally, I managed to answer one of the two questions, “What is your activity level, circle one of the answers below”, check and sign the application form. The second question was my blood pressure. I have no clue what my blood pressure is, so I left it blank, assuming a nurse would come and take it for me. I handed back all my material and sat back down, careful not to make eye contact with anyone else in the room. Every now and then, you hear a voice from inside the practice shout someones name, and the person solemnly gets up and walks through that door on the right.

Suddenly the receptionist called my name, I jumped up thinking I would finally meet someone face to face. No such luck.

“You haven’t taken your blood pressure. Please take your blood pressure. Sit down, take of your coat. Take off your coat, put your arm in as far as possible and press the start button.”

What in the world is she talking about? I must have had a look of utter confusion for her to need to repeat “take of your coat” with such exasperation. But then I realized. The ticket

willie-ij-temple-of-doom
Willie, in Indiana Jones and the Temple of Doom, sticking her arm in a bug infested hole in the wall.

machine was not a ticket machine, but a sphygmomanometer. I took of my coat, rolled up my sleeve, and hoped that this wasn’t an episode of Indiana Jones, as I stick my arm in the hole and start the machine. The sphyg tightens, and I watch the numbers displayed on the top. Then it’s over, and a ticket does actually come out with my blood pressure written on it. I sheepishly hand it to the receptionist.

“Is that all you need me for?” I hope her answer is yes, I just want to leave. My newfound claustrophobia isn’t helping. She takes the ticket and skims over my papers. “Yeah, that’s it I think.” They hadn’t checked my ID, or my address. I have no idea who Jen was, or who my consultant is (there was a list of people working at the practice on the top of the documents, so at least I know there are medical staff). The single medical task required was done by an automated machine that resembled a hole-in-the-wall trap from adventure movies. The only interaction with a person I had during my visit was with busy receptionists, who let the phone ring continuously for the 15 minutes I was there.

You forget, when you’re a student, that you are also a service user. And when you experience the healthcare system from the other end, it really makes you reflect upon your own behaviour and practice. Until now, I have only been in CYP services due to my placements, so this was my first experience with the GPs in the UK. I had previously been to the dentist here, and the dental nurse gave me a bit of a scowl when she found out I was a foreigner and a student nurse to boot. Yet that was such a small incident compared to the rest of my experience that it barely left an impact. Applying to the GP however, reminded me how lucky children in this country, and therefore, to an extent, how unlucky the adults can be when it comes to services. Whereas children get piles of toys and cartoon posters, in a brightly lit waiting room, the adults get a chair and patronizing health promotional posters on every inch of available wall space. Children get greeted with a big warm smile, and a “how are you?”, whereas adults are called for like misbehaving children at the principles office. It makes me sad to think that 18-year-olds must have this harsh transition from one extreme to the other. Although I’m sure they are glad to be rid of the stickers and pastels of paediatric services, I doubt they appreciate drab waiting room of the adults.

If I have any questions about my health, I think I will be waiting until I visit home.

Nur

The image of a nurse

nurse-1160810_640I grew up in a culture where being doctors, lawyers, and business managers was the goal – so I never gave being a nurse a second thought. However, as you can see, this has clearly changed. My image of what a nurse is has been torn apart and stitched back together through the many experiences that I have had since the starting my application to Salford. I have been fortunate to be in good health throughout my life, so I rarely went into hospital. So the only interaction with nurses I have had that I can remember was with the school nurse – a slightly stocky lady that seemed to live in the nursing office, who always seemed very skeptical. Or, they were the shadow in the background of popular TV shows who’s sole job was to obey the physicians or be a plot device.

But, as I found out recently, I was not the only one to have this idea of what a nurse was. Apparently, the media shapes our view of nurses a great deal more than you would expect, propagating the various stereotypes that can easily be associated with the nursing profession. Sandy and Harry Summers have done a very interesting blog series about the image of nursing that I suggest you have a look at, as they take each stereotype in turn. However, I thought I would look more specifically at the physical appearance that nurses are expected to have.

Before applying to be a nurse, I had a side cut and red (or purple or blueish black) hair and I would occasionally go to town with bright blue contact lenses and a bright purple wig. Yet, under the suggestion of family and friends – “to blend in, and have a higher chance of getting accepted to the course” – I grew out my hair, and saw my natural hair colour for the first time in years. And, they weren’t completely wrong.

The university has a uniform policy that you must adhere to, and each trust has their own too. During one of my lectures, we discussed the physical appearance nurses had to maintain according to the policies, and how subjective the language could be. The University policy (found on our Blackboard page) is fairly straight forwards, with little room for  misinterpretation. For the entire policy, health and safety, infection control, and professional appearance are the main reasons behind it. When I compared the uniform policy for  the Central Manchester Foundation Trust (CMFT), and that of the University of Salford, one article that is noted in the University policy that is not in the CMFT policy is acceptable hair colour (and consequently hair tie colour, although both agree they must be plain without adornment).

“Students should have a natural hair colour; this must be borne in mind if the hair is dyed or coloured.”

The reasoning, I presume, behind it is that the public may not see a nurse with brightly dyed hair as professional. However, walking around Manchester city centre, I get the feeling that natural hair colours are the minority!

This policy point seems to be based purely on what is expected of a nurse, to be unoffensive; approachable; trustworthy. I mean, someone with pink hair must be a party animal and irresponsible, right? But that would be judging a book by it’s cover – something we are all taught not to do from a young age. Although, I do understand the rationale that was made during induction – “you don’t know if you will come across a patient with a phobia or mental health illness that can be triggered by bright hair colours.” If that is the case, why is it not included in all trust policies? And why is it not true for other health professionals (I had the pleasure of meeting a junior doctor with amazing deep purple

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Where do you draw the line?

hair), are they not just as liable to interact with these patients ? When we were presented the uniform policy during induction, there was some confusion as the policy stated natural hair colours only, yet the lecturer said to “just be objective” about it, stating that fire-engine red was unacceptable but darker shades would be okay. However, you cannot underestimate the power of first impressions, so it strongly depends on the person across from you and their upbringing and beliefs.

I have been told (although I am unable to find it) that the Bolton Trust uniform policy states that nurses may not have”extreme haircuts”, which I assume is for the same reasons. Yet “extreme” seems to be very subjective of a term. Is a side-cut extreme? How about a male nurse with long hair (yet following uniform policy about tying it up). A female nurse who participated in”brave the shave“, would she be risking breaching uniform policy for taking part in a charity event or would that be seen as exempt due to circumstances?

During that lecture, we were told a couple of anecdotes around uniforms. One paediatric nurse, prior to the introduction of hair colour regulations at the trust, had bright red hair and worked with colleagues in pre-admission. They would visit the children at home, in their scrubs (or “pajamas”, as they are affectionately known) to explain the procedure to both them and the parents. This nurse found that, once in hospital, the children would recognise him thanks to his bright red hair and pajamas. They would feel as if they knew someone there, and were significantly more at ease. Another nurse, who’s uniform policy stated that only tan tights should be worn with a dress uniform, was told by a manager to change immediately as she was wearing black tights instead. Yet, at no point during these two instances was their skill called into question due to their appearance.

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ccCasparGirl

I think it all comes down to the professional image, and what the public expect of nurses. So I leave this question to you: how much value do you place professional appearance, and what do you consider to be professional?

Personally, I’d love a nurse with multicoloured hair – it would give me a great ice breaker!

Nur

Freshers Flu – or meningitis?

flu-97679_640The first week back at university has reminded me the joys of student life – reuniting with friends, checking out the societies and clubs, figuring out timetables, and sharing germs. Although I was in only two days during freshers week, I find myself, like many others, hording packs of tissues and sniffling in the corner of rooms hoping no one notices. I believe I may have freshers flu. Runny nose, sore throat, and fatigue – these seem to only be a few of the many symptoms associated with freshers flu. It’s the perfect melting pot of situations for the spread of illness. All it takes is one person in a lecture room to sneeze or cough without covering their mouth, sending droplets of saliva containing the germs everywhere, and the whole room is at risk of contracting whatever they have.

Although, this got me thinking, isn’t flu season closer to winter than mid September? If it’s not influenza then what is it? So I did what every student nurse should not do, and consulted WebMD. This not only gave me little hope for my chances of survival, but lead me down a bit of a rabbit hole of all the illnesses that had similar symptoms. This quickly dropped me at the front door of meningitis, a virus that has currently gained quite the negative reputation with parents of younger children.

Because the media focuses on the horrible, usually late stage cases, that occur in younger children, the teens and young adult demographic gets left by the wayside. Although meningitis is rare, it can still be life threatening. According to the British Red Cross, students are at a higher risk due to the proximity of living arrangements. But what exactly is meningitis? The virus or bacteria causes inflammation of lining around the brain and spinal cord, with meningococcal bacteria being the main cause of meningitis in the UK. Although we are all susceptible to the various bacteria that cause meningitis, young adults are most prone to meningococcal bacteria.

The symptoms tend to be very similar to other illnesses students would expect to contract during freshers week (e.g. common cold, flu, hangover), but if missed can be much more devastating. Symptoms such as fevers, headaches, aches and pains, fatigue, and – more concerning – rashes, are common signs of the illness. The British Red Cross gives a step-by-step guide of first aid for meningitis if someone is suspected to have contracted it, which I strongly urge you to have a look at.

But what can we do to avoid contracting the illness? It’s simpler than you might think. We are all taught from a young age what to do if we have a cold, the same basic principles apply for meningitis. If the bacteria or virus doesn’t reach you, you cannot be infected right? So doing the following is always recommended:

  • Wash your hands with soap (especially after toilet use, coughing, sneezing, and blowing your nose).
  • Try not to touch your face with unwashed hands.
  • Avoid close contact with others (e.g. kissing, hugging, or sharing cups with people who are sick)
  • Cover your mouth when you cough or sneeze with a tissue, not  your hands.
  • Clean and disinfect frequently touched surfaces (e.g. keyboards, door handles, phones).
  • If you are sick, stay at home.

vaccination-296946_640Additionally, there has been a strong push by the UK government to encourage students to get vaccinated against meningitis. Since the introduction of vaccinations, the number of cases of meningitis has greatly decreased. Although there is an increase of MenW, a very aggressive strand of meningitis, the MenACWY vaccination introduced has shown a drop in cases of young people aged 15 – 19. Those who had the vaccine were not recorded contracting the strain, and it also prevents against three others (MenA,MenC, MenY).

As a future paediatric nurse, I often wonder how my patients would perceive my knowledge and if they would find it hypocritical if I told them to get vaccinated if I hadn’t been. I often get the feeling that there is a lot of “do as I say, not as I do” in nursing, but that’s a topic for another post. So keeping that in mind, I believe that I will be doing some more digging about the vaccine, and get it if I haven’t already (moving hasn’t made keeping track of vaccinations easy). I hope that fellow students consider doing the same.

So although we may not think much of freshers flu, other than a passing experience of university life, it is important to be aware that it may not always be a case of the sniffles. But like most bacterial and viral infections caught during freshers week, simple precautions such as hand washing and using common sense (please cover your mouth when you sneeze, it’s not a pretty sight), we may just survive freshers flu together.

Nur