In good hands (1984)

does that hurt you there that's good arter fors you give two three four good morning good morning I've been told to come here at 10:00 this morning I've got nobody wants to go to hospital but the chances are that any of us could at any time we're all potential patients and if we become ill or if we have an accident whether we like it or not suddenly we're dependent on a team of people whose aim is to care for us and to help us nurses are important members of this team today their professionals in their own right responsible for the total nursing care of their patients a big change from earlier times when they were often seen as handmaidens of a doctor as one doctor explains well in the old days they would be the consultant and the matron and then the doctors and the nurses and at the very bottom would be the patients I mean if maton said feeling do this the nurse would do it it's a change from the old way that nursing care used to be organized which was that the most Junior nurse spent all her time with slle scrubbing bed pans and the sister spent all her time going around with the consultant to realizing that people appreciate having one nurse to look after them for a lot of the time and it's much more interesting and more rewarding for the nurse and better for the patient it's very different from how I envisaged it to start with I have far more responsibility now than I'd ever thought um I didn't realize how involved you got um with the job what knowledge was required from you that there was as much depth to it really learning to make decisions about patient care begins in the school of nursing these decisions require A thorough understanding of the way the human body works give an injection of atropine what anatomy and physiology would you there is a lot to learn these students are looking at the effects of medication given to patients before an operation work in the lecture room is combined with firsthand experience and during their three-year training students like Fiona spend much of their time on the ward and Mrs gold lady lady in room two in the cubicle she's going down for laparotomy this afternoon now she's on her C with a qualified nurse Fiona goes over the preparation of one of her patients for an operation check your name then edth gold k61 that's lovely with a staff nurse present Fiona gives the injection in this way classroom theory and practice come together your toes for us if we're giving atropin I wonder how you would explain the actual action of atropin it interrupts the action of atic Coline at the receptor site and dampens down the action of the parasympathetic in relasing the action of the sympathetic now you put it on press firmly on the top right at a later stage in her training the owner will spend some time in the operating theater she'll receive instruction and support from the qualified nursing staff of the surgical team and you take your knife back to the table and get ready with the sign clean knife and the DI me back into the quiver that's all I don't think that you could be a good nurse without having the theoretical knowledge behind your practical work what you're actually going to do on the ward has to be backed up the whole time by the theoretical side of things to know what is normal what is abnormal what's just the effect of a drug that you've given that is perfectly all right what to report to the doctor that's where your knowledge is very important and attach that onto the tubing I put the fluid all the way through the tubing until it comes to the end we attach a label to that to allow us to know what's inside there she during her threeyear training the nurse is taught to take an increasing role in the nursing management of the patient so that when she's qualified she can take on full responsibility she's a decision maker um and I think as time goes by it's becoming more of a decision maker about their care um and she's responsible for the outcome of the care okay ready it's never a boring job it's sometimes very rewarding sometimes it's not rewarding at all but sometimes you do feel that you've really helped somebody in what to them is a really major crisis in their life okay somebody's rung up your sister and she's going to come up but she's obviously got things to sort out first but she's on the way okay now I'm going to have to look at your bag leg okay I'm going to let this splint down which will be a bit painful don't worry if you will just want [Music] to sorry well done looks as though you've definitely broken your leg feels like it and you got a bit of a cut on there as well so you need to be plastered I get the doctor to have a look at it and we'll do certainly in casualty we very much work as a team and the medical staff make medical decisions but they're very much dependent on what we tell them um for example I receive patients from the ambulance Crews and the doctors will say which patient do I need to see first and they accept that I know what I'm talking about wasn't knocked unconscious he's got a lot of pain in his right leg MH um the ambulance could have thought looked a bit shocked see but his observations are fine bp1 1208 pulse 80 so they put a drip up but I've slowed it down just to keep the vein open the old sort of relationship where the doctor gave the orders to the nurse that that relationship is breaking down nurses in fact perform much better if they're given the opportunity to use their initiative if they're given the opportunity to question what was done in the past um because we're seeing that that old ways of working are perhaps not not the best ways of working because doctors come and go change quite frequently because they get to have to get experience here people who nursing staff here all the time really do know how the department should run which patients and priorities and you have to be you have to be a bit pushy to work here it's no use being terribly quiet and retiring because you've got to bully doctors sometimes say come and see this patient it only works as a team you know the doctors listen to what we say we listen to what they say what have you been up to then speci for B up you got a lot of pain at the moment yeah not to worry we'll get you into bed in a minutes and make you more comfortable with any road traffic accident regardless of whether there injuries or serious or not the patient is always shocked primarily they need a lot of reassurance they're frightened they don't know what's happened to them or even if they do they still are frightened of possible consequences can I please not at the moment no you may have got this pain in new tummy complaining about it before the doctors think the an important part of the nurse's role is to build up a close relationship with each individual patient in her care it makes it a lot closer relationship between the nurse and the patient because they get to know their nurse and depend on them more and probably confide in them more as well and does does that help the getting better I'm sure it does sure it does but obviously those psychosocial aspects the um emotional social needs of patients you're well aware how much more difficult they can be to to find out the problems and nursing care now looks at the whole patient body and mind are no longer separated at the school gram a third-year student discusses a patient on his Ward who's had a stroke which has affected one side of his body we're going just going to have to come to terms and he's got to come to terms with the fact that he all always have a diminished side and that he'll have to accept that his body involves one hand one arm how's the arm all right it's not hurting no shoulder all right yeah yeah let's see you move it a little bit that's not bad is it he sees a drink on that side and you can actually see that mentally he thinks oh I going and put my arm out he can't do it he has to take this one it's it's a a minor frustration I'm sure but it must build you think you'll be able to adjust to just walking with one leg Yeah and using the wheelchair around the house blanket bath isn't just a practical task it's it's a means of me being able to assess somebody be able to look at them we can use that 20 minute exchange to talk to them about it to actually sit down and find out their fears allow them to express their fears to talk through a situation which is very personal to somebody how are you hey yes oh good yeah we bet have your tea early tonight yeah you enjoyed yourself his interaction actually with his wife and with his children is very loving I think that they all sort of care enough about each other that they will be aware of what's happened to him and the wife especially I mean we we've talked about this this sort of problems that he's having and she's she's obviously very understanding that she doesn't want to sort of emasculate him by by taking over everything that's me we can get into the stage where he can handle a wheelchair by himself yes that's what I to get home and get around a little bit yeah then he's got to help yourself there a lot isn't he yeah I the thing with having someone's had a stroke it really is self motivation yeah actually some important decisions involving the community services have to be made before the patient leaves the hospital with the night sister Graham explores some of the ways these decisions might be reached another thing um I think might be an idea would be to us a help to call in as well and perhaps meet Mrs uh Groves before yes we could we could actually be that to meet at the home want to meet on the ward either it be perfectly possible all there we could actually have them that's right again we could arrange it through the district nurse meison now that we've checked the U fluid is clear that the prescription that this bag matches up with the prescription the expiry date and the patient's name Band by the time she's reached her third year of training the owner is able to pass on her skills to firste students want to touch the end of this tube which is going into sterile fluid all right now when you're putting this in it needs to be pushed quite firmly check that you haven't pierced the bag on the inside all right you have to be able to um look at the whole person or to step in to be able to fulfill a need for somebody right we hopefully look at a person now as slightly more than an appendix in bed five or a CVA in bed six we hopefully look at the effect of their illness upon their social status what's happening to them in their family due to their illness I mean is it anything I can help with I shouldn't think so do you understand how long you may have to take off work right I've heard I been told probably be sort of four to six weeks of taking it easy I think partly it's becoming recognized that you can't say well this person's got a physical illness and that their emotions have nothing to do with it because the essence of Nursing Care is to help the marry the emotions and the physical care what is this operation he might not need to have an operation we think he might have damaged some of his internal organs we have to to keep an eye patients relatives also have their fears and anxieties nursing care involves the family as well when his sister came in I realized that she was frightened as well and she also needed a lot of reassurance he'd been in an accident and she didn't quite know what had happened to him I think it's quite difficult to learn how to react towards them and not become over emotional in return because you have to learn to equate the way they're feeling the way they're speaking to you and I think that's quite hard and it takes a lot of experience to learn it how did you learn it something like by experience I think and watching others or listening to others rather anyway if you could U get something for so just have a look at a chart yeah yeah that' be lovely thanks very much cheers thanks I had a lady whose um condition um initially had been improving she was on all the right treatment for her condition but unfortunately um after a while it was apparent that if actually wasn't going to get better very I hadn't spent as much time I'd like to I don't think you should blame her brother who's very caring champ who' been up to see her quite often was puzzled by the fact that she seemed to be getting better and then I had to tell him that um that things were not getting better and that probably she was going to die that's a very difficult thing to do we'll have a cup of tea and um I'll explain things for you a it so how do nurses cope with death you never know what to say I don't think you ever do it's something that can't be taught um it's something that you go by Instinct but that leaves you very vulnerable um because there's no right thing to do or say that's very difficult it's not something you can you acquire in 5 minutes and it does tend to be more senior nurses who will do it and they'll try and work with Juniors so that they can see what you're doing if it isn't expected death it's not trauma traumatic it can be very sad especially if you've got very close to them um but if they're sort of elderly and it's expected no but if it's somebody who's young and it's totally unexpected it's very traumatic yes you go home and cry okay you just rest your arms down by sides okay you are taught to deal with stress I mean what is stressful for a first year student isn't for a staff nurse you taught throughout your training to deal with that stress and that's also part of the love of the job you ever had anything like this before when I've had this you can make a lot of Demands on you that you sometimes think you can't cope with anymore but you usually do it's a very tiring job it's very physically hard and you have to be able to think on your feet even though your feet AB killing you because you've been on them for 9 hours anyway the trip should be down um tomorrow I don't think any of us are Mars I don't think we do it without getting something back and you get a lot back and you become a lot closer to people you see them go home and you get to know their families and a lot about them become very close to them thank you yeah has dad got that the estimate has dad got the estim it's nice to be able to see majority them anyway getting up and getting better and seeing the progress of the healing of a broken bone sometimes we send patient home before it's completely healed but we do occasionally have patients in for three or four months until it's all completely better that's quite satisfying does a nurse's training stop at the end of their threeyear course no it doesn't there are a lot of opportunities to go into various fields of nursing a lot of courses available um there's Orthopedic nursing which I did myself there's orthic nursing children's nursing those lists endless it's they tangibles people's faces their expressions they're being able to help being able to give I mean that's always a nice feeling people come in very ill within a few minutes you can make them feel very much better and also that you get a lot of people say well I'm in good hands now and you get quite a buzz out that it's that ability to give something to somebody when they're very much in need that makes you feel good for