Tuesday, 1 September 2015

Metal Nurse Spaketh: 15 years in Healthcare

15 years now. This month I have worked in healthcare for 15 years. I can't say with much honesty that I have loved every minute of it. I have loved more then I have loathed it, that is for sure though. Out of those I spent 14 years and 6 months as a Healthcare Assistant/Auxiliary Nurse/Healthcare Support Worker/Clinical Support Worker/Nursing Auxiliary.In the last 6 months I have worked as a registered nurse. I sort of fell into it when I applied for a job in the local nursing home which mainly appealed to me because of the hours. And I found that I was actually good at it and (more importantly) people actually liked me for me. That was a new and fresh experience. I spent three years there and actually loved every minute of that. It was there where I first came across palliative care and the horror that dementia can inflict on people. This is also where I did my first Last Offices. Where dressed my first wound.  It's where I first learned how to make a plait!

While I was there I got asked frequently if I thought about becoming a doctor. I looked at the doctors who worked in that nursing home (it was part of the healthcare centre) and just saw how utterly exhausted they were. Generally if we were lucky we had two GP's, but most of the time it was just the one. And they (he, she) had a case-load of 2000+ people in an area that would take around three-four hours to drive across. No, I did not want to be a doctor. Besides the idea of spending 5-6 years in Uni (and then specialize) did not make it look any better. So I decided I wanted to become a nurse instead. Which was an unusual decision for someone of the male persuasion to want to do, in a town full of fishermen.

Then I moved to the UK in 2003. The plan was to do the NVQ's and then get into Uni and do my nursing. I found that although I like reading and learning I wasn't very academic. Which is why I liked the idea of doing the NVQ's. It seemed more practical, more hands on. Also it seemed for reflective. It was a five year plan that due to one reason and another got stretched to 12 year plan.

I was (and still am) slightly horrified at the state of the nursing homes in the UK. I am sure that there are nice private nursing homes out there. But I haven't come across a lot of them. And the two I worked in had some lovely staff but also had some not so lovely. I spent three years doing that. I learned a lot, I especially learned a lot of what should not be done.

Then in 2006 I got a job in the NHS. And I have stayed with the NHS ever since. I first got my break working in Mental Health. My wage nearly doubled. I had a decent amount of annual leave! Sick pay!! Holy mother load sick pay!!! People in the NHS really didn't know how lucky they were/are.

So yeah, I spent six years working in Mental Health, enjoyed most of it. Met some interesting people, both staff and patients. I finally managed to do my NVQ 3 when there. And I was trying for some time to push my career a little further. I got bored easily, I needed a new challenge. But it was for most parts more challenging and interesting. Mostly my interest were about physical health in mental health. As it seemed to me that it was a pretty neglected aspect of their care.

I worked within the acute hospital for 5 years (two of which overlapped with working in Mental Health). I applied for the bank with the hope to get a job on one of the wards. I never did get a job, not for the lack of trying. But hey, it worked out pretty good in the end. I really enjoyed being on the bank and I made a point of doing at least one bank shift on each ward. As can be expected some wards were nicer than others. My favourite place to work was ED. And after a couple of bank shifts on there I had fallen in love with that type of nursing.

In 2010 I made my first application for university. Didn't get in. Then in 2011 I applied again, this time I got accepted for March 2012. My mind was set on doing Adult Nursing. I figured that with my experience of working in Mental health that it would only improve my holistic nursing skills. And as I said previously, I wanted to work in ED.

Then in 2012. My training started. The group I was in was small, but full of awesome people. I really did enjoy learning in a university setting. Essays were maybe not my forte, but the good thing about them is that it forced me to read, it forced me to evaluate evidence and it forced me to really think about my nursing practice. It essentially changed my whole viewpoint on life. For example it was pretty hard to be indifferent on the vaccine issue when you meet people in their 70’s who had polio. Or were deaf because of measles. It was pretty difficult to be indifferent about helmets on cyclists when you come across people who, well should have used one. Or take care of people who've had strokes and not think of what risk factors you've got that you can  eliminate.

Because of procrastination I started writing other stuff that were unrelated to my studies. Mostly I started writing about music. But this has now evolved into writing about nursing stuff. And with reading other blogs like Respectful Insolence and Skeptical Raptor, I always make sure that I reference my healthcare related blogs as much as possible. It is still a source of pride when Skeptical Raptor asked if he could reblog my Flu Vaccine article.

During my training I did several placements, mostly in the hospital. I don’t think I had a bad placement, I had  a couple dull ones. But not really a bad one. I did do one in a nursing home, which I have to say almost rebuilt my hopes for the state of nursing homes in the UK. I met some awesome people. I took care of some awesome people. I learned a lot. But two placements stood out, CCU and ED. Those two placements really dug into my skin and have never let go since. What really got me was just how much nearly every subject interested me, stuff that I hadn't really paid much heed like sexual health, oncology, diabetic care and cardiac care. I was amazed at some of the technology that we have in healthcare and how much we take for granted. For example day surgery, I don't know how much people realise how amazing it is. I mean common, you walk in in the morning and walk out in the afternoon. We have managed to replace porcine/bovine insulin with genetically modified human insulin. We can replace organs. We can replace hips, knees and ankles! We can keep someone who's got a shot kidney alive with dialysis! Medical technology is amazing, and it just keeps on getting better. Yet, more often than not, people either don't notice that or ignore it.

I qualified in March 2015 and I got the job I wanted. ED. And I loved every minute of it. It was everything that I had hoped for. There was variety, there were different challenges on every single shift. I took care of a lot of awesome patients. I worked with a lot of awesome staff. I got into situations that normal people shouldn't have to deal  with. And it made me appreciate my life a lot more.

Now after six months as a staff nurse and a lot of soul searching I am on the move again. This time I’ll be on a medical assessment unit. No, it's the continuation of it. And so my healthcare saga continues. I do think I am very good at this job, not perfect, not great. But good enough to always keep on learning how to be better.

I cannot imagine doing another job.

Friday, 14 August 2015

Audience Killer Loop: Dir En Grey

Dir En Grey
Oh man. Where do I even start with these guys? Lets start with the obvious. They are unclassifiable. At best I could say that they are Avant Garde Metal. Essentially they use a loose template of metal and build everything else from there. Metal is the canvas but it is not the palette. These guys have been around since 1997 and have kept the same line up ever since. They originally started out as a Visual Kei band, but have since morphed into this Slipknot/Korn/Rammstein band that we can hear today. With downtuned guitars, slapping bass, hip hop rhythm and industrial sensibilities. They were originally born from the ashes of a rock band called La:Sadie's, but for whatever reason they disbanded. Or rather the then bassist left, but the rest decided to hire a new bassist and forge ahead under a new name, thank goodness. As I mentioned before, they've managed to keep the same line up ever since which is no mean feat, and you can really hear that in the latest album Arche. Which is quite possibly their best album yet. If only because it also comes across as the most focussed of their albums. Which also completely defies Angry Metal Guy's Law of Diminishing Records.

 I first became aware of them due to their phenomenal album Uroboros. An album that for me was the album of the year of 2008 just about dislodging Opeth's Watershed. I had never heard anything quite like them up to that point. Uroboros has got what I consider to the be best album intro. Every they release something I let out a little noise of celebration. They are possibly the biggest musical phenomenon to be exported from Japan and by all accounts they are the biggest metal band in Japan since X-Japan. Which shouldn't be too surprising since X-Japan overlord Yoshiki helped to launch their career and 'hide' was a major influence on Kaoru guitar playing. The other remarkable thing about them is that they managed to do all of that without having to sing in English. The only other metal band that has managed international success using their mother tongue is of course Rammstein.

Visual Kei era
So they went through a stage of Visual Kei playing slightly more alternative rock, more akin to Jane's Addiction. But seemingly completely shed that image by the time they released Withering To Death.  It feels a bit like they went through the same epiphany as Sepultura did when Korn released their brilliant debut album (Yes, it is brilliant). Withering to Death, is cut from the same mould as Korn's debut album, it's full of jagged edges, slight hip-hop bass lines, off kilter rhythms and maniac vocal stylings. The main difference being is that Kyo actually knows how to sing in tune, as well as flex his vocal chords into the suffering of every victim in the nine hells as described by Dante. All those usual pop influences have been swapped for something rawer, more energetic, avant garde and more personal. They are one of those bands that have managed to transcend any kind of genrefication. At best they would fall in Extreme Metal genre. They go from nu-metal to metalcore to progressive metal with the occasional dipping into pop. Amongst all the madness and surreal violence you get from them you also get nice little piano ditties like 'Shinsou'. Or they take a jazz foundation and turn it into some brutal like 'Asunaki Koufuku, Koenaki Asu'. Funking it out in 'Stuck Man'.

Kyo with blood on
face and chest
Now some of the puzzling things about this band is that some of the song titles are in English. But none of the lyrics are so that can get a bit confusing. Not that it actually detracts from the music. Kyo does apparently write extremely good lyrics. It's just that I can't be bothered to read the translations of them because they way I think of his vocals is that it's just another musical instrument. Talking about instruments. I can understand why Kyo gets as much attention as he does, I mean he completely and utterly outdoes Mike Patton in terms of vocal ability, but the rest of the band... Just wow, they are all individually amazing. On the bass front Toshiya seems to have taken some lessons from Jason Newsted, in the sense that the bass isn't just there to fill out some kind of void. But to be an active part of the songs without being the centrepiece. Though songs like 'Phenomenon'  and 'Bottom Of The Death Valley' do put the bass front and centre to great effect. Both the bass player and the drummer, Shinya, provide excellent foundation that let Kyo, Die and Kaoru let their respective talents loose onto the listeners ear canal. The guitar riffing is great, but what is really special is the guitar noodling that comes in to surround the main riffs. Always subtle and never in the way, all seem to enhance the listeners experience. The sense of melody that they imbue is just out of this world. Often it feels like the songs are just about to descend into a gigantic mess, but it never happens. 

By all accounts their live shows are something to behold. Prior to Uroboros Kyo used to, frequently and apparently, self harm whilst on stage. Due to his singing he's been hospitalized several times, couple of times because of oedema of the lyranx and vocal nodule dysphonia. Oh and partially deaf in his left ear. The man does suffer a lot for his art and from all the videos I have seen he squeezes every single emotion into his performance. As demonstrated in this video taken from their Tabula Rasa tour.

I am a little surprised why they haven't got as much of a recognition in Europe(Or maybe just in the UK) because these guys are one of the best bands out there right now. Pumping out quality album after quality album. And their evolution from Visual Kei band to what they are now has been fascinating.

Thursday, 6 August 2015

Metal Nurse Spaketh: Critical Thinking

Critical thinking. It’s an important aspect of life and living. If there is one lesson I learnt in uni was that critical thinking was probably the most essential part of becoming a nurse (Yes, people will say care and compassion are more important, but care and compassion can be done wrong if done without critical thinking). It is also the reason why it’s a three year course. That might seem like overkill, but just look at how long doctors have to train and thank your lucky stars.

My personal tutor always made a point of it when we talked about evidence and the use of it in good care.  It is one of the many reasons how student nurses become nurses. One of the biggest parts of their studies is how to critically evaluate the evidence, the research and how to critically appraise it. It is to learn how to distinguish between a bad study (that can hinder your care for someone, for example The Wakefield study) and a good study, as in a study that can, will and does positively impact on your patient group.

In our profession we have to deal with a plethora of different medical professionals, some of course more difficult than others. Because of this we have to learn how to think critically and also make sure that our evidence based practice is up to snuff. This does not mean that we know better, we don’t (always), it means that we should know when to ask the right questions, and also when to accept the answers. But with that, we should always make sure that we follow up on those questions and if we feel that we do know better we should be able to say so and back it up. This is why nursing education is so broad and this is why as a profession we are encouraged to adopt life-long learning, it does nobody any good if you just decide that you want to stay in your present role until you retire. That is not a good enough reason to stop learning. Even if you stay as a Band 5 throughout your career you still have to learn how to move with the times.

As nurses we shouldn't just do stuff, we shouldn't just carry out tasks without thinking WHY we are carrying out those tasks. Which is why there is always a big push for evidence based practice. It doesn't just apply to doctors, it also applies to nurses. We are not there to be at the beck and call for doctors, we are there also to work as safety nets for our patients. We are there to make sure that our patients get the best care and that does not only apply to regarding personal care. It also applies to the medical treatment they get. Since doctors cannot be there all the time, we have to be their surveillance system. Seeing as the doctors care of patient  is so dependent on the reports they get from the nurses. But along with that we also should be able to work with enough autonomy and knowledge, in case something needs to be done there and then.

And this is why it boils my piss when I come across nurses who should know better. There are way too many nurses (minority, yes, but still too many) who seem to follow trends and not the evidence. When I hear nurses spout of stupid stuff like “MMR vaccine causes Autism” or “80% of the immune system is in the gut”, “I’ve never had the flu, so why should I bother with the vaccine”. Or use words like “toxins”, “detoxify” or “chemicals” without proper context. Or dabble in homeopathy. Or claim that organic is better. Or read the Daily Mail for health advice. (Don’t get me started on the diet talk)

We should know better and the fact that I know nurses who do and have said stuff like that makes me a little sad.  We have come a long way from being essentially doctors handmaidens. We are not just the task-oriented workers of yore (Though, you’d be hard pressed to believe that when you meet some of us). But sometimes it feels like we are still battling through those days.

Just in case people get the wrong idea, I am not saying that us nurses (Just me) should be all knowing and perfect in everything they do. It would be nice, but it is never going to happen. What I am asking is that nurses take their time in following the evidence up. If they read an article that says somewhere “A recent study...” then please before quoting the article, see if the study is actually referenced and if it is, to actually read the study in order to confirm that the article represented that study well or completely misled the reader. If they have that niggling doubt to make sure that they follow up on that. Be skeptical, but do not deny. Accept the answers when the evidence is overwhelming.

Good evidence trumps anecdote and intuition. A nurse who works with good evidence in conjunction with finely honed intuition that has been developed over the years is even better. But in the meantime, while the nurse is getting that experience it helps to learn critical thinking.

The most important lesson every student nurse can learn is that there is always more to learn and that your knowledge base can always be broadened, widened and stretched.   Or in the words of Neil DeGrasse Tyson:

Wednesday, 20 May 2015

Usual Locations: KeMPR

Couple of months ago I had this urge to track down a musician I used to listen to. His name is Richard Kemp. I got to know him a few years back when I lived in Ulverston, saw him play in several open mic nights and generally got to know the guy. Then things turned a little sour, and I moved to Lancaster. And contact was lost. I sort of tried to keep at least one eye on what he was doing musically, but then it just seemed to go quiet one day. But as I mentioned, I decided to go on a little Google/Facebook hunt and see if I could track him down again. And lo and behold I find him, under a new name. KeMPR.

Now for a little background (Pieced together from some fragments of my memory). Richard Kemp (mostly known as Kempy, when I knew him that might have changed since) used to be in a band called 12ft Machete, that apparently created quite a stir on the Furness peninsula. From what I've been told mostly through Richard's phenomenal stage presence. Sadly I moved to late into that area to actually ever get to see them play.  The only track I could track down by them is a song called 'Albino Twist' but only as a remix by master local Furness producer Howie Venton. Which to be fair is a cracking remix and makes me really want to hear the original. But on this track you can hear what a great rock singer he is and why 12ft Machete managed to create a name for themselves.

 When 12ft Machete called it quits out of those ruins came essentially two(Now three, possibly four) different projects. One that I became quite fond of was/is called Runt Hörnet, who play a delightful punk rock music with some aid of home made instruments like their monobass (Usually played by Howie Venton) that is played with wrench instead of a plectrum

for cryin out loud from runt hornet on Myspace.

and Lobe which had Richard Kemp in it and they played more of acoustic ballady stuff with some folky over tones. 

Stars Above Headlights from Lobe on Myspace.

Since then Lobe has disbanded for whatever reason. (With one half now doing instrumental acoustic stuff under the name 'dogmusiC'.) I had heard that they had been active around the open mic arenas around the Furness peninsula. The last song was from 2007. And then on-line activity seemed to cease from them. The Grapevine had been telling me that there had been a few personal issues that needed to be resolved and suchlike. Which just saddened me because Kempi (Kempy, Richard, whatever!) always struck me as someone who really could go all the way with his music. Thankfully, due to some Facebook browsing and Googleing, I managed to find him. Only to find out that he had relocated to Halifax and thankfully was still making music!

Few years back I used to own a album of Richard's (Kempi's, whatever!) in which he worked with Howie Venton, and I loved it. But due to many many computer formatting, rebooting and rescheduling those music files were lost. Amongst those songs was an orchestral version of one of his most played songs

Though my personal favourite song from that album was a cold industrial song called 'February'. This song always somehow made me feel a little homesick.

Currently he seems to be making a name for himself both as a musician and as an artist. And has recently published a new album called 'Some Days are Harder Than Most'.

Since renewing my interesting in his music what I have found both excellent and surprising is the fact that he's pretty much continued with the folk/acoustic stuff from Lobe. And that's not a complaint by any means. Kempi has a very gentle singing voice which also makes you feel so much better about yourself. Most of the songs do seem to centre around not losing hope knowing that there are friends around. Even during the most dejected and downtrodden song 'Reject-0' has that element to it.

Possibly the best example of this Hope Prevails/Friends song type is "We'll be around".

In amongst those acoustic songs we get surprises like 'Supersizer' a delightful raunchy rock n' roll song.

I do hope he just keeps on cranking the songs out. Hopefully go on a bit of a tour. There is no doubt about it, he's got the song writing skills and he's got a bloody good voice, both for ballads and rock. And he's got the personality.

Wednesday, 21 January 2015

Student Nurse Perspective: Stroke Care

Seeing as my first job as a qualified nurse is going to be on a stroke unit. I thought for my own sake that I write a little about strokes. With that I thought I'd tie in with a little bit of information about thrombolysis. Mostly I am writing this as a refresher for myself and at the moment this looks like to be my last Student Nurse Perspective article. Due to be renamed Icelandic Metal Nurse. But I do hope that it will be useful for others as well, I will try my best to write it in such a way that everyone can read it and understand it (well, hopefully).

Haemorrhagic Stroke
Stroke (Apparently called Brain Attack in the US) is the common name for Cerebrovascular Accident (CVA). Every year around 100,000 strokes occur in the UK. It mostly occurs in people who are over 65. But it can affect everyone. It is a very debilitating condition and depending on which area of the brain it happens the symptoms vary. Mostly the effects are irreversible. Symptoms vary between what part of the brain is affected, and the larger the stroke the more areas of cognitive ability it will affect. Stroke accounts for over 46,000 deaths per year making it the third largest cause of deaths in the UK and it is the most common cause of adult disability.  There are big financial implications for society as a whole, total costs to the NHS is over £4.4 billion per year and to society due to lost income and informal care it is £9 billion.

Survival rates from a stroke is currently 20-30% after one month and 30-40% after one year, but those numbers do not mean a lot to the individual. Generally in terms of better prognosis is based on severity of the stroke, age of the patient, what type of stroke, ethnicity and co-morbidities. Physical recovery is based on how much function the patient has in terms of activities of daily living and it usually reaches it's peak six months post stroke.  Whilst we have come a long way in treating acute strokes and hospital rehabilitation for stroke patients, we have not progressed very well in terms of long term management and community based treatment for stroke patients who suffer from some of the more long term affects of strokes like psychological and social problems.

Ischaemic Stroke
Strokes fall into two categories, ischaemic strokes and haemorrhagic strokes. Ischaemic strokes accounts for 85-90% of all strokes. Ischaemic stroke occurs when there is a blood clot occluding any blood flow to a portion of the brain. Haemorrhagic stroke is when an artery in the brain has burst and blood leaks into the brain tissue. Haemorrhagic stroke can also be further divided into Intracerebral haemorrhage (bleeding in the brain tissue) and subarachnoid haemorrhage (bleeding on the surface of the brain). There are also some conditions that are sometimes known as stroke mimics, for example hypoglycaemia, epileptic seizures, severe migraine attack, encephalopathy and Transient Ischaemic Attacks. There are certain lifestyle factors that increase your risk of having a stroke such as smoking, alcohol consumption, poor diet, lack of exercise, obesity and drug use. There are also certain medical conditions that will raise that risk such as  high cholesterol, high blood pressure, atherosclerosis, diabetes and atrial fibrillation.
  • There are of course plenty of actions you can take to reduce your risk of getting a stroke. If you are a smoker then there is nothing better you could do than to quit smoking. I mean seriously. Just stop. Now. That stuff is bad for you.
  • Reduce your alcohol consumption. Those cans/wine glasses add up, especially when you are pairing gluten free German beer with French wine as smorgaswine.
  • Lay of those drugs. Or at least reduce your usage drastically. Please.
  • Pick up regular exercise. It doesn't have to be anything major. Just get of that sofa and go for a nice brisk 30-45 minute walk every day. Get a dog or failing that get a ferret.
  • Increase your intake of fruit and vegetables. The importance of a good diet cannot be underestimated. Sure go for the occasional fast food, but don't forget to include some salad with it.
  • Lose some weight. No I am not saying that you have to look like a sculptured Greek god/dess. I am saying that that apron you have around your waist needs to go.
  • If you're diabetic make sure that you keep your blood sugar ticking between 4-10 mmol/l. Fluctuating blood sugar can be a little disastrous. 

Thankfully due to the excellent FAST campaign most people know what signs to look out for if someone is having a stroke. But I'll go over it briefly again just to recap. When stroke begins the symptoms are pretty quick to show, first thing to notice will be if the face is drooping to one side (can they smile), if they can raise both arms and keep them raised for say 10 seconds or so and if their speech is slurred. Time is of essence here so if you suspect that a loved one is having a stroke phone the emergency services as soon as possible (999, 112 or 911, depending on your location). While there are lots more signs and symptoms those are the ones you should look out for. Symptoms also vary depending on where the damage is happening in the brain, if the symptoms are visible on the right side of the body then the left side of the brain is affected and vice versa.

Carotid Artery
If you've been found to be in a particular risk group then your doctor might decide to put you on some medications in order to reduce that risk. This is mostly medication based using drugs like statins, these are used to control and lower your cholesterol. Anti-platelet, such as aspirin or clopidogrel, are also per standard. These work by inhibiting platelets forming clots. Quite possibly the most important one, or possibly the most well known, you will also be prescribed a tablet from the anti-coagulation group, most likely Warfarin. Like the anti-platelets these work by reducing clot forming usually by inhibiting vitamin k production. As far as side effects are concerned there is the risk of bleeding. If you were diagnosed with high blood pressure you would also be put on either beta blockers or ACE inhibitors.  All of these drugs would also be used as a secondary prevention. If you had suffered from Transient Ischaemic Attacks your doctor might suggest that you have what is called Carotid Endarterectomy, this procedure is used to remove plaque from the carotid arteries. If this procedure is done in a timely manner post TIA's then lives can be saved and strokes averted. Not only that it is also sometimes a suggested operation to prevent another stroke from occurring and again time is of the essence. The sooner this operation is done the better outcome there is for the patient.

Recombinant Tissue
Plasminogen Activator
If ischaemic stroke is caught soon enough and time of onset is known then this type of stroke can be partially reversed or at least contained using a medical treatment called Thrombolysis. The alternative name for it is Alteplase and this is made from recombinant tissue plasminogen activator. It is biotechnology at its finest. This treatment is a bit of a controversial one, mainly due to the perceived ineffectiveness, the risk and the price.  About 1 in 7 actually benefits from it and there is the danger that it might turn an ischaemic stroke into a haemorrhagic one. In order to qualify for the procedure you have to have a CT/MRI scan to confirm what kind of stroke you have had. The time of onset has to be known and has to be within 4 hours, though the treatment is said to work better if it is within 3 hours. And the patient has to be weighed. If it has gone over 4 and half hours then you are in danger of damaging the brain even further. When it is effective then it is very effective, a study found that after three months from treatment around 30% of patients were back to normal or at least near normal neurologically and a further 30% had mild to moderate neurological deficit. Up to 50% had become independent in activities of daily living and 15% were moderately independent. But on the other side of things it also found that it up to 9% of patients who had received this treatment had died due to intracranial haemorrhage.

So in conclusion. Regarding strokes time, is of the essence so if you suspect that a loved one (or a stranger for that matter) is having a stroke get your phone out. Don't waste your time taking pictures, and phone for the emergency services. But it isn't just important to get them into the hospital for treatment it is also important to make sure that they end up in a specialist stroke unit as their chances of recovery are much better on there than on a general medical ward. The multi-disciplinary team on there should be made up from (besides nurses) Occupational Therapists, physiotherapists, Clinical Stroke Specialist Nurse, medical consultant and a registrar. Ideally after the hospital stay there should be an outreach team to assist with activities of daily living and further rehabilitation.