I am now more than half way through my first placement, and I have had many new experiences since writing my last entry. I have been involved in all of the day to day nursing duties: meds round; ward round; helping residents to wash and dress; assisting residents with eating meals; completing all the relevant paperwork and, most enjoyably, getting to know each of the residents by spending time with them.
A difficult time
I had a difficult couple of days a week or so ago, in the midst of several deaths. Over the week following the deaths I noticed how stories of those who had died were told over and over again in the staff room, alongside stories of other deaths which had been experienced. I reflected that the communal processing of grief was important for nurses, because fitting our experiences together and telling and re-telling them led to an acceptance of death and to moving on. We knew that we had done our very best to care for our patients during their stay at the unit, and in the end I felt honoured to have cared for them at the end of their lives, and no longer sad.
Another subject which struck me forcefully over the past weeks is the need for nurses to act as advocates for people suffering with dementia, and especially for those who are in the stages of the disease where they may have lost the ability to communicate verbally. Most of the residents at my placement are not able to choose from a menu prepared to their liking – they rely upon the nursing staff to make informed choices on their behalf to ensure that they eat a varied and balanced diet. Many of the residents cannot walk about unaided, and so cannot choose whether to sit in a sunny window or right next to the television or who to sit by. Nursing staff must consider what they know of the person’s history alongside non-verbal clues as to what mood or preferences are being expressed on that day, and then make an informed choice.
A good environment?
I have also spent some time reflecting on the physical and sensory state of the healthcare environment for those who are inpatients with dementia. If the rooms are moved around every day this may be confusing for the person with dementia; if different and unfamiliar staff help residents to wash each morning this may be confusing and frightening; if someone starts to offer food on a spoon without first explaining what they are going to do this could be frightening. If music is played or interesting sensory objects are available and nursing staff spend time talking to or sitting with the residents, then this creates a space for the residents to engage with the world around them and to express themselves. I have spent a lot of time getting to know the residents better, and over time I have learned to understand what they are saying to me better, and finding that it is indeed possible to have a conversation, one side of which consists solely of an array of meaningful facial expressions and gestures.
I am absolutely loving my placement and I will be really sad to leave. Every day something happens that puts smile on my face, and every interactive response from a resident, be it a belly laugh or simply the raising of an eyebrow, makes placement feel nothing like a job at all, and everything like a satisfying vocation.