A Reflective Writing Practice

As I've learnt that my lovely VA can say things much more eloquently than I ever could I am blogging another reflective practice piece. This time there is my VAs piece first & then mine, reflecting on the same incident at the start of this week.

Its been a tough week & monday morning heralded how the week would turn out. As the week went on V & I struggled to find ways to keep our chins up & our spirits elevated. You'll see that my conclusion & action plan is less than serious, however I have started action plan 2) in earnest with White Mischief Vodka that Suzi bought me as a thank you present & that which entirely lived up to its name.

Reflective Practice

1.     Description

It was in the morning at ICU medicine ward that I thought that it was not a good day at all. I saw a lot of serious patients lying on the bed and some relatives standing beside with worried faces. I took a look outside and I saw one patient surrounded by nurses, student nurses and some patient’s relatives crying and saying “Please help.” I knew that one patient was dying. His wife cried without releasing any sound because she was too depressed. Sooner or later, her husband died. Some nurses came and took back some equipment that was used before the patient died. I heard one student nurse’s voice. It seemed she was crying. I listened seriously and I could understand that she was laughing.

2.     Feeling

 I was really unhappy with his death and I felt so frightened because I haven’t seen people dying much. I imagined that if I were in that situation or if I were his son, what I would be like. However, I tried to convince myself that it was human life, dying is inevitable and it was so common at the hospital. What I really didn’t understand was that why the student nurse laughed while others were crying. I was so upset with this misbehaving.

3.     Evaluation

I did think that what the student did was not very polite. Even there was something that very funny, she shouldn’t have laughed while the patient was dying and the relatives were crying. It is not acceptable for me and other people

4.     Analysis

In my own inference is that the student was not paying much attention on working but on other thing else. If she really had paid close attention, she wouldn’t have laughed in front of patient. She would have felt like me if she had put herself in the situation as I did. I don’t know if there are any principles for doctors and nurses or not. What the nurse must do and what the nurse mustn’t. For example, doctors and nurses mustn’t behave in any ways that can make patients feel insecure or embarrassed.

5.     Conclusion

The student nurse’s mistake was laughing in front people crying. When people see someone laughing when there is another person dying, they will think that the laugher doesn’t give any value to life. He or she might think that life is not important. The student shouldn’t have laughed but should have shown that she also felt sorry for the death through facial expression or direct talking to the patient’s relatives.

6.     Action plan

I  know that this mistake or even more mistakes will be made next time, hence  if nothing can be done it would result more badly. I am just assistant who doesn’t have much power to effluence people in the hospital but my boss does, not entirely. It is a good idea to tell her about what I have seen and not so appreciate. I can tell her to tell to the nurse, not a form of blaming, but just giving some explanation of what nurse must not do.

Reflective piece

Description of the event

V & I went to ICU medicine on Monday morning and found a man on a trolley on the veranda in the sun. There were 3 student nurses taking his observations but it was clear to me that he was cheyne stoking & about to die. V said to me “it is not a good time to be here”, and I replied, “this is the best time to be here”. I asked V to try & find out what the story was. His wife told us he had been hit with a stick in the abdomen 10 days ago. There was no doctor seeing to the patient but Mr S came out & gave him some oxygen & brought out the suction machine. V translated to me that one of the nurses had told the family to tell the tuk tuk to stay as it could take the body away once he died. I knew that there was little I could do to save this patient & so instead afterwards I engaged in a conversation with the staff about triage & having a designated resus room for patients such as this patient. This was met with hostility & aggression. One nurse who had not moved from her seat in 15 minutes – just sat doing nothing - told me they were “too busy” to have triage & a resus room. Eventually Dr L arrived & we had a conversation, which was not aggressive or hostile but ultimately did not alter the outcome for the patient or how the ward is run.

Feelings & thoughts

Situations like this occur everyday for me here; I am left feeling impotent & useless. Firstly I am restricted, especially in an emergency situation where time is limited by inadequate communication & slow communication through a translator, also the staff will often not do what I ask or reverse my actions such as speeding up IV fluids. I feel helpless & inadequate; even though I know that this patient was past saving I feel I have let him down. It upsets me that a dying man only had 3 student nurses doing his observation with no trained staff coming until V & I appeared. The staff, it seems to me, just doesn’t care about patients & are happy to let them die without dignity, then pile them back on the tuk tuk that brought them. They never talk kindly to the family, show compassion or any evidence that they care. I find it hard to capacity build staff that bear little resemblance to my own ethics. I struggle with the balance of showing the staff respect in their workplace & wanting patients to get better care. When V told me “it is not a good time to be here.” I felt angry as I misunderstood what he meant & thought he was telling me that as the staff were busy we should leave them alone. I get very angry when the staff say they are busy because even at their busiest they do not work as hard as staff in the NHS on an average day. They say they are busy when they are sat watching karaoke on TV & doing no clinical work – this drives me mad. I know that they earn very little but my sympathy is with the patients & not them. This event leaves me feeling like a failure because although I tried to use it as an example of the importance of triage & resus I feel I failed to have ay impact on the patient’s outcome or future improvement of clinical care.

Evaluation & Analysis

I think that it was good that we stayed & tried to make something positive out of the patient’s lack of treatment & death. I am learning to ask V what he means as often things are lost in translation. I feel I could have been more proactive to try & get a doctor to come or move the patient to at least inside the ward instead of dying out on the veranda in public display.

Situations like this make me feel so impotent because in my role In the UK I would be leading the resus & staff would be listening to me & acting on my requests. Here I can’t even get an adequate history from the patient – in actual fact Dr L told me after that the patient had liver cirrhosis & ascites.

Sometimes I think the apathy of the staff is contagious & I am slow or reticent to act as I feel the same sense of hopelessness they have. After many times of trying to engage the staff & direct them towards better care & failing one becomes less inclined to try. Also it is hard to capacity build absent doctors.

It is my tendency to take on the failings & inadequacies of others – this is not good. I should only consider & take responsibility for my actions & behaviours.

I talked to the family.

I tried to engage with the staff around the patient’s bed.

It was too late for me to intervene to save the patient & there is no post resus care available here if I had successfully resuscitated him.

I spoke with the head of service after and tried to put forward positive changes rather than criticize the lack of treatment.

Conclusion & Action Plan

I think I can conclude that working in health in Cambodia is very challenging; staff do not care or do not want to listen to me. The patients keep dying despite me being here & the changes (if any) are so small & slow that I can not detect them.

My options are;

1)   Carry on calmly, trying to intervene in patient care & capacity building by role modeling despite the wall of hostility, resistance & active ignorance from the majority of the staff.

2)   Develop a drinking habit to help me through the working day.

3)   Go to a different hospital or work with other organizations some of the time so I am in the environment of the referral hospital less.

4)   Leave – go back to a well-paid job in the UK or Australia & leave the capacity building to the grown ups.

I am leaning towards a combination of 1), 2) & 3)!!!