The Mindful Nurse

It is 5.30pm on the last Friday in January. I am driving through heavy rain, the velvety darkness looming ever closer as I edge my way through rush-hour traffic to get to work, 26 miles from home. Storm Gertrude is fully embracing the thrill of the moment, her blustery vengeance rocking my car along the bypass. As I arrive at work and walk to the entrance, I am peppered with hard rain, so that by the time I get into the hospital corridor, my face and head are wet; the contrast of the dry, warm air is like standing in front of a recently-used, warm oven, devoid of a freshly-baked cake that was there before: slightly comforting yet tinged with melancholy, as I remember it's a Friday night and I am at work instead of spending time with my children.
As a bank nurse, I am employed by the NHS trust I work for, but don't have a permanent contract. I choose to work on the bank because it suits my life as a single parent. There is only so much help I can comfortably ask for, and I feel that I should be present in my children's lives as much as I can be. It also slots into my commitments to running my business as a mindfulness tutor. But I do miss being a part of a team, and I miss being given the responsibilities I used to have.
Tonight, I am assigned to work in the Emergency Department (ED), where I work regularly, and somewhere I enjoy. It is the busiest, most intense place to be at times; very fast-paced, with anything and everything coming through the doors at all times of the day.
I scamper to the canteen to grab a sandwich, eating it quickly on my way back to the ED, as I have only 5 minutes before I start work. At 6 pm I walk into the department and see the queue of patients on trolleys, waiting to be handed from paramedic to the hospital. There are no beds to assign them to at the moment, as the wards are waiting to discharge patients or wait for clinical decisions to be made. The nursing and medical staff are busy; very few have had time for a break. I am asked to go to help out in "minors", where people who self-refer come to be seen, and where the GP referrals come in to be assessed or assigned speciality beds.
This area has been short-staffed all day, so there is only one nurse triaging and handling the GP referrals. I am given a list of patients to get to ward beds as soon as possible, in order to free up cubicles for the other patients coming in through the doors.
I spend an hour or so transferring patients to wards, handing over to a wide stress-spectrum of staff. All of them are tired, busy, hungry, some are finding it more difficult to hide than others. I then return to the ED to help with triage.
A couple of hours later I am asked to perform a procedure I have been trained to do but haven't done for a year or so. I feel slightly under-confident but fairly sure I can remember how to do it. I begin well, and then I feel the doubts creeping in. My stomach tightens and my confidence wavers. Having already talked it through with a senior colleague, I then ask her to come to supervise me. She takes over, doing the procedure exactly as I would have done it. I feel stupid. Why didn't I believe in myself? I try to explain this, but it's too busy, and the colleague is also due to finish her shift. My feelings of stupidity continue to niggle away at me for the rest of the shift.
4 and a half hours later, I head to the staff room for a 20 minute break. I sit alone, half-aware of some rubbish on the TV that someone had forgotten to switch off before leaving. I hear the rain and the howling wind outside, I check the time and I feel tinges of emotions coming up. I reflect and ponder on the events of the shift so far, then head back out to carry on. More patients coming in, more to take to wards, more to triage. I try to work as effectively as I can. Stock hasn't been replaced during the shifts due to business, so it means going off to re-stock whilst seeing patients. This slows everything down - especially when I don't know where something is kept, and can't find a member of staff to ask.
My shift is supposed to finish at midnight. At 11.55pm I realise this is unlikely. There is still a fair amount of things that need doing on the patients I have been preparing for the wards and have been clerked by the doctors. They are important things like giving intravenous antibiotics, administering analgesia, performing procedures. My colleague has taken over triaging, and she is busy. It would make things more difficult for her and the patients if I left. I decide to offer to stay for another hour, to try to tie up as many loose ends as I can. My offer is taken up. I spend the next hour getting things as organised as I can, before leaving at 1am. This was a good shift.
My drive home is even more perilous than the journey in, not least because I am feeling tired. I am feeling frustrated, too. I mull over the events of the shift, conversations, reflect on what I could have/should have done, I try to see events from the perspective of the other parties, and conclude that we, as an NHS body, are stressed. We, as an NHS workforce, are at capacity and beyond. We, as people, are not valuing ourselves enough, we are not giving our own self-care, we lack self-compassion, not just individually but as a whole. I know this to be true of me, because my inner monologue on the way home was twenty-five miles of negative self-talk, and one mile of self-appreciation. An unusual ratio for me, as I was holding on to feeling stupid about the failed attempt at the procedure I was asked to do.
We spend so much of our working lives engaged in processes, care, standards and unrealistic, target-driven restraint enforced by madmen in suits, who sit in the upper echelons of political power, exercising what seems to me to be some form of delusional magnanimity whilst bankrupt of integrity. These are the people who are slowly but surely dismantling health care workers like a six year-old plays with Lego characters. Metaphorically speaking, bits fall off, bits get re-attached, torsos and heads are changed about, some are thrown back into the bucket, others are trodden on. Some are super heroes and carry on, intact, others are strong and many are simply doing their job as best they can, coping with whatever comes their way. These nurses I worked with tonight are heroes in their own way, as they are doing their job as best as they can. They are feeling the pressure. I felt sympathy for them; there is so much more good stuff to them. If only they could see that within themselves, too. I try to have sympathy with government and ministers, but I find it difficult.
So as I mindfully work my way through shifts, I remind myself of the importance of making sure I feel a connection with everybody I work with; but I feel such a need to reach out to the staff I work with, teach them mindfulness as a form of self-resilience and in care delivery. I understand. I get it, because I know the anger, the stress, the fatigue, the food and drink-deprived headaches and full bladders and achy legs and backs.
 I love being a nurse, not for the pitfalls - for the privilege - and there are so many.  It's just not always easy to see.

Pain, Relief

I used to work as a nurse practitioner in a GP surgery. I would see patients who were complaining of pain which had lasted anything from several hours to several weeks or more. In each case, I would ask what they had tried to help settle their pain. Often, the patient would explain that they hadn’t tried anything, not even a paracetamol. Often, this would then be followed up with “I don’t like taking tablets”, or “nothing works”. I would make suggestions about painkillers, ice, rest, activity, suggest exercises to ease back pain or refer on as required, depending on what type of pain the patient was experiencing, as well as other symptoms.

It is interesting to reflect with patients how they perceive their own pain, how they manage it, and what action they take to relieve it. Examples include those who stoically carry on without taking pain relief or other steps to manage their pain; others, who have tried lots of different medications but found that nothing works; and those who are reliant on their analgesia to get them through the day. As someone who has suffered with chronic back pain resulting from a car accident years ago, I used to fall into the “nothing works” category. I found that my life was dominated by the pain in my back: I had lots of time off sick (working in a hospital as a nurse is hard-going on the spine and one of the worst jobs for back pain and injury), which eventually led to surgery which required more time off, more pain, more medication, subsequently led to me being made redundant and then a subsequent  bout of depression, before finding a job I could manage comfortably. Gradually, I came to the realisation that I could control my pain through the meditation I practised, as well as yoga. Over time my pain management improved through a combination of painkillers, exercise, and meditation, as well as visits to an osteopath or chiropractor.

What I also find interesting is the way in which our NHS and healthcare system is dominated by pharmaceutical interventions to manage pain. In an article for the Mail Online, Dr Mark Abrahams explains the various options for treating pain with medicine and different medical interventions such as spinal blocks for relief, and discusses the dangers of over-reliance on medication to treat pain. He also suggests mindfulness as a method of managing pain. In my job I spend a lot of my time dispensing various pills and administering injections to patients in pain, but recently I have started to teach mindfulness to help with their pain, too. I have found it a very useful and successful tool in helping patients manage their pain, whether it is acute or chronic. I have also discovered that the exercises I teach my patients has altered the outcome of medicated pain relief, because the time I spend with them talking them through the exercise has reduced their pain score and their subsequent medication. I would never advise anyone to completely swap medication for meditation, but I do find that in the ward environment, spending five minutes teaching some simple mindfulness work with a patient who is not due pain relief according to their drug charts, has eased their pain. I see no reason why we can’t use mindfulness as well as painkillers.

As for my own experience, I can say with absolute certainty that mindfulness has helped me overcome pain. I don’t know where I would be without it!

pill-popping or hearts and minds?

Today's news has included an article about a new pill for men and women who drink excessively, to help them reduce their alcohol intake. It has made the headlines and induced discussions in the media, with the slant of being a new "wonder-drug" that will help many people.

That's great, isn't it?

Yes, it is great,

I don't think there is anything wrong with taking medication. I am a nurse, so I spend a great deal of my time administering tablets, medicines, drips and antibiotics to help make the people I look after, better. This is fine.

But...

I do also feel that as a society, we are easily swayed by medications to combat illness. We are conditioned to believe that a pill will make everything better, again. I find myself telling my children that "this medicine will make you feel better", or telling my patient, "this tablet will take the pain away", or "this antibiotic will kill the bug you have". Yes, they may well do, and invariably, that is what happens.

But...

Why do we think that we are only capable of fixing ourselves with a pill? What is it about our fixation with medicines to cure all ills? As a nurse, if I have a patient who is agitated, anxious or confused, the planned route would be to speak to the doctor to get a tablet to calm the patient down.

But...

With increasing frequency, I am using mindfulness techniques in my clinical practice to help my patients. I have had some surprising and successful results, from children to the elderly; from the scared and confused to the acutely ill, climbing-the-walls-with-pain patients.
For example, about a year ago I did a shift in A&E and was looking after a very scared, confused elderly lady. She did not know she was in hospital, and was desperate to go home. She had fallen at home and was very unsteady on her feet in the department, which was dangerous because she repeatedly got up from her chair to try to find her way into the cold, wet morning in her dressing gown and slippers. I sat down with her, did some breathing and focusing work with her, and then did a 5-minute meditation with her. As she relaxed in her chair, she settled, and then dozed off! In the time it would have taken me to either speak to a doctor about getting something to make her less agitated, or tried to get her to sit in her chair by telling her where she was, what had happened to her, and answered the repeating questions, thereby increasing her agitated state, I had simply taught her to relax her body and her mind for long enough for her to fall asleep.

So...

It works! So much so, that I am taking this further, starting with teaching mindfulness and meditation to my colleagues and other staff at the trust I work in.

Coming back to the news today, though, makes me feel a slight disappointment. Not because I don't think the tablet will work, as it sounds very effective; but because it compounds the all-round belief that we can only be fixed with conventional medicine. It reinforces the increasing belief in our society that the NHS can be relied upon to fix everybody, and it increases the "clinical" perception that society's health can only be managed "clinically". We are generally losing our ability to see things more holistically, that there can be some other frameworks that support an individual to take better care of themselves, manage their existing conditions as a "bundle" of care rather than singularly; and that by teaching people to connect within to understand why, for example, they feel the need to drink 3 pints of beer a night, they might be able to reduce their intake and feel healthier as a result.