Categories
Nursing

A&E Covid 19 Story Week 10

Covid-19 and BAME Inequality.

Previously, I have talked about the gender inequalities that wearing scrubs has exposed within the healthcare system. This weeks post there will be a wider focus on Covid-19 and BAME inequality. 

Recently, the murder of George Floyd, a 47 year old Black man, has been brought to the attention of the public eye. Footage has been shared of the (now charged) police officer kneeling on George’s neck. This happened for 9 minutes, whilst he begged for his life and can be heard saying “I can’t breathe”. This event lead to the murder of the 47 year old. This tragic death is an unforgivable casualty of police brutality and systematic racism.

A Subject People Find Difficult to Address

Firstly, it is undoubtably a difficult subject to address. It is extremely important to talk about, regardless of how uncomfortable it may be. Secondly, its important to address the leading voices on the matter Alicia Garza, Patrisse Cullors and Opal Tometi (Founders of the Black Lives Matter movement). Finally, I can only speak from my own expertise and experiences. Therefore, I wanted to make this next post about something I am very familiar with. Concluding this, this post will be (as you might have guessed) about Covid 19!

Covid-19 and BAME Britons

This week I would like to talk about how BAME Britons have a disproportionate mortality rate from this virus. This is twice the risk of death according to the ONS. This is a health inequality that needs addressing.

Whilst we are in the middle of the pandemic with a virus that has many victims (including young and usually health people) many people seem to think its unimportant to focus on specifics such as who is more affected. However, as the affects of the virus have unrolled across the UK, it has become ever more pressingly apparent that people from ethnic minority backgrounds are disproportionately dying from the Corona Virus. Out of the 200 health workers who have died in the UK from Covid 19, 60% of the people were BAME.

It has never been more important to collect, study and distribute the findings from a health crisis. To look into who is disproportionately affected by it and what we can do to minimise this public health inequality. In summary It is not ok to place unequal value on the lives that have been lost during this pandemic and its time we addressed it. 

On the 10th May there were calls for a public enquiry into this issue. 70 public figures (including London Mayor Sadiq Khan) signed a letter to the Prime Minister demanding transparency into this matter. Public Inquiry’s are important for safety, education and can lay foundations for future policy makers and research. An inquiry could help employers make appropriate allocation decisions based upon risk assessments increased safety for staff.

Risk assessment for BAME NHS staff

Gal-dem.com outlines excellently why there is a need for an independent public inquiry into this.

Moving on from the public inquiry, here are other recent and relevant pieces of news.

Firstly the first news story I will mention is, The tragic death of Belly Mujinga. A woman who lost her life 2 weeks after being spat on by a man claiming he had the Corona Virus whilst working her essential role at London Victoria station. 

Additionally, The tragic death of Trevor Belle a 61 year old taxi driver who died 3 weeks after being spat at by one of his passengers.

What you can do

Firstly, for people living in London who want to support communities in the capital.

Similarly, for people who want to volunteer:

Moreover, if you can donate money to support memorial services for BAME families, bereaved because of Covid-19

Additionally, if you can sign a petition supporting a public inquiry into BAME loss of life to Covid:

Categories
Nursing

Post Covid Complications: A&E Covid 19 story Week 9

This week I will be addressing post Covid complications. I think I looked after the first (known) patient at my hospital with post viral delirium due to Covid. It was a rather scary experience as the patient, who will remain anonymous, was usually healthy/non-elderly. Delirium is a dangerous condition in which a persons mental state is altered. This means people can be confused, disorientated, aggressive, restless, incoherent and/or unengaged. Delirium can be due to infection, sepsis and pain. It can also be from other reasons like hypoxia, recent extubation etc. Despite the cause, it is most likely always a sign someone is unwell.

In this particular situation, the patient was experiencing delirium as a viral complication due to a previous infection of the Corona Virus. Delirium is very serious and it can lead to an increase in the chance of mortality. It can also mean patients hurt themselves and do not tolerate treatment interventions they desperately need, such as cannulas, IV fluids, IV antibiotics and oxygen that they may need to reverse the delirium! My patient was being violent, throwing things around the room, trying to turn on the defibrillator in the room and spitting at staff. They needed to be sedated in best interest i.e. for cooperation in care so they were not a danger to themselves and would tolerate the treatment.

More Post Covid Complications

Other post covid complications I have noticed is many patients attending the emergency department with chest pain. When this happens the patient has blood tests, ECGs and chest Xrays (the appropriate investigations). If diagnostic test results show the persons life isn’t in danger from things like an MI (heart attack) or a PE (blood clot in the lungs) or severe sepsis/pneumonia/covid etc affecting the body; and the persons observations are stable i.e. oxygen saturation levels adequate without supplementary oxygen, then the person will be discharged. The doctors inform these people, who experienced Covid a few weeks/months ago that they are experiencing pain from the effects Covid has had on their lungs and it could take weeks to months to resolve. 

I have also encountered many patients who are experiencing Covid 19 symptoms saying ‘do you get many people with Covid in this hospital?’, and are worried about catching it in hospital when it is most likely they already have it. Many patients are also wearing gloves, touching their phone, using public transport and touching their face with the same gloves. Thus causing much cross contamination. The importance of following guidelines such as hand-hygiene is important to note here for infection prevention and control.

Innovation within the NHS

Covid has necessitated a lot of innovation within the NHS. Rapid Covid test swabs are one of the newest pieces of innovation I was excited to see rolled out. A limited number of these are now available in some A&Es for testing for patients who fit a tight criteria. For example, for patients who are at risk of becoming particularly unwell from the Corona Virus and need to be ‘shielded’ from Covid in hospital. This includes people who are immunocompromised, have diabetes or may be on chemotherapy.

Ideally, these patients need to be in a ‘non covid area’. The difficulty lies when these people need to be admitted to wards. However, they have presented with symptoms in which Covid cannot be ruled out as the cause of their illness. They also could have post covid complications. Therefore these people cannot go to wards where they could potentially pass Covid 19 onto other people. There is also a limited number of side rooms available in the hospitals as most of them are already occupied by similar patients.

Testing

The Rapid Covid swab machine technology is helpful here. As it results in 1 hour, it can dictate if patients are suitable to go to a Covid/Non-Covid area. This saves from breaches in A&E. (Find out what a breach is here)

There has also been the opportunity to have asymptomatic testing for all patient facing staff in the trust. Thus, allowing data collection on Covid 19 prevalence among healthcare staff without symptoms. This means preventing staff working with high risk patients such as on chemotherapy/cancer wards unknowingly spreading Covid to vulnerable patients. If any of the asymptomatic staff test positive for Covid they are to follow self isolation protocols as usual. There is also the opportunity for me to take part in a vaccine trial if I wanted to! I am not taking part in this trial however I am excited to hear more about it. Especially since it is beginning to look like social distancing will continue until a vaccine is found. So I am very much hoping there will be scientific advancements regarding vaccines quickly!

Antibody Testing

Antibody tests are another thing I am eager to try. I had Covid symptoms in early February. However this was before it was prevalent in the UK and I really want to know if I have had the Corona Virus or not as knowing this would make me feel less worried about catching Covid at work.

In conclusion, as we approach the 10th weekly #ClapforCarers this Thursday I think it is important to reflect on what the NHS has achieved during these times. I have seen an incredible amount of innovation and change in the past few months and I am incredibly in awe of everyone who made it happen and adapted to it so well.

Categories
Nursing

Scrubs and Inequality: A&E Covid 19 Story Week 8

Week 8: Scrubs and the Inequality Beneath

Today I am going to address something that has come to light due to Covid 19 which I believe deserves addressing, scrubs and inequality.

If you ask people who work in healthcare if they enjoy wearing scrubs, the majority of nurses (myself included) would say they prefer scrubs to the usual uniform as they are far comfier. Historically people adopted scrubs as they began to realise the importance of a clean surgical environment. Since then, in England it is my understanding that most nurses wear a uniform. The exception to this would be surgical/recovery nurses and nurses in some emergency departments. However, due to the Covid 19 pandemic most staff members who work in hospitals are now wearing scrubs. This is for infection prevention and control reasons – to prevent staff members bringing the harmful virus particles home and on public transport on their clothes. 

Pre-Covid-19

In a time before Covid, nurses, physios, health care assistants, domestics and porters wore a uniform whilst doctors seemed to be the exception to this rule. It seems doctors had the choice between wearing their own (smart) clothes or scrubs. This means doctors wear suits/dresses or ‘professional’ clothes whilst working on a ward, despite having contact with bodily fluids.

Whilst there is the argument there to say that doctors are involved in less direct patient contact than the nurses; it does not explain why it is suitable for a doctor to do a rectal exam in a suit with a thin plastic apron on whilst the nurses who hold clinics or research studies are still required to wear a uniform.

Guidelines

The Department of Health published guidelines known as the ‘bare below the elbow’ guidance. It also outlines the three objectives when it comes to what health care professionals should wear. To summarise these are: Patient safety (ie infection prevention and control), Public confidence (clean/professional workwear) and Staff comfort (I.e., cultural practises). Reviewing this guidance, I cannot see any reason there should be differences between what doctors and nurses should wear whilst at work. 

Now I may be mistaken here, but I believe the contradictions present in these rules date back to a time, pre Florence Nightingale. A time when doctors were the Professional staff members who held a degree and nursing was an uneducated profession. Hippocrates who is widely regarded as the father of western medicine, claimed doctors should be “clean in person [and] well dressed”.

I believe that due to nursing being a ‘pink collar’ job i.e. a profession held mostly by females (89% in the UK) there is a long withstanding lack of respect and recognition for the level of education and professionalism required nowadays in the nursing profession. 

Hierarchy

Sadly, there is a very intense hierarchy present in healthcare. Anyone who doesn’t work in healthcare probably couldn’t grasp just how tangible that hierarchy feels sometimes. I have seen some people disregard people in job positions such as health care assistants, domestics and student nurses. I was actively terrified of doctors when I was a student nurse which I now realise was ridiculous. Obviously, most organised workforces involve a hierarchical structure. However, this is a problem when it means people feel that they are less important than others. I find uniforms to be an important reflection of hierarchy. 

What about now?

Nowadays, an RN requires a Bachelors degree. Additionally, nurses register to a professional body, the NMC. The discipline of nursing also encompasses many advanced roles such as Advanced Nurse Practitioner’s and specialities i.e. Heart Failure Nurse. Many of these professionals take an active roles in the Medical team. They often prescribe, advise and consult – skills attributed historically solely to doctors. Many nurses also take on a senior roles in the hospital and community settings as matrons, managers and coordinators etc. So, yes it did raise a bone of contention when I saw an Advanced Nurse Practitioner wearing a uniform whilst the doctor holding the same clinic in the room next door did not. This prompted me to write this post – scrubs and inequality.

Going back to the present day, everyone, despite their role is wearing scrubs. Whilst this is more confusing and this practice will not last, I think we can all learn a lesson from this. Nurses and Doctors deserve equality in their uniform or non uniform policies. 

Categories
Nursing

A&E Covid 19 Story Week 2

Starting in the Emergency Department: A&E Covid 19 Story

Week 2

Welcome to A&E Covid 19 Story Week 2. When I first started writing, I had high hopes of following the ins and outs of every shift…this probably wont happen. Even though, like everyone else, I (sadly) have no social life to currently speak of. My state mandated hour of exercise, 2m apart queuing for Tesco and performing excessive amounts of laundry really doesn’t leave me with lots of spare time on my days off. In light I will aim for posts to be once a week. 

I start off as a supernumerary nurse. I am shown the staff room and where to change into scrubs. At the start of the safety huddle, one of the matrons asks how we all are. There’s a few seconds of awkward silence. She then thanks everyone for their hard work and says she wishes she could hug every one of us. This makes me nervous. I get a “everyone say hi to our new starter” shoutout and a lot of people laugh at the improbability and impracticality of starting in one of the busiest A&Es, in the capital city, mid pandemic. A lot of people comment things like “picked a good time to start didn’t you” but everyone is welcoming.

Inductions

I meet the nurse educator for an induction walk around. The department is intimidatingly big and I’m unsure how I’ll ever remember my way around it. She tells me A&E is split into the usual sections. This includes: Majors cubicles, Rapid assessment and treatment (RAT), Urgent treatment centre/treatments (UTC) and Resus. However this has changed due to Covid. Instead, there is a confusing switch around throughout the whole department. Meaning Majors is now entirely for Covid patients. UTC is in use for majors patients who aren’t suspected Covid. A select number of majors cubicles are now set up for a ‘covid resus’. Normal resus is now ‘clean resus’ for non covid patients. The Paediatric department is relocating and with it, all paediatric nurses. This including the nurse educator who is co ordinating my induction period.

Despite these changes, everything is going smoothly so far. The educator who is showing me around keeps remarking how quiet the emergency department (ED) is. It’s not unusual for ED to be quiet in the morning. However, the nurse tells me, on a regular evening it’s not uncommon to have 100 patients in the department. The lack of patients makes everyone uneasy. Therefore, people are throwing phrases like ‘the calm before the storm’ and ‘before shit hits the fan’ around. Apparently tourists, workers and students make up a large amount of the patients who come in and as central London is emptier than usual (understatement I know), this A&E department has the luxury of around a week with minimal patients to prepare for what we all know is coming. 

The Week

The week follows in a rush of training sessions and chaotic rearranging of the department. I learn how to use 3 different types of CPAP machines. the trust has just adopted new ones to prepare for the forecasted surge in demand for these, for the treatment of hypoxic Covid patients. There is a change in the PPE guidance daily, one day we are told we need to wear masks, aprons and gloves even whilst not seeing patients, the next day we are only told to wear masks at all times, unless we are seeing patients, in which case we must wear an apron and gloves.

A lot of nurses are moving beds and trolleys around to make more room for an increase in patients and stocking new PPE stations. There’s also a large induction of new doctors to the department. This is because they have been pulled from other areas of the hospital to support the Emergency Department for the upcoming weeks. The rules are switching and changing at an unsettling rate and I know this is only the beginning.

If you would like to follow SurvivingNurse on Instagram Click Here

If you enjoyed A&E Covid 19 Story Week 2, check out week 1 and week 2 by clicking on the links below!

Categories
Nursing

A&E Covid 19 Story Week 1

Week 1

A&E Covid 19 Story: Cancelled training sessions, E learning and apprehension

To begin the A&E Covid 19 story I start at week 1.This is mostly training. The first day I sit in a training classroom of about 30 people. We are given advice on hand washing and vague advice about isolating/not attending if you have Covid 19 symptoms. No one else on the induction is about to start in the Emergency Department (ED). Everyone looks slightly concerned when I tell them where I will be working. We are made to take part in teamwork activities with no respect shown to social distancing advice and we are given lunch. There’s plenty of hand sanitiser to go around and a lot of people are covering their phones with it too.

My online timetable shows the activities for the day but have gaps for the next day with no explanation of what they require me to do on these days. I emailed my line manager and received no reply so walked to the emergency department to suss out the situation about what they had planned for me for the week.

Covid-19!

There are banners everywhere, COVID-19. No visitors! Most importantly, there is a sense of alarm and panic once inside the department however it seems unusually quiet as there are no visitors. I meet with my manager who apologises for a chaotic induction week due to the circumstances and explains the clinical educators are both currently off work. 

The nurse asks me to go home and work on e-learning for the week. This is due to the cancellation of all of my training classes, apart form basic life support and IT system training.

I prep for the next week which is where I start working in ED. Click on the links below to read more on A&E Covid 19 Story.

Want to follow the journey? Click Here for the SurvivingNurse Instagram.