Saturday, 19 May 2012

Kozier’s ‘Fundamentals of Nursing: Concepts, Process and Practice’

You’re in your first year and you’re about to go out to your first practice. Regardless of your past experience, it’s going to be something new. Whether your only vision of healthcare has been through TV shows or reality TV, you have 2 years HCA experience or you've been seconded by your trust – you’re going to have a totally new experience when you step foot into the ward in your student nurse uniform. The only, and I mean only, difference is your level of confidence. It’s not that past experience isn't important (it is) or that your knowledge won’t be valued (it will) – it’s just that being a HCA is not the same thing as being a student nurse. Yes, there, I said it.

It is a different experience and no matter how good of an HCA you are or were, being a nurse means you’re accountable and as a student nurse, so are you. I did work some shifts and as a HCA you go in, do your work and go home. People want to complain, refer them to the nurse. Patients want their medication, refer them to the nurse. Patients want to know something about their care, refer them to the nurse. They don’t know if they should eat or drink, refer them to the nurse – I think you get the picture. That doesn’t mean that you’re rubbish as a HCA – it’s just a different role. As a student nurse, you’re going to need to know these things (but don’t worry, things start slowly).

I had no experience when I started – I had only done consultancy based work in offices or working from home. So when I stepped into a ward, it was like being in another planet. Of course, you have skills labs before placement and you have a lot of preparation but nothing quite prepared me for the fast-paced environment of a ward. Wow! It was baptism by fire, to borrow the old phrase. I very quickly decided that I needed extra support so I did some research and found a book that I could go to for help with the more practical aspects of nursing skills. Some people swear by the Royal Marsden – I found it too stuffy, oddly sectioned and didn’t like it much. I fell in love with another book – Kozier’s ‘Fundamentals of Nursing: Concepts, Process and Practice’ (I think Pearson publish it). In my years of nursing training, I have probably used every section it’s got. Nursing isn’t just doing what doctors want or knowing a few clinical skills. It isn’t an extension of the doctor’s role – it is a profession apart. If you’re nursing passively – i.e. merely following orders – eventually you will find yourself in a whole world of trouble which may end with you being struck off the NMC register. Knowing the nursing process and the frameworks we provide care from, knowing the legal and ethical dilemmas, the importance of advocacy, infection control and health promotion – this is vital information to know and operate from. There is also section after section about the clinical skills that you will need to know.

Take vital signs, for instance. This will probably be one of the first skills you’re going to learn (if doing adult nursing). If you’ve HCA experience, you’ll know how to strap on the BP cuff and the sats probe into a finger and you only need to see it once to have a fairly good idea about how to do it. However, as a student nurse you need to know about the correct positioning of it (same level as heart) and why, what the readings actually mean, what it is the sphygmomanometer is measuring and what the systolic and diastolic pressure actually mean. As a nurse, you will be accountable for all the decisions you make. So if you didn’t know (and got away with never knowing it during your 3 years training) that cardiac output is heart rate x stroke/volume and that there many factors that influence that and consequently the patient’s BP, and something happens to a patient and it just so happens that it was your observations that weren’t up to standard (or you failed to act), you will have a hard time justifying your actions. 

            You can get all stressed about the many things you will need to know or you can get a good book that you will always be able to refer to. For me that was ‘Fundamentals of Nursing: Concepts, Process and Practice’. I highly recommend it.

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