STUDENT COLUMN
Keeping an eye on things Whether you’re steering clear of buses, watching your children play, or measuring the weight of your patients, there’s no substitute for the power of observation, writes Ed Freshwater
1006
ago. All the visiting relatives and friends keep telling us ‘she’s changed so much’ or ‘she’s so much bigger now’, which in the day-today I just don’t see. Every few weeks, I need to adjust the straps on her car seat or her favourite top doesn’t fit anymore. People say that children grow up fast, but I can promise you they don’t—it’s slow and gradual and it’s hard to see any differences day by day. Observations in practice are kind of important too! On my last placement, I
I would have been under the wheels of that bus and that would have been the end of me. A second look makes all the difference returned to a ward I used to work on: a six-bed medium-secure ward for young people with a mental illness. Most people I speak to think it sounds scary, but I loved it. Practising the principle of ‘unconditional positive regard’—that is, basic acceptance and support of a person, irrespective of what that person says or does—can be challenging, but really rewarding. Part of the placement documentation requires me to undertake manual physical observations (‘obs’) using various pieces of equipment, so I got to be the one who did this every week. Two of the young people were pretty much inseparable, so it was hard to do their obs in the confidential way we’re meant to. Instead, they had a weekly competition about who had the ‘best’ pulse or blood pressure. Every week, one of them would be unhappy because his pulse was 62 while the other’s was 98, which is apparently ‘better’. Well, I suppose this was a good opportunity to do a bit of health education. One of the young people had had a severe reaction to his antipsychotic medication,
known as neuroleptic malignant syndrome, which is potentially fatal. It comes on quickly and needs immediate action, so taking regular observations is crucially important. Antipsychotics can also have long-term physical effects on the person, including higher cholesterol and an increased risk of diabetes. People taking antipsychotics often put on weight, so we nurses see very gradual changes that the person doesn’t even notice. But, over time, the line on the graph just keeps going up and up. Taking regular obs means we can keep an eye on any gradual changes and adjust treatment accordingly. There’s one other arena in which to take regular observations—and that’s in my own practice. Some things happen quickly, like viva exams that last 30 minutes and have a huge impact on my final mark. Other changes happen gradually but surprise you when you look again. For instance, on my first placement in my first year, I really didn’t know what I was supposed to be doing. But now I’ve been running shifts, completing the administrative tasks and being responsible for the safety of the ward. My next placement is the sign-off and our last module at university is about to start. Over the past 3 years, I’ve developed new skills and consolidated others, given up old practices and learned to challenge others in a positive way. I observe my own performance and reflect on what has improved, and what still needs to change. Some changes are sudden, some are slow—but all of them are important as I get ready to go into the big, scary, challenging and exciting world of being BJN a qualified mental health nurse.
Ed Freshwater,
3rd year student, BSc Mental Health Nursing, Birmingham City University.
© 2014 MA Healthcare Ltd
O
bservation is very important. I say this as a cyclist and motorcyclist— keeping a smart eye on what’s happening around you is vitally important. As I cycled in to placement one clear and sunny morning, I glanced over my shoulder to check the traffic behind and saw a bus—so I signalled and started to move to the middle of the road to turn right into the car park. There was no need to look again, as I’d seen the bus and knew the driver would be able to see me—a vision in day-glo orange and flashing lights, puffing and panting and pedalling as hard as I can to keep out of everyone’s way. So normally I don’t look a second time, but this day I did. And I saw the bus trying to overtake, on the wrong side of the road, on a busy street with parked cars and pedestrians everywhere. A quick evasive manoeuvre had me tumbling into a hedge, but without that second look, I would have been under the wheels of the bus and that would have been the end of me. A staff nurse I was working with was on the bus, getting ready to alight. He told me later he was certain I was about to get run down. Sometimes, a second look makes all the difference. Experiences like this shock your system and I was hyper-vigilant (and hyperventilating) for a while afterwards. It was a timely reminder of the importance of keeping an eye on my surroundings. Any time I’m on the roads, I need to watch the moving cars, as well as the parked ones; pedestrians stepping out from shops and schools; the road surface 10 to 50 metres in front of me; and even the weather miles ahead. Sometimes, situations change quickly—in the blink of an eye, everything becomes very different and you’re forced to think and react instantly. At other times, situations change really slowly. As I watch my daughter playing, I see tiny changes in her language and behaviour, which would be hard to notice if I hadn’t been looking at how she was a few weeks
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing.Downloaded from magonlinelibrary.com by 130.216.030.118 on October 16, 2014. For personal use only. No other uses without permission. . All rights reserved.
Keeping an eye on things Whether you’re steering clear of buses, watching your children play, or measuring the weight of your patients, there’s no substitute for the power of observation, writes Ed Freshwater
1006
ago. All the visiting relatives and friends keep telling us ‘she’s changed so much’ or ‘she’s so much bigger now’, which in the day-today I just don’t see. Every few weeks, I need to adjust the straps on her car seat or her favourite top doesn’t fit anymore. People say that children grow up fast, but I can promise you they don’t—it’s slow and gradual and it’s hard to see any differences day by day. Observations in practice are kind of important too! On my last placement, I
I would have been under the wheels of that bus and that would have been the end of me. A second look makes all the difference returned to a ward I used to work on: a six-bed medium-secure ward for young people with a mental illness. Most people I speak to think it sounds scary, but I loved it. Practising the principle of ‘unconditional positive regard’—that is, basic acceptance and support of a person, irrespective of what that person says or does—can be challenging, but really rewarding. Part of the placement documentation requires me to undertake manual physical observations (‘obs’) using various pieces of equipment, so I got to be the one who did this every week. Two of the young people were pretty much inseparable, so it was hard to do their obs in the confidential way we’re meant to. Instead, they had a weekly competition about who had the ‘best’ pulse or blood pressure. Every week, one of them would be unhappy because his pulse was 62 while the other’s was 98, which is apparently ‘better’. Well, I suppose this was a good opportunity to do a bit of health education. One of the young people had had a severe reaction to his antipsychotic medication,
known as neuroleptic malignant syndrome, which is potentially fatal. It comes on quickly and needs immediate action, so taking regular observations is crucially important. Antipsychotics can also have long-term physical effects on the person, including higher cholesterol and an increased risk of diabetes. People taking antipsychotics often put on weight, so we nurses see very gradual changes that the person doesn’t even notice. But, over time, the line on the graph just keeps going up and up. Taking regular obs means we can keep an eye on any gradual changes and adjust treatment accordingly. There’s one other arena in which to take regular observations—and that’s in my own practice. Some things happen quickly, like viva exams that last 30 minutes and have a huge impact on my final mark. Other changes happen gradually but surprise you when you look again. For instance, on my first placement in my first year, I really didn’t know what I was supposed to be doing. But now I’ve been running shifts, completing the administrative tasks and being responsible for the safety of the ward. My next placement is the sign-off and our last module at university is about to start. Over the past 3 years, I’ve developed new skills and consolidated others, given up old practices and learned to challenge others in a positive way. I observe my own performance and reflect on what has improved, and what still needs to change. Some changes are sudden, some are slow—but all of them are important as I get ready to go into the big, scary, challenging and exciting world of being BJN a qualified mental health nurse.
Ed Freshwater,
3rd year student, BSc Mental Health Nursing, Birmingham City University.
© 2014 MA Healthcare Ltd
O
bservation is very important. I say this as a cyclist and motorcyclist— keeping a smart eye on what’s happening around you is vitally important. As I cycled in to placement one clear and sunny morning, I glanced over my shoulder to check the traffic behind and saw a bus—so I signalled and started to move to the middle of the road to turn right into the car park. There was no need to look again, as I’d seen the bus and knew the driver would be able to see me—a vision in day-glo orange and flashing lights, puffing and panting and pedalling as hard as I can to keep out of everyone’s way. So normally I don’t look a second time, but this day I did. And I saw the bus trying to overtake, on the wrong side of the road, on a busy street with parked cars and pedestrians everywhere. A quick evasive manoeuvre had me tumbling into a hedge, but without that second look, I would have been under the wheels of the bus and that would have been the end of me. A staff nurse I was working with was on the bus, getting ready to alight. He told me later he was certain I was about to get run down. Sometimes, a second look makes all the difference. Experiences like this shock your system and I was hyper-vigilant (and hyperventilating) for a while afterwards. It was a timely reminder of the importance of keeping an eye on my surroundings. Any time I’m on the roads, I need to watch the moving cars, as well as the parked ones; pedestrians stepping out from shops and schools; the road surface 10 to 50 metres in front of me; and even the weather miles ahead. Sometimes, situations change quickly—in the blink of an eye, everything becomes very different and you’re forced to think and react instantly. At other times, situations change really slowly. As I watch my daughter playing, I see tiny changes in her language and behaviour, which would be hard to notice if I hadn’t been looking at how she was a few weeks
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing.Downloaded from magonlinelibrary.com by 130.216.030.118 on October 16, 2014. For personal use only. No other uses without permission. . All rights reserved.
