Wednesday, March 7, 2012

Our Guest Blogger Writes About How Risk Feels

We apologize to Kerry for not posting this entry sooner, when she wrote it and sent it to us the 22nd of January. We hope that she will comment at the bottom and provide an update on the patient she mentioned.

As always we are thankful for an entry from a woman we admire (and we get to meet this weekend!). Today was a paranoid day, one in which we were reminded about the risk of social media (it's all on our Tumbr post).

Did we mention Kerry is a wicked cool UK mental health nurse, has a published book AND her own radio show where she recently interviewed @Nick_Twist of Twitter, and New Jersey, fame? Did we mention she is beautiful, witty and is delightfully honest and blunt? Check out her website: it feels. For us sometimes it feels like drowning...but in the end we don't and it's an amazing feeling of life. It's how we feel almost every time we press 'Publish' on this, and some of our other, blogs. It never feels like a mistake. Without the risks we've taken over the past year we'd be miserable, and some of us living no life on the outside at all.

And now...Kerry Stott writes...
How Risk Feels

Oh. My. GOD! She’s going to die!!!!!

We all die, there is no getting away from that fact but in this day and age we are some what divorced from death and dying, it is whispered about in hushed tones.  We don’t talk to bereaved people for fear of upsetting them or hurting them.  I work daily with people who want to die, who feel so crap that they want to kill themselves.  There is plenty written out there about managing risk but no about how it feels like to deal with it on a daily basis.  This post is about just that and how I react and the process that I go through so I can sleep at night.

Life without risk is no life, or at the very best a half life.  I like taking risks; it makes life that bit more exciting and fun.   It’s why I do my job, it’s fun and challenging and interesting partly because the risks involved are huge and someone could lose their life if I get it wrong. When I have a patient who is suicidal I do everything I can to reduce the risks of them killing themselves but ultimately if someone does want to die they will find a way.

When someone dies that I, or one of my colleagues, has been nursing there is an investigation. The NHS has a ‘no blame’ culture, which means that you do not get fried if someone in your care dies.  In real terms it is a blaming-no blame culture and you get your arse kicked until your nose bleeds, hauled over the coals and generally chastised as though you had done nothing to prevent it.  So there is a high level of anxiety that ensues when someone wants to kill themselves.  For me to work effectively I have to be able to manage that anxiety, find somewhere to put it.

I work as part of a multi disciplinary team and one of the first things we do if there is serious risk involved with a patient is to ask advice.  The reason behind this is so that it prevents some half brained, power mad nurse doing what they want to patients and getting away with it.  It is designed so that there is a pathway of correct procedure to follow.  This procedure is examined and updated with each suicide or near miss so it is a robust way in which to work safely because it has been tried and tested.  It promotes, hopefully, transparent working so that should anything happen then everything is above board and can easily be seen and reviewed.  It helps to have more than just one person dealing with the problem as different people will bring different solution and options to the table, possibly things that I have not thought of.  Different people within in the team have distinct specialities and therefore their knowledge area is different to my own.

So here I am with a patient who wants to die. I have asked my colleagues for their input. I generally ask other teams for their input too, usually the Crisis Team but if they have physical health problems too I will include the GP, district nurse, the hospital; I may even include the police.  I can usually tell when I think that I have done enough because that gnawing feeling in the pit of my stomach goes, or at least subsides.  The next thing I need to do is document it.  There is a saying in the NHS: ‘if it’s not written down, it didn’t happen’.  Quite a lot of my time is spent documenting interactions, highlighting risk.  Unlike general nursing there are no short cuts, not short hand way of writing it down…good job I can touch type!  It is the first thing that they look at if someone dies (my trust call it a Serious Untoward Incident – SUI) is the paperwork.  By looking at the paperwork the investigator can see what was done and if there is anything that should have been done (AKA blame).  If the investigator is good, they will acknowledge the pressure that people are made to work under and that the patient had some form of input in their choice to die, if they are bad then the blame gets slopped about, people go off sick with stress and it is a nightmare.

The thing that complicates matter, which no one will even acknowledge, is if they nurse/clinician/doctor/health care professional likes the patient.  I know we are supposed to like everyone equally and treat everyone equally.  Everyone I work with strives to do that but we would not be human if we did not get on better with some people than we did with others.  THAT is the distressing part: coping with, dealing with, handling the fact that someone who you would possibly be friends with if they were not your patient, wants to die.

I have always said that the day I stop caring will be the day that I quit nursing.  I don’t think you can be a good nurse and not care.  However, caring should come with an emotional health warning; you can get sucked into the drama, become emotionally over involved when emotional distance is required.  This emotion comes at a price; normally that I think about work when I am not at work; worrying, going over and over things in my mind, have I done enough, could I have tried harder, could I have done it better?  Wearing away at me; grinding at my soul.  It is very draining and has a knock on effect in my private life.  It eats away at the time I spend with my family and how much thought and effort I put into them rather than my patients.  It is not fair of me to do that to my family, but they understand that I try to keep it to a minimum.

Like any other nurse I have had my sleepless nights worrying about patients, calling the Crisis Team in the morning to ask if they are still alive.  In my mind if I have done EVERYTHING I can possibly think of, then the rest is up to the other professionals I have involved and the patient.  As I said at the start, a life without risk is no life, there must be some form of choice to end it or to stay.

Today, I had a patient who will, in all probability die. I have spend days running around people, shouting, crying, getting VERY stressed.  Documenting every conversation so that should I end up in an SUI I can keep my job, that someone who has not had all this stress, worry and anxiety can tell me that I did everything I could.  It is very cold comfort, but it’s the only comfort I have.  It helps me sleep at night, helps me walk away at the end of a hard day and switch off.  But not tonight, I started this post at 3am, because I couldn’t sleep due to worrying.

Kerry x ((@kerrystott))

Kerry's Past Entries:

1 comment:

  1. I don't want to comment on any patients rather I wanted to illustrate what I do and how I manage risk in my head. There is an urban myth that all psychiatric nurses/psychiatrists are bad people who are power crazed and get off on it. I wanted to show the human side, the side that worries and that cares and the side that is sometimes torn apart. I wanted to show the emotional cost that I, and other mental health professionals, give willingly, every day, to help make people better. I say this because there are more people who willingly (without extra pay or incentive) go the extra mile for their patients because they care and they want to do a good job, in what is a flawed health care system, then people who don't care or who are burnt out.
    Kerry xxx