Friday 17 April 2020

I've had 5 days off. Originally we were supposed to go on holidays to celebrate a few big birthdays, but because of lockdown that obviously didn't happen. I'd offered to return my annual leave in exchange for shifts, but I was the sixth person to do so! And in the end I was actually quite glad I had some time off. After the uncertainty, tension and emotions of the last few weeks, I was more tired than I realised and a break was definitely needed. When I first started in this job, my then ward manager told me one day that you need a bit of time off every 2 months or so. You give so much in this job that you need time to recharge the batteries.
I thought I'd feel confident about going back, having done 2 shifts already. Oddly enough I felt nervous. Our WhatsApp group had been much quieter of late, suggesting we are settling into the new routine. There had been a few texts with do's and don'ts, a few supportive messages here and there, a happy birthday, but that was it.
So I really didn't know what it was like on the ward at the moment. Were we full? Lots of confused patients? Would we cope with increased patient numbers and the more demanding routine, where everything inevitably takes longer?
Annoyingly enough, I'd accidentally had a cup of caffeinated tea at 9pm. I turned the lights off at 11 and was wide awake. Normally I fall asleep within seconds, now I lay awake for hours. I must have dozed a few times because I had weird dreams, but it never felt like a proper sleep. Not a good start to the day.

One of the many gifts we have received. Lovely surprise and much appreciated

Another beautiful morning sky on my way in, which helped settled nerves somewhat. I found myself a set of large scrubs hoping for length - instead they were short and wide. Not the most flattering of looks! (see photo at end of post for a laugh)
We had about 15 patients in total (capacity of 23 beds with social distancing). A very manageable number. Originally I was supposed to 'float' which means not having a dedicated bay but helping out where and when needed, but because of a confused patient who needed regular supervision, I ended up assigned to two bays along with another nursing assistant and two nurses (one of whom was supernumerary).
This was the first shift since we had transformed to Covid19 ward where I had someone confused to look after, and it threw up a few new challenges. PPE isn't quick to put on, and no PPE means no care. You can't just quickly nip into the bay when someone is attempting to do something that puts them at risk (this usually means a patient is trying to get out of bed or chair when their mobility isn't good and they are at risk of falls). These patients often wear what's called a 'wanderguard', a device that sounds an alarm when they try to get out of their bed or chair. It gives you the chance to do some of your other tasks without having to stay with the same patient for your entire shift, which isn't really possible or practical. Our patient today was wearing a wanderguard and set it off several times, but by the time you have put on your apron, visor and gloves, the alarm is driving everyone spare - sometimes even including the patient! Fortunately she didn't put herself in any danger and the wanderguard was more of an extra precaution. We spent most of our time when not in the bay, by the window in order to keep an eye on her. It did make me wonder though how we'll cope when we have someone who is more at risk of falls.
We started off with five patients in two bays, but two of them were discharged in the course of the day. It meant we had plenty of time for our other patients, and I noticed we're gradually getting used to the new normal. New routines don't seem quite so strange anymore, and in some ways this makes me sad - of course it is good we're getting to grips with the new ways of working, but I don't want to forget this isn't normal. Because we had a confused patient, we spent more time inside the bays than during my first two shifts. You start to realise how uncomfortable, hot and sweaty it is to wear all your PPE for longer periods of time. We wear our surgical masks all of the time, and the elastic starts to hurt your ears after a few hours. Most of us now wear a strap of fabric with buttons on at the back of our head that the elastic attaches to.
My biggest realisation today though was how isolated and lonely patients must feel. We have had a no visitors rule for a few weeks now (apart from patients who are in their last few days or hours), and in some cases, patients have already been self-isolating at home. It's sometimes easy for us staff to forget that a hospital stay can be an anxious experience. Quite apart from the health worries, a lot of things happening in a hospital are familiar to us, but new, unknown and possibly frightening to patients. Add to that the lack of familiar faces, the reassuring presence of a loved one, having to stay in an isolated ward plus staff so dressed up that it's hard to make proper eye contact, and you can understand why now it is even harder to be in hospital.
One of my patients today needed a little help using the commode. As she got ready to sit down in her chair again, she remained standing, saying it was good to stretch her limbs after sitting down for a while. She then looked at me almost guiltily and said, I know I'm probably wasting your time. My heart just broke. I reassured her that I only had three patients to look after and that she could 'waste' as much of my time as she liked.
Every shift, it is obvious that we have to work in a more business like manner if we are to stop the virus from spreading. We have so many new things to remember, things that aren't second nature yet. With every shift it also becomes more obvious though that this pandemic doesn't just have an effect on our mental health, but on patients just as much. It's a balancing act - keeping patients and ourselves safe, while looking after their emotional wellbeing too. One I'm determined to master.

In full PPE kit, about to enter the sealed-off bay. I'm smiling - not that you can tell!