RETROSPECT

“The greatest people are ‘great’ because they’re willing to admit their greatest faults.”Craig D. Lounsbrough

Here comes the end of a very peculiar year. One that had so many unprecedented events. A year that almost brought humanity to its knees. A year where we moved from a state of denial when  Covid 19 began transversing the globe. To quickly escalating to panic-driven reactionary measures. To now being more accepting of our current realities and realizing we ought to adapt. This was also the year of the nurse and midwife. A year where we were to make bold moves as we reinforced our key roles within the healthcare provision teams. We had begun great till we forgot what our aim was but who can blame us we were dealing with something that for most of us, as long as I am ending the year alive and in good health,  it is the greatest blessing and accomplishment.

We have had to learn and unlearn a lot of things during this time and if we are keen enough this will then better our profession. Personally, it offered a great opportunity to examine what I can learn from other professionals. This has been through candid conversations and through observation of their day to day practice and behaviour patterns. What I got, out of it is that we need to work on our basics first so that we can generate one voice and only then can we all move forward.

1. Maintaining professionalism in digital media

In the current era where the internet is among our basic resources, there is now an emerging trend of developing professionalism in digital media. Read this,  Nurses and digital media Different platforms provide us with vast opportunities in supporting clinical decisions, learning new skills, documenting care, engaging patients and each other through support groups etc. Despite this, we have also witnessed several posts of inappropriate images or comments about patients, colleagues or our workplaces on social media.  Yes, the lines can be quite blurry but conversely, it doesn't excuse us from proper practice Before clicking the send button always think of this “What you post online speaks VOLUME about who you really are. POST with intention. REPOST with caution.” Germany Kent

2. Accept correction and correct lovingly

Think of a time where you made a grave error in your line of work? What was the result of it? Did learning take place? Were you made to feel inadequate by your colleagues or did they embrace you and have a good discussion with you on how to avoid repetition? Has it happened that you were on the other side of things? What was your response to things? Did you offer a solution or did you end up maligning the person? We have created such poor relationships among us that if we are honest enough we can admit that often it is easier to do the latter. Unfortunately, this helps no one. This tends to be a personal struggle and I am trying to unlearn bad habits and so should you. “Remember we are all human and can make mistakes that we should correct. However, no one should ever imagine that other people’s mistakes justify or lessen theirs.” C.A.A. Savastano

3.Team work

"We are all something, but none of us is everything." Blaise Pascal

Being a nurse in this decade is quite interesting. In the clinical areas, we are having very many cadres of nurses. We have certificate nurses, diploma nurses, undergraduate nurses, graduate nurses, general nurses to specialized nurses and also very young nurses to older generation nurses. Read this, Nurse's teamwork Honestly, you would think this matters but what is of more value is the quality of care provided to our patients and how best each member plays their part in making our workplaces more hospitable. For instance, do you seem to work better with some colleagues than others? In a clinical setup, it is often evidenced by having the same workload on different days but feeling more frustrated and fatigued on one day and feeling vibrant and ready to work on another. Of course, we are assuming other factors are constant. Teamwork is often a struggle but if we actively work on it we can derive a lot of pleasure in our workplaces and maybe just maybe our levels of burnout can be more manageable.

In summary, we have had a rough year but we should not allow ourselves to come out empty we should seek to grow into identifying our personal strengths individually and together. For "Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending." - Carl Bard 

DIE KINDER

“There can be no keener revelation of a society’s soul than the way in which it treats its children.” Nelson Mandela, Former President of South Africa

A few years ago while working in the outpatient department I attended to a four-year-old who had presented for a surgical review. He had been discharged about a week prior to having undergone surgery to create a temporary colostomy stoma. This was after presenting with sepsis secondary to a ruptured appendix. Further discussions with his surgeon revealed that the child had been presenting to different ERs with severe abdominal pain and would always be discharged with analgesics and at times even dewormers. It had been unclear in all those visits that he maybe suffering from an acute abdomen and by the time it was being identified his abdomen was taut, very tender and he was in septic shock. Maybe it is just me but in my years of practice am coming to appreciate how challenging it can be to handle this special population. This has further been reinforced with the children being at home in this pandemic season.  In the past several months, we are witnessing an influx of children presenting to the ER or outpatient with one form of emergency or another. Depending on the gravity of the situation some actually then end up in the pediatric wards, HDUs, ICU and the most fortunate are just sent back home for observation.

At this point then I pose the question. As a health professional or as a working parent in any career. Do you have children? Are you the primary caretaker/guardian of this special group? Are you content with the fact that if anything was to happen to them they would receive the most appropriate care in any health facility they are attended at? That includes where you currently practice. Well, the World Health Organization creates a dim outlook in its updated 2016 guidelines. They begin by stating that most pediatric deaths occur within the first 24 hours of admission. They majorly attribute this to;

•  Ineffective triage processes.
•  Delay in presenting the sick child to the hospital.
• Inadequate resources at the health facilities.
• Lack of basic skills and knowledge among the health workers in initiating appropriate treatment.

To explore this further read the following pdf document Updated guideline: pediatric emergency triage, assessment, and treatment: care of critically-ill children. Johanson et al; stated that in low-income countries, emergency care is among the weakest parts of its health systems. This is despite these systems experiencing higher patient loads and mortality than other regions, particularly for pediatric emergency patients. To view, this journal article click here Accessibility of basic pediatric emergency care in Malawi.

According to etat guidelines, pediatric emergencies are commonly categorized as trauma, seizures, respiratory distress, and toxicologic emergencies. A lot of emphasis is currently being placed in medical emergencies and it is wonderful that we are now observing a gradual improvement in practice. This has been facilitated further by the provision of periodically updated  MOH guidelines for instance  Basic pediatric protocols for ages up to 5 years. However, what strides have we made in handling pediatric surgical emergencies? How many specialists are available? Is it easy to even access those who are currently present?

Did you know that Africa is considered the most dangerous continent to live in? Naidoo and Murckart deduced so from the extensive studies they reviewed while conducting their own research. In their study, they identified that among the 181 children admitted with trauma injuries in their  Trauma Intensive Care Unit(TICU) 26 of them died. Among those who died, 88.4% of them had head injuries, 46.2% had injuries to their extremities, 38.5% had external injuries, 34.6% had abdominal or chest injuries, 19.2% neck injury and 11.5% had facial injuries. For a more in-depth analysis view it here  Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period. A study done at a tertiary teaching hospital in Kenya found that of all the pediatric trauma cases admitted in the facility most injuries were amongst boys (65.3%) and the very young had a mean age 6,  42.4% of the injuries occurred at home while 25.7% at residential institutions. The injuries were typically caused by falls (56.3%) or penetrating trauma (13.2%) and that they mostly resulted in extremity fractures (45.8% closed, 4.9% open)other types of injuries were burn or head injuries (in infants and small children). This study further revealed that their patients either received very little or no pre-hospital care (51.4% no care). Additionally, children with burns, brain injuries, or poly-trauma had the longest hospital stays and the highest rates of mortality. Such figures should prompt us to do better. What role have you played to make the needed improvements? To view the above article click here Patterns and outcomes of pediatric trauma at a tertiary teaching hospital in Kenya.

Simple ways we can improve outcomes is such cases can be broadly categorized as;

1. Human factors

1. Effective documentation to capture details on conditions and contributing factors present in the environment.Retrospect analysis of such data aid in the establishment of the root cause. eg Intentional trauma versus accidental trauma, good documentation makes it easier for researchers aiming to conduct chat reviews for further studies in this field, effective documentation provides a great opportunity for the collection of full information needed to conduct case presentations, etc. 
2. Effective communication - Asking the right questions the right way helps obtain information that may aid in treatment and identifying the mechanism of the injury which facilitates the early introduction of appropriate care.
3. Building a culture of learning- By enhancing our skills and knowledge on special groups it will help avoid the confusion and human errors generated by the use of the inappropriate intervention.

2. Organizational factors

1. Provision of needed equipment- Availability of basic emergency apparatus such as different branula bores, intravenous fluids, bag valve masks, oxygen therapy, splints, etc go a long way in stabilizing most trauma cases as a further plan of action is being created.
2. Creation of policies and guidelines that encourage adoption of appropriate care.- Policies by themselves create little to no change but the emphasis in their adoption does.
3. Put under consideration the development of health workers' exchange programs- Exchange programs aid in exposure to different setups hence one is more likely to learn while maintaining cost efficiency. This is so true when one gets the opportunities to train in resource-rich centers and transfer the new knowledge and skills to the resource-limited environment.

Other useful resources

• Identifying areas for improvement in pediatric trauma care in NSW Australia using a clinical, system, and human factors peer-review tool
• Kenya pediatric association
•  

In conclusion, as we seek to improve our health delivery services let us build a culture of thinking while doing and in this way, we shall be able to generate creative ways in improving the services we deliver. Remember this; “All children are born to grow, to develop, to live, to love, and to articulate their needs and feelings for their self-protection.”Alice Miller

SYNERGY

  “Every moment of one’s existence, one is growing into more or retreating into less.” Norman Mailer

 Over the past few years, I have had an opportunity to create beautiful friendships with people whom I have met at my workplace. Over time we have each slowly grown into our own space some of us more slowly than others but lest the same, growth has been evident. With this, it has meant that we move to different departments or regions and as much as it has been difficult it is proving to be worthwhile. John Maxwell a great American author once said, “Growth is the great separator between those who succeed and those who do not. When I see a person beginning to separate themselves from the pack, it is almost always due to personal growth.” For anyone left behind as this happens one experiences a barrage of emotions. One is happy to see them grow but then despondency creeps in. One can not fathom not seeing them for a long time. On some days despite offering our unmerited support we are left asking ourselves when is our time coming too. I am here to let you know that it is okay to feel unsure, the only difference is how you respond to it.

 A few weeks ago I was helping my friend pack her household belongings ready for the big move and she came across her vision board. I was quite taken aback by the intricacies within it. I remember seeing her lips moving but honestly not listening to what she was saying. My eyes were so glued on it. As far as I could tell she had achieved some major things on it and had modified some of the goals that were yet to come to pass. This current big move she was making was directly linked to all this and through revising her previously set goals she was on the right path to achieving them. I felt proud and decided maybe its time I put down mine too. Get all my ideas from my head to paper. Well, I did so and then this morphed into a learning process where I came across the term career mapping.

 Career mapping is the process of generating methods for individual progression within a particular area of one's choice of a career within a specified time frame. It differs greatly with professional development in that the latter only focuses on obtaining new skills and knowledge meant to remain relevant. As highlighted in some of my previous posts job satisfaction is key. It directly affects so many aspects of our lives that we can not afford to be lax about it. We invest too much of ourselves into it and when we can do something about it I believe we owe it to ourselves to do something.

 Analysis of research papers on this topic among the different databases revealed that for nurses, in particular, our career map is mainly informed by three key things;

1.  The level of formal education
2. The length and nature of our work experience
3.  Competency assessment

For a better understanding of this, I suggest the analysis of the article attached to the following link nurse career mapping. As an employer, one would be quick to dismiss this but do you know this also directly affects the services delivered. The benefits of engaging or being involved with your staff in their career mapping include:

• Reduced rates of staff turnover
• Better service delivery through the use of current knowledge and skills.
• Development of genuine loyalty to an organization. No trade secrets spilled
• Better work relationships by reducing work-related conflicts 

There are so many ways to generate a career map. To obtain the best out of it do proper research on what you wish to achieve. Be open to trying what you put down as proficiencies and new skills needed and guard it. Why? because not all people you wish to share with will be ready to assist you to achieve it some are more ready to be a hindrance. Here is a simple guide to creating your own simple career guide or map. It is never too late to start. Detailed description

1. Determine a starting point
2. Determine a final goal
3. Identify how to connect the two points
4. Create a series of smaller goals within two points
5. Put it at an easily accessible place where you can see it on a regular.

Additional resources on the above topic

• A moderated mediation model
• Career ladder and nurses retention
• Evolving career choices
• Late bloomer

 As we continue developing into the best versions of self lets us identify what we enjoy doing and as Katherine Whitehorn said  “Find out what you like doing best and get someone to pay you for doing it." 

 

I CHOOSE ME

  “Communicate unto the other person that which you would want him to communicate unto you if your positions were reversed.”Aaron Goldman

 Who would have thought that in the year 2020 a new virus would be added to the emerging and reemerging infections list? Well, maybe the epidemiologists, because that is primarily their role. Right? We have had to have a crash course on how to actively live within the pandemic and so far I must applaud us all for really giving our best version of what we think actively living is. For a long time, many of us had never fully appreciated how rapidly our emotions can fluctuate. From being vibrant one minute to experiencing grappling fear of the unknown the next minute. I am sure we can each give scenarios related to this. 

 Most recently I was handling a patient whom now in retrospect I should have handled with greater precaution. In this context, precautionary measures should have included full protective gear for at that particular time a lot was unknown. I had admitted an elderly male with underlying preexisting conditions who had acutely gone into pulmonary edema, therefore, had dyspnea, severe hypotension, and a deteriorating neurological function. A cardiopulmonary arrest was a sure outcome if no rapid intervention was done. He had already been initiated on oxygen supplementation via a non-rebreather mask at 15L/min, he had an ongoing Norepinephrine infusion running peripherally from the transferring unit and he had received stat doses of Lasix and Albumin. However, more needed to be done as he could no longer sustain enough respiratory effort. Urgent invasive intubation was done. Yes, we had the basic gown, surgical mask, and gloves but with the risk of exposure to aerosols, we had forgotten to wear a shield and the N95. Why? tensions ran high and the team leader shouting orders didn't aid much. A lot of mistakes were made in terms of our personal safety. Luckily, the patient was now adequately ventilating, and oxygenating. By this time his blood pressures were sustained. Later on, we had a debrief and the errors were discussed and it was noted that we need to improve on effective communication as this will encourage situational awareness which encourages the maintenance of personal safety at all times. We could have done better but I choose not to dwell on the what-ifs but rather what was the root cause of the problem.

 Heading home that day I managed to take a walk which allowed me to think through the day's activities. I realized all sense had gone out of the window because I could not imagine losing my patient. Adrenaline is a valuable thing as it makes the impossible workable but with it ushers a lot of illogical thinking. I felt obliged to help and this for a minute made me forget about myself. I am sure some of you may get this and some of you may not which is great as it generates a diverse audience for these conversations.

 A study done in Florida USA showed that often communication has been identified to vary by specialty, especially during a simulated operative emergency. This same study showed the effect of directed communication in eliciting a response depends on the clinical status of the patient. To read more on this follow the link operative team communication. In light of this pandemic, we do not have the luxury of this because we can not continue losing more health workers. We need to deliberately take steps to protect ourselves to continue providing care to all those who need us. Globally, as of June 23th 2020, the World Health Organization reported on more than 10 000 health workers in 40 African countries being infected with the covid 19 virus click here for more information W.H.O Africa. They further stated that inadequate access to personal protective equipment or weak infection prevention and control measures raise the risk of health worker infections. Coming to a realization of all this made me angry about myself for allowing it to happen. Currently, I am lucky enough to work for an organization that offers all protective gear yet I did not take advantage of this. Daily I am reminded that there is a group of my fellow colleagues who do not have this opportunity. I was angry because I contributed to the statistics that generate nosocomial infections. Wondering how? What if my patient had a highly infectious disease and I developed it after this exposure. Handling other immunocompromised patients would mean that they are at risk too. However, reflection reminded me of why situational awareness is key and why we need to work harder at working safely. We need to protect our families, ourselves, and our patients.

In conclusion, within healthcare, it is important to always be aware of the many reasons something can go wrong but at this time it is very crucial to do your best while playing your role accordingly. Simple ways we can achieve this is by holding each other accountable when errors are noted being made, be unanimously vocal. Vouch for what is right regardless of the situation we need to remember to take a few minutes in any medical/surgical emergency and make ourselves aware of the situation at hand.

“Doing what's right is never easy. You think you're right, but you lose track of what you were trying to do all along, and then there's blood and screaming and death. Doing a bad thing for a good end just sours the good.”Janice Hardy,

UNBELIEBTE MEINUNG

 The truth is incontrovertible. Malice may attack it, ignorance may deride it, but in the end, there it is.

Winston Churchill

Dear world,

This virus has decided to stay longer than we previously thought. We are possibly never reverting back to normal, and honestly, I am not sure if it is a bad thing. This season has been onerous on most people. It is offering a great opportunity for self-reflection. The moment you start questioning everything you know two things will happen. You may adapt and grow or you can breakdown and never recover. Despite the challenges, I would wish to enjoy my everyday life. “You were given life; it is your duty to find something beautiful within life, no matter how slight.”

Elizabeth Gilbert

 Most of what we do and how we act is through socialization and often we take in a lot of poor practices. We must closely examine ourselves to learn from past errors. and avoid repetition. Some errors that have come to light in this season are:

1. Believing my job is better than yours

I love how this pandemic has led to the realization that every job matters and just because I directly do not feel your impact it does not mean the role played is insignificant. For example, who knew the key to infection control and prevention would be the security officer, the watchman? The person whom on most days you used to swiftly dismiss as you hurriedly rushed home or to your work station. The person whom you thought was below you and you could not even spare greeting them. The person whom you never thought to invest in terms of knowledge of hygienic practices. Bitter pill to swallow, right? Better yet that wonderful housekeeping staff who ensures the surfaces and corridors are clean. The people where in most cases have never been provided with protective gear except for their uniforms. The majority of them have nothing to shield them from the disease. Have you ever taken the time to read the ingredients contained in their cleaning solutions? Some of them are very toxic and have lifelong effects and yet few take that into consideration. Have you noticed that especially in some government institutions they also provide tea to the other team members yet again no investment in knowledge of infection control and prevention practices is placed? I hope we can now see how we have been setting ourselves up for failure. "Conceit is God’s gift to little men."Bruce Barton

2. Mimicking limits invention

 We are learning the hard way that not every information generated should be applied. There is a great need for us to develop independent thinking while continuously being inquisitive. This leads to exploring our own ways of developing solutions to problems. For instance, despite this illness being new within our African context did we openly question the use of HCQ and Arithromycin before pumping them down our patients' throats. "Whether you think you can or think you can't, you're right." Henry Ford

3. Greed above everything

 We are being forced to acknowledge just how broken our systems are. We have been forced to realize how our greed in different institutions will lead to our death first before we enjoy our lives and " those profits" we are trying to generate. In the past, we have seen the wealthy move across the world in search of quality health services while leaving the poor to fend for themselves. It is ironic how just this pandemic is, no country is spared,  deaths keep occurring all around us and the funniest bit even if you set up intensive care units in your own home it doesn't guarantee you get out of it alive.

 The pandemic has reiterated that as humans we are often an ungrateful bunch. Unless something is serving our own best interest we are not ready to help. When was the last time you willingly offered to help someone? Not through coercion or a reminder to be humane but through taking personal initiative and actively searching for this person or persons and providing whatever little or much that you had. “If money is your only measure of success, do not be surprised when it is all you have.”Wayne Gerard Trotman

We should not be quick to write off this season we should look at it as an opportunity to learn to do better and be better towards our treatment of each other.“It's not the most advanced society we should be aiming to build that only cares for efficiency, rather our aim should be to build a healthy society with the right amount of advancement and a whole lot of humaneness.”

Abhijit Naskar