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Reflections from the United Kingdom
GUEST EDITORIAL
Reflections From the United Kingdom Melanie Oakley, MSc, BSc (Hons), RN, PGCE REFLECTION IS A skill every nurse uses. Some use it better than others, but we all use it to a greater or lesser degree, and I believe this is how the majority of practice evolves and moves forward. Recently, I have been reflecting almost continuously for various reasons. What I have reflected on has been many and varied, and in some instances private and not to be shared, which is the nature of reflection. Reflecting on one’s practice is not easy; it means self-examination and analysis. Often, the decision arrived at might not be easy to achieve. However, some reflection is pleasurable, with achievable outcomes that can be shared with others. When asked to write a guest editorial for the Journal of PeriAnesthesia Nursing, a whole gamut of emotions washed over me. Fear— surely they could not want my opinion. Excitement, followed closely by blind panic—what was I going to write about? This has been followed by a period of reflection, where consideration was given to what I was going to incorporate. The answer came to me—why not share my reflection rather than writing about a “topic” that covers a wide range of issues.
Melanie Oakley, MSc, Bsc (Hons), RN, PGCE, is the Editor of the British Journal of Anaesthetic and Recovery Nursing and Senior Lecturer in Anaesthetics and Recovery at Kingston University and St. George’s Hospital Medical School, Faculty of Health and Social Care Sciences, London, England. Address correspondence to Melanie Oakley, MSc, BSc (Hons), RN, PGCE, Kingston University and St. George’s Hospital Medical School, Faculty of Health and Social Care Sciences, 2nd Floor Grosvenor Wing, St. George’s Hospital, London, SW17 ORE, England; e-mail address: moakley@ hscs.sghms.ac.uk. © 2003 by American Society of PeriAnesthesia Nurses. 1089-9472/03/1802-0003$35.00/0 doi:10.1053/jpan.2003.50020 80
I am a member of the British Anaesthetic and Recovery Nurses Association, which is the equivalent to ASPAN, but on a much smaller scale. We represent the views of anesthetic and recovery nurses in England. We produce a quarterly journal and have a conference once a year. We have a very dynamic chair, Pat Smedley, who last year attended the ASPAN conference and met representatives of your organization. She returned hugely excited and full of ideas. One of these ideas was to develop links between our 2 organizations. This she has done tirelessly. Representatives of ASPAN will not only be attending our conference, but will be speaking and making the key note speech to mark the occasion—a fact we are not only proud of, but are honored about and looking forward to with great anticipation. Pat will be coming to your conference in April, so if you spot her name on a badge, please say hello. Apart from the size, is there a real difference between our organizations? Health care in both our countries changes rapidly—so rapidly that I defy anyone to keep completely abreast of everything. Underneath the change and supporting it, however, is an organization dedicated to nurses working to give the best possible care to the patients they look after. In England, recovery nurses have witnessed the most change. Recovery units were the “Cinderellas” of the operating department. If you were a nurse, you could work there because all it entailed was holding an airway until patients were awake and then sending them back to the ward. Most nurses could do this because within their training they regularly looked after unconscious patients in the wards. Journal of PeriAnesthesia Nursing, Vol 18, No 2 (April), 2003: pp 80-81
GUEST EDITORIAL
All of this has changed. Nurses, in their training, no longer regularly look after unconscious patients. Even if they are lucky enough to be allocated to the theatre department, they may only do 2 weeks of their 8-week placement in recovery. Therefore, a new breed of nurses has evolved, nurses who recognize that working in recovery requires distinct skills, its own evidence base, and its own body of knowledge. Added to this, surgery has become more involved and the anesthetic technique needed to support the patient has become more technologically advanced. As a result, the skills needed to care for a patient after anesthesia and surgery has become more specialized. Many of our units now have high-dependency bays staffed by recovery nurses. All of these advances make the nurse working in recovery a highly motivated, highly skilled practitioner. For the anesthetic nurse, change is just around the corner. After years of discussion and procrastination, the first pilot sites are being selected by the National Health Service Modernisation Agency to commence nurse anesthesia programs. As an anesthetic nurse originally, this is really exciting. With all this technology, however, we must not lose sight of the fact that we are nurses first and foremost. Much of what we do are skills that are
81
not particularly difficult to learn. The real skill of nursing in anesthetics and recovery is knowing when patients need comfort and how to provide this. Do they want their hand held, professional words of comfort, or both? The skilled anesthetic and recovery nurse will know what patients need within minutes of meeting them. They know which pain management regime is appropriate for which patient. I had major surgery a few years ago and one of the most meaningful things done for me in the recovery unit was being given ice to suck on; I felt that I was really being cared for. This knowledge and ability will be drawn from experience and thought. Being able to reflect on practice in an honest way, demonstrating self-awareness and a willingness to change, will enhance this knowledge and ability. So what is the conclusion to my particular reflection about undertaking this editorial? Initially, I felt so overawed by it that I was poleaxed into complete inactivity. This moved on to thinking about all that I could write, but dismissal of most of it. I then concluded that if I just wrote, what I have to say is valid, and possibly even interesting, because at the end of the day we are all nurses working in similar environments toward a common goal— excellence in perianesthesia practice.
Reflections From the United Kingdom Melanie Oakley, MSc, BSc (Hons), RN, PGCE REFLECTION IS A skill every nurse uses. Some use it better than others, but we all use it to a greater or lesser degree, and I believe this is how the majority of practice evolves and moves forward. Recently, I have been reflecting almost continuously for various reasons. What I have reflected on has been many and varied, and in some instances private and not to be shared, which is the nature of reflection. Reflecting on one’s practice is not easy; it means self-examination and analysis. Often, the decision arrived at might not be easy to achieve. However, some reflection is pleasurable, with achievable outcomes that can be shared with others. When asked to write a guest editorial for the Journal of PeriAnesthesia Nursing, a whole gamut of emotions washed over me. Fear— surely they could not want my opinion. Excitement, followed closely by blind panic—what was I going to write about? This has been followed by a period of reflection, where consideration was given to what I was going to incorporate. The answer came to me—why not share my reflection rather than writing about a “topic” that covers a wide range of issues.
Melanie Oakley, MSc, Bsc (Hons), RN, PGCE, is the Editor of the British Journal of Anaesthetic and Recovery Nursing and Senior Lecturer in Anaesthetics and Recovery at Kingston University and St. George’s Hospital Medical School, Faculty of Health and Social Care Sciences, London, England. Address correspondence to Melanie Oakley, MSc, BSc (Hons), RN, PGCE, Kingston University and St. George’s Hospital Medical School, Faculty of Health and Social Care Sciences, 2nd Floor Grosvenor Wing, St. George’s Hospital, London, SW17 ORE, England; e-mail address: moakley@ hscs.sghms.ac.uk. © 2003 by American Society of PeriAnesthesia Nurses. 1089-9472/03/1802-0003$35.00/0 doi:10.1053/jpan.2003.50020 80
I am a member of the British Anaesthetic and Recovery Nurses Association, which is the equivalent to ASPAN, but on a much smaller scale. We represent the views of anesthetic and recovery nurses in England. We produce a quarterly journal and have a conference once a year. We have a very dynamic chair, Pat Smedley, who last year attended the ASPAN conference and met representatives of your organization. She returned hugely excited and full of ideas. One of these ideas was to develop links between our 2 organizations. This she has done tirelessly. Representatives of ASPAN will not only be attending our conference, but will be speaking and making the key note speech to mark the occasion—a fact we are not only proud of, but are honored about and looking forward to with great anticipation. Pat will be coming to your conference in April, so if you spot her name on a badge, please say hello. Apart from the size, is there a real difference between our organizations? Health care in both our countries changes rapidly—so rapidly that I defy anyone to keep completely abreast of everything. Underneath the change and supporting it, however, is an organization dedicated to nurses working to give the best possible care to the patients they look after. In England, recovery nurses have witnessed the most change. Recovery units were the “Cinderellas” of the operating department. If you were a nurse, you could work there because all it entailed was holding an airway until patients were awake and then sending them back to the ward. Most nurses could do this because within their training they regularly looked after unconscious patients in the wards. Journal of PeriAnesthesia Nursing, Vol 18, No 2 (April), 2003: pp 80-81
GUEST EDITORIAL
All of this has changed. Nurses, in their training, no longer regularly look after unconscious patients. Even if they are lucky enough to be allocated to the theatre department, they may only do 2 weeks of their 8-week placement in recovery. Therefore, a new breed of nurses has evolved, nurses who recognize that working in recovery requires distinct skills, its own evidence base, and its own body of knowledge. Added to this, surgery has become more involved and the anesthetic technique needed to support the patient has become more technologically advanced. As a result, the skills needed to care for a patient after anesthesia and surgery has become more specialized. Many of our units now have high-dependency bays staffed by recovery nurses. All of these advances make the nurse working in recovery a highly motivated, highly skilled practitioner. For the anesthetic nurse, change is just around the corner. After years of discussion and procrastination, the first pilot sites are being selected by the National Health Service Modernisation Agency to commence nurse anesthesia programs. As an anesthetic nurse originally, this is really exciting. With all this technology, however, we must not lose sight of the fact that we are nurses first and foremost. Much of what we do are skills that are
81
not particularly difficult to learn. The real skill of nursing in anesthetics and recovery is knowing when patients need comfort and how to provide this. Do they want their hand held, professional words of comfort, or both? The skilled anesthetic and recovery nurse will know what patients need within minutes of meeting them. They know which pain management regime is appropriate for which patient. I had major surgery a few years ago and one of the most meaningful things done for me in the recovery unit was being given ice to suck on; I felt that I was really being cared for. This knowledge and ability will be drawn from experience and thought. Being able to reflect on practice in an honest way, demonstrating self-awareness and a willingness to change, will enhance this knowledge and ability. So what is the conclusion to my particular reflection about undertaking this editorial? Initially, I felt so overawed by it that I was poleaxed into complete inactivity. This moved on to thinking about all that I could write, but dismissal of most of it. I then concluded that if I just wrote, what I have to say is valid, and possibly even interesting, because at the end of the day we are all nurses working in similar environments toward a common goal— excellence in perianesthesia practice.