Drilling into a child"s leg left me thinking about empathy in nursing

I take a breath to steady myself. I’m about to drill into a child’s leg. She’s awake.

I’m part of a team who are desperate to get intravenous access into a eight-year-old. We need to be able to administer anaesthetic drugs and sedation so that we can put her on a ventilator because her oxygen level is dangerously low. Normally, we’d do this by injecting into a vein, but when you’ve had as many intravenous lines as this young girl has, there comes a point when your veins can’t take any more.

This is a procedure I have done many times, always because we have run out of other options. So why is it different today? This is a family I have known over a number of years in my professional role. I have seen this child grow from a baby into a girl of eight. Life is tough for them; she has multiple complex medical needs, she is unable to do many of the things most of us take for granted. I have seen this family through many ups and downs, hospital stays too numerous to count, admissions to the paediatric intensive care unit in the double digits. They cope. They just get on with it, and somehow they keep a sense of humour.

For all that, however, I know they don’t want this. Watching someone drill into your child’s leg with something that looks like a gun with a 5cm-long needle on the end of it in order to place an intraosseus cannula (a drip into the bone marrow) is not OK.

I tell the mother that we don’t have any choice. We need to be able to give the medication urgently and this is the last resort. She knows. We look at each other and she tells me, “OK”.

This is a procedure normally reserved for people in cardiac arrest or unconscious. There’s a good reason for that: it hurts. I do what I can in the short time I have to reduce any pain as much as possible. I use cold spray and some local anaesthetic under the skin.

Her oxygen levels are dropping rapidly. If we can’t improve them, her organs will suffer damage and she’ll get worse. The situation will become life-threatening in around 10 minutes.

This isn’t a particularly difficult procedure but everything is harder when you’re under pressure, when it really matters, when all eyes in the room are on you, including the child’s parents. As I inject the local anaesthetic, she moves. I know she can feel it and I feel a rush of emotion on her behalf. I tell her what’s coming and I can hear her parents reassuring her, kissing her, stroking her hair.

One more deep breath for me and the needle is through the skin. I depress the trigger to start the drill and am aware of the sound it makes as I enter the bone. No parent should have to witness this. In a second or two it’s done. Success. Relief. I have a rush of adrenaline and my hand shakes as I disconnect the drill from the cannula.

I say sorry to her and I look at her parents. They nod. It’s OK. One of my colleagues says, “Good job” and I know that he means, “I get it.”

We give the medications she needs and are able to pass the breathing tube into her windpipe without a problem. Her oxygen level starts to come up.

I’ve been in this job a long time, and I am still caught unaware by a rush of feeling sometimes. It’s important to remember the human aspect of this job. Although I’m here to do a job, for some families on the receiving end of the treatment I give, this is the biggest thing that’s ever happened to them. If I can’t recognise how it makes them feel and be a part of that, then I can’t do this job. I think for a moment about what I tell my junior nurses: “When you stop feeling it, it’s time to go” and I know that for this, and so many other reasons, I’m exactly where I should be.

Some details have been changed

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Drilling into a child"s leg left me thinking about empathy in nursing

NHS culture: how can the "empathy gap" be bridged?

‘I hope that my research will contribute to a culture adjust, which is not only more empathetic to sufferers, but also to the personnel who care for them.’ Photograph: Science Photograph Library/Corbis

As a student nurse I was advised to keep my distance and not get also concerned with individuals. I am sure this was meant to be beneficial, but as a approach it failed spectacularly. Inside of two many years of qualifying as a nurse I had left the occupation, I thought completely.

To care for and show compassion for patients takes emotional strength and resilience. It calls for workers to see the person in the patient, pay attention to their fears, issues and worries, to empathise and to think about by yourself in their shoes, not least to be in a position to help them enhance.

However apart from currently being informed to hold my distance, no-one taught me any coping capabilities or taught me how to handle my emotional responses to the challenges of becoming a nurse – for illustration to the death of a little one or young man or woman my age, or to an unsuccessful cardiac resuscitation of somebody who could be my father.

When the senior nurse discovered me crying in the sluice following the death of one more patient on the ward (the sixth that week) I was informed to “pull myself with each other” and get back on the ward. A single may well hope and indeed think about that, in the intervening 30 years, we have acquired far better at supporting junior personnel, but my investigation suggests college students and newly experienced nurses are nonetheless required to bury their feelings and hide their stress and distress, and this can usually lead to burnout and to nurses leaving the profession.

In today’s quickly-paced NHS, with far more acutely unwell patients in our hospitals than ever just before: 96% bed occupancy and a greater proportion of older patients with complex requirements, the stresses have, if anything at all, worsened.

Healthcare workers come into the profession to aid other individuals. If nurses cannot give the care that they want to give, they experience moral distress and cope by erecting a shield to shield themselves.

It is not only nurses that knowledge this. Studies of healthcare students also suggest that with out support, an “empathy gap can produce in health care students, whereby stress can harden students’ attitudes toward sufferers”. It is often surprising to these outdoors the sector that the vast majority of medical doctors and nurses never routinely get assistance or any debriefing following a traumatic event and are typically left to make sense of the aftermath themselves. Mental well being nurses, midwives and psychologists uniquely have standard supervision which, if well facilitated, gives an chance for reflection and debriefing.

An intervention, originally produced in the US, is now currently being implemented in practically 70 healthcare organisations in the United kingdom. Schwartz Centre rounds (or rounds) give an chance for all personnel in well being and care settings to meet when a month to talk about the emotional issues of their function.

Rounds consist of confidential meetings in which employees from various professions and backgrounds routinely come with each other to talk about the non-clinical elements of caring for sufferers..

Schwartz rounds are supported in the United kingdom by the Stage of Care Basis, and have been frequently cited as a device health and care companies can use to support compassionate care.

What is distinctive about rounds is that they are resolutely multi-specialist. They bring all employees with each other on an equal footing. This is important simply because, for also lengthy, compassionate care has been witnessed largely as the responsibility of nurses, whereas for patients, carers and households, the top quality of every single interaction they have with all personnel is important.

In the US, personnel involved in Schwartz rounds reported an enhanced potential to deal with the psychosocial demands of the task, better crew-working and a better organisational concentrate on delivering patient-centred care. Likewise, in a small research of the two Uk pilot hospitals, participants reported rewards for their day-to-day care of individuals and a strengthening of group operate.

With the help of a grant from the Nationwide Institute for Health Research Overall health Solutions and Delivery Investigation (HS&ampDR) programme, I am at present top the very first nationwide evaluation of Schwartz rounds in the United kingdom. We will be seeking to see to what extent they influence employees wellbeing at function, enhance relationships between staff and individuals, and support in the provision of compassionate care.

During the final yr the quantity of organisations implementing rounds in the United kingdom has elevated by over 300%. These organisations are not just acute hospital trusts, but also integrated care trusts, mental overall health organisations, hospices and personal hospitals.

I hope that my analysis will contribute to a culture alter, which is not only much more empathetic to patients, but also to the staff who care for them.

Professor Jill Maben operates at the Nationwide Nursing Research Unit, Florence Nightingale college of nursing and midwifery, King’s University London.

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NHS culture: how can the "empathy gap" be bridged?