Working as a Healthcare Assistant

So I have written a post about how I am working as a healthcare assistant at Bristol, but haven't followed this up with anything really on my blog. I have been doing this job properly now for around eight months and am loving it more and more, shift after shift.

The best thing about being a HCA is that you are learning so much about patients that lectures just cannot deliver. The lectures at uni are all about the physiology and scientific aspect of different diseases and conditions. You can learn about congestive heart failure down to the cytokine, but it presents itself differently in every individual.

Working as a HCA, I have met so many patients. Each of them completely unique in their own way - with the way they wanted their care delivered, the way they view their disease and their own prognoses.

I am also learning lots of practical skills. I actually found that I am becoming more confident in the way I speak with patients and help them out. At the beginning, I found myself quite reluctant to touch and get hands-on with my patients, and I think this was down to the fear of hurting or harming the patient. Now, I am much more confident. I can knock on the door loudly before entering and introduce myself with a smile (and not mess up my introductory lines!). I am yet to get to the level of the other HCAs I work with, but I'm hoping that will come with time.

As I now have a long summer ahead of me, I'm working as many bank shifts as possible. Not only am I earning money whilst doing so, but I'm keeping my head in the medical world so I won't get a shock in September when I start my year in Taunton's hospital!

OSCE Exams!

This was an abbreviation I had seen so much of during my research into studying medicine at university. Now, this was going to be my main assessment for second year!

An OSCE is essentially similar to the MMI stations that you will (have) sit to get into uni. The stations are made up of a number of sections and each OSCE will have a certain number of stations in total. For my exam, there were three stations with each being divided into three sections.

Each station would test an aspect of the content that had been taught in both years 1 and 2. It would involve a history or an examination on a patient with a presenting complaint, so like chest pain or breathlessness. It would then be followed with an interpretation task. So this could be looking at an x-ray (to test anatomy), processing lab data (to test practicals and lecture content) or interpreting graphical data. Finally, would have to explain something to the patient (ie. what they have, how to use an inhaler etc) or activate them to change their lifestyle (ie. stop smoking, stop drinking alcohol etc). The station could also have a clinical skill which we would’ve learnt In our clinical encounters, like dipsticking urine or doing a manual blood pressure.

But there were three of these stations to break it up (eg. One on chest pain, one on breathlessness and one on abdominal pain).

The examiner would sit there with a clipboard and tick as you were talking and working with the patient. The patient was an actor pretending to have the condition, or real patients who had what they were actually describing (eg. Psoriasis).

The whole exam lasted an hour. (Each station was 20 minutes)

It was great how the exams were so practical and you actually felt like a medical professional whilst speaking to the actor patients. It was very pressurising, like any exam, as the trick was to look both confident and friendly. In these examinations, you're being tested on both your person skills as well as your knowledge!

I got my results about a month later and was over the moon with a pass! Roll on Year 3...

Back to Lectures...

The main clinical block was now over, meaning we were back in lectures. After having a summer away from it, I couldn’t wait to get stuck in again. There’s something about getting up, grabbing a coffee and spending time with your mates in a lecture on something that confuses you by the fifth slide.

The lectures from now until Christmas will involve the foundations that were taught from first year and help guide us into the symptom-based teaching of after Christmas.

In comparison to first year, we were taught about every system individually. Now, we are being introduced to more complex physiology, like the turnover of skin, and how this process can be disrupted and present clinically as a disease. This year is more disease-based than normal physiology.

Our labs contain more interesting practicals, such as understanding what flow cytometry is and how it can be used to work out which cells are in a sample to the metabolism of aspirin. This is definitely a more sciencey block which is quite nice after just finishing clinical placements and times on the wards.

The knowledge we have developed this year can help us work out what tests and investigations we may want to do. Using the results from investigations, we are able to work out a possible diagnosis of particular patient cases.

In our clinical parts, we have been taught greater details on taking a well rounded history. For example, how to explore the different components of a drug history to make sure you don’t miss anything out. Like how people sometimes forget to mention their contraception drugs when giving the list of their current medications. Furthermore, we are completing system examinations on patients in the hospital and the GP after taking a history which is helping to marry together our findings!

Paediatric Placement!

With my first lot of clerking completed, we then move onto the second part of the year’s beginning: Student Choice projects.

I chose my student choice project last year from a long catalogue of different options. These options ranged from laboratory based research projects, research into behavioural sciences and ethics and loads of different clinical encounters of different specialities. I had chosen from the list that I wanted to complete clinical work on the Children’s Unit at the Royal United Hospital in Bath.

Playing and creating are two things children love doing! So as part of their care, we are encouraged to interact with the children to help combat boredom and fear of being in hospital.

We caught the coach each morning to Bath so that we would get a handover from the nurses and care assistants about the children who were inpatients on the ward. It was a fantastic opportunity to be able to meet such positive children and see how the diseases we had started to learn can manifest and present differently in younger children. We also had the chance to walk around NICU and see the neonatal care delivered there.

My favourite part was meeting the Play Therapists. These amazing individuals are responsible for using fun activities and toys in their delivery of care for the young patients. Play therapy can be used as a distraction, with one therapist saying that the mobile play machine (a contraption on wheels with a disco ball, flashing lights, mirrors and sticky-out twistable colourful things) can be used to make the child look away from something fearful like a needle.

It can also be used to help teach the patient and engage them with what is going on. For example, I saw a play therapist explain what an MRI scan would involve to a child. The therapist and the patient both acted out what it would be like, by pretending to put on the headphones, making the loud “brrrrrrr” whirring noise and where the child is required to lay still and flat in the machine, they “shook all the fidgetness out!” by wriggling around in their chairs. It was fascinating to watch the child so engaged and understanding what was going on.

Lastly, the play therapists told me about how it brings together the family through bonding. I sat with a family who said that the hospital encounter has brought the family closer together. Mum and dad would be at work, so having their child in hospital had brought them closer than ever before and they were able to paint together, produce clay artwork together and play with hundreds of different toys in the playroom - “something we would’ve never been able to do usually at home” the mother told me.

The ward had also been given a brand new innovative idea called the ‘Magic Carpet’. This was an interactive machine which used a projector that took shadows as touch. This meant the bulb would project a massive area of leaves onto the ground, and as a child ran across them, the leaves would disperse. There were loads of different interactive projections, from fish that run away when you touch them, or fun games like acting as a goalkeeper in a penalty shoot out.

At the end of this section, I had to write up my experience on the Children’s Ward as a reflective essay and comment on the findings I had made through my research into whether the hospital provided good support for the parents whilst their children were inpatients.

The biggest take home reflections I made from my placement was how amazing (and fun) the play therapy on the wards is. I had my face painted and got a different glitter tattoo each day of the three weeks!!

Consulting Placement!

We all have returned back to university! And by "we", I simply mean the medics! All of my friends don't actually start their lectures for another two or three weeks, so as they enjoy their final bit of summer, I'll be on placement.

Placement began at Southmead Hospital where we got involved in hands-on experience. Like I have said previously in a historic post, it's the most "doctory" we have felt so far on the course!

We were in hospital for three weeks. Each one was dedicated to a particular system: cardiovascular first, respiratory second and then the final week was gastrointestinal.

Waiting in the staff room!

The teaching was structured like this:

• We had tutorials and small hospital-based lectures that taught us how to take a full medical history from a patient.
• We had a practical tutorial which taught us the clinical skills for each individual system during their case week. For example, we learnt how to perform an abdominal examination (from keeping an eye out for tremors and visible clinical indicators on the body to being able to auscultate and percussion of the abdo). 
• We learnt how to perform other clinical skills such as taking a manual blood pressure and completing a full cranial nerve assessment.
• Each of the weeks had a dedicated 'patient' case associated with it. This was very similar to the case-based learning we have embarked all year. However, there was more information provided with these cases: from radiology findings (X-rays, MRI scan images etc), blood results and examination findings. This provided a more 'clinical' feel to the teaching we were receiving.

This was so far the highlight of the degree because of how 'medical' we felt. The teaching was more clinical which showed us the important of different disciplines when it comes to both diagnosing and treating a patient. For example, one 'case' was a female with pulmonary embolism. Her X-ray appeared normal but her CT scan showed the 'polo-ring' mass occluding one of her pulmonary arteries. Her blood results further supported our potential diagnosis and her history. This is why we were taught such greater detail about taking a history from a patient, because this can help support a certain hypothesis you may have (and help you exclude others).

The best part of the cycle was being able to go onto the wards and actually apply what we had learnt in the clinical skills room and our own independent learning. I was able to go on the wards and perform a cardiovascular examination and sit with patients and understand their full story to why they had been brought into hospital.

The hardest part of the cycle was probably trying to come up with differential diagnoses. These are the 'back-up' ideas you may have about a patient's condition but you may want to run more tests to help support for or against your other diagnoses. At the end of the day, there is a million and one things that could cause breathlessness - so you can't just jump on the first thing that you believe is the strongest diagnosis.

In case you are interested, this was the kind of clinical work we were completing in our tutorials before going to practise on real patients: https://geekymedics.com/cardiovascular-examination-2/ 

Summary of Year 1

Let's do an overall summary of Year 1...

• I arrived at university and met my flatmates. I had to make all new friends from my course and my student accommodation, who thankfully remained by my side throughout the whole year!
• I did house viewings and decided on my accommodation flat for next year!
• I learnt soooo much! From anatomy, to law, to sociology, to ethics, to histology, to biomedicine to biochemistry! There has been so much content on each individual system in the body which you can't help but feel excited to turn up to lectures.
• I have handled a lot of cadaver specimens and have been exposed prematurely to death. I have also taken part in shadowing a pathologist during a post mortem.
• I have taken part in clinical shadowing at GPs, where I did some clinical skills and did individual home visits. Here, I learnt how important communication is when it comes to talking to patients.
• I have also shadowed doctors at Southmead Hospital and have been taught by both patients and the teaching fellows about body systems and some clinical skills - such as taking blood pressure, blood glucose levels, auscultation and palpation.
• I completed an essay project, as well as an art project. This is based on medicine being both a science and an art.
• I have worked as HCA as part of the course, where I worked four shifts of 7 hours and one 12 hour shift.
• I loved being a HCA so much, I then went on to apply for a job as a healthcare assistant in Bristol. I went for the interview and then received my job offer. I then attended the training and now awaiting some shifts to sign up to!
• I have completed my exams, January and Summer and passed to progress into Year 2!

I can't believe how much I feel I know ever since starting just less than a year ago!

Year 1 has been filled with some very exciting moments and I have enjoyed every second of university life. You are so independent and have so much fun which is incomparable to any other experience I have ever had! I would say I would love to do it again, but I'm really excited to go into Year 2!

I hope all of your exams go well and you receive the results you both want and deserve. Have a great summer, and I will speak to you in September if not before!

Training as a HCA

Exams are now behind me, so I have been busy concentrating on my HCA role!

I had the pleasure of going to Southmead Hospital to undergo my beginning training as a healthcare assistant. I was lucky to be told that I only needed to attend the first day of the five-day induction because I was a medical student.

Looking at the programme, the first few induction training sessions were about patient safety, hygiene, human factors in the delivery of care and the importance of communication and rules of social media. Other days involved safeguarding, dementia etc - which I had already experienced when being introduced as a HCA for placements here in December!

The beautiful Southmead Hospital!

The training was delivered in a lecture theatre in the Academy. I was sat with other healthcare assistants, student nurses, porters and domestics who were also just starting their jobs.

The training was very informative and was a great opportunity to revisit things I had forgotten since December! I collected my uniform and have received a new ID badge (which I can keep alongside my medical student one!) so it feels all so real now!

I am waiting for the actual starting date to which I can sign up for bank shifts now.

Cheeky coffee and bacon butty for the journey to Bristol!

I was supposed to be attending manual handling the following Tuesday but this was last minute cancelled. Therefore, I'm waiting for this to be rearranged and then I will fill you in again with how that was!

Getting the job as a HCA!

Prior to finishing this term, I had to complete some more hospital shifts as a healthcare assistant. During my week, I had the opportunity to work on the ward for complex needs. This allowed me to develop experience working with patients with high dependence and little or no independence at all. The majority of my shift involved taking observations and speaking with the patients and nurses, or helping patients feed or go to the toilet.

On break...with a disgusting cold cup of coffee...

I have recently really enjoyed working as a healthcare assistant so decided to apply for the job at the hospital as a Band 2 Healthcare Assistant - which I am happy to say I got the job! It could possibly mean I could stop commuting to my hometown to work in my retail store (where I have been working now for three years) and live permanently in my new city and work at the hospital there.

In this article, I'll describe some of the questions I was asked in my group interview regarding working at the hospital as a healthcare assistant...

• Why do you want to become a Healthcare Assistant? What are you currently doing?
• Have you had an experience which demonstrates your excellence in quality of care you deliver?
• Have you had an experience which demonstrates your respect for the patient and their dignity?
• What characteristics should a Healthcare Assistant have? What characteristics have you listed, do you demonstrate? (And provide some examples)

I also had to take part in a 30 minute numeracy paper and a 30 minute literacy paper in the assessment centre.

I got the results two days later, saying my job offer is conditional on a reference from my current line manager which was successful!

All of the nurses I have worked with have said that the perfect doctors have been healthcare assistants once in their life. Apparently, it creates great doctors who sympathise with the rest of the team and respect all the staff on the ward as you understand everyone's role, stresses and job role. This reduces the chance of a "pretentious doctor walking down the ward like they're better than everyone else."

Case-Based Learning

CBL = case-based learning; this is the type of teaching which my university is using to deliver its information to us medical students.

I find this such a great way of learning and it's very useful because it keeps all the information together. Each cycle is the same, just with a different system. So far for this year, we have studied the musculoskeletal system, cardiovascular system, respiratory system, gastrointestinal system and the urinary system. After the holiday, in term 3, we will be studying the neuro system and finally the endocrine system.

The cases are taught in two week cycles. These two weeks contain three facilitation sessions, one day of labs (and one session in the anatomy dissection room), one day of placement (GP or hospital, these are rotated) and ten lectures that deliver information on this section.

At the beginning of the cycle, we are given a case (of around 500 words) which will introduce us to a condition or complaint being presented by a patient regarding the cycle. So for cardiovascular, we had a patient with high blood pressure. In the musculoskeletal case, we looked at the use of anabolic steroids to develop muscle mass. In the urology case, we looked at two people who drank a certain amount of water before a marathon and the effects of dehydration etc. The problems described in the case will then be explored in our lectures for this case.

As an example, I will be using the respiratory case:

• Three facilitation sessions where we discuss the current case that has been presented to us. We sit and go through the learning objectives in the first facilitation session at the beginning of the cycle. We can identify parts of the case we don't understand that may not be or fully covered in lectures, so we will distribute and delegate presentations to each other and present them in the following facilitation session. We have another facilitation session mid-cycle to work out where we all are, and then a final session to conclude the case and clarify any final information we are struggling with or want help with (from the guidance of our facilitator who supervises us).
• 10 lectures - all delivered on the respiratory system but divided up across the two weeks. In these lectures, we learnt about the anatomy of the lung, how the lungs ventilate to provide gaseous exchange, what is gaseous exchange and the respiratory and metabolic responses within the body (at a cellular and organ level).
• One lab session in anatomy where we used cadavers to study the respiratory anatomy. In this session, we located the lungs, the pleura and other structures in the chest and mediastinum. But we also learnt about reading and interpreting x-rays of the chest and an introduction to taking a chest examination.
• I had placement in the GP, which meant I had the opportunity to do a home visit and meet a patient who had severe asthma. On the home visit, I was able to use my history taking skills to listen to the patient and understand the difficulties she experiences, but also apply the knowledge I had learnt in this cycle about the pathology and physiology causing her symptoms.
• People that had placement at the hospital for this cycle had the opportunity to practise percussion (banging your fingers on the chest to produce a sound which can signify hollowness [from air] or dullness [from a build-up of fluid]). There was also the chance to auscultate the chest (use a stethoscope to listen to the different lobes of the lung) and where to place the stethoscope.
• One lab session using the simulation patient to look at the effects of hyperventilation and climbing in altitude on the patient's respiratory rate, consciousness and oxygen saturation levels.
• One lab session on the effects of exercise on respiration (so doing an exercise activity and measuring the increase in respiratory rate etc).

This is the same structure for all of the cases.

Labs - about talking?

This might be hard to understand, but we do have labs...not in labs...and not a pipette in sight!

These labs are based on consultation skills. They are endorsed with our placements, either in the GP or the hospital, which in turn strengthen the lectures and tutorials on a particular aspect of the consultation.

The consultation is broken up into different elements. These elements obviously craft together to make the perfect consultation with the purpose of finding out what is wrong with the patient (by taking a history and an examination) and then interpreting your findings to come to a conclusion and then a plan of action (such as medication).

If we are given a part of the consultation, like examining the complaint which is being presented to us by the patient, we will have a lecture on this. In the lecture, we will be taught about the purpose of taking a history of a presented complaint, and the type of questions we will have to ask. We can even hear of examples of when this goes wrong, or poor practice in doctor consultations that leads to poor outcome for the patient.

After the lecture, we meet in our small tutorial groups of around eight peers and discuss what we have learnt from the lecture. These are our "labs".

These labs involve a lot of role play. Such as acting out particular consultation scenarios, structured by a plan that has been prepared for the session. For example, we could be pretending to be Mr Smith who has a family history of cardiovascular disease and I have just presented very high blood pressure and need to answer my peer's questions (as the doctor) to help them breakdown my presented complaint to build up a possible diagnosis and plan of action.

These lectures and tutorials can be delivered either in the university or the hospital I'm doing my placements in.

The labs also involve developing communication. My university's Medicine course was updated last year (I'm the first cohort) to provide more teaching on the communication aspect of being a doctor. Imagine having a doctor who didn't know how to talk to you or deliver the information correctly or understandably. Therefore, this year they are focusing on providing more teaching on this! So in the labs, we learn how to use vocal cues in our consultations to give better understanding (eg. the importance of paraphrasing to show understand and using it as an opportunity to make sure you've collected all of the relevant points).

For example, we ask patients "What is your past medical history?" and they often think only of diseases and illnesses. They'll tell you about their pneumonia or chest pain ... but they always forget surgery! So make sure you ask whether or not the patient has had any recent surgery, as this can explain symptoms. Abdomen pain can sometimes be explained by previous surgery in this region creating weakness in the bowel.

Exam Results

When I left you before Christmas, I described about my stresses of exam revision over the holidays but also the structure of the exams I took part in.

I can happily say I have passed both exams! Thankfully, I have clearly revised what I had needed to for my advantage and have managed to somehow score greater than that pass percentage so that my grade sits in "green".

We were sent a generic email prior to our exam release time (which is set at a certain time and date, so we had to wait until 1:00pm for our results to be released). In the email, it was detailed what the pass mark was for both exams, and a general average. As it appears in the email, on average everyone has passed which is great for the year group!

But now that these exams are over, we get to move on and knuckle down more into the case-based learning aspect of our course.

A small side note though, I did take part in a fairly difficult consultation while completing my GP placement. While sat in the GP surgery, the GP I was shadowing met a patient who was battling with depression. He had progressed to a serious stage, where he contemplated ending his life and his value in this world. I found it very interesting to observe how the GP approached the patient's feelings to help break down the presented complaint in a comfortable matter.

To be honest, the appointment really hit me as I sat there. Hearing how the patient was describing his own worth, I realised how important mental health and wellbeing really is. Its significance is often suppressed. I, myself, have battled with mental health issues in the past with low mood (but I am grateful for the prescription medication which helped me get back on track). But today I witnessed when medication isn't the answer as the complaint is far more serious.

My partner and I from the placement then went home to discuss how we felt. Sometimes it is very important to speak openly but privately (respecting confidentiality) if you are struggling to cope. Many universities, including mine, have specialised student support which is readily available for you to approach and seek help if you do need it.

I feel for the situation you are going through right now, as I have experienced it myself. Whether it be application stress or exam stress, you can pull through this! Don't let it affect your mood, and if it does, monitor it closely. If you notice your mood deteriorating fast, whether it be a personality change (for the worse) or your attention/concentration being very weak, seek help and support and you'll be back to normal. Remember though, talk and use these support networks.

It was nice to sit down and enjoy a bottle of wine with a friend in the bar conservatory, talking about our results.

Drift to Shifts!

Stress from the exams are now in the past and now I drift to concentrating on my shifts as a healthcare assistant on the ward of a hospital I have been allocated to.

That is the best thing about the course structure at the university I'm studying at, we have the opportunity so early in the year to be exposed to the work on the ward! We have completed the training and the induction in December before we broke up for Christmas, which meant we learned many important skills for working in the hospital as a HCA. This included how to make a bed, the importance of safeguarding, what is dementia and the correct communication skills required.

I have had two shifts at the hospital I am in, working as a HCA. I am on the Stroke/Neurology ward, where I helped care for patients who have had strokes or suffer from neurological diseases.

I'm trying to work out the best way of writing this post without writing a long chunky essay that's saturated with paragraphs. Therefore, I'm going to break it up into the typical cheesy questions you usually get on a feedback form that school gives you:

What was it like working as a HCA for the first time?

• Very different, it is nothing like volunteering at all!
• As a HCA, you are allowed to handle patients where you have completed manual handling training. This is different to volunteering, which means you are allowed to help move patients from beds to chairs, help move them into comfortable positions or help manoeuvre patients while they are being cleaned.
• It is true, as a HCA you do help clean patients who may have soiled themselves or need aid in their daily washing routine. I didn't actually realise this was the case until I was on the ward.

What did I enjoy?

• It was probably the most "doctor"y I've felt so far in the course ... and ever!
• I did enjoy helping the nurses take observations of patients and learning how information is collated, kept and stored in the hospital setting in more interesting.
• In a way, you did feel a sense of reward after you have cleaned up a patient as they were grateful and you could now see they were happier and more comfortable. This is what made the cleaning job.

What were the challenges I faced?

• I will make it clear for you, as a volunteer you are not expected to handle body fluids at all. I know in my training as a volunteer, I was told that if a bed was soiled I wasn't allowed to touch it. As a HCA, you are exposed to the different body fluids. In my shifts, I cleaned up vomit, faeces and urine - but in my opinion thinking about it is definitely worse than when you're actually doing it. And you'll realise that. It isn't that much of a great deal and you do adapt to it after a while.
• As a volunteer, I found myself speaking mostly with the nurses and the other volunteers as we made the teas and distributed the meals. After this, I was sterilising medical equipment or help cleaning the ward. As a HCA, you are more patient-facing, meaning you do see pain and discomfort on a greater level. You are in situations that do make you feel uncomfortable, I was saddened by the news on my later shift to how one patient I had became close to and exchanged great chat and laughs with had unfortunately died the morning of my next shift.
• You do feel quite nervous when you are allowed to carry out observations on patients. For example, one nurse let me carry out a pupil examination on a patient, where I would shine my torch into their eyes to hopefully see a change in pupil size as a response to the bright light. I will admit, my hand was shaking as I did it. You are nervous, but by the end of the week I was more confident and did it more 'naturally' if you like.
• The long hours?? In fairness, as I groaned about the seven hours I was enduring, the nurses laughed as they were doing the hardcore twelve hours! You do need to realise that the shifts are long, and that there isn't always something to do. But it gives a great opportunity to speak with other members of the team or learn from patients.

Working as a HCA, it was interesting to observe how the ward was structured. I found that the healthcare assistants and the nurses were the main members of the multi-disciplinary team on the ward who were responsible for the primary care of the patients (providing comfort, meds etc) and recording the observations. The doctors made brief appearances throughout the day, analysing the observations and speaking with nurses about the progress or reviewing medication. This was quite an eye-opening observation, as you learn how the 7 or 8 patients that the nurses and HCAs are allocated each means they have more time with the patients so more of a presence, whereas the doctors could have around 30-40 patients on this ward, the next ward and maybe another ward in the hospital so their encounters with these patients can be more confined and brief.

Working four hours, I was dying for this cup of tea!

The nurses I was working with were absolutely amazing. When there was nothing to do, the nurse went through my handover sheet with me and explained the conditions to me. For example, she explained what a "thrombectomy" is and what "abx" means on the sheet. So I would recommend that as you complete your shift work (if you do it), do speak with your nurses and gain a better understanding of the patients you are dealing with and you can apply this knowledge to your studies!

The best thing about working as a HCA though is that when you're talking to a nurse about yourself, you're no longer saying "I hope to go to university and study medicine" as you did whilst volunteering, you're saying "I AM at university STUDYING medicine"! The dream has come true!