This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
This work belongs to Lulu it is provided purely as a guide to
other student nurses. It should in no way be copied or passed off as belonging to a 3rd party.
It is protected under the UK and international law of copyright.
The Unpopular Patient
Reflection
With two staff members off sick and a full ward I expected it to be very busy today. During hand over we had been ‘warned’ about a very demanding patient and I wasn’t surprised when she was allocated to me and the midwife in charge. Between us we had 2 bays and a side room but working with the midwife in charge I realised a lot of the work would be down to me.
The night staff had said the patient had accused them of ignoring her and that she was needing lots of attention, and because of this nobody was keen to care for her and her demands.
As we were short staffed I wasn’t able to spend as much time with each lady as I would have liked but I managed to get the bulk of the postnatal checks done before breakfast. On my return one woman asked if she could get help feeding but that baby was asleep at present. I explained that we were short staffed and very busy and that I would be with her shortly. However she got very upset and weepy and said how she felt she had been a neglected over night. At first I was a little annoyed as her baby was still sleeping, but I reassured her that I would be back and be able to spend some quality with her once I had my last task up to date.
When I returned she was still tearful, as somebody had asked if she was going home, and she felt she was being pushed out. I explained that the HCAs were putting fresh sheets on the beds of those that were staying. Mum said she didn’t think there was much point in staying anyway as she didn’t feel she had been supported during the night. I explained that I was on duty all that day and if she stayed I would be able to help her and this would hopefully give her and baby time to get more into a pattern. I saw it as a challenge not only to help with her breastfeeding but also to see her as an anxious new mum and not the ‘unpopular patient’ and help her overcome some of her anxieties.
She reluctantly agreed to stay after some persuasion from her husband, who could clearly see how distressed she was. Mum had felt baby wasn’t feeding well enough and was considering giving up with breastfeeding particularly after a night where her baby had slept for long periods and when she had woken she was very hungry and impatient to latch on becoming very distressed, leading to mum becoming stressed. One midwife did sit with her during a feed overnight and this had made her feel a little better but she doubted her own abilities.
She sadly explained how she felt like a ‘bad mum’ when her baby was crying and she was trying really hard to feed her and all the while her daughter was getting more and more distressed. I explained to mum that when she gets upset it could affect her milk flow too causing a vicious cycle of unhappy hungry baby and distressed mum. I showed her the breastfeeding room to so she had somewhere calming to go if she needed.
As baby was due for a feed mum got her changed to wake her a bit. She tried to help baby to latch on a few times but felt she was failing. I explained that babies have to learn too and that they don’t all go on at first attempt. I told her about the mechanics of tummy to tummy and nipple to nose to help her get the positioning right and to wait till baby had a big wide mouth. After a few more attempts baby latched on successfully and I gave mum lots of encouragement that she had done well
I thought that in addition to this giving mum some information from the discharge pack would help increase her knowledge. There was a very useful booklet about breastfeeding showing positions, technique and scenarios about what was ‘normal’. Mum had felt her baby wasn’t getting enough milk and the booklet backed up what I was saying that babies all have their own routines and there is no ‘normal’.
I was able to offer her information about breastfeeding support groups in her area, midwifery support when she goes home, baby’s wet and dirty nappies, we discussed cot death guidelines and I spoke to her and her husband at length about contraception including LAM as well as post natal depression and baby blues.
Mum felt she didn’t want to wait till baby woke up naturally as she found herself and her baby to be too distressed to breastfeed well then so between us we developed a plan that she would give baby 4 hours and if she hadn’t woken up mum would wake her gently and try her at the breast when she wasn’t too upset and ravenous.
Mum also felt she wanted to try expressing even just a small amount as she said this would reassured her that she had something to give baby to settle her a bit if she was distraught prior to breastfeeding.
Mum knew to buzz and ask for me if she needed help and by the 3rd feed of the day when I was buzzed baby was already latched on and feeding well. Mum was so pleased with herself and I was equally pleased to see a much more confident mum.
I continued to spend lots of time with her throughout the day and showed her how to do a baby bath and use the expressing pump.
From a tearful, unhappy mum wanting to give up breastfeeding his morning and feeling like a bad mum to being happy in herself and her mothering skills when I left this evening was a delight and a privilege....
It was just a pity this was spoiled by the night staff that came on duty carrying the same stereotypical attitude they left with this morning.
However both mum and dad came to thank me a separate occasions for the care, support and time I had given. One of the most appealing aspects of this job is knowing you have made a difference.
This has been a valuable lesson for me to see how adapting to the needs of the women and families in our care we can provide a package of support that empowers them to learn and gain confidence and become self reliant.
last updated 05/06/07
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