AT THE ROYAL Richard Babington spends five days behind the scenes at the Worcestershire Royal Hospit

Although operations are obviously a large part of hospital life, and there is huge pressure on medics to get through as many as possible to meet targets, patients are treated as individuals more than ever before.

This is where the specialist nurse comes into play. At The Royal, there are 30 of these experienced members of staff, and they are starting to get the recognition they deserve for the crucial work they do.

Diagnosed

Being diagnosed with a serious disease affects people in different ways, but in almost every case, the patient needs help to come to terms with it.

In the past, it was easy to feel very much alone after diagnosis. There were nurses on hand to give advice, but the patient was likely to see different nurses on each visit to the hospital.

Nurses such as Linda Cooke have revolutionised the way these patients are cared for.

The breast care specialist nurse at The Royal plays a huge part in helping patients diagnosed with breast cancer through their ordeal.

"The main part of my job is to meet patients who have been diagnosed with breast cancer, and give them comfort and support," she says.

"I try to help them come to terms with what's happened to them."

Mrs Cooke's role is less practical than that of most nurses, but no less important.

She gets involved with the patient straight after diagnosis, and starts by giving them advice to help them cope.

"We are usually there when they are diagnosed, and then we take them away to an area where we can sit and chat in private," she says.

Optimistic

"We do feel for them, but at the same time we are optimistic because we see hundreds of women going through this, and most do extremely well."

Her input is crucial at this early stage, when the patient is reeling from the devastating news.

"You're really a focal point for the patient," she says. "The hospital is a big place, with a lot of different departments. We make sure we're always there for them."

Mrs Cooke uses her specialist knowledge to help the patient make decisions about their treatment.

"We make sure the patient is seen as an individual, and the treatment is tailor-made for them," she says.

After this initial contact, Mrs Cooke and her colleague, Lynda Noble, regularly call the patients to make sure everything is all right.

They see about 40 patients at each clinic, and they then spend time on the ward to check on those who have had their operations.

"We give them more information to avoid post-operative complications, and make sure they are ok," says Mrs Cooke.

They then spend time answering phone calls and emails from patients, and see patients who have particular queries.

"Communication is a big part of our job," she says. "We phone patients at specific times after their surgery, to see what their concerns are."

They keep in touch with the patients for five years after their surgery, and get to know them and their families well.

"It's very rewarding, and we see a lot of positive outcomes," she says.

The Royal now has specialist nurses to deal with other areas such as lung cancer and urology, to provide more patients with the human touch.

'She's been here for me from start'

PENNY Curtis is one of the patients to have benefited from Linda Cooke's expert care and attention.

The 40-year-old from Powick discovered a lump in her breast three years ago, and had an operation early in 2001.

Mrs Cooke was on hand to help out from the day she was referred to the hospital, and has been there for her since.

"When I was diagnosed, they told me what they would do, but everything went over my head at that stage," she says.

"Linda took me to a private room, but I didn't say anything at the time. She just held my hand and talked through everything with me.

"The best piece of advice she gave me was that I would be on an emotional rollercoaster, which was so true."

When she got home, Mrs Curtis started ringing everyone she knew to tell them the news.

But in the evening, she burst into tears and just shook for three hours.

"After that, I found that my family were suffering more. As a patient you just go on to a higher level. You've just got to get on with it."

After having a mastectomy and radiotherapy, Mrs Curtis also had to have her ovaries removed. Mrs Cooke was there for her throughout her ordeal.

"She has been great," she says. "I come back to the clinic regularly and, each time, Linda is here.

"If anything is unclear, she answers all my questions, You walk away feeling confident."

Mrs Curtis now has two years to go before reaching the crucial five-year post operation mark.

She has just returned to full-time work as a training officer for West Mercia Constabulary.

"I feel really well and really healthy again," she says.

Off home after the last stitch

DAY cases now account for a much larger proportion of overall hospital work than they did even 10 years ago.

Remarkable advances in technology and medicine have allowed far more operations to be completed in a day than could be done in the past.

Patients who would once have been eating hospital food for a week can now often return home almost as soon as their last stitch is completed.

The Day Case Suite at Worcestershire Royal is therefore in great demand, and it has to deal with up to 40 patients a day.

It caters for people needing treatment such as hernia repairs, teeth extractions, keyhole surgery and even pacemaker installation.

Others come for exploratory procedures that do not involve surgery, such as endoscopies (the viewing of internal organs).

One phone call came through to the department while I was visiting asking about hip replacements, which was slightly optimistic, but there aren't many operations that can't be done here.

Unit manager Margaret Wright, who has 12 years' experience as a manager at both the old Ronkswood hospital and the new Royal, has to make sure the department runs smoothly.

"I have to make sure we are staffed efficiently, and I also get involved in hands-on care," she says.

"I have responsibility for a group of patients - I ensure they are admitted and prepared for theatre, and assist with their recovery when they come back from theatre.

"I take care of their needs until they are ready to go home."

There are 16 trained nurses and six health care assistants on the ward, who look after patients who have come in for operations and meet those who have come for pre-operation checks.

"We have a lot more people coming in now," says Mrs Wright. "It has changed completely.

"Drugs and anaesthetics have improved, and we get a lot more people done in the same day."

The demand means the department has to be ultra-efficient. Patients usually visit the ward a week or two before their operation, to make sure they are in a fit state.

They are weighed and have their blood pressure checked, and their operation is explained to them to make sure there are no surprises on the day.

They are also sent away with written information about their treatment and how it will affect them.

"We give people a lot of information because they are often worried and frightened," says Mrs Wright.

"Just because it's a day case doesn't mean they are any less frightened than if they were coming in for a few days."

On the day of their treatment, patients arrive in two blocks, and have their treatment either in the morning or the afternoon.

They have their operation in one of the hospital's eight operating theatres, or they may go to the separate endoscopy suite.

Mrs Wright says the department is a very popular place to work, with a low turnover of staff.

"There's no night duty here, and it's more predictable than in A&E," she says.

The department's early teething problems have now been ironed out, she claims.

"We had problems because we had in-patients in day case beds, but we're now managing the beds differently."

However, she would like to see more operating theatre lists dedicated to day case patients.

"We have mixed lists of in-patients and day cases," she says. "It means some days we have more patients than others. But I think we do a good job here. I'm proud of what we do."

Staff reassuring

NOBODY enjoys hospital treatment, and Sandra Moore is no exception.

The 42-year-old from Bewdley is waiting in the Day Case Suite for an investigative procedure, and looks extremely nervous.

She visited her GP three months ago, and was referred to the hospital.

"I was supposed to be in last month, but the hospital changed my appointment due to unforeseen circumstances," she says.

"I came in a while ago for tests as an out-patient. The staff have been very good, and they've tried to reassure me and keep me calm.

"They've explained everything to me. It's just the fear of the unknown; I'm still a bit nervous, but I know what to expect - unfortunately!"

Only nervous of injections

ANGELA Collins didn't have long to worry about her operation; she only found out she was having it the day before she came in.

The 26-year-old software engineer from Malvern was admitted for abdominal surgery, and was having to stay in overnight after having more extensive surgery than was first intended.

"I was only nervous about the injection," she jokes. "But I think it all went all right.

"It's a really nice hospital, and the nurses have been brilliant."

Experienced team of staff

STAFF nurse Ann Clare is one of several experienced nurses working in the Day Case Suite.

She has worked as a nurse for 15 years, and was previously based at Ronkswood Hospital.

"Everything goes smoothly here, to be honest," she says. "We've been working together for so long, we're a good, experienced team."

Mrs Clare tries her best to reassure patients and answer any questions they might have.

"People often worry about work and what to expect after the operation," she says.

"I like meeting patients and looking after them, and I enjoy working with my colleagues."

She is impressed with the new hospital, and feels it makes life easier both for staff and patients.

"Things work more efficiently. We don't have a long walk to theatre, and patients go on trolleys and come back on trolleys."