Knowledge
I have learned about two types of brain injuries: traumatic and acquired brain injuries. Traumatic brain injuries can be classified into two main categories: open-head injuries and closed-head injuries. Traumatic brain injuries can cause various medical conditions, such as hematoma, haemorrhage, concussion, and skull fractures. There are multiple types of acquired brain injuries, which include meningitis, asphyxia, hydrocephalus, and anoxia. During my time in the traumatic brain injury unit as a student nurse, I gained extensive knowledge and honed my nursing skills in caring for patients with brain injuries. I learned how to provide a wide range of care to patients with tracheotomies who required constant monitoring and management due to their brain injuries.
I also learned how to monitor and assess patients, take vital signs, and maintain hygiene while providing patient care. Brain injuries can be mild or severe, ranging from concussions to comas. The damage can also be focal.
I have learned about two types of tracheostomy tubes. Cuffed tubes have a soft balloon around the end that inflates to seal the airway. They are used when airway protection is crucial to prevent the aspiration of oral or gastric secretions. The patient cannot breathe around the tube if the cuff is inflated while the tracheotomy tube lumen is blocked. This assumes that the cuff is correctly placed and inflated within the trachea.
On the other hand, acquired brain injuries include meningitis, hypoxia, hydrocephalus, and anoxia. Understanding these types of injuries is crucial for providing adequate care to patients with brain injuries.
I learned about oral and peg feeding medication, stoma care, catheter management, and input/output monitoring.
Skills
Through my experience, I have developed the skills to gather patient information, prioritise their needs, and make informed decisions to positively impact their care. I have also improved my ability to assess News 2 scores, bladder scans, blood glucose levels, urine output, and suction patients.
Skills in promoting independence, understanding and managing cognitive and behavioural changes, and building rapport with individuals.
My adaptability as a student nurse in a brain injury unit is evident in my ability to demonstrate excellent teamwork skills and work using my initiative, regardless of the healthcare environment.
After taking the handover for the first time, I learned I should check all my patients to see if they are awake or sleeping. I use intentional rounding to monitor patients hourly and ensure their safety, especially if they can’t do so themselves. I also perform safety checks to manage tracheotomies, secretions, and chest health.
When working under a supervisor, I perform bumper-retained tube advances and rotate records. To do this, I must gain consent from the patient to perform a bumper check, clean the peg tube, and rotate it 5 inches to check for infection or blockage. I also perform cough assists to help mobilise and clear chest secretions if necessary. This involves inflating the lungs with positive airway pressure and shifting rapidly to negative pressure to help the patient cough.
As a nurse, I have learned that patients need a sodium chloride nebuliser before performing cough assists to help clear their secretions. Once the cough assist is complete, the secretions are usually removed from the mouth, which allows me to suction mucus from the patient’s mouth using a Yankee.
My approach to preparing and administering oral and peg-feed medications, as well as injections, is meticulous. As a student nurse, I always double-check the prescribed medication and dosage before administration, ensuring patient safety and protocol adherence.
My commitment to patient-centred care is evident in my performance of personal hygiene tasks, catheter care, food and drink monitoring, vital sign recording, oral care, bladder scanning, Waterloo assessment, and MUST assessment. Each task is carried out with the patient’s comfort and well-being in mind.
Before administering medication through peg feed, I have to use a 60-ml syringe filled with water to flush the peg tube to ensure it is not blocked before administering clonazepam 500 mcg. The preparation is calculated by dividing 500 by 1000, which equals 0.5, and then multiplying that by 5, which results in 2.5 ml. This is then administered through peg feed. After administering one medication, I must flush 600 ml of water before the following medicines. A drug chart indicates The amount of water a doctor prescribes.
I observed and practiced under the supervision of a senior healthcare professional to perform a bladder washout for a patient who had a suprapubic catheter. Before the procedure, I explained to the patient what I would do and gained their consent. The purpose of the bladder washout was to prevent the catheter from getting blocked and to flush out any mucus buildup within the bladder.
Attitudes and values
As a student nurse, I play a crucial role in the care of patients who are suffering from moderate to severe traumatic brain injuries during acute care. As an essential interdisciplinary team member, I have various responsibilities to assist in the patient’s treatment and recovery. These responsibilities include assessing the patient, coordinating and communicating care, providing technical and physical care, offering emotional support to the patient and their family, and advocating for the patient.
Autonomy is vital to patient care, as it allows patients to make informed decisions about their health. Nurses who value freedom should prioritise caring for their patients. Proactively advocating for patients and developing friendly relationships can also help enhance patient discretion in decision-making.