Author Archives: Bertha Adjei Ampomah

Feedback from groups presentation

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Feedback from marker:
Knowledge and understanding, both verbal and written.
An outstanding level of expertise and experience demonstrated excellent written and oral communication.
ASSESSMENT MARKING TEMPLATE –For Introduction to Public Health and Health Promotion Module 4

Local, regional and national levels are considered. These are excellent links to theorists. Outstanding exploration of local areas across East and
west and the implications on social determinants.
Excellent team working and support dynamic.
Discussion and analysis, both verbal and written.
Outstanding use of references linking nursing theories to strategies. Excellent awareness of current systems and how this would link
to strategy. Your approach is efficient and could be implemented
Summary
An outstanding presentation – well done
Feedforward:
Continue to use evidence and theories to support ideas
Follow referencing guidelines closely and consistently
Marker name: Scott Rodden & Beverly Brathwaite
ASSESSMENT MARKING TEMPLATE –For Introduction to Public Health and Health Promotion Module 5

Date: 07.06.23
Feedback from Service Users/Carers (if appropriate)
Excellent support, clear, concise ideas ready to go.
Service Users/Carers name: Eka Ike

Reflection in midwifery week.(Domestic Abuse).

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This week, I attended midwifery insight week, where I learned about newborn feeding with a focus on breastfeeding, domestic violence, and sepsis. Through group discussions, I was able to delve deeper into the subject. We discussed the benefits of breastfeeding for both the mother and the baby in the newborn feeding segment, which was incredibly informative. Breast milk is the most nutritious food for newborns and adapts to the child’s nutritional needs as they grow. Breastfeeding also helps prevent short- and long-term illnesses and disorders such as asthma, obesity, type 1 diabetes, SIDS, ear infections, and stomach problems. However, I learned that some mothers with chronic AIDS cannot breastfeed their children because it spreads the disease. In such cases, multidisciplinary teams will provide risk mitigation advice. As a student nurse, I recognize the importance of respecting the mother’s decision and not pressuring her to breastfeed. Instead, I must encourage them to do so because it benefits the baby’s cognitive processes and mental and emotional well-being. Providing practical breastfeeding assistance and appropriate guidance from healthcare experts is critical to ensure perinatal mental health protection. Nurses are essential in providing patients and their families with high-quality, trustworthy, evidence-based information.

Also, we watched a domestic abuse scenario as groups, stimulating practice. A 32-year-old pregnant woman was admitted to the emergency room for a fall. She is 32 weeks pregnant and has had bursts around her face and arms. The practice supervisor has asked the student nurse to take vital signs to check if the patient is okay. The student nurse gained consent from the patient and notified her that she came with her partner, and any time the student wanted to talk to the patient, the partner would not allow the patient to take it, but he would answer the question. Hence, the student recognizes the indicators of domestic abuse. The student escalates to the practice supervisor and says that something is going on with the patient, so the practice supervisor shows up and reassesses the patient.

I learned that the student nurse notes domestic abuse. The patient was terrified of her partner. The patient’s partner was the one to answer all questions and shout at her, Lazy woman. You will stay home for me to come back from work to cook for you. That is why you fall in the kitchen. This is an example of domestic abuse. Take control over everyday life by telling you where you can go, who you can see, what you can wear, and when you can sleep. This would help make the information more relatable and easier to understand for the reader.

The names of the patients and the NHS Trust will be changed to maintain confidentiality. As a result, I will go over what went well, what I learned, and what I will do differently the next time. Professional relationships in nursing refer to how nurses interact with their patients and other healthcare providers. According to the NMC code of practice, registered nurses must maintain professionalism and trust. Includes adhering to professional values such as honesty, competence, and hard work. The charge nurse directed the student nurse to take the vital signs of a 27-year-old pregnant woman admitted to the ward for the fall. The student approaches a patient to obtain consent, but the patient’s companion refuses to let the patient say so. Her partner began telling the nurse her name was Mary, that she was 32 weeks pregnant, and that she fell in the kitchen. He is concerned because she is sluggish and lethargic; they have been here for two hours, and no one has come to assess them, but he is relieved that a student nurse is here to observe them. The healthcare provider recognized anything that seemed amiss with the partner’s speech and behaviour. The patient appeared uncomfortable and apprehensive, and she only let her companion do most of the talking. Also, the injuries from the fall appear suspicious. At this moment, the student nurse became worried and attempted to communicate with the patient. The patient’s spouse eventually excused himself, and the nurse took advantage of the chance to ask questions to help the patient open up to her. As a nurse, it is critical to focus on your patient to spot any indicators of domestic violence, so safeguarding concerns must be highlighted. In this case, I realized the significance of examining the patient’s general look, mental condition, and posture. This setting made it very simple to recognize indicators of domestic violence since the patient seemed disturbed, nervous, and afraid. I’ve learned how to recognize when a patient is abusing themselves, how to escalate the situation, and how to assist them. I realize that soothing patients and asking closed and open questions are vital since they allow the patient to tell you what happened to her. I learned that I have a personal relationship with my patient and show compassion while obtaining and providing information to her. As a student nurse, I must advocate for, support, and defend patients. I have to make sure I deliver the fundamentals of care effectively. I have learned that Nurses must be cautious and know how to collect information to avoid triggering the patient and complicating matters. I learned that the practice supervisor would refer patients to multidisciplinary teams to safeguard the patient and any information about domestic abuse websites for the sake of the unborn child and the patient’s mental, emotional, and psychological health. MDTs, midwives, and nurses must share information to help mothers and children facing domestic violence and abuse at home and needing urgent care.

Nurses need to understand the relationship between exposure to violence and women’s ill health and be able to respond appropriately.

Reflection

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This essay will critique and reflect on my personal and professional development in my first years as a Trainee Nursing student. I will explain how I will continue to develop my knowledge and nursing skills once registered. The three standards of the NMC (2018a), which I will focus on, are: Being an accountable professional, promoting health and preventing ill health and working
in teams. I have chosen these three domains since I feel I have excelled more in them whilst working with patients, colleagues, and healthcare professionals. I will highlight some of the challenges I may have encountered in each and how I plan to deal with them as I continue to learn to improve my practice. As expected under the Nursing and Midwifery Council (NMC,2018b), I will not reveal the names of healthcare professionals. Where reference is made to any of these, I will use pseudonyms. I will also provide evidence for achieving the domains shown in my portfolio.
In the past one years, I have worked in several healthcare settings, including community and acute wards. Working in these settings involved applying skills and knowledge to
support patients’ healthcare outcomes and recovery from diseases and illnesses. Providing safe and quality patient care demands that nurses integrate several clinical skills whilst working with colleagues and patients. Such an opportunity offers a chance to learn and enhance one’s skills and knowledge (G Laser, 2017; Stonehouse, 2021). One of the responsibilities that I was involved in was promoting health and preventing ill health. Nurses are important in supporting patients to improve and maintain their overall health and well-being (Glasper, 2017). In the first years, I actively prevented and protected diseases and ill health by engaging patients, which allowed me to learn more from such interactions.

As part of our course, we were required to submit an essay on promoting health and
preventing ill health, which helped clarify how I executed this role. In the task that I
submitted. I explored the patient’s health needs relating to his physical, psychological, and social dimensions. I also considered how the patient’s holistic needs would be met to enhance the health and well-being of the patient. Some aspects I thought to promote health and prevent ill health were the social determinants of health and how these could be met. I educated the patient on medication, coping skills, and risks to his health, including how these could be overcome or minimised. (Glasper, 2017; Stonehouse, 2021). One of the things I learned was the need to integrate multiple health promotion approaches to support behaviour change. One of these was a behavioural change, which seeks to persuade individuals to take responsibility for their health using preventive services. I also learned about self-empowerment models that focus on enhancing one’s abilities using their strengths to control their health and the environment in
which they live.
I also learned that patients might have unique perspectives about their
healthcare needs. The role I assumed was supporting patients to make informed choices, and I realised this might not be an easy task. Respecting patient autonomy implies allowing them to make decisions I may disagree with based on my knowledge, understanding and current evidence. (Glasper, 2017; Stonehouse,2021). As patients exercise their autonomy, they can make choices that are not good for their health. However, I ensured that I provided them with all the information available while seeking help and support from other healthcare professionals to support patients make decisions that benefit them. The different standard that would be of interest is being an accountable professional.

Being an accountable professional requires nurse associates to communicate effectively using various skills and strategies with patients, colleagues, and other healthcare professionals (NMC,2018a). I have worked with different patients in healthcare settings and worked within the tenets of the NMC (2018b). One of the aspects of communication that I have embraced in the first year is maintaining confidentiality in line with the dictates of the NMC (2018b) code. Effective communication is integral in healthcare as it helps share information in ways that can be understood and acted upon as part of care provision (Bibi et al., 2022). However, before straining this course, I was Unaware of the important role of communication within teams or when working with patients. I also encountered problems in developing rapport with patients. I also faced challenges in communicating with members of the multidisciplinary team. However, I realised that my lack of communication skills was mainly based on a lack of confidence. Benner (1984) indicated that novice practitioners may not demonstrate mastery of key skills, but with learning and support, they can do so with time. Indeed, as part of the OSCA, we were taught the importance of using early appropriate communication tools such as the situation, background, and assessment.

During placement, I could also recognise signs of deterioration with the help of the NEWS 2chart (Royal College of Nursing, 2022). The NEWS 2 chart is a recognisable framework that can escalate care to senior healthcare professionals for quick action and response to minimise the risk of deterioration (Harris, 2021; Royal College of Nursing, 2022). Nurse associates can provide valuable data by using the NEWS 2 scores by escalating this using the SBAR communication tool as they fill the gap between registered nurses and support workers (Muller et al., 2018; Peate,2019).
On reflection, my communication knowledge has improved, making me more confident to practice effectively. I also appreciate that I have developed key skills in assessing patients using models such as the ABCDE approach advocated by the Royal College of Physicians (RCP) for evaluating critically ill patients. I have also learned more about relevant legislative
and ethical frameworks such as autonomy, beneficence, non-maleficence, and justice underpin safe and effective patient care. I have the confidence to deliver safe care to my patients while advocating for their needs.

The last domain that I settled on is working in teams. Whilst working as a healthcare assistant, I was paired with a nurse. Although the nurse’s student role is often underrated, they offer an important supportive role within multidisciplinary settings (Hickman and Leary, 2020). Nurse students are integral in interdisciplinary teams, collaborating and communicating effectively with other healthcare professionals to meet patient needs. This role includes demonstrating awareness of one’s position, responsibilities, scope of practice within the team and assigned duties and functions. During lectures, we were introduced to the importance of team working in healthcare. We were educated on the part of the team working to improve patient healthcare outcomes and reduce harm (Peate, 2019). Every time patients visit healthcare settings or are admitted, they expect quality care that meets their needs (Peate, 2021). Harris (2021) indicates that such consideration is impossible if healthcare professionals fail to collaborate as a team providing unique perspectives, ideas and skills that meet the patient’s needs. I demonstrated effective communication skills whilst working with diverse members or groups, which is vital in achieving the best patient outcomes (Peate, 2021).

In conclusion, this essay has provided a critique and reflection on my personal and professional development over the first year as a student nurse. After finishing my current course, I have explained how I will continue to develop in the key areas. I can note that the first year has provided me with a vital opportunity to provide care to patients that meet the tenets of the NMC (2018b) code. Specifically, I have demonstrated how I have communicated effectively, demonstrated my accountability in practice and the ability to work in teams. I have explored current evidence on why these domains and their preparation are critical in enhancing patient outcomes. I will continue strengthening my skills to demonstrate accountability and professionalism across these domains. I will improve these skills and competencies to deliver quality and safe patient care.

Feedback from practice supervisor

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We went to the patient’s house together to administer insulin medication. I was assigned to complete this task under the supervision of the practice supervisor. I introduce myself to patients, obtain their consent, and explain that I will check their blood glucose levels and then administer insulin medication.

First, I must clean the patient’s fingertips to remove any dirt or food residue that may interfere with the reading. The patient’s blood glucose level is nine mmol/L following breakfast. I need to look at the patient’s drug chart to see the insulin medication and how many units the doctor has prescribed. Novo-Mix insulin is required for the patient in the amount of 26 teams. Also, before administering insulin, I must check the expiration date and the last time it was issued. I inject 26 units of Novo-Mix insulin into the right abdomen. Because the patient’s patch medication was about to expire, I removed the old patch and applied a new one to his left shoulder.

I learned that Novomix contains fast-acting and intermediate-acting insulin and that Novomix is a class of insulin medicines used to treat diabetic patients who require insulin to control their blood glucose levels.

I have gained knowledge about patch medication. A transdermal patch is a current pain management treatment for chronic pain and other diseases.

I introduced myself to the patient and gained consent; before the task, I checked the patient’s folder to ensure the job needed to be carried out, and medication had not already been given. I cleaned my finger and continued to check my blood sugars. A good technique for sub-cut injection and the right site used for injection; – communicated with the patient and correctly disposed of sharps objects. I continued to apply the transdermal patch, using a different side to apply and checking the expiry date before application; the patient seemed comfortable and happy.

feedback from Link Lecturer Tutorial during clinical placement.

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I spent 40 minutes with Bertha, discussing clinical community nursing with her. Bertha and I discussed Diabetes Type 1 and 2 and the areas to check on for the care of the Diabetic patient. Bertha was able to recall the needs of the DM patient- handwashing, checking for blood glucose levels and how to manage a hypo/hyperglycaemic attack. I reminded Bertha that foot care of the diabetic patient is critical and discussed the reasons for this- peripheral neuropathy, that the diabetic patient is more perceptible to infection due to more circulatory glucose, and that feet and footwear should be checked as often as possible. We also talked about using a mirror to study under and behind feet for wound sites that may not be obvious. I asked Bertha to reflect on what she had learnt during the session by asking her questions, which she could answer. We also looked at how to find evidence for clinical activity through the library at UoR.

Feedback from practice supervisor

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We did a joint visit to redress a patient’s right foot necrosis wound. We arrived at the patient’s home, and he had just finished eating breakfast. I gained his consent and explained what we were going to do. The diabetic patient had DTI. I observed and practised under the supervisor’s guidance to redress the patient’s wound. I removed the old dressing, cleaned it with normal saline, and dried it with a tissue towel. I used an Inadine dressing to keep the wound from becoming infected. Kerramax help, N-A dressing, and yellow line

I have gained more confidence in my ability to dress a patient’s wound by applying dressings that speed up the healing process and may help to relieve pressure. Also, the patient is due for a month’s observation to check the temperature, which is 36.6, oxygen saturation, which is 90%; COPD patient; pulse rate, which is 64, respiration rate, which is 18; and blood pressure, which is 105/56, for a total news score of 1

I escalated this to the practice supervisor because oxygen saturation was low, and she asked the patient if he had COPD. Still, the patient said no, I don’t have chronic obstructive pulmonary disease. The nurse found out that the patient had COPD and an oxygen saturation rate of 90%, which is good because the normal range for COPD is 88%, so the news score is 0.

I have learned that reading patient notes before visiting their home is a good practice to know their medical history.

The student has gained confidence in her approach to seeking the patient’s consent and her skills in using aseptic techniques throughout redressing the patient’s wounds.

Feedback from supervisors

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We did a joint visit to the patient’s home, who had category 3 DTIs to the spine and sacrum and burns to the upper leg. We arrived at the patient’s home. The patient had personal care attended to by two caregivers. When we get their consent, we can check the patient’s wound. We cleaned the patient’s sacrum wound with normal saline and redressed it with Aqualcel ribbon brutal adhesive, with minimal exudate and a yellowish colour.

We cleaned the previously dressed DTI spine, removed minimal exudate, cleaned it with normal saline, and redressed it with urguotol.

Also, the patient’s burn wound on the right thigh was loose and wet, and the patient did not want the nurse to touch the dressing, saying she was going back to the hospital on Wednesday and it could be redressed in the hospital. The nurse explained the risk of infection to the patient, and she allowed her right thigh dressing to change but refused to remove the left thigh dressing as there was a slight strike-through. The patient emphasized not touching the wound. The nurse told the patient she would not feel it, but the damage was documented. I support the patient with medication left by the caregivers and breakfast.

She worked with student nurse Bertha. She is very cooperative and helpful. Always ready with a helping hand and willing to learn.

Bertha has good communication skills, which include explaining procedures to the patient and gaining consent before performing any task.

She is a happy and cheerful student to work with.

Feedback epad

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Midpoint interview

Knowledge

Bertha’s knowledge regarding palliative care has increased; she knows the importance of assessing the patient for symptoms. Bertha has also developed an understanding of using syringe drivers and how to work out the required doses.

Bertha has visited many diabetic patients and knows type 1 and type 2 diabetes and the differences. Bertha knows the different types of insulin, including fast-acting, slow acting and mixed.

Bertha understands the importance of checking care plans to ensure the proper care is delivered to patients.

Skills

Bertha has been giving wound care, including good bandaging techniques. Bertha has been dressing pressure ulcers, leg ulcers and skin tears.

Bertha has been checking blood glucose levels and understands when and how to treat a hypo. Bertha has also been administering insulin to patients under supervision.

Bertha has also been dispensing and administering oral medications and checking the drug chart correctly.

Bertha has been with nurses, watching and learning about catheterising, building her knowledge preparing to be able to do female catheters herself.

Attitudes and values

Bertha is always on time for placement, wearing the correct uniform. Bertha is polite to patients and staff. Bertha knows the importance of treating patients with respect when in their homes.

Ongoing learning and development needs: The student will identify their learning and development needs for the remainder of the placement and negotiate with their Practice Assessor how these will be achieved.

Learning and development needs

To change a female catheter with support/supervision.

To handover patient care

To develop communication skills with patients, asking about pressure areas etc., to ensure holistic care.

How will these be achieved?

Lead care for a patient visit (e.g. a wound care visit) and hand the patient to the team at handover.

Visits with nurses for female catheter care and changes

Final interview

Knowledge

Bertha has visited multiple patients with diabetes and demonstrated knowledge regarding the types of diabetes (type 1 & 2) and the types of insulins used. Bertha has increased her knowledge of the risk of pressure ulcers by visiting patients with reduced mobility (due to conditions such as MS). Bertha has used the SSKIN bundle to assess the risk of pressure damage.

Bertha has watched male catheterisation and understands the reasons for catheterisation. Bertha has also seen female catheterisation and understands the process; now would like to do this as a skill.

Skills

Bertha has been doing a lot of observations (checking blood pressure, temperatures, pulse, respiratory rates and saturations), documenting these on the NEWS 2 charts. Bertha has been giving dalteparin sub-cut injections, and their confidence has increased. Bertha has also developed her communication skills, talking to and listening to patients well.

Attitudes and values

Bertha has shown a good, caring attitude whilst on this placement. Bertha has been respectful of being in patients’ homes. All care has been given with dignity and respect. Bertha has built good professional relationships with both the staff and patients on the placement.

Learning and Development Needs: To be agreed between the Practice Assessor and the student.

Practice Assessor to identify specific areas to take forward to the next placement.

To develop and implement catheterisation (female) skills.

To increase knowledge of medications (the side effects, reasons for use).

To continue developing in the confidence of her ability.