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Reflection on episode of care.

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In your reflection, could you describe the episode of care and how you assessed, planned, delivered, and evaluated person-centred care?

While I was in the rehabilitating ward for five weeks, a practice assessor assigned me to care for a patient, whom I will refer to as Emmanuel, to maintain confidentiality under the Nursing and Midwifery Code. Emmanuel is 40 years old and has suffered a hypoxic brain injury. Hypoxic brain injuries occur when the supply of oxygen to the brain is restricted. The lack of oxygen causes the gradual death and impairment of brain cells. Following a cardiac arrest, the patient sustained a significant hypoxic brain injury, which impacted his level of consciousness and severely impaired his abilities. Damage to the brain has caused prolonged disorders of consciousness, including a vegetative state.

The patient underwent a tracheostomy procedure to manage their airways and facilitate ventilation. I understand that patients who experience cognitive and neurological impairments following a cardiac arrest often have difficulties breathing and managing secretions. The patient had a percutaneous endoscopic gastrostomy (PEG) tube inserted to provide nutrition and administer medication. The patient is unable to give consent due to a stroke. “I am responsible for carrying out all nursing interventions for the patient during my shift.” Nursing interventions involve suctioning the patient’s tracheostomy when required, administering nutritional requirements and medication through the PEG, and ensuring overall well-being. I hesitated about the tracheostomy suctioning procedure, which required advanced skills. I did not have prior experience in this area of my nursing training. However, with the guidance of an under-practice assessor from the nurse, I felt confident enough to proceed. “I provided care with a person-centred approach and adhered to appropriate infection control protocols to ensure patient safety. As my patient had a cognitive impairment and was unable to provide consent, I made sure that all interventions were in the patient’s best interest.

I explained the procedure to the patient and used a non-touch aseptic technique to prevent infection. To minimise the risk of coughing, I must assess the patient’s need for suctioning and perform suctioning if necessary. “I will remove the old dressing and clean the patient’s trachea using proton water and a cotton wound. This will help to clean the trachea and the area around the back of the neck to reduce the risk of infection. Then, I will remove the inner cannula and suction the tracheotomy tube to clear any secretions from the airway.” I have to connect Yankauer, the connecting tube, and the suctioning catheter size for the patient. Catheter suctioning size depends on the size and type of tracheostomy tube in place and on the individual patient’s needs. The appropriate catheter size will ensure adequate secretion removal and prevent airway tissue trauma. Before starting the procedure, I ensured that the suction unit was functioning properly and set up correctly. The doctor used a recommended trachea tube and a 10 mL syringe to clear the secretion and mucus from the patient’s airway. I made sure to document the amount of secretion aspirated from the patient. Aspirating the tube before suctioning is essential to prevent potential complications such as infection or respiratory distress. This also helps keep the airway open and ensures effective suctioning by removing any material that may have accumulated within the tube. I attached the manometer between the suctioning catheter and the suction source to maintain the correct pressure range of 10–15. If the balloon is under-deflated, using a 10-ml syringe to inflate it is always recommended.

“I made sure that the suctioning pressure was at a safe and appropriate level. Maintaining the right suction pressure is essential to prevent damage to the airway and ensure the suctioning process is effective. Then, I inserted the suctioning catheter gently into the tracheostomy tube and limited the suctioning time to 15-20 seconds. This was done to minimise the risk of hypoxia and avoid any irritation or harm to the patient.” While inserting the catheter, if the patient coughs and there is resistance, the catheter must be removed. If there is no resistance, you can continue to insert the catheter deeper. I closely monitored the patient’s response and vital signs during and after suctioning and provided oxygen as necessary. After suctioning, I placed the suction tube in a container of saline water while the suction machine was still on and raised it until it was cleared of mucus. I removed the tube from the saline water and cleared the mucus inside the inner cannula before drying it. I cleaned the tracheostomy site with Prontosan wash and ensured that the site was kept clean and dry. I noticed signs of infection and skin irritation around the stoma site during the procedure. Following organisational policy, I disposed of all tracheostomy waste in the orange bin bag.

Also, Emmanuel had a percutaneous endoscopic gastrotomy (PEG) for enteral feeding and medication administration. Before I administered feeding and medication to a patient, I had gained consent from the patient when administering the afternoon medication. The patient refused to take afternoon medication, so I must respect that patients have the right to refuse medication. I explained to him that this medication is vital for you to take at this time because levetiracetam is to prevent patients from having focal seizures, and still, patients say no. So, while I waited for some minutes to check if the patient was in distress, I found out that the patient went out with a physiotherapist and was very tired, which is why he refused the medication. I informed my practice assessor that the patient refused the medication, and I would wait for 1 hour and ask for consent again to see if the patient would give consent. I returned in 1 hour and explained to the patient that I would administer through his PEG. He was happy for me to administer the medication, and he blinked his eye to say yes, so I flushed the PEG with 60 mL of water first to see if the peg was not blocked. I administered Levetiracetam medication and prescribed 250 mL of water to the patient through PEG feeding. I learned that if the patient is distressed, they can refuse medication, and as a student nurse, I have to get to know my patients better and advocate for them if they cannot consent to treatment.

What did you do well?

It was my first time caring for a patient with a tracheostomy, so everything was new to me. Before the procedure, I researched the most recent tracheostomy care guidelines and best practices. I approached the procedure with empathy and patience, maintaining my composure throughout. I ensured that the suctioning pressure was correct and that the patient was comfortable.

What would you have done differently?

Tracheostomy care was a completely new experience for me, so before the procedure, I felt anxious. I was worried about potential complications associated with tracheostomy care, such as respiratory distress. However, the practice supervisor and I asked questions and sought guidance to ensure we were well prepared. In the future, if I face this complex procedure again, I will not hesitate to ask the practice supervisor for help and gain more knowledge. I understand that everyone starts somewhere, and asking for help signifies dedication to providing excellent care. And I asked questions and sought guidance. I believe that when I face this complex procedure, I will not hesitate to ask the practice supervisor to help and gain more knowledge. Everybody starts somewhere, and asking for help signifies dedication to providing care.

Describe how you have begun to work more independently in the provision of care and the decision-making process.

I worked more independently by ensuring that I had the necessary supplies for the procedure. I maintained appropriate infection control methods throughout the procedure by wearing my PPE and performing the procedure using an aseptic. I took more initiative in my work by ensuring I had all the required supplies for the procedure. I maintained appropriate infection control methods during the procedure by wearing personal protective equipment (PPE) and using an aseptic non-touch technique. I also positioned my patient correctly to ensure their comfort throughout the procedure. I also collaborated with my colleagues to ensure the patient received holistic care using a non-touch technique. I positioned my patient appropriately. I collaborated with colleagues to provide holistic care for the patient.

What learnings from this episode of care could be transferred to other areas of practice?

I understand that independent practice comes with experience. So, to boost my confidence, I will always seek guidance from practice assessors and a multidisciplinary team when faced with complex procedures.

Practice Assessor feedback

Based on the student’s reflection, your observation and discussion of the episode of care, please assess and comment on the following:

(Refer to Criteria for Assessment in Practice.)

If any of the Standards are ‘Not Achieved’ this will require a re-assessment, and the Academic Assessor must be informed.

Standard of proficiency

Promoting health and preventing ill health

Discusses the possible influences on the person’s or group’s mental health and physical health and can highlight a range of factors impacting them and the wider community.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to identify the complications of a post-brain injury and how they affect a person’s life and health in the long run. She was also able to learn how different multidisciplinary teams work together to improve patient’s condition through medication, rehabilitation and nursing care. She is able to learn during her placement how we are able to assess what level of rehab the patient needs and how simple things like goals can make their life a little better.

Assessing needs and planning care

Utilises relevant knowledge and skills to undertake a comprehensive assessment, continually monitoring a person’s condition, interpreting signs of deterioration or distress and escalating appropriately.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to check the patient’s physiological observations and use the NEWS score to determine if the person is well or unwell. She is also able to identify if the patient with brain injury is deteriorating based on their baseline presentation (level of wakefulness, response to stimuli and NEWS score.)

Providing and evaluating care

Applies relevant knowledge and skills in the provision of more complex, person-centred, evidence-based care, demonstrating effective communication skills and the ability to document effectively.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to use the tracheostomy care skills she learned and apply it day to day in her shift. She was able to confidently suction patients and escalate to the nursing staff when the patient has difficulty of breathing, is overproducing secretions or is desaturating. She is also able to do PEG care and administer medications through PEG with confidence.

Improving safety and quality of care

Undertakes relevant risk assessments, discusses risk management and can propose improvements to enhance the quality of care.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to raise concerns when the patient becomes ill and is able to administer proper nursing care under supervision. She does not hesitate to ask questions and seek guidance when she is unsure what to do. She is able to follow guidelines and take the lead whenever possible.

Coordinating and leading nursing care

Supports the person/persons receiving care and their families in maintaining independence and minimising disruption to their lifestyle, demonstrating understanding of the need for multi-agency working.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to work with patients and relatives well. Whenever the family calls for assistance, she will gladly volunteer to check on the patient and administer care when needed. She also does not hesitate to facilitate queries of families to the staff and she is able to work well with the nursing team

placement Interview Placement.( Feedback)

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This can be completed with a practice supervisor or your practice assessor.

Student to identify learning and development needs (with guidance from the Practice Supervisor / Practice Assessor)

Learning and development needs

 

. How to advocate for patients with brain injury conditions who are not able to communicate and anticipate needs.

. Tracheostomy care, how to suction patients with a tracheostomy , how to perform routine stoma care, routine tracheostomy tube change.

. Percutaneous endoscopic gastrostomy (PEG ): Gastrostomy tubes, types, the reason for the patient having a peg, peg stoma care, rotation of the tube, enteral feeds , enteral medication administration and water flushes .

. Continence care: patients who are double incontinent , catheter care, indwelling catheters; and suprapubic catheters.

. Skin care: learn about tissue viability, types of dressings and how to perform wound care .

Medicine administration via different routes : Oral PO , via PEG , injections ( IM / SC), and IV administration

. Vital signs for patients with brain injuries and NEWS trigger action.

Taking available learning opportunities into consideration, the student and Practice Supervisor/Practice assessor negotiate and agree a learning plan.

Outline of learning plan

 

All the above learning points are achievable within placement in BIS ( Brain Injury Service ).

Objectives : f

For student to be able to learn about normal parameters for vital signs and NEWS score—triggers and actions , frequency of repeating observations, and escalation . To be able to recognise when a patient is in distress / pain and to advocate in patient`s best interest when they lack capacity .

To learn about medication administration : drug calculations , preparing medications , learning about commonly used drugs, and administering medications under supervision according to guidelines .

To be able to perform PEG stoma care , advance and rotation of bumper retained tube , types of PEG tubes , indications for gastrostomies , and associated risks.

To learn about continence care and methods to support patients that are doubly incontinent , to learn about UTI , constipation , fluid balance and catheter care .

To be able to perform tracheostomy care, such as changing stoma dressing or tape , recognising if a stoma is healthy or has any abnormalities , observing tracheostomy suction and care, as well as routine changes of the tubes,.

To learn about tissue viability and wound care .

How will this be achieved?

 

Will be achieved theoretically and also by practice .

Student Bertha will work alongside nursing staff to enable learning.

Date and time of next interview (optional)

 

21 Mar 2024 00:00

If this interview is carried out with the Practice supervisor, please complete the following:

learning plan for placement agreed by the Practice Assessor (if applicable)

 

Practice Assessor’s name (if applicable)

 

Alina-Maria Lica

Practice Assessor’s email (if applicable)

 

alica@rhn.org.uk

Episode of Care Reflection.

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Student reflection on an episode of care

In your reflection, could you describe the episode of care and how you assessed, planned, delivered, and evaluated person-centred care?

While I was in the rehabilitating ward for five weeks, a practice assessor assigned me to care for a patient whom I will refer to as Emmanuel to maintain confidentiality under the Nursing and Midwifery Code. Emmanuel is 40 years old and has suffered a hypoxic brain injury. Hypoxic brain injuries occur when the supply of oxygen to the brain is restricted. The lack of oxygen causes the gradual death and impairment of brain cells. Following a cardiac arrest, the patient sustained a significant hypoxic brain injury, which impacted his level of consciousness and severely impaired his abilities. Damage to the brain has caused prolonged disorders of consciousness, including a vegetative state.

The patient underwent a tracheostomy procedure to manage their airways and facilitate ventilation. I understand that patients who experience cognitive and neurological impairments following a cardiac arrest often have difficulties breathing and managing secretions. The patient had a percutaneous endoscopic gastrostomy (PEG) tube inserted to provide nutrition and administer medication. The patient is unable to give consent due to a stroke. “I am responsible for carrying out all nursing interventions for the patient during my shift.” Nursing interventions involve suctioning the patient’s tracheostomy when required, administering nutritional requirements and medication through the PEG, and ensuring overall well-being. I hesitated about the tracheostomy suctioning procedure, which required advanced skills. I did not have prior experience in this area of my nursing training. However, with the guidance of an under-practice assessor from the nurse, I felt confident enough to proceed. “I provided care with a person-centred approach and adhered to appropriate infection control protocols to ensure patient safety. As my patient had a cognitive impairment and was unable to provide consent, I made sure that all interventions were in the patient’s best interest.

I explained the procedure to the patient and used a non-touch aseptic technique to prevent infection. To minimise the risk of coughing, I must assess the patient’s need for suctioning and perform suctioning if necessary. “I will remove the old dressing and clean the patient’s trachea using proton water and a cotton wound. This will help to clean the trachea and the area around the back of the neck to reduce the risk of infection. Then, I will remove the inner cannula and suction the tracheotomy tube to clear any secretions from the airway.” I have to connect Yankauer, the connecting tube, and the suctioning catheter size for the patient. Catheter suctioning size depends on the size and type of tracheostomy tube in place and on the individual patient’s needs. The appropriate catheter size will ensure adequate secretion removal and prevent airway tissue trauma. Before starting the procedure, I ensured that the suction unit was functioning properly and set up correctly. The doctor used a recommended trachea tube and a 10 mL syringe to clear the secretion and mucus from the patient’s airway. I made sure to document the amount of secretion aspirated from the patient. Aspirating the tube before suctioning is essential to prevent potential complications such as infection or respiratory distress. This also helps keep the airway open and ensures effective suctioning by removing any material that may have accumulated within the tube. I attached the manometer between the suctioning catheter and the suction source to maintain the correct pressure range of 10–15. If the balloon is under-deflated, using a 10-ml syringe to inflate it is always recommended.

“I made sure that the suctioning pressure was at a safe and appropriate level. Maintaining the right suction pressure is essential to prevent damage to the airway and ensure the suctioning process is effective. Then, I inserted the suctioning catheter gently into the tracheostomy tube and limited the suctioning time to 15-20 seconds. This was done to minimise the risk of hypoxia and avoid any irritation or harm to the patient.” While inserting the catheter, if the patient coughs and there is resistance, the catheter must be removed. If there is no resistance, you can continue to insert the catheter deeper. I closely monitored the patient’s response and vital signs during and after suctioning and provided oxygen as necessary. After suctioning, I placed the suction tube in a container of saline water while the suction machine was still on and raised it until it was cleared of mucus. I removed the tube from the saline water and cleared the mucus inside the inner cannula before drying it. I cleaned the tracheostomy site with Prontosan wash and ensured that the site was kept clean and dry. I noticed signs of infection and skin irritation around the stoma site during the procedure. Following organisational policy, I disposed of all tracheostomy waste in the orange bin bag.

Also, Emmanuel had a percutaneous endoscopic gastrotomy (PEG) for enteral feeding and medication administration. Before I administered feeding and medication to a patient, I had gained consent from the patient when administering the afternoon medication. The patient refused to take afternoon medication, so I must respect that patients have the right to refuse medication. I explained to him that this medication is vital for you to take at this time because levetiracetam is to prevent patients from having focal seizures, and still, patients say no. So, while I waited for some minutes to check if the patient was in distress, I found out that the patient went out with a physiotherapist and was very tired, which is why he refused the medication. I informed my practice assessor that the patient refused the medication, and I would wait for 1 hour and ask for consent again to see if the patient would give consent. I returned in 1 hour and explained to the patient that I would administer through his PEG. He was happy for me to administer the medication, and he blinked his eye to say yes, so I flushed the PEG with 60 mL of water first to see if the peg was not blocked. I administered Levetiracetam medication and prescribed 250 mL of water to the patient through PEG feeding. I learned that if the patient is distressed, they can refuse medication, and as a student nurse, I have to get to know my patients better and advocate for them if they cannot consent to treatment.

What did you do well?

It was my first time caring for a patient with a tracheostomy, so everything was new to me. Before the procedure, I researched the most recent tracheostomy care guidelines and best practices. I approached the procedure with empathy and patience, maintaining my composure throughout. I ensured that the suctioning pressure was correct and that the patient was comfortable.

What would you have done differently?

Tracheostomy care was a completely new experience for me, so before the procedure, I felt anxious. I was worried about potential complications associated with tracheostomy care, such as respiratory distress. However, the practice supervisor and I asked questions and sought guidance to ensure we were well prepared. In the future, if I face this complex procedure again, I will not hesitate to ask the practice supervisor for help and gain more knowledge. I understand that everyone starts somewhere, and asking for help signifies dedication to providing excellent care. And I asked questions and sought guidance. I believe that when I face this complex procedure, I will not hesitate to ask the practice supervisor to help and gain more knowledge. Everybody starts somewhere, and asking for help signifies dedication to providing care.

Describe how you have begun to work more independently in the provision of care and the decision-making process.

I worked more independently by ensuring that I had the necessary supplies for the procedure. I maintained appropriate infection control methods throughout the procedure by wearing my PPE and performing the procedure using an aseptic. I took more initiative in my work by ensuring I had all the required supplies for the procedure. I maintained appropriate infection control methods during the procedure by wearing personal protective equipment (PPE) and using an aseptic non-touch technique. I also positioned my patient correctly to ensure their comfort throughout the procedure. I also collaborated with my colleagues to ensure the patient received holistic care using a non-touch technique. I positioned my patient appropriately. I collaborated with colleagues to provide holistic care for the patient.

What learnings from this episode of care could be transferred to other areas of practice?

I understand that independent practice comes with experience. So, to boost my confidence, I will always seek guidance from practice assessors and a multidisciplinary team when faced with complex procedures.

Practice Assessor feedback

Based on the student’s reflection, your observation and discussion of the episode of care, please assess and comment on the following:

(Refer to Criteria for Assessment in Practice.)

If any of the Standards are ‘Not Achieved’ this will require a re-assessment, and the Academic Assessor must be informed.

Standard of proficiency

Promoting health and preventing ill health

Discusses the possible influences on the person’s or group’s mental health and physical health and can highlight a range of factors impacting them and the wider community.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to identify the complications of a post-brain injury and how they affect a person’s life and health in the long run. She was also able to learn how different multidisciplinary teams work together to improve patient’s condition through medication, rehabilitation and nursing care. She is able to learn during her placement how we are able to assess what level of rehab the patient needs and how simple things like goals can make their life a little better.

Assessing needs and planning care

Utilises relevant knowledge and skills to undertake a comprehensive assessment, continually monitoring a person’s condition, interpreting signs of deterioration or distress and escalating appropriately.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to check the patient’s physiological observations and use the NEWS score to determine if the person is well or unwell. She is also able to identify if the patient with brain injury is deteriorating based on their baseline presentation (level of wakefulness, response to stimuli and NEWS score.)

Providing and evaluating care

Applies relevant knowledge and skills in the provision of more complex, person-centred, evidence-based care, demonstrating effective communication skills and the ability to document effectively.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to use the tracheostomy care skills she learned and apply it day to day in her shift. She was able to confidently suction patients and escalate to the nursing staff when the patient has difficulty of breathing, is overproducing secretions or is desaturating. She is also able to do PEG care and administer medications through PEG with confidence.

Improving safety and quality of care

Undertakes relevant risk assessments, discusses risk management and can propose improvements to enhance the quality of care.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to raise concerns when the patient becomes ill and is able to administer proper nursing care under supervision. She does not hesitate to ask questions and seek guidance when she is unsure what to do. She is able to follow guidelines and take the lead whenever possible.

Coordinating and leading nursing care

Supports the person/persons receiving care and their families in maintaining independence and minimising disruption to their lifestyle, demonstrating understanding of the need for multi-agency working.

Yes achieved

No not achieved

1/1 Mark(s)

Comments

Bertha was able to work with patients and relatives well. Whenever the family calls for assistance, she will gladly volunteer to check on the patient and administer care when needed. She also does not hesitate to facilitate queries of families to the staff and she is able to work well with the nursing team.

My nursing jouney.

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My name is bertha, First-year adult nursing student. This is how my nursing journey started. I am a mother of three beautiful kids. I started Croydon College to access nursing level 3, but unfortunately, in 2019, Covid 19 made things worse for me to stop going to college. We have to do it online. So my grade was not meet the university’s requirements, so I had to start a foundation degree to gain all the Ucas points to start my adult nursing degree at Roehampton University.

I wanted to be a nurse to make a difference in someone’s life. I wanted to do something in my career that is challenging, interesting and makes a difference in people’s lives daily.

As nurses, we can empower our patients and their families with knowledge when I see that a patient understands their disease process and the care plan, it is an excellent feeling. A student nurse can bring understanding and peace during a challenging time.

I have no more incredible feeling than seeing people improve, recover and return to their loved ones. I love to help people and offer them the necessary treatment and emotional support daily. The fact that I know I am making a positive difference in someone else’s life is what makes my days fruitful and meaningful.

I have learned that great teams plan how their members act and work together. In healthcare, good team building happens when all team members understand;  In and work towards the shared purpose of caring and working for the patient.

Why I would be a good nurse, being a person who deserves a high level of respect, kindness, caring, emotional stability, empathy, and compassion are part of who I will be as a future nurse.

 

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 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.