Category Archives: Year 2

placement Interview Placement.( Feedback)

Posted on by
Reply

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.

Posted on by
Reply

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.

Additional feedback from Practice supervisors.

Posted on by
Reply

From day one, Bertha has been very keen to learn. She has good communication skills with patients and staff, and she has maintained her professional values. She is proactive with her clinical skills.

 

Providing feedback is crucial for their professional development and growth. It is essential for guiding nursing students on their journey to becoming competent and compassionate healthcare professionals; thus, this feedback is given to Bertha

Your Feedback

 

I supervised her in providing care to the patients, such as preparing the medications, giving the medications via gastrostomy tube and taking observations. She was also able to observe and participate in a bladder washout and bladder scan. The steps were explained to her, along with the rationale, through an exchange of question and answers.

Registered Nurse. practice supervisors to Bertha.

Your Feedback

 

Bertha effectively communicates patient information to doctors and works well with a multi-disciplinary team, including family members.

Bertha communicates well with all the patients and with co-workers. She has developed good interpersonal relationships with all the staff.

She gives patients emotional support when they need care. She takes the initiative to help everyone in the ward and communicates any concerns.

Arrianne Simundo, Charge Nurse

Your Feedback

 

Bertha is willing to learn new skills in the ward.

Today, she had the opportunity to do cough assist on one of our patients. I showed her how to do it once and she was able to perform it to our patient on 2 occasions with supervision. She also keeps practicing the skills she has already learned, like taking physiological observations, giving medications via PEG tube, doing buried bumper checks, and preparing and calculating medications. She is not afraid to ask questions and is willing to take on tasks that are new to her, which is a good quality for becoming a future nurse.

Practice under supervision to deliver care to patients who don’t have the capacity to administer drugs and water through their percutaneous endoscopic gastrostomy (Peg care). Patient has no capacity. I still have to gain consent from the patient and explain what tasks I am going to perform to the patient before I can carry out the task. I administer medications and water through peg feed. Before administering medication, I need to wear my PPE, stop the feeding nutrition, and flush the tube with 100 ml of water to see if it is not blocked. I also need to connect food nutrition to the peg.

Also check the patient’s vital signs and news score.

Your Feedback

 

Bertha performed her best today in administering medication under my supervision.

We discussed the correct way to administer liquid medication through PEG.

Discussed the 5 R’s of drug administration.

Drug calculation is also important, and she performed it well.

Learning from other feedback.

Posted on by
Reply

Reflect on your learning in outreach/short placements or with members of the multi-disciplinary team who are supervising your learning.

Where the learning took place

The name or description of the practice area

MDT Meeting Room, Devonshire ward

When the learning took place,

You can provide a single date or date range

25/03/2024

Who you learn from?

You can list one or more people or provide a team name

Kate Frost Occupational Therapist Senior, Adele Tomlinson Clinical fellow.

Student reflection

 

I had the opportunity to meet with multidisciplinary teams to review patient progress in their treatments. I learned how the MTD teams discuss patients who are yet to be discharged and patients who need another review. The meeting involves a doctor, a social worker, nurses, a dietician, and a psychotherapist.

I gained knowledge on how patient cases are reviewed. The patient’s EEG is reviewed due to the risk of seizures, not to wean. This can be kept under review, and if necessary, levetiracetam would be reduced first if we felt it was inhibiting potential behaviours.

The patient must complete ciprofloxacin treatment, which is an ongoing, vulnerable chest. Also, patients need more behavioural support from therapy staff. MDT has plans for the patient by calling the patient’s father to discuss the EEG and refer the patient to a salivary clinic for botox.

Due to their situation, I learned in the MDT meeting that the team can reduce the patient’s medication. This patient’s Cipro medication is to be continued for two weeks, and the cough assist was ongoing yesterday after nebulisers and thick and clear secretions. I also learned how the MDT discusses patient discharge and ongoing treatment after the patient is discharged from rehabilitation.

Practice Supervisor’s comments:

 

Bertha was able to have the opportunity to participate in the MDT case reviews, which is very helpful in knowing our patients more as the discussion is about overall patient care, from doctors’ point of view to therapy team to nursing team, sharing valuable information on how to help improve patient’s overall health and progress during their rehab phase here in Devonshire ward.

It is a very good experience for her as she will be able to learn how nursing staff would escalate/share what they know about patients during 24 hours of care and also be able to share about patient’s guidelines to see if they work, if they’re manageable for the team and the patient, and if they’re not,  with doctor’s appointments and for any medication adjustments.

Bertha enjoyed participating in the meeting, as she was able to learn a lot about patients and how the MDT works together as a team.

Learning from other feedback.

Posted on by
Reply

Reflect on your learning in outreach, short placements or with members of the multi-disciplinary team who are supervising your learning.

Where the learning took place

The name or description of the practice area

GYM session

When the learning took place,

You can provide a single date or date range

21/03/2023

Who you learn from?

You can list one or more people or provide a team name

Sydney Lai, occupational therapy.

Student reflection

 

I had the opportunity to observe an occupational therapist assessing a 56-year-old patient who had suffered from an acquired brain injury stroke. During the observation, I learned about the methods used by occupational therapists to evaluate stroke patients. I discovered that occupational therapy focuses on improving motor control and hand function in the affected upper limb after a stroke to help patients perform their daily self-care tasks more efficiently.

Occupational therapy interventions are tailored to maintain or enhance the soft tissue properties of the upper limb. For instance, stretching is a technique used to reduce spasticity and improve the patient’s overall condition. This specific approach in occupational therapy is crucial to enhancing motor control and hand function in the affected upper limb. Occupational therapy teaches stroke patients strategies to manage cognitive, perceptual, and behavioural changes and prepares the home and work environment for their return.

Practice Supervisor’s comments:

 

Bertha spent a morning shadowing several occupational therapy rehabilitation sessions. These included sessions in the gym aimed at improving upper-limb strength and cognitive function. Bertha showed her interest in the role of an occupational therapist by asking appropriate questions.

Feedback from Practice Assessor Final interview Reflection.

Posted on by
Reply

Knowledge

 

Bertha has learned quite a lot of background knowledge regarding patients with brain injury and how to care for them day to day. She does not hesitate to ask questions when she is not familiar with things or information, which is a good attitude as a nurse. She also always participates to Therapy sessions in order to observe how the PT, OT, or SLT assess patients level of care needs and capacity to help themselves. Bertha has also been attending some in-house hospital training in order to expand her knowledge and skills relating to brain injury. She has been doing well during her shifts.

Skills

 

Bertha has learned numerous skills like cough assistance, PEG care, administration of PEG medications and suctioning. She has been performing all these skills day to day during her shifts and has mastered them. She also knows the indication why these are being done for the patient. Bertha is easy to work with and knows how to deal with patient needs independently with minimal supervision. She has performed routine PEG care daily, which is part of our morning medication rounds routine. She is also able to operate the feeding pump, suction machine and Cough assist equipment with minimal supervision.

Attitudes and values

 

Bertha enjoy working in the ward with our patients. She is very dedicated and proactive in all her shifts. She also never hesitates to lend a hand to other staff members when the need arises, which is a very good trait in becoming a professional nurse. She also always shows compassion, kindness and empathy for each and every patient. She has good working relationship with all staff members and is able to work with anyone in the ward. Her attitude towards working in the ward is very good, as she always thinks positively and upholds RHN values every time she works. I enjoy working with her during our shifts together.

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

 

Bertha should continue to practice the skills she has learned here in RHN in order to fully master her skills, especially in tracheostomy care and suctioning and in gastrostomy care and medication administration. It will help her professional growth and enhance more her knowledge and learning as she continue on to her other placements.

Feed back from Practice Assessors Midpoint Interview Reflection.

Posted on by
Reply

Knowledge

 

Bertha has exhibited a good amount of knowledge with regards to patients with brain injury through her research and through attending MDT meetings and trainings provided in the hospital. She is very keen to learn new things and work with our patients. She is able to identify NEWS 2 scores that need attention and refers immediately to the staff nurse.

Bertha is also a fast learner when it comes to doing daily routines for our patients, like doing buried bumper checks, suctioning orally and tracheostomy patients, and other routines that we do for patient care. She also learned about tracheostomy care and weaning during the course of her placement, which is one of the vital things that we do for patients whom we aim to decannulate.

Skills

 

Bertha has acquired numerous skills in Devonshire ward during her stay. She has learned to do PEG care and administration of medications, feed, and flush via PEG/gastrostomy tube and balloon water change. She was able to receive tracheostomy care, suctioning, and participate in those cares as part of her daily routine. She was also able to learn how to do bladder scans, washes, and daily suprapubic catheter care for patients who have suprapubic/indwelling catheters.

Bertha is very eager to participate in daily patient care and does not hesitate to try things for the first time. She also does not hesitate to ask questions when she is unsure of something, which is a good attitude for a nurse in order to learn and grow.

Attitudes and values

 

Bertha is able to showcase a good attitude and values in her placement in RHN. She has good character and is able to work well with anyone in the wars, may it be a patient, a relative or staff member. She values the importance of good nursing care and is able to work well under a busy environment. She also takes the initiative to do nursing tasks with minimal supervision. She observes RHN values, which are an integral part of our nursing care. She is an excellent student and she can perform well under any circumstances.

Ongoing learning and development needs: The student is to 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

 

Bertha will continue to practice what she has already learned in the ward to master her nursing skills and for her professional growth.

How will these be achieved?

 

To apply it onto her daily nursing routines when in the ward.

Professional Values Reflection

Posted on by
Reply

Ensure confidentiality is maintained.

The first few weeks of my experience in the trauma brain injury service were incredibly diverse. I worked alongside many healthcare professionals, witnessing various tracheostomy tube and percutaneous endoscopic gastrostomy (PEG feeding) procedures. This experience helped me become a successful clinical nurse, and I realised that exceptional communication skills were necessary. I learned that my tone while speaking and delivering patient information must be compassionate. As a student nurse, I must advocate for patients by supporting and defending their rights. I have to make sure that I deliver the fundamentals of care effectively.

In my nursing practice, I have always followed the six Cs: care, compassion, competence, communication, courage, and commitment to patient care. I demonstrate empathy by imagining myself in the patient’s shoes and treating them as I want. Respecting the patient’s autonomy, protecting their privacy and confidentiality, and actively listening to their concerns are all essential components of my practice. This approach has helped me establish a strong rapport with my patients. I am committed to advocating for their health, respecting their values and cultural differences, and ensuring effective communication with the multi-disciplinary team for coordinated patient care and management.

During my second placement in a brain injury ward, I encountered a situation that brought to light the delicate balance between my professional development and the immediate needs of a patient. My practice assessor asked me to research a drug I needed clarification on. On my way to conduct the research, a healthcare assistant approached me with an urgent request for assistance with a patient lying in a filthy bed. Recognising the situation’s urgency, I prioritised the patient’s needs and assisted the healthcare assistant first. After attending to the patient, I researched the drug as my assessor had requested. However, she pointed out that I needed to improve my time management skills, emphasising the importance of drug knowledge and application as a student nurse. This incident caused me to reflect on the delicate balance between my professional development and the patient’s immediate requirements.

 

I provided the healthcare assistant with automatic assistance in ensuring the patient’s comfort, as I believed this to be of utmost importance, even above researching drugs. I could offer this assistance from my home if the ward becomes too busy. While I regret not addressing the issue with my practice assessor, I remain confident in my decision to prioritise the patient’s comfort. It was imperative to me that the patient did not stay in a filthy bed while I researched a drug. As per NMC 2008a, nurses need to justify their decisions. Following an incident, my assessor advised me to work on my time management skills due to my decision to assist a health care assistant. At first, I needed clarification on this feedback, but it ultimately motivated me to learn more about time management. Despite my belief that my time management skills were adequate since I was always punctual and had a prioritised task list, this experience made me realise that I needed to reevaluate how I prioritised my workload.

In this situation, I prioritised ensuring the patient was comfortable and clean. As a responsible student nurse, it is essential to prioritise the care of individuals, respect their dignity, and treat them as such, as the author emphasises. While shadowing my supervisor, I learned that, as a student nurse, I must possess knowledge about the different types of drugs and their uses. It is crucial to work within the limits of my competence, recognise my strengths and weaknesses, and develop the necessary skills for safe and effective practice when working independently. It is also essential to keep current with the latest advancements in practice by participating in appropriate learning and reflective activities. Post-registration education and practice are there to help healthcare professionals like myself provide high-quality care and maintain a high standard of training. It is an excellent framework for continuing professional development and a crucial component of clinical governance, although it cannot guarantee competence. This experience has made me realise the importance of prioritising patient care while maintaining the knowledge and skills necessary for safe and effective practice. Researching the drug was required, but not at the expense of leaving the patient in a filthy bed.

As individuals, we do not originate the notion of time, but we acquire knowledge of it from a young age as both a concept and a societal construct. In the Western world, time revolves around measurement tools like clocks, calendars, and schedules. As a student nurse, I know that the importance of time management will become increasingly apparent throughout my career. I will inevitably face a heavy workload and must determine the most effective way to manage my time. Time management involves consistent action and communication with my goals while adapting to changing circumstances. Developing strong prioritisation skills is crucial for effective time management. That consists in making difficult decisions about allocating my time and planning accordingly. By managing my time effectively, I can reduce stress and increase productivity, ultimately benefiting myself and my patients. Effective time management entails following three fundamental steps. Firstly, it involves dedicating time to plan and determine priorities. Secondly, it entails tackling the most crucial task first and completing it before starting another. Lastly, the nurse must reassess and reorganise their priorities based on any new information received. Effective time management entails following three fundamental steps. Planning is vital in all areas of our lives, including nursing, where it is used as a ‘care plan.’ Nurses rely on this process to guide their practice. The nursing process, or ‘Assess, Plan, Implement, and Evaluate (APIE),’ can be an effective time management tool. By adapting the meaning to “a systematic, rational method of planning and achieving a practical time management plan,” nurses can utilise APIE to manage their time efficiently. Assess/Analyse: Collect and organise data and form a statement of actual or potential time management needs.

Final interview Reflection

Posted on by
Reply

Knowledge

 

Medication was one of the learning objectives for this placement, and I learned about various types of medicine and why they are prescribed to patients with neuro-disabilities. I have learned that an acquired brain injury is an injury to the brain from any cause that results in neurological impairment. This can cause trauma, tumours, infections, metabolic insults, and disorders of the blood supply. The resulting impairments may improve, progress or remain relatively stable over time. I have gained knowledge of cough assist equipment used to assist in the mobilisation and clearance of chest secretions by inflating the lungs with a positive airway pressure and then providing a rapid change to negative pressure to help the patient cough. A turbine compresses ambient air and delivers it to the patient through a close-fitting facemask. I discovered why patients require cough assistance, commonly used in patients who cannot cough and effectively clear secretions due to neuromuscular disorders and spinal cord injuries associated with lung disease. Also, secretions are usually cleared from the mouth after coughing, so yankeur suction may be required.

In the Devonshire ward, most patients undergo percutaneous endoscopic gastrostomy (PEG). A gastrostomy tube is a surgically inserted device that provides direct access to the stomach for supplemental feeding, hydration, and medication. It is inserted into the patient’s abdomen and delivers nutrients directly to the stomach.

I learned about brain disorders. When a patient’s brain is damaged, it can affect various factors, including memory, sensations, and personality. I also learned about the multiple types of brain injuries.

Nurses must work with multidisciplinary teams when caring for patients with neurodisabilities. I work with speech and language therapists (SLT) to care for patients with difficulty communicating, eating, drinking, and swallowing. I discovered that SLT can assist adult patients who are having difficulty communicating due to a stroke or brain injury.

Finally, I invite you to the MDT meeting to review the patient’s treatment progress and discuss the next steps, including whether the doctor should increase or decrease the prescribed medication. Please attend the conference for patients about to be discharged to a family or care home.

Skills

With the guidance of my practice supervisor, I have gained appropriate skills in preparing and administering medication to patients through a PEG feeding tube. Additionally, I can administer nebulizer medication to help clear secretions from their lungs. I perform cough-assisted procedures for patients who cannot cough effectively due to neuromuscular disorders. I clear secretions from the patient’s mouth using yankeur suction during these procedures. I also practice tracheostomy care under my supervisor.

As a part of wound care, I must demonstrate my skills in using patient care technologies while being mindful, sensitive, and respectful of each patient’s values, beliefs, and needs.

I have experience caring for patients who require tracheostomy care. My duties include performing tracheostomy care for patients who have tracheostomy tubes. During this process, I suction the tracheostomy tube to clear any secretions from the airway, making it easier for the patient to breathe. To ensure the patient’s safety, I follow specific guidelines, including cleaning the suction catheter to prevent infections, replacing the inner cannula to prevent blockages, cleaning the skin around the tracheostomy to avoid irritation, and moisturising the air the patient breathes. This helps to loosen any secretions, making them easier to suction.

It is recommended that patients with PEG tubes be supplied with additional nutrients. I can administer the nutrients using the following steps: First, I will use a gravity feeding set and make sure the roller clamp is closed. Then, please attach the set to the feeding container with the right amount of feed and hang the container on the pole. To begin the process, squeeze the drip chamber until it is one-third full of the feeding solution. Next, remove the protective cap from the end of the giving set and open the roller clamp. Allow the feed to run down to the back to prime the line, then close the roller clamp. After that, connect the giving set to the enteral tube connector at the end of the tube. Open the roller clamp and set the flow rate by counting the drops per minute. As a guideline, 20 drops of standard feed equal 1 ml. The following equation calculates the drip rate: (ml/hour) / 3 = drops/minute. Open and close the roller clamp until the desired drip rate is set correctly. Finally, I will check the drip rate regularly to ensure the feed runs at the required rate.

I administer medication to patients through a PEG tube when they are unable to swallow oral medicines. Before administering medication to the patient, I have to gain consent. 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 glycopyronium bromide 800 mcg. The preparation is calculated by dividing 800 by 1000, which equals 0.8, and then multiplying that by 5, which results in 4 ml. This is then administered through peg feed. After administering one medication, I must flush 60 ml of water before administering the following medications. A drug chart indicates The amount of water a doctor prescribes.

I observed and assisted my supervisor in performing a bladder wash on a patient with a suprapubic catheter.

Attitudes and values

 

With the guidance of my practice supervisor, I have gained appropriate skills in preparing and administering medication to patients through a PEG feeding tube. Additionally, I can administer nebuliser medication to help clear secretions from their lungs. I perform cough-assisted procedures for patients who cannot cough effectively due to neuromuscular disorders. I clear secretions from the patient’s mouth using yankeur suction during these procedures. I also practice tracheostomy care under my supervisor.

As a part of wound care, I must demonstrate my skills in using patient care technologies while being mindful, sensitive, and respectful of each patient’s values, beliefs, and needs.

I have experience caring for patients who require tracheostomy care. My duties include performing tracheostomy care for patients who have tracheostomy tubes. During this process, I suction the tracheostomy tube to clear any secretions from the airway, making it easier for the patient to breathe. To ensure the patient’s safety, I follow specific guidelines, including cleaning the suction catheter to prevent infections, replacing the inner cannula to prevent blockages, cleaning the skin around the tracheostomy to avoid irritation, and moisturising the air the patient breathes. This helps to loosen any secretions, making them easier to suction.

It is recommended that patients with PEG tubes be supplied with additional nutrients. I can administer the nutrients using the following steps: First, I will use a gravity feeding set and make sure the roller clamp is closed. Then, please attach the set to the feeding container with the right amount of feed and hang the container on the pole. To begin the process, squeeze the drip chamber until it is one-third full of the feeding solution. Next, remove the protective cap from the end of the giving set and open the roller clamp. Allow the feed to run down to the back to prime the line, then close the roller clamp. After that, connect the giving set to the enteral tube connector at the end of the tube. Open the roller clamp and set the flow rate by counting the drops per minute. As a guideline, 20 drops of standard feed equal 1 ml. The following equation calculates the drip rate: (ml/hour) / 3 = drops/minute. Open and close the roller clamp until the desired drip rate is set correctly. Finally, I will check the drip rate regularly to ensure the feed runs at the required rate.

I administer medication to patients through a PEG tube when they are unable to swallow oral medicines. Before administering medication to the patient, I have to gain consent. 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 glycopyronium bromide 800 mcg. The preparation is calculated by dividing 800 by 1000, which equals 0.8, and then multiplying that by 5, which results in 4 ml. This is then administered through peg feed. After administering one medication, I must flush 60 mL of water before administering the following medications. A drug chart indicates The amount of water a doctor prescribes.

I observed and assisted my supervisor in performing a bladder wash on a patient with a suprapubic catheter.

As a student nurse, one of the most critical values in nursing is respecting patients’ dignity. This means treating patients with kindness and thoughtfulness while providing care, being aware of their emotions when talking to them, caring for them, and educating them about their health. Valuing human dignity also means recognising each patient’s right to choose healthcare services and maintaining privacy, which are crucial nursing values.