Category Archives: Reflections: Year 2

Colposcopy elective reflection

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Reflecting on my experience as a student nurse in the colposcopy clinic, particularly regarding HPV (human papillomavirus), has been insightful and educational. The clinic provided an in-depth understanding of the clinical implications of HPV and its role in cervical cancer screening and prevention.

HPV is a prevalent sexually transmitted infection, and its connection to cervical cancer is significant. Before my placement, I had theoretical knowledge of HPV, but witnessing its impact in the clinic reinforced its importance. The colposcopy clinic is often a follow-up step after abnormal Pap smear results, where HPV is a common factor. Understanding the virus’s role in the progression of cervical dysplasia to cervical cancer deepened my appreciation for early detection and prevention.

One of the most valuable experiences was interacting with patients, who were often anxious about their diagnoses and the implications of having HPV. I observed how the nurses and healthcare team communicated with patients, explaining the nature of HPV, the purpose of the colposcopy procedure, and the potential outcomes. This experience underscored the importance of clear, compassionate communication, especially when discussing sensitive topics like sexually transmitted infections and cancer risk.

During these interactions, I learnt how to provide emotional support while delivering important health information. Many patients had concerns about the stigma associated with HPV, and it was crucial to address these worries with empathy and factual information. This helped patients feel more at ease and empowered them to take an active role in their healthcare.

The technical aspect of the colposcopy procedure was also an essential learning experience. Observing the nurses and physicians during the examination allowed me to appreciate the precision and care required in identifying abnormal cervical cells. The process of applying acetic acid to the cervix to highlight abnormal areas and taking biopsies was conducted with meticulous attention to detail. I observed how the healthcare team ensured patient comfort throughout the procedure, which is critical in an invasive and potentially distressing process.

I also assisted in some preparatory steps, such as setting up the equipment and preparing the patient for the procedure. This hands-on experience was invaluable in developing my practical skills and understanding the workflow in a specialised clinic.

This placement has been pivotal in shaping my understanding of the role of a nurse in specialised clinics like colposcopy. The experience highlighted the importance of combining clinical expertise with compassionate patient care. It also reinforced the significance of preventive healthcare and the role nurses play in educating patients about their health and encouraging them to participate in regular screenings.

My reflection on working with HPV patients in the colposcopy clinic has emphasised the importance of empathy, clear communication, and technical nursing skills. It has also deepened my understanding of the impact of HPV and the vital role of early detection and treatment in preventing cervical cancer. This experience has been instrumental in my development as a student nurse, and I am committed to applying these lessons in my future practice.

Reflection

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During my elective placement in women’s units, I acquired knowledge of various treatment methods in the gynaecology speciality. I will be reflecting on my clinical experiences in colposcopy, hysteroscopy, endometriosis, and ectopic pregnancy during an elective placement, which can offer valuable insights into patient care, clinical skills, and personal growth.

During my elective placement, I had the opportunity to observe and participate in various procedures related to colposcopy, hysteroscopy, endometriosis, and ectopic pregnancy.

In the colposcopy clinic, I observed the procedure in which a colposcope was used to examine the cervix for abnormalities following an abnormal human papillomavirus (HPV) test. The speciality nurses emphasised patient comfort and clear communication to alleviate anxiety.

While in the hysteroscopy clinic, I assisted in preparing a patient for a hysteroscopy. This procedure involves examining the uterus using a hysteroscope and is typically performed when a woman experiences menstrual problems such as postmenopausal or irregular bleeding, polyps, and fibroids. The consultant explained the procedure to the patient and stressed the importance of managing pain and discomfort.

In endometriosis, I encountered a patient suffering from severe endometriosis, requiring both pain management and psychological support. The experience highlighted the chronic nature of the disease and the importance of long-term care planning. The patient has various birth control options to treat endometriosis, including mini pills, Mirena coils, patches, and surgery.

At the early pregnancy unit, we provide care for women who are 16 weeks pregnant and experiencing severe pain and heavy bleeding. Additionally, we provide support for women who have had previous early pregnancy complications such as recurrent miscarriage, ectopic pregnancy, and molar pregnancy.

During a critical ectopic pregnancy, quick decisions and teamwork by healthcare professionals were crucial in managing this life-threatening emergency.

At first, I was worried about taking part in these complicated procedures and handling serious conditions such as ectopic pregnancy. However, I was also excited about the chance to learn and help with patient care. Watching the team’s expertise reassured me, but I also felt the emotional burden of seeing patients in distress, especially those dealing with chronic conditions like endometriosis or facing emergencies such as ectopic pregnancies.

The experiences reinforced the importance of patient-centred care, particularly in maintaining clear communication and providing emotional support. The practical exposure to these procedures enhanced my understanding of the technical aspects and patient management.

The emotional impact of dealing with serious conditions was significant. Additionally, the complexity of procedures like colposcopy and hysteroscopy highlighted areas where I need further learning and practice.

These experiences have demonstrated the critical importance of balancing technical skills with compassionate care. For instance, in colposcopy and hysteroscopy, patients often experience high levels of anxiety, and the way healthcare professionals communicate can significantly impact patient comfort and cooperation. While managing cases of endometriosis and ectopic pregnancy, I have witnessed the significance of a multidisciplinary approach, which involves integrating pain management, surgical intervention, and psychological support.

I have learnt the importance of being prepared, not only technically but also emotionally, for the challenges presented by these conditions. I have recognised the need for continuous learning, particularly in developing communication skills and gaining a deeper understanding of the conditions that affect women’s reproductive health.

General clinic Fibriod, endomentorisis Reflection

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I sat down with the gynaecology consultant to discuss a patient who underwent post-operative surgery. We introduced ourselves to the patient and her mother. We ask the patient to confirm her name and date of birth to ensure she is the right patient. The consultants went over the procedure and explained that the operation they had performed on her fibroid revealed that it was cancer rather than a fibroid. Hence, the consultant informed her that she needed other surgery to remove her ovaries because the pathology test had confirmed that the patient had cancer and needed to be removed, so she would have surgery on August 30th and begin chemotherapy. The patient burst into tears as the doctor told her the patient’s shocking news. She had arrived with her mother, so it was a huge surprise for both of them, and the room was filled with emotion. As a student nurse, I went to stand between the patient and her mother, holding both hands, and encouraging them that everything would be ok, but unfortunately, things turned out differently. The patient’s mother is a diabetes patient, and when she heard that her daughter had cancer, she felt shocked and shaken, so I had to take her to a side room to look after her blood sugar level. The mother has hypoglycemia and tachycardia, so I offer the woman a biscuit to boost her blood sugar level. The lady refuses to take the biscuit, but I encourage her to take the biscuit or the candy. I will reflect on the patient’s need to bring her mother to the clinic while she knows that her mother is a diabetes patient and anything can happen there with that new cancer. I learnt that patients need support from family members but not their mums because if caution is not taken, patients will lose their mum from this shocking new cancer of the cervix.

Furthermore, the patient calmed down a bit and now remembers that she came to the clinic with her sick mother, and her mother has very high blood sugar. I was there to look after her mom while the doctor was meeting with the patient, and I did well to take care of the mother and encouraged her that her daughter would be okay because she was in safe hands and they were doing their best for her daughter’s treatment.

Reflection on colposcopy clinic

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Reflecting on my experience as a student nurse in the colposcopy clinic, particularly regarding HPV (human papillomavirus), has been insightful and educational. The clinic provided an in-depth understanding of the clinical implications of HPV and its role in cervical cancer screening and prevention.

HPV is a prevalent sexually transmitted infection, and its connection to cervical cancer is significant. Before my placement, I had theoretical knowledge of HPV, but witnessing its impact in the clinic reinforced its importance. The colposcopy clinic is often a follow-up step after abnormal Pap smear results, where HPV is a common factor. Understanding the virus’s role in the progression of cervical dysplasia to cervical cancer deepened my appreciation for early detection and prevention.

One of the most valuable experiences was interacting with patients, who were often anxious about their diagnoses and the implications of having HPV. I observed how the nurses and healthcare team communicated with patients, explaining the nature of HPV, the purpose of the colposcopy procedure, and the potential outcomes. This experience underscored the importance of clear, compassionate communication, especially when discussing sensitive topics like sexually transmitted infections and cancer risk.

During these interactions, I learnt how to provide emotional support while delivering important health information. Many patients had concerns about the stigma associated with HPV, and it was crucial to address these worries with empathy and factual information. This helped patients feel more at ease and empowered them to take an active role in their healthcare.

The technical aspect of the colposcopy procedure was also an essential learning experience. Observing the nurses and physicians during the examination allowed me to appreciate the precision and care required in identifying abnormal cervical cells. The process of applying acetic acid to the cervix to highlight abnormal areas and taking biopsies was conducted with meticulous attention to detail. I observed how the healthcare team ensured patient comfort throughout the procedure, which is critical in an invasive and potentially distressing process.

I also assisted in some preparatory steps, such as setting up the equipment and preparing the patient for the procedure. This hands-on experience was invaluable in developing my practical skills and understanding the workflow in a specialized clinic.

This placement has been pivotal in shaping my understanding of the role of a nurse in specialised clinics like colposcopy. The experience highlighted the importance of combining clinical expertise with compassionate patient care. It also reinforced the significance of preventive healthcare and the role nurses play in educating patients about their health and encouraging them to participate in regular screenings.

My reflection on working with HPV patients in the colposcopy clinic has emphasised the importance of empathy, clear communication, and technical nursing skills. It has also deepened my understanding of the impact of HPV and the vital role of early detection and treatment in preventing cervical cancer. This experience has been instrumental in my development as a student nurse, and I am committed to applying these lessons in my future practice.

Miscarringe Reflection in early pregnancy unit

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During my placement in a gynaecological ward, I encountered patients who had miscarried pregnancies. I provided emotional support, assisted in medical procedures, and ensured the comfort of the patients. I observed how the nursing staff managed these situations and learnt about the medical aspects and the importance of empathetic communication.

I felt a mix of sadness, empathy, and anxiety. Seeing the grief of the patients and their families was heart-wrenching. I also felt a bit nervous, knowing how sensitive the situation was and not wanting to say or do anything that might exacerbate their distress. As I continued to support these patients, I began to feel more confident in my ability to provide compassionate care. However, the emotional toll was still significant, and I sometimes felt overwhelmed.

I remained calm and professional, providing support where needed. I noticed that my communication skills improved as I learnt to listen more actively and respond with empathy. There were moments when I felt unsure about the best way to emotionally support the patients. I could have benefited from more guidance on how to handle such emotionally charged situations.

The event highlighted the importance of a holistic approach to patient care, particularly in sensitive situations like miscarriages or ectopic pregnancies. Emotional support is just as critical as physical care, and the ability to provide both is essential in nursing.

I learnt the significance of being emotionally present with the patient and the importance of creating a safe space for them to express their grief. I also gained insight into the medical management of miscarriages and ectopic pregnancies.

I learnt that dealing with loss is an essential aspect of nursing. It’s important to approach these situations with empathy and professionalism. I also understood the importance of self-care in managing the emotional impact of these experiences.

I plan to pursue additional training in providing emotional support and discuss these experiences with a mentor to gain different perspectives. Furthermore, I will consciously engage in self-care practices to maintain my emotional well-being.

I am committed to seeking opportunities to improve my skills in providing bereavement support, such as attending workshops or training sessions. I will make sure to have a support system in place, including mentors and peers, with whom I can debrief after emotionally challenging situations. I will also continue to reflect on similar experiences in the future and use these reflections to inform my professional development.

Reflection : Medicine Management.

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As a student nurse, one of my primary responsibilities is medication administration. I administered a few medications under the supervision of the nursing staff. I have learnt about medication management and how important it is to avoid errors by arming myself with seven rights. One of which is the right patient, the right drug, the right dose, the right time, the right route, the right reason, and the right documentation. Before administering drugs, it is essential to obtain patients’ consent, as service users have the right to refuse. Permission is obtained from them to respect the patient’s autonomy.

The clinical nurse’s role includes a significant amount of drug administration. Doctors prescribe medications, which the pharmacist dispenses but is responsible for. Registered nurses are in charge of administration. As a student nurse, this has become my responsibility, which I must practice and become proficient at. This practice is part of preparing, checking, and administering medication, updating medication knowledge, monitoring treatment effectiveness, reporting adverse drug reactions, and teaching patients about the drugs they receive.

Accountability also applies to students; if I felt I was not competent enough to dispense a specific drug, I would be responsible for speaking up and informing the practice assessor so that I could shadow them and learn from them to help me in future practice and administration.

I was asked to administer a drug to a patient named Mr. Mark for confidentiality purposes. I had observed the clinical skill several times and previously administered medication under supervision. I was observed and supervised to administer oral medication to a patient. The drug has been dispensed and is ready to be administered with patient consent for me to administer the medication. My supervisor talked me through the procedure and told me they were struggling. The patient and his family have complied with the drug before, so I should keep an eye on him and ensure that he swallows his medication and that he does not support it in his mouth. The medication that the patient is on is bisoprolol. The decision to use bisoprolol is not taken lightly because of the potentially life-threatening side effects. Awareness of side effects is essential to primary care practitioners because they have the most contact with them.

I learnt that bisoprolol is used with other medicines to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Bisoprolol belongs to a class of drugs known as beta-blockers. It works by blocking the action of certain natural chemicals in the patient’s body, such as epinephrine in the heart and blood vessels. I advised the patient that the side effects of bisoprolol are tiredness, a slow heartbeat, diarrhoea, and dizziness. Also, I informed the patient to reduce the risk of dizziness and lightheadedness and to get up slowly when rising from a sitting position.

I was aware of being under the practice supervisor, which made me feel nervous and self-conscious, so I had to ensure that I was doing everything correctly and made no errors. Once my practice supervisor questioned my practice concerning whether I knew the side effects of the drug I was about to administer, I became even more aware of feeling nervous and under pressure. The patient was present, and I did not want the patient to think that I did not know what I was doing. So, before administering, I had to ensure that I was giving the medication to the right patient at the correct dose at the right time and route. All of these had to be done to guarantee that I was competent in administering medication under the supervision of the practice assessors. This also allowed me to carry out this task and get it signed off by my practice assessor in the essential skills cluster. The nurse-patient relationship is, by many, considered the core of nursing. This can be done to build a good relationship and rapport with the patient.

Administering medication and how this, combined with care, communication, and compassion, form the basis of a holistic approach to care, and with the knowledge I got from supporting literature, formed the foundation of my learning and practice.

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.

Professional Values Reflection

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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

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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.

Placement Midpoint Reflection

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Knowledge

I have learned about two types of brain injuries: traumatic and acquired brain injuries. Traumatic brain injuries can be classified into two main categories: open-head injuries and closed-head injuries. Traumatic brain injuries can cause various medical conditions, such as hematoma, haemorrhage, concussion, and skull fractures. There are multiple types of acquired brain injuries, which include meningitis, asphyxia, hydrocephalus, and anoxia. During my time in the traumatic brain injury unit as a student nurse, I gained extensive knowledge and honed my nursing skills in caring for patients with brain injuries. I learned how to provide a wide range of care to patients with tracheotomies who required constant monitoring and management due to their brain injuries.

I also learned how to monitor and assess patients, take vital signs, and maintain hygiene while providing patient care. Brain injuries can be mild or severe, ranging from concussions to comas. The damage can also be focal.

I have learned about two types of tracheostomy tubes. Cuffed tubes have a soft balloon around the end that inflates to seal the airway. They are used when airway protection is crucial to prevent the aspiration of oral or gastric secretions. The patient cannot breathe around the tube if the cuff is inflated while the tracheotomy tube lumen is blocked. This assumes that the cuff is correctly placed and inflated within the trachea.

On the other hand, acquired brain injuries include meningitis, hypoxia, hydrocephalus, and anoxia. Understanding these types of injuries is crucial for providing adequate care to patients with brain injuries.

I learned about oral and peg feeding medication, stoma care, catheter management, and input/output monitoring.

Skills

 

Through my experience, I have developed the skills to gather patient information, prioritise their needs, and make informed decisions to positively impact their care. I have also improved my ability to assess News 2 scores, bladder scans, blood glucose levels, urine output, and suction patients.

Skills in promoting independence, understanding and managing cognitive and behavioural changes, and building rapport with individuals.

My adaptability as a student nurse in a brain injury unit is evident in my ability to demonstrate excellent teamwork skills and work using my initiative, regardless of the healthcare environment.

After taking the handover for the first time, I learned I should check all my patients to see if they are awake or sleeping. I use intentional rounding to monitor patients hourly and ensure their safety, especially if they can’t do so themselves. I also perform safety checks to manage tracheotomies, secretions, and chest health.

When working under a supervisor, I perform bumper-retained tube advances and rotate records. To do this, I must gain consent from the patient to perform a bumper check, clean the peg tube, and rotate it 5 inches to check for infection or blockage. I also perform cough assists to help mobilise and clear chest secretions if necessary. This involves inflating the lungs with positive airway pressure and shifting rapidly to negative pressure to help the patient cough.

As a nurse, I have learned that patients need a sodium chloride nebuliser before performing cough assists to help clear their secretions. Once the cough assist is complete, the secretions are usually removed from the mouth, which allows me to suction mucus from the patient’s mouth using a Yankee.

My approach to preparing and administering oral and peg-feed medications, as well as injections, is meticulous. As a student nurse, I always double-check the prescribed medication and dosage before administration, ensuring patient safety and protocol adherence.

My commitment to patient-centred care is evident in my performance of personal hygiene tasks, catheter care, food and drink monitoring, vital sign recording, oral care, bladder scanning, Waterloo assessment, and MUST assessment. Each task is carried out with the patient’s comfort and well-being in mind.

Before administering medication through peg feed, I have to use a 60-ml syringe filled with water to flush the peg tube to ensure it is not blocked before administering clonazepam 500 mcg. The preparation is calculated by dividing 500 by 1000, which equals 0.5, and then multiplying that by 5, which results in 2.5 ml. This is then administered through peg feed. After administering one medication, I must flush 600 ml of water before the following medicines. A drug chart indicates The amount of water a doctor prescribes.

I observed and practiced under the supervision of a senior healthcare professional to perform a bladder washout for a patient who had a suprapubic catheter. Before the procedure, I explained to the patient what I would do and gained their consent. The purpose of the bladder washout was to prevent the catheter from getting blocked and to flush out any mucus buildup within the bladder.

Attitudes and values

 

As a student nurse, I play a crucial role in the care of patients who are suffering from moderate to severe traumatic brain injuries during acute care. As an essential interdisciplinary team member, I have various responsibilities to assist in the patient’s treatment and recovery. These responsibilities include assessing the patient, coordinating and communicating care, providing technical and physical care, offering emotional support to the patient and their family, and advocating for the patient.

Autonomy is vital to patient care, as it allows patients to make informed decisions about their health. Nurses who value freedom should prioritise caring for their patients. Proactively advocating for patients and developing friendly relationships can also help enhance patient discretion in decision-making.