Reflection IP Speech, Language capacity, and Communication.

This week, I attended IP Speech, Language Capacity, and Communication, where I learned how to communicate with patients when they consent. Through group discussions, I was able to delve deeper into the subject. We discussed the benefits of communication with both the patient and the nurse. I have gained knowledge of communication disorders. Communication disorders can involve voice issues, but they are different. I learned that

Communication difficulties can significantly impact patient engagement with healthcare professionals. These issues may result from a need for more shared language, leading to misunderstandings about treatment plans or clinical situations. Poor communication can result in patients not seeking timely treatment, potentially leading to more severe health issues. It can also cause frustration and a sense of inadequacy among healthcare professionals, especially if complaints are made; improving communication has been shown to enhance the quality of patient care and lower costs.

I also learned that there are various types of communication disorders. Although they are different, most individuals with autism share common impairments in verbal and nonverbal communication, displaying difficulties in the following areas: Language comprehension, speech, social cues, facial expressions, gestures, and emotional perception. I gained knowledge in speech and Language therapy, which provides treatment, support, and care for individual who faces challenges with communication as well as difficulties related to eating, drinking, and swallowing.

I had a placement in the neuro-disability ward, where I had to administer medication to a patient. Who had a brain injury? I had to introduce myself to the patient, explain what I would do, and gain consent. Brain injuries are caused by blunt trauma, which can damage your brain tissue, neurons, and nerves. This damage affects your brain’s ability to communicate with the rest of your body.

During my shift, I assisted a patient named Emmanuel, who had a percutaneous endoscopic gastrotomy (PEG) for enteral feeding and medication administration. Before giving the afternoon medication, I obtained consent from the patient. However, the patient refused to take the medication, and I respected their decision, as patients have the right to refuse treatment. I explained to the patient that the medication, levetiracetam, was necessary for preventing focal seizures, but the patient still declined. I waited a few minutes to ensure the patient was not distressed. I discovered that the patient had been tired from interacting with a physiotherapist, which was why he refused the medication. I informed my practice assessor about the situation and waited an hour before asking for consent again. After an hour, I explained to the patient that I would administer the medication through the PEG. The patient gave consent, signalling this with a blink, so I flushed the PEG with 60 mL of water to ensure it was not blocked. Then, I administered the Levetiracetam medication and provided 250 mL of water to the patient through PEG feeding. This experience taught me the importance of understanding the patient’s condition and advocating for them if they cannot consent to treatment.

Simulated placement Reflection (Wound care)

My first week of simulated placement was a deep dive into wound care. I dove into the intricacies of managing patients with leg ulcers and the various types of wound dressing. A wound, as we know, is a disruption in the continuity of the epithelium. Understanding the normal physiological wound-healing process, which involves four stages—homeostasis, inflammation, proliferation, and remodelling—is crucial. This knowledge is particularly significant when dealing with chronic wounds, where the wound-healing mechanism is often impaired.

I learned the five ways of assessing wound care: wound assessment, wound cleansing, timely dressing change, selection of appropriate dressings, and antibiotic use. I knew pressure sores and leg ulcers were considered chronic wounds. They are slow-healing wounds with a likelihood of reoccurrence, and the pain that a patient feels may be severe and ongoing. The choice of dressing plays a significant role in reducing pain. Using the wrong dressing can cause discomfort when removing it. Therefore, the nurse needs to carefully assess before administering the dressing.

As a nurse, my role in promoting successful wound healing is pivotal. I must use a wound assessment tool to ensure accurate and consistent documentation, and regular reassessment of wounds is necessary to evaluate the effectiveness of the treatment. When conducting a wound assessment, I consider various factors such as the location, cause, tissue type, size, exudate, and the patient’s pain level. Selecting the most appropriate dressing for the wound is a critical decision, but it can be challenging due to the constant development of new dressings. I base my choice on the most current evidence available, and I must assess the wound for slough and necrosis, signs of infection, and malodor. Patient records should indicate the wound’s progress in healing, such as granulation and epithelial growth.

During my community placement, I had the opportunity to apply my theoretical knowledge in a practical setting. I visited a 60-year-old lady who had chronic leg ulcers on both legs. The district nursing team had been attending to her for several years. The lady had swollen legs and limited mobility and sat in a recliner chair, although the chair never reclined. I had visited her several times before, applied her dressings, and documented the procedures and dressings used in her district nursing records. On this occasion, the lady asked me not to apply the K-lite dressing and allowed another nurse to do it. She mentioned that the dressing I had used previously had become loose.

I assessed the wounds and updated the notes to reflect their current size. Then, I washed and redressed the legs according to the care plan. The plan specified washing the legs and applying Aquall Ag Silver, which is used for highly exudating wounds. Atruman was applied, followed by Resorb, Comfiest Yellow, and K-soft layers. I then handed it over to the registered nurse (RN) to use the final layer. While she did that, I documented that the patient’s leg had been washed, redressed, and mapped according to the plan. I also noted a strikethrough on the dressing before removal and recorded the patient’s pain levels before and after the redressing.

Additionally, I pointed out in the patient’s records that the patient had been advised to elevate their legs when resting to aid healing. It shook my confidence when the patient preferred the registered nurse to handle the top layer. The patient had never made this request before and always asked for the dressings not to be wrapped too tight because it made her very uncomfortable. I reassured her that I didn’t wrap them as tight as she had requested and apologised for the falling dressings. I promised her I would ensure they were secure but tight enough in the future. When I left the patient’s house with the registered nurse, she explained that this patient did this to all new nurses and advised me not to worry about it.

The ideal wound dressing should meet the treatment objective and protect the wound from further injury. It should be a moist wound healing dressing that manages excess exudates, prevents the wound from maceration and further breakdown, and ensures the prevention of the exit and entry of organisms. Additionally, it should cause minimal trauma upon removal and be cost-effective. A crucial factor in wound dressings is to ensure that dressings have maximum exposure to the wound bed. This can be achieved using a dressing that decreases the voids and spaces where bacteria can thrive.