I attended the syringe driver training that was held by Jo and Diane. I didn’t know much about syringe drivers as I hadn’t had previous training or much knowledge about it however, I enjoyed this training and took the opportunity to develop my knowledge and skills by participating and listening.

Syringe drivers require batteries and deliver medication subcutaneously.

The trainers brought in syringe drivers for us to learn how to set up the medication; which I found useful as I learn better by physically doing something. I learnt that syringe drivers are given continuously over 24 hours and often to patients who are at the end of their lives. Syringe drivers can also be used for any patient who can’t take medication orally and are ill. They make patients feel comfortable by managing their symptoms.

I still don’t feel completely confident in setting up/administering medication to a patient through a syringe driver however, I feel like I had a good introduction to the device and going forward I will have more of an insight about it.

I had the opportunity to attend the catheter and Bowel training with Wendy today and I honestly learned so much. I learnt that It is important to assess your patient for a catheter before putting one in. A patient may need a catheter for many reasons such as urine retention, after surgery, long-term conditions or because they have a pressure ulcer on their bottom which could get infected if they are incontinent.

I also learnt that long-term catheters increase the risk of developing UTI’s and blockages therefore, it is important for patients themselves and Nurses to give catheter care by cleaning the catheter every day. Is important to clean down the catheter and not up and cleaning down will not spread infection up into the genital area.

I was taught what solution to use and how to use it if a catheter does block. I was also given a leaflet with the relevant information.

I was able to practise inserting a catheter into a female and male model which I found beneficial to understand how the procedure works and the anatomy of the reproductive system.

During bowel training, I learned different types of procedures that can be carried out if a patient is suffering from constipation such as enemas and suppositories. Enemas are to be used if the stool is lower down in the rectum and other types of treatment don’t work such as medication.

Again, I was able to practise this procedure on a model working in pairs with other students. firstly I explained the procedure to the “patient” and explained why it was necessary to carry out the procedure. I asked if they had any pain, if they needed to use the toilet before the procedure and lastly when their last bowel moment was.

I then washed my hands, put on my gloves and then I went ahead with the procedure on the model. I reassured my patient that it may feel a bit uncomfortable but it won’t last long. I inserted my index finger into the rectum and turned my finger clockwise and anticlockwise (12-6). Wendy had inserted faeces into the model to which we had to guess which type of stool it was from 1-7.

Overall, I found the training beneficial and would love to join Wendy again for other training.

I worked with Resmi on the virtual ward team on 16/11/23. I had a really good day we went around to patients’ houses and checked their vital signs such as blood pressure, pulse oximetry, respiratory, temperature and heart rate. One lady that we visited was suffering from a cough so I was able to listen to her chest with a stethoscope. I found this very interesting as I had never had the opportunity to do this before.

I learnt that you can identify and diagnose a patient by the noises that you hear from the lungs through the stethoscope. An example of this is, pneumonia is a popping sound, COPD is a wheezing sound and normal is a soft smooth sound. It is important to check for crackles and wheezing.

For another lady that we visited we installed a current health monitor in her home. Again I found this very interesting as I hadn’t seen anything like this before. It consisted of a Samsung Galaxy tablet, a watch for the patient to wear, a blood pressure cuff and an internet box. The idea of the current health monitor was to record the patient’s blood pressure 4 times a day for 7 days.

The benefits of this I found were amazing, as it saves the nurses time so they don’t have to visit the patient every day to check their blood pressure. It also benefits the patient’s well-being positively; this is because the patient can have a normal day-to-day life by doing stuff that they enjoy and getting the things that they need to do done instead of being in the hospital or staying at home waiting for the nurses to arrive to check their blood pressure.

I enjoyed spending the day with the virtual team as I learnt new things and enjoyed visiting patients in their own homes and having nice conversations with them.

I worked with the respiratory nurse on 17/11/23. I found it to be an amazing opportunity to learn and develop my knowledge of the respiratory system. I was able to sit and observe Neethu in pulmonary rehab which was interesting. I learnt that pulmonary rehab aims to promote the quality of an individual’s life before going down the route of medication

The routine of pulmonary rehab is to first have an initial interview which involves wearing a monitor on the ear or finger which tracks the heart rate during exercises. The patient then has to walk up and down when they hear the bleep and the nurse is present to keep an eye on the heart rate and to see how breathless the patient gets. The patient then attends 12 sessions of rehab that contain exercises that patients can manage at home.

One thing I learnt is that pulmonary rehab improves your physical strength which aids in preventing chest infections; if you are not fit it is easier to develop infections.

Another thing that I also learned is that spirometry tests are used to diagnose COPD however, an X-ray of the lungs is also required to rule out other symptoms of breathlessness.

and lastly, I learned that it is important to use a spacer with inhalers and rinse your mouth after every use this is because you can develop oral thrush.

Observing the respiratory nurses i feel more confident on the respiratory system, signs and how to manage shortness of breath/ COPD.

I was able to observe a Capillary Blood Gas (CBG) while working with the respiratory nurse on 17/11/23. This was done using the patient’s earlobe. I was able to ask questions about why the earlobe was used and the anatomy. I have more of an understanding that the ear is used for this procedure as it is more comfortable for the patient and the gravity helps draw the blood from the ear.

The respiratory nurse bled the ear and collected the blood into a tube which then was put inside a machine. The machine then told us how much oxygen was in the patient’s blood on room air.

The patient then was asked to put on nasal specs and 2L of oxygen was delivered through the patient’s nasal cavity for 20 minutes. The same procedure was then carried out and tested. The nurse then compared the results to which we found on room air the patient wasn’t receiving enough oxygen and her o2 levels were 88% however after oxygen had been given for 20 minutes her o2 levels were 94%.

I found the procedure interesting and a good opportunity to watch and understand the anatomy behind a CBG and its different results.

I was able to observe Linda today (20/11/23). We went to a supported living accommodation for learning disability individuals. Before meeting Linda I was unsure of what her role is however, I understand more that her role is to go to different services and support them by looking at their patient files and staff files to prepare them for CQC visits and improve their service.

This also promotes the quality of life for the individuals that are being cared for because if their documents are up to date and correct their care needs can be met correctly providing them a person-centred care.

I was able to get involved with the meeting by looking at patients’ files and noticing things that needed changing or weren’t done correctly. I enjoyed this as it developed my skills and knowledge in the paperwork side of nursing and how care plans and Mar charts etc should be.

I liked the fact that Linda was positive and friendly because it taught me that you shouldn’t be against the staff. After all, as a Quality Improvement Officer, you should be there to help them. I noticed the benefit of this which was that the staff were grateful for the help and were willing to make the suggested changes, to meet the end goal.

To summarise, I had a good day and would love to be able to spend time with the Quality Improvement Officer team in the future to learn more and maybe follow this up as a potential career path to make a difference in care homes and supported living accommodations.

I had the opportunity to work with Vincent the Admiral nurse on 23/11/23. Before meeting Vincent I was unsure of what an Admiral nurse is and their speciality. I learned that an Admiral nurse specialises in dementia. Their job role is to support families that have a loved one suffering from dementia. I understand that some families don’t understand what dementia is and the effects it can have on an individual; they can find it frustrating seeing their loved ones in some cases deteriorating and they don’t know how to deal with it.

Therefore an admiral nurse offers a free service to families that are in need of support, knowledge, skills and somebody to talk to. Families are able to self-refer and call the Admiral nurses for information, however, for a family to qualify under the admiral nurses and be taken as a “client”, the individual suffering from dementia has to live in the Sutton area and have complex needs. There are 3 complex needs that the individual/ family must meet which are, health, social and risk to be under the Admiral team.

I was able to attend a home visit with Vincent during my time with him. We met with a lovely lady whose husband is suffering from dementia and meets the 3 complex needs mentioned above. The individual also has an addiction to alcohol use and was a risk to himself. I understood that his health was being damaged by the alcohol which was making his dementia worse. He is a risk to himself as his wife reports he is getting himself into trouble, being found in parks beaten up and constantly being robbed for his money and shoes.

However, prior to and during the meeting the individual had been in the hospital for 6 weeks, due to being found in the park alone and under the influence of alcohol whilst his wife was on holiday. The benefit of the individual being in the hospital is that he is currently 6 weeks sober! His wife had reported that due to not being under the influence of alcohol his memory seemed to be better. The reason the individual had been in hospital for 6 weeks is because his wife didn’t want him at home as he wasn’t treating her very nicely. She said she could deal with the dementia but not the drinking.

Vincent explained that the individual couldn’t stay in the hospital any longer as he didn’t need to be there and of course, hospital beds are valuable to which the wife understood and agreed.

The end result of the meeting was that Vincent arranged for the individual to attend a club in Sutton twice a week to keep him busy and do things that he was interested in as a hobby which was, laying tables and helping people. On the basis that the individual doesn’t continue to drink,

the wife said she was happy for him to come back home and for the Admiral nurses to continue supporting her.

I understand that dementia is a progressive long-term condition that can sadly destroy families.

I enjoyed my day spent with the podiatry team on the 27/11/23. I learnt the different types of dressings they use for wounds such as soft pore, inadine and melolin dressings. Melolin dressings are good for absorption. Semi-compressed felt is used as padding for the toes and aids in toe separation. This provides comfort and won’t allow the other toe to rub against the toe with the wound. A wound must be cleaned during dressing change. This is because the patient’s skin hasn’t been exposed to air therefore, the skin becomes flakey and you can’t see the base of the wound without cleaning the top.

inadine dressings are often used as it helps to dry the wound out and keeps biofields and organisms out preventing infection. I also learned that it is important to use a scalpel for the edges of the wound to allow fluids to exudate. I understand that patients who are diabetic often have poor circulation and immune system therefore, it is important to use a Doppler to check the pulses of the feet.

The instruments that the podiatrist uses to clean the wound is in a packaging with a catch number. It is important to record the batch number to cover yourself so the patient is aware that the tools are sterile if they were to call up and ask. If a patient’s wound doesn’t start to heal within 2 months then the patient has to be referred to the hospital.A patient is seen as low risk if they can feel the podiatrist poking the bottom of their foot. This means that if the patient was barefoot they could feel if they stepped on a piece of glass preventing the risk of infection.

Sutton and health care don’t cut nails routinely.

I spent the day with the diabetes nurse Jane. I was able to sit in the room during appointments with patients which I enjoyed. I enjoyed communicating with patients and I found it interesting listening to how they manage their diabetes at home. Jane gave me a huge insight about diabetes which really increased my knowledge.

Type 1 diabetes is when no insulin is produced. Type 2 diabetes is more complex and usually the insulin isn’t working and often the individual is overweight and extra adipose is blocking the cells. A hypo is when an diabetic individuals blood sugar is to low. The expression i was taught was 4 and 7 is diabetes heaven. If the individuals blood sugar drops below 4 this is seen as an hypo and immediate action should take place. The appropriate actions for a hypo would be to give fast acting sugar that will quickly get into the blood stream and bring the sugar levels back up fast.

Fast acting sugars are considered as, insulin, orange juice, jelly babies, glucogel. Chocolate should be given as a last resort as dairy takes longer to break down.

I learnt that every person that has diabetes has to have an annual review. They have to have screenings annually for their feet, eyes and HBA1C. HBA1C is a blood test that determines how much sugar is in the bloodstream. The ranges are 20-41 for an individual that doesn’t have diabetes, 42-47 for pre diabetes and 48+ for an individual diagnosed with diabetes.

The feet are checked by checking the pulses, the temperature of the feet, checking in-between toes for fungal infections, sensitivities and capillary refill (3 secs).

I also learnt that it is important for individuals that have insulin to not inject themselves in the same area all the time, this is because it can cause lipos. Lipos are damage to the skin from sharp objects that are being injected into the same subcutaneous areas. The fat starts to gather together in one area and holds the insulin being injected. The insulin then is released at different times.

There are 3 components of diabetes which are, medication, diet and activity. Medications that are often used for diabetics are metformin and glipizide.

I was advised by Jane that is very important for needles to not be reused. This is because it puts the individuals at risk of an infection.

Overall, I enjoyed my day with Jane and learnt a lot. One thing I would like to develop my knowledge and skills on is different types on insulins. I aim to do self directed study at home