Today I had the opportunity to sit in on a clinic with the heart failure nurse. We saw 4 patients that had heart failure aswell as other long term conditions.

I found the experience insightful and enjoyable. On this occasion the patients were follow up patients. The nurse conducted thorough reviews, which included assessing current medications, discussing how the patients were feeling holistically, reviewing recent blood results, and considering any necessary interventions. She also performed physical assessments, such as auscultating the lungs for any abnormal sounds.

I also was introduced to the heart failure in traffic light patient self-monitoring and management leaflet. The leaflet included information on establishing a daily routine, an explanation of what heart failure is, common symptoms, possible causes, contact details for the heart failure team, and an overview of the four pillars of medication used to manage the condition.

The heart failure nurse also expressed to me the importance of asking the patients how many pillows they sleep with at night. This is important because it can indicate how breathless the patient is. For example, if the patient sleeps with 1-2 pillows and this is their normal before they were diagnosed, then this is ok. However, if they have to sleep with more then 2 or in some cases have to sleep completely sitting up right or in a chair this shows that the patient is extremely breathless.

I learnt that the four pillar medication to treat heart failure is are ACEiS: Ramipril, Lisonopril, Enalapril/ARBs: Candesartan, Losartan, Valsartan/ ARNI: Sucubitril Valsartan (Entresro). Beta Blockers such as Bisoprolol, Nebivolol, Carvedilol. MRSAs: Eplerenone/ Spirononlactone. SGLT2s: Empagliflozin/ Dapagliflozin.

Diuretics such as Furosemide and Bumetanide may also be used for fluid offloading and symptom control if you have fluid retention.

During my placement today I cared for a patient with a tracheostomy who required routine tracheostomy care, including suctioning, changing the inner cannula and replacing the Swedish nose.

I firstly carefully removed the swedish nose and the inner cannula. I then began to suction through the outer cannula of the tracheotomy to remove any secretions this also helps the patient to cough, which aids in clearing the airway.

Once the airway was clear, I inserted the clean inner cannula and replaced the Swedish nose. After ensuring the patient was comfortable and stable I cleaned the used inner cannula in preparation for its next use.

This was a really good experience and it enabled me to get hands on with tracheostomy care and develop my skills and knowledge. However, I was nervous as it was my first time performing this skill. My aim for next time is to approach this skill with more confidence.

As part of a group task, three other students and I were asked to collaborate on a project related to ITU. After discussing various potential topics, we decided to focus on dignity. For our project, we created a poster that explored the importance of maintaining and promoting dignity for patients within ITU. We highlighted key principles of dignified care and included real-life scenarios we had observed during our clinical placements.

These examples helped show how dignity can be upheld in practice and emphasised the crucial role healthcare professionals play in advocating for patients rights and well-being. This project not only deepened my understanding of dignity in critical care environments but also highlighted the importance of empathy, respect, and advocacy in nursing practice.

I had the opportunity to follow a patient through to surgery and watch a tracheostomy be put into place. A tracheostomy is a surgical procedure creating a hole in the neck and windpipe to allow for breathing through a tube. The tube is called a tracheostomy tube and it provides an alternative airway, bypassing the nose and mouth.

I learnt that a tracheostomy can be temporary or permanent and is used for many reasons, including managing long-term respiratory support, or facilitating secretion clearance. I was drawn to how sterile the procedure was, I understand that this is very important because of the risk of infection.

I found watching the procedure interesting and I was amazed at how the procedure was done. However, it was also unsettling to watch because of the invasive nature of the surgery and the vulnerability of the patient. Seeing an opening made directly into the airway was a reminder of how critical these procedures are. The sound of surgical instruments and the sight of blood, made the experience intense and emotionally challenging.

This is a reflection on my time spent with the home dialysis team. Reflecting on my time with the home dialysis team, I feel a great sense of growth as I am able to develop my knowledge in dialysis. I was able to shadow amazing professionals, who gave me a good back ground on home dialysis and the benefits which has deepened my understanding of patient care and the importance of personalized treatment plans. I learnt that patients are able to dialysis at home and do it themselves. However, in order to dialysis at home themselves they have to be competent in cleaning their own dialysis line (central venous line). I was able to shadow the nurse in teaching the patient how to clean the line in the best and most sterile way as possible. The patients have to attend the training at the hospital for at least 3 weeks. This means the patient has to attend 3x a week for the next 3 weeks at the hospital to be shown how to clean their own line, be shown the dialysis machine and connect themselves.

Patients on home dialysis get delivery’s and are able to come into the hospital to collect stock. Once the patient is competent and the nurse and the patient are happy for them to dialysis independently at home, the nurse visits the patient once every 6 weeks to carry out assessments such as, relevant blood tests and to check their competency’s again. Personally I found home dialysis to have many benefits such as, more flexibility and better health outcomes. I was also able to speak to a patient on home dialysis and she said she is able to go on holidays now where as before when she had to come into the hospital 3x a week this was hard for her. Overall, I felt I had a positive experience with the home dialysis team and spending my time with the nurses and patients has contributed to my learning.