For my episode of care I did district nursing with my practice supervisor. On this day according to our handover we visited eight patients. All care was done under the supervision of my practice supervisor. The care of the patients were prioritised by checking the blood glucose level of the diabetics patients and administer their insulin. Consent is always gained and the reading of patients care plan before any nursing care maintaining confidentiality, dignity and privacy. Three of the patients were diabetes. One patient had libra on. Blood glucose was checked post breakfast and insulin given. I checked two of the patients their blood glucose before administering their insulin with pen insulin and insulated. Before I administered any medication I always abided to my six rights of medication administration, expiring date, batch number, allergies and my hand hygiene. The rational for checking the blood glucose is to know the level before administering the insulin. To know whether the patient is hypoglycaemia or hyperglycaemia. One patient had her tracheostomy neck strap changed. Myself and my supervisor washed the patient`s neck and changed the strap. The rational was to have the neck cleaned with clean strap provided as a routine. I administered enoxaparin injection to one patient to prevent blood clot. Together with my practice supervisor we undress and redressed the bilateral leg ulcers of a patient. The patients legs were swollen and exudated. We washed both legs and applied different dressings complying to infection control policy. The dressings applied were viscos paste, zetuvit pad, k-soft, k-lite and yellow line. The rational of the care of the leg ulcers was to help with its healing and to prevent any infection. We visited this patient who had pressure ulcer wound on the hand. The old dressing was taken off the wound cleaned and aquacel foam dressing applied. All pressure areas were checked and the patient was made comfortable. All care was delivered under supervision, documented on hard copy and emesis.

Effective communication always took place, person- centred as patients were always involved in their care and everything was evidence based.

This episode of care took place in a surgical ward. I taught a healthcare assistant (HCA) how to perform an electrocardiogram (ECG). I taught her the purpose of performing it and what to look for. The patient complained of chest pain and to overrule any heart rhythm problem, angina, myocardial infarction, or heart inflammation. The nurse was asking the HCA to do an ECG on him before calling the doctor. Since she was not confident enough to do it I volunteered to do it and teach her simultaneously. I first went to the patient who was alert and awake lying on his bed with the HCA, introduced ourselves and gained consent as to performing ECG on him due to the complain of chest pain. I then read his care plan to know of his diagnose and past medical history. I explained to him that I will be performing the skill and be teaching my colleague at the same time which he accepted. I then went for the ECG machine checked to make sure it is working and also had enough skin tact for performing the skill. On the ECG machine it had a human picture indicating where to put the ECG Leads so I used that as my teaching aid. I encourage the HCA to look at the picture and see where the leads has been placed. I then explained to the HCA the purpose of the skill although it is called 12 leads we will place 10 leads and also where all the skin tacts will be on the patients body. I explained to her that the ECG is to be done to record the electrical impulses that come from the heart. After explaining to her all that I am going to do, I asked her to paraphrase all that I have taught her to make sure she is having the understanding of what I taught her. I also tried to ask her questions all to check her understanding. Afterwards, we went to the patient bedside together with my practice assessor. Gain consent again from the patient and pull the curtains to maintain the patient’s dignity and privacy.I communicated effectively to both the patient and the HCA at every stage of the procedure. I told the HCA to ask me any questions in the process.

It was when I was applying the skin tact on the patient’s bare chest the V1 and V2 that is counting down the fourth intercostal space immediately both right and left of the sternum. I noticed they were not staying due to the hair on the patient’s chest. I then explained to the HCA that this problem was occurring because of the hair so with the patients permission I used razor to get the hair off all the body part to stick the skin tact. That was when I explained to the HCA to always first check the patients skin part where the tacts will be applied and get it ready before starting the ECG. I then asked the HCA the position of the human heart as to the reason of the position of the 6 skins tact on the Left side of the chest. I was communicating with the patient at every stage to make sure he was comfortable and also to be aware of what I was doing. I then taught her where to put the skin tact on the limbs. She knew only of the shoulder, so I explained to her that it can be put on the right and left arm too, including the two legs. I then attached the electro leads V1 and V2 back then V3 midway between V2 and V4, V4 is fifth intercoastal space mid clavicular line, V5 same horizontal level as V4 anterior axillary line, V6 same horizontal level as V4 mid-axillary line on the chest. Then the RA attach Red lead, LA attach yellow lead, RF attach black lead and LF attach green lead also to the limbs.

After all the teaching, I removed all the leads and the skin tacts, then made the HCA put them back on while I observed and supervised. She managed to put all the skin tact correctly on the patient which I confirmed. The HCA confidently attached all the V1-V 6 leads on the chest wall securely. She was not attaching the limbs lead correctly. That was when I corrected her. She then did it correctly. I taught her this sentence, “Ride Your Green Bike.” This was to guide her always when attaching the limb leads. She was grateful for the correction and was able to attach the skin tact and limb leads correctly. I also observed her communication and involvement with the patient to make sure there was person-centered care. After the application of all the leads I then printed the ECG from the machine while the HCA observed. Afterwards, I made her also to print a copy after learning how to operate the ECG machine since it was not complicated. On completion, the leads were taken out and the skin tact removed. The patient put on his hospital gown and made comfortable. Curtain pushed back and the ECG machine was cleaned before returned to the store room. I also taught her to make sure to document the patients details on the ECG immediately it is printed out that is the patient Name, Date of birth and hospital number before giving it to the nurse who will then show to the doctor. I supervised her while she put the patient details on the ECG. I did a little reading of the ECG with her due to her level. I showed her the P wave, QRS, and the T wave. I asked the HCA how she felt about the whole teaching she said she was grateful since she has learned something new in addition to what she already knew. The HCA said she has gained more confidence in performing ECG on a patient. I told her that she is a fast learner and has done well. I also told her to perform more ECG on patients to make her more competent. I also discussed how she was confused in attaching the limb leads and advised her to always remember the sentence I taught her. It will help her to attach the leads correctly. I was proud of myself with the idea that someone had acquired knowledge from me. My assessor then looked at the ECG before I handed it over to the doctor. She read it then went to assess the patient.