Apprenticeship Learning Log

Date of Learning: 28/05/2025

Time: 9:30 – 16:30

Title of learning activity: Living with the long-term conditions and end of life care.

Application of assessment tools. Skills session.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Long Term conditions (LTC) – generally last a year or longer and has an impact on person’s life. LTC cannot be cured but can be controlled by the medication.

Can be physical, neurological or mental health.

Living with a Long-Term Condition (LTC) have a range of impacts on an individual’s life, causing:

• Chronic pain or fatigue
• Reduced mobility or independence
• Ongoing need for medication or treatment
• Frequent hospital visits or medical appointments
• Anxiety or depression due to uncertainty or limitations

• Stress from managing symptoms
• Reduced self-esteem or identity changes
• Emotional strain from long-term care planning

• Social isolation or reduced participation in activities
• Strained personal relationships
• Difficulty maintaining employment or hobbies

• Loss of income due to inability to work
• Additional expenses for mobility aids or home adjustments

• Dietary or activity restrictions
• Dependency on others for support or care
• Changes in family dynamics

Understanding these impacts is crucial for providing comprehensive care and support individuals living with LTCs.

When planning care for individual’s with LTC, healthcare professionals should adapt highly recommended person – centred, holistic and collaborative approach. Creating a plan which tailor care adequate to each patient unique condition and preferences, covering individual’s lifestyle. Involving patient in decision making. Provide support with benefits, equipment and an access to the services. Collaborate effectively with other professional’s involved in patient care plan. Keep updating care plan to reflect on changes in condition or circumstances.

By taking these factors into considerations, professionals ensure, that care for people with LTCs is compassionate, effective, and aligned with important matters to the individual.

Principles of Person-Centred Care in End of Life

• Acknowledge the person’s unique values, beliefs, culture, and preferences.
• Always maintain the person’s dignity and offer care with empathy and kindness.
• Address physical, emotional, spiritual, and social needs.
• Ensure consistent care through effective communication among all healthcare providers.
• Enable individuals to express their wishes and maintain control over decisions about their care.
• Involve loved ones appropriately and support them through the process.

End of life care encompasses a wide range of aspects that support individuals who are approaching the end of life, as well as their families and carers.

Key elements in End-of-Life Care:

• Comfort and quality of life over cure
• Relief from pain and distressing symptoms
• Support for a peaceful, dignified death
• Bereavement support for family and friends

Bereavement Services offers:

• Emotional support for loved ones coping with loss.
• Professional-led groups for shared experiences and healing.
• Help with funeral planning, paperwork, and dealing with estates.

Living with a long-term condition and approaching the end of life are deeply personal experiences that affect every aspect of an individual’s life. Our care should reflect empathy, respect, commitment to making every moment count.

Second part of the day was dedicated to practical application of assessment tools. Based on certain scenario we were working collaboratively within a group. We analysed a given scenario to identify a patient long – term condition, adjusting relevant risk assessment framework.

KSBs addressed:

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care

K18: Understand and apply the principles and processes for making reasonable adjustments

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives

S10: Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

S31: Act in line with any end-of-life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences

Apprenticeship Learning Log

Date of Learning:21/05/2025

Time: 9:30 – 16:30

Title of learning activity: Smoking – a public health issue.

Introduction to public health and health promotion – alcohol consumption and healthy drinking.

Safeguarding children.

Delivering care in alternative settings workshop.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

The prevalence of smoking in the UK has reached a historic low. According to the Office for National Statistics (ONS) one of eight people in the UK smokes (11.9%) National smoking rates continue to decline.

Smoking has a significant and harmful impact on public health.

–  is a leading cause of preventable death.

–  it contributes to diseases such as: lung cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD).

–  long-term smoking damages every organ in the body and is associated with chronic respiratory conditions and various cancers (mouth, throat, pancreas, bladder)

–  smoking related illnesses lead to high medical expenses and place a heavy impact on healthcare systems increasing hospitalisations and long-term care.

– smoking contributes to reduced productivity due to illness, disability, and premature death, impacting the economy.

Public health interventions for smoking cessation involve a multi-faceted approach providing access to quit smoking services, utilising evidence-based treatments like nicotine replacement therapy and medications and implementing policies that reduce tobacco consumption.

Future public health initiatives that can enhance smoking cessation campaigns includes taxation of smoking, mass advertising campaigns in the media, peer education programs, community mobilization, motivational interviewing, health warnings on tobacco products, marketing restrictions, and banning smoking in public places.

Second subject on today’s session.

The implications of alcohol intake above the recommended levels of alcohol intake can have wide-ranging physical, mental, and social implications.

Physical Health Implications

1. Liver Damage
2. Cardiovascular Issues
3. Cancer Risk
4. Digestive Problems
5. Immune System Suppression
6. Reproductive Health

Mental and Cognitive Effects

1. Brain Function Impairment
2. Mental Health Disorders
3. Increased Risk of Dementia

Social Implication

1. Accidents and Injuries:

2. Work and Academic Issues

1. Violence and Crime:
2. Relationship Breakdown

Safe level of drinking

No more than 14 units per week, spread over 3+ days

• 1 unit = 10 mL (8g) of pure alcohol
• 14 units ≈ 6 pints of beer or 6 medium glasses of wine

To guide individuals in making healthier choices around their alcohol intake as a Nurse always start a conversation with empathy and respect, use open – ended questions, educate providing evidence-based information about the recommended unit, discuss the short- and long-term effect alcohol on health.

3^RD Subject on today’s session.

Safeguarding children L 2 refers to the actions taken to promote the welfare of children and protect them from harm. It is a legal and moral duty for anyone working with children—whether in education, healthcare, social care, or voluntary roles.

Types of Abuse

• Physical abuse
• Emotional abuse
• Sexual abuse
• Neglect
• Other concerns (e.g., child sexual exploitation, radicalisation, online abuse)

 Recognising Signs and Symptoms

• How abuse might present (physical, behavioural, emotional indicators)
• Risk factors and vulnerabilities

4^th Subject on today’s session.

National Health Service England, workshops on delivering care in alternative settings focus on expanding healthcare beyond traditional hospital walls, utilising technologies and partnerships to improve accessibility and quality of care. These workshops aim to equip healthcare professionals with the skills and knowledge needed to implement and manage these new models of care.

KSBs addressed:

K36: Understand the roles of the different providers of health and care

S6: Act as an ambassador for their profession and promote public confidence in health and care services

S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges

S11: Report any situations, behaviours or errors that could result in poor care outcomes

S22: Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that concerns are escalated

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required

S35: Accurately undertake risk assessments, using contemporary assessment tools

S36: Respond to and escalate potential hazards that may affect the safety of people

S37: Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies

Apprenticeship Learning Log

Date of Learning:14/05/2025

Time: 9:30 – 16:30

Title of learning activity: Health Promotion in Older People.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Health promotion in older people, focus on maintaining and improving physical and mental well-being, enhancing functional capacity, and promoting social engagement to foster independence and quality of life.

Physical Health Impacts of Ageing

1. Musculoskeletal System

• Decreased muscle mass and strength (sarcopenia)
• Joint stiffness and pain, often due to osteoarthritis
• Bone density loss, increasing the risk of fractures (osteoporosis)

2. Cardiovascular System

• Reduced heart efficiency – the heart may pump less effectively
• Increased blood pressure
• Higher risk of heart disease and stroke

3. Respiratory System

• Decline in lung capacity
• Less efficient oxygen exchange, making physical exertion harder

4. Sensory Changes

• Hearing loss
• Vision decline, including difficulty seeing at night or reading small print
• Reduced taste and smell, which can affect appetite and nutrition

5. Immune System

• Weakened immune response, making infections more frequent and recovery slower

6. Digestive System

– Slower digestion

– Greater risk of constipation

– Reduced nutrient absorption

7. Skin and Hair

• Thinning skin, more prone to bruising and injury
• Hair thinning and greying

 Mental Health Impacts of Ageing

1. 1. Cognitive Changes

• Slower processing speed and reduced multitasking ability
• Mild memory lapses are normal, but significant memory loss may signal dementia
• Increased risk of cognitive disorders, including Alzheimer’s disease

2. Emotional and Psychological Well-being

• Increased risk of depression and anxiety, often linked to isolation, loss of independence, or bereavement
• Sense of purpose may decline after retirement or loss of social roles
• Grief and loneliness are common due to the loss of peers or partners

3. Sleep Patterns

• Changes in sleep architecture, such as lighter sleep and waking more often
• Insomnia and sleep disorders become more common

4. Mental Resilience

• Some older adults show increased resilience, better emotional regulation, and life satisfaction
• Wisdom and life experience often contribute to emotional strength

Evidence-based activities can support the health and wellbeing in older people.

Physical Activity Programs, community walking groups, chair-based exercises, tai chi, yoga, swimming. Improves mobility, balance, and strength, reduces fall risk, enhances cardiovascular health and mental wellbeing.

Older adults face a range of physical, emotional, and social challenges that can impact their overall wellbeing. As a nurse, recognising these challenges and providing holistic, person-centred care is essential.

• Be a patient advocate: Ensure their voice is heard and respected.
• Deliver holistic care: Address physical, emotional, social, and spiritual needs.
• Foster trust and dignity: Treat everyone with respect and empathy.
• Support family and caregivers: Include them in care planning and provide education and reassurance.

KSBs addressed:

S6: Act as an ambassador for their profession and promote public confidence in health and care services

S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges

S8: Recognise signs of vulnerability in self or colleagues and the action required to minimise risks to health

S9: Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

2 nd Tri – partite, THLS – Feb, March, April

• Rising rates of anxiety, depression, and self-harm in children and adolescents.
• Increased demand for CAMHS services, with long waiting times.
• Impact of social media, bullying, and academic pressure on mental wellbeing.

• Nearly 1 in 3 children aged 10–11 in England is overweight or obese.
• Linked to increased risk of type 2 diabetes, heart disease, and low self-esteem.
• Decreased levels of daily physical activity and poor diet.

• Rising concerns about domestic abuse, neglect, and exploitation (e.g., county lines, online grooming).
• The cost-of-living crisis has increased vulnerability in some families, leading to housing instability and food insecurity.

• Delayed developmental assessments, autism/ADHD diagnoses, and speech therapy due to long NHS waiting lists.
• Health inequalities—children from low-income or minority ethnic groups often experience poorer outcomes.

• Drop in routine childhood vaccination uptake (e.g. MMR, HPV), partly due to misinformation and service disruption from the pandemic.
• Increases in measles outbreaks and respiratory infections in children.

• Increase in vaping, cannabis use, and alcohol experimentation in adolescents.
• Links to mental health issues and risk-taking behaviours.

• Substance abuse (e.g., alcohol, tobacco, drugs)
• Early and unprotected sexual activity
• Self-harm and suicidal behaviour
• Violent or criminal activity
• Risky driving and accidents

Apprenticeship Learning Log

Date of Learning: 30/04/2025

Time: 9:30 – 16:30

Title of learning activity: Introduction to Public Health and Health Promotion (Social Determinants of Health and Cultural Influences. Epidemiology and Demographics)

Introduction to the oxygen therapy.

Public Health – is the science and practice of preventing disease, prolonging life, and promoting health through organised efforts of society, organisations, public and private sectors, communities, and individuals. It focuses not just on treating illness, but on preventing it and addressing the factors that lead to health disparities.

Health Promotion – involves enabling people to increase control over, and improve, their health. This includes education, policymaking, and community development aimed at fostering healthier lifestyles and environments.

Social determinants of health – refer to the non-medical factors that influence a person’s health outcomes, including their living and working conditions, social relationships, and overall well-being. These determinants significantly impact health equity, influencing factors like access to healthcare, education, employment, and quality of life. 

Cultural influences significantly impact health in various ways, affecting perceptions of illness, treatment seeking behaviour and overall health outcomes. Cultural beliefs, values, and traditions shape how individuals understand health, define illness, and engage with healthcare systems. Furthermore, cultural factors can influence mental health, access to care, and adherence to treatment recommendations.

Epidemiology is the study of how diseases spread, their patterns, causes, and effects in populations. It provides essential data for:

• Identifying risk factors
• Designing public health interventions
• Evaluating health services
• Tracking outbreaks and health trends

Demographics – are crucial for tailoring health promotion strategies to specific population groups.

Demographics refer to statistical data about populations, such as: age, gender, ethnicity, income, and education levels. These data help to understand population health needs, plan and allocate healthcare resources, identify vulnerable groups, forecast future public health trends.

Disease surveillance is the ongoing collection, analysis, and interpretation of health data essential for planning, implementation, and evaluation of public health practice.

Epidemiology helps define what to monitor (e.g., symptoms, transmission patterns).

Demographic data pinpoints where to focus efforts and what populations are at risk. Enables early detection of outbreaks (e.g., flu, COVID-19) Facilitates response planning, including isolation, vaccination, and communication strategies.

Social factors influencing health – often referred to as the social determinants of health – the conditions in which people are born, grow, live, work, and age. These factors have a profound impact on health outcomes and are shaped by the distribution of money, power, and resources.

Associations between social class, gender, and ethnicity with health is a key to addressing health inequalities. Factors interact in complex ways, influencing access to healthcare, quality of treatment, and health outcomes.

 Social Class and Health Association – People from lower socioeconomic classes often have worse health outcomes.

Reasons include:

• • Poor housing and working conditions
  • Lower educational attainment
  • Limited access to nutritious food
  • Higher exposure to environmental risks
  • Reduced access to healthcare and preventative services

Working-class communities in industrial areas often experience higher rates of chronic illnesses (e.g., heart disease, diabetes) and lower life expectancy.

 Gender and Health Association – women generally live longer than men but often report poorer mental health and are more likely to suffer from conditions like depression or anxiety. Men are more likely to engage in risky behaviour, less likely to seek help, and have higher rates of fatal illnesses and suicide. Gender also affects access to healthcare, especially for trans and non-binary individuals, who may face discrimination or lack of appropriate services. Men in manual labour jobs may have higher rates of injuries and occupational diseases. Women may face delays in diagnosis of conditions like heart disease because symptoms are often studied based on male models.

Ethnicity and Health Association. Ethnic minority groups may experience poorer health outcomes due to racism and discrimination, cultural and language barriers in healthcare, socioeconomic disadvantages, genetic predispositions (e.g., higher rates of sickle cell anaemia in black populations) Black and South Asian communities in the UK have higher rates of Type 2 diabetes and cardiovascular disease. Indigenous populations (e.g., in Canada or Australia) often have much lower life expectancy and higher rates of chronic disease compared to non-Indigenous populations.

Theories of the social determinants of health (SDOH) aim to explain how social, economic, and environmental conditions influence health outcomes. These theories provide frameworks for understanding the root causes of health disparities and guide policy and intervention strategies.

Oxygen therapy is a medical treatment, provides supplemental oxygen to individuals who are unable to get enough oxygen naturally through breathing. It is commonly used in hospitals, clinics, and sometimes at home to treat conditions that affect the lungs or overall oxygen levels in the blood.

The main purpose of oxygen therapy is to:

• Increase the amount of oxygen in the blood.
• Reduce the work of breathing.
• Relieve symptoms such as shortness of breath and fatigue.
• Improve overall tissue oxygenation and organ function.

Conditions Treated with Oxygen Therapy

• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia
• Asthma (during severe attacks)
• Pulmonary fibrosis
• Heart failure
• Sleep apnea (with devices like CPAP or BiPAP)
• COVID-19 and other respiratory infections

Oxygen can be delivered using various devices depending on the patient’s needs:

Nasal cannula – A lightweight tube with two prongs that fit into the nostrils.

Face mask – Covers the nose and mouth for higher oxygen concentration.

Non-rebreather mask – Provides high levels of oxygen.

Venturi mask – Delivers a precise oxygen concentration.

Mechanical ventilators or CPAP/BiPAP machines – For patients with severe respiratory distress or sleep apnea.

Oxygen is considered as medication, which should be carefully prescribed and monitored to ensure the correct dose (litre per minute or oxygen concentration) prevent complications such as oxygen toxicity or carbon dioxide retention.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

KSBs addressed:

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes

K11: Understand the factors that may lead to inequalities in health outcomes

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

Apprenticeship Learning Log

Date of Learning: 05/03/2025

Time: 9:30 – 16:30

Title of learning activity: Comprehensive Patient Assessment.

Clinical judgement and shared decision making.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

On today’s session we were able to interact in group activities in Comprehensive patient assessment, clinical judgement and shared decision making. Considering certain scenario:

Harriet used to be a healthy child, never missed a day at school. Unfortunately, due to increasing numbers of pupils developing chest infection, Harriet has been admitted to the hospital with suspected chest infection. Based on given information’s our goal was to assess the patient, make a clinical judgement and care plan. Considering shared decision making.

Comprehensive Patient Assessment (CPA) is a holistic, systematic process that evaluates the physical, psychological, social, and functional aspects of a patient’s health. It goes beyond symptom-checking to understand the full picture of a patient’s needs, supporting safe, personalised, and effective care.

Key Components of CPA:

1. History Taking – including medical, surgical, medication, family, and social history.
2. Physical Examination – systems-based, tailored to presenting complaints.
3. Mental Health Assessment – mood, cognition, behaviour, and risk factors.
4. Functional Assessment – activities of daily living (ADLs), mobility, and support needs.
5. Social and Environmental Factors – home situation, carers, safeguarding, and socioeconomic status.

Clinical Judgement, refers to the cognitive process used by healthcare professionals to evaluate information, consider alternatives, and make informed decisions about patient care. It draws on knowledge, experience, guidelines, and evidence-based practice.

Elements of Clinical Judgement:

• Pattern recognition (based on experience)
• Analytical reasoning (especially in complex or unfamiliar cases)
• Use of clinical guidelines (e.g. NICE guidelines)
• Awareness of biases and uncertainties
• Risk assessment and prioritisation

Clinical judgement is critical in:

• Escalating care (e.g. NEWS2 scores)
• Prioritising referrals
• Balancing benefits vs risks of interventions
• Safeguarding decisions

Shared decision-making (SDM) is a collaborative process where patients and healthcare professionals make health decisions together, considering clinical evidence and the patient’s values, preferences, and circumstances.

Principles of SDM:

• Respect for autonomy
• Clear communication of risks, benefits, and options
• Use of decision aids (e.g. NHS SDM tools)
• Patient empowerment through education and support
• Documenting decisions and reasoning

Benefits of SDM:

• Improved patient satisfaction
• Better adherence to treatment plans
• Reduced decisional conflict
• Enhanced health outcomes

Integrating CPA, Clinical Judgement, and SDM

In practice, these three elements interact as follows:

1. CPA provides the data — gathering a full understanding of the patient’s condition and context.
2. Clinical judgement interprets the data — applying knowledge to identify priorities, diagnoses, and interventions.
3. SDM involves the patient — ensuring care is tailored to the individual’s goals and preferences.

Example in Practice:

Child (Harriet) admitted to the hospital with suspected chest infection.

Healthcare Professional action.

• Conducts a comprehensive assessment (physical exam, meds review, home risks).
• Uses clinical judgement to link hypotension and medication side effects.
• Engages in SDM with the patient and family to adjust the care plan, including community support and therapy referrals.

Comprehensive patient assessment, supported by sound clinical judgement and underpinned by shared decision-making, is fundamental to delivering high-quality, person-centred care. This approach aligns with NHS values of compassion, partnership, and respect for individual dignity.

KSBs addressed:

K11: Understand the factors that may lead to inequalities in health outcomes

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care

S2: Keep complete, clear, accurate and timely records

S3: Recognise and report any factors that may adversely impact safe and effective care provision

S10: Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions

Apprenticeship Learning Log

Date of Learning: 26/02/25

Time: 9:30 – 16:30

Title of learning activity: Behaviour change and motivational interview.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

On today’s session we were discussing behaviour change and motivational interview.

Behaviour change strategies are used to help patients make healthier lifestyle choices — like quitting smoking, improving diet, increasing physical activity, reducing alcohol intake, and managing long-term conditions.

We established commonly used modules by Healthcare Professionals:

1. COM-B Model (Capability, Opportunity, Motivation – Behaviour)
   • Core to the Behaviour Change Wheel (by Susan Michie)
   • Behaviour = result of:
     • Capability (knowledge, skills)
     • Opportunity (external factors)
     • Motivation (internal drives)
2. Transtheoretical Model (Stages of Change)
   • Precontemplation → Contemplation → Preparation → Action → Maintenance

3. 5 A’s Approach (Ask, Advise, Assess, Assist, Arrange)

Motivational Interviewing (MI) – is a counselling method used widely by the Healthcare Professionals to enhance motivation and support patients in making positive changes. MI is an effective way of talking with people about the changes.

To process motivational interview successively, we must establish a key principles of MI

1. Express Empathy – Use reflective listening to understand.
2. Develop Discrepancy – Help clients see the gap between current behaviour and goals/values.
3. Roll with Resistance – Don’t confront or argue; redirect resistance.
4. Support Self-Efficacy – Reinforce belief in ability to change.

Core skills need it in Motivational Interview (Also known as OARS)

• Open-ended questions
• Affirmations
• Reflective listening
• Summarising

People have impressive capacity to change themselves.

Example:

“What are some things you’ve thought about changing in your lifestyle lately?”
“What would make that change important to you?”

Emotional Interview is commonly used within NHS in:

• Health coaching
• Stop smoking services
• Weight management
• Diabetes and heart health support
• Substance misuse services
• Mental health services

During the second part of the day, we were introduced to injections. We also had an opportunity to practice injections on the skin imitation model.

Giving injections as a Nursing Associate Student is a common and important clinical skill, and it’s something I will regularly do in practice.

Types of Injections:

1. Intramuscular (IM) – e.g., vaccines, B12 injections
2. Subcutaneous (Subcut or SC) – e.g., insulin, heparin
3. Intradermal (ID) – e.g., TB testing
4. Intravenous (IV) – if trained, for meds or fluid therapy

Step by step in practice:

1. Check the prescription – Using the Medication Administration Record (MAR) or EPMA.
2. Gather equipment – Correct syringe size, needle, alcohol wipes, gloves, sharps bin, etc.
3. Check the “6 Rs” of medication administration:
   • Right patient
   • Right drug
   • Right dose
   • Right route
   • Right time
   • Right documentation
4. Prepare the medication – In a clean area, following aseptic technique. Reconstitute if needed.
5. Patient communication – Explain the procedure, gain consent, and assess the injection site.
6. Give the injection:
   • Clean the site (depending on protocol)
   • Insert the needle at the correct angle:
     • IM: 90°
     • Subcut: 45–90°
     • ID: 10–15°
   • Inject slowly
7. Dispose of sharps – Immediately into the sharps bin.
8. Document everything – Time, site, medication, dose, batch number (for vaccines), and any patient reactions.

Important aspect to be considered:

• Always work under your scope of practice – Only administer injections if you’re trained and competent.
• Follow trust policies – Each NHS Trust may have slightly different protocols or guidelines.
• You may be required to demonstrate competence through supervised practice and documentation.

Tips from Practice:

• For IM injections, the ventrogluteal site is often preferred over the dorsogluteal for safety.
• Rotate Subcut injection sites to avoid lipodystrophy (common with insulin).
• For nervous patients, talking to them or using distraction techniques helps.
• Always check allergies, especially with vaccines or antibiotics.

Pink/ red needle with filter used to get medication/ inserted into syringe.

Yellow needle used for skin injection, use in 45-degree angle

Blue needle used for muscle injection, use in 90 – degree angle

KSBs addressed:

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

S6: Act as an ambassador for their profession and promote public confidence in health and care services

S17: Protect health through understanding and applying the principles of infection prevention and

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

K11: Understand the factors that may lead to inequalities in health outcomes

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity

Apprenticeship Learning Log

Date of Learning: 19/02/2025

Time: 9:30 – 16:30

Title of learning activity: The Nursing Process and Care Planning.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

On today’s session we were discussing two very important and closely related concepts in healthcare, forming a systematic approach to patient care.

The Nursing process is a four – steps framework called: APIE

A – assess

P – plan

I – implement

E – evaluation

Used by Nurses to deliver quality, person centred and holistic care.

During patient assessment we identify patient needs. Checking patient Vital Signs.

During planning we established the changes and the impact on the problem and how to solve it. Making patient condition better.

During implementation, we carry out the planned intervention and provide care to achieve the goals, which is patient better condition or condition before nurse’s intervention.

Evaluation is a final step involves assessing the effectives of the interventions and adjusting the plan as needed.

Care planning is a written document that outlines the plan of care developed through the nursing process. It acts as a communication tool for healthcare professionals, ensuring continuity and coordination of care.

Nursing process and care planning improves:

1. Quality care. The structured approach of the nursing process and care planning ensures that care is delivered in systematic and comprehensive manner.
2. Patient safety, by documenting and following a plan of care, nurses can minimalised errors and ensure that patient receive the appropriate interventions.
3. Improved communications, care plans facilitate communication among healthcare professionals, ensuring everyone is aware of the patient’s needs and plan of care.
4. Patient involvement, care planning can be a collaborative process, involving the patient and their family in the development of their care plan.
5. Improved outcomes by using the nursing process and care planning, nurses can work towards achieving positive patient outcomes.

Second subject discussed on today’s session was, Health Promotion – the process of enabling people to exert control over the determinants of health and improves their health.

Five core principles of health promotions:

• broad health concept
• participation
• action competence
• setting perspective
• health equality

Health promotion is essential, as healthier population creates better economy.

The Ottawa Charter for Health Promotion is a foundational document in public health. It was developed at the First International Conference on Health Promotion, held in Ottawa, Canada, in 1986, and organized by the World Health Organization (WHO).

The Ottawa Charter outlines five key action areas for health promotion:

1. Build Healthy Public Policy
   • Health should be a central consideration in all areas of policy (e.g., transportation, housing, education).
   • Example: Implementing smoking bans or seatbelt laws.
2. Create Supportive Environments
   • Focus on making environments where people live, work, and play safe and supportive of healthy living.
   • Example: Clean air policies, safe walking paths, access to parks.
3. Strengthen Community Action
   • Empower communities to take control of their health by increasing participation and ownership.
   • Example: Community-led health campaigns or support groups.
4. Develop Personal Skills
   • Provide education and support to help people make healthy choices.
   • Example: Health education in schools, workshops on nutrition or mental health.
5. Reorient Health Services
   • Shift the focus from treatment to prevention and health promotion.
   • Example: More community-based services, preventive care programs.

Underlying Principles:

• Empowerment – Enabling people to take control of their health.
• Holistic view of health – Health is a resource for everyday life, not just the absence of disease.
• Equity – Reducing health disparities.
• Participation – People should be actively involved in decisions affecting their health.
• Intersectoral collaboration – Health promotion involves many sectors, not just healthcare.

KSBs addressed:

K11: Understand the factors that may lead to inequalities in health outcomes

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions

S23: Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate

S24: Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care

Apprenticeship Learning Log

Date of Learning: 18/02/2025

Time: 9:30 – 16:30

Title of learning activity: Introduction to promoting health and well – being across the lifespan.

Person Centred Care.

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Today we started a new Module 2024.25 Promoting health and well – being across the lifespan – CNR 020C113S

Health – According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”

Well – being – is not just the absence of disease or illness. It’s a complex combination of a person’s physical, mental, emotional and social health factors. Wellbeing is strongly linked to happiness and life satisfaction.

Well – being could be described as how you feel about yourself and your life.

Health promotion – is the process of enabling people to increase control over their health, and to improve, health aspect. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

Health Education England is an executive non-departmental public body of the Department of Health and Social Care. Its function is to provide national leadership and coordination for the education and training within the health and public health workforce within England. It has been operational since June 2012.

Role of the Nurse in Public Health

Public health nurses focus on:

• preventing illness,
• promoting health,
• protecting populations.

Their work is not just clinical but also deeply rooted in the social determinants of health and community well-being.

Key Roles:

• Health Surveillance: Monitoring disease trends and outbreaks (e.g., vaccinations, COVID-19 response).
• Community Assessment: Identifying at-risk populations and assessing needs for interventions.
• Advocacy & Policy Influence: Advocating for policies that improve access to healthcare, healthy environments, and equity.
• Program Implementation: Delivering public health programs (e.g., smoking cessation, maternal health).
• Emergency Preparedness & Response: Assisting during pandemics, natural disasters, and other public health emergencies.

Role of the Nurse in Health Education

Health education is all about empowering individuals and communities to make informed health choices. Nurses are uniquely positioned to educate due to their trust-based relationship with patients.

Key Roles:

• Health Promotion: Teaching about nutrition, exercise, mental health, etc.
• Disease Prevention: Educating about screenings, vaccinations, and lifestyle changes to avoid chronic illnesses.
• Individual Teaching: Providing one-on-one education on managing conditions (e.g., diabetes, hypertension).
• Group Education Sessions: Running workshops or community events (e.g., parenting classes, sexual health education).
• Cultural Competence: Tailoring health messages to diverse populations for better engagement and understanding.

Skills to Support Nursing Roles:

• Communication and teaching techniques
• Cultural sensitivity and inclusiveness
• Data analysis and interpretation (epidemiology basics)
• Leadership and interprofessional collaboration
• Knowledge of local health systems and resources

Person-Centred Care (PCC) is a fundamental principle within the NHS (National Health Service) that puts people at the heart of their own care. It’s about treating individuals with:

–  dignity

                   –  compassion

–  respect

Working collaboratively to ensure their preferences, needs, and values guide all clinical decisions.

KSBs addressed:

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health

K3: Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and well-being required to meet people’s needs for mental and physical care

K4: Understand the principles of research and how research findings are used to inform evidence-based practice

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice

K7: Understand the importance of courage and transparency and apply the Duty of Candour

K8: Understand how discriminatory behaviour is exhibited

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes

K11: Understand the factors that may lead to inequalities in health outcomes

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

K14: Understand the importance of health screening

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care