Date: 15/11/2024

Time: 9:30am – 04:30pm

Title: Electronic Practice Assessment Document (ePAD)

Today we looked at the ePAD, which is used by student Nursing Associates to document their progress, skills, and competencies throughout the placement. It includes various sections like placement orientation, initial interview, allocation of practice assessor and supervisor, professional values in practice, midpoint interview, assessment of proficiencies, obtaining feedback from service users, mentors, and other students.

The ePAD ensures I develop competencies to deliver safe and effective care. It also supports clear communication between students and mentors regarding progress and areas needing improvement. Using the ePAD also allows me to take ownership of my learning, identify my strengths and weaknesses and continually improve.

At my practice placement, I will ensure I set specific and measurable, attainable, relevant and time bound goals for each practice area. For instance, if a skill requires further development, I will arrange additional practice with my practice assessor. I will also consistently update and reflect in my ePAD.

Later, each of us were asked where our placement was and what we expect to learn from them. I will be working in a neuro-behavioural unit, and I expect to learn the behaviour and neurological conditions, how to identify these behaviours and how to communicate with them effectively.

KSB addressed:

K1: Understand the Code: Professional standards of practice and behaviour for Nurses, Midwives and Nursing Associates (NMC, 2018), and how to fulfill all registration requirements

k7: Understand the importance of courage and transparency and apply the Duty of Candour

S1: Act in accordance with the Code: Professional standards of practice and behaviour for Nurses, Midwives and Nursing Associates (NMC, 2018), and fulfill all registration requirements

S2: Keep complete, clear, accurate and timely records

S4: Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills

S5: Safety demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for Nursing Associates Annex A & B (NMC 2028)

Date: 11/11/2024

Time: 10:30pm – 03:30am

Title: Immune/Lymphatic System

The immune and lymphatic systems work together to protect the body from infection and maintain fluid balance. The lymphatic system includes lymph nodes, lymph vessels, lymphatic organs which filter and destroy micro-organisms. The immune system consists of white blood cells, antibodies, lymphatic systems that identify and destroy pathogens. There are two types of immunity:

Non-specific/Innate Immune System: This is the body’s first line of defence against pathogens and harmful substances. It’s acts quickly on pathogens and does not require activation.

·      Physical Barriers – These are the parts of the body that first come in contact with potential pathogens. They include skin, mucous membranes.

·      Chemical Barriers – These are bodily secretions that contains enzymes like lysozyme, stomach acid, sweat.

·      Complement System – These are chemicals that are always circulating in the blood and when they are triggered, they form a membrane attack complex.

·      Inflammatory Response – When tissues are injured or infected, chemicals like histamine are released. Cardinal signals of inflammation include redness, swelling, heat, pain.

Specific/Adaptive Immune System: They respond to specific pathogens and requires activation. It also forms memory cells to protect from future attacks. The adaptive immune system does not respond as quickly as innate immune systems. Keys components of the adaptive immune system include B cells (which produce antibodies) and T cells (which help destroy infected cells or coordinate immune responses)

Recognising the roles of immune and lymphatic systems is essential for effective care planning. As a student Nursing Associate, observing symptoms like fever, unusual inflammation could indicate infections or Immune related disorder requiring timely intervention. It also underscores the importance of infection control practices to prevent pathogens from compromising these systems.

Moving forward, I will work on developing my skills in clinical observation regarding immune health. Reflecting on future experiences and incorporating lessons learnt into my practice will strengthen my ability to care for patients who may have conditions affecting these systems.

KSB addressed:

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed

S39: Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately

Date: 07/11/2024

Time:10pm – 02:00am

Title: Sensory Systems

Sensory systems are responsible for processing information from our environment, and they include five senses: sight, taste, smell, hearing, and balance. Each sense has specialised organs and neural pathways that work to interpret stimuli. For example, the visual system involves the eyes and optic nerves, translating light into images while the auditory system uses the ears to process sound waves.

As a student Nursing Associate, learning and understanding the sensory systems is important for providing holistic care and are vital for everyday functioning and their impairment can significantly impact an individual’s quality of life. Working with elderly patients, I may frequently encounter age related changes in sensory functions such as reduced taste perception or hearing loss, which can impact diet and social interaction. And so, recognising the early signs is very crucial.

In future, I will look out for patients who are at higher risk of sensory loss focusing on sensory assessments, so that adequate care can be given as soon as possible. I will also learn and practice effective strategies with patients who have sensory impairments, ensuring they feel understood and supported.

KSB addressed:

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

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed

S39: Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately

Date: 06/11/2024

Time: 09:30 -04:30

Title: The Renal/Urinary System and Basic Life Support

The renal/urinary system consists of two kidneys, two ureters, one bladder and one urethra. It is responsible for maintaining fluid and electrolyte balance, filters blood and regulate blood pressure. There are three processes by which urine is formed. Filtration is where blood is filtered to remove solutes and produce filtrate. Selective reabsorption is whereby useful substances from the filtrate are reabsorbed back into the blood. Secretion is whereby harmful substances are secreted from the capillaries into the renal tubule.

The renal system is important for assessing and monitoring patient’s blood pressure and fluid balance. It also maintains homeostasis by regulating the amount of hydrogen ions, making sure we excrete the right amount of sodium/chloride ions.

In future, I will need to recognise signs of distress such as reduced urine output and respond quickly to prevent serious conditions. I will also observe renal assessment practices in my clinical placements to gain experience.

Later in the afternoon, we all went into the clinical area to practice basic life support using the acronym DRSABC

D- Danger

R- Response

S- Shout

A-Airway

B- Breathing

C- Call for help/Compression

For adults, 30 compressions and 2 breaths while for children is 15 compressions and 2 breaths. Cardiopulmonary resuscitation should only be stopped-

·      When help arrives

·      When the person wakes up

·      When exhausted

·      When do not resuscitate (DNR) form is in place

·      When there is danger

Basic life support skills are important for responding to life threatening situations. As a student Nursing Associate, knowing how to perform basic life support enables me to act quickly and confidently when someone is unconscious and stops breathing.

I will practice my basic life support regularly through stimulations and refresh my skills frequently to ensure I am prepared for any emergency. Observing code blue situations, if possible, in my place of placement will allow me to observe experienced professionals manage emergency responses.

KSB addressed:

K14: understand the importance of health screening

k16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care

k22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel movement

S4: Take responsibility for continuous self reflection, seeking and responding to support and feedback to develop professional knowledge and skills

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

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

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed

Date: 30/10/2024

Time: 09:30 -04:30

Title: Equality, Diversity, and Inclusivity / A-E Assessment

During the lesson i learnt in nursing, equality, diversity, and inclusivity are essential in ensuring that all patients receive, fair, individualised, and respectful care regardless of their age, sex, race, disability, religion/belief, marriage/civil partnership, pregnancy/maternity, sexual orientation, gender re-assignment.

Understanding patient’s diverse needs is critical for delivering high quality care. Equality in nursing means ensuring that all patients are being given equal opportunities and treated fairly while diversity involves recognising and valuing the unique background of each patient such as race and sexual orientation. Inclusivity is about creating a healthcare environment where everyone is included, valued, and respected irrespective of their differences. A failure to consider equality, diversity and inclusivity can lead to misunderstanding, reduced patient satisfaction and health disparities.

In future, I will avoid making assumptions and create safe environments for patients to express their needs and make an effort to understand and respect diverse cultural practices. I will also commit myself in attending workshops and training sessions.

During the afternoon, we looked at A-E Assessment which is an approach used evaluate a patient’s condition and respond promptly to any life-threatening issues.

A-Airway (Patent)

B- Breathing (Respiratory rate and oxygen saturation(spo2))

C- Circulation (Heart rate, blood pressure and capillary refill time (crt))

D- Disability (debrain, blood sugar, drug & allergy and disability)

E- Exposure (Check every surface of the body)

Each step is a systematic check, often repeated as necessary, to assess and prioritise life saving interventions. Using this structured approach helps Nursing Associates quickly identify and respond to changes in a patient’s condition, ensuring patient safety and effective care.

Moving forward, I will aim to practice more with experienced staff, refresh my knowledge on specific interventions for each step and attend more stimulations to build confidence.

KSB addressed:

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

K19: know how and when to escalate to the appropriate professional for expert help and advice

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

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed

S39: Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately

Date: 23/20/2024

Time: 09:30 – 04:30

Title: Endocrine System / Introduction to Multi professional working

The endocrine system is a messenger system that has a network of glands which secrete hormones directly into the bloodstreams. These hormones regulate bodily functions such as growth, metabolism, and reproduction. The glands include the hypothalamus, pituitary, pineal, thyroid, parathyroid, thymus, pancreas, adrenal, testes/ovaries. Hormones are critical for maintaining homeostasis, and imbalances can lead to various diseases like diabetes.

Understanding the endocrine system is crucial because hormonal imbalances can affect many patients especially those with diabetes or thyroid issues. for example, insulin produced by the pancreas plays a vital role in controlling blood sugar levels for patients with diabetes. Recognising symptoms of endocrine disorders like fatigue, weight changes or abnormal thirst enables early intervention and better patient outcomes.

Going forward, my goal as a nursing associate is to deepen my understanding of endocrine disorders and their management. I will also focus on building skills to monitor patient’s hormone levels such as glucose monitoring in diabetes and learn more about the medications used to treat these conditions. This will enhance my ability to provide effective care and support for patients.

At the later hours of the day, I learnt all about multi professional working. In multi professional working, healthcare professionals from various disciplines collaborate to provide patient care. For instance, in a hospital setting, nurses, doctors, physiotherapists, social workers, and pharmacists might work together on a patient’s care plan. One of the key benefits is improved patient outcomes. However, challenges such as communication barriers or role confusion might arise and so understanding these dynamics is crucial for developing teamwork skills.

Going forward, I plan to improve information sharing, communication skills and recognise how different team member’s contributions can enhance patient care.

KSBs addressed:

K19: Know how and when to escalate to the appropriate professional for expert help and advice

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

K33: Understand how to seek appropriate advice to manage risks and avoid compromising quality of care and health outcomes

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident

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

K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it

K42: Understand and apply the principles of human factors and environmental factors when working in teams

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes

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

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams

S40: Support and motivate other members of the care team and interact confidently with them

Dated: 09/10/2024

Time: 09:30 – 04:30

Title: Ethical and Legal Aspect of Nursing/ Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS)/ Vital Signs and NEWS

The day started with learning about the ethical principles in nursing, mental capacity act (2005), deprivation of liberty safeguards (DoLS), concept of consent, capacity and confidentiality and the four-quadrant approach to decision making.

Autonomy – This is the right of a person to make informed decisions about their care, support and treatment.

Beneficence – This is the act of doing good; be kind

Non-Maleficence – The desire to do no harm

Justice – This is equality and fairness

Mental Capacity Act (2005)

This is an act whose primary purpose is to protect and make decisions on behalf of adults who are unable to due to lack of capacity.

Deprivation of Liberty Safeguards (DoLS)

This is an amendment of the Mental Capacity Act (2005) which protect people receiving care whose liberty has been limited. There are six assessments that needs to be completed for a decision to be taken and they include age, mental capacity, mental health, best interest, no refusal, and eligibility.

Consent

This is when a person must give permission before they receive any form of care, medical treatment or an examination. Consent can either be written or verbal.

Confidentiality

This refers to the ethical and legal duty to protect an individual’s personal information. And making sure that they are informed about their care and that information about them is shared appropriately.

Quadrant Approach to Decision Making

·      Medical implications

·      Patient preferences

·      Quality of life

·      Contextual factors

It is crucial for Nursing Associates to understand the implications of capacity assessments and decision-making processes. Capacity assessments are crucial to ensure that patients are involved in their care and that their rights are uphold. Obtaining consent ensures that healthcare professionals respect the patient’s autonomy and legal rights.

Confidentiality is not only a legal obligation but also essential for building a trusting therapeutic relationship. Breaking confidentiality could lead to serious consequences such as loss of trust, harm to the patient, or legal actions against the healthcare professional.

Moving forward, I will strengthen my communication skills to better explain treatment options and outcomes, ensuring patients fully under their decisions before they give their consent. I will ensure that’s patient information handled with the highest level of discretion. I will also stay informed about the latest legislative updates, participating in training on capacity and consent and promoting person centred care.

During the afternoon I learnt about vital signs and how to use NEWS. Vital signs are crucial indicators of how the body functions. They help healthcare providers assess the overall health of a patient and detect any changes that could indicate a problem. These vital signs include respiratory rates, pulse, blood pressure, oxygen saturation, temperature. Afterwards, we all went to the clinical area to perform manual blood pressure on ourselves with consents approved.

NEWS refers to national early warning signs and it is a scoring system used to identify patients at risk of deterioration. A higher NEWS suggests that the patient is at greater risk of acute illness, which may require immediate attention.

This learning highlights the importance of understanding and recognising abnormal vital signs early. By interpreting the NEWS correctly interventions can be made early enough to prevent further deterioration of the patient. The experience of the practical work helps to guide me on how to take manual blood pressure accurately. Additionally, it taught me how to be more observant and proactive. While the nurses often lead decision making, the Nursing Associates can play a vital role in first line detection, raising alarms when necessary.

In the future, I will ensure I remain vigilant when measuring and interpreting vital signs. I will practice using NEWS regularly to improve my confidence in identifying patients at risk. If I notice abnormal readings, and will not hesitate to escalate them immediately, ensuring the patient receives appropriate care.

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

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

S1: Act in accordance with the Code: Professional standards of practise and behaviour for Nurses, Midwives and Nursing Associates in (NMC, 2018), and fulfil all registration requirements

S10: Provides, promotes, 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

S19: Recognise where capacity has changed and a how person’s capacity affects their ability to make decisions about their own care and to give or withhold consent

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

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

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers, and family members

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

Dated: 09/10/2024

Time: 09:30 – 04:30

Title: Neurological System/Importance of Communication and Professional Value relating to Nursing Practice

The day started with learning about the neurological system, it’s functions, components of the nervous systems, structure and function of the brain and nerve cell. The neurological system sends messages from various parts of the body to the brain, and from the brain back out to the body, to tell the body what to do. It gives fast response. There are two components of nervous system, and they include:

Central Nervous System

The central nervous system acts as the control system. It consists of the brain and the spinal cord. The brain processes sensory inputs, initiates responses and stores memories. The spinal cord acts as a communication link between the brain and the rest of the body.

Peripheral Nervous System

The peripheral nervous system consists of all the nerves that carry messages to and from the central nervous system. There are 12 pairs of cranial nerves.

1.    Sensory Nervous System (Afferent)- This goes from the point of action to the spine. It includes touch, nociception (pain), temperature and special senses.

2.    Motor Nervous System (Efferent)- This goes from the spine to the point of action.

• Somatic (Voluntary)- This controls voluntary movement such as skeletal muscles.
•  Autonomic (Involuntary)- This regulates involuntary functions like heart rate, digestion, and respiratory rate.

        ·      Sympathetic- This is responsible for fight or flight responses.

        ·      Parasympathetic- This is responsible for rest and digestion.

We also discussed about the different regions of the brain which include the cerebrum (thinking and memory) the cerebellum (coordination and balance) and the brainstem (heart rate and breathing).

The nervous system’s functioning is crucial for survival and well-being. Understanding it’s components and how they work together can help in diagnosing and treating neurological conditions. Understanding the structure and function of the brain is essential because it influences how we treat and manage patients, and it also helps in understanding patient’s behaviour, motor control, and cognitive functions which are critical when providing holistic care.

Going forward, I can apply this knowledge to improve patient outcomes by recognising early warning signs of nervous system issues to prompt timely interventions, educate patients on lifestyle changes to promote nervous system health like stress reduction or exercise for rehabilitation and assist in the management of neurological disorders.

At the later part of the day, we talked about the importance of communication and professional value relating to nursing practice, barriers of communication. Everyone had one or two things to say. Effective communication is important in nursing practise. Good communication ensures that patient’s needs are understood, treatment are properly explained, and any concerns or complications are addressed. However, there are barriers to effective communication such as language differences, environmental factors and emotional distress. These barriers can result in misunderstandings, errors in care and diminished patient satisfaction.

Communication is fundamental for building trust and rapport with patients. Understanding the barriers helps to develop strategies to overcome them, improving patient care and teamwork. For example, active listening, use of nonverbal clues, or providing translation services can mitigate communication issues.

To improve communication, it is essential i develop strong listening skills, be patient centred and adopt communication techniques based on individual needs. And reflecting on past communication challenges can help me learn and apply better strategies in future interactions.

KSBs addressed:

K19: Know how and went to escalate to the appropriate professional for expert help and advice.

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met

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

S2: Keep complete, clear, accurate and timely records

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

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

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

S18: Applying 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