Date of Learning Log: 05/04/2024

Time: 09:30-16:00

Learning Activity 1: Introduction to the module & Referencing and Plagiarism.

In this learning activity, we were introduced to the decision-making in care for nursing associate’s module. We looked at the module learning outcome that must be addressed in our exam-based essay. The topics covered in this module are A-E assessment, SBAR, End-of-life, and identifying deterioration in patients, including Adults, mental health, learning disability, and children. The topic also covers managing, supporting and escalating deterioration by making appropriate decisions.

In the early part of this session, I understood how the module will be assessed and how it focuses on clinical judgement and decision-making. We discussed our experiences in clinical decision-making in our practice area and explained why we made that decision and which evidence it was based on. The session then continued by understanding the factors and process of decision-making more profoundly. Different factors can affect decision-making, such as personal knowledge, evidence, the patient, and evidence. Decision-making is a process in which cues are used to systematically gather and analyse patient data. It is about making judgments and decisions, using critical thinking and evaluating outcomes. I collected some tips and advice regarding learning about being flexible with decision-making, reflecting through experiences, listening, identifying the problem, and selecting the best solution to improve a patient’s outcome.

I learned about evaluating a patient’s outcome and nursing intervention, whether the patient’s goal is met or if the intervention is effective. How it is achieved and its timeframe. We also explored short- and long-term planning, in which I understood the importance of decision-making with the involvement of a multi-disciplinary team, patients, and relatives. Clinical decision-making and clinical judgment are evidence-based. These are based on research, theories, clinical assessments, and, most importantly, the patient’s preferences and beliefs. We also explored problems when applying clinical evidence to individuals, such as guidelines describing the proof of a single condition, which can be ineffective for patients with several comorbidities. Everyone is unique. They may have different values and preferences from the clinician or person who created the evidence.

Learning Activity 2: Principles of A-E Assessment

In the afternoon learning activity, we learned more about interpreting data on the National Early Warning Score 2 (NEWS2) observation chart. We identified appropriate thresholds for escalation based on the score by analysing the data. We also explored the principles of A-E assessment and other additional assessment data.

The NEWS2 was developed by the Royal College of Physicians and was updated in 2017. It is used for all adult hospital patients using the A-E structure. During this session, I learned that there are two scale choices for SpO2, which I have misused in the NEWS2 chart before. Now that I clearly understand the purpose of 2 choice scales (Air/oxygen), I will produce better and reliable documentation in the future. Six physiological parameters can track and trigger NEWS2 (RR, SpO2, Temperature, Systolic blood pressure, HR, and level of consciousness). This is then categorised using the A-E structure (airway, breathing, circulation, disability and exposure). The total score generated will prompt specific actions such as frequency of monitoring, urgency of clinical review, and competencies of responding clinical team.

We investigated the reasons why NEWS2 might be triggered. Respiratory rate can be elevated due to high or low RR. Long-term conditions, pain, exertion, stress and shock can chronically elevate RR. Low RR can indicate acute deterioration or overdose, CNS depression. The SpO2 scale 1 in the NEWS2 observation chart is used for most patients needing a target saturation of 94%-98%. The SpO2 scale two is used for patients with target SATS of 88%-92% who have received a confirmed diagnosis of hypercapnic respiratory failure. It is important to record this information in the patient’s medical notes. The flow rate can be recorded under the airway and breathing section if oxygen is used. It also provides an area to document the device used to deliver oxygen. Oxygen use automatically triggers the NEWS2 chart.

Blood pressure and pulse rate are important indicators of a person’s health. Blood pressure has two numbers: systolic and diastolic. The systolic number represents the highest pressure in the arteries when the heart beats, and the diastolic number represents the lowest pressure when the heart is resting between beats. A person’s blood pressure can vary depending on their age, but it is essential to monitor it regularly. NEWS2 is a tool used to assess a person’s risk based on blood pressure and other vital signs. High blood pressure can be caused by stress, pain, or other factors and can lead to serious health problems such as heart disease, stroke, and kidney disease. Low blood pressure, on the other hand, can indicate sepsis, heart failure, or other medical conditions. Pulse rate is measured by counting the number of heartbeats per minute. A regular pulse rate is standard, but an irregular one could indicate an underlying condition such as an arrhythmia. An arrhythmia occurs when the heart’s rhythm is irregular or too slow/fast. Physical activity, medication, or illness can affect a person’s pulse rate. Regularly monitoring blood pressure and pulse rate is essential to maintaining good health.

The level of consciousness can be categorised into five levels: Alert, new confusion, voice, pain or unresponsive. This categorisation is also known as ACVPU. When a person’s level of consciousness is impaired, it could indicate severe brain dysfunction or systematic disease. These signs can be alarming as new confusion could indicate sepsis, and if the patient is assessed as being in pain or unresponsive, it could indicate airway compromise. The last assessment in NEWS2 is exposure, where the patient’s temperature is measured. A high temperature above 38 degrees Celsius can indicate an infection, but not everyone will have a high temperature. Hypothermia (low temperature) can cause cardiac arrest.

The NEWS2 escalation refers to the process of suggested actions regarding the total NEWS2 score of the patient’s baseline. This tool helps nursing associates assess the severity of a patient’s illness. It is a process of increasing the level of medical attention or intervention based on the patient’s NEWS2 score. A higher NEWS2 score indicates the deterioration of the patient’s condition. This will then trigger healthcare providers to take action to escalate the level of care accordingly. It helps ensure that the patient receives appropriate and timely treatment.

We discussed situations in which patients may refuse to comply when gathering observations. The reason for refusal must be explored, and as nursing associates, we must advocate for educating patients by explaining the pros and cons of having observations taken and escalating within the team if a situation occurs. A non-contact physical observation can be performed to get some idea of the patient’s condition.

The topic of this session is essential to me because it will help me recognise early signs of deterioration. This will allow me to intervene promptly, resulting in positive patient outcomes. By using the systematic approach of A-E assessment, I can maintain patient safety by identifying and responding to changes in their condition. These two tools will ensure that my patients receive the best possible care.

KSB Addressed:

Knowledge:

Skills:

Behaviour: