Date of Learning Log: 11/04/2024
Time: 09:30-16:00
Learning Activity 1: Managing Long-Term Conditions in Service Users with Learning Disabilities: Key Considerations for TNA’s
This session examined the critical considerations of long-term conditions within the learning disability (LD) population, including future implications for nursing associates. During the session, we reviewed and discussed our experiences working with people with learning disabilities. We learned about neurodiversity and how it is linked to LD. Additionally, we explored health inequalities, core considerations in the assessment approach, perspectives of carers with lived experiences, and how nursing associates can make positive changes to support the carers.
A learning disability is a long-term condition that affects an individual’s ability to acquire, process or retain information despite having average or above-average intelligence. Individuals who have a learning disability can impact various cognitive processes and academic skills. There are several key characteristics and aspects of learning disabilities, such as dyslexia, dyspraxia, dyscalculia, autism and ADHD.
Dyslexia is a condition a person may find challenging or complex in reading, spelling or writing. Their strengths include viewing things from different perspectives, problem-solving, empathy, creativity and good pattern recognition. Dyspraxia affects motor coordination and planning. Their strengths are problem-solving and viewing things from different perspectives. Dyscalculia is when a person finds math concepts, calculations or understanding numbers challenging. Autism is a developmental disorder characterised by social interaction, communication and behaviour. People with autism can present difficulties interpreting verbal and non-verbal language, difficulty in reading people, sensory sensitivities, repetitive behaviours and anxiety. ADHD is a condition in which an individual may find it challenging to focus on stimulating tasks, has hyperactivity or restlessness, poor time management or planning, is impulsive, finds it difficult to relax, is forgetful and excessively talking. However, they can be hyperfocus, creative, entrepreneurial, good at problem-solving, empathetic, energetic, enthusiastic, hard-working and sensitive.
The social theoretical perspective of learning disabilities (LD) focuses on people who fall outside the norm of society. In the medical field, it focuses on the underlying causes of the disease and looks for a cure. Statistically, it is assumed that any aspect of human behaviour can be measured and will have a mean and standard deviation. During our session, we delved into the approach known as the social model of disability. This approach provides a framework that considers disability because of the interplay between individuals with impairments and the societal obstacles they encounter. It shifts the focus from the impairments themselves to the societal barriers that contribute to the experience of disability. We also discuss health education, health promotion and teaching people new skills.
Common challenges and barriers to accessing healthcare are also discussed during this session. Stigma, not being identified with a learning disability, and failure to make the correct diagnosis and medications are the barriers and challenges people with learning disabilities face. Due to these factors, patients with learning disabilities has difficulties in accessing care. We also discussed the typical long-term conditions relating to learning disabilities are also discussed, in which we explored conditions such as heart disease, dementia, disabilities, sensory impairments, epilepsy, respiratory issues, obesity/malnutrition or weight issues.
Understanding these complexities helps in providing better, person-centred care. The complex care needs of individuals with learning disabilities need tailored healthcare approaches. Management of long-term conditions can significantly improve health outcomes and quality of life for the individual. It prevents complications and promotes equality and inclusivity by focusing on the health and well-being of everyone.
Learning Activity 2: Complex Respiratory Conditions
In this learning activity, we focused on complex respiratory conditions and discussed their pathophysiology and impact on individuals’ lives. We covered the following points: identifying signs and causes of airway obstruction, discussing airway adjuncts and management techniques, defining Type 1 and Type 2 respiratory failure, demonstrating an understanding of the pathophysiology, assessment, and management of common respiratory problems, considering theoretical and practical aspects of oxygen administration, stating appropriate targets for oxygen administration in different health conditions, and describing respiratory support available for patients with respiratory failure.
During the first part of the session, we discussed airway problems and management, including upper airway obstruction, its causes, and essential airway management techniques. Partial airway obstruction occurs when the airway is partially blocked, reducing airflow to and from the lungs. It produces snoring, gurgling, or stridor noises. Complete airway obstruction is silent. Airway obstruction may be caused by internal and external factors such as tumors, physical pressure, foreign objects, and airway swelling due to allergies.
Basic airway management techniques such as head tilt, chin lift, and jaw thrust were demonstrated. We also discussed using a suction machine to remove secretions, blood, etc., and prevent aspiration. We also explored a few airway adjuncts and devices used to maintain or open a patient’s airway. These are typically used in emergencies, anaesthesia, or critical care settings to ensure that the patient’s airway remains clear and that they can breathe adequately.
Breathing problems can stem from various conditions, from acute issues such as infections and allergic reactions to chronic diseases. Respiratory failure occurs when the respiratory system fails to adequately exchange gases, leading to insufficient blood oxygenation or inadequate carbon dioxide removal from the body. Respiratory failure is classified into type 1: hypoxaemia and type 2: hypercapnia. Hypoxaemia is often life-threatening due to low levels of oxygen in the blood. Hypercapnic is a condition caused by an elevated level of carbon dioxide.
We explored chronic respiratory conditions such as asthma, COPD, pulmonary fibrosis, pneumonia, pneumothorax, pulmonary embolism, and cystic fibrosis. During this session, we discussed the pathophysiology of each condition and how it can be managed. We also explored respiratory support, such as oxygen therapy and advanced respiratory support. Oxygen therapy aims to correct potentially harmful hypoxaemia; it supports oxygen delivery to cells. Patients who are at risk of hypercapnia are mainly severe or moderate COPD, whose target saturation will be 88%- 92%. If the patient is not at risk, target saturation is 94%-98%. Oxygen is a drug which is prescribed and must be administered correctly.
It is essential for nursing associates to learn about complex respiratory conditions. This knowledge helps in providing comprehensive care, recognizing early signs of deterioration, intervening promptly, educating patients effectively, collaborating with the multi-disciplinary team, and applying evidence-based practices in specialized care settings. Acquiring this knowledge will enhance my ability to deliver high-quality, patient-centered care and improve outcomes for patients with respiratory conditions.
KSB ADDRESSED:
Knowledge:
| 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 |
| 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 |
| K16 | Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of 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 |
| K19 | Know how and when 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 |
| 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 |
| K26 | Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld |
| K27 | Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies |
| K28 | Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions |
| K29 | Understand the different ways by which medicines can be prescribed |
| K30 | Understand the principles of health and safety legislation and regulations and maintain safe work and care environments |
| 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 |
| K37 | Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs |
| K38 | Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings |
| 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 |
| K40 | Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services |
| 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 |
Skills:
| S1 | Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements |
| S2 | Keep complete, clear, accurate and timely records |
| S3 | Recognise and report any factors that may adversely impact safe and effective care provision |
| S4 | Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills |
| S5 | Safely 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 2018) |
| 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 |
| 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 |
| S13 | Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people |
| S14 | Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing |
| S15 | Identify people who are eligible for health screening |
| S16 | Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity |
| 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 |
| S19 | Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent |
| S21 | Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting 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 |
| 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 |
| 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 |
| S30 | Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed |
| S32 | Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams |
| S33 | Maintain safe work and care environments |
| 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 |
| S38 | Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members |
| S39 | Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately |
| S40 | Support and motivate other members of the care team and interact confidently with them |
| S41 | Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others |
| S42 | Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promoting reflection and providing constructive feedback |
Behaviours:
| B1 | Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences |
| B2 | Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice |
| B3 | Be adaptable, reliable and consistent, show discretion, resilience and self-awareness |