Date of Learning Log: 12/04/2024
Time: 09:30-16:00
Learning Activity 1: Introduction to HF and managing risks and theory of decision making and clinical judgement.
In this learning activity, we explored the importance of the human factor, defined HF/ergonomics, understood the role of clinical decision-making and clinical judgment, and analysed the policies regarding decision-making.
Human factors are crucial in enhancing clinical performance, and ergonomics involves studying people in their working environments. Understanding human factors is essential for identifying potential errors in healthcare settings, thus improving patient safety by minimising the risks of mistakes. Furthermore, it improves communication among healthcare providers by ensuring accurate conveyance and understanding of information, which is crucial for effective patient care.
During our session, we delved into three distinct safety models, each offering a structured framework for identifying, analysing, and mitigating risks to ensure patient safety. These models are defined as follows:
- Model of Safety 1: Ultra Safe
- Model of Safety 2: High Reliability
- Model of Safety 3: Embracing Risks
It is incorporating human factors into nursing practice. This will result in patients receiving safer, more efficient, and more compassionate care and provide nurses with a better working environment.
Learning Activity 2: Sepsis
In this learning activity, we explored the definitions of sepsis and its pathophysiology, discussed the long-term and short-term management plans, and learned about its complications.
Sepsis is a severe medical condition when the body’s response to an infection triggers an overwhelming and systemic inflammatory reaction. This can result in extensive tissue damage, organ failure, and potentially even death. Sepsis is considered a severe and critical complication that requires immediate and intensive medical attention. The National Institute for Health and Care Excellence has issued guidelines emphasising treating sepsis with the same urgency as a heart attack. Healthcare professionals should always consider the possibility of sepsis in patients with infections.
Numerous risk factors are associated with sepsis, including environmental influences and organ sensitivity, such as respiratory infections, skin infections, urinary catheters, urinary infections, and IV lines causing skin infections. Recent trauma, surgery, or invasive procedures are all contributors to the development of sepsis. Sepsis is also anticipated in individuals with impaired immune responses or those with long-term illnesses such as diabetes, immunodeficiency, HIV/AIDS, neutropenia, splenectomy, and iatrogenic conditions. Additionally, factors such as age, improper management of infection, and genetic predispositions should be considered.
I acquired valuable knowledge during the educational session about the treatment, pathophysiology, indicators, and symptoms of sepsis. The principles of treating sepsis patients remain the same regardless of the cause. Initial evaluation and resuscitation should follow the ABCDE format and involve the appropriate Sepsis Screening Tool. Patients should be treated using the Sepsis 6 approach, and it’s crucial to promptly engage with Critical Care, particularly in cases of septic shock or multi-organ failure. The largest group of sepsis patients typically consists of those with pneumonia, though other presentations may involve gastrointestinal, urinary tract, biliary tract, and skin infections. It is crucial to approach the evaluation of a patient presenting with sepsis with an open perspective. Most organisations now have their recommended first-line empiric treatments for common infections.
Learning Activity 3: Sickle Cell Anaemia
In our recent learning activity, we delved into sickle cell disease. We explored the intricate genetic factors that contribute to this condition, gaining a deep understanding of how it is passed down through generations. We examined the various signs and symptoms of sickle cell, delved into the treatments available, and discussed the potential complications associated with this challenging condition.
Sickle Cell Disease (SCD) is caused by inheriting the sickle cell gene, typically when both parents have the disease or are carriers. Carriers do not have the disease, but they can pass it on to their children if their partner is also a carrier. SCD is a group of inherited blood disorders with insufficient healthy red blood cells (RBC) to carry adequate oxygen throughout the body. This is caused by an abnormal production of haemoglobin (protein in RBC) known as haemoglobin S. The haemoglobin molecules in people with SCD tend to form rigid and sticky, causing RBC to become shaped like a crescent or sickle. The irregular cell shape can block small blood vessels, reducing or stopping blood and oxygen flow to body parts.
The signs and symptoms of SCD vary from person to person and have a wide range of symptoms. The main symptoms are fatigue, anaemia, and pain. Painful episodes known as sickle cell crises are common and most distressing symptoms of SCD. They can be severe and last several days or weeks. Pain is developed when sickle-shaped RBCs block blood flow through vessels to the chest, abdomen, bones, and joints. This can damage the spleen, which fights infection. Therefore, frequent infections can occur. Other symptoms, such as delayed growth due to a shortage of RBC, can slow growth in infants, children and teenagers. SCD can also affect vision; blood vessels that supply the eyes will damage the retina, which leads to vision problems. The complications of SCD include stroke, seizure, limb weakness, speech difficulties and loss of consciousness. SCD can be diagnosed by a blood test, which tests haemoglobin S. If the test is positive, further tests will be done to determine whether the person has sickle cell trait or sickle cell disease. A low haemoglobin is a sign and can prove SCD and other blood tests.
The treatment for SCD aims to avoid crises, relieve symptoms, and prevent complications. Regular doctor visits are needed to review medications. Treatments such as blood transfusion, bone marrow transplant, antibiotics, analgesics, assessment of stroke risks, and vaccinations are available for SCD patients. Experimental treatments, such as gene therapy and turning off the defective gene while reactivating another gene, are also available.
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 |