Date of Learning Log: 19/04/2024
Time: 09:30-16:00
Learning Activity 1: Renal Patients and Decision-Making (Acute Kidney Injury – AKI)
In this learning activity, I learned about the anatomy and physiology of the kidney, classified stages of acute kidney injuries (AKI), the pathophysiology of AKI and its clinical features, treatments and common implications of AKI.
The kidneys perform several bodily functions, including filtering waste products and excess substances such as salt, water, and urea from the blood, which are then excreted as urine. The kidneys are responsible for regulating the body’s overall homeostasis by regulating blood pressure, blood pH, blood volume, electrolyte balance, blood osmolarity, and blood glucose.
An acute kidney injury is a sudden and rapid loss of kidney function over hours, which encompasses structural damage and impairment. According to NICE 2019, people who are at risk of developing AKI are individuals with chronic kidney disease, heart failure, liver failure, diabetics, abnormal low output of urine and individuals with neurological injury or cognitive deficit. AKI is diagnosed through blood tests, urine tests, imaging studies and sometimes kidney biopsies. Measuring creatinine, creatine, and urine output levels can help detect AKI.
Various factors can cause AKI, which is generally categorised into three types based on the location of the issue. Pre-renal causes are conditions that reduce blood flow to the kidneys, such as severe dehydration, blood loss, heart failure or shock, and severe burns. Intra-renal causes involve direct damage to the kidneys, such as acute glomerulonephritis, acute tubular necrosis, infections, and nephrotoxic medications. Post-renal causes are conditions in which there is an obstruction in the urine flow, such as kidney stones, enlarged prostate, tumours and urethral strictures.
The signs and symptoms of AKI include increased heart rate, arrhythmias, low BP if shocked or dehydrated, high BP if overloaded with fluid, decreased urine output, oedema, reduced level of consciousness, confusion and tremors. Managing AKI involves giving fluids – if BP is low and signs of shock, frequent vital sign monitoring, ECG, fluid balance chart, central venous catheter and central venous pressure monitoring, oxygen therapy, and treating hyperkalaemia. Early detection and treatment are crucial in managing AKI to prevent permanent kidney damage and other complications. Therapy addresses the underlying cause, such as rehydrating the patient, treating infections, or relieving obstructions.
Learning Activity 2: Medication Management/Drug Calculation/Safe Medicate Practice
During this learning activity, we delved into our Care Delivery module and discussed the learning and module outcomes, focusing on thoroughly examining the timetable and ePads medication management. Additionally, I gained insight into the significance of mental capacity assessment with administering medications and critically considered scenarios based on clinical practices.
This learning activity discusses the procedural competencies required for administering medications. It mentions that continuous assessment of the patient’s ongoing ability to self-medicate is crucial to identifying concerns, including when and how to escalate. It is important to undertake accurate drug calculations for various medications and exercise accountability in ensuring the safe administration of medicines to those receiving care. It is essential to learn about different routes when administrating medications, as this could be via oral, topical, inhalation, subcutaneous and intramuscular injections, etc. Safe medication involves assessing and managing the effectiveness of symptom relief medication, recognising and responding to adverse or abnormal reactions, knowing when to escalate concerns, and storing, transporting and disposing of medicinal products properly. Safe medication also includes acting according to the NMC, the code and standard of proficiencies, and understanding the ten rights of medication administration.
Consent is crucial in medication management; consent respects the person’s autonomy, which focuses on the patient’s right to make informed decisions about their own body and health. This acknowledges patients’ authority over what treatments they receive, including medications. Obtaining consent is a fundamental ethical principle that ensures that the patients are not subjected to treatments against their will, which upholds their dignity and personal rights. A valid consent can be verbal or written, which must be voluntary and informed, and the person consenting must be able to make the decision. In summary, consent in medication management ensures that the treatments are ethical, legal and aligned with the patient’s health goals and values.
The term “mental capacity” refers to a person’s capability to make decisions, especially regarding their health, finances, or personal affairs. It entails grasping, analysing, and appraising information to make well-informed choices. Mental capacity is not fixed; it can change based on the difficulty of the decision, the timing of the decision, and any temporary or long-term conditions impacting the individual. Mental capacity is essential in determining whether someone can consent to medical treatments, manage their own affairs or make other significant decisions. If a person lacks mental capacity, decisions may need to be made on their behalf, usually through legal or medical representatives and always with their best interests in mind.
A lasting power of attorney (LPA) is a legal document that allows a person to appoint one or more people to help them make decisions or to make decisions on their behalf. There are two types of LPA: health and welfare and property and financial affairs. The independent mental capacity advocate (IMCA) supports and represents the person in the decision-making process. Essentially, they ensure that the person’s mental capacity is being followed. The IMCA safeguards individuals who lack the capacity to make some important decisions.
Mental capacity is crucial for safely managing medications as it influences a person’s ability to provide informed consent, follow treatment plans, prevent errors, and take part in decision-making. Confirming that patients possess the capacity to handle their medication properly is essential for safeguarding their health and well-being.
KSB ADDRESSED:
Knowledge:
| 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 |
| 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 |
| 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 |
| K24 | Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain |
| 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 |
| 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 |
| K43 | Understand the influence of policy and political drivers that impact health and care provision |
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 |
| 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 |
| S29 | Give information and support to people who are dying, their families and the bereaved and provide care to the deceased |
| S30 | Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed |
| 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 |
| 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 |
| 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 |
| 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 |
Behaviour:
| 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 |