Date of Learning Log: 19/07/2024
Time: 09:30-16:00
Learning Activity 1: Cardiac Monitoring and ECG
In this learning activity, I gained an understanding of the indications for cardiac monitoring. During this session, the course convenor demonstrated how to set up cardiac monitoring and ECG. Furthermore, interpretation of ECG readings to identify normal and abnormal heart rhythms.
The electrocardiogram (ECG or EKG) is a non-invasive medical test that measures the heart’s electrical activity. It records the heart’s rhythm and electrical signals, providing valuable information that helps doctors identify various heart conditions. The ECG is a versatile tool used to detect arrhythmias, which are irregular heartbeats, and to assess potential damage following a heart attack. Additionally, it plays a crucial role in diagnosing conditions such as coronary artery disease. Moreover, the ECG is utilised to monitor the effects of heart medications as part of routine health checks, especially for individuals at risk of heart disease.
This test measures the number of times the heart beats per minute and determines whether the heart’s rhythm is regular or irregular. It also provides insight into the strength and timing of the electrical signals as they pass through different parts of the heart. It consists of waves: P wave, QRS complex, and T wave. The P wave represents atrial contraction (upper chambers). The QRS complex represents ventricular contraction (lower chambers), and the T wave represents the recovery phase of the ventricles.
The process of using electrodes involves placing small, adhesive patches on specific areas of the chest, as well as sometimes on the arms or legs. These patches are connected to a computer via wires, which then prints or displays the results of the electrical activity of the heart. The electrical activity of the heart originates from a specialised group of cells called the sinus node, which generates an electrical stimulus at a regular rate of 60 to 100 times per minute under normal conditions. This electrical stimulus initiates the contraction of the atria, the upper chambers of the heart. The electrical impulse then travels down through the heart’s conduction pathways and causes the ventricles, the heart’s lower chambers, to contract and pump out blood to the rest of the body.
Learning Activity 2: Neurological Assessment
In this learning activity, I gained an understanding of the principles of neurological assessment, how to use it in a clinical simulation environment and identify why these assessments are important in patient’s care.
Neurological observation serves two primary functions within the healthcare setting. First, it involves assessing a patient’s current neurological function. This entails evaluating various aspects of the nervous system, such as sensory and motor responses, reflexes, and overall neurological status. Second, neurological observation involves monitoring for any changes in a patient’s neurological status, which may indicate either improvement or deterioration in their condition.
The primary tool used for conducting neurological observation is the Glasgow Coma Scale (GCS), which provides a standardized and objective assessment of a patient’s level of consciousness. This scale evaluates eye opening, verbal responses, and motor responses, and the combined score helps in determining the severity of a patient’s neurological impairment.
A neurological exam, also known as a neuro exam, is a comprehensive evaluation of a person’s nervous system that can be performed in a healthcare provider’s office or clinical setting. It involves a range of assessments, including sensory perception, coordination, reflexes, and cognitive function. Healthcare professionals may utilize various instruments, such as lights and reflex hammers, to conduct specific tests as part of the neuro exam. Importantly, these examinations are designed to be non-invasive and generally do not cause any discomfort or pain to the patient.
During a neurological examination, a healthcare provider will assess sensory neuron and motor responses, including reflexes, to determine the integrity and functionality of the patient’s nervous system. This evaluation typically involves a thorough physical examination and a comprehensive review of the patient’s medical history. However, it only encompasses deeper investigations such as neuroimaging studies, which may be conducted separately based on the findings of the initial neurological assessment.
The primary purpose of the assessing pupil gauge should be to compare the size of the patient’s pupils to a quantitated size of a black circle. In this case, the pupils measure approximately 3.5 mm in diameter. A Finoff transilluminator is then used to determine the reaction of the patient’s pupils to light. Penlight assesses pupil response, or how fast the pupils constrict when suddenly exposed to a bright light.
Normal pupil size ranges between 1/16 to 5/16 of an inch (2.0 to 8.0 millimetres), depending on the lighting. 1. The size of your pupil can tell your healthcare provider quite a bit about your health. It’s essential to unlocking possible medical conditions you might not otherwise know about.
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 |