Date of Learning Log: 26/07/2024
Time: 09:30-16:00
Learning Activity 1: Wound Care: Suture/Clip/Drain Removal
This learning activity taught me about the integumentary system and wound healing process. The use of sutures and clips/staples and an understanding of the procedures required for removal and wound drains were explored. Additionally, the necessary procedures for the removal of the vacuum drain were also discussed.
When providing wound care, it’s important to start by cleaning the wound thoroughly. You can do this by rinsing it with either bottled or tap water, or by using sterile wipes. It’s also crucial to clean the skin around the wound with soap and water or antiseptic, but make sure not to get antiseptic into the wound itself. After cleaning, gently pat the area dry using a gauze swab or a clean tea towel. Once the wound is clean and dry, you can then proceed to put on a sterile dressing or a plaster to protect it.
The skin is composed of different layers, with the epidermis being the outermost layer. It provides a waterproof barrier and contributes to skin tone. Beneath the epidermis lies the dermis, which contains connective tissue, hair follicles, blood vessels, lymphatic vessels, and sweat glands.
Wounds are injuries that break the skin or other body tissues. They encompass a range of injuries such as cuts, scrapes, scratches, and punctures. While they often result from accidents, wounds can also be caused by surgical procedures, sutures, and stitches. Although minor wounds may not seem serious, it is crucial to clean and attend to them properly to prevent complications.
Wound healing is an intricate and highly regulated biological process that occurs in four primary stages: haemostasis, inflammation, proliferation, and remodelling, also known as maturation. These stages work in a coordinated manner to repair damaged tissue and restore the integrity of the skin or other affected tissues. Haemostasis, the initial stage, involves the process of clotting and occurs immediately after an injury. It is the body’s immediate response to stop bleeding and prevent further blood loss.
Each stage must proceed correctly for proper healing. Delays or complications at any stage, such as infection, can slow down or impair the healing process.
Signs of infection can occur in various parts of the body or after injuries and surgeries. Recognising these signs early is crucial for preventing complications.
- The skin around your wound is red or sore or feels hot and swollen.
- Your wound has liquid (often green or yellow pus) coming out of it.
- Your wound opens.
- You feel generally unwell or have a temperature (fever.)
To remove the drain, we follow a simple and usually painless procedure. First, we release the vacuum, then we remove the stitch holding the drain in place, and finally, we remove the tube. Your wound dressing may be changed once the drain is removed.
Grasp the drainage tube close to the skin with your dominant hand and remove the drain quickly and steadily. Distract the patient to help them prepare for the drain removal. You may feel slight resistance, but if there is strong resistance, pause and ask the patient to take a deep breath. The primary purpose of a vacuum drain is to prevent the accumulation of fluid, including blood and infected fluids, and to minimise the collection of air. Effective wound drainage management involves thoroughly assessing the wound area and current dressing. This includes evaluating the type and volume of exudate, the condition of the wound base, peri-wound skin, and wound edges, and selecting an appropriate dressing to maintain an ideal moist wound environment.
Learning Activity 2: Simulation consolidation of history-taking and assessment skills.
In this learning activity, I gained a good understanding of communication in providing person-centred care and analysed and assessed non-verbal cues and their impact on communication. The importance of active listening and its role in successful communication were discussed and illustrated. Communication barriers were discussed, and how to overcome them where possible. The appropriate communication strategy selection in different situations was explained.
As a nursing associate, I must meet the skills and standards set by the NMC, such as platform 3: Provide and monitor care, Annexe A and B, which includes history taking of patient’s past medical conditions, both physical and psychological. History taking in nursing refers to gathering comprehensive and detailed information about a patient’s medical, social, and psychological history. This is a critical step in assessing the patient’s health, identifying potential problems, and planning appropriate care. It helps nurses understand the patient’s health status and anticipate future healthcare needs. The skills required for history taking are interviewing, observation, reviewing documents, listening, clinical knowledge and understanding, and communication skills.
The process of effective history-taking involves good communication and active listening. Using open-ended questions allows patients to describe their symptoms or history in their own words. Active listening means paying close attention to what the patient says without interpreting. Additionally, showing empathy, understanding, and compassion towards the patient’s experiences is essential during history-taking. Asking follow-up questions and summarizing the patient’s words ensures accurate understanding. Non-verbal communication, such as body language, facial expressions, eye contact, gestures, and tone of voice, plays a crucial role in the history-taking process in nursing. It helps build rapport, show empathy, and create a comfortable environment for the patient.
Information can be gathered from the patient/service user, their families or carers, medical records, and referral information. Several barriers to communication must be anticipated during history taking, such as language, level of education, level of cognition, physical barriers, or abusive relationships. Nursing associates must ensure solutions to these barriers, such as booking interpreters, using communication aids, ensuring adequate pain relief if the patient is in pain, etc.
There are 6 sections on history taking, including the presenting complaint, history of the presenting complaint, past medical history, drug history, social history, and impression/diagnosis. The importance of family history is also essential during history taking, such as information about any significance in the family history, specifically about immediate family—parents and siblings—diagnosis, age of onset/age, and cause of death. Social history is an integral part of the history-taking process, where nurses gather information about the patient’s lifestyles, daily activities, relationships and environmental factors. This helps understand social determinants influencing the patient’s health, behaviour and well-being. Sexual history in nursing is vital to a patient’s overall health assessment. It involves gathering information about a patient’s sexual activity, practices, preferences, and potential risks related to sexual health. This helps nurses provide holistic care by identifying issues that may impact physical, emotional, or sexual well-being, such as sexually transmitted infections (STIs), contraceptive needs, or concerns about sexual function. Occupational history involves gathering previous and current employment, financial stability, and working patterns.
Review of systems, also referred to as system review questioning or ROS, is a structured approach utilized by healthcare providers, including nurses, to evaluate a patient’s well-being by inquiring about specific aspects of various bodily systems. This aids in pinpointing any symptoms or issues that may not have been communicated during the initial history-taking, and it guarantees a thorough evaluation of the patient’s overall health condition.
Effective history-taking consists of clarifying by recalling to the patient your understanding of the history symptoms and remarks, summarising the history back to the patient to clarify any discrepancies, and asking the patient if there is anything else to give the person a final opportunity to add any further information.
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 |