Date of Learning Log: 04/10/2024
Time: 09:30-16:00
Learning Activity 1: Critical Thinking and Evidence-Based Decision-Making
In this learning activity, I gained a deeper understanding of how to apply critical thinking skills effectively to analyse and improve the quality of care provided in health and social services. I explored various digital information frameworks and tools utilized in these fields, critically assessing their strengths and weaknesses. This involved evaluating how different technologies can support patient care, streamline communication, and enhance data management while also considering potential limitations, such as accessibility issues and data privacy concerns. Through this process, I have developed a more nuanced perspective on the role of digital tools in fostering improved outcomes for both patients and healthcare providers.
In the early part of the session, the definition of critical thinking and its importance were discussed. Improved Clinical Decision-Making: Critical thinking allows healthcare professionals to assess complex situations, weigh evidence, and make informed decisions. In nursing, this ensures that decisions are not based on assumptions but on a thorough evaluation of the patient’s condition, clinical evidence, and available resources. Enhancing Patient Safety: Critical thinking helps nurses identify potential risks and prevent errors, especially in fast-paced environments like hospitals. For example, evaluating patient history, possible drug interactions, and monitoring data allows nurses to foresee complications before they occur. Adapting to Evolving Healthcare: With constant advancements in medical technology and changes in healthcare protocols, critical thinking skills are crucial for adapting to new situations. Nurses must continually evaluate new research and technologies, determining how best to implement them in their practice. Evidence-Based Practice: Nursing and healthcare are increasingly focused on evidence-based practice (EBP), where decisions are guided by research and data. Critical thinking is integral to EBP because it enables nurses to appraise research critically, apply it to patient care, and continuously improve practice based on the best available evidence. In summary, critical thinking is key to making sound clinical decisions, ensuring patient safety, adapting to changes, and delivering evidence-based care—ultimately leading to better patient outcomes and improved healthcare systems.
Barriers of Critical Thinking includes:
- Cognitive bias refers to a broad set of unconscious errors in thinking that can affect judgments and decisions. These biases occur when the brain tries to simplify information processing, often leading to inaccurate conclusions or assumptions. Cognitive biases include many types of biases, such as confirmation bias, availability bias, and anchoring bias. A patient with cardiac disease has chest pain – nurse believes cardiac – reality reflux.
- Emotional Influence or attachment may cloud judgment – e.g., the patient reminds the nurse of a relative, clouds the nurse’s judgement, or downplays concerns/signs of deterioration.
- Time constraints – information may be overlooked in a busy environment.
- Workplace Culture—If the workplace discourages questioning authority or does not promote open communication, nurses may avoid raising concerns or offering alternative solutions, even when they spot potential errors in a care plan.
- Overreliance on Authority – A nurse may defer to a doctor’s decision without questioning it, even if they have noticed an inconsistency in the patient’s symptoms or test results.
- Stress and Fatigue—High stress and physical exhaustion can impair cognitive function, making it difficult to think critically and make sound clinical judgments.
The CRAAP test was introduced to critique articles. CRAAP stands for – currency, relevance, authority, accuracy and purpose. The CRAAP Test is a method used to evaluate the credibility and reliability of sources of information, especially in academic and research contexts. It helps assess whether a source is appropriate and trustworthy.
The PICO framework is used to help structure clinical and research questions, particularly in evidence-based practice. It ensures that the question is specific, focused, and relevant, making it easier to search for and evaluate the best available evidence. PICO means – population, intervention, comparison and outcome.
Professional Challenges in EBP:
- Time Constraints: Limited time to review evidence during clinical shifts.
- Resource Availability: Lack of access to high-quality evidence or clinical tools.
- Ethical Considerations: Balancing patient preferences with evidence-based recommendations.
- Resistance to Change: Overcoming reluctance from colleagues to adopt new, evidence-based practices.
- Patient Preferences and Values: Patients may have preferences that conflict with research evidence, such as choosing alternative therapies over evidence-based treatments.
Learning Activity 2: Nutritional Support and Artificial Feeding.
In this learning activity, the objectives are to learn what constitutes artificial feeding, identify the different types of feeding tubes, observe the insertion of NG feeding tubes, understand the impact of malnutrition on the individual, understand how to assist patients with their nutritional needs, the importance of monitoring and recording dietary and fluid intake, calculate BMI, centiles and height and weights of individual and understand screening tools used.
Artificial feeding refers to providing nutrition to individuals who cannot consume food orally or who cannot meet their nutritional needs through normal eating. This is typically used in medical or clinical settings for patients with swallowing difficulties, digestive disorders, or other conditions impair normal eating and drinking.
The MUST (Malnutrition Universal Screening Tool) is a widely used screening tool designed to identify adults at risk of malnutrition. It is a simple, evidence-based assessment that helps healthcare professionals quickly identify individuals needing further nutritional evaluation or intervention.
BMI (Body Mass Index) is a measure used to assess whether an individual has a healthy body weight relative to their height. It is a simple and widely used tool to categorise weight status in adults and can help identify whether someone is underweight, normal weight, overweight, or obese.
A Food and Fluid Balance Chart (often called an Intake and Output Chart) is a medical tool for monitoring and documenting the amount of food and fluids a patient consumes and excretes. It is commonly used in hospitals, care homes, and other healthcare settings to track a patient’s nutritional intake, hydration status, and fluid balance. This helps healthcare providers assess whether the patient receives adequate nutrition and hydration and whether any imbalances need attention.
Reason for feeding tube insertion:
- Dysphagia- psychological/physical
- Obstruction of G.I. tract- Cancer/growth/acute obstruction
- Reduced oral intake- pain/surgery, depression/MH,
- Stomach decompression
- Surgical requirement- bowel resection, head and neck surgery/reconstruction,
- Injury/trauma
- I bleeding
Types of Artificial Feeding:
- Nasogastric tube
- Nasoduodenal tube
- Nasojejunal tube
- Gastrostomy tube
- Jejunostomy tube
- Gastrojejunal tube
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 |