Date of Learning Log: 06/10/2023

Time: 09:30-16:00

Learning Activity 1: Behavioural Change and Motivational Interviewing

This session covered topics related to behavioural change, the role of nurses, political influences, unhealthy behaviours and lifestyle changes, behaviour change models, and motivational interviewing techniques to empower individuals to make lifestyle changes. The learning outcomes were to understand the rationale behind making healthy lifestyle choices. It also provided knowledge on behavioural change and models to explain these changes. Additionally, the session taught us that, as nursing associates, our roles can influence behaviour change using motivational interviewing techniques, and we practised these skills by presenting in front of the class.

Motivational interviewing is an effective technique that can help individuals to identify their strengths and aspirations. This approach aims to inspire motivation to change and encourages independent decision-making, empowering individuals to take on the challenge of making positive changes in their lives. Motivational interviewing has been proven to promote behavioural change in various healthcare settings, improve relationships between clinicians and patients, and increase efficiency in achieving better health outcomes. The principles of motivational interviewing include directing, guiding, and following.

Learning Activity 2: Clinical Judgement and Decision-Making

In this learning activity, we covered clinical judgement and decision-making. We discussed how we used clinical judgement in nursing practice and analysed the influence on abilities to make clinical decisions. The topic consists of identifying ethical considerations in the decision-making process and the principles of shared decision-making. We then explored the barriers and facilitators to shared decision-making and determined how shared decision-making is an advocate through policy and law.

In this session, we defined what we understand about clinical judgment. I stated that, to my knowledge, clinical judgement is one of the critical attributes of professional nursing; it refers to the process by which nurses make decisions based on nursing knowledge – evidence, theories, disciplinary knowledge, clinical reasoning, and critical thinking. It is based on evidence ranging from observations of patients to research studies. Clinical decision-making converts clinical judgment to performing the right nursing interventions when addressing health problems. We also discussed the importance of assessment in clinical judgment and the importance of accurate assessments. The nursing intervention will be delivered safely and effectively by gathering accurate assessments. We also looked at patient assessment and care planning models by Howatson-Jones et al. (2015) and ASPIRE (Wilson et al., 2019).

Clinical judgements are influenced by several factors such as experiences, intuition, person-centred care, shared decision-making, research, evidence-based care, time, resources, etc. We also discussed Tanner’s model of clinical judgement; it is a model that identifies the process of clinical judgement that reflects the way nurses think in practice. The process develops from noticing, interpreting, responding, and then reflecting. It also discussed the benefits and criticisms of the clinical judgment model.

Shared decision-making enables service users to control their care, resulting in better and more cost-effective outcomes. It ensures that individuals are supported to make decisions right for them. Shared decision-making is a collaborative process through which a clinician helps patients decide on their treatment. There are ethical and legal perspectives in shared decision-making. Healthcare professionals have duties of beneficence and non-maleficence; they must respect the service user’s autonomy, and offering shared decision-making is a legal requirement. The law requires that healthcare professionals ensure service users know of any risks involved with their treatment and if alternative treatments are available. During this part of the learning activity, we also discussed and identified different models of shared decision-making, how to fully inform service users, and how to support individuals in making decisions. We also explored different types of decision aids and how they can be beneficial to educate individuals regarding the health problems or treatment discussed. When the decision is made, it must be recorded through documentation or electronic medical records. It should be accessible to the service users as well as health professionals. Documents are used for different purposes, such as legal records of the shared decision, coordinating care, etc. These barriers are time, resources, standardised approach to practise, attitude, lack of decision aids, service users refusing involvement or inability to be involved and decision-making capacity.

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Date of Learning: 29/09/2023

Time: 09:30-16:30

Learning Activity 1: The Nursing Process and Care Planning

Today we explored the nursing process ADPIE and how it can be used in conjunction with the Roper Logan Tierney (RLT) model of nursing to provide a framework to plan, guide, and evaluate the provision of care. The learning outcomes for this session are to develop an understanding of the process used in nursing to assess, plan, and deliver care, to explore the use of nursing models in assessment, planning and delivering care, and to identify how these nursing models apply to the nursing process and to apply the nursing process to case study examples and formulate care plans.

The class session started by reviewing what we learned from the previous session, person-centred care. I defined person-centred care as personalised care in which we focus on their individual needs, preferences, and values. The patient is the centre of decision-making. Therefore, they need to be involved when it comes to decision-making. Person-centred care is important because it promotes independence, skills, knowledge, and confidence to make informed decisions about their health. Person-centred care is delivered by working collaboratively with the patient. It is about giving them choices or preferences and treating them with dignity and respect.

The nursing process allows nursing professionals to take a systematic approach when managing patients’ needs. It involves considering potential nursing interventions and evaluating their effectiveness. Assessment, planning, implementation and evaluation for short APIE is a process to direct nursing practice away from intuition and standard practice to a structured systematic way of dealing with care needs.

Patient assessment is needed to identify, understand, and determine the problem or issue. It is an essential requirement to gather accurate assessments to view patients holistically and thus identify their real needs.  Holistic assessment considers the patient’s wishes, mental, physical, social, cultural, spiritual, and personal needs. It is important to know the patient’s current condition, type and frequency of treatment, and observation to help inform clinical judgement and clinical decision-making. The assessment includes an evaluation of the treatment or procedure progress and identifies the patient’s values and preferences.

There are two types of patient assessment, these are comprehensive assessment and focused assessment. Comprehensive assessment provides fundamental and personalised knowledge about the patient and strengthens the therapeutic relationship between the patient and nurses. Nursing processes and models such as RLT, Neuman’s System model and the disease-illness model are examples of comprehensive assessments.  Focused assessment area detailed nursing assessment of a specific body system relating to the presenting problem or other current concerns. This may involve one or more body systems. As a nursing associate, I must utilise clinical judgement to determine which elements of a focused assessment are pertinent for the patient e.g., ABCDE, NEWS2

Good assessment involves subjective data and factual data when gathering information during patient assessment. Subjective data are verbal information provided by the patient, it verbalises the perception of the problem which is often put in quotes and referred to as a chief complaint. Objective data are information that is factual such as age, gender, allergies etc. This is information that clinicians can hear, see, smell, feel or measure. Objective data includes physical, psychological, and socio-cultural factors that may affect the patient’s health status. Past health history must be gathered and the current or present problem of the patient.

The process of comprehensive patient assessment starts with initial assessment, gathering subjective data, physical examination (objective data), explanation and planning, and closing the session and decision making. The key principles of assessment are to practice infection control techniques, establish rapport, gain consent and maintain privacy and dignity, use a systematic approach, listen to the patient, and summarise each stage of history history-taking process and ensure information is documented clearly, accurately and legibly at each stage. It is required to have communication skills when doing an assessment, interpersonal skills, active listening skills, observation skills, taking vital signs and reviewing documents. Some factors may affect the accuracy of an assessment. These factors can be physical, cognitive, psychological and environmental factors.

Documentation is a fundamental part of any nursing process. Assessments should be always documented. Documents must be in logical order. Using subjective data, objective data, assessment, and planning (SOAP) as a method of charting. It is important to use correct terminology and avoid abbreviations.

Care planning is a crucial stage of providing person-centred care. Learning about the different nursing processes and assessments made me understand how important it is to gather accurate information about the patient. By gathering all the right data, I will be able to provide the right level of care for the patients. I can meet their needs, and goals in a way that suits them.

Learning Activity 2: Planning and Monitoring Care – Formative Workshop

In this learning activity, we continued our session from the previous topic of nursing process and care planning. To summarise the session, we had a group activity in which we used the Rogan Logan Tierney Model. The learning outcomes for this session are to apply the RLT model to identify the patient’s care needs and prioritise care, to demonstrate an understanding of evidence-based care when planning and monitoring care, and to demonstrate an understanding of the importance of monitoring care.

The session begins with a discussion of the ethical aspects of the nursing process. Autonomy simply means that the patient has the right to be involved in shared decisions about their care. Care professionals can recommend when care planning, but the individual has the right whether to take it or not. Mental capacity must be considered within this ethical aspect. Beneficence is doing good. Professionals must ensure that assessments are considered for the welfare of the patient and always promote health. Justice simply means that resources, time and distribution of nursing interventions are equally spread. Non-maleficence means ‘doing no harm’. In this perspective of the assessment, it focuses on risk-assessing actual and potential problems. This is to prevent problems from occurring or to minimise the impact.

The Rogan Logan and Tierney Model (RLT) was introduced during this class session. The RLT model consists of 12 activities of daily living which are maintaining a safe environment, communicating, breathing, eating & drinking, eliminating, personal cleansing & dressing, controlling body temperature, mobilising, working & playing, expressing sexuality, sleeping, and dying. The framework offers a holistic assessment of a patient whilst developing a plan of care. We discussed factors that may influence an individual’s activities of living. These are biological, psychological, sociocultural, environmental and politico-economic factors. The activities of living are the centre point of the RLT model, this is used to assess a patient more holistically and the model depicts the patient’s level of degree of independence.

To put the RLT model in practice we had a group activity in which we used a case study to base our assessment. In this group activity, we used Case Study 1 based on Rosemary who was found by a carer. We presented to the whole class our findings and assessment. We introduced the case study, used the RLT to identify priority and explained why. We considered some focus assessment and nursing tools so that we could make a care plan. In this group activity, we used references to support our findings and used them to implement and evaluate the desired outcome to achieve.

Overall, the topic and group activity benefitted me. It reinforced skills that are relevant to the assignment. I gained knowledge of the content of my assignment and gained clarity on how it should be done. The teaching delivery was good which gave me tips and advice when creating my assignment. It was nicely structured and clearly presented.

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Date of Learning: 22/09/2023

Time: 09:30-16:30

Learning Activity 1: Social Determinants of Health and Cultural Influences Epidemiology and Demographics

In today’s session, we covered the demographics and epidemiology in planning appropriate services within health promotion and public health. The learning outcomes for this session are to gain knowledge of the importance of epidemiology and demographics, identify and discuss the social factors influencing health and the mechanisms by which they do so, understand the association between social classes and health, gender and health, ethnicity and health, and how this applies to specific groups, and to understand the theories of the social determinants of health.

The class session started by looking at an example of a health promotion poster related to our module assignment.  A good poster must be detailed, informative, and educational. The students had an opportunity to discuss both posters and we were able to gain more understanding of the assignment. We then moved on to today’s class session.

Demography is the study of statistics to determine the causes of health and diseases. The study of demography is the study of the human population concerning their size, structure and dynamics. It is looked at by the office for health improvement and disparities. A population is all the inhabitants of a particular place, such as residents in the same area. It is structured and refers to age, sex, ethnicity, and individual characteristics e.g., LGBTQI. Decisions on how and where resources can be allocated will be made based on these characteristics.

Epidemiology is the study of the determinants, occurrence, and distribution of health and disease in a defined population. We discussed an example of epidemiology in class, and we talked about COVID-19 and the rising number of HIV. Epidemiology can inform the health of the population, morbidity and mortality which can provide information about trends. It can help target delivering healthcare for diverse groups. The ethnic demography of an area will increase the possibility of certain genetic conditions being prevalent. The use of statistics, probability and the R-value assess the ability of a disease to spread. Statistics that are monitored are morbidity, mortality, life expectancy at birth, health-adjusted life expectancy, and studies that are often explored as ‘casual factors’ e.g., smoking.

Disease surveillance is an information-based activity involving the collection, analysis and interpretation of large volumes of data originating from a variety of sources. It is the core function of Public Health England (PHE) which is now known as The Office for Health Improvement and Disparities, they ensure that they have the right information available to inform public health decisions and actions. Good surveillance is significant because they must respond quickly and effectively to public health threats. It improves interoperability between systems and uses new technologies to improve outcomes. When gathering information, surveillance should have recognised goals and objectives. The data collected defines the target population as high quality, accessible, and contains interpretation and recommendations. To give a clearer interpretation about the topic we looked at disease surveillance in COVID-19 and tuberculosis (TB).

Social determinants of health are the non-medical factors that influence health outcomes. These are economic and social factors that have a profound effect on health. Conditions in which people are born, grow, and work. We gave some examples of what we think are social determinants of health which can influence health equity in positive and negative ways. These social determinants are income, social protection, education, unemployment, job security, working life conditions, food security, housing etc. Health inequalities are unavoidable and unfair differences in health between groups of people who are united by their shared socio-economic status or gender rather than by any health-related attributes.

We looked at and discussed some reports on health inequalities during this learning activity. The Marmot Review Report is an evidence-based report which proposes a strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age which can lead to health inequalities. There were a few reports we can look at to support and gain more knowledge about the topic. These reports are made by the Institute of Health and Equality, King’s Fund, World Health Organisation, NICE guidelines and Anti-social Behaviour.

The module was a great learning experience in which I enjoyed the topic and group activities. The class delivery was interactive, I gained more confidence in presenting since we presented our findings and research about the Marmot report. We looked at factors why it is worse to live in the Northeast of England than in deprived areas in London. We were able to gain relevant, evidence-based information. I also had an opportunity to remind myself how referencing should be and how it should support any literature included. I like how the module provides a clear understanding of each lecture which always relates to the assignment.

Learning Activity 2: Respiratory Care, Peak Flows and Oxygen Therapy

In this learning activity, I was introduced to oxygen therapy. The learning outcomes for this session are to identify different methods of administering oxygen therapy, discuss the use of oxygen therapy in practice including indications and cautions, and to become familiar with the equipment used for delivering oxygen.

The class started with a theoretical approach before going to the clinical simulation centre where I practised clinical skills on oxygen therapy. Administering oxygen has a different delivery system it will depend on the patient’s condition. It was discussed that oxygen treats hypoxaemia not breathlessness. Oxygen therapy aims to maintain the patient’s oxygen saturation within the range that is appropriate for them. The general respiratory assessment was discussed, some factors need to be assessed such as what physical position is the patient in – sitting or standing? Assessing any abnormalities by looking and listening to the patient. These could be the use of accessory muscles, intercostal recession, wheezing, coughing, nasal flaring, level of consciousness or any other noises.  Oxygen levels can be assessed by using a pulse oximeter, or blood gas analysis, and in some situations, it may not be appropriate to continue monitoring e.g., palliative care.

Oxygen administration should only be administered by trained staff. Oxygen is a medicine; therefore, it should be prescribed before administrating. Oxygen therapy can be administered only during an emergency, it should be given without any delay and the oxygen given should be documented as per local policy. In the prescription, it should indicate target saturation, percentage or flow rate as well as delivery device.

The target oxygen saturation for most people who are not at risk of carbon dioxide retention also known as the hypercapnia target of 94%-98%. People who are at risk of hypercapnia will need a lower target of 88%-92%. This includes patients who suffer lung conditions such as chronic obstructive pulmonary disorder (COPD), cystic fibrosis, bronchiectasis or chronic asthma. Some patients may have a lower target range such as 85%-90% which will be specified on the prescription.

There are different oxygen delivery devices such as nasal cannulae, Hudson masks, venturi masks, and non-breather masks. A nasal cannulae is a device that delivers extra oxygen through a tube and into your nose. It does not deliver a consistent concentration of oxygen 24%-30%. It is useful when low to moderate oxygen therapy is required usually up to 4 litres. Some patients may swap their oxygen mask with nasal cannulae when eating, drinking or receiving nebuliser. It is important to remind patients to breathe through their nose and out through their mouth. The tubing must fit over the nose and bring the tubes together under the chin. Nasal cannulae can irritate the skin therefore it is important that the comfort of the patient is ensured, and skin is protected.

Hudson mask is a simple face mask where the oxygen source attaches to the mask and exhalation ports allow the carbon dioxide to escape. The Hudson mask can be used for higher-concentration delivery of oxygen. The flow must be at least 5 L/min to avoid CO2 build-up.

The venturi mask is an oxygen device to delivers a known oxygen concentration to patients on controlled oxygen therapy. The oxygen flow through the venturi barrel which sucks in the room air through the small holes in the barrel which mixes with the oxygen and dilutes its concentration.

Non-rebreathe mask allows high flow rates of oxygen. It is usually used in patients who are critically ill, and it can only be used for short-term therapy. The oxygen must be turned on at the flow meter and the reservoir bag must be inflated before applying it to the patient. It is also important that the oxygen is at the desired level using the flow meter. The standard flow rate is 15L/min, minimum delivery of 10L/min to ensure that the oxygen reservoir bag does not collapse during inspiration.

The oxygen flow meter regulates the flow of the oxygen. When looking at a flow meter with a bobbin, the flow rate is read from its top. However, in flow meters with a ball, the rate is read from the centre of the ball.

It is important to explain to the patient the procedure of oxygen therapy and emphasise the need to keep the mask on their face and to make sure that they breathe normally. The patient must be seated upright unless it is not possible. The patient can hold it so that they can cover their mouth and nose if it is possible to do so. When the mask feels comfortable the elastic strap can help hold the mask in position.

There are few cautions when using oxygen therapy. The oxygen tank or machine should not be near an open flame, static electricity, newly applied alcohol gel, certain oils, greases and recently moisturised skin. If the patient has pressure sores a preventative dressing may be required. Oxygen therapy can also dehydrate membranes in the respiratory tract.

Oxygen can be humidified to reduce sensations of dryness in the upper airways. It can be added to moisten the gas and it is not normally required for short-term delivery of oxygen. Humidification can be used if they require high-flow oxygen for over 24 hours. It can also help loosen secretions for some patients. Humidification should always be used in patients who have tracheostomies when receiving oxygen therapy.

After covering the theoretical session of the topic, we then moved to the clinical simulation centre where Luke (one of the lecturers) set up different cases of mimic patients who are receiving oxygen therapy. Each student had an opportunity to explore and learn about different cases of the mimic patients. I was also able to see what a prescribed oxygen would look like and explored the different types of oxygen devices. I gained new knowledge and clinical skills during this learning activity which I can use in my future as a nursing associate.

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Date of Learning: 15/09/2023

Time: 09:30-16:30

Learning Activity 1: Health Promotion, Physical and Mental Well-being as a Nurse.

In this learning activity, I will reflect on an episode of learning from my module promoting health and well-being across the lifespan. In this class session, the learning outcomes are to understand the importance of maintaining own physical and mental well-being as a student nurse and to recognise own stress levels and how to manage these. We also discuss when and how to access help and support and our impact as a role model to patients, service users and the wider community.

The class session started with a brief recap of our assignment criteria and a quick review of our last class session. We had an opportunity to ask more about the assignment in which I was able to get some clarity about it. In the early part of the session, we looked at some statistics related to the health of the working-age population in the UK. I found out that 1 in 3 working-age people in the UK has a health condition, 1 in 6 adults have experienced a mental health disorder for the past week and 1 in 10 experienced a musculoskeletal condition.

Stress makes a difference in the overall well-being of a person depending on how people respond to stress. The class defined stress as a state of worry or mental tension caused by a difficult situation. It is a natural human response that prompts us to address challenges and threats in our lives. It was discussed in the class that the body has an alarm system called alarming adrenaline. An adrenaline hormone in the adrenal glands activates the body’s ‘fight or flight’ alarm. It is a system that helps or tells our body to prepare for a stressful or dangerous situation.

Personal stressors are events or conditions that occur in a person’s life that may impact individual health and well-being. Personal stressors can be issues that come up regularly or one-off events. It can be a big thing or a build-up of small challenges. The class was introduced to the traffic light system, which is a system used to understand own emotions and behaviours. It consists of green feelings, amber feelings and red feelings. The green feelings simply mean go – these are good-to-go emotions, emotions that are appropriate for all situations. The amber feelings mean slow down – these are proceeded with caution emotions, these emotions are more intense than normal but still have some control over thoughts, feelings, and reactions. The red feelings mean stop – these are out-of-control emotions, these emotions are extremely intense, and are not in control of thoughts, feelings, and reactions.

We had a group discussion on how we manage and reduce stress. Each student had different ways of stress-coping mechanisms. For me, journaling or writing helps when it comes to reducing or managing stress. Some of the students mentioned several coping skills such as talking to friends and families, walking, running etc. After discussing as a group how we manage and reduce stress, we were given a group activity. We were given a set of questions; our group task was ‘How does a nurse’s health and well-being impact patient care?’ Each participant contributes both positive and negative impacts. We then presented this to the whole class. Other groups presented the remaining questions which are: ‘How do nurses impact the health and well-being of other members of the nursing team?’ and lastly, ‘How does our health and well-being impact our lives outside of work?’

In this learning activity, we discussed that there are 5 key elements of emotional intelligence. Emotional intelligence is the ability to manage both own emotions and understand the emotions of other people around. The five key elements of emotional intelligence are empathy, social skills, self-awareness, self-regulation, and motivation. Empathy is the ability to understand another person’s feelings, experiences etc (Oxford Learners Dictionary, 2021). Social skills are the ability to communicate effectively, conflict resolution, active listening, relationship management and respect. Self-awareness is the ability to have an open mind, regulating own emotions to understand other’s feelings. Self-awareness is about knowing and being mindful of strengths and weaknesses. Staying focused, setting boundaries, and practising self-discipline. Self-regulation is the ability to manage own emotions and behaviours per the demands of the situation. It is a set of skills that enables you to achieve a certain goal. It is about managing own feelings, thoughts and impulses. Intrinsic motivation is doing an activity for satisfaction or due to enjoyment rather than for separable consequences. Extrinsic motivation is when someone feels motivated to do something to gain a reward or to avoid punishments or consequences. Emotional intelligence helps build relationships, reduces stress, and defuses conflicts.

Self-care is important when it comes to physical and mental well-being, it can help manage or reduce stress. An example of self-care would be regular 1:1 talks, reflective practice, journal writing, communication, hobbies or interests, physical exercises, seeking help when needed, meditation, prayer etc.

This learning activity made me realise and recognise the importance of maintaining my own physical and mental well-being as a student nurse/nurse associate. Nurse’s well-being affects patients and the quality of care they receive. High-quality patient care relies on motivated and skilled staff. When a patient is satisfied with the care received it reduces the days of hospital stays.

Learning Activity 2: Medicine Management

In this learning activity, we covered medication management and injection techniques for the care delivery module. The session explores the ethical, legal, and professional issues involved in administering medication. We identified processes involved in the safe administration of medication and discussed actions that are required when an error or adverse event occurs. We also looked at relevant drug calculations which we applied during our clinical simulation.

Administration of medicines is an important aspect of nursing; they must be registered under the NMC and a written prescription of a medical practitioner. It requires knowledge, skills and competence. The registered professional is accountable for his/her actions, own moral and ethical judgement is needed. Nursing associates must adhere to the law, standard policies of work organisation and the Nursing and Midwifery Council.

There are categories when it comes to medicines. General sales medicines (GSL) are over-the-counter medications. These medications can be bought without the presence of a pharmacist and can be usually found on supermarket/shop shelves. Pharmacy-only medicines (P) are medicines sound under the supervision of a pharmacist from a registered pharmacy. Prescription-only medicines are prescribed by doctors, dentists, or independent prescribers. Controlled drugs can be categorised into classes – Class A, Class B and Class C. It has a high level of regulation; this kind of drug can be addictive and harmful to our bodies.

Mistakes with medication can cause unpleasant or dangerous side effects. There are guidelines available to support professionals in delivering effective medication management. Professional guidance from the NMC The Code and the Royal Pharmaceutical Society was introduced in this class session. We also covered the importance of being competent which nursing associates must maintain to deliver effective medication management. In this learning activity, we covered the 6 rights of medication management which are right patient, right medicine, right dose, right route, right time, and right documentation. I learned about drug calculation and routes of administration. It is also important to know conversion on units when it comes to administering medication.

Learning Activity 3: Injection Technique

In this class session, we were provided with knowledge and clinical skills to administer both intramuscular and subcutaneous injections safely. The learning outcomes for this class session are to understand the rationale for administering medications via subcutaneous and intramuscular injections (IM), gain knowledge of risks/contraindications associated with IM injections, gain confidence in the procedures of administering injections and understand the importance of patient factors when administering medications via injections.

In this learning activity, we discussed the risks or contraindications associated with IM injections. Unsafe practice of injection can impact patient outcomes which can cause nerve damage, abscess, pain and possibly death. The rate of absorption is quicker than oral medication which can cause exacerbated anaphylaxis, infection, and bleeding if unsafely practiced. A common risk with IM injections is needle stick injury. Common sites for IM injections are the upper arm, buttocks, hips, or lateral thigh.

Good hand hygiene is the first step of the procedure. It is also important to gain consent and explain the procedure to the patient. The medication record must be checked, and the 6 rights of medication must be considered. Confirm any allergies to the patient and check if the medication is licensed to a particular site. Once all the equipment is gathered, consider the use of gloves if needed and prepare the patient’s skin. When preparing the equipment, the injection should be drawn up in a clean area and using an aseptic non-touch technique. We used a mimic of a deltoid site to practice our injection technique. A glass ampoule was used during this practical activity. I made sure that all the medication drained from the stem of the glass ampoule covered the neck with a sterile swab and broke off the top by snapping it along the score line. I made sure that there were no glass particles inside the ampoule. We were advised that if there are glass particles a new one must be used.

The process of preparing IM medication was to draw up the medicine, remove and dispose of the needle in the sharp bin, attach a new needle and tap the syringe to remove air bubbles. The next procedure is to take the prepared equipment to the patient and confirm the patient’s identity. Locate the site and proceed with the injection with the Z-tracking technique. The Z-tracking technique is slightly stretching the skin/area and then inserting the needle into the skin. After injection, wait for a few seconds before removing the needle. Some of the needle has safety cap which can be put after use and the needle must be disposed of in the sharp bin. The last step is aftercare for the patient’s skin and documenting the procedure.

Overall, the class session was helpful and useful for my clinical skills. I gained confidence in medication management and injection techniques. The class session was interactive which gave me plenty of new knowledge and skills for me that I will be able to use in the future of my clinical career.

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Date of Learning: 08/09/2023

Time: 09:30-16:30

Learning Activity 1: Introduction to Public Health Policy, Screening, and the Role of the Nursing Associate.

Today is our first session after our three weeks of summer break from university. We were welcomed by our two new lecturers, Paulette Ragan, and Scott Rodden. The lecturer at this early part of our class session was Paulette. The class started with a brief introduction of ourselves (the students) and our lecturer. The module assignment was introduced to us students and we identified that our Moodle access for the module was not available. However, Paulette shows us on the digital board how it is laid out. She began to discuss and explain our module assignment. She discussed the assignment criteria and how it is assessed.

The module assignment consists of a poster/leaflet and a report. It covers a demonstration of an understanding of the theory and its application to practice regarding public health and health promotion. As a student, I am required to develop a poster/leaflet and submit a 1,500-word report to support and discuss the need, evidence base, and relevance of the information shared.

The learning outcomes for today’s session are to understand the module learning outcome and understand the definitions of health and well-being, public health, health promotion, and health education. To enhance my knowledge of the role of nursing associates within the topic areas and to gain an overview of what is expected for the assessment of the module.

In this learning activity, we discussed what it meant to be healthy. I wrote keywords such as self-awareness, health status, diet, and physical, mental, spiritual, and emotional health. We then discussed influences on health such as cultural background, family, religion, media, social environment, and social policies. I was given a questionnaire which described the important of aspects my health and we compared each response with each other. We then had a group discussion about our results in which we all agreed that everyone is different and can be influenced by different beliefs and perceptions in life.

It was discussed that health encompasses these dimensions – physical, emotional, intellectual, sexual, social, spiritual, and societal. We also discussed models of health professional’s perceptions such as the medical, holistic, biopsychosocial, ecological, and wellness models.

The medical model is disease-oriented which focuses on the physical dimension rather than others. Health promotion in the medical model focuses on giving information to individuals to ensure they understand the pathology. The holistic model embraces the concept of well-being. It integrates health education and prevention activities when it comes to health promotion. The biopsychosocial model incorporates both medical and holistic models of health. It considers individual and group circumstances that may affect health. The ecological model is a framework that considers the individual and social environments mutually affect each other. Multiple factors are considered that might affect the lifespan such as individuals (genetics and behaviours), interpersonal (social support), institutional and community environment (work, school, transport etc.), broader social, economic, and political influences (social policies, law and social norms). The wellness model builds on the principles of the holistic model. It strives to improve the quality of life regardless of health status. It highlights the need for individuals to be resilient by adapting to changes.

In this learning activity, we looked at a website which statistically shows different countries which indicate individuals’ life expectancy, ecological footprint, and well-being. In the UK the average life expectancy is 81.3 years, the ecological footprint is 3.95 and well-being is 7.16/10. The website gave plenty of information about all the countries in the world that are affected by ecological footprint which affects the rates of life expectancy and wellbeing of the people.

Health promotion is enabling people to increase control and awareness to improve health. It is about an individual’s behaviour towards a wide range of social and environmental interventions. It is a core function of public health to promote health and support governments, communities, and individuals to cope and address health challenges. The World Health Organisation has been delivering health promotion worldwide.

Promoting health includes health education, which is teaching health and how to live healthily. It is a component of health promotion; it is about learning about health and illness. Public health is the art of promoting and protecting health and well-being by preventing ill health and prolonging life through organised efforts of society.

In this learning activity, I learned the importance of health promotion as a nursing associate and how important it is to be involved. I must contribute when it comes to identifying the health needs of the community and the most appropriate ways of intervening to improve their health. I must provide relevant information and support to promote and optimise positive health.

Learning Activity 2: Introduction to Delivery of safe and effective person-centred care.

In this learning activity, I will be reflecting on an episode of learning from the module – delivery of safe and effective person-centred care. We had a brief introduction; it was the first time we met the new lecturer, Scott. Following the brief introduction, we started discussing the module and assessment criteria.

The assessment is based on a case study in which I will need to demonstrate my ability to apply theory to practice by demonstrating my understanding and knowledge of holistic assessment, planning, and delivering person-centred care. The assignment consists of a 2000-word essay to be submitted on the 19^th of January 2024. The module learning outcomes are to describe the key stages of the nursing process, demonstrate the ability to conduct a holistic nursing assessment using appropriate frameworks, tools, or techniques, demonstrate principles of planning care through shared decision-making and lastly, identify the key components of high-quality person-centred care. After discussing the module assignment, we began to discuss today’s session.

For today we covered person-centred care. In this session I identified the principles of person-centred care and applied them to practice, we explored barriers and facilitators to person-centred care, and we identified how person-centred care is advocated through policies and regulated by the law.

We started the class with a group activity. We were asked by the lecturer what we think care means. My group wrote down some keywords and discussed each word in the whole class on why we think those words mean care to us. Person-centred care focuses on the needs of an individual, it is about ensuring that preferences, needs, and values are considered when it comes to clinical decision-making. It is about supporting individuals in a way to promotes their independence and treating them with dignity and respect. I particularly like how my lecturer defined person-centred care as a centre/core of the decision-making process.

In this learning activity, we discussed fundamental standards of care which are laid out by the Care Quality Commission (CQC). The CQC are independent regulator for health and social care in England. Hospitals and other healthcare providers are rated accordingly by the CQC. There are core values of person-centred care. The NHS England values involving people in their care. There are 8 values in person-centred care this are individuality, rights, privacy, choice, independence, dignity, respect, and partnership.

The principles of person-centred care discussed during this class session and how important it is when it comes to supporting individuals. It is about offering coordinated and personalised care, support, and treatment. Person-centred care is supporting an individual to recognise and develop their strength and abilities to enable them to live an independent and fulfilling life. Person-centred care is important when it comes to patient experiences which improves the quality of care and achievement of health outcomes.

In this learning activity, I learned the importance of delivering person-centred care. It benefits patients as they are more likely to be involved and satisfied with the care provided. Individuals are more likely to engage in positive health behaviours and to have better health outcomes. Person-centred care shares power and responsibilities with both patient and nurse about care planning. It involves effective communication and therapeutic relationships.

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Date of Learning: 11/08/2023

Time: 09:30-16:30

Learning Activity 1: Assignment Submission Week

This week is assignment submission week. We are off from university so that we can focus on assignment submission. This whole week was quite stressful for me because of the exam and assignment. On Monday, 7^th of August 2023 I completed the exam for the module – Understanding Health and Illness across Lifespan.

Today, I submitted my reflective assignment from the module -Developing Professionals and Academic Skills for Nursing Associates. I am glad that I have finally submitted my assignments and I am quite happy with the work I have done.

I also met Colin Rowe this week for my tripartite in which I gained feedback on my studies so far. I was given a lot of positive feedback and support during my studies. I am hoping to get good marks for my assignments. Upon meeting Colin, we discussed the topic covered for today’s class session which is Medication Management.

I read the theoretical presentation that the session covered for today. There is plenty of information regarding the topic. Colin reassured me that we would go over the topic in our Care delivery module.

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Date of Learning: 04/08/2023

Time: 09:30-16:30

Learning Activity 1: Child Development/Aging Process

In this learning activity, I will be reflecting on a learning from my module- Understanding health and illness across the lifespan. Our course convenor played clips about the ageing process- children, young people, and adulthood. The learning outcomes from this class session are to identify the main features of ageing, understand the impact of ageing on the human body and explore the concept of health ageing.

The class watched a clip called ‘The Human Body, Biology Documentary Series’ which gave me an overall insight from conception to childbirth. In this clip, I was able to see the stages of conception. Stages such as sperm transport, egg transport, fertilisation, embryo development to implantation. I learned that the natural environment of a vagina is acidic, the sperm with the greatest motility will travel through the layers of cervical mucus. When the female is ovulating, the barriers of cervical mucus that guard the entrance of the uterus become thinner and the acidity changes which makes it a friendlier environment for the sperm.

Egg transport is a process in which ovulation occurs and the egg has reached the uterus. Adhesive sites on the cilia, which are located on the surface of the fimbriae, are responsible for the egg pick-up and movement into the tube. The egg can move due to the cilia of the tube and muscular contractions.

Fertilisation and embryo development are processes of sperm, and the ovum forms a zygote. This is when pregnancy begins which leads to a pregnancy journey for a female. The human embryo undergoes multiple cell divisions a process called mitosis. At the end of the transition, the embryo becomes a mass of organised cells known as a blastocyst.

Once the embryo reaches the blastocyst stage, approximately five to six days after fertilisation it hatches out of its zona pellucida and begins the process of implantation in the uterus.

I was given clips to watch for self-directed learning which has given me a lot of information needed for my exam. There were 5 clips in total which are about childbirth to the end of life. Overall, the clips are informative in which I gained knowledge on how the human body works across the lifespan. My anatomy book was also a good learning method to fully identify and understand what was being said in the clip.

Learning Activity 2: Group tutorial/1:1 tutorial

In this learning activity, we had a review of the module – Developing Professionals and Academic Skills for Nursing Associates. The class started with a group tutorial in which we learned about the submission of our report via Turnitin. The course convenor showed us where to submit and how. Maria also demonstrated how plagiarism is detected and explained where to see the percentage.

After the group tutorial, we had a 1:1 tutorial in which she scanned our assignment and looked if there were improvements needed before submission. This class session was very useful for me because I started to overthink my report and wanted to change it as I was unsure if I was on the right track. I appreciate the reassurance and advice given to me by the course convenor.

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Date of Learning: 28/07/2023

Time: 09:30-16:30

Learning Activity 1: Being Human (Trip to gallery exhibition)

In this learning activity, we went on a trip to a gallery exhibition called ‘Being Human’. The gallery explores and expresses what it means to be a human in the 21^st century. The artworks are divided into four sections which are Genetics, Mind and Bodies, Infection, and Environmental Breakdown. It highlights diverse perspectives and overlapping identities – disabled people, artists, activists, and scientists.

Every artwork in the gallery has a caption describing it either in writing or braille. The gallery also provided an audio device for audio descriptions. I was physically able to touch some items which allowed me to feel the texture or shape of the object. Some objects that are not allowed to be touched are in a glass case.

There was an anatomical model that lights up when I press the button which indicates an organ. It was a very interactive model to play around and familiarise myself with what and where the organs are located. The gallery also has a section about genetics and infections. I saw an object made of HIV-infected human blood on the display. I was also surprised to see a do-it-yourself faecal transplant which consists of a blender, sift and other everyday household equipment. I particularly like the medication cardboard packaging displayed on a glass case labelled as ‘dignity’.

The trip to the gallery exhibition made me understand how innovative medical treatment is and how it evolves as each year passes by. It was an interactive day to learn especially for the exam coming up for the module.

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Date of Learning: 21/07/2023

Time: 09:30-16:30

Learning Activity 1: Mental Health and Communication Core Consideration for the Nursing Associate.

In this learning log, I will reflect on an episode of learning in which we discussed mental health and communication from the module developing professionals and academic skills. The class session aims to develop an understanding of core ways of working and communicating with mental health service users. We discussed a few topics around mental health such as challenging negative perceptions and assumptions. We explored core mental health diagnoses and elements used when collaborating and communicating with service users.

Exploring perceptions and expressing awareness around mental health helps reduce the stigma around mental health issues. The Mental Health First Aid (MHFA, 2023) stated that over a third of the public thinks people with mental health issues are likely to be violent but in fact, they are more likely to be victims and in danger to themselves than to others. We looked at the MHFA (2023) statistics: 80%-90% of people who die by suicide are experiencing mental distress. Studies and research showed that physical and mental health affects one another. King’s Health Partners (2017) stated that nearly half of people with mental illness also have at least one long-term physical health condition. 30% of people with long-term conditions have mental illness and an estimated 15–20-year shorter life expectancy.

NHS, 2022 stated that 1 in 4 people in the UK will experience mental health problems each year and in England 1 in 6 people report experiencing common mental health problems such as anxiety and depression in any given week. The NHS Digital (2021) also stated an increase in mental health illness in children. 1 in 6 children under the age of 16 were identified as having a probable mental health issue. Eating disorders increased to 13% in the 6–11-year-old age group and 50% of all mental health problems start by the age of 14. It was also reported that from 2015-2021 rates of self-harm doubled. Young Minds, 2023 stated that childhood mental illness has an impact on adulthood. 1 in 3 adults’ mental health problems is directly connected to adverse childhood experiences or challenges. Adults who experienced four or more adversities during their childhood are four times more likely to have low levels of mental well-being and life satisfaction.

In this learning activity, we talked about rates of suicides in England. The overall suicide rate was 10.5 per 100,000 and in 2021, 5219 suicides were registered (Samaritans, 2021). Male suicide rates (15.8) were higher compared to female rates (5.5). Male aged 50-54 were found to be at high risk of suicide. During the discussion, we explored why we think males are more at risk of suicide than females. Some argue that male values independence and decisiveness they consider acknowledging help as a weakness which results in them avoiding it. Women, on the other hand, value interdependence they communicate and consult friends or families and readily accept help. In my opinion, both males and females are at high risk especially if individuals lack self-awareness around mental health.

The theory of the mental health continuum model (Keyes, 2005) was explored during this class session. It’s a model that identifies where we lie now considers all the things that upsets us and works on minimising them. It describes different mental health conditions and their physiological effect which can suggest ways to improve. It consists of 5 stages – excellence, thriving, unsettled, struggling and in crisis.

We had a brief overview of some mental health diagnoses during this learning activity. We explored disorders such as anxiety, bipolar, mania, depression, psychosis, schizophrenia, and personality disorder. There are several types of anxiety disorders. It begins with overwhelming fear and anxiety. It affects work, relationships, school, and life in general. Phobic anxiety disorder, panic disorder, agoraphobia, and social phobias all belong to anxiety disorders. Individuals who suffer from anxiety disorders have psychological and physical symptoms.

Bipolar disorder has three different types. The disorder causes difficult shifts in mood, energy, and concentration and it disrupts the ability to take care of daily responsibilities. It lasts for several months at a time. Bipolar disorder is a serious and chronic mental illness with fluctuating course.

Mania or hypomania are periods of over-active and high-energy behaviour. Delusions, hallucinations, and thoughts become so disturbed that the person becomes incomprehensible. Mania disorder requires urgent assessment or treatment.

Depression affects a person’s mood. Persistent sadness for weeks or months can be considered mild, moderate to severe and may result in suicidal thoughts. Symptoms can be loss of interest, fatigue, disturbed sleep, poor concentration, low self-esteem, changes in appetite etc.

Symptoms of psychosis are hallucinations, delusions and disorganised thinking and speech. Experiencing stimuli that others don’t are hallucinations. Delusions are fixed or false beliefs about something that are not based and conflict with reality. Psychosis affects thoughts and feelings which makes it difficult to communicate with others.

Personality disorders cause individuals to have unusual and long-term depressive thought patterns, affecting all aspects of their lives. Childhood abuse or common trauma results in the disturbance of personality/emotional development. Extreme difficulties with thoughts, emotions, and relationships with others. It is highly stigmatised and/or misunderstood.

Communication with mental health needs can be both verbal and non-verbal. We discussed different ways to communicate with a person with a mental health illness. It is about building trust and rapport. Information-gathering techniques such as using closed or open questions, funnelling, reflecting, summarising, and paraphrasing. We explored several recovery models and communication styles such as Betari’s box, Berne (1957) and Maslow (1943).

The learning activity made me realise that all mental health disorders benefit from receiving awareness. If people are more familiarise with the illness, stigma and negative perceptions within mental health can be lessened and challenged. Stigmas and negative perceptions only cause people to suffer in silence. Breaking the stigma means encouraging individuals with poor mental health that they are not alone which leads to strength and commitment in getting treatment.

Learning Activity 2: Fluid Balance, Catheter Care and Urinalysis.

In this learning activity, we looked at and discussed topics such as fluid balance, catheter care and urinalysis. The learning outcomes from this class session are to accurately record and calculate fluid balance, gain knowledge on indications for catheterisation, and catheter care and identify the differences between different urine specimens by carrying out urinalysis.

The class session consists of two parts, the theoretical and practical sessions. The theory session discussed continence management and urinalysis in which we talked about catheterisation, skin integrity and urinalysis. In this first part of the session, we looked at the meaning of incontinence and how it affects a person’s physical, psychological, and social well-being. It was discussed that different types of incontinence can be assessed to reach a diagnosis. Stress Urinary Incontinence (UI) is an involuntary leakage of urine on effort or exertion. Urge UI is an involuntary leakage of urine following a sudden uncontrollable urge to void. Mixed UI is involuntary leakage of urine associated with urgency and exertion, effort, sneezing or coughing.

Standard assessment forms must be used to reach a diagnosis. It consists of recording the patient’s symptoms as described, duration and any previous treatment they had. Bowel history should also be recorded, and past medical history should also be known such as gynaecological or urinary tract surgery. We also discussed in the class session about faecal incontinence, we looked at the Bristol stool chart for different types of stools. It is also important to know if the patient is taking any medications. It is also important to include the patient’s social circumstances, home environment, personal relationships, occupational history, and lifestyle such as smoker or non-smoker. It is also important to note their body mass index (BMI).

Other additional assessments were discussed during this class session such as using quality of life assessment. Physical examination such as abdominal for bladder and colon can indicate constipation. Genitalia examination for abnormalities, discharge, or skin integrity. Vaginal examination such as pelvic floor contraction and urethral leakage – can be assessed by asking a patient to cough- this can be an indication of Stress UI. Urinary voiding is a process of emptying urine, using a bladder ultrasound machine that can measure the amount of urine in the body. During this learning activity, we also discussed factors that may be considered part of continence assessment such as cognitive awareness, mobility and dexterity, environmental assessment, quality of life assessment, urinalysis, assessment of bladder diary, visual examination of skin and onward referral if required.

Care can be provided when it comes to incontinence such as lifestyle change, using conveens, doing exercises such as bladder training or pelvic floor exercises, voiding, having medications, urinal/containment aids such as pads and as a last resort catheterisation. Onward referrals to continence specialists, urologists, gynaecologists etc. can also be a part of the care provided. The importance of skin integrity was also discussed such as using protectant barrier creams, repositioning to reduce pressure and regular toileting or pad changes.

Catheters are only suggested to be used if alternative methods of managing urinary problems have been considered (NICE, 2017). The procedure may relieve urinary retention to improve the patient’s quality of life and/or promote independence. Patient should have adequate information on how to take care of their catheter and the use of drainage equipment.

In the second part of the class session, we went to the clinical simulation centre. All the theories we learned from the first part of the session were practised in the simulation centre. I was able to practice my fluid balance chart where I recorded fluid intake properly by measuring and documenting it on the chart. I also had an opportunity to practice urinalysis and catheterisation during this time.

The session in the clinical simulation centre was taken over by another course convenor. In the simulation centre, we learned about female-dwelling urethral catheterisation. Luke a clinical staff were there to present the steps for catheterisation. One of the students was assisting him with the procedure. I learned the process for the procedure during this class session including gathering all equipment needed and the step-by-step stages. I also learned about catheter care and the importance of infection control. All students took turns to experience all the learning activities. It is always a good experience to learn new clinical skills in an immersive teaching environment.

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Date of Learning: 09/06/2023

Time: 09:30-16:30

Learning activity 1: Critical Thinking

The aim of this learning log is to reflect on an episode of learning from my developing professionals and academic skills module. In this session I was introduced to the concept of critical thinking for nursing associates. The learning outcomes from this session are to review what we already know as learners, to consider how to develop and enhance our critical thinking skills and how we can use critical thinking in academic work.

Critical thinking is proactively examining ideas and exploring all sides of arguments, its being objective and open minded against what you know. Bloom’s taxonomy of critical thinking was discussed and how the hierarchy model shows different levels of thinking. In this class, each learner participated on different topics we can critically think of. We identified key skill to critical thinking which are seeking information, interpretation, analysis, evaluation, inference, and explanation.

In this episode of learning, I learned that critical skills can be developed. The class delivered strategies that can help me improve my critical thinking skills. We were also provided a practical toolkit which will help build independent learning skills, become critical and reflective thinker, and excel with academic studies. I was surprised that the course convenor reminded each student that we are already using our critical thinking in our professional practice. It is important to critical think for me a nursing associate learner to avoid assumption, give evidence-based advice, to accurately assess health and when problem solving or decision making occurs. It was helpful to know that the University provides services in which they help and support students with academic skills.

Learning activity 2: Equality, Diversity, and Inclusivity

In this learning log I will be reflecting on an episode of learning in which we covered topics of equality, diversity, and inclusivity (EDI). The learning outcomes of this episode of learning is to refresh what we already know and to explore the concept of each topic. The Equality Act (2010) was also discussed and how we can apply the concept of EDI in nursing.

The class started by defining what ‘Equality’ means. Equality is not about treating everyone the same but fairly in which we meet individuals’ needs appropriately. It is about having the same chances and having equal opportunities. Diversity is recognising and celebrating individuals’ differences. It is about treating individuals’ values, beliefs, cultures, lifestyles with respect. Good equality and diversity practices ensure that people get the dignity and respect they deserve. Inclusivity links with diversity and equality, in healthcare socially excluded people can access and benefit from the service they need. Everyone is unique, it is important that everyone is included and treated equally and fairly.

At my practice workplace, discussion and learning about equality, diversity and inclusivity is a must. There is a legislation which emphasis this and it was also introduced in this module session. The UK’s Equality Act (2010) is an important legislation in which I should be familiar with as a nursing associate. It is used to protect characteristics and how everyone should be treated fairly. It is based on people’s age, disability, gender re-assignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, and sexual orientation. The legal framework protects individual’s rights and provides equal opportunities to everyone. The legislation reduces discrimination towards people with established characteristics.

Equality, diversity, and inclusivity is an integral part of my service as a healthcare worker. It provides equal opportunities regardless of their background, abilities, or lifestyle. Promoting EDI can meet individuals’ satisfaction within the service and that they get the dignity and respect they deserve. Inclusion is ensuring that people in the society is included and that I can maintain relationship to avoid social exclusion or social isolation. This module session has reminded me of how important equality, diversity, and inclusivity are within care settings.

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