LEARNING LOG        09/08/2024

The lesson started with an introduction of the module, the module learning outcomes, and the learning outcomes. We had some ice breaker on menti-meter that was very educational and I learnt from those questions and did some group activity. 

We looked at improving safety and quality of care.

Safety is the evidence of harm to patients during the provision of care. 

Quality – standardise care, holistic care , patient- centred care, timely, efficient.

Evidence based-practice in nursing – holistic quality care base in the best most to date research and knowledge rather than traditional method.

For improving safety and quality of care, the following is considered:

• Influences on safety and quality of care.
• Service evaluation and improvement methodologies.
• Audit 
• Service user and carer involvement.

Key – components of safety and quality in nursing are as follows:

• Evidence based practice (EBP).
• Patient centred care.
• Effective communication.
• Interprofessional collaboration.
• Continuous quality improvement (QI).

With regards to change in healthcare, according to (Goldratte, 1990, p.10), “ not every change is an improvement but every improvement  is a change and we cannot improve something unless we change it”.

There are different ways we can choose to improve our services, or innovations. The following are the ways we can improve these services:

• Personal experience( -ve or +ve experiences that need to be changed).
• Personal interest(enthusiastic/ passionate about something)
• Curiosity about something in the media.
• State of practice in a particular area.
• Solving a problem.
• Hot topics under discussion (patient voice/ involving patient in improving care).
• Personal values.
• Gaps in practice (discrepancy in practice)
• Healthcare policy (things beyond your control)
• epidemical/ demographic /other data(type 2 diabetics, causes of it).

The reasons for changes in healthcare are as follows:

• To improve the quality of care.
• The effectiveness of care / treatment/ processes.
• Patient outcomes.
• Patient health and well-being.
• Efficiency of services /treatment.
• Patient safety.
• Reduced hospital admission /A&E.
• Reduced cost /errors.

We were divided into groups for class group work, with different questions. I was in the third group with the question as follows? How can we reduce patient waiting times  in the GP practice? We discussed as a group and concluded with these answers and they are as follows:

• To organise and prioritise appointments, who urgently need care.
• Answering questionnaires.
• Offering phone appointments for non-urgent care.
• Ensure staff are aware of the delays and enable them to adjust as needed.
• If you need urgent care, advise alternative help such as 111 or A&E.
• Doctors to cover any sickness or support on busy days.
• Update or remind patients of their appointments to ensure they still need the appointments and attend on time to prevent delays.

                         KSBs ADDRESSED.

                                                KNOWLEDGE

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

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.

K8: Understand how discriminatory behaviour is exhibited. 

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.

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

                                                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. 

S3: Recognise and report any factors that may adversely impact safe and effective care provision. 

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).

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.

S9: Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues. 

S11: Report any situations, behaviours or errors that could result in poor care outcomes.

S43: Contribute to team reflection activities to promote improvements in practice and services. 

                                          BEHAVIOURS

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

LEARNING LOG                             06/09/2024

BOWEL MANAGEMENT

BOWEL PREP AND STOMA CARE. 

The lesson started with an introduction of bowel management and the learning outcomes, emphasis from the learning outcome were placed on the knowledge of prescribed laxatives, different types of laxatives, their mode of action, precautions and rationale for the use.

We described constipation as follows: 

• A common condition that occurs when it’s difficult or infrequent to pass stool.
• When stool is not passed at least more than three times per week, or going less than normal.
• Stools are unusually large or small and hard or lumpy.
• Needing to strain to pass stool.
• Not feeling as though the bowels are fully emptied.

In considering the administration of laxatives, check if the patient has any of the following:

• Have bowel conditions
• Have a colostomy or ileostomy
• Have heart condition, such as heart failure
• Pregnant or breastfeeding
• Have an obstruction somewhere in your digestive system
• Have difficulty swallowing(dysphagia)
• Have a lactose intolerance, as some laxatives contain lactose
• Taking opioid painkillers, such as codeine or morphine (NHS, 2022).

We looked at some common laxatives (oral):

• Bulk forming  – this helps stimulate the movement of bowels( fybogel, normacol, celevoc) normally takes 2-3 day to be effective.
• Stimulant – this stimulates the gut muscle helps movement down the digestive tract( senna, bisacodyl) normally takes 6 – 12 hours to be effective.
• Osmotic – draws water from the circulation to the bowel to make it easier to pass.(lactose, movicol, idrolax, macrogol) normally takes 2-3 days to be effective.
• Stool softeners – helps to soften stool by absorbing the water.(docusate sodium, arachis oil) normally takes 1 – 2 days to be effective.

Another set of laxatives (rectal) NICE guidelines, 2024.

• Glycerol (suppositories) – this hardens or softens stools. It acts as a stimulant . Effective 15 – 30 minutes.
• Bisacody (suppositories)l – this does not soften effectively. Effective 15 – 30 minutes
• Sodium phosphate (suppositories) – effervescent action. Effective 30 minutes.
• Docusate sodium (enema) –  softener and weaker stimulant, for hard or soft stools. – Effective 15 – 30 minutes.
• Sodium Citrate (enema) –  smaller volume than phosphate enema, for hard or impacted stools. Caution in risk of water retention patients. Effective 5 – 15 minutes
• Phosphate enema – this is for hard, impacted stool and is occasionally used. Effective 2- 5 minutes.
• Arachis oil – hard impacted stools. Not to be used for patients with peanut allergies.

Before administering laxatives, know your patients as to what works for them. Always start with the bulk-forming laxatives.

The following are the two types of bowel conditions: 

• Inflammatory bowel disease (IBD) – this refers to a chronic and recurrent digestive condition caused by an autoimmune response in the person.  They are further divided to the following:

• Crohn’s disease – this affects any part of the digestive tract from mouth to anus.
• Ulcerative colitis – this affect the lining of the large intestine(colon)

• Irritable bowel syndrome  (IBS) – this affects the digestive system. The cause is unknown, but it can be linked to stress and family history.

We also discussed stoma and the types of stoma. We defined stoma is a surgically created opening in the abdomen that connects the digestive or urinary system to the outside of the body.

Or defined as the opening on the abdomen that connects to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of the body.

The types of stoma are as follows:

• Colostomy – this affects the colon.
• Ileostomy – this affects the small bowel.
• Urostomy – a bladder bypassed
• Nephrostomy – affects the kidneys.

The different types of stoma products were discussed in class.

The spinal cord injury / neurogenic bowel were also discussed, they are as follows:

• The nervous system remains intact.
• Peristalsis continues but is less effective and transit time to the colon is longer.
• Increased likelihood of constipation.
• Descending input from the brain to colon and rectum may be loss of sensation of the need to open bowels, loss of voluntary control of sphincter muscle and loss of the brain’s influence over the reflex activity.

Bladder and catheter care was another part of the lesson. There are three types of urinary catheter and they are as follows:

• Indwelling catheter.
• Intermittent catheter
• External catheter – convene.

HOUDINI an acronym is a criteria to guide the daily review of continuing urinary catheter indication – facilitating timely removal of the urinary catheter as soon as it is no longer required.

Base on the acronym, it represent the following:

• H – Haematuria.
• O – Obstruction
• U – Urological/ major pelvic/prolong
• D – Decubitus ulcer 
• I – input/output
• N – Nursing (end of life)
• I – immobilisation.

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide 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. 

K8: Understand how discriminatory behaviour is exhibited. 

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. 

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. 

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. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations .

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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.

                                                         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. 

S11: Report any situations, behaviours or errors that could result in poor care outcomes. 

S12: Challenge or report discriminatory behaviour. 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing. 

S15: Identify people who are eligible for health screening. 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity. 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance. 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions. 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent. 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk. 

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.

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback. 

S43: Contribute to team reflection activities to promote improvements in practice and services.

                                                    BEHAVIOURS

B1: Treat people with dignity, respecting an 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.

                                                                                                                         AM SESSION       LEARNING LOG           06/09/24 .

PROVIDING AND MONITORING CARE.      

The session started with an introduction of the module, the learning outcomes and we had described collaborative working as working together with the MD,  family including the patient himself.

Partnership is working with other entities with the aim of meeting the same goal of the patient.

We had a recap on Patient centred care as treating a person as a whole(holistic care)  not the diagnosis, their preferences, goals and individually.

The biopsychosocial model is dealing with the biological, social and psychosocial aspect of an individual.

• For biological, genetics, medication, psychosocial and neurochemical.
• For social, family, peer relationship, culture and socio-economic.
• Psychosocial, emotions and attitudes, learning,  beliefs and stress management.

All the above is focused on the health of the individual.

I learned that in supporting an individual shared decision should be included, that is the patient himself should be involved in his or her care. (as there is ‘no decision about me without me’).

Partnership working deals with 

• communities at the centre of health and social care.
• Care for people’s values and voices.
• Health and social care organisations.
• Valuing and actioning upon experiences and feedback from communities.

The following are some of the principles of partnership working:

• The centre decision making and governance around the voices of people and communities.
• Involve people and communities at every stage and feed back to them about how it has influenced activities and decisions.
• Understand your community’s needs, experiences, ideas and aspirations for health and care, using engagement to find out if change is working.
• Build relationships based on trust, especially with marginalised groups and those affected by health inequalities.
• Work with healthwatch and the voluntary, community and social enterprise sector.
• Have a range of ways for people and communities to take part in health and care services.
• Tackle system priorities and service reconfiguration in partnership with people and communities.
• Learn from what works and build on the assets of all health and care partners – networks, relationships and activity in local relationships and activity in places.

A typical example of partnership working. 

It starts with the patients as they are the centre of all our care, information will be shared about proposed changes, with this people will understand what they mean.

Consulting – as people for their opinion, for one or more ideas or opinions.

Engage – listening to people to understand the issues and discuss ideas for change.

Co – design – designing with people and incorporating their ideas into the final approach.

Co-production- an equal partnership where people lived and learnt experience work together from start to finish.

With regards to professional values, these are important to us for self and others. (treat people as you wish to be treated).

There was a group activity that was very fruitful for me and I learnt alot from it. The activity is based on a decision. My own part of the question is “ how will you facilitate shared decision making”. I suggested the following, According to Nice guidelines, 2021. Decision making is a cognitive process resulting in the actions among several possible alternative option.  In facilitating decision making the following were discussed:

• Bring a diverse group together ( the requires organisational leadership and planning as well as practising skills)
• Collect opinions independently ( collaborative relationship between patients and healthcare professionals).
• Provide safe space to speak up( allow the patient to give his or her own  opinion as they are the centre of it all).
• Don’t  over-rely on experts( discuss risk, benefits and consequences of different options in the context of the person’s life and values.
• Share collective responsibility for the outcomes( be aware that different people interpret terms such as ‘risk’ ‘rare’ ‘unusual’ and ‘common’ in different ways).
• Use patient decision aids( patients aids as part of a toolkit to support shared decision making).

                                                              KSBs ADDRESSED.

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health. 

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.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice. 

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. 

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. 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld. 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations.  

K36: Understand the roles of the different providers of health and care.

K38: Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings.

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.

                                                      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.

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.

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. 

S9: Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues.

S43: Contribute to team reflection activities to promote improvements in practice and services 

                                                             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

Decision making writing exams

 WOUND CARE: SUTURE / CLIP/DRAIN REMOVAL             26/07/2024.

The lesson started with the introduction of the topic, the learning outcomes, and the structure of the skin.

The skin is divided into three:

• Epidermis ( this is further described as the epidermis – it is composed of 5 layers, it has a protective barrier, contains melanin, and a new epidermis every 25 – 45 days).
• Dermis (this layer contains – hair follicles, capillaries, sweat glands, nerve endings, iol glands, collagen and elastin)
• Hypodermis – this is also known as a subcutaneous layer ( this acts as a shock absorber, regulates temperature, connective tissue connects bone and muscle to the layer of the skin, nerves and blood vessels here connect to those in the dermis layer).

Note: the skin protects our bodies. The skin is a physical barrier,  when the skin wounds the barrier is open to infection. The PH of the skin is 5.5 and it is acidic to kill bacterias. The skin is sensitive to pain.

We described a wound as an injury that breaks the skin or other body tissue. Or a wound is a break in the continuity of the skin, through injury or surgery.

The stages of wound healing is as follows:

• Hemostasis
• Inflammatory
• Proliferative
• Remodelling.

Hemostasis ( vascular constriction, platelet aggregation, fibrin formation to create thrombus.

The inflammatory – inflammation attempts to rid the wound area of any foreign material, microbes or toxins. This prepares the site for tissue repair.

This phase is characterised by:

• Swelling
• Redness
• Heat
• Pain.

The proliferation (angiogenesis, collagen synthesis, reepithelialization, extracellular matrix formation).

The maturation and remodelling ( collagen remodelling, vascular maturation, edge contraction, scar tissue.

The following are abnormal healing. Failure to heal at least 40% within the 4 weeks:

• Infection.
• Devitalised tissue.
• Chronic wounds.
• Overgranulation.

We continued with wound assessment and the TIMES model. The learning outcomes were also discussed.  The types of wounds are as follows:

• Traumatic injury, eg skin tear, laceration, burn, abrasions.
• Pressure ulcer
• Legs ulcer/ diabetic ulcer
• Surgical, eg incisional, skin graft, ostomy, flap reconstruction.

TIME(S) is an acronym used to support a standardised approach to wound assessment and outline key considerations in the process.

T – tissue

I – inflammation/infection

M – moisture

E – edges. And the additional ‘s’ is to assess surrounding skin.

Note: we should make TIME to assess and manage a wound effectively.

The tissue can be: 

• Necrosis,
•  slough, 
• granulated, 
• hypergranulated.

Infection, the location.  

• (Wound bed only – treat the wound topically).

• Systemic (swab to be taken if a patient is  presenting with a systemic infection or a deteriorating condition. In these cases, oral antibiotics may be advised.

• odour

moisture(exudate) 

• Volume (low, moderate, high)
• Type /consistency (serous, haemoserous, purulent)

Edge 

• Rolled, fragile, hypergranulated

Surrounding skin

• Excoriated, macerated, oedematous.

                             KSB ADDRESSED

                       KNOWLEDGE.

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice. 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide 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.

K8: Understand how discriminatory behaviour is exhibited.

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 .

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. 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

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.

                                       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 

S11: Report any situations, behaviours or errors that could result in poor care outcomes 

S12: Challenge or report discriminatory behaviour 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing 

S15: Identify people who are eligible for health screening 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity 

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance 

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk 

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 

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback.

S43: Contribute to team reflection activities to promote improvements in practice and services.

                                 BEHAVIOURS

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.

Principles of A – E Assessment

The lesson started with an introduction of the module, the learning outcomes and the learning objectives. We looked NEWs2 2017, and how it works. The NEWs 2 is used for all adult patients in hospitals and ambulance trusts.

• It is also used as a choice scales to record Sp02
• Use of ABCDE structure
• For better documentation of oxygen flow and delivery device
• As a parameter ranges for each clinical variable
• ACVPU -new confusion added as a trigger.

In monitoring the Early Warning Systems (EWS), the is track and trigger by monitoring 6 physiological parameters and they are as follows:

• Respiratory rate 
• Oxygen saturation (Sp02)
• Temperature
• Systolic Blood Pressure
• Heart rate
• Level of consciousness.

For Airway and Breathing (A & B)

• Respiratory Rate
• Oxygen saturation (Sp02)

For Circulation ( C )

• Systolic Blood pressure
• Heart rate

For Disability (D)

• Level of consciousness

For Exposure (E)

• Temperature.

The total NEWs score generated from the physiological parameters prompts specific actions:

• Frequency of monitoring 
• Urgent clinical review (escalation)
• Competencies of responding to clinical teams.#
• For each physiological parameter a normal healthy range is defined.
• Measured valves outside of this range are allocated a score that is weighted and colour coded.
• The size of the score gives an indication of how abnormal the parameter is and reflects the severity of physiological disturbance.
• The individual scores are added together.
• The total score indicates the level of clinical risk (also colour coded)

The following are the clinical responses to the NEWs 2 triggers and thresholds.

• If the score is = 0, minimum 12 hours, the clinical response to continue routine  monitor.
• If scoring = 1 – 4, monitor minimum 4 -6 hours, the clinical response to inform the RN, who must assess the patient.
• In scoring 3 in a single parameter, 1 hourly, the clinical response, Rn to inform the medical team caring for the patient.
• If scoring 5 or more urgent response thresholds, minimum 1 hour, the clinical response, the RN immediately informs the medical team caring for the patient.

The RN to request urgent assessment by the clinician or team with core competence with the care of acutely ill patients.

• If scoring 7 or more, RN immediately informs the team caring for the patient, this should be at least a specialist registrar level. Clinical care in an environment with a monitoring facility.

We looked at blood pressure interpretation and they are as follows:

• Blood pressure is the force or pressure that the blood exerts on the walls of the vessels.
• The systolic Blood Pressure (SBP) this represents the peak pressure generated by the left ventricular contraction
• Diastolic Blood Pressure (DBP) represents the degree of contraction within the vascular system. This fluctuates less than systolic pressure.

Hypertension is a high blood pressure caused by:

• Pain, stress
• Significant risk factor for cardiovascular disease
• Major cause of stroke
• Can indicate renal disease or tumour of adrenal medulla.

Hypotension is a low blood pressure that indicates circulatory compromise or heart failure.

• Sepsis
• Hypovolaemia
• Cardiac failure (pump problem)
• Cardiac arrhythmia
• CNS depression

Pulse pressure (PP) – the difference between systolic and diastolic pressure indicating vascular tone.

• Narrow pulse pressure (<30mmHg) = vasoconstriction.
• Wide pulse pressure (> 50mmHg) = vasodilation.

Mean Arterial Pressure (MAP) this represents the average pressure on blood vessel walls throughout the cardiac cycle.

• Should be above 65mmHg – 70mmHg to maintain perfusion to organs.

Pulse interpretation is as follows: 

Bradycardia (low heart rate):

• Physical conditioning (athletes)
• Medications
• Heart block
• Hypothermia (low temperature)
• CNS depression

Tachycardia (high heart rate)

• Sepsis
• Hypovolaemia
• Pyrexia
• Cardiac failure
• full/bounding (vasodilation).

Consciousness represents the brain’s overall level of function. impaire d consciousness indicates:

• Serious brain dysfunction- head injury, CVA, drugs-opiates
• Severe systemic disease and loss of homeostatic protections( hypoxia, hypercapnia, hypo/hyperglycemia, uraemia, hypovolaemia, cardiac arrhythmia, peri/cardiac arrest)

Note – patients assessed as ‘P’ or ‘U’ are at risk of airway compromise.

Patient assessed as ‘C’ – new onset confusion is a worrying sign – could indicate sepsis.

Patient refusing observation – acute confusion is a sign of deterioration with the following:

• Explore – the reasons for refusal
• Explain – dangers of not having observations performed.
• Eye -ball – non contact physical health observation (NCObs) including Respiratory rate and A-E.
• Escalate – to the medical team and consider Critical Care Outreach Team (CCOT).

The following are the underlying principles:

• To use the Airway, Breathing, Circulation, Exposure (ABCDE) approach to assess and treat the patient.
• To do a complete initial assessment and re-assess regularly.
• To treat life-threatening problems before moving to the next assessment.
• Assess the effects of treatment.
• Recognise when you will need extra help. Call for appropriate help early.
• To use all members of the team. This enables interventions (eg, assessment, attaching monitors, intravenous access) to be undertaken simultaneously.
• Communicate effectively – use the situation, Background, Assessment, Recommendation (SBAR).

                                                   KSBs ADDRESSED

                                                    KNOWLEDGE

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K8: Understand how discriminatory behaviour is exhibited. 

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 

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.

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident.

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident.

K36: Understand the roles of the different providers of health and care. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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.

K43: Understand the influence of policy and political drivers that impact health and care provision Skills. 

                                             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. 

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.

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                       BEHAVIOURS

B1: Treat people with dignity, respecting an 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.

UNDERSTANDING  COMPLEX CARE NEEDS 

COMPLEX ENDOCRINE CONDITIONS LIVING WITH DM      10/05/2024.

The lesson started with an introduction of the module learning outcomes, followed by the learning outcomes, the aims and objectives of the module. An introduction of the topic was also done. The gastrointestinal tract (GIT).

• The GIT is basically one long muscular tube from mouth to anus.
• The digestive system breaks down food and drink through the process of digestion into nutrients, specifically carbohydrates, proteins and fats.
• These nutrients are absorbed  into the bloodstream and transported to cells throughout the body.
• Once in the cells they provide fuel for cell function and the building blocks required for cell growth and repair.

The digestive system starts from the mouth through the following parts:

• Oropharynx
• Stomach
• Small intestine (duodenum, jejunum and the ileum)
• Large intestine (caecum, colon ascending, transverse, descending, sigmoid)
• Rectum & the 
• Anus 

The walls of the GIT is made up the following:

• The mucosa (innermost layer)
• Sub-mucosa (outside the mucosa)
• Serosa (outermost layer)

The process of digestion is as follows: 

• An enzymatic process which converts complex foodstuffs into smaller absorbable units.
• The primary process used is hydrolysis (breakdown by addition of water)
• Some components such as water, mineral salts, vitamins and glucose are already in a suitable form for absorption.

There are basically three forms of food molecules, and they are as follows:

• Carbohydrates. (simple sugar and starch)
• Proteins ( dietary protein is required to supply the amino acids for formation of body protein, any surplus is used as a source of heat and energy).
• fats.( the main useful components of ingested fats are the triglycerides or triacylglycerols, because fats are not soluble in water, digestion of fats is complicated, detergents produced in the liver – the bile salts – emulsify the fat and render it susceptible to the action of lipases secreted by the pancreas which hydrolyse it to form monoglycerides and free fatty acids.

We looked at Diabetes Management (DM), ia a condition in which the body does not produce enough insulin, and / or the body does not properly respond to insulin. Insulin is a hormone produced in the pancreas. Insulin enables cell to absorb glucose in order to turn it into energy.

The role of insulin required for transport of glucose into : muscle, adipose, liver. The absence of insulin can lead to: glucose accumulates in the blood use amino acids for gluconeogenesis, converts fatty acids into ketone bodies ;like acetone, acetoacetate, beta hydroxybutyrate.

The following are the complications of DM:

• Hypoglycaemia
• Hyperglycaemia
• Ketosis
• Acidosis
• DKA (hyper + ketosis + acidosis)
• HHS

DKA is a state of absolute or relative insulin deficiency aggravated by ensuring hyperglycaemia, dehydration, and acidosis-producing derangements in intermediary metabolism, including production of serum acetone.

Hyperosmolar hyperglycemic state (HHS) is an acute metabolic complication of DM characterised by impaired mental status and elevated plasma osmolality in a patient with hyperglycemia. 

• Occurs predominantly in type 2 DM ( a few reports of cases in type 1 Dm)
• The presenting symptom for 30-40% of type 2 DM
• Not commonly associated with ketonuria and acidosis.

DM is classified based on the severity of the acidosis.

• Mild:  PH less than 7.3 and /or HCO3<15 mmol/L
• Moderate : PH less than 7.2 and /or HCO3<10 mmol/L
• Severe : PH <7.1 and/ or HCO3<10 mmol/L

The following are people at risk of diabetes:

• Age <12
• Those with low socioeconomic status.
• People with poor access to medical care.
• Stress (increased ketotic metabolism).
• Glucocorticoids, atypical antipsychotics, diazoxide, and some immunosuppressive drugs.

A question: why ketone? This is because:

• No carbohydrate intake  (fasting, gastroenteritis, Atkins diet, neonate fed -fat milk)
• Prolonged exercise, pregnancy.
• Lack of insulin activity (onset of DM, interruption of insulin delivery in patients with established DM).
• Increased in insulin resistance (infection, surgery, stress, illness)

The following are the signs and symptoms of hyperglycemia, ketosis and acidosis:

• Deep rapid breathing.
• Fruity breath odour.
• Dry mouth.
• Nausea and vomiting.
• Lethargy.
• Drowsiness.
• Thirst
• Tachycardia/shortness of breath
• hypotension/dehydration

In preventing DM, consider the following:

• Diabetic education.
• BM monitoring.
• Easily digestible liquid diet when sick.
• Supplement short acting insulin.
• Reducing , rather than eliminating, insulin when patients are not eating.
• Guidelines for when patients should seek medical attention.
• Case monitoring of high risk patients.
• Special education on patients on pump Mx

                                              KSB ADDRESSED.

                                               KNOWLEDGE

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice .

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

K8: Understand how discriminatory behaviour is exhibited. 

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. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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. 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K36: Understand the roles of the different providers of health and care.

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. 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.

                                             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.

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing.

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. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members.

                                    BEHAVIOURS

B1: Treat people with dignity, respecting an 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.

LONG TERM/COMPLEX CONDITIONS (LTC)                      11/04/2024

The learning outcomes and the learning objectives were discussed. A question, what is long term condition was asked. These are conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment.

It was said that these LTC are more prevalent in older people and in more deprived groups. 

The NHS long term plan for LTC 2019 is as follows:

• More people are living with cancer or dementia largely due to increase in life expectancy and falls in the rate of premature death.
• The United Kingdom mortality rate from heart and circulatory diseases has declined by more than three quarters in the last 40 years.
• Mental health, respiration and musculoskeletal conditions are responsible for a substantial amount of poor health.

The following are the LTC we have heard of:

• Asthma
• Cancer
• CKD
• COPD/Pulmonary fibrosis
• Diabetes
• Coronary heart disease
• Hypertension
• Heart failure 
• Dementia
• Depression
• crohn’s / ulcerative colitis
• Epilepsy
• Hypothyroidism
• Stroke
• Multiple sclerosis(MS)
• Parkinson’s disease
• Motor Neurone disease (MND)
• Chronic fatigue syndrome
• Arthritis.

The  following are the increase risk of LTCs:

• Genetics
• Lifestyle choices( smoking, diet, alcohol,recreational drugs taking, lack of exercise)
• Socioeconomics status (class)
• Obesity
• Stress
• Environmental factors -triggers.

The following can be the impact of living with LTCs:

For the physical;

• Mobility – independence
• Personal care/hygiene
• nausea/vomiting
• Pain
• Bowel disturbance
• Sleeping
• Breathing
• eating/diet restrictions
• Hair loss/amputation
• Acutely unwell episodes (hospitalisation).

With regards the psychosocial aspect:

• Financial 
• stress/anxiety/depression
• Employment/study
• Body image
• Role model within family
• Relationships
• Social life/sports
• Sexuality
• Grief

We looked at assessment as the process that identifies and defines the service user’s problems.

• Evaluates the service user’s wishes, mental, physical, social, cultural, spiritual and personal needs.
• Finding out what the service user’s can or cannot do.
• A multi-stage procedure.
• True likeness of the service user as an individual, highlighting their needs( present and near future) and the resources that they have  available to them.

The reason why assessment is important, failure to recognise and respond to an individual’s needs can result in them not being met and in a failure of care.

The following are the reasons assessment can be complex in service user’s with LTCs:

• Multiple LTCs.
• Symptoms may change over time.
• Often experience more than one symptoms
• May be taking multiple medications
• Complex need.
• Holistic assessment.
• Person-centred care.

In assessing people with LTCs, these are the assessment tools used:

• APIE
• ADPIE
  ASPIE.

The following are the skills required for assessment:

• Interviewing
• Observation
• Taking measurements.
• Review documents.
• Communication
• Listening.

In assessing  for service user’s with LTCs, the following should be considered:

• Understand the pathophysiology of the condition.
• Services for people with LTCs must take into account the emotional and psychological impact of being diagnosed or living with a LTCs.
• For many their condition will be relatively stable over a period of time with only irregular flare-ups.
• For people with more complex needs or with more than one LTC, their situation may be less stable and as a result more intensive or ongoing periods of care and support will be required.
• Integrated working.
• Consider the needs of carers/family members.

People with LTCs may need the following in their care:

• They may want to be involved in decisions about their care – they want to be listened to.
• They want access to their information to help them make those decisions.
• They want support to understand their condition and confidence to manage –  support to self care.
• They want to be joined up, seamless services.
• They want proactive care.
• They do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach.
• They want to be treated as a whole person and for the NHS to act as one team. (King’s Fund, 2014).

The following are the models of nursing:

• Give direction to the nurse when assessing the needs of the service user.
• There are many models which are selected for their appropriateness to the care setting and service user.
• Help to add consistency and continuity to person-centred care, because everyone will be working the same underpinning philosophy.
• Provide a framework to direct practitioners in their assessment and care- planning process.

The RLT model stresses the importance of cultural, environmental and economic factors affecting both health and well-being and encourages a nursing role in preventing, alleviating or coping with illness.

The important ideas that can be found within the model are:

• Individuality
• The activities of living
• A dependence – independence continuum
• The progression of a person along a life-span
• Influencing factors

                                    KSBs ADDRESSED.

                                                              KNOWLEDGE  

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K8: Understand how discriminatory behaviour is exhibited 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K36: Understand the roles of the different providers of health and care 

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 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

                                             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 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and well being 

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 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

                                          BEHAVIOURS

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

PRE & POST OPERATIVE CARE.

LEARNING LOG                                                  12/07/24

The lesson started with an introduction of the module, followed by the learning outcomes, its aims and objectives. There were questions asked in class, regarding the tools used to identify a sick person and why? What are some of the challenges when assessing a patient using A – E framework?

The question regarding the challenges when assessing a patient using A- E. the following are some thing we identify in class. 

• Learning disability
• Language barrier
• Mental health.

In the pre-operative care, we look at the airway. It is a comprehensive evaluation that looks for upper airway pathologies or anatomical anomalies. We consider the mouth opening, dentition, thyromental distance and neck circumference etc. LEMON is an acronyms use by anaesthetics to assess before operation.

For breathing, –

• Obstructive Sleep Apnea (OSA), 
• Any previous history
• Any respiratory diagnosis
• Recent chest infections
• Immunisation history
• Chest x-ray to name but a few.

For circulation –

• We look for any infection risk.
• Ask about drug history(anticoagulants, insulin)
• Any cardiac history including cardiac surgeries
• Pacemaker, ICD.
• Chest x-ray, ECG, and routine blood tests.
• Surgical site prep.

The post- operative nausea and vomiting (PONV), we look for 

• History of PONV
• History of motion sickness
• Age 
• Sex
• Non-smoker
• Post op opioids(side effects)

With regards the post operative care , we continue monitoring :

• Airway
• Breathing
• Circulation
• Disability
• Medications

Postoperative nausea and vomiting:

• Nauseous or nauseated.

For the anaesthesia related causes:

• Opioids
• Nitrous oxide
• Duration of anaesthesia
• Induction drugs eg propofol

The following are the common complications:

• Infection
• GI complications
• Respiratory complications
• Renal
• CVS(cardiovascular)
• Neuro
• haematological(bleeding, clotting)
• Others (wound dehiscence eg open wound)

With regards the missed opportunities:

• Poor monitoring of vital signs
• ABC not recognised
• Not acting on clear documentation
• Failure to use systematic approach
• Poor team work and communication
• Late referrals.

                                    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 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice 

K8: Understand how discriminatory behaviour is exhibited 

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 

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 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

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 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident 

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs 

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 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

                                                          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 

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 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

                                                  BEHAVIOURS

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