LEARNING LOG          19/07/2024.

CARDIAC MONITORING  &  ELECTROCARDIOGRAM (ECG).

The lesson started with an introduction of the topic, the lesson outcome. The aims and objectives of the lesson were also discussed.  

Cardiac monitoring is a system that allows healthcare professionals to continuously monitor a patient’s heart activity to assess their condition.

An ECG is a non-invasive test that records the electrical activity of the heart, including its rate and rhythm. 

The following are the reason for an ECG:

•  To detect any abnormality of the heart.
• The heart rhythm or conduction problems.
• Damage to the heart muscle caused by heart attack. 
• Enlarged heart.
• Heart inflammation.
• Imbalance of blood chemicals
• Effects of some medication on the heart.

When the cell is not active, it is negatively charged. And when positively charged, it is called DIPOLARISE.

REPOLARISE it returning to its normal state (relaxation).

I learnt some of the limitations of ECG: 

• The normal ECG does not rule out a problem with the heart.
• Not all heart attacks can be picked up by ECG.
• Not all angina attacks can be picked up by an ECG.
• Individuals with heart rhythm that is not stable, this is not picked up by the ECG.

There are six(6) methods for ECG interpretation:

• What is the heart rate?

Normal rate = 60 – 100 bpm

Bradycardia (too slow) = <60 bpm

Tachycardia (too fast) = > 100 bpm

• Is the rhythm regular or irregular?

R-R interval is constant 

• Is there ventricular activity?

QRS waves present

• Are the QRS narrow or broad?

If the QRS is narrow the impulse has originated from the atria (which is where it should come from).

If the QRS is broad, there is a delay in the conduction system and the impulse may have originated from the ventricles (which isn’t where it should come from).

• What is the relationship between the P waves(atrial activity) and the QRS complexes (ventricular activity)?

One P wave for each QRS complex

Is the PR interval too short, too long or just right?(too short means that the impulses has originated from the wrong place – either AV node / accessory pathway, too long means that there is a delay in conduction – heart block).

The rate determinant, six (6) second method (30 boxes)

• The ECG paper is marked at 3 seconds intervals (15 large boxes).
• Count the R waves in 6 seconds (30 large boxes), 3 seconds intervals.
• Multiply the number of complexes by 10 to determine the rate (in this example 7 * 10 =70)

                           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 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.

LEARNING LOG                        12/07/2024

UNDERSTANDING PEOPLE STRUGGLING WITH MENTAL HEALTH.

The lesson started with an introduction to the topic. The lesson’s outcome, aims and objects were also discussed. 

We looked at:

•  managing or assessing people with mental health. 
• The tools in assessing people with mental health.
• Causes/ understanding 
• remedies/ treatment
• How mental health services are structured.

We also noted that people with mental health crisis are: 

• Uncomfortable
• Confused
• stressed/distressed
•  Worried
• Isolated / alone
• Upset / low
• powerless
• Frustrated
• Withdrawn

I also noted that people working with mental health patients are also:

• Worried
• Terrified
• Unsure
• Concerned
• Empathy
• Supported.

We looked at the stress vulnerability model, stress vulnerability model is the tool professionals used to explain the causes of psychosis. Stress vulnerability has been instrumental in helping us better understand psychiatric ailment, it hasn’t been without crisis.

The stress bucket was created to help people measure their stress tolerance.

A group work was done in class and to present in class.

The topics to present on were:

1. Bipolar disorder.
2. Depression.

• identify the condition 
• Behaviour
• Thoughts , speech
• Treatment options

My group was to present on bipolar disorder.

The condition according to (NHS,UK,2023) is a mental health condition that affects your moods, which can swing from one extreme to the other known also as manic depression.

(mental health foundation, 2023) states that bipolar disorder is:

• full of energy
• Self important(have a lots of ideas and plans)
• No desire to sleep
• Make decisions or say things out of character, risky or harmful.
• Changes in mood or emotions 
• Elevated or extreme change.

The Behaviour of bipolar patients are listed below:

• (NHS, 2023) feeling sad
• (mind,2022) not doing things they normally enjoy
• Misuse of drugs
• withdrawn/ avoid social 
• Difficulty in concentrating and remembering things.

The other group presented on depression. (WHO,2024)They defined depression as a condition that can happen to anyone. It is characterised by low mood, loss of pleasure or interest in active ties for a prolonged period of time.]

They discussed the signs and symptoms

 (NIH,2024) A person with depression can experience:

• Feeling of hopelessness, pessimism
• Persistent sadness, anxious or empty mood.
• Feeling of guilt worthlessness, helplessness
• Loss of interest in activities
• Difficulty in sleeping, thoughts of suicide and death.

Treatment options(NHS,2024) are:

• Psychotherapist
• Counselling
• Medication

                                   KSB ADDRESSED.

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 

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 

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 

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 

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 

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

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives 

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services 

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it 

K42: Understand and apply the principles of human factors and environmental factors when working in teams 

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

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements 

S2: Keep complete, clear, accurate and timely records 

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

S4: Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills 

S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018) 

S6: Act as an ambassador for their profession and promote public confidence in health and care services 

S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges  

S8: Recognise signs of vulnerability in self or colleagues and the action required to minimise risks to health 

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

S10: Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments 

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, promoting reflection and providing constructive feedback 

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

S44: Access, input, and apply information and data using a range of methods including digital technologies, and share appropriately within interdisciplinary teams  

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                                          17/05/2024

PAEDIATRIC EMERGENCIES  (ASSESSING CHILDREN AND YOUNG PEOPLE) 

The lesson started with an introduction of the module, followed by the learning outcomes, with the lesson’s aims and objectives.

We looked at the paediatric (paeds) assessment ranging from newborn to teenagers, (birth to 19 years). Paeds initial assessment can be done or carried out before touching the patient. Visual clues can be done to determine if the child is sick or not.

With regards the appearance, the muscle tone, interaction with the environment, alertness, eye contact, consolability.

There are different types of assessment : 

• Clinical assessment – A-E
• Social / emotional assessment
• Physical assessment  
• Environmental assessment
• Family assessment 

Ensure you look at the present(reason for attending)  and past history. 

• The reason for attending 
• The health concerns
• Symptoms
• Pain.

For the past history:

• The relevant to take birth history 
• Previous illness
• Family history

Also consider the –

• age, 
• sex, 
• religion, 
• language. 

• Parental responsibility
• immunisation(are they up to date)
• Medication
• Any allergies

With regards family history,

• employed/ financially stable
• Where do they live
• parents/ sibling(any concerns)
• school/nursery
• Any other healthcare professional, social worker
• Any parental concerns.

I learnt that in using the Paediatric Early Warning Sign (PEWS) form, always ensure or consider the Drs/Nurse/Patient concerns. The respiratory rate, and the heart rate. And be mindful of the acronyms wet flag, (weight, energy, tube, fluids, lorazepam, adrenaline and glucose). 

The following are the signs and symptoms of allergies:

• Itching
• Urticaria 
• Angioedema,
• Washing,
• Coughing
• Dyspnoea
• Stridor
• Hypotension
• Nausea
• Vomiting
• Tachycardia.

The treatment is ABC, 

Oxygen/ventilation,

 inhaler to name but a few.

With regards foreign bodies choking, the signs and symptoms are as follows;

• Difficulty in breathing, speaking, or coughing.
• A red puffy face
• Signs of distress, they may point to their throat or grasp their neck.

The treatment includes:

• Cough out- encourage them to cough and remove any obvious obstructive from their mouth
• Slap it out- if coughing fails to work
• Call 999

Shock – is the failure of circulation of oxygen to tissues resulting in lactic acidosis.

The following are the types of shock:

• Hypovolemic – this is due to loss of blood or fluid
• Distributive(septic) – maldistribution of blood.
• Obstructive – reduce to vascular size and limit the blood flow.
• Anaphylactic – shock due to allergies.
• Cardiogenic – primary heat problems.

Seizures – seizure is a sudden, uncontrolled burst of electrical activity in the brain that temporarily affects the consciousness.

Febrile convulsion – children cannot maintain their temperature due to underlying conditions.

NOTE- document everything that you see, do not rely on their parents. 

The signs and symptoms are as follows:

• Altered mental status,
• Nystagmus
• Convulsion
• Secondary trauma. 

The treatments are as follows:

• Oxygen therapy
• Monitor glucose
• Vital signs
• Iv acess
• Administrator benzodiazepines
• Administer midazolam / diazepam
• Suction if necessary
• Recovery position.

Cardiac arrest – this is when the heart stops beating suddenly. The lack of blood flow to the brain to other organs can cause a person to lose consciousness, become disabled, or die, if not treated immediately. Therefore it is a medical emergency.

The signs and symptoms of cardiac arrest are as follows:

• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness

Sometimes other symptoms occur before a sudden cardiac arrest:

• Chest discomfort
• Shortness of breath
• Weakness to name but a few.

                     KSB 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. 

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. 

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 your 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

     LEARNING LOG         19/04/2024

 RENAL PATIENTS.                

The lesson started with an introduction of the module with the learning objectives.  We looked at the anatomy and physiology of the renal system. I learnt that all the oxygenated bloods are connected to the Venal Cavity.  

The right artery carries oxygenated blood to the kidney, while the right ventricle carries blood to the heart and  the kidney is situated between T12 and L 3.

The following are the functions of the kidney:

• To eliminate waste and excess fluid.
• For reabsorption
• To control BP
• To maintain haemoglobin (low HB)
• Signals to produce red blood cells.

We say the nephron is the functional unit of the kidney. The function of the nephron is as follows:

• Glomerular Filtration Rate (GFR) 

Normal = 90 – 120

            Abnormal = 15 – 30

            Early abnormality = 60 – 90

• Tubular Reabsorption
• Tubular Secretion.

I learnt that crantin is the main blood test carried out to prove the weakness of the kidney.

Acute kidney injury (AKI) is an abrupt disease in the kidney function that compromises  both injury (structural damage) and impairment (loss of function).

AKI is often a complication of another illness (10 – 15% of hospital admission).

Deterioration in renal function leads to the accumulation of waste products on the body.

This can lead to permanent injury to kidneys and sometimes DEATH.( 25 – 30% impatient mortality rate).

I learnt that patients with renal failure should not take anything with potassium (banana, spinach, avocado to name but a few). Medications like spironolactone, furosemide to name but a few. Meds to reduce potassium levels are insulin, sodium sulphate, salbutamol……

             These are some of the causes of AKI, and there are three different groups namely:

• Pre-renal – inadequate perfusion. Not enough blood at sufficient pressure to allow filtering.
• Renal – Cellular damage/intrinsic. Damage to the cells that make filtering mechanism possible
• Post -renal- obstruction. Urine unable to drain adequately-system back up.

                                                                 KSB ADDRESSED.

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 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.

LEARNING LOG                              03/05/2024

     VENEPUNCTURE

The lesson started with an introduction of the topic for the session. We looked at the aims and objectives of the module. We defined some key words 

– venepuncture as a procedure of entering a vein with a needle. 

– Phlebotomy is the incision of a vein for letting out of blood, the key principles of phlebotomy are legal and professional considerations, anatomy and physiology, infection control, products and documentation, procedural issues, site care and maintenance, and the risk management.

We defined accountability as to give an account or measure, explain, justify, and define in some way the results of decisions-making.  Being legally responsible for each and every clinical action undertaken or omitted.

Vicarious liability – if an employee commits an acts or omission, resulting in harm, while acting i the course of their employment, the employer can be held responsible to be vicariously liable for any resulting claim, even potentially if the staff carry out an act which was expressly forbidden , or omission represented a failure to follow reasonable instructions given. However, not all employers pay for insurance for vicarious liability for all staff.

I learnt that for a healthcare professional to retain the protection of vicarious liability, the healthcare professional should always ensure to practise within the hospital/trust policy and procedures.

Verbal consent is considered adequate for procedures with low level of risk. Consent is only valid if it is given voluntarily and accompanied by adequate explanation.( reason for the venepuncture, associated risks and duration of cannulation, if applicable).

We looked at the anatomy and physiology of the upper limb veins.

The blood vessels: veins, arteries, and capillaries are closed tubes which carry blood around the body. Only capillaries allow exchange of contents. Arteries  carry blood away from the heart. Veins return the blood to the heart .

There are 3 layers of the blood vessels:

• Outer layer: tunica adventitia (fibrous/connective)
• Middle : tunica media (smooth muscle)
• Inner: tunica intima (smooth epithelial cells)

The arteries carry blood that are under high pressure, therefore:

• Tougher serosa (more muscle)
• Stretch and rebound with each heartbeat ( a pulse)
• Narrow lumen
• Lie deeper than corresponding veins 
• Contain about 10% of blood volume
• Carry oxygenated blood away from the heart.

The veins and venules. Capillaries converge to form tiny venules and then veins carry blood towards the heart. 

Blood pressure drops in the capillary beds so blood passing through the venous system does not so under low pressure.

Venous walls are thinner than arterial walls ( if the vein is cut, it will collapse whereas an artery will stay open) thin walls enable it to stretch and hold a large amount of blood. Venous system  holds about ⅔  of the body’s blood- a useful reserve in the event of blood loss.

Valves are formed by folds of the tunica intima.

Cusps are semilunar (half moon)shapes.

Valves have concavity towards the heart.

The veins of the upper limbs, for phlebotomy in adults, the veins in the antecubital  fossa are the first choice because:

• Easy to access
• Not an especially sensitive part of the body
• Veins are large and well supported.

I learnt about the equipment for the procedure of taking bloods. The equipment should be single use and sterile:

• Sharpe bin
• Tourniquets
• Gloves
• Vacontainers for phlebotomy
• Blood bottles (colour coded)
• Clean dressing 
• Single use tray
• Needles
• Wipes
• Plaster

Site preparation – always ensure you follow the local policy. For phlebotomy, skin should be cleaned with 2% chlorhexidine in 70% alcohol swabs for a minimum of 30 seconds and left to dry. Do not re-palpate skin after cleaning.  

                                                 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 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.

                                               END OF LIFE CARE.      

Lesson started with the learning outcomes, whose mean aim is:  

•  To understand the concept of End-of-Life Care in the context of the dying adult person in their last days of life.  

• To gain awareness of management of symptoms: how to manage common symptoms without causing unacceptable side effects. To maintain hydration in the last. 

• To gain knowledge of the nurses’ role within the individualised person-centred care 

• To gain an overview understanding of Advance Care Planning. 

Having gone through the learning outcomes, we the class shared the understanding of end of care. This simply means according to my perspective, support given to a dying individual by making him/her comfortable, supporting with care, respect, dignity, and love, above all fulfilling his/her last wish. The recommendations apply to all people at the end of life, whether they are conscious or unconscious. The main aim is to improve end of life care for people in their last days of life. 

End of life care is a multi-professional clinic team approach requiring judgement for when a person is likely to die. (Usually within a few 2-3 days of death). 

Having a good death depends on:  

• The way in which people die and how long this takes varies widely, because of: 

.  The underlying diseases responsible but also the  

. Person’s robustness or frailty, and their social setting. 

• Some continue to be mobile and largely self-caring, continue with oral intake (medication until death) 

• Others may die suddenly and unexpectedly after a significant trauma or catastrophic medical event (gastric bleed). 

• Some may not experience any of the symptoms 

• Some experience a gradual decline. (Principle of communication, shared decision-making and pharmacological care can be applied far earlier in their care).                      

• Others have progressive disease. (Cardiac, pulmonary/neurological disorders, dementia to name but a few.) 

In recognising when a person is entering the last days, for some people who are in their last days of life, mental capacity to understand and engage in shared decision-making may be limited. This could be temporary or fluctuating, e.g. caused by: 

• Delirium its associated with an infection or a biochemical imbalance such as dehydration or organ failure. 

• Permanent loss of capacity from dementia or other similar irreversible conditions. 

For healthcare professionals, should be able to: 

• Recognise when a person is entering the last days of life or may have stabilised or be improving temporarily. 

• To communicate and shared decisions respectfully with the dying person and people important to them. 

• Healthcare professionals must be able to recognise when a person may be entering the last days of their life, or if they may be deterioration, stabilising or improving even temporarily. 

• If it is thought that a person may be entering the last days of life, gather and document information on: 

~  the person’s physiological (pain, fatigue), psychological (their wishes), social  

(With families, homeless), and spiritual (religious, cultural) needs. 

~ current clinical signs and symptoms (their clinical observations). 

~ the person’s goals and wishes. 

The following signs and symptoms of deterioration: 

• Agitation 

• Cheyne -strokes breathing. (Gasping between breath. 

• Deterioration in level of consciousness (unconscious). 

• Mottled skin 

• Noisy respiratory secretions  

• Progressive weight loss 

• Increasing fatigue and loss of appetite. 

The following information should be provided: 

• Accurate information about their prognosis (unless do not wish to be informed). 

• Any uncertainty. 

• An opportunity to talk about any fears and anxieties, and to ask questions about their care in the last days of life. 

• Avoid false but optimisms. 

• Information about how to contact members of their care team 

The role of the nurse, the delivery of meals, equipment, care at night, volunteer support or assistance from an organisation and their availability. There is a clear individual nursing care plan that includes:   the dying person, personal goals and wishes, preferred care setting, current and anticipated care needs, preferences for symptom management, needs for care after death, resource needs. These individualised care plan discussions and decisions should be clearly recorded, continually updated as situation may change as condition deteriorates or as they accept their prognosis. 

In providing individualised approach to anticipatory medicines for people who are likely to need symptom control in the last days of life. Specify the indications for use and the dosage of any medicines prescribed. 

Assess what medicine the person might need to manage symptoms likely to occur during their last days of life. (Agitation, breathlessness, nausea and vomiting, noisy respiration to name a few). 

Discuss any prescribing needs with the dying person, those important to them and multi-professional team. 

Always ensure that suitable anticipatory medicines and routes are prescribed as early as possible. These should be reviewed as the dying person needs change. 

Before these anticipatory medicines are administered, review the dying person’s individual symptoms, and adjust the individualised care plan and prescriptions as necessary. 

Advance care planning (ACP) is the term used to describe the conversation between people, their families, and carers, and those looking after them about their future wishes and priorities for care. 

There are policies to ensure that ACP is offered to adults who are approaching the end of their life. Policy should consider under-served and vulnerable groups. 

Patient should be supported with ACP if the person approaching the end of life agrees. 

Patient should be considered if there is lack of capacity to make decisions in line with the Mental Capacity Act 2005.  

Do not attempt cardiopulmonary resuscitation (DNACRR) decisions. 

                                                                                                                       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, genomic. 

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 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. 

                                                                                                            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.