WEEK 10 OF TEACHING TNA    7.5 HRS.

 MORNING SESSION:

 It’s a start of another week, another day. we had reflection as to ginger up for the start of the day/week. I was excited but a bit worried, since it was our last week of learning and a start of our placement. Exited because it is my dream to become a registered nurse and I know this is a steppingstone for me. Worried because things where not in place to meet the start of my placement.

We had a session on preparation for external placement, and the content of the session. We had a discussion about the set objectives, which are:

-To be an accountable professional.

-To promote health and prevent ill health.

-To provide and monitor care.

-To work as a team.

-To improve safety and quality care.

We discussed what is our expectation as a learner from our employers:

-To be able to provide safe and effective care.

-To be self-aware and be willing to take responsibility for self and others.

-To be able to demonstrate warmth and empathy and develop emotional intelligence and cultural competence.

-To be punctual and be able to manage time effectively.

We also discussed what is the university’s expectations:

-To be professional in all aspect of our practice and conduct during our placement.

-To demonstrate a keenness to develop our knowledge and practice through all opportunities made available.

-To complete the hour required.

We looked at the criteria for assessment during placement. I learnt that in this first year, it is a guided participation in care and performing with increasing knowledge, skills and confidence. These criteria should be achieved by the end of our first year. The guided participation is divided into:

* Knowledge, that is to be able to identify the appropriate knowledge base required to deliver safe, person-centered care under some guidance.

* Skills, a commonly encountered situations are able to utilise appropriate skills in the delivery of person care with some guidance.

* Attitudes and values, to be able to demonstrate professional attitude in delivering person centered care. To demonstrate positive engagement with own learning.

I learnt about the assessment for practice and the additional documentation such as the service user’s feedback (comments from any service user).

Reflection on learning from others (can be a specialist nurse, doctors, to name but a few).

Additional professional feedback and peer feedback (from other students within the same placement).

 Assessment from my Practice Assessor and my Practice Supervisor and their roles and what is expected from them. We had presentation on epad.

             KSBs ADDRESSED.

K1: Understand the code: professional standards of practice and behavior 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 recognize signs of vulnerability in themselves or their colleagues and the action required to minimize risks to health.

K3: Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of professional fitness and well-being required to meet people’s needs for mental and physical care.

S2: Keep complete, clear, accurate and timely records.

S5: Safely demonstrate evidence- based practice in all skills and procedures required for the entry to the registers: Standards of proficiency for nursing associates.

K7: Understand the important of courage and transparency and apply the duty of candour.

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 behavioral health challenges.

S8: Recognize signs of vulnerability in self or colleagues and the action required to minimize risks to health.

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met.

K22: Know how to meet people’s related to nutrition, hydration and bladder and bowel health.

              AFTERNOON SESSION

For our afternoon session, we had simulation, we were divided in three different groups with three different scenarios. In my own group we had subgroups of three, so everyone can participate in these scenarios.  The first scenario in our group was an elderly woman, who requested that she needs to be changed and that for the past hour nobody has checked on her and she cannot reach the call bell. The subgroup from the main group dealt with this situation. They introduced themselves to the patient, and she ended up requesting for help. She was saying sorry for what she has done, and at the same time thanking them for what they are doing. These two listened patiently to her request and they sorted it out by asking her if she want to be washed. she said she preferred just to be changed. They got the toiletry items ready, and they informed her by gaining her consent as the go to make her comfortable in every step. After everything they asked her if she wants to be repositioned and on which angle, she prefers, and they made her comfortable and she thank them for the work they have done.

The second subgroup, in which I was had a scenario of a patient who had a cut and was lying unconsciously with her head hanging in an uncomfortable position. We entered her room greeted her no response, and we notice the blood from the cut on her hand, I checked around for potential danger, I called her name loudly, shouted on her ears, shake her no response, we tried to lower the bed in a comfortable position as I shout for help, and I started chest compression. As the help arrive, I asked her to call 2222 for adult cardiac arrest and to get the defibrillator. When she arrives, she switched it on, while I was doing the chest compression until the she is ready to administer the defib, we made way for the connection by getting rid of her dress while the chest compression is still going on, we continue with it until the cardiac arrest team arrives.

                                             KSBs ADDRESSED

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

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

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met.

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep.

S32:  Accurately undertake risk assessments, using contemporary assessment tools.

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

MORNING SESSION.

Its a start if an other week, I was so happy to see everyone in class, but a bit worried because, I wanted to see and know my mock exam grades, I was not too certain or happy about it. We discussed about the mock exam and informed us about the  result of it.

I learnt about the INTRODUCTION TO MUSCULO-SKELETAL SYSTEM.

The aim of this session was to introduce us to musculo- skeletal system, and the functions of the skeleton is to protect the internal organs and tissues.

To stabilise and support the body.

To provide a surface for muscle, ligaments and a tendon attachment.

To produce red blood cells and

To store mineral salts.

I learnt that, there are textbooks that teaches about 206 bones in the human skeleton as the anatomical norms but not everyone has this amount of bones. And that there are some people that are born with extra bones such as the 13th pair of ribs or an extra digit, and there are some people even develop extra bones during their lives.

In infant, I learnt that there skeleton has 300 – 350 bones as a child’s skeleton is mostly cartilage that through the process of ossification(process of bone formation) and eventually becomes bone. They are naturally born with over 300 bones, originally made of cartilage, which are mineralised during the first few years of life, and some bones fuses together. The average age that bones stop growing is 21 years.

There are  seven (7) cervical vertebrae, 12 Thoracic vertebrae, 5 lumbar vertebrae, 5 sacrum  and 4 coccyx.

The Femur is the strongest and biggest bone, it carries the red blood cells.

The smallest bone in the human body are in the ear, that is the malleus (hammer), incus (anvil) and the stapes  (stirrup) and are also known collectively  as  Ossicles, they are not only the smallest bone in the body but they are also the only bone that do not remodel after the age of one.

We looked at the types of bones, their functions and examples,  they are briefly described below:

1.Long bones : It’s function is to provide strength, has bone marrow and the examples of long bone are Femur, Tibia, Fibula, Humerus, Ulna, and Radius.

2. Short bones : the function of short bones are for  multi-directional motion. Examples of short bones are Carpal bones( hands/wrists) the tarsal bones(feet/ankles).

3. Flat bones: the function is to provide mechanical protection to soft tissues beneath and it examples are Cranial bones, Sternum, Ribs, Scapulae.

4. Irregular bones: the function is to provide major mechanical support for the body. the Vertebra protect the spinal cord. the examples are Vertebrae, Hyoid bone, Spheroid bone and facial bones.

5. Sesamoid bones: The function is to protects from additional friction and use – and can form in palms and soles. The example, only one type of sesamoid bone is present in all normal human skeletons so it has a name: The Patella.

I also learnt about the Bone Cells. That mature bone cells are known as OSTEOCYTES. There are also Osteoblasts and Osteoclasts

The Osteoblast( bone forming or they create new bone cells) are present where bone is growing, repairing or remodelling. for example at site of fracture – deposit new tissue around themselves and become trapped then they change into Osteocytes.

The Osteoclast – cells that break down bone releasing calcium and phosphate. They are carnivore that chews off bone.

We further looked at Bone Marrow, that long bones such as the thigh bone, are filled with bone marrow made of fat cells, blood cells and immune cells.

In children , the bone marrow is red reflecting its role in making blood cells. While in adults, the bone marrow is yellow and containing 10 percent of all the fat in the adults body.

The difference between Osteoporosis and Osteoarthritis. Osteoporosis develops when bone removal occurs too quickly, replacement occurs too slowly, or even both.

Osteoarthritis degenerates non-inflammatory disease. when the cartilage between joints becomes worn and the bones are damaged and may cause unwanted bone growth. Osteoarthritis causes pain and restricted movement.

I learnt about the types of muscles which are the SKELETAL STRIATED MUSCLES, that most of the 600 skeletal muscles are attached to bones and extend across joint. The contraction of skeletal muscles exerts force on the bones and causes movement.

 SMOOTH MUSCLES, is found in the blood vessels where its action brings about changes in the vessels diameter. It is also found in the walls of the internal organs (peristalsis).

 CARDIAC MUSCLES, forming in the myocardium of the heart where is propels blood.

We depend on the muscles for every movement you make, even for sitting and standing. We also depend on the muscles internally to move food along our digestive tract and to control excretion of body waste. We depend on the muscles to circulate blood around the body and for breathing. Our life depends on the actions of the muscles.

We also looked at the manual of clinical procedures from the Royal Marsden. The VENTROGLUTAEL injection site, the DELTOID  injection site, the DERSOGLUTAEL injection site, the RECTUS and VASTUS LATARALIS injection site.

AFTERNOON SESSION.

For the afternoon session, we looked at CONTINENCE MANAGEMENT AND URINALYSIS. We looked at the meaning of urinary incontinence and faecal incontinence. That urinary incontinence is the inability to hold urine in the bladder due to loss of voluntary control over the urinary sphincters resulting in the involuntary passage of urinary. The complaint of any involuntary leakage of urine.

Faecal incontinence is the involuntary loss of solid or liquid stool that is a social or hygienic problem.

For the types of continence, It is important to assess the underlying causes through assessment which is carried out on different level. A full assessment is required in order to reach a diagnosis and decide on the appropriate treatment.

Stress UI; is the voluntary leakage of urine on effort or on sneezing or coughing.

Urge UI; is the involuntary leakage of urine following a sudden uncontrollable urge to avoid.

Mixed UI; is the involuntary leakage of urine associated with urgency and also exertion, effort, sneezing or coughing.

It can be assess by the use of standard assessment form which is helpful when taking the history.  Record the urinary symptoms as described by the patient, such as frequency, urgency, nocturia and leaking.

*  Ask  about the onset of symptoms , their duration and any previous treatment the patient has had.

*  Record the patient’s bowel history. should note the patient’s past medical history, especially any gynaecological or urinary tract surgery.

For an additional assessments:

* a physical examination- the abdominal examination for palpable bladder and loaded colon which may indicate constipation.

*Examination of the genital for abnormalities, discharge and skin integrity

* Vaginal examination, including assessment of the pelvic floor contraction, and observation for urethral leakage when asking the patient to cough, which would indicate stress urinary incontinence.

* Voiding normally results in complete bladder emptying.

We looked at skin care for the patient with incontinence, which is good hygiene. To keep the skin clean and dry as safe as possible. To consider the use of barrier creams. Pressure reducing equipment. To change position. To regulate toileting or pad change. Avoid oil base creams such as Sudocrem and talc. Catheters: Some patients may feel apprehensive about having a catheter inserted. The procedure may have been necessary to relieve urinary retention, or to improve the patient quality of life and offer greater independence. It is essential that patient who have had an indwelling catheter inserted are given adequate information on how to care for their catheter and change the drainage equipment. Some patients may be able to choose between using a continuous urine drainage bag or a catheter valve.

The types of catheters are listed below:

* the single lumen – unidirectional flow- ISC & sterile urine collection.

* the double lumen – Inflatable retention balloon in one channel and urine drainage in another.

* the triple lumen – Retention balloon in one lumen and allow for bi-directional irrigation in the other two lumens. I learnt that the bigger the catheter, the more the urethra is dilated.

We ended up doing simulation on catheter.

WEEK  OF TEACHING  TNA    7.5 HRS.          15/03/23

MORNING SESSION.

We had reflection on biology test and the reflective essay regarding our first placement. I am happy about my biology grade and I learnt my lesson based on the feedback / comments given to me about my essay. Having discussed this,  we were introduced to the module for the day PROMOTING HEALTH AND WELL-BEING ACROSS THE LIFESPAN. I find this topic quiet interesting because it deals with health and well-being in general.

A general question was asked, “what does it mean to be healthy?” There were different answers to this question, that being healthy is being well without medication, others says being stable atmosphere, but in my own perspective, being healthy is based on an individual, everybody is different. Looking at an individual, and try to see what it takes. Healthy lifestyle, good well-being,  free from stress, mentally stable, eating a well balanced diet, having a good work balance to name but a few when an individual is living

Dimensions of health which are physical, emotional, intellectual, sexual, social, spiritual and societal.

Looking at the models of health professional perception, they are basically categorised into four models.                                                       Looking at the medical model, it focuses on the patient, that is the physical dimensions rather than considering any others.  The health promotion will focus on teaching or giving information to patients ensuring they understand the pathophysiology.

The Holistic model, according to WHO 1946, defines health as the state of complete physical, mental and social wellbeing and not merely the absence of disease. Holistic health is hard to measure.

The Biopsychosocial model recognises that health and wellbeing cannot be understood in isolation from the social and cultural environment. That is recognises the individual’s physical health, disability, sex, beliefs, attitudes, self esteem, peer group, family circumstances, work and to crown it all,  drug effects, temperament, family relationship to name but a few.

The ecological model, create understanding of how individuals and their social environments mutually affect each other. It informs  public health and health promotion as it emphasises the link between multiple factors affecting across the lifespan.

The wellness model. this model builds on the principles of holistic model and that health should not be a state, but a process and resources for everyday life. This is relevant to  health promotion which strives to improve the quality of life for all people regardless of the health status.  Health professionals need to empower patients, facilitate and enable them to develop problems solving skills and improve self-esteem.

 General questions were asked that what does well-being means to each of us in the class? There were different answers to the question. In my opinion, well-being is having good sleep, free from stress/ reduced stress, eating a well balanced diet, and a healthy lifestyle.

                                                       KSB ADDRESSED.

K3,  S3,  S7,  K9,  K10,  K11,  K12,  K13,  S13,  S14,  S16,  S17, K20.

                                             AFTERNOON SESSION

We had an afternoon session and we looked at another module DELIEVERY OF SAFE AND EFFECTIVE PERSON-CENTRED CARE. This module was introduced and discussed the learning outcomes and on the nursing processes. We say the nursing process is a systematic way of assessing an individual and the care that is rendered should be centred on the individual.  To assess the individual and to  identify his/ her needs,  the individual’s rational care needs. Assessing the individual can be done using a subjective assessment tool, wherein the patient assess himself by getting information from the patient.

The use of objective assessment tool involves potential nursing interventions and evaluating their effectiveness, this can be used in the form of data collection, and it can be measured. Example of such can be MRSA results, Scan, BP, Vital signs to name but a few.

Nursing process is an effective and efficient assessment or standardised framework, model that help to assess in nursing care. The use of APIE which was the original format and its means to Assess, Plan, Implement, and Evaluate the patient you are supporting or caring for. This format was then modified and refined over the years into a version of the problem-solving approach that includes ADPIE and ASPIRE which is Assess, Diagnose, Plan, Implement and Evaluate. And ASPIRE is to Assess, Systematic nursing diagnosis, Plan, Implement, Recheck and Evaluate.

We looked at the RPL ( Roper, Logan, Tierney) model whose aim is to focus on the factors that comprise daily living in a holistic and systematic way, and its proposed 12 areas that makes up daily living. The aim is to move away from a disease-base approach to care, to an approach that recognise the holistic needs of the individual. RPL’s 12 activities of daily living are as follows:

1. Maintaining a safe environment.

2. Communication.

3. Breathing.

4. Eating and drinking.

5. Controlling body temperature.

6. Washing and dressing.

 7. Working and playing

8. Eliminating.

9. Expressing sexuality.

10. Sleeping.

11. Dying.

                                KSBs ADDRESSED.

K1,  K2,  K5,  S6,  K6,  S8,  S10,  K15,  K16,  K19,  S19,  S20,  K20,  K26,  S23,  S24,  K30,  S32,  K31,  K37,  K39,  S39,  S40.

WEEK OF TEACHING       7.5 HOURS        22/03/23.

It’s a start of another week. We had recap on the last week’s teaching, about the principle of person-centred care, the nursing process( ASPIRE, ADPIRE, & RLT)
Person-centred care as we discuss, is when we focus on care and support the individual needs and ensuring that their preferences, needs and values guide clinical decisions.

People are feeling able to speak about what is important to them and the workforce listening and developing an understanding of what matters to people. Supporting to develop their knowledge, skills and confidence, health and social care professionals work collaboratively with people who use services. we say person-centred care is important because many people want to play more active role in their health care. It is important because its aim to treat people with dignity, compassion and respect. It is important because it is cost effective- services are built on needs/preferences and to improve experience, quality and outcomes. I learnt about the origin of the Person-centred care, in the early 1960’s, (psychologist Carl Rogers) and in 1970’s (American psychiatrist George Engel) and these ideas began to become aligned with health care in 1990’s. I also learnt about Lord Darzi’s report in promoting high quality care for all in (2008). The Francis report in 2010, about the importance of person-centred care, focusing on dignity, compassion and respect and the Health and Social Care Act (2012) imposed a legal duty for NHS England and Clinical Commissioning Group(CCG) to involve patient in their care.  All health and social care services that Care Quality Commission(CQC) regulates are expected to meet the fundamental standards of care, this was introduced in April, 2015. We also highlighted on the four principles of person-centred care (Health Foundation 2018) they are:

1. Affording people dignity, compassion and respect.

2. Offering coordinated care, support or treatment.

3. Offering personalised care, support or treatment.

4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

We looked at the barriers to person-centred ways of working, we say time, listening skills, resources, experience, standardised way of practice, communication to name but a few. We will be able to assess base on the following, feedbacks received, patient survey, reviews,  to name but a few, will enable us to know whether person-centred care is being used in practice.

In supporting and delivering person-centred care, planning needs to be in place as goals are identified and the nursing team prescribes the care for the service used that will meet the service users needs. Person-centred is a process, and partnership between the nurse and the service user needs to be established. A shared decision making.

Goal setting should offer a short, directive statement as to the outcome of the nursing care. This could be short or long term. They should be simple, measurable, and recordable and devised within the limits of the available recourses to deal with the problem.

We looked at the criteria for goal setting, they are SMART = Smart, Measurable, Achievable, realistic, Time.

MACROS = Measurable, Achievable, Client-centred, Realistic, Outcome- written and short.

PRODUCT = Patient-centred, Recordable, Observable, Directive, Understandable and clear, Credible, Time-related.

We also looked at Care Planning, after identifying and agreed the goals with the service user, there is a need to prescribe care based on the update research and evidence. The plan for implementing care should direct the service user and their carers as to who is to do it, and where they are meant to do it.

In dealing with individual plans, start with a complete blank piece of paper and writing the care plan from scratch. To always ensure individual care plans are written, even if the are areas where these care plans are never used, its a skill that should be possessed.

Some barriers to individual care plans are time, lack of resources, skills, knowledge, confidence, some nurses feels that individual care plans are ‘paper exercise’ to name but a few.

We looked at the importance of documentation. To document the information; it cannot be shared if it is in your head or a brief discussion.
Documentation helps to improve outcomes – basis for evaluation. The activities that are required to reach the goals should be written in a way that leaves no room for misunderstanding. Documentation is a sign of evidence that things are done, if not documented, it didn’t happen.
We looked at the care planning stages. They are:
To  identify the problem and the nursing diagnosis.
To  establish the goals
To determine nursing interventions
To evaluate the care processes
To review dates.

KSB ADDRESSED .
K1
K2
S2
S3
S4
S7
S10
K14
K15
K18
S19
K20
K21
K23
K24
K25
S23
S24
S30
S35
K33