Category Archives: Uncategorized
CARDIOVASCULAR SYSTEM 03/05/2024
The lesson started well, by introducing the Topic for the session. We looked at the learning outcomes, the aims, and objectives of the lesson.
Some random questions were asked at the start of the lesson, to assess the base of our knowledge, questions like
- how does the blood get around the body?
To answer this first question, the arteries carry blood away from the heart and vein carry blood back to the heart.
- What are the functions of the primary organs of the cardiovascular system?
It brings oxygen, nutrients, and other good things to every cell in the body.
- How does the cardiovascular system work with other systems of the body?
The heart, blood, and blood vessels work together to secure the cells of the body.
It also supports the respiratory system by bringing blood to and from the lungs.
We looked the organs of the cardiovascular system, these are divided into three components, the heart, the systemic circulation, and the pulmonic circulation. Theses organs all work together to deliver oxygen and rich blood to the organs and tissues of the body.
The heart is approximately the size of the fist, it weighs about 230 – 280g in females, 280 – 280 – 240 g in males. It’s about 12 -14 cm long and 9 – 10 cm wide.
The mitral valve is 9cm in male, and 7.2 cm in females.
The tricuspid valve is 10.8 in female and 11.4 cm in males. Since the heart is essentially very strong, reliable muscular pump, this muscular pump is controlled by a sophisticated electrical impulse system. I learnt that the heart beats on an average of 115,000 times per day. The muscular pump action of the heart circulates on an average of 2000 gallons of the blood around the body per day.
The systemic circulation is comprised of the arteries, veins, and capillaries. These vessels form a transport network that delivers blood to and from the top of the heard and down to the toes, and everywhere.
The pulmonic circulation is the transportation that shunts deoxygenated blood from the heart to the lungs to be re-saturated with oxygen before it is dispersed. Pulmonic circulation comprised of specific set of arteries and veins whose purpose is to deliver blood to and from the lungs and heart. The Vana cava transport.
According to the video, we learnt about the doors that control the flow of blood between each chamber of the heart. These doors are known as valves, they are divided into four and are important to the normal functioning of the heart. The following are the four valves and their locations:
- Tricuspid valve, it is located between the right atrium and the left ventricle.
- Pulmonary, this is located between the right ventricle and the pulmonary
- Mitral valve, it is located between the left atrium and the left ventricle
- Aortic valve, this is located between the left ventricle and the left aorta.
The heart is endowed with three layers, the endocardium (the smooth inner layer), the myocardium (the thick muscle of the heart) and the epicardium (the outer layer or surface of the heart).
The coronary arteries are like all muscles in the body, the myocardium requires a steady stream of oxygenated blood to fuel its contractions. These contractions send blood throughout the body. The heart requires a continuous supply of oxygen to function and survive just like any other tissue or organ of the body.
The electrical system. As we all aware, that the heart functions with an important set of muscles that are responsible for moving blood around the body. The contraction of the muscles is controlled by a complex system of electrical impulses known as the heart peacemaker (SA NODE). These electrical impulses control how fast the muscles contract and how to the atria and ventricles contract in the best rhythm to maximize the efficiency of blood flow.
In assessing the cardiovascular system, the following tools are available to nurses to monitor the cardiovascular system:
– Pulse and blood pressure.
– Electrocardiogram (ECG)
– Circulation assessment (from A – E assessment)
– Coronary Angiogram
– Doppler Ultrasound
– Echocardiogram.
The following are the clinical presentation:
– Chest pain
– Nausea/vomiting
– Anxiety
– Dyspnoea
– Rapid irregular pulse
– Hypotension
– Peripheral cyanosis
– Sweating
The investigations are as follows:
– ECG
– Chest X-ray
– Bloods
– Echo
– PCI
– CT/MRI
For its management, the following should be used:
– MONA – (Morphine Oxygen Nitrite Aspirin) a treatment for stable and unstable angina.
– CABG – (Coronary Artery Bypass Graft)
– Heart transplant/ VADs (ventricle Assisted Device) to name but a few.
The complications are:
– Arrhythmias
– HF (Heart failure)
– MOF (Multiple Organ Failure)
– Cardiogenic shock
– Death.
KNOWLEDGE
K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and how to fulfil all registration requirements.
K4: Understand the principles of research and how research findings are used to inform evidence-based practice.
K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.
K8: Understand how discriminatory behaviour is exhibited.
K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.
K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.
K11: Understand the factors that may lead to inequalities in health outcomes.
K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical, and behavioural health, and well-being.
K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes.
K14: Understand the importance of health screening.
K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.
K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.
K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.
K18: Understand and apply the principles and processes for making reasonable adjustments.
K19: Know how and when to escalate to the appropriate professional for expert help and advice.
K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.
K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.
K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.
K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.
K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.
K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.
K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.
K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.
K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.
K29: Understand the different ways by which medicines can be prescribed.
K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.
K36: Understand the roles of the different providers of health and care.
K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.
K38: Understand the complexities of providing mental, cognitive, behavioural, and physical care needs across a wide range of integrated care settings.
K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.
K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings, or services.
K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.
K43: Understand the influence of policy and political drivers that impact health and care provision Skills.
SKILLS
S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.
S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.
S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and 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, 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.
S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed.
S38: Prioritise and manage own workload and recognise where elements of care can safely be delegated to other colleagues, carers, and family members.
BEHAVIOURS
B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.
B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.
B3: Be adaptable, reliable, and consistent, show discretion, resilience, and self-awareness.
COMMUNICATION SKILLS FOR ASSESSMENT
COMMUNICATION SKILLS FOR ASSESSMENT 03/05/23.
We looked at the learning outcomes, the definition of communication – communication – ‘all of the procedures by which one mind may affect another’ according to Argyle (1978). without communication there cannot be any person-centred care.
In building relationships and collaborative partnerships, building trust is crucial to the success of the therapeutic relationship.
Without trust this relationship may only provide superficial discussion. Communication is based on trust, respect and your own willingness to re-examine assumptions service users to be more open. We communicate with individuals based on what we know about them as people. It influences -what we say, how we say it and the language, and the communication strategies used.
In readiness for assessment, we looked at:
The preparation aspect:
Read the notes.
Set goals.
Consider how you will be perceived (behaviour and appearance)
Consider the environment.
The sequence:
Greet and establish rapport.
Set an agenda and invite patient story.
Identify and respond to clues.
Expand and clarify.
Generate hypotheses/working diagnosis.
Share decisions and treatment plan-next steps.
Thanks.
Close and reflect.
At the first impressions, your response sets the tone.
Crucial to establishing trust and dialogue.
Ask yourself: ‘what is the best way to communicate with this person?’
Introduce yourself.
Greet them appropriately, ask how they would like to be addressed.
The interview techniques are questioning(funneling), active listening, non-verbal communication, empathetic responses, summarizing, clarification, reflection, feedback, to name but a few.
We looked at the different types of questioning, which are:
The Enhancers:
Opening questions – general (speak generally about their issue/concern/reason) and specific (encourage the service user to speak in more depth about something).
Closed questions – this is used when you need a specified answer.
Probing questions – this is used to gather more details and information (what? where? when? how? why? and who?)
Rhetorical questions -this is dressed up as questions, but can be useful for engaging others, stimulating and provoking thought around a particular subject.
Guided questions.
The Detractors:
Multiple questions – can confuse the service user in the response that they provide.
Leading questions – it starts from the least invasive question and progresses to the more invasive ones. It should be avoided in healthcare assessment.
In listening skills, attentive listening is essential for all the assessment process. Being open, responding and reflecting are needed to help people tell their story. It helps to develop discussion.
In active listening, closely attend to what the patient is communicating. The use of verbal and nonverbal skills to encourage the service user.
In nonverbal communication, it provides important clues to our underlying feelings. Being sensitive to nonverbal cues allows you to understand the service user more effectively and send messages of your own.
Nonverbal communication includes:
Eye contact
Facial expression
Posture
Head position and movement such as shaking or nodding.
Interpersonal distance
Placement of the arms and legs.
Nonverbal communication can be culturally bound.
Empathetic Responses are responses that convey that you appreciate the way a patient is feeling.
It validates the legitimacy of his or her emotional experience.
Reassurance – identifying and acknowledging the service user’s feelings.
Nonverbal.
Verbal.
Empowering the service user: service users have many reasons to feel vulnerable during the interview process, eg they may be in pain, worried or overwhelmed.
The relationship between a service user and healthcare professional can be unequal.
Differences of gender, ethnicity, race, or socioeconomic status can contribute to feelings of vulnerability and unequal sharing of power in therapeutic relationships.
It is also important that the service user feels empowered throughout the assessment process, as this will enhance the information exchanged.
I learnt the techniques for sharing power, they are listed below:
- Evoke the patient’s perspective.
- Convey interest in the person, not just the problem.
- Follow the patient’s leads.
- Elicit and validate emotional content.
- Share information with the patient, especially at transition points during the visit.
- Make your clinic reasoning transparent to the patient.
- Reveal the limits of your knowledge.
In closing the interview:
- Ending the interview can be difficult.
- Let the patient know that the end of the interview is approaching.
- Allow time for any final questions.
- Ensure the service user understands any mutual plans you have developed.
- Ask if they have any questions.
- Summarise plans for future evaluation, treatments and follow up.
- Teach back – invite the patient to tell you the plan of care in their own words.
We looked at the three Dimensions of Cultural Humility:
- Self-awareness – you must recognize how culture shapes not only the service user’s beliefs, but also your own. Avoid letting personal impressions about cultural groups turn into professional stereotyping. Evaluate each service user as an individual.
- Respectful communication – let the service user be the experts on their own unique cultural perspectives. Find out about the service user’s cultural background. Maintain an open, respectful, and inquiring attitude. Learning about the service user’s culture enhances your knowledge as a nurse.
- Collaborative partnerships – build your patient relationships on respect and mutually acceptable plans.
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.
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 principles of epidemiology, demography, and genomics and how these may influence health and well-being 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.
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.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K36: Understand the roles of the different providers of health and care.
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.
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.
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).
S17: 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).
S18: 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.
S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes.
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.
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: when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.
S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.
S35: Accurately undertake risk assessments, using contemporary assessment tools.
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.
PERSON-CENTRED CARE AND CARE PLANNING.
PERSON-CENTRED CARE AND CARE PLANNING 22/03/23.
We had a recap on the previous lesson. We further on went to the learning outcomes of this lesson, which is THE NURSING PROCESS. We discussed the nursing process that is a model or tools or techniques used in assessing a patient. That is a systematic way of integrating assessment information with care decisions, which involves considering potential nursing interventions and evaluating their effectiveness. The technique or tools can be ADPIE /ASPIRE whose original format of APIE has been modified and refined over the years.
I learnt about some of the benefits Nursing Process (N/P) are listed below:
. The N/P gives direction to the nurse when assessing the needs of the patient.
. It helps to add consistency and continuity to person-centred care (PCC), because everyone will be working with the same underpinning framework. Another benefit of person-centered care s that Health and social care professionals work collaboratively with people who uses the service.
. It also provides a framework to direct practitioners in their assessment and care planning process.
According to the RLT model, whose main focuses on activity of daily living, in a holistic and systematic way. The model proposes 12 areas that makes up daily living, they are maintaining a safe environment,
communicating,
breathing,
eating, and drinking,
controlling body temperature,
washing, and dressing,
working, and playing,
mobilizing,
eliminating,
expressing
sexuality,
sleeping,
and dying.
The RLT model aim to move away from a disease-base approach to care, to an approach that recognizes the holistic needs of the patient/services users.
Person-centered means focusing on the individual at the center not the problem. Focusing on the care needs of the individual, ensuring that their preferences, needs, and values guide clinical decisions are met. Its enables individual’s feeling to speak about what is important to them and the workforce listening and developing an understanding of what matters to people. It support people to develop the knowledge, skills, and confidence.
This model is important because its aim is to treat people with dignity, compassion, and respect and to improve on experience, quality, and outcomes.
Many people want to play a more active role in their healthcare.
The four principles of person-centred care, according to the (Health Foundation 2018) are listed below:
- Affording people dignity, compassion, and respect.
- Offering coordinated care, support, or treatment.
- Offering personalized care, support, or treatment.
- Supporting people to recognize and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
Some assumption of person-centred care:
There is an established therapeutic relationship.
The patient and nurses share power and responsibilities in relation to care planned.
The patient carries responsibility for their part .
The patient must become well known to the nurse as a person, not just a patient, patient should be empowered.
There must be effective communication and effective therapeutic relationships.
The prerequisites of PCC – staff attributes, competence, skills, communication skills, values, beliefs, commitment.
The care environment – skill mix, shared decision making, sharing of power, supportive organizational system, innovation, physical environment, staff relationships.
Person-centred processes – patients’ beliefs and values, shared decision making, authentic engagement, sympathetic understanding, holistic care provision.
Person-centred outcomes – Good care experience, involvement in care, feeling of well-being, healthful culture.
I learnt about the assumptions of person-centred care that there is an established therapeutic relationship.
The patient and nurse share power and responsibilities in relation to care planned.
The patient carries responsibility for their part.
The patient must become well known to the nurse as a person, not just a patient, patient should be empowered.
There must be effective communication and an effective therapeutic relationship.
Some of the barriers to person-centred ways of working can be time,
skills,
resources (the right equipment),
experience,
knowledge,
standard ways of practice,
communication,
therapeutic relationship, and
self-awareness of staff.
I learnt about the ways of assessing person-centred care in practice. Feedback, patient survey, review, readmission, pressure sore or ulcer develops, are ways of assessing person-centred care in practice.
Criteria for setting a goal can be
SMART (Specific, measurable, Achievable, Realistic and Time),
MACROS (Measurable, Achievable, Client-centred, Realistic, Outcome-written and Short).
PRODUCT (Patient-centred, Recordable, Observable, Directive Understandable and clear, Credible and Time-related).
We looked at the barriers to individualized care planning.
Time.
Nurses often feel that the individualized care plans are ‘paper exercise’.
Resources.
Skills.
Knowledge and
Confidence.
Some importance of documentation
Document the information; it cannot be shared if it is in your head or a brief discussion
Documentation helps to improve outcomes- the bases of evaluation.
Activities that are required to reach the goals should be written in a way that leaves no room for misunderstanding.
If it is not documented, it didn’t happen.
In care planning stages:
- Identify the problem and nursing diagnosis- clearly defining what these are from the assessment information and discussion with the person.
- Establishing the goals – clearly defined benchmarks for measuring achievement of problem-solving which have been agreed with the person.
- Determining nursing interventions – listing nurses’ actions based on assessed understanding of the situation and your knowledge and expertise.
- Evaluation of care process – documenting outcomes of the care given.
- Review dates – the date on which it is expected that a change will have been made affected.
Planning care using the RLT Model:
- Purpose of
- setting goals is to solve or alleviate problems and, where possible, avoid potential problems from becoming actual problems.
- Goals should offer a short, directive statement as to the outcome of nursing care.
- If a baseline is where the service user is now in relation to the problem, then a goal represents where the service user should be because of the nursing care.
- Consider the available resources before setting the goals.
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.
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 principles of epidemiology, demography, and genomics and how these may influence health and well-being 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.
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.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K36: Understand the roles of the different providers of health and care.
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.
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.
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).
S17: 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).
S18: 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.
S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes.
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.
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: when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.
S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.
S35: Accurately undertake risk assessments, using contemporary assessment tools.
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.
INTRODUCTION TO PUBLIC HEALTH AND HEALTH PROMOTION.
INTRODUCTION TO PUBLIC HEALTH AND HEALTH PROMOTION 19/04/23
Vulnerable Groups.
We looked at the learning objectives, with regards the tri-morbidity of homelessness, and to understand the nurse’s role in managing the health care needs of marginalized or socially excluded groups.
We looked at the definition of a HOME and compared with others, looking at people’s personal experiences of been homeless, and how hard it is to become homeless. We say a home means to be safe and secure, to be loved, protected, the physical, mental, and spiritual well-being. Homelessness can be rough sleeping, temporary accommodation-bed, and breakfast, sofa surfing, hostel and hidden homeless-garden sheds, car parks, bin sheds.
Been homeless you are exposed to assault, theft, violent crime. Reduction in employability, low self-esteem. No fixed abode. Vulnerable to exploitation – (sex working, drugs running, begging)
I learnt about the tri-morbidity of homelessness, the physical, mental and substance use. According to Cambridge dictionary, morbidity of the disease is how many people have it in a particular population.
The physical health issues, because of tri-morbidity (how they are linked), the average age of mortality (men & women), the high risk of behaviors, infection (leg ulcer, chest infection), smokers (tobacco, crack heroin, dental issues, tuberculosis, blood borne viruses and long-term conditions- diabetes, hypertension to name but a few. Communicable disease- infectious diseases are caused by pathogenic microorganisms such as bacteria, viruses, parasites, or fungi – these can be spread directly or indirectly from one person to another.
Considering the mental well-being are depression, anxiety, learning disability, domestic violence, drug and alcohol use and unloved population. Substance abuse -heroin -cut with, crack cocaine, and alcohol- units.
The Nurses relationship specialist workshop deals with the skills built for the best outcomes with those marginalized groups. According to Daniel H. Pink, “Empathy is about standing in someone else’s shoe, feeling with his or her heart, seeing with his or her eyes. Not only is empathy hard to outsource and automate, but it makes the world a better place”. With empathy we take their perspectives, we consider their emotions and withhold judgment. Among these three, empathy is at the center of them all. Social exclusion will …….. to domestic violence, relationship breakdown, low educational attainment, drug and alcohol use, unloved population to name but a few.
We looked at a case study of a 43-year-old man, who has a long history of rough sleeping but has recently moved into a hostel where I am for placement. The staff inform me that this individual rarely uses his room in the hostel and when he does return, he does not speak to anyone and does not make any eye contact. The referral from the street team states that the individual has type 2 diabetes and hypertension. He has issues with drinking alcohol and ‘occasionally’ using street heroin.
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.
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
K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.
K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K36: Understand the roles of the different providers of health and care.
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:
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.
S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).
S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges.
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.
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. Accurately undertake risk assessments, using contemporary assessment tools
S35: Accurately undertake risk assessments, using contemporary assessment tools.
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.
General Guidance on E-pad and Placement
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.
Musculo-skeletal system.
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.
Promoting Health and Well-being Across the Lifespan
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.
person-centred care.
Entry: Saturday, 25 March 2023, 5:19 PM
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
PREPARATION -DAY 4
Today, been the 4th day of our preparation study day,
I can sense the relief of knowing each other as we see ourselves everyday, we spend time studying, doing group and class work together. We had an overview of the course, that it is a foundation Degree in Science for Nursing Associates Apprenticeship. That at the end of the course, we are expected to provide care across the lifespan, to make decision on what to and not to do.
I learnt about the requirement for both university requirement which is Maths, English and Care certificate and the Apprenticeship requirements which is the evidence of learning logs, KSBs and the End-point Assessment.
We further went to the introduction to A & P: Systems, Cells & Homeostasis.
At the introduction, I learnt about the Anatomical position,(standing upright, forward facing, to name but a few), and the reason to know your left from your right.
The positional terms ( superior, inferior, anterior/ventral, posterior/dorsal, medial, lateral, proximal, Distal to name but a few).
We looked at the body cavities and the regions.
The dorsal body cavity is the Cranial cavity(the brain) and the vertebral body cavity (spinal cord).
The ventral is the thoracic cavity (heart and lungs), abdominal cavity (digestive system) and pelvic cavity ( bladder, reproductive organ & rectum)
I also learnt about the Abdominal region which is right and left hypochondriac region, right and left lumbar region, right and left iliac region. The Epigastric region, Umbilical region and the Hypogastric region.
KSBs ADDRESSED
K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates( NMC, 2018) and how to fulfil all registration requirements.
K2: Understand the demand of professional practice and demonstrates how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise the risk to health.
K3:Understand the professional responsibility to adapt a healthy lifestyle to maintain the level of personal fitness and well-being required to meet peoples needs for mental and physical care.
K4: Understand the principles of research and how research findings are used to inform evidence-based practice.
S1: Act according to 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 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 demonstrates evidence-based practice in all skills and procedures required for entry to the registers: Standards of proficiency for nursing associates Annex A & B(NMC, 2018).
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 influence health and well-being outcomes.