The lesson started with different views on equality and what it’s meant to me. It is an equal society as one that ‘protects and promotes equal, real freedom and substantive opportunity to live in the ways people value and would choose, so that everyone can flourish’.
Equality also means protecting people’s characteristic (their disabilities, equal opportunities)

According to (Equalities review panel, 2007) an equal society recognises people’s different needs, situation and goals and removes the barriers that limit what people can do and can be’.
Equality means everyone having the same chances to do what they can. Some may need extra help to get the same chance.
Equality is not about treating everyone the same, but making sure people are treated fairly, meeting individual’s needs appropriately and changing the factors that limit individual’s opportunities.

We looked at the word ‘diversity’ and what it meant. According to (RCN, 2019) Diversity recognises and celebrates our differences as individuals, but also recognises the common needs that unite us, including the needs for good health and social care service when we need them. Diversity means ensuring that many different types of people contribute to society. According the NMC Code (2018) 1.3 to avoid making assumptions and recognise diversity and individual choice. The NMC standards of proficiency 1.14 provide and promote non-discriminatory, person always centred and sensitive care, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments.

We looked the word ‘Inclusivity’ and what it meant. The idea of inclusion is based on the belief that all people in society are entitled to share in society’s benefits and resources. It means that people who in the past have been placed at the margins of society should live as part of their communities, benefit from the facilities many of us take for granted and share the services (including health services) that all other people use. (RCN, 2019)’

Inclusivity also means involving everyone, to make people feel confident, embracing people’s values, protected characteristics, developing a feeling of belongingness, and to diminish barriers. Barriers can be language barrier, lack of training, difficulty in understanding the system, stereotyping to name but a few.
Inclusion is ‘being included within either a group or society as a whole’. Inclusion links with diversity and equality. It is important to understand someone’s differences so that you can include them and treat them equally and fairly. People can feel excluded if they are not able to join with activities.

We looked at how it will affect Healthcare. Healthcare workers should be able to address barriers to healthcare that may disadvantage individuals because of their specific characteristics, as all individuals should experience equal satisfaction of certain common rights and needs.

The loss of dignity in care that is experienced among diverse populations indicates that not all healthcare recognises the inherent and equal dignity of all human beings, nor do they value their diversity.
We looked at the Prejudice. If healthcare staff make judgements, because of personal biases, about those they care for, they may fail to see each as a unique human being, resulting in prejudice in care delivery. The word prejudice means ‘to pre-judge’, rather than approaching each person as an individual. Often, prejudice results from stereotyping, which is the assignment of attributes to somebody because they are a member of a particular group.

I learnt about the types of discrimination:
– Direct discrimination – where a person is discriminated against because of a protected characteristic or treated less favourably than others.
– Combined discrimination- the combination of two protected characteristics, a person is treated les favourably than those who do not share either of those characteristics.
– Indirect discrimination-when rules, polices, and procedures have a worse impact on people who share a particular characteristic than on people who do not share characteristic.
– Discrimination by association- treating someone worse than someone else because they are associated with a person who has a protected characteristic.

Disability is defined as a society, there are 2 definitions that have being developed for disability. These are known as the medical model of disability and the social model of disability. In sort, the medical model focuses on the disability as the problem, whereas the social model focuses on the environment as the problem.

It is important to note that not all disabilities are visible. Most understandings surrounding disability arise from the assumption that a person’s disability will be visible when hundreds of disabilities, such as, mental health problems, sensory impairments, and some mobility impairments have no visible symptoms.

I learnt the following:
– Discriminatory behaviour of healthcare workers can diminish the dignity of people accessing healthcare.
– Healthcare workers needs to recognise and value the diversity of those they care for, and endeavour to reduce inequalities in healthcare and experiences.
– Equality, diversity, and human rights are important to everyone working in health and social care, for patients and for service users.
– We all have a role to make sure that services are accessible and that everyone has a positive and inclusive experience.
– In the workplace we also need to think about inclusion and recognise the diversity of those we work with, ensuring that they feel valued and respected.
– Think about what you can do to promote values and behaviours advancing equality, diversity, and human rights in the work that you do.

KBS 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 demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.
K4: Understand the principles of research and how research findings are used to inform evidence-based practice.
K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.
K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.
K7: Understand the importance of courage and transparency and apply the Duty of Candour
K8: Understand how discriminatory behaviour is exhibited.
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.
K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.
K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.
K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations.
K36: Understand the roles of the different providers of health and care.
K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.

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

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.

The lesion is about people living with long-term condition (LTC). The definition of LTC according to (NICE:2019). It a condition that generally lasts a year or longer and impacts on a person’s life.

It applies to conditions that cannot currently be cured but can be controlled with the use of medication and /or other therapies.

It may be referred to as a chronic condition, but this is a somewhat date term.

LTC can be of physical, neurological, or mental health origin.

I learnt that this can be manifested at any point across the lifespan:

• From birth or childhood – including hereditary and congenital conditions.
• In childhood, adolescence, and adulthood as symptoms present.

The following are some of the Long-Term Conditions:

• Arthritis (Osteo and rheumatoid)
• Anxiety.
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Crohn’s disease
• Dementia
• depression
• Diabetes
• Epilepsy
• Heart disease
• Hypertension
• Irritable bowel syndrome (IBS)
• Motor Neurone disease (MND)
• Multiple sclerosis
• Parkinson’s disease
• pain
• Renal disease
• stroke
• Schizophrenia to name but a few.

Caring and supporting people with LTC, holistic care plan should be in place.

Example: physical health (group 1), mental health (group 2) neurological (group 3)

For Physical health: arthritis, pain (chronic), stroke, heart disease, hypertension to name but a few.

For mental health: schizophrenia, dementia, depression to name but a few.

And for neurological: motor neurone disease, Parkinson’s disease, to name but a few. Looking at the impact of having a LTC, having a LTC (or more than one) can have a significant impact on any or all aspect of a person’s life. Physically, emotionally, psychologically, and socially. Its affects people2y differently.  Multi-morbidity / co-morbidity refers to the presence of two or more LTC which can include: the physical and the mental health conditions such as diabetes and schizophrenia. Ongoing conditions such as learning disabilities.

Diagnosis of LTC may challenge individuals’ self-identity and self-esteem. The impact of LTC can result in a sense of changed self. For some living with a LTC will lead to it becoming part of their identity. Some individuals find the LTC restricts their activities and adversely affects their sense of identity. It may change the role that they play in society or their social circle.

Reconciling having an LTC- being able to accept and take ownership of a LTC is recognized to be a contributory factor in patient’s feelings of well-being. Perceptions vary between something that can be assimilated into life by those affected or seen as something to be contended with.  Can provide a new perspective on well-being that inspires the individual to find possibility within illness.

Conversely, for other people, a LTC may be viewed as a burden. They are unlikely to feel knowledge and may not accept all aspect of the condition.

LTC can impact on an individual’s independence. Individual may require assistance with some or all their activities of daily living.  He may be advised to learn to do things differently to maintain a level of independence where possible. He may be completely unable to carry out their everyday activities or feel obligated to change aspects of their lifestyle due to an LTC.

Their partners, family, friends, carers, and peers can play a significant role in supporting individuals many aspects of managing LTCs including supporting emotionally and encouraging lifestyle and adaptations.

Personal relationships may feel changed, particularly if those individuals take on caring responsibilities (change nature of the relationship) or they feel unsupported or trapped. They may experiences feeling of isolation as well as their loved ones.

Working with LTC is the ability to work and progress professionally may be affected by long periods of absence or disability because of the LTC. They may no longer be able to work or may require changes to be made at work. These changes may include:

• Alterations to their workplace
• Working different hours
• Working in a way that makes allowances for their condition (having more breaks)
• Provision of materials that may help.
• Changing job role.

The link between LTCs and social inequalities. When compared to those in the highest social class, those in the lowest social class have 60% higher prevalence of LTCs and 30% higher severity of conditions. (BMA:2016)

Life expectancy continues to improve for the most affluent 10% and multimorbidity is most common in areas of deprivation.

In planning care, the following are things to remember:

• People will have different experiences of how their condition affects them and this will influence what they see as their needs and priorities.
• Patient with multi-morbidities have a high treatment burden in terms of understanding and self-managing their conditions, attending multiple outpatient appointments and managing complex drug regimes.
• People with LTCs, and their carers must be at the heart of how we plan, design and deliver treatment and care (person-centred care).

KSB ADDRESSED.

KNOWLEDGE:

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

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

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, 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.

24/05/23

Clinical judgment is the accumulation of knowledge and skills over time, which contributes to the nurse’s ability to analyze and synthesize the patient presentation, objective, and subjective data, and to provide evidence base nursing interventions to improve patient outcomes.

It involves assessing the potential consequences (risk and benefits) of possible alternative actions before committing oneself or the other (decision making).

Shared decision is the process through which a clinical support of a patient is reach to a decision making about their treatment.  ASPIRE (Assess, Systematic nursing diagnosis, Plan, Implement, Recheck and Evaluate) is the method used to assessing patient.

The health professionals and patients working together to make decisions about treatment plan for the patient.

There are different choices available to discussed with the patient along with their risk and benefits.

Support the patient to understand and express what they want to achieve from their treatment or support.

Some benefits of shared decision making.

Health care professionals and the patient can gain understanding of what’s important to the other person.

The patient feels supported and empowered to make informed choices and reach a shared decision.

Health and social care professionals can tailor the care or treatment to the needs of the individual.

It enables the patient to be in control of their own care. This result in better and more cost -effective outcomes.

Involvement in care may lead to reduced hospital admission rates.

The importance of working in partnership enables shared decision making a relationship between the health care professional and the patient must be a partnership.

It is a relationship in which healthcare professionals and the patient work together to:

• Understand what is important to the person.
• make decision about their care and treatment.
• Identify and achieve their goals.
• Normally there will be choices to make about your healthcare.

Ensure these questions are answered:

“What are the options?”

“What are the pros and cons of each option for me?”

“How do I get support to help me make a decision that is right for me?”

The patient must be fully informed about the options they face.

They must be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions.

This involves:

• Providing reliable, balanced, evidence-based information outlining treatment, care or support options, benefits, risks, and outcomes.
• Decision support counselling with a clinician or health coach to clarify options and preferences.
• System for recording, communicating, and implementing the patient’s preferences.

In decision support, clinicians need to assess what patients need to decide and provide them with appropriate resources to support this process.

Support can be given in clinical consultations or through other sources such as counselling provided by trained health coaches.

Decision support resources aim to help people to develop the knowledge, skills, and confidence to manage their own health and make treatment decisions and/or lifestyle changes accordingly.

Decision aids can be provided that the patient can review and absorb at home, before returning to discuss their preferences and decide how to treat or manage their condition.

Decision aids are designed to inform patient and help them think about what the different options might mean for them helping them to reach an informed preference.

The patient decision aids take a variety of forms, for example:

One-page sheets outlining the choices,

Detailed leaflets,

Computer programs,

Interactive websites.

Some of the impacts of using decision aids in practice:

Decision can:

• Improve on the patient knowledge of the options.
• Helps the patient feel more informed.
• Ensure the patient has accurate expectations of the possible benefits and harm associated with their options.
• Encourage more participation in decision making.
• Facilitate discussion between the patient and the practitioner.

In recording, decisions must be documented in the patient’s notes or electronic medical record.

Document if the patient has used a decision aid.

The record of decisions or the care plan should be accessible to the patient as well as health professionals.

This document can be used for several different purposes:

• as a legal record of the shared decision-making process.
• To help coordinate care.
• As a personally held record that can be continually updated to support behavior change.
• To inform commissioning strategies.

Barriers to shared decision- making:

• Time
• Standardized approach to practice.
• Lack of decision aids.
• Patients not wanting to be involved.
• Patient unable to be involved.
• Decision making capacity.

I learnt about the decision-making capacity:

• Some patients can provide a history but lack the ability to make decisions.
• The need to determine whether a patient has a “decision making capacity” which is the ability to understand information related to health, weigh clothes and their consequences, reason through the options, and communicate a choice.
• A patient who is quite ill may be unable to make decisions about care but can regain capacity with clinical improvement.
• A patient who may be unable to make a complex decision but still able to make simple decisions.
• Even if the patient lack capacity for certain decisions, but still important to seek their input, as they may have definite options about their care.

The following are the elements of decision-making capacity. Patient must have the ability to:

• Understand the relevant information about proposed diagnosis test or treatment.
• Appreciate their situation (including their underlying values and current clinical situation)
• Use reason to decide.
• Communicate their choice.

KSB ADDRESSED.

KNOWLEDGE:

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

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

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, 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.

24/05/23.

We started with the definition of End-of-Life Care (EOLC). It is a form of palliative care or supportive care, or terminal care the individual receives when he/she is close to the end of life.

according to the general medical council 2022, people are approaching the end of life when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:

• Advanced, progressive, incurable conditions.
• General frailty and co-existing conditions that mean they are expected to die within 12 months.
• Existing conditions if they are risk of dying from a sudden acute crisis in their condition.
• Life threatening acute conditions caused by sudden catastrophic events.

The EOLC strategy 2008, define care that: helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both the patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual, and practical support.

According to World Health Organization (WHO), they define palliative care as an active approach that improves the quality of life of patients (adult and young) and their families who are facing problems associated with life-limiting illnesses, usually progressive.

It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems whether physical, psychosocial, or spiritual.

In England, the term ‘end of life care’ refers to the last year of life.

we looked at supportive care – it helps the patient and their family to cope with their condition and treatment of it – from pre-diagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and into bereavement.

I learnt about the Amber care bundle.

• Assessment.
• Management.
• Best practice.
• Engagement.
• Recovery uncertain.

The EOLC pathway comprises of 6 steps, and they are listed below:

Step1: discussion as the end-of-life approaches –

• It is an open, honest communication.

Step 2: assessment, care planning and review –

• Agreed care plan and regular review of needs and preferences.
• Assessing needs of care.

Step3: coordination of care –

• strategic coordination.
• Coordination of individual patient care.
• Rapid response services.

Step 4: delivery of high-quality services in different settings –

• High quality care provision in all settings.
• Acute hospitals, community care homes, extra care housing, hospices, community hospital, prisons, secure hospitals, and hostels.
• Ambulance services.

Step 5: care in the last days of life –

• Identification of the dying phase.
• Review of needs and preferences for place of death.
• Support for both patient and carer.
• Recognition of wishes regarding resuscitation and organ donation.

Step 6: care after death –

• Recognition that end of life care does not stop at the point of death.
• Timely verification and certification of death or referral to coroner.
• Care and support of carer and family, including emotional and practical bereavement support.

I also learnt about the Advance Care Planning (ACP), that it is a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care, while they have the mental capacity for meaningful conversations about these.

There are 5 points they are as follows:

• Think: about the future – what is important to you, what you want to happen or not to happen if you become unwell.
• Talk: with family and friends and ask someone to be your proxy spokesperson or lasting power of Attorney (LPOA) if you could no longer speak for yourself.
• record: write down your thoughts as your own ACP, including your spokesperson and store this safely.
• Discuss: your plans with your doctor, nurses, or carers, and this might include a further discussion about resuscitation (DNAR or Respect) or refusing further treatment (ADRT).
• share this: information with others who needs to know about you, through your health records or other means, and review it regularly.

The 6 ambitions of palliative and end of life care (PEoLC).

• Each person is seen as an individual – I, and the people important to me, have opportunities to have honest, information and timely conversations and to know that I might die soon. I am asked what matters most to me. Those who care for me know that and work to me to do what’s possible.
• Each person gets fair access to care – I lived in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life.
• Maximizing comfort and wellbeing – my care is regularly reviewed, and every effect is made for me to have the support, care and treatment that might be needed to help me to be as comfortable and as free from distress as possible.
• care is coordinated – I get the right help at the right time from the right people. I have a team around me who know my needs and my plans and work together to help me achieve them. I can always reach someone who will listen and respond at any time of the day or night.
• All staff are prepared to care – wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident, and compassionate care.
• Each community is prepared to help – I live in a community where everybody recognizes that we all have a role to play in supporting each other in times of crises and loss. People are ready, willing, and confident to have conversations about living and dying well and to support each other in emotional and practical ways.

In recognizing change, there are 4 points:

1. Stable from diagnosis – year prognosis.
2. Unstable advance disease – months prognosis.
3. Deteriorating, exacerbations – weeks prognosis.
4. Last days of end-of-life pathway – days prognosis.

Inequality in palliative and end of life care for people with learning disability.

I learnt that, according to CIPOLD; Mencap, people with learning disability are three times as likely to die early than the general population (CIPOLD;Mencap, 2007).

They are more likely to experience poor general health, and to have high levels of unmet physical and mental needs (Emerson et al, 2011).

The health inequalities for people with a learning disability also extend into palliative and end of life care.

Although people with a learning disability still die at a younger age than the general population, the median age of death for people with a learning disability is increasing (public Health England, 2017)

The ageing process seen in the general population, including the onset of frailty, will become more apparent in those with a learning disability.

In delivering high quality end of life care for people who have a learning disability, the aim is to support commissioners, providers, and clinicians to reduce inequalities in palliative end of life for people with a learning disability.

To focus on the ‘The Ambitions for palliative and End of Life care’.

KSB ADDRESSED

KNOWLEDGE:

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

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

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, 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.

26/04/23.

The lessen started with a recap and followed with a discussion regarding the assignment. We looked at the learning outcomes:

To understand the rationale behind helping individuals make healthy lifestyles choices.

To gain some knowledge of the definitions of behavioral change and how models help explain it.

To gain an understanding of how as nurses can influence behavior change using motivational interviewing techniques.

We discuss the NMC requirements as a future nurse: standard of proficiency for registered nursing associates (NMC, 2018). This explain and demonstrate the use of up-to-date approaches to behavior change to enable people to use their strength and expertise and make informed choices when managing their own health and making lifestyle adjustments. To assess motivation and capacity for behavior change and clearly explain cause and effect relationships related to common health risk behavior like smoking, obesity, sexual practice, alcohol and substance use, and communication and relationship management skills.

Looking at the healthy and unhealthy behaviors, government publications become confusing as to eating 5 portions of fruits and vegetables in a day, taking enough exercise, eating less sugar, practicing safer sex, eating less fat, (particularly saturated), give up smoking, having a social life, and to drink sensible amount of alcohol.

I learnt that there is a need, as a nursing associate to have an overall understanding in order not to only guide patients when they are ill, but also to answer questions from patients about healthy lifestyle in general, and to keep up with research and understand the evidence behind the guidelines to maintain the credibility with patients.

Looking at the cultural differences – race, ethnic and cultural differences exist in the occurrence of physical and mental illnesses.  Some of thee may be related to the adoption of behaviors related to health, possibly relating to values inherent in their culture. There may be some groups that has become vulnerable to illnesses. Groups may also differ with their help-seeking behaviors. Behaviors that are consider unusual in western cultures, are not seen in this same manner in other cultures.

We looked at the gender differences, it is thought that the behavior of females tends to be more variable. The treatment that suits one gender might not produce outcome in the other. Generally, women pay more attention to health behaviors- being more willing to have annual checks and attending education classes. Males and females also differ in their coping mechanisms. Social support is sought more readily by females -but they experience more frequent and variable stressors.

Looking at the behavioural models:

cognition -focusing on the thinking of the individual, so beliefs, values and attitudes are most influential (as a nursing associates work on those beliefs to change them). This model only works by making people think of suitable changes. This does not empower people to make the changes.

The social cognition model- introduces the influence of other individuals on a person’s behaviour, so that they worry about not being ‘normal’.  Sometimes the fear here is quite strong. There is an assumption that many factors act together in the failure to adopt health behaviour.

Empowerment model – this considers; how difficult it is to make a behaviour change. People need to become empowered through their own previous actions or they need to become empowered by others (the nurse and the patient). Empowerment is not just about gaining the knowledge; it is being able to weigh up the information and decide for yourself and boosting the belief that you can make the change. For a nursing associate, there is need to listen to the patient, value their opinions and give them space.

I learnt about the alternatives to behavioural change:

The educational approach – it does not set out to persuade or motivate change in a particular direction. It assumes that by increasing knowledge, there will be a change in attitude which may result in a change in behaviour. The goal of the client might be agreed upon bur this approach does not acknowledge the real socioeconomic constraints that might affect behaviour change. The education should come from a credible individual, and should be simple, brief and to the point, with emphasis on the consequences of not engaging.

The behavioural techniques: Open questions, brief interventions of 5-10 minutes, establish rapport, assessing the patient’s readiness to change, and develop an action plan.

The following are the qualities needed for motivational interviewing:

Unconditional positive regard and acceptance of others irrespective of their age, gender, culture, ethnicity, setting aside your personal values, and being non-judgemental.

Genuineness, being oneself, true, sincere, and non-defensive.

Empathic – understanding the world of another and appreciate meaning.

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.

Some facts about alcohol consumption, since the early 1980s, alcohol sales and the amount that people drink has steadily increased, until peaking in 2008 and declining slightly since.

Some of this decline is due to more adults choosing to be teetotal, as well as fewer under 18’s drinking alcohol. However, drinking behaviour varies between different groups. It’s the people who already tend to drink less that are cutting back, while those who are at high risk of health conditions, because they drink heavily, are drinking more now than they did before.

According to the UK Chief Medical Officers’ low-risk guideline and increase their risk of alcohol-related ill health. In England, over 10 million people consume alcohol at above the guideline.

There are:

–  8.5m drinking at increasing risk

–  1.9m drinking at higher risk

–  Increasing risk defined as drinking 14 to 50 units a week for men and 14 to 35 units a week for women.

–  Higher risk defined as drinking >50 units for men and >35 units for women.

In hospitalisation: 1 in 10 patients has an emergency alcohol-specific readmission within 30 days following an alcohol-specific admission.

In economic burden of alcohol is estimated at between 1.3% and 2.7% of annual gross national product (GDP).

Looking at the health condition, alcohol misuse contributes (wholly or partially) to 200 health conditions, with many leading to hospital admission. This is due either to acute alcohol intoxication, or to the toxic effect of alcohol misuse over time.

The following are the UK chief medical officer’s guideline that applies to adults (both men and women) who drinks regularly or frequently:

• To keep healthy risks from alcohol to a low level, it is safe not to drink more than 14 units a week on a regular basis.
• If you regularly drink as much as 14units per week, it is best to spread your drinking evenly over 3 or more days. If you have 1 or 2 heavy drinking episodes a week, you increase your risks of death from long term illness and from accidents and injuries.
• The risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis.
• If you wish to cut down the amount you drink, a good way to help achieve this is to have several drinks-free days each week.

As a nurse or healthcare professional, you can access free online training to become confident in identifying those at risk from alcohol and delivering brief advice to change behaviour.

You should ask patients about alcohol and provide simple, brief advice and support to help them minimise harmful alcohol consumption.

Identifying risk usually means asking a set of questions from a validated questionnaire, and scoring the answers then feedback to the patient what their score indicates about their health risk.

Encourage patients to think about their health risk and provide a patient information leaflet.

Direct patients who are drinking above low risk to trusted sources of information such as the NHS website.

Make yourself aware of the local specialist services through your local authority public health team or the use of alcohol addiction services search facility.

If the patient show signs of alcohol dependence, refer them to specialist services.

I leant about smoking, that it is important to make every contact count (MECC) making the best of every appropriate opportunity to raise the issue of healthy lifestyle.

Systematically promoting the benefits of healthy living

Asking individuals about their lifestyle and changes they may wish to make

Responding appropriately to the lifestyle issue/s once raised

Taking the appropriate action to either give information, signpost or refer service users to the support they need.

We had a group activity on these: to discuss and list the reasons why people smoke? What are the perceived benefits of smoking? Estimate the proportion of the population that smokes.

For my group, the reasons we listed are:

• To release stress.
• Anxiety
• Depression
• Peer group
• Socialisation

For the perceived benefits of smoking, we stated the following:

• Cope with peer group
• Stimulate to weight control
• Appetite control to name but a few.

The estimated proportion of the population that smokes:

• 3% as at 2021 equivalent to 6.6 million people.
• 7% as at 2018 equivalent to 7.2 million age range from 18 and above.

Smoking and cultures, peer influence; girls concerned with appearance, popularity and weight.

If parents smoke, then child statistically more likely to smoke.

Smoking influenced by religious beliefs and cultural norms.

I learnt about smoking and mental health. The percentage of mental health patients and smoking:

• 22% of population smoke
• 40% of people with psychosis.
• 42% of cigarettes in UK smoked by people with Mental Health problems.
• Highest usage in people with schizophrenia or bi-polar disorder (up to 75%)
• Average more than 30 cigarettes per day.
• Smoking in general population reducing, but little change over 20 years in people with MH problems

The following are the reasons people with mental health smoke:

• Self-medication.
• Smoking helps with distressing symptoms
• Cognitive effects
• Nicotine may help enhance cognitive negative symptoms
• Socialisation
• Smoking culture in MH settings
• Desire to bond and relieve boredom.

According to the Royal College Physicians (2013), stated the following:

• Stopping does not worsen symptoms
• In some conditions (depression) smoking makes mental illness worse
• Same interventions that work in rest of population do work in MH patients
• Nicotine replacement does help cessation
• Many MH in-patient services have banned smoking completely
• Most predicted problems can be answered
• Note symptoms of withdrawal and MH condition can be similar.

The second set of activity was to write and discuss the answers to the following questions. What is in a cigarette? Are e-cigarettes a good option? How does smoke effect the body – respiratory and other systems?

The answers to the above questions are as follows:

For the first question we say cigarettes are:

• Nicotine ( insecticide)
• Carbon monoxide
• Tar
• Benzene
• Cadmium ( batteries)
• Stearic acid (candle wax)
• Hexamine ( barbecue lighter)
• Toluene (industrial solvent)
• Ammonia (toilet cleaner) to name but a few.

The second question asking weather e-cigarette is a good option. The answer to this question is NO.

The third and final question, how does smoke affect the body?

The answer is:

• smoking causes cancer
• causes lungs disease
• causes heart disease
• Diabetes to name but a few.

The effects of smoking on respiratory system are as follows:

• Cilia that line airway become damaged, eventually disappear.
• Mucus cannot be swept away
• mucus secretions can provide bacteria with nutrients to multiply
• Immune cells attack bacteria and tar but also release enzymes which destroy proteins that normally keep lung tissue elastic.
• Blood capillaries are damaged and less surface area for gas exchange.

The following are the condition or diseases linked to smoking:

• Reduced Fertility, IVF -less successful implantations 50%.
• Erectile dysfunction / lower sperm count and ↓sperm motility.
• Risk of miscarriage –approximately 5,000 in UK/year, premature baby – 2,200/year, Peri-natal deaths 300/year. Babies around 30% smaller, quarter of all cot deaths linked to smoker in the home.
• In children ↑asthma, cot death, glue ear, meningitis, pneumonia and respiratory infections.
• Learning difficulties, attention deficit and hyperactivity disorders linked to smoke during pregnancy and having a smoker in the home.
• Congenital defects e.g. orofacial clefts, neural tube defects, facial/eye defects, missing digits or club food.
• Risk of embolisms in smokers who take oral contraceptive pill.
• Earlier menopause (linked to cigarette chemicals interacting with hormones)-
• COPD e.g. Emphysema, Bronchitis.
• Risk of Vascular Dementia and Alzheimer’s.
• Cancers: 85-90% lung cancer.
• High blood pressure, cardiovascular disease (coronary heart disease e.g. angina and M.I) Cerebrovascular disease (embolism, aneurysm, stroke) and Peripheral vascular diseases.

The role of a healthcare professional are as follows:

• Good understanding of the risks
• Awareness of your attitude to smokers/smoking
• Know where to access information
• Know how to refer someone for support
• Making Every Contact Count
• Role Model
• Supporter

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, 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.

10/05/2023.

We looked at the learning outcomes.

• To understand the primary difference between assessing children versus adult.
• To understand what is meant by assessing and what this entails.
• To understand the anatomical differences between adult and children.

We looked at the definition of assessment according to (Cambridge Dictionary, 2002). ‘The act of judging or deciding the amount, value, quality or importance of something, or the judgement or decision that is made’.

Children versus Adults:

We say children are not little adults.

Their health is more than absence of illness.

Children needs environment s which promote growth and development.

Adults must ensure that children are protected from environmental threats.

There are different types of assessments for children:

• Clinical
• Social and emotional.
• Physical development.
• Environment
• Family

Hospital setting assessment process guided by the great Ormand street manual of children’s practices (2012). The things to consider:

Age.

Gender

Cultural and religious beliefs,

Languages spoken,

Family history and medical history, and parental responsibility. For the assessment process, rapport – good communication skills are considered. That is verbal/nonverbal, interpreters are required, open and closed questions, clarify understanding.

The present history- the reason for attending, what are the main health concerns. What are the symptoms/pain depending on the age of the child. If younger the parent/guardian with supply this information.

The past medical history – may be relevant to take the birth history depending on the child’s age, the history of illnesses or the episodes if occurring. The current medication, any allergies. Updated Immunisation date.

The developmental aspect are speech and language, gross monitor, fine monitor, cognitive, social and emotional. The developmental norms – speech and language

Language – 18 month says approximately 20 words, 2 years say about 50 or more single word, to start to put 2-3 words together to make a sentence. 3 years uses up to 300 words, refer to things in the past, ask lots of questions – what? Why? Who?  4 years understands and say lots of words, longer sentences, and link them together, answer why? Questions. We looked at the developmental norms from 3 months up to 18 years.

Measuring Vital Signs – PEWS (Paediatric Early Warning System) in checking the vital signs of the children, we calculate the following: Heart Rate, Respiratory rate, Oxygen requirement, Saturations, Consciousness, Blood pressure, Capillary Refill Time, and skin colour. Theis will provide a score and a trend which is easily quantifiable as a red flag. The purpose to facilitate better communication between staff and to have a timely controlled management of care. Things to observe in measuring vital signs: normal respiration is a normal relaxed subconscious activity. Oxygen saturation is greater than 93%, pattern, effort and rate of breathing should be recorded, and the skin colour. In measuring their respiration for abnormal breathing: tachyaponea, retractions – subcostal, intercostal and tracheal tug, head bobbing, nasal flaring, apnea-pausing in breathing greater than 20 seconds and how the child positioning themselves.

Measuring the heart rate/pulse in children: always explain/show to the parent and child what you are about to do. Under 2’suse a stethoscope on the apex heartbeat and older children uses the radial pulse, ensure count for a full minute.

Measuring blood pressure, ensure the cuff size is correct (must cover 80-100% of the child circumference of the child’s arm but no more and there should be an overlap of the cuff), the cuff should be positioned over the artery, the dept of the bladder should not cover more than 2/3 of the upper area. Make sure the child is calm (sucking, crying, and eating can affect the reading).

Measuring the Capillary Refill Time (CRT): If using a finger, hand must be raised to the heart level. Compress for 5 seconds using forefinger, monitor time takes for the blood to return capillaries (normal skin colour) good perfusion if returns in less than 2 seconds.

Measuring the pain score: a valid pain assessment should be used, it should be age appropriate. This should be done on admission for a base line assessment, and accurate documentation should be done.

Measuring weight: to gain the accurate measurement on admission to calculate drugs. Ages 0-2 years should be weighed naked, 2 plus with minimal light clothing depending on the age.

At the end of everything, this should be recorded accurately. The clarity around the frequency, which observations needs recording, which limb was used for BP, the activity of the child when the observation was taken, and the consistence approach to how the result are documented.

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, 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