The following are the ethical principles:

Autonomy – The right of the patient to involve in shared decision making.

Beneficence – Related to doing good.

Non-maleficence – Related to doing no harm.

Justice – Equitable to the distribution of nursing interventions.

 

Accountability: according to the NMC Code (2018) 11 states that be accountable for your decisions to delegate tasks and duties to other people.

To achieve this, you must:

• Only delegate tasks and duties that are within the other person’s scope of competence, making sure that they fully understand your instructions.
• Make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care.
• Confirm that the outcome of any task you have delegated to someone else meets the required standard.

 

Accountability, according to pennels, 1997 is a requirement that each nurse is answerable and responsible for the outcome of his or her professional actions.

According to cornock, 2011, to be accountable, a nurse should:

• Have the freedom (autonomy) and authority to be able to make a professional judgement on which actions to take.
• Based on their knowledge of the possible options and consequences of each.
• A registered nurse is accountable to a number of people and organizations when making a professional judgement.
• The Purpose is to ensure that the public and patients are not harmed and to provide redress for those who have been harmed.

I learnt about the difference between accountability and responsibility:

• Responsibility relates to the acceptance and carrying out of a task or duty within a person’s sphere of competence.
• Accountability can be defined as being required or expected to justify actions or decisions

(Sharples and Elcock, 2011).

• An individual has to ‘account’ to a person or an organization for their actions, omissions and decisions in carrying out a duty or task.
• In nursing, the question of to whom you are accountable will depend on whether you are a registered nurse or a student.

We further on discuss who is accountable and to whom. As a nurse, nurses are accountable to:

• The Public
• The Employer
• The Patient
• The Profession

Don’t forget, you are also accountable to yourself

• Through criminal law
• Through contract law
• Through duty of care and tort of negligence
• Through the Code of Professional Conduct.

As a student nurse, learning in practice will take place under the supervision of a registered nurse or other professional.

The registered nurse will:

• Assess your level of competence, knowledge and understanding before delegating a task or activity. It is very important that you inform the nurse if you feel any task delegated to you is beyond your level of competence.
• The registered nurse will remain accountable for the overall care to be delivered. If you accept responsibility for the tasks delegated to you, you will then become accountable for your actions, omissions and decisions in performing those tasks (RCN, 2017).

As a student, you can be held to account by:

• The university.
• The law, through your duty of care.

In addition;

• As a student, you are not accountable to the NMC; however, an ability to demonstrate compliance with the NMC Code throughout your course is essential and this will be monitored by the university.
• On successful completion of your course, your university will sign a declaration to the NMC that you are of good health and good character sufficient to practice without supervision.
• This supports your own self-declaration of good health and character when you apply to register with the NMC.

The following are professional misconducts. If found guilty of Professional Misconduct:

• Judgement may be postponed.
• Referral may be made.
• The nurse may be suspended.
• The nurse may be cautioned.
• The nurse may be removed from the Register.

Consent is a general legal and ethical principle that valid consent must be obtained before commencing an examination, starting treatment or physical investigation, or providing care.

This principle reflects the rights of a person to determine what happens to their own bodies or what shapes the care and support they receive.

According to Griffiths and Tengnah (2017), touching a person without consent is generally unlawful and will amount to trespass to the person or, more rarely, a criminal assault- therefore it has a legal purpose.

• The clinical purpose comes from the fact that in most cases the co-operation of the person and the person’s confidence in the treatment is a major factor in their consenting to the examination, treatment or physical investigation, or the provision of care.
• Permission to touch a patient through obtaining consent is an important defence to a claim of unlawful touching.
• When giving consent for a procedure, patients are entitled to expect that the nurse is qualified to carry it out.

 

Additional considerations can be in the form of valid consent and capacity to consent.

 

Valid Consent:

• For consent to be valid, it must be given voluntarily and freely, without pressure or undue influence, by an appropriately informed person who has the capacity to consent to the intervention in question.
• Some people may feel pressurized, by relatives or carers for example, to accept a particular investigation or treatment.
• Registered nurses should be aware of this, and of other situations in which people might be vulnerable, for example, those resident in a care home, or in prison.

 

Capacity to consent:

• Principles underpinning UK mental health legislation and mental capacity legislation support “assumption of capacity”
• That is, adults are presumed to have the ability to independently make decisions about and decide whether to agree to or refuse any aspect of their care, treatment and/or support.
• A person who has capacity is able to provide or withhold consent for examination, treatment and/or care.
• If an adult makes a voluntary and appropriately informed decision to refuse care, treatment and/or support, then registered nurses must respect this decision.

 

An individual can only be regarded as “lacking capacity” and unable to independently make decision regarding their care, treatments, or support. Only deemed as such if all practicable help and support has been provided.

 

The 4-point test of capacity:

–  Is the person able to understand the information relevant to the decision?

–  Is the person able to retain that information for the time required to make the decision?

– Is the person able to appreciate the relevance of that information and to use and weigh the information as part of the process of making the decision?

–  Is the person able to communicate their decision (whether by talking, using sign language or any other means?)

If the answer to any question is no, then the person can be deemed to lack capacity

Whether the person has a particular condition is irrelevant to the question of whether they have capacity to make decisions in any matter.

 

For young people and consent, the following were mentioned:

• A young person under the age of 16 has the legal capacity to consent to medical examination and treatment, including contraception, if they have sufficient maturity and intelligence to understand the nature and the implications of that treatment.
• If a child is considered mature and intelligent by the nurse, they are known as Gillick Competent.
• The aim of the Gillick principle is to reflect the transition from child to adult.
• The degree of maturity depends on the gravity of the decision.
• Consent cannot be overruled by a parent.

 

For confidentiality, Individuals have the right to expect that any information they provide is used only for the purpose for which it was given and not disclosed without their permission.

• The nurse must keep this information confidential, no matter whether the patient has given the information or if the information was obtained from someone else – a family member, for example.
• The exception to this would be if you believed someone may be at risk of harm.

 

 

 

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 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.

 

 

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.

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

 

 

 

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.

Pharmacology is the science of drugs and how they act, including the search for new drugs, investigations into how they can best be used to treat disease, and their effects on the body.

I learnt what pharmacokinetics and pharmacodynamics are. Pharmacokinetics refers to what the body does to the drugs. That is:

– Absorption, distribution, metabolism, and excretion.

– Bioavailability

– Therapeutic range

– Half-life

– Peak-plasma concentrations

Pharmacodynamics – what the drugs do to the body:

– The drugs acting at receptors

– The drugs acting on enzymes

– The drugs acting on transporters.

With all the above explanation, pharmacology is defined as the science that examines the composition, effects, and uses of drugs.

Pharmacology is how the body process the drugs and it is broken down into four stages:

– Absorption – how the medication will get in?

– Distribution – where will the medication go? Transporters.

– Metabolism – how is it broken down? liver

– Excretion- how does the medication leave the body?

The route of medication is categorised into 3:

– Enteral, through the gastrointestinal tract, through the portal circulation and through the liver (oral, sublingual, buccal or rectal route)

– Parental, through IV, IM, or subcutaneous administration.

– Topical, application of a medication directly to a site, (cream, inhalations, oral rinses)

The first metabolism: the absorbed drugs then pass directly to the liver via hepatic portal vein.

Any drug taken orally will reach the liver first before reaching the systemic circulation.

A large proportion of oral drugs will be chemically altered during this ‘FIRST PASS’ through the liver.

Little drug may reach the systemic circulation.

The following are the routes that avoid first pass metabolism:

– Sublingual

– Intravenous

– Intra-muscular

– Subcutaneous

– Transdermal patches

– Rectal suppositories,

– Buccal

The distribution is the process of dispersion or dissemination of drugs throughout the fluids and tissues of the body.

Drugs are not evenly distributed through tissue and fluids.

– Fat soluble drugs will concentrate in adipose tissue

– Water soluble will concentrate in the body water.

Blood –brain barrier prevents many drugs from crossing.

Metabolism is the process which biochemically changes the drug molecule into a different form, which may be active, inactive, or more soluble.

It occurs mainly in the liver.

Metabolism converts the molecule into a water –soluble substance that is readily excreted.

More soluble substances can be excreted more readily.

The excretion is the removal of waste products from the body.

The main organs of excretion are the kidneys, although the liver and the gut also pass through the process of filtration, reabsorption, and active secretion in the renal tubules and are then excreted in the urine.

Some other drugs are excreted into the biliary system of the liver and pass into the small intestine in bile, these are then passed into faeces.

In maintaining therapeutic concentration, the following should be considered:

– To maintain concentrations within the therapeutic range, repeated doses are administered to ensure that concentration rises and remains within the zone as the successive doses overlap.

– The timing of these doses is decided by the half-life of the drug.

– Half-life: the time taken for the plasma concentration of the drug to fall by half as it is distributed through the body and then metabolised or excreted from the body.

The following that affects pharmacokinetics:

– Disturbances of the gastrointestinal tract (vomiting, diarrhoea)

– Circulatory disorders

– Liver disorders

– Kidney disorders

– Interaction between drugs that can affect their activity in the body.

We looked at pharmacodynamics- what the drugs do to the body: the study of biochemical and physiological effects on the body. The 2 common binding sites for drugs:

– Receptors

– Enzymes.

These are the drugs acting at receptors:

– Many drugs’ receptors are protein molecules on the cell surface.

– The drug molecule must be the specific size and shape to interact with the precise receptor lock and key)

The drugs that acting at receptors are as follows:

Agonist:

– Chemical that binds to a receptor and activates it to produce a response.

– Most drugs acting at receptors are agonists.

Antagonist:

– Chemical that binds to a receptor but does not produce a response.

– Block the receptor so that an agonist cannot exert its effect.

Partial agonist:

– Chemical that binds to a receptor to produce a response but has less than maximum impact.

Drugs acting on enzymes – enzymes are chemicals that speed up chemical reactions within cells.

Some drugs act as enzyme inhibitors by binding to the enzyme to decrease its activity.

 

 

KSB ADDRESSED.

 

KNOWLEDGE.

 

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.

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.

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, and pain.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

 

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.

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

 

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.

 

The lesson started, with a gentle reminder of the sensitive topic that we are to be kind to our colleagues, to express our views calmly, we are all individuals and must respect one another.

If affected by any of the topics covered (pregnancy, fatal development, fertility, FGM and sex) please feel free to take a small break and re-join us when you are able to.

The lesson continued with the reproductive anatomy of both male and female.

The female Reproductive Anatomy:

• External Genitalia
• Internal Genitalia
• Reproductive Cycle
• Breasts

The male Reproductive Anatomy:

• Scrotum, Testes, Seminal Vesicles, Ejaculatory ducts, Prostate gland, Urethra
• Penis – Erection & Ejaculation.

 

We looked at sex and gender. According to Boore et al 2021, they stated that “Sex refers to the biological composition of male and female, in the historically accepted sense. Gender is the social expression of the sense of being female, for example and is largely socially, culturally, and psychologically determined.”

 

The functions of the female reproductive system include:

• Formation of Ova
• Reception of Spermatozoa
• Provision of suitable environments for fertilisation and foetal development
• Parturition (childbirth)
• Lactation (Production of breastmilk)

The structure and function in closer details:

The Vagina:

• Fibromuscular tube
• Opens into the vestibule at its distal end and the uterine cervix at its proximal end.
• It runs upwards and backwards at approximately a 45-degree angle.

 

Functions:

• Acts as the receptacle for the penis during sexual intercourse
• Provide an elastic passageway for the baby during childbirth.

 

 

The uterus:

• Hollow, muscular pear shaped organ
• Lies in pelvic cavity between the urinary bladder and the rectum
• Sits almost at right angles to vagina
• Anterior wall rests partly on bladder below
• 5 cm long; 5cm wide
• Weighs between 30-40g

Fundus:

• Dome shaped part above the openings of the uterine tubes

 

Body:

• Upper 2/3rds of the uterus
• Pear-shaped.

 

Cervix:

• Narrow neck of the uterus
• Usually around 2.5cm long.

 

A series of ligaments keep the uterus in place.

The perimetrium is the layer of peritoneum that covers the uterus, uterine tubes and ovaries like a blanket.

The myometrium is the thickest layer in the uterine wall.

Mass of smooth muscles interlaced with blood vessels and nerves.

 

The endometrium is the functional layer that:

• Thickens and becomes rich in blood vessels in the first half of the menstrual cycle.
• If the ovum is not fertilised this layer is shed during menstruation.

 

 

 

 

 

The basal layer is the Sits next to the myometrium and is not lost during menstruation.

The fallopian Tubes –

The Structure:

• 10cm long
• Each tube has finger like projections (Fimbriae)
• Covered with peritoneum
• Lined with ciliated epithelium.

 

The Function:

• Propel ovum from the ovary using peristalsis and ciliary movement
• Fertilisation occurs, zygote propelled to uterus for implantation.

 

The function of the ovary:

• To produce ova
• To produce the female steroid hormones oestrogen and progesterone.

 

The two ovaries:

• Develop from embryonic gonadal ridges at 6 weeks of embryological development.
• Recognisable >10 weeks
• Composed of interstitial tissue and follicles
• Measure 3cm x 2cm x 1cm
• Weigh 6 grams.

 

The female reproductive cycle:

• It occurs every 26-30 days from puberty – menopause
• Consists of changes taking place concurrently in both ovaries  + uterine lining
• Stimulated by changes to blood hormone levels
• Hormones are regulated by negative feedback mechanisms.

 

The menstrual phase of the reproductive cycle:

• The functional layer of endothelium is shed
• Mostly lasts from 4-7 days (depending on length of cycle)
• Progesterone and oestrogen levels fall
• If the ovum is not fertilised = corpus luteum degenerates
• Painful cramping of the uterus
• Excessive pain = dysmenorrhea
• Can be a sign of endometriosis.

 

 

The Proliferative Phase of the reproductive cycle: Usually lasts 10 days

• One or more ovarian follicles are stimulated by FSH and grow towards maturity.
• They are producing oestrogen which stimulates the proliferation of a functional layer in the endometrium in preparation to receive a fertilised ovum.
• Rising levels of oestrogen stimulate a surge in LH which triggers ovulation
• One follicle will rupture releasing an ovum which is now called an oocyte.

 

The secretory phase of the reproductive cycle. Usually lasting 14 days.

• After ovulation LH from the anterior pituitary gland stimulates development of the corpus luteum from the ruptured follicle.
• The corpus luteum produces progesterone, oestrogen and inhibin.
• Progesterone increases production by secretory glands of watery mucous to assist the spermatozoa through the uterus to uterine tubes where the ovum is usually fertilised.
• After ovulation the combination of oestrogen and progesterone supress the hypothalamus and the anterior pituitary gland, and therefore FSH and LH levels fall.

 

Ovum Fertilised:

• No menstruation
• The fertilised ovum (zygote) travels down the uterine tube and embeds into the uterine lining, where it produces hCG
• hCG keeps the corpus luteum intact enabling the continued secretion of progesterone and oestrogen for the first 3-4 months of pregnancy. This ensures no further ovum are release
• When developed the placenta continues to produce oestrogen, progesterone, and gonadotrophins.

 

Anatomy of the female breast:

Growth initiated in puberty by an increase in hormones. The hormones are as follows:

• Oestrogen

Where are these hormone made? In the

• Ovaries
• Small amount in the adrenal glands.

 

What do they do specifically?

• The Oestrogen encourages growth of the milk ducts
• The Progesterone stimulates the lobules to prepare for lactation.

The following are the abnormalities:

• If a woman notices any changes out of the ordinary to her breasts or external genitalia = refer to the GP and practice nurse.
• Document findings clearly, draw a diagram if possible (only if observed).
• Refer to a sexual health clinic if lesions/discharge/growths detected in external genitalia.

 

We also looked at Female Genital Mutilation (FGM), that the:

• Female Genital Mutilation is illegal in the UK.
• There are different types of mutilation (Type I,II,III0
• The practice causes serious harm to female genitalia leading to a host of health problems.
• As a nurse you must document the occurrence refer onwards to the GP and an FGM clinic (especially if the woman is of childbearing age).

 

The male reproductive system and its functions. The function of this system are:

• Production, maturation and storage of spermatozoa
• Delivery of spermatozoa into the female reproductive tract
• Urethra is the passageway for urine excretion.

 

The sperm.

The head of the sperm:

• Almost completely filled with the nucleus which contains the DNA.
• Also contains enzymes which are needed to penetrate the outer layers of the ovum.

 

The body of the sperm:

– Filled with mitochondria to provide energy to fuel propulsion

The tail of the sperm:

• Whip Like – used for mobility to propel along female reproductive tract.

 

The lesson continued with pregnancy, we looked at ovulation to conception and fertilization of the ovum.

• Normally 6-7 days after fertilisation, the blastocyst begins to embed in the uterus and is completely buried by the 11^th
• The first stage of foetal development is the formation of two enclosed cavities which lie adjacent to each other, the amniotic sac, and the yolk sac.

 

 

The first 14 days:

• The blastocyst is nourished by its own cytoplasm. Primitive blood vessels for the embryo begin to develop in the mesoderm.

 

The next 14 – 28 days:

• Embryonic bloods vessels connect up with blood vessels in the chorionic villi of the primitive placenta. Embryo/maternal circulation is thus established and blood is circulating.
• Head of embryo can be distinguished from the body
• Leg buds and then arm buds appear
• Major body systems are present in rudimentary form.

 

• – 42days:

 

• Length Is approximately 12mm by the end of the 6^th
• Arms begin to elongate and hands take shape
• Rudimentary eyes and ears appear
• Ears are apparent but low set
• First movements can be detected on ultrasound from 6 weeks.

 

The development of the foetus. At 8-10/40:

• Head approximately the same size as the body.
• Fingers and toes can be defined
• Eyelids are formed but closed until 25^th week
• Intestines herniate into the umbilical cord because there is no room in the abdomen
• Cord insertion is very low in the abdomen
• If the mother’s abdomen is palpated too forcefully, the foetus will move away (observed on scan).

 

The screening for inherited condition:

• Antenatal screening tests include screening for sickle cell disease and thalassaemia, infectious diseases, the 20-week anomaly scan and screening for Down’s syndrome.
• Women should be told about the risks, benefits and limits of these tests.
• Screening for sickle cell disease and thalassaemia should be offered before 10 weeks.
• This is so women and their partner can find out about all their options and make an informed decision if their baby has a chance of inheriting these conditions.

 

 

 

 

At 12 -40:

• Body length is approximately 9 cm
• Weight 14g
• Foetal circulation is functional
• Renal tract begins to function
• Sucking and swallowing reflexes are present
• External genitalia are apparent and sex can be determined.
• Women can miscarry at early gestations due to a variety of reasons.
• Some spontaneous miscarriages occur early due to abnormalities in cell division.
• Women are offered early screening to detect some abnormalities early do they can make an informed choice on whether to continue the pregnancy. Especially prudent if the pregnancy is not compatible with life
• Around 1 in 4 pregnancies end in miscarriage (spontaneous and planned).

 

At 16 – 20/40:

• The rate of growth begins to slow down.
• The head is now erect and half the length of trunk.
• Facial features are distinctive with ears sited in normal position
• Eyelids, eyebrows and finger nails are all well developed
• Legs are in proportion with the body
• Skeleton is visible on x-ray examination
• Fetal movements can be felt by the mother from 18/40
• Fetal heart can be heard with a hand held Doppler from around 16/40
• Renal tract is functioning, 7-17mls urine being passed in 24 hours.

 

At 28 – 32/40:

• Lanugo begins to diminish
• Body beginning to become more rounded as fat is laid down.

 

At 32 – 36/40:

• Lanugo mostly shed, skin still covered in vernix
• Finger and toe nails reach the top of the digits
• Umbilicus now lies more centrally in the abdomen.

 

At 36 – 40/40:

• Ossification of skull bones is still not complete, but this is an advantage and facilitates the passage of the foetus through the birth canal.

 

 

Once the baby is born:

• Birth top-to-toe check – weight, head circle, Vitamin K, X2 baby labels
• Referrals made (not always addressed immediately with the mother unless asked a specific question)
• NIPE exam (within 72 hours) – time for further discussion
• Hearing screen (birth to 72 hours)
• Day 5 New born blood spot screening for inherited diseases:

MCADD, PKU, Cystic fibrosis, Sickle cell, Congenital Hypothyroidism

• 8 week check – GP

(Referrals for abnormalities must have been actioned.

 

 

KSB ADDRESSED.

 

KNOWLEDGE.

 

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.

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.

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, and pain.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

 

 

 

 

 

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.

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

 

 

 

 

 

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.

 

 

 

 

WEEK 6 OF TEACHING TNA.    7.5HRS.

MORNING SESSION:

We start our day with a reflection as we normally do, to ginger us up for the start of the week, which I think helps us. The topic for this week’s learning is ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM.

We looked at the learning outcomes and we say the nervous system detects and responds to changes inside and outside the body.

It’s also control vital aspects of the body function and alongside the endocrine system maintains homeostasis. The nervous system consists of the Brain, Spinal cord and Peripheral Nerves. They are grouped as:

Central Nervous System (CNS); the brain and spinal cord.

Peripheral Nervous System (PNS; all nerves inside the brain and spinal cord.

There are Sensory (Afferent) Division and the Motor (efferent) Division.

The sensory division contains sensory receptor and transmit impulses from receptors to the CNS. In the somatic sensory, it receives information from the skin, joint, skeletal muscles, sight, taste, smell, hearing and balance.

The motor division transmits impulses from the CNS to effector organs (muscles and glands) and consist of Somatic nervous system (voluntary) that is the motor innervation of all skeletal muscles and the Autonomic nervous system (involuntary), the motor innervation of smooth muscle, cardiac muscle and all glands.

The Autonomic nervous system is further split into two divisions, that is the Sympathetic division and the Parasympathetic division. The Sympathetic division mobilises the body systems during emergency situations ‘fight or flight’. (Its responds to hyper stimulus and increases heart rate) The Parasympathetic division conserves energy, protects non-emergency functions ‘Rest and digest’. (Responds to action and decreases heart rate).

We looked at Nerve Synapse, there is always more than one neurone involved in the transmission of a nerve impulse.

The neurones do not physically touch each other when transmitting impulses to one another.

The point at which the impulses conduct from the presynapyic neurone to the post synaptic is called the Nervous Synapse.

A nerve is a collection of neurones in a bundle, they are: Sensory, Motor and Mixed. The sensory/ afferent nerves carry impulses from the body to the spinal cord. The sensory receptors: respond to different stimuli inside and outside the body e.g: pain, cold, heat, touch to name but a few.

The motor/ efferent nerves originate in the brain, spinal cord and autonomic ganglia. It transmits impulses to the effector organs: muscles and glands.

The mixed nerves, where the sensory and motor nerves are enclosed in the same connective tissue, they are mixed nerves

                                                                                  KSBs ADDRESSED.

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

K10: Understand the Principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11: Understand the factor 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 behavioral health outcomes.

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

K16: Understand the body systems 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.

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

                                                          AFTERNOON SESSION.

For the afternoon session, we looked at Ethical and Legal aspect of nursing.

We briefly looked at the course outline and what the principles of ethics which are Autonomy, Beneficence Non-Maleficence and Justice.

Autonomy basically talks about the right to individual choice. No control or interference from others (thought, will and action).

Beneficence talks about the best interest of the patient. Nursing care should be a benefit to the patient.

Non-maleficence, which is doing no harm to the patient. The desire to do no harm which is more harmful, to do nothing or to do something.

Justice, the equality and fairness. We consider how resources are used – it is fair and just can cause moral conflict.

We looked at accountability and responsibility, that accountability deals with you as an individual has been accountable for, if anything goes wrong, it on you wholly, been accountable (RN) you delegate duties to other members of staff (HCAs), there comes responsibility, in this case the HCAs are responsible of the task been delegated to them. but in overall, the person (RN) is accountable for everything. I learnt that as a health worker, we are accountable to the public, our employers, the patients, the profession to name but a few.

We looked at Consent, that it is a general legal and ethical principle that valid consent must be obtained before commencing an examination, starting treatment or physical investigation, or providing care. This principle reflects the right of a person to determine what happens to their own bodies or what shapes the care and support they receive (informed consent).

We further on looked at Confidentiality, the information provided can only be used to the purpose for which it was given and not disclosed without their permission. The exception to this would be if you believe someone may be at risk of harm. Above all, we should respect people’s right to privacy and confidentiality.

                                                                  KSBs ADDRESSED.

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

K18: Understand and apply the principles and processes for making reasonable adjustments.

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 how the person’s capacity has affects their ability to make decisions about their own care and to give or withhold consent.

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

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

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

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

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

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WEEK 4 OF TEACHING       TNA   7.5hrs.

Another week of teaching. We had reflection on the past week’s woke. It was good and I am sure everyone was refreshed and ready for the day’s work.

We were informed about the Tri-partite form, and a meeting with our line managers or mentors in our different work places. The last five pages of the form should be printed, filled, scan and email to our Academic guardian after the meeting.

We looked at the structure and function of blood.

Blood is responsible for transporting gases (oxygen and carbon dioxide), waste products, nutrients, and also helps in removing toxins from the body to the liver and contributes in the maintenance of core body temperature.

The composition of blood, it is made up of cellular material in a fluid called Plasma, and it is a circulating tissues consisting of three types of cells that is the Red blood cells (Erythrocytes), White blood cells ( Leukocytes), and platelets( Thrombocytes).

The formation of blood, hematopoiesis is the formation and development of blood cells and they are all formed in the  hematopoietic stem cell.

We further looked at Anaemia as a red blood cell disorder or disease, its types ( iron deficiency anaemia, aplastic anaemia ,sickle cell anaemia to name but a few) symptoms  and the  treatment for anaemia.

we looked at the White blood cells, there are five different types of White blood cells which are split into two categories.

The  Granulocytes( multi-lobed nucleus and granules in the cytoplasm)and the Agranulocytes( large nucleus no granules). The granulocytes consist of the following:

1.The Neutrophils,

2.The Eosinophils, and

3The Basophils.

The Agranulocytes consist of the following:

1. Lymphocytes.

2. Monocytes.

We looked at Blood Group, that there are four major groups:

Group A: has only A antigens on the red blood cell, and B antibody in the plasma.

Group B: has only B antigens on the red blood cell, and A antibody in the plasma.

Group AB: has both A & B antigens on the red blood cells but neither A nor B antibody in the plasma.

Group O: has neither A nor B antigens on the red blood cells, but both A & B antibody are in the plasma.

We also looked at the Cardiovascular System, its aim and learning outcomes. I learnt that, the cardiovascular system has three components ( the Pump, the Fluid and the Tubes).

The cardiovascular system supply oxygen to the tissues, and transport carbon dioxide from the tissues back to the lungs.

Its also transport nutrients to the tissues of the body , and remove waste products for excretion from the body by the kidneys and liver.

Dissipation of the heart to maintain normal body temperature and to help maintain homeostasis. Its consist of the Heart (cardio), blood vessels (vascular) arteries, veins, capillaries.

I learnt that the Cardio-Pulmonary Atrium is the Right Atrium-Alveoli, that receives the blood from the body on the right atrium to the Right Ventricle and to the Pulmonary Artery.

The Pulmonary vein carries de-oxygenated blood to the heart. From the left artery to the Mitral Valve (Bicuspid), to the Aortic valve to the Aorta.

The opening and closing of the Bicuspid and Tricuspid valve makes the Lub-Dup sound ( Heart sound).

In summary the right side receives the blood back from the systemic circulation, delivers the blood to the lungs for gaseous exchange, and in the lungs the blood collects oxygen (O2) and releases carbon dioxide (CO2) to be exhaled. The left side receives the blood back from the lungs, which is now fully oxygenated, delivers to systemic circulation to supply all the organs with oxygen rich blood.

I also learnt that, the normal heart rate (resting) varies with age.

For new born – 6months 90 – 160.

6 – 12months 80 – 140

one – 3 years 80 – 120

3 – 9 years 70 – 115

9 – 14 years 65 – 105 and

adult 60 – 100.

The function of the vascular system ensure delivery of blood to all tissues to match tissues demands.

To be flexible and adaptable so that blood flow can meet metabolic needs of tissues/body as a whole.

To convert a pulsatile blood flow in arteries into a steady flow in the capillaries where transfer of substances occurs.

 To return blood to the heart.

I learnt that blood pressure is the pressure the blood exert against the walls of arterial blood vessels, this force ensures blood to circulate continuously. And that the circulatory system is a close system so the total flow leaving and returning to the heart will be the same.

Normal blood pressure replies upon 3 key factors:

Cardiac output( the pump)

Peripheral resistance( the tube)

Blood volume ( the fluid).

 The systolic pressure is due to the contraction of the left ventricle forcing blood into the arteries. For adult  110 – 140 mm Hg.

1 year 80 mm Hg

5years 90

10 years 97

15 years 109.

The diastolic pressure the lower pressure which occurs when the ventricular muscle relaxes, allowing the left ventricle to refill ready for the next beat. This is usually reported  as systolic/diastolic, for eg 120/80.

                                                         KSBs ADDRESSED

K14: Understanding the importance of health screening.

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

                                    AFTERNOON SESSION

We looked at Infection Control and use of PPE.

The learning outcomes and its importance. I learnt that there are good bacteria, and we can be find them everywhere. Bacteria can be transmitted by touching, airborne to name bit a few. The elderly, vulnerable are in high risk of viral infection.

We looked at the types of infection, Bacteria( staphylococcus,  pseudomonas)

Virus (norovirus, rotavirus)

Fungus ( candida, aspergillosis).

I learnt about the Health care- Associated infection(HCAI) that it is estimated that 300,000 patients  a year in England acquire a healthcare-associated infection as a result of care within the NHS.  As we are protecting ourselves, we protect the patients also, by protecting the skin, eyes, and clothing. we looked at the different examples of PPE and the Legislative underpinning of PPE.

PPE at work regulation.

Control of substances of Hazardous to Health Regulations (2002)

Health and Safety at Work Act (1974).

We went to a ward setting, where we had a session of the correct way of putting on the PPE and to safely doff  (remove) them to avoid contamination.

We also had a session on the correct moving and handling techniques, ( repositioning and transferring the patient with a pat slide and a sliding sheets), assisting patient with walking from a sitting down position. And on giving personal hygiene to a patients, ( facial wash, bed bath) checking and assessing the patient in the process. In all what you do to the patient, you communicate with the patient in gaining consent.

                                                    KSBs ADDRESSED.

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

K23:  Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.

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Time created Wednesday, 21 September 2022, 6:14 PM	Last edited Friday, 30 September 2022, 7:12 PM	Auto-rating Item percent setting 0%	Common error percent setting 5%
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