THE NURSING ASSOCIATE AND INTEGRATED CARE.

The lesson started with an introduction of the topic, followed by the learning objectives, that is:

• To consider the policies that govern the direction of care provided to patients.
• To understanding integrated care.
• To develop an understanding of the integrated care systems currently in place.
• To understand the nursing associate’s role in integrated care.

We had a quick session on the Padlet, this deals with the first learning objective how and why we deliver care? Considering both nationally and locally. Nationally, there are some ideas that we discussed, they are as follows:

• Health and social care policy, we looked at the NHS England (5 years forward view (2014), Delivering the forward view, (2016), NHS Long Term Plan (2019).

Health Education and the Department of Health and Social Care.

• Legislation (Health and social care Act (2014).
• National guidelines / Protocol (NICE).
• Investigatory Report (Darzi Report (2008) and Francis Report (20213)

For the local guidelines/protocols, we discussed the following:

• Trust/employer guidelines.
• CCG guidelines.
• PCN guidelines.

We also discussed the definition of integrated care, this is also known as integrate Health, coordinated care, comprehensive care, seamless care, or transmural care, is a worldwide trend in health care reforms and new organisational arrangements focusing on more co-ordinated and integrated forms of care provision.

According to Health Education England 2019, “It is care that is planned with people who work together to understand the service user and their carer(s), put them in control and coordinates and delivers services to achieve the best outcomes”.

Integrated care is about giving people the support they need, joined up across local councils, the NHS, and other partners.

Integrated care systems (ICSs) is about new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

Amendment to the Health and Social Care Act: the recent amendments to the health and social care act 2008 (regulated Activities) Regulations 2014 require that all those over 18 years of age (who have direct, face to face contact with patient s or service users for the purpose of the provision of a CQC regulation activity), must evidence that they have been vaccinated with a completed course of a medicines and Healthcare products Regulatory Agency (MHRA) approved COVID -19 vaccine, subject to limited exceptions, by no later than 1^st April, 2022.

We discussed about Nurses and Politics – there is a misconception that care, and politics do not mix. I learnt that an essential nursing skill is to understand how national politics impacts on commissioning, care provision and delivery, and evaluation of that services (RCN,2020).

I also learnt that Political advocacy and understanding how health politics can impact on an individual’s care experience is not always seen as part of the nursing role and education is key to enabling this. The nursing profession needs to understand how it can lobby for legislative change, and how embedded legislation can enhance care. (RCN, 2020)

And there are 26 candidates for the general election in 2019 had a nursing background which may suggest nursing adds value to politics. (Mitchell, 2019)

KSBs ADDRESSED.

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

K2: Understand the 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.

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.

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.

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.

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately.

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident, and a major incident.

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations.

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

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

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

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

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

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

SKILLS

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

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

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

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.

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

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

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

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.

INTRODUCTION TO DATA COLLECTION

The lesson started with a recap of the last session, and continued with an introduction of today’s session which is Introduction to Data Collection. We discussed the learning objectives of the session, and they are as follows:

Understand the elements of data collection for both qualitative and quantitative research.

• Become more aware of data collection methods and their pros and cons.
• Explore some common methods of data analysis.

The critical appraisal is about been able to distinguish between opinionated, one-sided arguments or good research on the other.

We also discussed the purpose of data collection, that data is meaningless by itself as it does not explain or change. The aim of gathering and summarising data is to transform this into information in order to:

• Identify variables/ facts.
• Measure variable/phenomena.
• Describe behaviour.
• Obtain evidence.

We discussed the sources of data collection; they are primary sources and secondary sources. With regards primary sources, they are document /record containing first-hand information or original data or topic.

In the secondary source, data already collected by someone else, and which have already been analysed.

The following are the considerations for the selection of data collection methods:

• Nature of phenomenon under study.
• Type of research study.
• Type of research subject.
• Purpose of the research study.
• Size of the study sample
• Distribution of target population
• Time frame of the study.
• Literacy level of subjects.
• Availability of resources and manpower
• Researcher’s knowledge level and competence.

We had a recall of quantitative research and the types of quantitative data collection.  The types of data collection are as follows:

• Surveys/ Questionnaires – (close-ended questions, scales, multiple choice questions, yes/no questions).
• Observations – (this r3equires skills and senses for getting the numerical data).
• Structured interviews – (face-to-face, telephone/ video interviews, (CAPI) Computer-Assisted Personal Interview)..
• Document review – (Public records annual reports, census, and personal documents eg patients notes, registration forms).
• Biophysiological methods in healthcare – (collection of physiological data from subjects to determine the biological and physical status of subjects e.g. BP measurement).

We also had a recall on qualitative research, its types and in assessing the trustworthiness in this type of research method. The trustworthiness deals with the following.

• Credibility
• Dependability.
• Confirmability.
• Transferability.
• Flexibility.

The types of qualitative data collection are as follows:

• Focus groups –(Their aims is to create an open and relaxed environment and to promote interactions between participants).
• Surveys or questionnaires
• Observation
• Case studies and
• Document review.

The qualitative observational methods involve direct, systematic detailed observation and recording of people, their actions, events, behaviours, talk and interaction.

The observational methods attempt to observe things as they are without any intervention or manipulation of the situation itself by the researcher.

KSBs ADDRESSED.

KNOWLEDGE.

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

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

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited.

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.

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.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

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

SKILLS.

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

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

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.

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes.

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

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.

The lesson started with a recap of the previous lesson. The recap was quite helpful because this prepared me for the next session. We briefly discussed the modules outcomes. and focused on the learning objectives.

The lesson was introduced, we discussed the definition of critical thinking in the context of nursing and healthcare.

We also discussed the importance of critical thinking in clinical decision-making and evidence-based practice, and to understand and apply the CRAAP model to research.

Critical thinking can be defined as the objective analysis and evaluation of an issue to form a judgement. In order words it is all about to clarify, identify, analyse, evaluate, and to create.

Critical thinking is important in healthcare for the following reasons:

• To improve clinical decision-making.
• To enable patient safety
• Adopting to evolving healthcare and to
• Promote evidence-based practice.

We discussed some barriers to critical thinking; they are as follows:

• Cognitive bias,
• Emotional influence,
• Time constraints,
• Stress and fatigue,
• Workplace culture,
• Overreliance on authority.

Some examples of critical thinking are:

Medication Administration

Patient Assessment

Prioritisation of Care

Evaluating Evidence-Based Research

Ethical Decision-Making.

A simple critical thinking framework Currency Relevance Authority Accuracy and Purpose (CRAAP)

We discussed some key concept with regards critical thinking in nursing.

• Improve clinical decision-making – evaluating patient data, weighting evidence, and considering.
• Enhancing patient safety – to prevent errors by assessing risks and considering all variables before actions.
• Adapting to evolving healthcare – critical thinking is crucial for integrating new researching, technology, and guidelines.
• Evidence -Based Practice – apply research critically to make informed, patient centred decision.
• Identify and overcoming bias – recognising cognitive biases to improve objective reasoning.

We also discussed the evidence-based decision-making and defined it as an Integrating clinical expertise, patient preferences, and the best available evidence to make informed decisions. We say this is importance because it ensures that clinical decisions are based on high-quality, up to date evidence. We use PICO (Population, Intervention, Comparison, Outcome) framework to structure clinical questions.

We had a scenario where in example: You are caring for a patient with chronic back pain and want to find the best intervention to reduce pain. Physical Therapy Vs Pain Management

PICO Framework:

P (Population): Adult patients with chronic back pain

I (Intervention): Physical therapy

C (Comparison): Pain medication

O (Outcome): Reduction in pain levels.

In evaluating the outcomes of interventions, you asked yourself a question why you evaluate? The answer to this question is to ensure the chosen intervention is effective in improving patient outcomes, and the following methods are used to evaluate the intervention.

• Clinical audits
• Patient feedback and satisfaction surveys
• Monitoring vital signs and recovery rates
• Performance metrics (e.g., reduction in readmission rates)

There are professional barriers or challenges in Evidence Based Practice, they are as follows:

• Time Constraints: this means with limited time to review evidence during clinical shifts.
• Resource Availability: Lack of access to high-quality evidence or clinical tools.
• Ethical Considerations: Balancing patient preferences with evidence-based recommendations.
• Resistance to Change: Overcoming reluctance from colleagues to adopt new, evidence-based practices.
• Patient Preferences and Values: Patients may have preferences that conflict with research evidence, such as choosing alternative therapies over evidence-based treatments.

KSBs ADDRESSED.

KNOWLEDGE

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

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

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited.

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.

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.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

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

SKILLS

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

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

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.

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes.

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

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.

                     LEADERSHIP AND THE NURSING ASSOCIATE  LEARNING LOG   27/09/2024

The lesson started with a recap from the last session and was focussed on the assignment with some queries. Later we looked at the learning outcomes and defined leadership as being a positive role model, with very high good values, being licensed, and it is based on values. 

Leadership can also be defined as an act of leading a group of people. It inspired and guided individuals towards a shared objective. Some examples of leadership qualities are to protect, head, mentor, teach etc. The public perception that impacts individuals is long wait times, poor performance on health at the A&E, Nurses/ Dr strike actions, lack of trust, burnout to name but a few. 

The NHS Constitution states that:

•  The NHS should provide a comprehensive service, available to all.
• Access to the NHS service is based on clinical need, not an individual’s ability to pay.
• The NHS aspires to the highest standard of excellence and professionalism.
• The patient will be at the centre of everything the NHS does.
• The NHS works across organisational boundaries.
• The NHS is committed to provide best values for taxpayers’ money
• They are accountable to the public, communities and patients that they serve.

According to NHS England, 2024, Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish.

There are 5 themes of clinical governance, they are as follows:

• Patient focus – this means focussing on the safety of the patient, by reducing errors and minimising harm. These will be carried out by patient and public involvement (partnership working), risk assessment, safety briefings,and safety toolkits.
• Information focus – information is held lawfully (bridging confidentiality), the principles of General Data Protection Regulation (GDPR) are upheld. These can be done by audits, ensure digital literacy and implement data protection and legislation (mandatory training).
• Quality improvement – this means improving patient experience, improving patient safety, and improving clinical effectiveness. They can be carried out by collecting data from both patient and their family members (feedbacks), questionnaires, patient advice and liaison service (PALS), friends and family test (FFT)
• Staff focus – safe and appropriate recruitment and management of staff, appreciate education and training. They can be carried out by appraisals, performance management, learning opportunities and training, access to resources to undertake roles.
• Leadership – empowering, valuing and supporting staff, by improving patient safety and experiences,  drives the key performance indicators (KPIs). These can be done by open and transparent leadership, appropriate leadership styles and undertake KPIs.

We had an activity in class regarding the definition of a leader, how is the student nursing associate/ nursing associate as a leader.

I thought of being a positive role model, being supportive, sharing experiences of good practice, to protect both the patient and colleagues, to monitor the day to day affairs.

We looked at three attributes of a leader.

• Interpersonal competency(building relationships, clear communication with colleagues).
• Contemporary clinical knowledge  ( keeping on up to date affairs)
• Acting a role model ( be a good example)

We also had an activity  on the padlet that was very educational. Leadership (skills) and management (position)  differences  and the types of leadership theories and styles were also discussed.

We looked at some characteristics of a compassionate leader:

• Emotional intelligence
• Integrity
• Listening
• Trust
• Authenticity
• Openness
• Caring
• Reflectiveness
• Commitment
• Genuineness

And in delivering compassionate leadership always be:

• Attending – actively listen to people.
• Understanding – understand how people feel, give them your time.
• Empathising – being genuine, avoiding sympathy.
• Helping – be solution focused, be practical and give your time.

                                   KSBs ADDRESSED.

                    KNOWLEDGE 

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

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

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

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.

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. 

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. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately.

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations. 

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

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

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

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

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

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

                                                 SKILLS

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

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

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

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.  

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

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

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

                                     BEHAVIOURS

B1: Treat people with dignity, respecting an individual’s diversity, beliefs, culture, needs, values, privacy and preferences. 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice. 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness.

PM SESSION.            20/09/2024

SEARCH STRATEGIES AND HIERARCHIES OF EVIDENCE

We looked at the learning outcomes, the search strategies. We consider key words, synonyms, inclusion and exclusion, criteria, publication date  to name but a few.  For the resources we looked at the : 

• library  catalogue, 
• a book- useful for background check
• Journal articles( most published articles research is found in peer reviewed journals) (key journals cover specific topic reports).
• Government or organisational reports (NHS, King’s Fund).

The database search mainly focuses on searching electronic data to find search papers that can be applied to the practice and used as evidence. 

The database search has 4 steps approach to searching electronic data:

• Key words
• Decide on appropriate databases to search.
• Search using index terms and text searching. Combine search terms and apply appropriate limits.
• Evaluate  and revise the search strategy, follow up results.

We used CINAHL as a demo on a search example. This was quite helpful, though I need more practice for this. 

The consequences of flawed research. A case study on the MMR vaccine controversy. Andrew Wakefield’s 1998 study linking MMR vaccine to Autism. The study design flaws sample size was based on 12 children, no control group, making results unreliable and inconsistent and flawed data collection methods.

The conflicts of interest were funded by lawyers preparing lawsuits against vaccine manufacturers, creating bias.

The ethical violations – unethical procedures on children without proper approval.

The following were the implication of poor research:

• Vaccine Hesitancy – Sparked a global movement of parents refusing the MMR vaccine, leading to disease outbreaks.
• Public Health Impact –  measles and other preventable diseases resurged as vaccination rates dropped.
• Damage to Trust in Science – eroded public trust in vaccines and scientific research. Misinformation continues to spread, influencing public health.

                                            KSBs ADDRESSED.

                                     KNOWLEDGE

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

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

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour. 

K8: Understand how discriminatory behaviour is exhibited .

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. 

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. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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

                                       SKILLS

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

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

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. 

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes. 

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

                                                    BEHAVIOURS

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness

LEARNING LOG FOR EVIDENCE BASED PRACTICE                        20/09/2024

INTRODUCTION TO RESEARCH METHODS AND METHODOLOGIES.

The lesson started with  a recap of the last lesson. We looked at the meaning of evidenced based practice deals with a clinical expert, patients values and it is the best evidenced based practice (random ice control trial). We also briefly discussed the importance of evidence based practice, the barriers to implementing EBP for nurses, and so on. 

We continued with the lesson for the day by going through the learning outcomes and we are focusing on the these two listed below:

•  Demonstrate an understanding of strengths and weaknesses of different forms of evidence for use in health and social care research and service evaluation.
• Analyse professional issues that arise when implementing evidence-based practice to enhance the quality of care.

We defined research methodology as the method used in conducting research.( surveys, interviews, experiments).

Research methodology is the process of using specific techniques to identify, select, process, and analyse information about research topics.( quantitative or qualitative approach). 

Quantitative – deals with quantity that is numbers and it focuses on quantity- counting things, measuring things, analysing numerical data etc.

Qualitative – deals with quality that is words and it all about understanding the quality of experiences or phenomena – words , interviews, observations, and narratives.

The systematic review deals with a thorough review of all available research on a specific topic, using the structured methods to assess the quality and findings of each study. 

An example of systematic reviews is assessing the impact of physical activity, interventions on preventing type 2 diabetes in a high risk population.

The method- comprehensive database search, critical appraisal of studies, synthesis of findings.

We had a group activity in class to describe the object quantitatively and qualitatively. My group was to describe a book. As a group we did the research both quantitatively and qualitatively and present the findings in class and the findings are as follows:

For quantitatively:

• The pages of the book are 261.
• The weight is 337 cm
• Length is 30cm
• Width is 19cm
• Breath is 4.5 cm
• Cost is £9.99

For qualitatively:

• The book is of facts of mind
• Name of the author
• The book is colourful, eye-catching and has nice content.
• Motivational pictures
• potable.

The research methodology tree was discussed, I learnt about the it is divided into four groups and they are follows:

• The methods – this deals with how data are exactly collected.
• The methodology – deals with the best way we should be collecting data.
• Epistemology – this deals with how we should investigate  the world.
• Ontology – this deals with how we view the world.

We discussed the common research methodologies in Healthcare and as follows:

• Phenomenology focuses on lived experiences eg, understanding the patient experiences with chronic illness.
• Ethnography these are studies of cultures and communities e.g. understand how a healthcare practice works within a group.
• Randomised controlled trials (RCT) Test the effectiveness of intervention by random assigning participant in the groups( testing new medication)
• Cohort studies follow a group over time to observe outcomes ( studying long term effects of healthcare, smoking effects).

In making sense of literature, the following needs to be considered:

• A literature review is the comprehensive study and interpretation of literature that relates to a particular topic.
• When undertaking a literature review, you identify a research question then seek to answer this by searching for analysing the relevant literature.
• Primary research articles are generally the main focus of literature reviews.
• It is important to consider carefully what types of evidence are relevant to the reviewed question.

The key point for evaluating literature are briefly discussed below:

• The generation of themes cannot be objective, this is because it depends on the experience and the insight of the researcher.
• This means that the researcher must take steps to ensure their credibility and their trustworthiness.
• The results of qualitative research cannot be generalised, but rather give deeper understanding to a topic.
• Sample sizes are small and there is not the emphasis on random sampling as there is within quantitative research.

We looked at research road map, and the following steps: 

• We start by generating research ideas, the things we need to improve.
• Conducting a literature review by looking at a piece of literature( a piece of research).
• Refine research question.
• Plan research questions.
• Create research proposal 
• Develop a study budget and apply for funding
• Obtain research ethics and operational approval.
• Regulatory task (legal requirement are met)
• Conduct study and collect data.
• Analyse data and disseminate  knowledge
• Study closure and achieving and publishing.

                                      KSBs ADDRESSED.

                          KNOWLEDGE.

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

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

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour. 

K8: Understand how discriminatory behaviour is exhibited .

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. 

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. 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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

                                      SKILLS

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

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

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. 

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes. 

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

                                                    BEHAVIOURS

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness

LEARNING LOG        09/08/2024

The lesson started with an introduction of the module, the module learning outcomes, and the learning outcomes. We had some ice breaker on menti-meter that was very educational and I learnt from those questions and did some group activity. 

We looked at improving safety and quality of care.

Safety is the evidence of harm to patients during the provision of care. 

Quality – standardise care, holistic care , patient- centred care, timely, efficient.

Evidence based-practice in nursing – holistic quality care base in the best most to date research and knowledge rather than traditional method.

For improving safety and quality of care, the following is considered:

• Influences on safety and quality of care.
• Service evaluation and improvement methodologies.
• Audit 
• Service user and carer involvement.

Key – components of safety and quality in nursing are as follows:

• Evidence based practice (EBP).
• Patient centred care.
• Effective communication.
• Interprofessional collaboration.
• Continuous quality improvement (QI).

With regards to change in healthcare, according to (Goldratte, 1990, p.10), “ not every change is an improvement but every improvement  is a change and we cannot improve something unless we change it”.

There are different ways we can choose to improve our services, or innovations. The following are the ways we can improve these services:

• Personal experience( -ve or +ve experiences that need to be changed).
• Personal interest(enthusiastic/ passionate about something)
• Curiosity about something in the media.
• State of practice in a particular area.
• Solving a problem.
• Hot topics under discussion (patient voice/ involving patient in improving care).
• Personal values.
• Gaps in practice (discrepancy in practice)
• Healthcare policy (things beyond your control)
• epidemical/ demographic /other data(type 2 diabetics, causes of it).

The reasons for changes in healthcare are as follows:

• To improve the quality of care.
• The effectiveness of care / treatment/ processes.
• Patient outcomes.
• Patient health and well-being.
• Efficiency of services /treatment.
• Patient safety.
• Reduced hospital admission /A&E.
• Reduced cost /errors.

We were divided into groups for class group work, with different questions. I was in the third group with the question as follows? How can we reduce patient waiting times  in the GP practice? We discussed as a group and concluded with these answers and they are as follows:

• To organise and prioritise appointments, who urgently need care.
• Answering questionnaires.
• Offering phone appointments for non-urgent care.
• Ensure staff are aware of the delays and enable them to adjust as needed.
• If you need urgent care, advise alternative help such as 111 or A&E.
• Doctors to cover any sickness or support on busy days.
• Update or remind patients of their appointments to ensure they still need the appointments and attend on time to prevent delays.

                         KSBs ADDRESSED.

                                                KNOWLEDGE

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

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

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited. 

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.

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.

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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

                                                SKILLS 

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

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

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.

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes.

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

                                          BEHAVIOURS

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness

LEARNING LOG                             06/09/2024

BOWEL MANAGEMENT

BOWEL PREP AND STOMA CARE. 

The lesson started with an introduction of bowel management and the learning outcomes, emphasis from the learning outcome were placed on the knowledge of prescribed laxatives, different types of laxatives, their mode of action, precautions and rationale for the use.

We described constipation as follows: 

• A common condition that occurs when it’s difficult or infrequent to pass stool.
• When stool is not passed at least more than three times per week, or going less than normal.
• Stools are unusually large or small and hard or lumpy.
• Needing to strain to pass stool.
• Not feeling as though the bowels are fully emptied.

In considering the administration of laxatives, check if the patient has any of the following:

• Have bowel conditions
• Have a colostomy or ileostomy
• Have heart condition, such as heart failure
• Pregnant or breastfeeding
• Have an obstruction somewhere in your digestive system
• Have difficulty swallowing(dysphagia)
• Have a lactose intolerance, as some laxatives contain lactose
• Taking opioid painkillers, such as codeine or morphine (NHS, 2022).

We looked at some common laxatives (oral):

• Bulk forming  – this helps stimulate the movement of bowels( fybogel, normacol, celevoc) normally takes 2-3 day to be effective.
• Stimulant – this stimulates the gut muscle helps movement down the digestive tract( senna, bisacodyl) normally takes 6 – 12 hours to be effective.
• Osmotic – draws water from the circulation to the bowel to make it easier to pass.(lactose, movicol, idrolax, macrogol) normally takes 2-3 days to be effective.
• Stool softeners – helps to soften stool by absorbing the water.(docusate sodium, arachis oil) normally takes 1 – 2 days to be effective.

Another set of laxatives (rectal) NICE guidelines, 2024.

• Glycerol (suppositories) – this hardens or softens stools. It acts as a stimulant . Effective 15 – 30 minutes.
• Bisacody (suppositories)l – this does not soften effectively. Effective 15 – 30 minutes
• Sodium phosphate (suppositories) – effervescent action. Effective 30 minutes.
• Docusate sodium (enema) –  softener and weaker stimulant, for hard or soft stools. – Effective 15 – 30 minutes.
• Sodium Citrate (enema) –  smaller volume than phosphate enema, for hard or impacted stools. Caution in risk of water retention patients. Effective 5 – 15 minutes
• Phosphate enema – this is for hard, impacted stool and is occasionally used. Effective 2- 5 minutes.
• Arachis oil – hard impacted stools. Not to be used for patients with peanut allergies.

Before administering laxatives, know your patients as to what works for them. Always start with the bulk-forming laxatives.

The following are the two types of bowel conditions: 

• Inflammatory bowel disease (IBD) – this refers to a chronic and recurrent digestive condition caused by an autoimmune response in the person.  They are further divided to the following:

• Crohn’s disease – this affects any part of the digestive tract from mouth to anus.
• Ulcerative colitis – this affect the lining of the large intestine(colon)

• Irritable bowel syndrome  (IBS) – this affects the digestive system. The cause is unknown, but it can be linked to stress and family history.

We also discussed stoma and the types of stoma. We defined stoma is a surgically created opening in the abdomen that connects the digestive or urinary system to the outside of the body.

Or defined as the opening on the abdomen that connects to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of the body.

The types of stoma are as follows:

• Colostomy – this affects the colon.
• Ileostomy – this affects the small bowel.
• Urostomy – a bladder bypassed
• Nephrostomy – affects the kidneys.

The different types of stoma products were discussed in class.

The spinal cord injury / neurogenic bowel were also discussed, they are as follows:

• The nervous system remains intact.
• Peristalsis continues but is less effective and transit time to the colon is longer.
• Increased likelihood of constipation.
• Descending input from the brain to colon and rectum may be loss of sensation of the need to open bowels, loss of voluntary control of sphincter muscle and loss of the brain’s influence over the reflex activity.

Bladder and catheter care was another part of the lesson. There are three types of urinary catheter and they are as follows:

• Indwelling catheter.
• Intermittent catheter
• External catheter – convene.

HOUDINI an acronym is a criteria to guide the daily review of continuing urinary catheter indication – facilitating timely removal of the urinary catheter as soon as it is no longer required.

Base on the acronym, it represent the following:

• H – Haematuria.
• O – Obstruction
• U – Urological/ major pelvic/prolong
• D – Decubitus ulcer 
• I – input/output
• N – Nursing (end of life)
• I – immobilisation.

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

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health. 

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

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care. 

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

K7: Understand the importance of courage and transparency and apply the Duty of Candour. 

K8: Understand how discriminatory behaviour is exhibited. 

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

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

K11: Understand the factors that may lead to inequalities in health outcomes. 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being. 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care. 

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

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care. 

K19: Know how and when to escalate to the appropriate professional for expert help and advice. 

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

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care. 

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

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

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life. 

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

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies. 

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

K29: Understand the different ways by which medicines can be prescribed.

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations .

K35: Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident. 

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

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs. 

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

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

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

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

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

                                                         SKILLS 

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

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

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

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

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

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

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

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

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

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

S11: Report any situations, behaviours or errors that could result in poor care outcomes. 

S12: Challenge or report discriminatory behaviour. 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people. 

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

S15: Identify people who are eligible for health screening. 

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity. 

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

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions. 

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent. 

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk. 

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes. 

S22: Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that concerns are escalated.

S23: Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate. 

S24: Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care. 

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

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health. 

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

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain. 

S29: Give information and support to people who are dying, their families and the bereaved and provide care to the deceased. 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed. 

S31: Act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health. 

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams. 

S33: Maintain safe work and care environments. 

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required. 

S35: Accurately undertake risk assessments, using contemporary assessment tools. 

S36: Respond to and escalate potential hazards that may affect the safety of people. 

S37: Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies. 

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

S39: Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately. 

S40: Support and motivate other members of the care team and interact confidently with them.

S41: Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others.

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promote reflection and provide constructive feedback. 

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

                                                    BEHAVIOURS

B1: Treat people with dignity, respecting an individual’s diversity, beliefs, culture, needs, values, privacy and preferences. 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice. 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness.

                                                                                                                         AM SESSION       LEARNING LOG           06/09/24 .

PROVIDING AND MONITORING CARE.      

The session started with an introduction of the module, the learning outcomes and we had described collaborative working as working together with the MD,  family including the patient himself.

Partnership is working with other entities with the aim of meeting the same goal of the patient.

We had a recap on Patient centred care as treating a person as a whole(holistic care)  not the diagnosis, their preferences, goals and individually.

The biopsychosocial model is dealing with the biological, social and psychosocial aspect of an individual.

• For biological, genetics, medication, psychosocial and neurochemical.
• For social, family, peer relationship, culture and socio-economic.
• Psychosocial, emotions and attitudes, learning,  beliefs and stress management.

All the above is focused on the health of the individual.

I learned that in supporting an individual shared decision should be included, that is the patient himself should be involved in his or her care. (as there is ‘no decision about me without me’).

Partnership working deals with 

• communities at the centre of health and social care.
• Care for people’s values and voices.
• Health and social care organisations.
• Valuing and actioning upon experiences and feedback from communities.

The following are some of the principles of partnership working:

• The centre decision making and governance around the voices of people and communities.
• Involve people and communities at every stage and feed back to them about how it has influenced activities and decisions.
• Understand your community’s needs, experiences, ideas and aspirations for health and care, using engagement to find out if change is working.
• Build relationships based on trust, especially with marginalised groups and those affected by health inequalities.
• Work with healthwatch and the voluntary, community and social enterprise sector.
• Have a range of ways for people and communities to take part in health and care services.
• Tackle system priorities and service reconfiguration in partnership with people and communities.
• Learn from what works and build on the assets of all health and care partners – networks, relationships and activity in local relationships and activity in places.

A typical example of partnership working. 

It starts with the patients as they are the centre of all our care, information will be shared about proposed changes, with this people will understand what they mean.

Consulting – as people for their opinion, for one or more ideas or opinions.

Engage – listening to people to understand the issues and discuss ideas for change.

Co – design – designing with people and incorporating their ideas into the final approach.

Co-production- an equal partnership where people lived and learnt experience work together from start to finish.

With regards to professional values, these are important to us for self and others. (treat people as you wish to be treated).

There was a group activity that was very fruitful for me and I learnt alot from it. The activity is based on a decision. My own part of the question is “ how will you facilitate shared decision making”. I suggested the following, According to Nice guidelines, 2021. Decision making is a cognitive process resulting in the actions among several possible alternative option.  In facilitating decision making the following were discussed:

• Bring a diverse group together ( the requires organisational leadership and planning as well as practising skills)
• Collect opinions independently ( collaborative relationship between patients and healthcare professionals).
• Provide safe space to speak up( allow the patient to give his or her own  opinion as they are the centre of it all).
• Don’t  over-rely on experts( discuss risk, benefits and consequences of different options in the context of the person’s life and values.
• Share collective responsibility for the outcomes( be aware that different people interpret terms such as ‘risk’ ‘rare’ ‘unusual’ and ‘common’ in different ways).
• Use patient decision aids( patients aids as part of a toolkit to support shared decision making).

                                                              KSBs ADDRESSED.

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

K2: Understand the 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. 

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. 

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. 

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. 

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately. 

K32: Understand what constitutes a near miss, a serious adverse event, a critical incident and a major incident. 

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes. 

K34: Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations.  

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

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

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

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

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

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

                                                      SKILLS

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

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

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

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. 

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

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

                                                             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

Decision making writing exams