LEARNING LOG                              03/05/2024

 

     VENEPUNCTURE

The lesson started with an introduction of the topic for the session. We looked at the aims and objectives of the module. We defined some key words 

– venepuncture as a procedure of entering a vein with a needle. 

– Phlebotomy is the incision of a vein for letting out of blood, the key principles of phlebotomy are legal and professional considerations, anatomy and physiology, infection control, products and documentation, procedural issues, site care and maintenance, and the risk management.

 

We defined accountability as to give an account or measure, explain, justify, and define in some way the results of decisions-making.  Being legally responsible for each and every clinical action undertaken or omitted.

Vicarious liability – if an employee commits an acts or omission, resulting in harm, while acting i the course of their employment, the employer can be held responsible to be vicariously liable for any resulting claim, even potentially if the staff carry out an act which was expressly forbidden , or omission represented a failure to follow reasonable instructions given. However, not all employers pay for insurance for vicarious liability for all staff.

 

I learnt that for a healthcare professional to retain the protection of vicarious liability, the healthcare professional should always ensure to practise within the hospital/trust policy and procedures.

 

Verbal consent is considered adequate for procedures with low level of risk. Consent is only valid if it is given voluntarily and accompanied by adequate explanation.( reason for the venepuncture, associated risks and duration of cannulation, if applicable).

 

We looked at the anatomy and physiology of the upper limb veins.

The blood vessels: veins, arteries, and capillaries are closed tubes which carry blood around the body. Only capillaries allow exchange of contents. Arteries  carry blood away from the heart. Veins return the blood to the heart .

 

There are 3 layers of the blood vessels:

• Outer layer: tunica adventitia (fibrous/connective)
• Middle : tunica media (smooth muscle)
• Inner: tunica intima (smooth epithelial cells)

 

The arteries carry blood that are under high pressure, therefore:

• Tougher serosa (more muscle)
• Stretch and rebound with each heartbeat ( a pulse)
• Narrow lumen
• Lie deeper than corresponding veins 
• Contain about 10% of blood volume
• Carry oxygenated blood away from the heart.

 

The veins and venules. Capillaries converge to form tiny venules and then veins carry blood towards the heart. 

Blood pressure drops in the capillary beds so blood passing through the venous system does not so under low pressure.

Venous walls are thinner than arterial walls ( if the vein is cut, it will collapse whereas an artery will stay open) thin walls enable it to stretch and hold a large amount of blood. Venous system  holds about ⅔  of the body’s blood- a useful reserve in the event of blood loss.

 

Valves are formed by folds of the tunica intima.

Cusps are semilunar (half moon)shapes.

Valves have concavity towards the heart.

 

The veins of the upper limbs, for phlebotomy in adults, the veins in the antecubital  fossa are the first choice because:

• Easy to access
• Not an especially sensitive part of the body
• Veins are large and well supported.

I learnt about the equipment for the procedure of taking bloods. The equipment should be single use and sterile:

• Sharpe bin
• Tourniquets
• Gloves
• Vacontainers for phlebotomy
• Blood bottles (colour coded)
• Clean dressing 
• Single use tray
• Needles
• Wipes
• Plaster

 

Site preparation – always ensure you follow the local policy. For phlebotomy, skin should be cleaned with 2% chlorhexidine in 70% alcohol swabs for a minimum of 30 seconds and left to dry. Do not re-palpate skin after cleaning.  

 

                                                 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.

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.

 

                                         

                                               END OF LIFE CARE.      

Lesson started with the learning outcomes, whose mean aim is:  

•  To understand the concept of End-of-Life Care in the context of the dying adult person in their last days of life.  

• To gain awareness of management of symptoms: how to manage common symptoms without causing unacceptable side effects. To maintain hydration in the last. 

• To gain knowledge of the nurses’ role within the individualised person-centred care 

• To gain an overview understanding of Advance Care Planning. 

Having gone through the learning outcomes, we the class shared the understanding of end of care. This simply means according to my perspective, support given to a dying individual by making him/her comfortable, supporting with care, respect, dignity, and love, above all fulfilling his/her last wish. The recommendations apply to all people at the end of life, whether they are conscious or unconscious. The main aim is to improve end of life care for people in their last days of life. 

End of life care is a multi-professional clinic team approach requiring judgement for when a person is likely to die. (Usually within a few 2-3 days of death). 

Having a good death depends on:  

• The way in which people die and how long this takes varies widely, because of: 

.  The underlying diseases responsible but also the  

. Person’s robustness or frailty, and their social setting. 

• Some continue to be mobile and largely self-caring, continue with oral intake (medication until death) 

• Others may die suddenly and unexpectedly after a significant trauma or catastrophic medical event (gastric bleed). 

• Some may not experience any of the symptoms 

• Some experience a gradual decline. (Principle of communication, shared decision-making and pharmacological care can be applied far earlier in their care).                      

• Others have progressive disease. (Cardiac, pulmonary/neurological disorders, dementia to name but a few.) 

In recognising when a person is entering the last days, for some people who are in their last days of life, mental capacity to understand and engage in shared decision-making may be limited. This could be temporary or fluctuating, e.g. caused by: 

• Delirium its associated with an infection or a biochemical imbalance such as dehydration or organ failure. 

• Permanent loss of capacity from dementia or other similar irreversible conditions. 

For healthcare professionals, should be able to: 

• Recognise when a person is entering the last days of life or may have stabilised or be improving temporarily. 

• To communicate and shared decisions respectfully with the dying person and people important to them. 

• Healthcare professionals must be able to recognise when a person may be entering the last days of their life, or if they may be deterioration, stabilising or improving even temporarily. 

• If it is thought that a person may be entering the last days of life, gather and document information on: 

 

~  the person’s physiological (pain, fatigue), psychological (their wishes), social  

(With families, homeless), and spiritual (religious, cultural) needs. 

~ current clinical signs and symptoms (their clinical observations). 

~ the person’s goals and wishes. 

 

The following signs and symptoms of deterioration: 

• Agitation 

• Cheyne -strokes breathing. (Gasping between breath. 

• Deterioration in level of consciousness (unconscious). 

• Mottled skin 

• Noisy respiratory secretions  

• Progressive weight loss 

• Increasing fatigue and loss of appetite. 

The following information should be provided: 

• Accurate information about their prognosis (unless do not wish to be informed). 

• Any uncertainty. 

• An opportunity to talk about any fears and anxieties, and to ask questions about their care in the last days of life. 

• Avoid false but optimisms. 

• Information about how to contact members of their care team 

The role of the nurse, the delivery of meals, equipment, care at night, volunteer support or assistance from an organisation and their availability. There is a clear individual nursing care plan that includes:   the dying person, personal goals and wishes, preferred care setting, current and anticipated care needs, preferences for symptom management, needs for care after death, resource needs. These individualised care plan discussions and decisions should be clearly recorded, continually updated as situation may change as condition deteriorates or as they accept their prognosis. 

In providing individualised approach to anticipatory medicines for people who are likely to need symptom control in the last days of life. Specify the indications for use and the dosage of any medicines prescribed. 

Assess what medicine the person might need to manage symptoms likely to occur during their last days of life. (Agitation, breathlessness, nausea and vomiting, noisy respiration to name a few). 

Discuss any prescribing needs with the dying person, those important to them and multi-professional team. 

Always ensure that suitable anticipatory medicines and routes are prescribed as early as possible. These should be reviewed as the dying person needs change. 

Before these anticipatory medicines are administered, review the dying person’s individual symptoms, and adjust the individualised care plan and prescriptions as necessary. 

Advance care planning (ACP) is the term used to describe the conversation between people, their families, and carers, and those looking after them about their future wishes and priorities for care. 

There are policies to ensure that ACP is offered to adults who are approaching the end of their life. Policy should consider under-served and vulnerable groups. 

Patient should be supported with ACP if the person approaching the end of life agrees. 

Patient should be considered if there is lack of capacity to make decisions in line with the Mental Capacity Act 2005.  

Do not attempt cardiopulmonary resuscitation (DNACRR) decisions. 

                                                                                                                       KSB    ADDRESSED  

                                                                                              KNOWLEDGE

 

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

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

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

K8: Understand how discriminatory behaviour is exhibited. 

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

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

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

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

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes. 

K14: Understand the importance of health screening.  

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

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomic. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

                                                                                                             SKILLS  

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

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

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

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

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

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

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

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

 

 

                                                                                                            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.