During this day, under nurse supervision I was looking after a patient with a chest infection. The patient was on hourly observations due to being on oxygen. Closely monitoring the patient when not present in the room by watching on the monitor the sats went down to 78%. As I already knew this patient I went into the room and helped mum to reposition her. This still had little effect so I informed the nurse I was shadowing. She put the face mask onto 4l and showed me how to complete chest physio.

We called physio for a review who did suctioning for the patient. After continuously triturating Oxygen up and down I was constantly asking my nurse questions when unsure and informing her of all observations taken.

What did you do well?

Respond quickly. Kept a close eye on observations. Learnt how to do chest physio.

What would you have done differently?

Turned up to 15l in an emergency situations wasnt sure if i was allowed.

Within your reflection, describe the episode of care and how you assessed, delivered and evaluated care.

During my first day, i was asked to help with personal care for a patient. As i have been away for ages i froze but it all soon came back to me. We grabbed all the linen we needed such as- bed sheets, blankets, incontinence sheets, pillow covers, nappies and wipes. In this personal hygiene episode of care i learnt that when removing metanium(nappy cream) to use olive oil and water. We made a plan as a team that we couldn’t do it with just three of us as the patient is restricted due to disability . So we decided to grab another member of staff. Gaining consent and making sure dignity was met.

As we removed the patients vest we decided to roll it up over the head as it was covered in faeces. Then we gave the patient a wash and make them more comfortable. We explained throughout what steps we were doing. Mum was in the room to start with and was happy to give consent as the child is non-verbal. However, mum left as we needed more nappies as we were running low. Once we finished washing and drying the patient we then added more metanium to the saccrum as this patient is suffering with nappy rash. We then redressed the patient with a vest being careful to quickly disconnect and reconnect the oxygen and peg feed. I was worried as i had never done this before but did it quickly.

During this change we checked the skins integrity due to the patient being bed bound. The patient kept sliding down the bed due to disability and problems with the spine. We then decided to use a slide sheet under incontinence sheets, to get the patient back up the bed as their feet were touching the end of the bed. When the position was good we made a v-shape with pillows and tucked one under the right arm as thats the side the patient slants.

What did you do well?

Team work and good communication throughout.

Learnt about metanium and how it can cause burns if its not removed properly.

Asked consent from parent.

Got everything we needed before hand.

Consent and dignity was met.

Worked well with two practice educators and another student.

Used the correct bags to dispose of linen that was soiled.

What would you have done differently?

Learned more about the patient before i walk into the room.

Learn more about removing peg and oxygen and putting back on quickly and efficiently.

Maybe look into moving and handling with restrictions due to disabilities and spine issues.

Less time as it took at least 30 minutes with four of us.

Episode of Care – Formative

Within your reflection, describe the episode of care and how you assessed, delivered, and evaluated care.

When learning how to help someone with person care with support due to having medical conditions I have discovered it’s not just about washing a patient. It is about making the comfortable and giving them company and someone to talk to. I think you must understand this isn’t nice for some patients as they want to be independent and not rely on others, so they need reassurance and understanding.

We started off by closing the curtains around the bed to ensure privacy and dignity was met as well as keeping a towel over the patient’s genitals when washing.

When we washed this patient, they were non-verbal which means they communicate by blinking in this instance or looking away. So, whilst me and the healthcare assistant were changing and washing, we told the patient exactly what we were going to do and talk throughout. If you wait you will get a reply or a facial gesture which I think is important to make them, feel empowered. Talking throughout our changing and washing is ensuring this is patient-centred care. We made sure the temperature of the water was not too cold or hot to make them comfortable. During the wash and changing we checked the pressure areas and making sure the skin was intact so we could report our findings to the nurse that oversaw this bay. This patient had bed sores on the sacrum area, so barrier cream was applied.

 When we changed the bedding, we removed the old ones and put them in the correct bag and disposed of correctly. Then the water we used because it contained bodily fluids, we took this to the sluice room and disposed of this also.

After we had finished the bed was still laid flat as this is key when changing a patient, using the beds electrical system we made sure the patient was sat up and made comfortable. For this specific patient they lean to one side so pillows are put in a cross position to prevent them sliding down the bed. Then we put the patients pressure sore shoes back on they are to keep the pressure from the heels. Adding lip cream to the patient as their lips were very dry this may be because they are peg fed through the stomach.

After we had finished, we asked the patient if they were comfortable.

What did you do well?

Temperature was good for the patient.

We completed a wash and change.

Always communicated between us and the patient and me and the healthcare assistant.

Checked pressure sore areas and skin was intact.

Privacy and dignity were met.

What would you have done differently.

I would have looked into the patient’s condition further to know if there was anything we could of done differently when moving the patient during the wash and changing.

I would like to know how to wash round a peg feed and what precautions to take.

Work with a learning disability nurse to learn more about communication with non-verbal patients.

Episode of Care – Summative
Within your reflection, describe the episode of care and how you assessed, delivered, and evaluated care.

In my placement I have been asked by the staff to take daily observations. This is important to manage a patient’s well-being and knowing if it Is needed to escalate. On one of the observations/vital signs I took a patient’s oxygen saturation which was 82% which was in range for a patient who has copd. However, I noticed her breathing was very shallow. I decided to escalate and ask a member of staff to come and check my findings.

What did you do well?

Escalate quickly.

Knowing that this wasn’t the ‘norm’.

Good communication with other staff members

What would you have done differently.

Maybe try to get the patient to change position and if they can’t do this themselves due to medical condition give them support. In this case the patient wasn’t talking and very sleepy even on oxygen 2l.