Student reflection on an episode of care
Within your reflection, describe the episode of care and how you planned and supervised the junior learner/peer in practice who delivered person-centred care.
I am on placement in a care home. There are no other students on the unit and I have discussed with my assessor the possibility of teaching a healthcare assistant and it was agreed with him to teach a healthcare assistant about oral care. Oral care is part of general health but often overlooked in hospitals and care home (BJN,2023, HEE,2018). I have noticed when checking healthcare’s care notes that sometimes, there was no mention about oral care being given. It was an opportunity to stress why it was crucial to assist residents in looking after their mouth and ensuring that those self-caring residents were brushing with the appropriate tooth brush and using the correct technic for optimal result. I first talked to the healthcare assistant who’s care note needed improvement and we agreed that the learning session was needed and would take place the following day.
The plan was to make a power point presentation and then supervise the healthcare assistant during oral care. The learning objectives were for the healthcare assistant to gain an increased knowledge and understanding of the importance of mouthcare, how to assess the mouth, how to perform mouthcare effectively and how to record the care provided. The mouthcare teaching was focused on elderly considering the nature of the placement. The power point was made using information gathered from British Geriatric Society (BGS), British Journal of Nursing (BJN), Health Education England (HEE), National Institute for Care and Excellence (NICE) and Public Health England (PHE) on delivering better oral health toolkit to offer an evidence-based information. The power point was predominantly made of pictures to capture his attention.
When I met with the HCA, I first wanted to check his knowledge about the subject to ensure I fill the gap by covering more on missing information. We discussed at length on the importance of the oral health, especially for most of care home resident who require assistance to meet their care needs. Using a mouth assessment tool, I explained how to assess the mouth and how to escalate if there was any cause of concern to avoid a minor issue becoming a major problem
I also cover how to encourage self-caring resident in looking after their oral health by prompting them to brush their teeth and supervising them to ensure there were doing it effectively. I used a Utube video to showcase the actual steps to be taken for the actual oral care and the recording of the care provided. We talked about our legal obligation to respect resident’s autonomy which require to obtain consent for every care to be provided.
One of a resident requiring assistance for oral care was identified and on our following shift, I supervise him performing the activity and recording on the appropriate sheet. Afterward, his feedback was that he found our discussion helpful and that it had helped him developpe his knowledge and understanding of oral care and that he will do his best to ensure the residents were routinely receiving oral care. That day, one HCA did not turn up and I was asked to help by joining the HCA team. While I was upset at first as it was taking me away from what was planned and aligned with my learning objectives, it turned out to be an opportunity to reinforce my teaching about the fact that we must always be respectful and compassionate towards residents in all aspects of care
References:
BJN (2023) Mouthcare: Why it matters-highlighting a neglected care need. Available at: https://www.britishjournalofnursing.com/content/oral-care/mouth-care-why-it-matters-highlighting-a-neglected-care-need
BGS. (2017) Improving dental health is essential to improving overall health. Available at: https://www.bgs.org.uk/resources/improving-oral-health-in-older-
HEE (2019) Mouthcare Matters-Improving oral health. Available at: https://mouthcarematters.hee.nhs.uk/2019/10/24/new-video-launched-supporting-patients-who-are-resistant-to-mouth-care/index.html
NICE (2016) Oral health for adults in care homes. Available at: https://www.nice.org.uk/guidance/ng48
PHE (2014) Delivering better oral health: an evidence-based toolkit for prevention. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention
WHO (2022) Global oral health status report: Towards universal health coverage for oral health by 2030. Available at: https://iris.who.int/bitstream/handle/.
What did you do well?
I researched the subject to get up to date information and evidence-based advice from reliable sources such as NICE, BGS, PHE and I used Video to support the teaching. This was useful in keeping the HCA’s attention. Before I start the teaching, I asked the HCA questions to check what he already knew about the subject, this allowed me to focus on filling information and discussing what he knew already. I was pleased how the information was conveyed as I managed to keep the HCA engaged. It was more a discussion than a lecture and the feedback received at the end was encouraging. Also, as I worked with him due to staff shortage, I had the opportunity to reinforce my message about the importance of providing a care that is respectful and compassionate. For example, by knocking the door and waiting for a response to show respect to resident and make them feel valued. Taking the time to explain to resident what is going to happen and talking through whatever we are doing.
What would you have done differently?
With the benefit of hindsight, I think the timing could have been better. The teaching took place shortly before resident’s diner time and I had to change my initial plan as I realised we will not be able to do the practical oral care that evening. The supervision was therefore rescheduled on our following shift together.
Describe how you have begun to work more independently in the provision of care and the decision making process.
I started working independently in the provision of care and decision making by assessing care needs and participating in care plan. I also regularly reviewed those care plans to ensure the care provided was still meeting resident’s needs. On drug round, I prioritised resident on time sensitives drugs such as one resident on Parkinson medication. I also know that some resident like to receive their medication earlier. Those also are on my priority list. There is also a particular resident who can be grumpy I before breakfast. I ensure that he get his breakfast before I offer his morning medication.
Regarding drug round. After I noticed that some supplemented were given at the same time as diner and that they were not drunk, I suggested that it could benefit resident if those supplements were offered at tea time. My assessor supported my idea
What learning from this episode of care will support your professional development going forward in your teaching and learning role?
I found that while researching to prepare my material, I was learning at the same time. I had to ensure I was confident with my knowledge before sitting with the HCA as I was nervous about not being able to respond to questions if they came up. Hence, I spent enough time researching. My worry was looking stupid if I did not have answers or could not provide adequate explanation if asked to clarify a topic. Fortunately, it went well and I felt at ease during our discussion. I learned new tips in the process on how to support service users who are resistant to mouth care.
Going forward, I will prepare a feedback form so that I can improve my teaching. Planning is of essence. In retrospect, the timing of the teaching and supervision could have been better to coincide with morning care for example.