During my first week of placement, I worked alongside the staff team to provide nursing care to patients. Some of the conditions the patients suffered from were lymphoedema, oesophageal cancer, kidney failure (CKD3), asthma, and seizures. At the start of the shift, I assisted in carrying out safety checks, such as oxygen and suction flow, and equipment used in emergencies, such as non-breathable masks, yankauer tube masks, and nasal cannula. These are used in emergencies to preserve and save lives. I assisted in providing personal care to a patient, I used this opportunity to assess the patient’s skin condition. In the ward, some patient assessments are done daily, such as water-low, fluid input/output, MUST and the nursing note.
I also assisted some of the patients with their feeding, The nurse in charge advised me that patient weight is checked once a week, and for patients 65 years of age and over, their lying/sitting and standing blood pressure will be checked. This is because the ward is haematologyy and oncology, and patients can deteriorate easily.
Also, I participated in medication administration, where I had the opportunity to learn some of the commonly used medications, such as Pantoprazole (reduced stomach acid), theophylline (bronchodilator), and tranexamic (control bleeding/help blood clot). For some medications that I don’t know or have forgotten what they do, I would use Medusa to check, and it is used by NHS staff.
Overall, I understanding of how the shift starts, the importance of taking handover and checking the patient. Safety checks are important, as in emergencies staff need to act fast. Involvement in the administration of medication has improved my knowledge of commonly used medication, and my awareness of 6R. It is essential to follow the ward and NHS policy when providing nursing and ensure that the care provided is evidence-based.
During my second week of placement, I went on outreach with a diabetes specialist nurse (DSN). During the outreach, I observed the DSN have conversations both over the phone and face-to-face with patients regarding their diabetes treatment and management. The conversation involves history taking and asking about current health conditions and treatment options. Some of the key questions the DSN asked the patients were, how often do you check blood glucose level? What is the lowest and highest blood glucose checked, Do you check before a meal or after the meal?. Also ask the patient if they understand the difference between hypoglycemia and hyperglycemia and know what to do in each case. In this case, some patients know what to do, but some patients don’t. Advice was given to patients, and free online training was offered to patients to educate them and make them aware of diabetes management so they could live a normal life.
As I observed and listened to the DSN and patient conversation, I went through all the leaflets about diabetes displayed in the unit for the patient to take home. For type 1, the body can not produce a hormone called insulin. Without insulin, the body can’t control glucose levels naturally. Type 1 diabetes is often diagnosed in childhood. However, it can develop at any age and family history can be a risk factor; however, type 1 diabetes is thought to develop due to a combination of genetics and other factors.
Insulin is the main treatment for type 1 diabetes and the patient will take it for life as there is no cure yet. Therefore, checking and managing blood sugar levels as well as taking medication is essential to reduce the risk of serious, both short-term and long-term health problems (diabetes complications).
The cause of type 1 diabetes is when the immune system attacks the insulin-producing cells that are found in the pancreas. This results in insufficient insulin being produced; therefore, the person would need to inject insulin. If left untreated, it can cause serious illness and lead to diabetic ketoacidosis (DKA) which can cause death. An HbA1c test is the main blood test used to diagnose diabetes. It tests your average blood sugar levels for the last two to three months. HbA1c level of 48mmol/mol or above and a patient with HbA1c between 42 and 48mmol/mol are at risk of developing type 2 diabetes
In type 2 diabetes, there are high blood sugar levels due to the body not making enough of the hormone called insulin or it can be due to the insulin not working properly ( insulin resistance). High blood sugar levels over time can cause other health problems like heart attacks and strokes, as well as problems with the eyes, kidneys, and feet.
Treatment includes regular health checks and getting support to be active, eat healthy and maintain a healthy weight. Also, the patient may need to take medication (metformin) including insulin and to check blood sugars regularly. There are many reasons type 2 diabetes develops but it mostly affects people over 25 often with a family history. There’s no cure but some people with type 2 diabetes can put their diabetes into remission. Type 2 diabetes can go undiagnosed for years if the person doesn’t have symptoms or symptoms are missed. Anyone can get type 2 diabetes but individual that are overweight or obese are at higher risk along with ethnicity
October 7th to 18th was hypoglycemia awareness in the hospital, which I took part in organising with the DSN. I was able to talk about diabetes (1&2) with patients, handed over leaflets and explained the steps to follow during hypo such as checking blood glucose levels, 15g of fast-acting carbohydrates, either 150ml (a small can) of non-diet fizzy drink, or 4 large jelly babies. I reminded the patients that lucozade is not recommended anymore as the glucose content has been reduced.
I also attended Annex B training, where I gained insight into the future of the nurse standard. As a future nurse, I am expected to demonstrate essential nursing skills and procedures to provide compassionate, evidence-based, person-centred nursing care. I observed and participated in male catheterisation, NG tube, and oxygen therapy management.
My first 3 weeks of placement have been insightful in nursing. It is a challenging career but rewarding. I have gained skills and knowledge that will help me in my nursing career. As 3rd year nursing student, a lot was expected of me and the staff and Pre-Reg team were supporting me.
I have developed different skills during my placement, such as the ability to manage the ward with another staff member and report any concerns. I can have effective communication with the patient and other health team professionals.
I work as part of a team and have developed good communication skills with patients, relatives and the nursing team.
I can receive and hand over nursing care to another staff. I carry out safety checks, such as checking that oxygen and suction pumps are working and equipment needed is at hand for emergency use. I can assess patients to check for pressure areas. I can write nursing notes (counter-signed by the staff nurse) and assessment notes such as water-low, fluid input/output, MUST and the nursing note. As some of the patients are on insulin, I am aware of the need to assess patients for lipodystrophy to improve insulin effectiveness. I have knowledge of cannulation, IV priming and administration. I know oxygen therapy, for example, in an emergency to give 15 liters of oxygen with a non-breathable mask.
I ensured to gain consent before commencing nursing care and promoted privacy and dignity at all times by closing the curtain, and providing person-centred care.
I treat all patients with kindness and compassion and speak to them in a professional manner.
I ensure to provide safe and high-quality care that is person-centred. As well, ensured all the care I gave to the patient was in their plan of treatment to avoid wrong treatment by reading the documentation
I am honest with the patient and respect their right at all times.
Good time management by ensuring to come on time
Reflecting on the skills at the end of my shift
I ensured to record patient care accordingly to avoid giving wrong information
I follow the trust and ward policy while carrying out my nursing care.