Author Archives: Mary-Charity Obianuju Nwosisi

Reflection on working on Hospital ward

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During my clinical placement on a hospital ward, I had the opportunity to care for a group of elderly patients, including those admitted due to confusion, falls, or shortness of breath. I ensure to apply the principles of the Nursing and Midwifery Council (NMC) Code, specifically the section on “practicing effectively. This section emphasizes communication, teamwork, delegation, and sharing skills and knowledge, all of which played a crucial role during my care of a confused elderly patient.

The patient was an 86-year-old man (Mr B) admitted with a urinary tract infection, which had contributed to increased confusion and disorientation. He was restless and agitated, frequently attempting to get out of bed without assistance, which posed a high risk of falls. Initially, I felt nervous, but I reminded myself of the importance of maintaining a calm, professional, and patient-centered approach as outlined in the NMC Code.

Communication is a key element of effective practice. I used simple, clear language, maintained eye contact, and ensured I spoke at the patient’s level. I introduced myself each time I entered his space to help reassure him, as he often did not remember who I was. I also used non-verbal communication, such as gentle touch and positive body language, to help build trust and reduce anxiety. These methods helped calm Mr B and allowed me to assist with the personal care more effectively.

I worked closely with the multidisciplinary team, including nurses, doctors, and physiotherapists, to ensure we were all aligned in the care approach. The NMC Code encourages collaboration for the benefit of patients, and I saw firsthand how vital this was in meeting Mr. B’s needs. For example, Mr B is mobile, but due to confusion, he wanted to walk but was not steady on the ground and was grabbing everything around him. I taught about the risk of falls and injury to oneself and others. I discussed this with my PA, and we supported him back to the chair. At this time, Mr. B was very disoriented, and to ensure his safety (practice effectively), we supported the patient back to bed and used the bed rail to keep him safe. At this time, the patient was trying to climb out of the bed due to being confused. I discussed with my PA that the patient will require 1:1 support to ensure his safety and that of others. The enhanced team was called, and they assessed the patient and provided 1:1. The enhanced team (ET) supported patients who were very confused or disoriented. Delegating the care to ET ensured that the patient was supported by the right care team. This allowed me to continue providing nursing intervention to other patients. Although I am a student nurse, I was given tasks within my scope of competence. I always work under supervision and report any concerns to my PA. This reflects the Code’s standard to be accountable for decisions to delegate tasks and duties to appropriate staff.

I also ensured that my knowledge remained up to date by reading relevant guidelines on delirium and confusion and asking questions to deepen my understanding. Practicing effectively requires continuous learning, and I found that understanding the reasons behind the patient’s confusion helped me approach their care with greater empathy and clinical reasoning.

Throughout this experience, I was mindful of ensuring patient dignity and promoting person-centered care. I learned more about the patient’s personal history by speaking with family. This helped me tailor my communication and build rapport more effectively. For example, the patient loved music from the 1950s, so I played some soft tunes, which helped calm the patient.

Another key aspect of effective practice was ensuring accurate and timely documentation. I recorded every interaction, observation, assessment, and intervention clearly in the patient notes (Cerner). This ensured continuity of care and allowed other staff to practice effectively.

In conclusion, this experience taught me the importance of practicing effectively according to the NMC Code. Caring for a confused elderly patient required clear communication, teamwork, safe delegation, accurate documentation, and person-centered care. It helped me develop greater confidence and deeper insight into the needs of vulnerable patients. I now better understand how the NMC Code is not just a professional guideline but a practical framework that supports high-quality, compassionate nursing care in real-world settings.

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During my placement, Fairfield 2 is a ward that treats and manages haematology and endocrine patients. The haematology and endocrinology doctor admits and treats patients with health conditions such as cancer, sickle cell, and anemia.

During my placement, I have bid by the Nursing and Midwifery Council (NMC) Code, “prioritising people” is fundamental to providing compassionate, person-centred care. I ensured that the needs, dignity, and well-being of patients were at the forefront of my practice. Prioritizing people encompasses not only clinical competence but also the ability to respect each patient’s values, preferences, ensuring they are treated as unique individuals rather than just cases or conditions. Also, I ensured continuous self-awareness and reflected on how my actions, attitudes, and decisions affect patients. For example, a bed-bound disabled patient on a PEG tube was admitted to the ward. Their only means of communication were body language and noise making. During personal care, I was courteous, gained consent and communicated throughout the time nursing care were given. Also, throughout the shift, I closely monitored the patient due to the lack of verbal communication. I ensured the patients were treated with respect, their rights were upheld, and no discriminatory attitudes and behaviours towards them.

I ensured to report any concerns to a staff member when appropriate and escalate as required as per trust policy, for example, during my fourth week, I was assigned to a bay with a nurse, during my observation round, one of the patient’s temperatures was 38.8OC and pulse rate was 125. I informed the nurse in charge. As the patient was already given tazocin less than 30mins before this change. Paracetamol was given, and I did an ECG on the patient while the nurse made a view call to inform the escalation doctor. The patient was assessed for urine output, and blood was taken to the lab, including a blood culture. After assessing the patient, the plan was to increase the patient’s antibiotics and check blood pressure hourly. In this case, the patient received the care needed without undue delay and I worked in partnership with other health professionals to deliver fundamental care effectively. Also, information was only shared with healthcare professionals involved in patient care.

During this placement, I ensured to gain consent for all nursing care given to the patients. I listened to what the patient had to say and responded to their preferences and concerns. For example, a disabled patient declined to be assisted with meals; a choice was offered but still declined. Soon after, the patient’s family came and assisted the patient in having all their meals. The patient relative explained to me that the patient sometimes skips meals

The NMC’s code prioritise people is at the heart of nursing and midwifery practice. It calls for a compassionate, patient-centred approach that upholds dignity, advocates for the vulnerable, and places the individual at the center of every decision. During this placement, I have reinforced my commitment to these values by advocating for patients and ensuring holistic care delivery.

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Reflecting on my journey as a student nurse, I see significant growth in my personal learning and professional development. My progression has been a blend of successes, challenges, and ongoing learning, each of which has shaped the nurse I aspire to become. At the start of my placement, I recognised that I needed to build a strong foundation in clinical knowledge and hands-on skills.

I work alongside staff nurses and join during meditation rounds and nursing care to improve pharmacology, practical skills and nursing interventions. I have gained confidence in applying this knowledge in clinical settings. However, I realise that nursing is a continuous learning process, and I still have areas where I want to improve such as IV administration.

For example, I have identified a need to enhance my critical thinking and decision-making abilities in more complex and rapidly evolving situations. While I am becoming more comfortable with routine patient care, administration of common medication, I find that in emergencies or when dealing with multiple comorbidity, I sometimes need additional support to make confident clinical decisions. For example, I had the opportunity to work alongside a staff nurse to provide nursing care to patients with a spiking temperature of 38:8C and patients with a ketone of 4.5. However, I am actively seeking more opportunities in more complex situations.

Throughout my training, I have become increasingly aware of the importance of embodying the core professional values outlined by the Nursing and Midwifery Council (NMC), such as compassion, respect, integrity, and advocacy. I take pride in delivering compassionate, person-centred care and believe that my ability to communicate with patients and their families is one of my strengths. I always strive to ensure that every patient feels heard, respected, and valued, which aligns with my commitment to prioritising people as set out in the NMC Code.

One professional value I continue to focus on is advocacy. I am learning how to effectively advocate for patients who are vulnerable or unable to speak for themselves. This involves not only being a voice for patients but also ensuring their dignity and rights are upheld. For example, I have been involved in the care of patients with cerebral palsy and non-verbal communication. Therefore, I spent extra time with them to communicate, listen and ensure person-centred care is provided.

During my placements, I have developed several key competencies, such as safely administering medications , wound care, ECG and monitoring vital signs, which has improved me significantly. I can manage patient care in a bay and report to the nurse in charge of any concern.

Additionally, I confidently document care accurately and communicate effectively with staff members. I have improved on my clinical skills, as well as emotional resilience, leadership, and collaboration. I aim to develop further my confidence in delegating tasks and leading small teams during shifts. At times, I hesitate to take the lead, especially when working with more experienced nurses or in high-pressure situations. I want to work on my leadership skills and learn how to delegate more effectively while maintaining an effective team.

I have participated in doctors’ rounds and contributed to discussing patient health and well-being. This has helped me in managing patient care and to identify signs that a patient is deteriorating. Also understanding of some abbreviations used in the ward and why different trays are used ( red for patients who need help with eating or different and blue for competent patients). I ensure to gain consent before carrying out any procedures or nursing intervention and promote person-centred care by encouraging the patient to do as much as possible for themselves. While providing care, I ensure to respect patients’ wishes and preferences. As my ward is haematology and endocrinology, fluid input and output are recorded; therefore, I encourage fluid and food intake to improve health and well-being, mostly for patients on catheters. Most importantly, I ensure to be on time to take handover, this is where clinical patients care are discussed, and plans in place are explained. At the end of the shift, I joined the staff nurse to give handover to the night staff for continuity of care.

I plan to work closely with mentors during future placements, asking for regular feedback on my clinical practice. This will help me identify specific areas where I can improve. I will seek opportunities to take on leadership roles during shifts, gradually building my confidence in delegating and coordinating care. I will regularly reflect on my experiences and receive feedback. I aim to continuously refine my ability to advocate for patients and uphold professional values.

 

Skills

 

Throughout my placements, I have significantly improved my clinical skills, such as administering medications, conducting assessments, and performing wound care. I am becoming more efficient at managing multiple patients and prioritising care. I am more competent; documentation has also improved, ensuring that patient records are accurate and up to date.

I build strong, trusting relationships with patients and their families, ensuring they feel respected and cared for. I have developed effective communication skills, both in listening to patients and in delivering clear, concise information to colleagues and other healthcare professionals regarding patient health and well-being. I can use ward equipment such as blood sugar/ketone device, infusion pump, blood pressure and ECG machines

I promote patient privacy, dignity and safety at all times and am always willing to support patients and their families as required while maintaining confidentiality. Understanding of palliative care and end-of-life care. I am involved in the administration of medication such as tablets of injections ( insulin and enoxaparin) and IV medications. Ability to use a wide range of communication methods such as active listening, gestures, lip reading and eye contact to support the patient with communication difficulties. I prioritise patient needs according to a current health condition, such as insulin, hypertension or hypoglycemic. I think critically and ask questions to improve my knowledge of patient conditions and the best way to support them. Demonstration of professionalism and maintaining a professional relationship with the patient and others

 

Attitudes and values

 

I use my initiative and ask questions to improve my knowledge of the patient’s condition and the best way to support them

Ability to contribute to nursing intervention

Good time management to be part of nursing handover

Caring and compassionate in the nursing care given to the patient

Communicate well with all healthcare professionals and follow instructions and procedures given by staff.

Work well as part of the team and in a professional way to improve patient health

Ensuring to gain consent and communicate the task to the patient to provide person-centred care and active participation

I advocate for individual patients,

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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.

SKILLS

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.

ATTITUDE AND VALUE

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.

READING LOG

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The study “Physical health monitoring in mental health settings: a study exploring mental health nurses’ views of their role” by Herbert Mwebe focuses on the role of mental health nurses in monitoring and managing the physical health of patients within mental health settings. Mwebe explores the perspectives of mental health nurses regarding the integration of physical health monitoring into their responsibilities and the challenges they face.

Key Findings:

Role Perception: Mental health nurses recognize the importance of monitoring physical health, especially given the higher rates of physical health issues in people with severe mental illness (e.g., cardiovascular diseases, diabetes). However, they often perceive their primary role as centred on managing mental health symptoms.

Challenges:

Lack of Training: Many nurses reported insufficient training to properly assess and manage physical health conditions, which can limit their confidence and capability in performing these tasks.

Time and Resource Constraints: The workload, understaffing, and limited resources in mental health settings make it difficult to balance both mental and physical health care.

Systemic Barriers: Nurses often feel that the organizational structure and policies within mental health care do not prioritize or facilitate adequate physical health monitoring.

Importance of Physical Health: Despite the challenges, there is a strong acknowledgment among nurses of the link between physical and mental health. They see physical health monitoring as critical to holistic care, yet systemic changes and better support are needed to effectively integrate this role.

however, enhanced training and education in physical health care for mental health nurses. Better staffing and resources to allow nurses to manage both aspects of care. Policy changes to ensure that physical health care is given equal priority in mental health settings. The study concludes that while mental health nurses are willing to engage in physical health monitoring, addressing these challenges is crucial for effective implementation.

limitation of the article

  1. Small Sample Size: The study likely involves a limited number of mental health nurses, which can restrict the breadth of perspectives captured. A small sample size may not fully represent the diverse views and experiences of mental health nurses across different settings.
  2. Qualitative Nature: As the study focuses on nurses’ views, it is primarily qualitative, relying on subjective experiences and opinions. While this provides rich, in-depth data, it may lack the quantitative measures needed to assess the prevalence of challenges or to statistically validate the findings.
  3. Geographical Scope: If the study is conducted within a specific region or healthcare system, its findings may not be applicable to other regions or countries where the healthcare infrastructure, resources, and policies differ.
  4. Self-Reporting Bias: The nurses’ responses are self-reported, which can introduce bias. Participants might provide socially desirable answers, downplay their struggles, or overstate their competencies in physical health monitoring.
  5. Limited Exploration of Patient Outcomes: The study focuses on the perspectives of mental health nurses but does not directly examine how these perspectives or the nurses’ physical health monitoring efforts affect patient outcomes. Therefore, the impact on patient health remains unclear.
  6. Focus on Barriers Over Solutions: While the study highlights the challenges mental health nurses face, it might offer limited insight into effective, evidence-based strategies for overcoming these barriers. The recommendations are useful, but the study may lack concrete examples of interventions that have been successful in other settings.

These limitations suggest that the study provides valuable insights but needs further research to confirm its findings and explore broader implications.

How this will inform my future learning and nursing practice

The study emphasizes the need for mental health nurses to be proficient in monitoring physical health conditions, particularly those common among individuals with mental illness. It suggests an interdisciplinary approach to nursing education, focusing on both mental and physical health care. The study also suggests the development of advanced clinical skills, such as physical health assessment and screening, to empower mental health nurses to take a proactive role in physical health management. It also advocates for a holistic care model, focusing on both physical and psychological aspects in their practice. The study also suggests the need for continuous professional development for mental health nurses in physical health care. It also suggests policy advocacy, urging for better integration of physical health protocols in mental health settings and resources for holistic care. The study also encourages nurses to take ownership of their role in physical health care, shifting their perception of it from secondary to a core part of their responsibilities. The study also opens avenues for research into effective physical health interventions in mental health settings.

Read Right Worksheet

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3rd Edition

Nursing Research, An Introduction,

By

Pam Moule, Helen Aveyard and Margaret Goodman

This textbook is a comprehensive guide to introduce student nurses and practitioners to some of the complexities of nursing research. It was written based on the experience and knowledge of nursing and nursing research.

The book aims to be used by students during research and includes four parts: Appraising Research, Preparing for Research, Doing Research and Sharing Research.

 

It includes 29 chapters covering key aspects of nursing research that introduce the reader to issues of research design, process, dissemination and implementation. The straightforward layout allows the readers/students to negotiate the content to meet their learning needs. Students can read individual chapters without the need to refer to other sections of the book constantly.

The chapters are structured to include learning outcomes, content with reference support and up-to-date examples from practice and literature, and a summary. In addition, some chapters offer reflective exercises. A comprehensive glossary is provided towards the end of the text. Each chapter ends with a summary that reminds the reader/students of the key issues presented. Suggested further reading lists, recommended websites and references were provided.

One of the examples used to illustrate these models is below

Let’s think about a possible practice situation where you are caring for a patient who has just been told he has prostate cancer. How would you know what was the best care to deliver for your patient and his family? Think about the steps you might take. One of the things you may need to do is source information that will help your patient understand more about prostate cancer. You could ask more senior staff for advice and what information they might use. It is also important to remember the need to deliver evidence-based care and use the best evidence available. You can use published evidence for healthcare professionals and patients and families, available from the Prostate Cancer UK charity (www.prostatecancer.org). You could read the current NICE guidance available on their website (www.nice.org.uk). This provides a robust evidence base for practice, which can give you both scientific and economic information to work with. The evidence covers what kinds of information might be provided; where to find this information; and what treatments might be considered. These guidelines are based on a range of research findings and evidence, and provide guidance for a range of healthcare professionals to help deliver best care.

This book has helped me understand the importance of research and how it is used, which is to provide evidence-based practice treatment/practice.

This book focused mainly on nursing research and was dedicated to the memory of Gill Hek who inspired many nurses researchers.

The terminology or language I need to note down and look up are critical appraisal, analytically reading, synthesis and hypothesis.

In conclusion

Nursing research has been shaped by its historical roots and political, economic and organisation influences. It has improved evidence-based practice in nursing and health services research. The development of evidence-based practice has been rapid and influential by research.  Most nurses become ‘research literate’ and learn the essentials of evidence-based practice. However, some nurses will become researchers as part of their role in practice, or through a career in teaching, policy development or leadership.

 

Progressing in to adult nurse, I will practice based on research outcome and evidence-practice.