Category Archives: Year 2

READING LOG

Posted on by
Reply

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

Posted on by
Reply

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.

Building on My Success

Posted on by
Reply

Over the last year of my second year in adult nursing, I have gained knowledge and developed various skills that have improved my competence as a nursing student. However, I have faced different challenges, such as in the A&E where patients are brought in Resus due to drug overdose, mental health and terminal illness. I have supported end-of-life patients in both hospitals and the community. In the hospital setting, healthcare professionals are everywhere and willing to support. However, in the care home or community, it is different. Therefore, the team/nurse has to work on their own and make critical decisions on the best way to support the patient. This experience has helped me to know what to do/expert while in a hospital or community setting.

Having gained knowledge and skills, what I am looking forward to in the next year is more independence. I want to be able to independently care for a group of patients on my own and seek clarification where needed. For example, if I am on placement in a stroke ward, I want to be able to support a group of patients with their health treatment.

Over the next year, I am hoping to manage patients with different health needs. Thereby becoming a competent nurse

Reflecting on learning from other during placement in A&E

Posted on by
Reply

During my placement, I was allocated two patients to provide nursing care under supervision. I carried out set observations such as ECG, blood pressure and saturation level hourly, this is to detect any change in patient health. I supported the staff nurse to provide care to the patient such as a patient (male) who required a new catheter change due to infection (CAUTI). The area was cleaned using and aseptic technique followed by deflating the balloon and removing the catheter. Optilube gel was applied followed by the insertion of the catheter using an aseptic technique. The patient was made comfortable. However, due to the patient’s infection, he was restless, complaining of pain and his whole body was itching. I spoke to the doctor in charge to prescribe pain relief (paracetamol was prescribed for him). I also discussed his itchiness with the doctor, the doctor explained to me that the patient will be going home and already has his prescribed cream at home, however, I should use any moisturizer cream at my reach as creams are not being kept at A&E. I explained and gained consent from the patient to wipe the body with warm water and apply barrier cream moisture to cool the body which helped.

At the start of my placement, I was down by seeing different patients with complex care and needs. After my experience with the catheter, I regained my confidence. To know my patients and build professional relationships I started communicating more with them. I started with history taking which helped me to know them better. They were always happy to see me and a few patients were requesting for me only.

My experience in the A&E major unit has been interesting as I get to observe and witness doctors discuss patient health and see other professionals do different things for the patient such as the OT assessment patient mobility. Seeing different patients with different needs has built my confidence because they came to the hospital to get treatment and improve their well-being. I feel happy within myself at the end of the shift that I had put a smile on the patient’s face and went home with new skills and knowledge to take in another area.

Feedback from mental health nurse during A&E placement

Posted on by
Reply

Mary has been very beautiful and compassionate member of the team. She demonstrated this towards a vulnerable patient. She had kindly supported and did not object in providing care to a homeless patient, who was in crisis. She went extra mile even to find language line solution so that Crisis team worker could have better communication about the Patient care.

Mary is truly and sincerely a lovely human being and shows true compassion and I and the NIC in Majors are truly grateful for her willingness and professional conduct.

feedback from nurse during placement

Posted on by
Reply

Student Mary-Charity has proved herself to be a proactive stuent who is keen and willing to improve her nursing knowledge . She maintains a professional disposition and works within her limitations as outlined by NMC.

Mary – Charity has demonstrated a good understanding of what is the normal ranges when taking patients vital signs and reports any concerns if any arises. Communication between patients , family and fellow peers has been effective. Mary- Charity is compassionate, caring and shows empathy. Importantly she demonstrates patient and family centre care by involving them in their care enabling involvement into their wellbeing. Mary – Charity is on her way to being a very good nurse and must continue to maintain evidance based practices linking practice to theory.

Elective Placement Feedback

Posted on by
Reply

We have truly enjoyed time when Mary as a student nurse worked in Kew house. It’s probably safe to say that all team members will miss her and I hope working with Kew team was good new experiences and help Mary to explore opportunities while also creating friendships.

 

Mary is a very mature, hardworking, and motivated compassionate student nurse with an exemplary work ethos. She worked hard and accepted and welcomed constructive criticism

in order to develop and hone her emerging clinical skills. She was well received by residents and team, being viewed as an effective team player and compassionate nurse student, I would consider hiring her if she completed nursing studies as a nurse.

During her placement Mary was part of the medication rounds carrying out by nurses, Mary was encouraged to participate in the administration of medicines under the supervision of a Registered Nurse. Mary under the supervision of a registered nurse also learned how to provide residents with basic nursing care, including wound dressings and catheter care.

Being a registered nurse requires having confidence in your knowledge and skills to be able to make wise clinical decisions, respond quickly to concerns and manage risk.

During the morning meetings we discussed health issues, how team to manage health issues and response , advice given from GM, DM or CL to team regarding clinical decision which helps Mary to have knowledge how to response to concerns, where to seek for support. Mary have grown to trust her instincts, acknowledging her own ability. Mary was part of the other professionals’ visits, such as tissue viability nurse , doctor – during doctor round ; district nurses taking care of the residents on residential community, end of life nurse. When Mary recognised that she would like to have knowledge about end-of-life care , she didn’t not hesitated to have conversation with end of life nurse and ask the questions.

Mary was also part of the manual and handling training to support Mary with practical knowledge how to safely lift, move, and handle residents in Kew House and safeguarding training which helped Mary to improve the knowledge of best practice for protecting individuals from harm in the Kew House and obviously in the future any other workplace, including what mary should do if she suspect abuse or neglect and how to report her concerns so that the various safeguarding partners can investigate such incidents further.

I’ve noticed that Mary always maintains professional approach with our residents and her collaboration with the team to ensure that all residents needs are met was exemplary. Mary updates our documentation with support of nurses / or clinical lead always thorough and timely, ensuring continuity of care. Mary did what was needed to be done without being asked, she showed compassion and care which was far over and above what was warranted. Mary is meticulously polite and spend time with residents , have a conversation and sped quality time with the residents.

All of this has influenced Mary’s work ethic, professionalism as being a student nurse is incredible adventure and being a successful registered nurse will hopefully be a new and bigger adventure for Mary.

Reflecting on learning from other during Elective Placement

Posted on by
Reply

On 30/07/24, I had the opportunity to work as part of the term and provide care to different residents. At the start of the shift, the handover was done, this allowed me to know more about the resident. First the resident was checked, and breakfast was served. As the resident has different needs, such as end of life and being less able to eat. I assisted with nutritional intake. Hydration is common with elderly residents, and drink was always available.

The Kew House Care Home has a residential community for residents with minimal support, a dementia community and a nursing community for residents who require full support for their activities of daily living. I worked together with the staff team to meet the resident’s needs.

Reflecting, it is important to give dementia medication (Levodopa -co-Beneldopa or Co-careldopa0 (Parkinson and Alzheimer’s) 15mins before due time or 15 minutes late. Anything early or later can cause deterioration to the patient. This means in-balance in the drug therapeutic level in the body system. In this case, I have observed the nursing team meeting the target. Also, I have observed and participated in checking resident pulse rate before administering digoxin medication. Digoxin is not given if the resident’s pulse rate less than 60 because the resident is also on midodrine used to treat orthostatic hypotension.

I attended 1010 meetings, where the activities of the care home (including clinical eg new wound, change in resident need/health and outcome from other health professional such as GP/OT/SALT) are discussed. This helped me understand more about the home and the different things that are being done to promote resident wellbeing, for example resident losing weight, less nutritional and fluid intake, EOL resident and GP list resident. During this meeting, I had the opportunity to know more about the resident and the types of care the given. Also, I observed and participated in updating resident care plan. This is because their need are changing for example one of the resident with speech difficult was assessed by SALT and tips to aid conversation was put in place and care plan updated. Also, providing high standards of care are being emphasis during the meeting.

Also I have observed good team work among the staff team. They communicated to each other about the resident care in case of any change. They also seek clarification from the nurse in charge or the management when required. They are different health professionals involved in patient care, working as a team is essential for fast recovery of the patient, as the group of healthcare professionals will bring in their expertise, skill and experience. Working with different team members at Kew House will help in the future to work as part of a team with other health professionals.

15/08/24

As well, in this placement, I had the opportunity to observe and participate in end-of-life care and was around when two residents passed away. On one occasion, I observed end-of-life care for the resident who was having Cheyne-Stokes breathing, End-of-life medication oxycodone was given and a plan for a syringe driver was discussed, but the resident passed away before it was due to be given. The resident family was around and the staff team sympathised with the family. The end-of-life nurse discussed what happens next and allowed the family time to ask questions. I observed the nurse verify death by check for response to painful stimuli, if pupils are fixed, dilated and unresponsive to light, Look, listen and feel for breath sounds and respiratory effort for 2 minutes, Look, listen and feel for central pulse and heart sounds for 2 minutes. The nurse called the Gp to inform them and sent the death verification form to them. The staff team has to do other paper work such as the RADAR.

After some time, I observed that the resident eyes were still open. I discussed closing the eye with the nurse, the staff team and the family. I gained consent from the family before closing the resident eye.

This experience has improved my knowledge and confidence in end of life care as i have experienced it, I will feel more confident in my future career as a nurse knowing what to expect.

Reflection on A&E placement experience

Posted on by
Reply

At A&E, there are different sections, such as resuscitation, Urgent Treatment Centre, subway, triage and Major. It is a systematic process starting from the receptionist, who is also a critical nurse. They are the first point of contact with the patient and will make a critical decision on where to send a patient for treatment. I have been in all sections during my placement and had developed different skills. Each section of the A&E are already equipped with all the necessary equipment that is required in an emergency to save a life. The health team acts without delay to their abilities to give treatment to a patient by prioritizing the care. For example, when there are two patients, one with shortness of breath and another with leg pain, the team will priorities the patient with shortness of breath first because they are more critical ( damage to the brain cell and organs due to lack of oxygen).

During my placement, I was assigned to provide nursing care to a patient, I gained consent and provided care to the patient as instructed. At a stage the patient started shivering due to their present health issue, as the patient has had paracetamol less than 2 hours, co-codamol was not given as it contained paracetamol, and codeine was offered to the patient, but the patient declined to avoid being constipated. I discussed with a doctor and ibuprofen was given to the patient by the nurse. In this situation, I have priorities patient care by discussing with doctor my concern about the patient and ensuring that the patient received alternative medication (ibuprofen) as required at that moment.

I have treated each patient as an individual and upheld their dignity by being kind, respectful and compassionate. I provide them with the care they need without delay under supervision. I listened to patients and responded to their preferences for example when a patient that is nurse in bed due to health conditions requested a commode due to not being able to excrete in bed. I work together with another team member to deliver the care effectively. Also, I have recognized and responded compassionately and politely to a patient who was distressed because they had not been in contact with or seen their family. I ensured to pay special attention to promote patient well-being and prevent ill health for example suctioning a patient that has secretion in their mouth as instructed by the staff team.

I advocated for patients by speaking up for them. For example, I have been approached by a patient complaining of pain on their ankle, I took the patient’s name, discussed the patient’s concern with the doctor, and requested if analgesia could be prescribed. The doctor went through the system and gave advice on the medication to be given to the patient. However, the staff were busy, so I explained the patient condition to the nurse for the patient’s to be prioritised by receiving their analgesia.

I prioritise patients by acting in their best interest by gaining consent before providing any care and after documenting it. I ensured to follow hospital and university policy by not carrying out any task unsupervised. I also informed the team I am working with about any concern that I have regarding patient care and needs, and I ensured to share only information necessary on a need-to-know basis. I communicate effectively and keep clear records (observations) accessible to another professional who will be looking after the patient. I ensured to work within my limitations and seek clarification to avoid any errors. Also, during handover, the need to escalate unwell patients is addressed, and the importance of carryout patient assessment is discussed, such as the pain score and the Glasgow coma scale to detect deteriorating patients. I understand that this is done to priorities patient care; therefore, I ensure to ask the patient that was assigned to me whether they are in pain and to score it 0 out of 10.