Category Archives: Year 1

Reflection on midwifery week on simulated placement

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Midwifery insight- week for simulated placement focussed was on domestic violence and abuse, infant feeding and sepsis. I gained in-depth knowledge and understanding on these topics as they were very educating and insightful.

The domestic violence and abuse forum begun with us watching a scenario of a pregnant woman who was brought into the hospital by her partner for falling and bruising herself. The nurse was to assess the patient by taking a set of observations. Upon assessment, the nurse suspected some sort of abuse which generated from how afraid and anxious the patient seemed and how the patients partner behaved and spoke. Again, the injury from the fall looked suspicious. The nurse became concerned at this point and tried to find a way to speak only to the patient. The patient’s partner at a point excused himself and the nurse used the opportunity to ask questions that could help the patient open up to him.

As a nurse, it is important to focus on your patient to notice any signs of domestic abuse they might be facing, so safeguarding concerns can be raised. With this scenario, I have gained understanding on the importance of assessing the patient’s general appearance, posture and mental status. From the scenario, it was easy to detect some signs of abuse as the patient appeared withdrawn, anxious and afraid. The scenario has opened my eyes to how abusers can be controlling by having a coercive and violent behaviour just like the patient’s partner. I have acquired knowledge of how to identify when a patient is being abused, how to escalate it and the support to offer. I understand that reassuring patients and asking closed and open questions are important as it allows the victim talk you through how the abuse happened. Nurses must be careful and know how to collect information and ensure questions asked do not trigger the situation or make it worse. As a nurse I understand that what I do must be in my patients best interest. Any information gathered from the victim must be shared with my supervisor so abuse can be appropriately escalated. When the abuse is escalated, multidisciplinary team members will be involved.

The infant feeding section mainly focused on breastfeeding. There were discussions on how breastfeeding is beneficial to both baby and mother. Some of the benefits to baby included protection from infection, nutrition for optimal growth and water for hydration. I gained knowledge on how milk production in the breast happens. I understand that when baby sucks, it stimulates the release of prolactin and oxytocin. Prolactin is the milk making hormone which causes the alveoli to make milk and the oxytocin is a milk releasing hormone. I understand that breast milk contains all the elements needed for optimal growth which includes vitamins, proteins, carbohydrate, minerals, water, antibodies and hormones. It is insightful to know that the World Health Organisation (WHO) and UNICEF recommend early initiation of breastmilk within an hour of birth. It recommends that breastfeeding should be exclusive in the first six months of life and even after the introduction of solids, breastfeeding must continue up to two years of age or beyond.

The day finally ended with an activity on sepsis which was quite interesting and fun. I gained vast knowledge and understanding of sepsis. I understand that sepsis is a life-threatening reaction caused by the body’s response to an infection. I had no idea how sepsis affected a large proportion of the UK population. Through this activity, I learned that in the UK, about 245,000 people get affected by sepsis and with at least 48,000 people losing their lives in sepsis-related illnesses every year. Globally, 11 million people lost their lives through sepsis-related illnesses. Again, I learned that sepsis costs the NHS £2 billion each year. I acquired knowledge about the sepsis six care bundle which included giving oxygen, taking blood cultures, giving iv antibiotics, taking lactate measurement and urine output monitoring to be instituted within one hour by healthcare professionals. This protocol is used to guide the identification and initial rapid response and treatment. These steps are used to control infection and restore circulation to ensure blood supply back to the tissue.

Before the domestic violence and abuse forum, I knew what domestic violence was but lacked understanding and would never have known how to act or behave if I had come across one. Learning about this topic has helped me gain in-depth knowledge and has boosted my confidence on how to act when I am faced with such a situation. As a student nurse, I understand the need to raise safeguarding concerns about patients and reporting my findings to my supervisor. I have a role as a student nurse to protect my patients always and keep in mind that whatever I do must be in their best interest. The NMC requires nurses to identify safeguarding concerns and be able to respond to these concerns and report them. Although the NMC code 5 expects nurses to respect people’s right of privacy and confidentiality, I understand that nurses need to share necessary information with health and care professionals and agencies only when the interest of patient safety and public protection override the need for confidentiality.

Preserving safety: In relation to the domestic violence scenario, the student nurse identified a form of abuse and became concerned about the patients safety. The nurse preserved the patient’s safety by raising and escalating these concerns to his supervisor (NMC 16.1). The nurse took all reasonable steps to protect the patient who looked vulnerable to abuse (17.1)

Promoting professionalism and trust: The nurse acted professionally by following the guidelines relating to the disclosure of information by sharing necessary information when he believed the patient was at risk of abuse (NMC 17.2).

Prioritising people: The nurse acted in the best interest of the patient and preserved her dignity. The nurse recognised how anxious and afraid the patient was but continued to encourage and empower the patient by reassuring her (NMC 2.3)

Practising effectively: Th nurse communicated effectively and clearly with the patient and supervisor. He worked together with his supervisor by sharing his concerns to ensure the patient’s safety (NMC 8.3).

Reflection on creative therapy on simulated placement

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Creative therapies are treatments involving art activities. On my simulated practice, I had a week of creative therapy session where the focus was on dance, music, drama and art therapies. The dance movement therapy was insightful, interesting and fun. It started by us mirroring dance movement by the facilitator. Personally, after the dance movement, I could feel some tension lifted off my body which made me feel more relaxed and focused. I understand that dance movements help with a person’s physical, cognitive, social and emotional integration. As nurses, our profession requires us giving so much to people and we tend to forget about ourselves. It is important to pay attention to your body and take care of you. These exercises help emotionally by releasing tension and also serves as a form of self love and care. Physically, it helps with good circulation in the body system. Mentally, it helps one regulate their emotions and feelings and ensures calmness of the mind.

I had the opportunity to gain knowledge about the history of Dance Movement Psychotherapy (DMP) where according to Marian Chace, dance is a communication and as such fulfils a basic human need. I learnt that Marian Chace (1896-1970), a dancer, choreographer and a performer was the first to experiment DMP where she volunteered at a psychiatric hospital for “Dance for Communication”. It emphasised on respecting patients and treating them uniquely as individuals where there was genuine interpersonal interactions. Marian chace reached her audience by using mirroring (movement and shape) to promote empathy, understanding and communication. At the DMP sessions she used rhythm and shared leadership to create connections and bonding and to acknowledge individuals creativity. These were linked to the six C’s of nursing which included care, communication, compassion, competence, courage and commitment. I understand that DMP involves communicating non-verbally and through that people are able to share information and feelings. 55% of communication happens with body language which includes facial expressions, eye contact, touch and gestures.

The music therapy session was interesting and educating. I understand that music breathes, meaning it either speeds up or slows down, just as the real world does. Music is a more accessible way of ordering emotions in everyday life and it evokes images and memories of feelings. Every individual connects to music. Music moves us because move rhythmically. Music is beneficial to everyone. Physically, it helps with relaxation. Socially, it helps with group bonding and social participation reducing self isolation. Singing helps with breathing control especially patients with chronic lung disease. It helps develop awareness of postural and breathing patterns and improves expiratory muscle strength and coordination. It helps build physical and vocal stamina and it is fun to sing.

Therapist uses art therapy to help patients interpret, express and explore their emotions, thoughts and feelings. I have gained knowledge of how arts therapy support service users autonomy by encouraging patient-centred approaches. As a nurse I understand the importance of respecting service users rights and values and giving them the opportunity to make their own choices. Arts therapy helps individuals communicate their thoughts, process and express their feelings and helps improve their self confidence and resilience. I understand that art therapy can happen in different types of settings including prison service, special and mainstream schools, palliative care, acute services and many more. Patients are referred for a number of reasons including loss or bereavement, communication difficulties, chronic health condition and trauma. In a setting where you have patients suffering from dementia, Art therapists uses visual arts to support communication where pictures are used to help patients make choices. During the session, we were presented with interesting scenarios where we had to make meaning of images. From one of the images presented, I could read loneliness from the patient where the patient was either not happy because they were in isolation. I was able to identify creative approaches to adopt to meet patients need when faced with certain situations. For example, having to insert cannula on a child who does not like needles. In a situation like this, I will use picture images as a distraction.

Finally, we had the drama therapy session which was so intriguing. From this session, I had a clear understanding of how drama therapy creates a safe environment for people to use verbal and nonverbal communication approaches to explore and process difficult thoughts and feelings they might be experiencing. Drama therapy supports individuals to use play and images to express their feelings and this in turn enhances their wellbeing. Similarly, drama therapy like the other therapies relates to the six C’s of nursing. I learnt that dance therapy is a full body/brain experience and serves as an indirect approach to problems or trauma. It involves the intentional use of the healing aspect of play with a person’s problem. Play in a drama therapy setting is imaginative which involves a creative process which brings out the best part of an individual. This helps an individual build trust, connect with others and serves as a source of energy.

Before the sessions, I never knew these therapies were important in my nursing career. I realised how these arts are linked to the Six C’s of nursing which includes care, compassion, communication, commitment, courage and competence. At the end of the creative therapy week, we made a group presentation on music therapy. My group composed a song and the lyrics in the song was about the strength of nurses and how music helps people communicate their thoughts and feelings. The lyrics detailed how courageous and caring nurses are. Being courageous is you acting on your own values and willingness to take risk by advocating on your patient’s behalf despite the risk involved. When one is courageous, you become committed to providing your patient with the best care. Through music therapy patients feel cared for and believe their concerns are acknowledged. During the group presentation, we gave each other an opportunity to lead which showed a good team work and helped build each others confidence. These art therapies have broadened my knowledge and given me a new perspective on how to support patients in different situations. I learnt that incorporating these art therapies will support patients in their healing and help build therapeutic relationships to achieve therapeutic goals.

Prioritising people: NMC code 2.6 expects health professionals to recognise when people are anxious or in distress and respond compassionately and politely. Creative therapy ensures that health professionals identify when their Patients are in any form of distress and react compassionately to them.

preserving safety: NMC 17.1 requires nurses to take reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse.

Promote Professionalism and trust: NMC 20.2 requires that nurses act with honesty and integrity at all times, treating people fairly without discrimination. Creative therapy helps patients explore their thoughts and feelings and as nurses we need to respect and acknowledge these concerns

Practising effectively: NMC 7.3 ensures that we use a range of verbal and nonverbal communication methods, considering cultural sensitivities, to better understand and respond to people’s needs. Creative therapy give individuals the opportunity to communicate their thoughts and feeling in both verbal and non-verbal means. As health professionals these therapies helps us understand the concerns of our patients which enables us support them.

Reflection on an outreach at the GP surgery with the practice nurse

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I spent a day with the practice nurse at the GP surgery. The practice nurse at the GP saw patients with all health issues ranging from assessing and dressing wounds, immunisations, educating patients about their health on the telephone, taking bloods, performing smear test to check for cervical cancer and many more.

A patient came in to have a wound dressing. Patient had C-section about thirty years ago and it seemed the c-section area has opened creating a tiny hole in it. Patient is taking antibiotics to treat the wound for infection. I observed the nurse dress the wound. With the consent of the patient, the nurse took out the old dressing and the wound seemed clean and dry. A wound probe was used to check the depth of the hole in the wound which was just less than a centimetre deep. The nurse soaked gauze in water and cleaned the wound and dried it after. The nurse used a paraffin gauze dressing to soothe and protect the wound. Finally the wound was covered with an absorbent dressing and kept dry and clean.

I observed the nurse taking bloods from a patient who needed their bloods to be tested. She performed her hand hygiene and gained patient consent before starting with the procedure. She set all her needles and other equipment ready for the procedure. First she tried to find the vein from which to draw the blood from and steadily held it before injecting the needle to draw the blood. After drawing the blood, she held tightly and steadily on the area with a a gauze to stop further bleeding and finally taped it. Patient looked fine after procedure.

I administered a baby with her 16 weeks immunisation under the supervision of the practice nurse. The baby came in for her MENB and DTaP/IPV/Hib/Hep b vaccination. Before administration, I gained consent from the baby’s parents’ and they were happy for me to go ahead. I performed my hand hygiene, prepared all medications and administered under the supervision of the practice nurse. Parents were given information about the aftercare of their baby’s vaccination including an aftercare leaflet.

The practice nurse had discussions on the phone with a diabetic patient concerning the care and management of their diabetes. The patient reported of increased levels of blood glucose ranging between 11 and 13. The patient’s blood glucose levels used to be between the ranges of 3 and 5. Nurse advised patient to continue monitoring their sugar levels because high readings are sometimes due to stress.

I observed the nurse have another telephone conversation with a diabetic patient whose urine was tested to have protein. According to the nurse, the patient’s HbA1c test looked perfect so the protein in her urine is not due to her diabetes because sometimes high blood pressure causes one to have protein in their urine. The nurse made me understand that, high blood pressure weakens the blood vessels in the kidney which in turn decreases the ability of the kidneys from performing its function by reabsorbing protein, therefore causing protein to flow in the urine. Again, protein in the urine could be due to infection.

I observed the nurse perform a doppler test on a patient and according to the nurse this was to check the competency of the arteries in their legs. The procedure involved applying a blood pressure cuff to both arms and legs of the patient and the machine recorded the pulse volume and provided a pictorial evidence which helped the nurse in her diagnosis.

 I enjoyed my time with the Practice Nurse and made the most of the learning experience. I am willing to gain practical skills and also extend my learning by looking things up to gain more knowledge.

 

 

 

 

Reflection on medicine administration

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As a nurse, medicine administration is one of my primary roles. In the community where I had my placement, I had the opportunity to administer quite a few medications under the supervision of the registered nurses. I have gained knowledge and understanding in the administration of medication and how important it is to avoid errors by equipping myself with the 8R’s which include the right patient, right dose, right route, right documentation, right drug, right date, right time and the right to refuse. I understand the need to screen for allergies in medicine administration to preserve patient’s safety and promote health. It is important to seek patients consent before drug administration as patients have the right to refuse. Gaining patients consent is a way of respecting their autonomy.

I have administered both intramuscular and subcutaneous injections under the supervision of the district nurse. I had the opportunity to administer a baby with her 16 weeks intramuscular immunisation under the supervision of the practice nurse from my GP outreach. I have always followed the appropriate techniques involved in administration. With intramuscular injections, the needle must be long enough to reach deep into the muscle and must be inserted in a 90 degrees angle. Whiles with a subcutaneous injection, needles must be inserted into fatty tissues by pinching up the tissue to prevent injection into the muscle. The needle is inserted at a 45 degrees angle to the skin.

In my administration of medication, I have always promoted health and preserved patients’ safety by following the guidelines of infection control by performing my hand hygiene and wearing my PPE. It is necessary to gain patient consent before administration to show respect to their dignity. I check the drug chart of the patient to ensure medication has not been given already and also to make sure I have the right patient, right medication, right route, right dose, right time and check for any allergies. I understand it is vital to follow the above rights when giving medication to prevent any form of medication error which will be detrimental to patient’s health.

I have always acknowledged patients’ feelings by expressing empathy, showing compassion, care and communicated effectively during administration. To prevent patients feeling anxious about the procedure, I have always explained to them what medication I am giving them. I ensure to introduce myself to them, give a warm smile and maintain eye contact when communicating with them.

Reflection on wound care and management

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I joined the district nurse to visit a patient in the community to carry out wound dressing. The patient had a diabetic foot ulcer wound. I had visited the patient with the district nurse on three different occasions and have observed the district nurse carry out wound dressing on him. On this occasion, which was my fourth visit to the patient, I performed the wound dressing procedure under the supervision of the district nurse. On my previous visits, the wounds were being dressed in urgo clean acting as the base cover, advazorb, k-soft and k-lite. The nurse reviewed the dressing and recommended a new dressing called medihoney to be used as base cover instead of urgoclean. The nurse made me understand that using medihoney as a base dressing helps to lift the slough and kill infection. It helps with rapid wound healing as it draws moisture out of the wound area thus dehydrating bacteria. The wound had a foul odour and was exudating at a medium level.

Before the start of care, I respected the patient’s autonomy by gaining consent. I understand the importance of avoiding complications with wounds, so I embedded good infection prevention and control practices to minimise the patient’s risk of infection. I washed my hands and wore my PPE as per policy. Even though, care was provided in patient’s home, I maintained patient’s privacy and dignity by letting them choose which part of their home they would like the procedure to be carried out. I equipped myself by reading more on patient’s wound care before the procedure in order to preserve patient’s safety. I ensured a person-centred approach by using verbal and non-verbal communication, so patient felt involved in his care. With the support of the district nurse, I prepared all equipment and dressings needed for his wound. Using an aseptic non-touch technique, I removed the old dressing with a non-sterile glove and assessed the wound. I assessed the wound and identified four areas on the foot with ulceration with extensive maceration of the surrounding tissue. All four areas had medium levels of exudate with the presence of slough which was yellowish in colour. I took a measurement of the width, length and depth of the wounds to help identify if wound was healing and to monitor if the new dressing was effective.

I cleaned the wound with gauze soaked in water and gently dried it and its surrounding skin. I asked patient if he felt any pain and he confirmed being in pain only when the wound is being dressed. I redressed wound with medihoney placing it on the wound surface and ensured the dressing was in contact with the wound bed. Advazorb non-adherent foam dressing was applied on top of the medihoney due to its absorbent nature. The use of medihoney will increase wound exudate and as such a good absorbent dressing must be used. Advazorb non adherent foam dressing rapidly absorbs and retains fluid in the dressing. I secured all in place by using a yellow line and wrapped the whole foot with the K-soft bandage to assist with healing as they are very soft and comfortable and helps redistribute pressure for ultimate comfort. Lastly, I applied the K-lite bandage which acted as a base for compression and used the yellow line to securely hold the dressing.

What did you do well?

I ensured a person-centred care by communicating with patient through the procedure. Patient felt involved as he communicated his concerns about how the wound is healing. I had the opportunity to apply knowledge I have acquired regarding wound care. Wound was assessed and pictures taken, and I noticed there was no odour so could tell the medihoney was being effective. I identified some dark tissues on the wound bed trying to fall off which I understand signifies healing. Performing this wound care procedure enhanced my aseptic non-touch technique skills and helped build my confidence. The experience has helped me gain knowledge about tissue viability, wound healing and helped me familiarise myself with the types of wound dressings used

What would you have done differently?

Upon seeing the wound, I did not know how to describe what exactly was happening to it. I could tell it was healing as it looked better than before. The wound was heavily sloughy. I intend to gain a broad knowledge and understanding in wound care management. I intend to communicate more clearly next time so my patient understand me better. The patient had other health conditions, example, insulin dependent diabetes, which impacted on the wounds and we discussed the importance of maintaining safe blood glucose levels to promote healing. The patient was independent with his insulin so I gave advice for a healthy diet.

Improving safety and quality of care

I undertook relevant risk assessments (e.g. falls, skin integrity, mental capacity) that may be required and demonstrated an understanding of the difference between risk aversion and risk management. On other visits, I carried out skin integrity assessments and I am  aware of other risk assessments and their importance. I utilised a range of communication skills to effectively engage with the person receiving care, their family/carers and members of the multidisciplinary team in the provision and evaluation of care. I was able to give a hand over to the rest of the team for this patient. I communicated well with the patient and I understand I could have contacted the TVNs for advice.

 

 

Urology and colorectal certificate

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Urology and colorectal services support adults and children with bladder, bowel or stoma and catheter problems by providing assessment and treatment to help patients and their family or carers to self-care and control their symptoms. Bladder and bowel specialist nurses advices patients on treatment options so they can both decide on the best way to help. Simple tests involving physical examinations are conducted to detect the cause of the problem.

Bladder and bowel issues in adults include

Bowel incontinence: inability to hold stools and urine

 

 

Certificate of attendance – Rita (1)