Reflection of placement on Robert Tiffany Ward Royal Marsden

Reflecting on this placement overall I feel I have met the learning and development goals I had set out for myself. I gained a good knowledge of different types of cancers and the way in which these can be treated and feel confident in discussing these as part of a MDT. I understand side effects and complications that can occur as a result of cancer treatment and living with a cancer diagnosis. As I have learnt here, cancer is no longer always a death sentence and people can live well with cancer. In order to develop I will take this knowledge with me into other areas where I may encounter people who are living with cancer.

I have learnt how to interpret blood results during this placement. I feel confident in identifying and escalating abnormal results. In order to develop I would like to expand my knowledge on how we would treat abnormal blood results. However, I am aware that abnormal results for oncology patients differ to other patient groups. Therefore, I am aware of how a cancer diagnosis can impact a patients ‘normal’ biology.

I have also gained good knowledge of medications that are commonly used medications. For example, if a patient complains of sickness to me I am able to read the drug chart and select an appropriate medication for their symptoms, using my ‘rights’ of medication. I would like to continue to develop my knowledge of medications and will do this using the BNF app and other reliable resources. In future practice I will encounter different patient groups and will continue to research and expand my knowledge of medications I commonly encounter there. I have also been actively involved in checking SACT medication with my mentor and feel confident using my ABCDE of chemo.

I was very lucky to do a couple of discovery days with the breast care nursing team. These gave me an insight into other parts of the patient’s journey, as an outpatient as I only have experience within an inpatient setting. This gave me an insight into diagnostics and treatment plans that bring people into a ward setting! In order to develop I will continue to do discovery days to expand my knowledge on different parts of patient care.

During this placement I have managed to achieve all my part 1 proficiencies and even some for my part 1&2 crossover. My communication skills have been a key focus throughout this placement and have been something I have been given the opportunity to develop throughout this placement opportunity. I have shadowed my mentor being in charge and have taken part in MDT meetings and handovers. I have delivered both bedside handover and the ward huddle. I feel confident in being able to discuss patients and their treatment plans. In order to develop I need to be mindful of how fast I talk sometimes and make sure I give people enough time to absorb information I deliver.

I have been able to practice dressing changes on this placement using ANTT. I feel more confident in doing this compared to when I started this placement. In order to develop I would like to continue to practice this skill with less guidance from my mentor.

I have had a lot of practice of drug calculations and have been actively involved in medications management. It has been nice to practice drug calculations in real practice. However, I would like to maintain and develop this confidence so I will continue to practice drug calculations using resources such as safe medicate.

During this placement I have experienced highly emotive situations. I have met many patients who have a poor/short prognosis and have witnessed people receive bad news. I am able to regulate my emotions and provide a listening ear to my patients. I feel that I communicate with my patients and give them time to talk through their emotions, thoughts and feelings towards news or treatment plans. In order to improve I would like to shadow the palliative CNS team in the future to learn how to better structure conversations around death and bad news. I have also been fortunate to give patients good news!

I believe that I am self motivated and able to effectively manage my own workload. I am aware of what needs to be done. When my mentors are busy I am able to go off and work independently within the limits of my competence and feedback to my mentors what I have done and escalate any concerns. If my patient has an abnormal NEWS score or abnormal blood results I feel confident to pick up the phone and escalate this to the appropriate team if my mentor is busy.

The ward can get really busy with patients having SACT treatment and sometimes there are not parts of this I can be involved in. in these situations I will go and check with the other nurses on shift if there is anything I can do to help them or their patients. As I move through the parts I hope to continue to build confidence and be able to practice with increasing independence.

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