Apprenticeship Learning Log

Date of Learning: 20^th of September 2024

Time: 09:30 – 16:30

Title of learning activity: Reflection – Induction & welcome week

Diary of Learning activity

Tri-partites meeting between 07th – 285h of October, to be arranged with line manager & lecturer.  To check availability with line manager closer to time, approximately 45 minutes duration.

Uniform issues/replacement – email student@grahamgardner.co.uk

Confirm identity, university, campus course & revision/amendment required

SWOT analysis & SMART objectives – SWOT analysis identifies strength, weakness, opportunities & stress

SWOT is an acronym for Strengths, Weaknesses, Opportunities, Threats.  The technique is credited to Albert Humphrey who led a research project at Stanford University in the 1960s and 1970s using data from leading companies involved in long range planning processes.

A SWOT analysis is a planning tool used to understand key factors – strengths, weaknesses, opportunities, and threats – involved in a project or in an organisation. It involves stating the objective of the organisation or project and identifying the internal and external factors that are either supportive or unfavourable to achieving that objective. SWOT is often used as part of a strategic or planning process, but can be applied to help understand an organisation or a situation, and also for decision-making for many different scenarios.

However, while the elements can appear deceptively simple and easy to apply, experience shows that to do a SWOT analysis that’s both effective and meaningful, requires time and a significant resource. Deciding what the strengths and weaknesses of an organisation are, as well as assessing the impact and probability of opportunities and threats, is far more complex than first appears. It requires a team effort and can’t be done effectively by just one person.

A SWOT analysis process generates information that is helpful in matching an organisation or group’s goals, programs, and capacities to the environment in which it operates. The ‘SWOT’ itself is only a data capture exercise – the analysis follows later.

• Strengths: positive tangible and intangible attributes, internal to an organisation and within the organisation’s control
• Weaknesses: internal factors within an organisation’s control that detract from the organisation’s ability to attain the desired goal. Which areas might the organisation improve?
• Opportunities: external attractive factors that represent the reason for an organisation to exist and develop. What opportunities exist in the environment, which will propel the organisation? Identify them by their ‘time frames’.
• Threats: external factors beyond the organisation’s control which could place the organisation mission or operation at risk. The organisation may benefit by having contingency plans to address them if they should occur. Classify them by their severity and probability of occurrence.

S.W.O.T Analysis For Personal Development – Andrew Cussons http://www.andrewcussons.com/s-w-o-t-analysis-for-personal-development/

SWOT ANALYSIS https://www.marketing91.com/swot-analysis/

SMART objectives is a useful guide for setting objectives, specific, measurable, achievable, relevant, time-based.  SMART can help when setting new goals for your next appraisal as a way to work on potential plans, ideas to improve, and achieve set goals.

Your objective should clearly state what you or the person needs to achieve. It should include a direction of movement or action, and your objective should describe what needs to be achieved. For example:

• Increase
• Decrease
• Apply
• Change
• Start
• Complete
• Understand
• Improve

Measurable

Your objective should include a measure that shows how you will know the objective has been met or the goal achieved. This measure needs to be tangible, able to be monitored and proof available that the objective has been met or the goal achieved. This could be:

• A KPI (key performance indicator)
• A standard
• A result
• Completion of something

Achievable

The goal or objective must be possible to achieve. Sometimes, you might need to stretch yourself to achieve it, but it should not be impossible.

Realistic

The objective or goal must be realistic in that it is in your realm of responsibility or authority to achieve it. Is it part of your role? Do you have the right authority, responsibility, tools, time and resources to achieve it?

Time-bound

The objective or goal must have a time of when it will be achieved. This can be a fixed point in the future or a reoccurring time if the objective is a regular task you complete as part of your job.

SMART is essentially a checklist you can apply to an objective you have written to ensure it is all of the above and, therefore a SMART objective or a SMART goal.

2024.25 Care delivery 1 (CNR040C115Y) on MOODLE

Oximetry – how does it work? By transmitting light through a finger, it can identify whether oxygen in the blood is at a normal level.

Pulse oximetry is a quick non-invasive monitoring technique that measures the oxygen saturation in the blood by shining light at specific wavelengths through tissue, most commonly the fingernail bed.  Deoxygenated and oxygenated haemoglobin absorb light at different wavelengths, 660 nm, and 940 nm, respectively.  The absorbed light is processed by a proprietary algorithm in the pulse oximeter to display a saturation value.

In most developed countries, pulse oximetry is the standard of care to monitor oxygen saturation for patients receiving anaesthesia.  Pulse oximetry is also used in emergency  departments, hospital wards, and ambulances to assess the blood oxygenation in patients with respiratory difficulties or to monitor the potential respiratory depressant effects of pain medications.

Can hypoxia happen with 100% SPO2?

Hypoxia is a condition where the body’s tissues don’t receive enough oxygen.  A normal resting oxygen saturation for a healthy individual at sea level is between 95% and 100%.  If oxygen saturation level drops below 92%, one should contact a healthcare provider, if it drops to 88% to seek immediate medical attention.

It is possible for hypoxia to happen even at 100% oxygen saturation if exposed to 100% oxygen for a prolonged period of time.  Breathing 100% oxygen  at normal pressure can lead to acute oxygen poisoning, which can cause symptoms such as:

• Fluid in the lungs
• Hyperventilation or laboured breathing
• Chest pains
• Mild burning on inhalation
• Uncontrollable coughing sometimes with blood

Hypoxemia is a term that describes low levels of oxygen in the blood, specifically within the arterial blood.  The condition may indicate a problem with blood circulation or breathing and may present symptoms such as shortness of breath.  Hypoxemia can occur for a number of reasons, which can involve underlying medical conditions such as chronic obstructive pulmonary disease (COPD), asthma, and anaemia.

Symptoms of low blood oxygen levels – low blood oxygen levels can result in abnormal circulation and cause the following symptoms, depending on severity:

• Shortness of breath
• Headaches
• Restlessness
• Dizziness
• Rapid breathing
• Chest pain
• Confusion
• High blood pressure
• Lack of coordination
• Visual disorders
• Rapid heartbeat

Causes of low blood oxygen:

• Insufficient oxygen in the air
• An inability of the lungs to inhale and send oxygen to all cells and tissues
• An inability of the bloodstream to circulate to the lungs, collect oxygen, and to transport it around the body

Conditions that can lead to hypoxemia:

Several medical conditions and situations can contribute to the above factors, including:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Interstitial lung disease
• Pulmonary hypertension
• Bronchiectasis
• Emphysema
• Acute respiratory distress syndrome (ARDS)
• Pneumonia
• Obstruction of an artery in the lung
• Pulmonary fibrosis, or scarring and damage to the lungs
• Presence of air or gas in the chest that makes the lung collapse
• Excess of fluid in the lungs

People should contact a doctor if they experience:

• Severe and sudden shortness of breath
• Shortness of breath when at rest#
• Severe shortness of breath that worsens during exercise or physical activity
• Irritability or confusion
• A rapid or irregular heartbeat
• Skin discoloration

Vital signs

A healthy human body is able to self-regulate through homeostasis, which is the body’s natural ability to maintain a stable internal environment by correcting abnormal conditions and balancing bodily processes.  Vital signs are indicators of the body’s ability to maintain homeostasis.

The four main vital signs routinely monitored by medical professionals and healthcare providers include the following:

• Body temperature
• Pulse rate
• Respiration rate
• Blood pressure

Vital sign measurements are considered important as they measure some of the body’s vital functions and provide necessary information about the patient’s physical wellbeing

The most important aspect of vital signs – heart rate (pulse)

Pulse rate is the number of times the heart beats per minute (bpm).  During the cardiac cycle, the pulse is the wave of blood that courses through the body when the left ventricle contracts.  After contraction, the heart rests as the cardiac muscle relaxes and the ventricle is filling with blood again.  Each pulse beat represents one complete cardiac cycle or one heartbeat – contraction and relaxation.

In a healthy adult, a normal per-minute resting heart ranges from 60 to 100 beats a minute.  With physical exertion, the muscles require more oxygen, resulting in an increased heart (pulse) rate and respiration (breathing) rate.

A resting pulse rate above 100 bpm is considered to be a rapid pulse rate, or tachycardia, and a rate below 60 bpm is considered to be a slow pulse rate, or bradycardia

Rhythm refers to the regularity, or equal spacing, of all the beats of the pulse.  Normally, the intervals between each heartbeat are of the same duration.  A pulse with an irregular rhythm is known as dysrhythmia or arrhythmia.  The irregular rhythm may be either a set of random irregular beats or a predictable pattern of irregular beats.  An intermittent pulse occurs when the heart occasionally skips a beat.  This is not considered abnormal if it does not happen frequently.  Exercise or drinking a caffeine-rich beverage may cause this to occur.  However, if arrhythmia occurs on a consistent basis, it may indicate heart disease and should be brought to the attention of the physician.  If an irregular pulse is detected, the apical pulse should be assessed.  The clinician may also order further testing, such as an electrocardiogram (ECG), to further assess the arrhythmia.

Pulse sites – there are 9 areas in the body that allow for easy measurement of the pulse

• Temporal – At side of head just above the ear
• Carotid – At side of neck between larynx and sternocleidomastoid muscle (pulse used in CPR)
• Apical – At apex of heart, left of sternum, 4th of 5th intercostal space below the nipple
• Femoral – In groin where femoral artery passes to leg
• Brachial – Inner (antecubital fossa/space) aspect of the elbow (pulse heard when taking BP)
• Radial – Thumb side of wrist about 1 inch below base of thumb (most frequently used site)
• Popliteal – Behind the knee, pulse located deeply behind the knee and felt where knee is slightly bent)
• Posterior tibial – On medial surface of ankle near ankle bone
• Dorsalis pedis arteries – On top of foot slightly lateral to midline, helps assess adequate blood circulation to the foot

Practical session – pulse check, respiration rate, SPO2

What is SWOT analysis? CIPD https://www.cipd.org/uk/knowledge/factsheets/swot-analysis-factsheet/

The SWOT Framework, CIPD https://www.cipd.org/uk/knowledge/factsheets/swot-analysis-factsheet/

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

S15: Identify people who are eligible for health screening

S16: Promote health and prevent ill health by understanding the evidence base for immunisation, vaccination and herd immunity

S17: Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance

S18: Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions

S19: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent

S20: Recognise people at risk of abuse, self-harm and/or suicidal ideation and the situations that may put them and others at risk

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes

S22: Take personal responsibility to ensure that relevant information is shared according to local policy and appropriate immediate action is taken to provide adequate safeguarding and that concerns are escalated

S23: Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate

S24: Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

S29: Give information and support to people who are dying, their families and the bereaved and provide care to the deceased

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed

S31: Act in line with any end of life decisions and orders, organ and tissue donation protocols, infection protocols, advanced planning decisions, living wills and lasting powers of attorney for health

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams

S33: Maintain safe work and care environments

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required

Apprenticeship Learning Log

Date of Learning: 19^th of September 2024

Time: 09:30 – 16:30

Title of learning activity: Reflection – Induction & welcome week

Diary of Learning activity

Introduction to Tri-partites – starting in October

Theory hours log – how to log study hours, self-directed study time at work, including training.

Developing professional and academic skills for Nursing Associates CNR020C112A – Developing professional values and behaviours.  Introduction to the NMC Code and the 6Cs

The NMC Code – The Code contains the professional standards that registered nurses, midwives and nursing associates must uphold in direct patient care and in leadership, research and education.

The Nursing and Midwifery Council Code: The code represents the professional standards that nurses, midwives and nursing associates must uphold in order to be registered to practise in the UK.

It is structured around four themes – prioritise people, practice effectively, preserve safety, and promote professionalism and trust.

The Code contains a series of statements that taken together signify what good practice by nurses, midwives and nursing associates look like.  It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism.

“Anyone practising as a registered nurse or midwife in the UK, or a nursing associate in England.”

Their role includes and is not limited to:

Prioritise people – According to the NMC, nursing associates are expected to put the interests of people first.  “You make their care and safety your main concern and make sure that their dignity is recognised, assessed and responded to.  You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.”

Treat people as individuals and uphold their dignity:

To achieve this, NA must:

• Treat people with kindness, respect and compassion
• Make sure you deliver the fundamentals of care effectively.
• Avoid making assumptions and recognise diversity and individual choice.
• Make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay.
• Respect and uphold people’s human rights.

The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions.  It includes making sure that those receiving care have adequate access to nutrition and hydration, making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.

The Registered nursing associate: an overview, Nursing Associates Ian Peate 23 March 2023, British Journal of Nursing, https://www.britishjournalofnursing.com

NMC Nursing and Midwifery Council, https://www.nmc.org.uk/standards/code/

The 6Cs of Care: What they are and what do they mean

The 6Cs core values are considered as qualities and standards all members (irrespective of their position and area of expertise) of any organisation or Trust actively involved in healthcare and working with and around patients are called to identify and relate to as much as possible.  Adherence to these values is a guarantee of excellence in the service delivered by nurses and healthcare workers to the public, ensuring service users receive consistent care and support in the different stages of sickness, treatment and end of life or on their path to recovery.

Care is one of the most important qualities required in the health service.  The lack of is far more detrimental to the patients; bearing negative impact on the service users, their families and relatives as well as the wellbeing and integrity of staff members failing to provide adequate care or others finding themselves in a constant struggle to maintain a consistent level of service to individuals.  Lack of care may result into a high level of complaints and disputes which could negatively affect the corporate /business image of the organisation, whistleblowing to the independent regulator leading to investigation and drastic measures e.g., suspension of services, lawsuits and job losses.

Compassion is defined as “sympathy and concern for the sufferings or misfortunes of others” and is such an important notion one would ideally keep in mind when interacting with patients and individuals, either directly or indirectly affected by sickness and poor health.  Compassion allows workers to cement and improve the relationship so much needed between patients and healthcare professionals; it is solely based on the ability to display empathy, provide person-centred care and holistic approach, to respond to the medical and mental health needs of service users.  People in need of care are often at their most vulnerable and those close to them are highly sensitive should they perceive care given is not right for their loved ones.

Competence is the state where all (sizeable as an independent individual, part of a team or a larger unit) in employment within any organisation providing healthcare services are able to practise based on the appropriate level of skills and abilities gained through continuous training, positive and result-yielding experience, adherence to agreed ways of working, policies and procedures.  Similarly, any organisation working in the patient’s best interest base their treatment and research on the use of appropriate equipment, technology, proper settings & environment, up-to-date clinical and latest technological knowledge.

Communication is essential in the early stages of establishing contact with the patient and their close ones, to help gain their trust, garner essential information on their medical condition (patient history) and how it could be affecting their quality of life.  Moreover, appropriate and respectful communication would involve active listening, making sure the patient or their advocate/next of kin is supported and involved in the decision-making process around their care and treatment in line with the Mental Capacity Act, so as to reach a mutual understanding and agreement.  Communication is also important across healthcare professionals and medical teams to ensure treatment and care is delivered efficiently in the service user’s best interest.

Courage is to muster the strength and will to stand out against malpractice and to speak up where legitimate concerns should the health and wellbeing of both patients and staff members alike is at risk.  It also takes courage and requires resilience for healthcare workers to stay open-minded and willing to abandon safety of limited perception, at times considered as misleading outdated views, and obsolete methods to keep up with everchanging and innovative ways of working.

Commitment is going that extra mile and beyond for those in need of lifesaving care, irrespective of their characteristics in such a way that all patients can be treated without bias, commitment is both a personal and team effort dedicated to maintain or improve the care and experience of all our patients

What does professionalism mean to you?

The definition of professionalism is the combination of all the qualities connected with trained and skilled people, where an individual is dictated to conduct oneself with responsibility, integrity, accountability and excellence.

In a clinical setting/environment, professionalism reflects on an individual’s behaviour at work, in their job role and interaction with service users and staff members alike.  It is applying and promoting agreed policies and procedures in their daily activities, encouraging their peers to remain focused on SOPs, and agreed ways of working, ability to show accountability for their actions and to explain the rationale for their initiatives, promoting integrity, workplace values and mission.

Professionalism is following national guidance and legislation, working in towards:

Promoting and respecting protected characteristics under the Equality Act 2010

Dignity and confidentiality, safeguarding and initiating measures to protect vulnerable individuals – reporting and escalating as required.

Whistleblowing and challenging discrimination, direct or indirect as well as practices putting oneself and others at risk.

Not engaging or coercing in activities that are not within their competence and skills.

Respecting and using the organisation’s resources effectively

Always maintaining an acceptable attitude at work, friendly while maintaining healthy boundaries with patients/public/visitors/colleagues, refrain from engaging in gossiping, adhering to the dress code at work, allowing others to engage and express their point of view (ideas, feelings, distress) with good communication and listening skills, showing their understanding and attentive to their own body language as well as others.

Introduction to module on Tuesday 24.09.2024

Principles of academic writing – Wednesday 25.09.2024

KSBs addressed:

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health

K7: Understand the importance of courage and transparency and apply the Duty of Candour

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

K31: Understand how inadequate staffing levels impact on the ability to provide safe care and escalate concerns appropriately

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements

S2: Keep complete, clear, accurate and timely records

S3: Recognise and report any factors that may adversely impact safe and effective care provision

S4: Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills

S6: Act as an ambassador for their profession and promote public confidence in health and care services

S7: Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges

S8: Recognise signs of vulnerability in self or colleagues and the action required to minimise risks to health

S9: Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues

S10: Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments

S11: Report any situations, behaviours or errors that could result in poor care outcomes

S12: Challenge or report discriminatory behaviour

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing

S24: Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed

S33: Maintain safe work and care environments

S34: Act in line with local and national organisational frameworks, legislation and regulations to report risks, and implement actions as instructed, following up and escalating as required

S36: Respond to and escalate potential hazards that may affect the safety of people

S42: Support, supervise and act as a role model to nursing associate students, health care support workers and those new to care roles, review the quality of the care they provide, promoting reflection and providing constructive feedback

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness