Apprenticeship Learning Log

Date of Learning: 19/04/2024

Time: 13:30-16:30

Title of learning activity: Session 1: Medicine management/Drug calculation/Safe medicate practice

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

• To discuss the requirements for the medicines management component of the e-pad and experiences.
• To reinforce the understanding of the role of the nursing associate in medicines administration.
• To increase knowledge and understanding of mental capacity assessment in relation to medicines administration.
• To critically consider scenarios based on clinical practice.

In this session we have the medicine management, drug calculations and safe medicate.

The session is about medicine management and drug calculation, focusing on the role of nursing associates in making sure the safe and effective medication administration. The session discussed the understanding of legal, ethical, and practical considerations of medicine administration, particularly in complex situations involving mental capacity and consent. The drug calculations focused was on improving basic numeracy skills and unit conversions, both of which are important for ensuring precise drug dosing and patient safety.

I recognised the importance of conducting thorough assessments, understanding patient consent, and adhering to legal frameworks, especially in relation to the Mental Capacity Act (2005).

The session is important as both medicine and drug calculations are vital to my professional role. The administration of incorrect medications or dosages can lead to severe, potential life-threatening outcomes for patients. A thorough understanding of the legal aspects surrounding mental capacity is essential to uphold patients’ and to ensure that treatments are delivered ethically, even when the patient are unable to make decisions themselves.

In the future, I will focus in regular practice of drug calculations to enhance my confidence and proficiency, making sure I can perform these tasks quickly and accurately in a clinical setting. I will also aim to expand my understanding of the legal framework surrounding medicine administration, particularly regarding mental capacity assessments, so I can better navigate complex clinical scenarios.

Additionally, I will prioritise remaining informed about the local and national guidelines on medication management, making sure that I am always equipped to make informed decisions regarding patient care. Finally, I will concentrate on improving my communication skills to ensure a clear understanding of the patient’s perspective, particularly in discussion related to consent or the refusal of medication.

KBS addressed:

Knowledges:

K1, K4, K6, K7,K14, K2o, K21, K27, K28, K29, K30, K37,

Skills:

S1, S2, S4, S5, S6, S7, S19, S22, S25, S33, S42,

Behaviours:

B1, B2, B3

Apprenticeship Learning Log

Date of Learning: 19/04/2024

Time: 09:30 to 12:30

Title of learning activity: Session 5: Renal patients and decision making AKI (done jus the kbs)

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

Apprenticeship Learning Log

Date of Learning: 12/04/2024: Sepsis

Time: 13:30- 16:30

Title of learning activity: Session 4:Sepsis

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

1)Define sepsis

2)Understand the pathophysiology of sepsis

3)Discuss long term and short term management of sepsis

4)Gain knowledge about complications of sepsis

During the session of sepsis, I learned about what sepsis is, how it affects the body, its risk factors, treatments and possible complications. The session highlighted that sepsis is a dysregulated bodily response that results in organ damage rather than just a serious illness. This is important because it changes the emphasis from treating the illness with antibiotics alone to treating the more extensive systematic problems that sepsis brings on.

Ealy detection and management are vital, as noted by the Sepsis-3 recommendation and the National Institute for Health and Care Excellence (NICE).  ‘Red Flag Sepsis’, is a concept which provides a practical approach for healthcare professionals, especially in identifying and managing sepsis promptly.

Reflecting on this session has improved my understanding of sepsis and its impact on patient care. Recognizing and responding to sepsis early is essential to reduce death rates.

The in-depth study of sepsis risk factors and pathophysiology helped me see its complexities. For example, the involvement of multiple organ systems and the risk of quick decline in patient with sepsis highlight the need for thorough patient monitoring and tools like the qSOFA and NEWS2 scoring systems.

Additionally, learning about the long-term effects of sepsis, such as Post-Sepsis Syndrome and its physical and mental impacts, has broadened my view on patient care. This information reinforces the need for a multidisciplinary approach in managing sepsis survivors, addressing not only the immediate threats but also the long-term rehabilitation and support needs.

I will apply this knowledge into my clinical practice by maintaining a high index of suspicion for sepsis in patients presenting with infection, especially those with known risk factors. I will also ensure that I am vigilant in using the qSOFA and NEWS2 tools to aid in the early identification of sepsis and prompt escalation of care.

I will be more proactive in explaining to patients and their families the seriousness of sepsis and the importance of early intervention. This will include clarifying that while antibiotics are essential, they are not the sole treatment for sepsis, and managing the body’s response is equally critical.

Lastly, I will advocate for improved follow-up and support systems for sepsis survivors within my practice, understanding the ongoing difficulties they encounter. This may include collaborating with the multidisciplinary team to provide holistic care that address the physical, cognitive and psychological effects of sepsis.

KBS addressed:

Knowledges:

K1, K4, K6, K9, K13, K17, K18, K19, K21, K22,  K24, K30,

S Skills

S1, S2, S4, S6, S7,  S17,

Behaviours:

B1, B2, B3

Apprenticeship Learning Log

Date of Learning: 11/04/2023

Time: 9:30 to 12:30

Title of learning activity: Session 3: Understanding long term (LT)/complex conditions in patients with learning disability (LD)

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

• To review and discuss what students already know about the strengths and challenges of people with learning disabilities
• To consider the concept of neurodiversity and how it links to learning disability
• To explore how health inequalities affect the learning disability population
• To consider core assessment approaches
• To identify top-tips from a healthcare professional lens
• To explore the perspectives of carers with lived experiences and how students can make positive changes

In this session, I learned about the management of long-term conditions in people with learning disabilities (LD). The session emphasised the prevalence of various conditions like coronary heart disease, diabetes, dementia, and epilepsy among this population. It also explored the challenges people with LD face, such as assessing healthcare services, experiencing diagnostic overshadowing, and facing communication barriers. A significant focus was placed on the necessity of person-centred care, regular health checks, and the adoption of a biopsychosocial model of assessment. The session also covered the neurodiversity framework, which acknowledge different cognitive functioning in conditions such as dyslexia, dyspraxia, autism and ADHD, each with its own set of challenges and strengths.

This session has improved my understanding of the health disparities experienced by individuals with learning disabilities. It was enlightening to understand the extend of health inequalities and how these can lead to preventable conditions and earlier deaths. Moreover, recognising the unique strengths and challenges associated with neurodiversity has encouraged me to reconsider my approach to treating patients with LD. It also highlighted my own knowledge gaps regarding reasonable adjustments that could be implemented in healthcare settings to improve accessibility for this group.

I intend to adopt a more comprehensive approach when engaging with patient with LD. This will involve advocating for the use of more accessible communication tools like easy- to read formats and promoting regular health checks for individuals with learning disabilities. Furthermore, I will actively work towards actively participating in creating more inclusive environments by ensuring the individuals with LD are involved in decision-making processes about their care. The challenges of these individuals face in healthcare system has strengthened my dedication to ongoing education, particularly concerning the manifestations of various conditions associated with LD and the importance of avoiding diagnostic overshadowing.

I will actively pursue opportunities to engage with multidisciplinary team (MDT) to facilitate comprehensive assessments and care plans are developed not only on physical health but also on mental and social well-being. Lastly, the session has inspired me to become an advocate for the reduction of health disparities, which will influence my approach to patient care as a nursing associate.

KSB addressed:

Knowledges:

K1, K4, K6, K7, K8, K9, K11, K12, K13, K14, K17, K18, K19, K20, K21, K24, K26, K3o, K36, K37, K38, K39, K41, K43

Skills:

S1, S2, S3, S4, S6, S7, S10, S22, S31, S32, S42, S44

Behaviours:

B1, B2, B3

Apprenticeship Learning log

Date of Learning: 11/04/2023

Time: 13:30 – 16:30

Title of learning activity: Session 4: Complex Respiratory conditions

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

• Identify signs & causes of airway obstruction
• Discuss airway adjuncts and management techniques
• Define Type 1 & Type 2 Respiratory failure
• Demonstrate understanding of pathophysiology, assessment and management of common respiratory problems
• Consider theoretical & practical aspects of oxygen administration
• State appropriate targets for oxygen administration in different health conditions & give rationale
• Describe respiratory support available to support patients with respiratory failure

This session enhanced my knowledge on the complexities involved in managing respiratory conditions such as asthma, pneumonia, and chronic obstructive pulmonary disease (COPD). It covered the pathophysiological mechanisms of these diseases, their assessment, and a range of treatment approaches, including oxygen therapy, ventilatory support, and airway management. I gained insights into critical signs of respiratory distress, including the use of accessory muscles, abnormal oxygen saturation levels, and altered mental status. Additionally, the session emphasised the importance of recognising the root causes of respiratory distress and implementing appropriate intervention, especially in emergency situations.

This session emphasises the complexity of managing respiratory conditions and the critical role of nurses or nurse associates in ensuring patients receive appropriate care. The detailed discussion about oxygen therapy made me realise the delicate balance between helping a patient and potentially worsening their condition through improper oxygen administration. I became more aware of the necessity of understanding blood gas results to tailor oxygen therapy accurately. Moreover, I understood how critical early detection of respiratory failure is and the role of non-invasive and invasive ventilation in supporting patients with type 1 and type 2 respiratory failure. This made me reflect on the need for vigilance and timely action in respiratory emergencies.

I will focus on improving my understanding of the different respiratory conditions and the specific interventions required for each. I will practice interpreting blood gas results and familiarising myself with oxygen therapy equipment to ensure safe and effective use. Additionally, I will review and practice the ABCDE assessment approach to improve my skills in recognising and responding to respiratory emergencies. By improving these critical skills, I can ensure that I provide timely and appropriate care to patients with complex respiratory needs, improving outcomes and patient safety.

KSBs addressed:

Knowledges:

K1, K4, K6, K7, K12, K13, K14, K17,  K18, K19, K21, K24, K27, K28, K29, K30,K35, K37,

S Skills

S1, S2, S4, S6, S7, S10,S15, S16, S42

B             Behaviours

B1, B2, B3

Apprenticeship Learning Log

Date of Learning: 05/04/2024

Time: 9:30-12:30

Title of learning activity: Session 1: Introduction to module and assignement and clinical decision making

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Learning outcomes:

a. Will know about the module in general

b. Can understand the details of the module assignments

c. Will explore decision making and clinical judgement briefly

During the session, my lecturer disccused the introduction to module and assignment expection, including the structure and submissio ndates.

The session continued discussing about clinical decision-making in nursing practice, highlighting how difficult it may be to make decision that are safe, patient-centred and in unpredictable situations. There are factors that can contributed in affecting on decision-making and this are the patient, the environment, my role as a nursing associate and my knowledge of the evidence. I learned the importance to methodically collect and analyse patient data in order to asses results and make well-informed judgements. Applications of evidence-based clinical judgement, acknowledging bias in decision making and using tools such as SMART objectives and SBAR were highlighted.

It was stressed the importance of the need of flexibility and reflection in clinical decision-making in the session. It showed me that good decision are built on patient data, research, experience and the input of others. This session reminded me to question my biases and not rely soley on patterns and intuitions. I also realised the imporatnce of person-centred care, understanding that patients’ comorbidites and preferences might differ from what clinical judgement suggest. I benefited in understanding this to ensure that my decision align with the patient values and preferences and that is a key for providing holistic, patient-centred care.

In the future, I hope to widen my understanding of evidence-based methods and improved my proficiency using clinical tools like SBAR. I will try to adapt care plans to the patient’s social situation, preferences and comorbidities. I also need to work on figuring out information that is required for each patient and practising asking appropriate questions. In order to improve patient outcomes and adjust my practise to the changing clinical environment, I will continously reflect on my clinical decision and take into account diverse perspectives.

KSB addressed:

Knowledges

K1, K4, K11, K13, K21, K26, K31, K33, K34, K36, K37, K38, K42,

Skills

S1, S2, S4, S5, S7, S10,

Behaviours

B1, B2, B3

Date of Learning: 05/04/2024

Time: 13:30-16:30

Title of learning activity: Session: 2 A-E Assessment/SBAR/NEWS2

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Learning outcomes:

• Interpret data documented on NEWS2 observation chart
• Identify appropriate thresholds for escalation based on NEWS2
• Understand principles of rapid patient assessment using systematic ABCDE approach
• Demonstrate awareness of additional assessment data

The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) assessment was covered in this session and it demonstrated a systematic approach to patient care. The ABCDE approach prioritises early detection of life-threating conditions and prioritises treatment based on severity. It involves using the National Early Warning Score (NEWS2), which monitors physiological parameters, and the Situation Background Assessment and Recommendation (SBAR) tool for escalation procedures. It also emphasises the significance of clinical judgement, interdisciplinary communication, clinical judgement, and the integration of ethical and legal frameworks.

This session is important to improve patient outcomes by using a structured, standardised approach. The ABCDE assessment enables nurses or nursing associates to identify early signs of deterioration, which can be crucial in preventing adverse events such as sepsis or cardiac arrest. The emphasis on evidence-based intervention and teamwork also reflects the modern healthcare multidisciplinary nature, where communication is key. This approach is especially relevant for patients in acute or emergency settings, where decisions must be made quickly and with accuracy.

I recognise that my clinical decision-making could be enhanced through the systematic application of the ABCDE assessment, familiarising myself with the NEWS2 chart and its thresholds and SBAR tool. By adopting this approach, I can respond more effectively to critical situations, thereby minimising potential risks to patients. The session also reminded me of the need to rely on clinical judgement, emphasising that if something feels wrong, it is crucial to escalate the matter.

Looking ahead, I intend to practice utilising the ABCDE assessment more consistently in both clinical simulations and real-life scenarios to increase my proficiency. Furthermore, I will prioritise becoming familiar with the NEWS2 chart and its associated thresholds, particularly for patients at risk of sepsis. Additionally, I must improve my communication skills, especially in conveying concerns to the interdisciplinary team using the SBAR tool. This will enable me to advocate for patients more effectively when necessary. Finally, I will concentrate on deepening my understanding of the ethical and legal considerations in acute care to facilitate well-informed decision-making in complex scenarios.

KSB addressed:

Knowledges:

K1, K4, K6, K7, K8, K18, K19, K20, K25, K26, K33, K36, K37, K41

Skills:

S1, S2, S3, S4, S5, S6, S7,S22, S40 S42

Behaviours:

B1, B2, B3

Apprenticeship Learning Log

Date of Learning: 04/04/2024

Time: 9:30-16:30

Title of learning activity: Session 1: Introduction to module and assignement

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

During the session, I meet my academic tutor for second year. She discussed the module and assignment expectations, including the structure and submission dates. This module will expand on my knowledge from Part 1 and deepen my understanding of long-term conditions, co-morbidities, and complex care. It will cover various long-term conditions such as mental health issues, diabetes, stroke, dementia, cancer, heart failure, respiratory diseases, and neurological conditions. The focus will be on assessment skills, care planning and person-centred care based on evidence-based guidelines while care planning will include maintenance and managing acute exacerbations both in and out the hospital. I will also gain understanding the impact of health and social care policy on care delivery outside the hospital, including integrated health and care services.
I also met one member of academic achievement team which discussed the importance of academic writing format, avoiding common mistakes, and academic integrity which the university has procedures in place to address academic dishonesty.

This session will help as a TNA understand what I need to do for my essay assignments. It will guide me to complete this module and be aware of what needed and what not to do.

KBS addressed:

K             Knowledge

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

K4           Understand the principles of research and how research findings are used to inform evidence-based practice

K6            Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice

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

K9           Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

K11        Understand the factors that may lead to inequalities in health outcomes

K13        Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes

K14        Understand the importance of health screening

K16        Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care

K17        Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care

K18        Understand and apply the principles and processes for making reasonable adjustments

K21        Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care

K35        Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident

K36        Understand the roles of the different providers of health and care

K37        Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs

K38        Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings

K39        Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives

K40        Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services

K41        Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it

K43        Understand the influence of policy and political drivers that impact health and care provision

S Skills

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

S5           Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018)

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

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

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

S33        Maintain safe work and care environments

B             Behaviours

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

Apprenticeship Learning Log

Date of Learning: 04/04/2024

Time: 13:30 -16:30

Title of learning activity: Session 2: Complexities of complex conditions and policies underpinning Long term/ Complex

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

In this session the topic was about understanding complex care. Complex care is given to individual to support their conditions or give extra help to manage their symptoms or daily task. Individual with complex care can be vulnerable because of their conditions. It is important for a nursing associate to have the knowledge and understanding in looking after individual with complex care as it takes longer to diagnos, treat, and look after them due to their co-mobilities. Co-morbidities is defined as more than one conditions or disease at the same time and it can be chronic or long-term conditions. There are load of long-term conditions but the top five are as follows: hypertension, diabetes, cancer, depression and heart disease. The complexity of this conditions can change the health outcomes and it also cost NHS more.

This knowledge will help me as a Trainee Nursing Associate to have knowledge in looking after an individual that needs complex care by understanding the pathophysiology, practice evidence base and follow legal and ethical policies. This knowledge can help in contributing and advocating for the individual on their health outcomes in making sure the individual gets the proper care and treatment that is person centred.

KBS 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.

K4 Understand the principles of research and how research findings are used to inform evidence-based practice.

K6 Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

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

K8 Understand how discriminatory behaviour is exhibited.

K9 Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.

K10 Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11 Understand the factors that may lead to inequalities in health outcomes.

K13 Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes.

K14 Understand the importance of health screening.

K16 Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K18 Understand and apply the principles and processes for making reasonable adjustments.

K21 Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

K26 Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.

K30 Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K32 Understand what constitutes a near miss, a serious adverse event, a critical incident, and a major incident.

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

K34 Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations.

K35 Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident.

K36 Understand the roles of the different providers of health and care.

K37 Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

K38 Understand the complexities of providing mental, cognitive, behavioural, and physical care needs across a wide range of integrated care settings.

K39 Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.

K40 Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings, or services.

K41 Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it

K42 Understand and apply the principles of human factors and environmental factors when working in teams.

K43 Understand the influence of policy and political drivers that impact health and care provision.

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.

S5 Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018)

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.

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, 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.

S35 Accurately undertake risk assessments, using contemporary assessment tools.

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

S37 Participate in data collection to support audit activity and contribute to the implementation of quality improvement strategies.

S38 Prioritise and manage own workload and recognise where elements of care can safely be delegated to other colleagues, carers, and family members.

S39 Recognise when people need help to facilitate equitable access to care, support and escalate concerns appropriately.

S40 Support and motivate other members of the care team and interact confidently with them.

S41 Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others.

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.

S43 Contribute to team reflection activities to promote improvements in practice and services.

S44 Access, input, and apply information and data using a range of methods including digital technologies and share appropriately within interdisciplinary teams.

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.

Apprenticeship Learning Log

Date of Learning: 12/04/2024

Time: 9:30 to 12:30

Title of learning activity: Session 3: Introduction to human factors, managing risk and theory of decision making and clinical judgement and sickle cell

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

Reflection on Learning Activity (include model of reflection e.g. Driscoll or Gibbs):

Learning outcomes:

1. Explore the importance of HF

2. Define HF/Ergonomics

3. Understand the role of clinical decision making and clinical judgement

4. Analyse the policies around decision making

5.  Define sickle cell disease (SCD)

6. Explain the genetics of SCD

7. Understand a little bit of history and how this is passed on to generations and its mechanism

8. discuss the S/S, diagnosis, treatment, and complications

In this session, There were three topics; human factors, managing risk and theory of decision making and clinical judgement and sickle cell disease.

First is about human factors, a video was shown and it shows a person, unfortunately loss her life connected to a lot factors which include human factors.

Human factors/Ergonomics focuses in analysing the relationships between humans and various components within the system. It is also the practice that utilises theories, principles, data and techniques to provide and create design that enhance human health and the overall efficiency of the system. In clinical practice it includes people, system and cultures and mental models.

I have learned that human factors or ergonomics mean the same but one terms may be used more in certain context or sectors and it can be affected by cognitive capacity, workspace, tasks, supervision, teamwork/colleagues, culture and organisation, rules and protocols, and personal stress, alertness, tiredness etc. Outcomes can be improved by being aware of some behaviours such as resolve, ambiguity, intervenes if deviation from standard, concentrates on facts not personalities, does not compete with others, encourages input from others, identify potential threats and errors and use open Q’s and seeks colleagues’ ideas.

In healthcare, there is potential for improvement through the mitigation of error consequence and it can be achieved by implementing measures to trap errors and avoid their occurrence such as standardising equipment, providing comprehensive teaching and training and preventing the administration of similar packets of medication and conducting audits. This can significantly contribute to improve the overall quality and safety of healthcare practices.

Second is managing the risk and theory of decision making and clinical judgement. In this topic I learned that clinical decision making can be simple and complex and it can be affect by knowing the evidence, yourself, environment and the patient/person while decision making process includes using cues and gathering and analysing patient data systematically, making judgement, making decisions and evaluating outcomes.

Last topic was the sickle cell disease (SCD) which is a genetic disorder with abnormal red bl0od cells that are crescent shaped, detached to the oxygen and stick together with other abnormal red blood cells and clogged the small blood vessels and blocks oxygen passing through and prevent the body from having enough supply of oxygen to the body. This abnormal red blood cells can only live for ten to twenty days which normal red blood cells on the other hand can last up to three months. The normal type of haemoglobin and genetics of SCD are Hb A, Hb A2 and Hb F while the abnormal is Hb S, Hb C and Hb E.

Diagnosis of SCD includes conducting a blood test to check for the presence of HbS. A negative indicates the absence of the sickle cell gene while positive result needs further testing to differentiate between sickle cell traits or sickle cell disease. Additionally, low levels of haemoglobin can serve as an indicator of SCD, along with other blood test.

Symptoms of sickle cell disease varies from person to person and change overtime

• anaemia
• fatigue
• pain (chest, abdomen, bones and joints)
• pain varies in the intensity and last for few hours or weeks.
• painful swelling of hands and feet
• frequent infections
• delayed growth
• vision problems

Complications of sickle cells includes;

• stroke
• acute chest symptoms
• pulmonary hypertension
• organ damage
• leg ulcers
• gallstones
• blindness

Treatment of SCD is usually avoiding pain, relieving symptoms and preventing complications

• regular doctor review of pain medication and prevent complications
• bone marrow transplant
• antibiotics
• analgesic
• assessing stroke risk
• vaccinations
• regular blood transfusion
• nitric oxide

There are also some experimental treatments like gene therapy and turning off the defective gene while reactivating another gene

As a TNA all this topic will help me and guide me in better myself in understanding human factors that can affect in healthcare outcomes, knowing and managing the risk of clinical judgement and decision making and also understanding how sickle cell disease develop, signs, symptoms, management and treatment.

KBS 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.

K3 Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and well-being required to meet people’s needs for mental and physical care.

K4 Understand the principles of research and how research findings are used to inform evidence-based practice.

K5 Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.

K6 Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K9 Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.

K10 Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11 Understand the factors that may lead to inequalities in health outcomes.

K14 Understand the importance of health screening.

K16 Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K17 Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care.

K18 Understand and apply the principles and processes for making reasonable adjustments.

K19 Know how and when to escalate to the appropriate professional for expert help and advice.

K21 Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

K22 Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.

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

K30 Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

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

K35 Understand own role and the roles of all other staff at different levels of experience and seniority in the event of a major incident.

K37 Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.

K38 Understand the complexities of providing mental, cognitive, behavioural, and physical care needs across a wide range of integrated care settings.

K42 Understand and apply the principles of human factors and environmental factors when working in teams.

K43 Understand the influence of policy and political drivers that impact health and care provision.

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.

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

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.

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.

S35 Accurately undertake risk assessments, using contemporary assessment tools.

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.

Apprenticeship Learning Log

Date of Learning: 19/01/2024

Time: 9:30-16:30

Title of learning activity Assessment tools

During the discussion, the focus was on various assessment tools that were presented to us. These tools included the National Early Warning Score (NEWS2), Malnutrition Universal Screening Tool (MUST) assessment, Pain assessments, Waterlow assessment and etc. Each of these tools serves as specific purpose in evaluating different aspects of a patient’s condition.

The NEWS2 is a valuable tool that aids in the identification and response to clinical deterioration in adult patients. It plays a crucial rolse in ensuring patient safety and improving overall outcomes. On the other hand, the MUST assessments are a five-step-screening tool designed to identify individuals who are malnourished, at risk of malnutrition, or obese. This tools helps healthcare professional address nutritional concerns effectively. While the Waterlow assessment, utilizes a point-based system to estimate the risk of pressure ulcers in adults. By considering individual data, this assessment helps healthcare providers identify who may be at a higher risk of developing pressure ulcers. Lastly, the Pain assessment is an intrustrment use to measure pain levels in patients.

Habing knowledge about these assessment tools equps me with the ability to conduct comprehensive assessments. By utilizing diferent assessment tools, I can effectively assist in determining, monitoring and developing a personalised plan of care for each individual. This ensures that their specific needs are addressed and that they receive the approporiate care and support.

Apprenticeship Learning Log

Date of Learning: 19/01/2024

Time: 13:30-16:30

Title of learning activity: Wound care

Diary of Learning activity

(itemise learning activity and reflect on the main points of learning from each. You should identify for each entry the relevant KSB)

The discussion revolved around the Aseptic No Touch Technique (ANTT), encompassing its principles, significance, and appropriate application in clinical procedures. The ANTT steps were demonstrated, acompanied by sample videos for better understanding. Furthermore, we explored the various factors that includince wound healing and different techniques for wound cleansing. Sample dressing and other material were shown, allowing us to acquire fundamental knowledge in wound dressing and practical skills in wound management.

This knowledge will enable me to comprehend the significance of wound dressing and wound management in supporting individuals under my care. This knoweldge will also aid in identifying any additional internventions required for individual wounds or providing assurance that can faciliate faster recovery.

KBS addressed: