Essay Writing

So I finally got down to beginning my first academic essay of my nursing career. 

It has to be in in February so yes, I have started it!

It is a reflective piece of writing on my time in placement so I have begun to formulate ideas and put them down on paper. From experience, I know many people would think my word limit (1500 words) is not a great deal and the essay should not take long to do. It shouldn't, if I didn't have to reference everything and research how my university and the School of Nursing like to have things written, as well as wanting to get a good mark. Any one can write 1500 words, but it's including what the markers want to see. 

This includes the size of the font, what type of font, the spacing (usually double), the margin size, if page numbers are needed, is my student number needed, it goes on! 

So that took up a good two hours of my time trawling through university web pages and my module handbooks to find out how things are to be done.  Of course I will also be asking those in the years above how things are to be done as well! 

So yes, essay has begun.  This is because as well as this, I have an exam in February.  I hand my portfolio in as soon as we are due back in January and then I have a lot of assignments and exams all in May. So it will be non-stop over the next few weeks. I am wanting to get as much as possible done however, just so I can have somewhat of a break over the Christmas period.  I definitely do not want to be worrying about getting my work done over Christmas instead of worrying about what to wear and who to get what! 

As this piece is reflective, I am going to use Gibbs Model of Reflection.  

(Image from Google images)

Gibbs model allows me to look at my time on placement and formulate and structure my essay.  I have a 1500 word limit so I have begun by doing my introduction then going into further detail.  I have found it best to start while I am in placement as I can then get the information I may need.  With it being reflective I am talking about what has happened while on placement, so I have needed to omit patient details and placement area details, just as I do on here.  I have replaced the patient's name with a pseudonym and I have followed NMC protocol.  I have found it very useful beginning while on placement as the nurses have been a great help.  They have also been able to help me regarding the patient.  As the patient has learning disabilities, I have had to talk to their named nurse and gain consent for me to refer to them in my essay.  This is due to the patient's lack of capacity in the ability to fully consent.  I could ask the patient, but due to lack of capacity, they would not fully understand the extent in to which I am asking.  
I have found essay writing a lot easier if I plan this first and write down key words of what I want to write about. I have then researched my topic and spent a lot of time in the library going through books, journals and articles.  I have then also spent time on placement reading patient care plans before I have chosen which individual patient I am going to refer to.  I have then also spoke to the other student I am on placement with to ensure I have referenced correctly in regards to the patient care plans etc.  I have also looked at local trust policies and guidelines in relation to the patient and their care.  
For a small essay a lot of work goes into it to ensure that you gain the mark you want to. Leaving it late, you quickly realise that the time goes quickly and you will run out of time to get your ideas down how you want them to. 

More often than not its the references that take time and a fair amount of your word count! So try to do them as you go along and it will make life so much easier. It's important to remember that you cannot do draft after draft asking your tutors to look over it and mark and re-mark it. This is university and it requires a lot of self discipline and your own work. 

A Not So Quick Trip To The Dentist

So this week marks the end of week 3 of placement.

I have again done a lot and some days not so much. I have laminated things, I have designed tables for patient information. I have answered phones and replied to emails.

As I am on placement with a third year I have learnt a lot from them. But in some ways this puts my learning to a disadvantage as they get them to do a lot rather than myself. So I have had to speak up and offer to do these things as well. The staff don't want to rush me or pressure me but I have said with my previous experience I want to be pushed rather than just guided.

This has meant that I have learnt from the student but I have also had to say I want to learn more.

Luckily enough though my mentor has been great and I have had plenty of opportunities. 

This week I have been able to go to the day care facilities, I have been to the dentist who specialises with patients with learning disabilities and I have been able to witness how resettling goes for our patients who are moving to the community and I have had my midway review. This is a discussion between my mentor and I and how we believe my progress is coming along or indeed if I'm not progressing.

My visit to the dentist was definitely eye opening this week. I was lucky enough to have the patient to consent to me being in the room during their treatment and the other health care professionals (HCP's) were more than accommodating. I was able to see the dentist, the dental nurse, the learning disability nurse who works in the dental department and the doctor who is there to oversee things and to administer the medications needed. 

The treatment was, what would to be to you and I, a basic check up and maybe a scale and polish. As this patient was very nervous and unsure of the dentist, the protocols involved in the treatment were quite extensive. The patient has a learning disability, and as such is unable to consent to treatment due to lack of capacity and understanding. This means that the patient's next of kin and carers had to be involved as well as others in a multi disciplinary meeting to ensure that the treatment is in the patient's best interests. Then after the meeting and the outcome has been decided, the various HCP's then have to decide how the treatment will take place and when. 

The patient is monitored and the procedure is explained to them in a way that they may understand and will reassure them. The amount of paperwork and meetings involved for this patient to have a dental check up is quite extensive. During the treatment, the patient's observations are taken and monitored. The patient is given a small amount of sedative to relax them and make them feel at ease by the doctor who is present during treatment. The dentist and dental nurse then work in tandem to complete the treatment, while myself and the specialist learning disability nurse continue to monitor the patient, assessing their respiratory status at all times and reassure the patient and monitor for any signs of distress. The patient's carer meanwhile, waits in the waiting room. The doctor was able to explain to me the medications used and why they are used for patients that are nervous of the dentist. As the medication is a light sedation that has been decided in a multi disciplinary meeting then the patient is deemed to be at risk but a small one. As the patient has their check up and plaque removed, it is thought necessary that the patient again be referred due to a tooth possibly needing further treatment. This will again involve a referral and perhaps several more meetings before it is decided whether to continue further treatment is in that patient's best interests. Health, age, mental status, ability to consent, their capacity and next of kin's opinion is all taken into consideration within these meetings. 

As the patient received a small amount of sedative, they are given medication to counteract this once the treatment is complete. They are monitored within the dental surgery for a short while before they are deemed okay to leave. The venflon is then removed and the patient is again observed for any signs of tenderness or allergic reaction to anything used in the treatment.

Different sized venflons

Before the treatment can even go ahead, the patient's medical records are scrutinised for anything that may deem the treatment unnecessary or that may affect the treatment whilst it is ongoing, such as epilepsy and any medications they may be on for that. 

So for a check up for you and I that may take perhaps ten minutes. this treatment took just over an hour. 

So next time you take a trip to the dentist, please try and remember that even if you feel a little nervous, you are able to reassure yourself and understand what is happening. For someone with a learning disability, this can be the most stressful time, full of anxiety and worry.  It is remarkable the process that goes into ensuring someone with a learning disability can access dental care.  If you happen to care for someone with a learning disability, professionally or personally, then please remember dental care is very important. Dental care is essential, and if someone has toothache or any cavities, this can impact on their diet, their self esteem, their behaviour and perhaps their relationships.  Even if a person has no teeth, gum care and pallet care are still as important. Oral cancer and differentiations in pallet can indicate a multitude of things. Thus the dentist will still require a visit! 

This week? Remember communication isn't just speech, it is your body language, it is music, games, sexual activity, symbols, gestures, objects of reference. It all makes a difference to that person's day. 

Learning Curve

I've now completed 2 out of 6 weeks of placement! 

And I have learnt so much. It has been up and down, busy, tiring and so much fun all at the same time. 

So what have I done this week? 

I have;

Completed a medication drugs round. 

Completed multidisciplinary notes, care notes and analysed blood results. 

Tested urine using urinalysis dip sticks.

Weighed a patient. 

Completed clinical observations and recorded these on a NEWS chart (under observation, then independently).

Taken a finger prick blood sample to test a patient's blood sugar levels then given insulin via a subcutaneous injection (again under observation as insulin is a medication).

Supported the patients with relocation on the ward. 

Helped transfer patients. 

Administered medication (under observation) via a PEG (percutaneous endoscopic gastrostomy) tube. 

Signed in controlled drugs (again under observation). 

Organised the clinical room.

Photocopied notes.

Answered phones.

Supported patients with dental visits.

Received injuries from patients.

I have enjoyed it all!!

I have essentially been kept busy! It has been a very busy and quite a long week. 

But I have loved every minute of it.

It has such a learning curve this week and I cannot thank the nurses enough for the advice and the support they give regarding my learning. I have also met other staff, from the domestics who clean everywhere, the transport bus drivers, the ambulance crew, the support workers, patient's family members, the administration staff, the doctors and I'm sure others in the upcoming weeks. 

It is important to remember that you may gain confidence and feel comfortable in your role, but never get too comfortable that you let your standards drop. You are there to be assessed and monitored in upholding the profession as well as your university. Your mentor may ask for feedback from other staff you have worked with and had any contact with when they are not on shift with you.  You do not have to work every shift with your mentor but it does help.  It has been stated to us that we have to work 40% of our shifts with our mentor. Luckily, my placement have been really understanding and flexible when it comes to student's shifts. They have us in when they are in, when they think it would be useful for us and when we are able. As they are used to having students in as well, the patients have been more than understanding and usually cooperative with us. 

I say usually as this is a hospital for those with learning disabilities. It does mean that they often have mental health needs and very challenging behaviour.  Due to this, I have been scratched twice now and the patients have actually drawn blood. Now I am not trying to scare you off, but I guess somewhat this is a hazard of the job! It shouldn't be, but due to the nature of the patient's disabilities and mental health needs this may happen.  Nursing students are supernumerary. This means we are never to be left on our own with a patient, always observed and never treated as an extra staff member. This is so you can gain the most out of your placement and learn as much as possible. So as I was scratched, this was witnessed and documented.  It's only small and it will heal! 

As for my other achievements this week.....

I used these...

And I analysed a urine sample that a patient was willing to do with the use of a commode, to look at various aspects and report back to the nurse in charge and the doctor.

And this is what you look for.

 

I then was able to draw up liquid medication into various sized syringes and administer these via a PEG tube. For those who have never dealt with a PEG, the picture below should give you an idea. These are usually in place for people that have no swallowing reflex left or have severe swallowing difficulties.  Usually it is a last resort after all other methods, such as the use of thickener in fluids, has been tried.

I am lucky in that I have experience of PEG tubes before.  More so than some of the nurses I work with. This goes to show, as you go through your training and into your career, you find your niche of where you want to work. So regardless of the branch of nursing you will do, you will always meet a nurse who will have knowledge and skills that you or another nurse does not. This is because you become specialised in your area.  You develop your knowledge and skills and you can hopefully progress within this area.  

For keeping records, a NEWS chart is a National Early Warning Score. This enables health professionals to see when a person may be at risk of deterioration. 

As you can see, they are self explanatory but it is worth reading up on these as a lot of hospitals will use them.  The table below shows the scores and how these will then tally up to give you a final score. The higher the score, or if they score 3 in any one area, then the more at risk the patient.

(All images have been taken from Google images)

Next week I have my midway review with my mentor. The week after I am hoping to do night shifts so I can see how things work at night.  The medication orders and ward organisation are done at night with it being a lot quieter. I am also hoping to get a lot of work done during the night, looking through the patient's Kardex, and looking at how all the medications are organised and how they are ordered through the hospital pharmacy. 

My mentor suggested the night shifts will be very useful for me and will also allow me to do night shifts that we are needed to do each year (3 in year one).

I am really looking forward to the next few weeks. I feel like my confidence has grown already and that I am always learning new skills. Placements are invaluable and I have to thank the staff and patients for being so accommodating. 

Tip for the week?

Be quick on your feet, and make sure those shoes are comfortable! 

And so placement begins...

So I have completed my first week of placement and it has gone so quick!

I had a mad dash into town to go and buy some shoes and I've been wearing them in around the house. I did want some trainers as they're usually a lot more comfortable but needles can easily go through them.

And it is in our portfolios to wear black sensible smart shoes for placement. 

Ironic thing is a lot of learning disability is in the community so I don't even know if I will be wearing them much! 

I rang up my placement again on the Friday before hand just to ensure I had everything right in my mind about how to get there, where to park, if they charge for parking and if I'm needed to wear uniform. 

I have to wear mine so at least I'm getting my money's worth! We had to pay £160 for our uniform so it's always good when you can wear it. 

For our off duty the staff have been really flexible and so helpful as they know students can live anywhere and may not be in close proximity to the hospital. They have asked us what we prefer to work and if we want to do nights etc.  It does state that by NMC guidelines we have to do so many nights each year of the course.  In first year we have to do at least 3. So I am aiming to do that this placement.  That way I can see what happens at night and enable me to hopefully get some work done!  It also means that if I don't get chance to next placement or the one after, that I am covered! 

In my placement I am actually in a hospital so I am really enjoying that. Of all the years I've worked with learning disabilities I have never yet worked in a hospital. It has always been in the community which is what I love to do. But this placement has certainly opened my eyes.

My very first day we had an emergency situation so that was certainly interesting. I have dealt with challenging behaviour, done my first set of observations independently and unobserved. I then recorded this using a NEWS chart. I have done my first bm (blood sugar test) and given my first few insulin injections. I have also been to the dentist this week with a patient and I have had the chance to speak to many nurses who are more than happy to help.  Ive also done my first set of administering drugs under observation and I have learnt a lot! 

It has been exciting and exhilarating having done so much in one week.

My task for the weekend is to learn about the drugs we administer in this ward and how each one works etc. 

I am also aiming to learn about a few others things as we have new patients coming in all the time.  

It has been a whirlwind of a week and my mentor has been really helpful. I have managed to observe an ECG (electrocardiogram) being done, I have been able to get to know the patients and to understand how a learning disability hospital setting operates. It is definitely the most rewarding aspect of nursing, being able to converse with your patients and respond.  Especially if their communication skills are limited. This is where it counts in getting to know your patients.

My advice for the week? 

Be enthusiastic and get involved wherever you can. Most places you will go on placement will have had students before. And if the patients don't mind, observe every chance you get. Everything on placement will help you learn, no matter how small you think it may be.  And all that will help throughout university and into your future career. 

Extra Curricular

As I have been so busy and have neglected all you readers for the last 2 weeks, here are two posts in one day!

Dont all fall over with shock.

Today is my day off!! 

I am working all weekend in my part time job, then I hit placement on Monday. So today I am making the most of it and organising, tidying and all the other grown up stuff that seemingly sucks at times when all you want is to have a pyjama day! 

I just wanted to let you all know what I have been doing, or attempting to do in my spare(ish) time.

I started rowing at the university and thoroughly enjoyed it. However with other commitments i have not been able to carry that on as yet. As I have mentioned before, I volunteer with St John Ambulance.  These past two weeks I have also had an exam in that as well. I was being assessed on my first aid skills and ability to use a defibrillator.  As I am sure you can understand, it has been a very busy few weeks.  The exam for SJA was an all day exam of training and assessments.  This may seem a lot but it is worth doing if you can.  Those in St John do notice a surge of people joining in September time to look good on applications and then dropping out later in the year.  However, St John will allow you to learn a lot more.  I have learnt a lot more about First Aid as well as ECG's and treating patients.  We do a lot of courses in our weekly meetings just for information for everybody.  This has come in handy especially for my university course.  So I am glad I am doing it.  

As well as that, I have also been elected as a course representative for learning disabilities.  So this means that I have had to attend meetings for that and try to keep everyone on the course updated with such things.  The university is looking into various ways to improve the application and interview process for nursing, hence a lot of our input is required.  

It is good to do though as everything always looks good on your curriculum vitae. There are possibilities to go on from here and represent your area with the RCN. They have elections each year and then every several years depending on the post.  This is something that will keep you busy but will also allow you to keep updated with what is going on in the nursing world.  

Then on top of that I have also been working part time to try and ensure I have an income! The bursary does help, but for anything for social activities and unforeseen bills etc, a little extra income is always good.  As i start placement on Monday, I will need to fund travelling to that until I finish and I can then claim this back from the bursary department.  This will mean keeping very organised and documenting mileage, keeping receipts and looking at parking costs.  I did look at public transport, however due to location it just is not feasible. 

Then, I have joined the university gym to try and keep fit and healthy.  You will feel so tired at some points, so I find staying in shape and exercising is a good way to maintain a good sleeping pattern and keep your energy levels up (along with a good eating plan!)

Sometimes it is impossible to go or you just have so much else on ( revision ) but it has helped in meeting others too.

To summarise, I feel like a very busy bee! 

On the other hand, I know if I'm not busy, usually that means something needs doing and I am probably avoiding something. It's good to keep organised and keep on top of things.  And above all, talk to people if you do start to feel overwhelmed..  There are plenty of other students going through the same thing and may just feel the same way.   

Must dash, vets appointment to attend now! (For the rabbits, not me!)

Phase 1 - Complete!

Apologies for the long gap in updating you all!

But that's my first phase of university done. The last two weeks have been a little mad. 

We had our presentation and exam to do, then found out in our tutorial we had to prepare another presentation. Just to keep us on our toes! 

So yesterday I had a presentation, an assessment and then an exam. It has been rather manic these last two weeks getting together with my group and then revising and preparing things as well as sorting out an order I had done for everyone. So it's been a busy couple weeks. But I've thoroughly enjoyed it! 

I hae been in touch with my placement and I have organised my hours with them and if I need to wear uniform or not. I have collected that last week and I have collected my name badge. I have my fob watch and I have a little notebook to put in my tunic pocket as well. So I'm all organised. I'm just going shopping on the weekend to get some food in for lunches while I'm on placement. 

It's has gone so quick it's unbelievable. I have learnt so much already and there's a lot more to come!

It has seemed so stressful but so worth it. I'm still awaiting my score on our presentation but for my exam i got a first so im happy as whoever Larry may be with that!

It has gone so quick and it is worth noting, revise as you go. It soon sneaks up on you all those deadlines that you have and what you need to do to keep organised.  University has had such an impact on a lot of people and it is sad when we see people having to leave to return next year due to unforeseen circumstances.  However, as it has gone so quick you do need to take everything on board and a little more. 

Make the most of it as I am sure before I know it, I will have finished first year! (Thinking positive) 

I start placement on Monday so I am sure that will be eye-opening.  I cannot wait.  A few people are a little nervous and dont know what to expect. This in itself is to be expected, especially if you have not had any sort of care experience before. It can seem a little daunting.  But you do have staff on placement to help you as well as the university staff.  So if you do struggle with anything, all I can say is make the most of the help available to you.  That's the good thing about doing a nursing course. The staff and others know that you're human. You can only do so much and you can only cope with so much. To have that support there is fantastic.  

So here I am, looking forward to another 6 weeks of work on placement, completing my portfolio and making sure I can get my skills and competencies ticked off. I have been told to read up on anything I am interested in and asking if i can observe and assist in procedures if I feel I am confident enough to do so. So there is my homework for placement! 

I am going to be trying to do as much as I can when i can and make the most of the 6 weeks. As if the last 6 weeks (7 if you include induction week) are anything to go by, I expect it to fly in. 

Good luck to everyone submitting applications, it is stressful and even more stressful waiting and not knowing.  But that in itself is a learning curve for you and how you cope under pressure and waiting for such a long time.  So make the most of the free time you do have. It is a luxury when you get any at university!