Placement 4

I have now completed two weeks of placement and I have really enjoyed it so far! 

I have been on night duty these two weeks so I have also been able to learn the layout of the building and familiarise myself with the stock room and the various health and safety checks etc that happen every day.  

I have also had time to read through the client's care plans and admission files to learn how the nurses admit and discharge patients and what it is that is needed.  This has allowed me to begin my care plans that I am needed to do, as my mentor on placement assesses these before they sign me off for the placement. 

I have also been able to set the child's enteral feeds up and run these through their pumps.  Many children tend to use the Kangaroo Joey pumps.  

Giving Set

Kangaroo Joey Pump

These are fairly easy to set up and some children will have these in a special backpack so it can be connected and running while they are out and about or in school. 

Many of the children will have their enteral feeds in the morning as well as school, and each school has a school nurse (that is also often learning disability trained) to set these up, oversee administration of any medication through their PEG tube or Mic-key button. 

A Mic-key button can be different sizes for the size of the child and these are assessed and changed on a regular basis as the child is still growing.  

A PEG tube fitting.

Positioning in a child.

                            A Mic-key button                                        A Mic-key button in a young child.

The locking system when attaching a giving tube.

I have pushed bolus feeds and bolus hydration through their Mic-key buttons as well as their medications.  Most medications are liquid, but some need to be dispersed in sterile water.  For the dispersible tablets, my mentor taught me to try and place the tablets within the syringe (by taking the plunger out).  Place the plunger back in as far down as it will go, then place the syringe within the sterile water and draw this up. Instead of placing the tablets in a medicine pot, dispersing the tablets in there and drawing up, it means you don't lose any of the medication from transferring from pot to syringe. Very clever idea and saves some time too!

I have also been fortunate to carry out my first female catheterisation on a young child too.  This young girl has intermittent catheterisation so it was not an indwelling one that I carried out.  The procedure to do so was quick and painless for the child.  

An intermittent one is similar to self catheterisation where you only insert the small catheter and the urine flows into a toilet bowl, pad or kidney dish for example.  As this was a child whom also had a learning disability, this procedure is carried out by the nurses. 

An indwelling catheter procedure would be similar to this;

There are plenty of videos available on YouTube and you will do this in practical classes within university too. A male catheterisation is much easier than a females, so try and get the practice if and where you can! 

I will be writing up my care plans this week (I have a draft of one done!). My mentor will be able to go through these with me and then I will be able to finalise these for my final week where I have my assessment with my mentor.  

So thus far, it has been a valuable learning experience.  I am hoping I am able to go into the schools soon and out with the children when I on my day duty. 

Hopefully I shall keep you informed! 

And don't forget, learning disability nursing is amazing.  All ages, all abilities and best of all, the greatest patients! 

P.E.G's, Enemas, Injections and Medications.

I have finished week 4 of my placement, which means I am two weeks away from finishing.

I cannot get across to you how quickly this has gone and how much I have enjoyed every minute of it so far. 

I have been able to spend time in the office and get to understand how the off duty is done, how patient appointments are booked and attended, how transport is booked. I have been able to go to the dentist, I have seen the aids and appliances being made for people with physical disabilities and epilepsy. I have been fortunate enough to really get to know my patients and to be able to understand a lot more from being on a ward placement. I am very lucky in that respect as the others from my year (and branch)  are mainly on community or day centre placements.  I have also been given my next placement which I am really looking forward to. Again, I will be in a hospital setting but this time I am in a children's ward.   So I am sure that will be fun to blog about! 

So this week I have again managed to experience a lot! I was able to go see the orthotics departments where they make the aids and appliances for people.  This is where leg splints, helmets, body braces etc are all made. This is very interesting to see the work that goes into seeing the patient, obtaining their measurements, hoisting them if necessary into bean bags that can mould around their body shape and then making their appliance.  This can be anything from moulded wheelchairs, seats, to specially designed helmets for self-injurious behaviour or epilepsy where they would possibly fall against things on a frequent basis. The staff were able to show me how things are made and on what time scale and how this can help improve a person's quality of life.  It is amazing the work that goes into all these different things that many people may not even think about.  

I was also fortunate enough this week to be able to administer insulin again, so I am feeling confident with that as well as blood sugar level readings.  I have also been administering medications via a P.E.G tube on a frequent basis (again always under supervision).  I have also been able to ensure that controlled drugs are signed off and see how a controlled drug check is carried out by pharmacy staff who come in.  They check that 2 people are signing off the controlled drug at all times, that it is signed, name printed and dated when any controlled drug is administered.  With controlled drugs, protocol is slightly different compared to other medications.  Unfortunately, within healthcare, it is medication administration errors that account for a lot of statistics.  So it is so important that you are good at your mathematics and drug calculations.  It is something you need to do. 

I have also been very fortunate in being able to administer flu vaccines this week as well. I was even more fortunate that the patients consented to letting me do this as well. It has been a very good week for learning this week. The nurses have also commented on how well i've done and how confident I have been for a first year on their very first placement.  This is where I think it does help immensely having any previous experience within the field of nursing you are doing.  Of course, without experience you're learning from the nurses first hand and won't have any bad habits or routines after your previous experience. So it can work either way! 

I have also been able to administer an enema to a patient so I've felt very lucky being able to do that. This was a very first for me so I am glad I have asked every step of the way to do things, as I've done things that they wouldn't have considered me doing with it being my very first placement. The enema is very effective and works within 5-10 minutes for the patient and can provide immense relief for someone. Within palliative care there is a great need for pain relief and as everything begins to slow down, the bowel can get lazy and cease to work where peristalsis is concerned. The faeces are not pushed through the bowel. This results in constipation and can be very painful and uncomfortable for the patient. An enema provides relief from this. 

So this week I have been very lucky in my learning.  And I have enjoyed every part of it. It feels very surreal that I am nearly finished this placement. I have learnt this week that if you dont' ask, you may not get! Especially if your mentor is not on duty.