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! 

Year 1 - Complete

Hi one and all! 

I have finished my final placement of year 1 and it has been amazing.

I had a great last day! We had a chippy takeaway, cake, juice and chocolate cake. Amazing.

I will really miss that place.

In six weeks, I was able to accompany the students on outings. I was able to assist with making decorations for the summer fete. I was able to run an art class which was super fun to do! I was able to assist with personal care. I was able to discuss oxygen therapy for seizures. I had so many learning opportunities.  

I went to epilepsy training ran by a RNLD and she was amazing in helping to go over the training and then assist in how we would write nursing care plans and assessments.  I know we have to do this next year so I was able to discuss this with her and gain some very useful information about this. The RNLD was in the process of writing up a nursing assessment for a new student starting at the centre, so I was fortunate enough to see how the process works of introducing the student to the centre and seeing how they settle.  They are assessed to see which room they would like to go in to and what activities would suit them.  They are then also able to look at the student and what assistance they may need in the centre and how they will get to the day centre, so their likes and dislikes of travelling and any requirement are also looked at in regards to buses and other students in proximity to them. The staff are then also looked at to see if they need any extra training, for example if the student has a PEG or a stoma or a tracheostomy.  This enables the students to attend the day centre and feel as included as possible.  The RNLD would then also train the staff where needed and formulate action plans and in case of emergency plans for the student and the staff.  

I was also able to then talk to the Speech and Language therapist who comes to the centre to work with the students.  I was able to see how she works with different individuals and I was also permitted to take part in a swallowing assessment for a student.  Listening to that with the stethoscope was a fantastic learning opportunity too. I then had the chance to look at the equipment that some students use, including apps on tablets that are very good for interactive learning. The technology out there is amazing, but the waiting list for assessments and access to some pieces of equipment is quite astounding. 

 We do have pages in our portfolios in each placement where we can get another health professional to write in it, so the SALT was able to do this for me.  I was then able to put this in that I had taken part in the various activities with the other health care professionals.  

The placement also allowed me to learn more about people with learning disabilities who have dementia.  I was able to support an individual who has been greatly affected by her dementia and is increasingly needing more support in the day centre.  Her care meetings would look at this, and how best to support her so she still enjoys coming in to see everyone as she has been attending for many years now.  The staff were able to facilitate her leaving a little earlier so she was not extremely tired by the time she returned home. 

I was also taught how to knit by several of the students! I thought this was amazing, they were so patient with me and so eager to help.  They were also amazing at giving advice and were brilliant in helping one another.  The relationships between the staff and the students are incredible and it is nice to see that there is that support and that trust amongst everyone.
I also learned that on an almost daily basis I would be getting hugs, my hair played with, my bum tapped, I would get asked how my family and pets were doing, the students would even bring in cardboard boxes or treats for my pets too! 
In many places I have been, many people worry about professional boundaries and this can seem a little closed off to many with learning disabilities as they may not understand this.  Especially for those who have no contact with any family. So the only close proximity or touch they may have, is with staff.  If I have learnt anything in one year of nursing. It is this.  It is okay to give someone a hug.  It is okay to laugh and cry with them.  It is okay to be there for them.  That's what nursing is about.  Of course, you still have to remain professional and you still need them boundaries.  However, we are all human.  And all of us like to have a hug when we feel bad or for someone to just offer a shoulder to cry on and an ear to listen.  It is all about striking the right balance.  

I am sad that my first year has come to an end, but I am so exhilarated and thrilled too! 
It means I am one third of the way there! 
It also means that I have learned a lot, I have experienced so much and more importantly, I have used that to ensure that I will be a great RNLD.