Placement 4 - Complete

So i have finished placement 4 and it has been amazing!

I have noticed a massive difference from first year to second year. 

I have had a lot more responsibility this placement and i have been expected to do a lot more on my own intitative.  

In this placement; 

I completed patient admissions; discharges; signed in and out medications; been responsible for patient belongings; ive changed beds; set up beds for patient arrivals; i have been able to meet the children's parents and families; i was able to complete their documentation, complete body check and risk assessment forms; i was able to do day and night duty shifts; administer medication; do pharmacy orders; set up feeds via pumps and administer boluses; monitor nutritional intake; the list goes on...

I was also able to go in with the children to one of their schools. I organised this myself after speaking to school staff.  I wasnt able to spend time with the school nurse as the nurse also had students with her on placement in there.  However, I wanted to spend time in the classrooms and see what happened day to day with the children and how the teachers and the school adapted to each child's needs.  The school was amazing and have also offered me to go in again any time if i need any help or want to observe any more lessons.  I was also fortunate enough to see them competing a dress rehearsal for their Christmas play. That was incredible!

Each child was involved and had done their own play for each group of ages, or classrooms due to the size of the school.  Some groups used video cameras to film and create special effects, some made some incredible props (a Dolerean, giant backdrops and jellyfish to name a few!). The children and the staff were amazing and i really couldnt fault them.  They were very welcoming and only to happy to help me with my portfolio.  I would love to go back at some point! 

I am now in the community for my next placement so I will be really looking forward to that.  I should be able to do assessments, be responsible for a case load and look after patients from admission to discharge.  This placement I have just finished should hopefully have prepared me for such!

I hope everyone has a good Christmas and A Happy New Year and I shall look forward to hearing how you got on with applications!

(I shall be enjoying a break home and then straight to the library for finishing me essay that is due in when im back)

Revision and assignments....the life of a nursing student.

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! 

Placement 2; Week 1

Hey everyone!

I have now completed my first week of placement and once again I have managed to do a fair amount. 

I am on a children's ward this time and I have loved it so far! 

I have learnt a lot about peadiatrics and peadiatric surgeries. It has been interesting to say the least. My youngest patient thus far has been a mere week old, and my oldest has been 17. This has given me a good chance to communicate and liaise with children of all ages. I have also been able to practice my clinical observations and the various documentation that comes with this.

I have looked at the different PEWS charts for the different age groups. (I am hoping to get copies of these as it is very hard to find on the internet!)

I have chance to observe a nasogastric tube being placed on a baby; 

how to obtain blood samples from young babies and I have seen children taken down to theatre and be placed under anaesthetic. I have been able to see a catheter insertion and I have had the chance to talk to parents and learn more about head injuries. I have children undergoing phototherapy;

As well as this I have observed patients being admitted and discharged as well as the care pre and post operatively.  It is remarkable the amount I feel I have done in one week.  I have managed to talk to the various staff on the ward as well as others. I am hoping i can get the chance to observe some surgeries during my placement as well. This should be really interesting to see the process from a patient being admitted, to their surgery, to their recovery and then discharge.  

To try and learn more about peadiatric processes and how to carry out clinical observations I have read up with this book from the library.

It is a good book yet I have found nothing is better than hands on experience. It is helpful having other students on the same ward as myself as well. I am on with both second and third years so I have had the opportunity of observing them and asking them questions as well.  It has been a quick week and I have enjoyed it.  I do think that you do need to be strong and have a good poker face when it comes to working with children.  I have seen parents so torn up and upset at seeing their child in hospital.  Because children cannot consent their parents do so for them.  This may involve putting the child through procedures that they are scared of and will say no to, or cannot as they are too young. Having to prevent a child from pulling their own nasogastric tube out as it is inserted is hard.  

Working with children, it is important that you are aware of the Gillick competency. 

See the below website for information.

NSPCC

It is also important that you are aware of confidentiality and how to report any suspicions of child abuse.  It is vital that you are aware of local child protection guidelines as well as nationally. Children and their health can be straightforward, however, it can be difficult as there can be various circumstances as to how that child is in that hospital or care facility that you are in.  This is where maintaining those professional boundaries come into effect. Reading up on any of these things before you embark on a placement with children will help.  Talk to your mentor and your university if there is anything you feel you are not comfortable with or if there is anything you want to clarify. 

I will say this, working with children is so rewarding.  I have had the opportunity of playing with some of the children and their siblings as hospital can be a scary place. Communicating with a child on their level may be difficult, but it is so important for that child.  I will say this though, be prepared for the unpreparable!   

(All photos available on Google images)