So here marks the end of my first week back on placement and
what a week it has been. Journaling is a new thing for me so please do bear
with me. I start to record my positive areas and also areas for development
mid-week and intend on carrying this on throughout my training as I'm finding
it very helpful, not only in my development in my training but also as evidence
for my progression criteria for my nursing assessment file.
Day 1 - Early shift
Today was my first day back to this placement since
September. I spent most of the day readjusting to the ward environment again. It
started out quite relaxed, teamed up with my co-mentor (brilliant lady!) who
let me tag around with her pretty much all day, assisting patients, completing
and organising patient notes, calculating IV doses, giving medications out,
checking vital obs, etc. I keep forgetting but I'm going to get myself a tongue
depressor to write common IV calculations on as a pocket guide. A lot of
nurses/students say they did this and it was helpful.
Day 2 - Early shift
Today I was very much floating around all over the ward - no
easy task when there are 27 patients and several nurses asking you to help them
out. For most of the day I took vital obs and ensured patients were
comfortable, documenting all the time. I went in to check on one patient who
was on a monitored bed and had been doing quite well. His respiratory rate was
up in the 30s (normal is between 12-20!), pulse over 120 bpm, oxygen SATs 85%,
temp over 38oC and BP barely readable. He wasn't very responsive and was pale
and clammy so I immediately got the nurse who had another nurse in the room in
less than a minute and a doctor to review as well. I remember just standing
there thinking, 'Oh God! What will I do when I'm the nurse?! Will I know what
to do?". Nursing is scary.
I also accompanied a patient to a CT scan as she was very
nervous. The nurse in charge of that side of the ward didn't seem overly
impressed really but I wouldn't have forgiven myself if I'd let her go by
herself, shaking and terrified.
Day 3 - Early shift
Today was my first day with my mentor since returning to the
ward. I helped to serve the breakfasts for patients and then assisted patients
to wash and get dressed. Following this my mentor explained that she wanted me
to look after the patients in the 4 bedded bay section of the ward, where 3 of
the beds were being used. This was quite a task since I'd never done it before
and I was quite nervous. My mentor explained the importance of problem solving
and managing time - 2 big things I need to work on. I had to ensure all tasks
were completed for each patient - vital obs, any planned scans/xrays, record
care rounding, document nursing notes from the morning and any new plans from
seeing the consultant, ensure patients were pain-free and comfortable, assist
to the toilet, support with nutritional intake, contact family to bring in more
clothes, contact a care home to discuss patient history and ongoing needs,
diffuse a situation with an agitated patient, monitor the condition of a
patient who appeared more weary than the previous day, completed an ECG, talk
to family members and friends of patients and refer to qualified staff where I
couldn't help with a query. I found all of this very challenging to say the
least alongside caring for one of the patients who had become increasingly
agitated and wanted to continuously move around despite feeling sick and being
very unsteady on her feet.
Whilst the ward had a meeting, I was also asked to ensure
the safety and comfort of 2 other patients just outside of the bay, and
although it was difficult to juggle, I managed and learnt the importance of
prioritising tasks. I now see (from a more restricted view of course) why
nurses are always so busy! I still have so much to learn.
Positives:
+ Managing numerous tasks
+ Staying positive all day despite how challenging it was.
+ Completed a full SBAR handover sheet for a patient leaving the ward which I'd never done before on my own.
+ Liased with other professionals including Nurses, Pharmacist, Physiotherapist, Occupational Therapist, Care Home Manager, Consultant and Dr (F2).
Areas for Development:
- Time management
- Prioritisation skills
- Delegation skills
- Try not to get side-tracked
Day 4 - Late shift
Today I was asked to look after the 4 bedded bay again. In
early PM there were only 3 patients but a new lady was brought up, meaning all
beds were full. 3 of the ladies had dementia/delerium.
I admitted the new patient to the ward, ensuring she was as
comfortable as possible and completing all documentation. This process was
quite difficult as the lady had quite an advanced level of dementia and was
very anxious about being in an unfamiliar place with very unfamiliar people
around. One of her daughters helped to answer some questions given that she was
unable to give sound answers due to her illness. All the while the patient was
trying to go home.
I think I managed my time more effectively today, allowing
equal time for each of my 4 patients and completing all vital obs and
documentation. I went with my mentor to administer medications and gave some
subcutaneous injections which I still feel a bit weird about. One person was
difficult to inject due to having a very tight and swollen abdomen. The next 2
that I did felt much easier but I still cringe thinking I'm going to hurt them,
which I know is ridiculous since it's a needle and is never a comfortable thing
to have. I'm hoping this improves with more practice. I haven't given any
intramuscular injections yet - I hate to think how nervous I'd be doing that!
I spoke to several family members regarding their loved
one's condition and answered any questions I could. If I couldn't help, I
directed them to a qualified member of staff.
With the help of my mentor I was able to diffuse a situation
with the new lady from my bay who was very distressed. Her daughters were
trying their best to keep her calm and seated but because they were stressed I
think it wound their mother up too. She stood up and tried to exit the ward,
saying she was going home and wouldn't be told to stay. Seeing my mentor's
expertise was quite inspiring. She knew exactly what to say and how to say it.
I just followed her lead and we worked together to calm the lady down quite
quickly actually. When I got home I researched different techniques to calm
escalating situations, particularly for those patients with dementia. There is
quite a lot of good advice out there about maintaining a calm environment but
when you're in a hospital setting, how calm can it actually be? It must be so
awful for patients like this.
Throughout the day I also found myself delegating tasks so
that I could complete the work I'd been asked to do rather than being
sidetracked by 1,000,000 other things, which believe me is so easy to do! My
mentor and I discussed the importance of completing tasks and not getting
sidetracked. I asked for assistance from HCAs who were more than happy to help
rather than me struggling and missing
things out.
Finally, I completed part of a handover sheet for the
nightshift staff about the new patients on the ward who I had been caring for.
My mentor also asked me to update the sheets for some other patients too but I
got sidetracked and only got half done. Boo! It's so, so, so hard to get
everything done, even with the best will in the world and being run off your
feet and asking for help. The information was passed on in the end by the way,
but verbally rather than being printed on the sheet ;)
Positives:
+ Managed time better
+ Completed all paper work (except some info on the handover briefing sheet!)
+ Completed most of a handover briefing sheet
+ Delegated tasks
+ Spent equal time on all patients in my bay
+ Diffused a situation effectively
Areas for Development:
- Still getting sidetracked - stay on task!
- More practice/confidence with injections
- Understand fully why a patient is in hospital and their journey to getting better and home
- Research: INR and Warfarin, PPI and Lansoprazole, injection technique and techniques to calm patients in distressing situations, especially those with dementia.
Day 5 - Late shift
Today was my last shift of the week and I was shattered to
say the least. My mentor and I were on a different part of the ward to the
previous couple of days so I wasn't looking after the 4 bedded bay.
I carried out what felt like 100 sets of vital obs which,
although they get a bit samey are...well, vital, as the title suggests.
They let you know how the patient is doing
and if/how they are responding to treatment. My ward cares for a lot of people
with COPD so it's really important to keep a check on their oxygen saturation
levels too.
I also admitted 2 new patients to the ward, completing all
necessary paperwork (reams and reams!).
Providing care for one particular patient was pretty
difficult for me. He had been admitted with end stage MS and was extremely
poorly. He was being fed through a tube in his stomach (called a PEG), had a
colostomy and a catheter bag, could only respond to voice and had extremely
limited speech and movement. For those who haven't read one of my earliest
posts where I explain this, my Mam has MS so seeing this was a bit close to
home for me. I know that MS affects people in different ways and that my Mam's
MS is a fair distance from this patient's at the moment, but it caught me
nonetheless. This could happen to my
Mam one day. I have absolutely no idea how I will deal with this when it comes
to it or if it will happen like this. It's just such an awful disease. Distancing myself personally from this was quite a difficult thing to do but I need to do it!
My mentor showed myself and a newly qualified nurse how to
set up a PEG feed drip. I've fed a lady through a PEG before but it had always
just been manual for her - flushing it with water through a syringe (with no
push), then pouring in the feed and then finally flushing it again with water.
It was always very interesting when the lady coughed. I'm sure you can imagine
what happened! A nice shower of Jevity (that's the name of the feed) for me,
haha! Anyway, I digress. My mentor also showed me how to completely change a
colostomy bag. I've emptied an ileostomy bag before and it was just a matter of
disposing of the contents and then closing it back up again, but this one had
to be completely removed and replaced. It was very strange seeing how it all
works and has lead me to several hours on YouTube trying to make sense of it.
My partner definitely didn't appreciate me talking about it over dinner, that's
for sure, hehe!
I found my time working alongside the newly qualified staff
on the ward extremely helpful today. They were always asking if I was OK or if
I needed help or advice which gives me so much hope for when I qualify in 2
short years. I can't wait to be able to offer the same support when I'm a Staff
Nurse.
I also found that after this week I feel much more settled
as part of the team on the ward. I've been on this ward for a total of 9 weeks
now (spread out over the year) and due to nerves and finding my feet I've held
my personality back a little bit since I've been mostly trying to keep my head
above water. But today I was able to work alongside people, feeling like I was
helping and not hindering, join in conversations and not hesitating for a
second if I needed some help/advice. Team work is so important in such a
stressful environment.
I had my initial interview (placement documentation) with my
mentor today to discuss what my targets are for this placement and to go
over my progression criteria that I need to meet by the end of the 6 weeks.
I've got 6 more to get signed off which I'm well on the way to getting but find
completing the evidence so tedious. My mentor said that she's happy with the
amount of progress I've made and highlighted the importance of approaching her
if I was struggling with anything. She's an absolute gem :) I really think that
although I have to travel to get to my placement, I have hit lucky with this
one. I get such a variety of experiences, a great team and a fab mentor. I doubt
I'll be this lucky throughout my training so I am definitely making the most of
it for now.
So here are my targets for final placement of first year:
1) Identify a group of patients at the beginning of each
shift to be responsible for, including all care, documentation, treatment and
discharge planning.
2) Widen knowledge of drugs commonly used on the ward
3) Identify and be aware of the signs of the deteriorating
patient and be involved in implementing the escalation of care
4) Attend Rapid Access Cardiac Clinic with Nurse Specialist
A lovely way to round off my last shift of my first week back
was when a patient's family came to find me to thank me for all I had done and
for helping their Mam so much during her time on the ward. Such a lovely
feeling :)
Positives:
+ More confidence with admissions process
+ Learnt how to set up a PEG feed and change a colostomy bag
+ Great to hear I'm making good progress
+ Improving delegation skills
+ Feel part of the team
Areas for Development:
- Distance from personal/professional situations
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