Patient Experiences & Expectations

Good afternoon readers!
I hope you are well (: I know i've been posting quite a lot but I want to make up for all the time that I was absent! Today I'll be talking about the expectations that patients will have of nurses and of their care and how we as health care professionals can improve the patients overall hospital/care experience! Enjoy!

Patient experiences and expectations
*Expect good standard of care from health care professionals
*Good communication between staff
*respect religious views i.e. same sex care
*Feel safe and be heard
*To be treated with respect and dignity

Health care professionals' expectations
*Correct resources to enable effective nursing
*To be treated with respect and acknowledgement
*Not be abused
*To be respected by other staff
*To be paid

Gaps between Health care professional and patients
*Shortage of staff
*Poor management or teamwork
*Lack of training, communication and experience
*Financial constraints
*Cultural differences
*Lack of equipment

Reducing gaps
*Improve staffing levels and education
*Educate patients
*Make patients more proactive in their care
*Reduce paperwork?
*Increase health promotion
*Increase awareness of risks of treatments
*Decrease use of jargon

Main focus of complaints
-Attitude of staff
-Communication failures
-Poor standards

Rights of patients
-To have complaint dealt with efficiently and properly investigated
-To be made ware of the outcomes of the investigation
-To take complaint to independent ombudsman if not completely satisfied
-To receive compensation if harmed
-Make a claim for judicial review if directly affected by unlawful act

How can health care professional engage effectively with patients to improve handling of complaints and improve quality of care delivery?
-Attend to complaint
-Listening and noting
-Checking needs regularly
-Knowledge and understanding
-Communicating
-Patient needs to be kept informed
-Try to resolve internally and not going to the media
-Know your boundaries as a student
-Understand patient expectations and get to know them when admitted
-Be open minded
-Support
-Explain complaint procedure
-Patient understands his/her right and responsibilities
-Have an awareness of advocacy services

Responding to complaints
-Apologise
-Ensure that it won’t happen again
-Decide how serious the issue is and how likely it is to reoccur
-What can be learnt?

Why feedback is important…
*Tells you what is working Helps you to identify the problems and risks and prevent them from worsening
*Highlight opportunities for staff development

Brief introduction to NICE
*An organisation set up in 1999
*Decides which new drugs and treatments should be available on the NHS (I'll probably discuss this is more detail in a later post so keep your eyes peeled!)

Above all...

Think about how your behaviour contributes to the patients overall experience

And that's it!!! I hope you have enjoyed this post! I'll try to post as much as possible. Time is very limited for me at the moment but I will do everything I can to give a weekly update AT LEAST!! (: Enjoy your day!

Emily

Guide To Clinical Placements

Hello everyone!!
What a fine day it is - the first of june!! I cannot believe how fast time has gone! I started this course on the 20th Feb and it feels almost like yesterday!
Today I'll still be talking about clinical placements but I'll be writing up a guide! I'll be explaining everything you should expect for your first day, what you should bring and what to do and what not to do. Enjoy!

What to bring

*Yourself - Kinda obvious but would be very hard without
*A fresh, clean and crisp uniform - The night before make sure your uniform is ironed, washed and hung-up on a hanger. You want to make a good impression, after all.
*An A5/A6 notepad - This is very important because on your first day you will learn a lot!! By writing these things down, you can research them later!
*Comfortable shoes - They always stress 'presentation' at university before you start placement. But sod that! You'll be on your feet a lot. Actually, you'll be standing about 95% of the time so pick out shoes that are FLAT and COMFORTABLE. They dont have to look particularly pricey and they dont have to stand out or anything. Just make sure they ensure comfort and are black. (It helps to check your trust policy too!)
*Your phone - bring this as your mum will no doubt want to ensure you are getting on ok but keep it in your locker, not on your person.
*Your practice assessment documents - this is very very important. Dont lose them eight because they have to last the whole three years!!
*Tea bags and your lunch - Normally you can't use the hospital tea bags because they are 'only for the patients' so bring your own. Or buy some at the hospital shop.
*An clear, open mind, ready to take in LOTS of information.
*A smile

What to expect of your placement

*Expect it to be busy - most wards/clinics are, so be prepared to come home feeling exhausted!
*The other staff nurses and HCAs might not be so friendly towards you - this is quite a common occurance but, to be fair, expect this when you start any new job. People in general are xenophobic or just hate training up new people. Dont take it personally. Also they might just be too busy to talk that much. Theres more time to chat on break, I suppose.
*Expect to meet lots of new people and remember lots of new faces - remember that you have to not only remember the faces and names of the patients but also the faces and names of the people you are working with!!
*Expect to be standing 95% of the time - when you get the chance, take a minute just to sit down. I don't mean everytime your at the nurses station, steal a chair for half an hour! I mean, just get the weight off your feet when you have a spare minute because you are bound to be tired and stressed.
*There will be doctors everywhere - well, maybe a bit of an exaggeration but you will see them pretty much everyday and they might ignore you. Try to take the initiative and ask them what they are doing and why. Most dont mind explaining things if they aren't too busy because most of them love their jobs!

What your placement will expect of you

*Be on time - Now, I didn't actually do this very often, I must say. And in my mid-point interview, the staff nurse kind of said, gently-put, that I should 'manage my time better'. Which was pretty fair enough.
*Relating to the last point, take on any advice they give you and do so in a humble manner - we all make mistakes and need advice from time-to-time. But try to accept anything they say because they know best. They are only trying to help you learn.
*Be honest - If you dont know how to do something, say. If you do something wrong, say. If you need help with something, say.
*Be willing - At handover, dont stand chewing gum with your arms crossed. It looks like you actually dont want to be there and you dont actually want to learn. Ask if you can take that cannula out, ask if the nurse you can document something, ask if you can take this patients obs, ask if you can go down to the blood bank for them, ask if you can order a patients TTAs for them. Not only does it show that you are willing to learn, they also realise that you are bothered and they may help you to seek out learning oppourtunities.
*Be tidy - Kind of said this before but I'll say it again because its so important. Remove jewellery, dont wear a ton of make-up, remove false nails and eyelashes. Dont chew gum and wash your hands before handover or touching a patient. Tie your hair up. Most things in nursing are common sense and this certainly is. So make sure you act and LOOK the part.
*Show commitment and be a responsible learner.
*Ask questions - they will not expect you to know everything neither will they expect you to have had care experience before because, believe it or not, a LOT of student nurses actually haven't had any care pexperience before their first placement. I didn't.

Adult learning

*You're not a sixth-form student anymore. You are responsible for your own learning which means that if you are happy to stand in the sluice (And, trust me, this happens!!) they won't come and fetch you and spoon feed you information. So, take the initiative.
*Make sure you keep your PAD docs up-to-date. This is vital as it is you who is responsible for getting the skills signed off. No-one else.
*On your days off, head down to the library and research some of the things you did not understand. If you are unsure what a colonoscopy is, open up the royal marsden and take a quick look. Or just research things online. It all aids towards gaining knowledge!
*On drug rounds, ask the nurse if you can take the leaflets that you inside the drug packets. These leaflets are amazing! They explain the uses of medication and how they work and are perfect for quick reference and gaining knowledge quickly and easily.
*Also, this might be an unconventional one, but you can neevr start learning too early. Even if its your first day, ask the nurse if you can give a patient their Clexane injection, ask if you can prepare medication for IV, ask if you can conduct a blood glucose test. It's good to start early. Better than starting late, anyway.
*Also, always maintain a professional character, you are representing yourself and the university, remember.
*Remember that you are responsible for your own actions.
*Research into your ward specialties.
*Remember your rights as a student and that you are classed as supernumerary and DO NOT count in the numbers.
*Moreover, bear in mind that you DO NOT 'work' there. You are a student and are gaining insight to the work of a nurse. You are there to learn as well as work. Also, you are not under an employment contract and therefore don't actually have the rights of an employee. But refer to a previous post entitled Guide To Choosing A Trade Union which explains why joining a trade union as a student nurse is important.
*Another thing: There will be times when you are sooo busy, yet again there will be times when you'll be sooo bored. When times get boring, don't just sit around. Take this advice: Open the BNF. Every ward has one. Or check that the patients have everything they need and are comfortable. Or just sit and chat to the patients. Fill in some charts. Take a look at the hoards of folders they have on infection control or ward policy. Ask the hostess if she needs any help handing out the trays of food. Check all documentation has been filled in and none are nameless or without a date etc.
*Also, remember to reflect upon mistakes. You can write it down or just vent on your mum! But remember CONFIDENTIALITY!! Dont use a patients name or any other personal detail.

Your mentor/s

*They are there to help you learn, yes, but they are there as a support network. If you are having troouble with something, they are there to sort out the issue you are facing. So, talk to them. That's their job. I actually have spoken to a few other students who have had many problems with their mentors i.e. their mentor didn't speak to them or their mentor was a 'rude cow' or whatever. Well, then, don't just complain about it, do something! Go to your clinical practice facillitator and they will also help you.
*Chase your mentor up to fill in documentation for you, as well! don't leave your PAD docs 'til the last week because you might not get it all done!

Other students

*On your ward, you will almost definately be with other students. These student may be older, younger or more experienced than you. Make sure you talk to them because they will help you as well. On my ward I had a 29-year-old, second-year (almost third-year, actually) who helped me so much. When the other nurses weren't available, she would teach me how to do things e.g. taking out a cannula or doing mannual BP. She also helped me on my assignments as well!
Don't forget to keep in contact with the other students in your cohort too! They act as a great support network for you.

Furthermore...

KNOW YOUR LIMITS!
Make sure that you don't do anything that the university has told you you must not do. i.e. don't touch an IV pump unless a nurse is there to supervise you, don't give an intramuscular if you haven't done the theory for it. Again, kinda common sense but when you are in a difficult situation it's hard to maintain your objectivity.

Ok, I think that's all! I hope you have had a good week and I hope this post has been of some interest to you! Have a good weekend,

Emily x

Nursing Practice: Pressure Ulcers

In this post I'm going to talk about what we covered in one of our first nursing practice lectures which was about pressure ulcers.

Nursing Practice

•Guideline – A general rule, principle or piece of advice
•Policy – A proposed or adopted course or principle of action. Something you must follow otherwise you may be disciplined
•Standards – A required or agreed level of quality. Recommended by regulating/professional bodies and must be followed EG The code of practice.

What is stroke?

A stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke also is sometimes called a brain attack or a cerebrovascular accident (CVA).

Pressure Ulcers
Pressure ulcers, also sometimes known as bedsores or pressure sores, are a type of injury that affects areas of the skin and underlying tissue. They are caused when the affected area of skin is placed under too much pressure.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

How pressure ulcers develop
Pressure ulcers develop when a large amount of pressure is applied to an area of skin over a short period of time. Or, they can occur when less force is applied but over a longer period of time. They can develop within two hours. So it is important to move a patient at least once every two hours.

The extra pressure disrupts the flow of blood through the skin. Without a blood supply, the affected area of skin becomes starved of oxygen and nutrients. It begins to break down, leading to the formation of an ulcer.

Healthy people do not get pressure ulcers because they are continuously and subconsciously adjusting their posture and position so that no part of their body is subjected to excessive pressure.

However, people with health conditions that make it difficult for them to move their body often develop pressure ulcers. In addition, conditions that can affect the flow of blood through the body, such as type 2 diabetes, can make a person more vulnerable to pressure ulcers.


Preventing pressure Ulcers
•Change a patient’s position at least once every two hours
•Use equipment such as mattresses or pillows to relieve pressure on vulnerable areas

Vulnerable areas for pressure ulcers
If a patient is bedbound (unable to get out of bed) they are at risk of developing pressure ulcers on their:
•shoulders or shoulder blades
•elbows
•back of your head
•rims of your ears
•knees, ankles, heels or toes
•spine
•tail bone (the small bone at the bottom of your spine)

If they are sitting or they are a wheelchair user, they are at risk of developing pressure ulcers on:
•the buttocks
•the back of your arms and legs
•the back of your hip bone

Other reasons for patient discomfort:
•If a patient is incontinent, urine is acidic which may burn their skin
•Hospitals can also become very warm which may cause them to sweat which can in turn cause discomfort

Hygiene needs of a patient

Assessment
•Check the nail beds and the skin to check for capillary refill time and circulation – press on the skin and check how long the skin takes to return to its natural colour
•Skin can be an indication of dehydration – this is obvious if the skin is dry, if, when the skin on the back of the hand is pinched, the skin takes some time to return to its normal state. And also if the tongue is dry.
•Check the patient for ulcers
•Find out if the patient is diabetic – because you must not cut diabetics nails in case you catch the skin because of slow wound healing which could make them more prone to infection
•Is their skin a healthy colour?
•Check health of nails – are they yellow or horn-like?

Nutritional assessment
•Is the patient overweight or underweight?
•Maintain holistic care whilst bathing – involve them in conversations by asking them how they are feeling, asking them what their name is. Make them feel at peace and comfortable.

However…
Allow them independence as much as possible. If they can, allow them to dress themselves or wash themselves without help. This also allows them to maintain dignity and self-respect

Social assessment
•Integrate them into the conversation if with another nurse and use a nice calming tone of voice

Evidence based practice
•Do not wear gloves unnecessarily (each box costs £8!!) and if there is no clinical reason to as this might frighten the patient or put up a psychological barrier between the nurse and the patient
•Do not touch intravenous infusions!!
•Pat a patient dry instead of rubbing – especially if the patient has dry skin as you do not want to aggravate the skin
•Check the skin for sores of ulcers
•You should work with your mentor approximately 40% of placement and you should have three meetings with them. One at the beginning, one two/three weeks in and one at the end.

Emily