*Book Review* Leadership for Nursing, Health and Social Care Students

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DISCLAIMER: This book was gifted to me to review. I have previously reviewed other books from the same publishers, which you can read here and here.

 

Beginning year 3 was daunting for me, especially after talking to my mentor on my last placement of year 2 about developing my leadership skills ready for my management placement in the second half of year 3. I really looked forward to reading and reviewing this textbook as I wanted to see if I could gain some tips that would aid my leadership and delegation skills going through year 3. The book itself is part of a new series of books called Essentials and aims to provide an insight into the world of leadership.

The book has a number of chapters, all focusing on different areas regarding leadership. One chapter focuses on theories of leadership, with the next chapter focusing on the skills and qualities needed to be an effective leader.

 

In chapter one, the authors discuss what leadership is and why it is so important in health and social care. I find this chapter a good insight into what the whole book will discuss and would be useful to use in any leadership or management module as well.

Throughout the book, there are scenarios which allow you to explore your own thoughts and ideas around leadership and how you would approach different situations within practice.

At the end of the book, there are full references used within the book which students may find useful for further reading and as sources of information for leadership modules at university.

In chapter 7, the history of healthcare and social care within the UK is discussed. I found this chapter really interesting to see how healthcare has changed and developed over time. The chapter also describes why having knowledge of government policy is important in today’s healthcare environment and I would suggest this is a must-read section for any student nurse, especially third years preparing to qualify and take their first newly qualified post.

The learning outcomes before each chapter are recapped at the end, which allows anyone reading the book to utilise each chapter and ensure they have understood the information contained within the chapter. I believe this book will help me to develop my leadership skills and give me a background knowledge on how leadership can be influenced by other factors and the skills needed to be an effective leader within my own career, which I feel every student reading this book would benefit from.

The book is written in an easy-to-read way, whilst containing a good amount of knowledge and information for students in any year of a degree course.

Love,

T x

Quantitative Research

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Quantitative research is used to answer questions that have numerical value answers. Quantitative research is also used to establish cause and effect relationships  between variables.

Quantitative research designs

  • Randomised controlled trial – considered to be the best design to establish cause and effect relationships. Key features of a RCT include a treatment arm/group and a control arm/group.
  • Quasi-experimental – similar to RCTs with no randomisation.
  • Cohort studies – follow a predetermined sample group to measure the incidence of outcomes. The purpose of cohort studies is to link an exposure to an outcome. Purely observational with no intervention from the researcher.
  • Case control studies – the retrospective form of a cohort study. Individuals with the desired outcome are chosen, with the researcher attempting to discover the exposure that the outcome can be attributed to. Highly prone to recall bias.
  • Cross sectional studies – used to determine the prevalence of an outcome within a specific group. Often conducted using surveys, cross sectional studies are common in healthcare due to being cheap and easy to conduct.

Types of data collection within quantitative research

  • Biophysical
  • Pre-existing data
  • Observation of behaviour
  • Self-reporting

Strengths and limitations of quantitative research 

Strengths:

  • Data can be interpreted using statistical analysis
  • Can establish cause and effect relationships
  • Computer software available to analyse data – saves time and helps to minimise risk of human error
  • Easy to replicate and generalise

Limitations:

  • Do not reflect real life due to the high control applied.
  • Reductionist – simplifying complex situations into simpler versions
  • All confounding variables cannot be controlled
  • Lacks breadth within data

Terminology associated with quantitative research

  • Internal validity – whether the results are based on the intervention or an unknown variable.
  • External validity/Generalisability – how well what is being measured can be generalised to the wider population.
  • Confidence interval – usually expressed as a percentage. Represents how certain the researchers can be that the mean for the entire population would fall within the identified range.
  • Hypothesis – a theory or idea that needs to be tested.
  • P value – a measure of the strength of evidence against the null hypothesis. a small p value < 0.05 indicates evidence against the null hypothesis, this is then rejected and an alternative hypothesis developed.
  • Independent variable – the variable manipulated by the researcher to measure its effect on the dependent variable.
  • Dependent variable – what the researcher is interested in measuring in the study.
  • Confounding variable – an outside influence that can affect the results of a study.

 

Love,

T x

 

Research methods – common terminology

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Here are some of the most common terminology used that it would be useful to understand for your research module.

critical appraisal – examines the practical application of research, assessing how valid and relevant it is to the practice area.

intervention fidelity – how well an intervention is delivered as intended

generalisability – attempting to apply study findings to settings/contexts other than the ones they were originally tested in. Applies to quantitative research.

transferability – how findings can be transferred to another setting/context. Applies to qualitative research.

standard deviation – the spread of results occurring around the mean. For example, the mean age of participants may be 40 with a standard deviation of 25 – 55. Often represented as S.D. A smaller S.D is preferred as this shows a small spread of data around the mean, a large S.D shows a wide spread of data, meaning it is less reliable.

confidence interval – usually expressed as a percentage. Represents how certain the researchers can be that the mean for the entire population would fall within the identified range.

hypothesis – a theory or idea that needs to be tested.

null hypothesis – no significant difference apparent between two groups.

alternative hypothesis – results are the result of a difference between two groups.

p value – a measure of the strength of evidence against the null hypothesis. a small p value < 0.05 indicates evidence against the null hypothesis, this is then rejected and an alternative hypothesis developed.

quantitative – research where the results are numerical such as statistics, percentages etc. Studies cause and effect relationships.

qualitative – research where the results are text based and may follow themes. Includes thoughts, feelings, descriptions etc.

mixed method – where researchers use both quantitative and qualitative data within the same study.

rct – randomised control trial.

randomisation – making something random ie the allocation of participants into a treatment or control arm. A good way of minimising the risk of bias.

treatment arm – where participants receive the treatment/intervention. Characteristic of a rct.

control arm – participants receive no treatment/intervention or they receive a placebo. Characteristic of a rct.

internal validity – whether the results are based on the intervention or an unknown variable.

external validity – how well what is being measured can be generalised to the wider population.

independent variable – the variable manipulated by the researcher to measure its effect on the dependent variable.

dependent variable – what the researcher is interested in measuring in the study.

Reflexivity – the questioning of one’s attitudes, values and prejudices and to appreciate how these could affect the outcome of the research.

homogenous sample – when participants have similar or identical traits ie same age, gender, employment etc.

heterogeneous sample – where every participant has a different value for their characteristics ie different ages, gender etc. Indicative of diversity.

blinding – where participants or researchers are prevented from knowing which intervention group participants are allocated to. Can be single blinded or double blinded.

T-test – used to determine if there is a significant difference between the means of two groups.

bias – a form of error that can affect the outcome of studies.

triangulation – using more than one method to collect data. A way of assuring validity within the research.

primary research – new research studies, carried out through experiments, trials etc.

secondary research – analysis or interpretation of existing research studies.

cause and effect – where one event (the effect) is the result of another event happening (the cause). Randomised control trials are the best method able to establish a cause-effect relationship.

 

 

 

Let’s talk about second year blues

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If you’d asked me in the summer months about second year blues, I would have told you that it was a little bit of a ‘myth’ and that if you kept yourself organised you would be fine. I even wrote a post containing tips to survive second year . My first module of year 2 was Research Methods and is often described as the worst module of the whole degree at my university by previous cohorts. I fell in love with the subject and wondered what everyone had been making all the fuss about. I achieved 95% in the assignment and genuinely thought I was set for the year…I couldn’t have been more wrong.

Autumn came and the second year blues hit me like a train. I lost all motivation to complete work and began leaving assignments until close to the deadline date, something I don’t do because I get stressed easily and not being organised is a trigger for me. My assignments were not up to my usual standard because of this and still I sat confused and upset when the results were released and I hadn’t achieved anything like the results I was used to. Instead of spurring me on to complete work early like I usually do, a rubbish result (or so I thought at the time) knocked me for six and I continued with no motivation wondering what the point was. I completed another assignment and submitted, knowing it wasn’t my best work but believing it was good enough to stay within my targets. Results were released and I was ready to quit university altogether that afternoon,  it was my worst result to date and the feedback felt brutal. I spent that weekend in what felt like a hole, at the end of my tether with this whole experience and genuinely thinking about leaving. I’m not ashamed to admit that I’ve had more negative days than positive days in year 2, I can probably count the number of truly positive days on one hand if I’m being brutally honest.

Second year blues are real and should be discussed more. It’s not enough to preach on and on about positivity, staying positive etc, because it really isn’t as simple as that. It’s hard to remain positive when every single day at university feels like a knock to your confidence, when you leave placement everyday wondering if you will ever really know enough to be a nurse and when every result makes you question whether you’re even intelligent enough to be doing this degree. I’ve lost count of the amount of times I’ve cried in the car park after a placement shift before setting off to go home, just from doubting myself and a decision I’d made that day or because I didn’t know something that I really feel I should by now.

My first placement of second year was amazing, I spent 6 weeks with the best team and felt like I knew what I was doing even though it was out of my comfort zone. I thrived in an area that is extremely specialised and that I was terrified of before I started. When I began my second placement of year 2, it all unravelled. I like being out of my comfort zone, but this was a whole other level. I knew nothing. And that’s not me being dramatic, I genuinely knew nothing. I was an adult branch student nurse, walking into neonatal having never really held a baby before, let alone cared for one for a 12.5 hour shift. Everything was so different to adult branch, it was like starting the degree again with no previous experience at all. I enjoyed the placement and my mentors were fantastic, but I spent the four weeks thinking I wasn’t showing my full potential because it was so different to what I’m used to and it completely threw me. I started my third placement of year 2 having lost all the confidence I’d gained from my critical care placement and not even knowing if I wanted to be a nurse anymore.

Year 2 has just felt like one knock after another and I will be glad to see the back of it. I have 8 weeks left of placement before year 3 starts and I’m excited to get back onto the ward and gain some confidence back ready for year 3. In all honesty, I still don’t feel 100% myself and if it wasn’t for certain people this year I don’t think I would still be at university now because I couldn’t have coped without them.

If you feel like you’re struggling at any point, reach out to someone. It doesn’t need to be a lecturer, it can be a friend or someone in your cohort. Even find someone on social media who you can confide in, don’t bottle it up like I did. I felt embarrassed to admit that I was struggling and keeping quiet for so long probably hasn’t helped the way I’ve felt for the past 4/5 months. I don’t think the ‘positivity brigade’ help at all, as much as they may think they are doing good, it’s hard to go on social media and see positive things all the time and no one talking about how hard things can actually be. I’m not saying people need to be negative nellies all the time either, but it’s about time we all started to show the real aspects of our experiences within this degree. Not just the highlight reel of achievements.

Love,

T x

The mentor that changed everything

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This post does not by any means suggest that my other mentors haven’t been amazing, because they have. I have been extremely lucky that every mentor I have worked with up to now have taught me so much and have always been fantastic to work with. There is just one mentor who changed everything for me.

Rewind back to the end of year 1, to me receiving my first placement allocation for year 2 and seeing HDU/ITU. I hadn’t been on an acute ward in my training yet and I was starting my acute experiences in one of the scariest places, A&E being another one that fills me with dread.

I spent weeks panicking (a common occurrence with me as you will know if you’ve read my other blogs 😂) and worrying that I really did not know enough to be trusted with this kind of placement. I was going from year 1, in a placement that I was actually quite confident in due to previous experience to my first acute ward. I did not have chance to visit the unit before starting placement so I walked in ‘blind’. The first thing I saw was all the machines and I must have looked terrified because one of the NQNs said ‘It’s not that scary once you get started, don’t look so terrified you will be fine!’. I met my mentor and she took me into handover. From the first moment she was welcoming and kind, I instantly warmed to her and felt a little less nervous. I picked up the handover sheet and was convinced it was in another language, I didn’t understand half of the actual handover and worried that this would happen every morning.

I started my placement with 2 weeks on HDU, so the ratio of patients is 2:1. My mentor started by showing me the crash trolley and the airway trolley. We then moved onto the bedside checks and the observation charts. By lunchtime, I was feeling confident enough to record the observations myself and my mentor was happy for me to do so. The next week passed so quickly and my mentor knew so much, the knowledge she had blew me away and I remember thinking to myself that I would never know all the things that she knew. At the end of my second week, I had 2 weeks annual leave for Easter. When I returned, I was on ITU.

I asked over and over if I was doing ok, if I was where I should be and was doing everything I should be. I was doubting myself as I always do and thought I didn’t know anything. My mentor encouraged me all the time to complete skills that she knew I could do, she had faith in me and taught me things that have since come in very handy on my other placements. The day she told me I was having my own level 2 patient in ITU, I remember thinking no, no way I’m not good enough. This is not happening I will mess this up big time. And guess what? I didn’t! I felt confident in the bedside checks and the observations, she provided me with support and encouragement and actually made me believe that I can do this. The next few days passed and I became more confident with everything, using my own initiative to complete tasks that I could do. Then my mentor said I was taking care of a level 3 patient. WHAT?! No, no thank you I do not know what to do and the ventilator scares me to death 😂 Of course I wasn’t on my own I had her supervision but I was allowed to complete tasks by myself, keep track of medication times and assess changes to care based on ABGs. She pushed me to make decisions based on my own knowledge without ever making me feel ‘belittled’ if I didn’t know anything or needed to check something.

Before this placement, I had absolutely no faith in myself at all and thought I wouldn’t make it as a nurse. This mentor completely changed my way of thinking. She showed me so much support and encouragement that it was impossible to continue doubting myself. She taught me so much and I genuinely think that if I become even half the nurse she is, I will be very lucky. She constantly made sure that I was feeling comfortable and gave me every learning opportunity, involving me in ward rounds and procedures such as intubations and tracheostomy procedures. I felt welcomed from day 1 and completely fell in love with the place, which is partly due to my mentor and the faith she had in me. The feedback she gave me made me cry and I always look back on it if I’m doubting myself and feeling low. To reiterate, I can say that I’m very lucky and all my mentors have been fantastic and I’ve learnt so much from them all, but there was something different about this woman. In 6 weeks, she took me from a nervous second year student believing she would never be a nurse – to a semi-confident (only because I’ll never be fully confident!) second year knowing that she could do this and that there was a good chance that she would qualify! I now feel slightly jealous of anyone who receives that placement in the time we have left on the course 😂

Let me know any stories you have of mentors like this!

Love,

T x

Second year is the worst….or is it?

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I’ve seen so many posts about how bad second year is and how difficult it can be, I am 6 months into second year now and thought I would share my top tips on how to make it a little more bearable!

  • Start work as soon as you get it. Gather references for the assignments before you start them as this helps when starting to write.
  • Remember how far you have already come. Think about your first day and how much you have learnt/changed since then. Write a list of achievements from year 1 that you can look back on.
  • Plan things throughout the year. I found this helps the time to pass a little quicker if you have things to look forward to.
  • For research modules – make sure you fully understand the terminology as this will help you when completing the assignment.
  • Take everything you hear from previous cohorts about assignments with a pinch of salt, you may really enjoy something that someone else didn’t.
  • Placement pre-reading. Placements will expect you to have a little more knowledge this year so pre-reading is a must.
  • Take on your own patients. Even if it’s only one patient for that day, take responsibility for their care (within the limits of what you can do with mentor supervision). This really helps to build confidence and third year responsibilities won’t seem as daunting if you have been doing them through year 2.
  • If you’re struggling, reach out to someone. Your personal tutor, another lecturer, someone on social media. It doesn’t really matter who it is just make sure you open up to someone, don’t try to manage through on your own if you feel you are struggling.
  • Get hold of a book on critical writing and thinking. The step up to level 5 writing can seem huge but it’s really about being able to say why something is done the way it is, wider reading and being critical in your thought process. I can recommend these two:
  • Take time for yourself. This is important in any year but do the things that make you happy. Self care can really help when you’re feeling fed up!
  • Chip away at assignments bit by bit. I start mine as soon as they are available and chip away, doing an hour or 2 a day if that’s the only time I have. Before you know it, the assignment is completed and it’s just the final checks you need to do.
  • Reference as you go! I say this all the time but with critical thinking comes more references, the last thing you want is to get to the end and have to find all 50+ of your references again to get them on your list.
  • Take on board previous feedback from year 1 and speak to lecturers about how to successfully write at level 5, they may have little hints and tips that will help you.
  • If you have to work around university, try to keep at least 1 full day off a week for assignments and yourself. You may even be able to join the bank at your hospital trust now, allowing more flexibility with shifts.
  • Try not to be disheartened if your first result is a drop compared to your first year grades. This can happen with the step up to level 5 writing, ask for guidance and really pay attention to your assignment feedback.
  • Try to save a little money each month, student finance drops in year 3 so saving a little bit during year 2 will help fill the gap.
  • Make sure your referencing is up to scratch, I have found this book really helpful for referencing (there is a website as well). Referencing tools are great but I prefer to create them myself then I can be confident that any errors are down to myself and you actually learn how to reference when you do them yourself.

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  • Keep up with your car maintenance, this may seem obvious but if you use your car a lot for uni and placement, wear and tear can occur faster than through doing normal mileage. The last thing you want is to be sat on the motorway waiting for the AA! (Other breakdown recovery companies are available 😂)
  • Email your assignments to yourself or save them on onedrive/google drive/a USB stick. Again, this may seem obvious but if your computer breaks or your work doesn’t save, you risk losing all the work you have done towards an assignment.
  • Keep in touch with your friends during placement, this kept me going through long shifts and weeks on placement.

Let me know if you have any other good tips for year 2 😘

Love,

T x

How to start blogging

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There have been some great blogs appearing recently on twitter, influenced by the 30 day July blogger challenge (@BloggersNurse) and the @WeNurses #70nursebloggers. I often see people asking how they can start a blog or for advice on what to blog about so I thought I would compile another one of my top tip posts around getting started as a student nurse blogger!

1. Choose your blogging platform

There are a number of free blogging platforms out there including WordPress and Blogger that are easy to use and can be personalised to how you want them. When you have been blogging a while, you could purchase a new theme or your own custom site address but for starting out the free ones are great.

2. Create a name

Try to choose something original and relevant to you. I chose student nurse and beyond because it describes where I am now and also allows me to carry on blogging using the same name once I qualify. There are some great blog names out there and you can really inject your own personality into them.

3. Personalise your blog

You can choose different themes and colour schemes to make your blog stand out. If you are a dab hand with graphics, you can design your own header or you can use one of the preloaded ones on the blogging site. I had my header designed by a friend and it gives my blog a personalised edge. Upload your own photos to give your blog a personal feel as well.

4. Create your first post

If you are a student nurse starting a blog, I would recommend blogging first about why you decided to start your nursing journey and why you chose the branch you did. This gives the reader an insight into you and helps to create a rapport with readers. Your posts don’t need to be too long and can be written in an informal style.

5. Read other blogs

Reading other blogs can help you to see different writing styles and what you may like to write about. If you see a topic on someone’s blog that you would like to write about, credit them within your post. It’s fine to take inspiration from other blogs, everyone does but people spend a lot of time of their posts so try not to just reword their posts to present as your own. Use your own skills and talent to create original content to you.

6. Don’t rely on a schedule

My advice would be to not put pressure on yourself when it comes to regular posting. Some bloggers post regularly and some don’t. Whatever works for you and your own schedule is good! Sometimes you can feel pressured to post once a week and it’s an added worry when you get busy and cannot manage to post that week.

7. Enjoy blogging!

I love blogging and find it really enjoyable to write, I like creating my top tip posts because I can give advice from my own experiences and if it even helps one person then that is fantastic! I personally stay away from commenting on political nursing issues but other bloggers comment on these really well (@Ewout1985, @CharlotteRCN, @JeepersMcCoy, @SchofieldRosie to name but a few). You can write about whatever you want to, but be mindful to maintain confidentiality at all times and to remain professional within your writing.

8. Don’t worry about the readers

It can take a while to build a regular readership on your blog, and even if you write a blog post to find only 5 people have read it it doesn’t matter! Write your blogs for you and if other people find them useful/interesting then that is a bonus. Blogging can soon become a ‘chore’ if you’re constantly writing to try to please other people.

9. Share your post

Promote your blog on social media – Twitter is a great place to share blogs! Some useful # to pop on your posts are: #nursebloggers #WeStNs #studentnurse

10. Continue blogging!

So you’ve got your first post out there and you really enjoyed writing it! Now carry on! Blog about your uni experience, your placement areas, your personal opinions, anything you want to write about.

If you want more information on how to start blogging, pop over to @WeNurses on twitter where there are some useful infographics to get you started!

Share your blog links with me as I love to read new blogs 😘

Love,

T x

Common equipment used in critical care

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Monitor – Every patient requires a monitor which allows for continuous monitoring of observations. These include blood pressure, heart rate, respiratory rate and oxygen saturations, CO² and temperature can also be added on to the monitor.

Ventilator – A ventilator can assist patients’ with their own breathing, or completely take over the control of a patients’ breathing. This allows their body to rest and recuperate. The patient will either have an endotracheal tube or a tracheostomy. A tracheostomy tube allows the patient to receive full support whilst awake. If the patient has an endotracheal tube, they will be sedated.

Arterial line – An arterial line is inserted into an artery and this enables constant monitoring of blood pressure, through being connected to the monitor. They also allow access for frequent blood samples and ABGs. The arterial line can be inserted into the radial, brachial, femoral or pedal artery. The most common ones I saw in critical care were radial ones. The arterial line is sutured to the skin to keep it in place.

Central line – A central line is an intravenous line, inserted into one of the larger veins in the body. They are mainly used for administering medications, IV fluids are also given through central lines. Central lines are usually inserted into the jugular vein, but they can also be inserted into the femoral or subclavian veins.

endotracheal-tube-500x500Endotracheal tube – This is a plastic tube that is used during mechanical ventilation. The tube is inserted into the patient’s trachea, often the tube will be cut to a size recommended by the Dr carrying out the intubation. A bougie may be used to guide the insertion of the tube. Once inserted, the tube will be attached to the ventilator via ventilator piping. There is a cuff on these tubes that will be inflated to prevent movement of the tube, cuff pressure is checked regularly to ensure there are no leaks.

Indwelling urinary catheter – All patients within critical care will have a urinary catheter in place. This is to ensure accurate monitoring of urine output for the patients fluid balance records. Urine output will usually be recorded every hour.

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Vas Cath – A vas cath is a specialised central line that is used only for dialysis. Placed in the jugular, femoral or subclavian veins. I only saw one of these in my time on critical care and it was placed in the femoral vein.

 

Product_PicWindow_Carefeed-AdultNasogastric tube – This is a flexible tube that is inserted through the nose and down into the stomach. The NG tube can be used to provide nutrition via a ng feed and to administer certain medications. The NG tube is aspirated regularly to check if the patient is absorbing the ng feed and to test the ph level of any aspirations collected. The position of the NG tube should be checked and recorded regularly by measuring the length of the tube visible. Before using the NG tube, the guide wire should always be removed.

tracoe-twist-ref-301-tracheostomy-tubeTracheostomy tube – A small tube placed into a hole made in the neck, allowing access to the trachea. A tracheostomy is used when a patient is being weaned from ventilator support. These are temporary and will be removed when the patient no longer needs them. The inner tubes are cleaned every 4 hours.

Intravenous infusion pumps – Used for any medication that is administered through a central line. The amount of medication infused every hour is recorded on the fluid balance chart. These are the ones used in my trust, others may vary.

 

Let me know if you’ve seen any other equipment on your critical care placements!

Love,

T x

 

 

A day on ITU

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The shift pattern on ITU is the same as the shift pattern on HDU (You can read my day on HDU post here) :

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

Just like on HDU, there is no ‘typical’ day on ITU as every day can be different from the next. Below is one day that I experienced on ITU.

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On ITU, the staff nurses’ have 1 patient each for the whole day (1:1).

07:45 – 10:00 – The nurse in charge checked the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses completed bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points were working and checking the infusions to ensure there is enough left to last a couple of hours. In ITU, there are also ventilator settings and alarms that need to be checked to ensure they are working correctly. After all these checks, the patient was assisted with personal hygiene needs and repositioned. Pressure areas are checked and patients on ITU are repositioned 4 hourly, with pressure areas checked on each reposition. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or a change in ventilator settings, depending on how the patient is responding to their current treatment plan. Sedation holds may begin around this time to allow the patient to have time to respond, sometimes the patient is not ready to fully break from sedation so the sedation may be restarted and a sedation hold attempted the next day.

12:00 – 18:00 – Again it’s hard to fully describe what happens in the afternoon as every day is different. Obs are usually completed hourly on ITU, they may be 2 hourly if the patient is self ventilating and being transferred to a ward. Obs on ITU include fluid input and output. Fluid input includes any medications given by IV or through a NG tube. Fluid output includes blood taken and NG tube aspirations as well as urine output. Every hour the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Patient observations are monitored closely and medications/oxygen can be adjusted accordingly. If a patient is responding well to ventilation, the ASB rate, PEEP or oxygen % may be adjusted to see how the patient manages. Extubation may occur if the patient is responding well to treatment but this will be planned in advance and discussed in the days leading up to the decision. ABG’s will be taken and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E, HDU or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Love,

T x

A day on HDU

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My first placement of year 2 is 6 weeks on ITU/HDU. At Derby university in second year, we have two hub placements. One is for 6 weeks and the other is for 12 weeks. We also have a spoke placement where we spend 4 weeks.

The shift pattern at my placement is:

Long day: 07:15 – 19:45

Nights – 19:15 – 07:45

There are 1/2 days but I won’t be doing any of these during my placement block.

There is no ‘typical’ day on HDU as every day can be different from the next. Below is one day that I experienced on HDU. Other areas/trusts will vary and I would love to hear about your typical days on placement!

07:15 – 07:45 – During this time, we received a handover from the nurse in charge. We then went onto the ward and received a more detailed handover for the patients we would be looking after that day. This included details about why the patient was admitted and followed the A-E approach with a few extra sections. This handover also included any planned interventions for that day, such as x-rays or planned transfers. On HDU, the staff nurses’ usually have 2 patients each for the whole day (2:1).

07:45 – 10:00 – The nurse in charge checks the resus trolley and ventilation trolley to ensure all the correct equipment is present, working and within the expiry date. The staff nurses also complete bedside equipment checks such as ensuring the equipment alarms are operating, checking the oxygen and suction points are working and checking the infusions to ensure there is enough left to last a couple of hours. After all these checks, the patient is asked if they would like to have a wash and a fresh gown. If the patient declines, they are re-positioned and a skin check completed. Everything is documented on the daily observations chart, an A3 sheet with information on both sides. All observations, fluid input/output and re-positioning is documented on there. The patients have a drink and breakfast if they are able to eat.

10:00 – 12:00 – Usually between this time, the consultants and nurse in charge will do a ward round. They discuss each patient and what the next step of their medical plan should be. Sometimes this will be a new medication or transfer to a ward such as respiratory or stroke wards, depending on the patient.

12:00 – 18:00 – It’s hard to fully describe what happens in the afternoon as every day is different. Obs are done hourly or 2 hourly, depending on the patient. Obs on HDU include fluid input and output. Fluid input includes any medications given. Fluid output includes blood taken as well as urine output. NG tube aspirations are included in the fluid output also. Every hour/2 hours the balance is recorded so we can see if the patient is in negative or positive fluid balance. Equipment checks are carried out once again throughout the afternoon to ensure alarms are still functioning correctly.

Personal care needs are met as needed and re-positioning is carried out regularly if the patient is unable to do so themselves. Patients observations are monitored closely and medications/oxygen can be adjusted accordingly. Equipment may also be changed if needed, such as changing a patient from a nasal cannula to an oxygen face mask. ABG’s may be taken in this time and the results recorded on the daily observation chart, as well as the patients medical notes.

New patients can be admitted from surgery, A&E or other wards.

18:00 – 19:15 – Daily notes are completed for the patients we have been looking after. The daily handover sheet is updated ready for the handover to the night shift team.

19:15 – 19:45 – Night shift arrive and the nurse in charge gives a handover covering the whole ward. The night shift team then come onto the ward and receive detailed handovers for their patients.

Look out for further blog posts in my HDU/ITU series!

Love,

T x