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    (Original post by Holamigo)
    i know! who thought the medics would be sooo interested in the nurses thread! haha

    its got to be about a patient from practice :/ so hopefully my next placement which is in may, will give me some ideas! still not exactly sure what my next placement is it says this:

    [64 beded community hospital providing rehabilitaion, assessment & intermediate care for in-patients. Also have outpatient facilities., including physisotherapy, with outreach for older people. Elderly, Rehabilitation, Sub/acute. Specific placement opportunities: Fundamental nursing skills; Holistic Approach; Complex case conferences dealing with complex discharges; Opportunity to work with MDT Special interest – physiotherapy; occupational therapy: Home visits, Some palliative care, Total patient management. ]
    Not really sure if it'll be similar to a normal ward or what?! don't know what to expect really!! This will be the placement i've got to do my OSCE on :-/ eeeek!


    Ooo and wow about applying for nursing graduate programmes in oz!! that's my dream I thought they require you to have 1 year experience or is that not the case ? how are you finding 3rd year??
    Ahhh you have a community hospital! They're really good, mostly nurse led and care of elderly but soooo interesting and you'd learn a lot about the 'management' and complex discharges of patients, what's your OSCE?

    I feel so silly..I left it this long to get my essential skills signed off, leaving me now with just 4 weeks to be signed for doing a full drug round, NG/PEG feeding, IVs, asessments and a whole manner of things

    OO but I did get 19.5/20 on my critical care OSCE

    Not long now...

    3rd year is ok, much better than 2nd year..but starting to get itchy feet now and want the money lol. Can't wait to be back at placement though on monday, i have fantastic mentors who are really encouraging. I had my own bay last fridau thought it was going to be a really sweet shift as 4 beds were empty and 2 were due for discharge, turned out my 2 for discharge were going to be told they had agressive cancer and it was going to be treated 'palliatively' totally out of the blue for them too, and with one being rather young. Was horrible shift having to deal with it. It shocked me the first thing one of them said when being told the news was 'well what about work?'!
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    (Original post by moonkatt)
    What do you mean by not accountable? Students are accountable for their actions, just not professionally accountable to the NMC.
    I meant not accountable professionally, legally but within our own 'skills mix'- aka what we are as students (ourselves, patient and ethically)
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    Stressedddddd!
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    Also stressed.

    Too many people are walking out of our lessons in tears / on the verge of a breakdown.
    Zero support from uni and when we complained about lack of support we got told off for moaning about it.

    So now not only does home suck, uni also sucks. Great.

    Second year blues and a half.
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    (Original post by Subcutaneous)
    Lol i know..didn't know so many medics were, feeling very big brother!


    Ooo whats it on? I'm spending the day applying for nurse graduate programs in Oz..it's a nice way to spend a dreary saturday afternoon in the uk lol
    *lurking* :ninja: In my defence, my brother is starting a nursing degree in September, so it's not all just interprofessional rivalry stalking :tongue:

    Out of interest, why the move to Aus? Cos of the NHS here, or just better opportunities out there? I've heard of a lot of medics emigrating out there, but never really heard about nurses doing it.
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    (Original post by dani_88)
    Also stressed.

    Too many people are walking out of our lessons in tears / on the verge of a breakdown.
    Zero support from uni and when we complained about lack of support we got told off for moaning about it.

    So now not only does home suck, uni also sucks. Great.

    Second year blues and a half.
    I know exactly what you mean love, i've had the worst year with the home/ uni combination.
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    (Original post by Becky_90)
    I know exactly what you mean love, i've had the worst year with the home/ uni combination.
    The worst thing is... according to the third years, things get no better in third year at our uni...
    Really looking forward to third year now... :rolleyes:

    And getting very frustrated that i have no idea where my next placement is...STILL!!

    Our class is just really sucky, like we're all segregated in different groups, we have no real good class rapport or anything..anyone got any bright ideas how we can all get better as a class?!?!

    As for the home situaiton..looks like i'm going to be needing two new flatmates...or a new place to live...eek.
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    (Original post by Becca-Sarah)
    *lurking* :ninja: In my defence, my brother is starting a nursing degree in September, so it's not all just interprofessional rivalry stalking :tongue:

    Out of interest, why the move to Aus? Cos of the NHS here, or just better opportunities out there? I've heard of a lot of medics emigrating out there, but never really heard about nurses doing it.
    OMG I just accidentally nagged you! Stupid iPhone!
    Er I think it's more a change of scenery , better pay, staff numbers higher, working conditions and their 'graduate' program for RNs seems really structured for your first year, which is nice. I've always wanted too so better late than never! I've decided to apply for 2 programs, and if I don't get them stay in the UK for a couple of years, then if I'm still free & single go travellung there and do agency shifts.

    Dubai & Saudi Arabia too..purely for the tax free wages! Oh and the nurses don't do much skills so rather easy money IMO!

    Had the worst shift today with a pretty dreadful uncaring nurse...don't you hate being with a nurse who's not your mentor?!
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    (Original post by dani_88)
    The worst thing is... according to the third years, things get no better in third year at our uni...
    Really looking forward to third year now... :rolleyes:

    As for the home situaiton..looks like i'm going to be needing two new flatmates...or a new place to live...eek.
    Yup, i think its that awkward stuck in limbo moment. Im egerly waiting third year, hoping its something i can finally get my teeth into opposed to the many tedious lectures we currently have.

    As for the home situation, its possible. After christmas 2 of my housemates said they werent staying, then around the middle of Feb another one said the same, so the remaining three of us have had to find three more- irritating but i can be done.
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    (Original post by Subcutaneous)

    Had the worst shift today with a pretty dreadful uncaring nurse...don't you hate being with a nurse who's not your mentor?!
    Depends on what the mentors like haha! might be a welcome relief sometimes! I do hate when you just get stuck with a random who clearly doesn't give a twizzle about teaching you anything though!
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    Hi

    I will be starting an adult nursing course next week. Is it okay to join?

    Thanks in advance

    Nix
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    (Original post by amyamy)
    Depends on what the mentors like haha! might be a welcome relief sometimes! I do hate when you just get stuck with a random who clearly doesn't give a twizzle about teaching you anything though!
    True! I just hate that transition when you're on a new placement or doing the odd shift with a new RN and you're both testing each other out over what they are happy for you to do, and them testing you on what you can do! I had some crap shifts last week with two different nurses each day.

    One said I would take the bay, but I then felt out of control (and learnt nothing) as she went off and did things..but expected me to do the writing and menot knowing what x doctor said or what referrals were made! The second one was bloody lazy, spent half her shift fretting over her off duty, and the other half worrying about missing notes..leaving me feeling confused, and unsure of how much control I had and just went into an auxiliary role instead, then she gave me grief over not doing drugs...when I was hardly going to do them with her off on the computer, chatting to friends..and loose my pin before it's gone!!!! Lol

    However spent 3 shifts now with my usual lovely laid back mentor! He is fab, making me FEEL like I'm already qualified but also I can approach him with questions/support. I was meant to have taken 2 patients today (who were quite sick and I didn't want them plus a whole bay too just yet! ) however as he's a band 6 at lunchtime he asked me to take the rest of the bay for an hour...6 hours later and some bedstate crisis he'd purposefully gave me the patients knowing he was going to be away for a while as he said I needed to realize I could do it! And I did!!!!!!

    I'm so proud, had 3 very sick patients one of which ended up in ITU, and did everything except iv's and drugs independently. I felt a bit shaky, like I felt really silly asking a doctor to write up fluids for a patient with low BP! lol as usually I'd just have asked my mentor what I thought and asked with his say, not on my own judgement...I felt silly though, like I was going to be laughed at! I think I need more confidence in clinical decision making. I'm dithering over so many things at the moment, and my mentor keeps saying I know it- but need to trust myself! Things like doing a wound swab, catheterizing a patient, doing referrals Aka SALT...I even dithered over whether to give movicol to a patient!

    It's frustrating me! Any tips, or will it come with experience? Luckily when qualified there'll be senior nurses to bounce ideas/questions off but I need to be more independent in management. It's getting there anyway..got told today I gave a handover like an old timer nurse lol
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    I've started running the unit I'm on, and by god it's terrifying. I'm so scared I'm going to muck up or kill one of my day patients or screw up MDT. But apparently I have the skill and I know what I'm doing I just need to believe in myself.

    Ps 6 months till i qualify!
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    Glad to hear both your placements are going good

    I rang mine today, start my district nursing on Monday. Im quite looking forward to it, the chance to be off a ward and everyone seems to say good things about district. Think i just want to get out there, im boring with uni a bit now.
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    awww im jealous, want to go back to district nursing! Had a patient with some wounds last week that needed dressing and everything i'd learnt with the DN's on wound care came flooding back...!

    Just doing some evidence for this placement, it has to be 'level 4'. However i'm really struggling to make it anything 'different or better than it was for the first two years of the course! I'm limiting it to 6 pieces on this placement, but making them good quality pieces. What do you think of this reflection, any improvements or expansions i can make?!

    Spoiler:
    Show

    Reflective writing one: RW1
    14/4/2011
    A Reflection around discharging a patient home, using Gibbs (1988).
    Related Evidence: WP1 (Discharge paperwork).

    The purpose of this reflection is to evaluate an aspect of my practice whilst on placement on a neurology/neurosurgical ward for females. According to NMC code of conduct confidentiality shall be maintained for my patient and protect identity (Nursing and Midwifery Council 2008). I’ll be using the reflective model used by Gibbs (1988).
    Description
    A middle-aged female who’d been admitted onto my ward after suffering lower-limb weakness was to be discharged due to progress she’d made and the decision by the medical team to see her as an out-patient. This then involved me liaising with the multidisciplinary team and also her family to ensure she was ready to go home for safety. I spoke to the physiotherapist who’d been working with her since admission on her assessment and once she’d agreed the patient was safe. I promptly completed relevant paperwork, worked with my mentor and ward pharmacist to ensure the patients medication was ready to be returned and ensured the patient had all relevant information upon leaving.
    Feelings
    I was pleased that my patient was returning home, and understood in terms of rehabilitation she’d improve much more in a familiar environment. However I recognised and discussed with her she had some work to do to return to her original mobility and independence.
    Evaluation
    I felt the process went well and through liaising and discussing with all relevant healthcare professionals ensured the patient was being cared for holistically. I also recognised it was important to discuss with her family about how they felt around this due to the care needing to be delivered. Finally through allowing the patient to have a say gave her empowerment into her care. However on reflection it could have been possible she may have needed more MDT involvement such as an Occupational Therapist, although this could be deemed unnecessary as she had all relevant equipment at her residence.
    Analysis
    The department of health (DH 2003) discuss that the discharge of a patient involves planning and is not an isolated event and should involve the consideration of the individual, carers and MDT and through effective and forward thinking planning this could prevent delays. A more recent document by the department of health in 2010 discussed ’10 steps’ to discharge for the elderly, despite my patient not being technically classed as an ‘elderly’ female the publication highlights issues which all patients of any age will face (DH 2010).
    One such issue it discusses is the role of liaising with the carer. It is important to recognise the role of the carer for the patient and indeed their own expert knowledge if previously been involved, although for many this could be their first experience of caring for someone with limited independence (DH 2010). The Department of Health document highlights to ensure the expectations of the carer match that of yours and the patients, alongside the rights to an assessment plus any government and local authority benefits they can access. (DH 2010)
    The Nottingham University Hospitals Trust has a policy regarding discharge which is agreed and published with local health and service agencies, which further discusses the need for preparing a patient physically and psychologically for discharge and the importance of discharge planning as soon as admission takes place. The policy also stresses the responsibilities of the registered nurse upon discharge, such as planning a safe and timely discharge, communication with the MDT, documentation is completed to appropriate standards and communicated to relevant agencies and the patient is educated appropriately on their health and care needs. (NUH 2010).
    When considering the interdisciplinary approach to discharge, Connolly, Deaton and Dodd et al (2010) discuss that the MDT activity in discharge is not always carried out effectively and research showed this could be due to lack of understanding of a colleagues role. When considering the research’s implication for practice it was discussed the nurse could have liased and balance any issues that arise in the MDT approach to discharge, alongside the usefulness of communication and effective handover.
    What does this mean to me?
    Whilst looking at the evidence behind initiating an effective discharge for a patient I believe I used best practice using the best available evidence throughout conducting this process (NMC 2008). Through recognising the integrated approach to discharge and communicating with the patient, family and MDT enabled my patient to go home safely and prevent readmission. However in the future it may be possible to consider in more depth the role of the ‘carer’ when discharging a patient who will need care, particularly those who are relatives (DH 2010) and to discuss with them the impact caring could have upon their own lives and the agencies they may be able to access. I’m also now more away of local trust policies regarding discharge and the services the trust can offer alongside the legal implications of discharge such as consent and discharging those who are homeless and in the future will be aware of literature I can use if faced with a conflicting situation. (NUH 2010). Finally through engaging in interprofessional education and practice it can help me understand other healthcare professional’s roles and values when approaching discharge alongside the importance of communicating with the MDT (Connolly et al 2010).
    Conclusion
    After doing a discharge on a female patient I ensured I worked with the multidisciplinary team to ensure the patient was safe and appropriately cared for, alongside the patient’s family and carers. This went well and I used initiative to complete relevant paperwork and work with the MDT with decreasing supervision. Relevant literature discusses effective discharge uses the MDT (Connolly 2010), good communication with carers (DH 2010) and planning from admission (NUH 2010).
    Action Plan using the SMART tool.
    1. I plan to increase my awareness of a patients discharge from admission and include this in my plan of care to be achieved during my management placement. I will do this through being aware of relevant documentation, policies and protocols in the place of practice and will discuss this with my mentor.
    2. I plan to get more involved in complex discharges and with the social care agencies involved during my management placement. This can be achieved through recognising patients who will fit into this category and taking a minimal supervision approach to their care and working with the MDT in a more complex case than the one discussed above.



    References

    Department of Health (2003). Discharge from Hospital: Pathway, Process and Practice. HMSO: London

    Department of Health (2010). Ready to Go? Planning the discharge and transfer of patients from hospital or intermediate care. HMSO: London

    G.Gibbs (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational Unit, Oxford Polytechnic.

    M.Connolly, C.Deaton, M.Dodd, J.Grimshaw, T.Hulme, S.Everitt, S.Tierney. (2010). Discharge preparation: Do healthcare professionals differ in their opinions? Journal of Interprofessional Care, 24(6), 633-643.

    NUH (2010) Discharge and Transfer Policy and Procedure. Nottingham University Hospitals: Nottingham.

    Nursing and Midwifery Council, (2008) The NMC code of professional conduct: Standards for conduct, performance and ethics. London: Nursing and Midwifery Council.
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    Anyone often feel like they keep drawing the mentor short straw!

    This placement is now my 4 out of 5 where i've had a sister as my mentor. Now im not overly complaining because dont get me wrong when they've got the time, they do know their stuff..but its getting the time! Gets a bit tiresome after a while.
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    In all honesty no. I've had two sisters including my mentor currently. I'm a third year and she hardly has time for me. However, we did organise that we meet for 20 minutes every week to make sure I'm getting on okay. Also it helps you see the managerial side of things.

    Moan: All the jobs want experience or to be a first level nurse..so I need to qualify before I apply for 85% of them! Well done! Someone in the NHS take me on, please!
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    Awful shift, never cried so much since starting the course. I'll post tomorrow- but put it this way, a career in teaching is so attractive right now.
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    (Original post by Subcutaneous)
    Awful shift, never cried so much since starting the course. I'll post tomorrow- but put it this way, a career in teaching is so attractive right now.
    Sorry to hear about your shift.
    Come pack and pour it all out when you want, problem shared and all that...!
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    Can anyone help,

    what assessment tools are available for someone who has difficulty mobilising?!
 
 
 
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