bethanyhelina
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deviant182
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(Original post by bethanyhelina)
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What have you been given via feedback?

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PaediatricStN
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(Original post by bethanyhelina)
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Initiative is something that can be difficult to develop, especially for new students who are not familiar with a healthcare context, but also depends on the context...

With regard to patient care, think ahead. Get stuff ready well in advance, stock up your patient's room at the start of shift with equipment you will need, group care together wherever possible to avoid disturbance to the patient. Not sure what year you are, but if your mentor is stuck with a patient for ages and you know obs & meds are due, crack on with the obs, get another nurse to do the meds if you know your mentor wouldn't mind... In short, keep on top of everything, and think about the patient as a whole. If you're free, offer help to other staff, restock the drug room, empty sharps bins and tidy sluices etc.

For your own learning: ask lots of questions, ask if there are other professionals you can spend time with e.g. physio, OT, SALT, specialist nurses etc, keep a notebook in your pocket and list common conditions/medicines in your placement area - research them and show this knowledge to your mentor at a later date. If you're learning about a procedure, ask if there's a guideline or protocol on it you can skim read...

Hope that kinda helps!
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bethanyhelina
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(Original post by deviant182)
What have you been given via feedback?

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Sorry for the lack of detail, I deleted most of my post because it was very long. Basically, my mentor decided that I was not progressing in domain 4 outcome 2 "is able to manage self effectively and when appropriate can take lead in coordinating, delegating and supervising care safely and managing risk", as im a second year, i need to do this with less direct supervision with confidence. (I was assessed as not progressing 3 weeks ago).

One reason was because I lacked confidence and needed to use my inititiative and i ask her things I already know. For example, when looking after a child with a temperature i asked her to get some paracetamol, then 20 minutes later i asked her whether i should re-check their temperature instead of just doing it.

She also said i lacked self-awareness. One of the examples she used is that I walked in on the ward round half way through (because she asked me to do a job, but i desperately wanted to following this families care process) and the mum complained because i walked in half way through the conversation. Another example is that i can panic in stressful situations. For example, when someone's sats aren't within satisfactory limits - I decided to go get her as family reported that the sats did dip with the illness and he was coughing quite a lot when i was assessing him. When my mentor came he had recovered and his sats went up and she said i panicked rather than assessed thouroughly.

I have since started having patients under supervision, handing over my patients, and doing my patients notes without being prompted. I also start observations early so that i can participate in medicine management without being told to just go do obs. In my last few shifts i have started being more involved in the team - talking to and bleeping doctors etc. I have a second mentor and when she was in charge on a really busy day i did a lot of the patient care and jobs she was always on ward rounds etc, I would go to her to remind her when medicines needed doing and i would delegate care when i needed help to other students and healthcare assistants.

Whilst i feel like i do manage better since this meeting, ive found that my confidence in myself has got worse and im scared of asking questions as im scared she'll say im still not using my initative. Im also scared to follow her and listen to conversations or get involved in care of patients that she hasn't delegated to me. I understand that i do lack confidence and even before she assessed me at this interview i told her that, i just dont know how to rectify it. Ive signed up for student wellbeing but there's no appointments in the near future. Im scared im not good enough and my final assessment is in two weeks, im terrified she's going to mark me as not achieved. What's made me worse is that she asked if she could borrow my book so the nurse in charge and her could count my hours. However, they wanted to do this alone in a separate room and i had an email from the clinical educator the day before with my total hours so far letting me know i was on track with them. They didnt have time to look at my book so she asked me to leave it over night. When i went back it was open on the page next to the one where i'm not progressing and my hours from that shift were not signed. All this occurred when i mentioned that we'd have to do my last interview soon. I feel like this placement is turning me into an anxious and paranoid person. I've never felt so low. I have got intouch with my academic adviser but since it's so close to the end i feel like this is pointless.
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bethanyhelina
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(Original post by PaediatricStN)
Initiative is something that can be difficult to develop, especially for new students who are not familiar with a healthcare context, but also depends on the context...

With regard to patient care, think ahead. Get stuff ready well in advance, stock up your patient's room at the start of shift with equipment you will need, group care together wherever possible to avoid disturbance to the patient. Not sure what year you are, but if your mentor is stuck with a patient for ages and you know obs & meds are due, crack on with the obs, get another nurse to do the meds if you know your mentor wouldn't mind... In short, keep on top of everything, and think about the patient as a whole. If you're free, offer help to other staff, restock the drug room, empty sharps bins and tidy sluices etc.

For your own learning: ask lots of questions, ask if there are other professionals you can spend time with e.g. physio, OT, SALT, specialist nurses etc, keep a notebook in your pocket and list common conditions/medicines in your placement area - research them and show this knowledge to your mentor at a later date. If you're learning about a procedure, ask if there's a guideline or protocol on it you can skim read...

Hope that kinda helps!
Thank you! I took your advice on-board the last few weeks and i feel like i am using my inititaive more! Just hope its enough for my mentor to decide im passing!
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PaediatricStN
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(Original post by bethanyhelina)
Thank you! I took your advice on-board the last few weeks and i feel like i am using my inititaive more! Just hope its enough for my mentor to decide im passing!
Well done! From your other post in reply to Deviant it sounds as if you are making progress.

It also sounds as if your mentor is providing you with areas of your practice that require improvement but not telling you how to improve them(!?). I also wonder if your mentor is expecting maybe a little too much of you considering you are only second year.

I don't know if you have been taught about the nursing process APIE. (I LOVE a bit of APIE!). Assess. Plan. Implement. Evaluate. With the very simple example of your child with a temperature this would go like this:
Assess: My patient has a high temperature
Plan: I will take of their baby grow and give them some paracetamol
Implement: To carry out your "Plan"
Evaluate: Rechecking their temperature.

Think about it like a process. You're second year, so I'm confident you can make an assessment e.g. High temp, increased WOB etc. Think about what you'll do to address the assessment - that's your plan. But then how will you address the effectiveness of that plan? That's your evaluate.

Another example for you:
Assessment: Child's BP is a bit low, CRT is 2 seconds and they have only passed urine once in the last 36 hours.
Plan: Contact doctors - likely to need IV fluids
Implement: Apply analgesic cream for cannulation, assist Dr with cannulation, administer IV fluids
Evaluate: Commence strict fluid balance, carefully monitoring urine output, recheck observations regularly.

With the sats example, first think about whether the monitor is picking up properly. 9 times out of 10 the child is wriggling or has kicked the sats probe off! Once you've done that do an A & B assessment. Is their airway patent? Do they need suction? Is their head in the neutral position? (For babies) or tilted back (For older children)? Are they working harder with their breathing? What's their colour around their lips like? Is their RR visibly faster? Does their bed or cot need tilting? - this can help with WOB... Or are they lying on the wrong side (If they have a collapsed lung on one side and are lying on that side it can affect sats). There is lots to think about, but I hope that helps. I kind of wish you were my student - we could go through it all at the bedside! You will get better at not panicking though, I promise!
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