Annexe B: Nursing Procedures

What Nicole did

During the practice learning experience, Nicole developed her understanding of the nursing care and procedures required to support a child with complex respiratory needs in the community. Under appropriate supervision, she participated in aspects of care relating to tracheostomy management, ventilator support, routine monitoring of respiratory status, oxygen saturation levels, heart rate, breathing patterns and overall wellbeing, alongside infection prevention measures. This enabled her to recognise the importance of ongoing assessment and early identification of changes in a child's condition.

Nicole considered Billy’s comfort, dignity and communication needs before, during and after procedures. She recognised that technical skills must always be combined with compassion, safety and person-centred care.

She also developed awareness of how nurses assess changes in condition, respond to risks promptly and ensure equipment is functioning safely within the home environment.

Nicole understood that student participation in procedures must remain within her level of competence and under appropriate supervision.

What this demonstrated

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Nicole gathered information from Billy, his family and the care team to understand his usual presentation, current needs and recent changes. She recognised the importance of combining communication, observation and family knowledge in assessment.

1.2 Physical health and wellbeing

Nicole developed understanding of Billy’s respiratory condition, tracheostomy care needs and overall physical wellbeing. She considered signs that might indicate discomfort, fatigue or deterioration.

1.2.3 Symptoms and signs of deterioration and sepsis

Nicole recognised that changes in Billy’s breathing pattern, energy levels or clinical presentation could indicate deterioration. She understood the need to escalate concerns promptly.

2.1 Take, record and interpret vital signs manually and via technological devices

Under supervision, Nicole observed and participated in routine monitoring relevant to Billy's care, including oxygen saturation levels and other physiological observations used to assess his respiratory function and overall condition. Through discussion with the supervising nurse and Billy's family, she developed an understanding of how observations are interpreted in relation to his usual baseline and how changes may indicate deterioration or the need for further assessment. She recognised the importance of accurate documentation, effective communication and timely escalation of concerns.

2.5 Manage and interpret cardiac monitors, infusion pumps, blood glucose monitors and other monitoring devices

Nicole developed awareness of how monitoring devices support safe assessment and ongoing care. She recognised the importance of checking equipment function and responding to alerts appropriately.

2.7 Undertake a whole-body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status

Nicole observed that assessment of Billy’s needs involved more than respiratory care alone. She developed understanding of holistic assessment across physical wellbeing, mobility, comfort and skin integrity.

2.13 Identify and respond to signs of deterioration and sepsis

Nicole understood that prompt recognition of changes in observations or clinical condition was essential, particularly within a home environment where family members are often the first to notice subtle changes in a child's health and wellbeing. She recognised the value of the family's knowledge of Billy's usual presentation and understood the importance of responding appropriately to concerns, seeking support and escalating changes in condition without delay.

2.16 Recognise and manage seizures, choking and anaphylaxis, providing appropriate basic life support

Nicole developed awareness of emergency risks relevant to children with complex needs, including airway compromise and choking. She understood the importance of emergency procedures and escalation.

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity

Nicole considered Billy’s comfort, fatigue levels and privacy during care activities. She recognised that procedures should be planned around the child’s wellbeing and dignity.

4.1 Observe, assess and optimise skin and hygiene status and determine the need for support and intervention

Nicole appreciated the importance of skin integrity, hygiene and routine comfort measures for a child receiving ongoing complex care. She recognised the need to monitor for irritation or pressure concerns.

5.1 Observe, assess and optimise nutrition and hydration status and determine the need for intervention and support

Nicole developed awareness that long-term conditions can affect appetite, hydration and energy levels. She recognised that these factors form part of holistic nursing care.

7.1 Observe and use evidence-based risk assessment tools to determine need for support and intervention to optimise mobility and safety, and to identify and manage risk of falls using best practice risk assessment approaches

Nicole recognised that mobility, equipment tubing and fatigue could create safety risks in the home environment. She understood the importance of safe positioning and hazard awareness.

8.1 Observe and assess the need for intervention and respond to restlessness, agitation and breathlessness using appropriate interventions

Nicole identified that anxiety or breathlessness could affect Billy’s comfort and tolerance of care. She responded by remaining calm, offering reassurance and seeking support where needed.

8.3 Take and interpret peak flow and oximetry measurements

Under supervision, Nicole used a pulse oximeter to support monitoring of Billy's respiratory status. She recognised the value of technology in ongoing assessment and understood how monitoring results, alongside clinical observations and information provided by Billy's family, contributed to the safe management of his care at home.

8.4 Use appropriate nasal and oral suctioning techniques

Nicole observed how suctioning may be required to maintain airway patency, comfort and respiratory function. She recognised that this procedure requires appropriate competence, safety and supervision and observed how communication skills were used to explain the procedure, gain cooperation, assess Billy's response and provide reassurance to both Billy and his family. She understood the importance of adapting communication to the needs of the child and family while delivering safe and effective care.

8.6 Manage airway and respiratory processes and equipment

Under supervision, Nicole participated in routine checks associated with Billy’s tracheostomy and ventilator care. She recognised the importance of equipment safety and responsive nursing care.

9.1 Observe, assess and respond rapidly to potential infection risks using best practice guidelines

Nicole appreciated that tracheostomy care and long-term equipment can increase infection risk. She recognised the need for vigilance and prompt response to concerns.

9.2 Use standard precautions protocols

Nicole followed appropriate hygiene and safety measures during care activities. She understood the role of standard precautions in protecting Billy, the family and staff.

9.6 Use evidence-based hand hygiene techniques

Nicole practised effective hand hygiene before and after care procedures. She recognised this as a fundamental aspect of safe practice.

9.9 Safely assess and manage invasive medical devices and lines

Nicole developed awareness of the careful management required for tracheostomy equipment and associated devices. She recognised the importance of observation, maintenance and prompt escalation of concerns.

11.6 Exercise professional accountability in ensuring the safe administration of medicines to those receiving care

Nicole observed the importance of medicines safety, checking procedures and supervision when medicines formed part of Billy's care. She recognised that safe medicines management in a home environment relies on effective partnership working between healthcare professionals and family members, who are often closely involved in administering medicines and monitoring their effects. She understood the professional responsibilities involved in ensuring medicines are used safely and effectively.

11.11 Undertake safe storage, transportation and disposal of medicinal products

Nicole developed awareness that medicines in the home environment must be stored and managed safely. She recognised the importance of following local policy and family guidance.