The focus of this scenario is the learning that Darren, a third-year student nurse undertook whilst on a shift on ward A which is a surgical ward.
Darren has just moved into year 3 of his programme and feels that he is lacking in confidence as he has not been in a hospital environment for a while.
He wants to gain more leadership, delegation and management experience whilst on this placement.
Darren’s joined on his shift by:
- Emma: a first-year student nurse
- Saima: a second-year student nurse
- Colin: a Health Care Assistant (HCA), also working in the bay
- Grace: the Registered Nurse (RN) who will be his practice supervisor
Darren also has a named practice assessor who is different to his practice supervisor and not working on this day.
Planning for his shift
Darren is feeling overwhelmed by the outcomes that he needs to achieve, so he’s identified clear learning objectives with his practice supervisor.
Together they decide that before he can coordinate the care of the whole bay, Darren will be responsible for the coordination of care for three people, allowing him to develop his confidence. This will enable Darren to delegate and supervise care to his fellow students and consider their learning outcomes too.
Darren's patients
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Female, aged 67
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Total abdominal hysterectomy two days ago for cancer
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Has a 10cm abdominal surgical wound, closed with clips, theatre dressing intact and due to be reviewed today
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Urinary catheter removed earlier today
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Lives at home and is a full-time carer to her husband, Robert, who has disabilities.
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Janet is experiencing a lot of pain and feeling nauseous.
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She is feeling extremely anxious and scared about both her diagnosis and how her husband is doing.
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Diagnosed with cancer only two weeks ago after experiencing weight loss and fatigue.
- Female aged 93 and normally lives in a residential care home; her son and daughter-in-law live locally
- Admitted with pyrexia, coughing, trouble swallowing, and shortness of breath, confusion, loss of appetite, weight loss, rapid heartbeat, and bluish skin around her mouth and finger-tips, and sputum that is pink.
- She has an initial diagnosis of aspiration pneumonia
- Various tests and investigations have been requested and carried out including blood tests, sputum culture, urine sample and a chest x-ray
Intravenous (IV) fluids, IV antibiotics, oxygen therapy and steroids have been prescribed and have been administered over the last 24 hours - Annie is mildly confused
- There were no medical beds available on admission and she may be moved later in the day.
- Female aged 19 years.
- Elouise has a two-year-old daughter (Riley) who she’s very concerned about as the last few months have been disruptive. Elouise lives with Riley in bed and breakfast (B&B) accommodation awaiting local authority housing. She moved to the B&B from a woman’s refuge having recently left an abusive relationship. Riley is currently being looked after by a trusted friend as Elouise is currently estranged from her family.
She had an appendectomy performed two days ago where an abscess was found, now she has an elevated temperature of 38ºC and her wound is looking inflamed. IV antibiotics have been prescribed and administered over the last 48 hours.
Learning objectives and priorities
Darren discusses his learning objectives for the day with his practice supervisor. Darren provided his supervisor with an in-depth level of understanding of the health status of all three women, clearly explaining the physical, mental and social aspects of their care and the interaction of their medications. He spoke about evidence that he had read concerning audit results of infection control in wounds and guidelines for treating the wound. Darren also recognised that a couple of people in his care were experiencing nausea, so he chose to research the evidence of anti-emetics and the length of time people should be ideally nil by mouth.
He also discusses the priorities for care and how he is going to coordinate and organise the work in the bay with the other staff and students.
Darren and his practice supervisor, Grace, agree that they’ll both need to support and coach the other two student nurses to care for the three women, especially with some of the more complex conversations and communications that were needed.
Following this, Darren delegated the care of:
- Janet to Emma
- Annie and Elouise to Saima
He asked Colin, the HCA to support both students to deliver care to all three women, but particularly Janet and Annie.
There was another RN on duty responsible for the other people in the bay.
Putting the proficiencies into practice
The Standards of proficiency for registered nurses list the knowledge, skills and behaviours that every nurse must have by the end of their programme.
The standards are set out in seven sections called 'platforms'.
There are two annexes in these standards that list the skills nurses must have, and the procedures they must be able to do when they join our register.
One focuses on communication and relationship skills, and the other on nursing procedures.
Through some examples see how Darren was able to demonstrate certain outcomes of these proficiencies through his learning experiences.
What Darren did
As there was a safeguarding concern for Elouise’s child, Darren co-ordinated the teams that were involved and ensured that when he required more support, he gained this from his supervisor.
When Darren introduced himself to each of the patients, he asked them their name and how they preferred to be addressed to enable him to provide and promote non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments.
What this demonstrated
Darren demonstrated in all aspects of the care that he was involved the ability to adhere to the Code, and clearly identified the Duty of Candour. He also had to think critically and used an array of evidence to draw conclusions and actions about the care he provided.
Darren promoted non-discriminatory and sensitive care accounting for personal needs and preferences
What Darren did
Darren uses aseptic techniques when undertaking wound care including dressings and suture removal. He takes the opportunity to promote wound healing by discussing diet, exercise and cleanliness.
What this demonstrated
Darren demonstrated the importance of making reasonable adjustments in the context of people’s individual circumstances.
He also ensured that he provided information in accessible ways to support each person’s understanding of their care and treatment, such as wound healing.
What Darren did
Carried out proficiently himself, or supervised others to carry out various procedures to assess and monitor Janet, Annie and Elouise providing person-centred care, identifying their holistic health care needs.
He also observed and assessed the skin integrity in all three women, accurately assessing each person’s capacity for independence.
What this demonstrated
Darren demonstrated an understanding of how the body works, knowledge of body systems and provided appropriate support and person-centred care.
For example, recognising and assessing comfort and pain levels, rest and sleep, taking appropriate action to reduce or minimise pain or discomfort. His supervisor was also able to observe him assessing Annie’s respiratory system (her laboured breathing) proficiently.
What Darren did
All three women were very anxious and scared and Darren considered each person individually to understand and alleviate their concerns.
Elouise was really worried about her daughter, Riley, and Darren took the time to listen to her. He also supported the other student nurses with care delivery and contacting support agencies.
Annie was having IV antibiotics and Darren noticed that she kept trying to pull the cannula out, so Darren found ways to distract her. He demonstrated this to Saima and Colin who were both able to keep closer observations of Annie. He also assessed Annie’s fluid intake and urinary output to ensure that she was not dehydrated, and asked Saima to monitor her pulse, temperature, respiratory rate and blood pressure.
Drawing upon his knowledge and that of his supervisor Grace, Darren administered intravenous drugs under her supervision.
What this demonstrated
Darren focused on person-centred care, knowing that each person reacts differently to being in hospital and has different personal concerns. He also knows that their understanding and responses to care is different and that he needs to provide cognitive, behavioural, and mental health care as well as the physical care required. He also needed to understand the cause of Annie’s confusion.
· Darren was becoming more confident in the administration of IV drugs.
What Darren did
Darren coordinated the staff in his bay and demonstrated a good understanding of human and environmental factors that affect care.
He also identified that he wanted to get involved with the care delivery and understood that he need to empower his fellow students to carry out the care under his supervision.
What this demonstrated
He exhibited leadership potential and coordinated the staff to ensure that the people he was responsible for received the appropriate personalised care.
Darren also started to show good supervision of students, understanding his own limitations and areas for further development.
What Darren did
Darren took a telephone call from a staff nurse who was ill and not able to come in for his night shift. Darren discussed this with the Ward Manager, who was able to arrange cover. He also listened to Elouise about her concern for her child and with her permission he contacted social services, who assured them that Riley was being cared for with her family friend.
What this demonstrated
Darren demonstrated an understanding of managing and reporting risks, including examples of staff phoning in sick and safeguarding issues
What Darren did
Darren was very aware of the need to start discharge planning very early on and ensuring appropriate referrals were made to social services for Elouise and discussed this with her.
What this demonstrated
Darren co-ordinated the care provided for his patients demonstrating an understanding of mental, cognitive, behavioural and physical care needs. His person-centred approach with Elouise meant that involving social services with her permission reassured her about the care of her daughter and would prevent any unnecessary disruptions for Riley.
Test your understanding
Questions to prompt reflection and discussion
In order for Darren to achieve his objectives in relation to leadership and management, identify two proficiencies that Darren still needs to learn and what learning opportunities would you consider might be available for him in your area to achieve this?
Examples could be:
Platform 7
5.1 understand the principles of effective leadership, management, group and organisational dynamics and culture and apply these to team working and decision-making
Under the supervision of the ward manager co-ordinate the work of the whole ward for one shift, following a period of observation and reflection of how this is done.
Through coaching, offer suggestions for Darren to link his learning of effective leadership and different styles to those nurses who would normally co-ordinate the ward.
5.12 understand the mechanisms that can be used to influence organisational change and public policy, demonstrating the development of political awareness and skills.
Shadowing opportunities with the Matron to,
- understand how issues raised in practice get addressed through governance, and
- how guidance or policy from the Department of Health and Social Care or other governing bodies is disseminated into practice
Revalidation
If you are a registered nurse you may wish to use this scenario and your reading as part of your continuing professional development (CPD) for your revalidation.
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