Learning Points
Kate and Adam reflected on this and discussed the importance of a person-centred holistic approach. Margarets confusion was new and this together with her history of falls and her medication including amiloride and non-steroidal anti-inflammatory drugs pointed to a diagnosis of hyponatraemia. They also discussed the assumption that Margarets confusion was a result of a UTI.
The following proficiencies were discussed as relevant to this experience:
Platform 1 Being an accountable professional
1.8 demonstrate the knowledge, skills and ability to think critically when applying evidence and drawing on experience to make evidence-informed decisions in all situations
Including: the analysis of Margarets medication history, recent falls and confusion and recognising the importance of the low sodium
1.15 demonstrate the numeracy, literacy, digital and technological skills required to meet the needs of people in their care to ensure safe and effective nursing practice
Including: Looking up blood results using available technology
1.16 demonstrate the ability to keep complete, clear, accurate and timely records
Including: Documenting the NEWS score, fluid balance chart and patient records
Platform 2 Promoting health and preventing ill health
2.12 protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance.
Including: discussion on the prescription of antibiotics for a suspected UTI. Disposal of vomit bowl and soiled bedlinen.
Platform 3 Assessing needs and planning care
3.2 demonstrate and apply knowledge of body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology and social and behavioural sciences when undertaking full and accurate person-centred nursing assessments and developing appropriate care plans
Including: Understanding of physiology, specifically osmolarity and fluid balance
3.3 demonstrate and apply knowledge of all commonly encountered mental, physical, behavioural and cognitive health conditions, medication usage and treatments when undertaking full and accurate assessments of nursing care needs and when developing, prioritising and reviewing person-centred care plans
Including: symptoms as above; awareness of root causes of hyponatraemia in the older person specifically medicines; person centred care planning
Platform 4 Providing and evaluating care
4.1 demonstrate and apply an understanding of what is important to people and how to use this knowledge to ensure their needs for safety, dignity, privacy, comfort and sleep can be met, acting as a role model for others in providing evidence-based care
Including: privacy, dignity and comfort – Margaret was vomiting, had a headache and was feeling generally unwell.
4.3 demonstrate the knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions
Including: Discussion of the care plan with Margaret and her daughter Pat
4.4 demonstrate the knowledge and skills required to support people with commonly encountered mental health, behavioural, cognitive and learning challenges, and act as a role model for others in providing high quality nursing interventions to meet people’s needs
Including: care of confusion and restlessness – explanation to family/carers why this may be happening and awareness of how this will provoke anxiety
4.5 demonstrate the knowledge and skills required to support people with commonly encountered physical health conditions, their medication usage and treatments, and act as a role model for others in providing high quality nursing interventions when meeting people’s needs
Including: demonstration of application of knowledge of osmolarity and hyponatraemia
4.7 demonstrate the knowledge, skills and ability to act as a role model for others in providing evidence-based, person-centred nursing care to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity
Including: help with mobility (muscle weakness and fracture); skin assessment; mouthcare after vomiting
4.8 demonstrate the knowledge and skills required to identify and initiate appropriate interventions to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain
Including: support with headache, nausea, vomiting and confusion
4.10 demonstrate the knowledge and ability to respond proactively and promptly to signs of deterioration or distress in mental, physical, cognitive and behavioural health and use this knowledge to make sound clinical decisions
Including: early warning scores and recognising distress
4.12 demonstrate the ability to manage commonly encountered devices and confidently carry out related nursing procedures to meet people’s needs for evidence-based, person-centred care
Including: digital thermometer; digital and manual sphygmomanometer pulse oximetry; infusion devices
4.14 understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies and demonstrate proficiency and accuracy when calculating dosages of prescribed medicines
Including: the process of medicines administration and medicines withheld; awareness of local policies and procedures.
4.15 demonstrate knowledge of pharmacology and the ability to recognise the effects of medicines, allergies, drug sensitivities, side effects, contraindications, incompatibilities, adverse reactions, prescribing errors and the impact of polypharmacy and over the counter medication usage
Including: medicines administration and medicines to be withheld – specifically medicines that affect sodium excretion including diuretics e.g. amiloride.
Platform 5 Leading and managing nursing care and working in teams
5.1 understand the principles of effective leadership, management, group and organisational dynamics and culture and apply these to team working and decision-making
Including: observing and reflecting on the leadership seen in a deteriorating patient scenario; multidisciplinary team working.
5.4 demonstrate an understanding of the roles, responsibilities and scope of practice of all members of the nursing and interdisciplinary team and how to make best use of the contributions of others involved in providing care
Including: the work of critical care outreach service and pharmacist
Platform 6 Improving safety and quality of care
6.1 understand and apply the principles of health and safety legislation and regulations and maintain safe work and care environments
Including: awareness and understanding relevant local and national policy for hazardous waste including sharps and contaminated bed linen.
Platform 7 Coordinating care
7.5 understand and recognise the need to respond to the challenges of providing safe, effective and person-centred nursing care for people who have co-morbidities and complex care needs
Including: reflecting on the importance of person centred care for older people with co-morbidities, specifically medication reviews.
Further considerations for you
- What opportunities do nurses, student nurses and student nursing associates have to learn about a person who is experiencing hyponatraemia?
- Is hyponatraemia considered as a cause of new confusion in older people?
- How are medication reviews carried out in your area and how are ‘over the counter’ medications?
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