This is a commentary related to simulated scenario 4. It will include a self evaluation of my performance, my response to the feedback from the assessors; give a summery of my learning that I achieved and implications for future development. The scenario 4 was about a man with learning disabilities which I needed to communicate with and carry out appropriate observations and appropriate actions during and/or after an epileptic fit with my colleague. As firstly I was assessed that my uniform was worn in a professional manner.
I arrived wearing my uniform that had been provided by Thames Valley University along with my name badge, fob watch and flat black shoes that were considered appropriate. I removed all jewellery, tied my all my hair back securely off my face, I also ensured that my finger nails were of appropriate length and were clean. I learnt about these skills from www. infectioncontrol. nhs. uk that was apart of my online learning activities at Thames Valley University.
It is important that as student we understand why it is important to wear this uniform correctly. The assessor marked me 3 on a scale of 1 to 5. Even though I had the correct full uniform on the assessor’s feedback to me was that this area can always be improved on. In future I will pay more attention to how I present myself and do this to the best of my ability. Before the assessment was carried out I insured that I took the correct measures to demonstrate good practice in infection control.
This was the next area the assessor marked. Every health care worker plays a vital part in helping to minimize the risk of cross infection – for example, by making sure that hands are properly washed, the clinical environment is as clean as possible, ensuring knowledge and skills are continually updated and by educating patients and visitors. I applied alcohol gel to my hands and rubbed it in carrying out the steps needed to ensure that all areas of the hands were decontaminated.
National Institute of Clinical Excellence (2001) states that “Hands should be decontaminated before direct contact with patients and after any activity or contact that contaminates the hands, including following the removal of gloves. While alcohol hand gels and rubs are a practical alternative to soap and water, alcohol is not a cleaning agent. Hands that are visibly dirty or potentially grossly contaminated must be washed with soap and water and dried thoroughly”. I then put on a pair of latex gloves and a disposable plastic apron.
The Gloves and apron were worn and should be worn whenever there might be contact with blood and body fluids, mucous membranes or non intact skin and in this occasion there was a risk of this happening. They are not a substitute for hand washing. They should be put on immediately before the task to be performed. I scored 4 of a possible 5 in this task. For future practice I hope to further my knowledge in this area by updating myself with new information/ training and reading reports on this subject.
Demonstrating good practice in infection control was linked to our learning outcome 1 which included hand decontamination and standard precautions. Once the universal precautions were carried out me and my college continued in our assessment. We both introduced ourselves to the patient but there was no response from Mr. Smith. The assessors then told us that Mr. Smith was unconscious after just having a seizure. I then planned with my college that we needed to commence a systematic ABCDE assessment on Mr. Smith checking his Airway, Breathing, Circulation, Disability and Exposure to check Mr.
Smith’s condition following his seizure. Also we decided to carry out Mr. Smiths vital signs. Myself and my college then told Mr. Smith what we were planning to do and why by using verbal communication. I believe I can improve on my communication skills. To “co-operate with others in a team” (NMC 2002a) is one of the principles for practice set out in box 2. 2 of the NMC Framework for Professional Practice. I scored 3 points out of a possible 5 for communication; I felt this is something I will need to develop.
The NHS Plan (DH 2001b) calls for the further development of communication skills among healthcare professionals as the need for effective communication is increasingly recognized. Communication between individuals is a broad and varied experience. Active listening is one of the most important communication skills in the healthcare setting (Bailey and Wilkinson 1998, McConnell 2001). The assessors told me that I needed to build my confidence in communicating with the patient and this will make the client feel more confident in my care delivery. This is related to learning outcome 4: communication skills.
My college started the Glasgow Coma Scale (GCS) assessment while I checked Mr. Smith’s vital signs while giving each other feedback and recording our findings from the GCS and vital observations. A variety of scales have been devised to describe patients’ level of consciousness (Barker 2002). However, the Glasgow Coma Scale (Jennett and Teasdale 1977) is the most universally accepted tool, which decreases the subjectivity and confusion associated with assessing levels of consciousness (Hickey 2003b). Mr. Smith had started to fit again during the ABCDE assessment.
Myself and my college then gave the assessor feedback on the appropriate actions that need to be carried out. We would ensure that the environment was safe by lowering the bed, raise the cot sides and place a pillow under his head, while monitoring the length of the seizure and document any injures if any sustained, then the ABCDE assessment would then have to be carried out again from the beginning. I scored a possible 3 out of 5 in both carrying out appropriate observations and appropriate actions during/after the fit and Documents observations correctly.
I feel that these were fair marks as I am just starting out in the course and feel that I will build my confidence in both these areas with practice and gaining knowledge in theory and practice. This part of the assessment relates to learning outcome 2: Anatomy and physiology and learning outcome 3. I think as nurses we need to know anatomy and physiology in order to assess a client and understand the physically implications on the patient. Before finishing our assessment my college and I both checked Mr. Smith to see if he was incontinent during following his seizure.
Ensuring that appropriate organisational arrangements were taken to secure acceptable standards of privacy and dignity to patient we explained to Mr. Smith that were we going to check him for incontinence. Mr Smith was incontinent so a change of clothes and bedding would need to take place, taking into account the Mr Smiths requirements to meet his physical, cultural, spiritual and psychological needs and Preferences. Kettering General NHS Trust, “Policy for Maintaining patients’ Privacy and Dignity” (2005) defines Privacy as Freedom from intrusion and Dignity as Being worthy of respect.
Following our assessment my college and I disposed of our gloves and aprons in the clinical waste bags and decontaminated our hands by using the alcohol gel again. The assessors then went through our marks with us and gave us feedback on our performances. In conclusion, I think this commentary has helped me self evaluate my performance in this scenario 4. It has helped me identify in-depth thoughts around my strengths, weakness and how I can further develop my knowledge in these areas.
I have found that I need to develop my communication skills with both my colleges and the patients. The NHS Plan (DH 2001b) calls For the further development of communication skills among healthcare professionals as the need for effective communication is increasingly recognised. Communication between individuals is a broad and varied experience. Now that I have done this evaluation on my performance I feel that I can easily identify what I need to develop and make a plan on how I can achieve these goals in the future.