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While on placement I wanted to understand laxatives in more detail so I decided to undertake some self direction learning and research different types of laxatives.
Common laxatives used on many wards are osmotic laxatives, this includes lactulose and macrogol. Osmotic laxatives work as  hyperosmolar agents, by drawing water in from the rest of the body to assist in softening the stool making it easier to pass. These medications must be taken with large amounts of water especially if the patient has a regularly low intake. These laxatives won’t work if the patient is dehydrated. Some osmotic laxatives can take more than 24 hrs to have effect.

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During placement I attended an inservice on congestive cardiac failure. The service was run by an RN and went through caring for someone with congestive cardiac failure and ran for 30 minutes.
CCF is where the heart muscle can’t pump the amount of blood the body requires, as the heart weakens fluid builds up around the body causing congestion. It is a long term condition that is caused by high cholesterol, poor diet or obesity or high blood pressure.
The service started with common symptoms such as shortness of breath, swelling in lower limbs, coughing or wheezing and rapid or irregular heart rate.
The nurse continued with nursing considerations and what to monitor for. Regular vital sign monitoring is important especially before medication to ensure the medication is being used appropriately. Daily weight it also vital for CCF patients to ensure they aren’t retaining fluid.
The nurse then went through nursing interventions such as reducing fluid overload by restricting fluid intake and tracking fluid intake and output.
Another common intervention are ACE inhibitors or ARB’s. These are medications that assist in opening the vessels allowing blood to flow with ease, they lower blood pressure and heart rate, and reduces the effort of the heart.

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On placement in the respiratory unit there were multiple patients with chest drains. I had seen them before but didn’t really understand the purpose or how to monitor them.
I asked my supervising nurse to run through it with me for about 30 minutes then i spent 30 minutes going through the policy and procedure “Drain Management” in accordance with ACT health.

A chest drain is a tube inserted into the chest that drains fluid or air trapped in the area between the lungs and the chest wall. Causes of this trapped fluid or air can be inflammation, infection or traumatic injury.

Monitoring of these chest drains and the insertion site are very important. The nurse is looking at the site of insertion for any leaking, redness, pain, ensuring the dressing is dry and intact. In accordance with the drain management policy, the area is cleaned every 1-3 days to minimise bacterial load and any risk of infection and the dressing must be changed every 72 hours. Unless in community.

The nurse records the amount and characteristics of exudate in the tube and canister every 4 hours as per the policy. In the AMU the nurses would record the drainage every 2hrs.

Bubble and swing are common terms used when monitoring chest drains. The bubble and swing is the movement on the fluid in the tube or canister and can be seen by the patient coughing or deep breathing. Seeing bubble and swing indicates the drain is still functional and draining. Continuous bubbling can indicate there is a leak or the patient is experiencing a pneumothorax (air in the cavity between the lungs and chest wall).

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OBSERVATION VS ASSESSMENT

This week we discussed different workplace injuries and the multidisciplinary teams that are involved in the treatment and care of the patient.
This week I thought about the difference between observation and assessment, and how different team members have their own process in assessments. As a nurse, our observations on patients are vital in their care. Nurses spend arguably the most time with the patient and we use our observations as cues for our assessments. Observations are a more subjective information and assessments are more factual information that shapes the treatment plan.
Observations from different teams will give cues to determine assessments and the plan. The nurse will be looking for specific care aspects and a more holistic approach including the patients movement and body language, mood and affects. Physio therapist or an occupational therapist will be observing specific to their field. The nurses observations can be helpful to multidisciplinary members. As a nursing student i enjoy being present for different multidisciplinary team sessions with the patients so i am able to learn about what they are doing and how a nurse is involved in holistic care practices.
On reflection I think it’s important to use observation and that nurse ‘gut feeling’ to form clinical reasoning to undertake assessments and form a plan of care. Observation and assessment go hand in hand and should be used together for best care.

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Reference list - First Nations Health Care Initiatives 

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Reference list - First Nations Health Care Initiatives 

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Australian Institute of Health and Welfare. (2023). Eye health measures for Aboriginal and Torres Strait Islander people 2022: interactive data. Retrieved from https://www.aihw.gov.au/reports/indigenous-australians/indigenous-eye-health-measures-2022-data

Australian Institute of Health and Welfare. (2020). Indigenous eye health measures 2020. Canberra: AIHW.

Aboriginal and Torres Strait Islander Primary Health Care Systems Evaluation. IAHP Yarnes | Indigenous Australians’ Health Programme IAHP Yarnes | Indigenous Australians’ Health Programme. (2022). https://www.iahpyarnes.com/phc/whats-happening-now

Australian Government Department of Health and Aged Care. (2022). Evaluating our indigenous health programs. Australian Government Department of Health and Aged Care. https://www.health.gov.au/topics/aboriginal-and-torres-strait-islander-health/primary-care/evaluations

Australian Government Department of Health and Aged Care. (2023). Indigenous Australians’ health programme. Australian Government Department of Health and Aged Care. https://www.health.gov.au/our-work/indigenous-australians-health-programme

World Health Organization. (2022). Trachoma. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/trachoma

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Medication administration practice from module 3 - fentanyl via MAD device  

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Explore and evaluate one primary health initiative aimed at reducing the disparity of health care for First Nations Peoples

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Explore and evaluate one primary health initiative aimed at reducing the disparity of health care for First Nations Peoples

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The Australian health care system has many initiatives and programs in place to attempt to bridge the gap between the First Nations people and non-Indigenous people in the way they receive and have access to health care. First Nations people face disparity in all areas of social determinants of health including education, living circumstances, economic status, and income. There are still many aspects of the health care system that are not culturally diverse but there are steps that we as new nurses can take to ensure our quality of care meets every individual in our community.

The Indigenous Australians health programme (IAHP) is a primary health initiative funding high quality health care for Aboriginal and Torres Strait Islander people. This program aims to reduce the disparity of health care by funding Indigenous led initiatives to increase and improve the health of Aboriginal and Torres Strait Islander people.

The program funds four main themes in Indigenous health. The program assists in primary health care services, improving access to primary health care, targeting health activities and capital works. The initiative allows the roll out of services such as immunisations and drug and alcohol treatment programs as well as giving access and managing the care of chronic conditions, the initiative also funds education to staff for culturally appropriate care.

The IAHP goals are to improve the health of all Firsts Nations people especially in rural and remote areas. Give access to culturally appropriate and high-quality care and to improve the way primary health services operate and are delivered to better cater Australians First Nation people.

One initiative funded by the IAHP is the ‘Eye and Vision Health for Aboriginal and Torres Strait Islander People’. This initiative is focused on Indigenous children and aims to prevent, treat and monitor eye diseases which in turn will help children at school, create and improve independence and increase opportunities for children’s futures. Trachoma is a disease that impacts individuals in remote areas and Indigenous communities, due to poor water and sanitation. Trachoma is a disease in the eyes caused by infection where the eyelids turn inward and can cause the eyelashes to rub on the eyeball causing damage to the surface. It can be extremely painful and repeated infection can cause blindness. The IAHP funds many schemes and outreach services bring health professionals to children at risk of eye diseases. From reports by AIHW it showed over 10 years the prevalence of trachoma in children aged 5-9 years in at risk areas reduced from 15% to 4.5% (Indigenous Eye Health Measurement, 2020). This shows that the funds provided by the Indigenous Australians health programme are improving children’s eye health throughout Australia. There is also ‘The Visiting Optometrists Scheme’ and ‘Eye Surgical Support Program’ that are funded by the IAHP. These two schemes support optometrists and eye surgeons to deliver care to remote locations. They assist these professionals finically by covering travel, accomodation, facility fees and any equipment necessary for care. In the AIHW annual reports from 2011 to 2019 showed that “the proportion of Indigenous Australians who had an eye health check as part of a health assessment increased from 11% to 30%” (Indigenous Eye Health Measurement, 2020).

To evaluate the IAHP’s contribution to the improvement of health care for Australians First Nation people the ‘Aboriginal and Torres Strait Islander Primary Health Care Systems Evaluation’ was implemented. The evaluation is is funded by the department of health and uses a range of different research tactics. The evaluation was first implemented in 2017 and is run by Allen and Clarke, a consultancy firm. The firm work closely with the Indigenous health sector and assess how appropriate the primary health services are and if they have been improved at all. The firm posts regular updates on the progress for the public to view. (Aboriginal and Torres Strait Islander Primary Health Care Systems Evaluation, 2022)

Strategies and initiatives are a great start to closing the gap of the disparity faced by First Nations people but many more can be done. I believe that education is a key part in improving health for every Australian. For health students a compulsory remote placement that incorporated community, mental health and clinical setting would be a great way to give a board insight to remote living and the challenges that remote communities face. It would also be interesting to be able to tag along with a Indigenous specify nurse or a Indigenous liaison to learn how to create a more holistic care approach and a culturally safe environment.

It is vital for nurses and other health care professionals to understand the importance of these initiatives when caring for all First Nations people. Nurses can utilise many resources to improve and provide the most optimal health outcomes. Every individual deserves to feel safe and it is our roll as nurses to provide a safe environment where a patient can express their questions and concerns about their own care needs.

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In the seminar today we heard from a mother from rural Victoria whose child, Quinn, had experienced serve burns. In the interview she went though the initial scene and the treatment in the ED and the burns clinic at the RCH. She expressed the different challenges her daughter and family went through.

Being rural her family faced the extra struggle of being far from the hospital and other resources, she had to wait 40 minutes for the ambulance. For the ongoing treatment Quinn still has to go to Melbourne once a month which is hard on the whole family. Quinns older brother is only 5 and really struggles being away from his mum when she has to take Quinn to her appointments. There is also added financial stress because they have to pay to travel and take off work, as well as a carer for Quinn’s brother.

She went on saying she had a positive nursing experience.
Quinn’s mum said the most important thing she wanted us to take away from her story is the importance of burn first aid. Burn first aid is extremely time critical in the treatment and healing process. The RCH website gives very detailed instructions on burn first aid for different types of burns which can be very helpful for parents and carers.

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Calimag, Chlebek, S., Lerma, E. V., & Chaiban, J. T. (2023). Diabetic ketoacidosis. Disease-a-Month, ⁶⁹(3), 101418–101418. https://doi.org/10.1016/j.disamonth.2022.101418

This semesters first topic was on diabetes ketoacidosis. At the time I didn’t know too much and hadn’t come across it on placement. During my time in the AMU many of my patients had diabetes so understanding DKA was an important part of caring for my patients. DKA is a medical emergency that occurs when insulin levels are low and there is an imbalance of regulatory hormones, meaning there is not enough energy being made in cells. The body counteracts this with an overproduction of triglycerides and amino acids that gives cells the energy they lack. This process creates a high level of acid in the blood. As the body tries to remove the excess ketones through urine, key electrolytes are also removed causing dehydration.

A patient may present with nausea, vomiting, high respiratory rate, abdominal pain, dry mucous membranes, low blood pressure and general weakness and lethargy. Treatment and management of DKA would include, consistent monitoring of BGL’s and ketones, insulin therapy, fluids with extra electrolytes such as hartmanns solution and a individualised diabetic management plan to prevent from future episodes of DKA.

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Canberra health services clinical procedure – iron infusion – adults only.

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Canberra health services clinical procedure – iron infusion – adults only.

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Canberra Health Services. (2021). Clinical procedure Iron Infusion-Adult only. CHS21/563 V1

The ACT health services provides all the policies and procedures to the staff and consumers to ensure safe and best practice on the offical canberra health services website.

In the AMU while I was on placement a procedure I looked in to was iron infusions. Iron infusions are necessary for patients where oral therapy is inappropriate, defective or in unlikely to replace the lost iron in the required time. The procedure outlines the indications, contraindication and precautions in iron infusions. It also outlines administration and calculations to make sure the patient is receiving the correct amount. The procedure lays out a step by step process on how to set up the infusion, monitoring and after care. As a student and a future registered nurse it is important to know my scope. Each procedure clearly states the scope of practice for different medical professionals. If I have any doubts on any policies and procedures I know I can look them up in the system and have a guideline to follow safely.

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Pneumonia, Aspiration Pneumonia, or Frailty- Associated Pneumonia? 

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Pneumonia, Aspiration Pneumonia, or Frailty- Associated Pneumonia? 

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Smithard, & Yoshimatsu, Y. (2022). Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia? Geriatrics (Basel), ₇(5), 115–. https://doi.org/10.3390/geriatrics7050115

My PEP area was the AMU (acute medical unit). This unit was a fast paced ward with many different cases. Patients in the ward were typically admitted from the emergency department and stayed in the ward for 24 to 48 hours then discharged home or were down streamed to a specialised team or ward.
In the AMU a common illness was pneumonia.
Pneumonia is an inflammatory infection condition of the lungs caused by virus or bacteria. Pneumonia can impact people of all ages but can be detrimental to frail patients. In the AMU the most common case was elderly patients with a history of a lung condition such as COPD. Pneumonia is directly linked to the frailty of a person. The frailty of a person includes many factors such as age, disability, independence, nutrition levels, and existing health conditions.  Identifying contributing factors to a diagnosis is extremely valuable in the treatment of pneumonia and creating a person centred care plan for the individual.

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This device is used by patients with fluid or mucous in the lungs.
The device is filled half way with water, then the user blows through the straw to blow bubbles in the water.
The vibration of the bubbles and the action of blowing bubbles moves the fluid and mucous around the lungs allowing it to move up and out of the lungs.
Cases where this is useful include infections of the lungs such as pneumonia or influenza (especially people with reduced mobility).

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This week in class myself and another student went into the simulation. The case was a 17 year old that was unresponsive. We entered the room and there was a pharmacist student that told us the patient was unresponsive. I tried to get a response from the patient and when i didn’t I thought that was reason for a MET call. I believe a MET should be called anytime the team is concerned or the MEWS is 4 or above. I asked the other student if she thought we should call it and she agreed. Once we called it we started the obs and a rough A to G assessment. It was quite stressful and i felt I forgot a lot of key elements of an A to G although we were able to identify the issue which was drug overdose and plan their treatment of naloxone administration. It was valuable to get the practice and to be able to debrief with the class after. If I am faced with a MET call in the future I now know to go in calmly and think over what I already know. It’s always ok to ask for help if you are unsure or concerned.

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My name is Grace, I have been studying nursing for the last 4 years and it’s finally coming to the end! I have honestly struggled with the idea of graduating, feeling as though I’m not prepared but through reflection I know I have all the necessary tools to transition into my bright future as a nurse.

I am able to use my doubt to push myself in my studies to ensure I become the best nurse possible, with the goal of bettering someone’s life, or simply their day, during my care.

When thinking of the skills a great nurse should have I think of kindness and compassion, organisational skills, team work and the willingness to improve and develop knowledge of different concepts. Through reflection of my personal and professional life, I believe I hold these qualities. I am able to learn from others and my own actions by reviewing the outcomes and considering the pros and cons of every choice.

To prepare for my transition from a student to a registered nurse I have created a focused and motivated goal using the ‘SMART’ goal acronym.

S –My goal is to acquire a new grad position in a hospital starting June 2024. There are programs in place to assist and support new graduates transitioning into the hospital.

M – This goal has four measurable steps. Step 1- acquiring references while on placement. Step 2- apply for the positions. After applying will be undergoing interviewing process. The last step is acquiring the position.

A – I feel this goal is achievable as I am coming to the end of my degree, feeling more confident to transition into the role of a registered nurse. With help and guidance of the teaching team I believe by the end of semester I will be ready to transition.

R – this is a relevant goals as the new grad position is for transitioning nurses.

T –My goal is bounded by the time of the application process and the starting date of June 2024.