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Let's Consider some ground rules or boundaries.

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Today we have covered a lot of information, we have explored areas that may have challenged your thoughts or beliefs. Let us use this time now to debrief.

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In groups please take 5-10 mins to discuss.

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What does accountability mean to you?
As a student, who would you consider you are accountable to, and for what?

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Goal
1.    Students feel safe and ready for learning.

2.    Students feel prepared for the three upcoming learning and activity days.

3.    Students are introduced to basic clinical skills and immersive learning.

4.     Students are introduced to the concept of professionalism and what professionalism means.

Learning Outcomes
1.      The students are introduced to the skills environment, take part in team-building exercises, and as a team set ground rules.

2.      Students will be able to list sessions to be covered during the three upcoming days.

3.      Students develop basic patient assessment skills by demonstrating the skills learned on mannequins to perform basic clinical observations (temp, pulse, Resp, and blood pressure). The use of case scenarios, the simulated ward environment, and Viomedix’s anatomy and physiology teaching tool enhances the immersive aspect of the course.

4.      Students will discuss professional and unprofessional behaviour.

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Take 10 mins to discuss this in your group. Make notes and then return to these notes after this week. One person from each group spends 5 minutes presenting what your group has discussed.

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https://www.nhs.uk/conditions/gender-dysphoria/treatment/

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Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.
What this means will vary from person to person, and is different for children, young people and adults. Waiting times for referral and treatment are currently long.

Treatment for children and young people

If your child is under 18 and may have gender dysphoria, they'll usually be referred to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust.

GIDS has 2 main clinics in London and Leeds.

Your child or teenager will be seen by a multidisciplinary team at GIDS including a:

clinical psychologist

child psychotherapist

child and adolescent psychiatrist

family therapist

social worker

The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.

Depending on the results of the assessment, options for children and teenagers include:

family therapy

individual child psychotherapy

parental support or counselling

group work for young people and their parents

regular reviews to monitor gender identity development

referral to a local Children and Young People's Mental Health Service (CYPMHS) for more serious emotional issues

a referral to a specialist hormone (endocrine) clinic for hormone blockers for children who meet strict criteria (at puberty)

Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.

Hormone therapy in children and young people

Some young people with lasting signs of gender dysphoria who meet strict criteria may be referred to a hormone specialist (consultant endocrinologist) to see if they can take hormone blockers as they reach puberty. This is in addition to psychological support.

Puberty blockers and cross-sex hormones

Puberty blockers (gonadotrophin-releasing hormone analogues) pause the physical changes of puberty, such as breast development or facial hair.

Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.

Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be.

It's also not known whether hormone blockers affect the development of the teenage brain or children's bones. Side effects may also include hot flushes, fatigue and mood alterations.

From the age of 16, teenagers who've been on hormone blockers for at least 12 months may be given cross-sex hormones, also known as gender-affirming hormones.

These hormones cause some irreversible changes, such as:

breast development (caused by taking oestrogen)

breaking or deepening of the voice (caused by taking testosterone)

Long-term cross-sex hormone treatment may cause temporary or even permanent infertility.

However, as cross-sex hormones affect people differently, they should not be considered a reliable form of contraception.

There is some uncertainty about the risks of long-term cross-sex hormone treatment.

Transition to adult gender identity services

Young people aged 17 or older may be seen in an adult gender identity clinic or be referred to one from GIDS.

By this age, a teenager and the clinic team may be more confident about confirming a diagnosis of gender dysphoria. If desired, steps can be taken to more permanent treatments that fit with the chosen gender identity or as non-binary.

Treatment for adults

Adults who think they may have gender dysphoria should be referred to a gender dysphoria clinic (GDC).

Find an NHS gender dysphoria clinic in England.

GDCs have a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including:

psychological support, such as counselling

cross-sex hormone therapy

speech and language therapy (voice therapy) to help you sound more typical of your gender identity

For some people, support and advice from the clinic are all they need to feel comfortable with their gender identity. Others will need more extensive treatment.

Hormone therapy for adults

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. The hormones usually need to be taken for the rest of your life, even if you have gender surgery.

It's important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. The decision to have hormone therapy will be taken after a discussion between you and your clinic team.

In general, people wanting masculinisation usually take testosterone and people after feminisation usually take oestrogen.

Both usually have the additional effect of suppressing the release of "unwanted" hormones from the testes or ovaries.

Whatever hormone therapy is used, it can take several months for hormone therapy to be effective, which can be frustrating.

It's also important to remember what it cannot change, such as your height or how wide or narrow your shoulders are.

The effectiveness of hormone therapy is also limited by factors unique to the individual (such as genetic factors) that cannot be overcome simply by adjusting the dose.

Find out how to save money on prescriptions for hormone therapy medicines with a prescription prepayment certificate.

Risks of hormone therapy

There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP.

The most common risks or side effects include:

blood clots

gallstones

weight gain

dyslipidaemia (abnormal levels of fat in the blood)

elevated liver enzymes

polycythaemia (high concentration of red blood cells)

hair loss or balding (androgenic alopecia)

There are other risks if you're taking hormones bought over the internet or from unregulated sources. It's strongly recommended you avoid these.

Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.

Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic.

Read more about fertility preservation on the HFEA website.

Surgery for adults

Some people may decide to have surgery to permanently alter body parts associated with their biological sex.

Based on the recommendations of doctors at the gender dysphoria clinic, you will be referred to a surgeon outside the clinic who is an expert in this type of surgery.

In addition to you having socially transitioned to your preferred gender identity for at least a year before a referral is made for gender surgery, it is also advisable to:

not smoke

lose weight if you are overweight (BMI of 25 or over)

have taken cross-sex hormones for some surgical procedures

It's also important that any long-term conditions, such as diabetes or high blood pressure, are well controlled.

Surgery for trans men

Common chest procedures for trans men (trans-masculine people) include:

removal of both breasts (bilateral mastectomy) and associated chest reconstruction

nipple repositioning

dermal implant and tattoo

Gender surgery for trans men includes:

construction of a penis (phalloplasty or metoidioplasty)

construction of a scrotum (scrotoplasty) and testicular implants

a penile implant

Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.

Surgery for trans women

Gender surgery for trans women includes:

removal of the testes (orchidectomy)

removal of the penis (penectomy)

construction of a vagina (vaginoplasty)

construction of a vulva (vulvoplasty)

construction of a clitoris (clitoroplasty)

Breast implants for trans women (trans-feminine people) are not routinely available on the NHS.

Facial feminisation surgery and hair transplants are not routinely available on the NHS.

As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.

Life after transition

Whether you've had hormone therapy alone or combined with surgery, the aim is that you no longer have gender dysphoria and feel at ease with your identity.

Your health needs are the same as anyone else's with a few exceptions:

you'll need lifelong monitoring of your hormone levels by your GP

you'll still need contraception if you are sexually active and have not yet had any gender surgery

you'll need to let your optician and dentist know if you're on hormone therapy as this may affect your treatment

you may not be called for screening tests as you've changed your name on medical records - ask your GP to notify you for cervical and breast screening if you're a trans man with a cervix or breast tissue

trans-feminine people with breast tissue (and registered with a GP as female) are routinely invited for breast screening from the ages of 50 up to 71

Find out more about screening for trans and non-binary people on GOV.UK.

NHS guidelines for gender dysphoria

NHS England has published what are known as service specifications that describe how clinical and medical care is offered to people with gender dysphoria:

Review of gender identity services

NHS England has commissioned an independent review of gender identity services for children and young people. The review will advise on any changes needed to the service specifications for children and young people.

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Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

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https://www.gov.uk/apply-gender-recognition-certificate/who-can-apply

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You can apply if you meet all of the following requirements:

you're aged 18 or over

you've been diagnosed with gender dysphoria in the UK

you've been living in your affirmed gender for at least 2 years

you intend to live in this gender for the rest of your life

You can apply even if you have not had any gender affirming surgery or treatments, or you do not plan to have any.

If you've got a Gender Recognition Certificate or something similar from an approved country or territory, you only need to meet the following requirements:

you're aged 18 or over

you have a document showing your affirmed gender is legally recognised in that country or territory

If you do not have a gender dysphoria diagnosis

You might still be able to apply, but only if you meet all of the following requirements:

you currently live in England, Wales or Scotland

you were in a marriage or a civil partnership on 10 December 2014 and living in England or Wales, or on 15 December 2014 and living in Scotland

you had been living in your affirmed gender for at least 6 years before those dates, and you have evidence of that

you have had gender affirmation surgery

If this applies to you, contact the Gender Recognition Panel admin team to find out how to apply. It's a different process to the one described in the rest of this guidance.

You can still apply through this route even if you do have a gender dysphoria diagnosis, so long as you meet all the requirements. However, you do not need to have had any gender affirmation surgery.

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Apply for a Gender Recognition Certificate

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Apply for a Gender Recognition Certificate to legally change your gender.

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How can I communicate with someone experiencing psychosis? - Practical strategies and tips for effective support (nsw.gov.au)

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How can I communicate with someone experiencing psychosis?

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The best way to communicate with someone with psychosis is to be supportive and not judgemental.

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https://www.gov.uk/government/news/stronger-protection-from-violence-for-nhs-staff

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The NHS violence reduction strategy includes measures to better protect staff and prosecute offenders more easily.

Secretary of State for Health and Social Care Matt Hancock is announcing the first ever NHS violence reduction strategy.

The new, zero-tolerance approach aims to protect the NHS workforce against deliberate violence and aggression from patients, their families and the public, and to ensure offenders are punished quickly and effectively.

The strategy includes:

the NHS working with the police and Crown Prosecution Service to help victims give evidence and get prosecutions in the quickest and most efficient way

the Care Quality Commission (CQC) scrutinising violence as part of their inspection regime and identifying trusts that need further support

improved training for staff to deal with violence, including circumstances involving patients with dementia or mental illness

prompt mental health support for staff who have been victims of violence

Matt Hancock is making the announcement in a speech to the Royal College of Nursing.

The most recent NHS staff survey showed that more than 15% of NHS employees have experienced violence from patients, their relatives or the public in the last 12 months - the highest figure for 5 years.

To understand the reasons behind the rise in reported violence, the strategy will allow staff to more easily record assaults and other incidents of abuse or harassment.

Trusts will be expected to ensure every incident is investigated in full and lessons used to protect staff from future incidents.

The government is also drawing up plans for violence and abuse data from across the NHS to be reported nationally. This should allow the government and NHS England to determine which staff are most vulnerable to violence and allow for appropriate action to be taken.

The new plans follow the Assaults on Emergency Workers (Offences) Act, which was recently brought into law and will see the maximum prison sentence for assaulting an emergency worker double from 6 months to a year.

Matt Hancock, Secretary of State for Health and Social Care, said:

NHS staff dedicate their lives to protecting and caring for us in our times of greatest need and for any one of them to be subject to aggression or violence is completely unacceptable.

I have made it my personal mission to ensure NHS staff feel safe and secure at work and the new violence reduction strategy will be a key strand of that.

We will not shy away from the issue - we want to empower staff and give them greater confidence to report violence, knowing that they will see meaningful action from trusts and a consistent prosecution approach from the judicial system.

Sara Gorton, UNISON Head of Health, and Social Partnership Forum Staff Side Chair, said:

NHS staff spend their working days caring and saving lives, and their safety should be paramount.

No one should be abused, threatened or attacked at work ‒ especially when all they're trying to do is help people.

It is encouraging that the government has listened to unions and agreed to review measures in place to ensure staff safety. This includes a more joined-up approach between the NHS, police and CPS.

Anyone who threatens or abuses NHS staff should be prosecuted under the new law protecting health care workers.

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Stronger protection from violence for NHS staff

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The NHS violence reduction strategy includes measures to better protect staff and prosecute offenders more easily.

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Caring for a person experiencing hallucinations

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Caring for a person experiencing hallucinations

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Caring for a person experiencing hallucinations (health.qld.gov.au)

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Your feedback is very important to us.

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Good feedback is about offering constructive information in response to efforts toward reaching a goal. Offer effective feedback with these seven tips.

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The 7 Steps of Hand Washing | Dialect Zone International

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Hand washing is vital no matter where you work - from offices and shops to hotels and hospitals. It carries even greater importance in some settings, such as healthcare and hospitality.

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A look at fetal circulation works in utero

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Fetal circulation in utero and after birth

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Key message: This is about supporting normal physiology and knowing when help is needed.

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Most babies breathe on their own at birth

A small number need extra help to start breathing

Midwives are trained to recognise problems early and act quickly

The aim is to help the baby transition safely to life outside the womb

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Most babies only need warmth, drying, and reassurance.”

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What usually happens at birth (the first few minutes)

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What usually happens at birth (the first few minutes)

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Baby is born → dried and kept warm

Airway checked

Breathing and heart rate assessed

Skin-to-skin encouraged where possible

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(scenario-based):

Baby is not breathing or breathing weakly

Baby is very floppy

Poor colour (blue or pale)

Low heart rate

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The midwife’s role (what you might see on placement)

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The midwife’s role (what you might see on placement)

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Preparation of resuscitation equipment

Clear communication within the team

A calm, structured approach

Support for parents during a stressful moment

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Most babies breathe without help

Neonatal resuscitation is structured and calm

Midwives are highly trained

Teamwork and communication are essential

Compassion for parents is just as important as clinical skill

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Labour is the process by which:

The womb (uterus) contracts

The cervix opens (dilates)

The baby is born

The placenta is delivered

Labour is a natural physiological proces

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A woman may notice:

Tightenings or contractions

Lower back pain

Show (mucus plug)

Waters breaking

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First stage – cervix opening

Contractions become regular and stronger

Cervix opens to 10 cm

Can last many hours

Second stage – birth of the baby

Woman may feel the urge to push

Baby is born

Third stage – delivery of the placenta

Placenta is delivered

Midwife checks mother and baby.

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Midwives:

Support and reassure the woman

Monitor the mother and baby

Encourage movement, choice, and dignity

Communicate clearly with families and the team

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Labour is a natural but individual process

Midwives support, monitor, and advocate for women

Birth is a significant emotional experience

Respect, dignity, and communication are essential