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Day 1- week 2: Extensive chat to Fiona around ward based behaviours.
Call bells not answered promptly.
Patients not being seen.
Ward appears to be task focused and not care focus.
Negative culture around ward management.

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Day 3- Tough day today. Great chat with Fiona. Discussed ward culture. I called out the lack of focus on the patient and patient care. The team do not even call patients by their preferred name. I was part of a ward transfer and when the receiving nurse asked if there was anyth

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Day 5- It's over. this placement has been up and down. It makes such a difference when you are placed with a nurse who is willing to share and allow you to grow.  Note to self when I have my own student nurses

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Mental Health Act 2015, states the circumstances you can be assessed,treated, cared for and supported. It protects yours rights and outlines the role and responsibilities of you care team.

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Low stream rehab:

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Day 1: Points to reflect on :
No handover sheet, how will I handover? What system will I put in place. Apparently handover on DHR- checklist. Must research this policy ?
Bedside handover? handover given outside of room. No patient inclusion.
Day 2:
Out of date medication found on med round. Reported to my RN. Further actions? My responsibilities?
Noted at handover mention of too many riskmans. Especially S8s. Reaction of team barely provoked a response. This is terrifying. A billion things running through my head: patient safety and notification to patient? someone has received wrong meds or no meds ? Have the patients been informed? serious breakdown of procedure, nurse accountability,

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Implicit bias- when we unintentionally,unconsciously made decisions based on our own values and beliefs. This can be around gender, religion, culture, sexuality, age,weight.
Images
A)Disabled but picture doesn't show this. Top of his game,
B) Strong- military uniform, constantly have to prove herself, work extra hard to get on in her career.
C)Transitioning, masculine jaw, Adam's apple present
D) Happy, life on track
E)Not safe things on floor, dark and dingy.
F) happy, life on track
I made assumptions purely from the picture.
Except for when I recognised an image, such as that of Dylan Alcott. I then automatically brought in things that I already knew such as his disability, his champion status. I made assumptions.
Being female I also had the bias of how hard it was to be a high ranking female and how much harder she had to work as opposed to if she was male.
Skill-Naloxone- Given when an opioid overdose is suspected. Binds to receptor sites so that opioid uptake is inhibited. Has a rapid response and should see the impacts 2-3 mins after administration. Can be given, nasally, IM, Subcut and also Intranvenously.

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Minerals that are dissolved in a fluid ( blood, urine, sweat). They are used for the metabolic processes such as :
- Nerve & muscle function:
Nerve impulses are generated by Sodium (Na+) ions moving the charge down the axon.
-Muscle contraction uses Calcium (Ca 2+) ions to allow muscle fibre to slide together and move over each other as a muscle shortens. Magnesium (Mg 2+) required so that muscle fibres can slide outward and can relax after contraction.

- Staying hydrated:
Sodium maintains fluid balance through osmosis , it prevents cells from bursting by either being too full or shriveling up due to dehydration.
- Maintain acid/base balance.

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Potassium-

regulates heartbeat

synthesizes protein

metabolises carbohydrates

nerve & muscle function

Hypokalemia symptoms:

feeling tired

weakness

confusion

muscles cramps

abnormal heart rhythm

Caused by diarrhea, vomiting, use of diuretics.

Low potassium can cause your heart to STOP.

Phosphate-

cell energy

DNA & RNA building

formation of bones & teeth

helps filter renal waste

Hypophoshatemia symptoms:

muscle weakness

loss of appetite

bone pain

anemia

coma

Caused by diabetes,inherited disorders and
alcoholism.

Magnesium-

builds protein

regulates blood sugar

regulates blood pressure

aids in nerve function

Hypomagnesemia symptoms:

nausea

weakness

decreased appetite

numbness/tingling

muscle cramps

seizures

abnormal heart rhythms

personality changes

Caused by GI diseases( Celiac, Crohns), T2D( incease in blood glucose, increase in urine output therefore increase loss og Mg), alcohol dependence, increase in age

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Skill- run fluids to hydrate and insulin infusion. Check policies of your organisation for specifics.
Sim- Take home messages.
-Gender Identity is important
- Support on discharge
-Education on condition
Sem- 5 Hallmarks of DKA
-Acidosis
-Hyperglycemia
- Ketosis
-Electrolyte imbalance
-Dehydration

Rating before: 5. Current rating :7.

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Skills-Focus on primary and secondary assessments. Remembering to return to airway if you notice a deterioration. Patient was Steven,74 yr old male who had sustained trauma via a 4m  fall, suffering L side chest wound and L side head wound.
Interesting in lab that I wanted to address Steven's pain with fentanyl and the rest of group were keen for paracetamol.

Sim- We meet Steven again from the skills lab. We were asked to check on Steven 2 hourly post arrival. His spine has been cleared, It was confirmed that he had broken ribs. Lessons learnt here that deterioration happens extremely quickly. Steven's heart rate was rapidly increasing and his blood pressure decreasing with pain sudden onset of pain in tummy.
Take home- See the big picture
- Always watch patient vital signs; they are indications of deterioration.
- Call for help.
Seminar- Interesting interview with members of the multi disciplinary team. Physio and OT looking at the bigger picture, On the impacts that the injury has on the patients life. On how their patient would return to their natural environment.

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Skill-Recognise escalating situation, what could be causing these symptoms, Do they have an infection ? UTI? or history of MH condition.
Seminar- MH-illness, journey, the medication
Forensic MH- same things but linking back to the crime, impacts on self, the victim and focus on prevention of further crime.
MH holistic and working with the MDT
Sim- De-escalation techniques. Ask open framing questions. Be open and recognise when things are changing. Call for help.

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Skills-IV re-hydration and pain management. Modifying the Parklands formula for use in children for resuscitation fluids .
Sim- Adjust your language for peds patients,
- Wong-Baker scale-use  observation skills
- involve parents
-deterioration in children is quick

Seminar- This interview was heart breaking. Anthea's poise in this situation is phenomenal. A long road to recovery. Lots of considerations for the entire family. Had never considered the impacts that such an injury would have on the entire family.

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Attended the make up workshop today. Great idea, thank you Bec and Team.

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What? Importance of Gender Identity in patient interactions
So What? In order to deliver person centred care. Gender Identity is important. Avery has stated that they are upset for not having been respected or listened too. The use of correct pronouns is essential in building a therapeutic relationship with our patient. Avery has a new diagnosis of Type 1 Diabetes and is also suffering from anxiety compounded by the use of incorrect pronouns. This additional suffering could of been avoided.
Now What? I will ensure that in all future practice that I respect individuals and their use of their pronouns. This is a powerful tool that can assit in relationship building

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Lots to unpack this week.
What ? importance of recognising deterioration in vital signs.
So What? I really need to revise my mews warning scores. Whilst the simulation was taking place I kept wishing I had memorised score triggered a met for each vital sign. I was always mindful of the head injury but hadn't considered internal bleeding.
Now what? Going to learn these scores and memorise them so that I can react faster in an emergency. Press that code Blue as soon as the threshold is reached so that patients will have better outcomes in emergencies. Not make assumptions on what I think I know.
What? Knowing the importance of nurses to the MDT.
So What ? Realising that the MDT only sees a snap shot of the patient  and they rely on the observations of the nursing team to fill in the blanks.
Now What ? Take this into practice. Build relationships with the MDT to ensure improved patient outcomes.
What? OTs have a focus on cognitive decline and it's impact on patients.
So What ? I had never thought of an OT focusing on cognitive decline and impacts of brain injuries. Figured they worked with physical limitations. Light bulb moment.
Now What ? Taking this one into practice. All injuries impact the lives of people. It's not just about work, it's the daily chore. These injuries impact the day to day activities of the entire family not just the worker.

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What ? Recognising escalating behaviours and making a judgment call before it's too late.
So What? These situations are in a constant state of change. Hence they turn bad very quickly unless you are able to read the signs such as altered body language, tone of voice, patient frustrations, increasing anger or aggression such as hitting walls and even swearing.
Also respecting the patient as a person. Build a therapeutic relationship, build trust and listen to your patient and be interested and acknowledge how hard it is for them. Alter your communication style when needed.
Now What? I need to ensure that as I transition into practice that I remember these steps and use these techniques.

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What? I had not ever considered the long-term impacts that injuries can have on the family's of individuals  with injuries requiring long-term treatments. Injuries like Quinn sustained.
So What? Quin required extensive follow up weekly appointments. Quinn's family had the added burden of distance, loss of income, another young child , even just trying to communicate to a 20 month old. Pressure on close family and friends.
Now What ? I will be now be cognitive of these additional burdens that are on family and friends of long term patients like Quinn and when in future practice.
I haven't had any experience in looking after a peds patient. Forming a relationship with kids would mean use appropriate language, building trust and ensure that they feel safe.

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Sent an email to Fiona (CLN) requesting that INC 6 students do not be sent there for their 5 week placement. It would be terrible if we lost a new novice nurse because of the ward culture here.
I often think each week I attend class that I should pop my head in and say hello to everyone. Maybe I will one of these days.

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What ? No significance for gender and job
So What ?Not surprised by this , I do consider that the best person for the role should be hired as opposed to a gender. In my previous employment I felt that their was a preference for promoting men into management roles. I always felt that I had to work harder. The result of this test is surprising to me.
Now What? Be mindful of this bias. Though the test didn't show this. I know that for all those years that's how I felt. I guess I still do. Self awareness is a good thing.