Student Nurse Section

The workbook will be owned by yourself and we would hope it will assist you with reflective conversations with your practice Assessor/ supervisor. We hope that you will gain practical experiences of the scenarios we have provided and the Student workbook will give you additional direction of what to consider when supporting a patient in the community .

They will also highlight that it will be through discussion between the practice supervisor / assessor and the student that will identify if part or all of the document is to be completed. 

The document will be your (students) property, it is not required as part of your university work but will inform your practice supervisor / practice assessor of your progress in placement and the evidence from this will inform interim and final assessment.

Take a few minutes to read through the following scenarios and think about what you would do as the newly qualified Staff Nurse in each scenario.  Think about how you would act at the time, what actions you would likely take, what you would do with the patient, who you would inform, and if you would follow this up with another visit/referral to specialists etc.

Discuss your answers with your Practice Supervisor or Practice Assessor. These are designed to give you scenarios to discuss are part of a reflective discussion.

Question 1

You are asked to visit a gentleman who has a sore bottom and it turns out he has a pressure ulcer on his right buttock. How would you assess this and what would your care plan consist of? What else would you do?

Assessment – Have you considered…

• What grade of pressure ulcer this is?  Pressure Ulcer Grading Chart
• Have you measured the wound?
• Have you considered the reason for the patient developing this pressure ulcer and looked at ways in which to minimise further damage?  (Think SSKINS)
• Have you informed the caseload holder?

Planning Care

• Think about dressings – what would you likely want to use for the different grades?
• Consider how much exudate (fluid) is coming from the wound
• Consider how often to visit and change dressing
• Consider what you want dressing to achieve (absorb, reduce bacterial load, protect, progress to healing etc)
• How often would you measure the wound?
• How often would you change / update the care plan?

Question 2

You go to visit a lady who has type one diabetes who requires the nurses to administer her insulin. What are the steps you would take prior to administering her insulin?

Have you considered…

• Have you checked her Nursing notes to ensure no-one else has visited this patient prior to your arrival?
• Have you checked her Direction to Administer?
• Once you have checked the patients Blood Glucose level, have a think about what the ‘normal range’ would be for this patient – discuss with your mentor.
• What steps would you take if the patient is hypoglycaemic / hyperglycaemic?
• If safe to do so, are you familiar with the device used for administering insulin?
• Is your device in line with the safer sharps policy?
• Have you disposed of the sharps appropriately?

Question 3

One of your patients who has a wound on their leg has phoned to say his wound is very painful and his dressing has fallen off. When you saw him yesterday there was minimal pain at dressing change however you did think it was exuding more fluid than before. What things would you consider when you go to visit this man? What would your assessment include?

Have you considered…

• Is the current dressing appropriate for the increased exudate levels
• Frequency of visits (may need increased)
• Are you expecting the wound to increase in pain?
• Consider wound infection – if likely, what steps might you take?  (Remember, is it localised or systemic?)
• Does this gentleman need referral to Vascular / TVN?
• Would you change his care plan, nursing assessment, waterlow?

Question 4

A patient phones to advise that their catheter bag has been empty all morning and their stomach is becoming painful. What would you do? Is there any advice you can give over the phone initially?

Have you considered…

• Asking them to change position to allow gravity to assist
• Asking the patient about their bowels (are they regular / constipated)
• Ask about fluid intake over past 24 hours
• Provide reassurance
• If requiring a visit – what would you be looking for?
• What would indicate a change of catheter is required
• Are there any signs of CAUTI
• How would you record your visit?  (Think about Catheter Assessment Procedure)

Question 5

The carer of a palliative patient calls to say that their loved one has become very distressed and is trying to get out of bed. They had been administered 2mgs midazolam only an hour before hand and are on a syringe driver with diamorphine for their pain. How would you assess this situation? Is there anything else that could be causing this agitation?

Have you considered…

• Patients’ position in bed / chair
• Bladder
• Bowels
• How many breakthrough doses over past 24 hours
• Is the breakthrough dose sufficient
• Should we consider adding Midazolam to the Syringe Driver?
• Medication review from GP / Independent Nurse Prescriber
• Support for family
• Home Care / Marie Curie

• NMC student standards
• PEF portal
• Diabetes UK – Resources for Professionals and Patients
• NMC – The Code
• Gibb Reflection cycle toolkit Edinburgh University
• NMC – Reflective accounts Revalidation