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Preparing for Your Placement in Critical Care

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Preparing for Your Placement in Critical Care

Your Critical Care placement will be a unique opportunity to develop skills, knowledge and gain confidence in caring for a critically unwell patient.

It is likely that you will undertake this placement during your final year of study to ensure you have the required depth of knowledge and experience needed to thrive.

Critical care areas will include Intensive Care Units or High Dependency Units.

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What to Expect From Your Placement

Critical care will include a variety of patients from a variety of specialities who will be suffering from a variety of conditions - critical care, if nothing else, is varied.

You should expect to look after a mixture of level two and level three patients.

What is a level three patient? Patients who requires a ventilator or multi-organ support. These patients may be sedated or awake.

What is a level two patient? Patients who are being invasively monitored, requiring drugs to maintain cardiac stability or those requiring non-invasive ventilation.

First and foremost, do not worry - you will be surrounded by very experienced Nurses, Doctors and allied healthcare professionals. Critical Care, generally speaking, is a very safe and controlled environment.

You'll be allocated mentors, like every other placement you've had, the main difference however is that you will be spending your whole shift with your mentor. You won't be left unsupervised for any significant period of time with a critically unwell patient. Your mentor won't expect you to have an in-depth knowledge of critical care interventions or treatments but they will expect you to ask questions and participate in care.

RELATED: How to Ace Your Management Placement

Preparing For Your Placement

There are a few things you can do to prepare for your critical care placement;

Try and visit your placement before you start. Intensive care units can be intimidating places. Visit the area you have been assigned to before you start and ask if there is anything you should be aware of prior to starting.

Identify your learning needs and outcomes. Identify these early and be aware of the skills you want to develop or learn – this will help you get the most from your placement.

Brush up on your anatomy and physiology. Familiarise yourself with the physiology and function of core systems, it will bode you well.

Look at ABCDE assessments and their importance. This systematic approach is used for everything within Critical Care - everything from handover to invasive treatment is based around an ABCDE model.

Getting The Most From Your Placement

Most of you won't be working in critical care after you qualify. So it is important that during your placement you focus on transferable skills you can learn and/or improve on in this area, relish the opportunity to deliver global (holistic) care in an environment where there is time.

The final and most important piece of advice I can give you is to ask questions and get involved. 

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Education

NMC launches new educational standards to 'shape the future of nursing'

Part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities.

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by Ian Snug.
NMC launches new educational standards to 'shape the future of nursing'

Student nurses will start to train against the new standards from January 2019.

Last week the Nursing and Midwifery Council (NMC) launched 'ambitious' new standards of proficiency that set out the skills and knowledge the next generation of nurses need.

Alongside the new proficiencies, the NMC has introduced a more modern and innovative approach to the way universities and their practise partners train nurses and midwives - the NMC claim these changes will allow greater independence of assessment, and greater innovation by placement providers.

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The NMC has also removed its standards for medicines management and instead encourages employers to instigate rigorous medicines management procedures.

Unlimited simulation.

Finally, part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities - despite concerns this could reduce the total amount of time student nurses could spend on placements.

The new standards represent two years’ work and have been developed alongside nurses - as well as students, educators, healthcare professionals, charities and patient groups from across the UK.

Jackie Smith, NMC Chief Executive and Registrar, said: “Our new standards represent a huge leap forward. They raise the bar for the next generation of nurses and not only match the demands of the role but the ambition of the profession. This is vital as in the coming years many thousands of new professionals will join our register, delivering care to millions of people.

“We’ve also overhauled the way universities train nurses and midwives. They’ll be given more flexibility to harness new ways of working and embrace technology so they can equip the nurses and midwives of tomorrow with the skills they need to deliver world class care for years to come.”

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Education

Do I really need to count a patients respiratory rate for a whole minute?

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

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by Matt Bodell.
Do I really need to count a patients respiratory rate for a whole minute?

Some staff feel that sixty seconds can be better spent.

It is well documented that the respiratory rate is the least accurately recorded vital sign but yet it can be the most important.

Reseach suggests that many students and registered nurses believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate for the full sixty seconds.

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The research, completed by Flenady et al, suggests that this debate isn't rooted in laziness but instead staff believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate.

Do I really need to count for a whole minute?

Yes! It is vitally important you count a patients respiratory rate for the full sixty seconds rather than counting for a shorter period and multiplying, or worse, estimating.

Respiration has differing patterns and without observing these for a whole sixty seconds you are unlikely to obtain an accurate measurement.

Do I really need to count a patients respiratory rate for a whole minute?

The critically unwell patient also sometimes tend to have apneic episodes and counting for a short period may not reveal these until a patient is in full respiratory arrest.

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

Finally, documenting an inaccurate respiratory rate could, potentially, have legal implications.

How should I count a respiratory rate?

You should count each full cycle of inspiration and expiration for a full sixty seconds.

Anecdotally, it is better to count a patients respiratory rate when a patient when they are not aware you are doing so - this ensures a patient is less conscious about their breathing and thus their respiratory rate is more natural.

Why is respiratory rate important?

Haemostasis and the bodies compensatory mechanisms mean that a change in respiratory rate could be one of the first indicators of deterioration in physiological condition.

Changes to a patients respiratory rate can indicate a number of things such as hypoxia, neurological or metabolic changes.

Picking up on these changes early should lead to earlier medical intervention and therefore better patient outcomes.

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Education

Student nurses to receive ‘political lobbying lessons’

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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by James M.
Student nurses to receive ‘political lobbying lessons’

Nursing students will learn how they can work with MPs to promote the nursing profession in a new training session organised by the RCN.

Members of the RCN’s student committee and student information officers - the RCN’s representatives in universities - will learn their way around the UK parliament and the government from the UK Parliament Outreach and Engagement Service.

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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The RCN’s public affairs team will talk through the college’s approach to engaging with parliamentarians, especially the crucial role members can play. The team will explain different tactics and approaches students can take as well as what they can ask MPs to do to show their support for nursing staff in their constituencies.

Janet Davies, chief executive and general secretary of the RCN, said: “To work effectively, any union must be able to engage MPs and ministers.

“We know our members make the most powerful advocates for the profession. When frontline nursing staff sit in front of parliamentarians, you can see they listen.

“It’s through the hard work of members that vital issues such as safe staffing, harassment and health policy reach the top of the agenda.

“When nursing faces challenges on every front, the RCN wants to make sure our advocates are fully-equipped.”

Charlotte Hall, chair of the students’ committee, said: “Student nurses represent the future of the profession. Learning to engage with MPs is vital if we are to effectively shape that future and ensure the best possible care for patients.

“With these skills, committee members and student reps will be able to help other nurses make their voices heard on behalf of the profession and patients.”

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