Charity Mukanya

I have worked as a paediatric nurse in Royal Manchester Children's hospital on ward 78 for just over three years now, and I have acquired a substantial number of skills and knowledge that is required for this job role. Ward 78 is a 32 bedded ward specializing in spinal surgery, trauma, neurology, neurosurgical and ENT.  I am a dedicated and motivated nurse, who strives to provide patients with exceptional care and ensure evidence-based nursing is carried out when nursing patients under my care. I embed the Nursing and Midwifery (NMC) code of conduct into the care I provide to ensure that a great rapport between nurse and patient is maintained, and the patient's needs and desires are prioritized when developing their care plans and completing nursing interventions. Every duty is carried out to the best of my abilities to promote confidence and trust within the service user group and their families. I use various forms of communication to make sure the multidisciplinary team involved in the patient's care are aware of the ongoing progress and management of the patient's health. Since qualifying I have developed a wealth of post registration experiences such as: caring for patients with complex needs and are at end of life, developing and implementing nursing care plans, and working alongside the multidisciplinary resuscitation team when emergencies arise on the ward. I have developed various nursing skills such as looking after patients requiring tracheostomy care, external ventricular drains and VP shunts, managing arterial lines, enteral tube feeding such as nasogastric or PEGs, central venous and peripheral venous catheters and urinary catheter care. I am aware that working in the community requires nurses to actively assess the patient's home and family environment and act as a patient advocate, which can include reporting to safeguarding if concerns are raised. I have experience in assisting police, social workers, and social services with non-accidental injury investigations, following the correct safeguarding protocols, and ensuring that confidential information is maintained to promote dignity, confidentiality, and safety at all times. I use the clinical governance guidelines to ensure I practice sharing patient information safely. An example of this is when completing admissions to the ward, I establish if the patient or parent have any social care involvement so I can cater to their social needs and contact their allocated social worker when necessary. I am a very respectful, open minded and an understanding nurse and ensure that the patient and family's spiritual, physical, and emotional needs are met to the best of my abilities. If I have concerns with the health, wellbeing or behaviour of my patient or the family, I am aware that I will need to escalate my concerns to my senior nurse to gain advice on the appropriate actions to take. This job role requires the candidate to be autonomous in managing their workload and one way I meet this requirement is through developing my leadership skills. 

I am one of two manual handling key trainers on the ward, whereby I am responsible for educating staff on the correct ways to safely lift equipment and patients, in addition to implementing the correct use of equipment needed for repositioning patients on the ward. I have done this through performing demonstrations to staff during my shifts and running manual handing group sessions to ensure the safest manual handling techniques are being carried on the ward. The manual handling key trainer role also includes adapting manual handling techniques to staff with limited mobility due to health issues or accidents sustained outside of work. I undertake risk assessments for staff returning to work to ensure they can carry out their daily duties on the ward safely and comfortably. Other ways in which I have developed leadership skills is by taking charge in emergency situations and delegating jobs to each staff member while maintaining a calm and controlled atmosphere, despite the severity of the situation. Two examples of these are when children have prolonged seizures, I refer to their individual seizure rescue plan and, if appropriate, administer antiepileptic medication to prevent them from going into status epilepticus. If I give rescue medication to the patient, I ensure I delegate a nurse to monitor the patient's saturations to ensure the patient's oxygen saturation does not to deplete to a dangerous percentage, which is common when having a prolonged seizure. Similarly, I have administered oxygen therapy and completed the jaw thrust manoeuvre to a patient with rapidly depleting oxygen saturations to ensure oxygen is still being administered to vital cells in their body. While doing so, I ask a nurse to inform the nurse in charge to make them aware of the severity of the situation and contact the allocated team of doctors for a prompt review. Another way in which I show leadership skills is by being an assessor for student nurses and trainee nursing associates. This makes me responsible for teaching them various nursing skills, shadowing them while they complete nursing interventions and signing off the clinical competencies they are set by their individual universities. I have also taken lead on providing conflict resolution when dealing with patient and family complaints and queries. 

I ensure that patient and family complaints and queries are prioritized to ensure the person-centred approach to care is maintained and that the necessary teams are informed so that the most effective actions are taken to resolve any conflicts that has or may occur. I deal with complaints and queries following trust policies and protocols and consider various factors that impact the effectiveness of the outcome such as race, religion, and culture. One skill that is essential in successfully managing your own workload is excellent organizational skills. As a staff nurse on the ward, I can prioritise my nursing duties and ensure that I work well as a team among other staff nurses and members of the multidisciplinary team to provide optimum care to my patients. I use the paediatric clinical handbook on the trust website to ensure that the care and treatments I deliver to my patients are backed by evidence-based practice and are safe to apply in the clinical setting. I ensure the patients and families I look after receive the relevant health information and education prior decision making so that they make informed decisions when choosing their treatment options. I do this to empower them to be active participants in their own care and promote autonomy and build rapport with my patients and their families. For example, I have been involved in using the parental NG teaching packs to teach parents on how to correctly check the ph. of a nasogastric tube prior usage for medication or enteral feeding purposes, which promotes confidence, trust and independence for the parent completing the feeds. Ward 78 is a specialist ward that caters to patients affected by orthopaedic, neurological, and neurosurgical conditions as well as children affected by ears, nose and throat complications. I have had great exposure to patients with spinal injuries including caring for children with kyphosis, scoliosis, spina bifida and trauma patients with spinal injuries. Moreover, I have looked after children with tracheostomies and children in need of deep suctioning without an alternative airway route. I am confident in the anatomy and physiology of the upper airway, and I am aware to work within my competence when administering oral or nasal suctioning. I have experience in documenting and monitoring the amount, the type and how often the patient needs suctioning and when to escalate concern regarding suctioning, e.g., if the secretions are too thick, I would recommend giving a saline nebulizer to loosen the secretions. 

My interest in this job role has been rooted in my own ongoing issues with atopic eczema affecting me from head to toe and I understand the implications any skin condition can have on mental and physical health. Therefore this familiarity allows me to have a greater empathy for patients suffering long term chronic skin conditions and I am able to better communicate with patients and families affected by dermatological conditions. I am very eager to ensure the highest standard of practice is adhered to when caring for patients who are already exposed to the hardships of eczema and I hope to add to the already amazing dermatology team at Salford.

> Maintain my patient's physical and neurological needs through physiological and neurological observations using the Paediatric Early Warning Score and the Glasgow Coma Scale

> Administer medications to patients in a safe and timely manner using the Standards of Medicines Management 2007

>Assisting patients by catering to their individual nutritional needs, e.g. setting up a nasogastric or percutaneous endoscopic gastrostomy feed to the rate and dose provided by the dietician

>Monitoring the output of patients with pathological conditions that affect their output (post surgical patients, spinal patients, patients with hydrocephalus) e.g. recording the total output of a patient's extra ventricular drainage, wound drain, urinal catheter and oral suction catheter, bladder washouts.

>Regular monitoring and changing wound dressings e.g. spinal surgical dressing, weekly dressing change for PICC and midlines, pin site dressings for patients with a Taylor spatial frame, portacath dressing changes

>Participate in regular repositioning of patients with complex needs and reduced mobility, and assess skin integrity using tissue viability risk assessment

>Promote healthy patient and nurse relationships by catering to their requests and being an advocate to patients during ward rounds and treatment plans with the multidisciplinary team

>Working alongside my team members to maintain moral throughout the ward and to equally share workload during the shift.

>As a Manual Handling Key Trainer, I advocate the correct manual handling techniques via facilitating teaching sessions for the staff nurses on my ward and ensure the right techniques are used for manual handling when I am on shift.

>I obtain blood samples via capillary gases, finger prick samples and bleeding back central lines to aid the tracking of patient's progress via blood results

>Perform hourly neurological observations on patients who are admitted for video electroencephalogram and monitor seizures and give rescue anti-epileptic medication when necessary.

>Work alongside the multiple disciplinary team to ensure clear communication is being carried out and treatment plans are being followed up.

>Act as an advocate and escalate concerns raised by patient, parents or staff members to the right senior member.

>Act as a safeguard advocate for patients and work alongside social workers and safeguarding team to raise concerns and follow up multidisciplinary meetings to ensure that the patient's safety and health is prioritised during their stay at hospital and after discharge

>Assess and supervise student nurses and trainee nursing associates in providing nursing intervention and implement action plans when competencies are not met. Facilitate a positive partnership with student nurses and trainee nursing associates to ensure they get the most valuable teaching placement

>Educate and assess parents who are new to completing tracheostomy cares, including suctioning and changing tapes. Moreover, I teach parents how to test nasogastric tubes before use, complete pin cares when a patient has a taylor spatial frame applied in theatre and how to correctly hoist children in bed.

2:1 MSc degree in Children and Young People Nursing at the University of Salford, March 2019