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Please use the examples below as guides for completing your ePAD. In particular, you should consider the length of the statements and how professional language is used. It is appropriate to include references as needed.

Please note that academic regulations with regard to plagiarism and the use of AI apply to the completion of your ePAD.

The examples below are not specific to any particular area; you will need to consider both your placement area as well as your field of nursing when completing the ePAD.

Where dates are needed e.g. in the initial interview or for action plans, you need to ensure that dates are realistic and achievable.

Initial Interview

Student to identify learning and development needs (with guidance from the Practice Supervisor / Assessor)

Learning needs I would like to focus on in this placement: Understanding of the whole patient journey from admission to discharge. Become competent in completing patient risk assessment paperwork (Braden scale/must/falls risk). Continue to increase in confidence, carrying out medication rounds. Develop a relationship with the team and be comfortable with delegating tasks. MDT working – understand how the different teams work together for the best patient outcomes. Understanding the nurse’s role in liaising with patients’ families and joint decision making (especially when a patient lacks capacity). Understanding the capacity assessment – when this happens and by whom? Understand how much involvement the nurse has in negotiating with patients around personal hygiene/washing, and dressing. Understanding how and where ‘evidence-based practice’ comes in – What evidence is there and how can I access it?

Taking available learning opportunities into consideration, the student and Practice Supervisor / Assessor to negotiate and agree a learning plan

Outline of learning plan

Following the patient journey from admission to discharge. Complete risk assessment paperwork. Learn about MUST scoring/how to complete paperwork. Neuro observations Complete skin care bundle

How will this be achieved?

Spend time with the integrated discharge team to understand the patient pathways. Arrange time with specialist nurses in falls and tissue viability to understand risk assessments and management. Arrange a day with the dietician to understand MUST scores and dietary requirements

Midpoint Interview

Student’s self-assessment/reflection on progress: Reflect on your overall progression, referring to your personal learning needs, professional values and proficiencies. Identify your strengths and document areas for development.

Knowledge

I have gained knowledge around the processes in the preoperative department, the importance of patient history taking to check suitability for surgery and general anaesthetics. I have really started to understand the theory behind patient optimisation, which guides patients to get physically ready for surgery through exercise, diet, or pre-op drinks. Changing lifestyle habits, such as smoking cessation and reducing alcohol intake, can also enhance recovery after surgery. 

I have learned about normal ranges of bloods, and how blood results being out of the normal ranges can impact surgery and recovery. 
I have worked on increasing my knowledge of commonly used medications, and in particular medications prior to surgery and how they can impact – There are drugs to omit and drugs to take before surgery (Stopping DOACS, ‘prils’ and ‘artans’) some patients need omeprazole/lansoprazole night before/morning of surgery but generally for people who have a BMI of over 30. 

Looking at the next half of my placement, I would like to practice pre-op assessment to build confidence, develop leadership skills by managing and delegating tasks to peers.
I need to work on hiding my annoyance when there are inconsistencies with running the surgical assessment area – I understand that generally different nurses will have different ways of organising their workload, and this doesn’t necessarily mean that it is wrong. I am understanding the need to be more flexible with my thinking, and I recognise how I work can be different to others. 

Skills

I have gained experience in many skills so far on this placement, including: 

ECG (electrocardiogram) – I can now perform these independently, and print for the notes for the doctor to review pre op. 
Careflow (managing casenote, navigating for test results and TCI letters)
MRSA swabs and pre-op observations, independently. 
Preop assessment documentation (Under supervision)
Admission checklist, both day case and inpatient stay
Writing up the surgical admission board! – I hope to work more with the coordinating nurse and surgical team to better understand how admissions are organised. 

Attitudes and Values

Gloucestershire patients are diverse, and it is important that they all feel valued and can expect to receive the same care, whatever their background. Every contact with a patient is an opportunity to discuss health promotion, from simple things such as staying hydrated to more complex discussions about reducing alcohol or smoking cessation. I also feel it is our duty to ‘practice what we preach’, however, we must address patients in a ‘non-judgemental’ way and treat everyone with compassion and kindness (colleagues included). I treat patients and colleagues with respect and dignity, and I hope this shows.

Integrity is also important, nurses are a trusted profession, and it is important not to abuse the uniform through misconduct (behaviour on social media, for example) or lack of professionalism. I am always mindful to be honest, and if I make a mistake, I am keen to learn from it. I would admit my fault, and by doing this, I feel it would prevent the same mistake in the future. This level of transparency is so important as we are human and make mistakes, especially as students, but in understanding how and why, these mistakes should not occur again, and therefore provide safer patient care. 

Empathy, compassion and kindness are required attributes of a nurse, I definitely have these but maybe sometimes too much. There is a fine balance between showing empathy and compassion to patients and staying on task. I find this difficult sometimes because I genuinely care about the people I see and want to solve all their health issues, which is unrealistic. I am altruistic in nature, but sometimes this is to my detriment (I feel), as I can sometimes get drawn into how someone is feeling, which pulls me off task slightly. I need to work on being compassionate without getting drawn into their emotional experience. This is part of professional boundaries, and I have discussed with my supervisors issues which have troubled me, and how they have managed similar patients. 

Endpoint Interview

Student reflection on meeting Professional Values: Choose one example from your practice on this placement to demonstrate how you practice within the NMC Code (ensure confidentiality is maintained). For each placement, please select a different section of The Code to reflect on.

NMC – Promote Professionalism and Trust

As a nurse, I understand that I represent the nursing profession; my attitude and behaviour must reflect the standards and values within the code. I understand that I must practice with honesty and integrity and treat all patients (and staff) fairly without discrimination.

One of the difficult jobs we have within the preop environment is having to tell patients who have been waiting hours that their surgery is no longer going ahead. Most of the time, the consultant will tell the patient, however, it is generally the nursing/NA teams that go in straight after to smooth things over when the patient is distraught. Sometimes we have to explain to the patients ourselves.

Being professional in this situation is having empathy and validating the patient’s feelings, not dismissing them or playing them down. On the other hand, we must remain objective and not get too involved with sharing the patient’s feelings, no matter how frustrated we feel, as we want them to leave the hospital with their regard for the NHS intact and a willingness to return another day for their imminent surgery. I tried to understand the factors surrounding bed flow so I was able to explain to the patients why their surgery was being cancelled, such as overnight movement into ICU/HDU and trauma patients taking priority over beds. Being honest with patients about ‘why’ seemed to help them accept the situation better and prevent a generally emotive situation from escalating. Integrity is important and helps to create a trusting relationship with patients, which promotes professionalism.

Although often these situations are out of our hands, as the link between the patient and theatres, we can influence the patient experience by apologising, showing empathy, validating the patient’s feelings of disappointment and also setting their expectations when they arrive by not over-promising that everything will always go to plan. Patients need to know that there is a possibility that any surgery can be cancelled on the day. If we are honest with patients and keep them updated regularly, we build trust and respect, which makes it much easier if we have to deliver the news that their surgery is postponed.

I have been in this situation a few times now and realise that a cup of tea (when patients have been fasting and on limited fluids) goes a long way alongside empathy and compassion, thus creating a professional and trusting environment

Reflect on your overall progression, referring to your personal learning needs, professional values and proficiencies. Identify your strengths and document areas for development.

Knowledge

My placement has offered me a wealth of knowledge and practical experience essential for my professional development. There are several key areas where I have gained valuable insights, skills and knowledge.

Patient Assessment and Monitoring:
I can conduct comprehensive patient assessments, including neuro observations, monitor vital signs, and recognise early signs of deterioration. I have a greater understanding of intravenous Therapy and medication administration, such as being able to ‘push’ (IV injection) certain antibiotics rather than run them through a bag with a diluent. I have supported the nurse, observing them administering IV therapy, flushes and medications and assisted with managing infusion pumps. Most of which is carried out using ANTT method. Having performed many, I can now recognise basic abnormalities on ECGs, and also recognise when blood results are out of the normal range.

Medical Knowledge:
I have a greater understanding of some of the common acute conditions such as; heart failure, respiratory distress/infection, sepsis infections, SOB + chest pain (ACS) and falls either caused by mechanical problems (such as old age) or alcohol related falls. I also have a better understanding of the pathophysiology of the underlying mechanisms of acute illnesses and how they affect the body, such as ‘AKI’, and the effect this has on many of our patients. In these patients, we consider strict input/output monitoring and IV fluids, restricting or holding nephrotoxic medicines and continuous monitoring of electrolytes in case of deranged sodium/potassium levels, which can affect heart function and further damage the kidneys.

Interdisciplinary Collaboration:
Teamwork and Communication are essential to planning and implementing patient care, working closely with doctors (going to the daily board round) and the multidisciplinary team (making the appropriate referrals), also working with physiotherapists, occupational therapists, and family members as necessary to provide person-centred, holistic care.

Skills

As highlighted in the Midpoint, I have completed a bladder scan (but only one), ECGS, cardiac monitoring, and observations. medication rounds with confidence using the 5 Rights. IV pumps and nebulisers. My confidence has further increased doing venepuncture using either an eclipse signal or a butterfly. Using CIWA scoring in alcohol withdrawal, and more recently using the MEOWS early warning system for a patient who was pregnant. I have also made many different referrals.

My confidence in SBAR handovers is increasing – I just need to try not to jump around and keep it structured and in order. 

My assessment skills are developing, and I feel much more confident in deciding which tests will be needed for certain presentations. 

I need to further develop my skills in doing neurological assessments (checking eyes and limbs) as I have not yet performed enough to feel competent. It takes me ages and I need some further feedback to improve how I do them. Catheterisation is another skill I have had very little exposure to, so this will be a focus for my next placement. 

Attitudes and Values

I have always maintained it is important to me that all the patients I care for feel valued and expect to receive the same level of care, regardless of their background. All patients (and colleagues) should be treated with compassion and kindness, respect and dignity. I try to ensure I demonstrate this every day. There are many different attitudes and values I feel are crucial in the field of nursing. Having the right mix of these contributes to the provision of high-quality patient care and a positive experience for the patient. 

I am beginning to feel much more like a professional nurse, rather than a student, and during this last year, I feel proud of the progress I have made. I feel confident in my approach with patients and their relatives, and have found a way to be empathetic, whilst also protecting my own feelings and not becoming too involved. I work within the NMC code, ensuring confidentiality, and feel more comfortable now when conversing on the phone and providing updates. 

Episodes of care

The example below is from Part 2, EoC 1. Please note the use of references in this section.

Student reflection on an episode of care:

Within your reflection describe the episode of care and how you assessed, planned, delivered and evaluated person-centered care:

This episode of care will discuss the care given to the patients I was allocated on my shift. When receiving the handover from night staff, firstly, I need to know if any of the patients are scoring on the NEWS2. NEWS2 is an evidence-based early warning score designed by the Royal College of Physicians (2017). I understood the need to prioritise my care based on need and which of my patients are unwell, if any. I was allocated three patients to assist for the duration of my shift. One patient was showing signs of respiratory distress but the other two patients seemed stable and well so I decided for this shift my main concern was assessing the patient’s condition, escalating if necessary, deciding on treatment or action plan, and then evaluating improvement/deterioration by regular assessment. For the purpose of this Episode of Care, I will refer to this patient as ‘X’
After introducing myself to the patient, I asked X how they were feeling. In doing this, I am assessing how breathless the patient is and also if they can tell me they feel unwell, as this may be normal for them. I explained to X that I needed to perform a set of observations, and gained their consent – I checked the notes to confirm which scale we would use for X’s oxygen saturations – X was on scale 2 – target range 88-92%. X had saturations of 76 – much lower than his target saturations. I know this is a concern so I escalated this to the junior sister after advising the patient but also reassuring him that we will soon make him more comfortable. I suggested to the nurse that we administer 1.5-2ltr oxygen via nasal cannula to achieve target sats which is reached quickly. As described by Cooper (2022) oxygen can become toxic to the body so oxygen may need to be continually titrated to keep with the target range otherwise you could effectively poison a patient. I left the sats probe in situ and continued to monitor the o2 levels while titrating the oxygen to maintain target range. It was difficult to manage as it would quickly go over target range (even on 1 litre) but then every time we stopped the oxygen the saturations would drop again suddenly to between 40 and 70%. The NEWS2 also highlighted increased heart rate (HR) and low blood pressure (BP). I am thinking about heart function and how this could be affecting the respiratory rate. I am also considering sepsis as I know this patient is on antibiotics for aspiration pneumonia (see appendix 1).
The supervising nurse and I escalated his worsening NEWS2 score to the doctors – his respiratory rate was also increasing, and they came to review the patient. While I looked after the patient, I respected his dignity and privacy at all times by talking to him and reassuring him, and I also pulled the curtains round when I could tell he was becoming more unwell. Unfortunately, I had training to attend with another team and I had to leave the ward. When I returned to the ward later at 4pm sadly X had already passed away. The patient already had a RESPECT form, which detailed his ceiling of care as ward-based only, and was not for resuscitation.
APPENDICIES Appendix 1 Aspiration pneumonia is a lung infection that is caused by any of the following: inhaled bacteria in inhaled saliva caused by dysphagia, inhaled food, drink, vomit or a foreign object which has caused inflammation and infection in the lungs. It is most common in the elderly population in care homes and generally in patients over 65, or patients with neurological conditions. The main symptoms are SOB, chest pain, coughing up blood or pus, wheezing and tiredness. Mortality rates from aspiration pneumonia in the elderly are thought to be between 11-30% (Sanivarapu, 2022).
REFERENCES Cooper JS, Phuyal P, Shah N. Oxygen Toxicity. [Updated 2022 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430743/
Sanivarapu RR, Gibson J. Aspiration Pneumonia. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470459/

What did you do well?

I am growing in confidence to recognise and escalate when a patient is deteriorating. I acted promptly and knew the course of action would most likely be administering oxygen. I respected the patient’s dignity and tried to reassure him at a frightening time, supporting him emotionally in addition to addressing his physical needs.

What would you have done differently?

I would have stayed with the patient. I was really disappointed that I had not stayed on the ward to support this patient in his last few hours (although at the time I did not realise he was in his last few hours). Aside from being there to show compassion, it would have been a good learning opportunity, I feel I missed out on. The next time I have an opportunity to follow a patient who may be nearing the end of life I feel I should stay with them for the shift. I have also never participated in ‘last offices’ and would like to experience it in the safety of the ward as a student rather than for the first time as a newly registered nurse.

Describe how you have begun to work more independently in the provision of care and the decision-making process.

Firstly, before I ask a nurse what to do in any situation, I make sure that I have read the patient file, previous notes and current diagnosis/history so I can begin to suggest, firstly, what the problem may be and what could be the course of treatment for a particular patient.

What learning from this episode of care could be transferred to other areas of practice?

Further cemented my knowledge of the NEWS2 document and how this can be used to show deterioration. I also feel more confident in recognising a deteriorating patient and when to use oxygen. I also appreciate how quickly patients can deteriorate with respiratory conditions now, too.