Before the simulation on Wednesday I completed the preparation work for the the week. I learned about pressure ulsers and how to prevent them, theatre (infection control and DHS procedure) and about best interests. theater prep work was particularly interesting and help me a lot in the simulation.

At the beginning of the week I already had a good amount of experience in theatre as I have completed 2 theatre weeks. I’ve had good experiences in theatre and have seen a range of cases from a DHS to endoscopy. Many radiographers talk about knowing the operation so you understand when the surgeon will need you. This links quite well to the pre activity where we had to fill in boxes on a DHS procedure. This helped me to consolidate my knowledge on the DHS procedure and assisted me in recalling the procedure during the simulation. Furthermore, doing the infection control activities was good given the current climate involving covid-19. It really helped to highlight everything that has changed. Doing these prep activities made me feel more aware of everything I have been doing on placement and gave me more context to what I was doing on placement. The simulation itself was very informative, I always like to practice moving the C-arm before I take part in any theatre case. The infection control simulations just helped me to consolidate what I already knew like putting a cover on the C-arm and making sure everything is in position to turn for a lateral so that no sterile areas become dirty. However, I did learn what a foot paddle on the C-arm was. I have never seen a foot paddle used before and no-one has ever showed me one. When the surgeon asked me to pass it to her I was unsure what to do and needed help from my peers to help me understand. This was a great learning experience and helped me to understand why surgeons cannot expose despite the theatre hierarchy.

This therefore leads me on to my action plan. Me action plan is to pay closer attention my equipment and ask more questions. This way I will hopefully be more aware and less likely to make mistakes. I am also going to do more work on the theatre hierarchy. This will help me understand my role more and what I am in control of in the operating theatre. I am also going to talk to radiographers about their experiences in theatre to find any tips they may have. For example, Claire mentioned taking the key out of the C-arm so no one is able to expose who isn’t qualified.

Moving on to the Mobile simulation, we X-rayed patients on beds that were angled in different ways. This was very helpful for me because it allowed me to see what I was doing wrong on a real X-ray and I was able to attempt it as many times as I needed to without fear of radiating the patient. After we had got the positioning correct, I felt very proud of us I learned that when X-raying kyphotic patient it’s is best to keep a straight tube. During the prep activities, I learned how to do a hospital corner. We were asked to replicate this in the simulation on one of the hospital beds. Making the patients bed after X-ray can help prevent pressure ulcers. This is really important to remember as pressure ulcers can kill. Furthermore, we were allowed to move the mobile and get used to adjusting it (like with the C-arm). This was also very informative because my placement site have just updated their equipment with mobiles similar to these ones. We also talked about acting in the patient’s best interests and how we measure someones capacity to understand and consent to a procedure. Specifically we talked about Gillick competence. Many of us in the group thought much younger children would have Gillick competence. However, Claire stated a child around the age of 13 would be judged to have Gillick competence.

My action plan for the mobiles simulation is to take part more in mobile examinations. It has been difficult in the current climate to get fully involved in doing mobiles. Due to covid-19 there aren’t many mobile examinations and when we do them, we often want to get in and out of the ward as soon as possible. However, I do need to get more involved especially in positioning the X-ray tube as this is what I find most difficult. During my next mobile week I will achieve this goal. To continue I always forget to re-adjust the patients bedding after an x-ray. This is now something I am more aware of and practice remembering to do this for every patient. Furthermore, I am in the pediatric department next week so learning about Gillick competence was very relivant to me and I am prepared to use my knowledge to successfully complete my pediatric competency.

Abby Conway 100505552

Day 1

On Monday we were set pre-reading to do which involved some interesting videos and some e-learning to do. The video of the terrorist attack showed how the hospital prepared for the incident and the stressful environment. It also opened my eyes to real paraprofessional learning and put the e-learning into perspective. I think this helped me, more than anything else, to understand real high intensity situations.

It was very interesting, but I still felt unprepared for the day after reading everything. I was unsure of the environment we were going to be in and what we were going to be doing. The e-learning course reassured me that I would be in a safe environment, however I still felt apprehensive especially after my mum told me she hated it when she was at university.

Day 2

Today was the first day of being in simulation. I felt comfortable in my group and felt I could make mistakes, and no one would judge me for not knowing something.

From my observations, the students started off well with ID and introductions to the patient. As it went on, they became more and more student focused by having lengthy conversations. I would talk with the radiographer but go into more detail with the radiographer once the patient was out of the room. The patient was also in pain while these discussions were happening, so both students were not being very patient-centred in this situation. The radiographer spoke clearly and gave polite instructions to the student. After seeing this, I took the other students’ comments on board.

In the next round, I was the student and my friend was the radiographer. I brought the patient in, introduced myself well, and ID checked. I got the patient on the table, however I had positioned for a foot instead of an ankle. I believe this is because I was nervous to take part in the simulation. I quickly re-positioned correctly and then I got asked to evaluate the image. The ankle was obviously broken but I wasn’t aware of any extra positioning that needed to take place. The type of injury the patient presented with was a maisonneuve fracture which I had not heard of before. The radiographer steps in and I step back, still not knowing what to do. After the simulation, we reflected on it and I got upset because I felt I didn’t know anything. I felt like I was under a lot of pressure, but the lecturer calmed me down and I was able to reflect on the situation. After looking up the projection that was needed for the examination I felt better and therefore more prepared for placement.

The first simulation of the afternoon was chest radiography which is something I enjoy. I volunteered to be the patient. The x-ray image was on the screen while we were setting up the simulation for the student and I was immediately able to identify the pathology as a pneumothorax. I was proud of myself and I was excited to be the patient. The radiographers treated me fairly well as a patient. They were good at communicating with me. For example, they told me the board would be cold and the x-ray would only take a second, which was reassuring. I think I did a good job being the patient as the observers told me it was realistic. In the reflection I learned it’s best to position someone by moving the sheets rather than pushing their body and what to do with the jewellery the patient is wearing. I was also able to name the area of interest with little help which boosted my confidence.

In the next simulation I was the student radiographer. I think I had good communication with the patient to start with. However, confusion over projections we were doing for the knee and lack of communication between me and the radiographer hindered my communication with the patient. I also forgot to prepare the room for a standing knee which took a while to set up once the patient was in the room. We spent a long time altering the x-ray tube which distracted me from the patient’s needs. He had mentioned he wasn’t good on his feet and we left him standing for a long period of time. Afterwards we said that we would give him a chair to sit on to make him more comfortable and prep the room beforehand. This would allow us to be more focused on the patient’s needs, and thus improving our patient-centred care and their experience. I was able to evaluate the image correctly using the ten-point check list.

Overall I think day two was very useful as it showed me the things that radiographers do automatically like preparing the room. It also made me realize the thought process behind evaluating an image and considering whether the image is of diagnostic quality. I also got used to the simulation environment and I know from personal experience that it is a safe space to make mistakes.

Day 3

It was very interesting to compare the simulated theatre environment to my experience on placement. It gave me new insights into what I can do as a student to enhance my experience. For example, watching the people coming in and out of the room to check they have lead aprons on, and introducing myself at the start of the procedure. From my experience, theatre isn’t as stressful as the simulated environment. If you can use the C-arm you can manage to do most things. However, the simulation did represent a more intense environment that can occur in high stress procedures. In these cases, I have learned that it is important to be clear when talking to the surgeon. In the afternoon, we interpreted chest radiography which really helped me understand clinical indications on request cards and what to look for on a chest x-ray.

Day 4

This morning we did mobile chest x-rays in the ward environment. This gave me a good insight into mobile radiography. I learned how important it is to introduce yourself to both the nurses and the patient. Furthermore, during my simulation, we needed to change the patient’s sheets and I wasn’t sure how to deal with this situation. During the discussion, the lecturer made it clear that we are part of a multidisciplinary team and that we needed to ask if the nurses wanted our help to clean the patient. In the future I will use my formative assignment to research the multidisciplinary teams and how to become a more effective team member. During the afternoon we learned about the technical side of CT and MRI. This helped me to understand the radiographers role while the patient is in the CT scanner. I will therefore use this knowledge on placement to ask better questions about CT and MRI and I will become an asset to the multidisciplinary team.

Abby Conway 100505552

I have reflected on the experiences individually in the previous post and this is an overall review of what I have learned on simulation week.

One of my improvements is to always consider patient needs first and not become too focused on the technical aspects of the examination. I can do this by not jumping straight into the examination and taking some time before hand to think about what I’m going to do. I need to prepare the room before that patient enters to make the interaction more efficient and less time consuming for the patient.

Furthermore, I need to work effectively in the multidisciplinary team. I will do research into the multidisciplinary for the Betty assignment and after finishing this assignment I will have a better understanding of interprofessional teamwork and the multidisciplinary team.

Lastly, I strive to become a more useful member of the team in theatre. I need to get more involved and feel comfortable talking to the surgeon. I will achieve this goal when I complete my next theatre week because I will become more comfortable with the equipment and the surgeons use of complex language.

In conclusion simulation week allowed me to make mistakes in a comfortable environment where I could practice my skills and learn from the experience effectively. Reaching the goals i have set for myself will allow me to develop my professional practice and become a more valuable asset to the team.