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Heading into our final INC for the degree I am excited and nervous. Im not Sure what to expect with the new format of lessons, but I am excited to have lessons down at the UC hospital space.

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A short introduction to you as a Registered Nurse including your SMART goal for your transition to new graduate practice (250 words)(+/- 10%)

A critical reflection supported by evidence which identifies a previous clinical event and explores the interconnectedness between the attitudes, values, practices and beliefs of the practitioner with NMBA standards 1, 2 and 3 while detailing strategies for successful demonstration of these standards in future practice (750 words)(+/- 10%) (1100 words total)

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standard 4: Comprehensively conducts assessments 

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standard 4: Comprehensively conducts assessments 

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RNs accurately conduct comprehensive and systematic assessments. They analyse information and data and communicate outcomes as the basis for practice.

The registered nurse:

4.1 conducts assessments that are holistic as well as culturally appropriate

4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

4.3 works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/ or for referral, and

4.4 assesses the resources available to inform planning.

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Australian Health Practitioner Regulation Agency

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standard 5 Develops a plan for nursing practice

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standard 5 Develops a plan for nursing practice

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RNs are responsible for the planning and communication of nursing practice. Agreed plans are developed in partnership. They are based on the RNs appraisal of comprehensive, relevant information, and evidence that is documented and communicated.

The registered nurse:

5.1 uses assessment data and best available evidence to develop a plan

5.2 collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

5.3 documents, evaluates and modifies plans accordingly to facilitate the agreed outcomes

5.4 plans and negotiates how practice will be evaluated and the time frame of engagement, and

5.5 coordinates resources effectively and efficiently for planned actions.

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Australian Health Practitioner Regulation Agency

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standard 6 Provides safe, appropriate and responsive quality nursing practice

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standard 6 Provides safe, appropriate and responsive quality nursing practice

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RNs provide and may delegate, quality and ethical goal-directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes.

The registered nurse:

6.1 provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people

6.2 practises within their scope of practice

6.3 appropriately delegates aspects of practice to enrolled nurses and others, according to enrolled nurse’s scope of practice or others’ clinical or non-clinical roles

6.4 provides effective timely direction and supervision to ensure that delegated practice is safe and correct

6.5 practises in accordance with relevant policies, guidelines, standards, regulations and legislation, and

6.6 uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards.

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Australian Health Practitioner Regulation Agency

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standard 7 Evaluates outcomes to standard 7: inform nursing practice

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standard 7 Evaluates outcomes to standard 7: inform nursing practice

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RNs take responsibility for the evaluation of practice based on agreed priorities, goals, plans and outcomes and revises practice accordingly.

The registered nurse:

7.1 evaluates and monitors progress towards the expected goals and outcomes.

7.2revises the plan based on the evaluation, and.

7.3 determines, documents and communicates further priorities, goals and outcomes with the relevant persons.

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Australian Health Practitioner Regulation Agency

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How do I feel before I start the module content ?

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How do I feel before I start the module content ?

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see word document for details

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Week one of placement was quite a rollercoaster.

Starting on evening shift, I was welcomed quickly and instantly assigned to a team of two nurses who were polite and friendly but just used arm gestures to vaguely point out the location of toilets, met trolley, medication trolley, and other basic landmarks. Then, I was instantly sent to an inservice in the tea room and missed the handover for the first shift of the day. Later on the shift, I ensured that I went through my own pre-planned checklist of where everything was so I knew for myself. As mentioned in the orientation of the hospital, I feel that we should ensure we know where everything is, and it should be our responsibility to seek the information out ourselves if not shown. I ensured this was the first thing I did after the inservice.

Reflecting on how I came onto the ward for the first time and was initiated, I felt that this rush of information and events did not allow for participation in handover, which led to insufficient time to discuss care provisions of the patients I was about to care for. I did not have the chance to ask questions from the previous shift during handover or engage with the patients at that time, which would have helped me formulate a holistic assessment and plan of care for the shift. This lack of opportunity to collaborate directly with the care team affected my ability to conduct a comprehensive assessment as required in Standard 4.1 (conducts assessments that are holistic as well as culturally appropriate) and Standard 4.3 (works in partnership to determine factors that affect health and well-being).

By not being able to participate actively in handover, I was also unable to develop a plan for nursing practice effectively. If given the chance to collaborate during handover, I would have better utilised Standard 5.1 (uses assessment data and best available evidence to develop a plan) and Standard 5.2 (collaboratively constructs nursing practice plans).

This rush of entering the ward on the first day also left gaps of information that I wouldn't realize were missed until Monday of week two, leading to the need for a Riskman to be completed.

IT issues were the main challenge of week one. Getting access to DHR took time, and once I was able to access it, I was quickly shown how to assign a nurse for co-signing, navigate to a patient list, and use the Rovers to enter patient vitals. Rovers were the primary device used by staff, and I was on evening shifts for the first three days. I was shown how to enter the vitals using the Rovers and was asked to do this on each shift, with the RN I was working with handing me a Rover. By Thursday and Friday, everything IT-related seemed to have worked out, and I was able to access the system, assign and see patient information, and use the Rovers for entering vitals without issue. I thought that everything was going well and was looking forward to week 2.

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Monday of week 2 was my birthday so as a gesture of something nice I baked a cake for the staff and felt happy to take on more responsibility.

This feeling was short-lived as when I signed into the COW for the morning it glitched and skipped the part where I sign in an RN for the co-signing. I changed cows and tried again; on the third attempt, I was able to keep the screen open and assign my designated RN for co-signing. (Standard 4.6 - Identifying and reporting potential system risks). We then used the Rovers to do patient vitals after 9 am, and my RN showed me how to prepare medication using the Rover, and we went to give the medication to the patient. Once the medication was given, we could not get the co-sign to appear for my RN to tap. We could not work out what was wrong, so we went to the cow to try. The system glitched again like it did in the morning, and it took three attempts to log in. We then used a different cow that became available after the Dr. had finished. This time we noticed the co-sign was for the wrong nurse. (Standard 5.5 - Coordinating resources effectively for planned actions). We both then asked assistance from the EN working with us, where she said that I put the wrong RN in the system. The RN I was with told her that we both tried to put the right one in, but it went back to the other person each time. My RN then said we tried to co-sign on the Rover, but it would not work, and the EN then said that's because students don't use Rovers, in a very stern voice like I was supposed to know this. The other nurses at the nursing station also said it the same way, like it was common knowledge and I should have known better (Standard 6.4 - Providing effective direction and supervision). A male nurse was kinder in communicating with me and showed me another way to fix the issue of co-signing and said that this should fix it (which it did) and that for now, just use the cows and let him know if there are other issues today (Standard 6.3 - Delegating aspects of practice appropriately). For the remainder of the day, I did not use technology as I was self-conscious and lacked confidence in entering data in fear of not being co-signed. That feeling that I had given medication without a co-signer lingered, as I did not know if anyone had co-signed. I was fully supervised by an RN at all times but still felt uneasy inside—a bad feeling in my gut that did not sit well (Standard 7.1 - Monitoring progress towards goals and outcomes).

Talking with other students the next day before meeting with our CLN, I mentioned how I was feeling, and everyone was confused about not being allowed to use Rovers, as they had all been using them. I mentioned the events to my CLN and was recommended to make an incident report of the event (Standard 7.3 - Determining further priorities and outcomes).

I made contact with the undergraduate coordinator at the hospital and discussed the event with her. She told me to let the ward know I was going to meet with her to do a Riskman on the event and briefly let them know why. We created a Riskman together, and she came back to the ward with me to explain in more detail why it was done (Standard 6.6 - Using appropriate processes to identify and report risks). She also stayed back to discuss the other issues we talked about, including students not using Rovers and that better communication is needed after I left the room, so as to not add more stress to me during that conversation, which was appreciated (Standard 6.5 - Practising in accordance with relevant standards and guidelines). I have continued the week trying to participate as expected, but inside still feel uneasy in fear of what I have said and done, like the kid that tells on their siblings and gets them in trouble. No one has made me feel like I did anything wrong; it's just the feeling I have inside me (Standard 5.3 - Evaluating and modifying plans to facilitate outcomes). I have used the COWs as requested from Monday onwards and done documentation as expected with increasing confidence. By Friday, my confidence had fully returned, and I was using the COWs to make notes, enter patient data, and guide me with handover with increased cohesiveness, although this area is still in need of much work as I still lack confidence in this particular area (Standard 5.1 - Using assessment data and evidence to develop a plan).

Standard 4.1 (conducts assessments that are holistic as well as culturally appropriate) was not applicable to this entry as I did not talk about a specific patient assessment or cultural factors however ward culture did cause issues for me during this experience. Standard 4.3 (works in partnership to determine factors that affect, or potentially affect the health an well being of people and populations to determine priorities for actions and/or for referral) was also not linked in my reflection of placement as I did not describe an instance where health determinants were evaluated.

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CHECK-IN

The concepts below are covered in the preparatory materials & are a good measure of your preparation for workshops...

Assessment tools for adolescent patient

Naloxone - usage, doses, routes of administration

Escalation of care - who? where? what? how? when?

This weeks content is an area I am not overly confident in. In particular it my ability to articulate appropriately and my lack of self confidence. I know I can do it I just lack the confidence in myself. Looking at the module content overview before exploring the content I am moderately confident in my knowledge and understanding.

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Week 5's simulation session involved a possible drug overdose and need for a MET call. In the simulation, there was a need for participants to use a range of assessment techniques and do them systematically to be able to prioritise what needed to be done next and what was most important for the MET call handover (Standard 4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice). They both worked in partnership with each other and included the second-year student in the room to determine what factors were possibly impacting the patient and used this to then guide what they did next, including the decision for a MET call (Standard 4.3 works in partnership to determine factors that affect or potentially affect, the health and wellbeing of people and populations to determine priorities for actions and/or for referral), and what was available in the room to assist them, such as the BGL kit, vitals machine, and oxygen (Standard 4.4 assesses the resources available to inform planning).

We then went over the simulation and looked at what was good and not so good and areas we wanted to look more in depth with, like an airway assessment. This is where I felt unprepared. The explanation that we need to go more in depth with our explanation and how this will be useful in the viva was daunting. I am confident in a basic explanation, but to dive deeper, such as including anatomy of the airway such as trachea, tongue, and larynx and the head position, and not just saying the head position is not good for breathing but mentioning why it’s important, such as having the head forward creates increased potential for obstruction and removing the pillow assists in opening the airway path (Standard 5.1 - Using assessment data and evidence to develop a plan). It's also good to mention other aspects, like how the respiration rate was 8 and with everything happening in the space during the simulation, this was hard to count and is worth remembering. In this simulation, RR of 8 was related to the finding of the opioid bottle under the covers and how opioids depress respiration drive and MU receptors in particular, which also affect other things like stress, temperature, and impact control of nervous system functions, impacting these different physiological functions (Standard 4.2 - Using systematic assessment to analyse information).

during the simulation a plan was constructed with participants agreeing on priorities, actions and goals, especially when it came to the MET call handover and airway management with reflects standard 5.2 collaboratively constructs nursing practice plans. The reflection on the simulation were we covered what was good and not so good and discussing ways to improve like deeper airway assessments fits standard 5.3 for evaluating and modifying plans to facilitate better outcomes.

Evaluating the outcomes of the simulation, including monitoring the progress of their skills like airway assessment, addresses standard 7.1 evaluates and monitors progress towards the expected goals and outcomes.

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Working together in small groups, we continued from the simulation, focusing in particular on Naloxone and how amazing it is. For me, I feel remembering what is important for a MET handover compared to a standard handover is crucial, as time is of the essence. The longer you take to hand over vital or relevant information, the less time the team has to help the patient, and missing just one piece of information could slow or impact the care given (Standard 5.2 - Collaboratively constructing plans to ensure priorities and timeframes are agreed upon). While I feel that all the standards have a way of fitting into everything we do, I feel that today's session demonstrated Standard 7.1 (evaluates and monitors progress towards the expected goals and outcomes) when the discovery of opioids under the bedding covers was made, requiring us to re-evaluate and monitor progress based on this new information. This discovery required us to use the new information in conjunction with other observations such as the patient's non-responsiveness, pinpoint pupils, shallow breathing, RR of 8, and decreased SpO2 at 92%. This meant that the plan of care needed to be changed from a diabetic focus to an opioid overdose (Standard 7.2 - Revising the plan based on the evaluation of new data). By systematically assessing the situation and using a range of techniques, such as identifying the patient's clinical signs and discovering the opioids which required us to shift care focus from diabetes to an overdose we addressed standard 4.2 ( uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice). Standard 4.3 (works in partnership to determine factors that affect, or potentially affect, the health and well being of people and populations to determine priorities for action and/or for referral) was also addressed when the group determined the factors affecting the patient's condition, which were both the opioid discovery and clinical signs which helped to prioritise the need for Naloxone and a MET call.

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Before beginning work on this weeks learning my confidence for this area before is low. Not having been in a mental health setting before and developing a care plan identifying appropriate support and referral services from government and non-government sources I have no idea where to even begin. So going in without doing any pre-work yet I would not feel confident I could do this right now. I am looking forward to the research for this to see where it takes me.

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After the classes, I feel much more confident. we covered a lot and for a while I was questioning what I thought I knew then it all just fell into place.

I volunteered first to go into the simulation and while I was scared I'm glad I did it. The feedback overall was very positive but I feel I need to be more considerate of others and give more opportunity for them to contribute. I feel that I need to work on allowing opportunities for other to contribute and be mindful of this when working with others.

In the labs, things all came together. I like that the med calculations make more sense now and even feel easy compared to when we were studying just last semester. Our group worked well when talking to each other and support learning which was great and I feel that the skills sank in better this week as a result.

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This seminar was interesting and a little sad but in a good way. As the class looked at all the images of people there were comments of how they looked happy or strong or confident or sad and many other such comments, and while we all would like to think we don't have bias we do and it influences us in so many ways not just consioiusly but unconsciously as well, like in making the comments of what we felt or thought when looking at the images. We all used our bias to do this activity. Bias is not all bad but it is part of us as humans and this was a good exercise in hi lighting how we use it all the time. I think the important thing is to always be aware it is there and that it shapes how we see others and how we feel towards them and to be mindful of the impacts on others this can cause.

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Professional Portfolio Part A Critical Reflection

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Today’s session was very engaging and passed so quickly as a result. It also provided an opportunity to discuss all the elements in the video of the female patient with the two male patients that looked as though they were attempting to herd the patient onto the bed and into submission. As we all reflected on the scenario, I identified connections to Standard 4.2: uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice, particularly in the lack of appropriate assessment techniques that could have addressed her individual needs more effectively. Our discussions also touched on Standard 4.3: works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/or for referral, as we explored alternative approaches that would be more supportive and therapeutic to the situation. We recognised that the actions taken did not prioritise the patient's safety and well-being, which relates to Standard 5.2: collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons, and how they apply to sensitive care. Overall, the group all seemed to agree that the scenario demonstrated unsafe practice and failed to meet the goals outlined in Standard 6.1: provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people for providing quality care. In the future as an RN I plan to integrate de-escalation techniques and focus on patient-centered communication to ensure that I can better support individuals experiencing distress.

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This session was fun, we separated into groups and brain stormed our topics then got to reflect and look at what everyone else did. I feel this was a good way to expand on what we did earlier in the workshop and after this class I feel more confident in the content we covered and applying it in the future. This links to standard 4.1: conducts assessment that are holistic as well s culturally appropriate as we engaged in collaborative learning processes that enhanced our understanding of different perspectives and approaches. It also aligns with standard 7.1 evaluates and monitors progress towards the expected goals and outcomes by reflecting on the session and feeling more confident shows that I am evaluating my own understanding and readiness to apply this knowledge to my future practice which I feel is crucial for continuous life long learning and improvement in my nursing practice.

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Do you have any experience in caring for a patient with a burn injury?

No, I don't have any direct experience, and I feel uncertain about how I would respond if confronted with a burn injury. I know basic first aid, but I'm unsure of the specific approach I would take in that situation.

Have you or someone close to you experienced a burn injury?

Yes, my mother had a burn on her hand from work. I didn’t see it until it was almost healed, so I only noticed the scarring.

Before you start working on the preparatory materials this week, reflect on your experience and confidence in caring for a paediatric patient.

Thinking about paediatric patients, especially those with burn injuries, is quite daunting for me. I find it particularly challenging to see children in pain. While I can manage in small doses, providing ongoing care feels overwhelming. Paediatric care is an area I often shy away from, but I recognise the importance of being prepared, as children can and do get hurt.

To establish and maintain a therapeutic relationship with paediatric patients, I would draw on the skills I developed as a primary school teacher. Key strategies would include:

Positioning: Ensuring I am at their eye level to create a more approachable and non-threatening environment.

Active Listening: Taking the time to listen and allowing pauses in the conversation, which can help children feel heard.

Inclusion: Always including them in discussions about their care, making sure they understand what is happening.

Overall, my confidence level, as in previous weeks, is still at one star but a little closer to a two star rating. I believe that as I engage with the materials, my understanding will deepen, and everything will start to come together. Right now, it feels a bit overwhelming, but I’m committed to learning.

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Today's simulation was different, more difficult and it was not obvious to us in the room just how tricky it was until the end of the simulation. We did not realise that all the medications had been given and there was nothing else charted that could be given. There was also the continuous crying of a distressed child in pain throughout the simulation, adding an additional stress element that made problem solving and staying calm more difficult. We could see the team struggle with the what-next component when noting medicinal options for pain relief, but then they made an amazing comeback that I do not feel I would have done as well. They asked for a Dr to review for a stat dose of pain medication and looked at other ways to support the mother and child, including hydration and comfort options. I felt this was very sensitive and supportive. I liked this as a holistic approach (Standard 4.1 - conducts assessments that are holistic as well as culturally appropriate), not just focusing on finding more medication to give but looking at other ways to support them. They worked in partnership with each other and then the Dr. to support the situation and wellbeing of both mother and child (Standard 5.2 - collaboratively constructs nursing practice plans until contingencies, options, priorities, goals, actions, outcomes, and timeframes are agreed with relevant persons). They assessed their resources for pharmacological options, finding there were no options left (Standard 4.4 - assesses the resources available to inform planning). They then sought other options after realising that progress towards manageable pain levels was not being achieved and revised the plan by asking the Dr to assist and asked what the mother needs or would like, providing family-centred care and support (Standard 7.1 - evaluates and monitors progress towards the expected goals and outcomes, Standard 7.2 - revises the plan based on the evaluation).

By the end of this session, I was feeling much more confident, and the content from the module all made more sense and came together.

Standard 4.1: Conducts assessments that are holistic as well as culturally appropriate was demonstrated today by the team when they considered both the child's physical pain and also the mother's emotional distress and emphasised the importance of understanding that when working with children, it's not just the child we care for.

When limitations in medication options were realised, they effectively collaborated with the doctor to revise the care plan so pain relief could be given. This showed the ability to engage with relevant professionals to enhance patient care and links to Standard 5.2: Collaboratively constructs nursing practice plans until contingencies, options, priorities, goals, actions, outcomes, and timeframes are agreed with relevant persons.

By prioritising comfort and hydration for the mother and child, a commitment to quality care that is more than just medication was demonstrated, showing the importance of providing compassionate, family-centred support. This links to Standard 6.1: Provides comprehensive, safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people.

The ability to assess the situation and see the need for alternative solutions, like seeking medical assistance for pain relief, showed the ability to adapt and make changes to the care plan and aligns with Standard 7.1: Evaluates and monitors progress towards the expected goals and outcomes, and Standard 7.2: Revises the plan based on the evaluation.

systematically gathering information about the child's pain, distress, and lack of medication options to adapt to their plan of care links to standard 4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice.

And lastly the decision to seek a stat dose of explore non-pharmacological interventions based on the assessment data of the child's pain and lack of further medication options links to standard 5.1 uses assessment data and best available evidence to develop a plan.

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Through the workshop, I gained increased confidence in calculating fluid resuscitation using the Parkland formula. Initially, I was not sure just how to do these calculations, but by working collaboratively with my team, I was able to accurately assess the burn injuries and calculate the appropriate fluid requirements. This experience has helped to strengthen my understanding of how critical these calculations are in providing timely care to paediatric patients with burn injuries. What helped a lot was seeing the images of the burns, charting where the burns were and calculating the percentage of body impacted, it all just made sense when we got to our station. Working as a team we chose the three chilli peppers option and loved the challenge. Next we moved onto calculating a dose for Fentanyl and using a mucosal atomiser dispositive (MAD). During this we identified that the medication order was not valid, we also identified that there was a medication error in the books and in medication cupboard with different doses of fentanyl mixed in the one box resulting in the count being incorrect which almost lead to an overdose as we thought the vile was 100 mcg/2ml but was actually 500 mcg/2ml. We as a team spent extra time ensuring the medication order and calculations were correct and identified several errors that needed correcting or checking before proceeding. During this workshop we demonstrated standard 6.6 (uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards) when we sought clarification and checking of medication orders by following appropriate processes to identify the errors and reported them before proceeding.

Standard 4.1: conducts assessments that are holistic as well as culturally appropriate was demonstrated by assessing burn injuries and calculating fluid requirements as I engaged in a comprehensive evaluation of the patient's needs and by collaborating with my team we considered all aspects of the injury.

The calculations that we did reinforced my understanding of the importance for using best available evidence to develop a care plan which is crucial to deliver timely and effective care especially for paediatric patients with burn injuries and meets Standard 5.1: uses assessment data and best available evidence to develop a plan.

Our team's attention to detail in finding medication errors demonstrated a commitment to providing safe and ethical care and by double-checking the medication order and calculations, we made sure that our patient was receiving the correct dose which meat standard 6.1 provides comprehensive safe, quality practice, 6.5: practises in accordance with relevant nursing and health guidelines, standards, regulations and legislation and 6.6: uses appropriate processes to identify and report potential and actual risk. Standard 6.6 (uses the appropriate processes to identify ad report potential and actual risk related system issues and where practice may be below the expected standards) was also met because we actively sought clarification on the medication order and identified discrepancies which could have led to significant harm and showed compliance to meeting safety protocols which highlights our responsibility to report potential risk to prevent adverse events. While this was not a planned part of the session I feel more confident as a result to speak up in future practice knowing that its not only ok to do so but of the up-most importance in patient safety and care.

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This week's simulation was more intense than all the others. Vital signs and alarms all in the extreme made for a stressful experience. We all felt that the volunteers for the simulation did extremely well, having a patient in pain, vomiting, and spinal precautions and no hand over just to mention a few, I feel this is a nursing nightmare plagued with danger.

In relation to the standards and what we did in the simulation, consideration and a timely response to the health and well being of the patient and what they could do with what they had available was important and relates to standard 4.4 (assesses the the resources available to inform planning) regarding the importance of assessing what resources are at h and and using them to make informed decisions, and standard 6.1(provides comprehensive safe, quality practice to achieve agreed goals and outcomes) since it involved diluting timely and appropriate care based on what is available to meet the patient's needs. The patient was declining fast and a decision for a MET call was made. We also covered primary assessment using A-G assessments and we noticed once the participants got to the pain and deteriorating vital signs including a seagull with heart rate above BP they began to freeze but calling a met call not Long after realising this they did well and if feel this falls under section 5.1 as they used what assessment data they could and the best available evidence to develop a plan for MET call, provide oxygen and emisis bag and chose to use nasal prongs even though Sp02 was very low they decided not to use a Hudson mask due to the nausea and risk of vomiting which also increases risk of aspiration for the patient.

Standard 4.1 (holistic and culturally appropriate assessments) here we we recognised the need to consider the patient's overall condition like their pain and possible anxiety. We used a range of assessment techniques as stated in standard 4.2 (uses a range of assessment techniques) like use of A-G and noticing challenges from extreme vital signs and how important data collection was and handover as when these were absent care was impaired.

Standard 4.3 (works in partnership to determine factors that affect, or potentially affect, the health and well-being of people and populations to determine priorities for action and/or for referral) was highlighted in this situation. We did not have a proper handover, which meant that essential collaboration and communication were missing. This lack of information impacted patient care and emphasised the importance of having a complete and accurate handover, especially in acute situations where timely and informed decision-making is crucial.

Standard 4.4 assessing available resources was met when the decision to use resources like oxygen and emesis bag which showed the need to evaluate what was available close at hand that could be used to ensure patient safety.

standard 5.1 use of assessment data, this was demonstrated when the team decided to call a MET as they used the data available and realised that the best course of action was a MET call.

Standard 5.2 collaborative construction of plans was demonstrated during the simulation through the need to work as a team in determining to use nasal prongs over a Hudson mask as while O2 was low the risk of vomiting and aspiration was greater with use of Hudson so use of nasal props at a higher flow was a safer option.

Standard 6.1 comprehensive safe practice was covered in the reflection in class after the scenario where we discussed the importance of providing safe, quality care especially in stressful environments like this one where they were in pain and at risk of aspiration.

Standard 6.2 practicing within scope, for this we need to understand our limits in that real at that time and identifying that during the simulation there was a point where there was limits to what they team in the room could do and that a MET was needed for more to be done and,

Standard 7.2 revising plans, the simulation offered a real time setting for the participants to adapt to changing conditions like Sp02 and shows the importance of flexibility in nursing.

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Today's take home messages

1: Knowing best practice for burns

The importance of what to do for burns for everyone, time is essential and knowing what to do can make a massive differences .

2: Reassurance through evidence-based practice and compassion.

Its important to reassure the family that they did the right thing and remind them of this, its easy to feel guilt, fear or regret among other emotions when your child is hurt and hurting and can leave parents with a sense of hopelessness so reassurance can go a long way.

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This week we continued from the simulation and went through a primary survey and secondary as well. We worked together to brain storm solutions to assist in patient care like alternatives for airway assistance for breathing like using a guedel if they were not conscious, and we looked at other ways to get fluids into the body including intraosseous infusion. Next we worked in groups to repeat the process ourselves and then as time was short we worked through the chilli challenges as a group. so we looked at the 3 chilli challenge in more detail and discusses the 3 questions.

1. Was about change in our concerns now we find this new medical information.

The answer is yes specifically the medications, propranolol is a beta-blocker used for hypertension and migraine prophylaxis and can hide symptoms shock but also can cause complications to his cardiovascular status especially after the fall so we need to be monitoring his heart rate and blood pressure more closely. As for the Fluoxetine, we need to watch for depression as this is an SSRI so we also need to consider possibility of serotonin syndrome especially when combined with other medications given in trauma, and Aspirin which puts him at increased risk of bleeding and as he has had a fall this is a big concern as he may have internal injuries or bleeding.

2. What might be happening? three key areas here of internal injuries, pulmonary issues and pain response. the fall could have resulted in internal bleeding especially with the aspirin. The tachycardia and low BP could indicate a compenation mechanism for blood loss. The low SpO2 of 93% on RA combined with the tachypnea could be a respiratory issue from pain or rib injuries. and his elevated heart rate could also be a response to pain from the fall.

3. Does this add or detract from your concern? We all said add. Considering his medication history there is concern for potential complications including bleeding and cardiovascular issues. He will also need close monitoring of his vitals particularly his heart rate and blood pressure and oxygen and will need assessments for possible fractures or internal injuries needing further investigations like imaging and lab tests to rule out or identify serious injuries.

We discussed in our group airway management and fluid management and considered the patient's needs and potential complications based on their condition and medication history which matches standard 4.1 Conducts holistic and culturally appropriate assessments.

4.2 Uses a range of assessment techniques was demonstrated by applying both a primary and secondary survey which demonstrated a systematic approach to data collections.He brainstorming of alternative airway assistance techniques like using a Guedel airway also showed a proactive assessment strategy for this standard.

By collaborating with peers to identify potential concerns and monitoring patient's need showed the importance of teamwork in assessing factors that impact the patient's heals and related to standard 4.3 Works in partnership to determine health factors.

5.1 Use of assessment data was demonstrated through the medication review of the effects of propranolol and fluoxetine when forming a plan.

As a group we discussed potential complications and the importance of monitoring which reflects collaborative planning and relates to standard 5.2 Collaboratively constructs nursing practice plans.

We discussed and looked at the need for safety, particularly regarding potential complications from medications and the fall that the patient had which aligns with providing quality care prioritising patient safety with meets standard 6.1 comprehensive safe, quality practice.

When we discussed monitoring the patient and looking at getting imaging and lab tests we were showing commitment to following established protocols to address the patients needs witch aligns with standard 6.5 compliance with policies and guidelines.

7.1 Evaluates and monitors progress towards the expected goals and outcomes was demonstrated when we focused on closely monitoring vitals like heart rate, blood pressure and Sp02 showing the importance of ongoing evaluation of our patients condition.

When information of new medication was introduced we had to alter our concerns for the patient and revise our approach regarding the plan of care which falls under standard 7.2 revises the plan based on the evaluation.

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This session we looked at another case for Michelle who had a workplace injury. We had the case information early to go over before class and the focus was on a comprehensive assessment and interdisciplinary collaboration needed for discharge planning.

This involved monitoring her vital signs specifically her low blood pressure and hight heart rate which signalled a need for timely interventions like IV fluids and oxygen.

The secondary assessment hi lighted their medical history including their crucial role as a caregiver. This added a psychosocial element to her care and we had to consider support systems and emotional well-being.

This session reinforced my understanding of the role of RN's in conducting thorough assessments and coordinating care to be able to ensure patients receive a safe discharge and improve patient outcomes.

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Reflecting for future practice. In relation to standard 4: comprehensively conducts assessments, my focus will be to ensure I provide a holistic approach by incorporating physical, psychological and social factors while also actively engaging with patients to gather detailed histories to help guid and plan care. I will prioritise gathering detailed histories where possible and consider the patient's context like those in care giver roles as part of future practice. Under standard 5: develops a plan for nursing practice I plan to utilise assessment data collected from standard 4 to develop collaborative are plans, while focusing on timely interventions and making sure they align with best practice. This leads into standard 6: provides safe, appropriate and responsive quality nursing practice where I plan to prioritise patient safety and ethical carer by using effective communication and delegation as part of the healthcare team to achieve agreed goals and outcome. And standard 7: evaluates outcomes to inform nursing practice is like the next step to end it all where I look back on the journey and evaluate patient progress, modify care plans as needed and document the outcomes to help improve my future practice.

All sessions today had a focus on timely, evidence-based interventions, that required us to recognise and respond to unstable vital signs which helped to reinforce the urgency of this in critical situations. So I plan to work on enhancing my skills in assessments to identify complications and respond accordingly. Teamwork this week was also important and will play a big part of future practice especially when working with multidisciplinary teams to ensure cohesive patient care and shared decision-making.

Patient-centred approach has been common in all areas of study. I have learned the value of engaging patients in their care plans, addressing concerns they have and providing reassurance. I will strive to keep this in mind so as to create a supportive environment that acknowledges patients' fears or concerns while also promoting their involvement in recovery. Today's sessions hi lighted the need for continuous education in trauma care, pharmacology and psychosocial support which I will commit to as part of lifelong learning to stay updated on best practice and enhance my ability to provide safe and effective care.

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Key takeaways from today:

Holistic care that addresses both physical and emotional needs in patient management.

Multidisciplinary approach to foster effective communication and teamwork among healthcare professionals.

Critical Thinking conducted through assessments and adapting care plans based on patient conditions.

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Moving forward after PEP and in my future practice as an RN, I plan to be more proactive in my patient assessments, ensuring they are not only comprehensive but also culturally sensitive. Additionally, I aim to deepen my understanding of the social and economic factors affecting my patients' health, collaborating more effectively with the healthcare team to make appropriate referrals and address the broader determinants of health, in alignment with Standards 4.1 and 4.3 and be mindful of how I felt during this placement and be sensitive to the needs of future student nurses and remember how I felt and take this into consideration when I become the person they ask for help or look to when things don't go as planned.

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This was the last session of the day. looking at four people in an age care setting and their symptoms. We had to prioritise them into order of priority of care as a team and say why. I enjoyed the engagement of prioritising care for individuals in an aged care setting. Our discussions were respectful and allowed us to systematically assess symptoms, aligning with Standard 4.2 (uses a range of assessment techniques). By working together, we identified critical factors affecting each patient's health, which reflects Standard 4.3 (works in partnership to determine factors that affect health and well-being). Collaboratively creating an order for our care priorities demonstrated Standard 5.2 (collaboratively constructs nursing practice plans), as we negotiated the best plans for each patient. In addition, the structured approach to evaluating care aligns with Standard 5.4 (plans and negotiates how practice will be evaluated), while our emphasis on understanding the patients' needs is consistent with Standard 6.2 (uses assessment data to inform care). Overall, this exercise reinforced the importance of evaluating and monitoring care progress, which is outlined in Standard 7.1 (evaluates and monitors progress towards expected goals and outcomes), in preparation for our upcoming VIVA assessment.

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In this week's workshop, I was assigned the role of team leader. It was not as easy as I thought to keep the others in my team on track. My task was to find out what their immediate priorities and concerns were for their patients (Standard 4.3 works in partnership to determine factors that affect or potentially affect, the health and well being of people and populations to determine priorities for actions and/or for referral). I had some read me their instruction sheets word for word but could not tell me the answers in a brief summary, which made it challenging to conduct effective assessments (Standard 4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice). I had team members move the information sheet from one patient room to another and work together in a group on one patient without addressing another, and I had others not give handovers in a timely way that explained what actually still needed to be done for the patient and instead provided the whole history of the patient to go on break (Standard 5.5 coordinates resources effectively and efficiently for planned actions). I felt very frustrated, thinking about how so much could go wrong and how I could fix this and delegate more efficiently to keep all patients safe and receiving care, especially as the patient in kidney failure had no one in that room at all tending to them (Standard 5.1 uses assessment data and best available evidence to develop a plan). I had to find ways to communicate to the team that was assertive but not mean while still expressing the need for the task, and that was not as easy as it sounds (Standard 6.4 provides effective timely direction and supervision to ensure that delegated practice is safe and correct). With so many things going on all at the same time, multitasking was essential (Standard 7.1 evaluates and monitors progress towards the expected goals and outcomes). I enjoyed it and feel there is so much I can take from this to grow and change in the future, but I look forward to the challenge.

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As I complete this journey and reflect on all the experiences, I want to express my deep gratitude for the guidance and support I’ve received. The lessons learned, both in and out of the classroom, have shaped me not only as a student but as a future nurse. Through every challenge and success, I’ve grown more confident, resilient, and prepared to face the complexities of healthcare with compassion and competence.

The support from mentors, peers, and patients has been invaluable in my personal and professional growth. From refining my clinical skills to learning the importance of teamwork and effective communication, I now feel more equipped to enter professional practice. These experiences have helped me develop the confidence to lead, the empathy to care, and the drive to keep learning.

As I move forward into the next phase of my career, I look forward to applying all that I’ve learned. The journey has only just begun, but with these experiences and the knowledge gained, I feel ready to contribute to a team that values patient care and professional excellence.

Thank you for being part of this journey with me. I will forever hold the memories, skills and experiences gained from being part of UC close to my heart with fondness. Thank you everyone. It has been a true honour to call myself a nursing student at UC.

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pre-module self rating on confidence, knowledge and understanding out of 5 stars

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pre-module self rating on confidence, knowledge and understanding out of 5 stars

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Recall and explain the role of key electrolytes (potassium, magnesium, phosphate & sodium) in DKA ⭐️⭐️

Evaluate contemporary research evidence related to the concepts of adolescent DKA presentation⭐️⭐️⭐️

Articulate discharge planning considerations for DKA patients and impacts on families ⭐️

Consider health promotion (diet, exercise, mental health) for patients experiencing DKA ⭐️

Consider the role of health literacy & nurses roles to assess DKA in paediatric patients ⭐️⭐️

Demonstrate implementation of organisational policy to ensure appropriate care of a patient experiencing DKA with inclusion of

Monitoring (BGL/ketones) ⭐️⭐️⭐️

Commencement & monitoring of insulin infusion⭐️

Commencement and monitoring of fluids & electrolytes⭐️

Interpretation and integration of health data for nursing rationale⭐️

Generate and critique a patient interaction with an adolescent patient experiencing DKA including

physical care/safety⭐️

psychological care/safety⭐️

referrals⭐️

health education⭐️