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1. Review DKA pathophysiology

Diabetic ketoacidosis (DKA) occurs when the body doesn't have enough insulin, which is the hormone that helps sugar (glucose) get into cells to be used for energy. Without enough insulin, the body can't use glucose for fuel, so it starts breaking down fat for energy instead.

When fat is broken down, it produces acids called ketones. If too many ketones build up in the blood, they make the blood too acidic, which can be dangerous. The body tries to get rid of the extra ketones via urine, but it can't keep up. This leads to high blood sugar (because glucose is stuck in the blood and not going into the cells) and a buildup of ketones and acid in the blood.

Key points:

No insulin = cells can't use glucose for energy.

Body burns fat for energy instead, producing ketones.

Ketones make the blood acidic, causing imbalance in the body.

The body becomes dehydrated (from trying to flush out ketones through urine) and blood sugar rises even higher.

2. Understanding of potassium, magnesium, phosphate, sodium in the context of DKA

Electrolytes in DKA

Potassium: Often normal or high initially but total body potassium is low. Monitor to prevent hypokalaemia during insulin therapy.

Magnesium: Watch for hypomagnesemia, which can cause arrhythmias and muscle weakness.

Phosphate: May drop with insulin treatment, leading to muscle weakness and respiratory issues.

Sodium: May appear low due to hyperglycemia.

I would like to rate a 4/10 for my pre learning outcome.

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INC 6 (11853) Professional Portfolio - Part A_u3237113

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This simulation made me realise how crucial it is to not only manage the clinical aspects of DKA but also address the emotional and educational needs of the patient.

Although DKA requires urgent medical intervention, the simulation highlighted that patients like Avery may lack confidence in performing basic self-care tasks, such as monitoring their BGL. This contributed to her anxiety, which could potentially worsen her condition if not properly managed.

Reflecting on my response, I realised that while I focused on the clinical management of DKA, I could have placed more emphasis on calming Avery’s anxiety and offering reassurance.

I should integrate emotional support and patient education more thoroughly into my practice.

Take-home message: It's okay to say "I don't know, but I'll find out"

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Week 2, We were asked by our CLN to pick a resident and present an ISBAR handover. This was a valuable experience that helped me practice structured communication, which is crucial in ensuring continuity of care in a busy clinical environment like aged care.

The handover I conducted involved transitioning care from one nurse to another at the end of my shift. I made sure to introduce myself (Introduction), provide a clear overview of the resident's condition (Situation), and highlight their medical history and any relevant past events (Background). In the assessment part, I detailed the resident’s current health status, including vital signs, medications, and any observations regarding their care needs. Lastly, I offered recommendations (Recommendation) for follow-up care, such as monitoring specific concerns or actions for the next shift to take.

This structured approach not only ensured that I delivered concise, clear, and relevant information, but also gave me confidence that I was passing on accurate details about the resident’s care. As I was relatively new to the team, using ISBAR helped me maintain professionalism and clarity, even if I was still getting used to the facility and the residents.

Reflection
Even though ISBAR handovers are typically brief and to the point due to the residents being in long-term care, presenting an ISBAR handover allowed me to practice crucial communication skills essential to nursing. It reminded me that effective communication is about conveying information clearly and systematically.

I learned the importance of preparation before handovers—having all relevant details organised ensured I didn’t miss anything important, like medication changes or observations about a resident’s condition. Moving forward, I’ll continue using ISBAR and focus on communicating confidently and concisely, especially in complex cases.

This experience highlighted how good communication in aged care can prevent errors and improve resident outcomes by keeping the whole team aligned.

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Avery a 17 year old girl who was brought in the hospital with some pain. When the nurses went to check on her she was lying unconscious. When the nurses further checked her, they find a box of naloxone tugged under her blanket. So it was a case of overdose.

I Found that communication was the key to stressful situation. And Education on Naloxone would have benefitted more. A-G assessment is the key to start any assessment.

I also reflected on the importance of treating Avery as a person, not just a case. Recognizing her emotional needs while providing medical care made me realize the balance needed in such situations. Supporting both Avery and her family was vital. In a situation like that calling for help/ MET call is essential.

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In this video, the two healthcare professionals failed to implement trauma-informed care principles, escalating the patient’s distress rather than alleviating it. The patient's mental health condition made them particularly vulnerable, and instead of providing support, the healthcare workers' approach seemed restrictive, dismissive, and controlling, which likely exacerbated the situation.

A reflection on this could highlight several important aspects:

Lack of Empathy and Listening: The professionals did not listen to the patient or acknowledge her feelings. This kind of approach often makes patients feel powerless, unheard, and invalidated, increasing their emotional distress. Listening to the patient's concerns is crucial for building trust and ensuring they feel respected.

Failure to Maintain Patient Dignity: Speaking to the patient in a manner that appeared restrictive instead of calming and supportive undermines the patient's sense of agency. Trauma-informed care emphasizes safety, empowerment, and choice. In this case, the healthcare professionals could have provided a more supportive environment by validating the patient's experience and offering a sense of control over her situation.

Escalation of Distress: Instead of de-escalating the situation, their actions contributed to it. Calming techniques, clear communication, and reassurance should have been used to help the patient feel safe. When patients are in distress, any form of coercion or dismissiveness can heighten anxiety and create a sense of hostility, making the situation more difficult to manage.

Opportunity for Improvement: This case underscores the need for healthcare professionals to receive training in trauma-informed and patient-centered care, particularly in mental health settings. By focusing on empathy, active listening, and clear, compassionate communication, healthcare workers can create an environment that promotes healing rather than intensifying distress.

Healthcare professionals should use strategies like Low and Slow communication, creating a calm environment, ensuring the patient feels heard, and working collaboratively to build trust and respect. This approach would have de-escalated the situation, promoting better mental health outcomes.

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In the simulation with Yasmin, a child of 4 yrs presenting with burns on her face, neck, and right side, I found the experience both challenging and very overwhelming as she continues to cry throughout the simulation. Yasmin's continuous crying and her mother's evident distress created an emotionally charged atmosphere, which underscored the importance of compassionate care in such scenarios.

I realised that during any critical situation, how important it is to perform the A-G assessment. I recognised how critical it was to evaluate Yasmin’s airway, breathing, and circulation while also being mindful of her pain. The Wong-Baker FACES Pain Rating Scale helped in assessing her pain level, yet despite administering pain relief, Yasmin continued to cry, indicating that her distress was more than just physical. This highlighted the complexity of managing pain in paediatric patients, especially when psychological factors are involved.

Reflecting on the situation, I realised that addressing emotional needs is just as vital as physical treatment. Yasmin's reaction was not just a response to her injuries but also a reflection of her fear and anxiety about her condition and the environment around her. The stress of her mother compounded the situation, emphasising the need for a holistic approach to care that includes the family. It’s crucial to provide reassurance and support, not only to the patient but also to their caregivers.

This experience showed the significance of effective communication. The nurses' ability to communicate clearly and empathetically and calmly can make a difference to not just the child but the mother to cope with the situation. I notice a calm environment could have helped in this situation.

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Primary Survey

The primary survey follows the ABCDE approach, focusing on the most critical life-threatening issues:

1. Airway: Ensure the airway is patent and clear. Look for signs of obstruction (e.g., foreign bodies, swelling). If the patient is unconscious, consider positioning or airway adjuncts (like an oropharyngeal airway).

2. Breathing: Assess the patient’s breathing. Check for adequate ventilation and oxygenation. Observe for chest movement, listen for breath sounds, and provide supplemental oxygen if necessary.

3. Circulation: Evaluate circulation by checking pulse, blood pressure, and capillary refill. Look for signs of hemorrhage. Control any external bleeding and initiate IV access for fluid resuscitation if needed.

4. Disability: Perform a quick neurological assessment using the AVPU scale (Alert, Voice, Pain, Unresponsive) to determine the level of consciousness and check for pupil reaction.

5. Exposure: Completely expose the patient to identify any hidden injuries while maintaining temperature. Be mindful of privacy and dignity.

Secondary Survey

The secondary survey is a more thorough assessment, usually conducted once the primary survey is complete and life-threatening conditions are managed:

1. History: Gather a detailed history using the SAMPLE acronym:

Symptoms: What brought the patient in?

Allergies: Any known allergies?

Medications: Current medications the patient is taking.

Past medical history: Any relevant past medical history.

Last oral intake: When did the patient last eat or drink?

Events leading to the present illness/injury: What happened before the injury?

2. Head-to-Toe Assessment: Conduct a systematic examination of the body to identify any additional injuries or issues. Look for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAP-BLS-T).

3. Vital Signs: Monitor and record vital signs (heart rate, respiratory rate, blood pressure, temperature, and oxygen saturation) to assess the patient’s hemodynamic status.

4. Diagnostic Tests: Depending on the situation, initiate further investigations like X-rays, CT scans, or lab tests to better understand the extent of injuries.

5. Reassessment: Continuously reassess the patient throughout the process, especially if conditions change or worsen.

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the simulation with Sam, who suffered a workplace injury affecting his head, neck, chest, and abdomen after a fall, I faced a challenging scenario when the nurse left a critical patient in the hands of a student nurse, who then sought my help. This situation was significant for several reasons.

Firstly, it emphasised the importance of teamwork and collaboration in nursing. In acute care situations, every second counts, and leaving a critically injured patient with someone who is still learning can lead to delays in essential care. I felt a mix of anxiety and urgency as the student nurse approached me for assistance. This highlighted the necessity for nurses to ensure that the care team is adequately supported and that critical patients receive continuous monitoring and treatment from qualified personnel.

Reflecting on this experience, I realised the vital role of mentorship and guidance in the clinical setting. While it’s essential to empower student nurses to learn and practice their skills, there should also be a clear protocol for handling critical patients. The nurse’s decision to leave Sam with the student, without ensuring that proper support was in place, could have jeopardised his care. This situation reinforces the need for effective communication within the healthcare team, ensuring that everyone understands their roles and responsibilities, especially in emergencies.

Additionally, this experience made me reflect on the balance between patient care and teaching. While mentorship is important, patient safety must always come first. In future simulations and real-life scenarios, I will advocate for clear communication and ensure that critical patients are always monitored by qualified staff.

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In our last class, I learned that managing a gastroenteric outbreak requires meticulous infection control to prevent its spread. We focused on patient care, learning that proper hand hygiene was crucial in reducing cross-contamination. The auditor observed that the infection control was carried out poorly because we moved between stations wearing the same PPEs. Hence, prioritising infection control by following proper protocols during outbreaks is crucial.

Outbreaks can be stressful scenarios, so I need to enhance my stress management skills to prevent burnout. I also need to prioritise effective teamwork and communication to provide safe and comprehensive patient care.

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Understanding of Opioid Misuse: The research explores how adolescents view opioid misuse. Many know opioids are for medical use but don’t fully understand the dangers of misuse. Some misuse opioids to manage pain, deal with stress, or because of peer pressure.

Risk Factors for Misuse: Factors like peer pressure, easy access to family medications, and lack of awareness about the risks of addiction and overdose contribute to misuse. While some adolescents are cautious, others aren’t as informed about the dangers.

Medication Safety Knowledge: Many adolescents don’t fully understand safe practices for storing or disposing of opioids, increasing the chances of misuse. The study shows a need for better guidance from healthcare providers on medication safety.

The Role of Education and Prevention: The article stresses the need for education programs in schools and healthcare settings to raise awareness about opioid risks, the dangers of sharing medications, and the importance of safe disposal to prevent misuse.

Peer Influence: Peer pressure is a big factor in opioid misuse among adolescents. The study highlights how some misuse opioids to fit in, showing the need to address social factors in prevention efforts.

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What To Do If Someone Experiences an Opioid Overdose | In Case of Emergency | Mass General Brigham

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Trauma Simplified:

1. What is trauma?

Can be from single or repeated bad events

Complex trauma: repeated, extreme, long-lasting, or from childhood caregivers

2. How common is it?

In Australia, 5 million adults affected by childhood trauma

Two-thirds of mental health patients have experienced child abuse

3. Effects of trauma:

Many people cope well (resilience)

Others struggle with health, emotions, relationships, and identity

Can affect victims, their contacts, and their children

4. Current problems:

Often unrecognized in health systems

Some survivors re-traumatized by uninformed care systems

5. Trauma-Informed Practice:

Based on safety, trust, choice, collaboration, and empowerment

Sees survivors as unique individuals who coped as best they could

Applies to all health and human services

6. Benefits of Trauma-Informed Practice:

Decreases symptoms and hospitalization

Improves daily functioning

Doesn't cost more than standard services

Enhances collaboration and staff morale

7. What's needed:

Implement trauma-informed practice in all health and human services

Provide specific trauma services to address consequences

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Dartmouth Trauma Interventions Research Center

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Burns Treatment Simplified:

1. Types of Burns:

Superficial: top layer of skin only

Partial thickness: first and second layer of skin

Deep full thickness: skin layers and underlying tissue

2. Healing:

Most burns heal on their own in 7-10 days

Some may need skin grafting

3. Treatment:

Special dressings or Vaseline (for face burns)

Closed dressing technique: wound covered, not open to air

Silver-containing dressings used to prevent infection

4. Home Care:

Keep dressings dry and clean

No baths, only sponge baths

For face burns: wash and apply Vaseline twice daily

5. Pain Management:

Most children have little pain after dressing

Use paracetamol if needed

6. Follow-up:

Regular check-ups to monitor healing

Dressing changes may be needed

7. Dressing Changes:

Can be upsetting for child and parent

Pain medication given before procedure

Distraction techniques used

8. When to See a Doctor:

Child becomes unwell

New discharge on face

Increased pain

Not drinking enough

High fever (above 38.5ºC)

FACT: I burned my arm with stream two days before my class. Usually i would have put an ice pack on my burnt but this time what i did differently, i let it run under running water. Believe it or not, my wound was not as bad as i thought it would be :)

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Kids Health Info : Burns – prevention and first aid

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Burns and scalds are a leading cause of injury to young children, with toddlers most at risk because of their increased mobility and natural curiosity.

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1. Definition and Causes: Viral gastroenteritis is an inflammation of the stomach and intestines caused by viruses, with common culprits including norovirus and rotavirus. It often spreads through contaminated food or water, or by coming into contact with infected surfaces.

2. Symptoms: Common symptoms include diarrhoea, vomiting, stomach cramps, and fever. Dr. Oller emphasises that these symptoms can lead to dehydration, which is particularly dangerous for young children and the elderly.

3. Prevention: The video stresses the importance of good hygiene practices such as frequent hand washing, especially after using the restroom or before eating, to prevent the spread of the virus.

4. Treatment: While there's no specific treatment for viral gastroenteritis, the focus is on maintaining hydration. Oral rehydration solutions are recommended to replace lost fluids and electrolytes. In severe cases, medical attention may be necessary.

5. When to Seek Help: Dr. Oller advises viewers to seek medical attention if symptoms worsen or if there are signs of severe dehydration, such as dizziness, dry mouth, or reduced urination.

This video serves as a helpful resource for understanding viral gastroenteritis, its impact, and how to manage it effectively.

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viral gastroenteritis - a patient education video by Dr. Carlo Oller

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Case 1: Yasmine, child with burns

NMBA Standard 4: Comprehensively conducts assessments

Yasmine’s situation required a thorough assessment, including pain evaluation. An A-G assessment was conducted to begin with. The nurses then used the Wong-Baker Faces Pain Rating Scale, adapted for paediatric patients showing faces depicting various emotional states as a child may not be able to identify their pain level from a numeric pain scale of 0 to10. Although analgesic was administered, Yasmine kept crying throughout the simulation. Realising that the implemented pain management strategy was ineffective, the nurses escalated the case to the doctor.

4.1 Conducts assessments that are holistic as well as culturally appropriate: The nurses assessed not just Yasmine’s physical injuries but also her emotional state. Continuous crying despite pain management (use of analgesic) suggested that Yasmine’s distress was not fully addressed, prompting a need for further intervention. Emotional and psychological trauma often accompanies physical trauma in pediatric patients, making it crucial to assess and address emotional needs. Recognizing that Yasmine’s mother was highly stressed and emotional, the nurses maintained their composure and included her in the care process by offering emotional support, fostering a family-centred practice.

4.2 Uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice: The initial A-G assessment covered airway, breathing, circulation, and other crucial systems, providing a broad picture of Yasmine’s physical condition. The use of the Wong-Baker Faces Pain Rating Scale, designed for pediatric patients, allowed the nurses to assess Yasmine’s pain more effectively, considering her young age and limited ability to articulate pain using traditional numeric scales. This systematic approach ensured collection of comprehensive and relevant data. Continuous monitoring of Yasmine’s vital signs was essential in ensuring her safety and adjusting care accordingly.

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: The nurses escalated the care to the doctor when the pain management strategy proved ineffective. This shows the importance of recognizing when initial interventions aren’t working and collaborating with other healthcare professionals to adjust the care plan. The nurses also partnered with Yasmine’s mother through empathetic communication, involving her in the care process which helped relieve the mother's anxiety, enabling her to provide emotional support to her child in a stressful situation.

Future Strategy: In my future practice, I could use non-pharmacological strategies such as giving the child a toy and running cold water over the burn areas to distract her and to sooth her pain so that proper assessments can be performed. I could also consult a doctor and request them for a urine and blood test to check for any possible infections that might be causing the pain, or a scan to check for possible constipation that could be caused by the use of analgesic. Nurses should also maintain a fluid balance chart whilst consulting with the mother on the child’s fluid intake and urine output by checking how many times the child has been to the toilet. A bed pan can be provided to measure the urine output. If possible, a social worker or a psychologist or paediatrician should be engaged to provide appropriate support to both the mother and child in a stressful environment. The nurse can also build a rapport with the mother by engaging in a therapeutical conversation with her and gaining her trust. As the mother is the primary caregiver for Yasmin, who is only a child, she (the mother) can provide us with valuable information about Yasmin to improve Yasmin’s care plan and a positive outcome/recovery. I could also invite the mother to participate in Yasmin’s care plan such as by letting her take part in the burn dressing.

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Case 2: Avery, 17-year-old with DKA

NMBA Standard 5: Develops a plan for nursing practice

Avery presented with an unusually high self-administered BGL reading and significant anxiety. The nurse must ensure that Avery’s BGL reading is accurate, so that they can develop a care plan for her that not only includes nursing interventions to address her DKA symptoms but also addresses her anxiety. In addition, patient education should be a part of the care plan to address lack of knowledge of proper self-administration of BGL reading and early signs and symptoms of DKA to manage the condition better.

5.1 Uses assessment data and best available evidence to develop a plan: To begin with, the nursing team conducted an A-G assessment to establish the patient’s broad physical condition. The nurse determined that Avery’s self-administered BGL was potentially inaccurate because the reading was unusually high, indicating hyperglycaemia which is caused by severe insulin deficiency. Precise monitoring of glucose level is crucial for managing DKA because inaccurate readings can lead to improper care plan. Hence, the care plan should include retaking the BGL and providing proper guidance to the patient on how to administer BGL correctly. Besides BGL, the nurses should check for signs of dehydration, thirst, excessive urination, shortness of breath, nausea, vomiting and abdominal pain, which are all symptoms of DKA. In addition, blood and urine tests should be conducted to check for electrolyte and ketone levels that would give an indication of the severity of acidosis. It is also important to review Avery’s medical history of DKA because that can help the nurses anticipate complications and include necessary interventions in the care plan.

5.2 Collaboratively constructs nursing practice plans until contingencies, options, priorities, goals, actions, outcomes, and timeframes are agreed with the relevant persons: In order to develop a nursing practice plan that works for the patient, the nurses must seek to clearly understand Avery’s concerns and anxieties about her condition. Perhaps Avery is anxious because she is unsure about how to properly self-administer BGL or unable to clearly discern the signs and symptoms of DKA. Engaging in an open discussion with the patient and their family/carer and involving them closely in the developing the care plan will instill a sense of control in the patient over their condition and may thus help reduce their anxiety. The nurse can collaborate with Avery to come up with an education plan to teach Avery and her family/carer proper BGL monitoring techniques and recognising the early signs of DKA so they feel empowered to better handle her condition, reducing anxiety and avoiding errors in future BGL readings. The nursing team should collaborate with other health professionals (GP, diabetic care team, psychologist) who provide care for Avery, so that they can monitor and adjust her insulin dose, ensure she is following her self-management educational plans, and arrange future check-ups.

Future Strategy: I will enhance my ability to collaborate with patients and their family/carer by improving my therapeutic communication skills, focused on age-appropriate language so that adolescent patients are not overwhelmed and intimidated using medical jargons and in general simplifying information for them to consume without confusion. I can educate Avery on how to use the BGL monitor and how to administer insulin. I can also incorporate “the teach back technique” into educating Avery about how to use the BGL monitor and then ask her to demonstrate how to use it. This will allow Avery to become confident with her reading. I can also plan a meeting for Avery with other health care professionals like a dietician or nutritionist to help her with her diet plan. Adolescents with chronic illness such as DKA can have mental health issues such as depression and anxiety, so it is important to include a psychiatrist to help Avery cope with such issues. Physical exercise should be encouraged as physical activity can help maintain sugar level. I will also educate myself more on DKA in adolescents through e-Learning/online courses, reading journal articles, and consulting with educators and senior colleagues. This will enable me to develop care plans that consider both the emotional and psychological needs of the patient and their family/carer, ensuring they feel engaged in managing their own care.

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Case 3: Clinical placement (PEP), wound care

NMBA Standard 6: Provides safe, appropriate, and responsive quality nursing practice

During my PEP, I was asked to perform a wound dressing change on a patient. I ensured proper wound care by adhering to aseptic technique and working within the scope of practice as a student nurse, providing safe care even though I observed nursing staff at the facility engage in poor wound care practice.

6.1 Provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people: I demonstrated my commitment to infection control by following proper hand hygiene by washing my hands thoroughly before and after the dressing procedure while using gloves to handle the dressing materials. In addition, I adhered to aseptic non-touch technique (ANTT) by maintaining a sterile field and not contaminating the sterile materials through touch. I also sought the patient’s consent before performing the wound dressing change as part of ethical nursing practice. Further, I respected the patient’s dignity by removing them from the lounge and taking them to their room to perform the dressing change.

6.2 Practices within their scope of practice: As a final year (INC 6) student nurse, I practiced within my scope by asking for consent and performing wound dressing change under supervision. Before the start of my PEP, I familiarised myself with the scope of practice of a final-year student nurse to comply with standard 6.2. Presence of a supervisor ensured that I was performing safe practice and gave me the opportunity to seek feedback on my performance. In contrast to the inappropriate wound care practice I observed, I avoided poor practices and focused on safe, evidence-based care.

Future Strategy: In my future practice, I shall use the TIME Wound Assessment technique to assess wounds to determine onset of infections and necrosis, so these can be addressed in a timely manner, preventing unnecessary pain and discomfort to the patient. If the wound condition deteriorates, I will escalate the care to a doctor for their intervention. Further, I will follow available prescribed wound care guidelines to ensure I am engaging in safe practice. It is also important to address the patient’s pain and discomfort by engaging them in therapeutic conversation to determine their pain level and offering analgesic if and when required. Accurate and timely documentation of the dressing change, recording the time, type of dressing used, wound status, and any patient feedback also form part of comprehensive safe, quality practice. Finally, as a nurse, I must reflect on my practice and experience to identify any areas of improvement, such as my dressing technique and therapeutic communication with the patient, so that I’m continually striving to achieve the best patient outcomes.

In addition, if I observe any unsafe practices amongst my colleagues, I will talk to them directly if appropriate, otherwise inform the nurse educator so they can intervene to ensure staff are aware of and following safe and evidence-based practices. I will stay informed on the latest evidence-based practices on wound care and infection control through professional development activities such as attending workshops, completing e-learning modules and practising wound care to improve my techniques. Further, I will regularly seek feedback from my supervisors and peers to identify areas of improvement and seek guidance when I encounter tasks that are outside my experience and expertise. Regular review of my competency and skills by a senior nurse or supervisor will ensure that I am practising safely and ethically within my scope of practice.

Finally, to foster a patient- and family-centred care, I’ll educate patients and their family/carer on proper wound management at home such as keeping the dressing clean and dry, getting dressing changes done on time by visiting the nearest clinic or GP centre.

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Case 4: Sam, workplace injury

NMBA Standard 7: Evaluates outcomes to inform nursing practice

Sam had a fall at her workplace from a three-metre height on to a concrete floor. Paramedics were called and she was rushed to the Emergency Department. She had injuries to the head, neck, chest and abdomen. In the ward, the nurse caring for Sam left a student nurse with the patient when she went on her break. No medication chart was on hand as the student nurse reported that it was taken away by the attending medical officer. The nursing team began by conducting a primary survey using A-G assessment to determine Sam’s broad physical condition. Sam was groaning in pain, so a secondary survey was conducted using PQRST (Provoke, Quality, Radiating, Strength, Time) pain assessment to determine the location, nature and level of pain. Sam complained of abdominal pain in particular, so an abdominal assessment was performed using Inspection, Auscultation, Percussion and Palpation method, determining a pain score of 8/10. The nurses observed that Sam’s SPO2 was dropping which prompted immediate intervention with Oxygen therapy and adjustment of patient’s head position to improve airway patency. It was important to evaluate the patient’s outcomes to address her evolving needs.

7.1 Evaluates and monitors progress towards the expected goals and outcomes: After conducting PQRST pain assessment and abdominal assessment, it was evident that Sam’s rib fracture and associated abdominal pain were causing significant discomfort and distress. The nursing team closely monitored Sam’s vitals and symptoms, such as Oxygen saturation (SPO2), heart rate (HR), and respiratory rate (RR). Regular and systematic monitoring of vitals, especially in trauma patients, is important as changes in readings can signal the need for urgent intervention. It is important to document these changes to track patient progress and adjust care plans as needed. For instance, after initiating Oxygen therapy, it is important to monitor oxygen saturation and respiratory effort to ascertain improvement or decide if further intervention is needed.

7.2 Revises the plan based on the evaluation: The ongoing evaluation of Sam’s symptoms and response to interventions (e.g., oxygen therapy and positioning) informed whether the interventions were effective or needed further adjustments. Based on the decline in Sam’s oxygen levels and increase in respiratory distress, the nurses immediately administered oxygen therapy via nasal prongs at 2L/hr to stabilise her oxygen saturation. This adjustment was essential in preventing hypoxia and further complications. Given Sam’s complaint of nausea and the risk of aspiration, her head was elevated. When her condition deteriorated, the nurses escalated the care to the doctor, ensuring patient safety.

Future Strategy: I will continue to perform primary patient survey using structured patient assessment tools such as A-G assessment to determine the patient’s physical condition, followed by a secondary survey such as PQRST assessment to ensure a thorough understanding of the patient’s pain and discomfort, especially in cases involving trauma. I will evaluate the pain score of the patient after the medical officer’s intervention, and if the pain decreases, I can request the medical officer for modification in the medication order and reduce the analgesic dose. Although, in this case the patient complains mainly of abdominal pain, I would also perform a Glasgow Coma Scale (GCS) neurological assessment because the patient had a head injury as well. I will expand my assessment toolbox to recognize potential signs of internal injury in trauma cases, by incorporating Focused Assessment with Sonography for Trauma (FAST) in my nursing practice and familiarising myself with trauma assessment techniques, including FAST exams, and work with senior nurses or doctors during trauma cases to observe how they assess for internal injuries. I can also refer Sam to a physiotherapist to help her regain her strength and mobility. She could also benefit from accessing the services of an occupational therapist to help her manage her care at home and at work. For instance, if she has trouble standing while showering, the occupational therapist could provide a shower chair for Sam. Further, if Sam is experiencing any mental health issues resulting from the trauma and the temporary loss of her ability to function independently, affecting her work, a psychologist or counsellor can provide Sam with therapy to deal with such mental issues.

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For the first two weeks of my placement, I was assigned to aged care. When I found out, my initial thought was, "Why am I placed in aged care? I'm in INC6!" However, once I started, I quickly realized that nurses play a crucial role in this setting.

Aged care facilities are home to many elderly people, often their final home. Initially, I had the misconception that nurses don’t have much to do in aged care. But after two weeks there, I’ve learned not to judge a book by its cover. While the nurses here may not perform as many procedures as those in hospitals, the nurse-to-resident ratio is much higher. Besides medication administration, therapeutic care, and communication, tasks like insulin management and wound care are a big part of their daily routine. This is why my reflection this week focuses on wound care.

The wound care practices I observed from a couple of nurses I buddied with didn’t follow proper techniques, in my opinion. I was surprised to see how poorly wound care was done. They didn’t follow the aseptic non-touch technique (ANTT) or maintain a sterile field. Honestly, it looked more like a layperson’s dressing than something done by a professional nurse. I noticed it right away but didn’t feel comfortable questioning the nurse at that moment.

A few days later, I got the chance to do wound care myself. I made sure to follow all the proper steps within my scope of practice. I introduced myself to the resident, explained that I was a student, and asked if he was okay with me performing the dressing. He was happy to let me proceed. I followed the aseptic non-touch technique carefully and engaged the resident in conversation while I worked. I felt really proud that, despite seeing shortcuts being taken by others, I stuck to my professional values and did my job properly.

At the end of the week, during our learning circle, I was pleased that our CLN took the time to emphasize the importance of wound care. We did an activity where we worked in pairs, picked papers with wound images, identified the type of wound, and performed a TIME wound assessment, reviewing different types of dressing materials. It was a great learning experience that deepened my understanding of wound care.

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Pre-class preparation:

Since there is no specific module to refer to, I am exploring the homepage to see how this semester differs from the previous ones. In the past, we have seminars and workshops on separate days, and we are encouraged to attend the seminars first so that we are better prepared for the workshops or simulation classes. However, in this final semester, everything is combined into a single three-hour class, held in a different location than our usual workshop sessions. I am feeling nervous because I’m unsure of what to expect.

Post class reflection:

Thank god I don't feel as nervous and lost as I felt prior to the class. It was a bit of a confusion as we went to a different location to attend our classes and the way the classes were set up was new yet interesting. I could not imagine sitting in one class for 3 hours straight, but the classes were structured in such a way that they were fun to attend.

Simulation: We met our classmates along with our wonderful and energetic teacher, Bec. She explained how the classes would be structured, and we had the chance to ask questions about the assessments and viva. The highlight of today's class was hearing, "we’ll be Registered Nurses in 18 weeks." It was thrilling to realise that our journey as students is nearing its end, but also a bit daunting, knowing that in 18 weeks, we won’t be able to say, "I’ll get the nurse," because I will be a nurse.

Clinical skill lab: We started our workshop with administering Intravenous antibiotics medication. We calculated the medication and administered it.

Seminar: We got to introduce ourselves and was getting comfortable with the cohort.