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Written on Tuesday the 30th of September 2025

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Written on Tuesday the 30th of September 2025

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Written on Tuesday the 16th of September 2025 

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Written on Tuesday the 16th of September 2025 

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Written on Tuesday the 9th of September 2025

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Written on Tuesday the 9th of September 2025

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Written on Tuesday the 2nd of September 2025

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Written on Tuesday the 2nd of September 2025

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Written on Tuesday the 5th of August 2025

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Written on Tuesday the 5th of August 2025

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Written throughout PEP from the 11th until the 22nd of August 2025

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Written throughout PEP from the 11th until the 22nd of August 2025

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Written on Tuesday the 26th of August 2025

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Written on Tuesday the 26th of August 2025

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Written on Tuesday the 29th of July 2025

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Written on Tuesday the 29th of July 2025

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As the first week of Integrating Nursing Concepts 6 (INC6) commenced, I was nervous about what the prospect of being a final-semester nursing student meant. I was also looking forward to solidifying the skills and knowledge I have gained over the past three years of study, my stepping stone into my nursing career. I have started to reflect that in a few months' time, I will be a Registered Nurse (RN), held to account by the Registered Nurse Standards for Practice (Nursing and Midwifery Board of Australia [NMBA], 2016), and also by patients and my own commitment to patient-centred care and advocacy. Prior to commencing this unit, I was unsure what the different layout that included a simulation would mean, but after the first module, I have developed a better understanding of how the unit is structured, including the different deliveries of information (seminar, workshop, and simulation).

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I particularly enjoyed the ball of yarn exercise from our seminar this week. I found it reassuring to hear from other students about what makes them excited, and also nervous, about this final semester. The exercise gave us the opportunity to build on each other’s experiences, listening to each other and connecting with each other. Of particular importance to me, was the deepening of knowledge, and the discussion about medications in general, and their administration, preparation, and calculation. I was able to share that sometimes I struggle with more complex medications, and I gained confidence knowing that the majority of my peers reported similar feelings. I also shared with the group that I was excited to continue hands-on learning in clinical spaces, including the added element of simulation, where previous simulations were educational.

The ‘Confidence Rating Scale’ self-assessment was particularly helpful for me. I was able to determine that while I feel very confident in my communication and therapeutic skills, I acknowledged that I am less confident in certain practical skills, including medications. Being able to identify my own strengths and weaknesses has given me areas to focus on this semester, and build into my learning each week. I will look to identify opportunities to practice them in workshops, and also actively develop a plan for my future professional practice. By doing this, I am aligned with Standard 5 (NMBA, 2016).

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I appreciated the opportunity to refresh my clinical skills, including intravenous (IV) infusions – a great way to ease into the coming weeks. I was months out of practice, so it was good to use the IV administration and preparation, including the IV pump. This was particularly helpful as my PEP placement is coming up in the Emergency Surgery and Trauma Unit very soon, and I know that medications will be a skill I can solidify over those two weeks. Refreshing my IV skills and revisiting the five patient rights reflects Standard 6, as I was able to deepen my understanding of my responsibilities in providing safe, appropriate and responsive care in preparation for my upcoming placement. This will also allow me to confidently practice within my scope of practice during PEP, as well as in future practice (NMBA, 2016).

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This week, there was no simulation, however, Belynda eased a lot of my worries about simulation-based learning by answering questions and giving an overview of what the expectations of simulation would involve. This discussion, along with the pre-learnings, clarified what the purpose of simulation-based learning is in a nursing context. I now understand that simulation is not only an opportunity to use technical skills, but also a safe environment that promotes the development of leadership in a clinical context, critical thinking and clinical reasoning, communication (both therapeutic and professional), and teamwork (Konstantinos Koukourikos et al., 2021). Because this environment is a simulation, there is an element of psychological safety, providing an opportunity to learn from mistakes and errors in a supportive environment (Jallad, 2024). By recognising this, I am engaging with Standard 7. I will be able to evaluate my actions, using feedback from the simulation debrief to strengthen my clinical reasoning, teamwork and communication (NMBA, 2016). Belynda discussed the importance of psychological safety in learning environments (Turner et al., 2023), and it was clear that this creates the most effective simulation environment and will allow me to engage with the NMBA RN Standards for Practice seamlessly.

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By the end of this semester, I will actively participate in all INC6 simulation-based learnings and class discussions, whilst applying the NMBA Standards 5-7 (NMBA, 2016). I will demonstrate this by contributing at least once per class discussion and during simulation debrief. I will also self-reflect after each module on how I can further improve. For this, I will utilise Borton's Reflective Framework (What? So what? Now what?) on the walk back to campus (Borton, 1970). I will continue practising my hands-on skills in workshops, using the clinical reasoning cycle. By doing this, I will be able to evaluate my progress, strengthen my clinical reasoning, my comprehensive assessment skills, and build my confidence in providing safe, appropriate, and responsive care during PEP and future practice - this aligns with all 8 Standards of the NMBA RN Standards for Practice (NMBA, 2016).

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​Borton, T. (1970). Reach, touch, and teach: Student concerns and process education.

McGraw-Hill.

Jallad, S. T. (2024). Effectiveness of Simulation-Based Education on Educational Practices of Communication Skills, Satisfaction, and Self-Confidence Among Undergraduate Nursing Students. Creative Nursing. 31(2), 135-143. https://doi.org/10.1177/10784535241301115

Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I., Iliadis, C., Fratzana, A., & Panagiotou, A. (2021). Simulation in Clinical Nursing Education. Acta Informatica Medica, 29(1), 15. https://doi.org/10.5455/aim.2021.29.15-20

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Turner, S., Harder, N., Martin, D., & Gillman, L. (2023). Psychological safety in simulation: Perspectives of nursing students and faculty. Nurse Education Today, 122, 105712–105712. https://doi.org/10.1016/j.nedt.2023.105712

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I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

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The topic of this week’s module is Diabetic Ketoacidosis (DKA). Upon consideration before I start the prelearnings, I have not discussed DKA since taking Pathophysiology and have not cared for, or observed someone with DKA during PEP placement. I do not feel knowledgeable on the subject and require a refresh. I am looking forward to discussing the learning outcomes for this week and growing my competence in responding to a real-life clinical setting. I do understand that DKA can be life-threatening if not treated in an appropriate and timely manner. Based on this self-reflection, I would rate myself a 5/10 overall in this subject.

The readings have helped me to feel equipped for this week's module. They have provided a comprehensive overview of the appropriate treatment for a person experiencing DKA. The readings also renewed my understanding of key factors of DKA, such as the typical presentation including clinical manifestations, who tends to be at higher risk of DKA, the pathophysiology and how this links to the correct medical treatments and risks for someone experiencing DKA. When reading the Canberra Health Services policy and procedure for a consumer experiencing DKA, I was able to understand what role an RN plays in their care, allowing me to consider what care I would be required to implement in my future practice, both as a professional and student on my upcoming PEP placement. Before attending this week's module, Standard 4 was engaged with through revisiting a comprehensive overview before this week, and then later applying comprehensive assessments during the workshop (NMBA, 2016). This includes identifying clinical manifestations and following the correct investigations for a person experiencing DKA.

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During this week's seminar, we were asked to consider how someone with DKA would present and what clinical investigations we as RNs would need to take. DKA is characterised by hyperglycemia (7.9 mmol/L after eating and 6.9 mmol/L when fasting), ketones in urine, and acidosis. This leads to clinical manifestations of polydipsia, polyuria, hyperglycemia and ketones, fruity-smelling breath, nausea, vomiting, abdominal pain, dehydration, confusion, and Kussmaul breathing (Lizzo et al., 2023). These symptoms may result in dehydration and increased metabolic abnormalities with progressive uncontrolled osmolar stress, which can lead to lethargy, obtundation, and if severe enough, may even cause respiratory failure, coma, and death (Pranita Ghimire et al., 2023). We discussed the role of an RN in supporting patients – which includes observation and testing. This includes hourly vital signs, BGL (blood glucose level) and ketone monitoring, taking initial laboratory tests including VBG (venous blood gas), electrolytes (calcium, magnesium and phosphate), blood urea nitrogen (BUN), creatinine, and complete blood count (The Royal Children’s Hospital Melbourne [RCH Melbourne], 2025). Infections, which are a common cause of DKA, can also be identified using relevant testing cultures (Ahmad et al., 2023).

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During the workshop this week, we were caring for an adolescent patient named Avery who was experiencing DKA. According to policy, upon presentation, RNs should do the appropriate assessments before starting rehydration fluids (0.9% Sodium Chloride +/- Potassium). The next step is fluid balance an hour later, continuing to assess vital signs and neurological observations, before starting the insulin infusion. Avery was charted for Actrapid (RCH Melbourne, 2025). Based on the pre-learning and research I had done before this week, I now understand the clinical reasoning behind administering Actrapid for DKA. Actrapid is a fast-acting insulin that is administered to correct the underlying metabolic disorder. It suppresses the ketogenesis, lipolysis, and the body's production of glucose. This reverses the ketoacidosis and restores the body’s acid balance (Castellanos et al., 2020).

We followed the order charted (which did follow the correct policy that we double checked), whilst also checking the drug book library, as this is a high-risk medication. The order charted was 50 IU(international units)/50ml 0.9% NaCl, and the vial of Actrapid was 100IM/1ml. Therefore, we needed to give 0.5ml of Actrapid. Belynda explained to us that there had been a mistake in the calculation during the last workshop and told us to take our time calculating. We then prepared the insulin and administered it to Avery after we had started the rehydration fluids. We also learnt that it is important to continue to monitor fluid balance, vital signs and neurological observations hourly, as well as other appropriate testing (Children's Health Queensland, 2023). During the workshop, Standard 6.5 was demonstrated by safely preparing and administering a high-risk medication in line with the appropriate policy, double-checking calculations, and actively monitoring and responding to patient status (NMBA, 2016).

The take-home messages from this workshop for me were:

·         always follow the clinical reasoning cycle,

·         be aware of potential cerebral oedema in relation to fluid replacement and DKA,

·         start fluid replacement before insulin infusion to avoid a rapid decrease in BGL, and

·         the response of an RN when responding to DKA is dependent on multiple factors, and close assessment is vital.

By following clinical reasoning and evidence-based guidelines to create a plan for Avery (such as prioritising rehydration before insulin infusion), I engaged with Standard 5.1 (NMBA, 2016).

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During the simulation, two of my peers volunteered to play the role of RNs talking to Avery, who had just been diagnosed with diabetes mellitus. Avery appeared quite distressed and had a lot of questions about diabetes, how to manage it, and was frightened of the impact this chronic illness would have on them. For example, they mentioned they were concerned about not being able to eat junk food ever again. The two volunteers did a great job of explaining the pathophysiology of diabetes, ensuring they were using appropriate language that Avery could understand. They also discussed how it is commonly managed and answered all of Avery’s concerns. Both allowed each other time to speak and used a therapeutic communication style. By observing this simulation, I was able to reflect on the importance of using therapeutic communication strategies, as well as respectful methods to gauge a person's health literacy level and provide further education (Sharma & Gupta, 2023). This simulation-based learning will inform my future practice, including my upcoming PEP placement, showing my engagement with Standard 7.2 (NMBA, 2016).

During the debrief, some key messages were:

·         acknowledging when we are unsure, not being afraid to tell a patient we are unsure, but always following up with a plan to find out,

·         communication, teamwork, and a mutual understanding/goal – for this case, therapeutic communication was vital to ensure that the patient could feel comforted,

·         gauging the health literacy of patients respectfully and providing appropriate education, and

·         creating environments for psychological safety, especially when one is unfamiliar with the patient.

After this week, I would change my overall rating from a 5/10 to an 8/10.

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During my upcoming PEP placement, I will strengthen my ability to respond to the potential signs of DKA and or metabolic deterioration in surgical patients with diabetes. This will be achieved through practising A-G (airway, breathing, circulation, disability, exposure, fluids and glucose) assessments under supervision at least once per shift, including accurately documenting patients' BGLs, and if necessary, escalating any abnormal vital signs to my buddy RN using the ISBAR framework. By using these strategies, I will be able to apply evidence-based knowledge, strengthen my clinical reasoning, and prepare for safe responsive management of acute DKA in all future practice. This aligns with Standards 5 and 6 of the NMBA RN Standards for Practice (NMBA, 2016).

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Ahmad, R., Mahendra Narwaria, Singh, A., Kumar, S., & Haque, M. (2023). Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools. Diagnostics, 13(14), 2441–2441. https://doi.org/10.3390/diagnostics13142441

Castellanos, L., Tuffaha, M., Koren, D., & Levitsky, L. L. (2020). Management of diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus. Pediatric Drugs, 22(4), 357-367. https://ezproxy.canberra.edu.au/login?url=https://www.proquest.com/scholarly-journals/management-diabetic-ketoacidosis-children/docview/2430681096/se-2

Children's Health Queensland. (2023). Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS) – Emergency management in children. Queensland Government. http://childrens.health.qld.gov.au/for-health-professionals/queensland-paediatric-emergency-care-qpec/queensland-paediatric-clinical-guidelines/dka-hyperosmolar-hyperglycaemic-state

Lizzo, J. M., Goyal, A., & Gupta, V. (2023). Adult Diabetic Ketoacidosis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560723/#:~:text=History%20and%20Physical,Patients%20are%20often%20ill%2Dappearing

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Pranita Ghimire, Dhamoon, A. S., & Doerr, C. (2023). Ketoacidosis (Nursing). In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568717/

Sharma, N. P., & Gupta, V. (2023). Therapeutic Communication. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK567775/

The Royal Children’s Hospital Melbourne. (2025). Clinical Practice Guidelines: Diabetic Ketoacidosis. RCH Melbourne. rch.org.au/clinicalguide/guideline_index/Diabetic_Ketoacidosis/#:~:text=The%20following%20bloods%20are%20part,Severity%20of%20DKA

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I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

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This week provided me with a variety of skills and knowledge for future practice that previous INC workshops have not covered. Throughout my study, we have not regularly had a paediatric focus (other than module 2). This week highlighted areas of further development for future practice, including safe paediatric medication administration, pain assessments, burns first aid/treatment, and using a person-centred approach, which includes the family or support system.

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During the seminar, we watched a video about a family and a child who experienced a paediatric burn injury. The mother, Anthia, was a NUM (Nurse Unit Manager) RN in the emergency department (ED) for fifteen years. Her 20-month-old Quinn suffered from a burn injury, after grabbing a cup of boiling water with her hand. This spilt on the right side of her body, affecting the face, neck, back, chest, shoulders, upper arms and fingers. The mother, though very distressed, completed the appropriate burns first aid. This included immediately removing clothing and placing the child into a cold shower for twenty minutes, and calling an ambulance. The child very quickly started to swell around the face and neck. After the shower, she wrapped the child in cling wrap and waited for the ambulance that arrived after forty minutes. This was in rural Victoria, and the child was very quickly flown from the local ED to the Royal Children’s Hospital Melbourne (RCH Melbourne), where she was treated. The treatment was ongoing for several months, including surgical intervention of skin grafts in four different areas. Quinn triggered a major trauma criteria due to her TBSA (total body surface area) and location (more than 10% TBSA) (Warby & Maani, 2023). Anthina shared her perspective, explaining that this was a very traumatic event for her and in that moment, she felt like a mother rather than a nurse. It was difficult for her to continue going to work after this. This story was very personal and considered the nursing perspective, highlighting the importance of self-care and understanding the emotional burdens this profession can have in our personal lives (Zhang et al., 2025). For Anthia, it would be important for her to reflect on Standard 3.1 of the NMBA Standards, to ensure she prioritises self-care to maintain her capability of practice (NMBA, 2016).

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During the workshop, I looked after 4-year-old Yasmin, a paediatric burns patient. Yasmin was treated with burns first aid by her mother at home. An hour later, the paramedics picked up Yasmin, but did not give any additional treatments, as they were unsure of the policy. This patient was charted for fentanyl via a mucosal atomiser device (MAD300). When preparing and administering, I followed the policy to ensure best practice (RCH Melbourne, 2025). This was my first experience using an intranasal route for medications, as I have limited experience with paediatric patients. In this workshop, we did not use real medication, so we were able to administer it to each other and assess how it felt. When preparing the Hartman’s fluid order, I used the modified Parkland formula to calculate the rate, which was 648ml. This led to a discussion around the use of a burrette chamber attachment, as the Hartman’s fluids are either 500ml or 1000ml, and this is the safest option.

I also had the opportunity to calculate the TBSA percentage using the Lund and Browder framework (RCH Melbourne, 2022). This was a challenge, as the burns were patchy. Our workshop lecturer explained that for a small area similar to this, the palmer method is useful. This means that the palm of the child’s hand is approximately 1% (RCH Melbourne, 2025). For Yasmin, I calculated 12% TBSA. It was difficult to determine the burn depth (superficial or deep) as the true depth and extent of the wounds can usually only be determined after 48 hours ‌(RCH Melbourne, 2025). These activities demonstrate engagement with Standard 4.2, as I was conducting assessments and applying comprehensive frameworks such as the Lund and Browder chart, the palmer method, the Wong-Baker FACES Pain Rating Scale (Wong-Baker FACES Foundation, 2019), and clinical reasoning to inform my practices (NMBA, 2016).

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During the simulation, the case study continued with Yasmin’s story. I volunteered for this simulation, where I answered a call from a concerned and anxious mother, whose baby was distressed and crying in pain. The mother, Sophie, explained her concerns and that she had never seen her baby in this much pain before and that it had been happening all morning. She asked me what I could do to help the situation. I reviewed the medication order, and all analgesia had already been administered – nothing else was due. I discussed with her that it can be very distressing to see your child in pain, having suffered extensive trauma. I reassured her that I would advocate to the medical team for further review of pain management solutions. I explained that all analgesia had already been given, meaning that there was nothing I could do in that moment, but that I would follow up on her concerns. I reiterated that I had heard her concerns and provided her with validation that, as her mother, she knows her child best. At times during this exercise, I felt overwhelmed by the baby crying, and the fact that I did not have anything I could do in that exact moment to relieve the child's pain – or the mother's distress.

I continued to use therapeutic communication and a person-centred approach. During this simulation, my response aligned with the NMBA standards of practice, Standard 5, Standard 6, and Standard 7. I used clinical reasoning and a person-centred approach to plan care (Standard 5). I provided safe and appropriate practice by recognising the limits of what I could immediately offer the patient whilst still ensuring advocacy for further pain management (Standard 6). I was able to reflect on my communication and emotional response afterwards to evaluate how I can strengthen my practice in future scenarios (Standard 7) (NMBA, 2016).

During the debrief discussion, there were common themes of the importance of involving parents in their children's care (which my peers mentioned I did well), the challenges of pain assessment in a child due to their communication ability, and managing the needs of both parents and children in a respectful and therapeutic approach. For this simulation, I think I did a good job at communicating and asking open-ended questions. I also think I did a good job of explaining to Sophie what the situation was and how I was going to find solutions. I was able to use good clinical reasoning. Areas where I need further development would be pain assessment in paediatric patients, and understanding that I will not always have an immediate solution. I also learned that sometimes discussions and a person-centred approach are the most appropriate and available tools in certain circumstances. Overall, I would like to gain more experience with paediatric patients, including in critical care settings. This debrief highlighted for me that I need to improve on pain assessment scales to better engage with Standard 4 in future paediatric pain scenarios involving assessments (NMBA, 2016).

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In future practice, including my final PEP placement, I will strengthen my ability to assess and manage pain in paediatric patients (which may include paediatric burns). This will be achieved through the use of age-appropriate pain assessment tools such as the Wong-Baker FACES scale (Wong-Baker FACES Foundation, 2019). I aim to do this for at least two patients during placement, ensuring that I accurately document pain scores and work with my buddy RN to assess what interventions are appropriate, while including the MDT in this process. These strategies will allow me to develop confidence in pain assessment and ensure I can provide safe, effective pain management for paediatric patients, which may include burns, in future practice. This aligns with NMBA standards 5 and 6 as evidenced by evaluating outcomes to plan my care, ensuring my practice is safe and effective (NMBA, 2016).

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Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

The Royal Children’s Hospital Melbourne. (2025). Clinical Practice Guidelines: Intranasal fentanyl. RCH. https://www.rch.org.au/clinicalguide/guideline_index/intranasal_fentanyl/

The Royal Children’s Hospital Melbourne. (2022). Nursing guidelines: Nursing management of burn injuries. RCH Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_management_of_burn_injuries/

The Royal Children’s Hospital Melbourne. (2025). Burns Unit: Clinical Information. RCH Melbourne. https://www.rch.org.au/burns/clinical_information/

Warby, R., & Maani, C. V. (2023). Burn Classification. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539773/

Wong-Baker FACES Foundation. (2019). Faces Of Pain Care. https://wongbakerfaces.org/

Zhang, Y., Fu, Y., Zheng, X., Shi, X., Liu, J., & Chen, C. (2025). The impact of nursing work environment, emotional intelligence, and empathy fatigue on nurses’ presenteeism: a structural equation model. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-02905-4

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During the first week of my PEP placement, I was exposed to a variety of complex patient cases that challenged me to expand my knowledge and extend my experience. The Emergency Surgery and Trauma Unit cares for patients with high acuity needs and requires a skilled multidisciplinary team (MDT) who are equipped for a variety of different needs. Initially, I felt overwhelmed coming into this high-stress environment, knowing I would be working alongside highly skilled senior professionals and may be required to respond to deteriorating and at-risk patients. Very quickly, however, I recognised that this was an invaluable opportunity for growth as a student nurse and emerging health professional.

I had the chance to prepare and administer medications, mostly IV antibiotics, which was beneficial as I was concerned about my progress and was not confident in medication administration. I also observed and assisted in the care of a range of invasive devices, including patient-administered analgesia (PCA) devices, nasogastric tubes (NGT), peripherally inserted central catheter (PICC), nephrostomy drains, stomas, and intercostal chest tubes (ICC). This exposure improved my understanding of the relevant policies and procedures for this unit, including device indications, assessments and requirements, such as dressing changes and monitoring outputs. I also practised completing pre-operative interviews, post-operative observations, and supporting pain management through both assessment and patient-education (particularly for PCA use).

Coming into the second week, my set goals are:

·         continue taking a full patient load,

·         plan shifts using the shift planner at the start of each shift instead of using the MAR to guide me,

·         continue to prepare, administer, and understand the pharmacokinetics and pharmacodynamics of the drugs prescribed, and

·         practice clinical reasoning and critical thinking, with patient goals and care plans.

Some areas for further development are:

·         consistent patient note-taking,

·         liaising with the MDT (including referrals), and

·         actively using the clinical reasoning cycle instead of simply doing tasks that are ordered.

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During week two, I continued managing a full patient load, developed care plans that did not solely rely on MAR, consolidated my knowledge of the pharmacokinetics and pharmacodynamics of the drugs I administered, and strengthened my clinical reasoning through structured planning and reflection. As for areas of development, I did have more opportunities to take notes and liaise with the MDT. As a student nurse, I need to develop my leadership skills, time management, and adaptability to the ever-changing circumstances that nursing care involves (Notarnicola et al., 2024). This week, I was involved in Medical Emergency Team (MET) calls, some diagnostic testing (such as ECGs), and handling code black situations involving compromise in patient safety, as well as my own. I cared for a patient whom I called MET/Code blue for, based on her MEWS (modified early warning score) of 8. This ensured the appropriate care was provided for a rapid deterioration, preventing further negative health impacts, which aligns with Standard 8 of the National Safety and Quality Health Service Standards (NSQHS) made by the Australian Commission on Safety and Quality in Health Care (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2021) and Standard 6.6 (NMBA, 2016). These experiences have allowed me to become more equipped in distressing situations, ensuring that in future I will follow appropriate steps to ensure the safest outcome (Davids et al., 2021). After the end of my second and final week of PEP, I have continued with my set goals and have strengthened areas that need development.

This PEP placement has been one of the best learning experiences of my three years of studies. This unit and the nursing team allowed me to be hands-on, assisting in and participating in procedures and general nursing care. In the times when my scope limited my practice, I used those moments to observe, further educate, and ask questions. Often, I had to take time to further my knowledge and educate myself outside of this placement due to the variety and complexity of the clinical setting. This placement provided me with skills to handle high-pressure environments with high acuity patients, including rapid assessment and specialised expertise. I also had the opportunity to follow patient journeys, and holistic approaches were still evident in my practice.

During this placement, I deepened my understanding of the NBMA RN Standards of Practice. I was able to engage with Standard 4 through the completion of thorough and holistic patient assessments that considered not just physical indicators (including vital observations) but also psychosocial and cultural factors. For example, I integrated patient anxieties and support systems when conducting pre-operative interviews. I also advocated for my patients' needs to the MDT, and collaborated to provide appropriate care. This ensured that my assessments were not task-driven, instead informed by a broader clinical picture (NMBA, 2016).

I was also involved in the development of planning, and was able to use the assessment and evidence to ensure my planning followed the clinical reasoning cycle (Tutticci & Huss, 2024). This was done in collaboration with policy, procedure, patient needs, and the MDT team. I ensured these plans followed patient goals, providing both a holistic and comprehensive plan that aligns with Standards 5.2 and 6.1 (NMBA, 2016). I was able to participate in providing quality and ethical goal-directed actions. I also contributed to comprehensive assessments using informed evidence, where the goal is to achieve planned and agreed outcomes for patients.

During this placement, my confidence grew and so did my understanding of relevant policies, guidelines, standards, regulations and legislation. Given the nature of the placement, I learnt about risk, and the associated Canberra Health policies and reporting procedures. In high-acuity settings, I must have the ability to evaluate outcomes to inform my practice and planning (Chatkhane Pearkao et al., 2023). This engages with Standard 7 (NMBA, 2016).

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This placement taught me a variety of skills and has strengthened my knowledge on high acuity settings, particularly trauma and emergency surgery, including the impacts, risks, and relevant nursing interventions. During my two-week PEP placement, I had the opportunity to participate in, and observe the scope of practice of RNs in this specialty, which allowed me to reflect on areas I need to develop as an emerging professional. In future practice, I will continue to provide safe and effective care in all settings, including those with high-acuity patients with a prevalence of trauma. I will achieve this through applying structured A-G assessments at least once per shift during my final placement and new graduate year, ensuring my documentation is accurate and I use the appropriate communication and relevant tools to escalate abnormal findings to my Buddy RN or senior staff. I will prioritise patients, considering where they will fit in a risk assessment tool, to ensure my care is equitable and evaluates patient outcomes, which aligns with Standard 6.6 (NMBA, 2016). These strategies will allow me to refine my clinical reasoning and ensure I can deliver safe, responsive, equitable, and evidence-based care as a new graduate RN. This plan for future practice also ensures that I am continuing my professional development, which is associated with the Continuing Professional Development Guidelines by the NMBA (NMBA, 2016).

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Australian Commission on Safety and Quality in Health Care. (2021). The NSQHS Standards.  Australian Commission on Safety and Quality in Health Care. https://www.safetyandquality.gov.au/standards/nsqhs-standards.

Chatkhane Pearkao, Wiphawadee Potisopha, Parichat Wonggom, Apinya Jumpamool, Korakot Apiratwarakul, & Kamonwon Lenghong. (2023). Outcomes of Emergency Trauma Patients After the Implementation of Web Application Operating Systems. Asian Nursing Research, 17(3), 174–179. https://doi.org/10.1016/j.anr.2023.06.003

Davids, J., Murphy, M., Moore, N., Wand, T., & Brown, M. (2021). Exploring staff experiences: A case for redesigning the response to aggression and violence in the emergency department. International Emergency Nursing, 57, 101017–101017. https://doi.org/10.1016/j.ienj.2021.101017

‌Notarnicola, I., Lommi, M., Ivziku, D., Carrodano, S., Rocco, G., & Stievano, A. (2024). The Nursing Theory of Complex Adaptive Systems: A New Paradigm for Nursing. Healthcare, 12(19), 1997. https://doi.org/10.3390/healthcare12191997

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Nursing and Midwifery Board of Australia. (2016). Guidelines: Continuing professional development. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

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Tutticci, N., & Huss, N. M. (2025). An analysis of sustainable decision-making using clinical reasoning. Teaching and Learning in Nursing, 20(2), 131–136. https://doi.org/10.1016/j.teln.2024.11.013

# data[].attributes.body
I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

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This module was particularly challenging, involving escalating care for a rapidly deteriorating patient. This week allowed me to strengthen my skills and knowledge in relation to medical emergencies, particularly the importance of early recognition of a deteriorating patient and guidelines for escalating care. I also gained confidence in communicating with the MDT (including those within the MET team). I was able to collect assessment data, understand systematic assessment in responding to deterioration appropriately, as well as reflect on the bioethical principles of decision-making capacity and nursing care delivery.

This aligns with NMBA Standard 4, to recognise deterioration early and follow the appropriate guidelines for escalated care, RNs must have the skills to complete comprehensive assessments, and have competency in what assessment results are indicative of deterioration (NMBA, 2016). Bioethical principles closely relate to an RN's ability to respond; in this case, non-maleficence underpins this practice, as failures to recognise deterioration can result in preventable harm and death (International Council of Nurses, 2021).

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During the seminar this week, we had a volunteer RN from Canberra Health Services provide education on this topic. This was really informative, and I enjoyed having discussions with a practising ED RN who responds to these scenarios every shift. We discussed the emphasis on clinical deterioration and how this closely relates to positive health outcomes; time is key during medical emergencies. We also discussed what systems are aids for recognising deterioration, including MEWS and PEWS (paediatric early warning score), GCS (Glasgow Coma Scale), A-G and vital signs. We discussed what diagnoses bring a significant deterioration, which are sepsis, STEMI (ST-Segment elevation myocardial infarction), CVA (cerebrovascular accident), DKA, and post-operative or recent history of surgery. We discussed the criteria for a MET call, including abnormal vital signs such as a heart rate below sixty, MEWS score of 4 and above, sudden change in GCS, and any other concerns. Escalation criteria link to Standard 5.1, as an awareness of those more at risk and the relevant diagnoses, allows nurses to create appropriate planning, including escalation pathways (NMBA, 2016). An example of this is the sepsis pathway by Canberra Health Services (Canberra Health Services, 2024).

We discussed factors that contribute to not recognising deterioration, including ineffective communication, lack of training, lack of awareness of what deterioration is for the varying scenarios, not doing timely vital signs, and an understanding of when vital signs are indicative of deterioration. For example, if a dementia patient has arrived at the ED and they are very confused, it is important to first identify their baseline before assuming that this is not a sign of deterioration. As a group, we also discussed the essentials for recognising patient deterioration, which can be both clinical and organisational. Ryan’s Rule was also discussed as an advocacy mechanism for families, and there was some discussion about utilising a family’s voice at times where concerns for a patient need to be amplified (Queensland Government, 2025).

After this discussion, we watched a video about how medical negligence during a routine operation led to the passing of a woman called Elaine. The patient was a middle-aged woman who was generally well, but suffered from a sinus issue, and her specialist recommended surgery. Before her surgery commenced during sedation, the ENT (ear, nose and throat) explained that her airway had collapsed, resulting in her oxygen dropping. Elaine ended up in the ICU (Intensive Care Unit), where her husband agreed to turn off her life support as she was brain-dead. During the surgery, multiple factors contributed to her death. During anaesthesia, before the surgery commenced, her saturation dropped very low within four minutes, and it was less than 40% percent. A MET was called, and multiple members of the team came to assist. They attempted and failed to intubate and couldn’t ventilate Elaine, which resulted in her brain death. The key factors contributing to this outcome were a lack of leadership (no one was sure of their role or who was in charge), loss of awareness of the time (30 minutes without breathing), loss of awareness of the severity of the situation, and a workplace culture that did not support open communication and shared decision-making (Fong, 2013).

The tragedy of Elaine’s death illustrated the consequences of poor adherence to Standard 6, as safe and responsive care requires situational awareness and timely interventions. The video documentary was narrated by Elaine's husband, Martin, and he explained to the audience that he wanted the staff involved to continue practising medicine after his wife’s death, and to learn from what happened. In cases where near misses or critical incidents occur, staff must use Standard 7 to ensure that they learn from these incidents and further prevent them from occurring in future (NMBA, 2016). This made me reflect on my ability to advocate for my patients even when there are complex factors impacting a case, for example, workplace culture. This also aligns with the NSQHS Recognising and Responding to Acute Deterioration Standard 8 (ACSQHC, 2021).

As a group, we discussed some take-home messages, including:

·         the importance of airway plans for sedated patients (including multiple backups),

·         the importance of roles and a leader in delegating them,

·         when intubation is unsuccessful, a tracheostomy can be performed (RCH Melbourne, 2021),

·         in these scenarios, it can become easier to be task-focused, but it is vital to be aware of the whole situation, and

·         don’t always trust and assume others are taking the correct steps.

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During this week's workshop, we also did an overview of an A-G for a deteriorating patient and had two different patients at each station. Our first patient was Avery, the 15-year-old from module two (type 1 diabetic who was last here for DKA), following their readmission for BGL monitoring (blood glucose monitoring) following several hypoglycaemic episodes at home. Avery’s parent asked the nursing staff to come and assess them due to a severe headache. I completed an A-G on Avery, and considered what additional assessments were relevant, and how I would escalate their care. Upon assessment, Avery had an altered level of consciousness, confused about person and place, and their BGL and ketones were normal. For Avery, it was likely that the hypoglycaemia was a potential cause for their confusion (Mathew & Deepu Thoppil, 2022). In the workshop, this was managed by giving quick-acting carbohydrates (jellybeans), then followed by a longer-acting carbohydrate (bread), with close monitoring. My group alerted the team leader and the doctor to the situation.

Our second patient, Jodie, was a middle-aged lady who fell off a horse, fracturing her left midshaft femur, which had been repaired surgically. She is on this ward postoperatively with a PCA of fentanyl. On the second day post-operation, her daughter alerted the nursing team that she had become very drowsy. We completed an A-G assessment with guidance from the clinical labs instructor. Jodie was unresponsive, so we called a MET call for assistance. She was snoring, which suggests an airway obstruction (Brady & Burns, 2023). This was managed by doing a jaw thrust. We then inserted an oropharyngeal airway (guedel), ensuring it was appropriately fit beforehand (measuring from the patient's incisors, aligning to the angle of the mandible). Contraindications were mentioned, including facial fractures or fractured base of the skull, but this was not relevant in Jodie’s case. While managing Jodie’s airway, she became apnoeic. CPR was commenced, and the AED was brought to the bedside. A bag valve mask was set up, and proper use was discussed. AED pads were applied, and the patient received one shock. During this, we spoke about safety considerations in using defibrillators, mainly noting the importance of clear communication to ensure that the bed is clear before shock delivery. Further assessment revealed Jodie had pinprick pupils, indicative of an opioid overdose, and a dose of naloxone was delivered to counteract this (Australian Resuscitation Council, 2025).

During this workshop, my response to both patient scenarios considered Standards 4, 5, and 6. I conducted comprehensive patient assessments (Standard 4), utilising my assessment findings to create an individualised and appropriate plan for my patients' needs (Standard 5), to ensure that the care I provided was safe, responsive and appropriate (Standard 6) (NMBA, 2016).

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During this week’s simulation, we watched a video of the INC6 students from last semester and built on our experiences. The video showed their response to a rapid deterioration scenario. The video was thorough and provided additional insights into what we learnt in the workshop. The scenario was 15-year-old Avery, who was found unresponsive when their parent returned after getting a coffee. The parent was understandably distressed, and when attempting to rouse her child, found a packet of Endone tablets, including an empty sheet of tablets, indicative of a possible opioid overdose. The parent called for help from the nursing staff and remained in the room. Assessment found that Avery was unresponsive with slow respirations of 10 and decreasing oxygen saturations of 88% (displayed on a bedside monitor). Avery was snoring, indicating a partially blocked airway. A rapid response was called, and oxygen was applied; with saturation reaching 97%. The nursing staff opened her airway through jaw thrust, snoring stopped, and the airway was clear. Her respiratory rate was consistently 10, which is consistent with opioid analgesia. Blood pressure and heart rate were stable. Avery was still unresponsive and had bilateral pinpoint pupils. A guedel airway was placed and measured, and their BGL was 5.5. One of the nurses left to get naloxone from the MET trolley, and observations were continued, and the simulation was stopped.

Key themes of this debrief were:

·         importance of A-G assessments,

·         not relying on technology (in this case, it was the bedside monitor),

·         the challenges of managing a distressed parent/family member, and

·         families witnessing resuscitation and the impacts, including research that supports family presence, as long as they are well supported.

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Across all healthcare settings, as an RN, I must be able to detect signs of rapid deterioration and know when and how to escalate appropriately for the setting I am in. This week provided me with a lot of insight into the complexities of deterioration, including its varied manifestations, highlighting that the management and treatment can vary depending on the individual circumstance.

In future practice, including my final PEP placement, I will assess all patients using A-G assessments at least once per shift, ensuring I use accurate vital signs and diagnostic testing to guide my plan of care. I will integrate the use of deterioration recognition aids and follow appropriate escalation pathways, escalating any abnormal findings to my Buddy RN during placement. As a new graduate RN, I will continue to apply these strategies by adhering to applicable local policies and guidelines, and seeking guidance when unsure, whilst advocating for my patients’ needs and goals. These strategies require me to use critical thinking, evidence-based care, and responsive care across any healthcare setting, ensuring positive health outcomes for my patients. This aligns with the NMBA standards, as I will conduct comprehensive assessments (Standard 4), develop care plans that involve the MDT and my patients (Standard 5), and ensure I provide safe and responsive care (Standard 6) (NMBA, 2016)

# data[].attributes.body
Australian Commission on Safety and Quality in Health Care. (2021). The NSQHS Standards.  Australian Commission on Safety and Quality in Health Care. https://www.safetyandquality.gov.au/standards/nsqhs-standards.

Australian Resuscitation Council. (2025). Guideline 9.5.2 – First Aid Management of Suspected

Opioid Overdose. ANZCOR. https://www.anzcor.org/assets/anzcor-guidelines/guideline-9-5-2-first-aid-management-of-opioid-overdose-289.pdf

Brady, M. F., & Burns, B. (2023). Airway Obstruction. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470562/

Canberra Health Services. (2024). North Canberra Hospital (NCH) - Identification and Management of Adult Sepsis. CHS. https://www.canberrahealthservices.act.gov.au/__data/assets/word_doc/0006/2595516/Identification-and-Management-of-Adult-Sepsis-Procedure-North-Canberra-Hospital-NCH.docx

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Fong, D. K. (2013). What we can learn from fatal mistakes in surgery. BBC News. https://www.bbc.com/news/health-21829540

International Council of Nurses. (2021). THE ICN CODE OF ETHICS FOR NURSES. ICN. https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf

Mathew, P., & Deepu Thoppil. (2022). Hypoglycemia. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534841/

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

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Queensland Government. (2025). Ryan's Rule. Queensland Health.  https://www.qld.gov.au/health/support/shared-decision-making/ryans-rule#what

The Royal Children’s Hospital Melbourne. (2021). Clinical Practice Guidelines: Can’t intubate can’t oxygenate (CICO) airway emergency management. RCH Melbourne.https://www.rch.org.au/burns/clinical_information/

# data[].attributes.body
I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

# data[].attributes.body
This week, we discussed the management and escalation of an acute mental health disturbance, with an emphasis on de-escalating an agitated patient and applying safety planning for both staff and consumers. I was able to build on my understanding of trauma-informed care and strength-based approaches in the context of consumers experiencing mental health disturbances. We also reflected on the relevant legislation and policies, and an RN’s role within the MDT. These principles align closely with Standard 6, as safe care in acute mental health contexts requires a delicate balance of clinical judgement, empathy, compassion, as well as evidence-based approaches and a primary goal of safety (NMBA, 2016).

# data[].attributes.body
We created a ‘class wiki’ of information on strength-based approaches, trauma-informed care, the collaborative mental health team, therapeutic relationships, and essential technologies in caring for mental health consumers. Our group’s picture is as above. This was a stimulating group exercise, and it guided me to think about how key factors in mental health nursing care are implemented into everyday practice. Though this was a mental health-specific module, this skill set and knowledge are relevant to all nursing practice.

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In this week’s workshop, things ran differently. Rather than using hands-on skills, experienced mental health nurse and senior RN, Andy, led this workshop. He encouraged discussion about de-escalation, using video examples of nursing failures in de-escalation, and a contrasting scenario where a nurse managed an agitated consumer safely. We observed that effective de-escalation management consists of verbal and non-verbal communication (such as body language), active listening, empathetic responses, and building trust and rapport with the consumer (JCU, 2022). Andy also shared his personal experiences as an RN, highlighting that real-life experiences are not simple, and can be multifaceted. I enjoyed this style of learning. We practised de-escalation with each other, playing the role of both RNs and also an agitated and hallucinating consumer. This was a fun and safe way to practice these skills, using therapeutic communication, with a heavy emphasis on body language, non-verbal cues, and safety. This part of the module also reinforced Standard 5, as trauma-informed and strength-based approaches require nurses to individualise care, using evidence-based practice for planning, and utilising the MDT to ensure consumer and staff safety. This also demonstrated Standard 6, where safe and responsive care depends on an RN's ability to tailor communication styles to meet the needs of the individual (NMBA, 2016). This was highlighted in the video portion of this seminar, providing me with further insight into the importance of communication within de-escalation strategies (Price et al., 2024).

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In this week's shadow box simulation, the UC teaching team were the actors in this video. Two emergency nurses were responding to Robin, a person who was admitted to the hospital for an exacerbation of asthma. In this simulation, they experience a mental health episode, which involved the nursing team safely de-escalating the consumer and managing the situation. When RN 1 entered the room, she sat down at the consumer's level, maintaining eye contact and speaking calmly and rationally. In responding to Robin’s questions, RN 1 was thorough, including providing education on consumer rights, and used open-ended questions. RN 1 noticed the hallucinations and did not escalate the situation, asking gentle probing questions about what the hallucinations were, and when they had started. When RN 2 came in, the consumer grew more agitated and aggressive. RN 1 removed herself and her colleague from the situation and told RN 2 to call a code black. This response highlighted that responding appropriately requires RNs to engage with Standards 5.2 and 7.2, adjusting the plan to maintain safety when the consumer grew more agitated (NMBA, 2016). Overall, this shadow box simulation highlighted the importance of de-escalation skills and knowing when and how to escalate care that keeps both the staff and consumers safe.

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In my limited experience over the past three years of studies during placement, I have experienced multiple agitated consumers in a variety of settings that were not mental health-specific units. This underscores the importance of my capability, as an emerging professional, to respond and de-escalate agitated consumers. Across all nursing settings, skilled de-escalation approaches are vital, and this skill is not limited to just a mental health setting. This involves considering one's own safety as well as the consumers.

In future practice, including my final PEP placement, I will strengthen my ability to respond to agitated consumers safely and effectively. I will achieve this through the use of trauma-informed care and strength-based approaches during consumer interactions, whilst also being mindful of my communication style, and understanding the importance of both my verbal and non-verbal communication when de-escalating agitated consumers. I will practice de-escalation strategies using the ‘LOW LINE technique’ at least once per shift when opportunities arise (NSW Government, 2025). During PEP placement, I will seek feedback from my Buddy RN on my communication techniques. As a New Graduate RN, I will seek advice and constructive feedback from senior members on the team, including the CDN (Clinical Development Nurse). These strategies will ensure I refine my de-escalation skills, which align with Standards 6 and 7. Ensuring I provide safe, responsive care across all nursing settings (Standard 6) and continuing to evaluate outcomes to learn and continue to develop (Standard 7) (NMBA, 2016).

# data[].attributes.body
JCU. (2022). 8 effective communication strategies for nurses. James Cook University. https://online.jcu.edu.au/blog/tips-for-effective-communication-for-nurses

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

NSW Government. (2025). How can I de-escalate a situation when someone is angry or agitated?. NSW Health. https://www.health.nsw.gov.au/mentalhealth/psychosocial/strategies/Pages/managing-anger.aspx

Price, O., Armitage, C. J., Bee, P., Brooks, H., Lovell, K., Butler, D., Cree, L., Fishwick, P., Grundy, A., Johnston, I., Mcpherson, P., Riches, H., Scott, A., Walker, L., & Brooks, C. P. (2024). De-escalating aggression in acute inpatient mental health settings: a behaviour change theory-informed, secondary qualitative analysis of staff and patient perspectives. BMC Psychiatry, 24(1), 548. https://doi.org/10.1186/s12888-024-05920-y

# data[].attributes.body
I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

# data[].attributes.body
This week’s module provided me with an overview of the specialised skills required to care for and understand the complexities of trauma patients, using a real-life scenario. During the seminar, workshop, and simulation, I was presented with the opportunity to assess, manage, identify, and escalate the care of a trauma patient. This week’s specific focus was on the nursing management of chest injuries (Queensland Trauma Education, 2025).

# data[].attributes.body
During this seminar, we discussed the burden of trauma in Australia, including statistical data and the relationship between Australian trauma governance and nursing care. We were asked to consider some of the risk factors of trauma for aged and paediatric patients.

My group was assigned aged patients, and the factors we considered were:

·         cognitive function (as well as recognising their baseline),

·         ageing changes (fragile tissue, blood vessels, and bones),

·         altered thermoregulation,

·         comorbidities,

·         polypharmacy,

·         communication barriers,

·         a higher mortality rate and recovery,

·         comprehensive care plan considerations, and

·         lack of support (Queensland Health, 2023).

The paediatric focused group considered factors including:

·         anatomical and physiological considerations (eg, their airways are smaller and more easily obstructed),

·         psychological and legal aspects,

·         family and parent involvement, and

·         assessment considerations (RCH Melbourne, 2025).

Our patient for this module was Sam, a 76-year-old male. Sam sustained a head and chest injury post-fall from a ladder. As a group, we brainstormed the gaps in knowledge required to implement the appropriate care for Sam.

This discussion focused on the importance of a primary assessment in a trauma scenario, including how to assess a trauma patient using the Trauma Nursing Process (TPN) [Emergency Nurses Association, 2023]. Using this systemic approach, my group were about to complete a comprehensive assessment in the context of this patient, which aligns with Standard 4 (NMBA, 2016).

After this, we discussed the mechanism of injury for Sam and the prevalence of injuries relating to falls, particularly those from ladders. This led to a discussion on chest injuries, which are the third-highest cause of trauma-related death (Attard et al., 2025, [slide 16]).

# data[].attributes.body
This scenario reflected an Emergency Department setting, where Sam had his initial assessment. I completed a primary assessment using the TNP. This primary assessment was slightly different due to the trauma focus. This scenario and assessment helped plan nursing interventions, diagnostic testing, and imaging (including C-spine examination), which aligns with Standard 5 (NMBA, 2016, Standard 5.1). During this workshop, as a group, we discussed secondary assessments for Sam, including a systemic head-to-toe, full patient history, and focused assessment of his head trauma and chest injury. This would include further neurological observations, a CT scan, and an MRI. By discussing what assessments were needed for Sam, I engaged with Standard 4.4, which further allowed me to create a care plan for Sam, and this aligns with Standard 5.1 (NMBA, 2016).

# data[].attributes.body
This week’s simulation continued with Sam’s case. Both the students who volunteered were providing care to Sam after he’d pressed the buzzer, complaining of pain. Immediately, the two nurses completed a full A-G assessment, whilst simultaneously using gentle probing questions about Sam’s current condition. One of the students, concerned by Sam’s responses, explained that they were going to escalate to the doctor. Very suddenly after this comment, Sam began to deteriorate and was no longer vitally stable. He became hypotensive, tachycardic, and had a low saturation level. One of the students quickly escalated care by providing oxygen via nasal prongs at three litres. At this time, the MET doctor came in and was informed of the situation. The student who provided the handover did an excellent ISBAR. The team continued assessing Sam, who declined further, and required an escalation to a Hudson Mask at 10 litres.

Our debrief considered differentiating when to escalate to a MET call rather than to the medical team, as well as what further management and interventions would be taken for this patient. It was helpful to reflect on what was appropriate for this patient, which will help me when I am responsible for chest injury patients in future. This aligns with Standard 7 (NMBA, 2016).

This week, I have reflected on my ability to provide comprehensive care to deteriorating patients, particularly trauma patients. During my Emergency Surgery and Trauma Unit PEP placement, I was exposed to rapidly deteriorating patients, and in this role, I was predominantly an observer. This workshop allowed me to have hands-on practice, including the use of appropriate trauma processes, which solidified my knowledge of caring for trauma patients and understanding the implications of their high acuity needs (Liu et al., 2024). I feel that I have grown my skills in providing safe and appropriate care for these patients, and I know how, when, and to whom to escalate when I am concerned. This equips me for future practice and aligns with Standard 6.4 (NMBA, 2016).

# data[].attributes.body
During my last placement, I had a great deal of exposure to trauma patients, including chest injuries, and my understanding and skills were limited to my student nursing scope. I now have more confidence in my hands-on skills when caring for trauma patients. However, as an emerging professional, I commit to continuing my professional development and lifelong learning.

In future practice as a New Graduate RN, I will solidify my ability to assess and manage trauma patients through the application of the TPN framework during each patient interaction that is relevant to (Emergency Nurses Association, 2023). I will document my assessments and nursing plan, considering patient context, including factors of age, risks, and specific injury management, and ensure that I escalate appropriately to the trauma specialists as a part of the MDT (Padinha et al., 2025). I will seek further feedback and guidance from senior staff on my nursing interventions, allowing us to collaborate in decision-making processes (Baharum et al., 2023). These strategies will ensure my care is evidence-based, collaborative, and responsive to my trauma patients' needs. Allowing me to engage with Standards 4, 5, 6, and 7. I will utilise assessment findings to establish a nursing plan (Standards 4 and 5), and I will evaluate my plan with the help of the MDT (including trauma specialists) and collaborate with senior nurses in my team to ensure that my practice is safe (Standards 6 and 7). This highlights my integration of the NMBA standards in consideration of future practice (NMBA, 2016).

# data[].attributes.body
Attard, M., Abbot, B., Chau, M., Wallis, E., & Mackay, D. (2025). Module 6 seminar – Care of the patient experiencing a traumatic injury [PowerPoint slides, slide 16]. University of Canberra. https://uclearn.canberra.edu.au/courses/18445/files/6269978?module_item_id=1546430

Emergency Nurses Association. (2023). Trauma Nursing Process (TPN). ENA. https://static1.squarespace.com/static/53e530a1e4b021a99e4dc012/t/68c1b1700c82f23a3c200897/1757524336593/TNCCN-+TNP+One-Page+Reference.pdf

Liu, Q., Xie, C., Tan, J., Xu, L., Zhou, F., & Peng, L. (2024). Exploring the nurses’ experiences in recognising and managing clinical deterioration in emergency patients: A qualitative study. Australian Critical Care, 37(2), 309–317. https://doi.org/10.1016/j.aucc.2023.06.004

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Padinha, S., Fernandes, J. B., & Castro, C. (2025). Nursing Interventions in Approaching Trauma Victims: Scoping Review. Journal of Clinical Medicine, 14(9), 3016–3016. https://doi.org/10.3390/jcm14093016

Queensland Health. (2023). Clinical Practice Framework: Trauma in older adults. Queensland Government. https://www.health.qld.gov.au/__data/assets/pdf_file/0023/1430654/Trauma-in-Older-Adults-Framework.pdf

Queensland Trauma Education. (2025). Delayed respiratory deterioration post blunt chest trauma. Queensland Government. https://qte.csds.qld.edu.au/resources/delayed-respiratory-deterioration-post-blunt-chest-trauma/

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The Royal Children’s Hospital Melbourne. (2025). Trauma Service: How are children different. RCH Melbourne. https://www.rch.org.au/trauma-service/manual/how-are-children-different/

# data[].attributes.body
I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

# data[].attributes.body
This week's module focused on prioritisation and rationalisation of care, the key concepts of nursing care for complex patients (such as ethical approaches, complex medication management, problem solving, interprofessional teamwork), infection and prevention requirements for outbreaks of gastroenteric illnesses, fluid volume deficits, treatment of dehydration, and the importance of teamwork in leadership skills.

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During this week's seminar, Danielle provided an overview of young Luca, a paediatric patient, for whom we were discussing nursing care considerations in the context of the VIVA rubric. This was for the preparation of our VIVA exam in week 12. This provided me with some additional context on the practical examination and offered an opportunity to ask questions; however, I still feel uncertain about the exam.

As a final-year and final-semester student, these final assessments, particularly this exam, are the final steps to completing my studies. There is a lot riding on my results, and I do not take this lightly. Over the past three years, and this year in particular, I have overcome a lot of obstacles and adversity in my personal life to get to this point. This year, due to my father, who suffers from debilitating bipolar disorder and schizophrenia, I have managed a recurrence of substance-induced psychotic episodes that compromised the safety of myself and my close family. This has been difficult to manage and, at times, very distracting from my studies, and has required me to seek a RAP (reasonable adjustment plan).

I have struggled to perform at my normal standard of academics. This degree, including PEP placement, requires my resilience and hard work to achieve well. This has been particularly challenging for me this year, and I would be very disheartened if my final results are not enough to meet my dreams of becoming an RN working in aged care and palliative care, which is truly my passion and is what drove me to the profession.

I aim to complete everything to the best of my ability, but am concerned that the expectations of this VIVA are to a higher standard than my peers and I were expecting. During this seminar, Danielle read some responses to the Lucas case and asked our group to grade the responses using the rubric. Everyone was surprised when we marked responses higher than the standard the teaching team was expecting. I will prepare to the best of my ability on Morgan and their case, particularly on Congestive Heart Failure considerations, as well as holistic considerations.

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During the workshop this week, our separate groups were taking care of Maggie, an elderly woman who was brought into the ED due to experiencing gastroenteric illness (SA Health, 2025). During this workshop, I took on the role of an RN, my peer was an observer, and my other peer played the role of confused and unwell Maggie. In ED, I completed a full A-G assessment, and Maggie appeared dehydrated and complained of fatigue and pain (Kranz, 2024). I reviewed the chart and prepared an IV bolus of Sodium Chloride 0.9%, according to policy. After this, our clinical lab instructor came over and said we were now in a ward setting and provided a handover.

My observer peer and I became the two RNs looking after Maggie. During this time, we had to consider prioritisation of tasks, including a wound dressing and IV antibiotics (She was charted for Cefazolin). We prepared the Cefazolin and administered it according to policy, ensuring we completed the five rights of medications, and answered Maggie's questions (Australian Medicine Handbook, 2025). I cleaned and dressed Maggie's wound, and this was the first time since INC4 that I had completed a wound dressing. This was a good opportunity to refresh my aseptic technique and TIME assessments (ACSQHC, 2021). It appeared that Maggie had a diabetic ulcer that was infected (Packer et al., 2023).

After this, we reviewed Maggie’s normal medications and were asked to assess what we would and would not give, explaining our clinical reasoning. For example, she normally has Metformin for her diabetes, but due to her current presentation and lack of food intake, her BGL was low, and therefore we would not give that due to the risks. This is due to a risk of lactic acidosis and a worsening of her current symptoms of GI upset and dehydration (Lea-Henry et al., 2017).

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During this week, our simulation was a table-top simulation involving prioritisation of a group of patients in an aged care residency, who were all experiencing an outbreak of gastroenteric illness.

We had four patients:

Mary, 85-year-old female

Diagnosed with mild dementia two years ago.

Difficulty with ADLs (assisted daily living tasks) due to cognitive decline.

Has episodes of anxiety and requires nursing staff reassurance and a calm environment.

John, 79-year-old male

Diagnosed with diabetes 15 years ago.

History of congestive heart failure.

Since the passing of his wife has struggled with compliance with diabetic dietary requirements.

Rose, 82-year-old female

Is very frail with a history of COPD.

Limited mobility due to COPD.

Can be sensitive about her respiratory illness, so it is highly important to maintain dignity when managing her care.

Paul 77-year-old male

Generally healthy with mild mobility issues.

Moved to the residency to be with his wife, whose health is declining.

Miriam asked us what order we were prioritising our patients based on this information and what our clinical reasoning was. This exercise is helpful for future practice as RNs are required to prioritise tasks and patients to ensure that patient care is equitable.

We were then handed another sheet for the first hour with observations of these patients, which guided us further on prioritisation for these patients, though all of them were at risk. John was who we were most collectively concerned about due to his high temperature and the extensive symptoms of vomiting and diarrhea. We were given the second sheet of information on the second hour. As a group, we collectively agreed we would need to escalate care to the hospital for three of the patients; this would be done via ambulance (Hodge et al., 2023).

As a group, we discussed that one of the main considerations for this collection of cases was infection and prevention matters (including preventing a further outbreak, as aged patients are more vulnerable to illness and can rapidly deteriorate). We discussed medication considerations, including the delivery of fluids through a subcutaneous route rather than IV, which I had never heard of before this. Moreover, this simulation highlighted to me that prioritisation, though a part of everyday practice, is not always simple and will require the use of the MDT in decision-making processes. Since this setting is an aged care residency, we discussed that at aged care residencies, most patients have a personal GP that is not necessarily a part of the everyday care team, which adds a layer of complexity to getting orders and access to medications such as IV rehydration fluids (Marshall et al., 2025).

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This week's seminar provided the opportunity to practice prioritisation of patients through determining the most equitable solution, and the workshop presented an opportunity to strengthen my task prioritisation. There was also a heavy prevalence of infection prevention controls. These learning objectives are evident in everyday practice for an RN and are important to master to ensure the safety of patients and others.

In future practice, such as my final PEP placement or as a New Graduate RN, to ensure that I am meeting the appropriate standards of an RN, I will first assess all patients using A-G assessments so that I can prioritise and tailor my care to the patient’s needs. I will use my assessment findings for my patient as the basis of my clinical reasoning. For example, if a patient is vitally stable but during my assessment they state a pain score of 7/10, my priority will become pain management. As a student RN, this will include escalating to my buddy RN and advocating for the patient. As a New Graduate RN, this would include administering pain relief according to policy and, if needed, advocating to the medical team. To ensure I am managing my time, I will use time management tools (such as a shift planner) every shift. This will not only allow for better use of shift time but also highlight my priorities for this shift.

I will also ensure that I follow infection prevention and precaution controls when necessary, for both the safety of my patients as well as myself and other staff. Using tools such as the ‘NSW Health Gastro Pack for Hospitals and Aged Care Facilities’ to guide my practice, and seeking further advice from senior staff and or the infection control team (NSW Health, 2018).

This aligns with both the NSQHS Standards and the NMBA Standards for practice. Preventing and controlling infections aligns with Standard 3 of the NSQHS Standards, which ensures the safety of all consumers, the public, and staff (ACSQHC, 2021). This reflects on Standard 6 as these strategies provide me with the tools to provide safe, responsive and appropriate care to all patients (NMBA, 2016).

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Australian Medicine Handbook. (2025). Cephalosporins: Cefazolin. AMH. https://amhonline-amh-net-au.ezproxy.canberra.edu.au/chapters/anti-infectives/antibacterials/cephalosporins/cefazolin?menu=hints

Australian Commission on Safety and Quality in Health Care. (2021). The NSQHS Standards.  Australian Commission on Safety and Quality in Health Care. https://www.safetyandquality.gov.au/standards/nsqhs-standards.

Hodge, S. Y., Ali, M. R., Hui, A., Logan, P., & Gordon, A. L. (2023). Recognising and responding to acute deterioration in care home residents: a scoping review. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-04082-y

Kranz, R. (2024). Symptoms of dehydration: What they are and what to do if you experience them. Harvard Health. https://www.health.harvard.edu/staying-healthy/symptoms-of-dehydration-what-they-are-and-what-to-do-if-you-experience-them

Lea-Henry, T. N., Baird-Gunning, J., Petzel, E., & Roberts, D. M. (2017). Medication management on sick days. Australian Prescriber, 40(5), 168–173. https://doi.org/10.18773/austprescr.2017.057

Marshall, K. H., Smith, O., & Rhee, J. J. (2025). General practitioners’ support and implementation concerns for Australia’s proposed aged care primary care model: a cross-sectional survey. Family Practice, 42(4). https://doi.org/10.1093/fampra/cmaf047

Nursing and Midwifery Board of Australia. (2016). Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

NSW Health. (2018). Gastro Pack For Hospitals And Aged Care Facilities. NSW Government. https://www.health.nsw.gov.au/Infectious/gastroenteritis/Documents/hospital-gastro-pack.pdf

Packer, C. F., Ali, S. A., & Manna, B. (2023). Diabetic Foot Ulcer. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499887/

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I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

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I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.

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Written on Tuesday the 7th of October 2025

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Written on Tuesday the 7th of October 2025

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This week was our final week of INC ever; instead of the usual content, we had a simulation, which involved collaborating with four-year medical students. Due to the large group of students, only one simulation was run, involving two RN nursing students and one medical student playing the roles of RNs and a junior doctor. I was an observer, and found this simulation to be the most educational this semester (Krielen et al., 2023).

In this simulation, the MDT were looking after Cody Walker, a 23-year-old male who was found on the floor by one of his friends with complaints of a headache. He was a type 1 diabetic with a past medical history of depression and no known drug allergies. He arrived at the ED, where this simulation was set, via ambulance, when his IVC (intravenous cannula) was inserted.

Belynda, playing the role of a student RN, asked for help as she was concerned about the patient, since her buddy RN was on break. The student RN gave an informal handover, explaining Cody had been having multiple episodes of emesis, was febrile, with a cough, and still felt quite nauseous.

Immediately, the two RNs completed an A-G assessment after introducing, gaining consent, and completing appropriate patient checks. During this, I noted clear therapeutic communication from the nursing team (Sharma & Gupta, 2023). During this assessment, the findings were indicative of DKA. This was evidenced by a decreasing saturation of 91%, BGL of 28 mmol/L, and right upper quadrant pain. After this was completed, the nursing staff escalated to the junior doctor. One of the nurses provided an informed ISBAR handover, while the other nurse comforted the patient and provided an emesis bag.

Soon after the doctor arrived, based on the nursing recommendations, verbal orders of Ondasetron and pain relief were given. Around this time, the junior doctor began their own assessment on the patient, asking further questions and agreeing that Cody's clinical manifestations were indicative of DKA. Before they had completed the assessment, the doctor had verbally ordered a few different dosages and medications from the nursing team.The nursing team were preparing the Ondasatron for the patient's nausea when the junior doctor noticed the policy for DKA on the table. Eventually, the appropriate order was charted that followed the policy. This consisted of rehydration fluids as well as an insulin infusion. This was one of the only parts of the simulation as an observer, I thought, that could have better managed by checking (and a knowledge of) the policy and communicating a summary of what the plan was in order of priority (ACSQHC, 2020).

The junior doctor ordered appropriate testing (such as blood cultures and a respiratory swab, where there was a moment of discussion around nursing of scope of practice), completed thorough assessments, and followed the policy for DKA. For the patient's pain, the junior doctor first verbally ordered 20mg of IV morphine, following which the nursing team replied that the patient's pain was only 5/10 and that paracetamol might be a better option at this time. Noting that opioid analgesia can worsen respiratory depression, and that the patient had decreased saturation already, this was an illustrative example of advocating for patient, ensuring their safety, and also using shared decision-making. The teamwork and communication throughout this simulation were professional, respectful, effective, and considered the timing of this medical emergency.

After the Ondansetron was given by the nursing team (which followed the five patient rights), the junior doctor, after being prompted by Belynda, called the senior doctor to come in for further assistance, where the simulation ended.

During the debrief the key points mentioned included:

·        therapeutic communication and what this looks like within interprofessional scenarios,

·        the importance of practising within one's scope,

·        nursing diagnoses (Toney-Butler & Thayer, 2023),

·        the importance of doctor-nurse collaboration (evidenced by the pain relief portion of the simulation),

·      partnering with consumers,

·      addressing problems as they are found, and

·      what being a part of the MDT means for positive health outcomes.

During this simulation, I was able to reflect on the NMBA Standards for practice (despite only having the role of an observer) through actively taking notes and heavily contributing to the debrief discussion. During this time, I evaluated how I would use this simulation for future practice. As a New Graduate RN I will recognise that this aligns with Standards 5 and 7. I evaluated the outcome of the simulation (Standard 5),and devised plans for future practice (Standard 7) (NMBA, 2016). As health professionals, it is vital to establish relationships within the MDT, to ensure that the multifaceted needs of patients are met, utilising a variety of different skills and experiences.

During the debrief, the ANU head of simulation asked us to reflect on what we would take home from this.. I stated that if I had been a part of this simulation, as a patient or RN, I would have felt comfortable because of the collaborative and respectful environment. Moreover, I reflected on the importance of ensuring I lead by example to create environments where both patients and staff can flourish. I also acknowledged that often, as health professionals, we are expected to adapt to work in high-pressure environments. This includes high stress medical emergencies such as this scenario. I explained that in my experience on PEP placement, MDTs that have built respectful and positive relationships that embody trust and work seamlessly, in environments when adaptation is necessary. To engage with all 8 of the NMBA Standards, acknowledging key factors such as understanding why interprofessionalism is crucial to safe, effective, and responsive care (Standard 6), as well as striving for collaborative working environments that include partnering with consumers (Standard 2), and the interconnectedness between the MDT and promoting a culture of safety and positive health outcomes (Standard 3.7) (NMBA, 2016).

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In future practice, including my final PEP placement, I will strengthen my interprofessional collaboration and communication skills by actively engaging with members of the MDT during at least two handovers and or patient care discussions per week, ensuring I use an IBSAR framework to promote clear communication and a shared understanding. I will also seek feedback from my Buddy RN and other colleagues regarding my communication abilities, my advocacy skills, as well as working within my scope of practice. I will follow this up with a weekly reflection to identify areas for further development, to enhance my teamwork skills. By the end of the PEP placement, I aim to demonstrate confidence in my role as an emerging professional by involving myself within the MDT, with the shared goal of person-centred practice. This aligns with the NMBA Standards as I am engaging therapeutic and professional relationships (Standard 2), developing a plan for my future practice as both a student RN and as a New Graduate RN (Standard 5), by evaluating outcomes through seeking feedback from staff (Standard 7), I am ensuring that I will provide safe, appropriate and responsive quality nursing care (Standard 6) (NMBA, 2016).

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Australian Commission on Safety and Quality in Health Care. (2020). Communicating for Safety resource portal. Australian Commission on Safety and Quality in Health Care. https://c4sportal.safetyandquality.gov.au/communicating-with-patients-and-colleagues

Krielen, P., Meeuswen, M., Tan, E. C. T. H., Schieving, J. H., Ruijs, A. J. E. M., & Scherpbier, N. D. (2023). Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace. BMC Medical Education, 23, Article 105. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04053-2

Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Sharma, N P., & Gupta, V. (2023). Therapeutic communication. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK567775/

Toney-Butler, T. J., & Thayer, J. M. (2023). Nursing process. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499937/

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I have not used any Generative Artificial Intelligence (GenAI) tools/services in the preparation of this assessment.  I understand that providing false or misleading information in the GenAI Acknowledgement Statement may constitute a breach of the University of Canberra (Student Conduct) Rules 2023.