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

  • Monitoring (BGL/ketones) ⭐️⭐️⭐️

  • Commencement & monitoring of insulin infusion⭐️

  • Commencement and monitoring of fluids & electrolytes⭐️

  • Interpretation and integration of health data for nursing rationale⭐️

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

  • physical care/safety⭐️

  • psychological care/safety⭐️

  • referrals⭐️

  • health education⭐️

The registered nurse:

4.1 conducts assessments that are holistic as well as culturally appropriate

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

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

4.4 assesses the resources available to inform planning.

The registered nurse:

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

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

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

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

5.5 coordinates resources effectively and efficiently for planned actions.

The registered nurse:

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

6.2 practises within their scope of practice

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

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

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

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

The registered nurse:

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

7.2revises the plan based on the evaluation, and.

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

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

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

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

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

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

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

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

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

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

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

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

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

• Assessment tools for adolescent patient

• Naloxone - usage, doses, routes of administration

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1: Knowing best practice for burns

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

2: Reassurance through evidence-based practice and compassion.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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