The discussion within this module had perfectly aligned with NMBA Standard 4 (Comprehensive Conduct of Assessments) as we were introduced to expectations within professional practise and strategies for patient assessments. When conducting assessments knowing the understanding is essential to deliver the evidence based and safe care.

Furthermore, the importance of Standard 5 (Developing a Plan for Practice) was explored by evaluating the unit outline as well as the key concepts of Bandura’s Social Learning Theory. Which this theory highlights that learning by observation, which is significantly relevant as I am preparing for my graduate year with my engagement through supervised practise and continuing reflection.

Standard 6 (Safe and responsive Practice) this was evident through our discussions about professional accountability and decision-making. Our unit lecturer highlighted even though nurses face and experience challenges, to reinforce the importance of adaptability and resilience within high-acuity environments.

To conclude, Standard 7 (Evaluating outcomes to inform practice) this standard resonated with me as while I was reflecting on how I will be tracking my personally progress throughout this final unit. Seeking feedback and engaging through self -assessment will be helping me to identify my areas that need improvements and ensure that I am confident and competent to enter my workforce of an RN.

Future Strategies:

·      Building Resilience – I will be proactive when seeking peer support and mentorship to help with navigating any challenges, this will remind myself that professional growth is about struggling as well at times.

·      Proactive skill development – I will be trying to use every opportunity that I get in my clinical skills workshops and clinical placements to build/refine my practical skills. This will ensure that I can perform the interventions and assessments competently.

·      Reflective practice – I will continue to maintain my journal entries each week to track what I have learnt, my strengths and identify any areas that will need improvements. This will ensure that I continue with developing strengths within myself to becoming an effective and safe nurse practitioner.

My first week session of module 1 reassured me that I am not the only one alone or having the feelings of uncertainty, but with the tactical preparation I can build confidences as I enter my new role of becoming a graduate RN.

·      DKA is a complication of diabetes that is serious, this happens due the body not producing enough insulin

·      DKA causes hyperglycaemia than forcing the body to start breaking down fats do have energy. Then producing acid ketones which leads metabolic acidosis

·      As the body is trying to fix this it causes for faster beathing which uses bicarbonate, making things worse

·      Symptoms for DKA include fruity breath, extreme thirst, nausea, frequent urination, vomiting and confusion

·      DKA also leads to an imbalance of electrolytes such as sodium, potassium, phosphate as well as dehydration this is because of the excessive urination

·      Treatments include balancing of the electrocytes, insulin and IV therapy to prevent further complications

11^th/02/2025 – Tuesday 09:30am to 11:30am:

Workshop:

For our workshop this week we were practising fluid resuscitation using normal saline of 100ml whilst calculating what the infusion rate would be aligning it to the hospital guidelines.  We as a grouped adhered the correct medication rights of administration whilst verifying the polices before the patient with hypoglycaemia was administrated the fluids and insulin therapy. Importance and precision of medication management was reinforced during this activity to ensure that the interventions for this patients care was aligning with protocols that are evidence based. Our workshop clinical task links to NMBA standard 6 as we particularly practised using the accordance of guidelines, regulation and relevant polices. This was done by cross-checking the hospital polices before administration the insulin and fluid, as my group was ensuring patient safety to minimise the possible medication errors that could occur. This reinforcing why it is important to follow the guidelines established to hold best practise when it comes to medication administration.

Strategies:

My strategies that I will be using to incorporate this into my practise for the future will be including further education particularly on medication administration as well as the patient centred care. I will be encouraging patients and their families to be involved in the process of care and when the information is getting provided regarding any treatments or medications. Furthermore, I will make sure to review the hospital guidelines and policies regularly as well as seeking feedback from the nursing team such as team leader to seek any areas that I could improve.

Simulation:

This week simulation, I was a volunteer with another student to take care of Avery who is a young patient that has been recently diagnosed with diabetes. Upon walking into the room, it was visible that Avery was overwhelmed and scared with her diagnosis especially when they must manage their blood glucose levels (BGL) independently. I performed my hand hygiene than introduced myself, I approached the situation in a supportive and calm demeanour. Avery was expressing their thoughts of fear regarding their condition and the ability they feel they currently don't have to self-manage, which I quickly realised why it is important to build that trust and provide the patient-centred education in these emotionally vulnerable situations.

Whilst I was validating their emotions and actively listening to the concerns, they had I tailored my explanations to the level of understanding they needed. I assessed their finger that they took their own BGL on to see if there was still bleeding and asked if they was in pain. Then I was explaining to them how they can takes a BGL step by step while reassuring them that they are not alone in this journey. I was assessing their social support as well while facilitating with referrals to a diabetes nurse educator and dietitian this ensuring that they have the ongoing guidance and support outside the hospital setting as well.

This simulation experience aligns with NMBA standard 5 as the significance of patient centred care, interprofessional collaboration and communication is emphasised. When the communication style was adjusted to Avery’s cognitive and emotional needs, this then ensured that management of their BGL was understood whilst they was connected to support services. Which I helped with establishing a sustained and comprehensive care plan. This reflecting on the standards explanation on teamwork, individualised planning and holistic care within the nursing care.

Furthermore, NMBA standard 4 had me considering other factors that Avery’s health other than their physical needs there is their health literacy, psychosocial well-being to meet their long-term needs. Avery's experience highlighted what a thorough assessment looks like and how to go beyond clinical indicators this requiring health professionals to understand patients fears, external support systems and their emotions.

Strategies:

As I am improving my nursing practise for the future, I will be using different tools of learning and knowledge to include Indigenous perspectives as well. I will be focusing on empathetic communication that is clear to make sure that patients and families are involved when it comes to making decisions about their care. My assessments will be a holistic approach to consider the emotional, physical and cultural factors. I will be building a therapeutic relationship that holds a strong bond with multidisciplinary teams in providing the collaborative care that reflects the Indigenous emphasis and overall knowledge. I will also be taking time to reflect through my practise with the continuous learning materials from research and recent academic articles to be providing the care that is effective and holistic.

The simulation for this week opened my eyes as it was reinforcing the importance of emotional support, collaborative care planning and patient-centred education when practising nursing. As we move forward, I will be continuing to build upon these skills, ensuring that I provide the safe, responsive and holistic care in nursing for my practise in the future.

I found for me that my highly valuable experience for this week was the assistance for the care of premature infant who receive respiratory support and nasogastric (NG) feeding tubes. When I was observing this delicate process of how to assess the respiratory status for infants this includes, to ensure that the tube is in the correct placement before giving feeds as well as the continuous monitoring of oxygen saturation levels. The nurses on the NICU ward did emphases the importance of gently handling neonates and to minimise stress for the prevention of any physiological instability.

NMBA standard 4 aligns my experience directly as the neonatal require assessments such as skin integrity, feeding tolerance and meticulous observations of their vital signs. Compared to adult patients, neonates have rapid and subtle changes with their clinical presentations, making it vital to recognise the signs of early deterioration. I was also able to witness the efforts that the multidisciplinary team collaborate on, this includes the respiratory therapist, neonatologist and lactation consultants who were working alongside each other to create the care plan which was uniquely individualised for each infant. This reflecting on NMBA standard 5 as the intervention for each neonate is based on their condition, how involved their parents are and overall, the developmental outcomes long-term

Palliative Care within NICU: emotional and eye-opening experience

Some aspect I did not consider before coming onto the NICU ward was end of life and palliative care for neonates. I was both saddened and surprised to be learning how NICU babies receive care and comfort when the curative treatments have no longer positive outcome. Seeing this beautiful baby on palliative care had me in such an emotional state. Making me reflect on how fragile life is and what the role of a nurse who provides the compassionate care during these difficult situations does.

As I observed the family centred and holistic palliative care that the NICU team was providing to ensure that the baby was kept surrounded by love, pain free and kept warm. The nurses supporting the parents were creating memories for keepsakes and facilitated a peaceful environment they did not push too much towards the skin-to-skin contact as the parents did discuss how they did not want to be there when they baby takes the last breath. It was incredible to see how the nurses balanced the deep empathy, guidance, offering reassurance as well as their clinical responsibilities while supporting the grieving families.

The importance of NMBA standard 6 was evident during my experience especially when providing compassionate, ethical and culturally sensitive care for end of life. While also reflecting on NMBA standard 7 which help me recognise the importance and how crucial it is to continue improving the way we approach palliative care, this ensures that the needs of the infant and family is meet.

Family centred care – communication with parents:

A key moment I learned from this placement was communication with parents that are anxious. There was a mother who understandably was in distress due to her baby being very premature whilst having all these different medical equipment’s surrounding her. While observing during this experience the NICU nurses where clear with explanations, gentle reassurance and were actively listening whilst providing the emotional support.  We were encouraging parents with skin-to-skin contact also known as Kangaroo care which is known for promoting the bond to stabilises vitals sigs of infant’s as well as increasing breast milk for mothers.

When supporting and providing the emotionally, holistic and culturally sensitive care to the NICU families aligned to NMBA standard 6 which was crucial for this nursing environment (NICU). Also, the significance of parents being involved connects to the NMBA standard 7 as the ongoing support and education improves the psychosocial and long-term developmental outcomes for not only the infant but the families as well.

Strategies:

·      Enhancing my medication calculation accuracy – NICU has many medications that are mostly weight-based, so I want to continue to improve the precision of the dosage calculation ensuring medication safety

·      Refining my neonatal assessment skills – I will be focusing on how to identify the subtle clinical changes within neonates this being early signs of feeding intolerance, thermoregulation issues and respiratory distress.

·      Improving my Neonatal palliative care understanding – I want to be exploring what is the best practices to provide the grief support, comfort care that is culturally sensitive for end-of-life care for NICU families.

·      Engaging myself and continuing to learn – I will be seeking opportunities to help with expanding my knowledge on developmental care, neonatal resuscitation and support for breastfeeding mother while providing that support with evidence and comprehensive based care plans.

·      Family centred communication – I will be practising my clear communication and empathy with the parents to ensure that they feel supported and informed when it comes to their baby’s care.

This week while experiencing the NICU environment of nursing had both been deeply emotional and incredibly insightful for me. I was able to learn how neonatal palliative care is done which was such a heartfelt experience, that showed the communication, interdisciplinary teamwork and compassion for this environment of nursing. I look forward to build and continue to grow my confidence for this specialised field where I will be in special care nursey next week.

The key factors and focus were weight gain and feeding particularly in SCN, where many babies where previously on a respiratory support or were born preterm so now they are being transitioned to the full oral feeds. I was assisting with both the breastfeeding support while also giving bottle feeds, where I observed how the nurses were assessing feeds and providing that guidance to the parents. My experience was aligning with NMBA standard 5 as we worked very closely with the families, ensuring that they feel confident or understand the feeding techniques before being discharged. To add on I also learnt the importance of infection control and thermoregulation for the babies in both NICU and SCN who are very vulnerable.

The skin-to-skin contact (Kangaroo care) was still being encouraged as well in the SCN this was not only to stabilise the baby’s breathing, temperature and heart rate but it was also a great time for bonding. This was reinforcing the understanding of how the family centred care and what the care in the neonatal health has non-invasive interventions as well.

Preparing for discharge: Parent rooming-in service

I found that one of the most valuable and unique service within the SCN was what they call the “in-rooming” service which was where parents had the opportunity to have a family room to be spending time doing night cares with their baby’s before being cleared for discharge. This gave parents a realistic experience on how setting techniques can be used, recognising any signs of distress but also the management of feeding, whilst having a nurse down the corridor to provide any support that they may need.

I had the opportunity to assist first time mums and observe their feelings of anxiousness and concerns about how they will care for their preterm baby at home. There was a mother feeling concerned with how she can recognise the cues of hunger and how she will manage the night feeds. I was able to support her by providing information and knowledge given by the nurses to reassure her that it is okay to seek out for help and demonstrated how to do paced bottle feeds this is to be preventing any aspirations. Highlighting the significance of patience, emotional support and education within neonatal nursing.

My experience vigorously relates with NMBA standard 6 as we ensured that parents felt prepared and confident to being discharged home which is essential to prevent any more hospital readmissions but also promotes the wellbeing of the infant. I was able to build those professional and therapeutic relationships which help build trust between the nurses and parents and fostered for that environment that is supportive which is key within neonatal nursing.

Final reflection/conclusion of my placement:

My placement had now come the end. I have been able to reflect on how much I have learned and grown both in my confidence but within all aspects of my clinical skills. Right through from NICU and SCN I have been developing my understanding of complex neonatal care, provided the emotional resilience and seen the importance of interdisciplinary teamwork during this vulnerable time that families go through. My biggest take away from this experience is how crucial the holistic family-centred care is. Neonatal nursing is not only the administrating of feeds, monitoring of vital signs and medication but it is more of the providing the emotional support, the empowerment of parents to ensure that they feel prepared and confident to be discharged home with their baby.

My last week working in the SCN has been so rewarding and uplifting experience to end my placement. SCN allowed me to see discharge planning, the importance of patient education and that transitioning from hospital to home care. I am appreciative for this opportunity I had as I have solidified my neonatal nursing skills preparing me to apply my emotional resilience, knowledge and skills into my practise for the future.

Future strategies: this is to help me build on my skills when working in the SCN and NICU environment again

·      Reflecting on my clinical experience – I will be continuing to take time out of day to be reflecting on my clinical experiences whilst seeking feedback from team leaders and the more senior nurses to improve my competency and confidences

·      Enhancing parent communication and parental education – I will be refining my ability to reassure and educate parents when addressing the concerns they may have but in a compassionate and clear manner.

·      Neonatal feeding support – I will be developing my knowledge further on the bottle -feeding and breastfeeding techniques especially for the infants that are premature

·      Neonatal assessments – I will be focusing on how to recognise the precise cues this being feeding tolerance, signs of infection and neonatal distress this will be providing the proactive care

·      Neonatal best practise and guidelines – I will be engaging in training sessions, workshops and any ongoing learning this is to ensure that I am aiming to remain to practise with evidence-based.

Workshop:

In the lab practical session this week, we were focusing on fluid resuscitation with the guidance of the Modified Parkland Formula which outlines the importance of pain assessment tools including FLACC and Wong-Baker as it ensures for the timely and appropriate interventions. This hands-on experience was reinforcing the significances of precise medication calculations particularly due to the calculations being weight-based for paediatric patients. When applying Standard 6, which is focusing on how to provide safe and evidence-based care, is especially relevant for burn management. A key learning point for me was the administrating of the intranasal fentanyl, which a non-invasive and effective option for pain control particularly for paediatric patients. Before attending this session, I was unaware about how fentanyl can be delivered intranasally, which offers a method that is less distressing and rapid for pain relief. Which this highlighted the importance of why staying up to date with evidence-based practices ensuring the optimal outcomes for patients. Continuing forward, I will be integrating these learnings into my future practice to improve my ability on how to assess paediatric pain much accurately, this means to advocate for early pain management interventions, and to refine my approach to support both the young patients with their families during these distressing situations.

Simulation:

In week 4, we were exploring module 3 which was focusing on burn injuries particularly on the case of Yasmin, who is a 4-year-old child who had a hot water spill on her body which led to her sustaining burns. We had a pre-brief session where 2 students had volunteer to participate in the simulation while the rest of class watched from a live video cam in another lecture room. The simulation was providing valuable insights into not only the challenging but the effective aspects of care for paediatric burns, which we than had a class discussion for reflection and feedback. The Volunteers were demonstrating strong teamwork as they were communicating effectively, while providing Yasmin’s mother with reassurance, they utilised the appropriate pain assessment tools and maintained a calm demeanour. The provided the medical officer with a handover that was structed and highlighted the accurate and importance information. Although, challenges arise, which included the lack of analgesia that was available and difficulty on how to manage the distressed parent, while also struggling to communicate with Yasmine due to being so young and her inability to verbalising her pain clearly. This was creating a sense of helplessness and was emphasising the need of adaptability for care within paediatrics. A key takeaway from this simulation experience was how to recognise and seek assistance from work colleagues while remaining calm during these high-pressure situations is vital. Furthermore, having to think out of the box and face communication barriers – including distraction tools, child-friendly language or non-verbal cues can help to improve the patient centred care.

Standard 4 was emphasising the importance of comprehensive assessments which is significantly crucial for the management of paediatric burns. This would be including have the accurate evaluation of the burn including the depts of the burn using the Lund and Browder chart which is determining the total body surface area (TBSA) affected. Furthermore, it important to recognise the psychosocial impact it has o the child and the family, as emotional distress can often influence not only the immediate but also the long-term recovery. This case highlighted why Yasmin’s mother should be supported as well including addressing her anxieties which are a contributing factor to how to improve the holistic approach to care

Strategies:

·      Encouraging family to be involved for the education of pain management as well as the aftercare which is a crucial step to improve the care. Furthermore, to promote collaboration with the interdisciplinary team

·      While developing future practice strategies, it is importance to provide safe, culturally care that is fostering rapport and trust with families within the paediatric setting

·      Offering family support such as counselling is important as burn injuries are often a traumatic experience

·      In conjunction with pharmacological interventions, the integration of non-pharmacological methods including such as but not limited to music therapy can be beneficial also.

Pre-prep work:

The importance of developing a nursing care plan that is comprehensive is crucial

·      Adherences to the clinical guidelines (NSQHS standards) this is ensuring escalation of care with a timely approach

·      Using evidence-based tools like CRAFFT and HEADSS

·      Patient centred care, collaborating with the multidisciplinary team and ethical decision making is crucial

·      Implementing validated mental health tools such as CRAFFT and HEADS when creating and assessing care plans

·      Recognising early deterioration for patients is essential

·      Engaging in reflective practice as it enhances care planning

·      Nurses should be updating their skills which is done by continuing to engage in education workshops, training etc

·      Pharmacological interventions need continuous monitoring for patient safety such as the administration of Naloxone for altering consciousness

·      Adherences to the clinical guidelines for escalation of care and prioritisation of early recognition of deterioration

·      Maintaining accurate and detailed documentations and handovers are crucial

Tuesday 11^th/03/2025: 09:30am – 12:30am

Workshop:

For our practical session this week, we had a scenario where Avery, who is non-binary and recently diagnose with diabetes, was found unconscious. Their Bp was 109/69mmHg, saturating 88% on room air (RA) and Avery’s BGL was 2.1 mmol/L. It had been reported earlier today that they were feeling dizzy; upon undertaking a thorough assessment, it was clear Avery was experiencing severe hypoglycaemia, which required urgent intervention to prevent further patient deterioration. The importance of standards was evident when conducting the A-G assessment which identified the altered level of consciousness and low oxygen levels as the immediate concerns.

Standard 6 is ensuring the safe and quality nursing care, which we were administrating oxygen therapy to help with improving Avery’s oxygen saturation as well as the close monitoring of Avery’s airway, breathing and circulation. Provided they had a BGL that was critically low, we started preparing an insulin infusion and securing IV access for the administration of dextrose as an intervention prepared for use upon hitting the emergency button. As we understood the urgency of Avery situation, we called a MET call to escalate their care promptly. This was demonstrating our capability to developing than implanting a care plan that is effective (standard 5) we prioritised the timely intervention and applied the appropriate protocol for escalation.

One key factor from this workshop was how to provide a handover that is concise and structured upon arrival of the medical officer. Utilising Standard 7 we were able to deliver an ISBAR handover than was clear and ensured that the medical team had the relevant and accurate information to guide them for further interventions. This included Avery’s presenting problem, recent diagnosis of diabetes, interventions performed, BGL, oxygen status and the requirement of ongoing monitoring.

This experience was reinforcing how important structured communication, systematic patient assessments and rapid escalation is in high-acuity settings such as Avery scenario. When standards 4,5,6 and 7 were applied in every part of the scenario we were ensuring that Avery was receiving the evidence-based, safe and patient-centred care, as well as enhancing our abilities to work together efficiently in situations that put us under pressure.

This workshop had reinforced my capability to communicate effectively, escalate care appropriately particularly in life threatening situations and how to prioritise interventions. This has been a valuable experience for my learning as it emphasised safe patient-centred care, teamwork and critical thinking.

Strategies:

·      Strengthening my handover skills by utilising the structured tool such as ISBAR to help with improve efficiency and clarity in emergency situations.

·      Enhancing my assessment skills by recognising the early signs of neurological decline, hypoglycaemia and respiratory compromise for high acuity patients

·      Continuing to practice communication strategies that support patient-centred care that is inclusive and ensure that non-binary and gender-diverse patients are feeling acknowledged and respected in the clinical settings

·      Increasing my familiarity of hospital protocols ways to manage insulin infusions, hypoglycaemia and oxygen therapy to ensuring evidence based and prompt interventions.

Simulation:

For the simulation, there was two students that volunteered to providing care for Avery, which Avery was experiencing an opioid overdose, while we were observing through a video cam in another lecture room. When the two volunteers entered the simulation room, they began working closely together with Avery’s mum, who was concerned and did not know what was going on. When assessing Avery, they were unconscious with their saturation at 89% room air (RA). As I was observing the two volunteers who were remaining focused and calm, they prioritised they A-G assessment very well. They were able to gather information from the vital signs and began to administer oxygen therapy while working effectively as a team. They escalated the situation appropriately to the medical team to investigate and provide recommendations.

Linking standard 4 to this simulation, the volunteers were applying the A-G assessment framework which is a systematic and comprehensive approach to evaluate a patient’s condition. This included their prioritisation of the life-threatening concerns, such as when Avery had compromised oxygen saturation; they ensured to keeping Avery’s airway clear and administrated oxygen. They also continued with monitoring Avery’s vital signs. They responded appropriately and continued working within scoop of practice.

Additionally, to linking Standard 5 to the simulation, the volunteers were demonstrating the key elements which was focusing on communicating and planning nursing care based on evidence and through assessment. As they implemented the A-G assessment for gathering information for Avery’s condition, they created a care plan that required oxygen therapy and continuing to monitor the vital signs. While collaboratively working with the student nurses, they were prioritising interventions and escalating care to the medical team when it was necessary required.

As they were demonstrating their understanding of the urgency of Avery situation, they efficiently coordinated resources and escalated the care when required, which showcased an evidence based and structured approach to nursing practice.

Strategies:

·      Expanding my knowledge on management of opioid overdose to help with strengthening my intervention skills and critical thinking.

·      Improving my communication skills to ensuring I provide handovers that are clear as well as providing proper escalation of patient care

·      Engaging in interprofessional simulations to help with improving my clinical decision making as well as enhancing my teamwork

·      Documenting interventions and assessments promptly for maintain comprehensive records for patients

·      Identifying my areas of improvements to enhance my learning while also reflecting on my clinical experiences

·      Practicing my A-G assessment regularly for accurate and quick patient evaluations

·      Increasing my knowledge of escalation protocols to responding to critical situations efficiently

To care for a patient who is showing signs of agitation, it is essential to be using de-escalation skills to be protecting not only the patient safety but also yours and the staff.

·      Providing patient with choices

·      Using simple and clear language

·      Always sitting down at an appropriate level this being to sit at their level instead of standing over them if they are seating down

·      Offering follow up support

·      Always acknowledge their feelings

·      Using body language that is non-threatening

·      Keeping an attitude that is calm

·      Actively listening

Tuesday 18^th/03/2025 – 09:30am to 12:30pm

Workshop:

During this week, we did not have a simulation class. We did participate for the rest of the 2 hours in practical and debriefing sessions. In these sessions we were watching various videos and a recorded simulation that demonstrated both effective and ineffective techniques for de-escalation for when caring for patients that are agitated.

The videos watched were all highlighting the importance of actively listening, remaining calm and to ensure patient safety before discussing treatment options. We were also engaged in a scenario where we role played and practiced how to calm down agitated patient. This exercise was reinforcing the significance of the need to adjust communication strategies basing it on the patient’s emotional state and to focus on de-escalation before discussing or implementing treatment interventions

When role playing a scenario, we were able to link NMBA standard 4 which was demonstrating the importance of accurate assessment and patient-centred care that is responsive. First, we addressed the patient’s distress, then we were ensuring that their emotional and psychological needs were being met before we implemented clinical interventions. Furthermore, our role-play exercise evidently showed NMBA standard 5 as, were emphasised respect for patient autonomy, effective communication and collaboration. Engaging with a agitated patient in a supportive and calm manner helped to build the therapeutic rapport and trust, which is crucial to ensure that there are actively participating within their care.

Strategies:

To help with improving my practice for the future, there is various strategies I can adopt that will be incorporating different ways of knowing how to include Indigenous viewpoint:

·      Advocating for inclusion and to support Indigenous health initiatives

·      Engaging myself in cultural competency trainings which will foster my awareness of Indigenous knowledge systems

·      Community engagement possibly could help with building relationships and to understand patient’s health approaches

·      Ensuring that professionalism is upheld this is done by keeping all patient’s information confidential

·      Providing feedback

·      Practice active listening

·      Staying informed about evidence-based practices

·      Ensure that their preferences are always prioritised

·      Collaborative care plans should have the involvement of the patient when developing patient’s care plans

Before heading into this week workshop and simulation, I decided to review the primary and secondary surveys conducted for trauma patients. This helped prepare myself for what I should be observing for this scenario regarding workplace injury. The case was involving a patient named Sam Green who had a fall from approximately four metres from a roof which he landed on cement. This was an unwitnessed fall where his co-workers had sited Sam on the fall than called the ambulance which brough him to the Emergency Department (ED).

Sam’s fall had resulted in significant injuries, including shoulder pain, rib fractures and a subdural hematoma (SDH).

The primary survey:

Airway – Ensuring that the patient’s airway is patent while also protecting the cervical spine just in case there is an injury. Without the proper support, there could be an occurrence of airway obstruction. To prevent this chin lift and jaw thrust should be used without having to move the neck and a cervical collar can be applied if this is needed.

Breathing – Assessing the patient’s chest movement, respiratory rate and oxygen saturation.  If this is not done correctly, this could result in the patient developing respiratory failure or hypoxia. Administer oxygen therapy when needed.

Circulation – evaluating pulse, blood pressure and capillary refill to check for signs of shock

Disability – Using the GCS and ACPU to assess the patient’s level of consciousness. If there is any alteration in patient consciousness this may indicate head injury, shock or hypoxia

Exposure – full exposure of the patient to identify the full body in case of hidden injuries

Tuesday 1/04/2025: 09:30am – 12:30pm

Workshop:

This week workshop, students were divided into the groups their usually in each week. The groups practiced providing the care for Sam, who was a patient admitted to the hospital due to fall he had, leading him to sustain serious injuries. First, we conducted an A-G assessment then a secondary survey, which is essential for Sam’s care. We rotated around the chilly questions where one task was to administer analgesia or antiemetics in which order and rationale of why either choice was picked to be first. Our group was discussing the need on why we should administer the antiemetic first due the common side effects linked to analgesia including nausea and vomiting. As we are trying to prevent these side effects from occurring, administrating the antiemetic first may help with the prevention. We also had a slight of confusion in our group on whether to administer the morphine or fentanyl first.  According to the case scenario Sam had already been given oxycodone earlier in the day for his pain, but he was still complaining of pain. While our group initially decided they wanted to administer morphine first w other member of the group suggested that fentanyl should be given first but with a low dose. Then when ineffective we can use a stronger analgesic. While linking NMBA Standard 6 of providing safe and effective care, the decision our group made to give the fentanyl first to Sam Green was focused on keeping the management of his pain safe and effective. Basing this off on carefully checking his pain history and how well he responds to opioids which is key when providing the right care. Fentanyl was first choice, as it works quickly but also is strong, which fits Sam’s needs and helps with the pain his experiencing. The decision of administrating fentanyl first is also helping to avoid side effects that could occur due to the stronger analgesia like morphine. We worked together as a group alongside seeking advice from the facilitator, which shows how important communication and teamwork are in providing safe care. overall, this showed the commitment to safe, effective and patient focused care as stated in NMBA Standard 6.

Strategies:

·      I will be educating patients about what treatment plans they have while fostering open communication

·      I will deepen my understanding of what are appropriate analgesia based on the individual patient factors while also regularly reassessing their pain and side effects that could occur after the administration of the medication

·      To enhance my practice for the near future for patients like Sam, I will be consistent with conducting the pain assessments to effectively monitor patient pain levels.

·      I will be seeking guidance and feedback from colleagues and team leaders

During this week’s simulation, I was observing two of my fellow peers with caring for a trauma patient named Sam Green. Sam had a fall from the roof, approximately 4 meters where he had landed in cement.  I observed this scenario through a live video camera with the rest of my class, which allowed me to also to feel involved while critically evaluating clinical decision-making without having to feel stress due to direct participation. Sam was presented at the emergency department with difficulty breathing, pain rated 9/10 and fractured ribs (3^rd and 5^th). Sam’s initial respiratory rate was in the high 20s while having a stable blood pressure with a history of hypertension. Notably, Sam remained verbally responsive and conscious during the transfer.

A key task in this simulation was the inclusion of Elizabeth, who is a first-year nursing student, and was able to assist during this simulation scenario while under direct supervision. This element was emphasising how important role modelling and mentorship is within clinical practice as stated in NMBA Standard 2 which includes fostering professional and respectful relationships not only with colleagues but with students as well. The supervising new grad nurses guided Elizabeth appropriately, as they demonstrated patient advocacy while maintain safety with her scoop of practice.

A strength I had when observing the simulation was the emphasis on spinal precautions throughout the assessment. Despite same being oriented and alert, the team was correctly maintaining the spinal alignment until they can rule out a spinal injury. This showed a strong application of trauma protocol that aligns with NMBA standard 6 especially under acute conditions where cervical injury is a concern. Another nuanced moment was how they were managing Sam’s pain and respiratory effort. Additionally, the analgesia had already been administrated when the team noticed that Sam was continuing to have difficulty, particularly when deep breathing. They prioritised have further pain assessments as they used the A-G assessment techniques to help with guidance for their interventions. This was a practical application of NMBA standard 4 which I recognised as the team continued to reassess Sam’s pain and respiratory function in real-time rather than just relying on the static initial observations.

Importantly, the students had a discussion regarding Sam’s reduced mobility and the recent findings, including the absence of blood in the urine which occurred from the previous shift, which indicated a good continuity of care. The handover was detailed and included observations, relevant history, injury mechanisms and treatment progress. This link to NMBA Standard 5, especially the need for accurate, clear and context-aware communication when transitioning and escalating care. Including such details of Sam’s x-ray findings and toileting status helps to contribute to holistic planning. As I observed the simulation, it was highlighting how crucial it is to noy only conduct assessments but also how to interpret the assessments in the context of trauma and recovery. Even with small details of how to manage patient pain while encouraging them with breathing and mobility, significantly influencing the outcomes.

Strategies:

·      I will be reflecting more critically in the simulation debriefs to help in identifying what worked and where improvements can have been made.

·      Enhancing my structured communication technique of using the ISBAR this is to ensure that efficient escalation and handover

·      To develop confidence in how to manage junior students through delegation aligning with the students scoop of practice as well as through active mentorships

·      I will be engaging myself in simulations opportunities educating on trauma-based to help with building my confidence as well as to reinforce primary and secondary survey processes.

·      Prioritising the continuous pain reassessment post-analgesia, particularly for patients with respiratory compromise

Workshop:

During our practical workshop, we were divided back into our usually groups where we role-played caring for a patient with gastrointestinal illness. I had been assigned the role of bring team leader, giving me the opportunity to practice my leadership skills and delegation for this clinical scenario. I was able to supervise the team while helping to coordinate care, including escalating any concerns to the registered medical officer when appropriate. One key procedure we focused on was performing how to insert a Nasogastric (NG) tube to support the patient with rehydration. Prior to this practical, our workshop teacher demonstrated what the correct method for insertion of NG tube while discussing the potential complications that could occur, such as aspiration and infection risk. As the patient scenario we were role playing was involving gastroenteritis, we heavily focused on infection prevention and control, particularly appropriate PPE use. My responsibility as team leader was to ensure that the standard precautions were being followed throughout the workshop. I was encouraging hand hygiene, proper donning and doffing of PPE, to maintain a clean clinical environment to prevent cross-contamination, particularly due to the high-risk nature of the GI illness. This experience was aligned with NMBA Standard 7, as taking on the leadership role help me realise how much of a challenge it is to balance, patient safety, task management and communication. It reinforced how vitally important it is to uphold protocols for infection control, especially in high-risk environments like gastro outbreaks.

Strategies:

·      Further practice my use of proper PPE and maintain infection control, particularly in outbreak scenarios

·      Strengthening my delegation and leadership skills through mentorship and simulation-based trainings

·      Continuing to review evidence-based guidelines for procedure like NG tube insertion

·      Using reflective practice to be identifying my leadership strengths and my areas of improvement

·      Promoting a culture of accountability and safety within the care team

Although not having a simulation this week, our class had a structured pre-brief activity where we individually divided ourselves into 4 groups with the direction of our teacher. All the groups had the same four patients where we were tasked to assess and prioritise the order of care for each patient who was part of the gastro outbreak in their residential home based on the clinical urgency. We discussed our rationales as a class and compared the different reasoning approaches and highlighting the differences in prioritisations. This collaborative exercise was especially valuable to develop decision-making and clinical reasoning skills. This is something I enjoyed, and wish we did more of these activities often. Working with my peers as a team has encouraged me to justify my prioritisation choices with the use of evidence-based assessments such as patient history, symptom severity and deterioration to further strengthen my rationale. An example was how we prioritised a patient who was showing signs of altered levels of consciousness and respiratory distress over other patients whose presentations were more stable. This learning activity was aligned with NMBA Standard 6; by simulating prioritisation in a time-pressured environment, we were able to learn how to apply critical thinking and ensure that the patients with the highest acuity received timely-care. This activity strengthened my confidence in how to identify early deterioration and my understanding of when to escalate concerns I have.

Strategies:

·      Staying up to date with the early warning cues for clinical deterioration

·      Continuing to develop my clinical prioritisation skills by using case-based simulations

·      Collaborating with the multidisciplinary team to validate care plans

·      Practicing my rapid assessment frameworks like the A-G to guide prioritisation

·      Using the ISBAR communication tool effectively escalation of care and patient handovers.