The first week of clinical workshop, I was introduced Bandura social learning theory which enhanced my understanding on the decision-makings within this unit (INC 6). I had chance to act out my care for Sam in administering IVABS. Coming back to new semester with fresh mind, I definitely have missed important factors of care such as medication calculations and hygienes. I felt that the first seminar was very focused on the students. The survey acknowledged what and how I was approaching with this unit. It was helpful to recap and learn about psychological safety in relation to how we can influence.

Application of Standard 4: Comprehensive and conducts assessment.

During the workshop, while presenting the care for Sam, I have demonstrated pain assessment, checked patient's overall comfort and initiated conversation to create safe space before administering IVABS. I have reflected myself on medication book and chart to ensure my care were based on a complete understanding of the patients condition. I have utilised an assessments and what patient said (acting) as my rationale and evidence for my decision making.

Application of Standard 5: Develops a plan for nursing practice.

Within planning care for Sam, we were assigned into group of 3. First action we did as group was plan and consider how we would approach Sam and what is required in his care. As a group, we have utilised medication books and patient informations to plan. It was important to identify patient's priorities and goal of care in order to act accordingly due to the limited time in workshop. During the medication administration, we conducted 5 checks and documented. By planning our actions, we were able to manage resources effectively and efficiently to support planned actions.

Application for Standard 6: Provides safe, appropriate and responsive quality nursing practice.

Before approaching the patient, we ensured that we have understood the correct dosages, methods, and potential side effects of the medication. However, reflecting on the first week workshop, I felt that we were completely focused on big factors (medication safety) so our attention did not flow to other policies that we always need to consider. This led to lack of safety such as not considering the hygiene policy when approaching patient and administrating the medication.

Application for Standard 7: Evaluates outcomes to inform nursing practice

Towards the end of the workshop, our group had a chance to talk with the educator and reflect on our care for Sam. I believe this action itself aligns with the standard 7.1. The educator listened our plans, actions and gave us her idea and evaluations of what she thinks any needs to be changes. She also suggested approaching the patient before any actions so that any patient related actions we do later is also known by the patient.

Future strategies

Within reflecting on week 1, I have acknowledged the impotence of keeping on track with different policies and procedures. I will continue to practice clinical skills based on standard 5. By planning the required care for the shift, I can stay up to date and oversee the other requirements since the shift will be organised. By following standard 5, I will ensure short 5 minute self reflection on how the shift went with what I planned. Therefore this approach highlights standard 7 and enhances the clinical skills.

In our simulation with Avery, we delved into essential topics like patient education, building rapport, the extent of nursing knowledge, and handling patient distress. We started an insulin infusion guided by evidence-based practices, applying critical thinking and analysis to make informed decisions despite conflicting information and team dynamics. We also examined the reasons behind various nursing tests, connecting ABG, ECG, UA, BGL, and biochemistry results to the key indicators of DKA: dehydration, acidosis, ketosis, hyperglycaemia, and electrolyte imbalance.

Application of Standard 4: Comprehensive conducts assessments.

During week 2 simulation, I had a chance to observe and reflect from other students simulation. While taking care of Avery, one of the positive action that I noted was when the students acted out checking BGL and A to G assessment. This was done very smoothly considering the patients age. I believe this action aligns with standard 4.1 and 4.2 because they have demonstrated holistic and culturally appropriate approach by considering patient's age. Furthermore, assessments through communication allowed them to gather compressive and accurate information about the patient's condition

Application of Standard 5: Develops a plan for nursing practice.

This standard was not strongly highlighted during week 2 actual clinical hands on practice. However, after the simulation when we talked about what went good and bad, this gave me an idea of different options in approaching patient. This links to standard 5.2. In relation to standard 5.1 and discussion after the simulation, I was able to gain different plans that I was not able to think of before. With collaboration of different perspectives on what went good and bad, I was able to construct a plan for Avery in workshop.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

During the clinical workshop, I had chance to apply different perspectives that was given out during the simulation. Our group goal was to give effective amount of insulin to maintain Avery's health. First of all, my small group aligned with standard 6.5 by reading over the relevant insulin related policies and procedures. We have worked to calculate correct dose. However, due to lack of experience, we had difficulties making an evidence based decision on good dose of insulin. Therefore, before making it into action we asked an educator for her idea and reasons. I believe that this process during the workshop presented standard 6.1 as the whole process of asking advice was focused on providing quality practice to achieve agreed goals and outcomes.

Application of Standard 7: Evaluates outcomes to inform nursing practice.

After the simulation, my small groups goal during the workshop was providing age considered communication and organised medication administration. After the workshop, we had conversation with an educator whether our goal was met or not. I remember receiving feedback of word choices, as the patient was paediatric and I was using medical abbreviations. Based on this experience during week 2, I believe this links to a standard 7.1 and 7.3.

Future strategies

Based on the week 2 experience, I have acknowledged the importance of age considered communication. Speaking and making word choices on each patients level. I believe keeping this in my future clinical practice will definitely enhance all standards 4,5 and 6. I found it helpful reflecting with an educator at the end of the class. Knowing this, I will utilise most chances as possible to always open communicate and learn from different senior nurses.

My first allocation for INC 6 placement was in gastro surgical ward. During my second week, I was assigned to provide a care for a patient who had Whipple procedure. However, as I had no idea what a Whipple procedure was, I researched on the Whipple procedure related anatomy and pathophysiology. Furthermore, RN and I went through the patients medication chart to have complete understanding on why patient was taking that certain medication. For example, the reason behind why patient was prescribed with Droperidol was to prevent the nausea and vomiting that may occur after surgery. After studying the medication, and patient history, RN gave me a plan to do which was an A to G assessment, environment (surroundings) check, vital check and abdominal assessment. With this plan, I approached patient, introduced myself and gained consent to provide care. During the A to G assessment, patient noted that he was feeling nauseous. Therefore, I checked his pain score and vital sign, and told him that there will be a medication for nausea and I will let RN know so that we can administer the medication in possible time. I offered him to sit up a bit as he was laying all day watching TV. With RN, I had chance to explain the medication to the patient. During this time, I found it challenging to provide definitions while trying to avoid medical terms. Therefore, RN assisted me to enhance medication understanding for the patient. After providing the short education session, RN and I went to administer the medication and completed every 30 minutes of vital sign check for 2 hours.

Application of Standard 4: Comprehensively conducts assessments.

While assisting the admission for new patient, the standard 4.2 was met through conducting A to G assessment, vital sign and abdominal assessment. Through an abdominal assessment, I was able to identify where patient felt the most pain and informed nurse about his dressing as it was getting wet every time when I did next due observations. Furthermore, RN and I met with standard 4.3 as we re-organised our plan after an abdominal assessment. For example, administering pain medication before meal was not planned and was not prescribed. However, as patients pain score was high, RN and I discussed with a doctor and decided that patient are allowed to take PRN before meal.

Application of Standard 5:

As mentioned previously, I believe that utilising the abdominal assessment and pain scale to develop future plan has demonstrated standard 5.1. Furthermore, discussion with doctors to make decision on administering PRN was a collaborative construction of nursing plan which aligned with the standard 5.2. Furthermore, not only with doctor but RN and I also had discussion with patient before asking doctor to prescribe the extra PRN. We suggested him to sit up a little, drink water and talking to family members on phone to make his mind away from the pain. However, as these interventions were not working, we have reached out for doctor to chart the PRN.

Application of Standard 6:

As we discussed our intervention with the doctor and patient, we were able to decrease the pain score and enhanced patients comfort by the end of our shift. Which aligned with the standard 6.1. During the conversation with patient while an abdominal assessment, when patient asked what he can do about the nausea, I have provided answer within my scope of practice, which was "I will first let my RN know about your nausea and check on the medication chart with RN". I have informed that I am not able to administer the medication by myself and patient understood. The standard 6.5 was met when RN asked me to conduct observation check every 30 minutes for 2 hours. This policy was under the Canberra Health Services Procedure, Post Operative Handover and Observations - Adult Patients (First 24 hours).

Application of Standard 7:

At the end of the shift, my CLN visited me to discuss about how the day went. I believe this covered all the standard 7.1, 7.2 and 7.3. Through this reflection, I was able to understand my lack of experience in abdominal pain since I was not really able to find out anything a part from where patient mostly felt pain. Therefore, CLN told me to watch relevant YouTube videos as it will be much more easier to understand compare to reading books. Which I did and learnt a lot from. Furthermore, CLN and I practice explaining medications to patient while avoiding medical terms. I found this really challenging as the way I memorised was straight from the text book. However, as I started with explaining mechanisms by imagining visually in my head how it works, this helped me to verbalise with easier words.

Future strategies

After this placement, my first goal was to work within time. This also aligns with the standard 5.5 and 6.4. When I was providing care for 3 patients, I realised that I was taking longer than what I planned, which resulted lack of care for other two patients. This was also because I planned out the whole day not realising there will be also changes to every patient throughout the day. I was not very aware of the impact of when the plans are required to be changed. However, to align with standard 5.5 and 6.4, I will continue practicing to plan little by little throughout the shift. Through this, I can be more flexible with changing plans and work efficiently. Reflecting as I write, I would like to be more aware and updated with policies and standards. Throughout the placement, I saw in myself and others how policies of hygiene were not really followed. If tasks were overloaded and becomes busy, I think there were lot of times I skipped order of taking PPE on and off. Acknowledging this, and to align with standard 6.5, my strategy is to follow again from the basic but most important policies. In my upcoming last placement, I will make it into habit to look up more policies with procedures. Therefore, that the care I provide to patient can be evidence-based.

In week 5, the seminar proved to be more engaging than the workshop for the first time. In the seminar, we examined the influence of implicit bias on medical decision-making, nursing care, and patient experiences. I have come to recognise how my preconceived thoughts can affect patient care. In the workshop, we explored basic concepts A to G assessment and administration of naloxone. Through practicing on the A to G assessment, educator guided us to demonstrate critical thinking in relation the patients condition and finding interventions.

Application of Standard 4: Comprehensive conducts assessments.

Standard 4.1 and 4.2 was present when our group conducted an assessment based on patients age, and her family. We had two people acting as patient and carer. Communicating about the assessment and discussing the outcomes with parents gave me an idea that through this discussion, and more the carers acknowledge about patients condition, it will be easier for them to understand nurses rationales behind their care. Lastly within group of 4, we have discussed what our next action should be after A to G assessment. Some gave an idea that we start administering medication and some suggested to educate patient about the medication (naloxone) first. Through this discussion, I believe that the standard 4.3 has shown.

Application of Standard 5: Develops a plan for nursing practice.

With suggesting ideas after conducting an A to G assessment, standard 5.1 and 5.2 were highlighted. In addition, as patient was had chance of overdose with an opioid medication, providing medication with plan and rationale were essential. By acknowledging this and separating tasks to do, I believe that the standard 5.5 was shown.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

The standard 6.5 was presented during the workshop when we were administering naloxone. We referred to the policies and drug book before accessing the medication. After administering the naloxone, we discussed with an educator what we can expect next as nurses. Standard 6.6 was shown when the educator explained the side effects and his own experience when he administered naloxone. Through this conversation, this helped me to enhance understanding on relevant policies and potential risks after administering naloxone.

Application of Standard 7: Evaluates outcomes to inform nursing practice.

The standard 7.3 was shown when we practiced critical thinking during assessments, with feedback from the educator, allowed us to set new priorities for our clinical practice. My initial priority in Avery's situation was straight to A to G assessment. However, the educator suggested listening to the situation and conduct with simple parts in A to G assessments first. Furthermore, after evaluating our understanding of naloxone administration and patient monitoring, I was able to document areas where I needed improvement and communicate those goals with educator for continued learning.

Future strategies

After module 3, I have acknowledged that there are diversity of perspectives than what I can think of. Knowing this, I was able to reflect on my latest placement. Through this experience and knowledge, I have been doing reflective practice with either an educator or other nursing students. Moreover, focusing in conversation about patients preferences, needs, and cultural backgrounds. This allowed myself to tailor my care when approaching each different individual patients.

This week module simulation was self directed learning activity and both seminar and workshop were in person. Starting with simulation, we looked into Robin. Through watching simulated videos, I have identified risks when providing care for patient with behavioural concerns. On phase 3, I realised importance of continous communication within nurses when patient escalates. Therefore, both nurses were on the same page with the situation. After analysing the videos, the convenor provided shadow box technique learning which answered and engaged with the questions that I had throughout the phase. Coming to the workshop, we practice de-escalation techniques within group of 3. Acting out allowed us to be more engaged compare to reading. We then planned out how our de-escalation would work and made critical thinking to create safety plan that both considered patient and staff safety. In seminar, we discussed based on 4 different mind maps. These were privacy, trauma informed, therapeutic relationship, and collaborative mental health team. Through exploring how those factors are maintained, students were able to learn the structure in depth and link to our future practices.

Application of Standard 4: Comprehensive conducts assessments.

The standard 4.3 aligned with our workshop when our group discussed to determine how our de-escalation techniques can impact on the patient. Firstly, we planned about what ways we are going to discuss with the patient. And we discussed with an educator about how our facial expression and tone of speech can impact on patient. In addition, we also delved into "maintaining safe distance". The educator told her experience why maintaining safe distance is important. This was meaningful as before this discussion, I thought that it was better to be close to the patient for myself to make an action quickly. However, through those discussions regards to different factors that can impact on patient, I was able to understand the evidence behind how de-escalation should be planned.

Application of Standard 5: Develops a plan for nursing practice.

As mentioned previously, our group discussed different de-escalation techniques and talked about how we can effectively manage escalation. I believe this aligns with the standard 5.2 as we discussed and structured our priorities and options. Through meeting these standard, when our group acted out, it was easier and timely managed as we knew what we had to do before going into a situation. In simple, our plans and priorities were alerting the team just in care if anyone in the team are unaware, making therapeutic communication and documentation on what happened and what could have been done differently. Which also aligns with the standard 5.3.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

As we practiced during workshop, our collaborative goal was to de-escalate patient and create safe space. We also identified risks related to behavioural concerns and learned the importance of the therapeutic communication during patient escalation. This aligns with the standard 6.1. In addition, the standard 6.2 was highlighted when we acted within our scope of practice by utilising verbal de-escalation techniques and planing out safety strategies. This practice helped us refine skills that us as future RN would use to manage behavioural concerns safely and effectively, without overstepping our boundaries.

Application of Standard 7: Evaluates outcomes to inform nursing practice.

Standard 7.2 was reached throughout the simulation and seminar. Watching the video of how nurses managed during the escalation such as adding more sensory input, I was able to acknowledge the importance of care delivery and how plan needs to be changed once patient escalates. In addition, the feedback from the educator provided insights on how to midday de-escalation tactics in future scenarios, ensuring that the plan of care is flexible and responsive to the patient's evolving needs.

Future strategies

First future strategy is to practice in daily life making eye contact and focusing on my facial expression during the conversation with anyone. I sometimes receive a feedback saying that I look mad when I stare at certain object. Knowing this and learning from week 6, my strategy and something to focus on will be my basic approach during the conversation. In next coming placement, I would also like to try out more therapeutic communication with different patients. I am not a person who initiates the conversation. Therefore, I will prepare some questions to ask to patients before my shift starts. Overall, this week was very reflecting week and I definitely found some places to work on that I keep ignored.

In week 9, we had simulation for burnt injured child and mum as a carer. It was the situation where the patient was crying due to pain and requiring PRN. However, no medications were due at that point. Therefore, nurses had to come up with a quick intervention. As a class, we discussed what went good and bad, and how parents are helpful and essential when taking care of paediatrics. We further discussed what could have been an options for nurses to decide when any PRNs are not available. Coming to the workshop, we utilised Lund and Browder chart and Parkland formula to select and administer fluid rehydration. Furthermore, with tips and demonstration from an educator, we administered intranasal fentanyl.

Application of Standard 4: Comprehensive conducts assessments.

Standard 4.1 was met during the workshop when we acted out administering intranasal fentanyl. We tailored our care for paediatric such as making funny voices, not only explaining but also acting out how it is going to work. Through this, we provided holistic approach by recognised the parent's involvement and the child's emotional needs. In addition, the standard 4.2 was shown when we utilised Lund and Browder Chart and Parkland Formula. This allowed us to systematically collect relevant information about the burn injury. Using theses validated tools ensured that the data collected is accurate and allowed to provide evidence based care when deciding appropriate interventions for fluid resuscitation and burn care.

Application of Standard 5: Develops a plan for nursing practice.

During the seminar simulation, I had chance to act as a nurse. Through mainly communicating with mum to create a plan and how nurses can structure the interventions, this demonstrated the collaboration when constructing plans which aligned with standard 5.2. By involving the parent in decision-making, the care plan became more holistic and person-centred, reflecting the partnership needed to agree on care priorities and outcomes.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

I believe the standard 6.1 was met through administering intranasal fentanyl for pain relief. This was based on the child's weight and using paediatric pain assessment tools which ensured that the practice was safe and effective, addressing the child's pain in a timely manner. Standard 6.5 was met when we watched demonstration of administering intranasal fentanyl. The educator explained the relevant policies. Furthermore, not only policies but also how paediatric patients should be held, and tips about how to tailor care for paediatrics were discussed.

Application of Standard 7: Evaluates outcomes to inform nursing practice.

Our group has demonstrated standard 7.3 by communicating about the priorities and potential changes to the care plan. Furthermore, practicing the documentation and communicating any changes to the care plan with the healthcare team and the child's parent. This ensured that all our team members were aware of the patient's involving needs and can adjust our care accordingly.

Future strategies

My future strategies after leaning in week 9, I have acknowledged the importance of knowing different ways of administering medication. I would like to extend my knowledge not only about medication but also how it can be administered depending on each situation. This will be done through researching specific about medication administration to paediatrics. In addition, as a student who participated simulation on that week, it was helpful receiving the feedbacks and what could have changed. Listening to different ideas encouraged myself to also think in different view points. By this experience, I will continue to seek for feedback throughout my nursing journey. I will demonstrate in front of senior nurses as seek for their feedbacks.

I believe that the key to this standard is the need for cultural competence, ensuring that assessments are appropriate and respectful of a patient's cultural background and health beliefs.

It emphasises collaborative, evidence-based planning, ensuring that nursing actions are well-documented, adaptable, and aligned with the patient's goals and the healthcare team's input.

I believe that the key aspect of this standard is practicing within scope of practice, ensuring it aligns with nurse individuals competencies, while also appropriately delegating tasks between team members. and this is done to be in timely direction and supervision.

I consider that the standard 7 guides nurses to improve both clinically and mentally. The continuous reflective practices and adaptability in nursing is within the standard 7. This is guided to result positive outcomes by ensuring that RNs practice remains effective, enhancing better patient outcomes and high-quality care.

In week 10, it was the most intense simulation. When patient's vital sign started to fluctuate, myself watching simulation found it hard to make evidence-based decisions. I again acknowledged that I still need more practices and always keep in mind that there are always chances of patient escalating at any point. During the workshop, we further looked into Steven Black. We conducted A to G assessment as a group and administered medication based on critical thinking and evidences. Lastly, one of the things that was interesting during the seminar was about interventions for management. For example, Rib #s - analgesia and R) shoulder pain - physiotherapy.

Application of Standard 4: Comprehensive conducts assessments.

During the workshop, our group utilised A to G assessment on Steven to collect information for an evidence to decision making. This aligned with standard 4.2. We have noted that "Steven's airway was obstructed with gauze, patient is able to speak, nil obstructions after extraction of obstruction". Standard 4.3 was met as we planned as a group what our next action will be after an A to G assessment. We decided to manage pain as pain score was 9/10.

Application of Standard 5: Develops a plan for nursing practice.

As a group, before we entered the patient room, we made a plan. Our start was to introduce and conduct an A to G assessment with therapeutic communication. After the assessment, we realised that the patient requires PRN, management of tachycardia and pale, cold skin. Upon these tasks to provide care, we have decided to manage pain first as patient was not able to move. I believe this aligns with standard 5.2. Furthermore standard 5.4 was met as our group documented the goals to be met and changed our priorities accordingly throughout acting out the care for Steven.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

Standard 6.6 was met when our group identified risks of Steven's usual medication. We noted that Aspirin can negatively impact as blood thinners who had work injury. We acted out what would be an appropriate process to report potential risks. We decided that first to is to inform any team nurses and doctors to give notice that aspirin may not be suitable for Steven at that stage. In addition, the standard 6.1 aligned when our group practiced explaining the care to Steven. We delivered our ideas to Steven regards to why Aspirin may not be suitable at this stage. This was done through avoiding medication terms such as blood thinners. It was done in a way of "Aspirin can make you bleed more".

Application of Standard 7: Evaluates outcomes to inform nursing practice.

Standard 7.1 was met after discussing with an educator what could have done differently. She mentioned that A to G could have been done much easier if we did not do one by one slowly. She also commented continuous documentation as we go and making those into a habit.

Future strategies

After week 10, I have been practicing base factors of an A to G assessment. Clearly knowing what needs to be done made me able to do 2 small assessments at the same time. For example, checking airway and having my hand on patients chest after receiving consent. This allowed me to do A and B together and address patients needs quicker. In next finally placement, I will practice writing notes throughout the shift rather than writing one full note at the end of the shift. This is for myself to keep details throughout the shift.

In week 11, we focused on prioritisation of the care. As we worked in groups of 7, I was able to hear about others perspectives. We managed care for 4 patients, listing who would come first as top priority. These patients were John, Mary, Rose and Paul. Most groups were definite that Paul was improving. However, there were difficulties in choosing between Mary and Rose as both were deteriorating. Coming to the workshop, we have got into groups of 2 and provided care for individual patients. We had to make critical thinkings on to provide evidence-based care. During seminar, we delved into the VIVA. This gave us more ideas on preparation and I was able to do more structure with my responses as I compare to the provided ones.

Application of Standard 4: Comprehensive conducts assessments.

Standard 4.2 was demonstrated during the workshop. My teammate and I were providing care for the patient with an abdominal pain, difficulties with fluid intake but continuous vomiting. Considering these situations, my teammate and I decided to start with a self introduction and A to G assessment. Through this assessment, we noted that the patient was in high pain and felt nauseous. The standard 4.3 was performed when we considered in what route we are going to administer the medication for pain and the nausea.

Application of Standard 5: Develops a plan for nursing practice.

The standard 5.2 and 5.4 was performed when we were considering the route of medication as patient was nauseous and under pain. However, as patient was not able to take oral medications, our team had to consider different route which was under mouth. We decided that ondansetron would be suitable for nausea. Furthermore, we planned to involve doctor and pharmacist with making decisions regards to the medications. Within this we also demonstrated the standard 5.1 by utilising the previous notes as an evidence to our morning shift care.

Application of Standard 6: Provides safe, appropriate and responsive quality nursing practice.

With standard 6.4, we have outlined what would be the top priority throughout the care. We decided that our priority will be managing the pain and nausea first. Second, we would insert a nato-gastric tube for rehydration, aiming for 1L of fluid over the next 12 hours. We decided that rehydration will be one of the top 3 priority as the patient reported overnight vomiting and diarrhoea. The standard 6.1 was demonstrated when we delivered medication education to the patient. This enhanced the comprehensive safe, quality practice to achieve goals, which are rehydration and pain management.

Application of Standard 7: Evaluates outcomes to inform nursing practice.

Towards the end of the workshop, teammate and I discussed what we did and our rationale behind our care. By talking with the team leader, I was able to extend my view point and consider how our priority could have been different. Team leader suggested including abdominal assessment with A to G assessment to be efficient and to effectively manage time. I believe this aligns with the standard 7.2. Whether the right or wrong, listening to different perspective on same scenario allowed me to reflect on my care and think what could have done differently.

Future strategies

For my upcoming placement, I would like to focus more on the standard 4.1. During the workshop this week, knowing that patient was deteriorating, I was completely focused on doing assessments in rush rather than thinking about how assessments can be done appropriate, such as asking for consent before an assessment and talking to the patient during the assessment. Reflecting on myself, only conversation that I did with patient during the assessment was asking how the pain was. Therefore, I would like to ensure that my care aligns with the standard 4.1 through more communication during the care. In addition, I would like to perform the standard 5.1 by having more wider perspective. Reading the notes, I was only focusing on main issues such as nausea and fever. However, to completely perform the standard 5.1, I will continue to practice considering patients history and focus more into details rather than straight picking up priorities. I acknowledged that I need some time for myself to have complete thinking rather than acting straight away after reading half of the note. Overall, my future strategies will be more person-centred communication and focusing into details when reading patient information.