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

McGraw-Hill.

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

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

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

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

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

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

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

·         always follow the clinical reasoning cycle,

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

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

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

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

During the debrief, some key messages were:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Coming into the second week, my set goals are:

·         continue taking a full patient load,

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

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

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

Some areas for further development are:

·         consistent patient note-taking, 

·         liaising with the MDT (including referrals), and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key themes of this debrief were:

·         importance of A-G assessments,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

·         altered thermoregulation,

·         comorbidities,

·         polypharmacy,

·         communication barriers,

·         a higher mortality rate and recovery,

·         comprehensive care plan considerations, and

·         lack of support (Queensland Health, 2023).

The paediatric focused group considered factors including:

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

·         psychological and legal aspects,

·         family and parent involvement, and

·         assessment considerations (RCH Melbourne, 2025). 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We had four patients:

• Mary, 85-year-old female

  • Diagnosed with mild dementia two years ago.

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

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

• John, 79-year-old male

  • Diagnosed with diabetes 15 years ago.

  • History of congestive heart failure.

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

• Rose, 82-year-old female

  • Is very frail with a history of COPD.

  • Limited mobility due to COPD.

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

• Paul 77-year-old male

  • Generally healthy with mild mobility issues.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

During the debrief the key points mentioned included: 

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

·        the importance of practising within one's scope,

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

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

·      partnering with consumers,

·      addressing problems as they are found, and

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

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

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

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

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

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

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