In this module, I learned about nursing care affecting patient's health outcomes in mental health. This seminar demonstrated that conducting practices in accordance with relevant policies, guidelines, standards, regulations and legislation are very important to improve quality of care and maintain safety culture for patient. It is not only safe for patients but also me as a RN. This is because I will ensure all my care plan and practices will adhere to government's law and policies of the hospital to avoid myself from misconduct which could lead to termination of employment.

For treatment of mental health patients, it is important that care plan must follow instructions from policies and regulations from the hopital. For example, in terms of mental health, mental health patients are very difficult to handle with, sometimes their mental stage is not stable, they could be very depressed, or upset with anything, including physical, metional interactions. It is not only for mental health but also other sector of health care such as aged care, emergency, acute care unit, intensive care unit, etc. Procedure or policy could help us to implement care plan effectively to help the patient promptly in terms of health deterioration or emergency to prevent errors. For example, in term of health deterioration, the Recognising, Responding to Acute Health Deterioration Policy instructs us what to do, who to do, who is involved to ensure that we could take in prompt action for deterioration patients. We could help patients promptly to prevent critcal health issues occur. Thus, if the care plan or nursing practice are implemented in accordance with relevant policies, guidelines, standards, regulations and legislation, it will be helpful to improve patient's health outcomes such as showing respect to them by conducting the patient's rights, complying with policies and procedures to gather accurate data to develop an appropriate care plan for the patient, etc. Especially, compliance of these policies, procedures regulations, and legislation ensure the safety for my patients as well as me as being at risk of misconduct of legislation.

In the seminar:

I was given simulation of Avery. She was distressed and confused about her DKA. She does not know what to do and how to manage her DKA at home. The students showed empathy on what she shared such as being active listeners, using body language, maintaining eye contact, sitting with patient. Then, the students discussed about solutions, discharge plan to the patient with her family. The student educated Avery and her familty on how to manage DKA at home as well as reassure them. The students discussed about agreed care plan with Avery and her family to ensure they understand and get involved in the plan. Refering them to allied health if they want to know further about current health condition such as DKA, medications, dietary, etc. I learned a lot about how to educate my patients as well as how to communicate with patient’s family to ensure they work in partnership with me. Then, I could seek for agreement and consent for my care plan, when I educate them on the plan. Also, my care plan will develop based on what they shared, as well as priorities of care need from them.

During my placement, in the ward I was working, I and my RN were looking after a female patient who had a background of chronic back pain. Current reason of admission is hypertension and chronic pain. Also, according to her medical history, she has obisity, hypertension, depression and is limited to mobilize herself. She needs at least 3 people to help her transfer from bed to commode chair to move her for toilet or shower. She is very depressed and frustrated when she wants someone to come immediately to help her otherwise she will do it herself without pressing call bell. I and my RN found out that our patient's ID band is not match on the name appeared on the system when we came to help her. My RN reported to teamleader to ask her to confirm which one is correct one, which is ID band or name on system, to ensure we could provide nursing practice effectively and safely within our standards. Also, my RN identified fall risk to add it on system to handover and alert other nurses to prevent her fall.

Standard 6.6 - using the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards:

I think this standard is relevant to my recount. Because this standard shows me that I should use appropriate processes such as Medication Safety Policy, Blood Management Policy, Informed Consent- Clinical Policy, etc to identify potential or actual risk related system issues and where I think my practice or other practice may be below the expected standards. For example, If the name of the patient on system is wrong and not match with the name on the blood bag, I must double-check with doctors or other teamleader to find out actual name and update it on system to ensure there is no error in blood tranfusion or other medication administeration which affect the patient's health. Reflect to the recount, my RN double-checked my work on DHR and found out that I filled information such as Vital Signs, and fluid output on wrong places and time. To prevent the error which may cause their practice to be below the expected standards, my RN identified and reported the risk to teamleader. These error on the system will put my patient in danger. For example, we could administer medications to a wrong person. Then, we could kill them or put them in danger. Also, it is the same with identified potential risks to my patient as she may have a fall due to current health condition. This will make our practice below the expected standards if I ignored the risks and let it happen to my patient. These mistakes from the system as well as neglect of care could put us below the expected standards and lead us to legal issues. This is why I should learn from my RN to ensure that in the future I must identify and report any potential and actual risk related system to help me and my colleague maintain our scope of practice within NMBA standards.

How will I demonstrate this standard in my future practice?

• I always need to double-check everything and ensure everything is matched between system and paperwork. As a result, I could prevent mistakes and risks related system which cause myself and colleagues in trouble of legal issues and below the expected standards. For example, when I administer medications according to Med Chart on DHR, I must conduct Medication Safety Policy. According to the Policy, it says that I must conduct 7 rights: Right Person, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation. if system has an error in showing a wrong name or MRN, I must withhold medications, inform my patient why I withhold until name or patient's information are updated. By doing this, I prevent actual risks to cause my practice below the expected standards.Reflect to case study above, I must always check and compare paperwork and system to ensure all information is matched. The errors could be from human or system. Thus, to avoid system issues or other issues affecting the standards, I must identify and report to prevent mistakes from system or other issues affecting patient's health outcomes or their own safety. For example, wrong medications, wrong MRN, wrong documentation, etc.

• Also, I must report the potential risk or actual risks if I identify it on the system. It may include wrong data, or information, delay of loading patient's information, lagging, or broken system/ softwares (DHR, PowerChart). This is because if the system is delayed or broken, It will slow me down to follow my care plan. For example, I try to administer medications in accordance with assigned time like blood pressure tablets for those who the doctor required to give it on time. However, my system is down and there is no replacement at that time. This causes me to take time to check medications on other COW to maintain Medication Safety Policy. I may miss the time I am supposed to administer important medications such as Levodopa. Alternatively, I may slow down my work throughout my shift and some of my patients may not receive help for personal care. As a result, I am not able to fullfil my duty and tasks during my shift which downgrades quality of care. Thus, my practice will be below the expected standards due to low quality of care.

• Apart from system issues, I must use processes to identify other issues where my practice may be below the expected standards. For example, when I look after a patient who has medical history of hypertension, I recognize that her blood pressure is not stable and repeatedly high during my shift. I must alert my nurse partner and identify her as a high fall risk due to attended hypertension. Also, I must update on system to alert other nurses to pay extra attention on her to ensure she is safe. I must keep everyting within her reach and ensure call bell is always within reach. I also must report my patient's health issues to teamleader or doctors to seek for interventions such as medications to reduce her blood pressure. By doing the process of nursing practice, I could identify potiential risks causing my patient's fall which downgrade quality of care and patient's safety. It results in bad performance in NMBA standards and misconduct of duty of care.

Why I think it is important?

This is because I will ensure my pracitce will be within or above the expected standards by improving quality of care through care plan or my nursing practice. If I could use appropriate processes to identify and report issues caused from the system or other issues affecting patient’s health or quality of care. For example, according to Medication Safety Policy, I identified wrong information of my patient on system, I would report it with teamleader to find relevant people to fix it and ensure it is correct to maintain culture safety. Also, there are several factors causing me to affect negatively my nursing practice which lead to be below NMBA standards, but system is one of the key opponents affecting my nursing practice. Because most of the time I work and conduct my nursing practice is on the system. For example, it includes checking patient details, medical history, reading notes from healthcare professionals, writing notes for handover, communicating among the team, etc. Risks related system definitely affect my nursing practice in both ways, direct and indirect ways. This leads to be below the expect standards as mainly affecting quality of care.

During the seminar after clinical skills lab, I was designated with other students to identify elements affecting patient's mental health outcomes such as patient's rights, collaborative mental health teams, therapeutic relationships with patient, trauma informed nursing care. Then, we will discuss on each opponents to break it down and learn from it. The opponent which impressed me the most is the patient's rights in mental health care. We discussed about Mental Health ACT 2015, Health Practitioner Regulation National Law 2009, Australian Charter Healthcare Rights. I leanred about how we ensure it is demonstrated in our future practice and why it is important to adhere to at work.

During clinical skills lab, I had a chance to practice medication calculation of Naloxone which is an opioid antagonist used to reverse or reduce effect of opioids. Also, I was in a group of 3 students to practice ISBAR handover to inform other healthcare professionals when the patient has symptoms of opioid overdose and how we conducted assessments and interventions to help the patient such as using Naloxone, checking vital signs, etc.

Standard 7.3 - Determines, documents and communicates further priorities, goals and outcomes with the relevant persons.

Why I think this standard is fit to my recount?

According to the recount above, I think standard 7.3 is fit to what I experienced in clinical skills lab this week. This is because I was given a case study of a patient who has symptoms of opioid overdose. I should review the documentation of that patient such as med chart, vital signs, nursing progress notes, etc. Then, I will develop clinical reasoning to identify factors affecting patient's heatlh deterioration such as slow, difficult or shallow breathing, being unresponsive or unerousable, vomitting, etc. I will conduct assessments to gather useful and accurate information to support my clincial reasoning as evidence-based nursing action to help me make right decisions on priority of care. Naloxone will be an intervention to reverse or reduce effect of opioids for the given case study after I identified the issue.

However, according to the standard, my responsibility is to ensure my patient is safe and care plan is followed up often after recognition of health deterioration. That is also my responsibility to evaluate the outcome after administering Naloxone. After administeration of Naloxone, I should document it and evaluate the effect of Naxolone to ensure my patien's health is stablized and effect of opioid overdose is reversed or reduced by conducting assessments in accordance with policies, guidelines, procudes from the hospital. When the MET team or other healthcare professionals come, I will provide a detailed ISBAR handover based on what I documented before. For example, my ISBAR handover should include what happened, what I decided to do to solve that health problems, when I administer Naxolone and why I think the patient is overdosed, what's my plan after administeration of Naxolone, etc. As a result, I could discuss further for my patient's care plan with other relevant healthcare professionals such as doctors, surgeons, teamleaders, etc. Thus, I will follow up updated care plan from healthcare professionals to ensure the patient's health is stablized and has good outcomes. Also, I must inform my patient for updated care plan to keep them up-to-date their treatment as well.

What should I do to ensure standard 7.3 will be implemented in my future practice?

To ensure this standard will be implemented in the future practice, I must:

• If I looked after a patient who deteriorate and health health concenrs, I must follow the policies and guidelines of recognising responding to Acute deterioration from the hospital. After that, I must document it on system like DHR to provide evidence-based approach for priorities, goals and outcomes. For example, according to the policies, if the patient has signs of health deterioration, I must promptly recognize, respond and take appropriate action, as detailed in the supporting procedures/ policies/ guidelines, where the patient experienced actue clinical deterioration. The policies/ guidelines/ procedures will be found on ACT health guidelines, and must be followed by me as a RN to ensure the patient is looked after promptly. For example, according to the Recognising and Responding to Acute Deterioration Policy, I must evaluate the outcomes by reviewing Vital Signs which are repeated within 45 minutes after medical interventions if MEWs scores > 4, if it’s above 4, I must escalate it and call MET. After my evaluation of care plan, I must determine and document it on DHR to communicate with an interprofessional team. For example, in terms of opioid overdose, after medical intervetion, I will evaluate outcomes by checking and reviewing Vital Signs to ensure Vital Signs within normal range according to the policy. I will update it on DHR and keep doing it in accordance with the policy.

• If the patient's health is deteriorated and received pharmacological and non-pharmacological interventions to help the patient to recover. However, after the interventions, their health is not stable and shows abnormal signs such as increased heart rate, decreased blood pressure, high respiratory rate. I must document all information I reviewed on DHR to ensure my care teams is up to date knowlege of my patient's current health. The doctor could review documentation such as Vital Signs, pain assessment, Med chart. Thus, they will prioritize care to ensure my patient gets treated promptly to prevent negative outcomes. Also, doctors will update care plan and outcomes to help me to follow up and keep evaluating care plan until further instructions are given from the doctors.

• How I know my patient’s condition gets better?. This is why I must review the vital signs to recognize signal deterioration on what I documented before. I must communicate clinical concerns, including in handover situations with other relevant people such as RNs, doctors, teamleaders, patient and their family. I document my evalution of MEWs chats to support me and my care teams for devleloping clinical reasoning for priorities, goals, outcomes for my patient. Vital Signs are documented to provide accurate data or information for further priorities, goals, outcomes. However, Vital Signs are not only evaluation I could do. There are various information I could collect. For example, pain assessment, wound assessment, mental health assessment like mental stage examination, etc. Based on these assessment, my documentation is very informative to help me to discuss for further priorities, goals, outcomes with doctors and nurses.

• I must work in partnership with the patient to ensure the patient is educated about their current health, inform consent, discuss and let them involve in care plan to ensure the patient gets respected and particiates in decision making on their goals, care plan, health outcomes. Especially, my patient has rights to know what is going on about their health. As a result, they could make decision on maintaining care plan, changing care plan or refuse care plan. I must document all evalutions from assessments to give them accurate information about their outcomes. I will communicate with their family if they consent me to reveal their clinical information to agreed people like family, relatives, friends, and clinical treating team such as GP, doctors, nurses.

Why I think it is important?

This is because I will ensure my evalution through my shift based on Vital Signs, assessments will be documented on DHR to inform practice to care teams. As a result, we can develop appropriate care plan to help my patient get better. Also, it is easy for me and my care teams to inform and educate patient and their family on what we are going to do, what is our care plan for that patient. I and my care team can discuss further on priorites, update a new goals to help my patient get better.

For this standard, I understand that the RN must conduct the assessments to identify factors affecting health. This includes reviewing your patient’s medical history, diagnosis, and medications. Then, the RN will develop a care plan based on accurate information and discussion with relevant healthcare professionals about priorities of care. This care plan will discuss with the patient to grant consent and agreement from the patient.

I think it is relevant to the recount above because the RNs constructed their nursing practice plans such as assessment, diagnosis, outcomes, implementation, and evaluation through hospitalization of Avery until all goals, options, outcomes are agreed with Avery and her family. This is why it is described in discharge plan for Avery which gets consent and agreement from Avery and her family. Also, in the simulation, Avery was distressed about her health issues and does not know how to manage her health issues. The RNs reassured her and educated her about discharge plan which includes contingencies, options, priorities, goals, actions, outcomes, and timeframes. The RNs explained her how it is important to her health as well as encourage her to follow the care plan at home to ensure she could manage her health issues. Also, the RN referred her to allied health if she has any concerns. The RN ensures that Avery understands and is well-educated in relation to discharge plan to be able to make decisions on her plan. As a result, the RN will grant the agreement from her to keep moving on care plan.

How I ensure that my future practice will adhere to standard 5.2 in the future?

To adhere to standard 5.2, my practice must include:

• I will work collaboratively with care teams (doctors, nurses, etc) and ensure that they can access the same information, give input, and join forces to provide the best care. For example, based on assessment data, I will develop a plan for patient's health outcomes. The plan will be discussed with relevant people such as doctors, physiotherapists, nurses, surgeons, etc to ensure it is effective and efficient for our agreed goals which are positive health outcomes of the patient. This example could reflect my future practice. For example, in this simulation, with DKA patients, I will develop a care plan based on medical history as well as current health issue to ensure my care plan is applicable and efficient. Care plan includes healthy diet, exercise, glucose management, diabetic medications, healthy lifestyle. The discharge planning include the goals which are to prevent high glucose levels, which helps prevent diabetic complications. The condition should be managed by an interprofessional team that includes the nurse practitioner, pharmacist, primary care provider, and an endocrinologist. To improve my plan, I must work collaboratively with an interprofessional team (the nurse practitioner, pharmacist, primary care provider, and an endocrinologist). This is because I will receive valuable information from the team to reinforce my care plan. For example, if doctors alert me that Avery's blood sugar is not stable and must check to monitor it carefully, my care plan will be to educate Avery on importance of careful monitoring of blood sugars at home and give her referrals if they need someone to contact for education.

• The well documented care plan developed by me should be collaborative with relevant people such as doctors, nurses, and patient. For example, when I developed a plan, I must inform my care team such as doctors, nurses to ask them to review and give feedback to improve my care plan. After the dicussion, my care plan will be set and asked for consent from my patient by educating them and giving them time to make decisions on agreement. Importantly, I not only work collaboratively with my care team but also my patient to let them get involved in their care plan to show respect and reflect their autonomy in healthcare practice. I will put this into case study of Avery to show what I will do in my future practice. When my discharge plan inlcuding my care plan is updated. My care plan will be reviewed by doctors to ensure it is applicable for my patient's conditon and could help to achieve agreed outcomes at home. The doctor and nurses could review and update additional plans of action to reinforce the care plan such as prescribing additional medications for glucose management at home, education of medications, etc. After updating care plan, the doctors and nurses will have agreement to finalize care plan for my patient.

• Prior to implementation of care plan, I must educate the patient about care plan, as well as let them invovle to develop care plan and make decisions on how they wanna follow the plan. When they are well-educated on care plan as well as how the care plan affects positively on current health outcomes. I can seek consent and agreement to go further on care plan and treatments for their health. For example, in terms of DKA in my future practice, I will discuss my care plan and discharge planning with my patient. I will explain them about how my care plan works. It include to evaluate knowledge of my patient to ensure they understand everything I put in my care plan. For example, I will ask my patient if they know how to check their blood glucose at home, or how they monitor blood sugars at home. I will show them my care plan to help them monitor blood sugars. I will discuss on what changes in their lifestyle, diet, and medication adherence to ensure my patient understands and takes some time to consider to make decisions on their health. After discussion, I will ask for consent or their agreement on my care plan. After modifying and getting agreement from the patient, I could start to proceed care plan and go further to modify and work collaboratively with my patient to achieve agreed outcomes.

Why I think it is important?

Conducting this standard is very important. Because I must ensure my patients understand and are educated about what I am going to do to help their health get better. Also, I could show my respect towards them by letting opportunities to get involved in nursing care plan, decision making. In terms of legislation and law, I fulfill and adhere to legislation and law in relation to human rights in healthcare published from ACT health government.

• Exploring, learning and applying policies, guidelines, standards, regulations and legislation from the hospital as well as government in my practice to ensure that all my nursing practice including care plan must follow policies, guidelines, standards, regulations and legislation. For example, if I look after the patient who is on medication of Hydromorphone, I will need to follow the policy published within the hospital to show me how to treat the patient who is on medication of Hydromorphone to avoid medication error or overdose. According to the policy, I must record the dose and time. When I administer Hydromorphone, I must do with another RN to ensure I administer correct dose, correct patient, fullfil medication safety policy to avoid medication error or overdose of Hydromorphone.

• In terms of regulations and legislation, I will develop my care plan or provide care to my patients in accordane with regulations and legislation. Also, I will be concern about scope of practice to avoid breach of standards, professional misconduct involves a breach of accepted ethical standards, lack of informed consent, unethical behaviour, etc. For example, in terms of the Privacy Act 1988, in the case study of mental health patient, when I collect and handle personal information, including health information, I must ensure that all information should maintain confidentiality and not disclose to other people who are not relevent apart from agreed relevant people such as doctors, nurse, etc. It also includes provisions that generally allow an individual to access information held about them. I am not allowed to take a picture of DHR or anything at hospital to protect patient's privacy and ensure to maintain confidentiality at work. My practice includes care plan must be confidential and share with agreed relevant people to protect privacy of the patient. Also, I am not allowed to comment, share or discuss anything in relation to my patients, colleagues, workplace on social media. It will show misconduct of The Privacy Act 1988 and lead to lose my nursing registeration and termination of employment.

• In terms of Australian Charter of Healthcare Rights, througout my nursing practice, I must ensure that patient's privacy is maintained. For example, when I and my care teams conduct assessments such as wound assessment, mental stage examination. I must maintain patient's privacy and grant consent from the patient to do. Also, medications and care plan must be agreed by the patient. The patient always has rights to deny treatment or medications. However, I must educate the patient before their refuse to ensure they understand care plans as well as medications to make decisions on their health. For the care plan, my patient has rights to get involved in developing their care plan as well to ensure they feel comfortable and inclusive in the treatment. Respect is the key opponent to reflect this regislation.

• In terms of NMBA standards, I must follow policies or guidelines from ACT health to ensure my practice is accurate and help prevent common errors and illnesses as well as reflect demonstration of NMBA standards. For example, according to standard 6.5, my pracitce must include hospital policies and procedures to improve patient safety by helping guide decisions in critical moments. For example, the policies include Clinical Governance Policy, Partnering with Consumers Policy, Preventing and Controlling Infections Policy, Medication Safety Policy, Comprehensive Care Policy, Communicating for Safety Policy, Blood Management Policy, Informed Consent – Clinical. For example, in terms of Medication Safety Polic, when I administer medications I must ensrue it includes 7 rights: Right Person, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation. For example, if I administer medication, I must conduct Medication Safety Policy, Informed Consent-clinical, communication for safety policy. Alternatively, when I do blood tranfusion, I must follow Blood Management Policy to prevent blood tranfusion errors which lead to critical health concerns. One more example to reflect compliance of NMBA standards, I am responsible for evaluating outcomes from agreed care plan to ensure the care plan works well and efficiently. For example, I must check fluid balance chart and conduct a bladder scan to ensure there is no fluid retention when the patient has fluid therapy after surgery.

Why is it imporant?

Because I could demonstrate culture safety at workplace by following hospital polcies, procedures, legislations, etc. For example, If I follow medication safety policy, I will prevent medication errors occurred in my practice. This one could protect my patient from critical errors as well as protect myself from misconduct of policies, procedures, legislation and law which leads myself to termination of employment and lose my registeration as well as legal issues.

In the clinical skills lab, I was given a scenario of a child, named Yasmin, 4 years old. I was designated to work with another student nurse in the seminar as RNs. In the scenario, Yasmin gets burned by an accident at home. She is hospitalized and get treated well by professional healthcare team. We got informed from Yasmin's mother as she was crying uncontrollably. When we arrived, we conducted A-G assessments, Wong-baker pain assessment as Yasmin is too young to provide an accurate pain score, also we review her wound to check condition of her wound and dressing in case of infection. We tried to have a look on Med chart to check whether we have any PRN medications we could give to alliviate her pain. Unfortunately, there is no medication we could give as all medication including PRN had given before the event occurred. We calmed down Yasmin by reassuring her and offering her anything which she likes by collaborating with her mother to find out what she likes to calm her down. For example, ice cream or candies which could help to comfort her. We also listened to her mother and showed empathy on what she shared. We reassured her as well. It is hard to measure her pain score as she is too young to indicate exactly what she feels. Also, she was crying uncontrollably that I felt like hitting a roadblock. However, we tried to offer non-pharmacological interventions such as cool therapy. We informed the doctor to come and see Yasmin. Prior to the arrival, we ensure all information is prepared to give the doctor a good handover such as Med chart, A-G assessments through Vital Signs, what interventions we conducted. When the doctor arrived, we conducted ISBAR handover. Then, we listened to doctor's instruction and do it promptly to ensure Yasmin feels comfortable.

Standard 4.3 is defined as interprofessional teamwork to identify factors affecting or potentially affecting the health and well being of the patient. This partnership also includes family of the patients. Based on accurate information gathered from assessments, RN will prioritize care needs to develop a care plan for the patient. This is why I think it is very applicable for this case study.

To be more specific, I will explain why I think standard 4.3 is well fit to this case study. According to the scenario given in the seminar, we conducted assessments such as A-G assessments, wound assessment and pain assessment (Wong-Baker). We tried to gather accurate information to identify factors which could explain the reason why Yasmin was crying. It comes from poor pain management. I and my partner worked in partnership with Yasmin's mother to identify factors causing her pain and conducted non-pharmacological interventions to help her alleviate pain. For example, we asked Yasmin's mother what she usually gives Yasmin to comfort her when she cries. As a result, we could offer her some sweets or ice cream according to Yasmin's mother. Consequently, we could identify factors based on what Yasmin's mother shared as she is the only one who stayed with her most often throughout her hospitalization. After conducting assessments to gather useful information, we documented on DHR and develop a ISBAR handover to deliver good handover to the docter when he/she arrives. In terms of partnership with my classmate, we designated jobs to ensure all tasks were done promptly and promoted teamwork to lead to better outcomes for Yasmin.

I could not do anything further to help Yasmin to alleviate her pain by conducting non-pharcomological interventions such as cool therapy, etc. I and my partner hit the road-rock as no options on PRN medications. This is why I seek assistance and advice from other health professionals for refferals such as the doctor in this scenario. Because the doctor could review her wound and pain to identify factors affecting her pain management which leads Yasmin to cry. Then, the doctor will consider to update a new PRN for pain management.

• Buidling a therapeutic relationship with patients and their family. I could do it by talking, educating, and letting patient and their family involve in decision making such as I inform them what medication I will give them, explain them what medication is used for, and respect their decisions on taking medications or not. For example, I will have a chat with patient and their family everyday when I am working. I show them my friendliness and professionalism to build up a therapeutic relationship. Maintaining conversation by keeping checking on their health, asking how they feel, being an active listener, showing compassion and sympathy on what they share about problems will be an important opponent for me to reinforce the therapeutic relationship with patients and their family.

• Building trust to patient and their family by informing them about treatment progress, current health condition as well as educating them on how to do the best to improve their health. Additionally, I will lisen to their feedback and what they share to show my empathy and respect. As a result, I could build trust from the patient and their family. Their family will work collaboratively with me to deliver the best care to the patient. For example, to build trust, I must show them professionalism at work such as maintaining privacy when I conduct wound assessments, asking consent before doing anything to respect them, documenting accurate information from assessments to inform practice to other relevant people such as doctors, and nurses. Also to maintain professionalism, I must ensure all my practice will adhere to NMBA standards, policies, procedures, regulations and legislation. As a result, my patient and family will trust me as they know I am doing right things to help them in accordance with NMBA standards, policies, procedures, regulations and legislation. They will know that I can conduct my nursing practice and seek for other assistance from the team such as doctors and nurses if they have any issues that they want to discuss.

• When the trust is built among myself and patient's family, I will be able to work in partnership with patient and their family. They will share with me information which is very useful to develop a care plan or interventions to solve urgent health problems. For example, the family informed me how the patient feels such as pain, identification of where the pain comes from. In terms of the elderly, it is helpful when their family assists us to encourage the patient to take medications or give consent to do wound assessment, etc. Patient's family is the one who stays with them most of the time. Thus, they will supervise patient's health condition as well as be very informative when I want to identify cues for identification of health deterioration. This is because the patient usually shares what they feel, also their family could know what abnormal signs from the patient's body or feeling as their family always looks after them such as personal hygiene, daily meals, chatting with the patient.

• Working in partnership with other health professionals to identify factors or potential factors affecting patient's health such as physiology therapists, occupational therapists, specialists, RN, surgions, etc. Thus, I could identify and refer patient and their family to any referals who could sovle the health problems. ISBAR handover is the process that I could work effectively and efficiently with other healthcare professionals. Informative ISBAR handover could help me and my team to develop an appropreate care plan to help patient's health get better and prevent any negative outcomes. Especially, working in partnership with another nurse helps me to manage my time and energy as well as avoid errors such as medication erros, neglect of care as I am busy and have no time to assist my patient and I must leave my patient alone without help. As a result, we could help our patients as a team to achieve agreed outcomes. My partner could help me to do assessments or share knowledge about my patient to help improve quality of care. For example, my partner used to look after my patient 2 days ago, and she knows of this patient what the patient shares about what they do not like, what they like. As a result, I could falicitate my care plan to ensure my work is effective and I will be able to identify any factor affecting my patient's health if it occurs.

Why I think it is important?

This is because when I work in partner with patient's family. They could provide me very useful and valuable information and data as they are closed ones to the patient. For example, the mother always visits her daughter throughtout her hospitalization, staying with her daughter everyday. She will be able to know how her daughter's condition better than me. She could give me some advice to assist me in administeration of medications or give support to me to encourage my patient to take medications or exlpain care plan to them to grant the consent. This support from the family will falliciate my nursing practice to deliver holistic care nad improve quality of care for my patient.

This week, I had a chance to work in partnership with another student in the scenario of Sam in the simulation. When we entered the room, a second year student was nervous and asking for our help as her RN was on break without giving a proper handover. Sam's condition was getting deteriorated. I was a bit nervous but I decided to intrdoduce ourself, and our role. Then, I and my partner reassured Sam. While talking to him, we conducted A-G assessments with assistance of the second year student who helped us to check Vital Signs. Sam gave me pain score 9 out of 10. When we wanted to check on PRN for analgesia, the student said that Med chart was taken by doctor and never return. We decided to call MET team as well as asked the student to call team leader on duty. While waiting for MET team and team leader to come. I and my partner gather all information regarding Vital Signs, A-G assessments, wound assessments, etc. We get everything ready to put it in ISBAR handover. Then, when the team arrived, we conducted ISBAR handover with all information as well as abnormal signs we identified. We worked collaboratively with MET team and team leader to ensure Sam's condition is stablized.

How I think I collect relevant and accurate information? It depends on how I develop my critical thinking to analyze the cues. For example, Sam complained about pain, I must locate where is the pain from, what tools of pain assessments I should use to evaluate how severe pain is. As a result, I could choose correct assessments to conduct to collect relevant and accurate information to inform practice to other healthcare professionals.

Also, if I use a range of assessment techniques to collect relevant and accurate information, it will be imformative in my ISBAR handover to other healthcare professionals such as doctors, surgeons, registered nurses, teamleader, etc. Thus, healthcare professionals could develop appropreate plan for the treatment for health deterioration and put it in action promptly to save the patient or help them to recover more effectively. For example, according to the scenario, I and my partner conducted A-G assessment, pain assessment, wound assessments, as well as neurological assessment. When the doctor arrived, I could give a very informative ISBAR handover to the doctor. Thus, they will act promptly to help Sam overcome his pain such as administering some analgesia to alleviate the pain, sending him for scan to identify bleeding site, etc.

• Able to identify factors affecting patient's health in terms of health deterioration. According to identified health issues, clinical reasoning will be developed to come up with other assessments to gather data or information. For example, if the patient complains about pain, I will ask them if they could describe their pain such as sharp pain, intensive pain, etc, where the pain comes from, when they have the pain, how long the pain lasts. I must check on med chart for PRN to review if analgesia works or not to evaluate the pain and think what causes the pain, maybe from internal bleeding, uncomfortable position on bed, or other issues. As a result, I could conduct pain assessment, and wound assessment to investigate further why the pain appears such as infection, bleeding, etc. These clinical reasoning will form other assessments such as sending patients for CT scan, taking blood for assessment, etc.

• Able to have think critically about a range of assessment techniques that could be used to collect accurate data and information. For example, if I doubt the patient have internal bleeding at surgical site, I should ask myself what causes internal bleeding, what cues indicate and prove my reasoning is correct, how I assess the issues, etc. As a result, I will make decisions on conducting apprepriate assessments to collect information that I need it and be useful to inform practice for prompt treatment. For example, checking their Vital Signs to review blood pressure, temperature. Checking pain from the wound to identify the problem and send them for scan to ensure what I doubt is accurate.

• Able to document relevant and accurate information collected from a range of assessments to ensure that ISBAR handover for other healthcare professionals is very informative and accurate based on all my assessments. If all information and data are collected and informative, I could prepare and give a good ISBAR handover which facilitates clinical decision making from healthcare professionals like doctors, surgeons, teamleader. As a result, they could interven to help the patient promptly in terms of health deterioration. For example, I must update information on DHR as well as put it into nursing progress notes for handover with other nurses and doctors to help them easily follow up my patient’s condition. Also, I will have accurate information to develop care plan for them as well as conduct my nursing practice to help my patients get treated on correct health issues. Accurate information prevent misdiagnosis or mistakes from inaccurate information which cause my patients worsened health issues.

Why I think it is important?

This is because when I am able to identify factors affecting patient's deterioration. I could choose accurate assessments to discover the issues promptly and develop my clinical reasoning to answer questions what causes it, how it causes,why I think it relates. As a result, I could gather accurate information and data to inform practice or provide the best ISBAR handover to care team (doctors, nurses, etc). Thus, my care team will develop care plan based on information or data that I gather from my assessments as evidence-based nursing approach.

After providing care plan for deterioration or to improve patient's health condition, I must evaluate practice based on agreed priorities, goals, plans and outcomes. For example, if the patient deteriorates, such as they have 4 episodes of diarrhea and have signs of dehydration such as dry lip, decreased urine output, dizzy,etc, I will discuss and educate my patient on what I think it is good for them such as drinking water to maintain hydration within the body. When the agreement is granted, I will document input and output of fluids on fluid balance chart to review. I will evaluate my agreed care plan by reviewing fluid balance chart to ensure the patient get hydrated and my care plan is going well as I discussed with my patient before about agreed outcomes.

Why I think it is imporant?

It is because If I could evaluate the agreed outcomes, goals, care plan, I will know how it actually affects patient's health, positive or negative. Also, I could measure how effective and efficient my care plan, goals, outcomes are. As a result, I could revise care plan, goals, outcomes to monitor it to go further for priorities, goals, outcomes with relevant people (doctors, nurses, patient and their family,etc) to make the plan better for the patient's health. Positive health outcomes are what I, care team, patient and their family are aiming for.