Excited to be back for the INC 6 workshops, what's even better is that we have 3 hours of it!!! Bec kindly orientated our course for this semester, which consists of 3 x 50 minute classes (simulation, clinical skills and reflection). Going ahead, I contain a bag of mixed emotions such as excitement, nervousness and a tiny bit of burnout. However, I am quite eager to not only advance my practical skills but also deepen my clinical understanding and reasoning of our roles as nurses and what leads us to make clinical decisions in our day to day nursing lives.

Thanks Liam ;)

The experience highlighted several critical areas of nursing practice, including the importance of patient-centered communication, health literacy, and clinical care standards. The two student nurses who participated in the scenario effectively demonstrated the need for a calm and reassuring approach when dealing with a nervous adolescent patient. They were successful in creating a supportive environment, actively listening to Avery's concerns, and maintaining a patient-centered conversation. This aligns closely with the NMBA Nursing Standards for Practice, particularly Standard 2.2, which emphasis's engaging and communicating in a therapeutic and professional manner, and Standard 2.4, which provides support and direction to resources to gain a clearer understanding of their health and decision making.

DKA is not my strongest subject. In previous placements and modules, I have found it a bit harder to align the issues/reasoning's to DKA, such as poor health education on diabetes, prolonged hyperglycaemia, medications and electrolyte imbalances. I have found that being a visual and hands on learner I tend to design/draw or focus attentively on animation diagrams to understand module concepts. The link above enables me to connect the dots of the why? what? when? and how? in pathophysiological topics. Rather than watching power slide points or reading chapters where I would not retain the information 5 minutes afterwards. I feel having these visual presentations, just like our debrief setups for simulations can not only drive my motivation of understanding various topics but also develop more subject focused goals that I can complete inside and outside of the clinical setting.

In applying NMBA standards, particularly Standard 5.1, I would use assessment data to tailor a plan that addresses Avery's specific needs, considering their limited health literacy. This includes collaboratively developing a nursing practice plan (5.2) that sets clear, achievable goals and educating them in a way that is easily comprehensible. Documentation and regular evaluation of this plan (5.3) would ensure it remains effective and responsive to them progress. Ensuring that all education and care provided aligns with the relevant policies (6.5) and is delivered within my scope of practice (6.2) is paramount. By effectively coordinating resources, such as engaging a diabetes educator, and providing timely supervision where necessary (6.3, 6.4), I can help facilitate a safe and supportive transition for Avery from hospital to home, empowering them and their family to manage them condition effectively.

As for my future practice, I am to master my understanding of DKA in adolescents, key future strategies include prioritising continuous education on the pathophysiology of DKA and its specific impact on adolescents, actively engaging in simulations and clinical practice to reinforce hands-on skills, and maintaining up-to-date knowledge on the latest research and guidelines for DKA management. Additionally, focusing on developing strong communication skills to effectively educate young patients and their families about DKA prevention and management, while also being culturally sensitive and considering individual health literacy levels, will be essential in providing holistic and patient-centered care.

Learning to draw up medication and utilise various tools has been a great experience. I've observed how seriously nurses take weight-based calculations, especially considering the vulnerability of paediatric patients to medication errors. The narrow therapeutic window in paediatric dosing means that even a small miscalculation can have significant consequences.

The mental health aspect of the ward has been particularly challenging. I’ve learned a lot about using appropriate language, especially during meal times with younger patients with eating disorders like anorexia and bulimia nervosa. I believe these disorders profoundly impact decision-making and self-worth, often driven by extreme judgment of one's weight and appearance. I was also not aware of what bulimia nervosa was!! I now know it involves losing control while eating large amounts of food and then attempting to purge the calories through vomiting, laxatives, and diuretics (Loop diuretics: Furosemide and Thiazide diuretics Hydrochlorothiazide). These two eating disorders profoundly impact decision-making and self-worth, often driven by extreme judgment of one's weight and appearance. Preventing the re-occurance of these behaviours required me to take initiative actions such as playing requested musicians on Spotify, conducting trivia and ranking movies, in order to create a stress free environment. They were effective, evidenced by the empty meal trays. I also found that some patients can be deceptive and manipulative when requesting certain tools or items to dispose food in or eliminate, and/or drinking excessive water to flush out food. We constantly reminded that these type of behaviours are not tolerated and further action such as 12/24 hour of restriction to bed rest, passing stools and urine in bed pan, and bolus feeds were taken. These actions are in place not as a punishment, but more so to psychologically remove those negative behaviours/actions for their own good.

To prevent these behaviors, it’s crucial for us as nurses to remain vigilant and maintain close supervision, especially during meal times. The use of 1:1 patient care is essential, as the negative actions mentioned can easily occur without proper oversight. While not all patients require continuous one-on-one care, it is important to tailor this decision based on each individual’s engagement with their care plan. As a nurse, I strive to foster a collaborative approach, providing guidance, encouragement, and constructive feedback to support patient recovery.

This approach aligns strongly with NMBA Standard 5.2, which emphasises the collaborative construction of nursing practice plans. By working with patients, their families, and the healthcare team, I can ensure that care plans are personalised, considering contingencies, priorities, and goals to support recovery. Additionally, this collaborative effort allows for the continuous evaluation and modification of care plans, in accordance with Standard 7.1, to monitor progress toward expected goals and outcomes, ensuring the care remains effective and responsive to the patient’s evolving needs. Through this reflective and dynamic process, I can deliver safe, quality care that is adaptable and focused on achieving the best possible outcomes for each individual.

In all honesty, I was quite gutted on my last day. I did not want to leave. The trust and rapport I had built with the team were exceptional. They made me feel as if I were a registered nurse. I was involved in leading action plans with my buddy RN, conducting discharge plans, calling the ward team when PEWS scores were above 4, or medications were not charted. I even acted as an educator to both parents and nurses when digital or cultural issues arose

1A was not the most frantic ward and mainly only consisted of 6/8 beds. However, that reduced number did not stop me from participating in every nursing assessment, even if it was not my allocated patient. These assessments and action plans would mainly consist of Neurovascular obs, head injury assessments, wound care management, IV antibiotic admin, traffic light mood behavior assessment, and even putting in Flags on DHR (DV order, Falls risk and risk of code blacks).

One thing that really stood out for me during this placement was how professional paeds nurses are in all aspects in their practice. De-escalating patients who have impulsiveness and mental health complications with phrases such as "I can see that you’re feeling really upset, and that’s okay. It’s normal to feel this way sometimes" and "I’m listening to you. Can you tell me more about what’s bothering you so I can help make things better?". These quotes and constant re-assurance enabled our patients to feel safe and trust that our actions assist and guide them in their health journey. When addressing those questions, I remained consistently aware of my patients' cultural backgrounds, health literacy, and other social determinants. This mindfulness allowed me to respond appropriately. Initially, I found it challenging to convey these messages effectively, but I made significant progress by observing and learning from the best RN's on my ward. Their techniques and insights inspired me to adapt and develop my own authentic approach.

As someone who enjoys engaging with people, the HEADSS tool provided practical tips for my future practice, such as:

• Being aware of the environment and ensuring the young person feels comfortable.

• Recognising that the goal is not to force trauma disclosure but to listen and acknowledge if it happens naturally.

• Focusing on strengths and identifying at least one adult the young person trusts.

• "Reading the room" and revisiting topics later if the child isn't responsive initially, especially when family isn't present.

These insights, particularly from the NSW Health videos, have boosted my confidence in connecting with patients and conducting assessments more effectively in upcoming simulations.

Additionally, I aim to expand my knowledge of identifying acute deterioration in patients, determining appropriate treatments, and knowing when and how to involve or refer others. I will also consider factors in escalating care for adolescents with mental health concerns, focusing on:

• Who: Key individuals like the adolescent, family, healthcare providers, and school counselors.

• Where: Escalation often occurs in hospitals, clinics, or community mental health centers.

• What: Recognising deterioration and initiating interventions, including therapy adjustments or hospitalisation.

• How: Identifying warning signs, reasons for admission, and past experiences.

• When: When the adolescent’s behavior and well-being are at risk, acknowledged by family, healthcare workers, or peers.

By gathering these clinical data cues, we were able to develop an informed plan for immediate intervention, including calling a MET and administering rapid pharmacological measures to prevent an opioid overdose. This approach aligns with NMBA Standard 5.1, as it utilises assessment data and the best available evidence to guide care planning and response

Section 5 had detailed guides of what personnel and actions are required in each MET criteria.

This weeks module looked at mental health considerations for hospital admissions and how legislation plays a role in these situations, including different types of orders e.g. ED11, ED3 & PTO).

Key topics that we will discuss include Voluntary admission and Involuntary admission, PTO, EA, & ACAT.

Voluntary: Happens when a consumer/pt with a mental illness agrees to be admitted to hospital because they may pose a serious risk to themselves or others.

Involuntary: Occurs when a consumer/pt with a mental illness is admitted to hospital without their consent. This is done to assess the most appropriate treatment required, that safely reintegrate themselves into the community without posing to themselves or others.

Australian Civil and Administrative Tribunal (ACAT): Is responsible for making legally binding decisions on mental health matters, such as guardianship and treatment orders. It reviews and hears cases to ensure that individuals' rights are upheld and decisions about their care are made according to legal and ethical standards. The tribunal also provides an independent forum for challenging decisions made by mental health services, ensuring a fair hearing and oversight.

Psychiatric Treatment Order (PTO): Issued by ACAT mandates specific psychiatric treatment for individuals, ensuring adherence to prescribed care such as medication or therapy. It provides a formal legal framework for enforcing treatment and includes oversight by ACAT to ensure that the orders are appropriate, necessary, and in line with legal and ethical standard

Mental health is one of those key subjects that whenever I rediscover it I always learn of different pathways about it. The Mental Health Act 2015, is such a meticulously structured policy that provides clinical appropriate approaches, management and monitoring of mental health. This legislation not only regulates processes and treatments but also ensures a comprehensive framework for addressing mental health issues. It was fascinating to see how methodical and detailed the system is, designed to balance effective care with legal and ethical standards.

What has become clear is that applying these policies in practice is not simply about following a set of instructions—it requires a deep understanding of how legislation directly influences patient outcomes and safety. In mental health care, each decision, from an initial assessment to the creation of a care plan, carries significant legal and ethical implications. This complexity has made me more vigilant about how I navigate these policies in practice, ensuring that I not only meet regulatory requirements but also offer care that is tailored to the specific needs of each consumer.

Looking ahead, I plan to further deepen my knowledge of both hospital-specific and broader legislative guidelines, which will allow me to anticipate potential legal or safety issues before they arise. For example, I will continuously review hospital procedures and policies related to mental health care, as these are constantly evolving. This proactive approach will not only ensure that I remain compliant with NMBA Standard 6.5 but also enable me to implement care plans that are both legally sound and patient-centered.

I was stoked to take the lead in my group, and we chose to highlight two key topics: Support for Professionals and the Multidisciplinary Team (MDT). For support, we talked about things like using self-care activities (cooking, journaling) to unwind, EAP services like Beyond Blue and Lifeline, burnout prevention training, and the importance of having friends to debrief with—both at work and outside. When it comes to the MDT, we saw it as the brain of patient care. Without all the different roles—nurses, doctors, cleaners, security, physiotherapists—working together, the quality of care would seriously drop. Having a strong team ensures that every part of a patient’s health is addressed, leading to more well-rounded and effective care.

For me, this experience highlighted how crucial it is to have strong collaboration and a clear plan in mental health care. It fits perfectly with NMBA Standard 5.3, which emphasises documenting, evaluating, and tweaking care plans as needed to hit our goals. It is not just about making a plan—it is about staying flexible and adjusting as the situation changes. We also covered Standard 5.4, which talks about planning and agreeing on how to measure success. In mental health, things can shift quickly, so having clear markers for progress is key to making sure the care we give stays on track.

We also touched on NMBA Standard 6.6, which focuses on spotting and reporting risks. I’ve learned that staying on top of potential issues—whether they’re system problems or areas where practice might fall short—is crucial for maintaining safe, high-quality care. It is all about being proactive and making sure we were constantly improving.

Looking ahead, this debrief has reinforced how important teamwork and self-care are in mental health nursing. By focusing on strong collaboration within the MDT and looking after myself, I will be better equipped to provide the best care possible while keeping my own well-being in check.

Burn severity is determined by body surface area, depth, and anatomical site. Total Body Surface Area (TBSA) is measured using tools like the ‘Rule of Nines,’ Lund and Browder chart, or Rule of Palm. Burns trigger fluid leakage due to inflammatory responses.

Early Management:

• Dressing changes require effective analgesia, such as titrated morphine, especially for children where distractions (e.g., stories, bubbles) are useful for calming.

Burn Types and Care:

1. Superficial Epidermal (scalds, sunburn):

   • Appearance: Pink, blistered, wet, painful.

   • Dressing: Saline cleaning, non-stick dressings.

2. Partial Thickness (second-degree):

   • Appearance: Red/white, blistered, painful.

   • Dressing: Antibacterial dressings like silver.

3. Deep Dermal (flame, chemical):

   • Appearance: Mottled, dry, less painful.

   • Dressing: Acticoat, moist wound dressings.

4. Full Thickness (third-degree):

   • Appearance: White/charred, dry, no spontaneous healing.

   • Treatment: Excision/grafting, antibiotics.

5. Hands/Feet Burns:

   • Dressing: Silver sulphadiazine, individual dressings to maintain function.

Pain Assessment:

• Multidimensional Approach (QUESTT): Combine self-report (age-appropriate tools), behavioral observation, and physiological measures (tachycardia, hypertension)

Key clinical information that has enhanced my understanding of the various types of burns and the effective treatments required.

Importance of cold shower?
Cold water halts burn progression by preventing the spread to deeper tissues, helping localise and minimise damage. It is a vital early intervention in burn management.

The interview also highlighted the significant challenges faced by families in rural and remote areas, where access to specialised burn care is often limited. In these regions, the absence of burn specialists, advanced medical equipment, and adequately trained healthcare staff can delay essential treatments, such as early cooling or wound care. This often results in poorer outcomes for pediatric patients, who need immediate and specialised care. For families, the additional burden of traveling long distances to access burn units, along with the emotional and financial strain, further complicates their ability to manage their child’s care.

In addition to these core interventions, NMBA Standard 7.1 and 7.2 underscore the need for continuous evaluation of outcomes. For example, fluid intake and output, vital signs, and pain levels must be regularly assessed to ensure the child is progressing as expected. Adjustments to the care plan, such as increasing fluid volumes or altering analgesia dosages, are made based on these evaluations to optimise the Quinn's recovery.

Communication is another critical factor in achieving successful outcomes. NMBA Standard 7.3 emphasises the importance of maintaining clear and regular updates with the healthcare team. Effective communication ensures that all members of the multidisciplinary team, including doctors, nurses, and allied health professionals, are aware of Quinn’s current condition and any changes in the treatment plan. This coordination helps deliver consistent, high-quality care and avoids any lapses in critical interventions.

Beyond physical treatment, psychosocial support is essential in burn care. Paediatric burns affect not only the child but also the family. Nurses must provide emotional support by explaining procedures in age-appropriate terms, offering resources like social workers, and engaging children in activities like play therapy to aid emotional recovery. This holistic approach ensures comprehensive care that addresses both the physical and psychological needs of pediatric burns patients, ultimately promoting better health outcomes.

In my future practice, I will consistently implement these NMBA standards to provide the highest quality of care. My approach will be comprehensive, ensuring that physical interventions, such as early cooling and fluid resuscitation, are complemented by robust pain management, continuous outcome monitoring, clear communication, and emotional support. By addressing both the clinical and psychological needs of pediatric burns patients like Quinn, I will be well-prepared to meet the complex demands of nursing practice, delivering care that is both evidence-based and deeply compassionate.

These are systematic patient assessments used in emergencies:

• Primary Survey: Rapidly identifies life-threatening conditions using the ABCDE approach—Airway, Breathing, Circulation, Disability (neurological status), and Exposure—to manage immediate threats first.

• Secondary Survey: A detailed head-to-toe examination after stabilization to find additional injuries or conditions. Involves vital signs, thorough physical exam, and patient history using AMPLE—Allergies, Medications, Past medical history, Last meal, Events leading to injury/illness. Includes focused assessments of body systems and may involve diagnostic tests.

Timely identification through these surveys is crucial for prompt treatment, better outcomes, and reduced long-term complications.

Workplace Injury

Workplace injuries profoundly affect individuals, their loved ones, and the broader community across four domains:

• Physical: Temporary or permanent disabilities limiting activities and performance.

• Emotional: Mental health challenges like anxiety, depression, and stress.

• Financial: Loss of income, increased medical costs, and resource strain.

• Social: Reduced ability and confidence to engage socially, affecting relationships and community participation.

Nurses' Role

Nurses play a vital role in providing holistic care to patients with workplace injuries:

• Short-term: Address immediate physical and emotional needs—assess injuries, manage pain, provide emotional support, and engage patients and families in care decisions.

• Medium-term: Facilitate recovery by collaborating with rehabilitation teams, educating on self-care and injury prevention, coordinating with multidisciplinary teams, and tracking progress.

• Long-term: Manage chronic effects, ensure access to rehabilitation and mental health resources, advocate for community support, and help patients set realistic recovery goals while adapting to permanent changes.

This therapeutic approach promotes resilience and optimal recovery outcomes.

In the assessments we covered the key factors on gas-exchange with the a rib fracture and head knock. Key findings was Paradoxical Breathing, where the the chest wall moves inward during inhalation and outward during exhalation, which is the opposite of normal chest movement. This fracture also consisted symptoms of high resp rate, shallow sharp breathing and reduced or absent breath sounds over the affected side due to the collapse of lung tissue. Signs of possible pneumothorax (collapsed lung).

In the lab, myself and a few other colleagues unpacked some key questions in the administration of analgesic and antiemetic medication. In this case, our patient was on spinal precautions and had been vomiting. I initially suggested administering Morphine (Analgesic) first to treat the pain (9/10), however one team member addressed that our patient was currently experiencing nausea from the head knock. Another member identified that our patient was on c-spine precautions. Through healthy debate and discussion, we came to an ultimatum of administering IV Ondansetron then IV Morphine. Rationale behind this consisted of multiple factors, including IV Drug Handbook, Ondansetron could be given rapidly over atleast 30 seconds, whereas Morphine, being a strong dose requires dilution of water due to it's strength, over a period of 4-5 minutes. 4-5 minutes is because a rapid dose may cause worsening of nausea, vomiting and dizziness. Other factors included the vomiting, main focus was keeping airway clear to improve oxygenation. And finally, treating the nausea may not be the direct reason for the pain.

NMBA Standard 6:

The initial reasoning and subsequent teamwork allowed for the discussion of crucial information, highlighting the importance of effective communication and shared-decision making in rapidly changing situations, such as rapid deterioration. This approach helps ensure patient safety from multiple perspectives.

NMBA Standard 4:

In managing a patient post-traumatic injury, conducting comprehensive and systematic assessments is critical for prioritising care and detecting early signs of deterioration. By utilising a range of assessment techniques in line with NMBA Standard 4.2, I can accurately evaluate the patients' condition and identify the most urgent clinical needs. This allows me to implement timely and appropriate interventions, ensuring that care is both responsive to the patients' evolving condition and aligned with their individual risks, such as c-spine precautions. Such an approach not only mitigates potential complications, like airway obstruction from nausea, but also ensures that all interventions are informed by a thorough understanding of the patient’s overall clinical picture. This process, grounded in collaborative communication with the healthcare team, ensures holistic and patient-centered care that adheres to the highest standards of clinical practice.

Future Practice:

I will work to deepen my understanding of spinal precautions to enhance the quality of care I provide to my patients. I will conduct thorough and systematic assessments to identify all areas of concern, enabling me to exercise sound clinical judgment and critical thinking when formulating care plans. Collaboration with other nurses and the multidisciplinary team will remain a priority, ensuring that we prevent further harm and optimize patient outcomes. To support my critical thinking and decision-making, I will continue to ask reflective questions, such as, "What is the immediate problem?" and "What poses the greatest risk to my patient's wellbeing at this moment?" These strategies will aid in effective prioritisation and the delivery of safe, patient-centered care.

This week's preparatory material focused on infection control, hydration management, and symptom relief in viral gastroenteritis. Managing this condition across multiple patients requires prioritising care, minimising cross-contamination, and offering holistic support.

Nurses must skillfully navigate various clinical settings by prioritizing patient care based on acuity while balancing the diverse needs of each individual. For instance, managing dehydration through timely administration of IV fluids and medications, alongside strict infection prevention protocols, becomes vital in ensuring both patient safety and effective care delivery. This requires a delicate balance between addressing urgent needs and maintaining comprehensive care for all patients under their watch.

Strategies for key prioritisation in nursing:

• Effective Communication: Use ISBAR for clear, concise updates with the healthcare team to manage multiple patients efficiently, especially during outbreaks.

  Example: A nurse uses ISBAR to quickly communicate with a physician about a dehydrated patient, ensuring prompt IV fluid intervention.

• Rapid Assessment & Critical Thinking: Prioritize patients using tools like AVPU and vital sign monitoring to quickly address deteriorating conditions.

  Example: A nurse identifies dehydration in a gastro patient by assessing lethargy and tachycardia, prioritizing IV fluids immediately.

• Infection Control: Strictly follow hand hygiene, PPE, and isolation protocols to prevent cross-contamination in infectious environments.

  Example: Cluster nursing tasks in contaminated areas, limiting the need to re-enter the room while using disposable gowns and gloves.

• Resource Allocation: Strategically allocate staff and equipment, focusing on critical needs like IV pumps for severe dehydration, while monitoring stable patients with oral rehydration.

  Example: Nurses prioritize equipment for the most critical patients while delegating tasks to assistants for less urgent cases.

• Patient Education: Empower patients and families with self-care tips, reducing the demand for resources and improving outcomes.

  Example: Educating families on signs of dehydration and proper hand hygiene to manage mild symptoms at home, preventing hospital re-admissions.

• Flexible Prioritisation: Constantly reassess patient needs, adjusting priorities based on changing conditions.

  Example: A nurse shifts focus from a moderately dehydrated patient to another patient showing respiratory distress, ensuring the critical patient is stabilized first.

• Time Management: Utilize shift planners and task lists to break down tasks and ensure timely interventions.

  Example: A nurse plans out IV administration and reassessments, ensuring each task is completed on time without delaying critical care.

• Delegation & Collaboration: Assign appropriate tasks to support staff, such as personal care, while focusing on critical interventions yourself.

  Example: Delegating hygiene care to assistants while focusing on IV administration for high-acuity patients.

To enhance my prioritisation strategies, I recognise the need for a more structured, systematic approach. Reflecting on both past experiences and recent simulations, it is clear that well-organised methods significantly improve patient safety, care outcomes, and team efficiency, especially in high-pressure environments.

One key lesson I’ve learned is the importance of acuity-based care for prioritisation. In complex ward settings, where patients present with varying conditions like gastroenteritis or chronic illnesses, using the ABCDE framework (Airway, Breathing, Circulation, Disability, Exposure) ensures life-threatening issues are managed first. This approach allows for swift responses to critical conditions, such as respiratory distress, while also addressing more stable cases. Moving forward, I will continue using this framework to maintain focus on urgent needs.

In the recent simulation, I adhered to NMBA Standard 7.1 by evaluating patient progress toward goals, such as monitoring nasogastric-fed patients and adjusting care as needed. While I successfully revised care plans and delegated tasks per Standard 7.2, I identified a need to respond more quickly to shifting priorities in high-acuity situations. Improving my speed in real-time decision-making will be a focus for future practice.

Time management tools such as task lists and shift planners proved crucial in organising workflow and coordinating with the team. Delegating routine tasks, such as vital sign monitoring, while managing complex care interventions for patients with COPD, enabled me to ensure quality care across the board. This aligns with NMBA Standard 7.3, where I clearly communicated revised goals and priorities to the team, ensuring cohesive patient management.

Prioritisation isn’t just about immediate needs; it involves balancing patient safety and holistic care, as reflected in NMBA Standard 4.1. Moving forward, I plan to improve resource allocation and delegation by ensuring equipment and staff are utilised efficiently in high-acuity situations. For example, I will prioritise critical resources, like high-flow oxygen, for the most urgent cases while delegating routine care tasks to assistants.

Effective communication remains essential for prioritisation. Clear handovers using ISBAR are crucial for maintaining continuity of care and guiding the team to focus on what matters most. In future practice, I aim to refine my communication to ensure critical information is conveyed efficiently throughout the shift, enabling the team to function cohesively and deliver high-quality care.