Attached above is a link to one of my favourite learning resources that I commonly use, RN Sarah, who creates educational videos for nursing practice. My longevity and eagerness to learn in finding new initiatives to learn has intertwined with NMBA first standard, standard 1.1: accesses, analyses, and uses the best available evidence for safe quality nursing practice.

In my pre-module preparation, I researched and evaluated various risk and mental health assessment tools for adolescents. The HEEADSSS assessment tool is a concise and practical resource that healthcare professionals use for paediatric patients presenting with self-harm ideation and mental health concerns. Additionally, the CRAFFT tool is designed for early intervention in identifying substance abuse and other substance use disorders in adolescents aged 12-21. I found both of these assessments extremely helpful as a student nurse, as they guided me in formulating questions and considerations for caring for a vulnerable paediatric patient. All three identified assessments are accessible not only to healthcare professionals but also to the general public, allowing individuals to self-assess and gauge their mental health status. These tools are available on verified health websites free of charge.

This pre-module preparation enhanced my participation in the simulation discussion, enabling me to critically consider which assessments to conduct and prioritise nursing care for Avery. I fulfilled and demonstrated standard 3.3 and 3.6 in my pre-module preparation as I followed my lifelong learning approach and actively engaged with the nursing profession to demonstrate continuing professional development for self.

The attached video was provided to us in our pre-module preparation on canvas. I wanted to include this in my padlet as I found this recording to be extremely helpful in determining the differences between Low and Slow, Name it to Tame it, and Regulate over Educate.

Prior to the INC workshop, I familiarised myself with Lund & Browder chart, Modified Parkland Formula, QUESTT and Wong-Baker/FLACC. This was EXTREMLY helpful as we completed all these assessments within simulation and workshop.

I also refreshed my mind on the integumentary system, learnt back in anatomy and physiology, and its function. The integumentary system provides physical protection, immunity, wound healing, thermoregulation as well as our bodies ability to feel and react to sensation. The integumentary system is made up of the epidermis, dermis, hypodermis, sebaceous and sweat glands, as well as the skin and nails.

• primary and secondary surveys

• the importance of spinal precautions

• the roles of multidisciplinary team members

Prior to caring for a patient who had experienced a workplace injury in class.

Primary and secondary surveys form the basis of emergency care. Knowing how to quickly evaluate a patient’s airway, breathing, circulation, disability, and exposure informed my nursing care plan. Rapid and appropriate nursing interventions can significantly affect the outcomes of a patient with a workplace injury. Secondary surveys are just as important. It allows healthcare professional to conduct a comprehensive assessment from a holistic viewpoint. This is vital for identifying underlying issues that may not be immediately apparent, ensuring that I can provide well-rounded care.

My research into spinal precautions highlighted the importance of minimising movement to ensuring patient safety. Understanding how to implement these precautions not only protects the patient from further harm but also reinforces my role as an advocate for their wellbeing.

Lastly, my research into the roles of the multidisciplinary team showed the importance of collaborative input within care. The multidisciplinary team will consist of similar healthcare professionals of a trauma patient, however will grow to be more specialised throughout patient recovery. By understanding the roles of the multidisciplinary team, I can better communicate and collaborate with them, ensuring that care is coordinated and comprehensive.

Assessments conducted:

Primary assessment

• A - check airway, change position, chin tilt, jaw thrust

• B - SP02 91%, RR below 12, oxygen supplement required, Hudson mask applied

• C - HR, BP, visual inspection of body

• D - AVPU, neuro assessment (GCS), pupil reaction to light

• E - temperature, skin, patients environment/position

• F - fluid, input/output, vomiting

• G - BGL/ketones

Nursing interventions:

• BGL taken

• Insulin administration as per Avery's treatment plan

• Oxygen supplement applied through Hudson mask

• Naloxone administration as per protocol

• Semi flowers position

• Rotated pt when vomiting to maintain airway management

• Escalation of care - MET and preparing for basic life support (standard 5 - develops nursing plan)

In the simulation debrief, we determined our classmates comprehensively conducted various holistic assessments (standard 4.1) to collect relevant and accurate information and data to inform their nursing care for Avery (standard 4.2).

It's crazy to think that 3 years have gone by this quickly!

This week's pre-work did not consist of a lot of additional study I won't lie! With the upcoming VIVA I choose to delegate my time and gain further insight as my classmates and I conducted practice VIVAs.

What I did prepare myself on was the experiences of newly registered nurses in highly trained and delegated roles such as a team leader. I reflect on the possibility of how daunting a new grad RN being in a team leader's shoes would be.

(Standard 5.2: collaboratively constructs nursing practice plans until contingencies, options, priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons)

Yasmin, a 4 year old patient, suffered from burns to 23% of her body. Her mother is staying with her in hospital and she pressed the nurse call button for assistance. When the group enter the room, Yasmin is screaming and crying in visible pain and her mother is becoming distressed.

Unfortunately, the group overlooked basic assessments, such as conducting a pain score, A-G assessment with observations and a wound assessment. Additionally, it was evident that the group struggled to prioritise care effectively. It would have been beneficial if someone had stepped up to delegate roles within the healthcare team to achieve a common goal. In doing this, the group would have achieved standard 6.3 by appropriately delegating aspects of practice to members of the multidisciplinary team in accordance to clinical or non-clinical roles.

Despite these challenges, we commend our teammates for their bravery in participating in the simulation. During the debrief, we provided support and guidance, praising the group for their successes. This collaborative effort allowed us to work together to identify factors affecting the patient's health and wellbeing, aligning with Standard 4.3.

In the post simulation debrief, we as a class discussed what the x2 RN's did well in the simulation with Sam.

• assessed the patient using a structured approach

• the importance of monitoring after a traumatic injury

• early signs of deuteriation

• administration of oxygen therapy

• considering bed position

• escalate care to a MET

Reflecting on this simulation, I find it hard to adjust to the possibility of providing care to patients conditions I am unfamiliar with. This simulation depicted a real life scenario of RN's having to cover staff member's tea breaks however knowing little to no information of the patient they are taking over care.

Naloxone is an opioid agonist. It's indication is for the management and reversal of the effects of an opioid overdose. It can be administered IV, IM, subcut and intranasal.

What is Avery's baseline? Normal BGL levels are between 4-7.8mmol/s.

If Avery has too much insulin in their body, they can go into hyperglycaemia. Ensure we as healthcare professionals check in on them during insulin self administration and monitor BGL afterwards.

What type of diet is Avery on? Was the right meal delivered to Avery? Avery should receive a diabetic meal when in hospital.

Ensure healthcare professionals uphold professionalism with Avery, respecting their pronouns during patient care. (Adhering to Standard 2: engages in therapeutic and professional relationships)

Prioritisation of nursing care:

• Observe Avery's medication administration techniques when administering insulin and taking BGL.

• Encouraging Avery to be independent with managing her BGL and insulin management when in the hospital (referring to Gillick Competence and standard 6.5)

• Educate patient on her medical condition. Provide useful age-appropriate resources and avoid medical jargon. (Standard 5.2: works in partnership to determine the health and wellbeing of people)

  
  

Ethical considerations:

• Promote autonomy when allowing Avery to conduct their BGL and administer insulin.

• Educate Avery's parents on safe medication administration and provide education around Avery's health condition.

• Ensure Avery still lives a regular teenage life. Maintains a good social life and does not let this medical condition rule her life. (Standard 4.1: conducts assessments that are holistic as well as culturally appropriate)

Cultural safety:

• Recognising Avery's pronouns and respecting her identity within care

• Work with Avery, not against her i.e. take time to develop a day care plan that works collaboratively

• Sharps management for insulin disposal (Standard 6.6: uses the appropriate processes to identify and report risk related issues)

Why language matters?

In a short video clip that we watched, we were ask to consider the language used in a handover between healthcare professionals while the patient was present. The RN choose to identify the patient as a "25 year old schizophrenic". This is seen as dehumanising choice of language from the RN, the patient is more than just her disease. Reflecting on this, I can recognise the RN did not fulfil NMBA standard 2.2, to communicate effectively and is respectful of a the patient's dignity, culture, values, beliefs and rights. If I was the student nurse conducting the handover, I would instead say "25 year old patient who has been diagnosed with ...".

Another choice of language the RN used which I found concerning was the comment: "claiming that the voices were telling her". This language is being posed as disbelieving to the healthcare professional and can be harmful to a therapeutic relationship built between nurse and patient. Reflecting on this, I would modify the RNs choice of language to "auditory hallucinations include statements telling her to ...".

Through this reflection, I have achieved standard 6.6 where I have utilised the appropriate processes to identify and report risk related system issues and where practice may be below the expected standards. In this case, the RN was communicating with her patient below the expected standards and codes of conduct as a RN.

As a class, we created 4 mind maps. The topics are:

1. Therapeutic relationships with patients in mental health

2. Collaborative mental health teams

3. Trauma informed nursing care

4. The patients rights

The Royal Children's Hospital Melbourne was our "organisational procedure policy" for the administration intranasal fentanyl in this weeks workshop. The intranasal administration is a less invasive method of drug delivery. Indications of use related to this case include: fractures/dislocations, burns and major lacerations.

Patient: Yasmin

4 years of age

Weights 14kg

As per the guidelines, Yasmin can have an initial dose of 20 mg of fentanyl, which has a volume of 0.4ml.

I conducted a primary survey:

Steven - 75 year old male

4 metre fall landing on left side - no loss of consciousness

A- Obstructed airway (see image)

B - Tachycardic RR29 Sp02 94% on RA

C - Tachycardic HR112 BP 103/77

D - APVU - awake and talking

E - Temp 36.5

9/10 pain

10mg - 2xtmg Morphine

4mg Ondansetron IV

Secondary:

Performed after primary assessment to determine any immediate life threatening issues. We were concerned about his GCS.

3 chill's formula: (Standard 5.1: uses assessment data and best available evidence to develop a plan)

Obstructive airway found in primary survey (1^st chilli) and the discussion if analgesia or anti-amidic should be administered first in a nauseas patient (3^rd chilli).

• promotes breaks

• improves your body circulation by standing up every 30 minutes

• allows you to avoid mental fatigue

• evidence based to improve your GPA

• enables questions to be asked from the previous 30 minutes of content

1 hour workshop clinical skills

1 hour reflection and tutorial

• terminology of body planes and directions

• basic anatomy of key organs (kidney, brain, heart, lung)

• pharmacology (drug classes in relation to nursing responsibilities, drug calculations)

• nursing assessment frameworks

This image, which I have taken on placement, outlines the recommendations for vaccines when travelling to Saudi Arabia. A family of 4 booked an appointment with their doctor to receive the required travel vaccines needed when travelling to Saudi Arabia.

Take home messages/what I found interesting:

• First aid process for burns (20 minutes under cool water, a burn can continue to burn for up to 4 hours after the indicial burn)

• Variety of different dressings used for burn patients

• Multidisciplinary team input for a burn patient

Patient Name: Michelle Freeman
DOB: 10/05/1974
URN: 91044

Unpack her case study from canvas announcements.

Michelle was adamant to be discharged from hospital going back to her job. What would drive her to do this? (Standard 4.1: conducts assessments that are holistic as well as culturally appropriate)

• Economic and financial burden

• Lack of support

• Lack of education of the healthcare system/healthcare professionals

• Lifestyle obligation (does she have kids to support/care for)

• Michelle is a carer for her husband who has MS. Michelle has obligations.

• Urgency for her to get back to work.

Brainstormed interventions/management for Michelle from a nursing perspective: (Standard 5: develops a nursing plan)

• Fractured ribs - analgesia, mobilisation, DB&C physiotherapy

• SDH - neurosurgery review, drain removed 48 hour after haemorrhage removed. neurosurgery outpatient follow up

• hypokalaemia - IV replacement, subsequent bloods demonstrated resolution K3.9

• Right shoulder pain - analgesia and physiotherapy

Ongoing multidisciplinary team interventions post discharge for Michelle – physio, GP, occupational therapist

Take home messages:

Always be over cautious with spinal precaution patients, we do not want to do more damage than good.

If in doubt, reassess!

If in doubt ... escalate!!!!!!

You will never get in trouble for escalating your patients care.

Reflecting on this module, I have sought to emend and add further information to the class activity mind maps. (Standard 7.1, 7.2 and 7.3)

For the therapeutic relationships with mental health patients mind map, I wish to add:

• Eliminate/remove the "problem" in the room (this might be a healthcare professional or family member that is creating irritation to the patient)

• Ask direct and open-ended questions

• Validate the patients/families concerns

For the collaborative mental health mind map, I wish to add:

• Family and friends’ connections

• Patient goals

• Pain team

For the trauma informed nursing care mind map, I wish to add:

• Walk alongside the patient - picture yourself in their shoes

• Work together with the patient, not against them

• Recognize and being mindful of the patients triggers

• Not labelling the patient as a “trauma” patient

• Create strategies to manage and improve the patient everyday and quality of life

• Recognise populations who have generational trauma, i.e, First Nations and the elderly (they are known to be reluctant when seeking medical advice)

• Offer support persons – allocate the same gender healthcare professionals for trauma informed patients if applicable within care

For the patients’ rights mind map, I wish to add:

• Right to have the access to safe and quality public healthcare

• Right to access non-discriminatory care

• Right to be offered their medical options

• Right to professional medical advice

• Right to free medical services

• Right to be identified and recognise as a human/person with feelings and opinions. Patients must not be identified as the condition they suffer from at present of care

Take home messages:

As mentioned before, I thoroughly enjoyed reviewing the attached calming and de-escalating techniques video from canvas. I believe these 3 strategies can be transferred to daily life, regardless of the situation and person.

Goal: regulate emotions

1. Give space and time

2. Stay calm

3. Provide a calming environment

Take deep breathes before the VIVA.

I can do this!

Group activity:

Priority of care activity – viral gastro introitus outbreak throughout the aged care facility

Location: Sunny side nursing home

In class we went through 4 aged care residents:

Rose – COPD and physical limitations

John - diabetes and congestive heart failure

Mary – mild dementia and anxiety falls risk

Paul – mild mobility issues

This activity worked through 3 stages to prioritise nursing care. At each stage, we were provided with an additional piece of information per patient. Some times the information would decrease the patients concern for risk, however others will escalate the nursing care.

By the end of the final stage, here was our prioritisation of care:

1.      John – ambulance ASAP (semi-conscious, lethargic, no urine output, rapid pulse, fever, BP bad, needed an ambulance)

2.      Mary – ambulance ASAP (no oral intake can be maintained, electrolytes are deranged)

3.      Rose – potential ambulance (if her respiratory conditions starts to decline and cannot be managed at the facility then call ambulance)

4.      Paul – can be managed at the facility – obs normal, gastro symptoms improving – recovering

As the RN, how you will implement appropriate infection control requirements within care:

-          Infection control

-          Hand hygiene

-          PPE

-          Delectate RNs to individual patients – don’t share RNs

I volunteered myself to be the team leader amongst a 7 staff team. My pre-module reflection of newly registered nurses stepping into team leader roles allowed me to recognise the challenges they face through a stimulated activity.

I had to balancing clinical responsibilities with leadership expectations and it was daunting!

As I reflected on my own attitudes and values, I can now understand the importance of mentorship and support in building confidence as a new grad nurse.

It's vital to foster an environment where open communication and collaboration thrive, enabling all team members to contribute effectively. My efforts in doing this was commended by my teammates and teacher.

This experience has allowed me to reflect and implement my skills of standard 6: provides safe, appropriate and responsive quality nursing practice.

Patient: Lucas

How will you proceed care for Lucas?

RUBRIC ANALYSIS

Critical thinking

What are the red flags? DKA, fruity breath, high BGL,

What are we concerned about?

Why are we concerned about this? These clinical findings indicate that Luca’s health of DKA is declining.

Complex medication management

What is medication administration safety? 5 rights, patient ID check, Australian medication handbook.

What medications will you give?

What route will you give it?

Medication management for the patient?

Patient education?

What is required on a medication chart order? Prescribing doctors order, correct dose, time and patient, correct route.

Prioritisation of nursing care

What are your nursing priorities for the patient? Prioritisation of Luca’s medical and psychosocial needs including his family. Fluid rehydration, health education, family support

Clinical decision making?

What are we doing, why are we doing this?

Evidence? Follow your organisational policies. Medical observations require intervention

Why did you do this? To care in the best interests of the patient, to improve the patients health, to rehydrate the patient, to manage his BGL, ketones and electrolyte balance.

Assessments you will conduct? A-G assessment, monitor fluid input and output, ongoing BGL, ketone and electrolyte monitoring, cardiac monitoring, full blood count, primary and secondary assessment, multidisciplinary team input.