NRSG367 Assessment task 2, Industry reflection PDF

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Reflective Essay...

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This reflective assessment task will reflect upon two selected National Safety and Quality Health service standard by using my past clinical experience and provide justification for each standard on patient care experience. I will be explaining the importance, relevance and my clinical experience in relation to standard 1 and 8. As per Australian Commission on Safety and Quality in Health Care [ACSQHC] (2017) standard 1, clinical governance focuses on improving and maintaining the safety, quality and reliability of health system and patient outcomes by monitoring and reporting performance. It develops protocols, policies, procedures and create learning environment. Likewise, standard 8 focuses on identifying and responding effectively on changing condition of patients to escalate care. Monitoring vital signs and conducting assessment plays vital role in detecting deterioration (ACSQHC, 2017).

During my clinical placement on a cardiothoracic ward, I was looking for my patient who is 68 years old, admitted with acute exacerbation of Chronic Obstructive Pulmonary Disease. I was monitoring observations and conducting A-G assessment. His oxygen saturation (SpO2) was 78% on 2litre nasal prong and his respiratory rate (RR) was 34 breaths/ minute. So, I have informed to my supervising Registered Nurse (RN) and documented it in SAGO chart. Although he has alter calling criteria his RR and SpO2 was in red zone, me and my supervising RN had initiated the rapid response to immediately assess and treat him to prevent and manage further deterioration (Hughes, Pain, Braithwaite & Hillman, 2014).

As this was not familiar situation for me I was frightened and unknown what to do next. So, I observed my supervising RN. From my clinical and theoretical knowledge, I knew the normal values for vital signs, which helps me to identify the deterioration (Haddeland,

Slettebø, Carstens & Fossum, 2018). I also realised that online modules and simulation practical classes has helped me to develop my skills and confidence to prepare myself for this kind of situation. According to the policy of the hospital and as advocated by the NSW Ministry of Health (2013), after initiating rapid response, we must inform the in-charge about it, stay with patient and monitor vital signs frequently. We have increased his oxygen to 4 litres and administer his PRN bronchodilator. Comfort measures has been provided by making him sit in semi-fowlers position and encouraged him to do deep breathing exercise (Russell, Ford & Barnes, 2011).

I have encountered this kind of situation in simulation class and knew how important is to provide relevant information to the team. So, I have handover the team by using ISBAR framework and maintain therapeutic communication. According to the Nursing and Midwifery Board of Australia (2017), as a student nurse or future RN, it is my responsibility to follow organisational policy and procedures to ensure safe practice and practice within my scope. Supervising RN and I has followed-up all the instruction given by team, explain and reassure patient. We have continuously monitored the patient observation according to the protocol.

In my past clinical experiences, I have seen nurses not being able to utilise theory into practice in such a critical situation due to stress and anxiety which is also supported by Odell (2015). Also, I realised that, I was only engaging with that patient, monitoring his observations and making him comfortable, due to which I have not focused in my other patients. I have not been able to follow my shift planner. Haddeland et al., (2018) mentioned that nurses fail to seek help when a patient deteriorates. So, from next time, in such situation I

will ask for help from my co-workers, to maintain the continuity of care for rest of my patients. Further, I will get training to improve my skills and develop confidence to handle stressful situation like this. Therefore, this incident helps me to recognise and respond in deteriorating situation.

I believe that I have met these two standards as I have practice within my scope by monitoring patient observation, conducting A-G assessment, documenting it and reporting to supervising RN. I have ensured safe practice by following policy and procedure of hospital. In this condition, rapid response was initiated on time for the safety and positive health outcomes of the patient. Despite of good clinical outcomes, clients are not receiving the recommended care and adverse events are continuously occurring such as delay in care, pain management, nosocomial infection and death (ACSQHC, 2017), so it is important to maintain clinical governance for the benefits of patients, health system and clinicians. Patient vital signs need to be monitored according to the individualised monitoring plan. It is very important to have necessary skills, equipment and knowledge to monitor the patient for early recognition. In the first week of my placement I have attended the training to use electronic system correctly and there was various in-service education organised in regular basis to provide new or to re-fresh the information. Thus, this critical situation has helped to meet these two standards.

References Amer, K. S. (203). Quality and safety for transformational nursing: Core competencies. New Jersey, USA: Pearson.

Australian Commission on Safety and Quality in Health Care. (2017). National Safety and Quality Health Service Standards: Guide for Hospitals. Retrieved from http://nationalstandards.safetyandquality.gov.au/resources

Clinical Excellence Commission (2018). Clinical incident management. Retrieved from http://www.cec.health.nsw.gov.au/clinical-incident-management

Gibbs, G. (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

Haddeland, K., Slettebø, A., Carstens, P., & Fossum, M. (2018). Nursing Students Managing Deteriorating Patients: A Systematic Review and Meta-Analysis. Clinical Simulation in Nursing, 21, 1-15. doi: https://doi.org/10.1016/j.ecns.2018.05.001

Hughes, C., Pain, C., Braithwaite, J., & Hillman, K. (2014). ‘Between the flags’: Implementing a rapid response system at scale. BMJ Quality & Safety, 23(9), 714-717. doi: http://dx.doi.org/10.1136/bmjqs-2014-002845

NSW Ministry of Health (2013). Recognition and Management of Patients who are Clinically Deteriorating. Retrieved from http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2013_049.pdf

Nursing and Midwifery Board of Australia. (2017). Registered Nurse Standards for Practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards/registered-nurse-standards-for-practice.aspx Odell, M. (2015). Detection and management of the deteriorating ward patient: An evaluation of nursing practice. Journal of Clinical Nursing, 24(1-2), 173-182. doi: https://doiorg.ezproxy2.acu.edu.au/10.1111/jocn.12655...