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NURS3002 Utilising Research To Promote Quality In Health

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NURS3002 Utilising Research To Promote Quality In Health

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NURS3002 Utilising Research To Promote Quality In Health

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Course Code: NURS3002
University: Southern Cross University

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Country: Australia

Question:
Please choose ONE example from your experience during your NURS3002 PEP. Examine and critically analyse this example to demonstrate how the four domains for professional practice on the assignment template have been meet.
 

Standard 1: Thinks critically and analyses nursing practice
 
Standard 2: Engages in therapeutic and professional relationship[s
 
Standard 3: Provides safe, appropriate and responsive quality nursing practice
 
Standard 4:  Evaluates outcomes to inform practice
 
 
 
 

Answer:

Standard 1: Thinks critically and analyses nursing practice
Family members recently transferred a patient named Monica Williams of 75 years old to our rehabilitation unit who was of Aboriginal decent. She had faced stroke two months back and was treated in the emergency ward for about a week. The stroke had paralysed most of the parts of her body and she was not even instructed for rehabilitation by the previous healthcare organization. This had resulted her to lead a very poor quality life. Her mobility is entirely affected. She had developed bedsores, lost her independence in activities of daily life, speech had been affected and many more. Therefore, when the situation went out of control from the hands of the family members due to her excess pain from bedsores, the patient was admitted to the ward for development of her mobility, speech activities, gaining independence, reduction of bedsores and others. Therefore, it was the duty of the healthcare team to allocate important experts as well as nursing professionals to meet each of her requirements and needs accordingly.
 
According to the standard one of the standards of practice provided by the NMBA, every nursing professionals need to utilize varieties of thinking strategies that would be aligning with the best available evidences in making decisions (Standard of practice, Nursing and midwifery board of Australia 2016). This would help in providing safety as well as quality nursing practice that would be strictly following the person-centred as well as evidence-based frameworks (Standard of practice, Nursing and midwifery board of Australia 2016). The nursing professionals would ensure that they are utilising evidence-based information after thoroughly analysing the research studies and their credibility (Mallah, Nassar and Badr 2015, pp 110). This might include the research findings that would help in providing safe as well as quality practice (Beeckman 2015, pp 1). Therefore, the professionals used some of the most trusted database that are used in the nursing professionals like Cinhal, Medplus, Pubmed and others and came up with some important evidence based information. One of the articles has stated that pressure relief is one of the most important actions that professionals should undertake (Mallah, Nassar and Badr, 2015, pp 110). It is very much important to relieve pressure from the affected area that can be identified as the purplish or reddish and warm skin. Therefore, according to the suggestions of the study, pillow and foam pads were used for relieving pressure from the patient from the area where purplish coloration of the skin was observed (Beeckman 2015, pp 1). This was mainly done, as the patient was not been able to be moved into a position that would not put any weight on the sore (Mallah, Nassar and Badr 2015, pp 110). Moreover, the professional also followed another paper which advised him to cover the sore with gauze or the moist bandage and thereby prevented the sores from getting irritated by rubbing on clothing or bedding (Lozano et al. 2016, pp 50). Moreover, the patient was suffering from immense pain from the pressure sores and therefore needed to make her relieve from the pain.  Evidences suggested that acetaminophen as well as ibuprofen can result in relieving some of the discomfort that patients experience from bed sores and therefore such medications were also provided to Monica (Lozano et al. 2016, pp 50). Moreover, evidence based articles also helped him to know that tropical antibiotic creams are also useful that can help the wound to keep moist when professionals apply bandage or dressing. This helped in reduction of the risk of infection and so, the professional also applied this intervention (Avsar et al. 2018, pg 55). He also learnt that soaking the affected areas in warm water result in smoothening of the painful beds sores and temporarily relieve from stinging as well as burning sensation and therefore this was also applied me. Another important arena is nutrition. Researchers are of the opinion that a diet with adequate  amounts of protein, minerals as well as vitamins are important for the healing and prevention of the sores from getting more infected or worse (Avsar et al. 2018, pg 56). The professional made sure that the patient would be provided with the diet that was comprised of vitamin C as well as zinc supplements along with the nutritious diet. In order to prevent any new occurrences of pressure sores, it would be important for reducing moisture on the skin, as this increase would help in decreasing the risk for pressure injury development (Clay et al. 2018, pp 14). This was done by applying barrier cream, keeping skin clan and dry and thereby investigating as well as managing incontinence. Following the evidences, the professional also used to reposition Monica at every two hours. I followed side lying, right side lying, left side lying, seated on a chair or a bed. He did not massage any bony prominences that could have proved harmful for the patient as per the evidences (Avsar et al. 2018, pg 57). This standard advises nursing professionals to practice through reflection. I have therefore often conducted reflection on his experiences as well as his knowledge  actions, feelings and beliefs, this not only has helped me to shape his practices but also has helped me in becoming self confident and perform smart jobs (Standard of practice, Nursing and midwifery board of Australia 2016). The professional was able to identify the skills that he was lacking and the clinical knowledge that he needed to develop. In a way, the professional has become more competent through the reflective practices. He have used the ethical framework of beneficence that dictates the professionals to provide safe service that are evidence based and are safest for the patient (Clay et al. 2018, pp 14). Non-maleficence is also followed which was based on the principle that the patient should gave no suffering or that the professionals should ensure that none of the intervention taken should harm the patient in any ways (Gunningberg et al. 2017, pp 56). Moreover,he also followed justice where he provided care to the best quality of the patient irrespective of culture and background of the patient. Documentation is one of the most important arenas where nursing professionals need to input the details of the interventions taken, results of the tests, everyday actions taken for the patient, medication list, progress update of the patient condition and others (Clay et al. 2018, pp 14). Therefore, he kept all the information of the patient by documenting it in a proper format. Documentation also helped the other members of the team to know about what each other is performing and what their views are about the patients (Butcher et al. 2018, pp 225). All these ensured collaborative work of the professionals. He followed all the legislations and policies and the other professionals like Human rights acts, Data privacy rules and others. In this way,he maintained the standard.                 
Standard 2: Engages in therapeutic and professional relationship[s
This standard mainly enables the professional to engage in effective therapeutic as well as professional relationships. This would mainly include maintaining a number of principles that would be based on the mutual trust as well as respect in the professional relationship (Standard of practice, Nursing and midwifery board of Australia 2016). This standard advice the professionals to maintain relationship with the patient which is entirely based within the professional boundaries and does not include any form of personal relationships (Standard of practice, Nursing and midwifery board of Australia 2016). He totally followed this principle while treating the patient. The patient and his family members were highly satisfied by his service and therefore as a matter of gratitude, they had invited him to their house for a dinner (Fisher 2017, pp 4). This was against standard 2 as he needed to maintain proper boundaries between professional and personal aspects of the relationship he shared with the patient (Fisher 2017, pp 4). The family members gave him gifts that were very auspicious to their culture but it was against the standard to accept such gifts therefore. He communicated with them politely and made them understand the main reason for his not being able to accept any gifts from them. They understood his explanation and were satisfied by his approach. This standard also states the importance of effective communication along with respecting the dignity, culture, beliefs and values of the person (Endacott et al. 2018, pp 915).He had realized that person centred care is the most important approach that brings out positive outcome on the patient. The aboriginal people were neglected over many generations in different ways in the nation and therefore they had lost all hopes from the western healthcare system (Wilson  et al. 2018, pp 25). They never expect culturally competent care from the present healthcare professional (Wilson  et al. 2018, pp 25). It was important for our team to change the ideas of the Aboriginal people (Fisher 2017, pp 4) . He along with his team members provided a culturally competent care that aligned with their cultural perceptions, inhibitions, beliefs and values. The patient felt that her dignity was respected. He had provided total freedom and autonohis to the patient allowing her to make her own decisions. According to her preferences, the interventions were provided only after her approval. Informed consent was taken and all the pros and cons of the interventions were discussed to her and her family members in details (Endacott et al. 2018, pp 915). Her autonohis was respected. Moreover, the standard also advises the professionals to provide support and direct patients as well as the family members to different important resources for optimizing different health related decisions. Following this, I sat into a discussion with the family members of the patient and accordingly made a list of the resources to the family members in order to find the proper services in the community and get in contact with experts who provide homecare services. This would help the patient and the family members to get in touch with the services and get support from them when they will go back home (Nagle et al. 2017, pp 10). This would help in reducing the anxiety and fear of managing the conditions of the patient. The standard expects the professionals to use delegation, supervision, coordination as well as consultation and referrals in professional relationships that would help in the achievements of the improved health outcomes (Ossenberg. Henderson and Dalton 2015, pp 13). Therefore, when his shift ended per day, he made sure that he delegated the task of handling the patient successfully to the other members of the nursing team. He documented the instructions properly so that they could follow them and accordingly plan their care in that shift (Ossenberg. Henderson and Dalton 2015, pp 13). He also used to verbally communicate the important instruction of handling the pressure sores of the nursing professionals who handled the patient’s next shift.  He also took up the responsibility of supervisor one day when his senior nurse was absent and he completed the action successfully (Jacob, Duffiled and Jacob 2018, pp 58). Another of the most important aspect of the care is the collaborative practice done by the team of the healthcare members. It was seen that different experts like the speech therapist, occupational therapists, physiotherapist, dieticians, nursing professionals, physicians and many others act in coordination with each other so that all the requirements of the patient was met (Jacob, Duffiled and Jacob 2018, pp 58). Just as the standard dictates that, the nursing professionals should foster a culture of safety and learning that include engaging with the professional relationships with others so that there is effective sharing of knowledge and the practices that support the person centred care (Ossenberg. Henderson and Dalton 2015, pp 13).The members of the healthcare teams were often seen to conduct meetings twice a week where the members used to share their knowledge, views and ideas about the treatment procedures of the patient and how different types of initiatives should be taken so that the patient is benefitted. Such discussion often helped in enlightening each other’s and regular constructive feedbacks from each other’s that helped in developing our expertise as well (Birks et al. 2016, pp 540).
Standard 3: Provides safe, appropriate and responsive quality nursing practice
This standard of the nursing professionals advice them to delegate quality as well as ethical goal directed actions. These actions would be such that they would depend on not only comprehensive or systematic assessment. They would also ensure best evidence based treatment so that the professionals can achieve planned as well as agreed outcomes (Standard of practice, Nursing and midwifery board of Australia 2016). For this, the standard advises the professionals to provide comprehensive as well as safe quality practices for achieving agreed goals as well as outcomes (Standard of practice, Nursing and midwifery board of Australia 2016). These outcomes would be such that it would be responsive for the nursing needs of the people (Jacob, Duffiled and Jacob 2018, pp 58). Following this, he first tried to analyse the important needs and requirements of the patient so that accordingly, he could set the interventions and the care plans. The first model that he used is the clinical reasoning cycle. This cycle is introduced by Levett-Jones and mainly consists of a number of steps that helps in identifying the cues of the patients and thereby understanding the signs and symptoms that the patient is having. According to that, the cues were associated with the respective pathophysiology of the issues she was facing (Birks et al. 2016, pp 540). Following these, the needs and requirements of the Monica were identified and accordingly goals were set so that all the requirements and needs of the patient were covered. Following these action each of the professionals took up plans and he needed to care for the pressure sores and medication of the patient and the others were caring for the other requirements.  Thereby he used this model so that a comprehensive care plan was developed after analysing the situation of the patient (Thompson 2016, pp 17). For this, he also used several important tools so that I can properly assess the patients and realize the needs of the patient. For this patient named Monica, he used the Glasgow Coma scale. This tool is mainly used for describing the level of consciousness in the person who is treated following a traumatic brain injury (Thompson 2016, pp 17). The tool mainly provided the professionals with a score that helps in understanding the conscious level state of the patient and is mainly assessed through three aspects that are the eye opening, verbal response and motor responses (Birks et al. 2016, pp 540). This assessment was very important for understanding the areas where the patient needed care. Moreover, pain assessment was done and accordingly score was to be assessed from 0 to 10 (Ayton and staff 2017, pp 11). The pain score showed for the patient was 8 and therefore, we understood that the pain from the bedsores was giving her a poor quality times and making her suffer. Therefore, accordingly to interventions were taken that included pain management of the patients. Therefore, through the procedure of effective assessments, comprehensive safe and quality practice was provided for developing goals so that the needs of the patient could be met (Birks et al. 2016, pp 541). Moreover, while taking care of the patient, he also helped the enrolled nurses so that they learn about the clinical interventions and the procedures they need to adapt as different clinical as well as non-clinical roles (Endacott et al. 2018, pp 915). By following the standard, he have provided effective timely direction and supervision to all the members of the nursing team so that he could make sure that the delegated practice is safe and correct. He also tried his best to maintain all the relevant policies as well as guidelines, standards, regulations and different types of legislation (Birks et al. 2016, pp 542). Moreover, by following this standard also he tried to undertake all forms of risk assessment so that the potential hazards could be identified (Birks et al. 2016, pp 542). He understood that the patient is exposed to two major risks which are aggravation of pressure sores or falls while manual handling (Cashin et al. 2017, pp 258). Therefore, it was significant for him to undertake consideration of this hazard and accordingly allocate resources and human factors properly (Thompson
Standard 4:  Evaluates outcomes to inform practice
This standard mainly helps the registered nursing professionals to take upon the responsibility of effective evaluation of the practices. This evaluation would be based on the agreed priorities as well as goals, outcomes and different plans. Accordingly, the professionals should revise practices accordingly (Standard of practice, Nursing and midwifery board of Australia 2016). The standard guides the healthcare professionals to evaluate and thereby monitor the progress towards the expected goals as well as outcomes (Standard of practice, Nursing and midwifery board of Australia 2016). Researchers are of the opinion that interventions applied by healthcare professionals cannot be termed as successful until the evaluation results shows to be effective on the health of the patient (Thompson 2016, pp 17). He also followed this  procedure and after application of each intervention, he used to conduct evaluation of the health condition of the patient. This was done in order to understand that the different interventions which he was providing for pressure sores were reducing the infection and healing the wounds or not (Thompson 2016, pp 17) . Moreover, he also conducted the pain score assessment in order to understand whether his interventions were relieving her from pain gradually. This assessment showed that the patient was responding to the interventions and her pain was relieving (Cashin et al. 2017, pp 258). Moreover, the experts also conducted their respective evaluation and documented the result in the electronic health record of the patient. The standard also expects the professional to revise the plans that are based on evaluation (Standard of practice, Nursing and midwifery board of Australia 2016). Following the evaluation, results that he submitted as well as that of the evaluation documentation that others submitted showed that the interventions were bringing out positive results. This showed that the health of the patients was progressing towards betterment. Accordingly the family members were communicated that helped the patients from relieving from anxiety as well as fear that they had regarding the patient named Monica (Standard of practice, Nursing and midwifery board of Australia 2016). The standard also discusses the importance of the effective determination, documentation as well as communication of the further priorities or the goals as well as outcomes with the relevant persons (Standard of practice, Nursing and midwifery board of Australia 2016). In order to follow this, effective meetings were undertaken with all the experts and healthcare professionals regarding the further interventions that one needs to take for the betterment of the patient (Ayton and staff 2017, pp 7). In such a scenario, all the reports provided by the experts were discussed and all of them concluded that the patient was responding to the intervention. However, the patient was not in the situation to be discharged home as most of her wounds were still needed time for effective cure. She needed expert help of professionals for management and dressing of the wounds as well as in the reduction of the pressure sores (Ayton and staff 2017, pp 8). If the patient is discharged, it might result in aggravation of the infection, as the wounds are still open. Therefore, he undertook discussions with the professionals and all agreed to his concern. Moreover, the speech expert and the occupational expert also stated that the patient needed more time to recover to a state that would be suitable to take her to home. Therefore, the meeting was conducted for respective weeks and progress update was documented on the electronic health media so that it can be circulated to all team members who were attending Monica (Ayton and staff 2017, pp 11).
Reference List
Av?ar, P. and Karada?, A., 2018. Efficacy and Cost?Effectiveness Analysis of Evidence?Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence?Associated ermatitis. Worldviews on Evidence?Based Nursing, 15(1), pp.54-61. https://doi.org/10.1111/wvn.12264Ayton, J. and Staff, L., 2017. Public consultation: NMBA draft Midwife standards for practice University of Tasmania (UTAS) submission pp 6-12. Retrieved from https://ecite.utas.edu.au/120474Beeckman, D., 2015. Do clinical guidelines for pressure ulcers serve as a barometer for the contribution of nursing sciences to evidence based pressure ulcer management?. Soj Nursing & Health Care, 1(1), pp.1-2. Retrieved from https://biblio.ugent.be/publication/7005834/file/7005835Birks, M., Davis, J., Smithson, J. and Cant, R., 2016. Registered nurse scope of practice in Australia: an integrative review of the literature. Contemporary nurse, 52(5), pp.522-543. https://doi.org/10.1080/10376178.2016.1238773Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C., 2018. Nursing Interventions classification (NIC)-E-Book. Elsevier Health Sciences. Pp 224-229 retrieved from :https://books.google.co.in/books?hl=en&lr=&id=L4lIDwAAQBAJ&oi=fnd&pg=PP1&dq=.+Nursing+Interventions+classification+(NIC)-E-Book.+Elsevier+Health+Sciences.&ots=AgjOTFa9V-&sig=P1cbGRhNVlK9ox4p16NNFfDZHhY#v=onepage&q=.%20Nursing%20Interventions%20classification%20(NIC)-E-Book.%20Elsevier%20Health%20Sciences.&f=falseCashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., Kerdo, E., Kelly, J., Thoms, D. and Fisher, M., 2017. Standards for practice for registered nurses in Australia. Collegian, 24(3), pp.255-266. https://doi.org/10.1016/j.colegn.2016.03.002Clay, P., Cruz, C., Ayotte, K., Jones, J. and Fowler, S.B., 2018. Device Related Pressure Ulcers Pre and Post Identification and Intervention. Journal of pediatric nursing. Pp 10-20 https://doi.org/10.1016/j.pedn.2018.01.018Endacott, R., O’connor, M., Williams, A., Wood, P., McKenna, L., Griffiths, D., Moss, C., Della, P. and Cross, W., 2018. Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses. Journal of clinical nursing, 27(5-6), pp.e913-e920. https://doi.org/10.1111/jocn.13987Fisher, M., 2017. Professional standards for nursing practice: How do they shape contemporary rehabilitation nursing practice?. Journal of the Australasian Rehabilitation Nurses Association, 20(1), p.4. retrieved from: https://search.informit.com.au/documentSummary;dn=084306952978817;res=IELHEAGunningberg, L., Sedin, I.M., Andersson, S. and Pingel, R., 2017. Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial. International journal of nursing studies, 72, pp.53-59. https://doi.org/10.1016/j.ijnurstu.2017.04.007Jacob, E., Duffield, C. and Jacob, D., 2018. Development of an Australian nursing critical thinking tool using a Delphi process. Journal of advanced nursing pp 52-58. https://doi.org/10.1111/jan.13732Lozano-Montoya I, Vélez-Díaz-Pallarés M, Abraha I, Cherubini A, Soiza RL, O’Mahony D, Montero-Errasquín B, Correa-Pérez A, Cruz-Jentoft AJ. 2016  Nonpharmacologic interventions to prevent pressure ulcers in older patients: an overview of systematic reviews [ONTOP] series). Journal of the American Medical Directors Association. Apr 1;17(4):370-e1 pp 45-65. https://doi.org/10.1016/j.jamda.2015.12.091Mallah, Z., Nassar, N. and Badr, L.K., 2015. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Applied Nursing Research, 28(2), pp.106-113. https://doi.org/10.1016/j.apnr.2014.07.001?Nagle, C., Heartfield, M., McDonald, S., Morrow, J., Kruger, G., Bryce, J., Birks, M., Cramer, R., Stelfox, S. and Hartney, N., 2017. A necessary practice parameter: Nursing and Midwifery Board of Australia idwife standards for practice. Women and Birth, 30, pp.10-11. https://doi.org/10.1016/j.wombi.2017.08.028Ossenberg, C., Henderson, A. and Dalton, M., 2015. Determining attainment of nursing standards: the use of behavioural cues to enhance clarity and transparency in student clinical assessment. Nurse education today, 35(1), pp.12-15. DOI: https://doi.org/10.1016/j.nedt.2014.09.002Standard of practice, Nursing and midwifery board of Australia. (2017). Retrieved 20th July 2018, from https://file https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspxThompson, J., 2016. Nursing update: Continence Nurses Society Australia standards for practice. Australian and New Zealand Continence Journal, The, 22(1), p.17. retrieved from: https://search.informit.com.au/documentSummary;dn=925112519948442;res=IELNZCWilson, N.J., Lewis, P., O’Reilly, K., Wiese, M., Lin, Z., Devine, L., Booley, R., Jaques, H. and Goddard, L., 2018. Reframing the role, identity and standards for practice for registered nurses working in the specialty area of intellectual and developmental disability in Australia: The NDIS and beyond. Collegian. pp 23-30 https://doi.org/10.1016/j.colegn.2018.06.002
 

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