Organisation: Department of Health
Provide an example/s of how you assess, plan, implement and evaluate nursing care.
Performing at CPE Group, on clinical handover of a particular patient who was due to be discharged from care, I identified irregular blood results. Seeking direction from my Registered Nurse (RN) mentor, I prioritised this patient’s care to assess their condition. Commencing assessment of this patient, I checked circulation as the patient presented unnaturally pale and appeared to be in distress. Through communicating with the patient, I was successful in confirming their pain levels, appetite and general wellbeing. The patient advised feeling anxious regarding their pending discharge.
Assessing the patient’s breathing, I took a manual heart rate which showed both the rate and rhythm were irregular and, following escalation protocol, I sought immediate backup. My RN mentor supported the administration of oxygen, and my coordination plan to perform an electrocardiogram (ECG). Upon evaluation of the ECG, I was influential in the decision to consult with the Resident Medical Officer (RMO) to review the patient. In accordance with doctor’s orders, I was involved in the implementation of Digoxin and metoprolol (oral), and intravenous infusions potassium and magnesium were implemented to stabilise the patient’s heart rate. Accordingly, telemetry monitoring was established, and my time management plan was altered to increase vital signs monitoring and upon follow up review by the RMO, it was confirmed the patient had stabilised. The nursing process provided me with a systematic approach, giving me proper recognition of early warning signs of my patient’s instability that allowed me to provide appropriate, timely care.
Provide an example/s of where your effective communication skills within a multidisciplinary team has resulted in quality patient care.
Proven in my ability to provide effective communication within a multi-disciplinary team consisting of Doctors, Nurses and Allied Health professionals, I effectively communicated to improve patient–centred care, specifically in a patient’s pleural drainage operation at CPE Group. Under supervision, throughout the operation I supported the patient’s shoulders and reassured the patient whilst communicating oxygen levels to the surgeon. During post-operative care, following the measuring and recording drainage from the intercostal catheter (ICC), I identified with my mentor that there were possible complications and that the patient required referral to Allied Health. Accordingly, I worked with both my mentor and the Clinical Nurse Specialist (CNS) to review the patient. On instruction from the CNS, I coordinated with the Patient Service Assistant to take the patient to X-ray, requiring a nurse escort that I negotiated at a convenient time to perform this internal transfer.
Demonstrating my ability to refer comprehensive care, I was successful in the assistance (in partnership with my mentor) of the procedure of chest X-ray for the patient. In consultation, I was a part of the process where it was determined by the multidisciplinary team (the Resident Medical Officer, radiotherapist, chest physiotherapist and the CNS) that our patient had a kinked intercostal catheter. With written and verbal communication of my nursing assessment, and electronic access to the patient’s chest by multidisciplinary team members, I achieved results in the coordination and utilisation of Allied Health’s different skill set and expertise to identify and prevent further complications for this patient.
Provide an example/s that demonstrates how you have considered the rights of an individual or group.
With a demonstrated record of commitment, consistency and a focus on quality service and outcomes, as a Registered Nurse, I am committed to creating a safe environment for patients and providing the highest respect for their individuality and informed participation. Providing care to an elderly patient in my duties at CPE Group, I developed practical experience in the insertion of a urinary catheter and witnessed the effect on patient vulnerability this can have. Through learning correct technique, I developed the professional knowledge and skill required to perform within my limits of education and training with minimal stress on the patient.
Following unsuccessful attempts by the patient to utilise alternative methods for emptying their bladder, I carried out a bladder scan in accordance with hospital policy and procedure. Recording my patient’s bladder volume, I informed my Registered Nurse mentor that the patient’s bladder volume was greater than 400 mL, indicating an intermittent catheter was required to drain the bladder. Being sensitive to the emotional support of my patient, I explained bladder management as a way of preventing bladder over-distension injury. Through clear communication, I explained the procedure to reduce anxiety, clarified my patient’s informed consent, and validated my ability to provide comfort and dignity. Providing patient privacy, I carried out sequenced standard aseptic technique procedure, carrying out the five moments of hygiene, and maintained aseptic non-touch technique in preparing equipment to facilitate inserting the urinary catheter and recorded the time and urinary volume output on the fluid balance chart.
Provide an example of how you can ensure that your practice is of the highest professional standard with reference to the role of the ANMC competency standards, clinical guidelines and hospital policies.
Possessing an in-depth knowledge of the ANMC competency standards, I am committed to the adherence to guidelines and hospital policies within my clinical duties to adhere to providing safe and competent patient-centred health care. Acknowledging that to accomplish meeting these targets, I will need to deliver on core values of collaboration, openness, respect and empowerment.
Through an understanding of the Computed Tomography Coronary angiogram and explicit set up procedures, I am focused on delivering high standards of service delivery and performance expectations in order to achieve safety and best practice. Performing my duties at CPE Group, I assisted my mentor with a patient who was due metoprolol, along with other medications. Adhering to procedure, I considered the possible harm that may result from an adverse reaction; I identified my patient’s prescription and patient history, including their use of a bronchodilator for asthma symptoms, and took the required precaution in relation to the dosage of metoprolol.
Adhering to the requirements for medications, relevant to my education, training and experience, I identified on the Monthly Index of Medical Specialties (MIMS) that metoprolol potentiates effects on the respiratory system at higher doses. In protecting my patient’s best interest under the supervision of my mentor, I consulted my patient’s pharmacist and doctor to clarify if this may cause bronchial constriction and confirm dosage. With the provision of metoprolol confirmed, I maintained hospital policy and guidelines for therapeutic administration by adhering to the six rights, including the right clinical scenario and confirmation with senior professionals.
