NRSG367 Transition to Professional Nursing

Please explain to the panel your understanding of two of the NSQHS standards and discuss relevant clinical nursing experiences from your clinical practicum, providing justification for each based on these patient care experiences.

1. Clinical Governance
2. Partnering with Consumers
3. Preventing and Controlling Health-Associated Infection Standard
4. Medication Safety Standard
5. Comprehensive Care Standard
6. Communicating for Patient Safety
7. Blood Management Standard
8. Recognising and Responding to Acute Deterioration Standard

Answer:

Description:

A patient was admitted to the emergency ward with faster heart rate. It was giving the patient a very hard time and when it was unbearable, daughter of patient Mr. Brown admitted him to the emergency ward. After the initial round of treatment, he was transferred to the medical surgical ward for further maintenance of his health and medication. I was working under a senior nurse with whom I was not very comfortable with. She often used to find fault in my practices and humiliated me in front of other junior nurses. I was very upset and it was also a very busy day. I had to attend more than twelve patients in the first hours of the day. Therefore, I did not get to communicate with the patient. I was hurrying. I went to his bed and wished him morning but in a hurry I called him by the wrong name. He was trying to initiate an interaction but I stopped him saying that I was busy and we would talk another day. Moreover, I could not understand what the senior nurse had written in the medication section of the document and therefore, I asked him to quinidine for his arrhythmia a dn faster heart rate. I got a call after about 5 hours where I noticed the senior nurse standing with two doctors and shouted on me stating that my drug quinidine had reacted with digoxin given by her. The patient was vomiting vigorously and was feeling nausea.

Feeling:

I was very scared from this situation. I felt guilty seeing that the patient was suffering only for me. Not only I was fearful of the outcomes of the medication error on my career but the complaint f the family members about my improper communication added to my distress. I totally lost my confidence on myself and felt like I may not suitable to take the responsibility of lives of my clients. However, I made up my mind not to be affected by them and self–regulated myself to develop my skills and be a skilled and knowledgeable expert in the future.

Evaluation:

The main bad part about the incident was that it created huge suffering for that patient and his family members both mentally and physically. My mentors pointed out that the care that I had provided did not follow the NSQHS standards. I realised that I had breached two important standards. One of them is that I have not followed the medication safety guidelines and had administered a medication out of confusion and miscommunication with other nursing professionals.  Medication error like drug-drug interaction has the potential to cause life threatening risks to the patients (Hayes et al., 2015). The patient was suffering because I administered a medication which interacted with another medication given by my senior. The second standard that I had breached was “communication for safety”. This standard states the importance of adopting correct strategies and systems so that effective communication can be established between patients, families, multidisciplinary team, clinicians and others to ensure safe safety (National Safety and Quality Health, 2017). I neither developed a therapeutic communication with the patient nor communicated with my senior when I had the confusion. These resulted in enhances suffering for the patient.

Analysis:

Medication error has large number of negative impacts. It associates with increased suffering of the patient, longer stays of the patient at the hospital, readmission of the patient and increased financial flow of the patients, increased depression and anxiety of patient and family members (Eliott et al., 2016). It also makes the professionals lose their confidence and develop a sense of guilt that act as barrier in their practices. They also get into legal obligations that affect their careers. The hospital authority also gets affected as they have to send more resources that they could have spent on more needy patients. Their brands reputation and revenue generation also get hampered (Vaismoradi et al., 2014). Therefore one of my mistakes of not consulting the document with my senior when I could not understand her handwriting led to situation of drug-drug interaction of digoxine and quinidine. Proper communication skills are extremely important for nurses to develop therapeutic relationships with patients (Noland & Carmack, 2015). Empathy and compassion of the nurses during communication make the patients feel that the nurses genuinely feel about their suffering and this helps in development of trust and bond with the professionals. These have positive outcomes on their health (Drach?Zahavy & Hadid, 2015). Active listening skills, feedback skills, asking for informed consent and many others ensure that the patients feel respected and honoured and their dignity and autonomy are also respected. In this way, therapeutic relationships are made that ensure patient satisfaction (Riley, 2015). I did not maintain any of these while communicating with the patient. I also did not communicate effectively with my senior that resulted in the medication errors.

Conclusion:

When such situation would occur in the future, I would ensure that I provide sufficient time to the patient and listen to him properly and try to develop effective relationship through therapeutic communication. This would ensure patient satisfaction and positive health outcomes on the patient. I should also ensure effective communication with my seniors and regulate my emotions of anger and disappointment on floor. When health of patients is concerned, I would out aside my ego and always communicate effectively with team members to en sure best healthcare of patients. Before administering of drugs, I would be also careful and ensure that no drug-drug interaction takes place.

Action plan:

I would be joining workshop to develop my communication skills mainly on weekends for about months. I would also interact with my mentors and take interviews of their experiences to learn new strategies to handle strenuous situations in team-working and communication issues. I would also join training sessions to learn ways of preventing medication errors and conduct evidence based studies to develop my knowledge and skills.

References:

Drach?Zahavy, A., & Hadid, N. (2015). Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. Journal of Advanced Nursing, 71(5), 1135-1145.

Elliott, R. A., Lee, C. Y., Beanland, C., Vakil, K., & Goeman, D. (2016). Medicines management, medication errors and adverse medication events in older people referred to a community nursing service: a retrospective observational study. Drugs-real world outcomes, 3(1), 13-24.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.

National Safety and Quality Health, (2017), e Australian Commission on Safety and Quality in Health Care Service Standards Guide for Hospitals,  https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-Guide-for-Hospitals.pdf

Noland, C. M., & Carmack, H. J. (2015). “You never forget your first mistake”: Nursing socialization, memorable messages, and communication about medical errors. Health communication, 30(12), 1234-1244.

Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.

Vaismoradi, M., Jordan, S., Turunen, H., & Bondas, T. (2014). Nursing students' perspectives of the cause of medication errors. Nurse Education Today, 34(3), 434-440.

Answer:

Description:

A patient was admitted to the emergency ward with faster heart rate. It was giving the patient a very hard time and when it was unbearable, daughter of patient Mr. Brown admitted him to the emergency ward. After the initial round of treatment, he was transferred to the medical surgical ward for further maintenance of his health and medication. I was working under a senior nurse with whom I was not very comfortable with. She often used to find fault in my practices and humiliated me in front of other junior nurses. I was very upset and it was also a very busy day. I had to attend more than twelve patients in the first hours of the day. Therefore, I did not get to communicate with the patient. I was hurrying. I went to his bed and wished him morning but in a hurry I called him by the wrong name. He was trying to initiate an interaction but I stopped him saying that I was busy and we would talk another day. Moreover, I could not understand what the senior nurse had written in the medication section of the document and therefore, I asked him to quinidine for his arrhythmia a dn faster heart rate. I got a call after about 5 hours where I noticed the senior nurse standing with two doctors and shouted on me stating that my drug quinidine had reacted with digoxin given by her. The patient was vomiting vigorously and was feeling nausea.

Feeling:

I was very scared from this situation. I felt guilty seeing that the patient was suffering only for me. Not only I was fearful of the outcomes of the medication error on my career but the complaint f the family members about my improper communication added to my distress. I totally lost my confidence on myself and felt like I may not suitable to take the responsibility of lives of my clients. However, I made up my mind not to be affected by them and self–regulated myself to develop my skills and be a skilled and knowledgeable expert in the future.

Evaluation:

The main bad part about the incident was that it created huge suffering for that patient and his family members both mentally and physically. My mentors pointed out that the care that I had provided did not follow the NSQHS standards. I realised that I had breached two important standards. One of them is that I have not followed the medication safety guidelines and had administered a medication out of confusion and miscommunication with other nursing professionals.  Medication error like drug-drug interaction has the potential to cause life threatening risks to the patients (Hayes et al., 2015). The patient was suffering because I administered a medication which interacted with another medication given by my senior. The second standard that I had breached was “communication for safety”. This standard states the importance of adopting correct strategies and systems so that effective communication can be established between patients, families, multidisciplinary team, clinicians and others to ensure safe safety (National Safety and Quality Health, 2017). I neither developed a therapeutic communication with the patient nor communicated with my senior when I had the confusion. These resulted in enhances suffering for the patient.

Analysis:

Medication error has large number of negative impacts. It associates with increased suffering of the patient, longer stays of the patient at the hospital, readmission of the patient and increased financial flow of the patients, increased depression and anxiety of patient and family members (Eliott et al., 2016). It also makes the professionals lose their confidence and develop a sense of guilt that act as barrier in their practices. They also get into legal obligations that affect their careers. The hospital authority also gets affected as they have to send more resources that they could have spent on more needy patients. Their brands reputation and revenue generation also get hampered (Vaismoradi et al., 2014). Therefore one of my mistakes of not consulting the document with my senior when I could not understand her handwriting led to situation of drug-drug interaction of digoxine and quinidine. Proper communication skills are extremely important for nurses to develop therapeutic relationships with patients (Noland & Carmack, 2015). Empathy and compassion of the nurses during communication make the patients feel that the nurses genuinely feel about their suffering and this helps in development of trust and bond with the professionals. These have positive outcomes on their health (Drach?Zahavy & Hadid, 2015). Active listening skills, feedback skills, asking for informed consent and many others ensure that the patients feel respected and honoured and their dignity and autonomy are also respected. In this way, therapeutic relationships are made that ensure patient satisfaction (Riley, 2015). I did not maintain any of these while communicating with the patient. I also did not communicate effectively with my senior that resulted in the medication errors.

Conclusion:

When such situation would occur in the future, I would ensure that I provide sufficient time to the patient and listen to him properly and try to develop effective relationship through therapeutic communication. This would ensure patient satisfaction and positive health outcomes on the patient. I should also ensure effective communication with my seniors and regulate my emotions of anger and disappointment on floor. When health of patients is concerned, I would out aside my ego and always communicate effectively with team members to en sure best healthcare of patients. Before administering of drugs, I would be also careful and ensure that no drug-drug interaction takes place.

Action plan:

I would be joining workshop to develop my communication skills mainly on weekends for about months. I would also interact with my mentors and take interviews of their experiences to learn new strategies to handle strenuous situations in team-working and communication issues. I would also join training sessions to learn ways of preventing medication errors and conduct evidence based studies to develop my knowledge and skills.

References:

Drach?Zahavy, A., & Hadid, N. (2015). Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift. Journal of Advanced Nursing, 71(5), 1135-1145.

Elliott, R. A., Lee, C. Y., Beanland, C., Vakil, K., & Goeman, D. (2016). Medicines management, medication errors and adverse medication events in older people referred to a community nursing service: a retrospective observational study. Drugs-real world outcomes, 3(1), 13-24.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.

National Safety and Quality Health, (2017), e Australian Commission on Safety and Quality in Health Care Service Standards Guide for Hospitals,  https://www.safetyandquality.gov.au/wp-content/uploads/2017/12/National-Safety-and-Quality-Health-Service-Standards-Guide-for-Hospitals.pdf

Noland, C. M., & Carmack, H. J. (2015). “You never forget your first mistake”: Nursing socialization, memorable messages, and communication about medical errors. Health communication, 30(12), 1234-1244.

Riley, J. B. (2015). Communication in nursing. Elsevier Health Sciences.

Vaismoradi, M., Jordan, S., Turunen, H., & Bondas, T. (2014). Nursing students' perspectives of the cause of medication errors. Nurse Education Today, 34(3), 434-440.