Reflecting On Nursing Practice: A Review Of Registered Nurse Practice Standards

Thinks critically and analyses nursing practice

Engages in therapeutic and professional relationships

Maintains the capability for practice

Comprehensively conducts assessments

Develops a plan for nursing practice

Provides safe, appropriate and responsive quality nursing practice

Evaluates outcomes to inform nursing practice.

Clinical Experience

The nurses have job responsibilities and job roles that can overlap among each other which can often lead to various complications associated professional competence. Often the nurses do not understand the most plausible course of action for the nurses in ethically pressing situations (Levett-Jones, Reid-Searl & Bourgeois, 2018). The registered nurse practice standards provides a set of clear guidelines for the nursing professionals so that they can engage in practice while adhering to all of the critical practice legislations and requirements. The registered nursing practice standards set by AHPRA provides a set of clear guidelines and practice care requirements (Ahpra.gov.au, 2018). In this essay I will reflect on the second and sixth standard of care as set by the registered nursing practice standards set by the AHPRA on the basis of the clinical placement that I have attained as an imminent registered nurse to be.

I have been given the opportunity to complete my clinical placement in the primary health care facility where I had been placed under the supervision of a senior registered nurse caring for a chronically ill culturally diverse patient. Her name and personal details will not be disclosed in the assignment in order to protect the privacy and confidentiality. However, in order to provide certain demographic detail, I would like to mention that she had been dealing with COPD for a considerable period of time and had been extremely exhausted and agitated due to the recent exacerbation event she underwent. Communicating with her had been a considerable challenge due to her extreme irritation and agitation along with the struggle of coping with the COPD exacerbations. I had been given the opportunity to communicate with her and administer a medication to her taking her consent and explaining about the need for medication administration (Barksby, Butcher & Whysall, 2015). When I approached to take her consent and perform the safe practice of five rights of medication administration, she appeared nonchalant and disturbed throughout me trying to communicate with her. However, as she started to get agitated with I continuously trying to administer the medication, my supervisor stepped in with a few calming and conventional gestures apt for culturally diverse patient, she calmed down and the medication was administered ultimately. Hence, I believe this particular experience easily aligns to the standard two (Engages in therapeutic and professional relationships) and standard 6 (Provides safe, appropriate and responsive quality nursing practice) (Ahpra.gov.au, 2018).

Adherence to Practice Standards

First and foremost, I would like to mention in this context that this had been an excellent opportunity for me to apply my theoretical knowledge in the practical practice scenario. This clinical placement scenario had been my first encounter with the real world patient care and I had been both euphoric and extremely tense regarding the experience. I would like to mention in this context that I am extremely grateful for the support and assistance I have received from the supervisor that I had been assigned to, and I strongly believe that her support and assistance has helped me tremendously in completing the placement experience successfully and also helped me acquire an array of different skills and expertise that will help me in the future practice. furthermore, considering the challenging issue that I faced in the placement, I would like to mention that I was very nervous, confused and scared while communicating with the patient and administering medication. Although, the help and support from the supervisor helped me overcome the challenges effectively.

The evaluation section of the Gibbs’s reflection cycle instructs the nursing professional to reflect on the experience, and discovering all the positive aspects in the experience that worked in the experience and the negative aspects that did not work in the experience (Levett-Jones et al., 2015). There are various positive aspects, firstly, I adhered to all the safe practice guidelines for care delivery while attending to the patient. I had been very respectful in communicating with her and attempted to appear compassionate and empathetic while engaging with her. According to the sixth standard of the registered nursing practice standards, the nurses are to engage in safe effective and responsive quality of practice while attending to the patients. In my case, I had been given the task of administering the medication to the patient, and as per the guidelines of the safe and effective practice, a nursing professional is expected to perform the 5 rights of medication administration, respectfully extract informed consent for medication administration while explaining the need for the medication administration before actually administering it (Chang, 2015). I had successfully adhered to all of the mentioned requirements which indicates that my performance had been concurrent with the sixth standard or registered nurse practice standards. On the other hand, discussing the negative aspects which did not work, although I employed effective patient engagement tactics, I completely forgot to implement nonverbal cues of communication while engaging with her which agitated the patient. According to the second standard, the nurses are required to engage in therapeutic and professional relationships. As mentioned by the authors, in this case the nurses are required to employ effective communication techniques, both verbal and nonverbal to establish therapeutic relation. Especially for the culturally diverse patients, effective nonverbal cues of communication such as gestures and eye contact has more impact on calming the patient and helping the patient feel respected and valued in relation to their cultural identity and dignity. Due to the excitement and nervousness, I completely forgot to implement effective non-verbal cues of culturally appropriate communication which must have seemed offending and disrespectful to the culturally diverse elderly patient which further agitated her. Evidently, when my supervisor stepped in with the correct gestures and eye contact while apologizing to her, she calmed down effectively and the medication administration procedure went smoothly, which indicates I was unable to adhere to the second standard (Tracey & McGowan, 2015).

Challenges faced by transitioning nurses

Although the experience left me flustered and embarrassed of my shortcomings and mistakes, my supervisor helped me realize that it is very common to make such superfluous mistakes while commencing with first encounter of medication administration (MacLellan, Levett?Jones & Higgins, 2015). She helped me identify the root cause of my error which had been my excitement, nervousness and gap between theoretical and practical knowledge. On a more elaborative note, confusion and nervousness coupled with momentary lack of confidence has been reported as very common sources of error and misjudgement in transitioning nurses. As discussed by the Fry et al. (2015), the transitioning nurses while engaging in their first clinical practice activity independently suffer from extreme fear, confusion and nervousness due to the complete lack of ideation and experience of the practical aspects of care. In support the Forsberg et al. (2016), have mentioned that the impact of the gap in the knowledge of the nurses that are graduating between the theory and practice leads to various errors, which leads to the nurses not being able to adhere to nursing standards. In this case as well, my lack of practice oriented knowledge in engaging with a patient led to an error which agitated a patient and violated the second nursing practice standard. However, for aspects that require theoretical knowledge and expertise, my skills and performance had been up to the mark with the standards of practice (6th).

This experience helped me tremendously in identifying the strengths and weaknesses in my practice. With the assistance of my supervisor I was able to identify that lack of confidence, nervousness and lack of knowledge in effective nonverbal communication are my key weakness which needs improvements. Hence, I would be enrolling in different professional development workshops to develop my professional as well as personal soft skills. Along with that, I will also be reaching out to my supervisor to avail suggestions to bridge the gap in my theory and practice successfully (Kumaran & Carney, 2014).

Conclusion:

On a concluding note, this had been a very helpful opportunity which not only had been my first encounter in clinical practice but also had helped me drastically in identifying my strengths and weaknesses in practice. It can be hoped that I will be able to use the knowledge and expertise gained constructively and with the aid of the action plan developed, I will easily be able to implement these skills in practice for professional growth in future practice.

Reference:

Ahpra.gov.au. (2018). Australian Health Practitioner Regulation Agency - Registration Standards. [online] Available at: https://www.ahpra.gov.au/registration/registration-standards.aspx [Accessed 30 Sep. 2018].

Barksby, J., Butcher, N., & Whysall, A. (2015). A new model of reflection for clinical practice. Nursing Time, 111, 34-35.

Chang, E. (2015). Transitions in nursing: Preparing for professional practice. Elsevier Health Sciences.

Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2016). Assessing progression of clinical reasoning through virtual patients: An exploratory study. Nurse education in practice, 16(1), 97-103.

Fry, M., MacGregor, C., Hyland, S., Payne, B., & Chenoweth, L. (2015). Emergency nurses’ perceptions of the role of confidence, self?efficacy and reflexivity in managing the cognitively impaired older person in pain. Journal of clinical nursing, 24(11-12), 1622-1629.

Kumaran, S., & Carney, M. (2014). Role transition from student nurse to staff nurse: Facilitating the transition period. Nurse education in practice, 14(6), 605-611.

Levett-Jones, T., Pitt, V., Courtney-Pratt, H., Harbrow, G., & Rossiter, R. (2015). What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience?. Nurse Education in Practice, 15(4), 304-309.

Levett-Jones, T., Reid-Searl, K., & Bourgeois, S. (2018). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences.

MacLellan, L., Levett?Jones, T., & Higgins, I. (2015). Nurse practitioner role transition: A concept analysis. Journal of the American Association of Nurse Practitioners, 27(7), 389-397.

Tracey, J. M., & McGowan, I. W. (2015). Preceptors' views on their role in supporting newly qualified nurses. British Journal of Nursing, 24(20), 998-1001.