This essay aims to demonstrate my application of the standards of practice for a registered nurse using a reflective methodology. I will use the Tanner’s clinical judgement model to reflect upon an incident that occurred during clinical practice session. The incident occurred in the third week of my clinical practice sessions when Warrin Dimer, a 23 year old male was admitted to the ward following severe depression. Upon admission I noticed that his wrist contained several bruise marks due to failed suicide attempts. On following his medical records, I realized that he was suffering from depressive disorder. I was assigned the task of administering him antidepressants.
This event was quite challenging and difficult for me as although I had acquired clinical knowledge on the pathophysiology and diagnosis of mental disorders, the thought of a hands-on communication with a vulnerable patient made me anxious initially (Chang and Daly 2015). On much persuasion, his elder sister revealed that he had a history of abuse in childhood. Soon, I went to the room where Warrin was kept, to establish a rapport with him before administering any medicines.
Initially I had noticed that Warrin and his family members were very reluctant to speak about his mental condition to any healthcare staff that was present in the ward. Since, they belonged to an aboriginal community; the stigma related to mental health was quite evident among them. As I introduced myself with the aim of building a good patient-nurse relationship, I noticed that on acknowledging their traditional views, I was able to gain their trust. This helped me to gain information on the possible causes that might have led to Warrin’s present condition.
On analysing Warrin’s history I interpreted that his past encounter with childhood abuse might have led to the development of suicidal ideations. Family and peer support supposedly works by preventing suicides. However, the stigma prevalent in his family, owing to their traditional and cultural values prevented them from supporting Warrin. This worsened his condition and increased his vulnerability to depression. I realized that administration of antidepressants along with perceived social support would act as mediators in his treatment.
The Nursing and Midwifery Board of Australia has set several standards of practice for enrolled nurses, which are essential for providing evidence-based and patient-centred holistic care approaches. Australia is a huge community with a rich mixture of linguistic and cultural diversity. During my clinical placement I will be expected to work towards building professional and therapeutic relationships with individuals and their families or communities. These individuals may have a range of disabilities or serious health issues related to mental or physical illness. The aforementioned incident helped me show compliance with 2 such standards of practice.
Standard 1: Critical thinking and analysis of nursing practice
I used a variety of best available evidences and thinking strategies while making decisions that were related to providing patient-centred care to Warrin. I followed this practice to provide a safe and good quality nursing practice.
- I accessed, analysed and used best available resources from different literature and research findings to investigate the patho-physiological and genetic factors that predispose a person to depressive symptoms. This helped me gain knowledge on the several selective serotonin reuptake inhibitors that act as potential antidepressants.
- I respected the experiences and cultures while interacting with Warrin and his family members. This practice plays an essential role in underpinning the health of aboriginals. I scheduled meetings with his family members and acknowledged the elders while making any clinical decisions related to Warrin’s condition. Seeking prior consent of the elders and choosing the proper form of language while addressing them helped me gain their trust (Atkins et al. 2017).
- I maintained a comprehensive and timely documentation of all the medical assessments that were done post-admission and thoroughly reviewed his previous medical charts to investigate presence of any health conditions that might interfere with the proposed treatment plan.
Standard 2: Engaging in therapeutic and professional relationships
I purposefully engaged in effective professional and therapeutic relationship with the patient. This helped me to develop mutual respect and trust, which futher assisted in enhancing my nursing skills in providing holistic care.
- I communicated effectively with Warrin and his family to gain a deeper understanding of the psychological and cultural factors that might interfere with his mental treatment. I tried to show respect to the cultures, rights and beliefs of his community. I spoke slowly and adopted a non-threatening tone to assure them of my intentions (Daly, Speedy and Jackson 2017). I developed a non-judgemental attitude and tried to use open-ended questions while asking Warrin about the childhood abuse he had faced.
- I advocated on his behalf when the few healthcare staff were found to make explicit comments regarding his mental status and abuse history. I tried to respect his autonomy when he refused administration of tranquilizers (Forrester 2017).
- I failed to report this notifiable behaviour of the healthcare workers to my mentor. I realised that advocating for a patient right gets justified only when such untoward behaviours are reported.
Thus, I can state that the incident helped me gain knowledge on the different challenges that a nurse can face in the practical settings. It helped me recognise the importance of culture and history in the health and wellbeing of patients. However, it also helped me realize that according to the standards that promote engagement in professional and therapeutic relationship, I should have reported ill behaviour of the staff to my senior. I intend to follow this on encountering such a critical incident during my future clinical placement.
Thus, it can be stated that the above incident made me realize the duties of a nurse in clinical settings. I understood that as a registered nurse, I will need to continuously think and analyse thoughtful development of constructive relationships. I will have to develop professionally and maintain my professional capabilities (Andre and Heartfield 2016). I will be responsible for determining, coordinating and providing a safe and quality nursing to my patients. The incident also assisted me to learn that nursing practices also require establishment of non-clinical relationship with clients for their betterment.
Andre, K. and Heartfield, M., 2016. Portfolios for Health Professionals. Elsevier Health Sciences.
Atkins, K., De Lacey, S., Britton, B. and Ripperger, R., 2017. Ethics and law for Australian nurses. Cambridge University Press.
Chang, E. and Daly, J., 2015. Transitions in Nursing-E-Book: Preparing for Professional Practice. Elsevier Health Sciences.
Daly, J., Speedy, S. and Jackson, D., 2017. Contexts of nursing: An introduction. Elsevier Health Sciences.
Forrester, K., 2017. AN INTRODUCTION TO LEGAL ASPECTS OF NURSING PRACTICE. Contexts of Nursing: An Introduction, p.153.