Analyzing Nurse Standards And Practices Discussion Paper
Standard One: Critical Thinking And Best Available Evidence
In the patient situation that I had, the patient called me and informed me that she was in severe pain. In this situation, I missed to think critically on the pain situation and use the best available evidence as required by standard one before acting. The NMBA standard one requires nurses to use a variety of thinking strategies and with the best available evidence to make decisions that lead to a safe, quality and evidence based practice. This means that as a nurse, I was supposed to maintain accurate, comprehensive and timely documentation of assessments, planning, decision-making, actions and evaluations when dealing with the patient. I did not achieve this since I missed to document the patient’s pain complaint and when I went to the RN she referred me back to the medication chart which is one of the tools used for documentation. However, I also realized that my actions, feelings and experiences can affect the way I react to situations since I sympathized with the patient situation and failed to follow the required nursing plan when responding to the patient’s needs.
Standards two requires nurses to engage in effective therapeutic and professional relationships with their patients. When working with the patient in the acute ward, I adequately engaged in therapeutic and professional relationships with the patient through effective communication and respecting the patient’s dignity, culture, values and beliefs. Through communication, I managed to build rapport and develop collegial generosity leading to mutual trust and respect between me and the patient. Through advocating for the needs of the patient, I ensured that she got relieved of her pain since the doctor reviewed her medication chart and doubled the morphine dose. Further, I recognized that people are experts in their own health and thus the subjective feelings and explanations that they give can be used to draw conclusions on what they are feeling. This is the reason why despite not using the pain scale to get an objective measure, it was evident that the patient was feeling severe pain. However, I need to work on controlling my feelings so that they do not affect my ability to use an EBP approach when dealing with different situations. This was seen from my reaction to the patient’s pain scenario which affected my professional approach to such an issue. Analyzing Nurse Standards And Practices Discussion Paper
Standard three requires nurses to maintain capability for practice through ensuring that nurses are responsible and accountable to their actions. For example, the nurse needs to respond in a timely manner to the health and wellbeing of the patient. To maintain capability for practice I responded immediately to the case of the patient by escalating the issue to the RN. This means that when responding to these situations, I needed to be accountable to my actions which I did very well. When the nurse asked me whether I had used the pain scale to assess the level of pain that the patient was feeling, I accepted making that mistake and also failing to refer to the medication chart to understand the type of medication that the patient was using. As a student nurse, the only way that I could improve my nursing experience was through actively engaging with the profession and learning from my supervisor. This way, I used feedback from my supervisor to identify the mistakes that I have made and correct them to improve my practice. For example, I learned the importance of using the medication chart and nursing notes so that they can be used during handing over.
Standard Two: Effective Therapeutic And Professional Relationships
Standard four requires the nurse to comprehensively conduct systematic assessments using the relevant nursing tools. This means that the nurse is supposed to analyze information and communicate outcomes from there to inform the basis of practice. As a nurse, I work closely with the patient and I am supposed to work as a bridge with the rest of the multidisciplinary team. This means that I needed to conduct assessments that are holistic and culturally appropriate using a range of assessment techniques. However, I failed to use the objective assessment tools for assessing the severity of the pain from the patient. When the patient explained the pain situation, I missed out on comprehensively conducting the pain assessment but rather relied on the subjective feeling of the patient. I was supposed to assess the level of pain that the patient was feeling and give a score of 0-10 on a rating scale. I missed out on this assessment since I concentrated more on the subjective assessment of the patient leaving out the objective pain scale which is an accepted scientific tool assessing pain level. When the nurse asked me about the pain level of the patient, I could not give an objective answer since I missed out on this part.
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Standard five requires nurses to develop a plan for nursing practice which is supposed to be done in partnership with the patient and multidisciplinary teams. In such cases, the nurse needs to appraise comprehensive, relevant information, and evidence that leads to the best nursing plan.
From the assessment data, I managed to develop a clear plan for responding to the patient’s pain situation. This was done in collaboration with a senior nurse and everything that I was doing was through collaboration and partnership with the RN. This is why when the patient complained about pain, I effectively sympathized with the situation and then promised to solve the situation after consulting the senior nurse. As a nurse, I am supposed to develop and implement nursing plans in collaboration with a senior nurse who was my supervisor. I also negotiated how the practice will be evaluated by linking the information from the patient and the nurse for clear decision making. Since the patient medication changed, it means that I also needed to revise the nursing care plan with the RN so that other clinical considerations can be added. I learned that the nursing care plan can change based on the alterations on the patient’s progress that will mean the need to adjust the plan and accommodate the improvements or the deterioration. For example, the dosage for morphine can be reduced or increased based on how the patient is responding to other medications.
Standards six requires the nurse to provide safe, appropriate and responsive quality nursing practice. This is achieved through quality and ethical directed goals based on comprehensive and systematic assessment that use evidence to achieve planned outcomes. The best way to provide safe quality practice is to work through the defined scope of practice. Nurses have different levels and at the novice level, I am not allowed to make clinical decisions before consulting with the RN. This is the reason why I escalated the pain issue from the patient to the RN who also escalated to the doctor for review. The outcome of working with the nurse and the doctor in charge made me provide safe, appropriate and responsive quality nursing based on the use of evidence based practices. Further, I learned the importance of practicing in accordance with relevant policies, regulations and legislation. For example, morphine is a controlled drug and can only be administered by approved persons. This is the reason why the nurse informed me that she needed to consult with the doctor. This is a way of also maintaining capability for practice and improving clinical outcomes. As I practiced according to the standard, I also ensured that I was reporting any potential or actual risks from the patient to the RN for immediate intervention. This was due to the changes in the medical plan that required frequent monitoring and reporting on the patient’s progress for any unusual side effects.
Standard Three: Maintaining Capability For Practice
Standard seven requires the nurse to evaluate outcomes to inform nursing practice. This is achieved through taking responsibility for the evaluation of practice based on the agreed priorities, goals, plans and outcomes. As a nurse, I am supposed to evaluate and monitor the progress of the patient towards the expected goals and outcomes. One expected outcome here was reduced pain level and thus when the patient complained of increased pain, I immediately informed the RN so that the patient can be restored along the agreed goals. This means that the patient’s plans can change and my expectation when escalating the pain issue was more pain killers to the patient to reduce the severity of the pain. Here the doctor responded by administering 20 mg every four hours and thus my nursing considerations for the patient were also adjusted based on the changes in the nursing plan. In responding to the new changes, I worked with the RN on how to revise the patient plan and evaluation to consider the dosage changes. After the nursing situation, I also evaluated the outcome of the nursing process to understand the areas for improvement and become a better nurse. This way I learned how to improve my capability for practice and become a better nurse.
When placed in the acute surgical ward, with a patient who had been admitted with severe abdominal pain and was diagnosed with small intestine obstruction which was managed through pre-operative surgical intervention. While working in the ward, the patient called me and said she was in severe pain and needed more pain killers. I introduced myself to the patient to build good rapport and establish a good therapeutic relationship as defined by the NMBA standards. What struck me most is the way the patient was the subjective way in which the patient was expressing herself to show that she was in deep pain. This petrified me because I had never come across a person in such pain but I assured her that I was going to talk to the senior nurse in charge and see how I can help her. When I went to the nurse, she asked for the patients drug chart and started asking me questions like how do I know that the patient was in severe pain. She also asked whether I had applied the trust pain scale to assess the level of pain which made me feel embarrassed since I had been overtaken by sympathy of the patient’s situation and failed to apply the required nursing procedures. The NMBA standard 4.2 requires the nurse to use a range of assessment techniques to systematically collect relevant information from the patient (NMBA, 2022). I surely missed out on this and thus went back to pick the drug chart and the RN explained to me that the patient is on oral morphine 10mg 4 hourly and the last dosage was given 2 hours ago and thus a doctor review was needed before another pain killer can be administered (Cali, Meade, Swanson, & Freeman, 2020). Morphine use needs to be regulated since it has many side effects like withdrawal symptoms which affect the patient.
Standard Four: Comprehensive Systematic Assessments
My first feeling was that the patient was in a lot of pain and the best way was to give her another dose of pain killer immediately to relieve her pain. This means that sometimes pain can be subjective and not objective which makes it difficult to measure it unless from the patients perspective. From the patient’s pain, I was so overwhelmed by the patient’s pain to the point that I forgot to assess the pain. When the nurse corrected me. I felt embarrassed and questioned by ability to work as a nurse since I had made an error that was so easy to avoid.
Being my first time to encounter a patient in acute pain I learned so much on the importance of using patient assessments rather than sympathizing with the pain of the patient. Evidence based practices require that morphine review is done before the patient can be administered within another shot of pain killers outside the prescribed dosage. Patient assessment is important since it helps the nurse to make objective assessments about the situation of the patient (Tandon, et al., 2016). To improve my knowledge on this, I asked the RN on the different ways to care for patients and how to respond to needs like pain professionally. I learned that patients are not concerned about the prescribed dosage but rather want to feel pain relief only. I also learned that I have deficiencies in my nursing skills especially caring for patients in acute settings since they require a lot of them. Nurses need to be adequately prepared with a variety of skills for responding to the different issues that patient’s face so that they can adequately improve them.
Form the case, I learned the importance of nursing skills and also following nursing standards. Nursing skills are important for dealing with the different challenges that nurses face when in ward while nursing standards exist to guide the patient with the nursing process. This means that I need more nursing skills to overcome the acute ward situations and challenges. On the other hand, I need to improve on my nursing standards so that I can learn to apply each one of them in the nursing situations that I deal with.
Conclusion
From the case, I can conclude that nurses face a lot of challenges when working in the acute ward and they need to have different skills that they can use to overcome these challenges. Nurses also need to have adequate knowledge of NMBA standards to ask as a guideline for the different nursing decisions that they make. Since nurses are the bedside workers and spend most of the time with patients, they need to empower themselves with adequate knowledge that can allow them also apply EBP approaches.
My action plan is to improve my nursing skills to adequately respond on different nursing situations.
The second action plan is to work on my knowledge on NMBA standards so that I can know where to apply which standard when dealing with a patient.
Lastly, I will work on the use of evidence-based approaches in dealing with different patient situations at all times.
References
Cali, R., Meade, P., Swanson, M., & Freeman, C. (2020). Effect of Morphine and incision length on bowel function after colectomy. Dis Colon Rectum, 43(2), 163-168.
