In my clinical placement in the ward, I noticed that few of the colleagues were not complaint to the hand hygiene technique. They were not following the 6 steps of hand hygiene necessary before delivering are to the patient. On confronting my fellow nurse, she took the situation very casually, by giving excuses such as she has a lot of patients on her watch and the sinks are too far away to keep washing hands in between seeing two patients in the ward (Lee & Jang, 2020). Upon her inappropriate reaction, I educated her on the importance of maintaining adequate hand hygiene for patient safety and ensuring a secure way of delivering the care. When I did not realise that my advice was taken seriously, I reported the act of negligence to my supervisor.
A positive organizational culture encourages an open and honest environment for the staff to increase the quality of work by caring for each other and providing support to one another (Melanie, 2017). The nature of the task of a healthcare worker or a health care professional is a very daunting and complex one. It is essential to work in collaboration and as a team to provide effective care to the patients and improve their outcomes of treatment. The Melbourne Safety Culture Program encourages the nurses to "speak up" regarding their concern for patient safety. Nurses are the front-line workforce which provides direct care to the patient and are closely related in dealing with the patients in a day to day life (Haller, Berends & Skillin, 2018). It is essential to maintain hand hygiene to ensure patient safety as they are vulnerable individuals suffering from various medical ailments or disabilities, especially those patients who are more sensitive such as patients admitted in ICUs and are in debilitating or severe condition and most of them are intubated, and in a state of coma. They require special care and surveillance in very short bouts of time. With chances of other infections getting manifested higher, management of these patients become very crucial. A study revealed that the reasons why nurses fear of retribution from other colleagues that keeps them from “speaking up” (Kim, Yoo, & Seo, 2018). However, by acquiring adequate knowledge and training of patient safety and the positive workplace culture driven by increase motivation to improve clinical outcomes of the patients and strive towards excellence help to encourage improving the clinical outcomes (Kong et al., 2019).
I believe that patient safety is one of the chief roles and responsibility of me as a nurse. From my experience in the clinical placements, I have learnt that it can be achieved with effective teamwork- working as a team, with a common goal and vision with intent to help the patients to provide them good quality of care. According to the Nursing and Midwifery Board of Australia Standards 1.1 and 1.2, a nurse has the role critically analysing the nursing practice, including evidence-based research to ensure safety as well as quality in clinical practice. The nurse must develop practice through reflection, and identify how it helps in shaping clinical practices. Standard 1.4 states that a nurse complies with the standards of requirement which are relevant to practice and according to standard 1.7, a nurse contributes to the quality improvement of patients (NMBA, 2016). I have recognized that an improved administration inspires an effectual facilitation of services, and helps in providing resolution in case of missed care and safety issues of the patients. A European revealed that a well-structured organization provides immense support in facilitating quality controls and enhancing of healthcare outcomes.
During my clinical posting in the emergency and trauma department, a patient entered on a stretcher and was in acute distress, he was not able to answer any of the doctors and when I quickly ran through his EMR records from the previous hospital and got access to his history and social background, I found out that the patient could not understand English because he was from an aboriginal background. I immediately arranged for a translator who could understand the patient and provide emotional support and the patient was relaxed after his needs to be understood was addressed.
The constantly changing and evolving nature of the healthcare system has become more dynamic due to the role of technology. It has helped in improved quality in the delivery of care, by incorporating electronic medical records. It has led nursed to exhibit the work tasks more competently and effectively. Use of electronic records provide more reliable means of abstracting the healthcare data of the patients not only in clinical use and practice but also in procuring insurance and claim benefits for the patients. Many a time the insurance companies ask for patient's health information to process their claims. Therefore, instead of using a hard copy of the visits and other diagnostic procedures, it is much easier to obtain medical records from different providers of the patients via the electronic means (Mendelson, 2020; Pandhi et al, 2018). This has revamped the entire hospitalization culture and helped to fasten the process of care for the patients (Gui et al., 2020). Using "Electronic MERs (medical records)" of the patient also provides different accesses to different healthcare professionals. Any information about one patient will be visible to the carers of that patient only, in this way it ensures compliance to the health information and privacy act. It is the duty of all healthcare facilities or institutions to safeguard the information related to their patients, it is also an ethical and legal responsibility of all the healthcare professionals that they protect the information of their patients, who are either indirect as well indirect care of the doctor/nurse/healthcare practitioner (Saleem & Herout 2018; ). Another effective utilization of the electronic medical records can be seen in the emergency departments when a patient is appearing in an extremely compromised state and requires immediate intervention for his or her life to be saved, all the doctors and nurses are heavily dependent on the EMRs to obtain critical information such as, the previous history of the patient, any case of known allergies, medical or surgical history all of which helps in the clinical decision-making process and thus have been able to increasingly improve the patient outcomes in case of emergency conditions (Penrod, 2017; Stevens et al, 2015) through which the patient has claimed insurance.
I believe that due to the revolution brought about in the healthcare sector, with incorporation of informatics systems, it has greatly benefitted the efficiency of the healthcare professionals in the workplace. Electronic Medical Records have helped overcome the staff shortage, by speeding up the process of tracking patient records, history and relevant information which has enabled me and other nurses to obtain relevant data about the patient in a matter of a few minutes, saving the time which was consumed in laboriously digging in for paperwork. The electronic medical records also ensure clarity of data, which was missing in the handwritten notes that left so much scope of interpreting discrepancies regarding any information of the patient, thus making it non-reliable source to abstract patient specifics. Therefore, use of this technology has helped all of us nurses to implement and provide improved care and to maintain sustainability in our workplace (Adams et al., 2015). Use of EMR has become easy and reliable for updating the patient prescriptions, without a physical visit to the patient, which is useful especially in times of COVID-19. Use of technology in the form of telemedicine has also been incorporated due to integration of “My Health Records”, especially in cases where patient consultations are necessary. Furthermore, I can say that it enabled me to improve my functional capacity as a nurse (NMBA, 2016).
Analysis: Two main challenges faced by the nurses during the transition to the workplace are fatigue due to being over-burdened (Hofler & Thomas, 2016). As a nurse, the practice involves interacting and dealing with patients with various diversification of needs. It is challenging to meet all their physical, emotional as well as psychological requirements, because of many factors, such as shortage of staff, increase in the population of sick elderly patients, who demand more care and increase in the comorbidities in each individual according to the lifestyle changes faced in today’s generation. As a nurse, I found it very difficult to handle the patient’s behaviour, especially while caring for the patients with mental health needs. Their emotions exhibited mainly in the form of abuse, self-harm, aggression and even apprehension to harm the carers as well. It became a cause of emotional frustration and stress in my professional as well as personal life. I started to doubt my competency skill as a nurse. However, with experience, I understood that as a nurse I must practice calm and display a therapeutic behaviour with my patients, keeping aside my emotional turmoil. Nonetheless, this scenario has grave consequences on the nurses and negatively influences productivity, leading to poor outcomes (Walker et al., 2017). The second most common challenge faced by then nurses is lack of experienced mentors and coaches to help them. This is as a result of lack of adequate staffing and over attrition of nursing professionals. Furthermore, there is an increased turnover of the senior nursing staff due to retirements, increased stress of work, lack of recognition and promotions, and increases in opportunities in different countries. This scenario brings challenges of training the graduate nurses efficiently as the management or the organizations are unable to leverage the skills of the experienced staff for mentoring and teaching purposes. Adequate coaching and continuous trainings are vital for fresh graduates in their transition phase. Thus, Hospitals must seek and ensure diversity for establishing the mentoring relationship of the graduates with other experienced staff, otherwise it may lead to unfruitful conditions and perpetual high turn-over of staff. (Hofler & Thomas, 2016).
Two positive behaviour attitudes which I will maintain during practice are providing patient centred care by developing a therapeutic relationship with the patient, showing empathy and trying to understand the needs of the patient (Ferri et al., 2017). The principles of patient-centred care have also been embedded in the standards of Nursing and Midwifery Board of Australia and is practised within clinical nursing practice. It is important for me as a nurse to reflect a positive and a caring attitude while providing care to the patient, so that the patients feel uplifted. This is what I would have expected if one of my family members were in the hospital, that they are cared without any negativity around.
As a nurse, I will comply with all the standards of delivering care and show competency in clinical practice. Secondly, I will work on enhancing my knowledge and skills, such as developing emotional intelligence, and living my values throughout the daily routine care activities (Hunter & Cook, 2018). I will be fully aware of my responsibilities as a nurse and fulfil the expectations of the patients by addressing their needs. I understand the relevance of the role of a nurse in the healthcare setting. The clinical nursing practice is a continuous learning process and requires development and upgradation of skills, by incorporating evidence-based research into practices, practice of reflection, in-depth knowledge of the subjects so that I can exhibit competency in clinical decision-making processes.
Two self-care strategies to take care of my physical, as well as mental well-being, are incorporating workplace resilience activities, such as reading, seeking support from colleagues and confiding in them (Slatyer et al., 2018). The recreational activities ensure that there is no feeling of being burn-out in our professional life and it also ensures protection against physical, mental as well as emotional fatigue which may be overwhelming while taking care of patients with complex mental and physical needs. The nursing practice establishes a strong core value system for delivering work in a clinical set up (Cynthia, H. S. A., & Stoots, 2013).
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