• Internal Code :
  • Subject Code : NSG3NRC
  • University : La Trobe University
  • Subject Name : Nursing

Standard 1: Thinks Critically and Analyses Nursing Practice

Objective

The objective is to ensure safety and quality care for the patients. By using the knowledge from the experiences and the practice the patients can be provided with improved care services by the nurses. The objective is to ensure that respectful and culturally safe care is delivered to the different community patients such as aboriginals or others. The nursing care delivered should comply with policies, procedures, and guidelines of the nursing practices. The patients should be supported in decision-making with the ethical framework of nursing practices.

Strategies with Evidence

Strategy 1: It is required to ensure the maintenance of registered nursing practice standard 1.6, which states that there should be accurate and timely documentation of the patient information (Nursing and Midwifery Board of Australia (NMBA), 2019). The documentation prepared by the nurses should be cross-checked or doubled-checked by the co-working nurse or educator. This ensures the least medication errors or medical errors and the safety of the patient (Asmirajanti, Hamid & Hariyati, 2019). With proper documentation in nursing thee is high chances of effective inter-personal communication to ensure quality care of the patient. If the documentation is timely maintained by the nurses then effective patient-centered care can be delivered. It should be ensured by the educator that the nurses are preparing clinical notes or other patient-related documentation such as handovers in clear, simple, and legible English language. The documentation should be signed appropriately and cross-checked with the bedside clinical notes of the patient. Timely documentation of the patient information results in assessments and identification of the risks to the health at early stages and such conditions can be immediately and effectively resolved by taking recommended medical actions.

Strategy 2: The use of ethics of nursing – autonomy, beneficence, non-maleficence, and justice (Gallagher, 2017). According to Devik, Munkeby & Finnanger et al. (2020), an exhibition of ethics in nursing practice ensures respect, dignity, humanity, and safety for the patient. Such practices ensure responsiveness and a focused attitude towards the job, safe environment, and handling of clinical dilemmas as well. With the use of ethics in nursing practices the patient can be the nurses are bound to deliver care services that do not harm the patient and promote good health. It is the right of the patient to get safe care, fair delivery of the medical services, no harm or reduction of the harmful situation during nursing, promotion of good health and prevention of the diseases, and right to make decisions for treatment or other plans. If the nurse maintains such factors then the choice of the patient will be respected and culturally safe care will be ensured. This will also result in patient satisfaction. It is found that if the ethics in nursing are maintained then the issues such as negligence, breach of duty, irresponsiveness, and unprofessional behavior can be ensured. If these factors are maintained then it can lead to the establishment of legal and professional nursing practices in the workplace; such factors always ensure quality care, safety, respect to the patient, humanity, and dignity.

Strategy 3: Use of National Safety and Quality Health Service standard of communication for safety standards. According to the Australian Commission on Safety and Quality in Healthcare (2020), with proper documentation maintaining and matching the risks of miscommunication or mishandling of handovers or clinical notes are prevented. Moreover, with the use of this strategy by the nurses ensure complete documentation of the patient’s information in the records in written format. The documentation should be re-checked twice to ensure safe care for the patient. Communication is a very important factor in nursing to ensure the safety and quality of health care services. It is found that poor documentation can result in poor communication risking the safety of the patient such as poor care outcomes, inappropriate treatment, misdiagnosis, and errors. All the health professionals of the multidisciplinary team ensure effective transfer of information about the patient by the transfer of well-structured and written documentation for effective communication.

Standard 2: Engages in Therapeutic and Professional Relationships

Objective

The objective is to support the guard the patient for various resources available so that the patient can receive better care services. To ensure that there is effective communication among health professionals so that coordination and supervision are maintained. It will ensure that the information that supports a patient-centered approach is encouraged, advocacy, and autonomy are ensured. With the motto to obtain collaborative care in nursing, various benefits can be achieved such as deliver better patient outcomes, improve the patient experience, and prevent medication errors. These factors of professional relationship development among nurses will ensure reduced hospital costs for the patient as well.

Strategies with Evidence

Strategy 1: The use of principle 4 of the NMBA code of conduct ensures that professional behavior should be maintained by the nurse (Nursing and Midwifery Board of Australia (NMBA), 2019). The nurse should identify the power imbalance among the health professionals and it should always be ensured that there is the establishment of professional boundaries and relationships with the workplace co-workers. According to Hartley, Raphael, & Lovell et al. (2020), professional relations and professional communication with other health workers can result in the development of the interpersonal skills of the nurse. Such professional behavior will ensure short or no delays in patient care, reduced changes of conflicts, and teamwork with the use of therapeutic and professionalism in nursing practice. These factors will also help in the development of professionals in the nurse.

Strategy 2: Maintenance of advocacy ensures that the patient’s issues, rights, or safety are maintained. Advocacy is not only for the patients but it is also for the co-workers. The workers/patients should be educated or informed about the resources or their rights. Advocacy is one of the ethical principles in nursing that ensures professionalism in the responsibilities and duties of the nurse. According to Kalaitzidis & Jewell (2020), it is the role of the health professionals to ensure advocacy for the co-worker whose practice or job performance may be impaired. A nurse can help a patient who cannot speak in reserving his/her rights by recording his/her preferences and informing the associated health professionals to plan carefully as per the patient’s wishes, before the commencement of the treatment. It should be ensured that the nurse’s problems do not affect the professional relationship and the patient’s needs and rights should be prioritized every time. Advocacy is reflected as one of the professional relationship skills of the nurses that can help in patient safety and quality care delivery. Such factors always ensure preserving dignity, promoting good health and support to the patient or co-workers in decision-making with the help of advocacy in professional relationships; so that job performances of the co-workers are also improved with patient’s health outcomes.

Strategy 3: Improvement of collaborative values among nurses by being a leader and successful; teamwork. This can ensure by the following factors: open-ended questions and answers, respectful atmosphere, enabling environment, regular or routine communication, clear specifications regarding accountabilities and authority, and shared responsibility for team success (Australian Commission on Safety and Quality in Healthcare, 2020). According to Zhang, Huang & Liu et al. (2016), the collaborative values of nurse and physicians results in job satisfaction and high turnover in the hospital. This collaborative value is very important for the stability of the health care team. For example, in Beijing, a cross-sectional study was conducted using non‐randomized sampling for data collection. It was found that it is negatively predicted the likelihood of quitting the current job and a positive correlation between the physician–nurse collaboration for job satisfaction. Thus, collaborative teamwork not only improves the job performances but also creates a healthy environment where the co-workers can develop more skills in the nursing profession and can deliver effective quality services with clear communication with other members of the team.

Standard 3: Maintains the Capability for Practice

Objective

The objective is to actively engage in the profession with timely conducted response and feedbacks. There should be continuous learning for professional development. For the development of professional nursing practices, the nurses should be accountable for their roles, duties, and responsibilities. With the promotion of the integral role of nursing practices so that the professional development is promoted and health outcomes are better and improved. The nursing practice standard will be maintained with accountability which will further ensure safety, delivery of information so that patients can be supported in their decision-making, and the capability to practice is developed.

Strategy 1: The aim to maintain or follow the ethical principle of non-maleficence will be helpful and can be used as a strategy. Non-maleficence in nursing states that the nurse should deliver the care services that ensure minimum or no harm to the patient. This can be achieved by ensuring the nursing professional standards such as the use of evidence-based practices with learning from the experiences and conducting the care effectively and comprehensively, these will limit the risks to the health of the patient and develop professionally as well. According to Jafari, Khatony & Abdi et al. (2019), the study conducted with nursing students for ethical principles knowledge showed positive results in care delivered; as the nurses maintained the safety of the patient by attaining proper knowledge about the health, clinical environment and beliefs of the patient so that no harm is caused to the patient and patient-centered care is delivered.

Strategy 2: Maintenance of documentation and evaluation is very important in nursing as it ensures timely and safe care. According to Stewart, Doody &Bailey et al. (2017), the documentation should be sequential, timely updated, reflective, and in a nursing-specific manner.

It should be ensured that there is no disclosure of the patient’s privacy and confidentiality, organizational confidentially, and professionally confidentially. The documented reports or notes should be maintained for reflective learning so that the nurse can keep a track record of improvement so that no unprofessional or unethical action could take place in the future. Hence, documentation is always helpful in reducing medical errors and promotes reflective learning that developed appropriate nursing values in a nurse. Moreover, if there is any look-alike or sound-alike medication then it is better to document it and double-check it so prevents risks to the health of the patient. Furthermore, the organizational support is also required for documentation maintenance which will ensure holistic nursing care and patients' perspectives.

Strategy 3: Appropriately handling of the handover. If the handover is not maintained appropriately then it can lead to violation of NSQHS standards of recognizing and responding to acute deterioration standards, comprehensive care standards, and clinical governance standards. There should be an interaction with the patient and checking the patient’s ID before signing the handover. Moreover, double-checking of the medical records is required before signing the handover with communication or transfer of the patient’s mental health state or other records between the nurses before the handover (NSW government, 2019). A professional nurse will always have complete information on all the medication and their side-effects management approaches. This ensures quality care and safety with no harm to the patient. It is required to be comprehensively assessed, monitored, and evaluated for the risk factors that can result in harm to his/her health. The patient should be checked for his/her history and present health state during handover management. An assessment during handover can identify the risks of deterioration and help in the use of alternative plans immediately to prevent poor health situations (NSW Government, 2019). There should be a checking of signs of swelling or infection during the handover procedure. The handover should also contain information about the tests that are recommended for the patient, the patient’s doubts should care about his/her discharge and there should be the transfer of information about the tests that the patient will be having in the future so that informed consent can be taken.

References

Asmirajanti, M., Hamid, A. Y. S., & Hariyati, R. T. S. (2019). Nursing care activities based on documentation. BMC Nursing, 18(1), 1-5. DOI: 10.1186/s12912-019-0352-0

Australian Commission on Safety and Quality in Healthcare. (2020). Communication for safety standard. Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard

Devik, S. A., Munkeby, H., Finnanger, M., & Moe, A. (2020). Nurse managers’ perspectives on working with everyday ethics in long-term care. Nursing Ethics, 0969733020935958. DOI:10.1177%2F0969733020935958

Gallagher, A. (2017). Care ethics and nursing practice. Key Concepts and Issues in Nursing Ethics (pp. 55-68). Springer, Cham. DOI: 10.1007/978-3-319-49250-6_5

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. DOI:10.1016/j.ijnurstu.2019.103490

Jafari, H., Khatony, A., Abdi, A., & Jafari, F. (2019). Nursing and midwifery students’ attitudes towards principles of medical ethics in Kermanshah, Iran. BMC Medical Ethics, 20(1), 26.DOI: 10.1186/s12910-019-0364-z

Kalaitzidis, E., & Jewell, P. (2020). The concept of advocacy in nursing: A critical analysis. The Health Care Manager, 39(2), 77-84. DOI:10.1097/HCM.0000000000000292

NSW government. (2019). Clinical Handover - Standard Key Principles. Retrieved from: https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2009_060

Nursing and Midwifery Board of Australia (NMBA). (2019). Professional standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Stewart, K., Doody, O., Bailey, M., & Moran, S. (2017). Improving the quality of nursing documentation in a palliative care setting: A quality improvement initiative. International Journal of Palliative Nursing, 23(12), 577-585.DOI: 10.12968/ijpn.2017.23.12.577

Zhang, L., Huang, L., Liu, M., Yan, H., & Li, X. (2016). Nurse–physician collaboration impacts job satisfaction and turnover among nurses: A hospital‐based cross‐sectional study in Beijing. International Journal of Nursing Practice, 22(3), 284-290. DOI:10.1111/ijn.12424

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