Practice Improvement Portfolio

NSG3RDP/RDM – RECOGNISING AND RESPONDING TO THE DETERIORATING PATIENT CONTEXT MAPPING TEMPLATE

NSG3RDP/RDM Subject Summary
In this subject you had the opportunity to extend your knowledge and skills to complex and dynamic patient situations. Through lectures, online activities, workshops, clinical skills laboratories and a clinical placement you will focussed on the assessment and interventions aimed at arresting sudden deterioration of a patient’s health. The clinical practicum allowed you to experience high acuity care settings and assume the responsibility of caring for individuals with time critical needs.

Subject Intended Learning Outcomes
1. Identify common pathophysiology that can result in sudden deterioration of an individual’s condition.
2. Apply the clinical reasoning cycle to provide person-centred care for individuals experiencing sudden deterioration.
3. Demonstrate competence in technical skills when providing person-centred care for individuals experiencing sudden deterioration
4. Articulate the role and responsibilities of a nurse caring for an individual experiencing a sudden deterioration.
5. Develop and awareness of and contribute to the risk management strategies of a healthcare agency

Guidelines and instructions on how to complete this subject mapping template
Please complete the subject template below by following the following instructions:
Step 1 For each of the seven standards, look at the ANSAT behavioural cues listed under that Standard.
Step 2 Tick the level you achieved for that standard at final assessment (please (Tick √) the relevant points column).
Step 3 Comments column – reflect on the level you achieved for that standard. Using the ANSAT behavioural cues to guide you, reflect and write comments on how you achieved that standard. Provide examples of how you achieved each of the standard during your clinical placement.

NSG3RDP/RDM – Expected level of achievement is a minimum of 3 points for each Standard

Nursing Standard with ANSAT Behavioural cues Points 1

(Tick √) Points 2

(Tick √) Points 3

(Tick √) Points 4

(Tick √) Points 5

(Tick √) Comments

(Instructions on how to complete the comments section)

Address each Standard and associated ANSAT behavioural cues separately
– there must be a reflection and discussion written for each Standard
– however, the ANSAT behavioural cues can be addressed as one summary
(please see the example template provided for this Assessment to guide you).

Step 1: Reflect on the Standard and associated ANSAT behavioural dues.

Step 2: Using your ANSAT or NCAS tool in Pebble Pad, tick the level you achieved for the subject at final clinical assessment (please use the points column to do this).

Step 3: Although the score to pass the placement for the subject was a minimum of (3), if you scored below a (5) reflect on and discuss why you did not score a (5). If you scored a (5), then reflect on and discuss how you achieved the high level.

Give some examples from your clinical placement at the time, to support your reflection and discussion for Step 3.

*IMPORTANT INFORMATION
When you review the clinical cues for each of the standards, you are not required to write a separate comment for each clinical cue.
Write a summary that incorporates all the clinical cues. There are samples provided throughout this template to guide your writing.

Standard 1 – THINKS CRITICALLY AND ANALYSES NURSING PRACTICE

COMPLIES AND PRACTICES ACCORDING TO RELEVANT LEGISLATION AND LOCAL POLICY
• Follows policies and procedures of the facility/organisation(e.g. workplace health and safety / infection control policies)
• Maintains patient/client confidentiality
• Arrives fit to work
• Arrives punctually and leaves at agreed time
• Calls appropriate personnel to report intended absence
• Wears an identification badge and identifies self
• Observes uniform/dress code
• Maintains appropriate professional boundaries with patients/clients and carers
USES AN ETHICAL FRAMEWORK TO GUIDE THEIR DECISION MAKING AND PRACTICE
• Understands and respects patients’/clients’ rights
• Allows sufficient time to discuss care provision with patient/clients
• Refers patients/clients to a more senior staff member for consent when appropriate
• Seeks assistance to resolve situations involving moral/ethical conflict
• Applies ethical principles and reasoning in all health care activities
DEMONSTRATES RESPECT FOR INDIVIDUAL AND CULTURAL (INCLUDING ABORIGINAL & TORRES STRAIT ISLANDER) PREFERENCE AND DIFFERENCES
• Practices sensitively in the cultural context
• Understands and respects individual and cultural diversity
• Involves family/others appropriately to ensure cultural/spiritual needs are met
SOURCES AND CRITICALLY EVALUATES RELEVANT LITERATURE AND RESEARCH EVIDENCE TO DELIVER QUALITY PRACTICE
• Locates relevant current evidence (e.g. clinical practice guidelines and systematic reviews, databases, texts)
• Clarifies understanding and application of evidence with peers or other relevant staff
• Applies evidence to clinical practice appropriately
• Participates in quality activities when possible (e.g. assists with clinical audit, journal club)
• Shares evidence with others
MAINTAINS THE USE OF CLEAR AND ACCURATE DOCUMENTATION
• Uses suitable language and avoids jargon
• Writes legibly and accurately (e.g. correct spelling, approved abbreviations)
• Records information according to organisational guidelines and local policy

Standard 2 – ENGAGES IN THERAPEUTIC AND PROFESSIONAL RELATIONSHIPS

COMMUNICATES EFFECTIVELY TO MAINTAIN PERSONAL AND PROFESSIONAL BOUNDARIES
• Introduces self to patient/client and other health care team members,
• Greets others appropriately
• Listens carefully and is sensitive to patient/client and carer views
• Provides clear instructions in all activities
• Uses a range of communication strategies to optimise patient/client rapport and understanding (e.g. hearing impairment, non-English speaking, cognitive impairment, consideration of non-verbal communication)
• Communication with patient/client is conducted in a manner and environment that demonstrates consideration of confidentiality, privacy and patient’s/client’s sensitivities
COLLABORATES WITH HEALTH CARE TEAM AND OTHERS TO SHARE KNOWLEDGE THAT PROMOTES PERSON-CENTRED CARE
• Demonstrates positive and productive working relationships with colleagues
• Uses knowledge of other health care team roles to develop collegial networks
• Demonstrates a collaborative approach to practice
• Identifies appropriate educational resources (including other health professionals)
• Prioritises safety problems
PARTICIPATES AS AN ACTIVE MEMBER OF THE HEALTHCARE TEAM TO ACHIEVE OPTIMUM HEALTH OUTCOMES
• Collaborates with the health care team and patient/client to achieve optimal outcomes
• Contributes appropriately in team meetings
• Maintains effective communication with clinical supervisors and peers
• Works collaboratively and respectfully with support staff
DEMONSTRATES RESPECT FOR A PERSON’S RIGHTS AND WISHES AND ADVOCATES ON THEIR BEHALF
• Advocates for the patient/client when dealing with other health care teams
• Identifies and explains practices which conflict with the rights/wishes of individuals/groups
• Uses available resources in a reasonable manner
• Ensures privacy and confidentiality in the provision of care

Standard 3 – MAINTAINS THE CAPABILITY FOR PRACTICE

DEMONSTRATES COMMITMENT TO LIFELONG LEARNING OF SELF AND OTHERS
• Links course learning outcomes to own identified learning needs
• Seeks support from others in identifying learning needs
• Seeks and engages a diverse range of experiences to develop professional skills and knowledge
• Supports and encourages the learning of others
REFLECTS ON PRACTICE AND RESPONDS TO FEEDBACK FOR CONTINUING PROFESSIONAL DEVELOPMENT
• Reflects on activities completed to inform practice
• Plans professional development based on reflection of own practice
• Keeps written record of professional development activities
• Incorporates formal and informal feedback from colleagues into practice
DEMONSTRATES SKILLS IN HEALTH EDUCATION TO ENABLE PEOPLE TO MAKE DECISIONS AND TAKE ACTION ABOUT THEIR HEALTH
• Assists patients/clients and carers to identify reliable and accurate health information
• Patient/client care is based on knowledge and clinical reasoning
• Refers concerns to relevant health professionals to facilitate health care decisions/delivery
• Provides information using a range of strategies that demonstrate consideration of patient/client needs
• Prepares environment for patient/client education including necessary equipment
• Demonstrates skill in patient/client education (e.g. modifies approach to suit patient/client age group, uses principles of adult learning)
• Educates the patient/client in self-evaluation
RECOGNISES AND TAKES APPROPRIATE ACTION WHEN CAPABILITY FOR OWN PRACTICE IS IMPAIRED
• Identifies when own/other’s health/well-being affect safe practice
• Advises appropriate staff of circumstances that may impair adequate work performance
• Demonstrates appropriate self-care and other support strategies (e.g. stress management)
DEMONSTRATES ACCOUNTABILITY FOR DECISIONS AND ACTIONS APPROPRIATE TO THEIR ROLE
• Provides care that ensures patient/client safety
• Provides rationales for care delivery and/or omissions
• Sources information to perform within role in a safe and skilled manner
• Complies with recognised standards of practice

Standard 4 – COMPREHENSIVELY CONDUCTS ASSESSMENTS

COMPLETES COMPREHENSIVE AND SYSTEMATIC ASSESSMENTS USING APPROPRIATE AND AVAILABLE SOURCES
• Questions effectively to gain appropriate information
• Politely controls the assessment to obtain relevant information
• Responds appropriately to important patient/client cues
• Completes assessment in acceptable time
• Demonstrates sensitive and appropriate physical techniques during the assessment process
• Encourages patients/clients to provide complete information without embarrassment or hesitation
ACCURATELY ANALYSES AND INTERPRETS ASSESSMENT DATA TO INFORM PRACTICE
• Prioritises important assessment findings
• Demonstrates application of knowledge to selection of health care strategies (e.g. compares findings to normal)
• Seeks and interprets supplementary information, (e.g. accessing other information, medical records, test results as appropriate)
• Structures systematic, safe and goal oriented health care accommodating any limitations imposed by patient’s/client’s health status

Standard 5 – DEVELOPS A PLAN FOR NURSING PRACTICE

COLLABORATIVELY CONSTRUCTS A PLAN INFORMED BY THE PATIENT/CLIENT ASSESSMENT
• Uses assessment data and best available evidence to construct a plan
• Completes relevant documentation to the required standard (e.g. patient/client record, care planner and assessment, statistical information)
• Considers organisation of planned care in relation to other procedures (e.g. pain medication, wound care, allied health therapies, other interventions)
PLANS CARE IN PARTNERSHIP WITH INDIVIDUALS/SIGNIFICANT OTHERS/HEALTH CARE TEAM TO ACHIEVE EXPECTED OUTCOMES
• Collaborates with the patient/client to prioritise and formulate short and long term goals
• Formulates goals that are specific, measurable, achievable and relevant, with specified timeframe
• Advises patient/client about the effects of health care

Standard 6 – PROVIDES SAFE, APPROPRIATE AND RESPONSIVE QUALITY NURSING PRACTICE

DELIVERS SAFE AND EFFECTIVE CARE WITHIN THEIR SCOPE OF PRACTICE TO MEET OUTCOMES
• Performs health care interventions at appropriate and safe standard
• Complies with workplace guidelines on patient/client handling
• Monitors patient/client safety during assessment and care provision
• Uses resources effectively and efficiently
• Responds effectively to rapidly changing patient/client situations
PROVIDES EFFECTIVE SUPERVISION AND DELEGATES SAFELY WITHIN THEIR ROLE AND SCOPE OF PRACTICE
• Accepts and delegates care according to own or other’s scope of practice
• Seeks clarification when directions/decisions are unclear
• Identifies areas of own or other’s practice that require direct/indirect supervision
• Recognises unexpected outcomes and responds appropriately
RECOGNISE AND RESPONDS TO PRACTICE THAT MAY BE BELOW EXPECTED ORGANISATIONAL, LEGAL OR REGULATORY STANDARDS
• Identifies and responds to incidents of unsafe or unprofessional practice
• Clarifies care delivery which may appear inappropriate

Standard 7 – EVALUATES OUTCOMES TO INFORM NURSING PRACTICE

MONITORS PROGRESS TOWARDS EXPECTED GOALS AND HEALTH OUTCOMES
• Refers patient/client on to other professional/s
• Begins discharge planning in collaboration with the health care team at the time of the initial episode of care
• Monitors patient/client safety and outcomes during health care delivery
• Records and communicates patient/client outcomes where appropriate
MODIFIES PLAN ACCORDING TO EVALUATION OF GOALS AND OUTCOMES IN CONSULTATION WITH RELEVANT HEALTH CARE TEAM AND OTHERS
• Questions patient/client or caregiver to confirm level of understanding
• Updates care plans/documentation to reflect changes in care
• Uses appropriate resources to evaluate effectiveness of planned care/treatment