Nursing Portfolio: Kyneton District Health Service and Community Nursing

This nursing portfolio discusses the Kyneton District Health Service and community nursing, including the services provided, the role of district nurses, and the care provided to LGBTI patients. It also covers the responsibilities of nurses in providing evidence-based care and maintaining patient privacy and confidentiality.

Running head: NURSING PORTFOLIO
Nursing Portfolio
Name of the Student
Name of the University
Author note

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Answer to question 1
I have been placed at the Kyneton District Health Service (KDH). It is the local health
service as the part of the Macedon Ranges community for over 160 years. These services help
population of 42000 people living in the surrounding areas and at Macedon Ranges Shire
Council. This pace is populated with 47, 512 people. The area comprise of maximum number of
people at post-retirement age and fewer number of preschoolers in the district. There is high
demand for age-based services. It is fulfilled through My Aged care service and supporting the
older people in the community. The Treehouse program is the health care delivery at home. It is
an innovative social program for caring life-limiting illness at home. The KDH health service
works with the vision of giving positive experience to every person. The service is delivered in
collaboration with the Cobaw Community health service, regional health care partners and the
medical professionals. The goal of the service is to provide care that is patient-centered, right and
safe (Kyneton District Health, 2018).
Acute services in KDH contain wide range of specialists to provide procedure such as
laparoscopy up to medium complexity. The hospital has the pharmacy department in the acute
ward that supplies medications as scheduled for the patient care adding convenience during the
hospital stay and discharge. The hospital has the haemodialysis unit, pathology service and also
own radiology department. The hospital also contains the allied health services including the
social work and physiotherapy. The social workers at the Kyneton provide supportive
counselling, practical support, therapy, and advocacy and referral service. The hospital provides
the counselling services to the families needing grief and trauma support. Group work is
provided to families who have lost a child. These services are meant for improving the well
being of the community. The physiotherapists care for inpatients in the acute ward, aged care

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patients in the transitional care program, and others in the community. The physiotherapists also
carry out the Post-Acute Care home visits.
The hospital also provide the home care involving the “Macedon Ranges community
nursing”, district nursing, transition care program, “hospital in the home” program,
“Macedon Ranges Palliative Care Services" and post-acute care. Older people can access the
transition care if hospitalised while arranging for long-term care. Outreach nurses can visit the
patient's home without cost to reduce the hospital stay, and treat the illness. Community nursing
is provided to each patient. Palliative care is provided to the patients with terminal illness and
encompasses the psychological, spiritual and emotional support. Post-acute care is meant for the
public patients who are at risk of unplanned re-admission to hospital after illness or surgery
(Kyneton District Health, 2018).
KDH also includes maternity and the surgical services (medical, surgical, diagnostic,
obstetric and gynaecological care. The hospital is well equipped with facility for elective
caesarean birth, information sessions, childbirth education classes for parents and breastfeeding
classes. The surgeries are provided in various areas like dermatology, urology, plastic surgery
and others (Kyneton District Health, 2018).
Answer to question 2
In the same clinical setting, was placed one of the buddy nurses. The role of the district
nurse in the division community nursing included serving people of all ages to help people
manage the health in home and give quality support (Reed, Fitzgerald & Bish, 2015). The above
role of the buddy nurse as a part of the district nursing aligns with the position summary where it
is mentioned that they must contribute to the multidisciplinary team. The registered nurse in

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district nursing is responsible to the NUM community nursing. The district nurse works to
achieve high standards of evidenced-based nursing care. It is the role of the nurse to ensure
positive treatment outcomes by implementing the evidence-based practice as well as ensure the
privacy and confidentiality of patient (Kyneton District Health, 2018).
The buddy nurse regularly monitored the vital signs of the visited patients and conducted
relevant observation and assessment. It includes blood pressure, heart rate, pulse rate, respiratory
rate, and others. The comprehensive patient assessment is in alignment with the standard 4 of
the Australian Nursing and Midwifery Council, registered nurse standards
(Nursingmidwiferyboard.gov.au, 2018). The buddy nurse assisted the patients with the wound
management such as change of dressing and maintaining aseptic wound care. The nurse gave
pain medication and managed symptoms’ like nausea. The nurse looked after the medication
management as well as after the catheter to prevent infections. It is evident of the knowledge in
central venous access device knowledge (Reed, Fitzgerald & Bish, 2015). While caring for the
patens with diabetes, the nurse educated the patients about on time intake of medication and
consequences of missing the right dosages (Heneka et al., 2018). Further, health education
includes adherence to the care plan, lifestyle modifications required by the patient such as weight
loss, physical activity, diet recommendations, and self-monitoring of blood glucose. These
measures taken by the nurse is evidence of proficiency in wound management, and diabetes. It is
the key selection criteria of the registered nurse – district nurse (Lee et al., 2015).
The buddy nurse worked in alignment with the position summary where accountability
and responsibility of the own practice must be assumed based on the level of education and
competence. The above role played by the buddy nurse is found to be similar with the standard 3
of the registered nurse standards set by the ANMC (Nursingmidwiferyboard.gov.au, 2018).

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Further the buddy nurse was observed to follow the guidelines given by the Kyneton District
Health and worked in accordance with the organisation’s values and policies. The buddy nurse
was responsible to maintain the privacy and confidentiality of the patient, advocate patients and
also mandated by NMBA code of ethics and registered nurse standards and KDH (Kyneton
District Health Service: Privacy of Patient Health Information, 2017). It helps the district nurses
reduce the moral and ethical dilemma inherent in nursing (Nursingmidwiferyboard.gov.au,
2018). The buddy nurse maintains the confidentiality as per Health Record Act 2001 of KDH
and is similar to the national legislation Health Insurance Portability and Accountability Act
useful in promoting the nurse-patient integrity which is essential in community setting (Feo et
al., 2017).
The buddy nurse did visit the patient’s (suffering from dementia) home for palliative
care. This was the key accountability of the nurse as per the (ANMC), scope of practice
(Nursingmidwiferyboard.gov.au, 2018). Other accountabilities taken by nurse that holds
similarity with the scope of practice are undertaking the educator role for the patient and the
family. The nurse obtained detailed patient history and reported concerning issues to the
community nursing staff. It demonstrates her responsibility to collect information before
attending patient. Providing the bereavement visits in line with the bereavement standards of
Kyneton District Health. It is also the key accountability as per the National competency
standards and code of conduct for Australian nurses and Midwives
(Nursingmidwiferyboard.gov.au, 2018). When providing the palliative care at hospital the buddy
nurse was found to allow a Christian patient to keep the prayer beads at bedside. The buddy
nurse maintained the calm and positive outlook to reduce the patient’s anxiety both in-home visit
and in clinical setting. The nurse was efficient in verbal and non-verbal skills. This practice of

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the buddy nurse demonstrated the provision of palliative care in combination with the medical,
emotional, and spiritual support mandated by the Kyneton hospital (Kynetonhealth.org.au, 2018-
community setting brochure). Thus, the district nurse integrated wide variety of services. It was
also in alignment with the holistic care perspective mentioned by Keall, Clayton & Butow
(2014).
The buddy nurse however did not fulfil other key accountabilities in the position
description such as assessing and sending the referrals using the “My Aged Care”. The nurse was
not found to actively link the family member’s problems to the appropriate volunteer services in
community. It is in contrast to the code of conduct of the RN- district nurse
(Kynetonhealth.org.au, 2018). The buddy showed active participation in programs of Kyneton
District Health such as transition care program and post-acute care. The palliative care provided
by the nurse in the setting and home demonstrated the engagement in the therapeutic and
professional relationships with the patient and the family to optimise the health-related decisions
as also mentioned by Nygren Zotterman et al. (2015). This action is similar to the second
standard of the registered nurse standards set by the ANMC (Nursingmidwiferyboard.gov.au,
2018). The therapeutic relationship allowed the nurse to promote healing and functioning
inpatient. The success of building capacity by the district nurse can be attributed to support
rendered by KDH. Such support by organisation affects the nurse’s capacity to strengthen the
therapeutic relationship. Therapeutic relationship is the key responsibilities of the KDH nurses
and is underpinned by key principles of that empathy, active communication, respect,
genuineness, trust and confidentiality (Nygren Zotterman et al. 2015).
Overall, this placement gave insights of the different roles of the hospital nurse and the
com unity nurse. The former focus only on the hospitalised patients whereas the community

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nurse focuses on the population of specific regions. The community nurse unlike the hospital
nurse has the medical autonomy to take the nursing decisions and implement them for patient
safety. They can advocate referral service and transfer patients from hospital to home. Hospital
nurse is however is guided by the clinician. Community nurses create awareness in community
managing diverse population (Fooladi, 2015).
Answer to question 3
When working after placement in the Kyneton District Health, there was an encounter
with the other nurses in the clinical setting who catered for the specific needs of the LGBTI
patients. The KDH in collaboration with the Cobaw Community Health service addresses the
needs of the LGBTI patients holding the values of the integrity, respect, equity and commitment.
The services designated for the health and well being of the LGBTI patients in Victoria are
mental and sexual health service, aged care service, alcohol and drug service and other general
health service. These services help address the discrimination, family rejection, marriage law
postal survey and other issues. It helps to address the health issues like substance abuse disorder,
mood and anxiety disorder. The patients are helped using the national projects such as "LGBTI
Mental Health and Suicide Prevention Project" as well as community-level projects (Cobaw
Community Health Service, 2017; Lesbian, gay, bisexual, transgender and intersex health, 2017).
According to “Guidelines for health care providers on LGBTI-sensitive health care”
provided on the website of the Northside clinic in Melbourne, the nurses and the healthcare
provides to demonstrate the awareness of the sexuality-based discrimination and health impacts.
They must be aware of the lesbian sensitive referral networks, support services and the
community groups for the lesbians. Further, the nurses must be able to demonstrate that they are

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aware of the health care issues among LGBTI patients and the mental health impact. It may
include common sexual practices, sexually transmitted diseases, reproductive life and midlife
changes, substance abuse pattern, ageing and mental health (Northsideclinic.net.au., 2018). As
per the information from the buddy nurse in KDH, the other nurses in the clinical setting
demonstrated a very strong understanding of the impact of the various health issues encountered
by the LGBTI patients, relevant support services in the community. The nurses also had poor
understanding of way to proactively address the needs of the older LGBTI patients with range of
mental health problems, giving sensitive information. This was something in contrast to the goals
mentioned in the report titled, “NATIONAL LESBIAN, GAY, BISEXUAL, TRANSGENDER
AND INTERSEX (L G B T I)- AGEING AND AGED CARE STRATEGY”, a report released
by the Australian government Department of Health and Ageing (Agedcare.health.gov.au, 2018).
In regards to the nurses and other carer’s attitude it is specified in most of the Australian
based guidelines that they must be non-judgemental, avoid heterosexuality related assumptions,
and other stereotypes. Further the nurses must be able to involve the lesbian partners in decision
making. The nurses must also be aware of the barriers that increase the stigmatisation such a
disability, age, ethnic minority status, or economic status (Northsideclinic.net.au, 2018). The
other KDH nurses in care for LGBTI patients were not fully aware of the factors of
stigmatisation as also found to be a barrier by Chapman et al. (2012). However, the nurses
demonstrated the non-judgemental attitude towards the patients and showed sensitivity to their
health concerns as also mentioned in McNair, Hegarty & Taft (2012). They addressed the
patient concerns by giving the best effort to ask questions in gender-neutral manner and to
facilitate the disclosure of information. However, there was need of greater cultural awareness
among the nurses to interpret the cultural beliefs and apprehend the values of the diverse patients

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in end of life care. This may act as a barrier to provide safe and quality care (Rawlings, 2012).
This was in contrast with the above guidelines and recommendations for the health care
providers mentioned in the report titled, “Health and sexual diversity- A health and wellbeing
action plan for gay, lesbian, bisexual, transgender and intersex (GLBTI) Victorians”
(Glhv.org.au, 2018). The nurses were successful preventing discrimination with the help of
Healthy Equal Youth project and funding programs arranged by Victorian government as well as
specific health service by KDH. The buddy nurse could address the violence related needs of the
patients through Cobaw’s support for LGBTI group ensuring safe and inclusive care (Cobaw
Community Health Service, 2017).
Further, investigation showed that the nurses assigned for LGBTI patients maintained
the confidentiality and privacy of the patient’s information as per NMBA standards
(Nursingmidwiferyboard.gov.au, 2018). Further the nurses also maintained the therapeutic and
professional relationships with the patients irrespective of the socioeconomic status and cultural
differences.. The nurses fulfilled their duties within scope and did not share their experiences
with LGBTI patients with other colleagues and nurses. It was found that the nurses acted in their
best possible way to avoid prejudice as it will lead to reduced access of health care services by
the patients (Pack & Brown, 2017).
They provided care based on the best evidence available in the literature. This
demonstrated the implementation of the evidence-based practice (Schmidt & Brown, 2014). The
nurses also mentioned that they followed the standards, code of conduct and code of ethics set by
ANMC strictly to avoid inconvenience to the patient. The other nurses also revealed that they
were in need of training in regards to better understanding of the health needs of LGBTI patients.
Some were eager to learn about attitudes and knowledge required to cater for mental health

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support of the LGBTI patients. This response is in alignment with the study of Riggs &
Bartholomaeus (2016) emphasising in the need of mental health nurses training for caring for
transgender patients to protect the respect and dignity of the LGBTI patients. Such need of the
nurses was also mentioned in the study by Strong, & Folse (2014).
In conclusion, it can be interpreted that the Australia is yet to fully address the needs of
the LGBTI patients. There is lack of adequate policies due to which the nurses still face issues
with different values and beliefs of the LGBTI patients. There is need of adequate training and
education without which the nurses would fail to promote and support the health and well being
of the LGBTI patients. The limitations in this area restrict the nurses to be competent in
providing care to the LGBTI patients. KDH plays great role in respecting the diversity in
communicating with the LGBTI people that is supporting the nurses to develop trusting
relationship with LGBTI and give safe care.
Answer to question 4
Content of incident
On my placement I had been assigned to a patient Mr X a 45 years old with ESRF on the
fourth day of my community placement. This was my first encounter with such patients and I am
not competent yet in coping with such situation. This was a critical incident for me. I was
assisting the nuddy nurse assigned for chronic illness.
Details of the incident
Mr X a 45 years old with ESRF also showed cardiac disease symptoms and was
presented to emergency unit. The patient lives alone in large house with his wife and three

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children. During the visit the patient's wife was emotionally down. The lady was emotional when
husband uttered words like “haven't lived yet”, and "not wanting to die". At times the patient was
very symptomatic and insists on staying home with his wife and children till he dies.
Thoughts, feelings and concern
I could well manage the patent with immense confidence and applied my knowledge to
its best with the support of other senior nurses and mentor. I immediately reported any abnormal
condition to the mentor. It levered my experience practically for the particular disease. I was
nervous initially as it was first encounter with patent suffering from ESRF and Heart disease. I
was very attentive to nursing interventions given and provide patient-centered care to lower
patient’s anxiety. I carefully monitored the fluid status maintained by the other nurse and
making of dietary recommendations for patients. I had learned a lot and there was a lot more to
learn especially the assessment of vital signs and treatment. I need to learn more about nutritional
requirement of patients with ESRD, psychological counselling and social support network. The
family was nervous with fear of death and it was crucial moment for me. I too felt powerless. On
involving the wife in health-related conversation, her anxiety was reduced.
Impact on my career
On evaluation I found that gaining confidence was the positive aspect of place where I
was assigned to chronic condition. I knew the rationale for every medication or intervention
given. I could well educate the patient but the need to stay in hospital till the risk is reduced and
that the nurse may visit home after discharge to reduce length of stay in hospital. It helped the
patient to calm down. For allowing the patient to better understand the illness I had explained
the disease progress and support adjustment to lifestyle changes. On giving home care referral

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and encouraging independence in self-care the patient showed positive feelings. This experience
had been very informative and helped me improve my communication skills as I worked with
district nursing. I learned that nursing is all about good critical thinking and clinical judgement.
Therefore, my action plan for future placement is to improve coordination with multidisciplinary
team. My goal would be to single headedly take care of patient, provide comprehensive care
including assessment, treatment, medication, as well as emotional and psychological support to
the patient without support of fellow nurses.

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References
Agedcare.health.gov.au. (2018). NATIONAL LESBIAN, GAY, BISEXUAL, TRANSGENDER
AND INTERSEX (L G B T I)- AGEING AND AGED CARE STRATEGY. Retrieved
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national_ageing_and_aged_care_strategy_lgbti_print_version.pdf
Chapman, R., Watkins, R., Zappia, T., Nicol, P., & Shields, L. (2012). Nursing and medical
students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender
parents seeking health care for their children. Journal of clinical nursing, 21(7‐8), 938-
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Health. International journal of community based nursing and midwifery, 3(4), 328.
Glhv.org.au. (2018). Health and sexual diversity: A health and wellbeing action plan for gay,
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https://www.glhv.org.au/sites/default/files/health_action_plan.pdf
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