Standards for Practice in Nursing: A Case Study of Rehabilitation Unit

This case study discusses the Standards for Practice in Nursing, focusing on critical thinking, therapeutic relationships, and quality nursing practice. It provides evidence-based interventions for a patient in a rehabilitation unit.

NURS3002 2018
Assignment 3 Template
Standards for Practice
Student Name: Student ID: Date: Submission Due Date
Date Submitted: Topic Availability: Class no:
Standard 1: Thinks critically and analyses nursing practice
Family members recently transferred a patient named Monica Williams of 75 years old to
our rehabilitation unit who was of Aboriginal decent. She had faced stroke two months back and was
treated in the emergency ward for about a week. The stroke had paralysed most of the parts of her
body and she was not even instructed for rehabilitation by the previous healthcare organization. This
had resulted her to lead a very poor quality life. Her mobility is entirely affected. She had developed
bedsores, lost her independence in activities of daily life, speech had been affected and many more.
Therefore, when the situation went out of control from the hands of the family members due to her
excess pain from bedsores, the patient was admitted to the ward for development of her mobility,
speech activities, gaining independence, reduction of bedsores and others. Therefore, it was the
duty of the healthcare team to allocate important experts as well as nursing professionals to meet
each of her requirements and needs accordingly.
According to the standard one of the standards of practice provided by the NMBA, every
nursing professionals need to utilize varieties of thinking strategies that would be aligning with the
best available evidences in making decisions (Standard of practice, Nursing and midwifery board of
Australia 2016). This would help in providing safety as well as quality nursing practice that would be
strictly following the person-centred as well as evidence-based frameworks (Standard of practice,
Nursing and midwifery board of Australia 2016). The nursing professionals would ensure that they
are utilising evidence-based information after thoroughly analysing the research studies and their
credibility (Mallah, Nassar and Badr 2015, pp 110). This might include the research findings that
would help in providing safe as well as quality practice (Beeckman 2015, pp 1). Therefore, the
professionals used some of the most trusted database that are used in the nursing professionals like
Cinhal, Medplus, Pubmed and others and came up with some important evidence based
information. One of the articles has stated that pressure relief is one of the most important actions
that professionals should undertake (Mallah, Nassar and Badr, 2015, pp 110). It is very much
important to relieve pressure from the affected area that can be identified as the purplish or reddish
and warm skin. Therefore, according to the suggestions of the study, pillow and foam pads were
used for relieving pressure from the patient from the area where purplish coloration of the skin was
observed (Beeckman 2015, pp 1). This was mainly done, as the patient was not been able to be
moved into a position that would not put any weight on the sore (Mallah, Nassar and Badr 2015, pp
110). Moreover, the professional also followed another paper which advised him to cover the sore
with gauze or the moist bandage and thereby prevented the sores from getting irritated by rubbing
on clothing or bedding (Lozano et al. 2016, pp 50). Moreover, the patient was suffering from
immense pain from the pressure sores and therefore needed to make her relieve from the pain.
Evidences suggested that acetaminophen as well as ibuprofen can result in relieving some of the
discomfort that patients experience from bed sores and therefore such medications were also
provided to Monica (Lozano et al. 2016, pp 50). Moreover, evidence based articles also helped him
to know that tropical antibiotic creams are also useful that can help the wound to keep moist when
professionals apply bandage or dressing. This helped in reduction of the risk of infection and so, the
professional also applied this intervention (Avsar et al. 2018, pg 55). He also learnt that soaking the
affected areas in warm water result in smoothening of the painful beds sores and temporarily relieve
from stinging as well as burning sensation and therefore this was also applied me. Another

NURS3002 2018
Assignment 3 Template
Standards for Practice
important arena is nutrition. Researchers are of the opinion that a diet with adequate amounts of
protein, minerals as well as vitamins are important for the healing and prevention of the sores from
getting more infected or worse (Avsar et al. 2018, pg 56). The professional made sure that the
patient would be provided with the diet that was comprised of vitamin C as well as zinc supplements
along with the nutritious diet. In order to prevent any new occurrences of pressure sores, it would
be important for reducing moisture on the skin, as this increase would help in decreasing the risk for
pressure injury development (Clay et al. 2018, pp 14). This was done by applying barrier cream,
keeping skin clan and dry and thereby investigating as well as managing incontinence. Following the
evidences, the professional also used to reposition Monica at every two hours. I followed side lying,
right side lying, left side lying, seated on a chair or a bed. He did not massage any bony prominences
that could have proved harmful for the patient as per the evidences (Avsar et al. 2018, pg 57). This
standard advises nursing professionals to practice through reflection. I have therefore often
conducted reflection on his experiences as well as his knowledge actions, feelings and beliefs, this
not only has helped me to shape his practices but also has helped me in becoming self confident and
perform smart jobs (Standard of practice, Nursing and midwifery board of Australia 2016). The
professional was able to identify the skills that he was lacking and the clinical knowledge that he
needed to develop. In a way, the professional has become more competent through the reflective
practices. He have used the ethical framework of beneficence that dictates the professionals to
provide safe service that are evidence based and are safest for the patient (Clay et al. 2018, pp 14).
Non-maleficence is also followed which was based on the principle that the patient should gave no
suffering or that the professionals should ensure that none of the intervention taken should harm
the patient in any ways (Gunningberg et al. 2017, pp 56). Moreover,he also followed justice where
he provided care to the best quality of the patient irrespective of culture and background of the
patient. Documentation is one of the most important arenas where nursing professionals need to
input the details of the interventions taken, results of the tests, everyday actions taken for the
patient, medication list, progress update of the patient condition and others (Clay et al. 2018, pp 14).
Therefore, he kept all the information of the patient by documenting it in a proper format.
Documentation also helped the other members of the team to know about what each other is
performing and what their views are about the patients (Butcher et al. 2018, pp 225). All these
ensured collaborative work of the professionals. He followed all the legislations and policies and the
other professionals like Human rights acts, Data privacy rules and others. In this way,he maintained
the standard.
Standard 2: Engages in therapeutic and professional relationship[s
This standard mainly enables the professional to engage in effective therapeutic as well as
professional relationships. This would mainly include maintaining a number of principles that would
be based on the mutual trust as well as respect in the professional relationship (Standard of practice,
Nursing and midwifery board of Australia 2016). This standard advice the professionals to maintain
relationship with the patient which is entirely based within the professional boundaries and does not
include any form of personal relationships (Standard of practice, Nursing and midwifery board of
Australia 2016). He totally followed this principle while treating the patient. The patient and his
family members were highly satisfied by his service and therefore as a matter of gratitude, they had

NURS3002 2018
Assignment 3 Template
Standards for Practice
invited him to their house for a dinner (Fisher 2017, pp 4). This was against standard 2 as he needed
to maintain proper boundaries between professional and personal aspects of the relationship he
shared with the patient (Fisher 2017, pp 4). The family members gave him gifts that were very
auspicious to their culture but it was against the standard to accept such gifts therefore. He
communicated with them politely and made them understand the main reason for his not being able
to accept any gifts from them. They understood his explanation and were satisfied by his approach.
This standard also states the importance of effective communication along with respecting the
dignity, culture, beliefs and values of the person (Endacott et al. 2018, pp 915).He had realized that
person centred care is the most important approach that brings out positive outcome on the patient.
The aboriginal people were neglected over many generations in different ways in the nation and
therefore they had lost all hopes from the western healthcare system (Wilson et al. 2018, pp 25).
They never expect culturally competent care from the present healthcare professional (Wilson et al.
2018, pp 25). It was important for our team to change the ideas of the Aboriginal people (Fisher
2017, pp 4) . He along with his team members provided a culturally competent care that aligned
with their cultural perceptions, inhibitions, beliefs and values. The patient felt that her dignity was
respected. He had provided total freedom and autonohis to the patient allowing her to make her
own decisions. According to her preferences, the interventions were provided only after her
approval. Informed consent was taken and all the pros and cons of the interventions were discussed
to her and her family members in details (Endacott et al. 2018, pp 915). Her autonohis was
respected. Moreover, the standard also advises the professionals to provide support and direct
patients as well as the family members to different important resources for optimizing different
health related decisions. Following this, I sat into a discussion with the family members of the
patient and accordingly made a list of the resources to the family members in order to find the
proper services in the community and get in contact with experts who provide homecare services.
This would help the patient and the family members to get in touch with the services and get
support from them when they will go back home (Nagle et al. 2017, pp 10). This would help in
reducing the anxiety and fear of managing the conditions of the patient. The standard expects the
professionals to use delegation, supervision, coordination as well as consultation and referrals in
professional relationships that would help in the achievements of the improved health outcomes
(Ossenberg. Henderson and Dalton 2015, pp 13). Therefore, when his shift ended per day, he made
sure that he delegated the task of handling the patient successfully to the other members of the
nursing team. He documented the instructions properly so that they could follow them and
accordingly plan their care in that shift (Ossenberg. Henderson and Dalton 2015, pp 13). He also
used to verbally communicate the important instruction of handling the pressure sores of the
nursing professionals who handled the patient’s next shift. He also took up the responsibility of
supervisor one day when his senior nurse was absent and he completed the action successfully
(Jacob, Duffiled and Jacob 2018, pp 58). Another of the most important aspect of the care is the
collaborative practice done by the team of the healthcare members. It was seen that different
experts like the speech therapist, occupational therapists, physiotherapist, dieticians, nursing
professionals, physicians and many others act in coordination with each other so that all the
requirements of the patient was met (Jacob, Duffiled and Jacob 2018, pp 58). Just as the standard
dictates that, the nursing professionals should foster a culture of safety and learning that include
engaging with the professional relationships with others so that there is effective sharing of
knowledge and the practices that support the person centred care (Ossenberg. Henderson and
Dalton 2015, pp 13).The members of the healthcare teams were often seen to conduct meetings
twice a week where the members used to share their knowledge, views and ideas about the
treatment procedures of the patient and how different types of initiatives should be taken so that
the patient is benefitted. Such discussion often helped in enlightening each other’s and regular
constructive feedbacks from each other’s that helped in developing our expertise as well (Birks et al.
2016, pp 540).

NURS3002 2018
Assignment 3 Template
Standards for Practice
Standard 6: Provides safe, appropriate and responsive quality nursing practice
This standard of the nursing professionals advice them to delegate quality as well as ethical
goal directed actions. These actions would be such that they would depend on not only
comprehensive or systematic assessment. They would also ensure best evidence based treatment so
that the professionals can achieve planned as well as agreed outcomes (Standard of practice,
Nursing and midwifery board of Australia 2016). For this, the standard advises the professionals to
provide comprehensive as well as safe quality practices for achieving agreed goals as well as
outcomes (Standard of practice, Nursing and midwifery board of Australia 2016). These outcomes
would be such that it would be responsive for the nursing needs of the people (Jacob, Duffiled and
Jacob 2018, pp 58). Following this, he first tried to analyse the important needs and requirements of
the patient so that accordingly, he could set the interventions and the care plans. The first model
that he used is the clinical reasoning cycle. This cycle is introduced by Levett-Jones and mainly
consists of a number of steps that helps in identifying the cues of the patients and thereby
understanding the signs and symptoms that the patient is having. According to that, the cues were
associated with the respective pathophysiology of the issues she was facing (Birks et al. 2016, pp
540). Following these, the needs and requirements of the Monica were identified and accordingly
goals were set so that all the requirements and needs of the patient were covered. Following these
action each of the professionals took up plans and he needed to care for the pressure sores and
medication of the patient and the others were caring for the other requirements. Thereby he used
this model so that a comprehensive care plan was developed after analysing the situation of the
patient (Thompson 2016, pp 17). For this, he also used several important tools so that I can properly
assess the patients and realize the needs of the patient. For this patient named Monica, he used the
Glasgow Coma scale. This tool is mainly used for describing the level of consciousness in the person
who is treated following a traumatic brain injury (Thompson 2016, pp 17). The tool mainly provided
the professionals with a score that helps in understanding the conscious level state of the patient
and is mainly assessed through three aspects that are the eye opening, verbal response and motor
responses (Birks et al. 2016, pp 540). This assessment was very important for understanding the
areas where the patient needed care. Moreover, pain assessment was done and accordingly score
was to be assessed from 0 to 10 (Ayton and staff 2017, pp 11). The pain score showed for the patient
was 8 and therefore, we understood that the pain from the bedsores was giving her a poor quality
times and making her suffer. Therefore, accordingly to interventions were taken that included pain
management of the patients. Therefore, through the procedure of effective assessments,
comprehensive safe and quality practice was provided for developing goals so that the needs of the
patient could be met (Birks et al. 2016, pp 541). Moreover, while taking care of the patient, he also
helped the enrolled nurses so that they learn about the clinical interventions and the procedures
they need to adapt as different clinical as well as non-clinical roles (Endacott et al. 2018, pp 915). By
following the standard, he have provided effective timely direction and supervision to all the
members of the nursing team so that he could make sure that the delegated practice is safe and
correct. He also tried his best to maintain all the relevant policies as well as guidelines, standards,
regulations and different types of legislation (Birks et al. 2016, pp 542). Moreover, by following this
standard also he tried to undertake all forms of risk assessment so that the potential hazards could
be identified (Birks et al. 2016, pp 542). He understood that the patient is exposed to two major risks
which are aggravation of pressure sores or falls while manual handling (Cashin et al. 2017, pp 258).
Therefore, it was significant for him to undertake consideration of this hazard and accordingly
allocate resources and human factors properly (Thompson 2016, pp 17).
Standard 7: Evaluates outcomes to inform practice
This standard mainly helps the registered nursing professionals to take upon the responsibility of
effective evaluation of the practices. This evaluation would be based on the agreed priorities as well

NURS3002 2018
Assignment 3 Template
Standards for Practice
as goals, outcomes and different plans. Accordingly, the professionals should revise practices
accordingly (Standard of practice, Nursing and midwifery board of Australia 2016). The standard
guides the healthcare professionals to evaluate and thereby monitor the progress towards the
expected goals as well as outcomes (Standard of practice, Nursing and midwifery board of Australia
2016). Researchers are of the opinion that interventions applied by healthcare professionals cannot
be termed as successful until the evaluation results shows to be effective on the health of the
patient (Thompson 2016, pp 17). He also followed this procedure and after application of each
intervention, he used to conduct evaluation of the health condition of the patient. This was done in
order to understand that the different interventions which he was providing for pressure sores were
reducing the infection and healing the wounds or not (Thompson 2016, pp 17) . Moreover, he also
conducted the pain score assessment in order to understand whether his interventions were
relieving her from pain gradually. This assessment showed that the patient was responding to the
interventions and her pain was relieving (Cashin et al. 2017, pp 258). Moreover, the experts also
conducted their respective evaluation and documented the result in the electronic health record of
the patient. The standard also expects the professional to revise the plans that are based on
evaluation (Standard of practice, Nursing and midwifery board of Australia 2016). Following the
evaluation, results that he submitted as well as that of the evaluation documentation that others
submitted showed that the interventions were bringing out positive results. This showed that the
health of the patients was progressing towards betterment. Accordingly the family members were
communicated that helped the patients from relieving from anxiety as well as fear that they had
regarding the patient named Monica (Standard of practice, Nursing and midwifery board of Australia
2016). The standard also discusses the importance of the effective determination, documentation as
well as communication of the further priorities or the goals as well as outcomes with the relevant
persons (Standard of practice, Nursing and midwifery board of Australia 2016). In order to follow
this, effective meetings were undertaken with all the experts and healthcare professionals regarding
the further interventions that one needs to take for the betterment of the patient (Ayton and staff
2017, pp 7). In such a scenario, all the reports provided by the experts were discussed and all of
them concluded that the patient was responding to the intervention. However, the patient was not
in the situation to be discharged home as most of her wounds were still needed time for effective
cure. She needed expert help of professionals for management and dressing of the wounds as well
as in the reduction of the pressure sores (Ayton and staff 2017, pp 8). If the patient is discharged, it
might result in aggravation of the infection, as the wounds are still open. Therefore, he undertook
discussions with the professionals and all agreed to his concern. Moreover, the speech expert and
the occupational expert also stated that the patient needed more time to recover to a state that
would be suitable to take her to home. Therefore, the meeting was conducted for respective weeks
and progress update was documented on the electronic health media so that it can be circulated to
all team members who were attending Monica (Ayton and staff 2017, pp 11).
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Standards for Practice
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Standards for Practice
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