Standards for Practice in Nursing: A Case Study of Stroke Patient Rehabilitation

This article discusses the standards for practice in nursing using a case study of a stroke patient rehabilitation. It covers the importance of critical thinking, therapeutic and professional relationships, and safe and quality nursing practice. The article also includes relevant studies and assessment tools used in the case study.

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
Mrs. Maraim Jones is of 65 years old Muslim woman and has suffered a stroke while she was
working in her garden along with her grandchild who was of 15 years. Following the stroke, she
had faced a fall on her knees that had large skin tears as well as bruises in different parts of her
body. She also was suffering from improper glucose balance in her body that was also giving her
poor quality life. Following the stroke, she was shifted to the emergency ward where she was
treated. However, she had suffered mild paralysis on the right side of her body and had speech
impairment. She was having issues with the mobility and she needed assistance with her daily
activities of life. Therefore, the doctor in charge advised for transferring the patient to the
rehabilitation unit for further treatment so that she can overcome the different barriers that she
was facing. In this rehabilitation unit, nursing professionals play one of the most important role in
the multidisciplinary treatment as they act as the care coordinators, communicators, assessors
and holders of meetings and discussions beside providing nursing care for the patient. In this
assessment as well, the duties of the nursing professionals will be discussed which will be mainly
based on the following of the four important standards of practice as allocated by the Nursing and
midwifery board of Australia.
Nursing professionals need to use a variety of the thinking strategies as well as the best
available evidences for making effective decisions (Standard of practice, Nursing and midwifery
board of Australia 2016). This is much important in providing safe as well as quality nursing care
that would be involving both the person centred approaches as well as the evidence based
frameworks (Fisher 2017). This standard usually dictates the nurse in accessing, analysing as well
as utilizing the best of the available evidences. These evidences should be such that it would
include recent findings do that effective quality and safe practices can be ensured (Standard of
practice, Nursing and midwifery board of Australia 2016). In case of the patient, it was seen that
weakness, spasticity as well as incoordination were common (Wilson et al. 2018). In such scenario,
the patient needs to be encouraged to undertake exercise sessions as researchers suggest that
this is one of the most effective ways for the brain to rewire and to try to recover physical fitness
(Saunders, Greig and Meid 2014). Studies also suggest that patients after stroke tend to lose their
cardiorespiratory fitness even on the unaffected side but at the same time, patients are seen to
complain that exercise brings very little output even when exercise regimes are taken in a
disciplined manner (Bernhardt et al. 2015). Still researchers like Morris et al. (2015) are of the
opinion that the exercises allow better recovery of activities of daily life and reduce the chances of
occurrence of strokes again. Spasticity was also a common problem after stroke that also affected
the patient that was giving her much pain and was limiting her movements (Livingston et al.
2016). Therefore, physiotherapists were assigned for her and a drug called baclofen was given to
her (Creamer et al. 2017). Many studies also suggest botulinum toxin injections (Demetrios et al.
2016) and it was also discussed with the doctor for furthur assurance. Psychological issues were
also seen in the patient and this aligns with the studies of many researchers who worked on the
mental health of the patients after stroke (Alajbegovic et al. 2014). The studies say that major
depression occurs in up to half of the stroke survivors (Robinson and Jorge 2015). However very
few studies have worked on the interventions that can be applied to such patients although some
of them have mentioned about the routine use of the antidepressant to be helpful (Mortensen

NURS3002 2018
Assignment 3 Template
Standards for Practice
and Anderson 2015). There are also evidences suggesting cognitive behavioral therapy to be one
of the mainstay treatments (Kootker et al. 2017). Pain was also another complication that was
seen in the patient resulting from contractures, spasticity, subluxation of the shoulder as well as
the excessive strain that was taken by the unaffected side (Gillen 2015). Studies suggested that
careful evaluation of the cause of pain as well as treatment of the reversible factors and then
using the analgesia (Harrison and Fielf 2015). Therefore, following these studies steps were taken.
Moreover, studies also state that painkillers should be given regularly than in times when pain
becomes unbearable (Harrison and Fielf 2015). Therefore, such studies were followed and
accordingly interventions were prepared from some of the best evidence based practices.
Moreover, such standard also showed that it is important for every individual to undertake
reflective practices (Cashin et al. 2015). Therefore, the healthcare professionals need to reflect on
the experiences, knowledge actions as well as the feelings and beliefs (Standard of practice,
Nursing and midwifery board of Australia 2016). Researchers are of the opinion that such practice
helps in developing confidence and helps in shaping the best effective care ensuring development
of expertise of the professional in the field (Cashin et al. 2017). I followed all the ethical
frameworks when she was taking decisions. I practiced beneficence that instructs her to provide
the safest care to the patient as well as non-maleficence that instructs the professional to provide
care that will not cause any suffering and pain to the patient. (Grace and DRN 2017). Informed
consent was taken by me from her in every of the interventions that were taken from her and she
was made the centre of all decisions. In this way, the standard was maintained (Nagle et al. 2017).
Not only that, following the standard one, the I also made accurate, comprehensive and timely
documentation of the assessments that she conducted every day of the patients. Researchers are
of the opinion that documentation is extremely important as it helps in maintaining a record of
the patient’s health that become useful in different types of purposes (Petkovšek-Gregorin and
Skela-Savič 2015). It can be used for helping to evaluate the betterment of the patient, health,
circulate among the team members of the multidisciplinary team so that everyone becomes
aware of the patient’s condition (Petkovšek-Gregorin and Skela-Savič 2015). It is also helpful to
prevent any form of legal obligation (Scanlon et al. 2016). It also acts as guidance when the
patient revisits the centre for any kind of treatment. All the important legislations were followed
along with important regulations, policies and guidelines for making the decisions as per the
instruction of the standard.
Standard 2: Engages in therapeutic and professional relationship[s
The nursing professionals should ensure that they are engaging in the effective
therapeutic as well as professional relationships with the patient and the family members. Such
relationships should be based on the mutual trust and respect while interacting with the patient
so that the patient experiences high level of satisfaction (Standard of practice, Nursing and
midwifery board of Australia 2016). While treating the patient, I made sure that I successfully
establish, sustain and thereby conclude relationships in particular approaches that helps in
differentiating the boundaries between professional as well as personal relationships (Ossenberg
et al. 2015). The patient and his family members were very satisfied with the care that the
professionals were providing them and therefore out of gratitude they wanted to give gifts to the

NURS3002 2018
Assignment 3 Template
Standards for Practice
professionals however, it was strictly denied by the entire team as it was against the professional
standards to accept gifts from service users (Thompson 2016). Moreover, I had also maintained
the very important guidelines that come under the standard. The standard states that
professionals should communicate effectively with the patient and she should respect the dignity,
culture, rights, beliefs and values (Bromley 2018). I developed therapeutic communication with
the patient that was both compassionate and empathetic. This helped in developing a bond of the
patient with me where the patient developed a feeling that the professional was trying her best
for helping her overcome the feelings and were having genuine feelings for the patient. She
respected the culture, values and beliefs of the patient when the patient stated that no male
members would be treating her. Accordingly, I made arrangements where the team only
comprised of female members. I also instructed the concerned authority to provide her with halal
meat so that her cultural preferences are respected. The standard expects the professionals to
accept that patients are the experts in their own lives and they should also provide them support
to the patient as well as to the family members regarding optimization of the health related
decisions (Jacob, Duffiled and Jacob 2018). I had taken informed consent where she had described
all the interventions to the patient in details along with their pros and cons. Accordingly, the
patient was given the full freedom to take her own decision and be the central part of every
decision-making activities. Researchers are of the opinion that such an action help in empowering
the patient where they feel that their self-respect was not harmed and their dignity was
maintained (Judkins et al. 2014). Moreover, I had also provided a list of the resources to the family
member of the patient from where they could arrange for services after the patient be discharged
home. This helps the family members largely as they were very anxious about how to take care of
such a patient in their home (Bryce, Foley and Reeves 2017). This standard also expects the
professionals to use “uses delegation, supervision, coordination, consultation and referrals in
professional relationships to achieve improved health outcomes” (Standard of practice, Nursing
and midwifery board of Australia 2016). I had taken active part in delegation where I
communicated the important details of the patient to the other nurse when I was leaving my shift.
Moreover, I also did my documentation in a way that helped the later nurse to completely
understand her duty and the steps that needed to be done. Effective delegation ensured that no
interventions were missed out and the other nurse followed all important care guidelines. I also
took the responsibility of effective coordination and supervision not only among the different
healthcare professionals but also among the different experts of the multidisciplinary team.
Effective collaborative practices were conducted as per the standard. I played the role of care
coordinators besides nursing professional and took the responsibility of arranging meeting,
discussion among the members about the planning to be adopted feedback sessions, setting of
appointments and for the therapy sessions of the patients and many others. It was also important
for the team members to work together to bring out the best outcome of the patient (Philips et al.
2017). I ensured that all the team members worked accordingly to the planned schedules,
maintained a transparent approach among the members, ensured a collaborative approach. They
coordinated and communicated among themselves like the occupational therapists,
physiotherapists, speech therapists, dieticians, diabetes educators and other nursing professionals
(Cross, Brown and Sein 2018). All of them coordinated and coordinated together for effective
health outcome on the patient. All of them shared knowledge and practices with each other that
helped in development of culture of safety as well as learning from each other. This helped in
developing and fostering a culture of safety in the organizational culture that helped in ensuring
better care for the patient (Birks et al. 2016).

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Standards for Practice
Standard 6: Provides safe, appropriate and responsive quality nursing practice
The nursing professionals are instructed for providing and delegating quality as well as ethical goal
related actions (Standard of practice, Nursing and midwifery board of Australia 2016) . These
actions would be based on the comprehensive as well as systematic assessment and even the best
available evidence for the achievement planned and agreed outcomes. The registered nurses are
expected to provide a comprehensive safe as well as quality practices for achieving agreed goals
and outcomes that are responsive to the nursing needs of the people (Cashin et al. 2017). The
nursing professionals need to practice within their scope of practice (Standard of practice, Nursing
and midwifery board of Australia 2016). The nursing professionals are also advised to ensure that
they are providing timely direction as well as supervision for ensuring that the delegated practice
is not only safe but also correct (Standard of practice, Nursing and midwifery board of Australia
2016). After the patient was transferred from the emergency ward to the rehabilitation ward, it
was very much important for me to recognize the needs and requirements of the patients. I
needed to first take proper assessments with proper assessment tools that help them in
recognizing the main needs of the patients. This could be exemplified with the help of the
assessment tools that the professional had used (NO REFERRENCES COULD BE PROVIDED HERE
AS IT IS THE EXAMPLE OF WORK THAT WAS CONDUCTED). For this specific patient, I had used the
Glasgow comma scale as well fall assessment tools so that the capability of the patient in such
arena can be ensured and accordingly interventions for development of their capabilities can be
ensured (Thompson 2016). Researchers Lewis et al. (2016) are of the opinion that assessment is
the first part of the nursing procedures that mainly forms the basis of the care plan. Lewis et al.
(2016) have also stated that essential requirements of the accurate assessment us to view the
patients holistically and thereby identity the real needs of the patients. The different types of
assessments that the nursing professionals need to do to ensure about the health of the patient
and understand the care needs are the test results, assessment of the physical, mental and the
different neurological status. Vital signs, airway assessment as well as lung assessment, CNS and
PNS assessment are the assessments that would also help in the understanding about the
condition of the patient (Cross, Brown and Sein 2018). Knowing about the real needs of the
patients is important following which the care priorities would be set. It is very important for me
to know about the care needs so that the interventions provided are not only safe but also helps
in covering all the requirements and needs of the patient and none of the needs are missed out.
For this, I utilized the clinical reasoning skills which was proposed by the famous Tracy Levett
Jones (Hunter and Arthur 2016) that help the professionals to take the proper assessments, utilize
the results for understanding the pathophysiology and accordingly develop the care goals (Hunter
and Arthur 2016). Following this, the professionals need to develop the care plan and then
accordingly apply intervention for the problems. Through the effective assessment of Jebsen
Taylor Hand Function Test, I found that the patient had motor deficits and had poor physical
fitness. Through the assessment tools Jebsen Taylor Hand Function Test, it was also found that
weakness, spasticity and even incoordination was found. For the psychological aspect, Beck
depression inventory was also used and through this, it was understood that the patient was also
suffering from depression as well (Ayton et al. 2017). The Glasgow comma scale initially helps in
understanding the level of consciousness of the patients. The pain scale from 0 to 10 helped in
stating how much pain the patient was suffering from which showed she was suffering from
moderately to high pain. Accordingly safe comprehensive care plan was prepared in order to
achieve the agreed goals as well as the outcomes that were responsive to the nursing needs of the

NURS3002 2018
Assignment 3 Template
Standards for Practice
people (Bryce, Foley and Reeves 2017). This standard also expects the professional to provide
effective timely direction as well as supervision for ensuring that delegated practice is safe and
correct (Ayton et al. 2017). Therefore, when the different members were acting in the tea and
providing care, the professional has maintained strict supervision to ensure that the delegations
that were carried on and safe. I worked according to the relevant polices, standards and
guidelines so that legal obligations do not occur and also to prevent any chances of complaints
from the patient as well as his family members. Another one of the most important aspect of this
standard is that the professionals should use the appropriate procedures for identification and
reporting of the potential and actual risk related system issues and where the practice may be
below expected standards (Baldwin et al. 2017). I was working with the patient had followed this
standard and had taken risk assessment hazards not only to realize the different risk that were
associated with the patient but also with that of the professionals in the team. Some of the
enrolled nurses were not being able to keep up with the treatment procedures and were missing
out on their responsibilities and hence, they were sent for training to identify their knowledge
gaps and thereby develop their skills and expertise.
Standard 7: Evaluates outcomes to inform practice
The nursing professionals need to take the responsibilities for the evaluation of the
practices that remain based on agreed priorities, goals, plans and outcomes and thereby revise
the practices according to the needs accordingly (Standard of practice, Nursing and midwifery
board of Australia 2016). The registered nurses need to evaluate and thereby monitor the
progress towards the expected goals and the outcomes. After the planning and discussions that
were done by the professionals of the team members in the clinical care, it was necessary to
analyze that whether the professionals ultimately meet the planned goals. Therefore, I supervised
the outcomes of the interventions and accordingly reassigned the responsibilities or discuss with
the professionals due another intervention that would be fruitful (Martyn, Zanella and Wilkinson
2017). The professionals were seen to report about the outcomes in the documentation
procedure that helped to evaluate about the recovery procedures of the patient and how well the
patient was responding to the recovery procedures. Moreover, the care-coordinator also took a
separate analysis to find out that the patient responds to all the applied interventions. The
standard also showed the important of revision of the plan based on the evaluation (Standard of
practice, Nursing and midwifery board of Australia 2016). However, in the care of the patient, it
was found that all the planned intervention was bringing out the positive outcomes on the patient
and she was gradually recovering and coming to terms with normal lifestyle. Therefore, no
revision of the plan was required as the response of the patient was quite satisfactory to the
treatments (Martyn, Zanella and Wilkinson 2017). Moreover, the standard also instructs the
professionals to determine and thereby document about the care of the patient. This standard
also stated the importance of the communication of the different priorities, goals and outcomes
with the relevant persons. As the care of the patient was continued, I held regular meetings. This
meeting mainly encouraged discussions about the health conditions of the patient and
constructive feedbacks from the different professionals of the teams. This helps every
professional to develop an idea about the next steps in the treatment plan that they needed to

NURS3002 2018
Assignment 3 Template
Standards for Practice
take and accordingly next set of intervention and plans were introduced. All information were
noted and documented for future activities.
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Assignment 3 Template
Standards for Practice