RN COMPETENCY GAP Name of the university: Name of the student: Name of the university: Author note: 1 RN COMPETENCY GAP Episode 1: Mr. Smith

Running head: RN COMPETENCY GAP
RN COMPETENCY GAP
Name of the student:
Name of the university:
Author note:

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RN COMPETENCY GAP
Episode 1:
During the time of my placement, I got the opportunity of caring for Mr. Smith who was
45 year old man suffering from obesity, diabetes and depression. He used to work in a factory
but increased weight and the associated conditions had made him leave his job. He lives on the
very few amount of money he had saved and states that he has no idea how to survive after his
saved funds get over. All these had made him suffer from depression and anxiety. He had left his
school midway after the death of his both parents and worked as a mechanic in garage. Presently,
he was admitted to the ward because of his unmanaged health conditions.
While undertaking assessment of the patient, I realized that only following the
biomedical model of healthcare would not be sufficient to provide holistic care for the patient.
The theory of biomedical care stated professionals to manage the biological determinants of
health that contribute to disorders (Blais et al, 2015). Studies opine that this model cannot ensure
quality of care of lives of patients as the disorders are seen to recur after few days again. In this
situation, I followed the bio-psycho-social model of care. This model of care makes nursing
professionals manage the different biological factors of the disorder along with that of the social
and psychological determinants which also shape the life of patients (Rumsey, 2017).
Prescription of the medications is not sufficient as nurses need to ensure that social determinants
of health and psychological condition of the patient also need to be managed (Matney et al.,
2016).
Therefore, I realized that that he had low level of education and for this reason his health
behaviors and lifestyles were not appropriate. Therefore, my aim was to develop his health
literacy and with the help of simple language and using of colorful charts and brochures, I tried

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to develop his knowledge on his disorder. I educated her about the negative lifestyle habits that
he would need to replace with good habits like healthy diet, active lifestyle, physical exercises,
regular screening and others. Lack of income and unemployment were other social determinants
of health that were contributing to poor quality lives and therefore, I refereed him to financial
councilors from where he could gain government unemployment schemes until the time he
becomes fit for new jobs (Townsend et al., 2017). It was also seen to that he was stress and
anxious that affected his mental stability and made him emotionally unwell. Therefore, a
psychological counselor was also allocated for him who proposed various psychological
therapies that helped him to gradually overcome depression. In such case study, I worked
collaboratively with dieticians, counselor along with occupational therapists ensuring that each
and every biological, social as well as psychological need of the patients is met (Saarikoski,
2018). We altogether used different tools like registered dietician tool kit for his diet
management, mental health screening tools, quality of life screening tools and others to assess
and manage his conditions in a collaborative manner and then planning his healthcare plan in a
coordinated way.
The main aim was to ensure holistic healthcare to the patient. Rather than focusing on the
illness or on specific parts of the body, holistic health ensures viewing the person as the whole
and how he or she interacts with the environment. I have realized that holistic health emphasizes
the connection of the mind, body and spirit. In the care of the patient, I had taken care of the five
dimensions of wellness which are physical, emotional, and intellectual as well as social as well
spiritual (Nickitas, 2018). I had ensured therapeutic communication with the patient and the
patient was seen to be highly satisfied with the care.
In this way, I have successfully covered the competency number of 2, 3, 5, 10, 14, 15.

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Episode 2:
During the time of my placements, I once got the opportunity to care for a patient named
Charon Gill who was 80 years old and was suffering from obesity, osteoarthritis and loss of
mobility. She also suffered from poor quality life as she could not go to meet her friends or to
shop for her daily requirements. She was brought by her neighbor and she was seen to be present
in dirty apparels and seemed to have not taken baths for days. She had suffered a fall and was
brought to manage the condition. She was highly depressed and did not want to communicate
with any professionals (Lui et al., 2015). She had been treated inappropriately previously by
healthcare professionals and was not ready to cooperate with the nursing professionals.
The patient was represented with a fall and therefore it was necessary for undertaking the
initial screening assessments for fall to develop an idea about different aspects associated her fall
incident and other general assessments for her health condition. The fall risk screen as
recommended by the American Geriatrics was followed by me. This screening assessment
consists of three questions and an answer “yes” ensures the person to be in the high risk fall
category. In case of the patient, it was found that she belonged to high risk category. As per the
screening tool, further multi-factorial assessments were required. However, the patient was not
ready to cooperate which created issues for the different nurses who were treating her.
I had to take the charge and lead the team in ways by which the nurses do not get
motivated from the non-cooperation of the patient and the various negative things she was telling
to the nurses who tried to help him. I undertook a transformative leadership role where I
continuously motivated them in ways by which they can tackle the situation successfully. Not

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only that, I also acted as the role model where exhibiting them about how such situations need to
be handled. When they saw me working alongside them, they gained confidence and support and
they promised me to work beyond their potential.
I took up the decision of developing a therapeutic relationship with the patient so that she
becomes comfortable in the healthcare environment. Therapeutic relationship development helps
in gaining trust of the patient and makes the patient feel that the nursing professionals genuinely
want to help them live better quality lives by understanding their concerns and needs (Bruce et
al., 2018). I showed high level of empathy and compassion and communicated with her in ways
that made Mrs. Gill feel better and gradually overcome her previous perceptions of healthcare
professionals. I ensured patient centered care approach where I wanted to make her the centre of
decision making so that she feels respected and collaborates with us in her won care. I asked for
informed consent from her. Informed consent is an ethical principle by which nurses need to
provide details of the disorder and discuss the pros and cons of the interventions that would be
provided (Bauer et al., 2019). This is then followed by asking for informed consent from the
patient. She was happy with the procedure as she felt that she was respected and her participation
was supported. Her autonomy and dignity was respected and this helped in developing a strong
relationship with patients.
With the development of trust and mutual respect, I was able to encourage her to
participate effectively in the assessment, screening as well as intervention planning parts of the
treatments. I collaborated with the patient making him the centre of decision making process
giving her the entire rights to decide about her (Dolezel et al., 2017). However, I also needed to
carry on the assessment procedure as the initial phase assessed by me found her in the high risk
zone. I enquired to her regarding her history of fall, medications, gait, visual acuity, neurological

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impairments, muscle strengths, heart rate as well as many others. Therefore, my healthcare
professional team collaborated with her to develop a plan of care at first by questioning and
offering suggestions to her regarding the approaches of care and thus with her consent and will,
we developed a range of possible alternatives and approaches to care. We further worked with
that of the healthcare team members to refine and expand the client assessment that had been
obtained from the initial assessments. Each of us in the team further conducted their own
diagnosis and important tests they believed to be important. Then we again called for meetings
and analyzed and further interpreted data from the client assessments that were done. After
assessing all her needs, we developed care plan that included first identification of the care
priorities, then setting of the goals. These were then followed by effective care planning and
interventions with rationale (Jensen et al., 2016). Each of the interventions was evidence based
with set outcomes for effective evaluation of the health of Mrs. Gill. I developed an education
plan of her diet and exercise regime with dietician for obesity management, provided medication
for the pain, referred physiotherapists and occupational therapists for development of mobility
issues. I also set up a social care worker with her to help her in different social activities
encouraging her social participation. I ensured that she was provided with holistic care. Social
exclusion, her financial capability, socio-economic status and education and other social
determinists of health were managed by me effectively.
In this way, I met up the standards like 20, 25, 27a, 27b, 28 a-f, 29, 30 and 17
successfully

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Episode 3:
During the time of placement, I got the opportunity of caring of a patient who had
suffered from stroke and was presently in the rehabilitation ward under the care of a multi-
disciplinary team. While caring for the patient, I realized that most patients in the community
have been suffering from cardiovascular disorders mainly because of their health behaviors
issues and improper lifestyles. Therefore, I realized that there was a need for educating the
patients which would prevent the patient from facing such serious issues once again.
The patient was suffering from weakness of one side of the body, problem forming
speech along with aphasia, problem in swallowing because of dysphasia, mobility issues,
numbness or strange emotions as well as depression. Therefore, I needed to develop
interventions that would ensure not only helping him to manage his presenting disabilities but
also to promote his health in ways by which similar such disorders do not affect him anymore.
My first intention was to collaborate with client as well as inter-professional health care
team for performing appropriate nursing interventions. Therefore, all the healthcare members
first sat together and discussed about the care plan of the patient to ensure that there is no
miscommunication and that all work in a collaborative manner for effective teamwork. Speech
therapists, physiotherapists, occupational therapists, dieticians, and other nursing professionals
first assessed the conditions of the patient and collaboratively developed a care plan (Kuiper et
al., 2016). Effective technological advancement helped the entire team to remain connected and
discuss with each other about the care plan. With the help of telehealth services and the Skype
calling mechanism, the professionals discussed with each other the further plans, the new
strategies that need to be taken if required, response of the patient to treatments and many others.

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All data were successfully stored in the electronic health records so that all team members could
use the information at the right time (Yoost et al., 2019).
Apart from the important nursing interventions that I applied while working in the
healthcare team, another important aspect of my nursing care was to ensure educating the patient
about ways by which they can live better quality lives. The patient was suffering from
hypercholesterolemia as well as obesity. The patient also had high smoking habits and all these
contributed to development of chances of stroke again. Hence, it was important for me to
promote his health and prevent any disorders and injuries. For all these, I ensured educating the
patient about stroke and discussed how each of the contributing factors were resulting in
increasing his chances of stroke. This made him feel enlightened and he thanked me for helping
him know about these. Then I suggested him ways by which he could develop better lifestyle
habits and healthy behaviors. I told him about the importance of diet management, significance
of exercises, taking part in smoking cessation program; undertake mindfulness-based therapies
and others. These helped in promoting health and further prevention of any disorders.
However, while working as a team member, there were many situations where often
conflicts arose among the members. There were often clash of opinions, clash of dates, issues
and many others. All the team-members were trained and they possessed strong conflict
resolution skills by which they solved each of the problems successfully (Masters et al., 2018).
They often participated in constructive feedback sessions where they explained to each other
about the actions they liked or disliked and if any conflicts arose, all members contributed their
best to solve the issues. Even my strong conflict resolution skills also helped me in handling
various demands of the patient successfully. Conflicts arose when the family member of the
patient interfered in the decision making procedures regarding care services of the patients. But

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my skills enabled me to overcome such stresses and provide care successfully (Cramer et al.,
2018). Therapeutic communication helped me in developing strong bonds with the patient based
on mutual trust and respect. Therefore, his adherence to my care plan also increased.
In this way, I followed the competencies of 46, 47, 31 a, be, e, 32, 36, 39
Episode 4:
During the time of placement, I got the opportunity to care for huge number of patients
with multiple chronic conditions. However, another important aspect that was also noticed was
that most of the nurses were more concerned in treating the immediate presenting symptoms of
the patient and after the patients overcame their symptoms, they were given the permission o be
discharged. I realized that they were mainly following the biomedical model of care where their
main goal was to help the patients in feeling relieved from their symptoms. However, the
patients were seen to be readmitted within few days with the similar symptoms. I tried to analyze
the situation and found that the nursing members were not managing the social and
psychological determinants of health which are indirect contributors of poor health services. It
was during this time, I revealed my feeling to my mentor who was quite impressed by the entire
aspect that i have represented. I was given the duty of leading the group of nurses who were not
aware of following the bio-psycho-social model of health services. I wanted to be accountable
for the decisions and the actions that I will be taking and therefore, I prepared myself for being
the leader. I wanted to practice my roles and responsibilities successfully. Hence, I tried to
become a transformational leader and continuously motivated them to consider the social
determinants of health like education, employment, income, addiction, food, mental health
conditions, socio-economic status, health literacy and many others about the patients. I even

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participated myself as role model where they witnessed me about how I handled and manage all
determinists successfully. They were happy with my leading them and within very few days,
they became expert in managing the social determinists of health.
In this way, I met the competencies of 45a, 48 and 50
Episode 5:
During the time of placement, I got the opportunity to serve an aboriginal aged man who
had uncontrolled blood glucose level and was suffering from various complications. Due to
diabetes related retinopathy, it was found that his eyesight had been poor and that he had also
suffered from fall several times. After the treatment procedure was over, I realized that their
education level was quite low and that their health literacy needed to be developed. I worked
collaboratively with the different members of the healthcare teams like the dieticians,
occupational therapists, physiotherapists, physicians and other experts and thereby jotted down
the care requirements that the patient and his wide need to be careful about after they are
discharged home. We worked collaboratively and developed a referral plan as well where each
of them refereed the important experts that the patient needed to meet once they are back home
for follow-ups (Yoost et al., 2019). However, after a few days, the patient was admitted once
again with the same symptoms and a fall. When the patient and his wife were enquired it was
found that they are not being able to keep up with the care needs and requirements and falling
back in meeting the significant care interventions that they need to take. I applied my critical
thinking skills as well as problem solving skills in order to find out the aspects of nursing care
that can help in overcoming the issues. I understood that I need to develop new ideas which

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would help in changing, enhancing as well as supporting nursing practices. There was an urgent
need to modify the plan of care and I applied my judgment making skills. I requested the higher
organization to help the inter-professional team be connected with the patient and his family
24*7 so that we can care and guide them every hours in his home. This would reduce the chances
of his failing to meet the care needs and recurrence as well. The organization usually does not
allow telehealth services o patients as they believe that it might restrict their monitoring power
about nurse’s abilities in caring for the patients. Conflicts arose between the higher authorities
and me. However, I got the support of the entire teams who backed up the suggestion and
showed the higher authority on the potential benefits of telehealth. I took the role of a
transformation leader and helped the groups of healthcare professionals learn about the ways by
which they can successfully handle the telehealth services. I helped them gather the knowledge
and skills that are required for professionals to be technology ready. They were very happy to
find that telehealth services helped them to be connected with the patients and their families and
reduced their work-burden of meeting them in person and caring for them due to re-admissions. I
took my healthcare team members to attend the different health fairs and also lobbied where they
also understood the significance of the tele-health services. From this experience, I also realized
that not all patients have equal health literacy levels and they might also be not comfortable
handling technology. Therefore, I instructed my team to first develop ideas about the learning
needs of the patients and accordingly refine the health teaching strategies so that the patients can
develop proper self-care abilities successfully in their own lives.
In this way, I had successfully met the important competencies of 51, 52, 53, 54, 55, 56,
5757, 57, 59, 60, 61 and 62

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Episode 6:
During the time of my placement, I got the opportunity of working with an old patient
who was aged and was admitted because of different unmanaged symptoms of multi-morbid
conditions. He had one leg amputed because of the deterioration of the foot ulcer that resulted
from unmanaged diabetes. He had hyper tension and also suffered from diabetes. Osteoarthritis
had restricted his mobility that had resulted him to be confined within her house. She also
suffered from depression and anxiety. He had suffered a fall recently and had bruised his arms
and face. He had become extremely negative about his life and did not want to continue hid
treatment although his family members wanted to get him cured by the healthcare professionals.
This had created an ethical dilemma for the healthcare professionals. This is mainly because the
healthcare professionals suffered from the clash between the two principles of autonomy and
dignity and that between beneficence.
Autonomy and dignity of the patients mainly means that nurses need to respect the
wishes of the patients in every form and work according to the needs and perceptions of the
patients to ensure dignity. In that way, autonomy would dignity instructs me to follow the wishes
of the patient and thereby stop from providing him any treatment as per his wish. This would
result in degradation of his health that might lead to threatening situations. The ethics of
beneficence instructs nurses to provide care that ensures safety and well being of the patient
along with positive health outcomes (Barnard, 2017). In that way, I needed to provide care that
helps the patient in developing his health. Therefore, I was torn apart between which decisions to

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take. I knew that the patient had become emotional and was stating so as she had become
frustrated with her health condition. Along with my mentor, I analyzed if that we can develop the
will of the patient, she would be able to become fit and live better quality life through proper
interventions. By critically looking into the matter, and with the help of ethical decision making
skills, analyzed the cost benefit ratio of the patient and found that he would be more benefited by
a good care interventions as chances of his living better quality life was higher. I undertook
motivational interviewing of the patient that enabled me to develop motivation in the patient.
This made him withdraw his decisions and started adhering with the treatment. In this way, with
effective critical thinking skills and decision making skills, I effectively overcame ethical
dilemmas successfully. I also advocated about the entire wishes of the patient to the family
members about how he did not want to take care because he was frustrated. At first, his family
members became quite concerned but with effective therapeutic communication, I helped them
to control their emotions and told them how I am determined for best health of the patient. Later,
when I was able to manage the patient in allowing us to care for him, the family members were
quite happy. In such situation, they wanted me to gift valuable items and even sent huge number
of gifts to my cabin. However, this was entirely against my values as accepting gifts from
patients is unethical and breaches my professional boundaries. Therefore, I politely denied
accepting of the gifts and made them understand how accepting gifts are against our professional
boundaries.
While working with team members, I tend to follow a number of ethical and moral
principles to ensure avoiding of conflicts and maintenance of harmony in the workplace. I ensure
respecting the culture, ethnicity, background as well as races and class of people working with
me and ensure of not making any discriminatory remarks against anyone (Murtagh et al., 2016). I

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treat every person equally and never disrespect anyone. I also make sure that I ensure a body
language which does not make others feel humiliated or discriminated but empathetic and
compassionate. I respect suggestions of every of my colleague making sure that everyone feel
included in the team. Such moral and ethical principles ensure that every members of the inter-
professional team can work in ways by which individuals can maximize collaborative client care.
In this way, I followed the competence of 75, 82, 80
Episode 7:
While working in the healthcare systems, I often went across an aboriginal patient who
had suffered from fall due to osteoarthritis. I found him to be suffering from obesity and this had
acted as the risk factor for developing osteoarthritis. When I enquired about his diet, I realized
that due to poor financial conditions, his community cannot get access to organic and nutrient
rich foods and have to live on calorie dense foods. I advocated on their behalf to the local
government. The latter was of the opinion that this is indeed becoming a real concern and hence
they promised to take active steps. In this way, I followed the competence of 78
Episode 8:
During the time of my placement, I got the opportunity of caring for a patient who had
undergone a cardiovascular surgery and was allocated to me for providing post-operative care
services. After the operation, it was later found by the physicians that his operation was not
successful and that he has to undergo another operation. After listening to this, he had requested
the healthcare team to not convey the information to his wife as it would affect her emotionally
as well as physically as she was a patient with hypertension (Savage, 2017). However, one of the
members of the team revealed the information to that of the wife of the patient although it was

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denied by the patient and was asked to be preserved. This affected the health of the wife of the
patient who was taken for further treatment. The patient hearing this was quite upset and wanted
to change the healthcare center as he could no longer trust the professionals.
Immediately, seeing these unsafe practices of the professional who revealed the
information, I reported the situation to the concerned authority. Such practices of the
professional might expose the patient to various harmful situations where even crimes can take
place. In the case of this patient, breach of privacy and confidentiality had affected the health of
the patient’s wife and even the patient felt disrespected as his information was leaked and ethical
principle of confidentiality was not followed at all (Vaismoradi et al., 2016). Therefore, my
reporting of the incidence to the concerned authorities helped them knowing about the practices
taking place that have negative impacts of people, resulting in legal obligations and affecting the
reputation of the organization. Breaching of confidentiality as well as privacy can expose
patients to not only loss of trust and respect on the professionals but they also get exposed to
various types of harm like physical harm from perpetrators because of various intentions. They
may be socially excluded due to presence of stigma about a disorder or suffer from social
exclusion. In this way, I followed the competence 83.
Episode 9:
The trends in healthcare and nursing professions are constantly changing. With the
advancement of technology and development in the research field of medical science, it has been
found the more and more efficient ways of treating various disorders, different types of life-
saving drugs and new ways of managing health behaviors of patients have evolved. In order to
succeed in the nursing profession and in order to provide the best care services to patients that

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reduce their suffering and enhances their quality of life, nurses need to continuously engage in
different evidence based studies that help them in developing their skills and knowledge (Dineen,
2017). Such evidence based practice helps the nurses by making them adopt practices that have
been proved to be not only safe but also of the highest quality that can be provided to patients.
Developing a plan to undertake evidence based research to keep up with the trends of healthcare
services provided to the patients is an important aspect of nursing professionals. Evidence based
practices not only help nurses to be aware of the changing trends in the healthcare system but is
also has many important benefits in the nursing professions. The evidence based practices can
help in learning of the new trends in healthcare helping in the improvement of the patient
outcomes and thereby helping in providing high quality care as well as reduction of costs and
even elimination of practices that are obsolete or are not effective (Van der Velden et al., 2015).
Basically with evidence based practices, nurses can be seen to be connecting scientific evidences
towards the clinical expertise for providing the best patient outcomes. The main purpose of this
is the reduction of the variations in practices and following the standard trends in healthcare. I
usually include evidence based care and plan to use the information in ways by which effective
care is ensured for safe and quality healthcare of patients.
In this way, I follow the competencies of 84 and 88.
Episode 10:
Initially when I started working in the multidisciplinary team taking care of the stroke
patients, i used to be very confused about the role of the team-members. I was also not efficient
in working within healthcare teams as I lacked team-working skills. Moreover, I was introvert
and often did not understand how to express myself to the patients as well as with the team-

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members. I could not develop rapport with the other team-members but could not understand the
reason for such issues. Although I tried my best, but could not recognize the attributes of team-
working that I lacked. In such situation, my mentor advised me to undertake reflective practices.
With the help of reflective practices, nurses can recall or look back on the various experiences
that she had faced during their practices trying to identify the negative and positive aspects of the
experiences (Pinar et al., 2016). Such practices mainly help the nurses in identifying their
strengths and weakness so that they can work on the skills and develop them for becoming expert
nursing professionals. I realized that the main aspects which I lacked in team-working after
taking reflective practices was that I was introvert, my body language seemed rude and I had
poor listening skills for which communication was affected. This reflective practice helped me
identify my weakness and helped me working over it.
While working in a stroke rehabilitation department, I often needed to work with
different team-members. Initially, I was not aware about the role of spec aliased experts other
than that of the doctors and nursing professionals. While working in the multi-disciplinary team
in the stroke rehabilitation , I learnt that the occupational therapists mainly assess the ability of
the patient to participate successfully in activities of daily living like that of kitchen tasks,
personal care and ability to manage in the home environment and also provide therapy for
supporting both physical and cognitive difficulties. Another important role is that of the
physiotherapist whose main aim is to re-educate movement as well as sensation and help in
balancing to help the patient in reaching the potential for recovery of mobility and independence.
Again, I also understood that the role of the speech and language therapist is to assess the aspects
of communication of the patient and thereby advise in how to help the patient and the family.
They mainly help in advising the most appropriate ways of keeping the patients ‘s swallowing

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process safe (Yoost et al., 2015). Dieticians can help in managing the nutritional requirements of
the individuals and also help in assessing the tube feeding requirements of patients. A clinical
neuropsychologist helps with stroke people who have problems with thinking, behaviors as well
as emotions that are faced after stroke. A care manager can help in advising the various services
for providing personal acre as well as domestic help along with respite care, mea; services and
other benefits.
In this way, I followed competencies like 85, 89
Episode 11:
While working with my facilitators, I was advised by them that I would need to develop
detailed ideas about the role of the government in the organization of Canada’s health care
system. They suggested that it would be extremely helpful for me when I will be arranging for
the different health promotion programs, advocating for patient and community health problems,
develop policies and others mainly regarding the funding system and for ensuring collaboration
among different healthcare sectors. Therefore, I started attending training sessions which helped
me in gaining more knowledge about understanding the different levels of the healthcare systems
and also approached my mentor so that he can provide some of his valuable time in helping me
develop ideas about how the system works. Not only that, I also undertook extensive research on
the internet to find out more on the topic of organization of healthcare at the three levels of
municipal, provincial as well as national level. The organization of the Canada’s healthcare
system is mainly determined by the Canadian constitution in which the roles as well as the
responsibilities are divided between the federal, provincial and even territorial governments. I
have realized that the provincial and territorial governments have most of the responsibility for

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delivering health and other social services. The federal government is also seen to be responsible
for certain delivery of services for certain groups of people. Public funded health care is seen to
be financed with general revenue raised through federal as well as provincial and territorial
taxation like that of the personal and corporate taxes, sales tax, payroll levies and other revenues.
I have learnt that provinces may also charge a health premium of the different residents for
helping in paying for the publicly funded healthcare services. However, non-payment of the
different premium must not limit access to different medically necessary services. I had also
gained the insight that the responsibility for the public health is seen to include sanitation,
infectious disorders and even related education and these are shared among the three orders of
the government that include federal, provincial/territorial and local or municipal. Most of these
services are however delivered at the provincial and local levels. I have been able to develop
extensive knowledge about the healthcare organizations at the municipal, provincial and national
level and thus would be able to handle different associated aspects of nursing successfully.
In this way, I have been able to meet the competencies of 86b, 86c and 86d.
Episode 12:
While working in my placement, I got the opportunity of working with a large number of
populations from the older cohorts. Most of them were seen to suffer from different types of
chronic disorders and most of them had multi-morbid conditions. They were found to suffer from
a number of different diagnoses and consequently have different multiple as well as complex
needs. When this was compared to that of the younger age group patients that was also treated, it
was found that a greater proportion of older people required an interdisciplinary approaches

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towards their care so that we can deal with complex multi-morbidity as well as social and
psychological issues (Murray, 2017). I realized that the best possible outcomes for the older
people were achieved through a consultative as well as collaborative approach for caring and this
actively involves the patient, their family and carers as well as an interdisciplinary team.
I got the opportunity of working with the healthcare team-members and learnt how to
undertake different important disciplines by working in a collaborative manner. I participated
successfully in setting goals with a common purpose and thereby make decisions and hence
share resources as well as responsibilities. I worked with the team of clinicians who came from
different disciplines along with that of the patients and thereby undertook assessment, diagnosis
as well as intervention and goal setting and participated in a collaborative manner in the creation
of the care plan. The patient as well as the family members and caregivers are always
encouraged by me to tale active part in decision-making (Dadgar et al., 2018. I have noticed that
this helps in making them feel empowered and hence their adherence with that of the treatment
increases.
One of the elements that I have realized from working with the teams of interdisciplinary
approach is effective leadership. I have got the opportunity of working with one of the best
leaders in the healthcare teams. I have realized that positive management as well as leadership
can help by giving clear direction as well as vision for the team by mainly promoting an
atmosphere of trust where the contributions need to be valued and consensus needs to be
fostered. Another important realization I had was that while working in the healthcare team, I
should not think and perform in an individual manner but constantly communicate with other
members and engage in constructive feedback so that the treatment that would be provided to the
patient comprises of the best care service from every members.

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I have always tried to follow the recent modern trends in nursing that had been proved to
have the best health outcome on patients both mentally, emotionally as well as economically. As
while working in the interdisciplinary team, I ensured to maintain the person-centered care
practice which is the newest trend in healthcare services. I have realized that with the new trend
in nursing of following a person centered care, nurses can successfully help by involving of the
patients in all aspects of their care and this helps in empowering them where they can speak up
and contribute to decision-making. I thereby formulated shared standardized interdisciplinary
care plans and records of the care that would help in contributing to comprehensive as well as
holistic person centered care.
In this way, I was able to successfully respond to the competencies of 91, 93, 94, 96, 97
and 98.
Episode 13:
While working in the interdisciplinary team-member in the healthcare department, I had
the responsibility of continuous evaluation whether effective feedback from the team-members
were done or not. Constructive feedback from the team-members can not only help in clarifying
different aspects of the healthcare interventions that were adopted but also helped in evaluating
the progress of the patient successfully for deciding on with further interventions (Denisco et al.,
2015). Such feedbacks also helps in clarifying what different members think about each other
and hence feedback helps in reduction of chances of power struggles and develops good bonds.
Therefore, I tried my best in evaluating and refining approaches so that all people in the team can
provide feedback successfully to the inter-professional healthcare team. I encouraged all in
meeting regularly at the beginning of the day and at the end of the shift so that all can provide

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chances of feedbacks. I also took the help of developing a social media group where all people of
the team can come together and help in providing their valuable feedbacks regarding each other.
Not only that, another of my focus was to evaluate how the present trends of nursing like
following person centered care as well as bio-psycho-social model of care are resulting in
positive health outcomes of the patients (Thye et al., 2018). As a nurse, it is always important to
evaluate the response of the modern trends that had been implemented in the care services by me
as well as the healthcare team members. I have also tried to implement different evaluation tools
like that of patient satisfaction as well as that taking after patient survey in the appointment
whether all the care needs of the patient being the social, physical as well as the emotional needs
had been approved or not.
Apart from the evaluation of the effectiveness of the modern nursing trends and also to
evaluate successfully that the teams are engaging in successful feedback exchange sessions, there
are two areas that also require other evaluation. One of the most important evaluations is also to
be aware of self so as to understand what specific areas one need to work upon. Effective self-
awareness also helps to prevent individuals in getting engaged in various types of the patients
and health teams without creating any conflicts (Van Der Zijpp et al., 2018). Self-awareness is
also an important procedure of objective examination of oneself and is considered to be one of
the most important tools for developing effective components of the nurse client relationship.
Self-awareness can be seen to develop an important tool which would help in developing a
therapeutic relationship with that of the patients for therapeutic healing. In order to evaluate
whether I have self-awareness skills, I would undertake reflection based studies as that would
help me in dissecting each and every experiences that I have gone through. This would help me
in evaluating whether I have sufficient level of self-awareness or that I would have to work on

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this skill. Reflection based studies helped in noticing that I have poor self-awareness skills and
hence approached my mentor to gather his opinion about the action plan that I need to develop
for ensuring better self-awareness (Robbins, 2018). I also under-took effective audit and
evaluation about the different physical resources with the help of my mentor who taught me how
to make checklist and how to proceed with the evaluation techniques. In this way, I learnt about
how to conduct effective evaluation of different aspects of healthcare and this helped in
becoming effective nursing professional.
By this way, I successfully developed the competence of 99,100, 101 and 102.
Episode 14:
During the time of my placement, I got the opportunity of working with different
experienced mentors who have helped me understand the significance of technologies and
informatics while providing care for the patients and also storing information. I can provide
important examples which would help in showing how my knowledge and skill developed
regarding handling of various technologies and ensuring following the law of informatics. One of
the most interesting healthcare technology that I have found to be of huge importance in
integrating pharmacy, one-did orders as well as documentation and saving of patient records
which are accessible by members of the team at any time. This technology had reduced
communication errors, documentations errors, missed documentations, medication errors and
many others (Bonnel et al., 2018). Another important healthcare technology is the m-Health or
the mobile health. Mobile health has now started acting as important tool by which patients are
seen to become active players in their own treatment by connecting communication with that of
biometrics. Patients can ask for support from professionals, professionals can also remain

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connected 24*7 for effective evaluation and monitoring of the patients, connect with other
patients having same issues and many others. Telemedicine on the other hand had been found to
be extremely important for getting connected with people from rural setting who cannot get the
scope of visiting the urban healthcare multi-specialty centers for consultation and guidance of
check-ups hereby increasing the accessibilities (Epstein et al., 2015). I have thereby participated
in many workshops so that I can gradually become knowledgeable and skillful about the ways
how technology is handled and the ways they can help people in providing high quality services.
I also found that health informatics is intricately associated with better quality healthcare. Nurses
need to be well aware of the use of health informatics. I learnt by observing my mentor about
how to utilize information in effective ways so that it results in better benefits for the patients. I
have learnt that by effectively collecting as well as analyzing and leveraging information
gathered through different technologies, nurses can successfully manage, interpret as well as
communicate the data that comes in and out of the healthcare faculties. These ultimately help in
improving patient services.
Initially, I have always followed the various aspects of nursing that had been proposed by
the professional body of nursing called the College of Nurses of Ontario, I have spent
considerable amount of time in understanding the various roles and responsibilities of CNO,
RPNAO and many others. My mentor had advised me that as registered nurses, I need to follow
the roles and responsibilities as well as professional standards so that I can not only avoid any
form of legal and ethical obligations and provides the best quality care that patients are seen to
be expecting (Dineen et al., 2019). The College of Nurses of the Ontario region can be defined
as the governing body for the various nursing professionals like that Registered Nurses (RNs),
Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) in Ontario, Canada. I have

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understood the different roles that the college fulfils and how following them can help me to
become better nursing professionals (Clark et al., 2018). They had established requirements for
entry of nurses towards practices as well as articulating and promoting the different practice
standards. It also helps in administering the quality assurance programs and also enforcing the
different standards of practice and conduct. I have followed each of the guidelines carefully and I
would incorporate each of the guidelines and standards set by them in practices so as to ensure
that all CNO principles are carried successfully and avoid any legal obligations. In Ontario, the
RPNs are found to be community college graduates and after completing their graduation, they
are seen to write a national certification examination. Once they are seen to successfully
complete the examinations, only then they become registered in practicing as the nurse by the
College of Nurses of Ontario (CNO) this is mainly maintained, controlled and managed by the
Registered Practical Nurses Association of Ontario. Not only that I have developed the concept
of nursing unions which is actually a labor union or an organization of workers that are formed
for protecting and advocating about the interests of the members. I learned that this advocacy
mainly takes the form of collective bargaining that is mainly seen to be aiming at the
improvement of employees' wages, hours, working conditions and benefits.
In this way, I have maintained the competency of 105, 108a, 108b, 108c as well as 109.
Episode 15:
The nurses’ Codes of Professional conduct is also called the Nurse’s codes of ethics. This
is actually a compilation of ethical rules that are designed for guiding the nursing professionals
in making the correct decision in different difficult patient-care situations. While caring for
patients, I have realized that in the practical areas, nurses might find many issues that act as

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RN COMPETENCY GAP
barriers while following professional conducts (Tluczek et al., 2018). Once, one of my
colleagues had done one medication error although it did not result in threatening situation of the
patient. However, the nursing professionals were supposed to report of the unsafe practices he
conducted. However, he did not do so and even requested me to not to reveal. As I was aware of
the different professional codes of conduct, I adhered to that of the standards of practice of the
profession and also responded professionally to the unacceptable behavior. I successfully
identified and responded to the incidents of unsafe practices of professional misconduct. I
reported the incident first to the mentor and then to the concerned authority and thereby fulfilled
my responsibility as the nursing professional following the professional conduct.
The advancement of the healthcare technologies had resulted in massive transformation
in the healthcare industry with quality patient care and higher satisfaction (Rantanen et al.,
2018). It has been found that with this advancement, it has become much important for the
nursing professionals to develop the skill by which they can use the technology and help in
providing high quality care to patients. However, I had always been shaky while using
computers and therefore, I was quite concerned as to how to adapt to the environment. I had
known that for healthcare professionals the utilization of the computer technology help by
providing quick access towards different important information about the health and even the
illness. Computer skills are also very important for managing electronic health record along with
the documentation of each and every step of treatment provided to patients (Hannawa et al.,
2017). RNAO or the registered Nurse’s Association of Ontario had also described the importance
of this skill within their health education Fact sheet. To achieve the competency, i have joined
computer education workshop as well as joined a training session which teaches individuals
about how to handle technology successfully. Gradually, I developed my computer working skill

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RN COMPETENCY GAP
so that I can not only keep up with the changes of the healthcare center like implementation of
the different healthcare technologies but can also document information of client care, obtaining
and forwarding information with agency and also obtaining and forwarding information outside
the agency. I undertook effective evaluation of the different changes in the healthcare system that
affects the nursing practice and evaluated the impact of informatics and technology in healthcare
In these ways, I have successfully followed the competencies of 113a, 113b, 113c, 113d,
116, 117a, 117b, 117c, 117d, 120and 121 successfully.
Episode 16:
During the time of my placement, I got the opportunity of working in an inter-
professional team who was providing care to a diabetes patient. He had severe foot
complications where the ulcer had got deteriorated in such a way that it needed nursing care till
the wound heal properly. While caring for such patient, I witnessed that many of the members of
the healthcare team did not follow the hand hygiene protocols. As a result, it was found that the
patient had acquired hospital related infection that created far more pressure on the health of the
patient making them suffer more and result in extended length of the hospital stay and flow of
resources. Therefore, I reported about the practices to the concerned departments and was
summoned by them for discussing the issues in details. The higher authority official was
extremely happy about the action that I had taken about reporting of the issues to the concerned
department. When they asked for my suggestion about what kind of strategies can be taken, I
suggested of developing a quality assurance systems through the implementation of training
sessions. The trainees would be able to develop about knowledge and skills regarding important
healthcare hygiene strategies with more importance on the hand hygiene guidelines. Not only

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RN COMPETENCY GAP
that I also suggested to implement technologies and informatics into the healthcare organizations
so that infection control can take place successfully. In a busy ward, healthcare professionals are
always fund to be in a rush and infection control actions might get missed under different
circumstances. In such areas, healthcare technologies would help in ensuring infection control
and will reduce the rate of the number of patients being affected by hospital acquired infections
and the huge expenditure of the healthcare resources. I suggested them of the implementation of
technologies like that of very recent robotic system that helps in disinfecting rooms with the help
of UV rays like that of the XENEX. Many other UV bacteria killing robots are found to be
cleaning the hospitals rooms which have the ability in sanitizing different healthcare facilities in
a much better ways than humans. The higher authority was found to be quite happy with my
proposal and decided to proceed forward with it.
In this way, I met the competencies 113e and 113f.
Episode 17:
During the time of my placement, I was quite surprised to see that the new nurses were
not at all aware about the importance of confidentiality and privacy in the healthcare practice
settings. They were often found to discuss about patient information among each other and
gossip about them. I was quite upset about the unprofessional practices of the nurses. Moreover,
they also lacked the critical thinking skills about how to manage situations when they are forced
by family members or relatives and even friends and strangers were pressing them to release
patient confidential information. Often they use to reveal such information to them which are
entirely against the bioethical practices of privacy and confidentiality. These expose the patients
to physical harm as well as emotional and mental turmoil, social exclusion. Another important

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RN COMPETENCY GAP
areas where breach in confidentiality and privacy is highly likely to occur is due to leaking of
information from the electronic health records. Many vases have been found that insurers have
been able to get much crucial information that remains stored in EHR. However, it is not clear
about how such situations take place but leakage of information from improper use of HER
while linking information of patients to insurances can be considered as one such practice.
Accessing and gathering information and then spilling out such information from HER results in
negative usage of the beneficial healthcare technologies. In order to prevent such practices, I
worked closely with the HR department as well as the higher authorities to develop policies that
prevent such practices, strict penalties and legal obligations were included to stop the people
from misusing the machine as well as breaching ethics. Proper training sessions for effective
handling and managing information about HER was also proposed.
In these ways, I met the competencies of 115 and 118

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RN COMPETENCY GAP
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