NRSG367 - Reflection on Clinical Practice and NSQHS Standards, S1 2020

This report is a reflective analysis of a clinical experience by a nursing student, focusing on a breach of the National Safety and Quality Health Service (NSQHS) Standard 6.9, which emphasizes effective communication within the healthcare team. The report utilizes the GIBS reflective cycle to explore an incident involving poor communication between registered nurses, leading to a potential risk for a diabetic patient with hypertension. The student reflects on their feelings, evaluates the positive and negative aspects of the experience, analyzes the situation in light of relevant literature, and concludes with an action plan for future practice. The analysis highlights the importance of proper documentation and communication in promoting patient safety and adhering to NSQHS standards. The student aims to improve communication skills, review clinical handovers, and seek feedback to enhance clinical practice and minimize risks. The report emphasizes the legal and moral obligations of nurses to provide safe patient care and the value of reflective practice in identifying and addressing safety concerns.

Running head: NRSG367 ASSESSMENT 2 REFLECTION
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Title page
Student Name:
Semester 1, 2020
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NRSG367 ASSESSMENT 2 REFLECTION 2
Introduction:
With the global burden of disease, the need for comprehensive clinical practice
is intensifying for meeting the high demand of the patients. Therefore, in the clinical
setting, providing the best comprehensive care to the patient is a fundamental part of
quality nursing practice (Johnstone, 2016). To provide guidance in appropriate
clinical practice, The National Safety and Quality Health Service (NSQHS) Standards
were established with the assistance of the Australian Commission on Safety and
Quality in Health Care and the Australian Government (Www.safetyandquality.gov.au.,
2018).The combination with the patients and multidisciplinary team is considered as the
fundamental part of effective practice. This paper aims to provide an in-depth
discussion of one such standard (6.9) by using the reflective process in the following
paragraphs.
Description:
The chosen standard in this context is standard 6 of NHQSH, specifically
standard 6. 9 which suggested that clinicians and the multidisciplinary team must
involve in the clinical communication process for effectively communicating health risk
promptly so that clinical decision about the care can be taken and family members can
be informed regarding the changes (Www.safetyandquality.gov.au., 2018). The incident
I will be reflecting on occurred during the placement as a registered nurse within the
medical ward due to poor communication between registered nurses. In the clinical
placement, I was appointed to provide care of a diabetic patient of 46 years. The

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registered nurse in charge provided me with a clinical handover regarding details of the
patient and suggested me to provide her with some food and assess the vital signs.
Since the registered nurse was in a hurry, she left after providing the clinical handover
with appropriate communication. After providing food and reviewing the clinical
handover, the estimated blood pressure was 165/ 90 and the patient stated that she had
high blood pressure in the morning. I was anxious and contacted my supervisor and
supervisor identified that the patient had high blood pressure which the nurse in the
previous shift failed to mention.
Feeling:
Prior to the clinical experience, I was mindful to involve in effective clinical
practice such as a comprehensive assessment of the patient and provide safe care to
the patient. However, after assessment of blood pressure, I was anxious and
apprehensive to handle a patient with high blood pressure. I was nervous that I failed to
provide adequate provide care to the patients. It impacted my clinical practice.
Evaluation:
This section of the reflection will reflect on both positive and negative experience
which will lead to an understanding of the experience of patients and my role as a
registered nurse. Considering positive experience, I have identified that the clinical
incident provided me with an opportunity to involve the patient in the effective
communication, assess the vital signs of the patient and gather proper skills of the
clinical assessment. However, the negative experience is that I failed to communicate

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with a registered nurse who was in charge of the care of the patient and provided
patient with food that might contain sodium that can elevate the blood pressure of the
patient. It subjected patients to high risk and questioned patient safety. It also impacted
my practice as a registered nurse to provide comprehensive care to the patient.
Analysis:
Assessment of the patient, proper documentation along with communication
between health professionals is a fundamental part of holistic practice. Therefore, after
a comprehensive assessment, the alteration of vital signs must be documented and
nursing professionals must communicate within themselves to promote safe practice
(Kilpatrick, Elliott, & Fry, 2019). The standard 6.9 of NHQSH suggested that nursing
professionals must effectively communicate with other health professionals so that
patients receive safe care. In the clinical setting, diabetic patients usually have high
blood pressure as diabetes damages the arteries and make them hard which resulted in
blood vessel damage (Peterson et al., 2016). Therefore, patients with diabetes and
high blood pressure are required to avoid food that contains sodium such as salty fish
and cottage sandwich (Bajorek et al., 2017). Taking a deep insight into the situation, it
can be said that the poor communication between registered nurses subjected the
patient into a high level of psychological distress (Malatzky & Bourke, 2017). The
nurse of the previous shift failed to document the alteration of the vital signs and
communicate the critical information to me. Consequently, due to a lack of
communication, I provided the patient with food that might contain salt and other
ingredients that induce the blood pressure and subjected patient to high physical risk.

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Therefore, the overarching factor in this context is the lack of communication and lack of
proper documentations that hindered me to comply with the NHQSH standard 6.9.
Conclusion:
On a concluding note, it can be said that lack of communication is considered as
one of the most serious issues that subject patients into high risk of harm. While I was
unaware of the importance of communication between nurses, this experience provided
me with an opportunity to understand the importance of communication and
documentation. If I was in a similar situation, I communicated the information to the
nurse and document it in the handover so that safe care can be improved.
Action plan:
In future, I aim to be a more professional while dealings similar situation. When I will
encounter a similar situation, I will communicate with the registered nurse and review
the clinical handover before providing patient with any food. I report the discrepancy in
the vital signs and clinical handover if I identify while providing care. It will improve
patient satisfaction and improve patient safety. To improve my clinical practice, I will
involve in training and workshops with my peers regarding effective communication and
documentation. I will seek feedback from my supervisor regarding my documentation
and clinical handover so that I can improve my clinical practice and identify the factors
that can subject to a high risk of harm.
Conclusion:
On a concluding note, it can be said, nursing professionals have legal and moral
obligation to provide safe care to the patient. Reflective practice is one of the most

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suitable means to identify the discrepancy in safe care. The reflection involves a clinical
incident which breached NHQSH standard 6.9. I will incorporate the knowledge
gathered in my future while I will encounter a similar situation.
References:
Bajorek, B., Lemay, K., Magin, P., Roberts, C., Krass, I., & Armour, C. (2017). Patients’
attitudes and approaches to the self-management of hypertension: perspectives
from an australian qualitative study in community pharmacy. High Blood
Pressure & Cardiovascular Prevention, 24(2), 149-155.
Husebø, S. E., O’Regan, S., & Nestel, D. (2015, August). Reflective practice and its role
in simulation. Clinical Simulation in Nursing, 11(8), 368-375.
http://dx.doi.org/10.1016/j.ecns.2015.04.005.
Johnstone, M. J. (2016). Key milestones in the operationalisation of professional
nursing ethics in Australia: a brief historical overview. Australian Journal of
Advanced Nursing, The, 33(4), 35.
Kilpatrick, J., Elliott, R., & Fry, M. (2019). Health professionals’ understanding of person-
centred communication for risk prevention conversations: an exploratory
study. Contemporary nurse, 1-12.

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Malatzky, C., & Bourke, L. (2017). When the social meets health in rural Australia:
confronting the disconnect. Health Sociology Review, 26(2), 190-203.
Peterson, K. L., Jacobs, J. P., Allender, S., Alston, L. V., & Nichols, M. (2016).
Characterising the extent of misreporting of high blood pressure, high
cholesterol, and diabetes using the Australian Health Survey. BMC public
health, 16(1), 695.
Www.safetyandquality.gov.au. (2018). National Safety and Quality Health Service
Standards. Retrieved 2 March 2020, from
https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-
and-Quality-Health-Service-Standards-second-edition.pdf