University Nursing: Critical Reflection on AHPRA Standards

This report presents a critical reflection on two key Registered Nurse Standards of Practice as defined by the Nursing and Midwifery Board of Australia (NMBA). The student analyzes their experiences in clinical practice, focusing on Standard 1, which emphasizes critical thinking and analysis in nursing practice, and Standard 2, which highlights the importance of engaging in therapeutic and professional relationships with patients. The reflection details instances where the student faced challenges, such as time management issues, lack of cultural competency and errors in medication administration. The student discusses the importance of establishing patient-centered relationships, building trust and providing culturally safe interventions. The report identifies areas for improvement, including the need for enhanced time management skills, cultural competency training and improved ability to build therapeutic relationships. The student concludes by emphasizing the significance of adhering to ethical standards in nursing and outlines plans for professional development to address identified weaknesses and enhance overall patient care. The report references key literature to support the reflections and recommendations.

Running head: CRITICAL REFLECTION
CRITICAL REFLECTION
Name of the Student:
Name of the University:
Author Note:

1CRITICAL REFLECTION
Introduction:
On assuming the role of a registered nurse, it is extremely important to abide by the
ethical standards of the nursing profession. This paper would discuss my ability and experience
to comply with ethical standards of the nursing profession and deliver appropriate services. The
two AHPRA standards that have been chosen by me to critically reflect upon are the standard 1
and standard 2. Standard 1 effectively deals with the critical engagement in nursing practice and
standard 2 deals with the ability of the professionals to establish therapeutic relationship with the
patients. I would talk about my personal experience and reflection with respect to the two
standards in the subsequent paragraphs.
Standard 1: Thinks critically and analyses nursing practice
The primary duty of an efficient registered nurse is to critically plan and undertake a
clinical decision (Nursingmidwiferyboard.gov.au.,2018). A variety of decision making
frameworks and evidence based strategies are used in the process
(Nursingmidwiferyboard.gov.au.,2018). In order to think critically it is important for a nursing
professional to access and analyse the best evidence to deliver a safe and standard service
delivery. It is also important for a registered nurse to be able to reflect upon the experience
gained through clinical practice (Nursingmidwiferyboard.gov.au.,2018). In addition to this, it
should be noted that the ethical considerations also include the fact that nursing professionals
must be culturally competent to deal with a culturally diverse group of patients
(Nursingmidwiferyboard.gov.au.,2018). Also, the nursing professionals must adequately comply
with the patient welfare policies and guidelines while devising interventions and commit
themselves to provide quality service delivery (Truong et al., 2014). The nursing professionals

2CRITICAL REFLECTION
must be proactive and efficient in documenting patient details and accurately make use of the
ethical frameworks while clinical decision making (Nursingmidwiferyboard.gov.au.,2018).
On critically reflecting upon the ethical guidelines of the nursing profession, I feel that
there is a lot that I still need to learn in order to become an efficient registered nurse. The major
complexities that I have faced while working in the hospital include my inability to manage time
and prioritize tasks and lack of cultural competency. In this context, I would like to mention an
instance where I mistakenly administered a drug intravenously which was supposed to be
delivered intramuscularly. This happened because of my carelessness. The major problem that I
face while handling clients is the lack o efficient time-management. A number of tasks need to
be taken care of, that includes, documentation, explanation of the treatment intervention and
follow up. I find it extremely difficult to prioritize tasks and accordingly proceed. It seems as if I
am entitled to manage everything at the same time and as a result I have often made mistakes
while documenting observations or documentation of patient details. Another problem that can
be listed is my inability to provide a culturally safe intervention. In this context, I would like to
mention an incident where I was supposed to administer electrolyte to the patient intravenously.
While checking the progress notes of the nurse who had been in charge earlier, I noticed that the
patient was an aboriginal old man. I did not feel comfortable with the patient. I could not
communicate efficiently and I felt that I was not capable of providing a culturally safe service
delivery which is the most important aspect of the nursing profession. Hence, I feel that I need to
work a lot on improving my skills so that I am able to provide quality in terms of care and an
also prioritize tasks with efficient time management.

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Standard 2: Engages in therapeutic and professional relationships
While designing an intervention for the patient, it is extremely important to build a
therapeutic relationship so that the patient can trust the professionals who are taking care of him
with his condition (Visser et al., 2014); (Nursingmidwiferyboard.gov.au.,2018). A registered
nurse must be able to establish and sustain patient-centred relationships, communicate effectively
and voice advocacy for the patients at times of need (Lecca et al., 2014). At the same time, it is
essential to recognise people as the experts of their experiences in life and direct them to
undertake health-related decisions (Gelso, 2014). Registered nursing professionals should further
engage with the clients in a patient-centred relationship and deliver excellent service delivery
(Brainbridge et al., 2015); (Nursingmidwiferyboard.gov.au.,2018). Also, the professionals must
engage the clients in a therapeutic partnership and maintain a record of the health professionals
and other workers working at the hospital (Greenberg, 2014).
On reflecting upon my personal experience I feel that I yet have to absorb a lot in order to
be an efficient registered nurse. In this context, I would like to narrate an incident where I was
supposed to administer intravenous fluid to restore the electrolyte balance in an indigenous
woman who was suffering from acute diarrhoea. I examined the vital signs of the patient and
proceeded with the intervention directly. This was not the correct procedure. As an efficient
registered nurse I must have engaged the family members of the patient while devising the
intervention and must have adopted the family centred approach to provide holistic care. I did
not educate the patient or the family members about the medical health condition of the patient
and the rationale behind the designed intervention (Fonagy & Alison, 2014). I directly proceeded
with the intervention and this represented an example of ineffective care.

4CRITICAL REFLECTION
Hence, I believe that I have not been able to demonstrate an example of positive patient
care during my practicum. This is an area where I must improve in order to deliver effective
patient care. In order to improve on my skills, I would like to work in close association with my
supervisors so that I am able to absorb knowledge from them and improve on my skills of time
management and building a patient centred therapeutic relationship (Coyne, 2015). Further I
would also like to participate in a workshop that imparts training with respect to cultural
competency. I believe it would help me in developing my ability to handle indigenous patients
with care and provide a culturally safe service delivery. On thorough compliance with these
strategies, I think I will be able to gain sufficient experience in order to become an efficient
registered nurse.
Conclusion:
Hence, it can be concluded that it is extremely important to abide by the ethical standards
of the nursing practice in order to practice as a registered nurse. On considering my present
ability to handle patients and my performance within a clinical environment I feel that I still am
incapable and have a lot to learn. I am yet to abide by all the ethical guidelines properly and
deliver service. In order to incorporate necessary reforms to address the existing lacunas as a
nursing professional, I would like to work in close association with my professionals and gain
experience on how they cope with critical situations and efficiently undertake an effective
clinical decision. Further, I would also absorb from them the expertise with which I can
efficiently handle patients and prioritize jobs so as to manage time and avoid medical errors.
Further, I also feel that attending workshops or informative sessions on cultural competence
training can help me in becoming culturally competent and delivering culturally safe treatment

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intervention to the indigenous patients. It would also help me in dealing with critical cases and
establishing an efficient therapeutic relationship to achieve positive patient outcomes.

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References:
Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Cultural competency in the
delivery of health services for Indigenous people.
Coyne, I. (2015). Families and health‐care professionals' perspectives and expectations of
family‐centred care: hidden expectations and unclear roles. Health expectations, 18(5),
796-808.
Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic
relationship. Psychotherapy, 51(3), 372.
Gelso, C. (2014). A tripartite model of the therapeutic relationship: Theory, research, and
practice. Psychotherapy Research, 24(2), 117-131.
Greenberg, L. (2014). The therapeutic relationship in emotion-focused
therapy. Psychotherapy, 51(3), 350.
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient‐
centred care? A narrative review and synthesis of the literature from health policy,
medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
Lecca, P. J., Quervalu, I., Nunes, J. V., & Gonzales, H. F. (2014). Cultural competency in health,
social & human services: Directions for the 21st century. Routledge.
Nursingmidwiferyboard.gov.au. (2018). AHPRA - Server error 404: Content not found.
Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards/registered-nurse-standards-for- practice.aspx
Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in
healthcare: a systematic review of reviews. BMC health services research, 14(1), 99.
Visser, M., Deliens, L., & Houttekier, D. (2014). Physician-related barriers to communication
and patient-and family-centred decision-making towards the end of life in intensive care:
a systematic review. Critical Care, 18(6), 604.