NRS162 Nursing Workplace Learning Scenario: Assessment Answer

Situation

In the scenario, the nursing student Rory is assisting a patient named Lizzie. Both of them have developed a good therapeutic relationship in the first week of placement. When Rory was assisting Lizzie to the bathroom, the patient reported that the wound dressing was falling off and she was experiencing pain due to this. Rory went to find the RN to initiate wound dressing but she could not find any RN. Lizzie was bleeding but yet no RN was available to attend to her. Rory could not wait anymore and he started applying a new dressing to the wound although it was not within her scope of practice. From the review of the scenario, it can be seen that Rory is attentive and committed to patient’s needs. She is trying her best to provide immediate care.

Past Experiences

Based on my previous knowledge about the scope of practice of a student nurse, Rory has breached the scope of practice of a student nurses in this situation. This is said because student nurse can only perform non-invasive nursing intervention without supervision. In case of all invasive procedures such as medication administration or wound dressing, supervision of registered nurse is important (Dungen, 2021). But Rory was doing the dressing without any supervision of the RN. she was being observed by another student nurse. The negative aspect of Rory’s action was that she attempted to prepare medications and redressing of the wound without the direct supervision of the RN. According to the Nursing and Midwifery Standard of Practice (NMBA) for registered nurse standard 6.4, nurses should provide timely direction and supervision to ensure that the delegated practice is safe and correct (NMBA, 2016). The RN in the scenario failed to cover this standard of practice. 

Read and Refer

The scenario depicts that the student nurse Rory was in an ethical dilemma. She prioritized safety of patient and to avoid adverse event or delay in care, she started dressing herself. Nurses are required to engage in ethical and moral practice. But evidence shows that nurses and nursing students experience various ethical conflicts which is difficult to manage. They need to balance harm and care. This judgment leads them to perform nursing actions that are often against their personal and professional values (Albert, Younas & Sana, 2020). Similar issue was experienced by Rory. The ideal course of action in this situation was to calm the patient and use distraction strategies until RN was available. This was because she was not capable of competently performing wound care and dressing. Kielo-Viljamaa et al. (2022) argues that wound care is an important part of registered nurse’s work and they are responding for wound assessment, monitoring the wounds and changing dressings. Poor attitude towards wound care may lead to negligence and adverse safety event.

Other Influencing Factors

Through reflection of my internal and external factors that could influence understanding of the scenario, it was found that I could connect with the emotional state of Rory. Rory’s anxiety level and her concern for Lizzie were some of the factors that did not allowed her to wait for RN. Rory had developed good therapeutic relationship with Lizzie and her inner values of compassion could have resulted her to act different. Differences have been found in terms of what was provided to students and what they actually required (Dalvandi et al., 2019). Hence, level of empathy and compassion may determine response in emergency situations. The external factor that could be influencing behaviour could be the anxiety to perform well or fear of disciplinary action in case of adverse event. The emergency care environment evokes various emotions due to the work pressure and the reactions of patients. These emotions play a role in the caring process (Jiménez-Herrera et al., 2020). Thus, positive and negative moral emotions influenced caring relationship of nurses.

Understanding

From the evaluation of nursing scope of practice and professional standards for RN, it has been found Rory’s action of dressing the patient was not appropriate. Rory’s intention behind the action could be to immediately attend to the needs of patient and do no harm to her. She intended to provide therapeutic benefit to patient with her actons. However, such incident could result in negative repurcussions for Rory and her colleague Paul. This is because she is guilty of legal action because of violation of her scope of practice. Secondly, it would affected her goal of completing the course as legal action could prohibit her from completing other unit. Her colleague Paul also did not intervened and reminded her about her duty during the situation. This could have saved him from ethical actions. Another concern associated with dressing is the risk to patient safety due to lack of competency. Instead of causing benefit to the patient, the situation could have further affected the reputation of the university. Thus, in future placement, it is paramount that Rory and her colleague work within their scope of practice and implement actions that are within their scope of practice. For instance, Rory could have implemented non-invasive pain management techniques to distract patient.

Taking it Forward

One knowledge or lessons that we all can learn from the reflective process is that adhering to ethical and professional standards of practice is paramount for both RNs as well as student nurses (Wilkenfeld & Durmis, 2022). The student nurse Rory decided to work beyond her role due to her commitment towards the job, empathy towards patient and anxiety of adverse outcomes. However, she failed to judge her boundaries and competence in completing the required action. Such issues can lead to issue of ethical breaches and lead to negative repercussions such as fines, penalties and cancellation of nursing candidature for nurses. Hence, Rory should have taken the action to further communicate the need for immediate supervision by the RNs. Thus, when faced with similar situation in the future, the nurse student should focus on what other actions she can implement to calm down the patient and manage her bleeding. To achieve this, the SMART goal is to initiate actions within the scope of practice and tailor my care according to the needs of the patient. In case the patient is not manageable even after the implementation of non-pharmacological, Rory can further initiate emergency help.

References

Albert, J. S., Younas, A., & Sana, S. (2020). Nursing students' ethical dilemmas regarding patient care: An integrative review. Nurse education today, 88, 104389.

Dalvandi, A., Vaisi-Raygani, A., Nourozi, K., Ebadi, A., & Rahgozar, M. (2019). The importance and extent of providing compassionate nursing care from the viewpoint of patients hospitalized in educational hospitals in Kermanshah-Iran 2017. Open Access Macedonian Journal of Medical Sciences, 7(6), 1047.

Dungen, D. (2021). The Royal Children’s Hospital (RCH) Scope of Practice for Entry to Practice Student Nurses. https://www.rch.org.au/uploadedFiles/Main/Content/nursing-education/Scope%20of%20Practice_July2021.pdf

Jiménez-Herrera, M. F., Llauradó-Serra, M., Acebedo-Urdiales, S., Bazo-Hernández, L., Font-Jiménez, I., & Axelsson, C. (2020). Emotions and feelings in critical and emergency caring situations: A qualitative study. BMC nursing, 19, 1-10.

Kielo-Viljamaa, E., Suhonen, R., Jalonen, L., & Stolt, M. (2022). Areas of nursing competence in acute wound care: A focus group study. Collegian, 29(1), 44-53.

NMBA (2016). REGISTERED NURSE STANDARDS FOR PRACTICE. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Wilkenfeld, D. A., & Durmis, C. (2022). When law and ethics come apart: Constraints versus guidance. Nursing Ethics, 29(6), 1430-1440.

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