1.Describe what type of health services your placement?setting provides and the typical patient/client population using this service (500 words). Include artefacts (i.e. photos of the venue entrance, scanned brochures, short videos, voice files etc.) and refer to those artefacts throughout your discussion to illustrate points you make.
2.Explain the roles and responsibilities of the nurse (your “buddy nurse”) in the?clinical setting you have attended and compare/contrast your observations with the same/similar roles and responsibilities described in the academic literature; you must include the nurse’s role in supporting patients to self- manage chronic conditions (1000 words). ?
3.Find out how nurses at the clinical setting you have attended cater to the specific needs of?the LGBTI patients (seek guidance from your buddy nurse). Compare/contrast your findings and observations with the current recommendations from the academic literature (1000 words). Include artefacts (i.e. relevant policies, brochures, pictures of posters, short videos or voice files etc.) and refer to those artefacts throughout your discussion to illustrate your discussion points. ?
4.Reflection on your community placement (500 words): Follow the provided example of the Critical Incident Analysis; include the following subheadings: (1) Context of the incident; (2) Details of the incident; (3) Thoughts, feelings and concerns; (4) Impact on career. This part does not require referencing and should be written in 1st person. ?
1.I have been placed at the Kyneton District Health Service (KDH). It is the local health service as the part of the Macedon Ranges community for over 160 years. These services help population of 42000 people living in the surrounding areas and at Macedon Ranges Shire Council. This pace is populated with 47, 512 people. The area comprise of maximum number of people at post-retirement age and fewer number of preschoolers in the district. There is high demand for age-based services. It is fulfilled through My Aged care service and supporting the older people in the community. The Treehouse program is the health care delivery at home. It is an innovative social program for caring life-limiting illness at home. The KDH health service works with the vision of giving positive experience to every person. The service is delivered in collaboration with the Cobaw Community health service, regional health care partners and the medical professionals. The goal of the service is to provide care that is patient-centered, right and safe (Kyneton District Health, 2018).
Acute services in KDH contain wide range of specialists to provide procedure such as laparoscopy up to medium complexity. The hospital has the pharmacy department in the acute ward that supplies medications as scheduled for the patient care adding convenience during the hospital stay and discharge. The hospital has the haemodialysis unit, pathology service and also own radiology department. The hospital also contains the allied health services including the social work and physiotherapy. The social workers at the Kyneton provide supportive counselling, practical support, therapy, and advocacy and referral service. The hospital provides the counselling services to the families needing grief and trauma support. Group work is provided to families who have lost a child. These services are meant for improving the well being of the community. The physiotherapists care for inpatients in the acute ward, aged care patients in the transitional care program, and others in the community. The physiotherapists also carry out the Post-Acute Care home visits.
The hospital also provide the home care involving the “Macedon Ranges community nursing”, district nursing, transition care program, “hospital in the home” program, “Macedon Ranges Palliative Care Services” and post-acute care. Older people can access the transition care if hospitalised while arranging for long-term care. Outreach nurses can visit the patient’s home without cost to reduce the hospital stay, and treat the illness. Community nursing is provided to each patient. Palliative care is provided to the patients with terminal illness and encompasses the psychological, spiritual and emotional support. Post-acute care is meant for the public patients who are at risk of unplanned re-admission to hospital after illness or surgery (Kyneton District Health, 2018).
KDH also includes maternity and the surgical services (medical, surgical, diagnostic, obstetric and gynaecological care. The hospital is well equipped with facility for elective caesarean birth, information sessions, childbirth education classes for parents and breastfeeding classes. The surgeries are provided in various areas like dermatology, urology, plastic surgery and others (Kyneton District Health, 2018)
2.In the same clinical setting, was placed one of the buddy nurses. The role of the district nurse in the division community nursing included serving people of all ages to help people manage the health in home and give quality support (Reed, Fitzgerald & Bish, 2015). The above role of the buddy nurse as a part of the district nursing aligns with the position summary where it is mentioned that they must contribute to the multidisciplinary team. The registered nurse in district nursing is responsible to the NUM community nursing. The district nurse works to achieve high standards of evidenced-based nursing care. It is the role of the nurse to ensure positive treatment outcomes by implementing the evidence-based practice as well as ensure the privacy and confidentiality of patient (Kyneton District Health, 2018).
The buddy nurse regularly monitored the vital signs of the visited patients and conducted relevant observation and assessment. It includes blood pressure, heart rate, pulse rate, respiratory rate, and others. The comprehensive patient assessment is in alignment with the standard 4 of the Australian Nursing and Midwifery Council, registered nurse standards (Nursingmidwiferyboard.gov.au, 2018). The buddy nurse assisted the patients with the wound management such as change of dressing and maintaining aseptic wound care. The nurse gave pain medication and managed symptoms’ like nausea. The nurse looked after the medication management as well as after the catheter to prevent infections. It is evident of the knowledge in central venous access device knowledge (Reed, Fitzgerald & Bish, 2015). While caring for the patens with diabetes, the nurse educated the patients about on time intake of medication and consequences of missing the right dosages (Heneka et al., 2018). Further, health education includes adherence to the care plan, lifestyle modifications required by the patient such as weight loss, physical activity, diet recommendations, and self-monitoring of blood glucose. These measures taken by the nurse is evidence of proficiency in wound management, and diabetes. It is the key selection criteria of the registered nurse – district nurse (Lee et al., 2015).
The buddy nurse worked in alignment with the position summary where accountability and responsibility of the own practice must be assumed based on the level of education and competence. The above role played by the buddy nurse is found to be similar with the standard 3 of the registered nurse standards set by the ANMC (Nursingmidwiferyboard.gov.au, 2018). Further the buddy nurse was observed to follow the guidelines given by the Kyneton District Health and worked in accordance with the organisation’s values and policies. The buddy nurse was responsible to maintain the privacy and confidentiality of the patient, advocate patients and also mandated by NMBA code of ethics and registered nurse standards and KDH (Kyneton District Health Service: Privacy of Patient Health Information, 2017). It helps the district nurses reduce the moral and ethical dilemma inherent in nursing (Nursingmidwiferyboard.gov.au, 2018). The buddy nurse maintains the confidentiality as per Health Record Act 2001 of KDH and is similar to the national legislation Health Insurance Portability and Accountability Act useful in promoting the nurse-patient integrity which is essential in community setting (Feo et al., 2017).
The buddy nurse did visit the patient’s (suffering from dementia) home for palliative care. This was the key accountability of the nurse as per the (ANMC), scope of practice (Nursingmidwiferyboard.gov.au, 2018). Other accountabilities taken by nurse that holds similarity with the scope of practice are undertaking the educator role for the patient and the family. The nurse obtained detailed patient history and reported concerning issues to the community nursing staff. It demonstrates her responsibility to collect information before attending patient. Providing the bereavement visits in line with the bereavement standards of Kyneton District Health. It is also the key accountability as per the National competency standards and code of conduct for Australian nurses and Midwives (Nursingmidwiferyboard.gov.au, 2018). When providing the palliative care at hospital the buddy nurse was found to allow a Christian patient to keep the prayer beads at bedside. The buddy nurse maintained the calm and positive outlook to reduce the patient’s anxiety both in-home visit and in clinical setting. The nurse was efficient in verbal and non-verbal skills. This practice of the buddy nurse demonstrated the provision of palliative care in combination with the medical, emotional, and spiritual support mandated by the Kyneton hospital (Kynetonhealth.org.au, 2018- community setting brochure). Thus, the district nurse integrated wide variety of services. It was also in alignment with the holistic care perspective mentioned by Keall, Clayton & Butow (2014).
The buddy nurse however did not fulfil other key accountabilities in the position description such as assessing and sending the referrals using the “My Aged Care”. The nurse was not found to actively link the family member’s problems to the appropriate volunteer services in community. It is in contrast to the code of conduct of the RN- district nurse (Kynetonhealth.org.au, 2018). The buddy showed active participation in programs of Kyneton District Health such as transition care program and post-acute care. The palliative care provided by the nurse in the setting and home demonstrated the engagement in the therapeutic and professional relationships with the patient and the family to optimise the health-related decisions as also mentioned by Nygren Zotterman et al. (2015). This action is similar to the second standard of the registered nurse standards set by the ANMC (Nursingmidwiferyboard.gov.au, 2018). The therapeutic relationship allowed the nurse to promote healing and functioning inpatient. The success of building capacity by the district nurse can be attributed to support rendered by KDH. Such support by organisation affects the nurse’s capacity to strengthen the therapeutic relationship. Therapeutic relationship is the key responsibilities of the KDH nurses and is underpinned by key principles of that empathy, active communication, respect, genuineness, trust and confidentiality (Nygren Zotterman et al. 2015).
Overall, this placement gave insights of the different roles of the hospital nurse and the com unity nurse. The former focus only on the hospitalised patients whereas the community nurse focuses on the population of specific regions. The community nurse unlike the hospital nurse has the medical autonomy to take the nursing decisions and implement them for patient safety. They can advocate referral service and transfer patients from hospital to home. Hospital nurse is however is guided by the clinician. Community nurses create awareness in community managing diverse population (Fooladi, 2015).
3.When working after placement in the Kyneton District Health, there was an encounter with the other nurses in the clinical setting who catered for the specific needs of the LGBTI patients. The KDH in collaboration with the Cobaw Community Health service addresses the needs of the LGBTI patients holding the values of the integrity, respect, equity and commitment. The services designated for the health and well being of the LGBTI patients in Victoria are mental and sexual health service, aged care service, alcohol and drug service and other general health service. These services help address the discrimination, family rejection, marriage law postal survey and other issues. It helps to address the health issues like substance abuse disorder, mood and anxiety disorder. The patients are helped using the national projects such as “LGBTI Mental Health and Suicide Prevention Project” as well as community-level projects (Cobaw Community Health Service, 2017; Lesbian, gay, bisexual, transgender and intersex health, 2017).
According to “Guidelines for health care providers on LGBTI-sensitive health care” provided on the website of the Northside clinic in Melbourne, the nurses and the healthcare provides to demonstrate the awareness of the sexuality-based discrimination and health impacts. They must be aware of the lesbian sensitive referral networks, support services and the community groups for the lesbians. Further, the nurses must be able to demonstrate that they are aware of the health care issues among LGBTI patients and the mental health impact. It may include common sexual practices, sexually transmitted diseases, reproductive life and midlife changes, substance abuse pattern, ageing and mental health (Northsideclinic.net.au., 2018). As per the information from the buddy nurse in KDH, the other nurses in the clinical setting demonstrated a very strong understanding of the impact of the various health issues encountered by the LGBTI patients, relevant support services in the community. The nurses also had poor understanding of way to proactively address the needs of the older LGBTI patients with range of mental health problems, giving sensitive information. This was something in contrast to the goals mentioned in the report titled, “NATIONAL LESBIAN, GAY, BISEXUAL, TRANSGENDER AND INTERSEX (L G B T I)- AGEING AND AGED CARE STRATEGY”, a report released by the Australian government Department of Health and Ageing (Agedcare.health.gov.au, 2018).
In regards to the nurses and other carer’s attitude it is specified in most of the Australian based guidelines that they must be non-judgemental, avoid heterosexuality related assumptions, and other stereotypes. Further the nurses must be able to involve the lesbian partners in decision making. The nurses must also be aware of the barriers that increase the stigmatisation such a disability, age, ethnic minority status, or economic status (Northsideclinic.net.au, 2018). The other KDH nurses in care for LGBTI patients were not fully aware of the factors of stigmatisation as also found to be a barrier by Chapman et al. (2012). However, the nurses demonstrated the non-judgemental attitude towards the patients and showed sensitivity to their health concerns as also mentioned in McNair, Hegarty & Taft (2012). They addressed the patient concerns by giving the best effort to ask questions in gender-neutral manner and to facilitate the disclosure of information. However, there was need of greater cultural awareness among the nurses to interpret the cultural beliefs and apprehend the values of the diverse patients in end of life care. This may act as a barrier to provide safe and quality care (Rawlings, 2012). This was in contrast with the above guidelines and recommendations for the health care providers mentioned in the report titled, “Health and sexual diversity- A health and wellbeing action plan for gay, lesbian, bisexual, transgender and intersex (GLBTI) Victorians” (Glhv.org.au, 2018). The nurses were successful preventing discrimination with the help of Healthy Equal Youth project and funding programs arranged by Victorian government as well as specific health service by KDH. The buddy nurse could address the violence related needs of the patients through Cobaw’s support for LGBTI group ensuring safe and inclusive care (Cobaw Community Health Service, 2017).
Further, investigation showed that the nurses assigned for LGBTI patients maintained the confidentiality and privacy of the patient’s information as per NMBA standards (Nursingmidwiferyboard.gov.au, 2018). Further the nurses also maintained the therapeutic and professional relationships with the patients irrespective of the socioeconomic status and cultural differences.. The nurses fulfilled their duties within scope and did not share their experiences with LGBTI patients with other colleagues and nurses. It was found that the nurses acted in their best possible way to avoid prejudice as it will lead to reduced access of health care services by the patients (Pack & Brown, 2017).
They provided care based on the best evidence available in the literature. This demonstrated the implementation of the evidence-based practice (Schmidt & Brown, 2014). The nurses also mentioned that they followed the standards, code of conduct and code of ethics set by ANMC strictly to avoid inconvenience to the patient. The other nurses also revealed that they were in need of training in regards to better understanding of the health needs of LGBTI patients. Some were eager to learn about attitudes and knowledge required to cater for mental health support of the LGBTI patients. This response is in alignment with the study of Riggs & Bartholomaeus (2016) emphasising in the need of mental health nurses training for caring for transgender patients to protect the respect and dignity of the LGBTI patients. Such need of the nurses was also mentioned in the study by Strong, & Folse (2014).
In conclusion, it can be interpreted that the Australia is yet to fully address the needs of the LGBTI patients. There is lack of adequate policies due to which the nurses still face issues with different values and beliefs of the LGBTI patients. There is need of adequate training and education without which the nurses would fail to promote and support the health and well being of the LGBTI patients. The limitations in this area restrict the nurses to be competent in providing care to the LGBTI patients. KDH plays great role in respecting the diversity in communicating with the LGBTI people that is supporting the nurses to develop trusting relationship with LGBTI and give safe care.
4.Content of incident
On my placement I had been assigned to a patient Mr X a 45 years old with ESRF on the fourth day of my community placement. This was my first encounter with such patients and I am not competent yet in coping with such situation. This was a critical incident for me. I was assisting the nuddy nurse assigned for chronic illness.
Details of the incident
Mr X a 45 years old with ESRF also showed cardiac disease symptoms and was presented to emergency unit. The patient lives alone in large house with his wife and three children. During the visit the patient’s wife was emotionally down. The lady was emotional when husband uttered words like “haven’t lived yet”, and “not wanting to die”. At times the patient was very symptomatic and insists on staying home with his wife and children till he dies.
Thoughts, feelings and concern
I could well manage the patent with immense confidence and applied my knowledge to its best with the support of other senior nurses and mentor. I immediately reported any abnormal condition to the mentor. It levered my experience practically for the particular disease. I was nervous initially as it was first encounter with patent suffering from ESRF and Heart disease. I was very attentive to nursing interventions given and provide patient-centered care to lower patient’s anxiety. I carefully monitored the fluid status maintained by the other nurse and making of dietary recommendations for patients. I had learned a lot and there was a lot more to learn especially the assessment of vital signs and treatment. I need to learn more about nutritional requirement of patients with ESRD, psychological counselling and social support network. The family was nervous with fear of death and it was crucial moment for me. I too felt powerless. On involving the wife in health-related conversation, her anxiety was reduced.
Impact on my career
On evaluation I found that gaining confidence was the positive aspect of place where I was assigned to chronic condition. I knew the rationale for every medication or intervention given. I could well educate the patient but the need to stay in hospital till the risk is reduced and that the nurse may visit home after discharge to reduce length of stay in hospital. It helped the patient to calm down. For allowing the patient to better understand the illness I had explained the disease progress and support adjustment to lifestyle changes. On giving home care referral and encouraging independence in self-care the patient showed positive feelings. This experience had been very informative and helped me improve my communication skills as I worked with district nursing. I learned that nursing is all about good critical thinking and clinical judgement. Therefore, my action plan for future placement is to improve coordination with multidisciplinary team. My goal would be to single headedly take care of patient, provide comprehensive care including assessment, treatment, medication, as well as emotional and psychological support to the patient without support of fellow nurses.
References
Agedcare.health.gov.au. (2018). NATIONAL LESBIAN, GAY, BISEXUAL, TRANSGENDER AND INTERSEX (L G B T I)- AGEING AND AGED CARE STRATEGY. Retrieved from https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/08_2014/national_ageing_and_aged_care_strategy_lgbti_print_version.pdf
Chapman, R., Watkins, R., Zappia, T., Nicol, P., & Shields, L. (2012). Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of clinical nursing, 21(7?8), 938-945.
Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective and caring nurse-patient relationships. Nursing Standard, 31(28), 54-63.
Fooladi, M. M. (2015). The Role of Nurses in Community Awareness and Preventive Health. International journal of community based nursing and midwifery, 3(4), 328.
Glhv.org.au. (2018). Health and sexual diversity: A health and wellbeing action plan for gay, lesbian, bisexual, transgender and intersex (GLBTI) Victorians. Retrieved from https://www.glhv.org.au/sites/default/files/health_action_plan.pdf
Heneka, N., Shaw, T., Rowett, D., Lapkin, S., & Phillips, J. L. (2018). Exploring Factors Contributing to Medication Errors with Opioids in Australian Specialist Palliative Care Inpatient Services: A Multi-Incident Analysis. Journal of palliative medicine.
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Kyneton District Health., (2018). Kyneton District Health Service :: Our services. Retrieved from https://www.kynetonhealth.org.au/index.php/our-services/our-services/
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