VIDEO 1

This first lesson will build on aspects of the Registered Nurses role in providing clinical education and/or workplace learning support. In particular focusing on quality, safety and risk management when supporting nursing students or other less experienced staff. 

This video is based on real situations that occurred with students of nursing during their clinical placements and provides, many discussion points around what it means to be a “good” learner and a “good” role model/educator for students. As many of you will be moving into the RN role at the end of this semester and/or at the end of the year it is important for you to start thinking about safety when you have a student working alongside you.

Question 1

After watching the video reflect and make comments/suggestions on the clinical practice of the student in the video in relation to safe practice.  please refer to relevant policy/standards to support your answer.

1. List 3 positive attributes of the students practice in relation to safety (3 marks)

and

2. Identify at least 3 areas of the students practice that are a safety concern (3 marks).

Question 2

After watching the video reflect and make comments/suggestions on the clinical practice of the Registered Nurse (RN) in the video in relation to safe practice.  Please refer to relevant standards/policy to support your answer.

1. List at least 3 positive attributes of the RN’s practice in relation to safety when providing learning support (3 Marks)

and

2. Identify at least 3 areas of the RN’s practice that are of concern in relation to educating and supporting students to ensure safe practice (3 Marks)

Question 3

Did you identify any mistakes or omissions in relation to the medication round? 

List all that you observed and discuss and make reference to any potential breaches to standards of practice and the implications of this for a registered nurse (6 Marks).

VIDEO 2:

This video story is a true account and has been used with the permission of Iona and her family. It focuses on the experience of Iona and her mother Lesley, an experienced Registered Nurse. Iona’s story begins with a major car accident and follows her journey though Intensive Care, a neurological ward, a rehabilitation facility, and eventually her discharge home.

Registered Nurses professional codes and standards emphasise the role of nurses in protecting and advocating for patients. The Nursing and Midwifery Board of Australia, Registered Nurse (RN) Standards for Practice (2016) specify that RNs must:

 

 *Communicate effectively, and be respectful of a person’s dignity, culture, values, beliefs and rights (Standard 2.2)

 *Advocate on behalf of people in a manner that respects the person’s autonomy and legal capacity (Standard 2.5)

In addition, The International Council of Nurses Code of Ethics (2012) advocates that:

 * RNs must promote an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected

*RNs must demonstrate professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity.

Question 4

Iona suffered numerous traumatic and serious injuries – but the loss of her hair had a lasting impact on her and her family; and was, in some respects, a metaphor for the loss of her old identity. While the ICU nurses cared for Iona’s hair, washing and braiding it regularly, on the neurological ward her hair was so neglected that within two weeks it had to be cut off.

Post a short response to the following questions regarding this video

1. In the digital story, how did the images of Iona’s hair make you feel? (2 marks)

and 

2. Why do you think the nurses on the neurological ward may have failed to take care of Iona’s hair? Please list at least 3 reasons. (3 marks)

and

3. Do you think this neglect was a breach of the RN Standards for Practice and/or the ICN Code of Ethics? If so please list at least 3 reasons with rationale for your answer? (3 marks)

Question 5

In the digital story, Iona described one nurse who reprimanded her for ‘wetting her nappy’.  

1. How did this make you feel? (2 marks)

and

2. How might Iona’s dignity and sense of self have been compromised by the nurses speaking to her in this way? (2 marks)

and

3. What do you think could have been done differently when caring for Iona? (2 marks)

Question 6

Iona was fortunate to have had the support of her mother who is an experienced RN, and other family members with considerable medical and nursing knowledge.

1. What do you think Iona’s hospitalisation experience might have been like from her Mother’s perspective? (1 marks)

and

2. What support do you think families need at times like this, and how is this support made accessible? (2 marks)

and 

3. What happens to patients if there is no family or support system? How can nurses support these patients? (2 marks)

Finally

4. What have you learned from Iona’s story that you will use in your future nursing practice? (1 mark)

VIDEO 3:

The focus of this lesson is to examine the skills needed to speak up for yourself, your patients and others when you witness unsafe practice. Power differentials, intimidation by oppressive team cultures are reported to restrict student’s ability to be able to speak up to advocate for themselves and their patients (Hanson et al., 2020). 

Nursing students more than any other health students, are more likely to observe/witness and/or be asked to participate in practices that breach patient safety and often lack the moral courage and communication skills to speak up (we discussed  this at residential school).

As we have seen in the online residential school, communication and teamwork are important human factors in patient safety and many errors and sentinel events involve substandard communication within the health care team. 

The 2 coroner’s cases we have studied in this course (Roy Jacobs and Troy Almond) highlight the importance of effective communication and teamwork and the critical responsibility nurses have in being able to speak up and advocate for the safety of patients.

Nickson (2019) states that communication is a key non-technical skill particularly in times of crisis, however communication may fail in a crisis for many reasons. Two important reasons are listed below:

1.      Physicians often fail to communicate what they are doing, and why, in a crisis — and when they do they often only do so with other physicians

2.      With nurses there is often a delay between identifying problem and communicating it to the rest of the team

Communication strategies in a crisis and /or for patient safety

There are a number of approaches and techniques that can help you to speak up when needed, such as:

·         being professional and respectful

·          focusing on the problem and potential outcomes rather than who is right or wrong

·         starting with a curious rather than adversarial approach 

The ability to be assertive is a critical teamwork skill and one that can be learned. Hanson, Walsh et al., (2020,p.2) define graded assertiveness as:

a technique used to improve communication when challenging unsafe practice. It is a skill equips nurses with a process of structured thinking, communicating, advocating and directing care during stressful or crisis situations, assist with  making suggestions in a direct and non-confrontational manner as well as to be able to act on patient assessments in a problem-solving way.

Graded assertiveness can help to avoid conflict and defensiveness while still facilitating escalation if needed. Three examples of frameworks for graded assertiveness are CUSS, PACE and 5-STEP ADVOCACY: 

1. CUSS 

The following mnemonic can be used to remember:

 Concern (My concern is that the temperature has not been recorded.)

Uncertain/Unsure (I’m unsure if this medicine can be given when the patient has high body temperature.

Safety (It is unsafe to give the patient a drug like this. It could be a patient safety issue.)

Stop (We need to stop the medication and seek an alternative.)

 2. PACE 

(Probe, Alert, Challenge, Emergency), includes scripted sentences to respond to concerns (‘red flags’) and refers back to objective findings and observations about the patient rather than direct criticisms of the actions of other health professionals ( Yianni and Rodd, 2017).

  The following mnemonic can be used to remember:

 Probe (Do you know that …?)

Alert (Can we repeat the procedure please?)

Challenge (Please stop the procedure while we check …)

Emergency (STOP what you are doing!)

 

 3. 5-STEP ADVOCACY

Get attention (Excuse me, Doctor….)

Express your concern (The patient is hyperventilating.)

Speak out the problem as you see it (I think we need to get help now.)

Suggest a solution (I’ll arrange for a transfer to the Intensive Care Unit.)

Acquire an agreement (Does that sound fine to you?)

Question 7

1. Put yourself in this students shoes-what are your thoughts/concerns for the student in this video (the student is wearing the white uniform)? (2 marks)

and 

2. With respect of the situation in the video and using one of the three frameworks (CUSS, PACE or 5-Step Advocacy approach) develop a script for the Student nurse to speak up and voice their concerns about what was happening in the video (4 marks)

Question 8

1. What are your thoughts and concerns for the RN in this video? (2 marks)

and

2. Using one of the three frameworks (CUSS, PACE or 5-Step Advocacy approach) develop a script for’ the Registered Nurse  to speak up and voice their concerns about what was happening in the video (4 marks)

References

Hanson, J., Walsh, S., Mason, M., Wadsworth, D., Framp, A. & Watson, K. 2020 Speaking up for Safety: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis. Nurse Education Today, 84. pp 1-7.

International Council of Nurses. (2012). The ICN Code of Ethics for Nurses. Retrieved from: https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_eng.pdf

Nickson, C. 2019. Life in the fast lane –available at https://litfl.com/speaking-up/

Nurses and Midwives’ Board of Australia, (2016). Registered Nurse Standards for Practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professionalstandards/registered-nurse-standards-for-practice.aspx

Pich, J. & Bramston, L. (2018). Iona’s story of an acquired brain injury. University of Technology Sydney, NSW. Australian Technology Network of Universities, 2018, Virtual Empathy Museum

Richards, D & Gunilla, B. 2019, “Shitty Nursing”-the new normal? International Journal of Nursing Studies, 91 148-152.

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