MANAGEMENT OF NURSING CARE

2.1 Provides planned nursing care to achieve identified outcomes.

Give 2 examples from your clinical placement of how you have used the nursing process to

decide whether or not your care plans have achieved identified outcomes for your patients.

1. After the shift change, I visited each resident's room and noticed that Mr. P

appeared tired and unwell. When I asked, he confirmed feeling very tired. I promptly

informed my preceptor and checked his vital signs, noting a temperature of 38.5°C.

With his permission, I adjusted the environment by opening the curtains, removing

extra blankets, and positioning him in the Fowler's position for comfort. I assured

Mr. P that I would return soon and reported his vital signs to my preceptor, who

then administered paracetamol as PRN. After giving Mr. P the medication, I

encouraged him to drink fluids and promised to check on him again in an hour. Upon

rechecking, his temperature had decreased to 37.5°C and he reported feeling better.

2. During my placement, I had the opportunity to provide nail care for Mrs. J. When I

entered the room after knocking on the door, Mrs. J was sitting on the recliner. I

explained the nail care procedure to her, and she agreed. I ensured she was

comfortable and arranged all the necessary items for the nail care nearby. First, I

filed her nails and cleaned them with a swab. Then, I applied antifungal drops to

each toe and advised her to leave them on for 15 to 20 minutes. Throughout the

procedure, I maintained therapeutic communication with Mrs. J. After 20 minutes, I

reassessed her toes, helped her put her socks back on to prevent infection, and

made her comfortable on the recliner. Mrs. J was very happy and comfortable after

the nail care.

2.2 Undertakes a comprehensive and accurate nursing assessment of patients in various

settings.

Give 3 examples from your clinical placement of comprehensive & accurate nursing

assessments

1. During my placement, Mrs. M complained of chest discomfort and coughing. I

conducted a thorough respiratory assessment, first explaining the procedure and

obtaining her verbal consent. I positioned her comfortably in Fowler’s position and

then examined the appearance of her chest, checking for symmetry and retractions.

I listened to breath sounds in both the upper and lower lungs, both in the front and

back of the chest, and for any abnormal sounds. I also assessed her chest using

percussion and palpation techniques. After the assessment, I discovered wheezing

during auscultation. I promptly informed my preceptor, who then reported the

findings to Mrs. M's GP. Following the consultation, Mrs. M was advised to perform

coughing exercises and was prescribed medications.

2. While on my placement, I encountered Mr. B who had a newly developed wound on

his left anterior shin. My preceptor and I followed the wound assessment policy to

evaluate the wound and utilized the STAR acronym for wound care: S for stop

bleeding and clean, T for tissue alignment, A for assess and dress, and R for review

and reassess. Firstly, we measured the wound with a paper ruler and took a picture

of it. Then, we cleaned the wound with normal saline and covered it with a non-

adherent dressing. We informed the clinical care manager, clinical nurse leads, and

the family via email, and also documented the incident. Additionally, we shared the

information and pictures with the wound specialist nurse for further management.

The following day, the wound care nurse specialist came and provided instructions
 to clean the wound with normal saline, apply bactigras, and then cover it with a non-

adherent dressing, which was finally secured with hypafix. As per the specialist's

guidance, we changed the dressing every 2 days. After 10 days, the wound had

healed well. We sent the latest picture of the wound to the wound care nurse

specialist to report the progress.

3. During my rounds, I entered Mr. K’s room and found him lying on the bed in distress.

Mr. K has a known case of dementia and cognitive impairment. I monitored his vital

signs and noticed that his pulse was slightly elevated. To assess his pain, I used the

Abbey pain scale, considering his vocalization, facial expression, body language, and

behavioral, physiological, and physical changes. The score indicated moderate pain,

so I administered controlled PRN pain medication. After an hour, I reassessed Mr. K’s

condition and vital signs which were normal, and he was sleeping well.

2.3 Ensures documentation is accurate and maintains confidentiality of information.

Give 2 examples from your clinical placement.

Consider the following:
• Confidentiality
• Privacy and sharing of patient information with appropriate colleagues
• Patients’ rights in information sharing, keeping patient records safe e.g. logging off, locking
away notes
• Your timeliness of record keeping
• Legalities of documentation

1. During medication rounds, the preceptor will use her login ID and password to

access Medimap and administer medications to the residents at appropriate times.

After each medication round, she will log off from Medimap.

2. Residents' information must be entered into V care. Each staff member has their

own login ID and password. All care provided to the residents, such as nursing

progress notes, food and fluid charts, bowel charts, wound management, vital signs
 monitoring, GP rounds, and referrals, should be recorded in V care. It is important to

update all information in V care after each use and log off to maintain confidentiality.

We are not authorized to share residents' information without their consent and

must always ensure privacy. Treatment plans will be shared with the residents and

their families after the GP's rounds, and the final decision will be made by the

resident and family whether to accept the treatment plans or not. My preceptor

reminded me to keep all documents confidential and ensure to log out safely.

2.4 Ensures the patient has adequate explanation of the effects, consequences, and
alternatives of proposed treatment options.
Give 2 examples from your clinical placement.
Consider the following:
• Patient refused medication/treatment. (what did you do and why?)
• Legal – informed consent, refusal of treatment, rights of your patients
• How do you ensure your patient understands the information given?
• Health literacy
• Informed consent in difficult circumstances, e.g. impaired cognition, children & teens
• Is the patient ready to participate in education?
• Enables patients to choose appropriate interventions/ therapies by explaining options
• Patient-centered care
• Gain procedure/surgical consent

1. During the medication rounds, my preceptor and I went to Mr. P’s room to

administer diuretics. At first, Mr. P refused to take the medication because he was

concerned about needing to urinate while at the coffee club and not being able to

immediately use the restroom. I explained the purpose, the mechanism of action,

the dosage, and the potential side effects. After hearing my explanation, Mr. P

agreed to take the medication.

2. During my clinical quality assessment, I spoke with Mr. O about the Buerger Allen

exercise, which can help improve lower limb perfusion. He mentioned that he had

never heard of the exercise before. I explained the research study on the Buerger-
 Allen exercise, its steps, and how to assess the outcome. After our discussion, he

agreed to do the exercise, and we observed positive results.

2.5 Acts appropriately to protect oneself and others when faced with unexpected
patient responses, confrontations, personal threats, or other crisis situations.
Give an example from your clinical placement that demonstrates that you can think
& act spontaneously and safely when presented with an unexpected event.
• Managing an emergency call
• Cardiac arrest
• Combative/Distressed/aggressive patient (de-escalation)
• Family/partner violence
• Management of safety issues for staff colleague

While on my clinical placement, I received an emergency call bell from room 42 as

Mr. K had fallen and was lying on the sensor mat over the bed. A caregiver was

present, and with the help of my preceptor, we moved him onto the bed. I assessed

Mr. K's vital signs, and pain scale score, and checked for any signs of a fracture.

There were no signs of a fracture, his vital signs were normal, and his pain score was

7 out of 10. We provided him with PRN controlled pain medication and ensured he

was in a comfortable position, assessing him every hour. I updated the fall risk

assessment, and with the guidance of my preceptor, entered the information into

the V care system and completed an event form. I informed the clinical care

manager, nursing leads, and Mr. K's family about the incident. Mr. K showed no

complications due to the fall and was monitored hourly.

2.6 Evaluate patient’s progress towards expected outcomes in partnership with patients.
Give 2 examples from your clinical placement.
NOTE: This evidence should include your patients' response (evaluation).
Consider the following:
• MDT meetings
• Family meetings
• Family conferences
• Care coordination
• Care Planning and goal setting with patient/family
1. During the morning rounds after receiving the handover, I visited Mrs. N's room and

inquired about her well-being. She informed me that she was experiencing

abdominal distension, hadn't had a bowel movement in the past 2 days, and was

feeling constipated. I advised her to increase her intake of oral fluids, fruits, and

vegetables and suggested that she walk around the corridor. Additionally, I

administered 30 ml of lactulose to her as PRN, as per my preceptor's instructions.

After three hours, Mrs. N informed me that her bowels had opened and that she was

feeling better.

2. During my medication rounds, Mrs. L had difficulty breathing and seemed distressed.

Her family was also very concerned. She had a known case of COPD. I checked her

vital signs and informed my preceptor. I placed her in a high Fowler’s position and

provided her with 2L of O2 through nasal prongs. After an hour, her condition

improved. I also gave her regular inhalers and corticosteroids. I rechecked her vital

signs hourly, and they were within normal limits. During lunch, I saw that she was

dining with her peers, and her family also seemed happy.

2.7 Provides health education appropriate to the needs of the patient within a
nursing framework.
Give 2 examples from your clinical placement.
Consider the following:
• Educate a patient e.g. medications, equipment, managing at home, ADLs, diet,
exercise, etc.
• Educate family/carer on caring for their relative/friend
• Educate prior to treatment/interventions to ensure informed consent
• How do you ensure your patient understands?
• Answer patient concerns, questions, and requests for more information
• Provide health promotion

1. During my placement, I encountered a resident named Mrs. C who had a

known case of bronchial asthma. The GP ordered the administration of the

inhaler using a spacer. I approached Mrs. C in her room with my preceptor

 and obtained her verbal consent to provide health education regarding the

inhaler and spacer. First, I instructed her to place the spacer between her

teeth and close her lips tightly around it while keeping her chin up. Then, I

directed her to breathe slowly through her mouth. Next, I advised her to

spray one puff into the spacer by pressing down on the inhaler and counting

to five, or taking 2-4 breaths without removing her mouth from the spacer,

followed by another puff. Additionally, I suggested that she take slow, deep

breaths.

2. During our rounds, we noticed that Mrs. B had purplish discolouration and

redness in the sacral area. As per my preceptor’s instruction, I made a

pressure injury assessment using the Braden scale assessment. And also,

provided health education to the caregiver regarding pressure injury,

pressure points, and the importance of positioning. Instructed the caregiver

to maintain a 2-hour positioning chart.

2.8 Reflects upon, and evaluates with peers and experienced nurses, the effectiveness
of nursing care.
Give 2 examples from your clinical placement.
NOTE: This is about the efficiency of care, not your personal journey
Consider the following:
• Debriefs after critical events
• Regular team meeting to discuss patient/care progress
• One-on-one discussion with colleagues regarding issues with a patient’s care
• Evaluations of care e.g. audits
• Situations where you reached your level of skill/knowledge and asked for assistance

1. I had a patient, Mr. W, who was in palliative care and required continuous

subcutaneous infusion of pain medication using a syringe drive. At first, I was not

familiar with the syringe drive, but my preceptor showed me how to insert a

subcutaneous cannula and connect it to the syringe drive, explaining all the
 necessary parameters. With my preceptor's guidance, I later had the opportunity to

perform this procedure.

2. During the meeting, we discussed Mrs. M's infected wound on her left foot. While

she was getting her wound dressed, she cried due to the pain. The clinical manager

instructed the staff to give her fentanyl nasal spray before dressing her wound, as

per the GP's order. Before removing the dressing, they soaked the wound with

normal saline and prontosan to remove the pus and exudates and promote wound

healing. Then, they used aquacel Ag and non-adhesive dressing and finally secured it

with hypafix. After a week, the patient expressed her appreciation, and her wound

had healed.

2.9 Maintains professional development.

Give 2 examples from your clinical placement.
Consider the following:
• Development of professional portfolio
• Training courses, E-learning
• Forums
• Webinars
• Updating on new best practices, treatments, interventions, and guidelines

1. During my placement, I selected an article about the Buerger Allen exercise, which is

known to improve lower limb perfusion among type 2 diabetes patients. I presented

this topic and demonstrated the exercise to one of my residents. Before and after

the exercise, I checked his ankle brachial pressure index and compared the values. I

found a positive outcome from the comparison.

2. During my placement, I had the opportunity to participate in a first-aid training

session for the facility staff. The training covered providing care for unconscious

adult, paediatric, and neonatal patients, as well as for choking patients, and the use
of AED. This experience helped me refresh my skills and learn how to handle critical

situations.