Nursing Post - Issue 18 : Nursing Abroad/CPD Quiz

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The Career and Education magazine for Nurses and Health Professionals

Inside this issue

CPD Quiz / Working Abroad 19 September 2011 - Issue 18

Visit us online for the latest jobs and articles

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From the Editor...

Inside this issue

Welcome to Issue 18 Welcome Readers, to our special double feature issue on Working Abroad and of course, the always popular CPD Quiz! Nurses, here is your chance to catch up on your CPD minutes with our Quiz!

Don’t forget to turn to page 17 to read our truly inspiring ‘Reader Story Competition’ Winners’ tales. Di Brown shares her story about working in Bali just after the devistating Bali Bombings, and Emma discusses what she learnt from her experience working in Pakistan just after the country was hit with the devistating floods in 2010.

CPD Quiz /

A big congratulations goes to Rebecca Smith for her Front Cover Competition’s submission!

It looks like the Cocos Island Team is having a super time as they were “celebratng International Nurses Day with a breakfast on Home Island, Cocos Keeling Island, Western Australia.”

Next issue

Working Abroad

What a wonderful front cover submission Rebecca, congratulations to you and the team!

Keep an eye out for our next issue readers, as we bring you a sneak peak into the field of Child Health and Paediatrics. Do you want to shift your career into a different direction? Then we may have the answer for you in our next issue!

Paediatrics /

Child Health

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Inside Cover 1 3 4 5,10 6 7 8 9 11 12 12 13 14 15 19 21

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Feature - Working Abroad

Working

ABROAD WELCOME TO OUR SPECIAL FEATURE ON ‘WORKING ABROAD’. WE GET A REAL INSIGHT INTO WHAT WORKING OVERSEAS IN A DIFFERENT CULTURE IS LIKE WITH THE MOTIVATIONAL READER STORY SUBMISSION BY DI BROWN (TURN TO PAGE 22 NOW). CONTINUE READING ON PAGE 17 AS EMMA CHILDS GIVES US AN INSIGHT INTO HER EXPERIENCE WHEN SHE WORKED IN PAKISTAN AFTER THE DEVISTATING FLOODS BACK IN 2010.

16

One Nurse in Pakistan

by Emma Childs I

arrived in Karachi back in 2010 with an NGO called Australian Aid International (AAI). I arrived just after the terrible flooding that had been hitting the country since late July.

Pakistan suffered from the heaviest monsoonal rains in 80 years. The water covered one fifth of Pakistan’s total land area and affecting 20 million people, destroyed property, crops and infrastructure.

While the initial death toll of 2,000 may seem low, the problem was the amount of people left affected that were desperate for food, water, shelter and basic healthcare.

Aid did not arrive fast enough into Pakistan. This created further, prolonged problems with people forced to drink unsafe water for several weeks and unfortunately for the people of Sindh Province - where I was helping - further flooding occurred in late August. There was no break from the devastation.

Karachi is an intimidating city.

I have travelled extensively around the world, but this was something new. Each country has unique ‘rules’ and ‘norms’ and I was going deploying to a place where women were still rarely seen outside of the house, and even more rarely heard from.

Everyone has heard of Pakistan’s difficulties with security and terrorism, something that was always on my mind. It kept me vigilant and aware of goings on all the time; I am sure that I really did learn to sleep with one eye open. Not a week went by where we didn’t hear of serious local disputes, crimes and shootings. However, as foreigners there to help, we were seen as good people in town and were assisted by many, particularly our neighbours. I met so many wonderful people and felt so welcomed by people I had only just met.

The journey to my ‘new home’ from the airport was an eye-opening event; the scene dominated by men, with not a

single woman in sight. In just 2 hours we hit a donkey, were stopped by the Police looking for bribes, dodged massive potholes, avoided overloaded buses, swerved for unlit rickshaws.

Luckily, I was in good hands! More events like this were to happen during the time there; they were nothing too out of the ordinary for a country like this.

My role for this deployment was as an emergency project nurse, but that is not where it began or ended. I was there to provide healthcare, education to local staff, collate information and data, attend meetings with the United Nations’ Office of Coordination for Humanitarian Affairs, liaise with other NGOs, ensure supplies were adequate (which they were far from at many times) and contribute to the team’s psychosocial welfare at all times to ensure we were all coping.

The aim of our mission was to provide essential healthcare through a mobile medical clinic to those in need in the remote villages that had not been reached 17

Feature - Working Abroad

already by aid. This was easy to establish, as so many areas were still untouched and in need of humanitarian assistance. By mobile medical clinic, I mean a suitcase with drugs and dressings and the hope we would find somewhere to base ourselves. Each village had different things to offer, but some really had nothing more than a desire to be helped. We would work out of disused schools, outside the village leader’s house, in the centre of a village where we were supplied with a table or two, or we would simply work on the floor in some places. The poverty was extreme. People looked startled when we would arrive, unsure as to what we were doing there, why would we be giving the time to help them. These are some of the most grateful people I have come across, and some of the saddest. Many children were orphaned, being looked after by other children, unknown if parents were dead or simply displaced.

The damage was clearly noticeable with destroyed buildings, the remnants of floodwater looked as if it was the ocean and that it had always been there, I was assured it was not and that they were fields of what should have been their crops. Power was lost, as was clean drinking water and food 18

sparse. The mark this flood had left was sure a big one! The marks do not end there…the thousands of IDPs in camps along our daily route were shocking, they were set up along the river banks where people had fled to, every type of material known to man was attempted to be held together for shelter and large drinking water tanks and sanitation units had been set up.

Without the basic support we offered to care for skin infections, respiratory infections, water borne disease and nutritional problems, (amongst others such as some malaria and acute watery diarrhea) these people may have been left without any assistance resulting in very ill health or worse. Something seen as so easy to treat in first world medicine is so far out of their reach that it is indescribable.

We were not practicing first world medicine here, we were practicing with whatever resources we had to make a little bit of difference to the people we could, remembering it is better to treat one person well than 20 people poorly.

The days in the field were long. They began early and finished late, usually involving a 2 hour journey to site. We were here helping people the best we could, referring and guiding them onto hospitals for treatment as required.

Basic medicine as we see it, could easily help people, they just didn’t have the access. Even with access, the hospitals were running low on resources, they were poorly sanitized and in a state of disrepair.

With no rubbish collection in town you can imagine where clinical waste was dumped.

Many a heartbreaking situation did come out of this country. Some people would not accept help; some women would not let us take action without the husband being there, yet other people we could not do enough for.

One incident will remain with me for a long time. A six year old, physically and mentally disabled girl. The reason she was bought to us was not for us to solve these problems, but the grandma was concerned she was not eating.

Immediately we could see she was malnourished, could hear the gurgling from her chest and see her mouth covered in sores, she was barely responsive; eyes would flicker when we touched her, the mother had died in childbirth.

There was nothing we could do out in the field but we decided if we did not act, this child would die soon. We took the decision to take her for further treatment. In Australia her condition could be easily improved, IV antibiotics,

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Feature - Working Abroad

chest physiotherapy, Peg feeding, we could have a reasonable healthy child by the end of it.

However, our situation here was different, we took her to the local hospital where the doctor was reluctant to have her, ‘she might die and then we’ll be stoned’ was the response. With further discussion he allowed her to stay, but no treatment was to be given, there was blood and urine on the floors and walls, we would collect her in the morning. We took her to Karachi Children’s hospital over 2 hours away with a different grandmother and the father after big discussions as to what they wanted for their child. As we were foreigners we were rushed through the doors into the arms of doctors who were very attentive and interested. They gave us hope they were going to help her. After spending the day there we left the family with her and planned for their accommodation, food and return.

Less than 48 hours later they were on their way home… clearly she can’t be better already.

However they returned and she was as ill as the day we took her to Karachi. What had happened there could not be established.

Did the parents not want the 20

Embassy advising against travel at this time. Seeking information did not stop there, I saw it as my responsibility to look out for my personal safety by researching further the possible security threats and problems. Despite all this information knowledge I had gathered and been supplied with, I made an educated decision to go.

People were in desperate need of assistance, and the AAI team needed a nurse. This was what I had been working for. treatment? Would they not give the treatment? Did they want to get home for festivities? We could not get answers. Despite this the father was in good spirits, he was on his way home to sell his buffalo for the religious festivities of Eid, a way in which he would make money to provide for his family.

How this story ends, I will never know, but I can guess.

When I deployed with AAI I was 25, with only 3 years postgraduate nursing up my sleeve, having emigrated from England 2 year’s prior. I’d known for a long time that humanitarian work was the career I wanted to pursue, so I set about getting there. A different route to the usual, but I was determined.

Being able to work with minimal resources and staffing is something you can never learn enough of, but it is so vital in this line of work. I set about working in rural Australia to develop on these and emergency skills after gaining critical care work in the large city hospital.

Prior to my deployment, AAI made sure that I knew what I was getting myself into. I was given a briefing and told all the necessary information. It was now my decision to go, despite the British

This experience was life changing. One year on, I have had time to reflect upon what I experienced and the person I have become. I learnt so much about people’s coping mechanisms and vigilance, culture and religion, as well as experiencing a multitude of emotions being far from home in such a challenging environment.

I developed friendships I will never forget and I met people who have helped develop me into the person I am today. It was a good decision to deploy, but I sure didn’t go without apprehension.

If anyone is interested in more information, please view Australian Aid International’s website www.aai.org.au. We also offer an Introduction to Humanitarian Operations course that is well worth the time for anyone interested in getting involved in aid work.

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Feature - Working Abroad

Australian Nurse

Di Brown making a difference in Bali M

embers of the Nurses for Nurses Network travelled to Bali to provide a wound care education workshop to Balinese colleagues. This eventuated after a meeting an inspirational Australian nurse who is doing exceptional work in exceptional circumstances at the Sanglah Public Hospital in Denpasar. Sanglah hospital is the largest hospital in Bali and was the main treatment centre for many of the victims of the Bali bombing.

Di Brown is a registered nurse and her role at Sanglah Hospital is Practice Improvement Coordinator.

Di undertakes this role as a volunteer through Australia Volunteers International (AVI) and has been at the hospital since August 2009.

Di and her husband always planned to do aid work when she retired. Di had previously worked in Indonesia for a World Bank project in 2001 for 3 years in a project that focused on improving nursing and midwifery education and practice. Di also worked for 3 months in the Aceh post with the World Health Organisation for the Indonesian Tsunami.

Di has a strong focus and background in education having previously worked in education in Sydney at UTS and then at Charles Darwin Uni, her final job before retirement was as a District Director of Nursing in NW Queensland. Di also currently works with the University of Indonesia in the Faculty of Nursing lecturing in the PHD programme .

22

The improvements that Di has coordinated at the hospital include: • Patient centred handover • Revising the decision making framework to encourage nurses to think differently • Introduction of medication vests to minimise disruption and resultant mistakes during medication rounds • Improving the cleanliness of the hospital that followed on from the work already established by the Orthopaedic Outreach Programme • Updating the manual handling processes at the hospital – implementation of slide sheets and a “Safe Lifting – Safe Handling” program.

• Review of clinical documentation • Review of observation charting and monitoring Di has built upon the work of another volunteer group called the Orthopaedic Outreach Team who

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Feature - Working Abroad

have been coming to the hospital for the last 2-3 years providing education to staff. This group also provides the opportunity for Balinese staff to undertake training in Australian Hospitals. Two nurses from Sanglah have been funded by Orthopaedic Outreach to undertake clinical skills development at Royal Darwin Hospital.

Di also managed through Bill Cumming and Orthopaedic Outreach to gain funding from the Australasian College of Surgeons for three other nurses to undertake an orthopaedic skills development training program at the Royal Darwin Hospital.

One exciting initiative that Di is working on is a 5 year programme which involves nurses, doctors and senior managers going to Royal Darwin Hospital to improve clinical governance, patient safety and quality.

The aim is to prepare the hospital to gain international accreditation in 2014. Phase one of this program has been funded by the Northern Territory government, and focuses on staff from the emergency division of Sanglah Hospital.

Over 650,000 Australians travel to Bali each year and many are transferred to RDH if they are seriously injured. After the Bali bombings many of the victims were initially sent to Darwin, so it makes sense to develop closer links between the two hospitals. Di 24

is managing the budget and related logistics. The programme includes sending 14 nurses and 3 doctors from Bali to undertake a training program at RDH for two months starting in May. There are also plans for nursing staff from the Royal Darwin hospital to have an opportunity to work at Sanglah hospital.

Regardless of location and demographics Di confirms that Nurses everywhere are faced with common challenges; changing the mindset and practices of staff including senior staff and leaders through education, exposure to opportunities with strong mentorship and dealing with internal politics.

The hospital has a strong medical hierarchy with no nurses on the hospital executive and Doctors are in charge of all departments including finance, administration, human resources and medical records.

In the hospital the head of nursing is a medical doctor and the Director of Nursing reports to this doctor. There are many operational difficulties with real challenges for nurse leaders. If nursing staff become highly educated and assertive, then the traditional models of power are challenged. This creates all sorts of difficulties for nurses who, while keen to improve practice and the status of nurses, are constrained by the organisational structures that work against their empowerment.

Everyday there are operational challenges to be faced in relation to patient care, as there are only skeleton levels of staff available after 1300hrs. The care of patients remains heavily reliant on the patients family; including the provision of sufficient food and oral fluids.

Nurse training is very different in Indonesia. There is no national registration process, there are a number of

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Email: neralie@pulsestaffing.com.au

www.pulsejobs.com

FAR AND AWAY THE BEST 25

Feature - Working Abroad

agencies that regulate education facilities but none that have been created to monitor professional practice and protect the public.

Nursing is a university degree that consists of 4 years of theory and 1 year of clinical practice. On completion of this course these nurses are known as S1 level nurses. It is rare for nurses with this level of education to practice in a hospital setting – they usually go into health education or open their own health care clinics. Less than 2% of clinical nurses have degrees, hospitals are staffed predominantly by nurses with a Diploma 3 qualification, which is more or less equivalent to an Enrolled Nurse. This means that even the most senior staff in the hospital will only have a D3 qualification.

The health care system is user pays and you will receive the package of care that you are able to pay for and everybody must pay something. The very poor are able to get treatment but it is very limited. The model of care is a managed care model which means that treatment options that are available, including of the

experience of medical officers treating you and the medication available, are governed by the level of funding available, or your capacity to pay. For example a poor person could come into ED with a fractured femur and the free care would include having an X-ray and possibly a splint or plaster, but if they needed surgery the family would have to pay for the operation. This means many patients end up with natural healers, or do not get the care they need.

Di’s greatest challenge was working at the level the local staff were at instead of where their Australian counterparts would be. Culturally, illness is seen as karma so the empathy that Australian health providers have is not always evident in the health care culture in Bali. Emotional investment is with your immediate and extended family in Bali not the broader community.

Di’s final word of advice to tourists visiting Bali – ‘don’t leave your brain at home when you come to Bali’ and she strongly advises to ensure you have evacuation insurance. She cites a young Australian tourist who was travelling on a bike with three other people – she fell off and sustained a compounded of her humerous and multiple abrasions. She presented to the hospital at 3am but because she had no money she was not treated until Di found her at 9am and contacted the grandfather to transfer money so that she could be treated.

Members of the Nurses for Nurses Network can assist with the work that Di is doing. Di would welcome: 1. For the first time at the hospital there will be Nurse Educators to mentor and train staff in-house at the bedside so any orientation programmes that people would be willing to share, competencies ,etc aimed at Enrolled Nurse level for all specialties – surgical, medical, palliative, midwifery, etc.

2. Training packages that people may use in their workplace to train their own staff – Di can get them translated into Balinese.

The Network will be the conduit for Di – so if you can send your information to us we will pass it on. Di can then choose to contact individuals direct. info@nursesfornurses.com.au

26

UTOPIA

Urapuntja Health Service Aboriginal Corporation

Exciting new opportunities for true believers in Primary Health Care.

Currently recruiting:

• Health Promotion Officer • Clinical Nurse Manager • Experienced Registered Nurses; full time ready now!

Urapuntja Health Service needs Experienced Registered Nurses with current clinical experience. Acute care medicine and primary health care experience preferred, with proven communication and computing skills, you will support a team with full commitment to primary health care. You will be working together in a multi-disciplinary team in a cross-cultural setting. We encourage Indigenous nurses to apply for these positions.

We are also looking for a Public Health Promotion Officer; for a position with a focus on a choice of programs ‘hygiene and nutrition’, mothers and babies program, or a focus on ‘youth and healthy lifestyles’ This is not necessarily an RN position; health promotion experience or similar must be proven.

As our team is now growing strong, we would like to add a Clinical Manager, are you looking for a challenge, have good ideas on public health and ready to lead a team into the future?

Don’t hold back - if you think you fit the bill give me a call! For application and information please call Sarah Doherty (08) 89569875 or send an email to : ceo@urapuntjahealth.org Urapuntja Health Service is an Aboriginal community controlled health organization situated in the Alyawarr region of Central Australia, 280km NE of Alice Springs. We have a population of 1200 people living across 16 small communities. Attractive wages, salary packaging arrangements, and subsidized accommodation in a beautiful setting, is on offer to reliable resilient individuals who have some time to devote to us.

DO YOU REALLY WANT TO MAKE A DIFFERENCE IN REMOTE ABORIGINAL HEALTH? This is your chance to take a crucial role in an organization whose mission is to maximize indigenous health and has remarkable statistics to prove it. Opportunities to put your ideals into practice exist in this exciting time in health evolution.

27

Educational Courses, Conferences & Events

Educational Courses, Conferences & Events

Article: Care Planning..........................................................................30-31 Ausmed Publications................................................................................32 CPD QUIZ.................................................................................................33 The College of Nursing..............................................................................34 Oceania University of Medicine.................................................................35 ACNP 6th Conference for 2011.................................................................35 HALO Education........................................................................................36 ACCYPN Inaugural Conference, October 2011..........................................37

September CATSIN Annual Conference “Are we there yet?”

Congress of Aboriginal and Torres Strait Islander Nurses 21-23 September 2011 Mecure Hotel, Brisbane Qld www.indiginet.com.au/catsin/

2011 Australasian Sexual Health Conference “Sex in the Capital City” The RACP 28-30 September 2011 National Convention Centre, Canberra, www.sexualhealthconference.com.au/

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9th International Conference for Emergency Nurses Showcasing, exploring and celebrating the diversity of Emergency Nursing practice College of Emergency Nurses Australia 28 September - 1 October 2011 Adelaide Convention Centre, SA www.cdesign.com.au/cena2011

Aged Care Nurse Managers Conference “Clinician, Colleague, Carer & In Charge” Total Aged Services 21-22 September 2011 Caulfield Racecourse, Melbourne www.totalagedservices.com.au

(PNAQ) Annual Conference 2011

Australasian HIV/AIDS Conference 2011

“Standing on the Shoulder of Giants” Perioperative Nurses Association of Queensland Inc 29 September - 1 October 2011 Royal Pines Resort, Gold Coast www.pnaqconference.net.au

23rd Annual ASHM Conference Australasian Society of HIV Medicine 26-28 September 2011 Canberra, ACT www.hivaidsconference.com.au

ACMHN’s 37th International Mental Health Nursing Conference “Swimming Between the Flags” Australian College of Mental Health Nurses 4-7 of October 2011 Marriott Resort & Spa, Gold Coast www.astmanagement.com.au/acmhn2011

2011 CRANAplus Conference “Supporting the Full Spectrum of Remote Health Practices” CRANAplus - Remote Health Counts 11-14 October 2011 Novotel Langley Hotel, Perth www.crana.org.au/200-2011-cranaplusconference.html

6th ACNP National Conference 2011 “Nurse Practitioners: Coming of Age” Australian College of Nurse Practitioners 6-8 October 2011 Hilton Hotel, Adelaide www.dcconferences.com.au/acnp2011/

Oceania Tobacco Control Conference “Burying the Habit: Moving to a Tobacco Free Future” Cancer Council of Queensland 17-20 October 2011 Brisbane Convention & Exhibition Centre, QLD www.oceaniatc2011.org

ACM’s 17th National Conference “A Midwifery Odyssey” Australian College of Midwives 18-21 October 2011 Australia Technology Park, Sydney http://www.acm2011.remark.com.au/

9th Asia/Oceania Congress of Geriatrics and Gerontology “Ageing well together: Regional perspectives” Australian Association of Gerontology 23-27 October 2011, Melbourne http://www.ageing2011.com/

RMA’s Conference 2011 “Ageing well together: Regional perspectives”

Rural Medicine of Australia 28-30 October 2011, Alice Springs www.acrrm.com.au

Inaugural (ACCYPN) Conference “Navigating New Directions in Children & Young People’s Health Care” Australian College of Children & Young People’s Nurses 19-21 October 2011, Sydney http://www.accypn2011.eventplanners.com.au/

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OCTOBEr

Continue to page 33 for the CPD QUIZ

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CARE PLANNING: The Who, What, Why and How of Nursing Care Plans for Patients Care planning encompasses multiple and diverse nursing theories. They are developed with a well-established series of steps called the nursing process. The process of patient care planning is a system for obtaining the appropriate nursing diagnosis for the patient, choosing appropriate interventions, acting accordingly, and evaluating the results of the interventions. Re-planning and re-evaluation may be required for complex care problems.

Making A Care Plan: A Short Step-By-Step Guide The Nursing Process: Assessment, Diagnosis, Planning, Intervention and Evaluation (ADPIE) The first step is to assess the physical, emotional and social aspects of a patient to determine if there are any ongoing health conditions, or other concerns. If a wholistic care plan is to be achieved, assessment needs to be comprehensive and include psychosocial and spiritual considerations as well as physical concerns.

The second step involves formulating a nursing diagnosis. This identifies the existing, and potential problems of individual patients. It also acts as a guide for developing appropriate nursing interventions.

The third step is the planning stage, which is based on the nursing diagnoses. Here you will need to consider: - what are the nursing care and management steps that need to be made in order to fully or partially resolve the identified problems?

- in which priority should they be listed in the care plan?

- how to document the nursing interventions that, in conjunction with the treatment orders and medical diagnosis, are most likely to benefit the patient.

30

- that, whenever appropriate, the rationale behind your decisions is evidence-based.

The fourth step is the implementation of the nursing care plan. This stage is based on your assessment, your nursing diagnoses and your plan of action and includes: - your observations - your nursing knowledge - clinical reasoning - evidence-based choices.

Altogether, this underpins and guides the documentation of what is to be implemented in response to each of the identified problems.

The final step is evaluation. This is where the outcomes of previously implemented nursing care are assessed and measured in order to determine what was of benefit to the patient.

Problems that have not responded - or have only partially been resolved – are also evaluated and the missing characteristics identified. The knowledge gained from evaluating and measuring any unsuccessful nursing intervention becomes a guide towards new assessments and the formulation of a revised care plan for the patient.

Adapted from PowerPoint presentation available to members of Ausmed’s Online education service at: www.AusmedOnline.com

NANDA, NOC & NIC: A universal language

Documentation Tips

NANDA diagnoses, NOC outcomes, and NIC interventions give nurses a universal language for care planning (Hughes, et al., 2008).

- Documentation must always be honest, accurate and comprehensive. Here are some general do’s and don’ts concerning documentation:

NANDA: The North American Nursing Diagnosis Association exists solely to develop and define nursing diagnoses that are used all around the world. Their research produces evidence-based diagnoses in the hopes of improving patient care and safety (NANDA, 2010). It has been widely adopted by the Australian nursing profession.

- DO chart as soon as possible after the fact, so that everything that happened is remembered. If immediate recording of observations and facts is not possible, keep comprehensive notes to refer to later.

NIC: Nursing Interventions Classification is another system of classification, with a focus on nursing interventions. They are standardized and as such, are the logical next step after the nursing diagnosis has been defined for each problem. They also promote evidence-based decisions to guide care and provide a common language between nurses in all areas and many countries.

How do nursing diagnoses differ from medical diagnoses?

Definition: “A nursing diagnosis is a clinical judgment about individual, family, or community experiences and responses to actual or potential health problems and life processes” (NANDA, 2010).

- If altering or creating a care plan on a paper template, DO make sure that any changes or additions are initialled.

- Documentation by exception may be acceptable in some facilities or situations; it may not be the best way to chart. For example, writing that “…the breath sounds were auscultated to both bases with no adventitious sounds identified” shows that the chest was fully assessed.

- DON’T use white-out in documentation. Instead, draw one line through the error, write the word error above it and add initials. Records written by nurses are considered legal documents.

- TRY TO AVOID using the term “normal” in charting, as it does not describe what is the interpretation of normal. Instead, describe what was found. For example, charting that the patient’s skin was normal is not ideal. It is more accurate to record that “…the patient’s skin was pink, warm, dry and intact”.

- Including relevant details when documenting patient care is always better than omitting such details.

Basically, what this means is that nurses use a nursing diagnosis, rather than a medical one, to tailor the individualised care they provide to patients. A physician may diagnose a patient with Chronic Obstructive Pulmonary Disease (COAD).

Continued Professional Development provided by

A nurse might identify the nursing diagnosis as “impaired gas exchange in lungs”. The difference is that nursing diagnoses describe potential situations for the patient and also imply interventions that nurses can decide upon themselves, using their clinical judgment.

Ausmed has recently added over 10 hours of medicines education to AusmedOnline, this content is available exclusively to our members.

Visit www.AusmedOnline.com today to learn more about membership.

Nurses cannot prescribe bronchodilators, but they can monitor oxygen saturation and apply supplementary oxygen to the patient. In accordance with medical orders, nurses can administer bronchodilators as an intervention.

Comment on this clinical article at: www.ausmedonline.com/nursing-blog.html

REFERENCES Hughes, J.R; Lloyd, D; Clark, J (2008) A Conceptual Model for Nursing Information. International Journal of Nursing Terminologies and Classifications. Volume 19 (Issue 2), Pages 48 – 56.

North American Nursing Diagnosis Association (2010).

Nursing diagnosis. Frequently asked questions. Retrieved from http://www.nanda.org/NursingDiagnosisFAQ.aspx.

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NOC: Nursing Outcomes Classification is similar, except that the classified 330 nursing outcomes relate to the nursing diagnoses and interventions.

They are a standardized and evidence-based way to define how successful the interventions were for the patient. They become an integral part of the evaluation process when developing care plans.

- DO sign and date all charting so that there is no question as to who wrote the documentation.

Clinical Nursing

Assessment Skills

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2011 Dates Adelaide: Brisbane: Melbourne: Sydney: Perth:

26 - 27 September 12 - 13 September 13 - 14 October 21 - 22 November 7 - 8 December

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ACCUMULATE CPD MINUTES HERE! Complete the Quiz for your opportunity to earn CPD minutes towards your yearly quota!

Listen to lectures at www.AusmedOnline.com to earn additional minutes towards your CPD Nurses!

32

QUESTIONS 1. A patient has diarrhoea. A potential nursing diagnosis would be:

2. You are assessing a patient’s chest at the start of the shift. Respirations are

noiseless, non-laboured and are at a rate of 18 per minute. What should you chart?

A. respirations normal B. respirations unlaboured C. I would chart nothing; the respirations are unremarkable D. respirations18/min, deep, easy and noiseless 3. The nursing process requires critical thinking. True or false?

A. true B. false

CONTINUING PROFESSIONAL DEVELOPMENT (CPD) Information By reading this fact sheet and successfully completing the quiz questions you have earned 15 minutes towards your Continuing Professional Development, if you have identified a need to revise the nursing process as part of your CPD plan. This should only be considered professional development if the activity is relevant to your ‘context of practice’.

DOCUMENTING YOUR CPDs Ausmed’s Free CPD Organiser will assist you with your CPD documentation and quickly take you through the correct process of recording. The CPD Organiser is available at: AusmedOnline.com.

3) The answer is ‘A’, true. The nursing process, and all nursing behaviours, should involve critical thinking.

2) The answer is ‘D’. It fully describes the assessment and the assessment’s findings. ‘A’ assumes that we all describe normal the same way, ‘B’ describes only a portion of the assessment, and ‘C’ is an example of charting by exception, which would be no help to a nurse examining her charting in court years later.

1) The answer is ‘C’, diarrhoea. ‘A’ is a medical diagnosis, ‘B’ is a potential symptom of diarrhoea and ‘D’ is a potential cause for the diarrhoea.

Answers 33

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A. C.difficile B. weight loss C. diarrhoea D. infection

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Continuing Professional Development CPD courses starting from just $77.00 October Rehabilitation nursing (NSW) Bowel care and colostomy update (ACT) November Drug and alcohol issues (NSW) Diabetes update (NSW) December Palliative care (NSW) The deteriorating patient (NSW) Distance Education (National) Immunisation for RNs Principles of emergency care (RN & EN Div 2)

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Just send Send us photos of: us some happy •individual or group shots snaps of you and •your colleagues or yourself working your colleagues •special or social events •someone you think deserves to from your ward!

HERE is your chance to show off your photography skills (or modelling skills) by entering the Nursing Post photo competition.

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It’s important that you get expert advice in order to make the most of the opportunities and that’s where Promesse can help. Currently we are recruiting for these new and exciting opportunities; to learn more about any of them contact Christine Kohleis RN right away.

40

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