Preparing for Clinical Placement PDF

Preparing for Clinical Placement NSB 102: Module 5 lecture Dr Audra de Witt  Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the Traditional Owners – the Jagera and the Turrbal peoples of the land where QUT now stands and recognise these...

Preparing for Clinical Placement NSB 102: Module 5 lecture Dr Audra de Witt  Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the Traditional Owners – the Jagera and the Turrbal peoples of the land where QUT now stands and recognise these places have always been places of teaching and learning. We pay our respects to their Elders past and present, and acknowledge the important role Aboriginal and Torres Strait Islander peoples continue to play within the QUT community www.reconciliation.qut.edu.au  Expectations 1 Charter of patient rights Reporting Obligations 2 Professional Boundaries Bringing it All together 3 Applying what you’ve learnt When on Clinical Placement As a student nurse …. § People and families will have expectations of you § Employers will have expectations of you § Colleagues and the nursing profession will have expectations of you § The wider community will have expectations of you Charter of Patient Rights § Developed by the Australian Commission on safety and quality in health care § Apply to all people accessing health care any where health care is provided in Australia § Good for everyone to be aware of their rights when accessing care, and § As a student nurse (going on placement) you need to be aware …  Charter of Patient Rights Australia what consumers can expect when receiving health care In Australia  Expectations of the public (continued) § The Code of Conduct for Registered nurses set out the minimum standards NMBA expects all nurses to uphold when practicing in Australia § The Code of Ethics for nurses provides guidance to all nurses relating to expected ethical conduct § The Standards for practice for nurses informs the public what standards they can expect from nurses NMBA Codes of Conduct for Nurses, 2018 (recap) https://www.youtube.com/watch?v=BMy8nokXgaY Code of Ethics for Nurses in Australia (recap) https://www.youtube.com/watch?v=-NfDQVXzKmU  Registered Nurse standards for practice https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for- practice.aspx Expectations from Employers - examples ü Work within your scope of practice – tell them what you can and can’t do ü Adhere to the nursing frameworks, standards, codes and requirements (eg. code of conduct, code of ethics, nursing standards for practice etc) ü Good communication - tell them if you are not able to complete tasks, not within your scope of practice (they may not know), need to be shown how to do something – like patients, you also have the right to feel safe in your workplace setting ü Each organization will have their own guidelines and regulations – be aware of this and work within these – attend orientation, complete required tasks prior to clincal placement ü Provide culturally safe care ü Mandatory vaccination requirements and evidence (eg. whooping cough, hepatitis B, covid-19 etc) Queensland Health organizational cultural competency framework Mandatory requirements prior to placement (Dept of Health, Qld) Mandatory vaccination requirements (majority of front line clinical roles) o Hepatitis B o Measles o Mumps o Rubella o Pertusis (whooping cough) o Varicella (chicken pox) o Other forms to complete e.g. TB screening questionnaire QUT Medical Centre offers Immunisation Placement Clinics every semester – to get vaccinations. Check dates. Contact them early. Reporting Obligations  Mandatory notifications requirements § It is part of the National Law to protect the public § Separate guidelines for mandatory notifications about registered health practitioners and registered students § Guidelines about students – relevant for students, registered health practitioners and education providers of registered students § Students should be familiar with these guidelines § According to info on NMBA website - The National Law does not require a student to make a mandatory notification (complaint or concern), a complaint or concern can be raised about an impaired student Source: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/codes-guidelines/guidelines-for-mandatory-notifications.aspx  Mandatory notifications about students Who should make a mandatory notification? § Treating practitioner (practitioner providing treatment to a student & has a concern while providing treatment) § Non-treating practitioner § Education providers Must report if have concerns that by undertaking clinical training with an impairment, the student will be placing the public at ‘substantial risk of harm’ NOTE: Students are NOT required to make a mandatory notification about a practitioner or another student in relation to this context. Can discuss concerns with education provider https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/codes-guidelines/guidelines-for-mandatory-notifications.aspx How does the National Law protect notifiers (mandatory notifications re students continued) § The Law protects anyone making notifications in good faith. ‘Good faith’ ordinary meaning = ‘being well intentioned or without malice’ § Section 237 of the National Law – protects from civil, criminal and administrative liability including defamation, for those making notifications in good faith (if not in good faith can be subject to regulatory action e.g. caution). § Making a notification is NOT a breach of professional etiquette or ethics or departure from professional conduct standards - it is consistent with professional conduct & is an ethical responsibility § Privacy obligations do NOT prevent a person from making a mandatory or voluntary notification  What issues must be reported? Mandatory reporting about students continued § Can only be about concerns about impairment § ‘Impairment” as defined by the National Law: o Physical or mental impairment o Disability, condition or disorder (including substance abuse or dependence) That detrimentally affects or is likely to affect the students capacity to carry out clinical training An illness or condition that does not have a detrimental impact on a students capacity to undertake clinical training is NOT an impairment. A person has to form reasonable belief before making a mandatory notification. ‘Reasonable belief’ = a state of mind based on reasonable grounds. Professional Boundaries Professional Boundaries and Nurses Professional boundaries in nursing: ‘limits which protect the space between the professional ‘s power and the client’s vulnerability, that is they are the borders that mark the edges between a professional, therapeutic relationship and a non-professional or personal relationship between a nurse and a person in their care’. Ø Ultimately serve to protect the community Ø When boundary is crossed, behaviour is unprofessional and misuse of power in the relationship Codes-and-Guidelines---Professional-boundaries-for-nurses---February-2010%20(1).PDF A Continuum of Professional Behaviour DISINTERESTED NEGLECTFUL (under involvement) THERAPEUTIC RELATIONSHIP (zone of helpfulness) BOUNDARY VIOLATIONS (over involvement) Every nurse-client relationship can be plotted on the continuum of professional behaviour Codes-and-Guidelines---Professional-boundaries-for-nurses---February-2010%20(1).PDF  Guiding principles for safe, professional practice 1. Dual relationships and boundaries - Avoid, but if unavoidable be clear to establish, maintain and communicate boundaries - Take steps to minimise risks of harm 2. Access to or the disclosure of information - Protect personal information of clients/patients - Consider carefully need to disclose information 3. Therapeutic and care relationships - Never withhold care as punishment - Be aware of potential person discomfort with eg. physical contact and respond accordingly 4. Gifts, services and financial relations § Anything beyond ‘token’ gifts can compromise the professional relationshiop § Check with the organization you are working at if unsure Codes-and-Guidelines---Professional-boundaries-for-nurses---February-2010%20(1).PDF Applying what you’ve learnt into practice How do we do that??  Cultural safety – a recap Can mean different things in different contexts 1. A philosophy: what is the nature of reality and existence § seeks social justice and fairness-wealth, jobs, opportunities, confronts discrimination and racism, raises critical debate, sees issues in terms of power imbalance and social experience. 2. Epistemology: a theory of knowledge: the scope and validity of knowledge § knowledge based on critical perspectives aiming for social change, theory of social constructionism i.e. knowledge is constructed by humans and is value and power laden. § 3. A model for practice – this is our main focus in this unit  Cultural safety - a model of practice § Flexible, responsive and respectful health care - power sharing and negotiation § Prioritising clients needs - at the centre/ heart of nursing and health care § Recognising that health means different things to different people, is determined by the person & family - especially important when caring for person/family from another culture Culturally safe nurses … § Have undertaken a process of reflection on own cultural identity and social position § Recognise the impact of own personal culture and social position and its impacts on own professional practice and interactions § Are knowledgeable about Australian history and current social practices and have taken a stance on these § Consider, reflect and are aware of professional and health organisation cultures, its impacts on client care and takes actions accordingly  Principles of cultural safety § Culture can be defined in many ways. Culture is learned and dynamic. Multiple realities and no universally agreed definition of health § Ongoing critical reflection is needed – personal and organizational awareness (remember organisations have cultures too). Need to acknowledge power and privilege § All human interactions have cultural dimensions. All people are unique and people are experts on their culture § Power sharing and negotiation is an important to challenge racisim, class privilege and ethnocentrisms. Human rights approach to health and advocate for equity  Why we need a culturally safe and responsive heath system? § Improves access to health care & quality of care Accessible health care = physically accessible/close to home, affordable, appropriate, acceptable § Culturally safe = respects cultural values, strengths and differences – recognizes that practices of dominant culture is not the only &/or best way § It addresses racism and inequity It requires h/professionals & health services to be culturally responsive & take action to overcome racism & power imbalances § Delivers care based on individual needs based on personal values, cultures and beliefs, rather than expecting people to ‘fit’ into a ‘one size fits all’ system So cultural safety in the health context –defined with reference to peoples’ experiences of receiving health care (positive? negative?), how health care is delivered (respectful?) and accessibility of services (ease/friendliness)  M2 Australian M3: SDH & HCS & Equitable Nursing Health Regulations System Your NSB 102 Journey … M1: Culture, Self & Nurse M4: Power, Corporatio ns & Culture  M1: Culture, Self & Nurse YOU M2: M4: Power, Corporations Culturally Australian HCS & Safe & Culture Nursing Regulations Nurse M3: SDH & Equitable Health System Culturally safe nursing practice and YOU What does this all this mean for me? How do I apply what I have learnt into practice? How will I know if I’m doing it right?  Some of the things you have learned … Nurses are obliged by law to provide respectful and culturally safe care based on the unique needs of each person Health and health care is not that simple – it is complicated Social determinants are outside the control of individuals – significantly impacts health We have a good but complex health care system Some people find it difficult to navigate the health care system Racism has a detrimental impact on health and wellbeing The biomedical model of health is a dominant approach to health in Australia Nurses are trusted is society, and the biggest health workforce  Thoughts on how you can apply what you’ve learnt into practice ü Engage in self-reflection – use a diary ü Understand and accept that not everyone shares the same values, beliefs, thoughts and attitudes as you ü Understand and accept that people are unique beings, and they have varying ways of living and priorities in life ü Everyone has the right to live life according to their beliefs and values ü Have a positive attitude and open mind - about things, people and places ü ‘New’ things you come across in life are opportunities for self growth, expand your mind, learn new skills, experiences, things etc ü The ‘norm’ in society is simply ONE way – it is not the ONLY or best way eg to live ü When caring for others – engage therapeutically, be interested, show care and kindness  Thoughts on how you can apply what you’ve learnt into practice 2 ü Remember that health is a human right ü Everyone has the right to receive person-centred, quality and culturally safe care ü Nurses in Australia are obligated by law to provide culturally safe and respectful health care to all people ü As nurses we want to leave people with positive experiences of care so they continue to engage and access h/services in future when they need to ü Always remember - social determinants of health significantly impact health and lives ü Avoid blaming people for poor health and/or not ‘complying’ with their treatment/regime – think deeper, explorer further for reasons ü You have the right to feel safe and valued when caring for others ü You have the right to not participate in certain types of care or treatment if you feel uncomfortable, or you don’t feel you have the skills to carry out the care; but you must make sure the patient is safe (you can get someone else to step in to do it)  Thoughts on how you can apply what you’ve learnt into practice 3 ü Be a continuous learner – read nursing journals, attend conferences, talk with your colleagues, join professional organisations, consider further study, subscribe to podcasts, watch the news ü Advocate for people and community ü Work well with your colleagues and team members ü Be reliable, dependable and trustworthy ü Contribute as a positive team member ü Practice within you scope of practice ü If you don’t know how to do something – say so and ask someone to teach you ü Make time to look after yourself –engage in regular self care activities ü Find someone you trust who you can talk to – to share good things and also when you’ve had a hard day ü Be that friend to someone else  Thoughts on how you can apply what you’ve learnt into practice 4 ü Seek out an interpreter if there is a language barrier when providing care – ask workplace for more information ü Be aware that some cultures have different ways of thinking about health care ü Some people may refuse western medicine and may want to be treated in other ways outside the western medical model of health ü People have different levels of health literacy. Check and share knowledge in a culturally safe and respectful way ü While on placement – check in with your buddy nurse, ask your QUT facilitator, talk with QUT nursing student colleagues also talk with and your mentors Over to YOU – how else can you apply what you learnt into your clinical practice? Keep calm health system. Culturally safe nurses from QUT on their way.  References Charter of healthcare Rights. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/australian-charter-healthcare- rights-second-edition-a4-accessible NMBA Guidelines for mandatory notifications. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/codes- guidelines/guidelines-for-mandatory-notifications.aspx NMBA codes of conduct: being a midwife or nurse means something. YouTube video. https://www.youtube.com/watch?v=BMy8nokXgaY Code of Ethics for Nurses in Australia. YouTube video. https://www.youtube.com/watch?v=-NfDQVXzKmU Registered Nurse Standards for Practice. 2016. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional- standards/registered-nurse-standards-for-practice.aspx A nurse’s guide to professional boundaries. NMBA. 2010. https://www.nursingmidwiferyboard.gov.au/documents... Queensland Health organizational cultural competency framework. https://www.health.qld.gov.au/multicultural/contact_us/framework Cox, L. and Taua, C. (2017). Understanding and applying cultural safety: philosophy and practice of a social determinants approach. In Crisp et al. [eds] Potter and Perry’s Fundamentals of Nursing 5e. Sydney: Elsevier.