Standard 1: Thinks Critically and Analyses Nursing Practice

Standard 1 of the ‘Professional standards for Australian Nursing and Midwifery Board mainly guides nurses in their profession to think critically and analyse their practices in order to provide the best care to patients. Often patients come to the cardiac department centre with acute pain in their chest. It becomes extremely important for the nurse on the duty to critically analyze the source of the pain (Birks et al. 2016, pg 530). Chest pain may occur from simpler reasons like indigestion, muscle strain or some innocuous reason. However, it may also be due to more serious and potential causes which include life threatening diseases like acute myocardial infarction. It becomes extremely important for the nurse to maintain the standard of nursing practice in Australia which states that a nurse should critically analyze the patient and his symptoms in order to provide the correct intervention (Scanlon et al. 2016, pg. 135). As in here, thepatient was complaining of chest pain, the nurse should firstly undertake the vital sign analysis which should be followed by PQRST pain assessment. This will give nurses the idea to proceed with an intervention. Analyzing the pain, quality, radiation, severity as well as the time by asking proper questions for proper analysis, she can reach a conclusion about what kind of intervention will be helpful for the patient. Often critically analyzing the patient results in helping the nurse to understand that whether any of the symptoms are getting neglected or not (Halcomb et al. 2017, pg. 57). If the nurse decides an intervention for the patient with any factors which is not likely to be true for the patient, then the patient may suffer from wrong treatment and hence may be threatening for him. Therefore, the nurse should be very careful and critically analyze the patient’s condition in a sequential manner to provide the best treatment (O’Connell et al. 2014, pg 2732). However, while finalising the intervention, the nurse should also take care to involve family and the patient and discuss with them the intervention by clearly defining the causal factors for the intervention chosen. The intervention chosen should be evidence based as it will ensure that the intervention will be highly successful in case of such patients. Moreover the nurse should also conduct a proper evaluation method foe assessing the success of the intervention. The rates provoded by the patient while assessing their feeling of pain will help the nurse to understand the success of her intervention.

Engaging in therapeutic and professional relationships is another standard called the Standard 2 of the ‘Professional standards for Australian Nursing and Midwifery Board’ that should be followed by the nurse on duty. When the person has come to a nurse with severe ache in his cardiac region, the nurse should fisrt maintain the therapeutic steps that need to be performed for his recovery. Then she also needs others important steps as well. Maintaining a distinction between the nurse’s professional and personal relationships is also important (Kleinpell et al. 2016, pg 9). She should also maintain dignity and respect of the person so that he feels that his choices and values are considered and paid importance to. She should also help in the maintenance of a culture which involves discussions and supports from other health professionals and participating in collaborative approaches and practice notifying each other. The nurse should also help the patients with suggestions that would direct the resources that will help in the optimization of healthrelated decisions (Scanlol et al. 2016 pg. 242). In this case of the person suffering from heart ache, once the nurse recognizes the real reason behind it, she needs to perform tasks maintaining the Standard 2 of the guidelines. After recognizing that the person is suffering from myocardial infarction for example, the nurse should make the patient aware of the disorder that he is suffering from. Here the nurse after informing the patient of his disorder, need to ask for his permission to provide him with the intervention of taking glyceril tri-nitrate which act as coronary vasodilators. This is done to maintain dignity, autonomy and respect of the patient. After prescribing for morphine to relieve the patients’ pain, the nurse should inform senior staff in order to assure anything else should be done or not (Melnyk et al. 2014, pg 10). Collaborative practices tend to provide a better outcome negating any ill effects on the patient. Like a professional she should also document the vital signs, note down the result of the PQRST pain assessment, order diagnostic tests and others. This type of professionalism is to be maintained to avoid any legal complications. The nurse should engae in aperson centered approach to ensure that effective communication is carried out and dignity of the patient is maintained. This will reduce the chances of information gaps. Respecting the patients’s dignity and maintaining the principles of patient engagement in planning the intervention will assure less conflicts. Maintaining the dignity and autonomy of the patient and informing the family memberswill help him to be away from legal obligations.

Standard 2: Engages in Therapeutic and Professional Relationships

Standard 6 mainly deals with the major concerns regarding the safety and appropriate and responsive quality nursing practice. This mainly covers the safety precaution and the guidelines that the nurse should maintain in order to avoid any sort of potential risk for the patients. Even during practice the nurse should be careful enough and should monitor to ensure that the delegated practice is safe and correct. She should also practice in accordance to relevant policies, guidelines, standards, regulations so that a legal obligation is avoided by him (El Haddad, Moxham, Broadbent2013, pg 235). In this case, it was seen that the patient was suffering from myocardial ischemia. Therefore it seems important to increase the oxygen content of the blood reaching to the heart in order to reduce the demand of oxygen. Here the nurse should try to follow the guidelines about the management of the acute coronary syndromes which is published by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Following such guideline is very important as Standard 6 has mentioned. This guideline suggests that the routine use of supplemental oxygen cannot be recommended. The nurse should know that oxygen therapy should only be conducted when the patient is hypoxic with a SpO2 less than 93%. It can also be given when the patient develops a symptom of evidences of shock. In case of patients who are not hypoxic like (SpO2 >94%), oxygen therapy may not benefit at all and may even provide uncertain and unsafe results which may also prove harmful for the patient (Mussell et al., 2013). Therefore Glyceril nitrate is provided which reduces intracellular calcium levels leading to vasodilatation of the coronary vessels. This in turn helps in improving the coronary perfusion and in return helps in increasing oxygen supply to the heart (Gill et al. 2015, pg489). It mainly acts in two ways. It helps in the realaxation of the blood vessles that becomes widen. This reduces strain on the heart. This becomes easier for the heart to pump blood in different body parts. It also results in the relaxation of vessles in heart andthereby increases flow of blood to heart.The later intervention is safer than the previous one and can be followed under standard 6 of the guidelines. However it  should be avoided in cases of patients with kidney disorders, head injury and low blood pressure. Proper documentation should be maintained which would not only help in delegation but also to avoid legal complication. 

The standard 7 usually involves evaluation of the outcome to inform practices that involve the evaluation as well asmonitoring of progress towards expected goals and outcomes. It also advises the nurse to revise the plan. If it was not found to be apt enough, modification need to be done. This should be followed by determining, documenting and communicating important goals, outcomes and further priorities with the relevant persons (Ferguson et al. 2016, pg 9). In this case of the patient with the myocardial ischaemia, after providing GTN administration, the nurse should also evaluate whether his pain has subsided or not. After proper evaluation, if she finds that chest pain is not reducing, she can provide aspirin, which also prevents the formation of thromboxane A2. Morphine is also prescribed. The nurse should also have the EGC test done to be checked by medical officer to ensure that the outcomes of the GTN administration have been favourable or not. Moreover in order to evaluate the outcomes, the ECG recently conducted should be compared with a previous one taken to note the acute changes that had taken place. Moreover evaluation of the patients’ response to defibrillator should also be assessed. Once the nurse correctly evaluates the outcomes of the interventions taken by her and modifies her plan accordingly, one can assure that the patient will respond better with fast recovery (Johnstone 2015). After this practice, the nurse should critically assess the success of her initiative and determine the various barriers and postive aspects thst the nurse had faced in this intervention. This reflection would help her to develop a safe practice and apply such interventions in next cases.

Reference List

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El Haddad, M, Moxham, L and Broadbent, M  2013, ‘Graduate registered nurse practice readiness in the Australian context: an issue worthy of discussion’, Collegian, vol. 20, no. 4, pp.233-238.

Ferguson, C, Inglis, SC, Newton, PJ, Middleton, S, Macdonald, PS and  Davidson, PM 2016 ‘Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses’, BMC medical education, vol. 16, no. 1, p 9.

Gill, FJ, Leslie, GD, Grech, C, Boldy, D and  Latour, JM 2015, ‘Development of Australian clinical practice outcome standards for graduates of critical care nurse education’, Journal of clinical nursing, vol.  24, no. 3-4, pp. 486-499.

Halcomb, E, Stephens, M, Bryce, J, Foley, E and Ashley, C 2017, ‘The development of professional practice standards for Australian general practice nurses’, Journal of Advanced Nursing, vol. 89, no. 8, pp. 45-89.

Johnstone, MJ 2015. Bioethics: a nursing perspective. Elsevier Health Sciences.

Kleinpell, R, Scanlon, A, Hibbert, D, Ganz, F, East, L, Fraser, D, Wong, FKY and Beauchesne, M 2014, ‘Addressing issues impacting advanced nursing practice worldwide’,  Online journal of issues in nursing, vol. 19, no. 1, pp.235-243.

Melnyk, BM, Gallagher?Ford, L, Long, LE and Fineout?Overholt, E, 2014, ‘The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs’, Worldviews on Evidence?Based Nursing, vol. 11, no. 1, pp. 5-15.

Mussell, K. (2017). Assessing Need for Long-Term Oxygen Therapy: A Comparison of Conventional Evaluation and Measures of Ambulatory Oximetry Monitoring. rcjournal. Retrieved 10 April 2017, from

https://www.rcjournal.com/contents/02.03/02.03.0115.pdf

O’connell, J, Gardner, G and Coyer, F 2014, ‘Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing’, Journal of advanced nursing, vol. 70, no. 12, pp. 2728-2735.

Scanlon, A, Cashin, A, Bryce, J, Kelly, JG and Buckely, T, 2016, ‘The complexities of defining nurse practitioner scope of practice in the Australian context’, Collegian, vol. 23, no. 1, pp.12