Understanding and Applying Australian Nursing Standards in today's Healthcare system

Author: Iloka Benneth Chiemelie
Published: 5th April 2017

Introduction

The nature of healthcare have changed over the years both locally and internationally. This is due to the fact that the healthcare system is undergoing a wide range of reforms as the system attempts to enhance overall integration of care and facilities that connect the providers of healthcare services with the actual services being offered. In line with this reform, the health professionals have been mandated to enhance their role in promoting health activities and primary mediation in order to slow the advancement of chronic diseases (Australian Nursing and Midwifery Accreditation Council, 2012). In order to achieve this, there is an increasing emphasis on the need to build stronger primary cares systems that will be able to provide both preventative healthcare solution as well as the management of ongoing chronic diseases (Francis, K., Anderson, J., Mills, N., et al., 2012; Witt and Almeida, 2008; McCarthy, G., Cornally, N., Moran, J., et al., 2012; Oandasan, I.F., Hammond, M., Conn, L.G., et al., 2010).

Existing evidence have suggested that health care systems are best run under the guidance of teams  health professionals from different discipline that work as a union with a common course of providing an integrated health care system (Wagner, EH., et al, 2001). In order to ensure that the integration between team members and optimize the distribution process involved providing healthcare practices across the team. It vital to guarantee that all the teams members are fully conscious of adopted scope of practices and competence that is required in the professional team (McCarthy, G., Cornally, N., Moran, J., et al., 2012; Wagner, EH., et al, 2001; . White, D., Oelke, N.D., Besner, J., et al., 2008; Todd, C., Howlett, M., MacKay, M., et al., 2007). The confusion and ambiguity of roles have been identified as major barriers when it comes to professional collaborations (Oandasan, I.F., Hammond, M., Conn, L.G., et al., 2010; Moaveni, A., Gallinaro, A., Conn, L.G., et al., 2010). On the same note, it is vital to ensure that necessary information about the roles that should be carried out by the different health care professionals should be conveyed in a clear way to communicate the eminence of health care services are improved; the consumers are granted higher access and interaction with both the services and service providers (Witt and Almeida, 2008; Halcomb, Peters and Davies, 2013).

In the course of the past five decades, the duties of different professionals in the healthcare system have experienced tremendous transformation (Australian Nursing Federation, et al, 2008). There have been an emergence of new specialties, introduction of new specialists and advanced roles and experience changes in the scope and practice of certain professionals (Australian Nursing Federation, et al, 2008). This has shaped the need to discover and redefine boundaries within the healthcare sector and scopes of practices for all professionals in the health care industry.

Nurses are very important when it comes to providing efficient, safe and high quality primary care (Australian Nursing Federation, et al, 2008) and they are vital for the continued delivery of agenda that are intended to strengthen the quality of principal health care services (White, D., Oelke, N.D., Besner, J., et al., 2008; Billingham, 2003; Walker and Godfrey, 2008). Notwithstanding he increasing growth in employment of nurses within the General Practices in both Australia and across the world, the potential role and scope of their practices are still not clearly understood (McCarthy, G., Cornally, N., Moran, J., et al., 2012; Duckett and Willcox, 2011). The National Competency Standards enacted for registered nurses (Witt and Almeida, 2008) and enrolled nurses (Australian Nursing and Midwifery Council, 2002) Nursing and Midwifery Board of Australia (NMBA) are the fundamental standards that will define the level of safety and competency that is necessary for all nurses to possess when offering nursing services (Australian Nursing Federation, 2005). In general, these Australian Nursing and Midwifery Federation (ANMF) National Practice Standards for Nurses have been designed to aid the NMBA standards and define all features of professional services that nurses can provide under general practice sphere. This documentation is considered superior than the past Australian Nursing Federation Competency Standards for nurses in all-purpose practice (Australian Nursing Federation, 2005).

The specific focus of these standards are applicable to registered and enrolled nurses within the Australian context. This standards are divided into seven sections as illustrated in the figure (1) above. However, the objective of this paper is to present personal reflection on how the writer feels that gained experiences from undertaking a bachelor degree in nursing and midwifery has equipped her with necessary stills to deliver the standards 4-7 of the Australian nursing standards. As such, this paper is divided into six parts. The first part is an introduction, followed by a reflection on the standards 4.7 (cover the preceding four parts respectively), and conclusive summary of the study is presented in the final part.

Standards 4: Comprehensive conduct assessment

This standard deals with the need for registered nurses to accurately perform a comprehensive and systematic assessment of their patients, analyze available information and data and disseminate the outcome of their experience on practice level bases. This is based on the following criteria and reflection on each of the criteria are discussed below.

·         4.1. Conducts assessments that are comprehensive, systematic and holistic as well as culturally appropriate.

In the course of my nursing career, I have been taught a number of research tools and methodologies as well as the ethics of such practice. In a culturally diverse society, there is no doubting the fact that certain cultural differences can bring about issues between the nursing practitioners and the patients. The most featured cases are aboriginals and the practice of nullius as it related to equity and fairness. Such lectures featured different kinds of tools that can be used to gather data such as questionnaire and face-to-face interview. The ethical aspects feature the need to conduct such process in an unbiased and fair way.

Evidentially, I have been equipped with necessary tools to conduct successful assessment of health related issues faced by patients in a comprehensive, systematic and holistic way. In line with the nursing professional standard, essential assessments must be made by the professionals when they are faced with issues in their working place (Nursing and Midwifery Board of Australia, 2006). Decisions should not be based on gut feelings and emotions; as the professionals are employed to conduct relevant assessments in the course of delivering expected report. I have been carefully groomed to undertake such practices as I tend to personally value the need for comprehensive research after my experience in the academic setting. Thus, I feel that I am capable of fulfilling this aspect of the nursing standards in my future workplace as a professional nurse.

·         4.2. Uses a range of assessment techniques to collect relevant and accurate information and data.

Data gathering is essential in the course of reaching any specific decisions. Once the right data are corrected under the right settings, decisions reached tend to be more accurate and precise in terms of the ability of such decisions to handle circumstances for which it was reached. There are different forms of data gathering but the most feature are exploratory, explanatory and descriptive methods. In the exploratory method, the nursing practitioner aims as review, understanding and redefining established principles in the context being studied. In the explanatory research, the main purpose highlight and explain reasons behind certain actions and outcomes. The descriptive method is aimed at giving a clear view of how an option can be applied. No matter the technique adopted, collecting relevant and accurate information and is essential in the nursing profession as it helps to understand strategies that have been applied, weaknesses of such strategies and how they can be redeveloped to offer enhanced valued.

There are two forms of data gathering as: qualitative and quantitative. The qualitative aspect is focused on value of data gathered while the quantitative aspect is focused on volume. They are both integral in the nursing profession. When obtaining information about a patient’s state of health, qualitative research is used while quantitative research is adopted when seeing information from the general public on how they explore certain policies. My academic experience has solidified my overall competency in all the kinds of research. This include development, review and distribution of question. Defining variables as either dependent or independent, statement of hypothesis, analyzing and proving stated hypothesis, and data analysis with the aid of statistical tools like IBM SPSS software. No matter the angle, I have been equipped in the course of my degree to undertake this research processes successfully.

·         4.3. Works with people to determine factors that affect or potentially affect the health and wellbeing of people, families, communities, and/ or populations and determines priorities for action and/ or for referral.

Just as is applicable in other fields, teamwork is very important in the nursing field. This is because it helps to develop cohesion, innovation and creativity in the produced outcome. Two heads they say are better than one; thus, multiple heads would be the best of all. Teamwork is very important as it allows tedious works that would generally require high volume of time when conducted by an individual to be performed easily within a short period of time.

In the course of my study, I have been assigned to work with different teams (either directly or indirectly), and I have been the team head in many cases. Therefore, I have been carefully trained on how to work in a team and help the team in the course of developing desired outcome from any experience. In my nursing professional, I think this will significantly help me in meeting the above standards. This is because I can easily assimilate information being disseminated in the group, assess the weight and regroup based on level of importance, conduct necessary analysis and derive new conclusions that can aid the group achieve set goal. From a personal sphere, I can also gathered information from large group of people (such as families, communities, populations etc.) at ease I have a comprehensive understanding of the steps applicable in such settings (such as questionnaire, phone interview, online interview, face to face interview and different kind of sampling methods). In essence, I am fully capable of meeting the standard set this subsection in my future workplace as a nurse.

·         4.4. Establishes the need for nursing action and/ or the need for referral

For every profession, the professional are limited in a number of ways to the things that they can undertake.  In line with earlier understanding, the health care profession has changed in a number of ways over the past decades, creating new specialty and complex jobs that demand new specialists (Australian Nursing and Midwifery Accreditation Council, 2012). Additionally, the focus of every healthcare professional should be on improving consumers’ health, which implies that this profession is not such that should be based on guess work or gut feelings (Nursing and Midwifery Board of Australia, 2014). Only facts can be used in the course of delivering services to consumers in this profession.

I have been clearly taught on the need of limiting my services in areas where my profession is deemed limited. In order to ensure that the overall quality of lives of the consumers are maintained, I must only undertake parts that reflect my own understanding and profession, while directing or referring them to other consultants or professionals in the healthcare system in areas where my competence (or skills) are not reflected. This is very important because it allows the professionals to deliver enhanced quality to the consumers are experienced practitioners are accorded necessary tasks of handling issues in their areas of specialization. The essence is that it will improve quality of services and enhanced overall safety of consumers’ health. It is clearly a professional and ethical thing to do, and I clearly understand the need for such from my academic experience as a student of nursing and midwifery.  

·         4.5. Assesses the available resources to address the need and plans accordingly.

In my study, I have discovered that there are numerous sources of information for the professional nurse. Effective evidence based practice is considered an important aspect of the nursing profession. If nurses are to demonstrate credibility, they must be able to showcase overall competence with applying evidence in their practices. This will also help to improve the quality of services as things that did not work in the past will easily be ignored and focus shifted on those that have been proven to work (Nursing Times, 2007). Additionally, evidence based practices help to improve the confidence level of nurses. Evidence can be sourced from varied materials like: Textbooks – they contain information about rigid facts (e.g. gross anatomy), and summary of recent and complex practices (McKibbon & Marks, 1998). Journals offer the right forum for sharing of experences gained through learning in the nursing profession (McKibbon & Marks, 1998). Nurses can also access bibliographic as it provides citations on original studies as well as successful practices within the field (McKibbon & Marks, 1998). Basically, different sources of evidence exist in the nursing profession, and nurses should access them in order to ensure that that poor practice measures are eliminated. My experience as a nursing student has not only shown me the sources of information for nursing practitioners, but has also taught me how to gather these information and analyze them to form realistic meaning in the course of my professional life.

Standard 5: Develops a plan for nursing practice

In this standard, it is highlighted that registered nurses are accountable for planning and communicating nursing practices. Any plans agreed must be made in partnership. They are to be based on a comprehensive assessment, proof and decision that are recognized and communicated to the pertinent individuals. This is based on the following criteria as reflected in my personal experience as a nursing student

·         5.1. Uses assessment data and best available evidence to develop a plan

In the standard 4, it was noted that data and evidence as necessary in the course of assessing the quality of information obtainable within the nursing profession (Sackett, D.L., et al., 1996). The importance is reflected on the understanding that quality of services will be improved in the process, and consumers’ health will be made much safer. Still in line of my demonstrate skills when it comes to data gathering and analysis, my academic experience has equipped me with relevant for assessing available data and basing nursing plans on evidence.

In line with some of my courses, the general purpose of nursing plan is to service consumers better and provide them with higher security when it comes to the quality of treatment they are accorded. Thus, health plans must be based on evidence (Australian Institute of Health & Welfare, 2013). These evidence can be gathered directly from the consumers visiting the hospital or by going out and sourcing information from the general public. I have performed this in varied cases as is mandated by some of my assessments and projects throughout the course of undertaking my degree. Thus, I am more than capable of meeting this standards as I understand the value it will present in cases where it is properly meet.

·         5.2. Co-constructs nursing practice plans until priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

Goals are the definition of what one expected from any activity undertaken. In the nursing sector, the general good is quality health care that is not biased, discriminating or preferential, in order to ensure that consumers quality of life is enhanced in the process. Thus, goal setting goals is very important as a student and a professional in the future.

In my courses, I have been taught how to set both short-term (instant goals for instant expectation), and long-term (higher goals with higher expectations). The method I am most familiar with is SMART Objectives. Smart is an acronym for Specific (strategic), Measurable, Achievable, Realistic and Timely. That is to say, the goals must have specific objectives it aims to achieve, the objectives must be measurable (quantifiable), achievable (feasible or viable), realistic (something that fits perfect within the domains of the person setting such objectives), timely (have a framework of time for which the objective must be achieved). Overall, I have been equipped with necessary skills and competence from my studies and I will easily deliver this standards in my practical working life.

·         5.3. Documents, evaluates and modifies plans to facilitate the agreed outcomes

Documentation, evaluation and modifications are important in the sense that documentation makes it easy to reference the plan, evaluation analysis the extent of such plan being achieved, while modification aims at eliminating barriers that can hinder such process in order to ensure that than set objectives are aligned with overall approaches to deliver the target at the end of the day.

This paper is a clear example of my competence when it comes to document, evaluating and modifying plans in order to deliver expected outcome. I have been greatly taught by my wonderful professors on cohesive and comprehensive writing, detail analysis and other aspects of documentation with a few on the importance in future. Thus, I am competent when it comes to this standards and I can easily meet whatever criteria contained in-herewith.

·         5.4. Plans how practice will be evaluated and the time frame of engagement

·         5.5. Coordinates resources effectively and efficiently for planned actions

The two basic features in the planning process of practice evaluation are budgeting and time schedule. Other functions such as definition of responsibility and approaches are also vital. In budgeting, the plan determines the amount of resources (both financial and non-financial) that must be invested in the process in order to deliver desired practice. Time scheduling on the other hand focuses on allocating time for different tasks. Additionally, the individual to undertake each process as well as the methods to adopt are also necessary.

In line with the reflection of 5.4, I have clearly demonstrated this competence by planning this work carefully, budgeting necessary resources and delivering it on time. Thus, I can competently deliver the expectations of this standards in my future work place as a professional nurse.

Standard 6: Provides safe, appropriate and responsive quality nursing practice

This standard highlights the importance of registered nurses being able to delegate and implement self-centered, and ethical goal directed actions (Nursing and Midwifery Board of Australia, 2013). It is based on a ample and methodical assessment, and adopting the finest obtainable evidence for the purpose of attaining desired planned outcomes. They are based on the below reflected criteria.

·         6.1. Provides comprehensive safe, quality nursing practice to achieve agreed goals and outcomes

The overall objective of the nursing profession as indicated in earlier understanding is to offer quality services that guarantee consumers’ heath safety. I understand as well as believe strong in the importance of ethics within this profession as demonstrated on earlier discussion that I will recommend patients to the right referrals once their issues are beyond my professional practice scope.

·         6.2. Practices within their scope of practice

Similar with the 6.1 case above, my academic experience has dully instilled in me, the need to always undertake practices that fall within my scope and recommend non-related practices to the appropriate professionals. As such, I am more than confident that I will meet this standard as it relates to the need to offer quality services that will enrich the health of consumers.

·         6.3. Appropriately delegates aspects of practice to enrolled nurses according to the enrolled nurse’s scope of practice and/ or others according to their clinical or non-clinical roles

·         6.4. Provides effective timely direction and supervision to ensure that delegated practice is provided safely and correctly

In the course of delivering 6.1 and 6.2, the above cases of 6.3 and 6.4 must always be put into practice. I will only recommend the consumers to the professionals that fall within the scope of their health issues. I also understand the importance of time when it comes to health care service delivery and I will ensure that I effect necessary assessments and reach conclusions as fast as possible. This will offer needed health safety to the consumers.

·         6.5. Practices in accordance with relevant nursing and health guidelines, standards, regulations and legislation

·         6.6. Reports and raises concerns where own or others’ practice may be below expected standards, errors have occurred and there is potential for harm.

Earlier discussions indicate that the above standard is the generally acceptable standard in the Australian nursing profession. I understand every aspects of it from 1-7 and I have read cases where they were applied as demanded by the various courses undertaken in the process of graduating with a bachelor degree in nursing and midwifery. With the standards clearly understood, I am more than confident that I will do whatever is necessary within my power to always adhere to such standards. In cases where I face issues within my profession, I will effect necessary reports in order to help provide solutions to such issue a deliver better quality services in the future.

Standard 7: Evaluates outcomes to inform nursing practice

The assertion here is that registered nurses need to take responsibility when it comes to evaluating practices based on agreed terms, planning and revising practices accordingly (Britt, H., et al, 2004). It is based on the following reflected understanding.

·         7.1. Evaluates and monitors progress towards expected goals and outcomes with people based on agreed priorities

·         7.2. Revises practice plan as needed and determines further priorities and goals with people as indicated.

In cases where nurses undertake their profession without recognizing set standards, it is possible that they might remain unconscious of the impact of such on the lives of consumers (Iloka, 2014), and it makes it important for nurses to follow set standards in order to avoid such risks (Nursing Times, 2007). Thus, nurses must always look back at some point in their professional lives to reflect on what they are doing and ensure that process adopted are in line with set standards.

This process entails monitoring and control. The importance of monitoring is to ensure that what is being undertaken is actually what is desired, while control has the responsibility of limiting deviation from the actual objectives. Thus, it can be seen that the potential of a nursing practitioner to achieve set goals does depend on the competence of such person to monitor and control the goal delivery process. I am competent in this area as it helped me to successfully delivery the objectives of this paper. That is to say, I am confident of meeting this standard in the future.

Conclusion

From the above discussions, it can easily be visualized that meeting the set nursing and midwifery standards are vital. The overall objective is to ensure that the quality of services offered is enhanced and health of consumers made safer. In the conduct of ethical practice, it is important to ensure that fair and non-biased decisions are taken. As such, nurses must constantly review available resources and adopt them when delivering assessments on the need of their consumers. As indicated from the above analysis, I have been equipped compressively, through my academic life, on the necessary competence and tools required to deliver an effective and efficient nursing practice. Thus, it is expected that I will be able to enhance overall quality of services offered by the Australian nurses through the direct and indirect exercise of these competence and tools for the greater health benefits of the consumers.

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