This year Monash University’s Nursing and Midwifery school in Victoria offered two new units to internationally qualified nurses to help them provide safe, high-quality and competent nursing care in Australian healthcare settings.
The first unit aimed at facilitating knowledge and understanding of the Australian healthcare system and nursing frameworks for the delivery of care (NUR5113 Unit Guide 2019).
The second unit aimed at facilitating the transition into the Australian nursing workforce.
It was designed to facilitate the development of nursing knowledge and skills necessary for practice in the Australian context (NUR5112 Unit Guide, 2019).
At the conclusion of the units, the students were asked about how they might practise abroad having studied in Australia.
Five nurses, from India, Kenya, and the Philippines, submitted their reflections.
A summary of their responses reflecting the significant lessons they learnt from their training included:
1) practise person-centred care;
2) prioritise patient safety;
3) focus on accurate and timely communication;
4) implement best practice; and
5) bridge the gap between nurses and doctors.
Practise person-centred care
The nurses said they would implement practice centered care. They took this to mean partnering with patients to meet their needs, and allowing them to think and make decisions about their care. Person- centered care is also about giving patients authority and voice, and considering their desires, families and relationships (Health innovation network, n.d.).
In short, this approach allows patients to be managers of their health!
Below are statements made by the nurses depicting this concept:
Nurse 1: … with limited staff and limited resources [from back home], the “person-centred care” concept will be the first thing nurses will tend to neglect. … However, proper explanation, effective communication, therapeutic relationship, and psychological support are essential.
Nurse 2: … it would be hard for an Australian-trained nurse to get adjusted in that environment. Australian nurses are more patient-centred [than local nurses].
Nurse 3: The nurse-patient ratio in public hospitals is horrific, so there is no time for person-centred care which is practised here. This means no proper patient assessment, implementation, poor documentation, no evaluation, let alone time to critically think. I will allow patients to participate in their care.
Nurse 4: One concept I would love to put to practice is the Patient Partnership. Usually, the patient relies too much on the doctors and nurses to decide on their health. Empowering patients to be proactive in deciding for their health is an excellent way to increase patient cooperation and positive outcomes.
Prioritise patient safety
After finishing the Australian Nursing Studies units and learning the standards of practice of nurses in Australia, these cohort of nurses concluded that patient safety will be a challenging task for them to apply in their countries of origin. They determined that patient safety and their role in minimising the incidence and impact of adverse events, and maximising recovery from them is a priority. The areas covered are many (Becker’s Hospital Review, 2015), and the nurses named some of these strategies:
Nurse 3: … Make patient identification a priority as this is the first step to safety. Prioritise medication safety by providing specific storage (locked medication room). Additionally, encourage incident reporting. The close collaboration of nurses will ensure patient safety.
Nurse 4: A bedside handover will boost patient safety and ensure that the patients are aware of their plan of care. I will suggest also the use of a lifting machine such as a hoist. Majority of the hospitals in my country only use pat slide and sliding sheet when transferring patients. Lifting machine can help protect nurses and patients.
Nurse 5: As what I have learned and practiced in the Australian setting, there must be two RNs checking the drugs. I would like to implement and influence my colleagues to practice this to prevent and eliminate medication errors.
Emphasise accurate and timely communication
Effective communication is central when building a therapeutic person-nurse relationship. The nurses rightfully identified this aspect of practice as paramount when providing high-quality health care and achieving good health outcomes. Much conflict and dissatisfaction are due to breakdown in communication and relationships (Australian Commission on Safety and Quality in Health Care, 2016). The nurses describe this core clinical skill as follows:
Nurse 2: But I will be more patient-centred and will be very good at communicating with patients.
Nurse 3: Other issues I will focus on are empowering nurses to advocate for patients, encouraging communication and feedback, listening to patients, and spending time with them. Furthermore, I will utilise “reflection” as a means of learning.
Nurse 5: Another thing that I would like to improve on is the clinical handover of nurses. … As an Australian-trained nurse, I learned to utilise the ISBAR. It is more succinct and focused type of handover so as to save time that could be used for direct nursing care instead.
Implement best practice
As Australian-trained nurses, these nurses aimed to incorporate the standards of nursing practice of Australia into patient care. They valued the evidence-based approach that integrates the best available research evidence in clinical practices.
Nurse 3: I will suggest the following practices: Abandon the use of restraints, especially in mental health and delirium patients. Include discharge planning and community-based care. No one ever asks patients “Are you okay to manage on your own?” This explains the difference in mortality rates and the life expectancy between the two countries.
Nurse 5: If I were to practice in my country of origin, I would like to reinforce the use of anti-embolic stockings for patients who are at risk for DVT. I would like to give emphasis on early ambulation and discharge. Moreover, I would like to impart my knowledge about managing different types of wound and the care and dressings that different wounds require for healing.
Bridge the gap between nurses and doctors
The positive and smooth relationship between the nurses and doctors was noticeable to the nurses. The interpersonal interactions were healthy, constructive and helpful in creating a positive atmosphere at the workplace. Unlike some previous experiences where “Doctors tend to manipulate nurses, so there is tension which exists between those two professions” according to Nurse 1, they were impressed that Australia nurses were held in high esteem, respected, and were not viewed as handmaidens.
Nurse 2: … However, for an Australian trained nurse, it would be very tough to go there [country of origin] and work. Because in Australia, people appreciate whatever nurses do for them and thank them for their efforts. Doctors and nurses have their standards, and nobody is inferior or superior. Nursing is one of the most respected professions in Australia.
Nurse 4: I was also empowered as a nurse by this program. Before, I rely too much on the doctors’ orders when taking care of my patient. I do not question the decision of the doctors. Now, I will critically think first the rationale and the benefit of my nursing intervention. I am more confident to face the different challenges in my profession.
Reynold Lim, Daphine Moseti, Ganga Nair, Navneet Navneet and Sheen Rombano are successful Australian Nursing Studies students. Dr Joy Penman is a Senior Lecturer from the Monash Nursing and Midwifery.
Australian Commission on Safety and Quality in Health Care. (2016). Patient-clinician communication in hospitals Communicating for safety at transitions of care. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/Information-sheet-for-healthcare-providers-Improving-patient-clinician-communication.pdf
Becker’s Hospital Review (2015). 10 top patient safety issues for 2015. Retrieved from https://www.beckershospitalreview.com/quality/10-top-patient-safety-issues-for-2015.html
Health innovation network. (n.d.) What is person-centred care and why is it important? Retrieved from https://healthinnovationnetwork.com/system/ckeditor_assets/attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf
NUR5112 and NUR5113 Unit Guides. (2019). Retrieved from https://unitguidemanager.monash.edu/view?unitCode=NUR5112&tpCode=S2-01&tpYear=2019