The Value of Nursing Students Work - Assignment Example

The Value of Nursing Students’ Work 1.0 Introduction: Being a nursing student myself, I have conducted this paper to analyze my work based learning experience in nursing education. I have made this report with special relevance to my personal and professional growth during this training program without surpassing the NMC defined standards. Experience is pertinent part of education for nursing students as they have to confront challenges related to patient care in real world health settings (Daly, 2005, p.336). Like most trainees I was also unclear about my role, had little confidence in my abilities and was scared of the risks involved in practical application of my knowledge. As practice based learning is linked to the learning activities that require application of theories in a practical work scenario; it provided me the insight of the workplace which could not be achieved by sitting in a lecture room. Cherry et al. (2005) proposed that effective communication is the core of nursing profession. Keeping this in mind I have tried to analyze my communication skills developed, as part of the training session, by issuing handover reports to the nurses on the next shift. I have also made an effort to appraise the level of improvement in my listening skills. Through reflection I tried to summarize my personal and professional development during training. 2.0 Development: 2.1 Handover/Communication assessment: It is a process in which nurses’ team delivers the information about the patient’s care to other nurses normally as the shift changes. It usually focuses on the nursing care plan (Smith, 2004, p.4). Continued reflection on my experience enabled me to assess that handover is one beneficial way of communicating with other nurses. 2.1.2 Essential components of handover: Through handovers nurses are better able to conceive the patient’s condition. Before this work based learning experience I used to make disorganized handovers but by the end of this shift I have witnessed several handovers instructed by the senior nurses and now I am proficient enough to develop a concise hand over in time. During my experience as a trainee nurse, I have seen nurses making unstructured handovers that were a total waste of time as they indicate patient’s information in a biased manner. The time assigned to submit a hand over was usually limited. Attendance was also mandatory at the time of handovers. According to me the current handover practice was efficient as I never witnessed the time of handover process changed. Handovers also formulates a way for personnel education and debriefing (Jones & Bourgeois, 2006, p.155).Nurses used to exchange handovers informally thus bridging communication gap with each other as well as sharing the stress of co-workers. Latimer (2003, p. 105) indicated that this process make nurses able to experience their emotions that are understood by a group of colleagues so that they feel their work stress has lessened. They rely on the information of patients from “previous shifts and communicated these matters to each other as they paired to do routine rounds” (Latimer, 2006, p. 41). Nurses must have a considerable knowledge of anatomy and physiology (Daly, 2005, p. 123). When I began my training in the work place setting, the main issues that I encountered were due to my lack of medical knowledge but as my professional growth continued I learnt basic terminology that later helped me in conducting handovers and examining patient’s symptoms. At the initial stages I regarded handovers as a complex activity because I had difficulty in understanding some medical terminology and abbreviations but with the passage of time I have learnt to clarify the patient care information as a student nurse. 2.1.2 Handover submission: I have observed and practiced that handovers were submitted at the hind bed space of the patient. “Bedside handovers allow for greater patient involvement as the nurse taking over the next shift can put a face to the name and remember more easily who is who”(Thomas, 2006, p.90) Latimer (2006, p.32) said that handovers in nursing may be termed as “one way communication channel as information and instructions go down, along or up the hierarchy”. Usually ward matron supervised hand over circulation. The issues of concern were that the patient’s information should be kept private. Confidentiality of patient’s data is a primary concern while making handovers (Ely & Ian, 2007, p.92) I tried to maintain this exercise in practise. Because of this reason after the completion of my training I approve that the placement of handovers at the end of patient’s bed is a not a good gesture to keep the information out of earshot distance. 2.1.3 Confidence: My experience as a student nurse has undergone a great upheaval in terms of gaining confidence. Practise of pertaining knowledge in the real world helped me to become more apt at dealing with patients. I have learnt to manage clinical time while processing handovers and get prepared for handling tight situations. Professional development progressed from being dependant on the instructions of the supervisor to gaining self confidence and showing independence in actions. 2.1.4 Prioritizing duties: Work based learning has taught me to make a schedule that will comprise my day to day activities. My mentors helped me a lot especially by teaching me how to present a handover and told me how and when the interim and final evaluation will take place. The major transition being that now I am able to jot down the important excerpts rather than all that is being told by the senior nurses. 2.1.5 Communication Skills: Crawford et al. (2006) have provided guidelines for effective communication by following which nurses and other health professionals can enhance their communication in a clinical setting. In the light of these instructions I came to know that I was not apt at dealing with patients in some specific situation e.g. while introducing myself to them or taking handovers for the new arrivals. When I progressed to third year my professional development improved as well as my ability to communicate well with relevant others. As mentioned by Smith (2007, p.19) listening skills encompass the use of gestures to convey a message that you are aware of what the other person is saying. The nurse should maintain a relaxed posture and friendly eye contact with the patient. It will encourage the patient to explain his position in a better way. This practise really helped me in coping well with the patients while taking handovers. According to me communication unpins everything we do within nursing. Being a mature student I believe that I have managed to attain good communication skills with time that are needed for excellence in my profession. Efficacy expectations are derived from emotional arousal (including psychological states like anxiety) and vicarious experience through observing another person” (Rosen, 2000, p.232). These I have learnt through experience when I promptly informed a qualified nurse that the condition of an acutely unwell patient in the gastroenterology ward is worsen. If I wouldn’t be able to express my views at the right time the patient might have expired. First year students would just have noticed the vital signs but couldn’t convey their expression through words to the authorized nurses, that’s what experience teaches. As the role of nurses require a constant and intimate contact with patients, their relatives and clients, therefore communication skills are very important. “Reynolds et al. (2000) suggest that more attention should be placed on the relational and therapeutic communication whilst Stevenson et al. (2004) propose the need for more person-centered communication skills” (McCarthy et al. ,2008, p. 213). “The shift handover is a crucial period for maintaining communication and continuity of care (Thomas, 2006, p.89). The teaching methods that were given importance in the training were influenced by the humanistic approach to teaching and learning consisting of group works, role play, personal development diary (PDD), video recordings and feed back (McCarthy et al. ,2008, p. 213). 2.2 Reflection: The legitimate aim of reflection is to convert experience into learning(Smith, 2004, p.27). In third year, through reflection, I was better able to perceive my personal capabilities and analyze my weak points. Suhre & Harskamp (2001) indicated that reflective learning is a useful experience for students as they do report positive changes in their practice. It is through reflection that I made analysis of the safe care I was intended to provide to the patients. 2.2.1 From Novice to Expert: Dreyfus model of skill acquisition was used as a referral by Benner who deduced how the skill level of even an experienced nurse can reduce to novice level when she enters an unfamiliar situation (Benner P, 1984, p. 13-34). After qualifying as a graduate student I intend to return here in order to gain as much professional experience as possible and then I will be regarded from an expert student to a novice nurse. Patients wouldn’t be able to differentiate me as a new addition to staff and will regard me as someone highly proficient in nursing skills but with the passage of time I will improve my efficiency level in order stand with confidence among my senior colleagues. I will try to remain honest with my profession and tell them my quest for learning, in turn they will be able to understand my position and would respond to my questions enthusiastically. 2.2.2 Evaluation of Theory and Practice: Bolten, G. (2008) suggests that nursing institution should provide evidence based teaching as reflection of the present clinical setting. Hallet (1997) found that as students gain experience they began to observe links between theory and practice, assisted by the supervisors who promote reflection. Glaze (2001) described that students develop greater awareness of what nursing actually is when they “pushed the boundaries of practice and deepened their reflection” using theory and literature to affirm their ideas. My critical reflection improved using Goodman’s (1984) levels of reflection as a basic framework. For professional competence I developed self consciousness as Stein-Parbury (2008, p.60) has rightly stated that through self evaluation nurses remain in touch with what they are doing and how this is affecting patients for whom they care. At the beginning of my training I was being irritated by the continued repetition of certain lectures but now upon reflection, I contradict those feelings. Obviously mentors lecturing on skills like communication, and patient care basics often repeat them as they are the foundation of nursing education e.g. I could never comprehend the significance of research module but it is with the passage of time that I started to understand most of the technicalities. I do feel that my theoretical training was restrained. Students in adult education have to study on their own but still I think the lectures on physiology and neo natal care were not sufficient enough. e.g. during my placement at the Gynae ward I had problems handling new borns. Their can be loopholes in students’ knowledge of anatomy prior to their placement settings which they realize when they face a particular situation relevant to that knowledge. My training was also helpful in the social context. I learnt how to cope with fellow workers as sometimes we were assigned duties in the same wards. We used to share our experiences as most of our learning issues were of the same nature. Graham (2000) studied group reflection and found that “supportive elements of group discussion and analysis as well as the difficulties of revealing thoughts and feelings” adjusted students to a more student centered learning approach. Hyrkas et al. (2001) explored that mentor acts as “clinical supervisors” to the group of practitioners in ward settings”. During my last six months of training, students of first and second year considered me more knowledgeable and capable at handling diverse clinical situations. This was mainly due to the highly encouraging mentors I had in my third year who valued me as an individual, answering all my queries relating to practical nursing. Reflection on my work base training reveals that getting a mentor who is able to convey her expertise to the students is only by sheer luck. Most of the student nurses including me have at least one time suffered at the hands of a not-so-concerned type mentors. In my first year I happened to have a mentor who was not willing to let me take patient’s blood pressure and do bandaging of severe condition patients with the assumption that I could not do it the right way. In a nutshell I consider that a gap still exists in theoretical knowledge and its practicality. Scanlan et al (2002) found through research that more experienced teachers know how to establish the missing link between theory and practice. Student nurses have to be well informed about the nursing theory to have a pragmatic acumen in work place setting but with proper knowledge, the role of mentors in honing nursing skills cannot be neglected. 3.0 Conclusion: Work based learning focuses on the learning process itself, by initiating self evaluation; I perceived a new understanding of my surroundings. Thus personal experience becomes the foundation step for constituting learning and traditional education takes a back seat. Work based learning facilitates mentors to give a better understanding of the theoretical concepts learnt in nursing education. I remember that I kept on being irritated by the constant repetition of the basic nursing theories when the senior nurses gave lectures but they later turned out to be fruitful. Furthermore the workplace should provide practitioner a welcoming atmosphere to begin his professional growth. Practice provides the trainees personal and professional competence. It also enables them to deal with critical situations and to provide better care to the patients. If all the contextual factors that affect professional development are well managed, work based learning approach has the niche to bring tangible benefits to the organisation, patients and practitioners alike (Clarke & Copeland, 2003, p.244). Properly executed preceptorship training can help to bridge the gap between theory and practise as what was taught in lectures about dealing with a patient could be extremely opposite in the real hospital setting (Morgan-Eason, p.80). The benefit of practice is that the trainee receives hands-on instruction from someone knowledgeable in the field- the mentors. Good mentors in turn inculcates autonomous attitude in student nurses, giving them confidence to act swiftly as the situation demands. (Morgan-Eason, p.80). During my work based learning experience I came across a number of mentors, some of whom were very influential and challenged me to get my self practically involved in tasks. 4.0 Recommendations: Clinical teachers need to make the learning more explicit by identifying work place cultures and practices and helping trainees in developing a sense of that. Workplace-based assessment tools can be used to identify opportunities for learning and development through workplace-based activity. Trainees should be assessed periodically so that their competence level is determined and clinical teacher should know whether he lacks in competence or experience. It is also essential to access the trainee’s thinking to make sure he is on the right track. NMC (Nursing and Midwifery council) have performance standards for qualifying nurses (NMC, 2001). As the trainees mostly learn by watching, therefore mentors should make sure that they are explaining the procedures accurately so that there is no chance of mistake. Actively engaging students and trainees will make them feel welcome and will motivate them to play an active part in the team. A learning atmosphere should be created where everyone is provided with an equal opportunity including those who lack the confidence or enthusiasm. A good way to evaluate the training method is determining the patient’s feedback. It determines whether to reinforce practice or seek new methods. Work based learning should aim at improving students’ critical thinking and analytical skills, proficiency in psychomotor, time management and communication skills and to raise their self confidence while performing as capable nurses. 5.0 References Atkins Robert (2008), Getting the Most from Nursing School: A Guide to becoming a Nurse. Jones & Bartlett Learning. Basford Lynn & Slevin Oliver (2003).Theory and practice of nursing: an integrated approach to caring practice. Nelson Thornes Benner P, (1984) from Novice to Expert : Excellence and Power in clinical nursing Practise. California: Addison-Wesley. Bolten G (2008) Reflective Practice. Writing and Professional Development. Paul Chapman Publishing Ltd, London. Chan, D. (2002) Development of the Clinical Learning Environment Inventory. Journal of Nurse Education. 41(2). Cherry Barbara & Jacob Susan R. (2005) Contemporary nursing: issues, trends & management. Elsevier Health Sciences Clarke David J & Copeland L.(2003) Developing Nursing practice through work based learning. Vol 3. Issue 4, Elsevier Ltd. Crawford P. et al (2006) Communication in Clinical Settings. Nelson Thornes. Daly John (2005) Professional nursing : concepts, issues and challenges. Springer Publishing Company Ely Christine & Ian Scott (2007) Essential study skills for nursing. Elsevier Health Sciences. Goodman J.(1984) Reflection and teacher education: A case study and theoretical analysis. Interchange 15 Glaze, J. (2001) Stages in coming to terms with reflection: students advanced nursing practitioners’ perceptions of their reflective journeys. Journal of Advanced Nursing, 37. Graham, I.W. (2000) Reflective practice and its role in mental health nurses’ practise development: a year long study. Journal of Psychiatric and Mental Health Nursing, 7. Hallet, C.E (1997) Learning through Reflection in the community. International Journal of Nursing Studies, 34. Hyrkas, K. Tarkka, M.T & Paunonen Illmonen, M.(2001). Teacher candidates’ reflective teaching and learning in a hospital setting-changing the pattern of practical training: a challenge to growing into teacher hood. Journal of Advanced Nursing, Vol.33. Levett-Jones Tracy & Bourgeois Sharon (2006) The Clinical Placement: An Essential Guide for Nursing Students. Elsevier Latimer Joanna (2003) Advanced qualitative research for nursing Elsevier Health Sciences Marriner-Tomey Ann & Alligood Martha Raile (2006). Nursing Theorists and their work. Elsevier Health Sciences. McCarthy et al. (2008) Person centered communication: Design, implementation and evaluation of a communication skills module for undergraduate nursing students – an Irish Context. Contemporary Nurse Vol.27 Morgan-Eason Andrea, Work based Learning in Nursing Education: The Value of Preceptorships. The Transit Journal Rosen et al.(2000) Associate and Baccalaurateate Degree Final Semester Students’ Perception of Self Efficacy Concerning Community Health Competencies. Public Health Nursing Vol 17 No.4. Blackwell Science Inc. Smith Graeme (2004) Get set for Nursing. Edinburgh University Press. Scanlan, J.M., Dean Care, W. & Udod, S. (2002) Unravelling the unknowns of reflection in classroom teaching. Journal of Advanced Nursing 38(2). Stein- Parbury Jane (2008). Patient & person: interpersonal skills in nursing. Elsevier Sciences. Suhre, C.J.M & Harksamp, E.G.(2001).Teaching Planning and reflection in nurse education. Nurse Education Today, 21. Thomas Jerry (2006) Survival Guide for Ward Managers, Sisters and Charge Nurses.Elsevier Health Sciences. 6.0 Appendix 6.1 SWOT (Strengths Weaknesses Opportunities and Threats) Analysis: SWOT Analysis will help organizers manage their nursing programmes by formulating appropriate strategies that exploit the work environment’s strengths and external opportunities, buffer or protect the concerned group from external threats or even correct serious weaknesses ( Robbins & Coulter, 2008, p.209). SWOT analysis of my experiential learning in a hospital environment revealed that work based learning has a lot to offer. According to me the strengths of the programme included its beneficial nature for the personal and professional development for students. Opportunities for practically applying theoretical knowledge are provided to nursing students so that they no longer hesitate in taking appropriate actions. Mentors are there to guide at every step thus inculcating their experiential training in the future would-be-nurses. Such comprehension is impossible in a classroom setting. Several skills like that of communication, reflection and self confidence are polished in the course of three year training programme. Weaknesses of the program were that sometimes senior nurses instead of playing role models for emerging professionals, tried to hamper the learning development by not trusting internees in dealing with patients. Getting an encouraging mentor is only by sheer luck. Specific behavioural standards are not adopted by senior nurses so that all students get equal share of experience. “Being a nurse is rewarding, exhausting, sociable and a continual learning experience” (Smith, 2007, p. 12). Work based learning programme may suffer from certain threats e.g. if nursing students are not given confidence to handle complex situations, future of nursing as a profession would be in jeopardy. Institutions will produce scholars who would be unable to practically serve the nation for which they were groomed. Read More