The Nursing Practice Processes - Essay Example

?Reflective research Reflective research Introduction Reflective research guides nursing practice processes. Critical awareness of problems and theirsolutions through evidence –based practices helped to improve the quality of care provided by nurses (Taylor, 2001). The complex, diverse, interpersonal relationships that nurses cultivated with patients facilitated positive outcomes. Skilled nurses had a broad base of knowledge which they acquired through reflective processes including research. Delivering quality care became wrought with chaos and constraints which nurses had to overcome through their own efforts. Various models of reflection had been postulated for the benefit of nursing. Nurses attained professionalism by the concept of reflections. They analyzed past occurrences and experiences and learnt from them. Reflection may be defined as “the ability to reflect into past experiences for the purpose of continuous learning” (Schon, 1983). The reflective processes assisted systematic problem-solving in a stepwise manner. Reflective nursing was a learning on-the-job where nurses were able to learn from past incidences apart from the theoretical knowledge. Experience was insufficient to provide a learning process. The experience had to be combined with reflection to bring out subtle details to enhance the learning process (Boud et al in Horn and Freed, 2008). Journaling had been advocated for closing the gap between theory and practice (Horn and Freed, 2008) Writing down notes after a particular experience or daily reflections helped a nurse develop the critical thinking process. Nursing students could consider the experience with each client as unique and record the experience in the journal. Metacognition had been recognized as another method to modify the learning experience (Horn and Freed, 2008). When a group of students had an experience concerning a single client or event, their experiences and interpretations could be different and sharing them with each other could produce enhanced learning and enriched reflections (Boud et al in Horn and Freed, 2008). Active learning was possible through dialogue and helped retain information for longer periods. Models of reflective practice Various models had been identified for the learning process through reflection. Gibbs’ model of reflection (1988), John’s model of reflection (1994) and Kolb’s learning cycle (1984) were different learning models for nursing. The following is Gibbs cycle. Figure 1 Gibbs Model of Reflection Description What happened? Action Plan Feelings If it arose again, What were you what would you do? thinking and feeling? Conclusion Evaluation What else could you What was good and have done? and bad about the experience? Analysis What sense can you make of the situation Gibbs’ model helped nurses learn from reflections. The description of what had happened provided the details of the day’s incident. The emotions that accompanied the incident expanded the circumstances under which it occurred and how one responded. Positive or negative emotions could have accompanied the incident. The evaluation of the incident contained the reason for it happening. This could further be analysed to infer how that event should have turned out had you been an experienced nurse and acted in another manner Analysis enabled one to argue how the outcome could have been improved and made different. This led to the conclusion. Using this conclusion the nurse could plan the action for the next time such an incident was repeated. With that she could make an imprint in her mind which she could use later. When the new incident happened, it would similarly help her through the steps of the Gibb’s cycle and produce more learning. A novice nurse who used this cycle for her learning process could reach competency very early in her life as a nurse. The incident which stimulated the research The memory of Mrs. Lopez, a 69 year old grandmother, recovering in the rehabilitation ward and who had a fall still upsets me. It was a terrible and avoidable incident that made me feel guilty for not providing ample changes in the ward. I had been on duty and she was my responsibility. She had not waited for me to help her up and was trying to prove that she could walk and manage by herself. This had happened when she was waiting to go home in another week. This poor lady sustained a fracture head of femur and had a setback to her walking prowess. The fracture was attended to and she was transferred to the orthopaedic ward. This incident upset her a great deal and she soon developed depression and her physical condition deteriorated. Her demise followed not long after. How to prevent elderly falls The risk of falling could be reduced by an exercise program which improved the sense of balance and made the patient stronger (Preventing falls, CDC). Tai chi was an exercise form which improved balance and coordination among the elders. Inappropriate or lack of exercise made them weak and prone to falls. As a nurse, my job was to provide the advice on exercise by cultivating good interpersonal relationships with the elderly. The surroundings needed to be safer to prevent falls (Preventing falls, CDC). Clothes or rugs or shoes were things that could be tripped over. Rugs could be kept in place using double sided tapes. These may also have to be removed to other places. Items which the patient needed frequently must be placed in a box or cabinet within reach and not in an unreachable high position. Grab bars needed to be placed where the elderly patient had to walk or get up from the bed, in the toilet and the shower (Preventing falls, CDC). Non-slip mats had to be used in the bathroom and shower. Lighting needed to be improved as the vision in the elders had a chance of being bad. Frosted bulbs and lampshades could reduce the possible glare (Preventing falls, CDC). Staircases needed to be lighted well and handrails had to be placed. Shoes selected for the elderly needed to be strong and have non-slip soles. Slippers and athletic shoes must be avoided (Preventing falls, CDC). The medicines being taken by the elderly person must be checked once in a while to know if elders were taking the right medicines in the right dosage (Preventing falls, CDC).Some medicines produced different actions or reactions in the body even after the patient had been taking them for a long duration. This was because the actions could change in the elderly who usually had some alterations in metabolism. The concepts of how a fall could occur is shown in the next page. Figure 2 Concepts for elderly falls. Figure 3 Concepts for Prevention of elderly falls indicating multidisciplinary approach . Vision of the elderly had to be checked frequently (Preventing falls, CDC). Adequate support from the family and community could help in the patient being visited and looked after. If necessary supervised care may be instituted. Preparation for aging included the setting up of an elderly-friendly atmosphere at home or in nursing homes. Social support could help them through their aging days. Medical insurance could provide for their care in the event that some emergency occurred. Concept mapping was discussed in Trochim’s article (1989). My knowledge on the subject greatly improved. Methodology The search began in the databases for nursing and behavior science. Cinahl Plus with full text and the Medline database provided the relevant literature. However the selected literature articles were both from Cinahl Plus. The Medline articles did not meet the criteria looked for. The main keywords used were “elderly” and “fall” with the truncation “prevent”. The articles that I could select from numbered 546. When I narrowed the selection, the number available was 232. When I added additional rows to the selected articles by adding hospital or community, there were very few articles. The use of advanced search and Bolean tools like peer -reviewed and full text revealed some articles which I searched through visually and selected two out of them. “A framework (conceptual or theoretical will typically be found in a chapter of its own, often sandwiched between the literature review and the methods section. This was apt, as an effective framework acts as a bridge between what has gone before the theory and what is to come –the prospective study” (Crooks & Davies, 2004) Analysis of the research articles selected Corsinovi , L., Bo, M., Aimonino,N.R., Marinello,R., Gariglio, F., Marchetto, C., and Gastaldi, L.et al (2008). Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Archives of Gerontology and Geriatrics 49 (2009) 142–145. Elsevier. The believability of the research could not be questioned as the report had been written well considering that the researchers were qualified nurses who were lecturers in the School of Nursing and Midwifery in the University of Dublin. The purpose of this qualitative longitudinal observational study had been clearly identified. The title was very clear, accurate and unambiguous. The abstract did not have the usual sub-headings of sample, methods, etc. However the information had been added in a haphazard manner. Elderly falls were the phenomenon of interest. The study was the evaluation of fall incidence, the predictors and features of the falls. Hospital outcomes were also explored. The ethical requirements were fulfilled and approval had been obtained. The significance of the study was the improvement of patients’ global health status and the planning of ideal preventive strategies for achieving this and the reduction of medical costs for their care. A small amount of literature had been selected for the background or introduction but no literature review was evident. Information from only six articles from 2004 to 2007 had been chosen. Literature regarding elderly falls could be just a handful, hence the lack of literature review. No theoretical framework or philosophical underpinnings had been identified. Theories were generated. Ethical considerations could have been practiced but this was not found in the report. Approval for the study was shown. 620 elderly patients were the samples selected. There was no reason for harming the elderly patients. The report did not include information on the confidentiality of the patients. Data collections were done by using questionnaires. Rigour of study was not mentioned. The findings had been appropriately discussed. The original purpose had been achieved. Generalisation was not possible as only a selected population had been involved. Hendriks, M.R.C., Bleijlevens, M.H.C., van Haastregt, J.C.M., Crebolder, H.F.J.M., Diederiks, J.P.M., Evers,S.M.A.A. et al. (2008). Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial. JAGS 56:1390–1397, 2008 . The American Geriatric Society. This study was a randomised controlled trial and the report was better for being grammatically correct than the earlier one, the authors being epidemiologists working in the University of Maastricht. The abstract was clear and had all the headings of objectives, design, setting, participants, intervention, measurements, results and conclusion. The reader got a clear idea of the research and would be tempted to read the rest of the report. The title was precise. The purpose of the study was accurately identified. The logical manner of the report was impressive and the links were clear. This study also avoided a literature review. A study in London was to be replicated in the Dutch Healthcare system. No specific framework was mentioned. Aims and objectives were clearly stated. The sample was 333 patients who were randomly assigned to two groups: intervention group and the control group. Ethical principles were followed. Fall prevention programme was the intervention. Data analysis was done using SPSS version 1.3.and strategies were described. The researchers had described how rigour was maintained. The findings were aptly delineated. The implications were also mentioned. Five recommendations had been suggested for improving the lines of the study in the future. The conclusion was that the multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in the Dutch healthcare setting. Conclusion Reflective nursing enabled nurses to reflect on an experience and learn from it by critically analyzing the situation. The next step was to explore what could have been changed to improve on the outcome. “Reflection is an important human activity in which people recapture their experience, think about it, mull over it and evaluate it. It is this working with the experience that is important in learning” (Boud et al in Horn and Freed, 2008). These words of Boud correctly convey the message about reflections in nursing. References: Crooks, PA & Davies, S. (2004). Research into practice: essential skills for reading and applying research in nursing and health care, Bailliere Tindall, Edinburgh. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Brookes University. Horn, V.R. and Freed, S. (2008). Journaling and Dialogue Pairs to promote reflection in clinical nursing education, Nursing education Perspectives, July 2008, Vol. 29 (4): 220-225 Proquest Nursing and Allied Health Source. Johns, C. and Graham, J. (1996) Using a reflective model of nursing and guided reflection. Nursing Standard, 11(2), pp.34-38 Kolb, D.A. (1984) Experiential Learning: Experience as the source of learning and development. New Jersey: Prentice Hall. Preventing Falls Among Seniors, NCIPC, http://www.cdc.gov/ncipc/duip/spotlite/falltips.htm#1 Center for disease control and prevention Schon (1983) (cited in Greenwood, 1998)“Thus teaching relies on the practice of reflection, and reflection ‘in’ and ‘on’ practice has been adopted as a learning process by many nursing programs at both undergraduate and graduate level” it is the strategy of keeping a reflective e diary has been widely adopted. Taylor, B. (2001). Identifying and transforming dysfunctional nurse–nurse relationships through reflective practice and action research. International Journal of Nursing Practice 2001; 7: 406–413 Trochim, W.M.K.. (1989). Concept mapping: Soft science or hard art.Evaluation and Program Planning. Vol. 12:87-110 Pergamon Press Publishing Read More