Nursing as a Critical Field That Requires Accuracy - Assignment Example

of the West of England Faculty of Health and Social Care Teaching and Assessing in Practice Level 3 Module UZURAR-20-3 Teaching and Assessment Logs Student Identification No: Name: Date: 5 July 2006 Abstract This compiled research demonstrates how teaching and assessments are carried out in the field of nursing. The assessments took place in a medical ward. 1There are various nursing logs which have been studied to gain information into the different areas that are under requirement to be reviewed and assessed for their efficiency and skill level. Nursing is a critical field and requires accuracy on the part of the nursing practitioners in order to guarantee quality care with patients. In this regard, the research defines how important it is that nursing students and nurses already holding a degree remain in the percentile of nurses that are considered to be practicing top-notch effective treatment in the medical field. The conclusion sums up the issues of teaching assessments by presenting the facts on how worthwhile and beneficial they are to student nurses as well as practicing nurses due to how they can guide nurses into utilizing more effective nursing techniques to provide more up to date services and meet the demands of patients. Teaching and Assessment Profile for Log 1 We were a large group, made up of nurses, midwives and radiographers. To enable us all to effectively undertake our micro-teaching session on the same day, we were split into smaller groups of 5 students with one tutor. Our group comprised of adult nurses, all from different wards and specialities. Our group met at the designated time and place allotted to us. It was a large classroom, which when we entered was hot and stuffy and with the agreement of the group, we opened the windows to cool the room down and make it conducive for learning. The desks were moved into a semi-circle to allow a less formal atmosphere. The subject I decided to teach was on fluid management of a patient undertaking C.A.P.D. (continuous ambulatory peritoneal dialysis) as this is a subject that my fellow students had little knowledge. An Overview of the Learning Environment, Philosophy and Rationale for the Teaching The large room where learning on fluid management of a patient undertaking C.A.P.D. (continuous ambulatory peritoneal dialysis) was a conducive environment for learning. Having opened the window to let fresh air made it even better for the learner would be comfortable thereby concentrate on the teaching. One important factor that influenced the learning session was that my colleagues and I have a good working relationship. It made the learning environment more relaxed and conducive. The rationale to use a humorous attitude to a serious topic was to emphasise the need for a humanistic approach when teaching the patient such a daunting subject. Diaz-Buxo, J.A (1996) Identifying the Needs of the Learner The learners were not familiar or had little knowledge on fluid management of a patient undertaking C.A.P.D. (continuous ambulatory peritoneal dialysis). The few learners who had little knowledge of the subject did not understand an exception period when dialysis solutions are being exchanged. When exchange is taking place, the old dialysate is allowed to drain by gravity through the catheter into an empty container. After this is completed, a fresh bag of dialysate is connected to the catheter. The solution flows into the peritoneal cavity by gravity, and the bag is disconnected once it is empty. This process is repeated three to five times daily. Flessner (1997) The students did not also know the techniques for assessing the adequacy of peritoneal dialysis which are controversial. Survival appears to be most strongly correlated with residual native renal function, which is better preserved in patients on peritoneal dialysis than with haemodialysis. It is difficult to provide adequate dialysis by PD for some adults with little or no residual renal function. Properties of the peritoneal membrane differ between patients, and over time in individual patients. 2Episodes of peritoneal infection and responses to dialysate may damage the membrane. This may lead to deterioration of control of biochemistry and fluid balance, and over a long period many patients who start treatment on peritoneal dialysis transfer to haemodialysis. Problems with fluid balance are particularly common. Inadequate ultra filtration (net fluid removal) is an important cause of morbidity, mortality, and treatment failure. Piraino (1996) Outlining the Aims and Outcomes The main aim of teaching about fluid management of a patient undertaking C.A.P.D. (continuous ambulatory peritoneal dialysis) is to ensure my colleagues knows the first step in initiating peritoneal dialysis. The first step in initiating peritoneal dialysis is establishing a viable pathway or access into the peritoneal cavity. A catheter is implanted through the abdominal wall, penetrating into the peritoneal cavity. The Tenckhoff catheter is considered the gold standard, although there are numerous types of catheters to choose from. Doe, J. Q. (1999) The external end of the catheter is usually tunnelled through the patient's abdominal subcutaneous layers, and the exit site is offset from the midline. Most catheters incorporate two cuffs placed above or below the abdominal muscle layers. Scar tissue forms, an adhering cuffs to the surrounding tissue. These cuffs secure the catheter against movement and provide a barrier to the migration of bacteria from the skin into the peritoneal cavity. The success of peritoneal dialysis depends on a functional catheter. It must have a good dialysis flow rate with no leaks and must be secure, painless, and resistant to infection. Tenckhoff and Schechter, (1968) Once the catheter has been implanted and sufficient time for healing has been allowed, dialysate may begin. "Continuous" in continuous ambulatory peritoneal dialysis (CAPD) means that the dialysis solution is always in contact with the peritoneal membrane. Doe, J. R. (1987). As this was a large subject, I used only one aim, which was to highlight the need for fluid control in C.A.P.D. The learners are supposed to listen and follow my steps and the outcome will depend whether they have followed the steps closely when they do it in practice. The outcome was to raise the awareness of the importance of fluid balance and management in C.A.P.D. patient. Stating if a Learning Contract was Set Before the Event No written learning contract between me and the learners due to the spontaneity of the given task. As defined by Ghazi and Henshaw, (1998) learning contract is used to structure the learning experience to meet the needs of an adult learner. Profile for Log 2. When assigned a student nurse to mentor during my placement, we met for our initial interview. We did this in the sister's office and we asked not to be disturbed. This interview was to define the learning outcomes she required to achieve during this placement. The aim was to identify what her knowledge base was and how it could be expanded. It was apparent that her knowledge on fluid balance and fluid management of renal patients was poor, since this was an important part of the patients care; the outcome, became a spontaneous teaching session as I felt it required a full understanding before she commenced working on the ward. Several other assessment areas were identified at that interview and a learning contract was formulated to cover these also. An Overview of the Learning Environment, Philosophy and Rationale for the Teaching Spencer (2003) recognizes that ward settings do not always provide an ideal learning environment hence at the sister's office where I had an interview with my student nurse then was a conducive learning environment. It was essential for the student to have knowledge on fluid balance and fluid management of renal patient since hers was poor. This was important before she commenced working in the ward. Identifying the Needs of the Learner The nurse student I assigned to mentor was on placement at the medical ward and I wanted to identify what her knowledge base was and how it could be expanded. I discovered that her knowledge on fluid balance and fluid management of renal patients was poor. This is usually an important part of the patients care hence she had to be equipped with the knowledge. Cloonan, C.C, Gatrell, C.B & Cushner HM (1990); Outlining the Aims and Outcomes When I was assigned a nurse student to mentor and discovered her knowledge on fluid balance and fluid management of renal patients was poor hence this became a spontaneous teaching session as I felt it required a full understanding before she commenced working on the ward. My aim was to assist the student perform the clinical task and achieve safe level of performance on fluid balance and fluid management of renal patient The outcomes will depend on the success of the task involved. The student followed the step-by-step procedure and with my direct supervision, she was confident to go through the task if required. Stating if a Learning Contract was Set Before the Event There was no written learning contract between me and the nurse student due to the spontaneity of the given task. As defined by Ghazi and Henshaw, (1998), a learning contract is used to structure the learning experience to meet the needs of an adult learner. We agreed verbally that I would directly supervise her when given a fluid balance and fluid management of renal patient's case. Teaching Methods Although there has been a rise in the use of clinical skills laboratories Hilton (1996) (Studdy et al 1994a, 1994b) most clinical skills learning will continue to take place within the clinical placements. That is why opportunities to perform clinical skills in a busy ward setting will all depend on the needs or demands of the patients. Chapman (1990), cited in Charters, (2000) believes that encounters with patients should always form the basis of and also, learning in the clinical environment plays a significant part in the education of student nurses. In teaching a completely new skill, the preceptor need to step back and analyse what is happening in the execution of his skill. Being the mentor and an experienced nurse, I was very familiar with the whole process that I could no longer clearly identify what was to be done when practising this skill. It was useful for both the nurse student and I to break the skill down into its component parts, so that each sub-routine of the skill may be identified. By doing this, I was able to instruct the student in the manual operations required at each step and to identify what essential knowledge was necessary. Curzon LB (1990) Teaching is not only the preceptor's responsibility - it depends in part on the student's willingness, ability and motivation to learn. The learners are supposed to acquire skills to practice what they have been taught. According to Bachman (1990), skills are 'characterised by forethought with reference to the consequence they will produce'. These definitions make it clear that a skill is action oriented, but it also requires an element of thought. A skill should bring together both theory and practice - it is not just about being able to do something, but about understanding the rationale that underpins the action. Maher, J.F (1990) Kolb's learning cycle involves applying skills to practise, the actual experience or situation, analysis and discussion, and formation of meaning and ideas. Kolb (1990) The nurse student relied on theoretical knowledge where as I relied on my experience. The learners should also be encouraged to consider the activity about to be undertaken, so that she can set the new knowledge and skills within the context and safe level of performance. The nurse student that was assigned to me to mentor was a welcome opportunity for me to practise my teaching skills. I built up my confidence when we had the microteaching session and the feedbacks given to me by my colleagues (my supposed learners) were positive. As stated earlier, due to the spontaneity of the teaching session, there was no concrete learning contract and the aims and outcomes will all depend on the given task. The teaching session was successful as evidenced by the student nurse who kept on asking question showed the teaching was interesting. My performance as a teacher followed the humanistic approach where, according to Rogers (1983), the role of the teacher is seen as being that of a facilitator, obtaining information and creating learning opportunities for the student, rather than a conveyor of information. And also, in adult learning, behaviourism took part in the learning process as it is deemed necessary to associate rewards and encouragement or positive reinforcements as advocated by Pavlov, et al (1927) Robertson (1980) says that on reflection, not all learning environment can provide students with all the opportunities all of the time. It is not always appropriate to develop a particular skill at a particular time. A useful way of thinking about this is the notion of 'what is essential, what is desirable, and what is possible'. Lameire N and Ringoir S. (1989) Profile for log 3 After two weeks of the student nurse carrying out drug rounds under my supervision, I felt it was time to assess her knowledge and skill. The assessment was undertaken during the lunchtime round as it was the quietest time in the ward. I made the rest of the team aware that an assessment was being carried out and that no interruptions should take place. Should they require assistance with a problem, they should speak to the sister on duty. An Overview of the Environment, Philosophy and Rationale for the Assessing Event Chosen. The environment for this assessment profile remained in the clinical setting of a busy acute, medical ward. The philosophy stated earlier in the previous logs focus on the mentor's role to support pre-registration students in their learning and achievement of goals. 3The rationale of the assessment was to determine the readiness and competence of the learner in performing the clinical task of carrying drugs around. Outlining the Aims of the Assessment Event. The aim of the assessment was to determine the level of competency of the student on the required clinical task of carrying drugs around and provide support that will enable the learner to perform this task safely without compromising with health and hygiene of the drugs. The outcomes will generally depend on the results against the outlined criteria of the assessment tool. Identifying the Assessment Criteria of the Learner, Or Peer Requirements The assessment criteria was based on the performance level of the student as defined and outlined in the Policies and Procedures of the hospital in handling and carrying drugs around. Skill pertains to 'observable, voluntary human motions'. This definition, therefore make it clear that a skill is action oriented, but it also requires an element of thought. Harrow, (1972) Stating if an Assessment Plan was Drawn Up Before the Event. My rationale for this assessment was, as a third year student nurse she was required to build upon her knowledge of the legal aspects of safe delivery of prescribed medications in all forms and administrations, under the NMC guidelines and also under trust policies. We prepared for the assessment by reviewing the student documentation prior to starting, to ensure cover of the subject was appropriate to the assessment. Focus for log 4 An Overview of the Environment, Philosophy and Rationale for Assessing Event Chosen. The environment is a medical ward where most patients are receiving some form of dialysis. The assessment of a student nurse took place at lunch time as it was the quietest time in the ward. The learner is a student nurse and who carried drugs around I thought it was time to assess her knowledge and skills. I made the rest of the team aware that an assessment was being carried out and that no interruptions should take place. Should they require assistance with a problem, they should speak to the sister on duty. . The philosophy remains the same, as in previous logs, to promote adult learning through facilitation. I would be giving her feedback as she considered me as an experienced nurse in carrying drugs around. Identifying the Assessment Criteria of the Learner, or Peer Requirements. As mentioned above, the learner was a student nurse who has been carrying out drug rounds under my supervision. The nurse student after carrying drugs rounds under my supervision for weeks needed the informal training session to enhance her skills in handling of drugs. Outline the Aims and Outcomes of the Assessment Event The aim of the assessment is to provide the nurse student with an honest, subjective feedback in the development of her competence on handling and carrying of drugs around. The outcome was based on the assessment of carrying drugs around and my feedback at the end of the session. Stating if an Assessment Plan was Set up Before the Event. The training and feedback sessions were part of the assessment any nurse student should undergo during placement. As I mentioned earlier the assessment was made to a student nurse after two weeks of carrying out drugs around under my supervision and I felt it was time to assess her knowledge and skill. Giving Feedback The atmosphere was rather informal in a relaxed way and the assessment environment was conducive. The nurse student did not feel threatened by my honest opinion. I pointed out that the areas that needed improvement was on carrying drugs around. Constructive feedback is an approach for the development of practice, rather than see it as lacking in performance. Ewan and White (1996) suggests that feedback is most helpful when it is offered and received in a context of challenge and support. One should avoid making prejudicial evaluation focuses on the assessment upon the individual. 3The plan of action was to help the nurse student enhance her competence in carrying drugs around in a more hygienic and professional manner. We agreed that after she proved to have improved in this area of carrying drugs around, I would give her subjective feedback. The nurse student had a sound knowledge base of the skill but required updating in practice. Butterworth and Faugier (1992) recognise the importance of assisting in the gaining of knowledge that may be lacking and providing a safe environment for the nurse to practice for the purpose of continuing professional development. Charters (2000) says that feedback that is accurate, meaningful and sensitively presented has the potential to reduce anxiety, increase job satisfaction and enhance motivation. It is also important that feedback should be recent and confidential. The ward where we were discussing provided a confidential place and the atmosphere was informal and in a relaxed manner. Finally, I can say that felt that I was honest and direct with my opinion. I recognised my colleague's existing sound knowledge of carrying drugs around and it helped me focus on areas that needed improvement. This gave her the confidence to perform subsequent tasks and master the skill. Both positive and negative feedbacks are accepted in practise as it facilitates learning and promote good relationship among colleagues. References Bachmann K (1990); Using mental imagery to practice a specific psychomotor skill. Journal of Continuing Education in Nursing. 21, 3, 125 - 128 Bernardini J, Holley, J.L and Johnston JR, et al. (1991); An analysis of ten-year trends in infections in adults on continuous ambulatory peritoneal dialysis (CAPD). Clin Nephrol. 1991; 36:29-34. Butterworth, T and Faugier, J (1992). Clinical Supervision and Mentorship In Nursing. London: Chapman and Hall. Charters, A (2000). Encouraging Student Centred Learning in a Clinical Environment. Emergency Nurse, 7(10), 25 - 29. Coulter M (1998) A review of two theories of learning and their application in the practice of nurse education.. Curzon LB (1990) Teaching in Further Education. Fourth Edition. London, Cassell. Cloonan, C.C, Gatrell, C.B and Cushner HM (1990); Emergencies in continuous dialysis patients. Am J Emerg Med. 1990; 8:134-148. Diaz-Buxo, J.A(1996); Peritoneal dialysis modality selection for the adult, the diabetic, and the geriatric patient. Doe, J. Q. (1999). Title of an article. Title of a Magazine, 212, 23. Doe, J. R. (1987). Title of an article. Title of a Scholarly Journal, 35, 112-128. Flessner M. F (1997); The peritoneal dialysis system: Importance of each component. Perit Dial Int. 1997;17(Suppl. 2):S91-S97. Ewan C and White, R (1996) Teaching Nursing: A Self-Instructional Handbook. Second Edition. London, Chapman and Hall. Ghazi F and Henshaw L (1998); How to keep students motivated. Nursing Standard. 13 (8), 43 - 48. Harrow, A.J. (1972); A Taxonomy of the Psychomotor Domain. New York, David McKay. Kolb D (1990). Experiential Learning. New Jersey, Prentice Hall. Lameire N and Ringoir S.(1989); Pharmacokinetic aspects of drug transport in continuous ambulatory peritoneal dialysis. Adv Exp Me Biol. 1989;260:105-116. Leonard, E. F and Bluemel, L.W (1958); Factors influencing permeability in extracorporeal hemodialysis. Trans Am Soc Artif Intern Organs. 1958;4:4-16. Lowrie, E.G, Huang, W.H, and Lew, N.L(1995). Death risk predictors among peritoneal dialysis and hemodialysis patients: A preliminary comparison. Am J Kidney Dis. 1995;26:220-228. Maher, J.F (1990); Physiology of the peritoneum: Implications for peritoneal dialsysis. Med Clin North Am. 1990;74:985-996 Maner, M. (1999). Women and eighteenth-century literature. Retrieved August 9, 1999 from the World Wide Web: http://www.wright.edu/martin.maner/18cwom99.html Minton D (1997). Teaching Skills in Further Education and Adult Education. London, MacMillan Press Limited. Morrison J (2003). ABC of learning and teaching in medicine: evaluation. British Medical Journal. 326 (7385), 385 - 387. MS Knowles, The Modern Practice of Adult Learning: From Pedagogy to Andragogy (Chicago: Follett Publishing Co. 1980) 43 - 44. Nicklin P and Kenworthy N (2000). Teaching and Assessing in Nursing Practice (3rd edition). London, Balliere Tindall. Piraino, B. (1996);. Management of catheter-related infections. Am J Kidney Dis. 1996;27(5):754-758. Port, F.K(1992); Risk of peritonitis and technique failure by CAPD connection technique. A national study. Kidney Int. 1992;42:967-974. Robertson CM (1980) Clinical Teaching. London, Pitman Medical Rogers C (1983) Freedom to Learn for the 80's. London, Charles E Merrill Publishing. Ronco C. (1997); Adequacy of peritoneal dialysis is more than Kt/V. Nephrol Dial Transplant. 1997;12(Suppl. 1):68-73. Rowntree D (1987) Assessing Students: How Shall We Know Them London, Harper & Row Swartz, R.D (1985); Chronic peritoneal dialysis: Mechanical and infectious complications. Nephron. 1985;40:29-37. Spencer J (2003); ABC of learning and teaching in the clinical environment. British Medical Journal, (326) 591 - 593. Taylor III, C. A, Abdel-Rahman E, Zimmerman SW, et al.(1996); Clinical Pharmacokinetics During Continuous Ambulatory Peritoneal Dialysis. Clin Pharmacokinet. 1996;31(4):293-308. Vanholder, R.C and Ringoir, S.M. (1992); Adequacy of dialysis: A critical analysis. Kidney Int. 1992;42:540-558. Editorial Woodrow, G Turney, J. H, Brownjohn, A.M.(1997); Technique failure in peritoneal dialysis and its impact on patient survival. Perit Dial Int. 1997;17:360-364. Tenckhoff, H and Schechter, H.(1968); A bacteriological safe peritoneal access device. Trans Am Soc Artif Organs. 1968;14:181-186. Read More