Personal and Professional Development - Essay Example

? Personal and Professional Development Introduction: Due to “the complexity of work within the healthcare professions,” it becomes difficult for these professionals in healthcare to be effective in their work (Taylor 2010, p.16). There are so many roles, tasks, relationships, unforeseen aspects for negotiation and expectations which tend to make the practice unpredictable and chaotic. But the importance of reflection on what is learnt in practice has been critical in development of the required knowledge and skills. Adopting Gibbs Model of reflection, commonly used among health professionals as indicated by Taylor (2004), this paper would describe what I learnt during my transition period, my feelings on that then evaluate the program and give a conclusion and the impact on my future professional growth. This reflection respects the principle of confidentiality for the clients and institution as stipulated in the Code cited by the Nursing and Midwifery Council, NMC (2010). Description: In a transition program, students reflect on various learning activities in their field of study that they have been engaged in. My second year transition activity was undertaken in a pharmacy. It was a one day activity that involved learning the operations in the pharmacy and the roles of a pharmacist. I observed how the pharmacist received prescriptions and orders for medicine and the due process involved before giving the medicine or dispatching ordered medicines. I also studied the side effects that specific medications would have when administered to psychiatric patients. Rationale The motivator for choosing this kind of transition program was the desire to develop my knowledge on identification of different available drugs and how such medicines would work in the human body. Among my aims was to understand drug calculation and administration which is a critical skill in avoiding adverse effects due to poor medication. My interaction with the pharmacy team equipped me with the knowledge on the required procedure for dispensing drugs and what measures to take so as to curb medication errors in healthcare institutions, a paramount skill in my future role as a nurse. Thus, this analysis paper evaluates my experience with psychotropic medication, communication and its importance in a healthcare setting, legislation on drugs and pharmacy operations. Feelings: When I started this transition program, I expected to learn so little because the program was only to run for a day. More so, I expected that since to the pharmacy team it would be a normal working day, they would have little time to explain to me their operations. But the team was co-operative and helpful which made me view them as colleagues. Despite me being a student, they respected me and I will not forget the pharmacist always wanting me close so that I could learn effectively and as much as possible. Evaluation: Among the people with mental health disorders, the greatest needs include understanding the happenings within their environments; feeling their emotions but also learning to manage them; being able to communicate with those who make decisions for them; and feeling stable in their thinking (Solchany 2011). Medications have been used in treating mental disorders symptoms in conditions of depression, anxiety disorders, bipolar disorders, schizophrenia and attention deficit-hyperactivity disorder, ADHD. These medications used for treating mental health and behavioural problems are referred to as psychotropic medication as used by the National Institute of Mental Health, NIMH (2008). There are varied types of these medications for particular circumstances and among the ones I encountered include antidepressants such as imipramine and clomipramine selling under the brands Tofranil and Anafranil respectively; anti-obsession medication including fluoxetine and vilazodone trading under the brands Prozac and Vibryd; and psycho-stimulants such as metyhlyphenidate trading under the brands Ritalin, Metadate and Methylin. Other classifications cited by Bank (2012) include bipolar disorder medications, anti-anxiety, sedatives, antihistamines, mood stabilisers and hypnotics. These drugs occur as pills or solutions. Psychotropic medication lessens symptoms accompanying mental health disorders but they do not cure. This argument has been supported by various scholars including Cottingham (2009). They provide behavioural support and stability among the people with mental health disorders and should therefore be administered appropriately. Psychotropic medications, just like many other forms of medication have side effects on some users but could disappear after sometime if well managed. Some of these side effects include drowsiness, skin rashes, rapid heartbeat, menstrual problems among women, blurred vision and being sensitive to the sun. I found it unadvisable to drive or operate machinery when new to antipsychotics because of effects like drowsiness and increased heartbeat. This could be appreciated by Szabo (2011) who also claims that antipsychotics and mood stabilisers are the psychotropic drugs with most adverse effects. In the long run, use of antipsychotic medication could cause tardive dyskinesia, TD which cause uncontrollable movement of muscles especially around the mouth. Honkola et al. (2012) and the NIMH (2008) note that some psychotropic medication such as antipsychotics could result into considerable weight gain and alteration of metabolism which could lead to high cholesterol and risk of diabetes and heart disease. One’s physical condition could be as a result of psychotropic medication such as situations of endocrinologic and cardiovascular side effects (Osborn 2001). I found the British National Formulary, BNF to be an important reference book in guiding pharmacists to determine the identity of the prescribed drugs, their dosage, side effects, names and costs of generic and proprietary formulations and other important facts about the medicines. Distributed free to professionals in healthcare in the UK, these books are published twice every year in the months of March and September. Nonetheless, NHS Foundation Trust (2011) noted that there are non-formulary medicines which have been classified by the Medicines Management Committee as not fit for inclusion in the BNF and should therefore not be prescribed to GPs for prescription. An example quoted by this institution includes Reboxetine and newer medicines which have not been considered for the BNF (Hughes & Blegen 2008). During my transition program, I witnessed a few cases of drug-drug interaction though Sandson, Armstrong and Cozza (2007) argue these are common cases and widely contribute to mortality and morbidity in patients. Mozayani and Raymon (eds. 2012) noted that these interactions could be pharmacodynamic or pharmacokinetic. With pharmacodynamic interactions, there would be synergy of the effects of the drugs at the receptors. On the other hand, pharmacokinetic interactions could occur due to alteration of absorption, excretion, metabolism or distribution of drugs. To curb drug-drug interactions, patients should be encouraged to have their prescriptions administered from one pharmacy where patients would be advised to enrol in the monitoring program for drug interactions. Communication Effective communication is paramount in ensuring proper medication. In fact, Schillinger et al. (2005) argue on communication errors as the leading problem in medical errors. In a mental health situation, breaching confidentiality and not explaining informed consent are among the most common communication errors. Related to errors in communication would be poor teamwork, incompetence and disrespect (Friesen, Hughes & Zom 2007). Research studies by Hughes and Blegen (2008) emphasize on the importance of nurses communicating with each other so as to assist them in troubleshooting problems associated with equipments, changing medication regimen and clarifying on medication orders. I noted that communication with pharmacists should be effective especially on administration of medication. Illegible physician handwriting could be a possible cause of medication errors. Policies assist in facilitating consistency in medication administration and in supporting provision of quality and safe care. I learnt the existence of standards such as the American Association of Critical-Care Nurses Standards for Establishing and Sustaining Health Work Environment, which Friesen, Hughes and Zom (2007) reckon address the significance of effective communication. It would be critical that nurses accurately record any verbal instructions, with Saskatchewan Registered Nurses’ Association adding that such nurses should repeat “the order to the prescriber for verification and assessing the appropriateness of medication for the client” (2007, p.6). In transcriptions, the nurse should validate that the transcription is accurate and complete. I learnt that nurses have the responsibility of questioning unclear medication or that which is not consistent with therapeutic results, an argument supported by Bolton (2005) who claims that healthcare practitioners should be responsible for their actions. To reduce adverse effects of errors in medication, medication reconciliation, MR would be used with medication information being transferred across the care duration. Saskatchewan Registered Nurses’ Association (2007) appreciates that this process propagates the accurate collection and communication of client’s information so as to ensure continuity of the respective pharmaceutical care. Clients should be given support should be offered to them to find out why they receive the medication that they do and any consequences of past drug usage. Just like in any other care or treatment, their consent would be sought in administering medication. It would be acceptable that a client’s cooperation could be adequate enough to indicate implied consent. Administration techniques like the invasive techniques would probably call for verbal consent. The Canadian Nurses Association, CNA (2002) states that it is the ethical and professional responsibility of registered nurses to ensure that clients get informed and that they are competent to consent. Clients have the right to withdraw or refuse consent for either treatment or care at any particular time. Therefore, I deduced that registered nurse-client relationship has its basis on recognition and the client’s ability to make own decisions for their lives. The ethical principle of autonomy according to McCarthy (2006) requires that a patient’s liberty of thought, action or choice should stay out of other persons’ interference. It supports the fact that rational persons have the right to make their own choices without any external interference. This principle holds even in drug administration as I observed the mentally ill persons having a choice on the kind of medication they preferred. But Husak (2000) notes that if such rights would cause harm to oneself, then the principle of harm overrides the principle of autonomy. Similarly, if one appears not to be autonomous, then the principle of weak paternalism overrides autonomy, for example in cases of dealing with children. The principle of autonomy has also been infringed in employment of drug formularies. Mandatory formulary systems do not leave any option for patients to choose between therapeutic and generic substitution. These two principles of consent and autonomy require full disclosure by the healthcare professional on what would be done to them. Husak (2000) noted that the principle of disclosure dictates that the patient be informed on what drugs would be administered to them, the benefits of such drugs and the risks associated. Rogers (2002) brings in the perspective of communication arguing that if a healthcare practitioner fails to communicate effectively to the patient, the two principles would be infringed. In view of all these principles, I observed that for incapacitated patients, healthcare providers would share the relevant information with the family of the patient. This therefore calls for proper professional judgement on whether this would be viable at any particular moment. The assumption in this case has been that for someone to be with a patient, the patient should have consented for that person to be in charge of his or her care. Legislation of drugs There are two major statutes that regulate availability of drugs that I learnt; these are the Medicines Act and Misuse of Drugs Act. The Misuse of Drugs Act 1971 is particularly meant to deter use of certain drugs for non-medical reasons. This therefore makes it superior as it controls both the medicine drugs in the Medicine Act and the non-medicinal drugs. Since most controlled drugs are of medicinal uses, the Medicinal Act provides for authorisation of supply, possession and importation and export of the drugs by the government. On the other hand, the Home Office licences possession and supply of restricted drugs, mostly for research (Independent Drug Monitoring Unit 2012). As such, these drugs would not be prescribed by unlicensed doctors. The Drugs Act 2005 has reduced the burden of need of proof of legality of possession of any possessed drugs that was there before, with the defendant currently needed only to prove that the drugs in possession were not meant for supply. Most patients in mental health institutions would evade taking medication consistently as I have observed from experience. But this transition program taught me that those who do not comply with the prescribed medication could be compelled under the Mental Bill 1983 to do so. This is to avoid them posing a threat to the rest of the society as cited by the Parliament Office of Science and Technology (2003). Qualifications and roles of pharmacists Administration of controlled substances requires accountability in properly and accurately handling them as observed by Saskatchewan Registered Nurses’ Association (2007), thus the need for qualified personnel to administer drug movement in hospitals. This refers to a pharmacist whom from the experience I gathered should be someone with expertise in medicine with some background experience with medicines. Such a requirement would call for a minimum of a degree in pharmacy. But Hudson, McAnaw and Johnson (2007) observe the importance of even higher education in this discipline which led to the introduction of Doctor of Pharmacy in California, now spread globally. Due to their interaction with varied sources including the internet and pharmacy database, computer literacy would be critical. This is a role that calls for supervisory, communication and interpersonal skills. Due to the constant interaction with medication, pharmacists specialise in risks associated with specific clinical areas. Since a pharmacist has no intense knowledge as a clinician, this role would be taken up by a pharmacy technician, whom together with the pharmacist and pharmacy assistant makes up the pharmacy team. Other than observing quality control procedures on manufactured medicine and arranging and dispensing clinical trial medicines, the Association of Pharmacy Technicians United Kingdom (2012) adds that this team would also be responsible for manufacturing medicines from their respective raw materials, providing information on medicines to the public and healthcare professionals and training, assessing and supervising trainees and junior staff. With additional training, NHS Careers (2012) notes that pharmacists could prescribe medicines for particular conditions. The role of a pharmacist is critical in smooth hospital operations. I observed the pharmacist maintaining the inventory of all the drugs and making new orders. On arrival, the pharmacist would check to confirm that the delivered drugs meet the quality standards required. Orders for supply of any medication had to have the date, details of the recipient and details of the prescriber. The pharmacist would then countersign for dispatch. Dispensing remains the sole responsibility of the pharmacist who executes the orders to do so after determination of appropriateness and authenticity of prescription order. When requested from other departments or hospitals, due authentication follows after which the drugs would be assembled and dispatched in various bags which have been colour coded differently. According the Association of Pharmacy Technicians United Kingdom (2012), this selective use of colours plays a critical role in enhancing the safety of patients. If appropriately used, this technique would enhance processes that would make dispensing of medication and administration operations effective. It plays a critical role in preventing mix-up of drugs, dosage errors, wrong-patient administration and problems of legibility (Royal Pharmaceutical Society of Great Britain 2011). Analysis: The transition program was beneficial since from this, I got knowledge on psychotropic medication, drug administration and potential side effects, including drug-drug interaction. An understanding of the governing legislation was important in enabling me observe appropriate ethical measures when handling patients with mental disabilities and understanding their legal rights, including autonomy and consent and the right to know how each medication works. It was important to also note the critical role that communication plays in the healthcare institutions, both between the professionals and the patient and between the professionals themselves. Learning the operations of a pharmacist was crucial knowledge that would enhance my performance when giving prescriptions. However, the program only lasted for one day which was inadequate to get all the information. This was therefore not a SMART – Specific, Measurable, Achievable, Realistic and Time-bound – goal as the goals were unrealistic and unachievable. Conclusion: The pharmacist is one of the key arms of a healthcare facility. The pharmacist authenticates any drug prescriptions before administration hence play a critical role in ensuring that drugs are administered appropriately and also meet the required standards. In case of any concerns with drugs, the British National Formulary could give the appropriate guidance. There are legislations which protect both the practitioner and the patient and as such, ethical principles such as consent and disclosure should be observed. There was so much information to learn in one day and I purpose to have a longer transition program in future. Action plan: Having acquired these various skills in the pharmacy, I look forward to giving professional service as a nurse, knowing well the implications of my service. I am better able to explain some symptoms in my patients resulting from usage of some specific drugs and give solutions appropriately. The knowledge on BNF provided an aid in prescribing and understanding psychotropic medication. Even so, I now understand the importance of seeking consent from patients on any prescribed medication as ethically required and in line with the governing legislation. Communication skills are what I need to perfect in my profession due to its importance in my duties. 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