Reflections of a Student Nurse - Assignment Example

?Introduction I am a learning disability nurse, currently undertaking placement at a care home. I have a mentor who is assisting me to achieve the competencies required in me to fulfil my career ambitions of starting out as a competent nursing professional, and growing to my potential in the field of nursing. To this end my mentor and I have entered into a learning contract that involves me completing several predetermined tasks and reflecting on my thoughts and actions during the execution of the tasks. This exercise is to develop reflective thinking skills. Through reflecting on my thoughts and actions, I will develop critical thinking skills that will assist me in integrating the knowledge I have gained from the formal classrooms with my experiences and clinical reasoning, to act as a support platform in my practice as a nursing professional (Rushing, 2009). Taking a Service User Out for an Activity Description: I was given the task to take a service user out to attend piano lessons. This individual had a Learning disability (LD). According to Rennie 2009, p.3, “in the U.K. the term ‘learning disability’ is used to mean mental retardation or intellectual disability.” Feelings I was nervous initially because I did not know the exact location of where the Piano lessons were held. I was relying heavily on the service user to direct me. In addition, I wondered whether the service user would be comfortable with me taking the service user out, as this would be the first time the service user would be out alone with me and may not have confidence in me, as I am a student. What was good and bad: In spite of all these feelings, it felt good to be given some responsibility by the staff. It was obvious that they trusted me and had confidence in my abilities to fulfil that carrying out of the task given to me. What wasn’t so good was that although I know the service users better now, in comparison to when I first started, I did not know them in the same way as the staff did, and did not know their preferences, which could affect the way I support them (Bender, 2008). What sense can I make/conclusion Thinking about this later on, I do now realise that this may be because of me not having complete faith in the service user ability to guide me and I felt as though I was the responsible one, out of the two (Bender, 2008). It should be the support worker leading the service user, and not the other way around. Now that I have talked to my Mentor, I realise that historically people with learning disabilities (PWLD) were looked down on by society (Sudbury, 2010) and were devalued and seen to be incapable because of their disabilities (Sudbury, 2010). I now know that as Government policy on PWLD has developed (Department of Health, 2001) and societal understanding has increased about PWLD, attitudes towards PWLD have significantly changed for the better (Walmsley, 2008) and PWLD are recognised as individuals with their own skills and abilities (Thomas & Woods, 2003). Action plan In the event a service user was to lead me to an activity, I would not keep questioning them about where it is, unless they tell me that they are unsure and at that point I would be prepared with directions or a map to look at. Body Mass Index (BMI) Measurement Description I had to measure each service user’s weight in order to work out their BMI and document it in the care plan. I approached a service user whilst the service user was at on the dining table and asked if it was possible for the service user to stand on the weighing scales, making it clear that I would appreciate an honest answer. Feelings When I first told the service user to be honest, I did not feel much or give it much thought, considering it a routine action on my part, but after taking the weight and speaking with my mentor, I feel different now. My mentor asked me to put myself in the shoes of the service user. This role reversal made me realize that I would feel disempowered and incapable of taking care of myself. Moreover, as a 20 year old student nurse, asking someone twice my age to perform a task may make the individual feel devalued, because of the assumption that the individual is incapable of performing the task of weight measurement on their own without assistance (Grant et al, 2005). . What was good and bad The good part was that the service user did not object to this and allowed me to measure the weight, however when I have asked previously I have been refused. To me this means that the service user feels more comfortable with me, which is good to know. It was good to talk to my mentor about what disempowerment means. The bad part was that I still wasn’t sure what time of the day would be best to take the BMI, because I did not want to cause him any inconvenience What sense can I make of the situation/ conclusion? I now realise how easy it is to cause disempowerment to an individual with PWLD, without even realising it. In the past, when I have asked the service user to complete a task, I hardly ever considered how they might feel about being asked to perform a task. I have learnt that empathy is vital in order to reflect about a situation (Grant et al, 2005). When thinking about the service users capabilities, it may be possible for the person to measure the weight on their own once in a month and document this accurately. By doing what service users are capable of, it deskills them. It is important to measure the BMI of individuals to see if there are in the healthy range of the BMI scale, so that we can predict health risks associated with excess weight (Kotecki, 2011). Action Plan I will assess whether the service user is capable of performing the task on their own before completing it for them, in order to protect their skills. I will also explain why we take BMI measurements to the service user, so that the service user has a better understanding and can make an autonomous decision on using BMI measurements. Monitor Fluid input and output of an individual who wears a catheter. Description I approached a service user, who wears a catheter, with his catheter monitoring file and a pen. I encouraged the service user to write down the fluid input and output on the form. I told the service user that it may be a good idea to write down everything from the morning itself, to prevent the possibility of forgetting it later on. Feelings I felt that the service user may feel that his fluid chart information is private and that I was invading the privacy of the service user, by observing the information filled in the chart. I was also worried that it may appear that I was actually telling the person to do something, instead of advising/encouraging him What was good and bad? I was pleased that the form was filled in the first time I asked/encouraged, because if there was delay in filling it and I kept encouraging the service user throughout the day, I would feel that I was pressurizing the service user for my own purposes. What sense can you make/conclusion? The service user was empowered by filling out the chart without my assistance and was able to keeps a mental record of the fluid input/output. This also implied trust in the ability of the service user to provide correct information in the chart, as the information documented in it was not verified manually. In conclusion, the service user retained full control over the maintenance of the fluid chart. Furthermore, by recording the information on paper and not orally disclosing it, the privacy and dignity of the service user was maintained, as the information on the fluid chart would be read by only those healthcare professionals associated with the catheter care of the service user. It is important to measure fluid input/output of a person using a catheter to prevent fluid imbalance in the body (Lemone & Burke, 2008). Action Plan In future, I would ask the service user whether the fluid chart has been filled out, when I know the service user has not. This would act as a reminder, causing action to fill out the fluid chart. I think this would be a better approach then the one I had taken, since when I approach the service user with file and pen and ask the service user to fill out the chart, it would seem as though I want the service user to fill it out fluid chart immediately. Contact Fighting Fit Description I rang an organisation called Fighting Fit to come and re-visit one of the service users who is obese. Feelings I thought that this would be a simple straightforward call, where I would explain that a resident is obese and that they would come and explain how to reduce the weight through diet, exercise and other lifestyle changes. However, to my surprise I was asked many questions about the resident, which I did not expect. I did feel reluctant to answer some, because as a student I am not in a position to answer complex questions and I have not been here a long time and do not know the service users very well. I felt nervous and so kept on referring to the staff that were present and to the care plan to answer the questions. As a student, I felt over powered by other health care professionals, who are more experienced, qualified and older than me. What was good and bad? It was good because I learnt how uncertainty about a given subject could lead to many complications, in this instance, a wrong weight management program. Although some of the information I gave was incorrect, I was happy that for most of the factual questions about the service user, such as height, weight, care manager, etc., I was able to provide answers for, by referring to the health care plan. The bad part was that had it not been for my mentor, who rang the person I spoke to and gave the correct information, I would have got the wrong health care professionals involved and in addition I was not alert enough to note the name and phone number of the person I spoke to. What sense can you make/conclusion? The person I was speaking to asked many complex questions and that combined with my lack of knowledge and experience resulted in me giving some incorrect information. What I should have done was to tell the person I was speaking to that I would call them back. In the meantime I would need to consult my manager to clarify everything I was not sure about. I may not have done this because I kept thinking that the conversation would come to an end very soon and had no idea that what I said could involve physiotherapy and psychologist and other health care professionals. I might have also been reluctant to seek to much help, as I knew I needed to make this phone call to meet one of my competencies to promote health. Obesity has reached endemic proportions in many parts of the world. The significance of this explosion in obesity for care homes is that it threatens to heighten health risks for the inmates in spite of the professional health care provided in care homes (Schneider, 2006). Action Plan In future, I would make a brief note of the conversation taking the person’s name, position and phone number, which I did not do, and make sure I am certain about something before passing information. Complete medication accreditation Description I attended a medication course on the trust induction and sat through a power point presentation, which explained everything about medication policies, European and national legislation. I was then given a book to complete with questions and it involved having to research all the medication the residents I am working with are on. Feelings I was excited to attend the course, as I thought it would be interesting. I was thankful to be placed on it, since I would meet new people and increase my knowledge on medicine administration. I was not too confident filling in the work book initially, but the staff helped me a lot and I was given a hardcopy of the local policy which was very informative. What was good and bad? The good part was that I met other people on the course and enjoyed learning together as a group, and I now have a better understanding of certain behaviours that service users display, after researching the medicines they have been prescribed using the BNF. Bad part was my poor knowledge on medicine administration, which was the reason for lack of confidence in filling out the work book. What sense can you make/conclusion? I understand the importance of a trust induction on medication training and to be familiar with the law, local policies, European legislation on drug storage, administration and health and safety aspects related to drugs. Trust inductions are important because it assists in reducing the possibility of misuse of drugs (Morgan, White & LaBella, 2011). To be aware of legislation on drugs is important, because nursing professionals handle medicines on regular basis in their professional practice and legislation tells the nursing professionals the safe storage norms and also the rules and regulations that govern the prescription and sales of medications in the UK (Debnath, 2010). Action Plan I will now practice more safety in the use and storage of medicines, as I am now aware of company policies and government legislation related to medicines. I will continue to attend similar training courses and keep my knowledge up to date with evidence based research Person centred plan Description I was given the opportunity to participate in a person centred plan of one of the residents in the care home. I, my mentor, a member of staff, the service user’s friend and the service user were all present. Feelings I was looking forward to the meeting, as I have done a lot of work about person centred plan (PCP) at the university. I had also attended a trust induction course, but this would actually be the first time I would be practically involved in PCP and so I was very pleased and excited. However, I wasn’t sure how the service user would respond to me taking part and was slightly apprehensive about that. What was good and bad? I got a very good insight on the service user’s short term and long term goals, the hopes and the likes/dislikes. This helped me to understand the service user better and I can now be a part of helping the service user achieve the objectives of the service user. As I was not present in the previous PCP meeting, I could not comment on whether the service user had achieved any of the goals that were set out the last time. Although the service user kept getting side tracked, my mentor was very good at keeping the service user focussed and explaining questions in a way that it was understood, either by rephrasing or using examples. What sense can you make/conclusion? Collaborative PCP is useful in determining the quality of life goals and objectives of the patient user and determining the ways and means of assisting the service user towards these goals and objectives. During PCP it s very useful to have experienced and skilled healthcare professionals present in the discussions. A key aspect in a successful PCP is the communication skills present in the nursing professional. The development of an efficient PCP is not dependent so much on the creation of the plan, but more so on full involvement of the service user and the identification of the service user’s needs. This can only happen when effective communication skills are present in the nursing professionals involved in the development of the PCP of a service user (McNally, 2006). Action Plan I will develop my communication skills both verbal and non-verbal, now that I am aware of the importance of communication skills in a nursing professional for efficient handling of the care needs of service users. I will practice my communication skills and hone them, so that my communication with the service users in no way hinders efficient care planning and care provision. Literary References Bender, W. N. 2008, Learning Disabilities: Characteristics, Identification, and Teaching Strategies, Allyn & Bacon, Boston, MA. Debnath, R. 2010, Professional Skills in Nursing, Sage Publications Ltd., London. Department of Health. 2001, ‘Valuing People: A New Strategy for Learning Disability for the 21st Century – a White Paper’ [Online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009153 (Accessed December 13, 2011). Grant, G., Goward, P., Richardson, M. & Ramcharan, P. 2005, Learning Disability: A Life Cycle Approach to Valuing People, McGraw Hill-Education, Berkshire, England. Kotecki, J. R. 2011, Physical Activity and Health: An Interactive Approach, Jones and Bartlett Publishers, Sudbury, MA. Lemone, P. & Burke, K. 2008, Medical-Surgical Nursing: Critical Thinking in Patient Care, Fourth Edition, Pearson Education India, NOIDA, India. McNally, S. 2006, ‘Person-centred Planning in Intellectual Disability Nursing’, in Care Planning and Delivery in Intellectual Disability Nursing, ed. Bob Gates, Blackwell Publishing Ltd., Oxford, pp. 68-84. Morgan, B. D. White, D. M. & LaBella, C. T. 2011, ‘Nursing Education in Addiction and Substance Abuse’, in Lowinson and Ruiz’s Substance Abuse: A Comprehensive Textbook, Fifth Edition, eds. Ruiz Pedro, Strain, Eric. C. & Lowinson Joyce, H., Lippincott Williams & Wilkins, Philadelphia, PA., pp.957-964. Rennie, J. 2007, ‘What is Learning Disability?’ in Learning Disability: Physical Therapy Treatment and Management – A Collaborative Approach, Second Edition, ed. Jeanette Rennie, John Wiley & Sons Ltd., West Sussex, England, pp.3-48. Rushing, J. 2009,, ‘Clinical Judgement in Professional Nursing’ in Role Development in Nursing Professional Practice’, Second Edition, ed. Kathleen Masters, Jones and Bartlett Publishers, Sudbury, MA, pp.190-204. Schneider, M. 2006, Introduction to Public Health, Second Edition, Jones and Bartlett Publishers, Sudbury, MA. Sudbury, J. 2010, Human Growth and Development: An Introduction for Social Workers, Routledge, Oxon. Thomas, D. & Woods, H. 2003, Working with People with Learning Disabilities: Theory and Practice, Jessica Kingsley Publishers Ltd., London. Walmsley, J. 2008, ‘From Care to Citizenship’ in Understanding Health and Social Care, eds. Julia Johnson & Corinne De Souza, The Open University, Milton Keyes, UK, pp.233-242. Read More