Knowledge to Enhance Quality of Care in Adult Nursing - Coursework Example

Knowledge to enhance Quality of Care in Adult Nursing Introduction. As I look forward to becoming a registered nurse from my current hip shortly, I feel now is the right time to ponder over how I am going to graduate to the new role. Of several elements of the profession which I will be faced with, I perceive that ‘personal and professional development’ should be my first priority which will greatly help my transition consistent with the frame work of competencies prescribed by the code of Nursing and Midwifery Council that calls for continuous personal and professional development. I am confident that my conscious personal and professional development will automatically take care of the other elements in the process. Rationale The personal and professional development encompasses all the aspects of the profession. The Nurse once registered becomes the member of the Nurses and Midwifery Council and is expected to act within frame work of the competencies prescribed. Pursuant to the requirement of learning and self development, the policy of the council expects that the member should be always willing and be ready for further development as a member. It is the duty of the member to keep acquiring knowledge and getting acquainted with the profession throughout the career. Thus the member should be able to grasp solutions quickly whenever faced with new problems. The member should be always prepared to receive constructive feed back and learn from others. I have chosen this element for my over all personal and professional development. This exercise is vital for me at a time when I will be transitioning from the capacity of a student to that of a Registered Nurse. Adult nursing is the chosen area for my practice as a nurse. The future hospital setting will give me vast opportunities for exposure to adult nursing practice and I will be leaving no stone unturned to achieve my proficiency for the ultimate benefit of patient community who will be reposing strong faith in the hospital assiduously developed my would be predecessors and seniors at the hospital. (nmc.uk.org) Analysis Of Role Transition There is general impression that nursing students, who tend to be too academic while studying, become confused when they are suddenly faced with clinical practice. Hence it is all the more essential that I am not only equipped with theoretical preparation and but also with sufficient competence for clinical practice as nurses have to work in the environments that demand cognitive skills. It is with this in view, my faculty provides me with support, tolerance, patience and encouragement as I learn to absorb these values. I do not find any tension in my forthcoming transition to a registered nurse as I will be under the preceptorship of an experienced nursing professional. I will be entitled to have four months of working under my preceptor as per the NMC guidelines. This will enable me to learn to practice observing the standards for conduct, performance and ethics. This preceptorship will enable me to gain confidence as a nurse in due course. I will have regular meetings with my preceptor whom I expect to be considerate and compassionate with me in imparting practical knowledge of the adult nursing profession. As per the NMC guidelines, my preceptor will put me at ease in my transitioning during which period she will help me gain full confidence in my professional practice, become sensitive to the patients’ requirements, and act with team spirit and keep updating of my professional knowledge and practice. My preceptor will be giving me positive feed back on my performance while at the same time being critical of my certain failures. She may not hesitate to voice her misgivings and also to rectify wherever I falter. I hope that my preceptor being well aware of standards and competencies set by the hospital I will be employed in, will help me achieve them and also enable me to gain latest knowledge and skills. I am well aware as a new registrant that I must practice in accordance with the NMC Code of professional conduct. I will do so by identifying my inadequacies and charting out a plan for overcoming these needs with the able guidance of my future preceptor. Of course, I will be reflecting on my practice as a mirror of my own and also will be seeking feedbacks from my preceptor and all others whom I will be working with. I know that I can also have preceptorship duration extended if need be in the light of any negative feed back I may receive from my preceptor or even my employer on my performance. (Nursing Midwifery Council, 2006) I am well aware of the common problems I will be encountering during the transition arising out of theory-practice gap. They relate to technical procedures, time management, administering of medicines, assessing patients and writing of reports besides having to assume responsibilities of caring several patients at the same time, working as a team member and accountability. The two most important management concepts I have to use in my professional development are ‘working with team sprit and effective communication’ which will be of considerable use in my transitioning role. The feeling of being part of the team will help me in socialising with my co-workers including my preceptor without having to undergo the uneasy feeling of being a compulsive part of the team. I will acquire the knowledge, skills, and behaviours by being part of the group working as a team like a single individual with different organs. This team work as a management concept will help me a great deal. As this learning process cannot be automatic by merely being part of the team without the adequate pre-knowledge of the profession, I have to make use of the transitioning process wisely with common sense and pre acquired knowledge. As a team member, I will apply my theoretical knowledge acquired during the period of my studentship, so that I get feed back on my application while on the job.(FitGerald and Amadio, 2008, p 29) I have learnt in the theory that effective communication as a management concept will be of great help at work in my future workplace. Human communication is a mixture of exchange of ideas, thoughts and feelings. They are both verbal and non-verbal. I have learnt the importance of communication in nursing practice especially while I will be on interaction with patients. As a result I have now the confidence of being able to understand the patients’ personal perceptions relating to their illness and respond to them in a a way as to promote their well being and enable them to participate in their care delivery to the extent it is possible for them and desired by them. (Parbury, 2008 p 163) It maybe recalled that The United Kingdom Central Council for Nursing Midwifery and Health Visiting (UKCC) advises that in order for a nurse to be fit for practice, she should develop her communication and interpersonal skills so as to engage in, develop and disengage from her therapeutic relationships with patients. I have been able “to understand the importance of communication in nursing, integrate the behavioural and relational aspects of communication in a nursing context, identify evidence based enquiry relating to the problems in nursing communication, discriminate between the different verbal and non-verbal channels of communication, reflect on my own use of communication skills using critical incidents and a communication diary, and relate communication theories to adult nursing” (Kenworthy, Snowley and Gilling,2001, p 254) Reflection Of the four reflection models recommended in literature, I find it easy to understand and apply the John’s model of reflection (1994). I have learnt as a student nurse that reflection is a practice by which I am relating certain situations in my clinical practice as having learnt some thing which will be of value in my future practice and future career. The experiences can be either positive or negative. I reflect on both occurrences and relate the theories learnt to these practical situations and confirm how relevant the theories are. The four recommended models are Gibbs’ model (1988), Johns’ model (1994), Kolb’s Learning Cycle (19840 and Atkins and Murphy’s Model (1994). Johns’ model I adopt for my reflective practice is described below in Appendix 1. I believe that the above model can also be called as critical incident analysis which is a learning technique of breaking down an event into several main components to facilitate reflective analysis. (Crouch, 1991) The following incident during my student-trainee period can be cited as one of my reflective practices which I do almost every day now. Adams was 45 year old man and had been admitted with facial injuries following an assault on the street. Basically he had been admitted for his psychiatric condition. In fact I had already met him soon after the unit was settled after his admission. He appeared very calm but confused. As I was in the night shift, around 2 am, I heard some noise from his room and came out of my chamber and found him smoking inside the ward which was a prohibited area for smoking. When I told him not to smoke there as it was a prohibited area and asked him to put out the cigarette which he did without any murmur. But an hour after that incident, I heard some disturbing noise coming from his ward. I saw him again smoking and since he did not resist last time, I adopted an authoritative tone and ordered him to go back to his ward after putting out his cigarette. But this time, he cried and became more agitated. Without any forethought, I attempted to take the cigarette from his hands but he pushed me aside and started abusing me. At this unexpected behaviour, I got scared and thought he would attack me as I was lonely there. I became action-less due to fear and confusion. Fortunately a trained staff member rushed hearing the commotion and started coaxing John and managed to take him inside the ward. Subsequently, John became quiet and retired to bed. I reflected that I was completely out of control and felt having put my self at a serious risk of being assaulted. and felt having become a person of hatred to John. I should not have been so arrogant to him as a man already felt abandoned by the society. How I could have possibly expected him to adhere to the rules of society that had abandoned him. I felt guilty of having tried to impose my authority over him. I was bit overcome in my intention to adhere to rules. I did not show him any caring or empathy which could have helped me out of that provocation from him. Applying John’s model above, I have realised the importance of reflection now after due discussion with my professor and mentor .This incident has taught me that I should deal with psychiatric patients in an appropriate manner especially in respect of communicating with them. The communication as a concept of management now became even more valuable as a tool in dealing with patients.( Hogston and Simpson,2002, p 409-411) I have now learnt the importance of factors like “proximity, posture, eye contact, touch and voice tone to the interactions” (Hogston and Simpson, 2002 p 411) Personal Development Plan The NMC has made it mandatory for registered nurses to draw up Personal Development Plan as part of continuing professional development.(CPD) as a personal portfolio of their learning activity in consultation and in agreement with the preceptor or line manager. There is no uniform PDP prescribed by the NMC. Hence it is left to the individual nurses and hospitals concerned and the way it is implemented without remaining a mere formality, would be reflective of their commitment to their professional development .It is kind of lifelong learning practice for the nurses. My personal development plan identifies gaps or weaknesses in knowledge, skills or attitudes, topics for learning in response to changes occurring in my role from time to time, my learning needs and goals in order of priority, justification for my selection of my goals, time frame to achieve my goals and the method of evaluation of my learning outcomes. I will be revising the PDP every year according to changed circumstances. I can look back what I have learnt and demonstrate to others how fit I am to practice my adult nursing. . (Higgs, Chambers, Wakley, 2005 p 2) References Birmingham City University, Using a Model of Reflection, Department of Practice Learning, Available from accessed 8 November 2008 Crouch, S. (1991) Critical Incident Analysis. Nursing 4:30-1 Fitzgerald Mary and Amadio Judy,(2008) Chapter 3 Becoming Part of a team in Chang Lan, May Esther, Chang Esther, Daly Chang, & Daly John. Transitions in Nursing: Preparing for Professional Practice, Elsevier, Australia, p29 Higgs Jane, Chambers Ruth, Wakley Gill, (2005) Demonstrating Your Clinical Competence in Cardiovascular and Neurological Conditions Redcliffe Publishing p 2 Hogston Richard and Simpson M. Penelope, (2002) Foundations of nursing Practice Making the Difference, 2002 Palgrave Macmillan, Hampshire p 409-411 Kenworthy Neil, Snowley Gillian and Gilling Cynthia. (2001) Common Foundation Studies in Nursing, Elsevier Health Sciences, p254 Nursing Midwifery Council, (2006) Protecting the Public through professional standards, NMC Circular 21/ 2006 NMC-UK-ORG, A Competency Frame Work for NMC Council Members, Available from < http://www.nmc-uk.org/aDisplayDocument.aspx?DocumentID=2394> accessed 8 November 2008 Parbury-Stein Jane (2008), Chapter 11, Communication for effective nursing, in Nursing: Preparing for Professional Practice, in Chang Lan May Esther, Chang Esther, Daly Chang, & Daly John. Transitions in Nursing: Preparing for Professional Practice, Elsevier, Australia, p.163. Appendix 1 Johns model of reflection (1994) The following cues are offered to help practitioners to access, make sense of, and learn through experience. Description Write a description of the experience What are the key issues within this description that I need to pay attention to? Reflection What was I trying to achieve? Why did I act as I did? What are the consequences of my actions? • For the patient and family • For myself • For people I work with How did I feel about this experience when it was happening? How did the patient feel about it? How do I know how the patient felt about it? Influencing factors What internal factors influenced my decision-making and actions? What external factors influenced my decision-making and actions? What sources of knowledge did or should have influenced my decision making and actions? Alternative strategies Could I have dealt better with the situation? What other choices did I have? What would be the consequences of these other choices? Learning How can I make sense of this experience in light of past experience and future practice? How do I NOW feel about this experience? Have I taken effective action to support myself and others as a result of this experience? How has this experience changed my way of knowing in practice? (Birmingham City University) Read More