Clinical practice as a Significant Part of the Nursing - Essay Example

Professional practice issues and reflection Name Course Tutor Date Professional practice issues and reflection Introduction Clinical practice is normally determined as the foundation of nursing learning clinical placements quality across a range of contexts are critical to the growth of capability and competency of professionals. Nevertheless there is proof, both empirical and anecdotal, signifying that clinical placement experiences for students are burdened with challenges. The work practices need to go beyond individual expertise to strong, observable nursing leadership factor that creates a positive work atmosphere and a ‘‘safety culture” for both employees and students posted for clinical placements (Laschinger & Leiter, 2006, p.259). The quality enhancement project discussed in this paper aimed analyzes the student professional practice and learning experience at a certain health facility. In this paper I will analyze legal, professional or ethical practices encountered during clinical placement. Finally I will also describe reflection in addition to highlighting my strength and weakness in relating in theory to practice and present a general wrapping up of my experience. A professional practice issue clinical placement experiences Nurses bear a key role of making correct and proper clinical decisions. The nature of decision making is what differentiates nurses from ancillary or technical personnel (Kim, Laschinger &Wong 2005). When given the duty to help persons in regaining and maintaining their health status, a nurse ought to think critically in line with problem solving and get the most excellent solution for a consumer’s demands. In addition, qualification to practice needs nursing curriculum completion, qualification and registration with a clinical body, in particular NMC. During training, student nurse like me are required to fulfill educational standards and demonstrate that they are competent, thinking, health-orientated, change-receptive, reflective and accountable practitioners (Pender & Looy, 2004, p.27). Therefore during my 2 month placement, I grew and overcame several challenges. I accomplished a number of skills from the beginning and improved as I acquired experience. Throughout this placement, I have appreciated that I enjoyed operating with geriatric patients. It was my first day of placement and I walked into the geriatric ward and nearly ran back because of the noise and health status of the adults in that ward. The ward was a 10-bed unit with traditional ward doors, patient charts; precaution carts various medical equipment and doctors getting into the ward. I was assigned to care a 50 year old man independently but in a supervised environment. The 50 year old patient, Jim had been brought for care and treatment of diabetes. It was time for a nurse who was working the on the ending shift to handover to me one of his patient. Since I had only learnt this as a theory I panicked because I thought I could mix up the information. However, I recalled that my mentor told me not to panic and also rely on communication. That nurse wrote to me the basic information concerning Jim for instance name, date of birth and admission reason. This was both professional and legal part of the assignment. Taking information was meant to remind me of what kind of patient I was dealing with and should anything happen I would be held responsible for it. While the handover was taking place I kept listening to sights and sounds that eventually became more calming as opposed to frightening. I also kept asking myself how I was going to deal with placement and if how it would be embarrassing if I forgot significant skills. However, I could not forget that it was unprofessional and unethical to share the patient’s information. The only person privy to this information was the patient and I. According to NMC (2008) standard code of ethics, performance and conduct requires every nurse and medical care practitioners to know obligation of confidentiality they owe to patients which is part of code of professional stating that information regarding patients should be taken as confidential and apply it just for the intention which is appropriate. Because it is not practical to get consent consistent information is shared with various multi-disciplinary, one must make sure patients recognize that some information could be made accessible (Johnstone, 2008, p.126). I met this preceptor who was nurse having 30 years of experience and was this actually intimidated me. She made me understand that I would work in the direction of covering her patient load, but with her supervision. I was also supposed to understand dosage calculations and every fact about medication; the nurse mad me understand that “robot nursing” is not the right way of handling patients. Nurses around told me that preceptor was tough form their experience because she had taught them for a number of years although I would discover several things under her custody. To a fresh student like me this was encouraging. While in the ward my preceptor asked me to begin and I froze. Then, swiftly I remembered, “We normally assess first”. I recalled this as we did it the first nursing classes, in college. I first checked my health and safety before checking on the patient’s safety. This is in context that nurses hold a significant role in making sure of patient safety owing to their strong intent of reporting patient safety challenges (Carayon, et al, 2006, p.476). I went ahead and checked the sugar level on the patient, administer medication and ensure he adhered to medication. I also advise the cooks to consider dietary for Jim. As we continue she enabled me to finish more and quizzed me in every of them. All these I did while maintaining professional communication, relationship and commitment with the patient. Initial I discover that I had to depend a lot on my notes to give care to the patient so as not to blunder. This was extremely supportive and kept on doing this up to the point I felt prepared to offer a handover with no noting anything, after this, I felt more confident because I was comfortable with the rest of nursing team and did not feel as uncomfortable as I used to when I first came to the facility. However, this did not stop missing my family. At the end of the day I felt that working on my career towards being a nurse in future would help me assist various people in need. In this entire duration clinical placement I encountered assisting individuals on every day basis. Most of these days ranged from carrying out a bed bath and engaging patients in conversation over their health (McMurray et al, 2011, p.21). By carrying a bed bath and enabling the patient feel refreshed and comfortable enabled me feel progress in my career. I also felt confident of my work see I could observe that the patient was feeling relaxed and comfortable. I also took some time during my placement talking to a cognitive patient. Jim told me he did not have several family members who could visit him much, therefore being capable of sitting; talking and laughing with him made both of us feel excited keeping. At the same time I also felt miserable since it seemed Jim felt lonesome and neglected by his family. I kept him company for long hours and discussed with him regarding his life, family, life experiences, friends and work. He maintained stressing on how the kind of life he was living made him lot of think of whether he was living his life completely as others. It made me to make various adjustments so as to make him feel normal and happy. Various effects that may have risen if un-professional undertakings were to be done could have possibly resulted in a patient feeling uneasy communicating with me concerning particular topics. Some other effects could have been lack of comfort or patient infection owing to inappropriate methods applied during bathing. It I can only conclude that the placement was a good experience because most of what I practiced at the health facility just practical of the theory of what learnt in college. For instance a disease like diabetic mellitus that I encountered in the ward with the real patient, I could only relate with what I studied in classroom and in that manner I ensured it remained in my mind for future practice as a nurse. The second incident was at the ICU which I was also assigned for the first time. This room was a 12-bed unit, two crash carts at the ends, precaution carts; patient charts apparently all over, IV poles, glucometers and pumps, physicians very busy in the unit, spitting out rhythm strips and telemetry monitors beeping. I kept reflecting how I going to tackle a clinical placement on this \unit bearing in mind that I have never been in ICU before and the knowledge I had was just theory. My first placement was in diabetic ward which needed different skills. Therefore I tried very hard to recall the skills and also upbeat of if I fail to remember the needed skills? I met this tough taking preceptor who had worked for this hospital for the last 15 years. Apart from that she had an experience of 17 years. She was willing to help me in different areas although she was very strict. That intimidated me very much; and she told me she would like to see how I handle patients from communication, hand over and dosage calculations. To start my assignment on this day we met patient duty board to get information about the patient from the nurse who was working on the night shift. She categorically took me through every patient on board telling me “patient present to emergency room insensitive…” another patient was who was intubated and extremely sedated. He went ahead and told me “this patient is on Cardiezem drip. Lastly he told me of the patient on septic shock. Listening to all these made me nerves on how would handle all these. The first patient to handle had a ventilator, acute respiratory distress syndrome and congestive heart failure. Together with my preceptor we went to unit and she told me to start off. First I tensed. Not to make her noticed, I collected myself and remembered the thing which is always assessment of myself, the room and the patient. She realized I had forgotten to check pedal pulses and cautioned on forgetting such an important thing. However, she reassured me that she was aware I was doing full assessment for the first time. As the continued my preceptor allowed me to finalize more assignments. As I carry out these she asked me questions time to time. Whenever I did a mistake or was about to commit a mistake she was ready to correct me and show me how it was supposed to be done. Healthcare institution normally advice senior health practitioners to help student nurses due to the fact that hospitals deal with lives of people. Therefore should a patient die due to actions of a student nurse, it is the hospital that will be held accountable. At around 10 am I was suctioning the patient I was in charge of on a ventilator. I was also learning “how to use ventilator settings such as PIP, PEEP, Ftot, VT, Fio2, VE and numbers that correspond to physiology” Carayon et al, 2006, p.481) . During this process I also learnt what every number implied in terms of patient’s health status. The same day as I was extubating him, his patient family came to reassure care. I was told by the preceptor that later in the day I would be carrying out post mortem on my patient. This is when a realized I needed to learn quickly and be thorough on my work to be able to handle several assignments at the ICU. Going around in various units I discovered that every unit had its speed, its rhythm and student ought to become part of the pace not to work against or obstruct it. Even in my second situation of handing a patient, I realized communication was given much attention. Just as Teng, et al (2009, p.304) have recommended in many occasions both verbal and non-verbal communication was applied to comfort patients like close proximity, touch, clarification, validation, prolonged eye contact, a composed and soothing voice and reflecting feelings and thoughts while handling the patient. Critical examination of such experience has pointed out to the reality that I had some shortages in my skills, to determine covert and overt signs presented by patients to his demands. I had emphasized on the presenting duty to take care of him, with my mind engaged on his safety because of the nature of his breathing problems. Reflection as a Registered Nurse I sympathized with Jim because of number of years he had struggled with diabetes. At first he felt uneasy telling me that he “was dying inside” because of the disease. I considered that if a patient expressed such feelings he ought to be taken care of and not to be ignored. Older people tend to face solitude and ought not to be neglected and dread particularly when suffering from several diseases. In my situation with my patient, it was significant for me to enhance the therapeutic relations which built a strong the nurse and patient relationship. In this relationship, the therapeutic relationship creates some form sense of mutual understanding existing between the nurse in charge and their patients (Teng et al 2009, p.306). During my placement I establish this as an important learning experience. Another headache was hand over. Even though the first handover did not work as I thought, that did not deter me, in turn it prepared me how to handle handovers better in future. I felt my confidence had improved in this field and expected it to continue improving once I qualified and gained enough experience each day. I also felt that the experience I had gained during these placements had assisted me become conscious and keen of other factors of my nursing career that did not all the time go as I planned. I realized that it was possible to change a horrid experience to a positive one. I felt safer with the knowledge I gained and that it was acceptable various things could go wrong and that is was up to me t o use reflection as an instrument so as to change a bad experience into a constructive one. These simple efforts make a big difference to the most difficult patients. The attitude towards learning different skills also needs to be an optimistic one. The experience during experience also taught me the if a future nurse like me want to offer patients the best care, for him or her to perform this one ought to begin by practicing the most outstanding skills in clinical, laboratory, and preceptorships. Ferguson et al (2007, p.216) each day in clinical practices offers new challenges; one will come across things they did not know they were reluctant to carry out, although with the assistance and leadership of a clinical instructor or preceptor, one will go through the practice and improve with time. Scully (2011, p.95) argues that student I needed to advocate for myself, gain as a lot of experiences possible prior to graduation and become independent nurse. It is recommended that student nurses get a lot of exposure to the real life situation and handle day-to-day nursing cases to gain confidence. If an employed nurse down the unit has another patient carrying out procedure done, request to observe. If another patient requires a dressing adjustment, request to perform it. I knew I had to bear resolute thinking, with the conviction that “I have to practice for my profession today,” and not to embrace the “ugh, of I’m tired, why do should I be here” attitude. I knew that nursing was my career of choice and nobody would force me to focus on clinical, therefore could have been consequences for not attending practice but eventually the decision to go to school and to be there clinical was my personal choice. Conclusion Clinical practice is regarded as a significant part of the nursing students in the career. This preparation enabled me the opportunity to connect theory with the real life practice of caring for patients. During my placement I have learnt nursing skills and how a ward really operates; the general nursing practice. I believe the knowledge and skill I have acquired by means of manifestation of my experience will not all the time make sure that I will provide care for patients with unqualified positive regard, just due to the diversity in the human nature and the environment. I have acquired a new viewpoint throughout my practice which has made me set personal goals that will ensure good relationship and communication with the patients. References Carayon, P., Hundt, A.S., Alvarado, C.J., Springman, S.R., & Ayoub, P. (2006). Patient safety in outpatient surgery: The viewpoint of the healthcare providers. Ergonomics, 49(5), 470–485. Ghaye, T. and Lillyman, S. (eds) (2000). 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Professional commitment, patient safety, and patient-perceived care quality. Journal of Nursing Scholarship, 41, p. 301-309. Read More