Reflecting on Needs in Nursing and Healthcare

The aim of this essay is to critically reflect on one academic and one practical learning need. This essay will reflect in relation with my professional development as a health care practitioner based on the identified needs. John’s (1995) model of reflection will be used as an aid to reflect on this assignment. The Nursing and Midwifery Council (NMC) PREP continuing professional development guidelines format will be implemented during this writing. Confidentiality of the ward and patient’s information will be maintained throughout this essay in line with the United Kingdom, Data Protection Act (1998) and NMC (2008) codes of conduct on confidentiality, therefore the patient will be referred to as Mark a pseudonyms during description of the scenario.

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My identified clinical need based on information gathered from the first placement of my third year has improved my communication structure during patient’s handover to all members of staff. Improving this need is significant to me because, communication during patient’s handover can be considered as a paramount aspect of nursing care. Dossey and Keegan (2013) supported this by expressing that effective communication must be enhanced in order for holistic intervention to take effect in nursing practice. I researched about my clinical need for about twenty hours on different databases including government policies prior to writing this essay.

On arrival to the ward I was asked by my mentor to hand over Mark a surgical patient to the nurse, health care assistant and another student nurse. During handover, I wanted to be outstanding and impress the health professionals as well as passing the vital information. However, this left me more nervous which made me realised how much I was struggling to articulate my sentence due to lack of structure. Odom-Forren (2007) study analysed handover to be a real time process of passing essential patient’s information between care givers in order to ensure continuity and safety of the patient. The purpose of this article was outlined as the importance of using structure for standardizing patient’s hand over, this made me understand that I have not being able to deliver this during the handover of Mark due to lack of structure. Street et al (2011) research identified how application of structured standardised handover has displayed significant improvement during nurse’s handover. Structured handover makes the process more concise, objective and relevant (Griffen, 2010). Popovich (2011) research, Novak (2012) and Fenton (2006) study discussed how Implementations of a handover tool assists in recognising changes in patient’s status more quickly. Structured handover allows the receiving nurse to ask question related to the patient status and promotes accountability between shifts (Laws, 2010) therefore there is correlation in the research regarding structured handover.

This motivated me into questioning myself in regards to why I had felt the way I did, and thought perhaps this could be due to insufficient amount of handing over and gathering essential information prior to handover which has not enabled me in developing confidence when handing over. Forren (2007) study sample size only focuses on perianasthesia setting handover which made this study relevant to me as my placement was in the theatre. The study could have been more applicable in future if the sample size was extensive to other clinical area as recommended by Russell and Gregory (2003) that articulated that studies with small samples may help to identify theoretically provocative ideas that merit further research. Lilleyman (2004) described handover as the most perilous procedures in patient’s care, a communication hotspot it was articulated that errors such as misinformation can jeopardise patient’s safety and workflow. I realised how limited my nursing intervention was when it comes to handing over and how I have not being able to adopt a systematic approach during my communication with the nurses when handing over which can influence the quality of care I deliver while also limiting my personal nursing development. This does not comply with the PREP has outlined in the NMC.

Manser and Foster (2011) research recognized the significance of effective handover communication as it is critical to patient’s safety and quality of care. This has empowered me in recognising that developing my limited structured communication and organising clear thought during handover has numerous amount of effect on patient’s safety during care. Meeting this essential need also acquainted me with compliance to government policies such as NHS outcome 2013/14 that sets out the vision of the white paper which encourages improvement in the care quality provided to patient such as reduced delayed care. The Quality and Outcomes Framework (QOF 2013) which is also a legal requirement by the care quality commission that focuses on increasing patient’s standardised safety, experience and outcome.

A qualitative research conducted by Benham-Hutchins and Effken (2010) identifies insufficient amount of communication during handover can endanger patient’s care by causing communication breakdown which can also lead to mistakes such as drug error. This research was conducted in an acute setting, the researchers conducted the research by asking staff to describe the method used for handing over however one major drawback of this approach is the methodology of the research which appears to be ambiguous. The researchers failed to take into consideration whether the staff nurses will be totally honest in the method used during handover. As I have seen while out in practice that not all nurses follow the tools available for handover, a more appropriate method will be to observe the nurses during patient’s handover. An example of communication breakdown can also be identified as reported in the Francis inquiry (2009) where patient’s care was endangered. Understanding of this has enabled me in accepting how I was unknowingly limiting my patient’s care and the impact it has on my ability to perform to my full potential as a final year student nurse which can lead to delay patient’s care, poor quality, risk and mistakes.

In also developing this practical need I will be able to provide an individualised handover based on patient’s need to all member of staffs rather than a broad overview of patients. NMC code of conduct (2008) expects nurses to treat patient as an individual and respect their dignity. Pertinent information will also be assimilated in order to provide continuity of care to my patient as acknowledged in Manias and Street, (2010) research. Development of this need will enable to me to provide adequate handover which shows my competency while also enabling me to be accountable for my actions in order to make informed decisions and provide seamless care as obligatory by the NMC code of conduct (2008). My communication skill during handover will also be improved as it shows my professional development which is a requirement for PREP. This is also authorised by the Joint Commission (2012) that emphasises that well organised communication is extremely central to patient’s safety as communication can be considered as one of the leading issues contributing to patient’s harm. Therefore they recommended in the national patient safety goals that effectiveness of communication should be improved among care givers. Organising my thoughts before handover will support me to work in accordance to the embracement of the 6Cs values of care, compassion, competence, communication, courage and commitment of the nursing practice.

Reflecting on areas that I went wrong and the positive feedback received from my mentor has equipped me in feeling more confident while also promoting self-regulation of clinical reasoning and questioning prior to, after handover and also during any form of nursing intervention. Scott and Ely (2007) emphasised that, positive performance should also be considered in reflection. In eagerness to improve this need I started incorporating evidence based into my practice during handover through reading, making notes of the structure used by observing my mentor when she handed over. Situation, background, assessment, recommendation known as the (SBAR) was one of the tool I observed my mentor and other nurses using in practice. The application of this tool aided my handover process as the questions within the tool allowed me to focus on vital information and be concise. Using this tool also enabled me in spending less time on handover as the information needed for communication during handover was gathered before handover. This action facilitated clarity, effective and assertiveness in my communication which made the task of handing over a lot more easily.

Another tool that I used as a structure in providing effective handover is the modified early warning scores (MEWS) pathway. This pathway allowed me to identifying when a patient starts to deteriorate. in order for a patient’s deterioration to be passed on during handover as it was recommended on the chart that a patient with a MEWS score of four or more can be transferred within department as long this is communicated with the receiving department. The Mews chart enabled me to stand as an advocate in ensuring the patient’s care handed over to the other staff will not be compromised as I was able to document the exact figure of observation on the chart for monitoring while also maintaining patient’s continuity of care and safety. NMC code of conduct (2008) expressed, nurses to act as an advocate for those in their care, helping them to access relevant health and social care, information and support. Currie (2002) CUBAN was used to enhanced patient’s care during handover by adopting Confidentiality during handover, uninterrupted communication, brief and concise information, accurate and relevant need, and Name nurse would be me and my mentor as we were looking after the patient

Based on the knowledge I have gained through research and in-depth reading of this need, I now have more detailed understanding of the effect the gap in my knowledge had on how I was limiting my patient’s care as I was missing pieces of important information. Now I can confidently apply the handover tools to practice which shows evidence based. This has changed my practice to improve the care I give on daily basis as indorsed by PREP.

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My identified academic need is critical thinking. The learning activity of this need took place over the first semester of my final year. The learning activity took me a week to gather all my feedbacks together from my entire previously submitted essay. After reading through my feedbacks in depth I realised how all my tutors have stated I need to apply critical thinking to my essays. Research on this academic need took me fifteen hours of gathering literatures to enhance my knowledge of this need in order to be able to critically analyse the need in accordance to my development.

I have decided to elaborate on my academic need of critical thinking because Girot (2000) identified that in order for nurses to be safe, compassionate, competent and skilled practitioners must develop an aptitude of critical thinking. This made me realised how crucial it is for me to develop critical thinking as a nurse as it will assist me in identifying and challenging assumptions in practice and when writing my essays. McGloin (2007) research made me understand how I have not being reading widely to empower my ability of being able to think critically through development of arguments which has influenced my written work and care given to patient therefore limiting my personal development (PREP). Greetham (2008) also discussed how most student underused critical thinking whereas it is the most pertinent skill needed to improve academic writing.

In meeting my academic need I am expecting to get better understanding of my work prior to writing my essay. Cotrell (2008) suggested that having a clear thought through reading widely about that specific area before writing the essay enables student to gain adequate result. This shows that low marks in my essays are impacted by my lack of reading and lack of appropriate preparation before writing my essays. The ability of not being able to source evidence based practice will also have an effect on my nursing care. Critical thinking will allow me as a student to prioritise my work load when writing essays and while also out in practice (Hutchfield and Standing, 2012). Prioritising work load also provides space to be able to review and edit work on different occasions (Davis et al, 2011). Having a critical thinking skill will influence my patient care as I would be able to apply the skill of reasoning and questioning into complex situation encountered in practice. The Department of health (2010) also encourages critical thinking as it is a feature that is needed to be an advanced professional practice which is also required.

Whiffin and Hasselder (2013) Research paper discussed how critical thinking is one of the characteristics that should be possessed by registered practitioners who owes the duty of providing critical solutions to problems that are complex. Gopee (2002) discussed that health care practitioners and student nurses applies critical thinking skill in their day to day practice whether they undertake the degree level or diploma programme but finds it difficult to transfer it into writing. Chan (2013) discussed how all nursing students can be considered as critical thinkers due to relating theory of what is learnt in class into practice. Hicks (2001) suggested that critical thinking can be developed through experience that involves undertaken complexity activity. Lauder and James (2001) study analysed that there are no significant differences for graduate and non-graduate student when it comes to critical thinking which nicely correlate with Gopee (2002). Understanding of this and having read through different research on what critical thinking is has enabled me to understand what the term critical thinking is. This made me recognise this is a skill I have been applying into my practice unknowingly which I have developed through series of placement but I have not being able to apply it thorough into my academic essay. For example in practice I was told by my mentor that we needed to trial without catheter (TWOC) a patient, this made me question why we were taken this action earlier than usual, whether it was documented by the Doctors, if the patient has been informed and what the after plans were. Reflecting back made me understand this action can be considered as being critical to maintain efficient care. However Girot (2000) research causes lack of consensus by articulating that graduate nursing students possessed greater care planning and decision making skills than non-graduate nursing students. Development of my need connect more with Gopee(2002), Lauder and James (2001) because not all nurses seen in practice undertook the degree program but they are still able to apply critical thinking into the daily nursing activities.

Critical thinking will enable me to have the characteristics of a critical thinker while making me accountable for my actions and provide quality nursing care as recommended by Scheffer and Rubenfield (2000) that analysed critical thinkers in nursing exhibit habits of confidence, contextual perspective, flexibility, inquisitiveness, open mindedness and reflection. In realising this it made me understand development of this need has huge impact on my nursing profession as it essential for me to examine every underlying assumption. Critical thinking will result in me providing higher quality of care as I will be able to meet the need and concerns of my patient which is required by the care quality commission. In meeting this need I will be able to consider alternatives, preferences and question any uncertainty. Booth (2008) discussed practitioners must sought after the best available tool to reach the best available decision when providing nursing intervention. In order to impact my patient with positive experience, maintain safety and deliver positive outcome I will need to apply my critical thinking skill by assessing the best practice for my patient through autonomously holistic care. Profetto-McGrath (2005) and Scheffer and Rubenfield (2000) discussed how critical thinking improves patients outcome through evidence based practice. Gadamer (2000) research discussed how critical thinking enable nurses to develop as an expert through knowledge and proficiency stage as this allows the nurse to move from being task orientated towards patient specific care and need. This academic need has been limiting my development because awareness of this has made me gathered how much I could have been task orientated in my essays and nursing intervention in order to get the task done rather than reading and seeking for ways to provide an expertise care and work. Chan (2013) study made me realise reading widely is encouraged as it assist student to develop more sophisticated form of reasoning which make complex problems a lot more easier to deal with.

This need has a huge impact on my nursing development because appliance of critical thinking enables me to provide quality essay through informed research and also provide safe evidence based care through clinical judgement by finding and applying guidelines in practice (Young, 2004). Critical thinking will enhance my professional development by enabling me to seek out the truth by actively exploring a problem or situation. It will also facilitate me to provide adequate patient centred nursing assessment and intervention while also acting as an advocate for my patient. Development of critical thinking reflects my competency as this is one of the expectations of the NMC code of conduct (2008) and National Institute of health and care excellence (2010) laid emphasised are laid on the importance of critical thinking in nursing practice to perform higher care (Chang et al 2011). Development of this truth seeking need can also leave an impression on my colleagues to strive for the best practice available hence influencing the work environment positively which has a great impact on patient’s experience as covered in Chan (2013).

Applying critical thinking into my essays has enabled me to be more analytical when using research as evidence to back up points in my writing. Critical thinking has assisted me in planning efficiently before conducting my academic work for example I had to utilise this skill when it came to selecting the best literature to critique and analyse my work prior to writing. Price and Harrington (2010) discussed one of the components of successful academic writing is thorough preparation and through planning. As critical thinking is an on-going skill I will continue applying it to my learning and practice by reading more. Critical thinking can be considered as a key ingredient to lifelong learning that characterizes personal growth and development through experience and practice (Banning, 2006).

In conclusion development of these needs has influenced my knowledge and ability of being able to provide evidence based practice into my patient’s care. It has also impacted my academic work by enabling me to question the validity of research before applying it to my essay.