...CRITICAL INCIDENT ANALYSIS Reflection is an important aspect of nursing education therefore for this assignment an acute event that occurred during a practical placement will be selected, reflected upon and critically analysed. To do this effectively a reflective model will be used. The model selected was Marks-Maran and Rose (1997). Reflection and analysis of a critical incident is recognised as a valuable learning tool for nurses (Rich and Parker 2001). In doing so it allows the opportunity of adapting our way of practicing, thinking and developing self-awareness (Alphonse 2007). It also helps to gain a better understanding of an incident, therefore exploring whether the correct decisions were made or whether alterations should be made to future practice. The scenario that will be used is one that was encountered while on practice placement. To protect the patient’s confidentiality in line with the Nursing and Midwifery Council’s (NMC) code of conduct a pseudonym of Mrs Smith will be used (NMC 2008). Mrs Smith was admitted to hospital following a collapse at home. An emergency craniotomy and evacuation of a blood clot following a large Posterior Fossa Haemorrhage was performed. After the surgical procedure an external ventricular drain (EVD) was inserted. An EVD is a drain that is inserted through the skull into the area of the brain that encountered the haemorrhage, this allows any extra fluid and blood to be drained, and it also assists with maintaining the intracranial...
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...opportunities and programs for nurses as a result of the Affordable Care Act of 2010, which aims to increase quality, access and value of care. For this to come to fruition, the nursing scope of practice will be utilized to the fullest capacity, nursing education will include expanded skills and leadership roles will be increased from clinical setting to board rooms. With every decade, nursing has become an increasingly integral part of health care services, so that a future without large number of nurses is impossible to envision. (Institute of Medicine [IOM], 2010, p. 87). Transforming Nursing Practice Nursing practice will have to change from outdated scope of practice policies and procedures to updated ones that will allow for the creation of patient center systems. Health care is centering on more chronic conditions and less on acute and specialty settings. Long- term care and palliative care will be on an upward trend in the coming years due to the aging population. RNs will be better utilized as roles shift and expand to free up physicians from procedures such as IVs and cardiac outputs, health histories and performing exams. There will be increased RNs to patient ratio, which will result in less medication errors and lowered infection rates. On the other hand, given the projected nursing shortage, task shifting to overworked nurses could create unsafe patient care environments, especially in acute care hospitals (IOM, 2010, p. 107). RNs will need to utilize LPNs and...
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...approaches in developing acute skills for nurses in critical care wards. In this section of the literature review, we will discuss policies in the nursing profession, case studies and various approaches to work based acute skills learning programmes. For our purposes we conducted a literature search using popular medical databases and terms such as ‘acute skills’ ‘learning programmes’ and ‘critical care learning’. Our review highlights on the several important approaches to work based learning ranging from reflective practice to experiential learning and work based formal practical training to enhance professional skills. A learning programme for acute ward nurses responsible for caring of critically ill patients has been the central focus of nursing practice development. According to Coad et al (2002), a work-based learning approach has been found to empower ward staff with the necessary skills of nursing and the authors studied the efficacy of a five-day competency based high dependency skills course in enhancing professionalism and quality of care in nursing. The aims of comprehensive critical care are developing leadership potential and enhancing networking opportunities for nurses within critical care and acute ward areas. Critical care is the most challenging aspect of nursing care and acute skills in nursing are enhanced not just by work-based learning programs but also from first hand nursing and emergency experiences. Titchen (2003) describes emergency care in which one professional...
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...improve the health status of individuals, families, and populations. History and Development Public health and community health nursing has been in circulation for more than 120 years. Lillian Wald is known for being the established leader in this specialty. The goal of public health nursing has been to develop strategies to respond to prevailing public health problems. One of the earliest traditions of public health in America was similar to the British law known as the, Elizabethan Poor Law of 1601 (Stanhope & Lancaster). This law guaranteed medical care for the poor, blind and lame within their county of residency. In the late 1800s, Lillian Wald and Mary Brewster began visiting the poor in New York and this establishment later became known as the Henry Street Settlement. The Henry Street Settlement in the late 1800s is now known as Community Health Nursing. Today many agencies continue to provide home care to the ill and dying....
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...introduction of the knowledge and skills framework (DH 2004a) and emphasis on quality of health care and patient centred, interprofessional, health and social care (DH 2000; Leathard 2003; Thompson et al. 2002) health care professionals and students will need to be able to demonstrate the quality of our care and team working abilities. There is a connection between practice and thinking about practice – action and reflection are interdependent; they need one another. Reflection may be triggered by an awareness of a gap between theory and practice, a difference between what ‘should be’ and ‘what is’ (Sullivan & Decker 2005). Our actions and the quality of our care are improved by reflection-on-action, by making sense of what we have experienced, and thinking about how we might act differently in the future (Lillyman & Ghaye 2000). Reflection has a rôle in maintaining one's personal portfolio and maintaining competency and continuing professional development. Support and supervision from managers, who already have a responsibility for assessing competence and continuing professional development of staff can help make this process much easier (Jasper 2001). Reflection is a very personal matter, through our reflections we learn not only about our own feelings and knowledge of the situation reflected upon, but also something about our own personality (Rolfe & Gardner 2006). Unlike most academic work a reflection is...
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...A REFLECTIVE CLINICAL PRACTICE EXPERIENCE Introduction My reflective clinical practice experience was based on my eight weeks placement in an acute mental health ward in a hospital. I was not sure of what to expect because I have never worked or placed in an acute ward and this was my second placement. Before starting my placement, I visited the ward and was inducted around the ward. This gave me a bit of confidence and reassurance about working in an acute ward. Reflection is a process of learning from ones experience (Spalding, 1998). The objective of my experience is to show the positive effect of using therapeutic communication skills with patients. Therapeutic communication can be described as a face to face technique of forming a rapport between a nurse and a patient that focuses on advancing the psychological, physical, social and emotional well-being of the patient. It usually involves providing health education and the use of strategies that give confidence to a patient to communicate feelings and ideas and that conveys acceptance and respect. Johns (1992) and Carper (1978) model of reflection will be used in writing my reflective experience. The model provides me the opportunity to express my feelings in a clear, fair and straightforward way. In the first week of my placement, I was assigned a mentor. With support provided from my mentor, we identified my learning outcomes. One of my learning outcomes is to provide support to three identified patients under my...
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...York teaching Hospital NHS foundation trust, of York is looking for a band 5 dietitian to work in an acute hospital environment. The post holder will take a clinical role in the dietetic and nutrition service in the region of medical, surgical, and care of the elderly patients (NHS Jobs, 2015). The post holder will provide care to both inpatient beds and outpatients. This position entails working in a multidisciplinary team to certify every patient’s necessities are met. Working in a multidisciplinary team can be trying due to several factors, such as dispute with team members, absence of effective communication within a team and dissimilar acuities. To conquer these challenges, I will recurrently communicate and deliver up to date development...
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...Critical Reflection on current clinical knowledge and development Within this assignment I will critically reflect on my clinical knowledge to date and consider my future development needs with a focus on my final management placement and future career as a registered nurse. I have chosen two areas which I feel are relevant to my future development needs namely Quality Assurance and Multidisciplinary/Agency team working and using the Gibbs model (fig. 1)as a framework will reflect upon my own learning experiences and achievements to date and write an annotated reflection highlighting my development needs from which I will formulate a Personal Development Plan. This undertaking demonstrates my commitment to the need for continuing professional development in order to enhance my knowledge, skills values and attitude needed for effective nursing practice (proficiency 4.1) and will address deficits in my knowledge and skills and identify any shortcomings within my own or others practice and help me cope with practice related issues experienced within my previous placements. I have chosen Gibbs reflective model as a basis for reflection as I feel it is easily understood and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, conclusion and reflection upon the experience to consider a solution if the situation arose again (Brooker & Nicol 2003). It has been advocated that reflective practices are a method of bridging the gap between...
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...The aim of this assignment is to describe through reflection, and analyze a clinical encounter I was involved with during my placement which gave me an opportunity to engage in a therapeutic manner. Critical reflection has become an important part of learning and development (King 2006). Gibbs (1988) noted that in recent years reflective practice has been embraced by professionals such as nurses, social workers and teachers. He said the process of reflection provides a systematic way of describing how a learner’s performance grows in complexity when mastering academic tasks. This work will employ a reflective model to analyze the therapeutic engagement with one of the patient that I was involved with. The central theme of this assignment is to explain the condition of a client who was admitted to the ward via accident and emergency department. For the purpose of this essay the patient will be referred to as Mrs. X. The pseudo name is given in accordance with the confidentiality and privacy code NMC (2004). Mrs. X has a condition of schizophrenia (a condition of mental health) because she had not complied with her prescribed medication. I selected this patient for my reflective essay because of the insight that my interaction with her gave me. In my encounter with Mrs. X, I had to administer medication on her by intramuscular depot (Injection). I decided to reflect upon this patient and the nursing procedure carried out on her because it was my first time to administer...
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...Benchmark Assignment: Evolving Practice of Nursing and Patient Care Delivery Models The Evolution of Nursing Practice To my colleagues, the health care system has begun a decade of transitions that, for the nursing profession, promise to change the practice of nurses, expand current nursing roles and create new ones, and provide many opportunities for nurses to participate in shaping the future delivery system. With the passage of the Affordable Care Act (ACA) in 2010, care delivery and financing systems are undergoing significant transformations that will accelerate in 2014, when major provisions of the legislation are implemented. The purpose of the this letter is to explain how the practice of nursing is expected to shift and to also discuss the concepts of continuum of care, accountable care organizations (ACO’s) medical homes, nurse-managed health care clinics (NMHCs). Under the Accountable Care Organizations, strategies will be developed to align the goals of health care delivery reorganizations, enhance care coordination, and improve patient transitions across the care delivery continuum. Expansion of medical care homes, NMHC’s, and enhanced coverage for preventative care services will help to shift the delivery system's current focus on acute care to a greater emphasis on prevention and treatment of chronic care conditions using health care teams and information technology. Medical homes, sometimes referred to as NHMC’s, are identified as a concept that began in pediatrics...
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...of Institute of Medicine (IOM) of october 2101 “ the Future of Nursing” states that the nursing profession is the leading agent of work force in health care today. With the implementation of the Affordable Care Act (ACA), which will entitle additional 32 million Americans to have access to health care, the nurses will need to be well educated and be prepared to meet the current and future demands of the health care system.( pg 271). In this paper I will be discussing the impact of the IOM Report on nursing education, on nursing practice, particularly in primary care, impact of the IOM Report on nursing role as a leader, and finally, how I as a nurse will implement these changes in my practice to meet the goals of the IOM Report. Impact on Nursing Education; With the evolving health care demands, changing and expanding nurses role in acute setting as well as in the community education plays most important part. In the IOM report the emphasis was placed on advancing nursing degrees, to make easy, seamless transition to advance nursing practices and to improve education system. Advancing Nursing Degree. First is advancing nursing degree by increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020, and double the number of nurses with a doctorate by 2020. ( pg 22). IOM directs health care organizations to encourage nurses to advance their degrees within 5 years of acquiring Associate Degrees in Nursing (ADA) degree. In order to achieve that...
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...assessment form of Queen Elizabeth Hospital (figure 1) and Gordon’s functional health pattern (figure 2) are presented, and comparisons between these two assessments on the aspects of structure, comprehensiveness, and applicability will be explained. Comparison between hospital assessment and Gordon’s functional health patterns Queen Elizabeth Hospital admission assessment form and the Gordon’s functional health pattern assessment form also can showed the evaluation of Ms Wong’s condition, Ms Wong was admitted to QEH because of slip and fell with left patella fracture. Both assessment forms had clear subjective and objective data on health perception and elimination pattern. It can provide data for us to making nursing diagnosis and care plan. However, there are something difference in terms of structure, comprehensive and applicability of these two assessment. Structure The format of Gordon’s Functional Health Patterns Assessment form is simple categories and concise typology. This layout is clustering and is easier to understand and complete. However, hospital assessment forms but not detail to separate category. The Gordon’s Functional Health Patterns Assessment form provides organization framework within which health assessment takes place, so as to clarify and identify client needs, risk factors and specific health problems. The Gordon’s functional health assessment forms including 11 domains in functional health patterns as follows. This is Health perception...
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...explore an acute deterioration in the health of an adult I have encountered during a clinical placement, in an acute care setting. The essay will begin with a definition of acute care, followed by the introduction of my patient and predisposing factors. This essay will include an explanation of the significant pathophysiological changes and related clinical manifestations and a critical analysis of the nursing interventions implemented during the acute episode of care, focusing on holistic care, rationale and evidence base. It will then describe the actual deterioration in the patient’s condition, and discuss the nurse’s role in the recognition and assessment of the actual deteriorating condition following the trusts policies. Assessment tools, monitoring, detecting and reporting will be considered. Finally this essay will include a discussion of the importance of multidisciplinary team collaboration in the diagnosis and provision of care during the acute episode, and a discussion on whether the deterioration could have been prevented by identifying any areas of practice which could change in relation to evidence based practice. For the purposes of privacy and confidentiality, in accordance with NMC (2008) code of conduct, the name of the patient will be changed to Peter and the placement area will remain as an acute care setting. According to McFerran (2008) the term “acute” is described as a disease of rapid onset, severe symptoms, and brief duration. Acute Care refers to riding...
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...Professional Development of Nursing Professionals In 2010 the United States Government passed into law the Affordable Care Act (ACA). Passage of this act enacted broad sweeping changes across the health care system focusing on expanded coverage, control of health care costs and improvement in the health care delivery system (Kaiser Family Foundation [KFF], 2013). This represents the largest change to the nation’s health care system since 1965 with the creation of Medicare and Medicaid programs (Institute of Medicine of the National Academies [IOM], 2010). As the “largest segment of the health care workforce,” nursing is at the forefront of these historic changes and as such, plays an integral role in the successful implementation of the ACA (IOM, 2010, p. 1). In order for nursing to be the leading agents of change, the nursing discipline itself must undergo a transformation to meet the challenges that lie ahead in the following three categories, nursing education, nursing leadership and nursing practice in the primary care setting. As new medical therapies are being developed at a rapid pace and the sweeping effects of the Affordable Care Act role out, nursing is called upon to take on more complex roles in the care of patients. “To respond to these demands of an evolving health care system and meet the changing needs of patients, nurses must achieve higher levels of education and training” (IOM, 2010, p. 7). In its 2010 article “The Future of Nursing: Leading Change...
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