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 nursing theory and practice, and as a tool to develop knowledge embedded in practice (Chong 2009). Furthermore in reflecting on the way we deliver care we can identify weaknesses, build on strengths and develop best practice (Myser et al 1995, Johns 1996). However, there are those who are sceptical of the practice and the idea of reflection in nursing is ambiguous and confused and not based on discipline related evidence based research (Gustafsson et al (2007). Some studies however, have shown a positive response from practitioners who have attributed reflective practice to changes in their practice (Paget 2000, Cooke & Matarasso (2005). In consideration of these views my approach to reflection as a means of recognizing strengths and weaknesses in my learning and practice to enable me to make positive changes to my future practice will be unbiased. Therefore my reflective account will include an open and honest description of what I have gained from the experience
In conclusion, my main aim is to enhance my professional development by reflecting upon past education and clinical experience using the Nursing and Midwifery proficiencies as a benchmark. Furthermore by utilizing the reflective model I will not only identify my strengths and weaknesses but also recognize potential opportunities or threats which will enable me to prepare for my future development and alert me to any threats allowing me to overcome any difficulties I may encounter. Teekman (2000), states that throughout the literature it is well emphasized that reflective practice is an effective tool to reduce or eliminate the perceived theory-practice gap. I will therefore endeavour to utilize this exercise to transform my theoretical learning into evidence based practice. By doing this I can substantiate my claim to having knowledge of evidence based care to ensure safe practice (Proficiency 2.5)
Gibbs Reflective Cycle
Description
What happened?
Action plan
If it arose again what would you do?
Feelings
What were you thinking and feeling?
Conclusion
What else could you have done?
Evaluation
What was good and bad about the experience? Analysis
What sense can you make of the situation?
Fig. 1
REFLECTIVE SELF-ASSESSMENT 1ST DRAFT
Gibbs (1988) model begins with asking the question ‘What happened?’ and asks ‘What were you feeling’. This allows me to give an account of the events that occurred, and in order to add significance to the narrative I will relay my feelings about the event directly after explanation about the incident.
During the course of my placement whilst working in an acute psychiatric in-patient I was delegated some responsibility for particular patients by senior members of staff. In addition I was often allowed to facilitate both group and one-to-one sessions supervised by a trained member of staff. However, due to other demands within the ward environment staff were often unable to run the groups and one-to-one sessions with the patients could often be time limited.
However, on one particular day I was approached by a patient for whose care I was given responsibility He appeared very agitated and complained that over the previous few days he had become frustrated by the lack of attention he was been receiving from nursing care staff the lack of information he was being given in respect of his care. He also complained that he had been informed that he would have regular access to therapeutic groups and this was not happening. This patient had show a keenness to participate fully in his care to facilitate a quick recovery and discharge from the ward
I was aware that staff had been busy but felt uneasy at his distress and afraid to tell him that staff had been too busy therefore unable to run the groups. In addition I did not feel confident enough to explain his treatment plan. I was quite annoyed though that he had not been consulted or involved in this previously, therefore I consulted with his named nurse voicing my concerns and asked if she could alleviate his concerns. (NMC Proficiency 2.6) was achieved by my articulating my own emotional and psychological responses to situations with colleagues in a professional manner. By also being aware of my own limitations at the time I achieved (NMC proficiency 1.1). The nurse took him into a quiet room and in my presence explained the situation to him apologising for the apparent lack of attention he had received. She assured him that the therapeutic group would be commencing later that day and allowed him to vent his feelings and concerns about his care and anxieties about his illness. She reviewed his plan of care with him taking account of his wishes and desired outcomes. On listening to how she handled the session, I felt quite inadequate afterwards thinking I should have been able to deal with the situation as I was competent at formulating care plans.
Following the session I decided to approach my mentor to ask to discuss the situation and we agreed that I would take the time to read through the Integrated Care Pathway of each patient under my care and become familiar with their use by suggested I attend and participate in multi-disciplinary meetings. By recognising this I was adhering to the code of professional conduct (NMC) 2008, to consult with a colleague when appropriate and work within the limits of my competence. Moreover, I achieved (NMC Proficiency 4.1) by demonstrating a commitment to the need for continuing professional development and personal supervision activities.
In addition a multi-disciplinary meeting was arranged for the patient and his father and my mentor allowed me to co-ordinate this and provide feedback on his progress in order that I gain experience in multidisciplinary working. Prior to the meeting I scrutinized his ICP to familiarise myself with his situation and plan of care to enable me to identify his needs and achieved (NMC Proficiency 2.2) by providing relevant and current health information to the patient during the meeting. Rees et al, (2004) informs us that ICP’s are tools which map out the pathway of clinical events and activities for all professionals involved in a specific patient group. The ICP helped clarify my roles and responsibilities as well as improve team working and communication. This enabled me to become more informed and also provide the patient with information on his plan of care which would be carried out throughout his journey from admission to discharge
In attendance at the meeting were the Consultant Psychiatrist, Named Nurse, Pharmacist, Community Psychiatric Nurse, Occupational Therapist and myself. I provided feedback on the patient’s progress to the Consultant Psychiatrist and other team members, and highlighted the patient’s concerns about his treatment demonstrating (NMC proficiency 3.2)by working collaboratively with multi-disciplinary team members to enable the delivery of effective patient care, prior to the patient and his father attending. This provided the Consultant Psychiatrist with an overview of the patient’s mental health and progress to date. The patient and his father were then invited to attend the meeting the patient was given the opportunity to tell the Consultant Psychiatrist how he was feeling and discuss any issues he may have. He was also given the opportunity to talk about his prescribed medication and ask questions which were answered both by the doctor and pharmacist. The pharmacist also gave some advice about his present dose of prescribed medication making suggestions to the doctor about possible changes due to a complaint by the patient that he was experiencing stiffness in his legs. The patient was allowed to discuss his involvement in therapeutic groups he had attended and their benefits. The patient’s father was also given the opportunity to ask any questions and voice any concerns he may have. Discussion between me, the consultant and patient provided clearer picture of the situation I and felt more at ease having further clarified the process of his care would be while on the ward. I felt more confident and satisfied that the patient was now more at ease and satisfied with his present care and was able to meet (NMC proficiency 2.4) by updating the patients plan of care following the meeting.
The next stage Evaluation Gibbs model ‘making sense of the situation’ and asks ‘What was good or bad’. I was pleased to see a positive outcome which was due to inclusion of the patient in his plan of care and collaboration within the multidisciplinary team meeting which alleviate the patient’s concerns. I was not happy at my own lack of confidence to initially deal with the client’s concerns and the fact that the patient had to complain before being fully involved in his care. Having this awareness of my own emotions and of weaknesses in my practice and consulting with the patient’s named nurse assures me that I am managing myself, my practice and that recognizing my own abilities and limitations (NMC Proficiency 1.1) and resolving this by taking action to improve in this area of practice.
In conclusion, stage five of the Gibbs (1988) model, I feel the more experience I gain in the ward environment and more I learn about ICP’s I can improve patients quality of care and collaborating with other members of the multidisciplinary team I will gain knowledge and confidence to enable me to take that step from being a student to becoming a confident registered nurse and deal complex situations such as described above.
In the final stage of Gibbs reflective model the question is asked ‘If the situation arose what would I do?’ I will continue to utilize reflective practice to improve on my knowledge and skills and develop my Personal Development Plan to highlight gaps in my knowledge. I will use my personal development plan within my final placement to address my weakness and build on my strengths whilst seeking opportunities for further development taking account of any threats.
EVIDENCE BASED RATIONALE
I have used the two main areas within my recent practice where I have identified both strengths and weaknesses. Although multidisciplinary working and the quality assurance tool Integrated Care Pathways are interlinked they will be discussed separately to maintain coherence and facilitate separate Personal Development Plans.
I will therefore begin by discussing Integrated Care Pathways as a quality assurance measure, what I have learned to date, highlighting my development need, and why this is important to my practice.
Integrated Care Pathways
Evidence Based Rationale
My experience of Integrated Care Pathways during my training has been limited, therefore I require to improve my knowledge and participation in undertaking and documenting a comprehensive, systematic and accurate nursing assessment of physical, psychological, social and spiritual needs of patients. It is necessary therefore require to further enhance my knowledge and the requirements of (NMC proficiency 2.3) as part of my development needs. ICP’s have not been implemented within any of my placements in the community or long term ward settings. However, an Integrated Pathway for admission and discharge has been implemented within an acute ward setting where I was placed. This has been implemented to standardize practice across every psychiatric admission ward within Lanarkshire (Kent & Chalmers 2006), and to facilitate better co-ordination of discharge planning and facilitate continuity of treatment in the community (NHS Lanarkshire 2007). The purpose of Integrated Care Pathways has been defined in different ways within the literature. Quality Standards Scotland (2007) highlights the quality assurance aspect indicating that ICP standards will support service improvements in relation to the process or care and outcomes for individuals.