Evidence-Based Practice in Nursing - Essay Example

number Essay, nursing reflective In my elective placement, I opted to focus on a wide array of the hospital wards in thehospital. It was one of my placements in this nursing discipline and hence I am writing this essay in light of the learning outcomes across the elective as compared to the rest of the class work. The paper will also address the various approaches and lessons that I adopted towards facilitating my competence as well as influencing the same approaches into having future placements. The essence of the essay I that I am looking forward to putting my learning into considerable context through explaining the learning method adopted by my clinical educator which later led me into critically reviewing the learning methods in place. The goal of the essay is reflecting on the learning experience in totality which will make me a comprehensively better practitioner. The nursing reflection in this case will be classified as a tool for importance in elemental learning. In its exclusion, it cannot be entirely expected to develop my clinical practice as I go into the previous situation which I gain the diversely relevant insights for ways in which approaching certain situations again is appropriate. Moreover, the effective form of learning does not overly occur in exclusion of reflection (Jasper 210). The initial comparison I will focus on making regards to neurological assessments. The physiotherapy assessments need to be clear logical processes of ensuring that findings for which there are both transferable and complete skills to others (Wheeler 28). For the placements, I sought to complete at least four comprehensive assessments on my own hence completing the concise objective and subjective investigations. In one of the wards, I was expected to correctly complete such assessments while writing them up concisely and the feedback I got was that I had not reasoned clinically enough across the objective process that would later relay on the part of the treatment. From Florence Nightingale to the modern day form of nursing, it is inevitable to consider an escape for which nurses have while faced with challenges of being in a position of having a critical impact to the delivery and management of care. Such challenges continue changing across the years even though there is various factors which have insured that, all aspects ranging from the government level all the way to the ground work force coupled with the challenges are well managed and have a positive on change (Hendrick 201). This is based on the advanced of education in terms of having individuals wanting to implement such changes in place. In the long run, Florence was in a position of implementing changes while articulating and having the education of arguing the need for such changes with evidence and facts, across all levels. For today’s world, more pressure is towards nurses in delivering and managing total individualistic care for the ever fluctuating economic climates coupled with the role of nurses in going above and beyond the expectations of previous practice in cases where the wards could be ran by matriarchal matrons (Howatson-Jones 29). They passed their orders to the ‘sisters’ who later enforced them in the ward. The modern day nurses have become rather qualified autonomous professionals towards delivering care that also encompasses the fundamentals, evidence based theory, health promotion, intuition, interdisciplinary working, ethical practice, advocacy, self awareness, autonomy as well as legal frameworks. For this reason, it is through the clarity of the placement experiences for which there are various hours in a given shift for which nurses are able to provide the fundamental care, liaise with doctors, referrals, observations, social workers, dressing changes, family members while other healthcare professionals as well as the patient themselves are able to include advocacy. For purposes of being in a position of doing this in an effective manner, I understand that nurses need to be skilled and competent for purposes of recognizing their respective roles and that of others in a given group (Kraszeski & McEwen 89). This also includes the appropriate use of effective communication skills and embracing the inter-professional workings coupled with the challenging of non-evidence based attitudes. Such a view can be echoed into the Nursing and Midwifery groupings to meet the Standards of proficiency in pre-registration nursing. While members of the profession, it is critical that the registered nurses take personal responsibility for the actions and omissions which is an essential part of the full recognition of their respective personal accountability. In the university, we are taught the best way of achieving this through learning about communication, self awareness, health promotion, accountability, professionalism, psychology, sociology, ethics, autonomy, responsibility, in conjunction with clinical skills. It is my belief that my studies have equipped me with the necessary tools of being in a position of making a thorough difference immediately I am qualified. This is both in providing the theory and giving me an opportunity of applying the theory in practice (Griffith & Tengnah 34). They have developed my personal qualities which are considered to be essential aspects at the beginning of my studies while learning on the best ways of incorporating such elements into my nursing practice. In a number of times, I felt that for purposes of facilitating my learning in the placement, I had to communicate the information to the elective clinical educator. We came into agreement that all patients I had involvement in seeing I would develop a clinical reason for the objective assessment as well as inclusion of the least one outcome measures regarding the stroke patients. For the clinical educator, there was need to have me comment on the abnormalities I spotted (Thurman 72). For example for gait, I ensured that I made a comment for the head position, pelvis, trunk, lower and upper limbs, stride length and cadence which was a possibility based on the reasons for the abnormalities. The approach in this case enormously helped me, as I felt that the presentation of the patients was in most abnormalities finding it hard to have an awareness of where exactly to begin (Herring 65). However, breaking down gait for segments helped me in the identification of the problem areas regarding treating the patient effectively hence impacting on the decisions of the outcome measures considered appropriate to use. Such a consideration does not mean that I have not been oriented on this approach previously even though I feel that I can make impact in clinical settings as compared to lecture rooms. In turn, the ICF availed a comprehensive framework in understanding the extreme rehabilitation structure due to the fact that it was segmented into various sections namely; impairment, activities and participation. Again, this is not new to me even as a clinical settings having real patients I am in appreciation of learning to appreciate for what valuable tools this has in relation to the physiotherapists which tailor-making rehabilitation plans in turn of suiting all patients individual needs is concerned. My educator pointed out that I was expected to write reflection pieces on the patients’ treatment programs, which I was keen to observe (Parahoo 59). This came in handy in helping me see the areas which I had not addressed as well as the consequential plan into the subsequent sessions (Ellis 38). I also saw the good parts of the treatment for instance based on the reflection. It is through reflection that I was in a position of improving my handling skills across the placement. From the completed assignment, the included reflection led the literature surrounding such reflection for the essay to understand the essence of reflecting on the success of becoming autonomous practitioners. At university, my tutors came in handy in encouraging me to keep exploring my own learning in challenging ideas. It is through this that I have discovered the theory of nursing by Watson. Here, Watson observes that in a more humanistic nursing theory that is in recognition of the individual’s personal ethics as well as values in turning to be a caring, competent, ethical, safe, professional practitioner together with the necessity of embracing clinical education (Edwards 17). The adopting of Watson’s nursing model is the initial step towards the development of my professional and ethical practice coupled with the other domains set out by the governing nursing council for which the nursing students need to pass in achieving success both during their studies and in the ongoing components of nursing in their future in being qualified nurses. The elements in consideration include developing professional and ethical practice; managing care; providing care as well as developing an effective lifelong and independent learner. The degree program in turn has equipped me with nursing knowledge that is necessary in enabling me develop my professionalism and ethics in my practice through the provision of education with respect to the ethical as well as legal frameworks for which the nurses need to practice within while still encouraging the involvement in independent learning (Moss 102). In addition, I have been taught to continually evaluate the care given while questioning the level of knowledge I have towards safely caring for the patient as well as the need of referring the this patient to healthcare professionals. Other considerations I encountered during my placement include whether the patient was receiving evidence based care (safe) and the scope of permission I had as a student in giving such care (Donelly & Neville 23). Issues of respecting the patient’s confidentiality and respecting their autonomy were some of the ethical and social issues at the patient while working within the ward and the organizations’ protocols and guidelines. In essence, this taught me the best ways of being autonomous in my workings while upholding the proficiency standards required for registered nurse which include guiding all nurses irrespective of the field of nursing chosen. There is some debate regarding whether or not today’s graduate education embraces the caring aspect for nursing in its curriculum taught. Even though this could be difficult to fully achieve, I feel that in my studies, this has been of the essence in forming an opinion for which such demands are managed rather effectively through the use of good leadership as well as in the time management skills. Further, I had the opportunity of testing this perspective into practice while I was appointed to take up the responsibility of bay (Morrisey & Callaghan 29). I also found out that through adoption of a nursing process for purposes of prioritizing care involves the incorporation of critical thinking skills which are the most effective approaches to ensuring that I am in a position of planning well in advance ahead. For the final year, I have encountered encouragement towards starting to plan my working shifts while in preparation for a role as qualified nurse. In addition, at handover I have started using such mnemonic as suggested in listing the activities and goals to be achieved. For this reason, the estimates time needed in carrying out each of the activities allows me create more time for the unscheduled activities and errors. The prioritization of the activities and organization of activities of the day also enable memory. For purposes of being in a position of doing this, I have acquired knowledge that I needed to develop a proper understanding of clinical and ward protocols coupled with the nature of patients’ care and critically developing the clinical thinking skills while planning ahead of the circumstances change coupled with the ability of effectively delegate to subsequent members of such teams (Gustafsson & Faberberg 102). This is also based on the fact that I was encouraged to continue developing my critically thinking skills across the period. For this, I am now able to re-priorities care while patients need change and appropriately responding. Through the incorporation of clinical and critical thinking skills, the effective management of my time and delegating to subsequent team members I was in a position of proving to myself that the challenges could be effectively managed while still allowing sufficient time for demonstrating and developing the art of caring (Tilly 93). Part of the most influential factors which have helped me in developing my practice as well as making the largest improvements on the care I deliver is the enhancement of my ability for reflection. I attach critical value to reflective practice as well as its significance both in my personal life and in my nursing career. I also find that I am mostly a reflective person by default nature who always evaluates the day and reflects back on positives as well as negatives with the aim of identifying where I need to improve on my performance (Walsh 19). Through having an ability of reflecting has been a universally agreeable approach in what I probably part of the most successful approaches to ensure that nurses remain up dated on their skills. This seeks to enable them become lifelong learners while continuing with their professional development. For this reason, the reflection involves the in-depth critical analysis as well as synthesis (for the evaluation of the critical analysis as well as forming new perspective) and the evaluation of the incident. This enables establishment of an ideal action to be taken based on reflection and the recognition of the possible skills of reflective practice that are an integral part of progression into becoming competent and qualified in the nursing field. The practice also forms an essential partnership for reflection (Cowen, Maier & Price 72). This way, the contributions I have done across the period continues to incorporate the reflective skills for the analysis of my abilities in identifying the areas which I need to improve for me to be in a position of taking responsibility in future. It was through the use of the skills necessary for reflective practice coupled with the application of my new learning and knowledge which I have been in a position of developing my skills into competent levels hence allowing me take responsibility in my practice. Further, my studies highlight the need for me in continuing to apply the reflective skills to practice and as I get qualified, I need to encourage future students within my mentorship to embrace the same. In case I want continue making relevant impact on the care that is under my delivery and management immediately I am qualified, my studies will have demonstrated to me the diverse benefits of having to incorporate the relevant principle nursing foundations that will ensure that I keep doing so even after the graduation. This also includes having confidence and competence of making sensitive and logical ethical judgments that are evidence based and centered on patient care that my educational and personal growth keeps instilling (Bryman 89). My studies equips me with the scientific, humanistic, and reflective skills for enabling me to become lifelong learners which ensures that I continue to be a patient’s advocate for the patients, general public, and the community, once qualified. The educational package has also equipped me with ideal communication skills which are necessary in challenging non-evidence based attitudes in ensuring that I become a graduate who continues making an integral impact across all levels. During the time of my observation, I was keen to make notes relating to the prominent questions in all the disciplines which were essentially ready for leading the group assessments. This came in handy in helping me to both formulate questions and put them in running orders based on the ability of flexibility in case the answers cropped up a little bit earlier than was expected. On the other hand, this preparation was not sufficient in helping me adapt the essence of the situation while the patients suffered Cerebral Vascular Accidents (CVA) (Bulman & Schutz 101). This affected their right frontal lobes. It was one of my essential incidents which I reflect on as I appreciate the overall impact on the future of my learning. The right-sided frontal of the accident had the potential of decreasing a patient’s inhibition while within the group assessment. It was observed that the patient made inappropriate comments to the MDT members where one of them was directed to me. I became unsure of the best way of reacting so I reacted as I did in other awkward circumstances (I laughed). It formed the essence of the wrong reaction even though it was not as intentional (Barksby & Harper 17). It turned out to be one of the therapists directing the patient into assessment once again. On reaching the assessment’s end, my clinical educator requested that I tell her of the happenings. I explained to clinical educator on the occurrences saying that immediately he made the inappropriate comment, I laughed. She swiftly explained that rehabilitation of a stroke does not necessarily limit itself on a physical rehabilitation but also mentally (Rolfe, Jasper, & Freshwater 91). During physiotherapy sessions nurses have a responsibility of enforcing the appropriate boundaries across all conversations. From the moment onwards, while dealing with patients in question, I sought to remain as focuses on enforcing polite conversation boundaries and being professional. In comparing these placement experiences I developed a feeling that I had underestimated the application of outcome measures up to my elective. The outcome measures include tools which are chosen for the testing of the diverse effects of treatment as well as matching the treatment through making it clear and measurable irrespective of knowing of the application of outcome measures and were not until I constantly used them with all patients that I could see the diverse benefits of each of them (Bryman 62). I also believe that such benefits of the procedures include the ability of tailoring a rehabilitation programme on the basis of results for each of the patients and that the patients have measurable components in seeing where they started and the manner in which they progress during their essential stay and the subsequent hospital departure. I have also come to learn the need of appreciating the major outcome measures which were previously not sensitive enough. For instance, the motor assessment approach describes actions which the patient has to undertake mostly for the hand even though does not address the quality of movement and how long it can take (Barksby & Harper 36). Ultimately, even though the outcome measures keep providing information for the practitioners with diverse clues of the cognitive state of the patient, there is thorough consideration of the identity of residual weakness. For this reason, the realise of the outcome measures comes as effective tool for the completion of assessments that hand answers which both the practitioner and the patient need to consider. While reflecting this incident, there is proof that those essential tools while dealing with patients of such kinds will in turn be impacted upon through my learning. I now know that it was not right to laugh even though I do not blame myself for doing it as it was not one of the situations that I had encountered before (Porter 83). Laughing was my natural reaction for such an uncomfortable situation mostly due to the fact that when I am under pressure. However, I have appreciated that from this, there is need to remain professional across all times. This is even more with the cognitively impaired patients where the understanding is based on the duty of care to most of my patients (Aveyard & Sharp 26). In the event that I do not efficiently enforce such social boundaries for etiquette within a clinical setting I will not be providing the patient with best care. The other comparison of the learning outcomes in this case addresses the learning outcome for clinical reasoning regarding treatment plans. During my placement I was asked to follow the Goal Attainment Setting plan in formulating a problem list which I was again subjected to in my elective and expected to take a step further while in the placement. This meant that based on the guidance of my clinical educator, a decision was made that the patients needed to goals set in adherence to the ICF outcomes. Works Cited Aveyard, H. & Sharp, P. A Beginner’s guide to evidence based practice in health and social care.  Maidenhead: Open University Press.  2009. Print Barksby, J. & Harper, L. Duty of care for learning disability workers. Exeter: Learningmatters. 2011. Print Bryman, A. Social research methods 3rdEdn. Oxford: Oxford University Press. 2008 Bulman C &Schutz S. Reflective practice in nursing, 3rd edition. Oxford: Blackwell Publishing. 2004. Print Cowen, M. Maier, P. Price, G. Study skills for nursing and healthcare students.  Harlow: Pearson Longman. 2009. Print Donelly, E. & Neville, L. Communication and interpersonal Skills. Exeter: Reflect Press. 2008. Print Ellis, P. Evidence-based practice in nursing.  Exeter: Learning Matters. 2010. Print Edwards, S.D. 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