Multi-Professional Support of Learning and Assessment in Practice - Essay Example

? Multi Professional Learning and Assessment Grade (12, December, Outline Outline 2 Introduction 3 Urine dipstick as an innovation and its usefulness in practice 3 Learning outcomes reflection 6 1) Development of effective relationships with learners within the context of learning 6 2) The opportunities and limitations of the learning environment in relation to the facilitation and evaluation of learning in practice 9 3) Enabling of learners to integrate theory and practise 12 Conclusion 13 Multi Professional Learning and Assessment Introduction The urine dipstick is one of the most critical innovations in the nursing profession. An accurate diagnosis is essential in enabling the right treatment process. Its applicability in different situations is a valuable opportunity for learners and mentors to reflect, appreciate, and enable learning in nursing practise. This tool was an opportunity to sharpen a series of learning outcomes. Urine dipstick as an innovation and its usefulness in practice Urinalysis is a preferred method of testing because of its ease of administration, relevance to many diseases, and its relative inexpensiveness (Hedin et. al., 2002). Nursing students who intend on becoming serious professionals cannot brush through the study of this test. It is done by immersing a test strip into urine, where a reaction will occur and the results will be interpreted on the basis of that reaction. Nurses use the test to detect diabetes, urinary infections, renal failure, pregnancy, and several other ailments (Juthani-Mehta et. al., 2007). The following diseases are evident in the test strip. Once a practitioner finds glucose, then this could be a sign of diabetes mellitus. However, confirmatory tests need to be done in order to make conclusive diagnoses. Renal malfunctions may also be found when proteins are in the test strip. However, this should apply to hypertensive patients. Urinary infections can be diagnosed if the strip contains blood. The latter may also be indicative of urological cancer. Other diseases that could be diagnosed include obstructive jaundice, and diabetes mellitus if leucocytes, and billirubin are found, respectively. When conducting the test, nurses must perform go through a series of precautions prior to actual administration of the tests. They must confirm that the sample was collected no less than four hours after storage in the bladder (Deville et. al., 2004). It is always preferable to use fresh samples for the tests. Professionals must exercise caution when storing and timing the tests. A nurse must then immerse the reagent strip into the urine and remove it immediately. Thereafter, the dipstick should be placed horizontally and the subsequent colour should be compared with a colour chart in the lab. Abnormalities should be noted and recorded. Source: http://learn.parallax.com/reference/urinalysis-test-strip-color-chart Nurses need to take into account a number of things that might interfere with the accuracy of results. First, they must consider the possibility of false positives and negatives caused by smoking, taking vitamin C and other drugs or conditions. This implies that they ought to consider the background of the patient’s illness. Sometimes the possibility of wrong test diagnosis may be true if the patient continues to report similar complaints. The practitioner may need to repeat the test for confirmation. Result interpretation ought not to be taken at face value. For instance, the presence of bacteria may not always be indicative of an infection. This is only confirmed once the nurse determines the quantity of the pathogens. Once the threshold has been reached, then conclusive assertions can be made. White blood cells may seem abnormal but such a condition may not immediately mean that the patient has a disease related to their immunity. Sometimes cervical and vaginal white cells may contaminate samples. Additionally, the presence of epithelial cells should immediately be assumed to indicate the presence of a malignancy. Instead, one should consider the quantity and existence of clumps before making this decision (Coffey, 2004). Poor diagnosis of the disease may cause patients to undergo unnecessary treatment options. Most times, urinary tract infections are treated through antibiotics. Therefore, incorrect diagnoses that lead to false positives may cause medical professionals to prescribe antibiotics. It is a known fact that wrong antibiotic consumption leads to the development of immunity and this hampers doctors from taking the patient through a similar treatment option in the future. Some safety procedures must also be followed prior to and after the test. One needs to look at the expiry date of the reagent. Additionally, it is critical to go over the manufacturer’s instructions. The reagent strip needs to be under constant temperature and should be kept away from sunlight (Juthani-Mehta et. al., 2008). Perhaps another issue that nurses need to be aware of is the debate surrounding the accuracy of this tool. Scholars place its accuracy levels at 85% (Ducharme et. al., 2007). Therefore, confirmatory tests may be necessary once they are completed. When conducted against the background of the patient’s diseases, the tool may be critical in reducing congestion in laboratories for urine testing. When viewed holistically, this urine dipstick test is quite cost effective to a health institution in terms of the workload at its laboratories as well as in treatment wards prior to administration of antibiotic therapy. Learning outcomes reflection My mentorship of a nursing student who was learning about the urine dipstick took place within my institution. This was her first nursing placement. Therefore, her insecurities, weaknesses and abilities were fertile ground for conducting an analysis on my effectiveness as a teacher within the practise environment. 1) Development of effective relationships with learners within the context of learning I believe the first opportunity to create an effective relationship with a nursing student is during their arrival or at least during their first day of mentorship (Hughes, 2004). I noticed that the learner was quite apprehensive about the whole placement experience. She seemed to be overwhelmed by the sheer amount of knowledge that she needed to possess. Most times, she appeared to have a lot on her mind. In order to put her at ease, I called her aside and sat her down. We then had a light conversation about placements in general. I avoided being overly instructive or giving her a number of dos and don’ts. Instead, I shared my experience with her concerning my first placement. This level of confidentiality may have worked in the situation because it served to calm her nerves. Reassuring a student and demonstrating empathy can go a long way in easing tension and making students realise that the mentor is on their side (Beck, 2002). I believe that this strategy helped to make me appear human to her and thus more approachable. Literature also indicates that building trust between the mentor and student is critical in establishing a relationship with them (Chow & Suen, 2001). I knew that the best way of achieving this objective was by being consistent. If I made a commitment to the learning student, I would make a point of showing up as expected. This aspect was quite difficult for me because sometimes I had other commitments to attend to at the agreed upon time. Whenever this took place, I always made the point of creating a replacement meeting at another time of the day. I knew that the student had to count on me. During practice, it is often tempting to dwell only on the technical aspects of learning, yet these may obscure other components of the nursing programme that can also be developed through the mentor-mentee relationship. Therefore, I often made the point of accepting my student for who she was; a learner. She was not expected to know everything and it would be unfair to expect her to do so. In one scenario, we had to conduct a urine analysis for an elderly patient. I asked her to perform the test because I felt that she had already familiarised herself with the intricacies of it. However, I realised that she started performing the test without looking at the manufacturer’s instructions or the expiry date. Instead of randomly shouting at her or stopping her from carrying out the test, I let her complete it and asked her to remember doing those two important things next time. This approach indicated that the atmosphere during the test was a non judgemental one. The student realised that I has unconditionally accepted her position as a learner. The above descriptions may make it seem like I had a friendly relationship with the mentee. However, I always kept in mind the fact that I was a mentor and we needed to be professional (Teekman, 2000). The student sometimes wanted to talk about her social life and other personal issues. I usually refrained from engaging too deeply in such conversations. Most times, I would reorient the dialogue back to some academic or clinical topic that we were concerned about. Urinalysis gave us a critical opportunity to cement the mentor-mentee relationship. I was aware that my communication skills needed to be sharp in order to capture the moment under reflection. For instance, after we had administered the urine tests, I asked the learner to interpret the findings using the chart. I realised that she remembered to put the strip horizontally when comparing the colour to the chart. I then watched as she gave me possible suggestions on what she thought could be the problem. I nudged her to proceed until she considered all elements and decided that it was a urinary tract infection (Doughterty, 2004). The mentor had come up with an accurate diagnosis that I could have done in the same manner if I was doing it. However, she did not consider the patient’s drug history. Therefore, I asked her the following question: “What would you do differently if you had more time?” She did not seem to know what I was implying. Therefore, I gave her an even more direct hint, and she talked about the vitamin D that the patient had been taking. My ability to communicate effectively with her through open ended questions caused her to reflect upon her learning. This allowed her to gain confidence in her own abilities as a thinker. An effective mentoring relationship is one in which the teacher allows the student to grow into her own skin as a nursing professional. This was what I was trying to achieve through communication tactics. 2) The opportunities and limitations of the learning environment in relation to the facilitation and evaluation of learning in practice Numerous opportunities exist for facilitation and evaluation of learning in practice. The learner is able to see the practical applications of what they have learnt. Furthermore, some of the information in nursing courses may be redundant or simply good for general knowledge. Through the clinical environment, the nurse is able to determine which information is useful to her in practise and which ones are not. She can thus be in a position to sharpen those skills. As the mentorship process went on, the nursing student realised that she needed to perfect three critical things in the urinalysis test: sample collection, test administration and interpretation. The practice setting was an opportunity to cull through all the excessive information in class by focusing on what counts. It was also an important opportunity to learn most nursing skills fully. Classrooms are crucial in introducing new information to the learner but their passive nature often impedes learners from becoming good at these crucial skills. The social learning theory can best explain how my mentee acquired skills on the urine tests. Observation of the skill under analysis is the first step in the social learning theory. A learner will normally observe certain behaviour as is takes place. This observation process allows them to think of the behaviour as distinctive and useful. Such was the case with the nursing student during the learning of the urinalysis tests. She was able to single out this activity as useful in her profession. Additionally, the observer will be keen to learn the skill as it proceeds. This took place with my mentor as she had previously received instruction on her learning skills in the past. Mental retention of the skill is the second aspect of the social learning theory. As a student continues to perform the skill, it becomes mentally assimilated into their mind. This causes them to rehearse the modelled behaviour (Hughes, 2004). I realised that the nursing student was quite apprehensive during the first week of placement. She always refrained from volunteering. However, after we went through a step by step process of the urinalysis tests, it began to be mentally assimilated into her mind. Since the samples were always different, there were always new things to assimilate and master as she went on in the learning process. These opportunities would not have been existent in the practice environment. A clinical setting allows the observer to carry out the skill and evaluate the performance. This is what makes it so insightful in the teaching process. During the implementation of the urinalysis test midway through the placement, the nursing student realised that she was getting better at the test but often forgot small things about the tests like possible false positives. It is only through practice that one can effectively become one’s own assessor. I also found that the practice environment provided the nursing student with opportunities to reinforce and adopt behaviour. For instance, when she gave me curious insights about why certain procedures had to be followed in the urine tests, I would often praise her for knowing these things. She seemed to respond very positively to these praises (Mallette et. al., 2005). For instance, in the scenario where she had failed to consider the vitamin D element, I was quite impressed by all the procedures that she had followed. I immediately complemented her on this and even added that I would have done the same thing if I was in her shoes. She surely appreciated these components and is likely to adopt the approach that she used because of reinforcement. Such opportunities are almost none existence in the classroom settings. Therefore, clinical practice is critical, in bringing out the best elements of the patient’s practice by encouraging her. Regardless of these immense opportunities for facilitation of learning, I also realised that plenty of limitations also existed in the practise environment (Murphy, 2004). The ward unit had not set aside time for our mentorship activities. Sometimes I had to perform duties back to back and it became almost impossible to reflect or evaluate the leaner’s progress. I often had to persuade the head of the ward to provide sufficient time to us in order to meet with the mentee. In some instances, I often found that I was overwhelmed by these activities. My workload was quite intensive and this mentorship program was making it even more demanding. Sometimes it was not possible to convince ward supervisors about the importance of our mentorship activities. This actually indicated that the institution did not acknowledge the relevance of education during the dispensation of services. This aspect is sometimes common for nurses carrying out mentorship roles. They sometimes have to take on the legitimising role in their hospitals. I found that I almost became an advocate for nursing students in the ward. Such an aspect took away the time that we would have dedicated towards our own mentorship program. Sometimes the practice environment may come in the way of teaching more theory. I found that my mentee was finding it difficult to carry out research during the placement period. She seems to have assumed that theory was a reserve for the classroom and practice was to occur exclusively in the ward. In fact, I found that it was quite necessary to dismantle the notion of practice and theory as two separate entities. We somehow overcame this problem by frequently asking the learner about theoretical explanation for the analysis. 3) Enabling of learners to integrate theory and practise The learning theory that I depended on during the mentoring relationship was problem based learning. I encouraged the nursing student to ask how and why every time we did something (Saarikoski & Leino-Kilpi, 2002). For instance, I had mentioned that it was not prudent to detect some bacteria in the test strip and deduce bacterial infections. The student asked why this was so, and I responded that the sample may have been contaminated during collection. However, this sort of contamination only spread a small quantity of the microorganism in the sample. I then turned around the scenario and asked her what could be used to deal with this matter. She immediately stated that the quantity of the bacteria will indicate whether an infection is true. The problem-based learning approach allowed the patient to merge theory with practice by considering various concepts that she had learnt. It was possible to see a link between sample handling, pathology of disease and clinical diagnosis. Theory would simply have dealt with these issues separately. However, by probing the student to think about their justifications, she was able to understand why certain things occurred in the manner that they did (Williams, 2004). Additionally, I had mentioned to her that morning samples are the best type. Using the problem-based approach, she began wondering why this was necessary. I urged her to research this and come back with the response the next day. She had all manner of explanations on why this was so but did not mention what I had in mind. I finally told her that sometimes bacteria in urine may act on nitrates and convert them into nitrites. Therefore, one can find these nitrites in urine and deduce bacterial infections. However, the reaction often takes place after a period of four hours of incubation in the bladder. It is for this reason that overnight samples that come from the patient’s body in the morning are quite appropriate for the analysis of such processes. The nursing student seemed awed by this explanation because she had already spent a lot of time looking for the answer. She was thus more than anxious to establish the reason behind this occurrence. Theory rarely went beyond the test results and the interpretation. However, the problem based approach we used assisted the nursing student to realise that there was more to the test than simply procedure. Practice often required one to stretch one’s theoretical knowledge, which is what was occurred (Nancarrow & Mackey, 2005). Conclusion Multiprofessional learning is best epitomised through a mentor mentee relationships. My experience concerning the teaching of the urinalysis tests demonstrated the usefulness of establishing trust, predictability and effective communication when forging relationships with one’s mentee. I also realised that the practise environment was useful in providing opportunities for learning. The nursing student could observe the urine tests, record it mentally, practice it and receive enforcement for it through the practice session. These opportunities would have been difficult to find in a non practice session. Regardless, the limitations were also evident in the practice session. It was difficult to squeeze in time for mentorship activities. Furthermore, commitment to education in nursing practice seemed to be a low priority issue for some supervisors. I found that I was overwhelmed by these activities and sometimes wanted to do away with them. Integration of theory and practise is critical in mentoring relationships. I enabled this merger through the use of the problem-based approach to learning. Here, the nursing student discovered the association between certain theoretical elements and the urine test. She began realising that procedures were not just existent for their own sake. Overall, the relationship was quite insightful in bringing out my strengths and weaknesses. References Beck, A. (2002). Communication Studies: The Essential Introduction. London: Routledge. Chow, F.L.W., & Suen, L.K.P. (2001). Clinical staff as mentors in pre-registration undergraduate nursing education: students’ perceptions of the mentor’s roles and responsibilities. Nurse Education Today, 21, 350-358. Coffey, A. (2004). Perceptions of training for care attendants employed in the care of older people. Journal of Nursing Management, 12, 322-328. Deville, W., Yzermans, J., Van Duijn, N., Bezemer, P., Windt, D., & Van der, B. (2004). The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. 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