Workplace Learning in the Intensive Care Department - Literature review Example

Workplace Learning Assignment 2 Transitions to effective practice Semester 2 2012 Contents Introduction 3 Learning Required for Newcomers 4 Types of Knowledge 4 Proposition Knowledge 4 Procedural Knowledge 5 Dispositional Knowledge (Personal Disposition) 6 Practice-based Learning 6 Individual Level 7 Group Level Learning 8 Organisational Level Learning 9 Strengths of Workplace Learning 9 Limitations of Workplace Learning 10 Actions Required to Develop Best Practices 10 Summary 11 Conclusion 11 Transitions to Effective Practice Introduction The selected workplace that will be discussed in this paper is a public hospital that serves as a tertiary referral centre. This hospital provides a wide range of services such as medical services, mental health care, surgical services, rehabilitation, and aged care among many other services. The organisational structure of this hospital is lead by the chief executive officer (CEO), who heads and oversees the general operations of the hospital. The hospital has several departments such as the surgical department, the medical department, the specialist services department, the aged and the community care department, and the intensive care department. These departments are headed by directors who report to the hospital’s CEO. The hospital has over 1, 000 staff members working in various departments in the hospital. Among the hospital’s staff are nurses who operate in different departments in the hospital. The nurses work under the chief nursing officer, who delegates and supervises the activities of the nurses. The hospital is comprised of different types of nurses who perform different functions. For instance, critical care nurses in this hospital work in the intensive care department. They carry out functions such as intensive, cardiac, and neurological care. They generally work with patients who are suffering from life threatening health conditions. They ensure that these patients are cared for by providing diagnosis, care planning, treatment, and rehabilitation services (Brilli, Spevetz, & Branson, 2001). This paper will focus on the intensive care department comprised of critical care nurses. In order for people to work in this department, they have to be trained and certified as nurses. They should also be equipped with clinical knowledge and skills that will enable them to showcase effective decision-making, leadership, and practice (Marshall, Currey, Aitken, & Elliott, 2007). In this case, learners will refer to newcomers or qualified and certified nurses who have been recruited to work in the hospital’s intensive care department. This paper will discuss the type of learning required for newcomers in order for them to be effective in this workplace. In this case, the findings of Billet (2001) on different types of knowledge will be referred to in order to establish the type of learning required for newcomers in this workplace. Secondly, this paper will discuss how practise-based learning experience can be used to develop capacities that help to assist the smooth transition of newcomers in the intensive care department to effective practitioners. Cross and Israelit’s (2000) model on levels of learning will be used to examine how practise-based learning experience can be used to develop capacities. According to Cross and Israelit, there are three levels of learning: individual level, group level, and organisational level. Learning Required for Newcomers Newcomers in intensive care department require solid knowledge and effective skills in working with patients and their families. They are expected to learn how to apply their clinical knowledge and skills towards the provision of interventions that contribute to disease prevention and promotion of the overall well-being of patients. They should also learn how to maintain high nursing care standards by using relevant and up-to-date nursing approaches and strategies. Alspach (2008) observes that the provision of effective clinical services begins with understanding the needs of patients. Therefore, newcomers must learn to identify the medical needs of their patients and identify ways of addressing these needs in order to enhance the well-being of patients (Alspach, 2008). In order for these newcomers to be able to implement effective practise as highlighted in the above section, they require different knowledge types. These knowledge types can be categorised as follows: propositional knowledge, procedural knowledge, and personal disposition knowledge. Types of Knowledge Proposition Knowledge According to Feldman (2003), propositional knowledge can be considered as knowledge based on irrefutable facts. As earlier stated, personnel working in the intensive care department have to be trained and certified as nurses. Therefore, newcomers in this department must have basic knowledge of what is expected of them as well as their responsibilities and roles. Moreover, they should be aware of the ethical guidelines that govern their nursing practice. As first time critical care nurses working in the intensive care department, their propositional knowledge must also incorporate knowledge of the Hippocratic Oath and knowledge of the laws and policies relating to their nursing practise in the intensive care department. In addition to this, newcomers in this department need to have basic clinical knowledge of dealing with emergencies and catering to the needs of patients with complicated and critical health conditions (Benner, Benner, Tanner, & Chelsa, 2009). Procedural Knowledge According to Anderson (2001), procedural knowledge is an essential knowledge type since it what we use to act or perform an action. Procedural knowledge can also be described as the “know-how” knowledge or the knowledge of how to do things (Ryle, 1949). In the intensive care department this type of knowledge is very important since it is the knowledge that determines the decisions that will be made or the steps that will be taken to address the medical needs of patients (Haibach, Reid & Collier, 2011). When working in the intensive care department, newcomers must be equipped with procedural knowledge of how to attend to emergencies and patients with critical medical conditions. For instance, they should posses in-depth knowledge on know how to administer resuscitative first aid during emergency cases, operate a defibrillator and other medical machines, conduct cardiovascular and neurological examinations, monitor vital signs in their patients, prepare patients for medical procedures, and prepare surgical machines and equipment during emergencies. Moreover, according to Stevenson (2001), this knowledge can be categorised into three key levels. In the first level, the focus is on understanding the set goals. Therefore, in this case, newcomers working in the intensive care department should understand that the key goal of this department is promote better health outcomes for patients. The second level involves understanding the steps that should be taken in order to achieve the set goal. This may involve learning which strategies or approaches can be employed in order to promote better health outcomes for patients. The third level involves problem solving. Although the focus of this paper is to examine the transition of newcomers in the intensive care department into effective practitioners, it is also crucial for these learners to possess knowledge of problem-solving. Given the fact that the job description of critical care nurses working in this department involves dealing with emergencies and patients with critical conditions, it is essential that learners should possess relevant knowledge of problem solving so that they are able to address various challenging issues that may arise. Basically, nurses operate in a dynamic and challenging professional environment that requires them to have effective problem solving knowledge and skills. The third level of procedural knowledge is important for newcomers working in the intensive care department. Therefore, newcomers should be guided through all these levels in order for them to be able to carry out effective practice (Wyckoff, Houghton, & LePage, 2009). Dispositional Knowledge (Personal Disposition) Personal disposition incorporates one’s values, identity, attitudes, interests, and affects relating to work (Parwat, 2001). Billet (2001) notes that people are less likely to passionately acquire knowledge that they do not value. Personal dispositions enable a person to act or behave in a way that reflects their values, identity, attitudes, interests, and affects (O’Donnell, Reeve, & Smith, 2011). It is essential for newcomers working in the intensive care department to develop appropriate dispositions that will enable them to perform their duties effectively. In order for these newcomers to becomes experts in this field, they should possess dispositions that are consistent with their expertise. For instance, they should have positive values and attitudes when it comes to the care patients with various chronic illnesses. Their interests should be directed towards the well-being of their patients and not their own personal interests. Moreover, they should portray the highest level of ethical conduct and professional responsibility. In addition to being provided with relevant clinical knowledge, learners should also be equipped with the right knowledge for leadership and complex decision making (Marshall, Currey, Aitken & Elliott, 2007). Practice-based Learning According to Billet (2010), learning can be exerted for and through practice. This goes to show that inasmuch as learning is often conducted for preparatory purposes, learning is continuous and can also take place in a work environment. As discussed in the above section, newcomers working in intensive care units require both theoretical knowledge and practical competencies in order for them to effectively carry out their services. These competencies can be achieved through preparatory training in colleges or universities. Nevertheless, there is a need to sustain these competencies through continuous education and training in the work environment (Marshall et al., 2007). In order to effectively examine the extent to which practise-based learning can be used to develop capacities that help to assist the smooth transition of newcomers in the intensive care department to effective practitioners, Cross and Israelit’s (2000) model on levels of learning will be used in this paper to discuss how practise-based learning can be used to develop capacities among newcomers in the hospital. Individual Level In any work settings, an individual is the smallest unit in the structure of the organisation. When an individual joins a particular work setting, they come with their own knowledge and set of skills based on their previous educational or work experience. Nevertheless, as they interact with others and undergo various experiences in the new work environment their knowledge, skills and experiences are moulded (Cross & Israelit, 2000). For instance, when trained and licensed nurses are recruited to the intensive care department, they may come with limited knowledge and skills with regards to attending to emergencies and taking care of patients with critical medical conditions. However, as they interact with other experienced critical care nurses and observe the work practices in this environment, they are bound to gain new insights and experiences. This may in turn mold their knowledge and skills in nursing. Learning can take place at an individual level and facilitate the development of people’s capacity to become an expert in a particular field. Nonetheless, it depends on the willingness and dedication of individuals towards their learning process. There are various ways in which individuals can learn. In the course of their work practice, individuals can learn through personal reflection and experiential learning. Personal reflections can either be formal or informal. Formal personal reflections may include departmental daily reports and performance review sessions that are mandatory for every staff member in the department (Daudelin, 2000). Informal personal reflection may include the use of a personal work journal to record events and experiences that take place in the course of work. In this case, learning can take place when professionals reflect on their experiences by writing personal journals or reports or filling out a performance review sheet. For instance, in the intensive care departments, daily reports and performance review sheets can help critical care nurses to reflect on their practice with regards to their achievements, challenges experienced, and lessons learned. With time, this practice can help nurses to understand their weaknesses and strengths as well as identify areas that require improvement. As a result, this can help to develop the capacity of critical care nurses and increase their efficiency in their nursing practice. Furthermore, at an individual level, the development of newcomer’s capacity to gain expertise and practice can take place through experiential learning. According to Kolb (2000, xv), experiential learning can be described as “learning that take place through a cycle of experience, reflection, formation of concepts and testing of implications.” For example, through experiential learning, newcomers in the intensive care department can develop expertise when it comes to dealing with emergency cases and taking care of patients with critical health conditions. They may also form new concepts on effective nursing practices. Group Level Learning Another significant form of learning in the workplace takes place at the group or team level. Group learning is the process through which teams in the workplace develop knowledge for the members of the team or group, the organisation and for others (Kasl, Marsick, & Dechant, 2000). Group learning is based on the concept of a learning organisation and provides workers with opportunities to acquire knowledge and skills consistent with best practice learning models. The hospital should strive to ensure that critical care nurses have the opportunity to gain knowledge and nurture the development of their expertise through communities of practice as conceptualised by Cross and Israelit (2000). Communities of practice provide a powerful mechanism for problem solving and the integration of specialist knowledge in the workplace. In the hospital, a community of learning takes the shape of the daily briefings and weekly meetings convened by the head nurses of the intensive care unit and by the chief nursing officer. At these briefings and meetings, critical care nurses discuss any new developments in the workplace such as the conditions of patients. This forum enables them to share some of the challenges they are currently experiencing in provision of care with their peers and superiors alike. At these meetings, critical care nurses exchange information and experiences, which facilitates skill acquisition among both experienced and newcomer nurses as they are able to apply the lessons learned from each other’s experience in various aspects of work, such as how to better communicate with families of patients in intensive care (Kasl, Marsick, & Dechant, 2000). Organisational Level Learning Addition to individual and group learning, learning can also occur at the organisation level (West, 1996). At this level, an organization is able to acquire knowledge, skills and experience from its structures and operations which subsequently influences how it organizes or reorganizes its structures to become more efficient and effective (Isaacs, 1993). Organisational learning for the hospital occurs as critical care nurses engage and interact with nurses from other hospitals or within the ACCCN. One of the primary objectives of the ACCCN is to promote the provision of optimal care. This is achieved through the collaboration of critical care nurses from various hospitals in developing best practice care standards that are implemented in the hospital. In addition to the ACCCN, organisational learning also occurs in various other frameworks or associations. Opportunities for learning are also presented by the hospital’s membership in the Australian Healthcare and Hospitals Association and the Australian Association of Practicing Nurses. Through these various frameworks, the hospital’s administration is able to identify and implement best practice critical care standards or to identify organizational deficiencies either in the administrative structure or operations that impact efficiency in service delivery. Strengths of Workplace Learning As argued by West (1996), the concept of the learning organization has increasingly been embraced by many organisations. Organisations that subscribe to this paradigm acknowledge that providing opportunities for learning in the workplace is commensurate with their complex and rapidly changing environments where learning “just in case” no longer applies. There are various strengths and benefits of workplace learning for critical care nurses in the hospital. Workplace learning is more efficient due to the accessibility of learning opportunities as opposed to costly simulation and re-creation. This is especially significant for critical care nursing since it is impossible and unethical to find opportunities such as critically ill people on whom to experiment due to the nature of the profession. Workplace learning also provides critical care nurses with access to a wide range and depth of expertise in the form of more experienced peers and head nurses who can scaffold the development of their own expertise. Workplace learning also helps the organisation improve its efficiency as the feedback from critical care nurses constantly aids the development and implementation of best practice in care provision. Limitations of Workplace Learning There are several limitations to workplace learning that are both generic and unique to critical care nursing. One of the generic weaknesses or limitations relates to time and resource constraints since due to limited working hours and the demands placed on the hospital in terms of performance standards, effective learning may only be achieved at the expense of some the hospital’s goals such as reducing triage time. The nature and demands of critical care nursing profession is also another major limitation. Critical care nursing is a life and death issue with no acceptable room for error or experimentation. In addition, it is unethical and in contravention of the Hippocratic Oath for health personnel not to provide the best and most experienced care for critically ill patients, which limit active learning opportunities for new critical nurses (Benner, Benner, Tanner, & Chelsa, 2009). The pressure or mental and psychological demands and stress of critical care nursing, such as being accountable to the families of patients and bereaved, may also negatively affect learning on the job for critical care nurses. Actions Required to Develop Best Practices To take advantage of the opportunities presented by workplace learning and to mitigate the limitations of workplace learning, hospital administrators should take several actions to develop best practice. These include: (a). restructuring the intensive care unit nursing structures to ensure that at all times newcomer critical care nurses are paired with more experienced nurses, (b). Increasing opportunities for critical care nurses to develop skills and expertise by identifying and sponsoring them to attend specialist training courses both locally and abroad and, (c). Initiating a reward scheme where best performing critical care nurses are recognized and promoted. Summary The best practice standards discussed in this paper are effective and consistent with the concept of the learning organisation (West, 1996). Some of the actions recommended, such as pairing newcomers with more experienced nurses, are generically applicable to most professions and workplaces. However, due to the nature of critical care nursing, the application of the hospital’s model of learning may not be parsimonious or applicable to other organisations and contexts. For example, as mentioned, critical care nurses are bound by the Hippocratic Oath, so it would be unethical for critical care nurses to engage in experimentation or not to provide the most experienced care option (Benner et al., 2009). Unlike other professions such as driving, flying (piloting), or teaching, critical care nursing has absolutely no room for error. Therefore, the main difference in applying the best practice standards discussed is that in other professions, there is room for experimentation as well as trial and error. Conclusion This paper has discussed how workplace learning enables newcomers to develop skills and expertise to become effective practitioners in the workplace as outlined by Cross and Israelit (2000). The findings in this paper depict that workplace learning can be effective due to the accessibility of learning opportunities available in work settings. Moreover, workplace learning also provides critical care nurses with access to a wide range and depth of expertise in the form of more experienced peers and head nurses who can scaffold the development of their own expertise. It can also helps an organisation improve its efficiency as the feedback from critical care nurses constantly aids the development and implementation of best practice in care provision. Nevertheless, when it comes to critical care nursing there are various limitations related to workplace learning. Some of the major limitations related to workplace learning revolve the nature and demands of the profession. Therefore, there is need to develop capacities that will ensure that there is smooth transition of newcomers to effective practise. One of the ways of ensuring this is by introducing policies and regulations that support workplace learning. In addition to this, training and mentorship programs should be introduced in the workplace to develop capacities that will ensure that there is smooth transition of newcomers to effective practise. References Alspach, G. (2008). ‘Recognizing the primacy of competency and exposing the existence of incompetence’. Critical Care Nurse 28(4), 12-14. Anderson, R. (2001). ‘Acquisition of cognitive skill’. In Billet, S. Learning in the workplace: Strategies for effective practise. NSW, Australia, Crows Nest: Allen & Unwin. 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