Self-Reflection on Beginning Level Practice as a Registered Nurse - Essay Example

Running head: SELF REFLECTION Self reflection on begging level practice as a registered nurse Name: Course: Institution: Instructor: Date: Self reflection on beginning level practice as a registered nurse In my own experience as a student nurse I encountered challenges which different current literature has attempted to analyze and solve (Cardillo, 2010). This literature reviews are based on research conducted in nursing colleges and universities from the nurse’s experience of clinical practice. In addition the literature has incorporated ways of improving the care nurses give to patients through the use of good clinical practices in regard to current research based practices. Discussed below is the literature in view of my own self reflection that I experienced during my clinical practice. My reflections include one communication breakdown that is often experienced between the student nurses and the clinical educators. The other reflection is the conflict between role ambiguity and expectations from the student nurses by the nurses. Lack of continuity between the student nurses and the preceptor due to change of shifts is another reflection. Lastly the emotional barrier experienced by the student nurses towards the patients during clinical practice is another reflection that I have used to review the current literature on clinical practices. According to the November/December 2006 journal of continuing education in nursing titled evidence-based nursing in clinical practice: implications for nurse educators, the nurse educators are teaching clinical nursing with evidence based approach (Potter & Perry, 2009). However this approach has encountered difficulties with the registered nurses due to issues that have resulted from clinical practice setting. This has resulted to the foundation brainstorming on the way forward to eradicate these issues. As a result the foundation has insisted on the need for both the nursing educators and clinical nurse educators using evidence based nursing in practice settings. In regard to these, the situational issues that I experienced in practice setting as a nurse student were the expectations from the nurses. The nurses expect the student nurses to know how to perform tasks based on the theory taught to them by the nursing faculty (Fedoruk, 2011). The nurses during my clinical practice expected me to perform some procedures without any guidance and assistance despite the fact that the nursing faculty does it practically using dummies. This was really tough for me since handling a patient is a different experience al together compared to doing it on a dummy. This in reflection to role ambiguity and expectation from nurses hinders the proper incorporation of evidence based nursing in practice setting (Burton & Ormrod, 2011). For example the hospital would receive a lot of patients after an accident which caused a shortage in nursing staff. Some patients had lost a lot of blood which required them to have a transfusion immediately in some cases they were unconscious, had several fractures and were in excruciating pain. Despite all this the nurses would instruct me to perform the transfusion on my own. This was a challenge for me because I had not performed such a task before and due to the emergency no nurse was available to guide me through the procedure. When the nursing educators taught me in college there was no real patient to perform such a procedure on hence it was difficult for me to do it on my own (Alligood & Marriner-Tomey, 2010). However if the foundations recommendation that the nursing educators adopt the evidence based approach in clinical practices too will ensure that in future the student nurses will be more capable. When these evidence based approach is adopted in teaching the student nurses it will ensure that the role ambiguity and expectations conflict the nurses have from them is minimized. Since the student nurses will be able to perform some tasks without the nurse’s guidance or assistance under pressure (Temple, 2012). The journal says that the evidence based approach ensures that the patients receive the best clinical care from the nurses when this approach is used. The evidence based approach incorporates intuitive action, sound judgments and current research that are guided by clinical practices. This approach eradicates all the rituals, clinical experiences, ungrounded and traditions that are followed as the basis for guiding clinical practices. With all the new research that has been conducted in the past years it is important to incorporate them into clinical practices through teaching them to student nurses. The emergence of new technology has also made it possible for this evidence based approach to be adopted since it will improve the care patients have access to. The journal states that a research carried out proved that patients who received evidenced based care were better off than patients who received the normal routine care (Cullum, 2008). This is because the evidence based clinical care uses modern technology to care for patients. For example due to the evidence based approach registered nurses can now use new developed technologies and ways that have been discovered to assist physiotherapy patients. This has in turn accelerated their recovery compared to the pace of recovery they would have acquired through the routine clinical care. This approach has also introduced traditional non-clinical method and ways that have proven to work on patients through the clinical guidelines laid down. This gives the nurses an opportunity to blend in theory learnt in school and new current clinical practices that have been proved more efficient. In my own reflection this approach has also reduced the communication breakdown that often exists between the student nurses and the clinical educators. When I was in nursing school different lecturers taught different ways of assessing observations and performing a task. This confused me a lot when I went to practice clinical care on patients since I dint know which was the best way to asses any observation and perform tasks. For example when I was performing a neurovascular assessment on a patient one of the clinical educators had indicted that I should always strictly follow the five p’s that is pain, pulses, paraesthesia, paralysis and pallor. While on the other hand a different educator had indicted that the affected limb may show different symptoms hence a different assessment was required to stop amputation. This was one of the challenges I experienced when I joined a hospital since back then the clinical practices were carried out based on routine. I could not assess a patient or perform a task on intuitive or quick sound judgment based on that particular case since there was a strict procedure to be followed However this proposed evidence based approach ensures that the clinical educators teach the student nurses current ways of assessing and performing tasks (Ackley & Ladwig, 2010). Since this approach takes into context that there are different ways of performing a task and is based on research that is current. This makes sure that new quicker and faster assessment methods are adopted and integrated within the clinical guidelines. This makes it easier for student nurses to understand that the different methods their educators teach should not confuse them rather they should equip them. They should use the different methods taught to them to carry out current research that are based on the laid down clinical guidelines to improve their skills. The students are advised to use the three phase model that will ensure that they integrate evidence based approach effectively and practically in their clinical care. The model starts by identifying a clinical question that is evidence based, next the students identify the evidence and lastly they translate this into an evidence based change that will be put to use in their clinical practice (Melnyk & Fineout-Overholt, 2005). There is the need for student and registered nurses to form clubs where they can deliberate on new evidence based changes using this model. This clubs will benefit the registered nurses to adopt this approach more easily and do away with the routine clinical care that they have been used to. However this evidence based approach is being hindered by issues that occur during the clinical setting. These clinical practices issues have inhibited the evidence based concept from being realized in all nursing practices. This is because they make it difficult for the registered nurses and student nurses in clinical settings to use this approach. One major issue is the time factor. During clinical practices the student nurses and the registered nurses are busy al the time hence do not spare a few minutes to participate in evidence based activities. These activities include joining clubs, forming nursing support groups or discussions that will foster this approach. In my own experience time was one of the challenges because there are many patients that were being admitted to the hospital. This made me work for long hours with short breaks such that by the time I left the hospital I had no moment to spare on critical thinking. This inhibited me from evaluating the way I performed my tasks or evaluated symptoms but followed routine in carrying out these tasks. I never challenged myself to study and look into better ways of performing tasks or assessment since there was no time to do so. I did my tasks strictly following the routine that existed in the clinical setting. If I had spared time on weekly or monthly basis to analyze on how to improve my skills on performing tasks by researching I would have given better care to patients. The challenge is that even now with evidence based practice having been proved to be better, it is hard to do away with the routine practices due to lack of time to educate these registered nurses. The other factor is lack of information and resources in their place of work where it is most appropriate to have access to this information. The hospitals have not taken the responsibility of providing nurses with new information and resources that they require to update their knowledge. For this approach to work the hospitals must have fully equipped libraries with plenty of reading materials and internet accessibility for their nurses (Craig & Smyth, 2002). In my time of starting nursing clinical practices there was no library within the hospitals for me to access. I expected to learn clinical skills from the registered nurses who were experts in them from their expansive experiences. I did not see any reason to research on the internet at home since all that was required of me would be achieved through learning from the nurses. There was no doubt in my mind that what they taught me would be challenged or not be the best. This restricted and limited my ability to discover new skills or think outside the routine task performance (Capezuti, 2008). It hindered my growth and progress in my nursing career beyond the routine practice. It also prevented me from giving better effective care to my patients other than what was expected of me. Therefore there is the urgent need for the administrators who are in clinical settings to encourage the nurses to use the libraries once they are put in place in order to integrate this evidence based approach (Andrew, 2003). Also the administrators should continuously supply the libraries with current data, medical statistics reports, books and journals to keep up to date with information. The third factor that affects the incorporation of evidence based practice is lack of sound research knowledge, learning opportunity and skills to research. This is due to the fact that most of the nurses have not taken the initiative to go back and refresh on their knowledge. The nurses have not learnt the new technology available like computer skills that will ensure they can research on the internet (Craig & Smyth, 2007). During my transition into practice my desire was to learn from the nurses and become an expert like them. I did not have the desire to go back to school and refresh my knowledge since I thought that I was done with school work. Even when new technology was discovered that was not related to nursing I did not the initiative to study it as it seemed useless to my clinical nursing practices. I was of the mentality that I had learnt all that I was expected to and all I needed was to put it to practice. I did not engage in seminars and conferences that would update me on current statistics and new information. This according to the journal can be evaluated by assessing the registered nurses ability to put the research into practice, ask the relevant clinical question and frame them into research (Polit & Beck, 2010). In addition it is important to test their skills on carrying out research, read and fully understand the research results. Even after acquiring these skills it is important for the clinical nurses to continuously educate themselves on new and current skills. The fourth factor is the culture that exists in current nursing practices which makes it difficult to incorporate evidence based approach (Polit & Beck, 2008). The current nursing culture does not question whether patients are receiving the best care through the common routine practices. Rather the nurses perform their duties as usual without evaluating whether there is another better way. When I joined practical nursing I did not think that the quality care the patients received was my duty to evaluate. Rather I knew that my work was to perform the normal tasks that as a nurse am delegated to do. For example when I was checking their vital signs I did so without informing the patient why it was necessary to check them (Berman, & Kozier, 2008). I did not put into consideration that some patients had phobia for needles and needed to be counseled before a procedure. It never crossed my mind to assess why some patients were violent, non cooperative and declined the treatment that was offered to them. I did not take the time to talk with them and understand since my assumption was that my work was to perform the tasks only. I do agree with the journal when it states that there is need to do away with the nursing culture that exists since it is a stumbling block to the evidence based approach. It is therefore important for clinical nurses to learn how to research on individual basis other than referring to one another for advice. This encourages inaction to research by the nurses since they know that they can rely on each other or the physicians for information. This culture can be eradicated by encouraging the nurses to research on current clinical practices which when incorporated with experience, knowledge learnt from nursing school and intuition will guarantee the best care (Malloch & Porter-O'Grady, 2006). The nurses should be persuaded to drop the dependency on each other to acquire new skills and embrace individual research to acquire appropriate skills (Scott, Estabrooks, Allen & Pollock, 2008). The new student nurses joining practice should be informed from onset that to offer the best care they must be ready to keep learning new skills through research, questioning and critiquing the routine practices. Through the student nurses the clinical educators are in a better position to incorporate evidence based practices into patients care since the students have no prior experience. In addition at this level the student nurses have not developed any nursing culture that may deter them from incorporating this approach as they join clinical practice. Therefore they would be the agents to bring this approach to the registered nurses who may not easily adopt it. Therefore there is the need for the educators to prepare the student nurses on how best to transits into clinical practices to avoid being influenced by the routine practices only. As for the registered nurses the way to approach them is by raising their interest to put this approach into practice (Ubbink et el, 2011). Once this approach works better than the routine they are used to, it will make them want to learn and research more on this approach. Clinical educators can offer the nurses free mentorship by teaching them how to research, ask and frame clinical questions, implement the evidence to practice and supply the resources to them. In addition they may encourage the nurse to form clubs based on their schedules, whereby the educators will be attending meetings regularly to offer them the support they need (O’Dunn-Orto, Hartling; Campbell & Oswald, 2012). The role clinical educators play greatly determines the incorporation of evidence based approach to both registered and student nurses. It is also the most important role which will guarantee that this approach is adopted in all areas of clinical activities. According to Catherine burns article titled mastering the preceptor role: challenges of clinical teaching appearing in the journal of pediatric health care the role of preceptor is important in shaping a student nurse ability to provide quality care. The preceptors assist the student nurses to link what they learn in college to practical clinical management of patients. It is therefore important for the student nurses to be allocated one preceptor who will guide them systematically into developing good standards and strategies to practice. However this is not always the case due to the pressure, complexity and types of patients that present themselves daily (Sedgwick & Harris, 2012). When I was a student nurse I often had to work with different preceptors due to emergencies that required my preceptor to attend to immediately (Penn, 2008). Other reasons were working schedule, transfer to another hospital, and unpredictable factors like theatre operations. This was really hard on me since working with different preceptor made it hard to gage how much I had learnt and skills I had acquired. In addition each preceptor had a different approach and technique that they used which was difficult to alternate. It often confused me since it was hard to work with different preceptor compared to one whom I had established a one on one relationship with. Working with one preceptor it is easier to grasp the concepts and strategies of practicing clinical nursing than with different preceptors who don’t often know what a student nurse has learnt so far. The journal says that there is need for preceptors to form strategies that will assist them in understanding each student nurses capability. In addition to understanding the student nurses these strategies will assist the preceptors to handle this role and their other roles (Myrick & Yonge, 2005). This will ensure that they achieve the best results in both their workloads and preceptor ship. These strategies will be structured in a manner that will cater for situation where the student nurses encounter more than one preceptor. Some of the strategies adopted include observation and modeling, case presentation and direct questioning (Gardner & Supplee, 2009). References Ackley, B. J., & Ladwig, G. B. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care. Maryland Heights, Mo: Mosby. Alligood, M. R., & Marriner-Tomey, A. (2010). Nursing theorists and their work. Maryland Heights, Mo: Mosby/Elsevier. Andrew, B. (January 01, 2003). 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Teaching musculoskeletal clinical skills to medical trainees and physicians: A Best Evidence in Medical Education systematic review of strategies and their effectiveness: BEME Guide No. 18. Medical Teacher, 34, 2, 93-102. Penn, B. K. (2008). Mastering the teaching role: A guide for nurse educators. Philadelphia: F.A. Davis Co. Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer Health/lippincott Williams & Wilkins. Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing. St. Louis, Mo: Mosby Elsevier. References Scott, S., Estabrooks, C., Allen, M., & Pollock, C. (January 01, 2008). A Context of Uncertainty: How Context Shapes Nurses' Research Utilization Behaviors. Qualitative Health Research, 18, 3, 347-357. 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