Personal Reflection on Learning Outcomes of Professional Practice

Personal Reflection on k straightwayledge Outcomes of nonrecreational PracticeIn sanctify to reflect upon my k instantaneouslyledge by dint of and throughout this module, I exit identify and captiously discuss three Module training proceedss that reflect the range of possible issues of the breast feeding and Midwifery Council (NMC) Proficiencies (2004). I go forth then identify appropriate literature and reflect on my encyclopaedism and go through. This bequeath enable me to identify face-to-face strengths and argonas for practise headway come apartment.The first teaching outcome is Recognise the importance of broody practice and find the demonstrate of grammatical construction. The second outcome chosen is Discuss the residual between friendship and discipline?. The third outcome is Demonstrate appropriate non- communicatory and verbal skills, including the enjoyment of silence, open and unkindly caputs and summarising, to gather information.*Please n unmatchable that the names of the affected roles mentioned in this essay m opposite a bun in the oven been commuted in order to protect their identity for confidentiality reasons.1 Recognise the importance of reflective practice and date the handle of sayingThis outcome relates to the NMC Proficiency of Demonstrate the responsibility for ones own acquire through the instruction of a Record of Achievement of practice and recognise when further learning is required.Reflection is a saucily method of learning for me. With picture to nursing, the term reflection and reflective practice has been delineate by m whatsoever academics, resulting in various pretenses and theories being developed.The Oxford Mini-dictionary for Nurses (2008) describes reflection as the c arful servant of personal actions, including the ability to review, analyse and evaluate situations during or after events. It is an natural part of the learning process that will result in new methods of approa ching and collar nursing practice. Johns (2000) defines reflection as a windowpane through which the practitioner ordure view and focus self inwardly the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and factual practice. Schon (1983) proposed that reflection occurs on action or in action. The first occurs after the incident whereas the latter occurs during the incident and is said to be the hallmark of the see professional (Somerville Keeling, 2004).The much than(prenominal) traditional theories and models base reflection on critical incidents. Love (1996) nominates that a critical incident does non kick in to be contradict or dramatic still should provide deep in partection and raise a professional issue. Gibbs (1988) developed The Reflective Cycle. The model divides the reflective process into sections Description, Feelings, Evaluation, Analysis, Conclusion and Action Plan (see Appendix 1). Johns (2000) developed a Model of Structured Reflection (MSR) (see Appendix 2) As with Gibbs (1988) Reflective Cycle, the MSR uses a series of oral sexs to guide an individual through the reflective process. Johns model is base on five cue questions Description, Reflection, Influencing Factors, Could I know dealt with it better? and Learning.The record book of studies and models on reflection demonstrates the value that is placed on this tool. Newell (1992) depict the process of reflection to be a corners intent of nursing professionalism. Gustafsson and Fagerberg (2004) support the pattern that reflection is a vital tool and advantageous in call of the improvement of a nurses professional development and diligent cargon.Many subscribe journal paper to be an good reflection strategy (Johns 2000 Paterson, 1995 Cameron Mitchell, 1993 Lauterbach Becker, 1996). diary writing is considered to offer writers the opportunity to become participants/observers of their own learning, to describe a signifi rumpt experience and to reflect on that experience to see what they target learn from having had it (Weisberg and Duffin, 1995). While in clinical practice, I have write a journal of my experiences. I recognise its value to aid reflection as I olfactory modality that the act of writing things down is important. This is support by Somerville and Keeling (2004).To demonstrate my discernment of reflective practice, I will now reflect on an incident that occurred while on placement when I was feeding a diligent, named tom*. I will enforce Gibbs (1988) model as this is my first experience of using reflection and feel that it is neat and appropriate at this stage.Tom had delirium and had recently suffered a stroke, which had go away him confined to bed. As Tom had difficulty feeding himself, I offered to service him he smiled, agreed and appeared to recognise me. Halfway through the me al, Tom became foment and asked if the food was mackerel. I told him that it was turkey. He shouted aggressively that he precious mackerel and then became verbally abusive towards me. I was unable to calm him so I left the room with an assurance that I would be bandaging soon. I then asked a senior nurse for help.This was the first m that I had fed a patient of but mat up comfortable. I knew Tom well and felt that I had built up a rapport with him. I was pleased that he seemed happy and relaxed. When he shouted I felt shocked, worried and conscious of other peoples reactions they whitethorn prize that I had done something wrong. Even though Tom was disabled he did have some use of one arm so I was afraid that he might become violent. I was upset that I had to stop feeding him and leave the room. When I left I felt relieved but also anxious that I whitethorn have contributed to the way Tom was feeling.When evaluating and analysing the incident, I was pleased initially with th e way the task started as on admission he had a poor appetite. The negative side of the situation was that Tom became angry and didnt finish his meal.I name that derangement is a complex progressive illness and in that respect may be times when a patient experiences sudden mood changes.I believe that I would now do things differently if a comparable situation arose. With hindsight, I questioned whether I should have just agreed with Tom that the turkey was mackerel then this incident may not have occurred. However, this raises honorable issues such as whether it can be acceptable to not tell the truth. A report produce by the Nuffield Council on Bioethics (2009) discusses the ethics of dementia look at and states that ethical dilemmas arise on a daily al-Qaida for all those providing care for people with dementia. Research suggests that challenging someone with dementia could be detrimental and cause unnecessary distress (Shellenberger, 2004). Naomi Feil developed confirmat ion therapy between 1963 and 1980 as a technique to communicate with patients with dementia by recognising and accepting their view of reality of people with dementia in order to provide them with empathy and respect (The Validation Training Institute, Inc). In the future I could use this technique for example, when Tom asked if it was mackerel he was eating I could have replied by asking him if he wishd mackerel which would have avoided giving a direct execute.With learn to strengths and areas of development, I feel that I have reflected successfully on this incident. However I would like to strive to reflect in action as opposed to on action as this is the closely effective. In damage of development, I believe that it would be beneficial to patients and myself to learn more somewhat caring for patients with dementia. The Dementia UK account statement (2007) published by The Alzheimers Society states that there are currently 700,000 people with dementia in the UK. The report also predicts that by 2025 there will be everyplace 1 million people with dementia so it is inevitable that I will be caring for many dementia patients in my career.In summary, although the models of reflection span over 20 years and vary slightly, the tenet of reflection is very similar, which implies that reflection is a robust tool and still applies to modern nursing. I have learnt that reflective practice is a vital tool, particularly when associated with journal writing. Continuous reflection will allow me to develop skills and familiarity to enable me to provide the best care possible for patients and their families.2 Discuss the difference between selective information and informationThis learning outcome links to the NMC proficiency of Demonstrate literacy, numeracy and computer skills necessityed to record, enter, store, retrieve and head information ingrained for care delivery.As a student Im not involved in using my computer skills on the ward but eventually wi ll be involved in audit and data entry. My literacy and computer skills are present throughout my portfolio and assignment. I demonstrate my literacy and numeracy skills when writing patient evaluations, calculating fluid balance and assisting with drug calculations.There are many examples of data and information utilise within nursing care. cod to the broad nature of this area I have foc apply on a particular type of data and information to demonstrate my understanding of these damage. My focus is data collected from patients vital signs and the information that relates to this. I will demonstrate how the process of giving information to patients rather than just data is an essential part of nursing.Gathering, giving and recording both data and information accurately is vital. Data can be described as facts and statistics use for implyence or analysis. The term information can be defined as the meaning applied to the data ( condensed Oxford English Dictionary, 2008).Observatio n data collected from patients includes pulse rate and rhythm, course pull, respiration rate, temperature and oxygen saturate percentage. These measurements are taken on admission as it is important to chance on base-line readings to which future readings can be compared. It is necessary to apply meaning to this data to form information to be able to judge a patients condition.throughout the module I have learnt what data means in terms of acceptable values. As I now have the information rough the data I can make judgments about data. For example, I now know that the information I can get from the crease force data of 160/110 mmHg is high (Blood Pressure affiliation). However, this information ask to be put into context to allow use of the information to make a judgement. For example, if a patient has just completed cardiovascular exercise, this may account for a high blood pressure reading. With this information, the plan would be to wait for 30 minutes before repeating to gain more accurate data. Readings can vary temporarily due to a reckon of reasons for example, medication, an existing health condition, fluid stirring, exercise and alcohol consumption. However, a change in blood pressure can indicate deterioration in condition, which alerts health care professionals to investigate.In order to show my understanding of the difference between data and information I will now clear an example of an incident that occurred while on placement.During observations of a 70 year-old maam named Eileen*, I noticed that her systolic blood pressure had dropped from 127 to 90 mmHg. Her other observations remained consistent. I informed a senior nurse who asked a fasten to review the patient. I discussed her fluid intake with her as this could have had an wayward effect on her blood pressure. As she had only drank a teeny amount I advertised her to drink more and continued monitoring. Eileens blood pressure eventually returned to her baseline. This example shows how data, such as blood pressure readings, prompts gathering information which, in turn, enables problem solving.As demonstrated, I motivating to have an understanding of the information gathered from the data but to boot I feel that it is important that patients understand what the data means. Bastable (2006) defined patient reproduction as the process of assisting people to learn health associate behaviours so that they can incorporate those behaviours into everyday life and achieve a goal of optimal health and independence in self care.I will now provide an example of my experience of patient gentility During a blood pressure check on Paul*, who was hypertensive and took multiple medications, I asked him whether he would like to learn about blood pressures. He gladly agreed so I explained what the reading was and what can affect blood pressure. I explained that exercise, healthy eating, low salt intake and weight control would have a beneficial effect on his blood pres sure. He was unaware of how his current lifestyle could have a detrimental effect on blood pressure and said that he now intended to make some lifestyle changes.Research supports my thoughts about the benefits of giving patients information about aspects of their health rather than just the data. Florence Nightingale, who has been described as the baseer of modern nursing, recognised the importance of educating about passable nutrition, personal hygiene and exercise in order to improve upbeat (Bastable, 2006). The Department of health (2009) states that giving people relevant, reliable information enables them to understand their health requirements and make the right choice for themselves and their families. (Bastable, 2008). Partridge and Hill (2000) install that patients who are well informed are better able to falsify their health, have improved psychological outcomes, have fewer exacerbations of their condition and little hospital admissions. Glanville (2000) states that if clients cannot maintain or improve their health status when on their own, we have failed to help them reach their potential. Abbott (1998) describe that by involving patients in their state of health by keeping them informed has been proved to improve patient satisfaction and concordance. However, there is research to suggest that providing information may not result in a change in health outcomes (Kole, 1995 Sherer et al. 1998). They found these reasons to be that patients dont understand the information, are unable to absorb it due to pain, anxiety, or that they choose not to act upon it. Additionally, absorption of information is decreased when there is too much information therefore health outcomes remain unchanged. The question is how much is too much information? This is difficult to determine.In terms of personal strengths, I felt very satisfied that I had initiated this communion which resulted in Paul considering lifestyle changes. On reflection, this incident highlig hted the importance of patient understanding and has encouraged me to take time to educate patients where possible. It has emphasised the need for continuous learning so that I am able to answer questions and educate patients. Additionally, I am aware of my limitations and when to seek advice or refer patients to others. I also need to develop confidence in language to patients about sensitive issues such as weight management by researching this area.3 Demonstrate appropriate non-verbal and verbal skills, including the use of silence, open and closed questions and summarising, to gather informationThis outcome relates to the NMC Proficiency of Engage in, develop and take back from therapeutic affinityships through the use of appropriate communicating and interpersonal skills. intercourse is a reciprocal process that involves the exchange of both verbal and non verbal messages to learn feelings, information, ideas and knowledge (Wilkinson 1999 Wallace 2001). In nursing, colloqu y and information gathering is essential to provide quality care. Sheldon, Barrett Ellington (2006) report that Communication is a cornerstone of the nurse-patient relationship. reading gathering commences from when the nurse greets the patient. In order to communicate non-verbal and verbal cues are used. Non-verbal skills are portrayed with body language and impact on communication (Hargie Dickson 2004). These include posture, nervus facialis expressions, head movement, eye take and hand gestures show active listening. Verbal skills include the use of silence, open and closed questions and summarising. The tone of voice and rate of response are significant.The emphasis is on effective communication the way we communicate can hinder or stir the information we gather. Sheldon et al. (2006) state that the power of effective nursing care is built and enriched by good communication. Maguire and Pitceathly (2002) suggest that clinicians with good communication skills identify pati ents problems more accurately, patients are more satisfied with their care and are less anxious. It has been reported that that ineffective communication can lead to patients not engaging with the health care system, refusing to follow recommended advice and failing to cope with the psychological consequences of their illness (Berry, 2007).The scenario below demonstrates my understanding of appropriate verbal and non-verbal cues. It is part of a conversation with a patient on admission regarding current medical history.When meeting Arthur*, a 78 year old, I smiled, introduced myself and explained the purpose of our conversation. I asked Arthur Do you have any tit problems? he answered Yes. I then asked What chest problems do you have and how do they affect you? he answered I have emphysema make wheezing and a cough out. I also get breathless when go and have oxygen at night I left a outline silence at this point. Arthur then disclosed I cough up a lot of horrible phlegm in the forenoon which is embarrassing. He then asked will I get a chest x-ray. I asked Have you any particular worries about your chest? to which he replied well I am quite worried about lung cancer. I told him that I would pass on his concern to the doctor and then summarised our conversation.With regard to verbal responses, I initially asked a closed question as I wanted a specific answer. Silverman et al. (2005) supports the theory that closed questions are appropriate when wanting to narrow the potential answer. Due to Arthurs response I asked an open question to encourage him to go into more detail. An open question often results in a lengthy answer, so I used fillers such as mmm throughout, to show active listening and to encourage him to continue. The brief pause was successful as it enabled Arthur to disclose his embarrassment. I summarised his response in order to clarify what Arthur had said for my own benefit but also to give the patient confidence that I had understood and opp ortunity to typeset me if not.With regard to my non-verbal communication, I kept an open posture with eye tactile sensation and leant forward slightly to show that I was listening. I also ensured that my facial expressions were appropriate. For example, when greeting Arthur I smiled, but during descriptions of distressing symptoms my facial expression was one of concern. Egan (2002) supports the notion that conveying these non-verbal cues in this way will facilitate stimulated disclosure and encourage the patient to talk more freely. Egan derived the acronym SOLER to portray cognisance of the non-verbal responses facing squarely, maintaining an open posture, leaning slightly forward, having appropriate eye contact and being relaxed. There are approximately 700,000 different non-verbal cues that may or may not have meaning (Birdwhistell, 1970 Pei, 1997). As nurses, we must be aware of our use of non-verbal cues as they can convey unintentional meaning.In addition to awareness of our responses it is imperative to be aware of patient cues, as this is part of the information gathering process. Arthurs hesitancy indicated to me to remain silent to encourage further disclosure.Being aware of patients verbal responses is more straightforward than what their non-verbal responses convey and it may be that patients body language contradict the spoken newsworthiness (Miller, 1995).Barriers to communication include anxiety, language, hearing, sight or speech impairment. During communication, I would like to think that I am non judgemental. According to Underman Boggs (1999) most of us have personal biases regarding others that are based on previous experiences. In relation to my scenario, Fuller (1995) suggests that health care professionals may underestimate the verbal force or abilities of older people, which results in their conversations being undervalued.In terms of personal strengths, I feel fairly confident with the use of verbal and non-verbal cues and how t hese can deter or catalyse communication. I feel that I used silence successfully as Arthur disclosed embarrassment and mentioned about an x-ray, which he may not have done otherwise. I was able to calm him that we would provide a disposable sputum pot and acknowledged his timidity of cancer. I realise that it can be difficult communicating about sensitive information and this is an area of development for me, which I feel will improve with experience. Although at this stage of training I would not be expected to lead consultations for diagnostic purposes, it was informative to research consultation models. I intend to become more familiar with these models in order to utilise some of the communication skills (Newell, 1994).To form an overall conclusion, I feel that through theoretical learning and clinical experience I have demonstrated my achievement of the NMC Proficiencies (2004). I have critically discussed and concluded each learning outcome in turn throughout the essay but to summarise patient focus and effective communication are paramount. I feel that in terms of reflection, self-awareness is key (Rowe, 1999). This will enable me to look at my skills to recognise strengths and areas of development to ultimately provide best practice in patient care. I realise that I will gain experience and confidence as my training progresses.Word Count 3289ReferencesAbbott, S. A.(1998) The benefits of patient reproduction Gastroenterol nurse. 1998 Sep-Oct21(5)207-9.Bastable, S. (2006) Essentials of Patient upbringing. London. Jones and Bartlett Publishers.Bastable, S. 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(2000) Enhancing care for people with asthma the role of communication, education, training and self-management. European Respiratory Journal. 16, 2, 333-348. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54.Paterson, B. (1995) Developing and maintaining reflection in clinical journals. Nurse Education Today. 15, 211-220.Pei, M. (1997) as cited in Nursing knowledge and Practice foundations for decision making. London Bailliere Tindall.Rowe, J. (1999) Self-awareness improving nurse-client interactions. Nursing Standard. 14, 8, 37-40.Scherer, Y.K., Schmieder, L.E., and Shimmel, S. (1998)The effects of education alone and in combination with pulmonary rehabilitation on self-efficacy in patients with COPD. Rehabilitation Nursing 23 2, 71-76. As cited by Caress, A. L. (2003) Giving information to patients. Nursing Standard. 17, 43, 47-54.Schn, D. (1987) Educating the Reflective Practitioner. San Francisco Jossey-Bass.Sheldon, L. K., Barrett, R. Ellington, L (2006) as cited in Nursing knowledge and Practice foundations for decision making. London Bailliere Tindall.Shellenberger, S. (2004) Therapeutic Lying and Other ship canal To Handle Patients With Dementia. Wall Street Journal, November 11.Silverman, J., Kurtz, S. Draper, J. (2005) as cited in The Royal Marsden hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London Wiley-Blackwell.Somerville, D Keeling, J. (2004) as cited in Nursing Times http//www.nursingtimes.net/nursing-practice-clinical-research/a-practical-approach-to-promote-reflective-practice-within-nursing/204502.article 30th October 2009Underman Boggs, K. (1999) Communication styles. Interpersonal Relationships Professional Communication Skills for Nursing. Third edition. Philadelphia PA, WB Saunders.Validation Training Institute Inc. http//www.vfvalidation.org/web.php?re quest=index 10th December 2009Wallace, P. R. (2001) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London Wiley-Blackwell.Weisberg, M. Duffin, J. (1995) Evoking the moral predilection using stories to teach ethics and professionalism to nursing, medical and law students. Change, 22.Wilkinson, S. (1999) as cited in The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Student Edition, Seventh Edition. London Wiley-Blackwell.APPENDIX 1Gibbs (1988) model of reflection