Discuss about the Nursing for Clinical Skill Reflection.
The clinical practices are the combination of professional knowledge, skills, culture, attitude, behaviour and personal perceptions. Any individual has to modify all these features to become a clinical professional. The personal reflection is a tool to analyse the development of these features in once perception while performing as a healthcare professional (Morris & Faulk, 2012, pp.67). This essay is one such attempt by me as a learner where I am going to explain the importance and value of personal reflection in nursing followed by reflecting on one of my clinical skill (taking observations of the patient). This clinical skill is analysed by detecting my strengths and weaknesses in practice as a clinical nurse. As a Practice Nurse, I am reflecting on one of my clinical practice where I was allocated to take physical and psychological observations of one patient.
Personal reflection is described as essential human activity that recaptures the experience for which critical thinking is developed and mindful evaluation is performed for better learning and improvement (Dossey et al. 2012, pp. 98). As nursing profession is the collaborative functionality of personal and theoretical knowledge, the clinical reflection works as a tool for life-long learning, self-insight, awareness and development (Bulman, Lathlean & Gobbi, 2012 pp. 12). According to Borders (2014 pp. 160), personal reflection helps to establish high care standards, patient centred care, professionalism and honesty towards perceptions. Further, reflection also helps to implement the best use of knowledge, eliminate past mistakes, confront and repair professional knowledge base.
Horsfall, Cleary and Hunt (2012 pp. 931) opine that personal reflection is the foundation of meaningful nursing practice by gaining wisdom, connecting with truth and approaching excellence in healthcare. Sumner (2010 pp. 162) indicated that when dealing with the human body and mind the chances of repetitive error should be very less or negligible because the error once occurred can bring drastic outcomes. Therefore, personal reflection works as a tool to minimise the changes of such error by detecting and correcting them selflessly. Blum, Borglund and Parcells (2010 pp. 34) considered personal reflection as a spiritual act where nurse establishes a connection between inner self and outer world for humanness of their patient and establishing healthy relationships. Decker et al. (2013 pp. 28) studied that self-reflection based on critical thinking, reviewing, analysing and evaluating experiences to develop conclusion works as a positive future action for effective nursing practice. Lastly, Green, Wyllie and Jackson (2014 pp. 6) indicated that personal reflection helps to develop a critical, autonomous and advanced practitioner in nursing practice.
The clinical practices for taking observation varies as per their aim and process depending on factors like intensity, engagement, frequency, duration and watching from distance. The need of observation depends on potential risk, physical condition and therapeutic engagement (Morris and Faulk, 2012 pp. 86). As a practising nurse, my purpose of taking observation was to access the physical and psychological health of the patient with constant (arm’s length) level of observation. I adopted some of the most essential qualities to perform an effective observation that involves critical analysis of patient, environment, effective patient centred communication, systematic assessment and team functioning with a step-by-step approach.
In the first step of my observation, I entered the patient’s room performing an environmental analysis to detect the availability of required equipment’s, room conditions and hygiene as well as hand hygiene requirements. Borders (2014 pp. 155) indicated that nurses should carefully perform patient observance, environment observance and essential requirements while entering the patient room. Further, Sumner (2010 pp. 167) also stated that hand hygiene is a major requirement before and after patient assessment, observation and care, therefore, it is essential equipment for care process. Therefore, as per my theoretical knowledge, I performed these initial steps of observations.
Horsfall, Cleary and Hunt (2012 pp. 933) indicated that collecting background information about history, past experience, on-going health issues etc. helps in effective observation process, therefore, I collected all possible background information from other caregivers involves in the treatment process of this specific patient. Further, before initiating one-to-one observation, Blum, Borglund and Parcells (2010 pp. 31) indicated that it is required for a professional to inform the patient about this observation, its purpose and process. The observation changes and processes should also be communicated followed by regular feedback regarding the experience of the patient. I took this initiative by communicating complete information about observation to my patient. However, I missed the step of collecting patient feedback after each observation due to my panic for completing with observation process within the limited time duration.
Even Williams and Stickley (2010 pp. 753) studied that nurses should invite patient for suggesting the ways for taking observations, for example, nurses can ask patient questions like “How should we catch up?” but I realised that my clinical observation process was very professional creating a discomfort to my patient. This process should occur at the beginning of observation, however, I realised that I missed patient consent before starting my observation process. This can be considered as a major error of my clinical skill. According to Sumner (2010 pp. 164) taking observation is not only a physical visualising but it is the combination of physical sighting followed by mental sighting with effective communication. The nurses should adopt the formal and informal communication strategies while taking the observation to get best possible information about the patient condition. While taking observations I adopted best possible strategies to perform effective communication by asking the patient about their pain, assessing patient consciousness, medication details, on-going treatments, eating and drinking habits, urinary and faecal elimination. Further, I documented all the information and detected problems as per clinical standards.
After these initial observations, I performed a complete vital sign assessment involving temperature, respiration, pulse, blood pressure, blood glucose, oxygen levels, and body mass index. Borders (2014 pp. 156) indicated that vital sign assessment is a complete observation of physical, psychological and environmental stressors. Further, a Mental State Examination (MSE) was performed to determine the overall psychological observations. McDonald et al. (2012 pp. 380) studied that MSE covers complete assessment to the mental health condition that can detect symptoms and dynamics of any mental health disorder. Therefore, I consider it as a suitable tool for my patient observation process.
According to Blum, Borglund and Parcells (2010 pp. 33) nursing responsibility involves maintaining standards, right skill mix, seeking advice and right resources while practising with the patient. I tried to accommodate all these responsibilities as a professional in my clinical skills process, but I detected that my observation process was lacking advice from other healthcare professionals. I didn’t even involved expert advice while developing my observation protocol and report. This can be considered as a professional error highlighting lack of experience and professionalism in my nursing practice.
My lack of experience, the limited time duration for observations and negligence were some of the defects that created issues and defects in my observation practice. However, I was perfect in taking observations, patient communication, creating awareness, my attitude, perception and performance but I lacked professionalism, experience, team functionality and ethical stability (not taking patient consent) in my clinical skill practice. DeBrew and Lewallen (2014 pp. 635) indicated that patient consent is a formal process that is considered to be mandatory for any clinical practice. If there is the requirement or not it is the duty of professional to attain informal or formal consent from patient as per Australian code of nursing ethics. Therefore, I need to work on some of these professional errors to establish a perfect clinical practice.
Conclusion
As per this study, it is clear that clinical self-reflection makes it very tranquil and easy to detect the error committed by oneself in clinical practice. It is an important tool to judge oneself by thinking, analysing and evaluating once experience and practice. My self-reflection on clinical skill of taking observation was perfect in terms of my practice, communication, personal perceptions and performance but it also highlighted lacking professional experience, ethical standards and team engagement in my practice. These errors are generally not detectable but they can create a risk situation for the patient if continued in nursing practice. Therefore, I strictly need to concentrate on these specific errors for improving my professional practice to address my professional goals in healthcare scenario.
References
Books
Dossey, B.M., Certificate, C.D.I.N.C., Keegan, L. & Co-Director International Nurse Coach Association, 2012. Holistic nursing. Jones & Bartlett Publishers.
Morris, A.H. & Faulk, D.R., 2012. Transformative learning in nursing: A guide for nurse educators. Springer Publishing Company.
Journals
Blum, C.A., Borglund, S. & Parcells, D., 2010. High-fidelity nursing simulation: Impact on student self-confidence and clinical competence.International Journal of Nursing Education Scholarship, 7(1), pp. 31-34.
Borders, L.D., 2014. Best practices in clinical supervision: Another step in delineating effective supervision practice. American journal of psychotherapy, 68(2), pp.151-162.
Bulman, C., Lathlean, J. & Gobbi, M., 2012. The concept of reflection in nursing: qualitative findings on student and teacher perspectives. Nurse education today, 32(5), pp.e8-e13.
DeBrew, J.K. & Lewallen, L.P., 2014. To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students.Nurse education today, 34(4), pp.631-636.
Decker, S., Fey, M., Sideras, S., Caballero, S., Boese, T., Franklin, A.E., Gloe, D., Lioce, L., Sando, C.R., Meakim, C. & Borum, J.C., 2013. Standards of best practice: Simulation standard VI: The debriefing process.Clinical Simulation in Nursing, 9(6), pp.S26-S29.
Green, J., Wyllie, A. & Jackson, D., 2014. Electronic portfolios in nursing education: a review of the literature. Nurse education in practice, 14(1), pp.4-8.
Horsfall, J., Cleary, M. & Hunt, G.E., 2012. Developing a pedagogy for nursing teaching–learning. Nurse education today, 32(8), pp.930-933.
McDonald, G., Jackson, D., Wilkes, L. & Vickers, M.H., 2012. A work-based educational intervention to support the development of personal resilience in nurses and midwives. Nurse education today, 32(4), pp.378-384.
Sumner, J., 2010. Reflection and moral maturity in a nurse’s caring practice: a critical perspective. Nursing Philosophy, 11(3), pp.159-169.
Williams, J. & Stickley, T., 2010. Empathy and nurse education. Nurse education today, 30(8), pp.752-755.
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