Question:
What is Critical Reflection, Critical Analysis durinig nursing practices?Describe Them and After then write down what is conclusion u have founded during nursing practices?
Understanding of professional responsibilities and knowledge of the pre-requisite competencies are two main principal requirement of nursing practice. Most of these learning with respect to the competencies can be acquired with the help of nursing education, which form the foundation of professional basis. Furthermore with time and with the learning opportunities by virtue of involvement in routine nursing practice, more competencies can be acquired into the personal perception of any nurse. In other words, the competencies being acquired in the course of professional time, is referred to as experience. It is hence, with this preliminary definition, it can be understood that the scope of the present report is thus based on the description and illustration of the learning, requirement for the conduct and execution of effective nursing practice. This information will ultimately reflex the optimistic vision of professional in terms of clinical decision, decision support and use of wisdom in the routine practice. In particular, this assignment will reflect on the practical learning need to develop and enhance my professional development as a nursing student. The assignment shall be written in the first person and confidentiality shall be maintained in accordance of the Nursing and Midwifery Council (NMC, 2010). In order to generate knowledge one has to reflect the theoretical learning and find out practical knowledge that lies buried with their own practice (Rolfe, 2001). I have decided to use Rolfe (2001) model which is based on the “What, So What and Now What” concepts in order to reflect upon time when I gave the nursing handover. The PREP guideline (NMC, 2011) is going to be referred in the whole assignment of my learning need. The learning practical need I have to choose to reflect on, is to communicate effectively during handover. Communication with respect to the documentation part (handover) is important as it conveys the medium of knowledge translation, sharing of information, keeping the record of information and helps in professional conducting of routine practice. It is hence the present report can be referred to as a self-reflection part, where the learning input, sources, factors impacting, probable outcomes, improvement areas and region for implementing changes are mentioned and described with evidences and reference. Furthermore, it is also noteworthy to mention that the crucial information, which I have added in the present report, has been based on my self-analysis as well as based on the ideology and views of experts in the field with the help of various literatures. The information contained within various literatures are thereby correlated and cross-referred with each other, in order to exclude any false positive information (Street, 2011, pp.133; Sexton, 2004). Furthermore, it was believed that the importance of this report lies in context to the future prospect part, where efforts can be input for the improvement in nursing practice.
During my placement I was allocated to look after a two patients under supervision from my mentor. During my initial days, I had been caring for these patients and because of low content of knowledge with respect to the documentation; I found difficulty in preparing and providing the handover to the next shift.
According O’Connell, MacDonald & Kelly (2008, pp.2) allowing students’ nurses to take accountability for getting better the quality of their handovers will develop continuity of care, patient safety and outcomes. I believed that my mentor would give handover as she had been doing it all the time. Although I have been listening to staff giving handover several times, but at that particular time, especially on my first day of professional accountability, I was not prepared to incorporate the requisite information to be added for the completion of the handover report. It is hence the information I was giving to the incoming staff was not adequate and appropriate. When handing over I was mumbling at times and it was unclear to other staff, where the patient background information, suggestions from other professionals, my reflection for the care and intervention requirement of the patient, critical information regarding medication, diet, patient posture and other important details have not been included. My mentor noticed that I was struggling and she took over the job of preparing the handover and make it complete. While my mentor was preparing the handover, I noticed these parameters to be crucial and necessary for delivering the information to next nursing professional.
According to Cohen & Hilligoss (2009) unsuccessful handover increases the possibility of errors in medication, draws back the course of treatment, and decreases patient satisfaction and stays longer in hospital. Furthermore, the organizational objective of improved health care practices, increased patient satisfaction, and positive patient outcome was also found to be hampered with the inclusion of error in the documentation part (kerr, 2011, pp.342).
After the handover, I reflected on my practice, as I felt embarrassed and ashamed because I was not confident enough and lack the requisite knowledge for the preparation of handover with respect to my nursing practice. I thus realised that the theoretical knowledge with respect to the crucial information of patient, details of the care and measures needed for the health restoration of the patient, use of appropriate terminology and vocabulary, following the procedure and methods in accordance to the organizational policies, local and national guideline framework, are crucial (Chaboyer, 2010, pp.27). My mentor took me aside and reassured me saying that “it happens to everyone but with practice I will construct my confidence gradually”. According to Collins (2004, pp.12) a session of patient handovers in a secure atmosphere can help student nurses to build up the skills and self-confidence required to take into practice successfully. This opportunity has given me an insight to plan my personal improvement needs in relation to handover and think about how to apply the learning into practice. According to Kitson, Muntlin, Elliott, & Cant (2014, pp.1228) a more robust approach is required to know the complex process of getting better nursing communication behaviours, mostly around the nursing handover. These approaches use the usage of appropriate terminologies and vocabulary that should be standard and common in nursing practice usage. The advantage of this term lies in context to the that the standard terminologies provides advantage when it comes for sharing of the information from one hand to another hand. Thus the scope of miscommunication, confusion and problem with respect to understanding of critical terms is thus minimized, which reduces the possibility of error in the nursing care and intervention (Anderson, 2014).
The first part I realised is to be familiar with the format of the handover. I noted that there are various formats that are needed to take care, while working in other department, and the relevance of each format is crucial. Next as mentioned in the earlier context, that the use of standard vocabularies and terminologies while preparing the handover is crucial. Knowledge of both of these can be learned and acquired in the course of nursing learning. Other important and crucial requirements understand the type of information that are necessary to be incorporated in the handover. The specifications with respect to the treatment and care plan of the patient, use of medication and combination of drugs for the treatment should be mention with respect to route of administration, quantity of dosing, frequency and timing of medication management (Staggers & Blaz, 2013, pp.247). Likewise, the diet related information, patient posture while moving, any special requirement of the patient and relevant details are also needed to be incorporated in the handover, which will help in understanding to the nurse of next shift. All these information ensures that the care and treatment course of patient is not being hampered with respect to job and nursing responsibilities in the institution. I also realised that the assessment of patient taken during the session of responsibility, the critical reflection obtained with the help of assessment, special referral or discussion related information that are confirmed from other multi-disciplinary professionals are also necessary to be incorporated in the handover. My mentor, suggested me that these information are crucial not only for the part of informational exchange from one professional to another, but is also crucial for the documentation and record keeping purpose. These documents are thus helpful for the future course of analysis, clinical judgement and necessary implementation measures to be taken for the wellbeing of the patient. With the narrated scenario, I realised that the documentation and communication approach in preparation of the handover is thus crucial part of professional responsibility and routine practice. It is thus, owing to this experience, I attempted to go for further reading and discussion with my mentor as well as other senior nurses, which facilitates in improvement as well as increment in the knowledge regarding the documentation and handover preparation.
With reference to the above discussed content, it can be clearly understood that the concern of this self-reflection report is based on the illustration of effective communication skills in conjunction to documentation and handover preparation. The crucial reflection shed light on a real part scenario, which pave importance on the learning and adoption of requisite nursing competencies. Moving on to the next, the present section deals with the critical analytical part of the same concern, which I learned by virtue of literature survey and in the due course of professional practice afterwards. Certainly, the learning and understanding of the contents in this regards, helps in achieving the professional requirements, which are analysed (Holly & Poletick, 2013).
According to Kerr (2014) communication forms an integral part in the health care services, as it is the key player in deciding the fate of health and social care outcome. In simple terms the approach of exchange the view, ideology, concern, expression and emotional attributes are crucial along with the treatment regime and medications. It is equally important to understand the requirement of patient, the concern of the health care professionals and sustaining the morale of the patient, which ensures the effectiveness and efficacy of the completely health care service exchange system (Ganz, 2015, pp.49). The advantage of effective communication skills lies in the context of framing partnership models, establishing trustworthy relationship; reduce the complication of information dissemination and accurate exchange of information among both the health care providers and health care consumers. The relevant communication theories applicable to the present scenario are (Klim, 2013, pp.2233; O’Connell, 2014, pp.560; Li, 2012, pp.941):
(1) Activation theory of information exposure
(2) Health belief model
(3) Theory of reasoned action
(4) Fear appeals theory
It is important to state that these nursing theories and nursing practice models are not only effective with respect to the understanding of documentation part, but are also relevant with respect to the communication strategies (verbal and non-verbal) other than documentation.
With the advancement, the improvement and implementation has been performed with maximum effort to ensure effective communication flow at the health care settings. These efforts include, usage of IT resources, communication devices cum monitoring equipment and occupational training to staff and health care professionals (McMurray, 2011, pp.19). It is hence along with the regular health care related competencies, the professionals are also required to make use of the resources and tools for increasing the effectiveness of the process. The common methods of communication are usage of internet resources, videos, DVDs and audio recording. These methods will not only facilitate the exchange of information from both the ends, but will also help in ensuring that the message is being received and understood by both the parties (Hunt, 2012, pp.310).
Regarding the confidentiality and security of patient information, data protection Act of 1998 is suitable where the information cannot be used without the consent of the patient. It is important to make clear that the documentation and information practices within the health care settings are a part of communication where information storage, retrieval and exchange are main issues. Personally I revealed that the use of standardized vocabularies and terminologies in the documentation is also necessary to ensure error free information exchange between multi-disciplinary professionals. Likewise, appropriate training and resources should be provided to the health care professionals to deal with cultural and ethnical diverse health care consumers. Special training and assistance should be provided to the patients having poor English proficiency and hearing impairment. Avoiding the excessive usage of medical jargons, especially in the context of general health care consumers is also one of the good practices (Staggers, 2011, pp.209; Gage, 2012, pp.43).
Other important legislation constitutes, National Health Service Act of 2006 and Health and Social Care Act 2012. These guidelines described related to the training and assistance to the health care professionals, functions and responsibilities of the professionals, regulatory bodies to collect intervention record, assessment records, monitoring the procedure and protocols, interaction and communication approach by the health care professionals with the consumer, and similar issues.
The ethical and legislation criteria of local, national and international code of conducts should be take care while attempting to impose a positive communication impact. These attributes, include the following points, which I learned are (Eberhardt, 2014, pp17; Lu, 2013):
(1) Restriction of inappropriate language
(2) Restriction and training to avoid usage of incongruent language
(3) Clear and precise communication to avoid any misinterpretation
(4) Breach of confidentiality
(5) Breach of trust within the scope of health care practice
(6) Ethical conduct to avoid any threat and abuse
(7) Respect to the power of the individual, autonomy and choice of patient with respect to the health restoration method.
Health care settings should facilitate necessary resources and requirements to ensure that health care professionals face minimal challenges while interacting with the consumers having poor or no English literacy cum proficiency. Use of internet resources, information system, evidence based practice, inclusion of third party, translator, family members in communication is worthy in this regard. Effective strategies of communication are necessary not only to deal with single target audience, but are also necessary for conveying the message and receiving the response from mass community and from other health care professionals. Apart from the handover in conjunction to the discussed concern, there are other means, which I realised are necessary to enhance the effectiveness of the communication process. Conference, flyers, newspapers, publication and use of media resources are always found to be worthy when it comes to address huge mass (Bradley & Mott, 2013). Public policy pave crucial role in this regard by defining and mentioning effective guidelines to deal with the communication strategies for communication. (Scott, 2012, pp.14) Particularly in NHS, RIO is one of the approaches where the information and related content of patient are used to be stored in form of electronic records and database. This helps in making a common point or repository for the community health related information (Gage, 2013).
The effectiveness in the communication skills among the health care professionals can be improved with some of the suggestions as mentioned in the preceding section. The particular mode of improvisation in the communication process is mediated thorough appropriate training for health care professionals (Clarey, 2014, pp.419). Effective and efficient communication skills is one of the most essential competency for health care professionals which ensures that the meaning and convention of any ideology, concern and review is translational among various personals associated with the health care practices. Understanding cultural diversity, respecting the values of individual, offer equality in terms of treatment and health care requirement are the noteworthy elements in this regard (Ferguson & Cioffi, 2011, pp.5). The effectiveness in communication means should be made included within the requirements of health care practice by the policy priority means. It is hence sufficient ethical and legislative measures should be present as active part in the guidelines and regulatory measures of day-to-day practices. Particularly in the field of health care, it is the duty of educators, leaders and managers to ensure that effective means of communication is processed and channelized in the routine health care practice (Pope, 2012, pp.24). On the contrary, the most effective strategy for improvement in the communication methodology is the understanding of the professional responsibility by the health care professionals itself. It is hence the motivation of professional satisfaction and professionals’ characteristics can work for being a patient listener and effective advocator irrespective of any issue within the content of health care services (Allan, 2011, pp.847).
With the help of learning and understanding from literature review, I learned that an appropriate and accurate handover should include following points (Voyer, 2013; Johnson, 2012, pp.462):
(1) Patient background information
(2) Patient assessment related information
(3) Details and suggestions of any other health care professional
(4) Information with respect to the dietary concern, adverse food drug information, dietary precaution, administration of medication in conjunction to dietary habits.
(5) Medication management and the legal and ethical concerns involved in the medication management.
(6) Clinical decision, involved in the course of intervention and treatment regime involved.
(7) Decision support and discussion minutes if carried out with other nurses and other health care professionals.
(8) Detail of the description with respect to the use of wisdom in the decision making process.
(9) Electronic prescribing, storage, retrieval and exchange of information, if needed.
(10) Connection with a common server, hence the information can be accessed from any point, anywhere within and outside the health care settings, as per the requirement in the nursing practice.
(11) Support and development for the ongoing operational processes, in conjunction to the on-going nursing intervention or treatment regime.
(12) Risk identification and assessment as per the situation. It should be noted that the present concern is also important to be communicated verbally, depending upon the requirement and need of the hour.
(13) Details of any instrumental necessities with respect to the assigned responsibility. These information can also be linked with the instrument specifications, readings, defects, need for the up-gradation and other related requirements.
Conclusion
In conclusion, it can be said that the present report illustrated the critical reflection and critical analysis the nursing competencies with respect to communication strategy for documentation and communication by handover. The error in nursing practices is majorly linked with the documentation and handover part, and hence the said paradigm should be understood with depth knowledge and attention. All the learning, which I conferred with the help of theoretical and professional experience, is thus summarized in the report. Moreover, it is also believed that the present information is helpful for relevant readers for learning and understanding of the need for effectiveness in communication and usage of standardised vocabularies and terminologies.
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