Discuss about the Reflective Practice for Healthcare Professionals.
I was born and brought up in India. I have migrated to Australia in 2005, when I was 26 years old. Currently I live in Victoria. I have completed my graduation in Monash University, Burwood. I have attained certificates in the areas of nursing to increase my professional competence. I have worked in three different hospitals and have gained a good professional experience and I am planning to enhance my professional competence and skills to a higher level.
I am a fun loving person and love to read books to enhance my worldly knowledge. I am vivid reader of various scientific journals based on health and medicine. As a child I was always inspired with the life of nurses as they make a difference to people’s life. I wanted to become nurse since I was ten years old. I love the variety in routine involved in patient care. I feel satisfied on helping people in difficult times. I am optimistic about this profession as I know I will be successful on pursuing job of my interest. Moreover, it is a growing career. Therefore, I have commenced my career with nursing.
Personal interest in this field has become strong after my placement in the Pre/post op medication, in oncology department for acute medical care and mental health placements. My graduation and clinical placements have improved my professional knowledge in regards to illness, disease symptoms, pathology, diagnosis, evidence based practice, clinical guiltiness in treatment and prevention of illness. I have learnt the communication required in the clinical setting. This knowledge will help me in maintaing the health and safety needs of the patients in the health care organisation.
During my nursing journey the philosophy which I will stand by is providing empatheic, compassionate, and competent holistic care. The philosophy is based on the values and beliefs instilled in me by my parents. My values and beliefs are accompanied by respect, honesty, affection, and compassion. These beliefs drive me as I care for my family and community. In order to keep in stride with my philosophy I am engaging in continuous education and enhancing my skills. I am confident about respecting the cultural and linguistic diversity of patients. I vow to adhere to the code of ethics and NMBA professional standards. I will be accountable for legal and ethical responsibilities. I will overcome the challenges and practice errors by engaging in critical reflection process so that I can deliver my practice in a manner that will do no harm to the patients.
“The very first requirement in a hospital is that it should do the sick no harm.” ? Florence Nightingale (Goodrads, 2017).
My 1st placement was of 160 hrs in Pre/post op medication in ABX hospital- (put semester and date)
In this hospital I was placed in the post operative care unit in a surgical ward. The patients in this ward have undergone hip surgery. I have gained the knowledge of pre-procedure assessment, pain assessment, supervising vital signs, giving discharge instructions, and patient education.
Acute medical placement in oncology (3) weeks and Orthopaedic (2 weeks) 240 HRS in Box hill hospital- (put semester and date)
I received exposure in this field through interview. In Box Hill hospital, I have learned to direct the patient care involving chemotherapy. It was challenging because one needs to be very alert and responsible in administrating the correct patient with correct dose and drug and in correct route. I have seen nurses struggling to manage the numerous symptoms of the cancer patients. It is the nursing priority in oncology ward to manage the daily changing symptoms.
In orthopedic ward, nurses deal with the patients having musculoskeletal disorders. Nursing includes treatment and prevention of acute problems such as fractures, and chronic systemic disorders such as loss of bone density. When I was placed by my institute in the orthopedic ward I could observe and learn monitoring the neurovascular status, care for the patients with external fixation.
Mental health placements 3 (160 hrs) weeks and 2 (80) weeks in community placements Alex medical hospital 240 hours- (put semester and date)
I received the placement here by communicating with some of the senior nurses who informed me of interview process. I have learned about involuntary admission of mentally ill patients in this hospital. I had to visit the (name of community) with my mentor/ I have learnt about active listening skills when dealing with patient’s stories or narrations. I have learnt how to ask open ended questions to the patient during collection of history, assessment, crisis intervention, assisting patients with mental health drugs and therapies.
Acute medical and surgical ward for 5 weeks in Frank hospital. 200 hours (put semester and date)
I have attended the Frank Hospital after receiving placement in acute medical and surgical ward. In this ward I have encountered many elderly patients acutely ill with chronic kidney diseases. In this ward, I was trained on administering the medications and educating the patients and their families, giving the discharge instructions and admitting the new ones. Working in this ward requires robust managing skills as I had to juggle from one patient to another. Home visits have also helped me to learn how to care the patients at home. The techniques that I have learned are chest tube insertion, bone marrow aspirations, intravenous medications and blood transfusions.
My professional experience by attending various education sessions and the ward in-service are as follows:
With this case study of George, I have gained a good insight of the Schizoaffective disorder. I was able to demonstrate in my assignment the recovery oriented approach for mental health nurse. I was able to depict the evidence based information promoting recovery in the case of George. I was overwhelmed on completing the assignment as I could develop the care plan that promote recovery oriented approach in mental health service. I have recived good score in this assignment.
I am grateful to get this assignment because I was able to learn what is PICO method. Before, this assignment I was not competent in preparing the annotated bibliography. However, with the help of my tutors, senior colleagues and online tools I could prepare literature review on “Dementia: A Communication Challenge for Nurses”. This assignment is memorable to me as it helped me to understand the importance of promoting therapeutic relationship with dementia patients. I can use this knowledge, when I will be placed in mental health setting future.
The group presentation on Warfarin helped me to learn the team work. I was a well organized presentation that has fetched me god marks. I was gaining more knowledge on how it reduce complications when patient receiving warfarin, importance of anticoagulant and Dietary precaution while on Warfarin. This assignment has helped me learn tactics of smart presentations.
My learning contract 1 is based on goal to improve the pharmacology knowledge and the physiology of the drug action and the pharmacokinetics. I was uncertain not knowing as to where I will be placed. However, upon reflection I have realized that I have a gap in the area of pharmacology. Before my final placements, I needed a more clear understanding of the drug mechanism and the pharmacokinetics. It will help me in delivering effective treatment care.
My first learning objective includes gaining clear knowledge of the fundamental principles of drug actions. The objective is to understand how these drug actions in the acute care setting. I wanted to establish the various mechanisms that would impact on pharmacology. On evaluating myself with set of questions I could gauge on the knowledge acquired, learning levels, and obtained. I have a successfully achieved the first objective. I was able to demonstrate the rightful application of the drugs in the intensive care units. I was able to emphasize on the fact that nursing skills must be correct when administering the drugs during the critical care condition. It was clear to me that on what purpose the drugs are administered. I could demonstrate the basic principles of care in pharmacology. I was able to understand the mechanism by which the drugs are inactivated and the receptor ligands mechanism of drug synthesis. However, based on my assessment results, the article that I have selected for the purpose of gaining the concept of pharmacokinetics was relevant. I have realised that I could have chosen better article that would have been easy to understand the release of receptor in first attempt. I was happy to find during evaluation hat basics of drug synthesis was more or less clear.
I have gained in-depth knowledge on the localized action of the drugs on brain, different body organs and the neuro-muscular junction. It was difficult for me to understand the factors affecting the absorption of drug such as metabolism and distribution. Upon assessment I found that my knowledge pertaining to this was insufficient. I have chosen better reading material. I was able to highlight that the drugs can exhibit unwanted relationship with the receptors that may have adverse consequences. I could highlight from my readings that the nurse must establish the patient factors such as diet and age as well as genetic factors. Overall I was confident about the basic functioning of drugs, concentration locus of cation, the binding effects and biotransformation.
Talking about my second objective, which was to analyse the various aspects of pharmacology and drug management, I was able to meet this to satisfactory extent. I had minimal confusions in this area which could be cleared easily by consulting my mentor. For attaining this objective, I was able to demonstrate specific patient characteristics that would effect on the drug response. I could explain basic underlying of drugs, impact of drug action on pregnancy and age, and any undesirable clinical effects, and influence on drug interaction. I have presented the classification of adverse drug reactions and was appreciated for work by professors. My classroom presentation on anticoagulants (warfarin) previously was also helpful. I evaluated the learning experience by taking online test, questionnaires, quiz and multiple choice questions. As per my self- evaluation using online tools I was able to meet the second objective as well. I scored more in MCQs and less in online quiz contest. For better score next time, my strategy is to maintain Q cards. Time was the main factor that hindered my performance in online test as I was not able to recall certain words quickly. However, experiences from my previous placements in medical and surgical ward, palliative care and post op medication has helped me in relating with concepts. Bulk of my pharmacology comes from this placements.
My third learning objective was to understand nursing interventions and protocols in an event of adverse drug reaction. To meet this objective, I was engaged in group learning activities and group presentations. I could demonstrate poor understanding of the plans aiming at ensuring maximum effective communication in crisis situations. For future I need to collect evidence based options in implementing the nurse responses and protocols. Upon reflection I have realised that I should have used better learning materials.
I was good enough to choose the reading material such as “Food, K. (2008). Drug Administration. 2005. Food code, 18, 123”, for meeting the first learning objectives. Later I realised there are better papers in lucid language. Next time I have to implement better literature search strategy and use good databases. I need to implement smart search strategy. I need to increase my concentration while reading and increase the catching power. This factor was hindrance to completely achieve my learning objectives.
Obtaining the first learning objective gave me the confident to attain my first clinical placement. The most helpful learning strategies were making sticky notes and maintaing short notes while learning. Use of flow charts and concept map was even better. Later I realised that there were some good videos available online. It was my mistakes not consider this strategy. For my future learning I would use videos as it is a quick process of catching concept. Further, the use of websites https://accesspharmacy.mhmedical.com, https://apps.who.int/medicinedocs are reliable said my seniors. These websites were helpful in meeting the second learning objectives. Due to regular reading habits, I was competent in understanding the abbreviation, and medical terminology. These factors helped me in achieving my learning objectives. However, I need to use better reading resources for meeting the third learning option. I have used more websites such as “www.merckmanuals.com and www.nurseslearning.com” than pharmacology journal articles. I will use more books and journals on pharmacology for adverse drug reactions and nursing responses. I will also have to keep drug name suffixes and prefixes handy.
Overall the learning contract 1 was a good opportunity to prepare for placements. It gave me a good experience and helped me understand my flaws, which I would omit in my clinical placements. In addition, the class assignments and group work has also helped in learning team work. It will be helpful for my profession. Performing in online tests and real clinical setting is different. Therefore, before my final setting I will keep watching more videos on emergency care mediations by nurses, to apply pharamacology appropriately in real life situation. In addition, I need to be more competent and dedicated to work.
During my clinical placement, I was able to conduct COPD diagnosis of patient. I was able to design evidence based care plan. While administering the medication, I knew the rationale for drugs, the pathology of disease, treatment modalities and appropriative nursing interventions. I was able to use the Calgary-Cambridge Model of Communication when interacting with the nurses and the patients. It helped in nurse patient interview and examination. Thus I could practice and apply the medical interview process. I could accurately apply my medical knowledge. Therefore, I could successfully achieve my first learning objective to enable the learning skills needed for ensuring building of confidence levels among students like me.
I was able to achieve my objectives due to care guide and online tools, search guide by educator/buddy nurses, group learning objectives, and personal experience. I was also able to achieve some of my objectives due to learning contract 1. In learning contract 1, I could demonstrate the pulmonary care process during presentation in my class on COPD. I scored above average marks and the learning materials were appropriate in gaining this knowledge. I was appreciated for citing work from American journal of respiratory and critical care medicine, and International journal for quality in health care. It helped me to meet the second learning objective of demonstrating basic understanding of how the structure and function of lungs and its gaseous exchange. My presentation on COPD is evidence that I have strong knowledge on the respiratory system and lung. As per my online formative tests, my concept on gas exchange in alveoli and progress of pulmonary disease was adequate in learning contract 1. The website “https://www.proprofs.com” was a good source for online quiz. I have also achieved my third learning objective which was to have basic understanding and administration of drugs in pulmonary care (COPD) from learning contract 1. As evident from my COPD presentation I could introduce the concepts of injury, inflammation and necrosis which include the pharmacology drug action, absorption and drug development. I have learnt where to look for protocol and guideline of the attended hospital; and I am also confident about the IV administration and drug calculation from my previous placements.
However, I was inefficient in depicting the drugs used in management of pulmonary care. In some of my assignments I could not meet the learning objectives. It was due to lack of time management and distraction from work and from ad hoc task and lack of skills in taking running note and non-skillful communication. Overall I could meet all the learning objectives of learning contract 2. Despite completing only three NMBA competency learning objectives, I am well acquainted with the role and responsible of a competent nurse. I future, if I encounter any challenges in my profession I would refer to NMBA – National competency standards (Taylor, 2010) for the registered nurse. However, I have not encountered any ethical issues so far and that is one area where I am nervous.
In future, my goal would be to practice ethical behavior in nursing. As per my previous clinical placements, the lesson I have learnt for future nursing profession is the enhancing effective communication skills. This strategy for future nursing will help develop collaboration with the interdisciplinary team members especially in emergency and medical-surgical ward. In my future placement I will keep asking more questions and clarify my doubts on time with my seniors. It is necessary for building strong rapport with my seniors and mentors and learn to address ethical dilemma in work place. I plan to be more empathetic, and sensitive to patients for building therapeutic relationship with clients. Overall the learning contact 2 has given me deep insights of the “Nursing Midwifery Broad of Australia’s” competency requirement (Nursing and Midwifery Board of Australia, 2017). Since the work pressure for nurse is very high, I will engage myself to work and accustom to the climate as soon as possible as initially it will be difficult to implement the theoretical knowledge in practice in future.
References
Goodreads (2017). Florence Nightangle > Quotes, Retrieve from: https://www.goodreads.com/author/quotes/83031. Florence_Nightingale
Nursing and Midwifery Board of Australia (2017). Professional Standard: National competency standards for the registered nurse, Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Taylor, B.J. (2010). Reflective Practice For Healthcare Professionals A Practical Guide. 3rd ed., McGraw-Hill Education, Berkshire, Retrieved from:
https://reader.eblib.com.au.ezproxy.lib.monash.edu.au/(S(0rzalhyvs20hkfm1pkwuyt1n))/Reader.aspx?p=771426&o=90&u=vUCIssqYUX8%3d&t=1465651284&h=7D213516A8229DA17E40F016046B8964B5667667&s=25938397&ut=233&pg=1&r=img&c=-1&pat=n&cms=-1&sd=1
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