A Reflection On The Nursing Skills

Inter-professional education module focuses on teaching all health care professionals the acquired skills required to successfully learn and work inter-professionally. During work placement I recognised that the skills taught in this module were applied amongst the multidisciplinary team. In this essay I will be identifying and discussing these skills as well as referring to Rolfe et al (2005) reflective theory model to support my explanation of how these skills would be applied in practice based on my experiences

During the seminars of the Inter-professional education (IPE) module I was able to identify reflection, communication, consent professionalism and consent as the skills acquired from collaborative learning:

I see reflection as a process use to learn alternative methods of carrying out a task that may have been challenging, Simply because when I reflect back on how I handled some tasks I am able to identify some mistakes that were not noticeable while I was physically doing the task. It can be argued that we learn more through physical experience rather than reading from a text book. Jasper (2003) explains that “the learning that we achieve using reflective strategies is different from the theory that provides the knowledge underpinning our practice. It is also different from acquired skills by watching others and mimicking what they do because it involves consciously thinking about things and actively making decisions” (P.1).

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During placement I joined staff nurses, physiotherapist, occupational therapist, doctors and other health practitioner when they reflected back on the care given to the patients during handover and multidisciplinary meetings. I noticed that handover enabled all health professionals to detect alternative methods to care for patients, while reflecting we would go through a reflective spiral. Members in a multidisciplinary would be discussing the previous care they have given a patient, the nurses would share their past experiences, reflect on these experiences with the physiotherapists, and then both professionals would find a new perspective to put into action. After trying out their new perspective both professional would have to re-access and reflect again which usually lead to them identifying new changes or information, they would take this new perspective into consideration and try again. Jasper (2003) describes a reflective spiral as a “Continual spiral incorporating several reflective cycles” (p.3).

During placement I found it easier to reflect inter-professionally rather than individually. I realised that when reflecting alone I am not always honest about the challenges that occurred in my experiences but I tend to have more time to reflect on my own than I would with my colleagues. However, I now prefer to reflect or re-access care plans inter-professionally because often other people see positive factors and a clear picture of an experience, especially if they have learnt from a similar past experience. I also prefer reflecting with my colleagues because individual members contribute to different ideas for example; one member usually ask questions I don’t think of, one member may suggest an alternative method of carrying out the task and another member can be an advocate on my behalf depending on my boundaries.

Communication skills are essential in collaborative learning, it improves the care process and it ensures that all health professionals involved in the patients care are aware of the patient’s condition and progression. In practice communication is also needed to gain consent from patients in order to give them delicate health care such as personal care, distributing medication, giving them injections etc. Code of Conduct (NMC, 2010), states that all nurses must use excellent communication and interpersonal skills. Their method of communication must always be safe, effective, compassionate and respectful. This code also states that nurses must have the ability to work with service users and others to deliver care as well as enable access to services.

In practice I observed that record keeping is also a form of written communication. What health professionals wrote in the patient’s medical and care plans were vital information that needed to be shared with other health professionals. For instant when admitting a new patient on to the ward one method of getting information about the patient is reading the previous medical notes. Record keeping also serves the purposes for communication in collaborative learning which is keeping all health professionals aware of the condition and progression of the patient.

I have also had the opportunity to writes some medical notes myself, I am aware that different clinical settings have their own style and expectations when writing medical notes. However, based on the medical notes I have read and NMC (2010) record keeping guidance medical notes should always be in sufficient detail, accurate and all decisions made regarding the patient’s care should be kept securely and recorded even if this was done as a form of written communication or over the phone. The medical notes should also explain why these decisions were made and who initiated these decisions. Medical notes or care plans should be complete as soon as possible therefore the time and dates should always be stated, referrals should always be included and reassessments should be made and confirmed by all the health professionals involved in the patient’s care. Most importantly, original records should never be changed or tampered with in any way.

As I mentioned in the previous paragraphs verbal communication is one method of asking for consent. Consent as is asking the patients permission to give them any type of health care. However, at placement there would be a situation where the doctor has gained consent from the patient to perform a procedure but the nurses would be the one actually carrying out the procedure. I found this to be wrong practice for example the doctor would gain consent from a patient to give two units of blood in a blood transfusion, the doctor handovers to the nurse, the nurse assumes the patient is aware that they would be giving the procedure when in fact the patient didn’t consent to the nurse they consented to the doctor .When nurses or other health professionals are obtaining consent, they must ensure that the patient agrees to all the treatment they intend to carry out. Nurses must also carefully explain all the treatment or touching that will occur when obtaining consent (Griffith and Tengnah, 2010).

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The IPE module and my experiences in practice have taught me that in order for a patients consent to be valid and fully given: they have to be informed reasonably this also means simply explaining the procedure leaving out the medical jargon. The patient has to give the consent freely with no pressure or influences by family member, next of kin or health professionals. Also in some cases with patients with dementia you have to continue to ask for consent.

During practice I observed that remaining professional in a multidisciplinary team has a positive impact on how successful the health professional work inter-professionally. My perspective of being professional is: respecting confidentiality and having a non-judgemental approach, respecting all service users and providing equal opportunities, safeguarding all service users and maintaining a professional therapeutic relationship with the service users as well as respecting the job role of other health professionals. Kasar, Clark, Watson and Pfister (1996) suggest that when people think about professional behaviour or being professional they usually expect dependability, professional presentation, showing Initiative, empathy, organisation, cooperation, supervisory process, clinical reasoning, and excellent verbal and written communication skills.

The NMC (2010 recognises part of being professional is having ‘accountability’. Griffith and Tengnah (2010) described accountability as being answerable to a higher authority for your actions. All through practice placement I found that when collaboratively working, the nurses were usually confident and initiative regarding the care of their patients. However, they were accountable for the decisions they made even if the decisions were made whiles working collaboratively. According to Griffith and Tengnah (2010) a registered nurse would be professionally and legally accountable for their actions, regardless of whether they are following the instruction of another or using their own initiative.

The IPE module has taught me that nurses and even student have obligation to answer for their actions to a range of higher authorities, these higher authorities could be; my university the NHS Trust of my practice placement and the NMC and even the court law if I commit a criminal offence even when I’m not training.

Ethics is used to justify or explain why people from different societies make decisions that could be considered morally right or wrong. Thompson, Melia and Boyd (2000) explained that ‘morals’ and ‘ethics’ are terms often used to refer to social customs and explain their rights and wrongs, in theory and practice, of human behaviour. ‘Moral’ is used to explain what people believe is right or wrong and it is influenced by their culture, experience, upbringing, education and religion. I observed in practice that sometimes in practice ethical and moral decisions can cause conflict. This was usually because different health professionals may have experienced different things in the duration of their profession and often health professionals tend to have their personal moral views on what is right and wrong practice.

In conclusion, an inter-professional team of various health professionals are expected; to reflect inter-professionally on the care they deliver, practice all type of communication with each other and keep each other informed with the care process. They should always ask consent from their service users and conduct themselves in a professional manner at all times regardless of the ethical issues that may occur in practice. These skills are acquired from collaborative learning amongst health professionals and when taken seriously they also contribute to the well-being of service users.

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