Analyzing the value of nursing students’ work based learning experience in the achievement of personal and professional competence
1.0 Introduction:
Being a nursing student myself, I have conducted this paper to analyze my work based learning experience in nursing education. I have made this report with special relevance to my personal and professional growth during this training program without surpassing the NMC defined standards.
Experience is pertinent part of education for nursing students as they have to confront challenges related to patient care in real world health settings (Daly, 2005, p.336). Like most trainees I was also unclear about my role, had little confidence in my abilities and was scared of the risks involved in practical application of my knowledge. As practice based learning is linked to the learning activities that require application of theories in a practical work scenario; it provided me the insight of the workplace which could not be achieved by sitting in a lecture room.
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Cherry et al. (2005) proposed that effective communication is the core of nursing profession. Keeping this in mind I have tried to analyze my communication skills developed, as part of the training session, by issuing handover reports to the nurses on the next shift. I have also made an effort to appraise the level of improvement in my listening skills. Through reflection I tried to summarize my personal and professional development during training.
2.0 Development:
2.1 Handover/Communication assessment:
It is a process in which nurses’ team delivers the information about the patient’s care to other nurses normally as the shift changes. It usually focuses on the nursing care plan (Smith, 2004, p.4). Continued reflection on my experience enabled me to assess that handover is one beneficial way of communicating with other nurses.
2.1.2 Essential components of handover:
Through handovers nurses are better able to conceive the patient’s condition. Before this work based learning experience I used to make disorganized handovers but by the end of this shift I have witnessed several handovers instructed by the senior nurses and now I am proficient enough to develop a concise hand over in time.
During my experience as a trainee nurse, I have seen nurses making unstructured handovers that were a total waste of time as they indicate patient’s information in a biased manner. The time assigned to submit a hand over was usually limited. Attendance was also mandatory at the time of handovers. According to me the current handover practice was efficient as I never witnessed the time of handover process changed.
Handovers also formulates a way for personnel education and debriefing (Jones & Bourgeois, 2006, p.155).Nurses used to exchange handovers informally thus bridging communication gap with each other as well as sharing the stress of co-workers. Latimer (2003, p. 105) indicated that this process make nurses able to experience their emotions that are understood by a group of colleagues so that they feel their work stress has lessened. They rely on the information of patients from “previous shifts and communicated these matters to each other as they paired to do routine rounds” (Latimer, 2006, p. 41).
Nurses must have a considerable knowledge of anatomy and physiology (Daly, 2005, p. 123). When I began my training in the work place setting, the main issues that I encountered were due to my lack of medical knowledge but as my professional growth continued I learnt basic terminology that later helped me in conducting handovers and examining patient’s symptoms. At the initial stages I regarded handovers as a complex activity because I had difficulty in understanding some medical terminology and abbreviations but with the passage of time I have learnt to clarify the patient care information as a student nurse.
2.1.2 Handover submission:
I have observed and practiced that handovers were submitted at the hind bed space of the patient. “Bedside handovers allow for greater patient involvement as the nurse taking over the next shift can put a face to the name and remember more easily who is who”(Thomas, 2006, p.90)
Latimer (2006, p.32) said that handovers in nursing may be termed as “one way communication channel as information and instructions go down, along or up the hierarchy”. Usually ward matron supervised hand over circulation. The issues of concern were that the patient’s information should be kept private. Confidentiality of patient’s data is a primary concern while making handovers (Ely & Ian, 2007, p.92) I tried to maintain this exercise in practise. Because of this reason after the completion of my training I approve that the placement of handovers at the end of patient’s bed is a not a good gesture to keep the information out of earshot distance.
2.1.3 Confidence:
My experience as a student nurse has undergone a great upheaval in terms of gaining confidence. Practise of pertaining knowledge in the real world helped me to become more apt at dealing with patients. I have learnt to manage clinical time while processing handovers and get prepared for handling tight situations. Professional development progressed from being dependant on the instructions of the supervisor to gaining self confidence and showing independence in actions.
2.1.4 Prioritizing duties:
Work based learning has taught me to make a schedule that will comprise my day to day activities. My mentors helped me a lot especially by teaching me how to present a handover and told me how and when the interim and final evaluation will take place. The major transition being that now I am able to jot down the important excerpts rather than all that is being told by the senior nurses.
2.1.5 Communication Skills:
Crawford et al. (2006) have provided guidelines for effective communication by following which nurses and other health professionals can enhance their communication in a clinical setting. In the light of these instructions I came to know that I was not apt at dealing with patients in some specific situation e.g. while introducing myself to them or taking handovers for the new arrivals.
When I progressed to third year my professional development improved as well as my ability to communicate well with relevant others. As mentioned by Smith (2007, p.19) listening skills encompass the use of gestures to convey a message that you are aware of what the other person is saying. The nurse should maintain a relaxed posture and friendly eye contact with the patient. It will encourage the patient to explain his position in a better way. This practise really helped me in coping well with the patients while taking handovers.
According to me communication unpins everything we do within nursing. Being a mature student I believe that I have managed to attain good communication skills with time that are needed for excellence in my profession. Efficacy expectations are derived from emotional arousal (including psychological states like anxiety) and vicarious experience through observing another person” (Rosen, 2000, p.232).
These I have learnt through experience when I promptly informed a qualified nurse that the condition of an acutely unwell patient in the gastroenterology ward is worsen. If I wouldn’t be able to express my views at the right time the patient might have expired. First year students would just have noticed the vital signs but couldn’t convey their expression through words to the authorized nurses, that’s what experience teaches.
As the role of nurses require a constant and intimate contact with patients, their relatives and clients, therefore communication skills are very important. “Reynolds et al. (2000) suggest that more attention should be placed on the relational and therapeutic communication whilst Stevenson et al. (2004) propose the need for more person-centered communication skills” (McCarthy et al. ,2008, p. 213).
“The shift handover is a crucial period for maintaining communication and continuity of care (Thomas, 2006, p.89). The teaching methods that were given importance in the training were influenced by the humanistic approach to teaching and learning consisting of group works, role play, personal development diary (PDD), video recordings and feed back (McCarthy et al. ,2008, p. 213).
2.2 Reflection:
The legitimate aim of reflection is to convert experience into learning (Smith, 2004, p.27). In third year, through reflection, I was better able to perceive my personal capabilities and analyze my weak points. Previously, in lectures it didn’t make any sense, seemed purely illogical but it is the reflection which enabled me to develop a connection between theory and practice. However, progressing from basic to more complex skills allowed me to gain self-confidence as they demonstrate competency in the work place. Such methods are helpful in giving a better understanding of theory and practice relationship with each other. It enables individual to develop critical reflection, deepens their understanding and enhances their practical skills.
“Fitness for Practice report” published in December 1999 discussed the issue of initial education for nurses. It was widely approved that students must be able to practice reflection and develop critical awareness, thus supporting the inspiration of reflective practitioner (UKCC, 1999, p.38).
2.2.1 John’s Model of Reflection:
I have used John’s model of reflection (John C, 1995, p. 226) to simplify my experience and reflect on the “process and outcomes”. For professional competence I developed self consciousness as Stein-Parbury (2008, p.60) has rightly stated that through self evaluation nurses remain in touch with what they are doing and how this is affecting patients for whom they care.
2.2.2 Dreyfus Model of Skill Acquisition:
Patricia Benner proposed that in order to become proficient in a skill, nursing students have to pass through “novice, advanced beginner, competent, proficient and expert levels” (Benner P, 1984, p. 13-34). Evaluating my skills in terms of Dreyfus model of skill acquisition, I believe I have learnt a lot. Being a third year student I am better able to apply my theoretical knowledge into practicality.
During my last six months of training, students of first and second year considered me more knowledgeable and capable at handling diverse clinical situations.
3.0 Conclusion:
Work based learning focuses on the learning process itself, by initiating self evaluation; I perceived a new understanding of my surroundings. Thus personal experience becomes the foundation step for constituting learning and traditional education takes a back seat. Work based learning facilitates mentors to give a better understanding of the theoretical concepts learnt in nursing education. I remember that I kept on being irritated by the constant repetition of the basic nursing theories when the senior nurses gave lectures but they later turned out to be fruitful. Furthermore the workplace should provide practitioner a welcoming atmosphere to begin his professional growth.
Practice provides the trainees personal and professional competence. It also enables them to deal with critical situations and to provide better care to the patients. If all the contextual factors that affect professional development are well managed, work based learning approach has the niche to bring tangible benefits to the organisation, patients and practitioners alike (Clarke & Copeland, 2003, p.244).
If properly executed preceptorship training can help to bridge the gap between theory and practise as what was taught in lectures about dealing with a patient could be extremely opposite in the real hospital setting(Morgan-Eason, p.80). Improper Preceptorship training is one of the main issues faced by nursing students during work based learning programme.
During my training in the third year I felt professionally mature as my preceptor highly encouraged me to participate, gave me enough knowledge to hone my capabilities. Within my training programme of three years, I was able to appraise preceptorships. Unlike clinical instructions by mentors, it is a “student centred learning” in which students are assigned a role model (a senior nurse) whose day-to day activities are observed by students. This in turn inculcates autonomous attitude in student nurses, giving them confidence to act swiftly as the situation demands. (Morgan-Eason, p.80).
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The benefit of practice is that the trainee receives hands-on instruction from someone knowledgeable in the field- the mentors. Good ones will encourage students to strive towards development; poor ones can knock off the confidence level of students and leave them on a path of negative reflective cycle. During my work based learning experience I came across a number of mentors, some of whom were very influential and challenged me to get my self practically involved in tasks.
4.0 Recommendations:
Clinical teachers need to make the learning more explicit by identifying work place cultures and practices and helping trainees in developing a sense of that. Workplace-based assessment tools can be used to identify opportunities for learning and development through workplace-based activity. Trainees should be assessed periodically so that their competence level is determined and clinical teacher should know whether he lacks in competence or experience.
It is also essential to access the trainee’s thinking to make sure he is on the right track. NMC (Nursing and Midwifery council) have performance standards for qualifying nurses (NMC, 2001). As the trainees mostly learn by watching, therefore mentors should make sure that they are explaining the procedures accurately so that there is no chance of mistake. Actively engaging students and trainees will make them feel welcome and will motivate them to play an active part in the team.
A learning atmosphere should be created where everyone is provided with an equal opportunity including those who lack the confidence or enthusiasm. A good way to evaluate the training method is determining the patient’s feedback. It determines whether to reinforce practice or seek new methods.
Work based learning should aim at improving students’ critical thinking and analytical skills, proficiency in psychomotor, time management and communication skills and to raise their self confidence while performing as capable nurses.
5.0 Action Plan
“Being a nurse is rewarding, exhausting, sociable and a continual learning experience” (Smith, 2007, p. 12). After qualifying as a graduate student I intend to return here in order to gain as much professional experience as possible and then I will be regarded from an expert student to a novice nurse. Patients wouldn’t be able to differentiate me as a new addition to staff and will regard me as someone highly proficient in nursing skills but with the passage of time I will improve my efficiency level in order stand with confidence among my senior colleagues.
5.0 References
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Basford Lynn & Slevin Oliver (2003).Theory and practice of nursing: an integrated approach to caring practice. Nelson Thornes
Benner P, (1984) from Novice to Expert : Excellence and Power in clinical nursing Practise. California: Addison-Wesley.
Chan, D. (2002) Development of the Clinical Learning Environment Inventory. Journal of Nurse Education. 41(2).
Cherry Barbara & Jacob Susan R. (2005) Contemporary nursing: issues, trends & management. Elsevier Health Sciences
Clarke David J & Copeland L.(2003) Developing Nursing practice through work based learning. Vol 3. Issue 4, Elsevier Ltd.
Crawford P. et al (2006) Communication in Clinical Settings. Nelson Thornes.
Daly John (2005) Professional nursing : concepts, issues and challenges. Springer Publishing Company
Ely Christine & Ian Scott (2007) Essential study skills for nursing. Elsevier Health Sciences.
Levett-Jones Tracy & Bourgeois Sharon (2006) The Clinical Placement: An Essential Guide for Nursing Students. Elsevier
Latimer Joanna (2003) Advanced qualitative research for nursing Elsevier Health Sciences
Marriner-Tomey Ann & Alligood Martha Raile (2006). Nursing Theorists and their work. Elsevier Health Sciences.
McCarthy et al. (2008) Person centered communication: Design, implementation and evaluation of a communication skills module for undergraduate nursing students – an Irish Context. Contemporary Nurse Vol.27
Morgan-Eason Andrea, Work based Learning in Nursing Education: The Value of Preceptorships. The Transit Journal
Rosen et al.(2000) Associate and Baccalaurateate Degree Final Semester Students’ Perception of Self Efficacy Concerning Community Health Competencies. Public Health Nursing Vol 17 No.4. Blackwell Science Inc.
Smith Graeme (2004) Get set for Nursing. Edinburgh University Press.
Stein- Parbury Jane (2008). Patient & person: interpersonal skills in nursing. Elsevier Sciences.
United Kingdom Central Council for Nursing Midwifery & Health Visiting (UKCC) 1999.
Thomas Jerry (2006) Survival Guide for Ward Managers, Sisters and Charge Nurses.Elsevier Health Sciences.
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