Learning and Growth through Group Clinical Supervision

Introduction:

Group clinical supervision is referred to as the formal and disciplined working alliance, in which supervisee's clinical work will be reflected and reviewed by professionals and experts (Buus et al. 2018). This essay is a self-reflection and will highlight an experience that was brought and discussed in my clinical group supervision in the module in order to focus on own skill and strength that are developed during the supervision process. This assignment is going to maintain confidentiality of all clinical information and agreement documentation in order to assure that there is no chances of unauthorised access of the database. For the sake of this assignment, confidentiality will be maintained in agreement with the nursing and midwifery council code of conduct (NMC, 2018).

This essay will also use Rolf et al Reflective Learning model in terms of highlighting that, how skills and knowledge are gathered during the clinical group supervision process. It is well-known that Dewey was the person who originally advocates learning by reflection (Bussard, 2016). Rolfe et al (2011) review Dewey’s (1938) model of reflective learning as knowledge through observing and reflecting on existing or past actions which lead to the new experience of self- awareness (Tylor and white 2002).

Finlyson (2015) says reflecting is to measure the strength and to develop knowledge and act effectively in the future. This assignment aims to review and supervise personal skills, clinical knowledge and experience through analysing the strength and weakness throughout the supervision process. Moreover, this essay has the purpose of showing how the clinical group supervision process assists a person to enhance their skill, competence and knowledge through reflecting upon their professional development and performance standard during dealing with clients.

The reflective process is associated with the continuous development of professional and personal skill with executing own strength and weakness (Kenny, 2017). For me, it is the foundation of professional growth and the learning process that will transform a beginner to expert. NMC (2018b) advocates the use of reflective practice for professional growth; it is an important part of continuing professional development (CPD) and is necessary by all regulatory body in healthcare to continue registration. But not many nurses engage in reflective practice, as a result, they don’t perform their jobs effectively (Lawrence, 2011).

According to Ellis (2017), group clinical supervision assists a person to improve their clinical skills and knowledge in order to maintain a strong professional standard in the workplace. Moreover, through the continuous supervision process in a clinical setting, individuals would be able to find out their weakness, strength and areas of improvement through the working. According to the National Institute of Care and Excellence [NICE], self-reflection in case of clinical group awareness is one of the most important processes which assist supervisee to focus on their activities, behaviour, values and strength [NICE, 2019]. Moreover, through self refection process, it is possible for the clinical staffs to make constant improvement of their professional standard in order to offer high-quality service to clients for meeting their ever-changing health needs (Bussard, 2016).

According to Travers et al. (2015), reflection is considered as the process of executing own skills, knowledge, activities, thoughts and understanding for making the betterment of their professional and personal capabilities of individuals. In this aspect, National Institute of Care and Excellence [NICE] has mentioned that in the clinical supervision process, refection is one of the important aspects that assist the supervisee to understand own faults, strength and areas of betterment (NICE, 2019). Reflective practice brings opportunity for others to criticise in a positive manner and also give advice for the reason for the improvement of care delivery to patients (Lee, 2018). Reflection also helps health personnel towards sharing information with other people, help them making meaning of a difficult and complicated situation (NMC, 2018). There are barriers which may prevent people from reflecting (RCN, 2014) such situation is insufficient time to carry out reflective practices. In the clinical framework, refection is sometimes considered as a time-consuming and delayed process that can interfere with timely service delivery process and maintaining quality work (Tisi, 2017). In most of the time, clinical staffs need to deal with overburdened work which makes it difficult for them to execute their own skill and knowledge in order to make continued self-reflection process (Bussard, 2016). For example, in the radiology section the clinical staffs who are assigned to deal with scanning, imaging and report formation, have to deal with the strict schedule in each day, in this aspect it is difficult for them to undergo clinical supervision process for reflecting on their own skill and knowledge [NHS, 2019].

Eckroth- Bucher (2010) Self- awareness has been known to be essential in nursing practice with the knowledge resulting in better skills. Self-awareness helps to find out new things about own skills, strength and ability, that individual can implement in order to gain success in their professional and person al life (Waltman, Frankel and Williston, 2016). According to Bussard (2016) self-awareness makes individual informed about their strength, weakness, cognitive and intellectual skills. Through executing these skills, individual can use self-awareness process in order to develop own knowledge, quick decision-making ability and problem-solving skill that are important in both the professional and personal lives of individuals.

It is important to practice self-evaluation in-between work practice in order to notice the improvement of personal development. The importance of reflective practice is highlighted in reflective practice in healthcare. Oelofen (2012) described self-awareness as having the ability to think critically about situations, events, and acts which happened throughout the exercise with the intention of focusing on the development of individual growth. Royal College of nursing (2015) has recommended that it becomes valuable for students to maintain a diary for the use of reflection. They also suggest a number of guidelines to help when documenting history, these are being open and truthful; ‘impulsive’ and express their feelings and view by using shorthand or drawing if found helpful.

Nursing and Midwifery council recommends that reflective practice will help nurses to identify their limitations. This, as well, will help them to develop their problem-solving skills. Thus, the reason for thinking reflectively is to change a circumstance, where there is uncertainty to something meaning (May 2017). Few numbers of nurses do not participate regularly in reflective practice, as a result, are lagging behind in their duties and performances (Rcni, 2017).

The Rolf et al reflective model (2001) has three interventions- What?, So what? Now what?- Will be used in this essay because it will help me share experiences, learn from them and support me in well structured writing. As reflection is viewed as an important practice for professionals who embrace lifelong learning development (Jasper, 2013).

I will be reflecting on an incident which was shared in group clinical supervision. This relates to a first-year student on placement who was wrongly accused by a ward manager (head nurse) for placing patients document in a wrong folder. I will talk about the importance of documentation, assertiveness and communication in nursing practice.

What?

During clinical placement setting the student was able to gain the companionship of the clinical support workers as well as senior nurse, which assist me to gain mixed experience about the clinical group supervision (Embo et al. 2015). In this setting, the student was assigned to manifold activities such as health assessment of patient health in a regular basis, documentation of patient’s current health reports, fluid balance chart, transfer of each information to the staff nurse and other health professionals, medicine administration and ensuring that patients needs a met in a timely manner. Throughout the working process, the student used to discuss her work with the senior nurses and health professionals who assist her to find out the areas of improvement and strength. As stated by Nielsen et al. (2016), effective communication is important in the self-reflection process which assists the individual to get the views of other people about improving their own skill and understanding. Through maintaining effective communication with the nurses and health professionals the student was able to improve her professional speaking skill and language fluency.

That also implied that checking the mental fitness of patient was important when assessing and questioning them, therefore talking in a way that a patient would not feel intimated and offended would promote respect and dignity, reduce patient anxiety which was important. Reflecting in between admissions was also important to the student in order to record activities and skills gained. The student was observing a patient’s respiratory rate manually on patient’s folder when she was called upon to attend to another patient. Hurriedly, the student left all she was doing including patient documentation and went to attend to the patient and on reaching there after carrying out routine observations she noticed the patient is deteriorating and was on NEWS 5 and 3 was on respiration. While she was still attending to the patient another nurse noticed the unattended patient folder on the table and decided to put them away, but instead, put them in a wrong folder. Later that morning, the manager (nurse) came in to review the patient the student nurse was previously attending and to check if the care package given earlier was suitable for their needs; quickly the manager realised the document placed on the patient’s folder was not for the named patient. Without a formal investigation, she immediately accused the student of placing the wrong documentation in a wrong folder. According to Buus et al. (2018), in the clinical group supervision process, registered nurses need to assist the trainee nurse in order to understand how to manage perfect balance among all tasks in order to reduce chances of any errors in their work. The student was startled but kept quiet and did not challenge. The paper was later retrieved from the wrong folder and was put back in the right folder. Throughout the process, the student nurse understood the importance of proper interaction and quick decision making skill, which can assist her in order to convince the manager nurse that error in the documentation was not her fault. Moreover, she understood that in her workplace, she needed to be enough concerned about interactive skill in order to make useful communication with care manager, doctors and other nurse in the case homes regarding different clinical aspects rather than only focusing on patient’s health and wellbeing. In this context, Buus et al. (2018) mentioned that, interactive skill is important in clinical group supervision, which assist student nurse to improve own analysing and judgemental skill, through which she or he can understand the underlying meaning of each clinical statement.

The student felt very saddened and uncomfortable working in such environment that impacted on her confidence and ability to learn. She also felt unsupported by her mentor regarding the incident. The incidence was very challenging for the student because the manager made her feel as though she lacked self-confidence. She thought she would have used her critical thinking skills earlier.

During the discussion of own experience in the group, the student had shared her memories with a peer which assist her to allow the group to provide valuable advice on her skill and knowledge. The group members understand the critical situation that she had passed through and assist her to recover from these memories by enhancing her mental strength. This process assisted the student in order to understand the important group discussion in the clinical setting in order to understand own strength and weakness. Moreover, the group discussion process is highly effective in terms of gaining positive and effective advice from the peer as well as mentor assists the individual to develop their personal and professional skill.

Throughout the discussion in this group, the student was able to make the group members understand that she has faced the unfair judgement which denoted the lack of proper judgemental and management skill of the organisation. They not only assisted the student in order to recognise her own areas of improvement but also request the care manager to make a proper investigation of the overall working process of each nurse in order to reduce the chances of unfair judgement (Ellis, 2017). Through this process the student learned the benefits of clear interaction with group members and peers in order to solve the different issues in the professional life. The group members assist the student to understand the importance of maintaining positive and good relation with the care manager and team members in order to make a perfect balance among different task. Moreover, through group discussion, the student nurse learned how to develop critical thinking and judgemental skill in order to analyse and executive own strength and weakness. Through overall discussion with group members, student also understood the importance of proper documentation of different aspects such as time management, and good organisational skills. Moreover, the student nurse gained advice on improving her way of communicating and interacting with her teams and the mentors. She understood that she needed to develop her knowledge and understanding of handing multiple asks along with supervision of patient health. From the start the response the student from the manager was unexpected and thought that no matter the amount of explanation she would have given, it would have not changed the attitude of the manager which was disrespectful and unprofessional. But after a prolonged self-examination she was motivated by the group. The group reassured her and believed that it was wrong for her to have been wrongly accused; the group also talked about the moral principles and implication of the event the student; this was professionally helpful to her.

After the incidence, the student reflected on the whole situation and it became clear to her that she lacked the confidence to handle such a situation and then realised the importance of being assertive.

The Nursing and midwifery council (2018) declare that communication is vital in nursing because it is how people influence other people's behaviour, guides to the successful outcome in the nursing intervention (Benbenishty and Hannink, 2015). However, there are pros and cons in communication because it is a two-way process which are thought and feelings, if left unnoticed the two-way communication may often send the wrong message and result to a negative conclusion (Russel, 2010). The NMC (2018) identifies communication as one of the important skills in nursing; the compassion in practice policy document (NMC, 2019) identifies communication as one of the 6Cs. The RCN (2017) also emphasises on the importance of communication as it helps for continuity of patient care, helps increase confidence in nursing practice, and reduces stress and errors in practice (mcdonald 2016). However, there are factors which can contribute to poor communication and inconsistent documentation such as lack of time and lack of information (RCN, 2014).

Communication is composed of verbal and non-verbal elements. Language psychologists working on communication indicate that communication embodies three formula 55/38/7 which refers to 55% of body movement communication, 38 % of voice tone, and 7% of spoken expression (Benbenishty and Hannink 2015). However, the student ability to communicate and challenge was affected because of the incidence and how she felt at the time, looking back at the student’s reaction, body language and her response it was clear that she communicated non verbally. Non-verbal means of communication forms the communication that supports or reinforces the spoken language. This communication pattern occurs where there is no speech this includes factual expression, smile and eye contact. Communication encourages patient autonomy, stresses and holistic view of a person, it communicates that the nurse is here to listen and help (Banar, 2012). According to Nurses and Midwifery Council [NMC], communication is one of the most important processes in which clinical staffs and the nurse can make effective interaction with patients in order to understand their needs, preference and current health condition [NMC, 2019].

Mineyama (2013) recommends that active listening can be beneficial to improve communication difficulties.

Frankee, Erin HMS (2010) says that communication helps to develop a bond which leads to patient opening up and expressing themselves which is the most important aspect in care

Communication skills are important in nursing because it helps t build rapport with the client (Gray, 2015). It has been argued that the dignity and care of the patient is not the priority which makes a patient feel disregarded and not valued but how busy the environment is can be challenging (Morrissey, 2011). The prioritising patient need is important in order to achieve this outcome.

The student was seen by the nurses as incompetence and someone who lacked experience and didn't have confidence in herself because they got the impression that most first-year students lacked experience. No one believed her when she said she did not do it that made her very emotional. The group realised that it was lack of time that made the student to live the document lying; after she was accused it created more awareness of the importance of documentation and assertiveness.

According to Nurses and Midwifery Council, nurses need to have proper understanding and knowledge of good documentation in order to reduce the chances of any interference on confidentiality and proficiency of database [NMC, 2019]. Moreover, the nurse would be highly proficient in order to make the error-free document that will be understood by another healthcare staffs as well as other health professional.

However, looking back at the situation the ward was very busy with high patient demand and shortage of nurses in the ward. However, this could be the reason why the error occurred. Layer (2013) emphasised on the reason for inaccurate documentation in healthcare this could be as a result of some emergency situation when patient’s needs comes first. This could later result in an error in documentation as the nurse might not remember what time such an event occurred. Research has it that too much time is spent on documentation when the time could be spent on patient. (Krost et al 2011).

In this case teamwork is important to achieve a set goal ( Sullivan & Garland, 2010) furthermore Clements et al., (2012) said partnership is the basis of a healthy of a healthy team and along with excellent communication is the key of getting a high quality result. Here if the nurses had assigned another staff to take over the students’ duty while she attends to the emergency patient that would have reduced the chance of error in documentation. Farley, (2010) highlighted that Shared responsibility is collaborative working.

However, when the error was noticed the manager was quick to blame the student without a thorough investigation or communicating to her in a manner of self-respect.

NOW WHAT

On reflecting on the student experience, the group thought she was very courageous to have shared her experience. She is now aware of how she would have handled the situation better. The group was very understanding and supportive and felt that it was professionally appropriate she acted the way she did. The group was very sorry about what happened and gave advice for strategies that might have helped and could also be used in future practice. Kolyva and Glaze (2016) recommends the intention of providing feedback to help the receiver improve their interpersonal skills.

I have noted that effective communication, documentation and assertiveness are important aspects of this reflection. However, I have known that there is a lot the student will have to do to develop her communication, assertiveness and documentation skills; because improving these skills are essential in nursing practice (NMC, 2018).

Pines et al (2012) stated that sometimes nurses communicates very poor as they use to implement the similar pattern of communication process rather than focusing on maintaining the effective and innovative process of communication-based on the individual needs of the patient. According to The Nurses and Midwifery Council [NMC, 2019], nurses and midwives need to have proper knowledge about the different type of communication in order to interact with different type of patients. For example, in the case of a patient with disabilities, the nurse needs to use non-verbal communication processes such as written communication, sign language or body language.

Therefore there is a continuous need for training and creating awareness with the importance of the use of effective communication. Also Assertiveness is a resource used by individuals to work against people that intimidate, it helps to improve the nerve-racking condition, and burst confidence (Fulton, 2010). Through maintaining effective communication nurses can form a trustworthy relationship with the patient. Moreover, an effective communication process assists nurses to form mutual understanding and proper information sharing process (Garneau, 2016).

Crisp and Taylors (2010) looked at the importance of documentation in nursing as it communicates and contributes to clients care. This statement is in line with competency standard of the NMC (2018) requirement which emphasised that nurses have to practice in-line with the regulations. Documentation is in a written or printed form which is used to show evidence that is legal or official (Nursing Standard, 2018). Through documentation nurses and health professionals can clearly know a patient present state of health and the kind of treatment needed to be carried out on patient that would be beneficial to their health. This is in-line with the Owen (2011) which recommends that documentation should provide accurate, up to date, complete and reliable information about assessment and care of the patient. (Layer, 2010) quotes “if you didn’t write it, you did not do it.” He conveys the word as an expression that puts fears in nurses when recordings and documentation are incomplete. Looking at Owen (2011) it states that this approach was adapted by the court of law. There could be many reasons for inadequate documentation such as in the cases of urgent situations when patient needs have to be prioritising (NICE, 2013).

According to the guidelines of NMC, clinical documentation would be done in an appropriate manner in order to represent the transparent and accurate database. Moreover, the document would be stored in a safe place in order to avoid the unauthorised access for maintaining the strict confidentially of database [NMC, 2019].

The national health practice has made it a mandatory training for all staff handling patient large information to undertake training on general data protection regulation (nhs, 2018). At present, I am unsure of how much training the student and the group will receive in relation to this during this programme. I can do further research looking at different reflective scenarios, previous and new studies and evaluate the areas that need improvements such as communication, documentation and assertiveness. The entire group also need to keep in mind the importance of documentation practice.

The group imagined how much stress the student may have experienced at the time of the incidence and is aware of the challenges first year student can face working in a busy ward and in a pressurised environment, and sometimes will need to prioritise patients care needs over others which may sometimes result in error in documentation because the time of incident may be forgotten.

From my experience on placement it has been observed that most error or mistake made in the ward has been shifted on student nurses instead of the nursing staff taking responsibilities of their action because they thought such mistake can only be done by the student because of lack of experience in their nursing skills. However, it was inappropriate to accuse the student of making error in documentation without properly investigating. The manager’s action was seen as being unfair. Looking back the student was trying to do her job by prioritising a patient who was on sepsis pathway and needed urgent care as the NMC (2018) advised nurses to prioritise patient care at all times. The student was afraid and lacked the confidence to speak. She also thought that being a first-year student if she did her carrier would be jeopardised and she won’t be supported as before.

During the clinical supervision process, the student has faced with the adverse experience that affects her understanding, self-confidence and decision-making ability (Ellis, 2017). She was unable to discuss her feelings and thoughts of how she could have made things right ; she looked sad and tough that she did not use her critical thinking skills when it was important due to lack of self-confidence and poor interactive ability. The group assisted her to develop her skill and understanding regarding the different clinical task such as health assessment of patent and documentation through discussion and feedback. The group appreciated her effort of being in control of her emotion in spite of her feeling at the time of the incident which has been a huge challenge for most nurses and this relates to Bond (2014) who states that being unprofessional in healthcare settings are thought to be wrong when feelings are expressed inappropriately; due to the societal and cultural injustice a lot of nurses are advisede to deal with their emotion to avoid not being branded as a” disappointment". From my experience, many nurses become vulnerable to crying especially when being accused wrongly. This made me analyse deeper about the action of the manager not only on the student but because of the error which in some cases could lead to patient death should have been investigated properly, it has been advised that nurses should evoke the principle of non-maleficence (Carrick, 2012).

Haven’t listened to the student experience, I am now aware of using my judgement in assessing situation in time of emergencies, document correctly, good communication skills and to be assertive. Having awareness of these will help reduce medical errors, ensures that patient general wellbeing is maintained and help nurses at the workplace to express how they feel and also challenged poor medical practice. (Valentine, 2010)

The group also discussed how the nurse's action, culture and unjust behaviour of the staff nurse on that ward will always reflect and impact on oncoming first-year student on placement. The culture of an organisation determines the environment (Mosadeghrad, 2014).

Conclusion:

This essay has helped me reflect upon an experience that was brought forward to the group clinical supervision.

I found Rolf et al. (2001) of what, so what and now what very useful as it helped me to apply the three interventions when analysed and used research evidence to back up my points while writing. It also guided me in planning efficiently before writing as I only choose literature related to the topic. As said by Harrington (2013) the basic component of effective academic writing is a detailed academic writing and good planning.

This essay focused on the importance of documentation as it allows communication between professionals, delivery of care and continuity of patient care as maintained by NMC (2018), Assertiveness will help nurses at workplace to express how they feel, challenge poor medical practice, and communicates which improves safety of patient and quality of care (Manser and foster, 2011)

This assignment showed how the group applied their critical thinking skills which helped to seek the truth by effectively exploring the situation. Development of this truth will help the group to attempt the best in clinical placement thus influencing the work environment positively (Chan, 2012).

This incidence made me reflect on my practice, identify the importance of placing patient document in the right place, recognize my weaknesses in confidence, being positive to seek help from mentor and colleagues and my limitation in communication. My awareness of documentation, communication and assertiveness is an ongoing skill. Through the process of documentation and communication, I was able to learn how to use appropriate phrase, sentences and words, in order to make brief as well as useful written communication with patients, their families and care staffs. During documentation process, I had learned that how entire clinical documents, recordings and statements are prepared and stored in proper confidential manner in order to protect all document from any kind of unauthorised access. Communication process assist me not only in forming appropriate verbal interaction with my patient and doctors, but also supported my written communication skill, in which I had learned how to use simple and understandable phrase and sentences to make the clinical documents easily understood by everyone.

I have also discussed how to improve my communicating skills by listening attentively, convey care and concern when spoken language is not present by the use of the facial expression, body language etc. Throughout the module, I had learned how to use body language, facial expression, gesture and posture in order to communicate with patient with disabilities. For example, in terms of dealing with patent suffering from dementia, I noticed that senior nurse and health professionals used non-verbal communication sign and symbols such as facial expression, gesture, posture and movement of their heads, hands and lips. Throughout the process, I also understood that how to execute different type of needs of patient with disabilities such as emotional needs, physical needs and psychological needs.

Moreover, I have learned not only the way of communication and interaction with patient and health professions, but also the importance of NICE guidelines that set health standard and codes of practices for prompting compassionate healthcare system. From senior nurse and health professionals I got the training of how to implement the NICE guidelines into practices in order to ensure high quality and compassionate care for the service users. Throughout the training sessions, I had learned about healthcare ethics, moral values and level of commitment, that the healthcare staffs and nurse need to carry out in terms of assuring high quality healthcare process.

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