Reflective Journey of a Student Nurse Expansive Learning

Introduction:

In nursing, expansive learning is important for student nurses to improve their professional knowledge and skill throughout the nursing practice. Throughout the training, student nurses pass through several learning processes that shape their existing skill and develop new professional skills thereby enabling them to use the evidence-based approach into practices to promote holistic wellbeing of services users. Here the reflective essay is going to use Driscoll’s reflective model to reflect on the experiences that a student nurses gathers throughout the nursing training. This essay will also reflect on self-awareness and learning that the student nurse develops through these experiences during the training and how the self-awareness assists student nurse to complete journey from student nurse to registered nurse. Here the reflective essay will reflect on the strength and areas of improvement of the student nurses that are identified throughout the training process. Finally, this essay will discuss an action plan that will assists nurses to develop effective strategies for improving the areas of weakness by developing essential skill and professional standard.

NMC (2018) mentioned that, student nurses must learn from their experiences during their placement and training process, that will enable them to develop their ability to deliver high quality care to patients. As mentioned by Reljić et al. (2019), self-reflection is important in nursing prates that enables the student nurses to not only identify their strengths as well as professional standard but also determine their weaknesses which assist them to develop an effective action plan for improving their nursing skill. PHE (2018) mentioned that, student nurses must learn how to work under the level of competence and professional expertise to ensure patients’ safety [PHE, 2018]. Reflective discussion among student nurses is highly effectives that enable student nurses to improves their behaviour towards their colleague, seniors and clients and improve their professional ability to deliver highly effectives and compassionate care to service users. As mentioned by Pai et al. (2017), an expansive learning is important in student nursing, which assist student nurses to improves their nursing skill, professional knowledges and professional standard thereby promoting their effectives personal and professional development. An expensive learning is associated with gaining the in-depth understanding on anything that improves their skill and abilities of an individual (Chen et al. 2018). NMC (2018), student nurses must pass through an expensive learning and training process that will improve their knowledge in determine patients’ health needs, understanding patient’s psychology and emotional and development and empathetic communication to promote holistic wellbeing of patient [NMC, 2018]. In this reflective essay Driscoll’s Model of Reflection is going to be used in which the three elements will be incorporated into the reflective discussion to reflect on the entire learning process (Contreras et al. 2020). These three stages are what, so what and now what. The first phase will reflect on the event that I experience during my placement. The second stages will discuss what I realise and conceptualise throughout the event. The third and last phase will present an analytical discussion on what I have learnt from these experiences.

What:

In one of some busy days during my practice placement in emergency ward, a 45 years old lady, Stella had been admitted with severe chest tightness, breathing difficulties, wheezing, chest pain and heavy cough with sputum (van Vliet et al. 2017). Under NMC (2018), the real name of this patient in changed for maintaining confidentiality and privacy of her identify [NMC, 2018]. By analysing the premedical history of Stella, it was understood that Stella had a 3 years history of COPD. Immediate after her admission into the emergency ward I was instructed to provide her with the nebuliser along with the intramuscular administration of salbutamol or SABA (Bosnic-Anticevich et al. 2017). Short acting beta agonists or SABA is one of the most effective bronchodilators that is used for improving the oxygen supply to lung of COPD patients. Although I had successfully arranged and set the nebuliser to patient’s mouth, I was very nervous to perform the intramuscular administration of SABA to patient’s body. This is because, as this was my first practice placement as a student nurse, I had no practical experiences on administering intramuscular drugs into patient which made me nervous and lack of self-confidence.

NMC (2018), while dealing with the critical patients’ nurses must ensure that they have proper knowledge and expertise regarding all the processes and tolls that they are going to use in patient’s care to ensure patients safety {NMC, 2018}. Although I had good theoretical knowledge on the intramuscular administration of salbutamol, I did not have any practical knowledge. Therefore, I thought that I must handover the task to the mentor otherwise it could interfere with patient’s safety (Hwang et al. 2018). In this context I informed the entire matter to my mentor who then handed over the task of safe administration of salbutamol to other experiences nurse in my team. Then I was instructed to made physical assessment report on patient’s oxygen saturation, BP, pulse rate, breathing rate and heart rate and body temperature. I had done proper physical assessment of the patient by performing different tests such as HRCT test, oxygen saturation test, PFT test, Fasting and post prandial blood sugar test and Complete blood test (Bjerkvik and Hilli, 2019). From the test report it was seen that Stella had 85% lung-blockage with only 87% oxygen saturation rate. From the HRCT test it was diagnosed that she had primary lung malignancy and perforated lung wall. The assessment also informed that Stella had a normal BP 127/84 and an average heart rate 66-69 BPM.

During this health assessment I faced severe difficulties in maintaining systematic and regular communication with senior nurses and health professionals as they could not manage time together to discuss these test report. While performing the HRCT test, I was very nervous as I had never done this test before. At the time of performing this test there were no senior nurse or doctors in the emergency room for helping me I performing this test appropriately. In that case, I had to wait till senior nurses and mentors came to the ward and help me to perform this HRCT test with accuracy. After 1 hour I was finally able to get the valuable assistance of my mentors in performing the HRCT test accurately ((Song, and Kim, 2018). After analysing all the test report, it was seen that Stella needed an immediate and effective care plan for not only improving her oxygen saturation and lung functions but also improving her lifestyle and dietary habit which will improve her overall quality of living.

So, what:

During the abovementioned event I had followed systematic and professional pathways to make appropriate response and rection to these situations (Fenizia et al. 2020). Under NMC (2018), while dealing with patient suffering from chronic illness, nurses must ensure that they develop the effective and highly relevant care strategies to deal with all the impediments that are associated with an effective care delivery process (NMC, 2018). PHE (2018) recommended that, student nurses must learn how to deal with that different challenges in care delivery process to ensure safe, high quality and compassionate care delivery to patients.

During this abovementioned event I tried to maintain a clear and effective communication with that patient, senior registered nurses, health and social care staffs, my peers and doctors (Turner and McCarthy, 2017). I tried to maintain a transparent information delivery within the ward through which I could transfer all the health-related updates of Stella to senior nurses and doctors. I also tried to solve the communication related issues with my mentor and colleagues by maintaining two important types of communication such as synchronous and asynchronous communication, when I realised that there were difficulties in bringing all the members of my team together for conducting face to face communication with all the members in my team regarding Stella’s health progress, I used to follow the asynchronous communication process. As mentioned by Kunst et al. (2017), in modern nursing an asynchronous communication is highly useful for assisting nursing professional and doctors to make such communication in which they can communicate with each other at any time. While taking care of Stell I used to follow the asynchronous communication process such as ward rounding, care report, recoded communication and drug chart, through using this communication process I made the observation report of Stella reading her current health updates on regular wise and handed over them to the senior nurses and doctors (Rasheed et al. 2019). On the other hand, the synchronous communication assisted me to maintain face to face communication with my mentors, health and social care staffs, and senior registered nurses in the multidisciplinary team regarding any health progress of Stall, her medication process ongoing treatment and current health needs.

I used to assist the multidisciplinary team to develop an appropriate risk assessment framework for Stella which could provide her with immediate clinical support if an emergency situation came (Barbour and Schuessler, 2019). Under NMC (2018), throughout the nursing training, a student nurse must learn how to assessed, determine and eliminate the possible risk that are associated with the care delivery proves to ensure the patient’s safety (NMC, 2018). Under the instructions of my mentors, I learn to identify and eliminate possible risks of needle-stick infection and the blood borne infection while administering intramuscular injection to Stella. As mentioned by Sidhu and Park (2018), registered nurses must have the skill and professional expertise in performing the safe intramuscular administration of medicines to patients’ body for eliminating risks of health care infection to patients as well as to the health staffs. Another important risk assessment I had done during the abovementioned event is maintaining effective medicine administration as well as medicine management (Yun et al. 2020). PHE (2018) mentioned that there are many cases of mortality and morbidity of patients in the hospital setting due to administration of wrong dose of medicines or inappropriate medicines. For avoiding the chances of any health complication to Stell due to incorrect medicines administration, I checked regularly that of she is administered with the right dose of SABA and LAMA. I also checked that whether there were any side effects or consequences of these bronchodilators on Stella’s physical and mental health.

Now what

While treating the COPD patient (Stella) throughout the above-mentioned event I realised that I need to make improvement in many of professional areas the first thing that I realised while dealing with the above-mentioned event is that, I need to focus deliberately on developing my understanding on the ability of COPD patients in performing the activities of daily living ((Choperena et al. 2019). PHE (2018) mentioned that, while dealing with any COPD patient, nursing professionals must determine how much the patient is able to perform his or her activities of daily living which impact potentially on patient’s quality of living (PHE, 2019}. I also realised that for gaining clear understanding on activities of daily living of COPD patients I need to improve my communication skill and interactive ability which will enable me to maintain a healthy, trustworthy and clear communication with the patients (Kim and Kim, 2019). On the other hand, the abovementioned incidences also made me realise that how important is the empathetic communication skill for a nursing professional in terms of building good therapeutic relationship with a patient. In this context, I had learnt that what the empathetic communication is, how it can be developed with a critical patient and what are barriers that are associated with forming an empathetic communication.

Throughout the practice placement I also realised that I need to develop a clear and concise knowledge on how to formulate an effective care plan for a COPD patient by following the systematic process (Leonard, 2017) While working on the multidisciplinary team to provide the effective treatment to Stella, I had learnt how to carry out an effective health assessment of critical patients for determining current physical health status, current health needs and health issues or pain of the patient. While performing different physical health assessment tests for Stella, I realised that I need to develop clear understanding on different health assessment tools such as ABCDE model, APIE tool, PEPSI COLA and Roper-Logan-Tierny model.

The encounter with the COPD patient, Stella, made me realised the importance of effective time management and right decision making in providing immediate and appropriate care to the patient (Wang et al. 2020). Throughout the event I had learned the importance of timely recognition and response to the health deterioration of COPD patient by using the effective time-management and quick decision-making skill. PHE (2018) mentioned that there are many cases of deaths of COPD patients in hospital setting due to the delayed recognition and response to the health declines in COPD patients. As mentioned by Duncan (2021), nursing professionals must develop the quick decision making and good time management skill that enable them to take the right decision while patient is in an emergency situation. While providing the nebuliser and intramuscular administration of SABA, I had learnt the process of providing the systematic and timely clinical support to COPD patient by using proper decision making and time management skill.

Throughout the practice I also learned about the effective medicine administration and medicine management (Herron et al. 2019). NMC (2018) mentioned that, student nurses must be properly trained about how to administrate intramuscular or intravenous injection into patient’ body to ensure patient health and safety (NMC, 2018). Additional during the event I also learned the process of effective medicine management such a hew to observe the drug chart, what are the right dose of bronchodilator for COPD patients, what the vital criteria of a good drug chart and which is way of appropriate administration of medicine for COPD patients.

During the care delivery to Stela, I had also learnt how to work in multidisciplinary team with different care professionals to maintain a synergistic work practice thereby providing the high quality and optimum care to patient. I had developed good conflict management skill that will assist me to deal with any work-related conflict with my colleagues and seniors in my future workplace as a registered nurse.

Action plan:

Based on the experiences and learning that I gathered throughout my practice placement, I have developed an action plan in which I enlist some important objectives that I need to meet to become a highly skilled register nurse. The first objective is to develop my written communication skill. For achieving this objective, I will work hard on making case report of different patients in my placement and will discuss them with my mentors to understand the strength and weakness of my writing. Here I will focus on imploring my grammatical silk and sentences formation skill that will assist me to use simple and understandable English while preparing during patient’s case report.

The second objective is to improve my analysing and judgement skill that is important to analyse the health needs of patients and judge the usefulness of the proposed care plan for the patient. In this context I will attend group discussion and the lecture of senior nurses and doctors regarding how to improving the analysing skill.

My third objective is to improve my knowledge on patient’s health assessment, systematic process of patient’s discharge and follow up process. For improving my knowledge on these aspects, I will closely with senior nurses and other health professionals and will follow the strategies and work process that they apply to assess patients’ health condition, conduct the safe discharge process and perform an effective follow of ongoing treatment.

Conclusion:

From the abovementioned discussion it can be stated that student nurses need to pass through effective learning and training process that will improve their professional skill and abilities to deliver high quality care. Through self-reflection student nurses will be able to determine their strength and areas of improvement that are important for shaping their existing skill and developing new skill thereby assisting them to becomes a highly skilled registered nurse.

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