SNPG917 Evidence into Practice: The Practice Of Critical Reflection

What recurring themes came up for you in your journal that made you feel uncomfortable and/or blocked your progress in some way? Identify at least two (2) recurring themes

The two recurring themes that came up in my journal that made me feel uncomfortable were related to cultural competence and prioritizing tasks. I feel that these two areas hampered my ability to deliver quality care services. I somehow do not feel comfortable while dealing with clients who are indigenous in origin. As a health care professional, I should be able to deliver a culturally safe care but I believe I lack cultural competency to deliver the same. This is primarily because of the stigmatized perception about the aboriginal community that already exists in my mind. I feel the major lacuna is my inability to communicate well with the indigenous community members. The stigmatized thought of them being unhygienic and untidy makes me reluctant towards dressing their wounds or performing an examination. This is extremely incorrect on my part and I should incorporate measures to improve my ability to provide a culturally safe treatment intervention to the members of the indigenous community. Another issue that I believe has blocked my ability as a professional to deliver quality services is
my inability to prioritize tasks and manage time. At a hospital setting, there is an immense amount of workload and poor team coordination. This makes the work atmosphere full of confusion and several tasks are expected at the same time from a single professional (Cormack et al., 2018,p.117). I often fail to manage multi-tasking proficiently and end up making errors. I believe these two key themes have contributed heavily in posing an impediment in the path of my professional progress.

Why do you think they occurred?

I believe these instances primarily occurred because of my inability to comply with the NMBA guidelines and nursing professional ethics. I feel that theoretical understanding of the professional knowledge is not sufficient until and unless a professional incorporates the understanding in the practicum (Dang & Dearholt, 2017,p.74). I believe I have not been able to successfully integrate the same in my professional practice and that has primarily led to the development of the problem.

What did you learn that was important for you as a person and/or professional during the journaling process?

As a professional I learnt that journaling is important as it facilitates self-reflection on the practicum experiences. Most of the professionals are too worked up with their professional duties and hence the critical reflection step is often overlooked or skipped (Eng & Pai, 2015,p. 452). Maintaining a regular journal entry with proper date helps in reflecting upon the experience and evaluating self-ability to deal with the encountered incidence in an appropriate manner (Felton & Royal, 2015,p.40).

How might you use your reflection and learning to improve your practice now or in the future if you are not currently practicing?

Critical reflection has helped me in the process of identification of my strengths and weakness. It has helped me in identifying the key areas where I need to improve so as to deliver services that would yield positive patient outcomes. Based on my experience, I have identified the central areas as lack of cultural competence and inability to prioritize tasks. These two areas are extremely important for the nursing profession. Hence, I would like to devise an action plan for myself and according design tasks so as to make myself proficient in the process of practicing. In addition to this, attending an academic seminar on cultural competence and reflecting upon the aboriginal history can help me develop skills to administer a culturally safe care plan (Gandhi & Vajrala, 2018,p. 10). Also, developing respect and honor for diverse linguistic and cultural backgrounds can help in proving a holistic treatment care to the patients (Yan et al., 2015,p.25). Devising an action plan and working in close association with the supervisors can facilitate my ability to undertake efficient clinical decisions and prioritize tasks so as to avoid any possibility of committing a medical error.

What might you share with colleagues (now or in the future) to enable/influence them to improve their practice?

I would like to share with my colleague the importance of identifying key strengths and weaknesses so as to facilitate a scope of improvement. It is important to be aware of the professional lacunas as it helps in developing ways to improve on the same (Garneau,2016,p.128) In my case, I have indentified the two major obstacles that have served as major obstacles in my professional life. In the same way, I believe early identification of strengths and weaknesses can help in building an excellent professional career and also avoid failures.

How would you support a colleague to undertake reflection?

In order to support a colleague to undertake reflection, I would educate the colleague about the types of reflection models. I would also highlight the advantages and disadvantages of undertaking critical reflection and further set an example how I could work on my flaws and make myself a better professional after undergoing critical reflection. I would also gift my colleague a diary and a pen so as to encourage regular maintenance of journal entry and keep asking about how the process is going every now and then. I would also tell her/him about my experiences and exchange opinions about how either of us could improve on the identified lacunas and in this way I believe I would be able to inspire a colleague to undertake reflection.

Introduction:

Gibbs reflective model is one of most user friendly and simple form of reflection framework that comprises of six important steps (Glen,2017,p.66). These are the description of the events, feelings about what the individual was feeling at the particular time of the event (Glen, 2017).  The third step is evaluation where the student would be evaluating good and bad components of the event followed by analysis stage and the conclusion stage. This is followed by action stage. This reflection model has many advantages or strengths like giving scope of past experiences, encouraging systematic thinking about the different phases of the experiences and the activity (Redmond et al., 2017). It also provides the opportunity for the students to analyse the various perspectives on the given experiences issues as well as actions. It also helps the practitioners for having a more balanced as well as the precise judgements (Naber et al., 2014). It also has several limitations. The questions are narrow as well as it also requires professional and experienced guidance. Many of the researchers are of the opinion that because of the lack of the detailed questions at the various stages of the reflective framework, a more elaborate model of reflection would have provided a deeper reflection (Lestander et al., 2016,p.220). Moreover, the introspection required at “feelings” stage can be also frightening as well as intimidating to some of the people as it requires open and honest view about oneself (Eng & Pai, 2015).

Reflection:

As already discussed above I have faced the most problematic and embarrassing situations while dealing with aboriginal patients on account of my cultural incompetency. Also, I have not been able to provide a therapeutic patient-centred care on account of my discriminatory attitude. This can be identified as a major violation of the ethical standard of the nursing profession and the same time my limitation as a care provider (Miraglia & Asselin,2015,p. 72). As a responsible care giver, I should be able to communicate efficiently with the patients irrespective of their cultural background and accordingly help them with the treatment intervention. I should empower and educate my clients about the disease condition and devise a care plan based on their requirement and also adapt a family-centred approach. Further, in order to efficiently manage my ability to prioritize task and distribute time, I must be able to segregate tasks based upon the urgency of the situation. I should be able to coordinate with my supervisors and seniors efficiently and undertake quick and efficient clinical decisions.

Knowledge and Skills required:

One of arenas where I need to work upon is my communication skills. I need to join workshops so that I can develop both verbal and non-verbal communication skills as they are important foundation for person centred care and effective teamwork.

Another skill that I need to develop is my self-regulation skills. I need to join therapy sessions like mindful-based therapies and also engage in meditation and yoga. Moreover, I will also engage in reflective practices to ensure that the workshops and therapies are helping me or not. These two arenas will make sure that I not only provide care in a competent manner but also act as effective team members in healthcare teams (Naber & Wyatt,2014, p.34).

Strategies to be undertaken:

One of the most important strategies that I would be applying would be enhancing my self-regulation skills. This aspect would prove to be beneficial for both my personal as well as professional development (Lestander et al., 2016); (Van Houwelingen et al., 2016,p.29). Self-regulation can be defined as the effective control by an individual over one’s behaviours, emotions and through processes in the pursuit of long term goals (Gandhi et al., 2018); (Nguyen & Wyatt,2014,p. 34). I would be developing mainly my emotional self regulation skills by going through mindful-based therapies, yoga as well as meditation. In different spheres of healthcare actions like during interacts with payments of various natures and team members with different view-points, this skills would be immensely helpful. I will be able to control my emotions, frustrations, disappointments and many others. This would prevent development of any negative situations and prevent conflicts. It will help in smooth flow of work (Dang & Dearholt, 2014).

Another strategy that I would be also incorporating is regular reflection on my practices, experiences as well as knowledge gathered by me on a daily basis. I need to enhance my reflection skill and learn proper modes of using reflective frameworks. Researchers are of the opinion that effective reflection can help nurses to review their practices as well as enhance their professional and personal skills and knowledge on healthcare activities (Carabez et al., 2015,p.50); (Roh et al., 2016,p.59). This strategy would help in ensuring the development of their ability for providing high quality, safe and evidence based care to the patient. It is one of the most important components for professional growths and would ensure continuous professional development (Sundler et al., 2015,p.35).

Impact of achievements:

Hence, I believe complying with the devised action plan I would be able to improve on my professional skills to provide quality care services to the clients. Also, I believe that my professional skills would be appreciated by my peers and supervisors and recognized. This would facilitate brining in motivation and inspiration for my colleagues and peers so that they too incorporate the practice of critical reflection and essentially work on their professional ability to yield standard care and positive patient outcome (Redmond,2017,p.19).

Conclusion:

Hence, to conclude it can be said that journal entry helps in undertaking the process of critical reflection. The advantage of practicing critical reflection is that it helps in the recognition of key strengths and weaknesses and accordingly helps in devising methods to improve on the professional skills and abilities. It also helps in self-evaluation and comparison of the degree to which there has been improvement in the professional ability.

References:

Arnold, E.C. and Boggs, K.U., 2015. Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.https://books.google.co.in/books?hl=en&lr=&id=7DAxBgAAQBAJ&oi=fnd&pg=PP1&dq=skills+required+in+nursing&ots=uYuFP1uEQq&sig=54YlX3ivtVkmUozSqPApVG2CI-I#v=onepage&q=skills%20required%20in%20nursing&f=false

Barton, G., Bruce, A., & Schreiber, R. (2017). Teaching nurses teamwork: Integrative review of competency-based team training in nursing education. Nurse education in practice. https://doi.org/10.1016/j.nepr.2017.11.019

Carabez, R., Pellegrini, M., Mankovitz, A., Eliason, M. J., & Dariotis, W. M. (2015). Nursing Students Perceptions of their Knowledge of Lesbian, Gay, Bisexual, and Transgender Issues: Effectiveness of a Multi-Purpose Assignment in a Public Health Nursing Class. Journal of Nursing Education. https://www.healio.com/nursing/journals/jne/2015-1-54-1/%7Beb879fba-a34d-4c9f-80cf-dd9941df857f%7D/nursing-students-perceptions-of-their-knowledge-of-lesbian-gay-bisexual-and-transgender-issues-effectiveness-of-a-multi-purpose-assignment-in-a-public-health-nursing-class?version=1

Cormack, C. L., Jensen, E., Durham, C. O., Smith, G., & Dumas, B. (2018). The 360-degree evaluation model: A method for assessing competency in graduate nursing students. A pilot research study. Nurse education today, 64, 132-137. https://doi.org/10.1016/j.nedt.2018.01.027

Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.https://books.google.co.in/books?hl=en&lr=&id=SZU6DwAAQBAJ&oi=fnd&pg=PP1&dq=reflection+model+in+nursing&ots=_glSEtTmwa&sig=4AWkQ42fLdjHLE8KffmxySp1mnE#v=onepage&q=reflection%20model%20in%20nursing&f=false

Eng, C. J., & Pai, H. C. (2015). Determinants of nursing competence of nursing students in Taiwan: The role of self-reflection and insight. Nurse education today, 35(3), 450-455. https://doi.org/10.1016/j.nedt.2014.11.021

Felton, A., & Royal, J. (2015). Skills for nursing practice: Development of clinical skills in pre-registration nurse education. Nurse education in practice, 15(1), 38-43. https://doi.org/10.1016/j.nepr.2014.11.009

Gandhi, S., & Vajrala, B. (2018). A Study to Evaluate the Effectiveness of Structured Psychomotor Clinical Module on Knowledge and Attitude among Nursing Students in Selected Colleges. International Journal of Nursing Education, 10(3). https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=09749349&AN=132143659&h=xBrjl8S%2bUSuCRjQwhzyWe9hzdpNZVvALEu1pjYR5o%2bMCe8ggVKtnNRO%2fFDb00nGzGIslRwreFPOSDUh8C8Nvmg%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d09749349%26AN%3d132143659

Garneau, A. B. (2016). Critical reflection in cultural competence development: A framework for undergraduate nursing education. Journal of Nursing Education, 55(3), 125-132. https://www.healio.com/nursing/journals/jne/2016-3-55-3/%7B757f04d2-a66c-4882-a95e-7b0fc076171d%7D/critical-reflection-in-cultural-competence-development-a-framework-for-undergraduate-nursing-education

Glen, S. (2017). Problem-based learning in nursing: A new model for a new context. Macmillan International Higher Education. https://books.google.co.in/books?hl=en&lr=&id=vlFdDwAAQBAJ&oi=fnd&pg=PP1&dq=reflection+model+in+nursing&ots=Ew2qCOqKmH&sig=Wk5wRlU0-Ra8hM-h6CRD0wJpfs4#v=onepage&q=reflection%20model%20in%20nursing&f=false

Lestander, Ö., Lehto, N., & Engström, Å. (2016). Nursing students' perceptions of learning after high fidelity simulation: effects of a three-step post-simulation reflection model. Nurse education today, 40, 219-224. https://doi.org/10.1016/j.nedt.2016.03.011

Miraglia, R., & Asselin, M. E. (2015). Reflection as an educational strategy in nursing professional development: an integrative review. Journal for nurses in professional development, 31(2), 62-72. doi: 10.1097/NND.0000000000000151

Naber, J., & Wyatt, T. H. (2014). The effect of reflective writing interventions on the critical thinking skills and dispositions of baccalaureate nursing students. Nurse Education Today, 34(1), 67-72. https://doi.org/10.1016/j.nedt.2013.04.002

Nguyen, C. M., Jansen, B. D. W., Hughes, C. M., Rasmussen, W., & Weckmann, M. T. (2015). A qualitative exploration of perceived key knowledge and skills in end-of-life care in dementia patients among medical, nursing, and pharmacy students. Journal of palliative medicine, 18(1), 56-61. https://www.liebertpub.com/doi/abs/10.1089/jpm.2014.0029

Redmond, B. (2017). Reflection in action: Developing reflective practice in health and social services. Routledge. https://www.taylorfrancis.com/books/9781351905930

Roh, Y. S., Lim, E. J., & Issenberg, S. B. (2016). Effects of an integrated simulation-based resuscitation skills training with clinical practicum on mastery learning and self-efficacy in nursing students. Collegian, 23(1), 53-59. https://doi.org/10.1016/j.colegn.2014.10.002

Sundler, A.J., Pettersson, A. and Berglund, M., 2015. Undergraduate nursing students' experiences when examining nursing skills in clinical simulation laboratories with high-fidelity patient simulators: A phenomenological research study. Nurse education today, 35(12), pp.1257-1261. https://doi.org/10.1016/j.nedt.2015.04.008

van Houwelingen, C. T., Moerman, A. H., Ettema, R. G., Kort, H. S., & ten Cate, O. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse education today, 39, 50-62. https://doi.org/10.1016/j.nedt.2015.12.025

Waugh, A., Smith, D., Horsburgh, D., & Gray, M. (2014). Towards a values-based person specification for recruitment of compassionate nursing and midwifery candidates: a study of registered and student nurses' and midwives' perceptions of prerequisite attributes and key skills. Nurse Education Today, 34(9), 1190-1195. https://doi.org/10.1016/j.nedt.2013.12.009

Yan, Y.E., Turale, S., Stone, T. and Petrini, M., 2015. Disaster nursing skills, knowledge and attitudes required in earthquake relief: Implications for nursing education. International nursing review, 62(3), pp.351-359. https://doi.org/10.1111/inr.12175