Introduction
According to the (NMC, 2018) it is a requirement for nurses who are undergoing pre-registration nursing courses to use essential skills clusters as guidance in clinical practice. Placements are therefore very important as according to the NHS, it has been edited in the Nursing Standard for a nursing student to build the workforce of the future (NHS, 2016). Nursing students, therefore, make use of reflective writing, which is an essential tool for learning. Like everyone, nurses can also learn through reflection. Primarily, nurses have the responsibility for implementing care to the greatest ability to patients and their families (NMC, 2018). Also focus on their experience, talents and performance, ensuring that the demands are met presented to them by this responsibility. Furthermore, this contemplative practice is the role of nurses that regularly prompt update of specialised skills. Reflection, therefore, plays a valid role in the development of student nurses in their present and feature career.
Many nursing students make use of Group Clinical Supervision, which is a disciplined tutorial that involves opinions transformed within the practical experiences to offer support and administrative assistance to nursing students. The intervention provided by lecturers and peers promotes a relationship creating a possible way for evaluation. It extends over time linking use of simultaneous support, which enhances professional learning, and it monitors the quality of services offered to the patients it also serves as a guide to entering the profession. The aim is to promote student groups to have reflective and reflexive discussions that facilitate a link between practice skills to theory and the latest evidence-based practice.
According to (Beskine, 2009) nursing educators and students have to obtain education and learning opportunities through content and teaching methodologies so that they can integrate practice with knowledge. Composition of nursing programs should be a combination of learning and practice simultaneously. It is also linked with the responsibilities of teachers that they should provide enough knowledge to nursing students to make them capable of integrating with practice and knowledge.
According to (Duffy, 2008), familiarisation of students with reflection through proahm is effective because it accomplishes the purpose of linking nursing theory and training as a method. Thus, nursing theory works in practice in an integrated manner. In another study, (Green, 2002) has asserted that reflective practice enables and enhances learning capabilities and their development. In a review of the Scope of Practice for Nursing and Midwifery, asserts that nurses should be able to exercise more responsible behaviours through reflective practices by developing expertise in it. Reflection may be a channel through which preferences or opinions can be examined or modified (Pulcini et al., 2010).
The reflective account intends to provide a summary of practice experience as discussed. Patient care, feedback from mentors and the role of group clinical supervision were also discussed. The chosen model of reflection is Gibbs (1998). I have chosen this model (Gibbs, 1988) because I discover that it is the most practicable and appropriate to guide me through. Also, by using the six stages of the Gibbs Model, I will describe the reflection to explain my feelings through evaluation of the topic in this paper. Moreover, analysis and drawing conclusions for learning have been included as well. I will also provide an action plan which will help me in the future (Gibbs 1988). The names and institutions used in this essay are anonymised. Peter will be the name of the patient and Sylvia will be the name of Mentor consent has also been taken as this is a fundamental issue to care for (Department of Health DOH, 2010).
Description
It is stated that half of the time spent on the programmer should be assigned to placements in which nurses that are qualified will act as mentors or assessors (NMC, 2018). A criterion aimed at acknowledged education that corresponds to mentor student nurses remains obligatory besides they are set by (NMC, 2018). It also pertains to building a great functioning relationship through placement familiarisation; promoting and including evaluation learning. Evaluation and obligation create an atmosphere that promotes training and making sure that students know how important the context of training, evidence-based practice and management. In this case, a thriving practice placement must have some or all of these features, including student motivation (Casey and Clark, 2011).
Being proactive was also very important while working in the situation. I did not rely only on nursing staff and handout material, but I would also observe patients deeply so that they can be treated with their required care. Using clinical judgment can make the work proactive where related patient care would be provided. Customised care is possible when I have to provide care according to the patient, and there are not any guidelines for the specific treatment of any patient.
Even though I have selected the Gibbs reflective Model of practice, other reflective models which come to my mind are Donald Schon and David Kolb Models. In Donald Schon’s model, it provides a thinking framework, even though it is important to note that it is not a must for learning to be a step-by-step report process. Whereas David Kolb’s Model is, to a large extent, meant for experimental learning, and it is more of a trial-and-error reflective learning model. I opted out of these reflective learning models because they do not suit my learning style (Chandan and Watts, 2012).
Even though Gibbs Model has its weakness, strength for outweigh its weaknesses. Like the Gibbs model, many other models have their limitations and if not carefully selected, will bring out undesirable outcomes. In the case of Gibb’s model, it has more benefits than deficits in its application. The Gibb’s model avails me the opportunity to learn from my experiences as it stresses on systematic thinking through activity-phases, providing opportunities of viewing different perspectives on certain issues and enabling me as a practitioner to have an accurate view and make right decisions some of its disadvantages include questions which twist professionals’ arguments and the stage-by-stage application difficulty (Colaizzi, 1978).
The case is about an Intensive Care Unit (ICU), where I was looking after Peter, under the close supervision of Salvia. Pater is a 78 year old man who came in with a cardiopulmonary arrest and to facilitate treatment he has to be under sedation. He had a tracheostomy, a nasal cannula and a urinary catheter. Patients in ICU demand effective nursing care at all levels. Having a placement in the ICU has given me an insight into what nursing care is all about. During one of the usual busy days at the unit, Sylvia and I decided that I should be in charge of the care of Peter for the whole shift while she supervises. During the ward round the doctors agreed to stop the ventilator and to continue maintaining Peter’s airway through an Oxygen Mask, which seems to be a better option. All necessary nursing and patient care procedures were followed, and the patient and next of kin consented to the care I was going to provide him. As in every morning routine, I started with the Airway, Breathing, Circulation, Disability and Exposure, (ABCDE) assessment is also required by Nice (2011). This was one of the preferred routines in the unit. On this day I have to explain to Sylvia what I was doing and why do I had to do that. She will ask me questions, and if I do not give a correct answer to a question, she will ask me to go and look it up on the computer, at which time I will have to leave the care I was providing the patient (Keçeci and Taşocak, 2009).
There was limited communication and less feedback given in this case, the working environment became stressful. When feedback is given, Sylvia will do it in front of patients, family members or colleagues. This issue created anxiety and lack of feelings and gave me the feelings of being over supervised (Hierl, 2018). I assured Sylvia of my competence even though she was still sceptical of my knowledge, which dampened my confidence. I felt disappointed. I felt disappointed then, as I was hoping to gain the best knowledge from this unit and her long-time working experience. However, taking a lead role of looking after the patient while she supervises me helped me in regaining my confidence (Bulman and Schutz, 2013).
Feelings
I was proud of myself that I had cared for Peter, especially when I assisted him with his nutritional diet through his Nasal Feed tube. I felt privileged and motivated to work with a patient with critical condition. On the first day that I met Sylvia, I knew I was going to learn something, and she clearly stated that she wanted things to be done perfectly. We had time in the intensive care unit, where she could apply her knowledge as an important factor. I had confidence and motivation, as I have always liked to be on placement. I also believe I possess the relevant experience to impress a mentor like Sylvia. Before meeting her, I was already informed by a colleague that she is one of the best mentors, but she is very strict. Indeed, she was, and I thought for a slow learner like me, she may be of great help. I do not doubt motivational skills’ however, meeting a new mentor is always a great and nervous experience, I also worried that most mentors have plenty of tasks and job duties to do in one shift. As senior staff that are in charge of a shift in most of the shifts she works, it can be difficult for her to give her fullest support. However, I expected her to have said it to the placement educators that she cannot take the tasks of a mentor (Freshwater and Rolfe, 2001).
I met Sylvia on the second week of my six weeks placement; working with Sylvia on the first shift drew my attention that there are a natural dialogue and conversation between us. She teaches in a way that makes her feel she is in command, and this reflects more of power differences than the actual learning that I was looking for from Sylvia. I cannot retain the knowledge she imposed on me as there was more fear than learning. As she keeps telling me that my understanding is low, and she thinks the NMC should bring back the system of certificate nurses where some nurses should only work under supervision. I think it was wrong to say so and I invited her for a talk.
It also reminds me about a topic we discussed in one of the groups clinical supervision sessions in class; the transactional theory (McGuire and Kennerly, 2006); which made me feel like I was a child while Sylvia took the place of a parent. I told Sylvia how good and experienced she is in her job; however, I felt it was not right for her to speak to me in front of the family members and patient in that way. Nevertheless, I could see she was not ready to see a point in what I was saying instead she told me she was not going to be with me in the next allocated shifts because she thinks she will be off sick (Emanuel et al., 2011).
Evaluation
In terms of evaluating my practice experience, it can best to link it with an article on the Department of Health (ENB, 2001), in her book ‘Energize your Workplace, the writer stresses the key to energising a workplace is to sustain a high-quality connection (Dutton, 2003). Similarly, an article on The Royal College of Nursing states that mentors have a responsibility to secure a fruitful functioning relationship with the student. This could also be evident in the book edited by (Brockbank, McGill and Beech, 2017) who affirmed; an occurring natural dialogue may reflect the power differences in a situation, and this hinders learning, so the senior member of staff whose discussion with the juniors takes the form of dialogue about how other members of team should do things with which they are obliged to agree is unlikely to promote thoughtful learning for improvement to transformation. The intentional dialogue takes account of experts, recognises them moreover deliver them understandably hence wherever chain supervision exists, indeed, they are honestly acknowledged and if possible avoided. It reduces my confidence, making me feel I do not know anything. Thus, the point is to have a collaborative climate and relationship between student and teacher or subordinate and a manager. In the result, a collaborative effort takes place which enhances learning and development of ones who are not perfect in knowledge and learning.
In our conversations on the second day, I worked with her, she told me how she expected me to have known everything she has asked me, most of which she has not taught me. There was no proper introduction between Sylvia and me. Therefore, I cannot meet her expectations and some of the equipment she expected me to know I have never seen. According to Harrelson (2007), the introduction of the student to other staff, the ward, practice and knowledge, vision expectations, procedures manners and specialist equipment should be the beginning of a good relationship between a mentor and a student.
It is also important to note my experience on previous placements, simulated practices, class lectures and group clinical supervisions helped me gained patient’s consent and improved my confidence despite the negative feedback (Edward and Mills, 2013). However, the feedback has made me stronger and makes me more assertive in my practice. On my last shift with Sylvia, she admitted I have improved in the way I worked but still needed to keep an eye on my timekeeping. She also said my communication skills, and the care given to the patient has improved. In all my hostilities with Sylvia, the group clinical supervision sessions have helped me in a way that I had other students give advice and tell their stories similar to my incident. The group and teamwork helped me to tackle the situation, and I learnt how an understanding of the situation could help get rid of an unpleasant situation. I understood that dealing with different and diverse kinds of people in the workplace is necessary. Therefore, I changed my perspective to learn about the situation and take a professional approach. Therefore, whenever I met with her, I would be calm and remember what was said. I would focus on the job and responsibilities as a result of job activities. I would make sure that being calm can help me with the job in a great way. I should apply the knowledge gained at the workplace. Even though the incident with Sylvia was very challenging for me as she made me think she did not take into consideration the effort I put in. I have, however, gained more knowledge in my active listening as she expects to be listened to at all times when she speaks. I can communicate both verbally and non-verbally in a challenging situation. I aimed to unravel the problems of the patient and to work together with staff to see that the needs of the patient are met (Sullay and Dallas 2010). I also tried to be non-judgemental when Sylvia chooses to teach the way she is teaching. I managed to get good information and knowledge from her, which means that I took care of professional responsibilities and learnt to coexist with others. My compassionate skills applied to good use by showing empathy to the patient and his family in line with requirements of the act of Equality and Diversity (2010) also highlighted in the (Health and Social Care Act in 2008) to correct me on issues.
I can also empathise with Sylvia, especially when she has to be in charge of the unit and at the same time has to make sure she gives me the knowledge I need to achieve in the unit. It can be seen that the curtailments of staff, inadequate resources including the absence of assistance of high education institutions and supervisors can limit mentors from providing enough support for a student on placement (Duffy, 2008). Some authors have lent credence to this, as they revealed that student nurses who dropped out of pre-registration education in most cases did so as a result of poor practices with mentors and on placements (Edward and Mills, 2013).
A professional and perfect start and work during placement have a win-win situation for the quality of placement as well as for the student. By being pro-active, I did not only rely on the nursing assessment and the handover notes available to me, but I also went to observe the patient (Hutchings, Williamson and Humphreys, 2005). In contrast, I lacked adequate knowledge and experience with regards to delivering care to acutely ill patients who cannot consent to treatment (Jingree, 2015). My lack of experience reminded me of the fact that, as Nurses, we need to continually be prepared to depart from the standard procedure and act within the legal frame. Even though the patient cannot speak at that moment, he has already given me consent to care for him and if Sylvia asks me to go to the nursing station and look up nursing vocabularies whilst in the midst of helping the patient, it will confuse the patient and create insecurity for both the patient and me. However, in reality, some nurses will say they are following usual procedures by respecting patient rights and choices by most using their clinical judgements (Veeramah, 2016).
Also, there were some communication confusion and barriers between men and Sylvia, and I did not know enough about what Sylvia wanted me to do. Moreover, there was also confusion and difficulties to come up with communication difficulties. It challenged me to have communication difficulties but later, I improved this difficulty and problem with communication. She also did not create time for a meeting regarding my learning requirements. Some of the reasons given by Sylvia were that she had to supervise other members of staff that were new in the unit. And most of the time she is in charge of shifts which leaves her with no time to give required standard mentorship. Her mentorship performances can also be influenced by the intensity and the risk involved in the unit. As these patients are at great risk, working in this environment is risky and can be stressful. And I saw that Sylvia was in a stressful situation. Bassett and Makin (2002) and affirmed by (Heyland et al., 2006) in the book caring for the seriously ill patient that nurses should be able to come up with all needed requirements to fulfil their job. Seriously ill patients have unique types of problems and nurses should be there to provide them with support round the clock.
Suitable activities for seriously ill patients and normal patients will enable nurses to use their skills and knowledge to secure a possible outcome efficiently and effectively for the patient. The writer also advised staff to seek support in the following: stress management, clinical supervision working conditions for staff and their efforts to explore these areas of management so that the whole team can be prepared. High education institutions and healthcare institutions are necessary as the student needs it as an assisting tool in practice. It remains evident that it is the help gained from the mentors that is deemed to be the most significant. Other studies also suggested that even in a far from distance placement, the mentors are in control in making the learning encounter effective and suitable for the student (Edward and Mills, 2013). Hence, the success of a student relies on the fair mentors and supervisors and assessors or who so ever take part in their learning (Papastavrou et al., 2010).
It is required for student nurses to gain knowledge from placement. However, as students, we sometimes find ourselves in the transactional states, the ego state the parent and the adult ego can be forced to be adopted (Hutchings, Williamson and Humphreys, 2005). Being in transactional states means that there is always a carrot and stick atmosphere, and one has to be ready for punishment for any mistake. On the other hand, ego also plays its role to orient and direct behaviours at the workplace. For example, autocratic, fault finding, dismissive and destructive employment relations are similar black holes that consume up pressure that people require to perform their duties. It also applies to the situation where a more friendly and cooperative relationship has been more effective and useful. In contradiction, close professional links generate as well as maintain effectiveness because these links enhance cooperation and teamwork.
In the result of in-depth analysis, energy uses as an action to illustrate the influence of positive and negative relationship in people’s experience towards work. Founder Jane Dutton renders three pathways for transforming negative connections into positive thoughts that produce and maintain domestic resilience and adaptability, promote the pace and essence of training, including building own responsibility teamwork (Dutton, 2003). Both mentors and students need individual support on placement; this will enable us to function accurately. The support will be regular clinical supervisions from experts; they also need the devices required to create high-quality relationships on placement (Rylance et al., 2017).
These works and studies have given a broader perspective of how mentoring and the relationship between mentor and student would proceed in future. As the writer, Jane Dutton has put forward three pathways so that a positive relationship can be promoted and encouraged. Domestic resilience is crucial, which makes a person able to face hardships and difficulties bravely. Adaptability is very important, and it is the inevitable aftermath of mentoring because a student has to adapt to new realities and knowledge through mentoring. The essence of training lies in the centre of this process, which is enhanced by teamwork and collaboration.
Analysis
Nursing education is designed to train nurses professionally. In this case, a nursing student is expected to be competent in creative problem solving; they are also expected to be able to think critically and make beneficial decisions as asserted in (Taylor, 2000). Consequently, a helpful interaction between the mentors, supervisors, or assessors and student can improve the student’s learning and equips the student with opportunity in developing their required interactive skills and team building (Pierson, 2003) Even though the studies that states that there is inadequate research concerning communication between students and their educators in the nursing training.
Experiences of my own and those of other students have enabled me to learn how things go during my responsibilities at the placement. For example, some biases may be experienced by students based on their background and age. One of the students has pointed out the biases about age, and the other student showed concern over the background of students. Such biases exist in the nursing field, and nursing students and staff might have experienced it. Moreover, it has been noted that the mentor thinks older and second-year students know very much already. It is not always the case, and such expectations may prove to be burdensome for students of higher grade and older age. Such issues emerge while working in a team and a more just and friendly environment is needed among team members (Kawasaki et al., 2014).
Here, a point is important that burdening someone based on his age or higher grade is not effective. The role of mentoring may also affect the result if high expectations are associated with students. Considering older and higher-grade students for mentoring is more effective as they can be furnished and polished in a better way. It is said in similar studies that even in far from perfect clinical placements, the mentor has the power to make the learning encounter a convincing one for the student (Scanlan, Care and Udod, 2002). Thus, the success of a student in placement is reliant on sufficient mentoring and the staff who engage in the mentoring role (Platzer, Blake and Ashford, 2000).
Action plan
These issues mentioned above have emphasised some aspects that are significant to my future practice. After Sylvia’s feedback, I knew I had to read more on time management, medicine management and I have been so keen on asking questions during placements. I have taken some pieces of advice from my mentor, and I will make sure in the future that discussion is better with mentors, supervisors, or assessors, especially when there is uncertainty about what is going to be done. I also discussed the issues during the Group Clinical Supervision sessions and students relayed the same problems that are happening to them on some placements.
To conclude, I will say that there is a great need to reflect on good and bad practice, and students and mentors should make good use of group clinical supervisions both at work and in the classrooms as asserted in (Brockbank, McGill and Beech, 2017). I also believe that the only possible way for both mentor and student is to create a good rapport and a mutual understanding between them as it remains evident that the assistance obtained from the mentors is considered to be the most important. Though, the collaboration between high education and health care institutions is necessary for student’s aid in practice. A successful mentor offers support and guides the nursing student to complete a task for a nursing role. I know it is hard to allow students to make mistakes, which creates stress. However, alertness can prevent the errors, and the student will quickly learn to correct them, and over a course, the relationship and conversation between the mentor and student will change from guiding in the initial meeting to asking what you thought in the final session (Ness et al., 2010).
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