Introduction

The aim of my essay is to produce a professional portfolio, which will focus on four key areas of my practice and demonstrate an understanding and use of reflective and analytical processes. The four broad areas of practice to be analyzed are clinical practice, teaching and learning, management and research. I will use Gibbs reflection cycle to analyze the past five years of working in care of the elderly, and in particular on a manual-handling incident that occurred while I was at work. The use of the Gibbs reflective cycle is particularly helpful for its holistic nature (Wilding, 2008) and especially in the nursing profession where details are thoroughly considered. In my essay, I will use SWOT analysis, first identified in the Harvard Business School (Bryson, 1998) to reflect on what happened during the incident, and how I might improve my practice

Clinical Practice

I am a Registered Nurse, who has worked as a Staff Nurse in taking care of the elderly for the past five years. During this time I worked in at least three different individual areas, these were Palliative Care, Intermediate Rehabilitation, and Management of Long-Term Conditions, and a Falls Prevention Clinic. In the Palliative Care Ward, the care being delivered involved a significant amount of manual handling. I have a raised awareness of safety issues associated with manual handling, as a result of my experience in the Palliative Care Ward, and in particular, some accidents that occurred during my time there.

Having suffered an injury to my right shoulder at work, I had been temporarily redeployed to the Outpatients Department, because in that role I wouldn’t be required to do lifting and handling, and it would provide me with ‘light duties’ while I recovered from my shoulder injury. Ideally, it is normal for nurses to be transferred to lighter duties in case of incapacitation (Alfaro-Lefevre, 2014).  I was asked to record lying and standing blood pressure readings for a patient in my care. In a bid to achieve this task, it was necessary to assist the patient to lie on a bed/couch. The victim had managed to sit on the sofa but then said that she couldn’t raise her legs onto the bed to lie down. In attempting to assist the patient in raising her legs onto the bed, I aggravated my shoulder injury.

I should explain that a relative of the patient and an Occupational Therapist were both present at the time of this incident. However, I was reluctant to ask either of these two persons to assist the patient onto the bed. I felt embarrassed to admit in front of the patient’s relative that I couldn’t help the patient because of my injury. One of the key points is that because of the shoulder injury that I was recovering from, it wasn’t safe for me to assist the patient onto the bed, since doing so risked exacerbating my shoulder injury. On reflection, I now realize that I should have carried out a risk assessment before undertaking that task (Hannigan, 2001). A realistic risk assessment would have identified the risks to me. Having identified the risks to myself, I should have been more assertive in pointing out the risks to myself and in declining to assist the patient onto the bed.

In the case of the patient who required lying and standing blood pressure recordings, I should have risk assessed the situation, and should have been more assertive in explaining that I could not personally assist the patient, and in asking for another member of staff to support. If I were confronted by a similar situation in the future, I would act differently. I now realize the importance of “think before you act” and in particular the need to be more assertive in asking for help where appropriate. But I now realize that depending on the situation it is important to think before I act, and call for assistance where it is available.

As regards my personal strengths, these include my commitment to nursing; the fact that I enjoy working in a people-centred role, and the interaction with my patients. I am an excellent team player, who enjoys the interaction with my healthcare colleagues, and I have a keen appreciation of the importance of fostering mutually respectful working relationships. I am also committed to equality and enjoy working within a diverse workforce.

Opportunities

At the time of joining the Trust, I had the opportunity to attend mandatory induction training, which included some basic manual handling training. However, because this was just one element of the induction training package, it was quite basic and relatively minimal.

Weaknesses

Reflecting on this incident that I have referred to above, has led me to have a greater understanding of my weaknesses. I think that these include a reluctance to delegate or ask for help on occasions, and sometimes being less assertive than I should be. I now realize that the weaknesses that I have just identified may have contributed to the incidents that I have described. I understand that as a registered nurse it is important that I address these weaknesses to strengthen my practice in future.

Threats

Regarding the situation on the Palliative Care Ward, I should mention that on night duty on the occasion of the accident, I was in charge of the Ward and had only two care assistants with me. I consider that because some of the patients were highly dependent, this level of staffing was inadequate to provide a safe degree of care and a safe working environment for the staff.

Conclusions

In the descriptions of the incident that I have chosen to focus on in this essay, and in my analysis of the strengths, weaknesses, opportunities and threats that applied to those situations, I have included reflections on what happened. The process of reflection is of vital importance as part of personal learning and development (Boud et al, 2013). Unless one reflects on experiences that one has had, both good and bad the ability to learn will be severely limited. It is that reflection which vitally informs the learning process.

MANAGEMENT

A qualified nurse needs to have management skills and leadership skills as well as clinical skills (Benjamin & Curtis, 2010), because often he or she will be in charge of a team of nurses, or perhaps even a ward or department. Communication is an important part of management because of course a manager needs to be able to communicate effectively to the people that they are managing as to what needs to be done. The nurse who is in a management role needs to develop a rapport with the staff that he or she is managing, ideally adopting a relaxed and friendly style without becoming too close to those being managed (Guzik, 2013). A lack of communication can lead to problems in the patient-professional relationship.

Successful management includes elements of trust and mutual respect. It also includes leadership by example. If the ward or team manager demonstrates a respectful and non-judgemental attitude, this is likely to be reflected among their staff. A nurse manager needs to be able to delegate tasks to those that she manages as appropriate. To delegate a task the nurse manager needs to know what tasks and duties the person being given the tasks is capable of completing competently. Delegation is a skill in itself because the manager needs to know what it is suitable to delegate and whom. The manager remains responsible and accountable for any work that he or she delegates and needs to be available to supervise doing the work that has been commissioned (Lundy et al., 2016).

One of the many skills that a nurse manager needs to have is that of conflict resolution. Reflecting on my nursing experience, I recall that there have been occasions when conflict among different members of the team that I have been managing has come to the surface. Sometimes it’s just a matter of a personality clash between individuals in the team. On other occasions, it has been related to the way in which nursing and caring duties in the department are organized.

This situation was already established when I began work in the department. I quickly became aware of the conflict and tensions within the team, and I had to decide how I was going to manage it when I was on duty and in charge. In fact, I think that I was relatively lucky in avoiding conflict during the times that I was in charge of the team. My personal approach is to adopt a management and leadership style that is cordial and friendly (Fowler, 2012) while at all times remaining professionally appropriate. I like to think that I have skills in prioritizing and allocating caring tasks among the team that contributed to diffusing the conflict.

Reflecting on this time, there is a sense in which I had already gained experience in previous nursing roles, which helped me deal with the situation. But also, I feel that during my time in that department I was learning as I confronted that situation. The turning point came when I had the opportunity to attend a Conflict Resolution Course. This course gave me a deeper insight into the conflicts within the team that I managed, and also equipped me with skills that enabled me to address conflict successfully.

Having attended that course, I was able to reflect on situations that arose and better understand the reasons for the underlying conflict. I had also learned skills in de-escalating, diffusing and resolving conflict, which I began to put into practice. After a given situation had occurred, I would reflect upon the approach that I had used in dealing with it, how I felt at the time, and what the outcome had been. This process was all part of the skill set that the course had given me. I was putting into practice the skills and techniques that the course had provided, in real-life situations. Of course, when you use skills and techniques you are in effect practicing them, and in the process, you learn what works best (Boud et al, 2013). One of the things that the course emphasized for me was the importance and value of being a reflective practitioner

Strengths

I believe that my chosen management style as described above represented a personal power, which enabled me to manage the nursing team successfully, despite the prevailing conflict situation, even before I attended the conflict resolution course. Having attended that course, I had gained a set of skills and techniques, which gave me an enhanced ability to address the dispute. The fact that I had attended that course and was able to put what I learned into effect was an additional strength.

Weaknesses

As regards personal shortcomings, I think that one of my weaknesses was the fact that I had never attended management training. On reflection, I feel that management is a critical aspect of a qualified nurse’s role and that management training should, therefore, be compulsory for nurses. I also realize that sometimes I am not as assertive as my role or the situation demands. Given the importance of communication in management and leadership roles (Hooghiemstra, 2000), I recognize that this can be a weakness. However, it is something that can be addressed by appropriate training, and the Conflict Resolution Course helped in this regard, even though it was not an assertiveness course.

Opportunities

The most obvious opportunity in the situation I have described above is the chance to attend the conflict resolution course. This turned out to be a treasured opportunity. Nurses often have difficulty in getting access to training that would be very beneficial to them. There is a sense in which working in a ward where a conflict situation prevailed, provided me with an opportunity to practice and enhances the skills that I had gained on that course.

Threats

The situation I have described above included some threats. The heavy workload and shortage of staff are perhaps the most obvious. That situation gave rise to further threats, including the risk of the quality of care falling below acceptable standards, and also the risk of a nurse under pressure making a mistake which in turn would put her nursing registration in jeopardy. A conflict situation is in itself a threat to the smooth functioning of a ward or department where it occurs.

Conclusion

The experience I have described above and the learning opportunities that he has given me will all be precious I feel if I am to pursue a career in occupational health nursing. While many persons referred to the Occupational Health Department will be suffering from physical complaints, others will be complaining about stress at work because of bad management, poor staffing, etc. The role of the Occupational Health Nurse includes an element of counselling, even though it is not formally part of the role. In my consultations with patients who report stress at work, perhaps because of conflict situations, I may be able to propose ways in which they can address their condition.

TEACHING AND LEARNING

The role of a mentor in many respects is similar to that of a tutor. It involves elements of education, including assessing the students learning needs, developing a learning plan, choosing the appropriate teaching style and setting milestones (Butterworth & Faugier, 2013). As regards the personal qualities and skills that a mentor needs to discharge their role, there are many overlaps and similarities with the role of a manager or leader. The trainer needs to be able to develop a friendly and approachable style so that they can achieve cordial and yet professional relationships with their students.

When a new student arrives in the department, the mentor to whom they are attached will need to develop a good rapport with the student while at all times keeping the relationship within professional boundaries. The relationship needs to be mutually respectful and based on trust so that the student can make the most of the learning opportunities that it provides. As a starting point, there will need to be an assessment of the students learning needs, and an education plan will be developed that will be supplementary to that which has already been agreed with their university. That learning program will need to take account of the student’s preferred learning style, and may include a series of milestones (Hunt & Michael, 1983).

Typically, the education plan will be agreed at an initial meeting, and there will be a midpoint meeting midway through the student’s allocation, and a final session at the end of their time in the department which will include an evaluation of their learning experience.

I shall now reflect on my expertise in the mentorship role. I had the opportunity to attend a mentorship course, which I was very pleased to do. Even before attending this course I was in a mentorship role because we had students in the department, and it was important that they had a beneficial learning experience while in our ward. However, after attending the mentorship course, I was able to take a more structured approach to mentoring students.

I recall that when I was first asked to become a formal mentor to a student, it was in effect a mutual learning situation for my student and I. Of course, it was a learning situation for my student, but also it was a learning situation for me. As it was my first time formally mentoring a student I needed to build up my confidence. In a sense, I was not only evaluating the response of the student I was teaching, but also how fortunate my approach to teaching that particular student was being. Additionally, I was aware that preferred learning styles will differ from one student to another (Butterworth & Faugier, 2013). I, therefore, needed to discover that individual students preferred learning style, and then choose a teaching style that would best meet their needs, and the topic I was teaching.

The choice of instruction style will in many cases be influenced by the particular topic or clinical procedure that is being taught. In this particular instance, I decided that the most appropriate teaching method was to demonstrate a compression-bandaging technique while the student observed, and then to give them an opportunity to practice under supervision. In fact, I showed the technique twice before giving the student the chance to practice. I used Kolb learning style, experience learning (Kolb, 2005).

After this first teaching session in a formal mentoring role, I reflected on how the session had gone and in particular how I felt about it. I concluded that the teaching session I had just delivered had been successful, because I felt satisfied that the student would be able to competently apply a compression bandage. Prior to the session I have to confess I had been a little lacking in confidence, but now after a successful teaching event, my confidence was boosted.

RESEARCH

It is important for every qualified nurse to be a reflective practitioner. This involves routinely reflecting on the quality of their practice, always questioning whether their nursing practice and the techniques they employ are in line with current best practice (Oelofsen2012). Any nurse who is not a reflective practitioner risks mechanistically and routinely delivering the same care without becoming aware of evidence-based research, which could improve their practice (Hannigan, 2008).

Research takes many forms, and the quality of research varies considerably from one research project to another. Students and practitioners looking for reports of research studies, now routinely use the Internet. However, it is important to be aware that the quality of material to be found on the Internet is very variable. Just because a particular report is labelled as a research report, doesn’t necessarily mean that it is the outcome of a robust piece of research work. In order to guard against being influenced by poor quality research reports, the student or reflective practitioner should take care to use high quality sources of research papers, containing results that have been properly validated, evaluated and peer reviewed (Cochrane, 2016). The Cochrane database for example contains research reports that have been fully evaluated validated and can be assumed to be the result of robust quality research (Cochrane, 2016).

The practitioner working in a clinical setting is typically working as a member of a multidisciplinary team. In a Ward or Department where multidisciplinary team meetings routinely take place, such meetings provide an ideal forum where research reports that promote innovative approaches to aspects of clinical care, e.g. dressings can be discussed with a view of deciding whether to adopt or trial those new approaches (Moore et al., 2015). In a department providing rehabilitation for elderly patients, the temptation, particularly among general nurses, may be to focus on physical care. However, rehabilitation may also include attention to psychological factors affecting the morale, confidence, and motivation of the patient (Moore et al., 2015).

Continence Care

It was quite common for patients admitted to the Rehabilitation Ward to suffer from varying degrees of incontinence. When I began work on the Ward, it was common practice on that Ward for any patient thought to be at risk of incontinence to routinely wear incontinence pads. I was fortunate enough to attend a course in continence care. Then after completing the course I had an opportunity to work for some three months in the continence clinic. When I returned to the Ward after finishing the training and the experience in the clinic, I decided that I wanted to improve the way in which continence was managed on the Ward.

The continence care training had included training in the use of bladder scanning equipment. On return to the Ward, I was able to put that training to good use in that I could very promptly conduct a bladder scan on any patient for whom this was considered appropriate. Previously, the patient would have been referred to the continence clinic and that would have been a delay in a scan being conducted. The purpose in conducting a bladder scan was to establish what the likely cause was of the patient’s incontinence. Quite apart from conducting bladder scans, I was able to teach patients pelvic floor exercises where appropriate. Having taught the patient these exercises, I would encourage them and remind them to do the exercises as part of their daily care. This was something that would previously have only been provided in the continence clinic.

What I was seeking to do following my continence care training, was improve the way in which care of urinary incontinence was managed on the Ward. I wanted to achieve a higher level of alertness to urinary tract infections so that they were detected early and treatment provided sooner than had sometimes been the case in the past. The early detection of UTIs, use of bladder scans, promotion of pelvic floor exercises were all part of achieving a more understanding and effective care of incontinence for any patient who had that problem. Sometimes, particularly in care of the elderly it is the small improvements in the quality of care that can make the difference.

Urinary incontinence can potentially have an adverse impact on the well being of the patient (Guzik, 2013). It is a potentially embarrassing problem, which the patient may be reluctant to admit. Therefore, it can damage the patient’s self-esteem, undermine their confidence and thereby delay their successful rehabilitation. If the patient’s urinary incontinence can be successfully addressed, perhaps removing the need for them to use incontinence pads, it will improve their chances of achieving successful rehabilitation.

My personal strengths in the situation described were my willingness to undergo continence care training, and the fact that I was keen to put that training into effect on my return to the Ward. On my return to the Ward, I was nominated as the ward’s lead nurse for incontinence care

In the situation described the weakness was that prior to my attending the Continence Care Course no one on the Ward had received continence care training. This situation meant that the quality of continence care on the Ward was perhaps not quite ideal. The opportunities were as follows, the opportunity that I had to attend the continence care course. The opportunity to spend some three months working in the Continence Care Clinic, and the opportunity to put what I had learned into practice on my return to the Ward. Sometimes people attend training, but then don’t have the opportunity to put what they have learnt into practice.

The threats that we can see in the situation described are as follows. The fact that no one on the Ward had previously been able to attend continence care training could be regarded as a threat to the quality of continence care on the Ward. NHS staff frequently find that whilst they would like to attend training, they do not have an opportunity to do so because of the difficulty in releasing them for training. This represents a threat for individual nurses concerning not achieving their continual professional development (Wilding, 2008).

Conclusion

I will articulate how my significant learning from Manual Handling, Risk Assessment, and Health & Safety at Work has given me the knowledge skills and experience will help me to make a great contribution to Occupational Health course. In my essay, I draw upon my knowledge of manual handling incidents, and I reflect on how the lessons, which are relevant to occupational health, will contribute to the course. These lessons will ultimately help to inform my practice as an Occupational Health Nurse

 

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