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The Last Clinical Placement Question: Identify ONE practical learning need from your last clinical placement, in relation to your continuing professional development. Critically reflect and critically analyse how you met this practical learning need on your THIRD year placement.   Answer: Learning Need From The Last Clinical Placement: Going through the description of the nursing task that I performed in the elderly ward with the patient suffering from Alzheimer’s disease and diabetes it is starkly highlighted that I lacked the ability to work with confidence. The lack of knowledge in me regarding the handovers is also clearly depicted in my missing of noting down the essential details of the patient. It limited my efficiency of caring for the patient because as conveyed by O’Connell & Penney (2001), without the complete knowledge of the medical details of the patient it is impossible to deliver an effective care service. It is evident from researches revealing a higher percentage of patients reflecting dissatisfaction with those nurses who lacks apt knowledge regarding the patients. I was aware that I prevent myself from asking questions about the patient during the handover. This limits me to extend my knowledge and hinders my capability of providing high quality care and therapeutic relationship towards the patients. Henderson et al. (2012) suggest that by questioning practices I will encourage myself to explore evidence around different patient management strategies. Considering the hospital where I worked, the hospital management system appeared unorganized. It led me to face issues while visiting the chamber of the ward manager. It consumed a lot of time and left me with very less time to prepare the handover. Although I was prepared for the handover, ultimately I had no time to prepare it and had to depend on my colleagues to prepare it correctly. According to Finnell, Osborne & Gerard (2011), the medications and the interventions are the most important part for the recovery of a patient. If there is any kind of mistake in the intervention or medication then entire treatment will go wrong. With the lack of adequate knowledge and confidence, I depicted the inefficiency to identify the details of medications and interventions of the patient thereby lowering my ability to help recovery of the patient efficiently. Initially I bored a very theoretical perspective regarding the patient information collection and trying to remember in a mechanical way. However, later on I developed the perspective necessary to conduct my work, which is to consider the care for the patients as a duty and service from heart. I felt happy that my colleagues helped me to make the handover successful. I was embarrassed due to the fact that being a student nurse working at level 6, I was supposed to do it rather than receiving guidance from others. I was concerned about my impression on others due to my incapability of conducting my own work efficiently and handling a small incident as such. It clearly indicated two things, firstly I was lacking the required knowledge for a successful handover and secondly, I was deeply lacking in relevant clinical knowledge for handover preparation. Research suggests, when student nurse are placed in clinical situation they tend to face issues due to lack of practical knowledge and anxiety developed due to self-consciousness (Mellinclavage, 2011). With regard to personal learning experience, it was a valuable experience. As far as pre-registered student nurse is concerned they are not expected to know everything of a clinical situation. I am happy, that I have identified my practical need much ahead of my final placement as a registered nurse. If this incident had occurred during my professional career, it would have affected me much from professional as well as personal point of view. I was strongly supported by colleagues, mentor and my friends also. This was another factor, which helped me in overcoming fear, anxiety and developed my skills. Research shows support of senior staffs enhances the handover skills and only through their support, the newly registered nurse can gain knowledge and perform better (Kerr et al. 2011).   Critical Analysis Of Meeting The Need: In order to rectify my mistakes and improve my efficiency in aspect of confidence and knowledge regarding the handovers, I need to adopt a more patient-centric approach for my nursing practice. As opined by Tilford & Dylak (2015), improvement of the patient care efficiency can be brought about by searching for nursing journals, and articles, which suggest how to go for an effective handover. Following this, I collected all recent articles from Google database, MedLine, PubMed and CINHAL database. I categorised them as per my need. Post categorisation, I made notes of handover protocols recommended, skills required for handover and how to perform better in pressurised situation. As per the articles and journals, I noted down all those information, which I need to share with my colleague who will be taking over charge from me. I also made some notes on exactly what to make her understand in which aspects. I realised it is essential to prepare a note prior to handover.  However, at the same time it seemed to be time consuming. In an environment like health care sector being a nurse or a student nurse, I cannot afford to spend much time behind such note preparation. In addition, I was getting heavily used to it, which was making my progress very slow in practical. I decided to reduce the note to such points, which are of utmost importance. It is evident in several studies by Bhabra et al. (2007) that note taking during a verbal handover significantly improved the amount of information retained. On missing any information regarding the patient from the handover, I can go through patient folders and note down the information that I misheard or missed. I followed the patient file as a guide. Although, I was very nervous due to the amount of accountability but it gave me an immense pleasure as well as confidence to go for my next handover without any note preparation. This practice improved my self-consciousness along with the enhancement of my communication skills with the colleagues. As conveyed by Sturm & Dellert (2015), it reduced the feeling of low self-esteem. As a nurse, I determined to approach the patients personally and utilise my enhanced communication skills to develop a close relationship with them. It enabled me to identify their issues and requirements along with the details noted in the handover. I got the idea of which tasks to prioritise keeping in mind the concerns and needs of the patient. It assisted highly in the delivery of an effective health care service earning higher level of satisfaction from the patients. The experience helped me to gain self-confidence. I was able to fasten my process of writing the handover (Currie, 2002). This helped me to reduce the time to a considerable extent. It also helped me to gain information about the patient. Taking notes helped me to keep a track of the necessary information about the patient. I could reduce my mistakes to a considerable extent. The patient file provides detailed information about the patient. I could easily add new information about the patient in the hardcover. This helped be perform my job in a more efficient manner. Nursing handover is defined as oral communication with the person who is taking charge in context of patient health status and interventions. Although, many scholars argue for a written context also, still the most accepted one is the oral communication. Ünal (2012) opined communication as the key to successful caring relationship towards the patient and effective teamwork. The central theme of any handover is the patient safety, which has been supported constantly by scholars from years. The reflective model proposer John has also defined handover as an aesthetic value added by a nurse by briefing colleague about patient health (John, 2013). Research articles indicated observation could help in improving the handover skills (Gordon & Findley, 2011). Whatever knowledge I have accumulated with regard to handover, it was through observing my seniors and staff colleagues. Nevertheless, currently the SBAR tool is made which has included different skills and requirements to make handover to be effective for students or qualified nurses, as this will shape them to be eligible and ready for clinical placement. I was lacking in knowledge of handover, which should not have occurred if I would have given proper attention towards my curriculum (Wilson, 2011). Although, research suggest there is a huge gap between theory and practical in context of nursing where students fail to implement theoretical knowledge in a practical situation. While searching Internet database, I found OSSIE guidelines for clinical handover published by Australian Commission for Safety and Quality in healthcare (2010) (Manser & Foster, 2011). It was a wonderful guideline, which has not only explained how a handover process should be, but also has different sections on how handover guidelines developed based upon evidence-based studies. I think searching for this and such other guidelines earlier would have helped me in effective handling of situations to improve my handover management skills and activities. Research suggest written handover can act as helping guide for those nurses and other allied staffs who have been managed service and less knowledge about the settings (Welsh, Flanagan & Ebright, 2010). At the same time, it reduces the time of reporting. I was happy, that my approach towards handover in a written format was not odd and research has shown its advantages too. The staff colleagues gave me good support and said they also have faced similar issues during their student time. This gave me good amount of self-confidence that I can also attain such expertise only by improving my knowledge and implicating it in my routine practice. While improving my capabilities of confidence and knowledge about handovers in the nursing practice I also identified the learning need for developing an effective communication skill to ensure an efficient nursing practice. Communicating with staff nurses with regard to the encountering problems can help in solving them with ease (Levett-Jones & Burgeois, 2010). As I saw, regularly working with other staff nurses and clearing doubts slowly reduced my dependency upon notes. Bi-directional communication has also been suggested as a tool for development of nursing skills (Drach & Shilman, 2015). The failure in carrying out a handover resulted in valuable feedback from my team and my staff nurses. Research suggests, when student nurses are given valuable feedback on their work in a positive way, the chances of error reduces. Feedback also helps student nurses to assess their knowledge and skills, improvise upon their loopholes and march towards perfection (Henderson et al. 2012). During my handover, I was so disturbed I have uttered patient name and age in a loud voice to my staff nurse, which I was not supposed to as it breached patient confidentiality. Time management is an important aspect to be learnt by a nurse. I learnt from my experience that the handover contains the most important information about the patients. If I fail to put them accurately, especially information about the medication and intervention then it can result in any kind of wrong treatment risking the patient’s life. I have to be very careful while preparing the handover. My experience reveals that a nurse has to be very patient towards the patients and colleagues to manage the several complexities that might arise in the nursing practice. Another thing, which I learnt from my experience, is that a nurse should have clear idea about the tasks to be performed. The nurse should not take any decisions based on assumptions as assumptions can lead to big mistakes. Conclusion: The current essay reveals the significance of developing an effective communicative skill by the nurses to ensure the efficiency in handover preparation. The inability of the student nurse in preparing an accurate handover for the patient is seen to affect the patient’s health massively. Especially it is potential in producing detrimental results to the patients due to incidents as wrong treatment. However, SBAR tool and other such mechanisms emerge efficient in developing the capability of preparing a correct handover of patient. The essay also identifies the learning need for time management as well, which is vital in the nursing practice context.   References Bhabra, G., Mackeith, S., Monteiro, P., &Pothier, D. D. (2007).An Experimental Comparison of Handover Methods.Annals of The Royal College of Surgeons of England, 89(3), 298–300. Currie, J. (2002). Improving the efficiency of patient handover. Emergency Nurse, 10(3), 24-27. doi:10.7748/en2002. Drach‐Zahavy, A., &Shilman, O. (2015). Patients’ participation during a nursing handover: the role of handover characteristics and patients’ personal traits.Journal of advanced nursing, 71(1), 136-147. Finnell, D., Osborne, F., & Gerard, V. (2011). Development of the Patient-Centered Recovery Resource System for Veterans on Long-term Mental Health Medications. Archives Of Psychiatric Nursing,25(4), 235-244. doi:10.1016/j.apnu.2010.08.006 Gordon, M., & Findley, R. (2011). Educational interventions to improve handover in health care: a systematic review. Medical education, 45(11), 1081-1089. Henderson, A., Cooke, M., Creedy, D. K., & Walker, R. (2012). Nursing students’ perceptions of learning in practice environments: A review. Nurse education today, 32(3), 299-302 Johns, C. (2013). Becoming a reflective practitioner. John Wiley & Sons. Kerr, D., Lu, S., McKinlay, L., & Fuller, C. (2011). Examination of current handover practice: evidence to support changing the ritual. International journal of nursing practice, 17(4), 342-350 Levett-Jones, T., & Bourgeois, S. (2010). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences. Manser, T., & Foster, S. (2011). Effective handover communication: an overview of research and improvement efforts. Best practice & research Clinical anaesthesiology, 25(2), 181-191 Melincavage, S. M. (2011). Student nurses’ experiences of anxiety in the clinical setting. Nurse education today, 31(8), 785-789. O’Connell, B., & Penney, W. (2001). Challenging the handover ritual. Collegian, 8(3), 14-18. doi:10.1016/s1322-7696(08)60017-7 Sturm, B., & Dellert, J. (2015). Exploring nurses’ personal dignity, global self-esteem and work satisfaction. Nursing Ethics. doi:10.1177/0969733014567024 Tilford, S., & Dylak, P. (2015). What leaders need to know about patient safety collaboratives. Nursing Management, 21(9), 11-11. doi:10.7748/nm.21.9.11.s11 Ünal, S. (2012). Evaluating the effect of self-awareness and communication techniques on nurses’ assertiveness and self-esteem. Contemporary Nurse, 1839-1862. doi:10.5172/conu.2012.1839 Welsh, C. A., Flanagan, M. E., & Ebright, P. (2010). Barriers and facilitators to nursing handoffs: Recommendations for redesign. Nursing outlook, 58(3), 148-154 Wilson, R. (2011). Improving clinical handover in emergency departments: Ron Wilson reviews findings from an audit of a simplified handover process that can involve patients and their families in discussions about care. Emergency Nurse, 19(1), 22-26.

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