Essay: Learning for professional development

This essay will critically reflect and analyse one practical area of my learning need during my last placement, it will explore how the need was met on my current placement to enhance my continuing personal and professional development (CPPD). I used 60hours of researching and writing this essay in accordance with the Post ‘Registration Education and Practice (PREP) 2011 guidelines. ROLFE et al (2001) model of reflection frame work will be used. The patient’s name is hereby changed to Miss Joy to maintain Confidentiality in accordance with the Nursing and Midwifery Council (NMC, 2010).
During one my second year clinical practice this learning need was identified as a feedback from my mentor based on her observation of my lack of confidence in handing over the right information to the Multi-Disciplinary Team (MDT). I was asked by my mentor to join her in the assessment of needs for Miss Joy, my mentor took lead of the assessment as I also joined in by asking Miss Joy few questions which I made note of. Two days after the assessment I was asked to handover to the team about the assessment, I was not told that I will be handing over to the team. I was terrified when I heard I will handover. I tried to remember what the assessment was all about and some of the questions that were asked.
This was a huge responsibility for me in my nursing practice as I have never handover patient’s assessment before but have only witnessed other professional given handover during MDT meeting. I struggled explaining to the team about Miss Joy assessment as I didn’t expect it. This limited the team understanding of the care that is required for Miss Joy as well as providing continuity of care.
In nursing practice, handover is an important process during which professionals share information, as well as exchange authority and primary responsibility to improve patient care (Currie, 2002; Haig et al. 2006; Velji et al., 2008; Hatten-Masterson &Griffiths, 2009; Porteous et al., 2009; Yee et al., 2009; Thompson et al., 2011; Wilson, 2011). However, nursing handover can be long, unpredictable and if not done well, can have an undesirable effect on nursing and patients outcomes (Clinical Excellence Commission 2008). One of the four domains of the Nursing and Midwifery Council’s (2010) Standards for Pre-Registration for Nursing Education is developing a good communication and interpersonal skills. It is clear to me that these skills form a large part of my preparation for my nursing registration.
Klim, Kelly, Kerr, Wood and McCann (2013) in their Mixed method study (Survey and Group interviews) developing a framework for nursing handover in the emergency department which uses a personalized and systemic approach. The survey involved (n = 63) and is aimed at investigated perceptions of current practices and preferences for handover structure While the group interviews (n = 41) which includes 38 females and 3 males, explored nurses’ opinions about essential features and information of an effective nursing handover in the emergency department.
The findings in the survey were that most nurses (96%) perceived receiving adequate information during handover. However, gaps were recognized, including omission of important information regarding medications, vital signs and other nursing care needs while the group interviews identified essential features of effective handover such as using a systematic approach for treatment, appropriate environments, reference to documentation or charts and efficient communication. And other information includes patient details, present problem, future care or disposition plan, treatment and nursing observations. Though the research cannot be generalised because of the design method used focused on Emergency Department nevertheless it is of relevance to my learning need as I was able to understand how lack of structure and the use of handover framework impacted on my ability to handover the right information about Miss Joy. This study complements Johnson, Jefferies and Nicholls (2012) qualitative study of exploring the structure and organization of information within nursing clinical handovers. The study acknowledged the importance of having structure and some form of standardization in nursing documentation (Johnson et al, 2012).
The study also identified five major themes of information which are identification of the patient, clinical history/presentation, clinical observation, care plan and outcomes of care. This study made me to think of how the use of SBAR could improve my handover. The SBAR framework has four stages – Situation, Background, Assessment and Recommendation. The tool gives structure to handover so that crucial information is not missed (Collins, 2014).
Henrietta Lee, David Cumin, Daniel A. Devcich & Matt Boyd (2014) in their Quantitative study of expressing concern and writing it down which was an experimental study investigating transfer of information at nursing handover. The study aim was to examine the effects of two factors on the transmission of clinical information at nursing handover. These factors were how an affective statement expressing concern about the information handing over and verbal reference to a written summary of the information. The design method used a randomized, single-blind, controlled experiment. A total n=157 nurses participated. The study noted the vulnerability of verbal information in handover. For example, information retention was lowest when it was verbalized and not supplemented by any form of written communication. The study can be generalised. The study shows that affective aspects of communication can enhance retention of information. For example, memory can be enhanced by inserting emotionally aversive words into sentences rather than neutral words (Brierley et al. 2007). However the study emphasised that directing attention to written notes alone may not improve the quality of information transfer at handover. Conversely, there are consensuses on the most effective mode of information transfer during handover. Though, combining verbal plus written approaches is now commonly used in nursing handover (Philipin, 2006; Staggers & Jennings 2009). This research made me understand that both verbal and written note will improve my handover.
Weiss, Bhanji, Fontela and Razack (2013) in their preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer acknowledged five domain of clinical reasoning, it’s effectiveness on handover which are effective summary of events; expressed understanding of the care plan; presentation clarity; organisation and overall handover effectiveness. The study enabled me to see how ineffective my handover was as well as improving my thinking that my lack of confidence could be as a result of not being able to summarise Miss Joy assessment properly, lack of understanding of her care plan as it then affect the clarity of my presentation during handover as well as the organisation of the information in other of importance and the overall effectiveness of the handover as a whole.
More so, Manser and Foster (2011) stated that handover is used as a means of communicating important information about patients and their care. In the light of this I was able to see how I failed Miss Joy by not being able to summarise her needs. Poor handover has been evidenced in resulting to lack of ability to summarise patients care which is shown to have negative impact on patient safety (Rosenstein and O’Daniel, 2008; Robinson et al, 2010). Also, evidence has it that communication during handover is a complex process, comprising much more than just a linguistic component but involves both verbal aspect of communication and awareness of non-verbal cues (McDonald, 2012). It requires the interpretation of the non- verbal cues of communication which are speech, tone of voice, facial expressions, body language, gestures and assumptions shared between the communicants about the context and purpose of the exchange. (Pergert, Ekblad, Enskar, Bjork, 2008). This implies that I will not only need to have the right information about Miss Joy but the ability to be able to summarise and aware of the non-verbal cues like the use of eye contact, tone of voice and body language will improve handover.
Zenobia CY Chan (2012) in his qualitative study on non- verbal sensitivity in nursing student explores nursing students’ perception of the meaning and roles of non-verbal communication and sensitivity. The study aim is to understand how different factors in’uence their non-verbal communication style, the importance of non-verbal communication in nursing practice lies in good communication for ef’cient nursing practice delivery. However, there has not been much discussion so far to assess the non-verbal communication of nursing students and the in’uential factors and then few studies focused on recognising cues, the non-verbal communication process and the effect between nurses or physicians and patients (Mast 2007, Uitterhoeve et al. 2009, Jansen et al. 2010). By understanding the non-verbal communication cues will help me to be confident in delivery of Miss Joy assessment to the team which is essential to prepare me in my future practice. The Nursing and Midwifery Council (NMC) standard for pre-registration for nursing student required Nurses to be able to work collaboratively with others professionals in promoting care (NMC, 2010) while the Code of conduct emphasized the need for Nurses to use effective communication exploring all aspect of communication to improve care (NMC, 2008).