Domain 3: Nursing practice and Decision-making What? My abilities to nursing practice and decision making are identified by appendix 1 (the self-review). Also, these abilities are supported by appendix 3 (nursing skill sheet) and appendix4 (the leadership self-assessment tool) Decision-making is an integral part of nursing practice and the decisions nurses make affect patient care, patient safety and patient’s outcome (Lauri et al, 2001). In appendix 4 shows 90 years old male patient admission with fall, urine track infection and delirium.
After a week of anti-inflammatory treatment now I found out his news (National Early Warning System) score is 3 due to his temperature:39. 6 and heart rate: 111/mins. And I noticed the patient had very dry skin and lip, poor urine output. Also, I recognised the patient possibly regained urine track infection and he has the risk of dehydration due to his high temperature and poor fluid intake. Now I am able to use my critical analysis and action plan to solve the problem by appendix 3 (skill sheet)
So what Good decisions or judgments are not only directly influenced by the cognitive process but also by how the information is weighted, prioritised and the nurse’s ability to recognise and quickly respond to salient aspects of an ambiguous clinical or non-clinical setting (Pearson, 2013). In this case, I delegated health care assistance to recheck patient’s OBS every 30 mins, also offered some water to prevent patient getting dehydration, administered paracetamol 500mg under supervision.
Furthermore, I did a urine dip to confirm if patient regained rine infection and monitored patient’s fluid balance. In this nursing practice in consideration against Belbin team role theory (2014), I self-identified that I looked like a recourse investigation and team worker more. I worked collaboratively with other professionals to improve patient’s outcome more effectively by sharing ideas and effort (Walsh and Kahn, 2010). The Early Warning Scoring System was used in conjunction with clinical judgment and holistic assessment and it will help the nurse to recognize which patient need further support and monitoring (Dougherty and Lister, 2011).
Also, I use SBAR (Situation-Background-Assessment-Recommendations) to inform the doctor regarding with my concern. I recommended the doctor to prescribe IV fluid for the patient. Through the literature study and previous practice, I have found some policy and pathway of dehydration prevention by following NICE Guidance and I have applied this knowledge and skills into practice with positive effect to promote patient’s outcome. Then Tam confident to complete patient’s dehydration care plan, ongoing observation of the patient and nursing implementing and recording documentation.
NMC code (2010) point out all practice should be informed by the best available evidence and comply with local and national guidelines in order to apply safe and effective immediate care to the patients. In this nursing situation, it is more likely I am a leader without authority to undertake this nurturing and to advance the adapted form for evidenced based dehydration prevention management so that I can make a rapid decision under conditions of uncertainty based on subjective and objective information and data collected (Hewison, Jasper and Hewison, 2004).
In the nursing practice, I demonstrate my ability to raise my concern and to use effectively clinical judgement and decision-making competencies in order to protect patient safety and apply possible best evidence-based practice for the patient. The challenge areas as a student nurse are that I didn’t know the practice hospital local policy, clinical protocol and pathway very well. And also i have low level experience of specialising nursing care (elder patient care and acute care). These will impact on my clinical judgement and decision making.
The American Association of Colleges of Nursing (2014) and the Institute of Medicine (2010) confirms that level of education and practice has a significant impact on the development of critical thinking skills that will result in influencing decision-making competencies. The next step I will further explore the specialised nursing area (elderly patient care and acute care) both theory and practice on the nursing assessment and early effective intervention to prevent patient deterioration. Now what?
In the final placement, I will work in the endocrinology ward. There are lots of opportunities to look after elderly patients; I will learn more clinical protocol and nursing pathway to better look after them. Secondly, I will take reflective practice. Reflective practice is fundamental to reflect on myself, analyse the experience and learn from it (Enuka and Evawoma-Enuka, 2015). It allows me to evaluate the specific aspect of the scenario and take the chance to learn the skills related to patient safety.
Secondly and I will take some clinical decisionmaking and judgment courses to enhance my skills in clinical decision making because the research shows that the high-level education employ nurses have better patients outcome (Aiken, Clark, Cheung, Sloane and Silber, 2003). At last, I will regularly utilise resources to update my knowledge and skills also I will explore and discuss these finding of research with my mentor and colleagues so that I can apply the best evidence into nursing practice.
These actions are consistent with the code of NMC code (2015) that the nurses need to maintain knowledge and skill you need for safe and effective practice. Domain 4: Leadership, management, and team-working What? My leadership, management, and team-working identify from appendix 4 (leadership self-assessment tool), they are supported by the appendix 5 (microteaching feedback) and appendix 6 (Nursing journey post). Also, Appendix 4 (leadership self-assessment tool) exactly show me my current level of leadership capacity and appendix 6 show what I put developing mentorship into my future nursing care plan.
Appendix 5 (microteaching feedback) came from the same group about my microteaching session that I introduced how to safely administrate Ramipril for the patient long-term selfmanagement. NMC (2015) documented all staff nurse should share your knowledge, skills, and experience for the patients and other professionals. So What? Mentoring is the purposeful activity that facilitates career development, personal growth, caring empowerment and nurturance that is integral to nursing practice and leadership (Wroten and Waite, 2009).
Mentoring is a nurturing process, in which a more experienced person supports another’s professional development, a mentor and mentee have been identified the main factors related to effective education practice (Hodgson and Scanlan, 2013). The mentor should be approachable, knowledgeable, honest, friendly, experienced, enthusiastic and willing to spend time with the mentee and the mentee should be willing to learn and become competent. McCloughen, O’Brien and Jackson (2011) further pointed out mentoring is used to identify, nurture, support and develop new leaders.
Through the microteaching session, I identified my leadership style was coaching to help the patient improve long-term medicine self-management, but the result needs further improvement (Frankel, 2008). Throughout the effective communication, I built the effective therapeutic relationship with the patient. The nature and quality of the relationship are fundamental to the process of mentoring. Young (2009) confirmed mentoring relationship that is based on mutual respect and common goal through effective engagement and respectful communication.
Tuse PDCA (plan-do-check-act) cycle to complete my teaching session with a positive effective. However, there still have some aspects I need to improve in the future practice. First I feel I have lack of confidence to share my knowledge, experience, and skill with others although I had a good preparation. Then it made me feel nervous and worried so that I didn’t realise that I repeated lots things that I should not do. I used the Root Cause Analysis (National patient Safety Agency, 2011) and Five whys (NHS Institute for Innovation and Improvement, 2008) to identify my problem.
Also, I used fishbone diagram to help me quickly understand an issue and identify all the possible cause, then I can implement the problem better (NHS, 2015). The root cause of my problem concludes I didn’t have so much experience in teaching. Further exploration it possibly involved culture conflict. Open discussion is the way I will take to cope with this problem in the future nursing practice. Coleman et al (2014) thought that open-discussion plays a positive role in mentoring relationships in raising our concern and gathering other’ opinions and ideas.
Secondly, in the coaching session, my feedback was completed by other members of my group. The quality of feedback possible is affected because we are under the same education and practice level. Now what? I will use PDCA to prepare my microteaching task in order to improve the quality of care. Also, I will ask for honest feedback from my mentor and other professionals to identify my weakness and seek further advice and support from her. Furthermore, I will take the mentor course after I have qualified so that in the future I can facilitate student learning, guide, and support during the clinical placement.
These related to the NMC (2010a) which points out all staff nurses must facilitate student nurses and others to develop their competencies. In addition, will develop my leadership capacity throughout the professional practice and continuing professional education to support my personal and professional growth, these capacities enable me to better transit my clinical knowledge and skills into my practice and apply the best practice to meet patients’ complex need (Daly et al, 2015)
Conclusion Thave shown my ability to critically analyse my leadership capabilities on the NMC 4 domains. Firstly I have fully understood the nurses’ role to promote patient’s dignity in nursing practice. Secondly, effective communication is the key to delivering safe and quality care for the patients and emotional intelligence is the important factor to promote effective communication. Meanwhile, I realised this is my weak areal need to improve in the following practice.
Thirdly, I have demonstrated my ability to make good clinical judgment or decision for the patients and enable applying the possible best evidence base practice care for the patients. Finally, I explore how to develop mentorship by analysing my microteaching session through the lifelong learning (Swearingen, 2009). Throughout the reflection I developed the action plan for each domain, these acts will help me to improve my weak areas in the final placement and transit my leadership capabilities into a newly qualified nurse role smoothly.