Demonstrating Achievement of Learning Outcomes in Nursing

Demonstrating Achievement of Learning Outcomes in Nursing Analytical summary of portfolio to demonstrate achievement of the learning outcomes This essay is primarily aimed at analytically reviewing the portfolio that I have assimilated in the recent past. It effectively is a record of a number of key episodes in my student career. The portfolio itself documents a number of different aspects of events in my practice whereas this essay sets out to take an overview of the aims, goals and achievements that have been set and the degree to which they have been achieved. (Green J et al. 1998) The portfolio opens with a statement of intent as far as the original preparation was concerned. Although I have addressed the issues of professional requirement I have also approached the project form the viewpoint of my own personal benefit. I appreciate that this tool gives me the ability (amongst other things) to review my professional development and to document my evolution through my time as a student nurse. During its preparation I have therefore always kept in the forefront of my mind the eight learning goals enumerated in this statement. Reflections on academic and clinical experiences Continuing professional development and lifelong learning Decisions about the quality of my work Effective critical thinking Reflection on professional growth Empowerment to take responsibility for my own learning Development towards being a critical, reflective practitioner Document achievements (Pearce, R 2003). In terms of an analytical assessment of this portfolio, one should consider the work of Knowles and others in the field of adult education (Knowles, M. 1984 a ). Knowles’ theory of andragogy highlights the necessity for the adult student to appreciate the need to know something and the fact that adult students learn most effectively through experience and adaptation (Knowles, M. 1984 b ). Although not explicitly expounded by Knowles, the adaptive process is helped to a considerable degree by the process of reflection. As such my experiences have been recorded in a series of case studies and other investigations, and the process of adaptation has been illustrated through the mechanism of reflective practice. (Palmer in Bulpitt Martin 2005) The move towards evidence based practice has been one of the most noticeable aspects of the various changes in emphasis in practice in most areas of medically related work in recent years. (Berwick D 2005). I have been at pains to consider the evidence base which supports the various areas that I have either worked in or examined. To illustrate this point, let us consider the section presented on the subject of moral reasoning and health care law. This chapter examined a wide spectrum of ethical issues and associated moral dilemmas. Ethics is an area which in some respects is universal but in others is determined by local issues which include environment, culture and belief systems. (Kuhse Singer 2001) The evidence base for the various views expressed is presented and documented. An analytical assessment of this piece would have to include the fact that it only covers a small area of the whole potential issue. There is no apology for this, as the whole area of ethics is vast and the literature on the subject is extensive. It was not considered appropriate to do more than present an overview of one area. But the elements of this area are covered and presented with the important guiding principles that form the evidence base being set out, such as Bolam and the professional guidelines together with specific examples such as the precedent of the Charlotte Wyatt case. The evidence base element is also demonstrated in the clinical spectrum and I can cite the case study on Mrs Y (an MRSA infection case), as an example which not only allowed me to examine the issues of evidence (citing Pennington) but also to reflect and learn from the experience. (Taylor, E. 2000). It is always possible to criticise writing as not being totally inclusive of all of the available evidence and clearly such a criticism could be levelled at my work. In defence, I would suggest that much of the private reading and research that I have done that has helped to inform me in my professional life does not appear in the portfolio on grounds of expediency. In addition one is aware that the evidence base is constantly changing as new work is published and assimilated into the pool of accepted medical knowledge. (Sackett, 1996). In the case study that I presented relating to Angela, the evidence base played a large part in both the study, the learning experience derived from it and also the actual presentation of the evidence. I suggest that it is obvious that I clearly spent a great deal of time researching the various elements of the case and presenting them in an authoritative and evidence based fashion. I believe that this gives the work a greater credibility and also a greater learning potential for myself. (Holland K et al. 2003) Reflection is a large element in this portfolio. I make no apology for this as I have found reflective practice to be an invaluable learning tool and as can be seen in the substance of the portfolio I have used it extensively. It should be noted that although I have recorded a number of instances of reflective practice using the Gibbs model, (Gibbs, G 1988) it is a technique that I frequently use in my daily practice. Stockhausen, (L. 1994) makes a differentiation between reflection on practice and reflection in practice. I think that his analysis is both valid and relevant. Reflection on practice is a retrospective process that encompasses those processes that allow reflection at a stage after the event, and allow for modification in processing and response mechanisms to be employed when a similar situation is encountered for a second time. Reflection in practice refers to a dynamic process that occurs at the time of an action or intervention and is a shorter and more truncated process than the previously cited example. It is accepted however, that such a shorter process may not have the intellectual validity of a more protracted process. I have used both mechanisms both in the portfolio and also in my daily practice the case study of Angela demonstrates my ability to reflect on practice and the case study (year 1 chapter 3) shows that I am also quite able to use reflection in practice. As such I think that the portfolio is representative of my abilities in a clinical situation. I note that I frequently return to the concept of self assertiveness in my analysis of a situation. This is an area which is difficult to promote as a student nurse as one is hampered by both inexperience and lack of seniority. As I have progressed through my training, I feel that the process of reflection has helped me to identify situations where I can usefully be more self assertive, either to put forward my own point of view based on my own knowledge and beliefs, or to act as the patient’s advocate in situations where I believe that the patient’s best interests may not have been fully considered. (Koole S. L. et al. 19990 This element of self assertiveness has another and more profound implication. There is an implied responsibility incumbent on all healthcare professionals to disseminate and knowledge or experience that they may have to their professional colleagues. The element of learning and teaching comes within this remit. (Yura H et al. 1998). I fully recognise that, as a student, I have not been in a position to consider the possibility of teaching, as my own knowledge base has been dependent, at least in part, on the benevolence and knowledge of others. I am aware however, that as my own knowledge base has increased, I have been better placed to offer opinions and to add specialist knowledge into situations that are appropriate. I believe that this aspect of my training and development has also bee clearly demonstrated in the portfolio. For example, I can cite the section on basic life support that is presented in the portfolio. Having completed this element of the course, I now feel empowered to pass this specific knowledge on in areas where I encounter people (both patients, carers or other professionals) who may not have this type of specific knowledge at their fingertips. (Fawcett J 2005) I have little doubt that, as my professional knowledge increases, I shall be able to assume this role in a greater variety of areas and help to play my part in the future education of both patients and aspiring professionals. A large proportion of the portfolio documents my assessment of the impact of policy on the current mechanisms of health care delivery. The entry relating to equality in the health management of minority groups could be considered typical in this regard with a review of the issues of the Care Standards Act (CSA 2000) and the Disability Discrimination Act (DDA 1995). This particular case study was a major learning experience for me as it was by doing this analysis that I became more professionally aware of the possibilities for overt and covert discrimination both in terms of sexuality and disability and the need to be fully aware of these possibilities and to take positive steps to ensure that they do not colour my professional activities. There is a great deal of literature on the subject of discrimination in its widest applications and a critical analysis of my work could reasonably conclude that such a large area is underrepresented in the overall portfolio. This particular critici sm could clearly be levelled at virtually any work in this area and I am aware that I have had to make a judgement in this (and many other areas) where the line of balance between presenting all of the arguments both in favour and against a particular topic, can be drawn in the interests of both expediency and practicality. It would have to be conceded that even it the portfolio were 100 times as long as it is, it could not reasonably be expected to cover all of the arguments in the area. A sensible overview has had to be taken and I would suggest that the finished article is the product of these two opposing considerations. Some elements of the portfolio are specific and detailed case studies. I again refer to the case study of Angela, a 58 yr old lady with anal cancer. I cite this is being particularly informative for me as it not only is a demonstration of my research into the many issues that were impinging on this case but also in my ability to follow Angela through her illness trajectory (Newell et al. 1992) and I was able to reflect at length on the issues that she faced as her diagnosis was faced and the treatment. The major learning issue here, which is probably applicable to virtually all areas of professional work, is that effective communication is one the most important skills that the professional nurse can acquire. Effective communication can help to deal with some of the elements of the sequelae that can arise in this situation such as depression as well as the more positive aspects such as empowerment and education of the patient. (Mason T et al. 2003). This particular case study also highlights the need to assess and assimilate the social (and other) elements of the patient’s case. The reductionist school would have us regard the patient as a set of symptoms and nursing problems to solve. Although reductionism can be a useful analytical tool to assess the most appropriate forms of treatment, it can be criticised for removing the human angle from the professional assessment of the patient. (Jacobs, B B 2001) I have always been a staunch advocate of the holistic approach to patient care and reductionism is diametrically opposed to this viewpoint. (Thompson C 1999) I believe this is demonstrated in my presentation of the socio-economic situation as it pertains to Angela. The consideration that her mother lives alone and has a Yorkie dog to contend with is all part of the overall spectrum of consideration for Angela, as her hospitalisation will effectively impair her mother’s ability to both survive independently and also to care for her dog. These are vital and important elements in a patient’s care and should realistically be incorporated into the decision making process that evolves from the patient management considerations. (Hewison, A. 2004). I hope that this particular essay demonstrates my ability to pursue a logical and rational approach to decision making based on a strong evidence base and a holistic care plan. In terms of my own professional development, this portfolio represents a number of â€Å"snapshots† in my trajectory through the undergraduate course. It has helped to focus my attention on a number of specific issues, some were specified by the tutors and some were self determined. It is a feature of adult education that learning in one area often opens up possibilities for research and interest in other related areas.(Merriam S B 2001) I have certainly found this to be true, as my reading on one issue will frequently be punctuated with explorations into other areas that may be related. This may not necessarily feature in the portfolio itself, but will inevitably add to the knowledge base that I have accumulated throughout my undergraduate career. This comment is not intended to be viewed as a weakness but is presented as a strength. It has to be said that the portfolio does not fully reflect the professional development that I have been able to achieve and is not intended to do so. It should be more critically seen as a record of the stages of my development and some of the areas that have been actively explored. I am aware that it is in the nature of a professional career in nursing that every interaction with patients and staff brings the possibility of new learning experiences. (Hogston, R et al. 2002). It is my hope and belief that this portfolio illustrates the fact that I have taken advantage of these possibilities as they have presented themselves to me. I believe that I have grown in professional stature and competence as a direct result of having had the experience of completing it. In viewing the work there are a number of areas in which the portfolio could be considered deficient. The very act or recording and writing is itself a trophic and dynamic process (Meleis A. 1991) and thereby records a process of evolution from my early days as a nursing student to the present. It can be therefore seen that some of the earlier entries lack the degree of maturity and knowledge that the later entries clearly have. I do not believe that this is actually a deficiency as, to a large extent, this documentation of process is one of the major functions of the portfolio. I believe that I learned a great deal relating to the processes of effective reading, efficient research and informative presentation during this process which I believe are just some of the less well publicised attributes of the modern nurse every bit as much as the clinical skills and knowledge that is perhaps more generally accepted as a core requirement. (Clarke J E et al. 1997). It would appear to me that a critical assessment of the portfolio would also have to include the realisation that some of the earlier elements are clearly not as sophisticated nor perhaps as informatively written as the later ones for this very reason. The very fact that I have been able to take a critical overview in this particular essay, to a large degree, underlines the point that I would not have been able to write an essay of this nature when I started on my undergraduate career but I feel that I have now been enabled to assimilate sufficient knowledge to reflect critically on the learning process and to comment on it. With the benefit of hindsight, I feel that if I had appreciated the importance of the evidence base in discussions at an earlier stage in my education, I believe that I would have placed a greater emphasis on it in my earlier writing. As I have observed earlier however, it is this learning evolution coloured by experience which is perhaps one of the greatest benefits that can be both seen in and derived from a portfolio such as this. It is the act of research, reading and then the committing of analytical concepts to paper, which is a fundamental learning stimulus of the adult student. Looking forward, I believe that the experiences that I have derived from compiling this portfolio will stand me in good stead for my future professional career, not only in terms of the factual knowledge that it contains but also the conceptual methodologies that it represents and that I have now been able to experience, evolve and put into practice. (Kazdin A E 1998). I now more fully appreciate the need for critical analysis and evidence based practice particularly if I wish to enhance my professional status by imparting good practice and knowledge onto other colleagues in due course. References Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005 ; 14 : 315 316. Clarke J E Copcutt L 1997  Management for nurses and Healthcare Professionals.  Edinburgh: Churchill Livingstone 1997 CSA 2000  Care Standards Act. (2000).  Government White Paper  HMSO : London 2000 DDA 1995  Disability Discrimination Act. 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Stockhausen, L. 1994  The Clinical Learning Spiral: A Model to develop Reflective Practitioners.  Nurse Education Today 14, 63371. 1994 Taylor, E. 2000.  Building upon the theoretical debate: A critical review of the empirical studies of Mezirow’s transformative learning theory.  Adult Education Quarterly, 48 (1) , 34-59. Thompson C 1999  A conceptual treadmill : the need for middle ground in clinical decision making theory in nursing  Journal of Advanced Nursing Volume 30 Page 1222 November 1999 Yura H, Walsh M. 1998  The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. ############################################################### 3.7.06 PDG Word count 3,549