Revision and future learning

17 Revision and future learning





Developing good practice in learning


So how can you ensure that you capture what you have learnt? There is a variety of techniques that help you to capture your learning, and identifying some aspects of your learning may be easy. For example, if you have been placed on a respiratory medical ward, it is anticipated that your knowledge of respiratory conditions, the medical treatments and nursing care of patients with respiratory problems will have increased. Some learning will have developed more slowly, however, and you may struggle to articulate exactly what you have learnt.


It is important that you look back at your first meeting with your mentor and think about what you identified as your learning outcomes. Were your learning objectives specific, measurable, achievable, realistic and timely (SMART)? Did you meet your learning objectives? If not, why not? Did anything get in the way of your learning, for example ill health or lack of ongoing contact with your mentor? Students and their mentors are expected to work and learn together in various ways for 40% of their placement learning (Nursing and Midwifery Council (NMC) 2010). Recent guidance from the NMC (2011) states that an appropriate registered professional can also assess you as long as they have been suitably prepared. For example, your mentor could ask a physiotherapist to assess you in positioning a patient or assisting them to mobilise. If you did not work with your mentor enough, it is important to explore why that happened. Did you have other commitments or did your mentor work mainly nights or have to take sudden leave? Did you prefer to work with your associate mentor? How did you deal with this? If this was to happen to you again on another placement, what could you do differently?



It may be helpful to consider the following points:



Often the answer is to ensure effective communication. If you have other commitments, it is important that your next hospital or community placement understands what these are and to find out whether they are able to accommodate your requests for particular shift times or to work on specific days. If they can accommodate your requests, they will then allocate you a mentor who is most likely to work the same shifts as you. It is essential that the university (i.e. your personal tutor) is aware of any special circumstances that may affect your ability to work in your placement area or adjustments that you require when in placement.


If you missed placement time due to ill health or personal reasons, you now need to think about how you are going to negotiate making up this time. The NMC (2010) requires each student nurse to undertake 4600 hours of learning during their pre-registration nurse training programmes. Fifty per cent of these hours must be undertaken within clinical practice. Clinical skills simulation can contribute towards this but cannot exceed 300 hours over the entire pre-registration programme.


You also need to think about how you are feeling now and whether you need to think about making an appointment with your personal tutor or occupational health service.


In Chapter 3 we discussed how you would prepare for your placement and what you could expect from your mentor. Now look back at your initial meeting with your mentor; you will have identified some learning needs and agreed them together. It is important that your identified learning needs were closely linked to your curriculum documentation learning outcomes. At your mid-point meeting with your mentor, a review of your learning objectives identified in your initial meeting should have taken place to ensure you were on track. At this meeting, you may have realised that you had met those initial learning outcomes and identified some more learning objectives with your mentor. In the final meeting with your mentor, you should be able to see what you learnt, areas of strength and some areas for future development. It is important that you take this forward to your next placement as a continual record of your learning.



Evaluating your learning post-placement


Another helpful tool is the ‘strengths, weaknesses, opportunities and threats’ (SWOT) analysis which helps you to identify your strengths and weaknesses, the opportunities and threats that may present themselves. Some students undertake this before and after each placement as they find it useful to understand some of the areas which they need to focus on and the barriers that might prevent them from getting there.


It can be helpful to think about your first day on your medical placement and what you actually knew then and what you know now. If it is your first ward, you may have felt completely lost and worried about approaching a patient, undertaking essential skills and fitting in with the team. By the end of your first placement, you should feel much more confident in all of those areas. As a senior student, you may have worried about undertaking the shift handover for a group of patients and prioritising your workload. It is important that you check your learning in this area and think about what you still need to do and how you can achieve it.


See Table 17.1 for examples of some SWOT analysis comments made by students.


Table 17.1 Examples of some SWOT analysis comments made by students















Strengths Teamwork
Linking abbreviations
Confidence increased
Coping with activities of daily living
Coping with stress
Bed making
Applying theory to practice
Time management
Communication
Eating and drinking
Universal precautions
Helpful mentor
Able to maintain confidentiality and dignity
Good link lecturer
Lots of learning opportunities
Working under pressure
Time keeping
Building relationships with patients and staff
Being independent
Being assertive
Good library
Being accepted as a student
Giving good care to patients
Always asking consent and explaining treatment to patients
Weaknesses Spelling
Vital signs
Language
Doctors’ notes illegible
Not enough computers
Mentor not familiar with curriculum documentation
Not enough time
Balancing placement with academic demands
Not enough available time with mentor
Time management
Not feeling part of the team
Not enough staff on ward
Working under pressure
Not enough time to provide quality care to patients
Opportunities Given opportunity to meet learning outcomes
Doing dressings under supervision
Observing drug rounds
Writing nursing notes
Involvement in admission and discharge
Meeting and working with different members of the multidisciplinary team
Seeing a cardiac arrest
Taking part in last offices
Working with experienced staff
Caring for my own patient and handing over verbally and in writing
Escorting patients to X-ray
Attending multidisciplinary team meetings
Being challenged
Giving injections under supervision
Reading patients’ notes
Meeting people from different backgrounds
Threats Doctors not understanding how junior we are and our level or knowledge
Keeping up with academic work
Not able to complete learning outcomes
Losing manual skills by relying on electronic equipment
Mentors not having time for us
Feeling tired, not having enough sleep
Not realising own limitations
Being asked difficult questions by patients

When you return to university, you will be asked to complete an evaluation form about your placement. Different methods may be used to evaluate your placement – some universities will use a combination of group discussion and formal written feedback and in other universities your evaluation may be completed electronically. This evaluation is fed back to your placement anonymously to allow placement staff to understand what is going well and to take action where areas for development have been highlighted.


It is important that learning is quality assured and enhanced for future students. The evaluations are usually linked to national educational standards that are incorporated into clinical learning environment audits for the placement area. This audit is usually reviewed annually for each placement area. It is important that you identify what was good about the placement so that the area is aware of its strengths regarding student learning. It is equally important for the ward placement area to understand how learning could be enhanced for future students.


This feedback is shared with the placement areas, educational leads in the hospitals, senior nurses, lecturers and the programme directors. There is usually a trust and university committee where the feedback is discussed and action agreed and disseminated. If a ward has received outstanding feedback, there may be an award ceremony which incorporates a reward for the best placement.


Some universities also encourage students to nominate exceptional placements and mentors for various awards and tributes. If your placement has been outstanding, it is important they receive that recognition because they often go above and beyond what is expected of them despite having heavy workloads. Your feedback is vital to ensure that the practice learning experience continues to be enhanced.



Developing your role as a nurse


The role of the nurse within the medical placement was discussed in Chapter 1, and the fact that this placement should furnish you with transferable skills that you can take forward to your next placement or into your preceptorship period was discussed in Chapter 3. Now that you have come to the end of your placement, it is important to reflect upon how you have developed your role as a student nurse during your time on the medical ward. If this was your final placement, you will need to consider what your learning needs might be as a newly qualified nurse commencing your preceptorship period. The Department of Health (DH; 2010a) and the NMC (2006) recommend preceptorship for all newly qualified nurses.


The NMC (2006) states that:



Whether you are at the end of your first, second or third year, you will have had learning objectives to ensure that you gradually develop your nursing role in line with the NMC requirements. Your curriculum documentation will have incorporated the NMC domains for professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management and team working (NMC 2010). Those of you on the NMC 2004 regulations and competencies will consider the domains of professional and ethical practice, care delivery, care management, and personal and professional development (NMC 2004).


Wherever you are in your training, you should have sat and discussed the care that you were giving and the rationale behind it with your mentor. You will have spent time following the nursing process of assessment, planning, implementation and evaluation (Habermann & Uys 2005). You will have used all of these phases of the nursing process during your time on the ward and now is the time to look back and think about what you have learnt about care giving and what you can transfer to your next placement.



As a final-year student, your mentor will have expected you to be familiar with the nursing process and care planning and will have allocated you a group of patients under supervision. Initially this can seem challenging, but as a more senior student, your skills of assessment, planning, implementation and evaluation will have steadily improved during your placements. You may have struggled sometimes with goal setting as patients in a medical placement are rarely straightforward and can often present with a multitude of complex health problems. As your placement progressed, you should have started to feel more confident and felt your dependence on your mentor reducing. Combining your knowledge of anatomy and physiology within the context of your patients’ conditions will have allowed you to be more proactive in suggesting nursing actions, reviewing and evaluating care for your patients.


The nursing team will have had a good working knowledge of their patients, and as a first- or second-year student you will have been allocated one or two patients to care for to enable you to develop person-centred holistic care. You will have needed to know your patients well, their care and treatment and progress made and been able to communicate this among the team.



Nurses need to have good interpersonal skills, not just with a patient but with everyone involved in the care of that patient, and many would argue that good communication is the cornerstone of good care (Sully & Dallas 2010). Within your curriculum documentation for practice, communication will have been identified as a learning outcome whether you are a junior or senior student. In fact, in the NMC (2010) competencies, communication and interpersonal skills are now a major domain for becoming ‘fit for practice’ as a qualified nurse. This major shift is due to the substantive evidence base linking effective communication and quality of patient care delivery (Lynch et al 2008, McGilton et al 2009, DH 2010b).


A unique factor of the nurses’ role is their 24-hour presence in the care environment, as a member of the nursing team is always present in the ward environment. Within day care, intermediate care or the virtual ward, the nurse is probably going to be the professional most involved in the care of patients.



Everyone on the ward coordinates care to some degree. All students will be helping patients to navigate their way through their healthcare journey. As a more junior student, you may have observed third-year students and registered nurses liaising with the multidisciplinary team, learnt about their roles and communicated with them about any patients within your care.


As a third-year student, you will have contributed to discussions with the multidisciplinary team and made referrals under supervision. The importance of relaying information clearly, logically and appropriately may have seemed challenging at times, but as you look back on the experience it is important to reflect on what went well and to identify areas for development that you can take forward to your next placement. There may have been more junior student nurses who required support during your practice experience and, at this point, you could consider how it felt to advise and support more junior colleagues (Gilmour et al 2007).


As you near your final placement, you will have been given the opportunity to shadow the shift coordinator and may have been able to act as a shift coordinator under supervision. You will have needed to share information with the team, been adaptable and flexible. This opportunity will have greatly enhanced your team working and coordinating skills.








Quiz: test your knowledge


(Answers on p. 283.)



17.1. What are the key areas you need to consider when communicating?






17.2. Name four health professionals that you have liaised with while on your medical placement.


17.3. Medical ward handovers will often incorporate an office handover and a bedside handover: true or false?


17.4. COPD means:






17.5. SBARR is:






17.6. A low blood pressure and raised pulse could signify:






17.7. Which of the following could cause a raised respiratory rate?






17.8. Normal oxygen saturations are?






17.9. Normal peak flow readings depend on which of the following?






17.10. Which of the following observations is normally incorporated in an early warning score?










17.11. What do you need to consider before discharging a patient home?


17.12. What waterlow score would prompt you to take action?


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Feb 25, 2017 | Posted by in NURSING | Comments Off on Revision and future learning

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