17 Revision and future learning
• To establish current knowledge base about a range of health problems
• To identify future learning needs
• To provide you with some revision questions to test your knowledge
• To encourage you to reflect on your medical placement and to consider how this will impact on your future learning experiences
Developing good practice in learning
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:
• If your mentor was unavailable for more than a week, did you inform anyone, e.g. placement manager, key mentor, practice experience facilitator, link lecturer, personal tutor?
• If you worked with your associate mentor more than your main mentor, you need to think about why this happened.
• Did you feel uncomfortable working with your mentor or associate mentor? If so, did you report this to anyone, e.g. placement manager, key mentor, practice experience facilitator, link lecturer, personal tutor?
• How will your assessment and documentation meet the required standards of your university and professional body (NMC 2008, 2011)?
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.
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
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 |
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:
• practise in accordance with the NMC code of professional conduct: standards for conduct, performance and ethics;
• develop confidence in their competence as a nurse, midwife or specialist community public health nurse.
To facilitate this, the ‘new registrant’ should have:
• learning time protected in their first year of qualified practice; and
• have access to a preceptor with whom regular meetings are held.
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.
How have you been involved in following the nursing process during your placement? Write a reflective account using a reflective framework of your choice about an episode of care where you used the nursing process (see Ch. 3 for an example of a reflective framework). Think about what you learnt from this and how this affected/enhanced your ability to plan care for your patients.
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).
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).
Quiz: test your knowledge
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?
17.6. 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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