CRITICAL REFLECTION DETAILING KEY LEARNING POINTS DURING PRACTICE-BASED LEARNING

Reflection is a practice mainly used in nursing and social care practices. According to Cartwright (2011), reflection is a part of portfolio development and evidence-based learning. Billett argues that through a reflection model, nursing students demonstrate everyday learning (2019, p.14). Self-reflection also assists in processing thoughts on various nursing incidents and making critical decisions in the future (Howatson-Jones, 2016, p.1: Bach & Ellis, 2015, p. 15). Cartwright (2011) argues that using a reflection model in nursing for reflection helps the nurses focus on learning and self-awareness after nursing incidents.

For this reflection, I will use the Gibbs Model of Reflection (1988) towards my professional practice. This model has a couple of stages, as indicated in the below diagram. The steps include a description of the nursing event, a description of the feelings encountered, evaluation of the experience, and analysis of the experience (Bilett, 2019, p.149). The last stage is the action plan. The model will be used in my reflection, where I will refer to an incident where I failed to communicate effectively and proper time management. The experience elicited both positive and negative thoughts towards my career as a future registered nurse. I learned about the importance of using nursing time management skills and professionalism when dealing with every patient and supervisor.

Description

This stage covers the inner and external elements of the clinical incidence (Bilett, 2019, p.150). During my practice-based learning back in a hospital setting, the supervisor (Mr. Paul) appointed me to be a leader of all the student nurses in the organization. In places I have worked as a leader, I have always adopted a democratic leadership style. In democratic leadership, group members have a participative role in the decision-making process (Banerjee & Ugemuge, 2018, p.5). However, the supervisor in charge of the nurses in the organization adapted the autocratic type of leadership. He had control over all the decisions regarding student nurses in the organization. Ercetin & Acikalin (2020) argue that autocratic leaders act like the boss and never consider the subordinates’ suggestions. In most cases, he never listened to recommendations or even explanations from the student nurses.

It was on a Monday morning when I came to the hospital and met with Mr. Paul, who asked me to research about specific drugs. On my way to check those drugs, I met a student nurse whom I had met the previous week, and we had become friends. He was rushing towards his allocated ward. I greeted him, and he told me that he was hurrying to check a patient he was attending to.  He then told me he had a challenge pricking an 8-months baby who required some blood tests. On checking the child’s files, the student nurse realized that the child was suffering from phlebotomy. During my practice, I had encountered a similar case, and I succeeded in pricking. Since researching the drugs was not an emergency, I decided to go and assist in pricking the baby. Over my practice, I was always hesitant to prick children due to the hidden vessel as a result of their tender age. Such a child requires extra attention during venipuncture (McCall et al., 2011, p.6). The venipuncture process should be performed by a phlebotomist (Infusion Nurses Society et al., 2011, p.559).

The student nurse (colleague) had tried to prick the child but failed. Fortunately, I assisted him, and we succeeded. After analyzing the experience, we realized that we followed the right procedure in the patient identification, test interpretation per requisition, and effectively drawing blood. We also indicated it with the correct addictives (World Health Organization, 2011, p.1). Before the process, we explained to the parent about the required tests and delivered the specimens to the laboratory for testing. In the quest to help, I neglected my priority, as requested by my supervisor. My main aim of choosing to assist the nurse is the fact that I thought it was an emergency, and I would research the drug later. As Jones et al. (2017) note in their work, pricking the wrong vein can result in many compilations, including nerve damage, infections, and neuropathic pains. Abbas, Mukinda & Namane (2017) add that it can also lead to blood sample rejection in the laboratory as a result of insufficient blood volume, among other issues. Helping my colleague seemed like the very best decision until my supervisor called and rebuked me.

When my supervisor called asking about the drug results, I rushed towards the research center, but it was already closed. I headed straight to his office and narrated what happened. He was angry, which made me feel guilty and argued that I lacked time management and communication skills, and I needed to work on them. Gault et al. (2017) argue that nurses require effective communication skills. My supervisor went on to explain to me that as a nurse, I needed to know about various drug use and side effects. This situation left me thinking about my priorities, patient needs, and my professional learning and development. On self-analysis, I realized that I exhibited poor communication and improper planning since I could have communicated to my supervisor about helping my colleague before embarking on it.  In various instances, nurses should pursue knowledge regarding effective communication (Evans, Coutsaftiki & Fathers, 2017, p.28). Even after we were done helping the patient, I continued chatting with my friend and forgot about the task given by the supervisor.

Feelings

As a student nurse in the ward, I was always trying to help where I could. When I saw my colleague hurriedly walking towards the ward, I knew something was amiss and desired to assist. When he told me about the situation, I felt it was a priority to assist him since drugs could have been researched later. Democratic leaders value fairness, kindness, honesty, and come up with creative solutions for organizational issues (Dahlkemper, 2017, p.148). As a democratic leader, I opted to help since I realized that it was an issue of an emergency. I felt happy that we sorted the issue with much ease.

When the supervisor confronted me, I felt embarrassed and guilty that I never consulted him before deciding to help my colleague in drawing blood from a child. I also felt disappointed that I thought I had made the right decision, which seemed wrong to him. Previously, I felt concerned about the patient, and I justified assisting in pricking, which seemed an emergency at the time. I thought that researching the drug was not an emergency and could even be done on my way home or even the following day. When my supervisor told me that he was very disappointed with my actions, I felt remorseful and apologized. However, he never took an apology but kept on insisting that I needed to work on my communication and time management skills. According to the study that was conducted by Finkelman & Kenner (2013), nurses need to justify the decisions they take on a day to day basis. Barton & Allan (2015), in their work, also argued that nurses should work on their time management skills.

Evaluation

After analyzing the experience, I came to realize that it had good and bad points. On the positive points, I choose to assist my colleague in pricking the child since I thought it was the priority, and we succeeded. Pricking of the wrong vein may result in many complications. Additionally, many nurses have challenges identifying children’s veins because of their young age. In this action, I portrayed my nursing core values. According to the study by Al Banna (2017), nurses should adhere to various core values, including human dignity, where they treat individuals as unique. Other core values include altruism, social justice, integrity, and autonomy (Al Banna, 2017, p.170).

On negative points, I highly disappointed my supervisor because of my poor communication skills. The incident also made me understand the importance of effective time management and communication skills. It also made me realize how informing my supervisor about the incident could have changed the situation. Probably he could have permitted me to research the drugs later. As O’Connor et al. (2017) note in their work, nurses should grasp strategies to prioritize clinical options in nursing care. As a responsible practitioner, it is prudent to have knowledge and skills for an effective practice even without supervision. Following the experience, I realized that helping my friend could have been the priority. However, the main mistake that I did was to embark on helping my friend before requesting permission from my supervisor.

Analysis

As nurses, we do not invent time. However, it is our responsibility to learn about it and utilize it effectively. As a registered nurse in the future, I will probably be inundated with the nursing work that will require excellent time management. Gaining time management skills is a dynamic process that nurses should master (Mohamadkhani et al., 2017, p.3679). From an analysis of the incident, I realized that time management skills go hand-in-hand with prioritization skills. In this case, a good time manager decides upon priorities and plan accordingly. From the study that Nayak (2018) conducted, effective time management appropriately reduces nurses’ stress and increase productivity.

According to APIE (assess, Plan, Implement and evaluate) method, there are three main steps towards effective time management. They include setting time aside to plan activities and establishing priorities (Toney-Butler & Thayer, 2019, p.48). The next step includes carrying out the highest task as soon as possible before embarking on another. Handling two activities at ago may work as a distraction. The last step, in this case, is prioritizing the tasks to be accomplished based on the information received.  Nurses plan their work through what is known as a “care plan” (Toney-Butler & Thayer, 2019, p.48). The tool presents a systematic and rational method for effective planning by the nurses, as Toney-Butler & Thayer (2019) argue.

Assess, Plan, Implement and evaluate (APIE) Tool
Step	Action
Assess/Analyze	In this first step, the nurse collects and organizes the data. The next objective involves forming a list of actual/potential time management requirements.
Plan/Prioritize	This step involves formulating the plan. In this step, the nurse should devise goals and their expected results, set priorities, and discover interventions that help towards attaining the goals.
Implement/Intervene	This step involves implementing the action
Evaluate	Work on assessing the results and examining how the actions measured against the goals

In my future practice, I know I will face unvarying demands on time and consideration. The identification of priorities may also prove a challenge. When it comes to patient care, priorities tend to change rapidly, and as a nurse, a constant re-accessing of situations and responding is required. In nursing interventions, O’Connor et al. (2017) argue that priority setting involves establishing the preferential sequence. The nurse should begin by deciding on the intervention that requires attention first, the second, and even the third one. Instead of ranking them, nurses group priorities in a high, medium, and low priority. In their work, Toney-Butler & Thayer (2019) argue that life-threatening situations should be grouped as a high priority. The decreased coping ability should be grouped as medium priorities, and issues in normal development need as low-priority issues (Kozier et al., 2008).

During this occurrence, this question was asked, “What will be the consequence of not helping my student nurse colleague in pricking the child?” The patient and the mother would have waited for long while I spent minutes researching the drug, and my colleague would probably make mistakes in pricking the child. Pricking the wrong vein, among other errors, may result in many complications, as argued earlier. In the nursing practice, being overwhelmed by the patient’s care and time constraints may result in many medical errors, the exclusion of the patient’s essential details, and burnout and incompetence. Time management skill remains a nursing skill which is cultured and enhances with nursing care (Potter et al., 2016, p.284).

Conclusion

After thorough research on time management, I feel like my supervisor was not right in questioning my time management and communication skills in such an incident. In the situation I found myself in, the priority seems to be assisting in pricking the child compared to researching on drugs, which was not an emergency. He later argued that I need to know various drugs and their effects, which I learned. If my friend pricked the child wrongly, it could have led to many issues, and I could have felt bad that I never helped. As a registered nurse in the future, if a similar occurrence happens, I think I will react in the same way I did.  I believe that my action minimized the patient’s risk. In the future, my priorities as a registered nurse will change, and in this case, focusing on professional development is extremely important. Caring for my patients is a priority, and I will strive to treat them as individuals and integrity.

Action Plan

In the nursing increasing emphasis on efficiency, managing time is an important consideration (Porter-O’Grady, 2018, p.304: Porter-O’Grady & Malloch, 2016, P. 294). In working towards sharpening my time management skills, I will;

• Break down my tasks and see how long it takes to do specific tasks
• Use APIE as a time management tool. I will work on writing a list of high, medium and low priority tasks and keep on evaluating the list
• Delegate tasks when appropriate

Through this reflective practice, I am aware of what needs professional development, and in the future, I will challenge and question things that do not seem to contribute towards the patients’ interests. To attain this, I will;

• Engage in assertive communication where I will justify my actions
• I will research more on time management, assertive communication, and task prioritization.
• Apply the learned lessons.

According to what I went through during my practice-based learning, I learned that beneficial and learning chances are mostly obtained from the mistakes we make. In this case, a reflection can indeed show forth our shortcomings; hence many students may give excuses to avoid reflecting. Understanding where you made a mistake and gaining the courage to make the right decisions in the future is a significant achievement. Suppose I never examined my practice-based learning exercise, I am sure that I would not have taken a keen interest in both time management and communication skills. I would probably make similar mistakes in the future, even as a registered nurse.

Bibliography

Abbas, M., Mukinda, F. and Namane, M., 2017. The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town: A quasi-experimental study. African Journal of Primary Health Care & Family Medicine, 9(1).

Al Banna, D., 2017. Core Professional and Personal Values of Nurses about Nursing in Erbil City Hospitals: A Profession, Not Just Career. Nursing & Healthcare International Journal, 2(6), pp.169-173.

Bach, S., & Ellis, P. 2015. Leadership, management and team working in nursing. Los Angeles : Learning Matte.

Banerjee, T.,& Ugemuge, S. 2018. Dr. Leader Imbibing Leadership for Holistic Patient Care. Cham, Switzerland : Springer.