Learning to Learn in Nursing

Essay

Learning to learn is an essential component in nursing practice due to the amount of knowledge that a nurse requires to ensure that patients get the very best of care in both a clinical and holistic capacity. This essay aims to explore the learning barriers and weaknesses identified by a student and how these can be overcome by reflection and problem solving in order expedite the students learning for further advancement into education. The art of self-evaluation is important, it allows students to be able to recognise their own learning requirements and evaluate their performance which in turn allows for good reflection of oneself. The student noticed that the learning outcome of interpersonal and communicative skills directly related an experience in clinical practice; where it was discovered that when comfort is established; along with good clear lines of communication, that it decreases the chances of patients becoming withdrawn, distressed or combative. Stein-Parbury (2017) expresses that patient centered care and communication is just as important as the technical data to allow for human interaction and clinical competence.

The Medical terminology was challenging for the student learn so additional time was spent to study the terms and their meanings using Mosby’s (2016) medical dictionary [Appendix. A]. Tutor feedback was then actioned upon as a result. This allowed the student to reflect and connect the theory to the practical work. It is imperative for a nurse to be fluent in the medical terminology in order to converse with other medical professionals, and to make sure what is being said is accurate which also minimizes mistakes. Additionally, it allows for the nurse to explain terminology to patients and whanau when they may not have a clear understanding of what has been said to them. Gray (1993) explained that having an accurate grasp on human anatomy and physiology will precipitate students learning. Schoenwald and Douglas(2018) emphasize how much knowledge a nurse can gain by communicating and liaising with patients and their whanau which leads to good interpersonal relationships by building trust with patients.

The student identified several learning barriers to overcome in order to achieve at a high standard and constructed SMARTA goals [Appendix B]. By using Cottrell’s (2013) guides and outlines for timing and planning cycles, the student learnt to have good time management skills by setting schedules. Time management is an essential aspect in nursing to be able to meet the demands of the job and prioritise in times of stress and heavy workloads. Brown (2018) states that nurses need to apply critical thinking in order to be able to recognize, respond and react in an according manner at all times. The student had to be mindful of maintaining patient privacy and confidentiality, this was a challenge as students were taking notes to use in their Clinical Learning Guides (CLG). The student overcame this by making sure that no patient names, areas of health or medical practice were use in order to make the patients unidentifiable in the CLGs, as well as offering to draw curtains and speak at a volume that was not loud enough to be heard by other patients or visitors in a four bedded room. It is imperative that nurses understand and adhere to both their legal and ethical boundaries by following the code of conduct set out by the Nursing Council of New Zealand in regard to respect, trust, integrity and partnership; which the NCNZ (2018) state are the values that underpin professional conduct in nursing; along with privacy and confidentiality. Burgess (2012) explains personal information about a patient or his/her medical conditions is not to be divulged to anyone that is not directly responsible for caring for that person in a professional capacity.

The student recognised that it is imperative to have a comprehensive understanding of human anatomy and physiology in order to have a sound background and understanding of how the human body system works, how homeostasis can be thrown off kilter; thus affecting the entire body, and how cells perform their functions, mutate and ward off pathogens. The student put this knowledge into practice by making sure thorough hand hygiene was carried out after understanding how easily bacteria can be spread by poor hand hygiene and incorrect use of personal protective equipment. Osborne (2018) encourages nurses to educate both patients and visitors on the importance of good hand hygiene to reiterate to them how easily bacteria can be spread and Wepa (2016) states that reframing practice to ensure whanau contribution and understanding will result in better patient outcomes. It is important for nurses to understand cellular structure and how cells mutate because of how rapidly pathogens can spread. Every single cell in the body plays its own part in maintaining homeostasis so any change or damage to cells can affect the body’s ability to maintain an equilibrium (Lee & Bishop, 2016).

Cellular transport and structure were challenging for the student to learn as the mitochondria is such an intricate organelle; so much takes place during the Kreb’s cycle, so the student spent additional time learning how it all functions. [Appendix. C]. Boore, Cook & Shepherd (2016) state that the Electron Transport Chain manages the energy production which requires oxygen. The student then linked this knowledge to the oxygen supply and demand framework learnt in class with a patient suffering from chronic obstructive pulmonary disease (COPD) which the student attributed to the alveoli no longer functioning at capacity. McKenna and Lim (2015) specify that COPD results in an over inflation of the lungs with reduced gas exchange. Scully(2018) and Scott (2012) concur that COPD deteriorates the airways which leads to a loss in lung function and alveolar hypoventilation then occurs. This highlighted the importance of taking regular vital signs as Reed-Poysden and Gupta (2015) state that all patients should have their airway, circulation and breathing assessed and that hypoxaemia should be treated with supplementary oxygen.

As well as the technical aspect of science, the student also learnt about patient comfort, mindfulness and emotional intelligence. This is extremely important for a nurse to know and have a full comprehensive understanding of, as it is the core of patient centred practice. Nurses need to be mindful and develop a good sense of emotional intelligence to manage patient relationships effectively; understand a patient’s point of view and how they can be helped to feel at ease when they may be feeling scared, stressed or anxious in an unfamiliar clinical environment as well as the ability to recognize signs and symptoms that are not being verbalized by the patient. Levett-Jones, Reid-Searl & Bourgeois (2018) suggest that a comfort talk will keep the patient focused and allow them to see their own progressions. This will allow the nurse to ascertain what is important to each individual. Stein-Parbury (2018) emphasises that comfort comprises of reassurance, but nurses need to be careful in which phases they use to issue comfort as some may interpret certain phrases as being brushed off or not listened too. The student recognised a barrier to emotional intelligence which was being mindful of words spoken so they did not come across as patronising or make patients feel inferior. This self-reflection made the student feel anxious, so additional planning using a mind map was drawn out with key phrases to use. Brownie & Nancarrow (2013) stress the importance of comfort and state that the benefits include mental and physical positivity, increased motor functions, and psychosocial outcomes for residents. [Appendix D]

In conclusion, as reiterated throughout the essay, self-reflection has allowed the student to see the importance of self-evaluation and recognize strengths and weaknesses; how the weaknesses can be overcome by imploring good problem-solving skills such as concept maps and time schedules [Appendix. E]. The self-reflection allows the student to be a better person and team player and it also allows the student to be able to connect the concepts to the literature, and then forward into clinical placement, which in turn grants the student the ability to learn and grow through progression and education. Stein-Parbury (2018) emphasizes how essential reflection is in the advancement of incessant education.

Appendices – 

Appendix A – CLG (Vitals 2, Feedback)

What a great CLG, you are nearly there, and are thinking and acting like a nurse, along with supporting your work with relevant literature.

Some clarity re your terms – the patient was diaphoretic, or the patient had diaphoresis – both terms mean the same but are referred to differently depending how you are describing the situation.

The patients chart indicates that they are prescribed allopurinol, candesartan and aspirin. An electrocardiogram (ECG) and Trop??? had been undertaken and were both negative. The students noted that the patient had a history of cardiac issues, which related to the pharmacological treatment. – Remember to explain terms and I have rephrased this section as it appears as it would in the notes, not in an academic piece of writing.

Tara.

Appendix B – Action Plan

See attached Action Plan.

Appendix C – SLJ

Appendix D – CIQ

I felt most connected to the learning during the class discussions and teamwork when everyone was sharing their knowledge and bouncing ideas around about ways to self-evaluate and reflect on actions.

References –

• Boore, J., Cook, N., & Shepherd A. (2016) Essentials of anatomy and physiology for nursing practice (2nd ed.). Melbourne, Australia: Sage
• Brown, D. (2018). Patient safety and clinical reasoning: Thinking like a nurse. In Brown, D., Edwards, H., Seaton, L. & Buckley, T. (Eds.). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (4th ed., p.24). Chatswood, Australia: Elsevier Australia. 
• Brownie, S., Nancarrow, S. (2013). A systematic review: Clinical interventions in aging. Effects of person-centered care on residents and staff in aged-care facilities. Doi: 8, 1–10. 10.2147/CIA.S38589
• Burgess, M. E. (2012). A guide to the law for nurses and midwives (4th ed.). Upper Saddle River, NJ: Prentice Hall.
• Cottrell, S. (2013). Time management as a student. The study skills handbook (4th ed., p.147). London, England: Macmillan International Higher Education.
• Gray, H. (1993). Gray’s anatomy. (30^th ed., preface).Liverpool, England: John W. Parker and son.
• Lee, G., & Bishop, P. (2016). Prevention and control of infectious diseases. In Microbiology and infection control for health professionals. (6th ed., p.245). Sydney, Australia: Pearson.
• Levett-Jones, T., Reid-Searl, K., & Bourgeois, S. (2018). The clinical placement: An essential guide for nursing students (4th ed.). Sydney, Australia: Elsevier Health Sciences. 
• McKenna, L., & Lim, A. (2014). McKenna’s pharmacology for nursing and health professionals. (2^nd ed., p.839). Sydney, Australia: Wolters Kluwer.
• Nursing Council of New Zealand. (2018). Code of conduct. Retrieved from http://www.nursingcouncil.org.nz/Nurses/Code-of-Conduct
• Mosby. (2016). Mosby’s pocket dictionary of medicine, nursing & health professions (7th ed.). St. Louis, MO: Elsevier Health Sciences.
• Osbourne, S. (2018). Understanding infection control. In Crisp, J., Taylor, C., Douglas, C., Rebeirio, G. & Walters, D. (Eds.). Potter & Perry’s fundamentals of nursing – Australian version (5th ed., p.656) Sydney, Australia: Elsevier
• Reed-Poysden, C., & Gupta, K. (2015). Acute coronary syndromes: Continuing education in anaesthesia critical care & pain. British journal of anaesthesia. 15(6), 286–293. https://doi.org/10.1093/bjaceaccp/mkv010
• Schoenwald, A., & Douglas C. (2018) Monitoring vital signs: Using a primary survey approach for patient assessment. In Crisp, J., Taylor, C., Douglas, C., Rebeirio, G. & Walters, D. (Eds.). Potter & Perry’s fundamentals of nursing – Australian version (5th ed., p.555) Sydney, Australia: Elsevier.
• Scott, W. (2012). Respiratory disorders. In Pathophysiology made incredibly easy! (2nd ed., p. 169). Philadelphia, PA: Lippincott Williams & Wilkins.
• Scully, N. (2018). Preserving oxygenation. In Crisp, J., Taylor, C., Douglas, C., Rebeirio, G. & Walters, D. (Eds.). Potter & Perry’s fundamentals of nursing – Australian version (5th ed., p.1260) Sydney, Australia: Elsevier
• Stein-Parbury, J. (2017). Patient and person: Interpersonal skills in nursing (6th ed.). Sydney, Australia: Elsevier Health Sciences. 

• Wepa, D. (2015). Cultural safety in Aotearoa New Zealand (2nd ed.). Cambridge, England: Cambridge University Press.