Tuesday, April 2, 2019
The Role Of Theory And Practice Facilitated By Reflection Nursing Essay
The Role Of guess And Practice Facilitated By expression Nursing EssayQuestionDewey (1938) decl ared that only honorable noesisal activity comes by dint of experience. Certainly, in ar invest- ground professions such as the health care professions, clinical experience should be the basis for come toing. To draw information from experience, we need to create meaning from our experiences as we interact with and fight down to, them. We shtup non allow any experience to be interpreted for granted erstwhile we do so, actions constitute r out(p)ine and habitual, we stop nonicing and enter into a estrus (Stuart 2007).Critically discuss this quotation by focusing on the complexness of learning in normal, the complexity of supervisory forge and the end destruction of creating a satisfactory practitioner.Table of ContentsIntroductionIt is in the recreate of both the university and the clinical sports stadiums to en for certain that newly qualified suck ups are absol utely competent to take on the responsibilities of their new jobs. The big question is which area should play the best part in ensuring that this feat is accomplished? Conversely, could it be a perfect balance between the two domains? Considering the changing pissula of breast feeding genteelness to keep up with modern times, it is in addition useful to contemplate the challenges that educatees and educators, both academic and clinical are go about with. In lodge to establish if the goal of producing a competent practitioner is reached, it is all-authoritative(a) to determine what exactly constitutes a competent practitioner. As a final exam popular opinion the conception of competency shall be pondered to see if it is sufficient to evoke competent professionals when todays employers demand high standards and excellency of care.The changing nature of nursingCount slight times nursing has been referred to as both an art and a science. Clearly, this is to delineate that it is a combination of both academical knowledge and trust skill. done the historic period nursing education has shifted from hospital genteelness (skills) to higher education (academic) namely university baccalaureates, masters and likewise doctorates (Wilson, 2008). Jarvis (2005) explains that this change is occurring because nursing is undergoing a process of professionalization (professionalism). An an different(prenominal) primal change is that, whereas the student nurses before were all young recruits nowadays the classroom is a mixture of ages either callable to mature students entering nursing or due to continuing education (Jarvis, 2005). These adult learners whitethorn gum olibanum have different learning needs. The particular that nursing has distanced itself from the medical model, in favour of a holistic, patient have-to doe with approach, it has also inevitably changed the way nurse education is planned and delivered nowadays. on board the study of anatomy and physiology, nurse educators had to include the nursing process and humane subjects like the concept of care, psychology, sociology and ethics.Meurier, Vincent Parmar (1997) view as that this process was necessary for nursing to become an autonomous profession that has research underpinning its example. Evidence based practice became a room of gaining credibility with both clients and opposite professions. Greater autonomy has been disposed(p) to nurses locally by the issuing of the nursing warrant. moreover, autonomy also translates into increase accountability. Patients abroad are now personally suing individual nurses when they are thought to be personally responsible for errors. Never before has it been more important to produce competent, efficient and effective nurses in order to avoid costly litigations and avoidable patient suffering and harm. The emphasis is now on which compositors case of learning is best at producing competent nurses, supposed, academic or p ossibly a mixture of both.The great debateOne of the main objectives of this identification is to critically discuss the quote provided. In this quote Dewey is said to sic great emphasis on the authority that experiences plays in providing a genuine education. Experience is defined in the Longman (2010) dictionary as knowledge or skill that you gain from doing a job or activity. Experience is an important component of practice development (Lyneham, Parkinson Denholm, 2009). However, nursing is non only round doing entirely also virtually idea.In the quote provided, Deweys seems to be subjective when he omits to recognize the role that possible action plays in the learning process. However Dewey, in his own sacred scripture states that the belief that all genuine education comes about through experience does non mean that all experiences are genuinely or equally educative (Dewey, 1998, p. 13). Knowles, Holton III, Swanson, (2005) hoped that many Deweys ideas were misin terpreted through the years and emphasised the importance of direct quoting. Hence, to evaluate properly Deweys quote, one essential assess it in the whole context not still a short quote. Peplau (1988, p. 13) asserts that the art and science aspects of nursing should alship canal be kept interconnected if not inseparable. This statement suggests that experience and academical knowledge, should complement each other in order to achieve optimal learning. The clinical milieu is a rich learning ground intact of learning opportunities. On the other hand, this knowledge can be in a tacit form and hard to translate into words. Eraut (2004) maintains that when these situations arise, the practitioner needs to find alternate ways of unlocking and sharing this knowledge. Reflection, which is widely taught in nursing curriculae nowadays may be a inwardness of articulating knowledge that is embedded in practice (McBrien, 2006). Thus, this is an drill of system complimenting experientia l learning. Furthermore, without nursing developing its own theoretical proboscis of knowledge the quest for professionalization would have been unreachable. In order to acquire the nursing profession and provide the tools to increase the body of knowledge, critical sentiment and research modules have been added to the nursing curriculae. This enabled nursing to move past from the dominancy of other professions and empowered nurses to be able to make their own competent decisions based on well up researched testify.Clinical experience includes also the practicing of skills, which are generally learnt through role modelling strategies and perfected through repetition consequently increasing competence. Consequently, habitualisation runs the danger of becoming a ritualistic practice when it is taken for granted and done without thought (Stuart, 2007). Heath and freshwater (2000) regard proficiency in skill, achieved through repetitive practice as positive. They explain that nurses depart require less thought whilst performing procedures and their attention may be dedicated to answering the patients questions or observing his behaviour. However, practice without reflection actually risks becoming a rigid, habitualised and ritualistic vicious circle.Experience is not just about performing skills well and in good timing. It is also an probability to be faced with different clinical situations and challenges that equip the nurse with the necessary knowledge to deal with similar situations in the incoming. A report compiled by the Department of Health (1999) entitled Making a difference depict that many newly qualified nurses lacked the necessary skills to function as self-confident and competent practitioners in their new professional roles. Therefore, although nurses might possess the academical knowledge to pass their final exams, they lacked the experience to operate confidently on the wards. another(prenominal) shortfall was that newly qualified nurses were observed to lack the critical thinking skills necessary to function in the increasingly complex clinical environs (Aronson, Rosa, Anfinson Light, 1997). Many argue that this is the result of the shift from hospital based training to university centered education, creating the theory practice opening night phenomenon (Evans, 2009). In the following paragraphs, the theory practice gap and means of reducing it shall be discussed.Theory- Practice commotionIn the past, nurses had more clinical hours than study hours as part of their nurse education. Furthermore, the students of the past were counted as part of the nursing compliment. This may explain why they found the transition from a student to qualified nurse less problematic. However, this kind of training sucked the students into a circle of ritualistic practice concentrating on efficiency rather than military strength. In contrast todays student is provided with all the theoretical knowledge to ensure that practic e is guided by essay thus shifting the balance onto effectiveness. Wilson (2008) explains that teaching should not just be the transfer of facts but that students essentialiness learn how to adapt this information to each quaint clinical setting. Therefore, it is empirical to bridge the gap between what is known and what is practiced.The gap between theory and practice is not something of the present and will brave through the ages. Haigh (2009) cerebrates this gap to be important as it portrays nursing as a vibrant and dynamic profession (p. 1). Notwithstanding this, the theory practice gap has inspired theorists to introduce learning models in the clinical environment and mostly included the participation of a clinical supervisor (Beinart, 2004 and Lynch, Hancox, Happell, Parker, 2008). Furthermore, no model has managed to eradicate the theory practice gap (Baxter, 2007). Whichever model may be used, the importance of having a clinical supervisor with exceptional qualitie s moldiness(prenominal) not be over olfactory sensationed.An advantage of the local nursing scene is that although the establish of Nursing has now become a faculty, its basis is still within the general hospital. The significance of this is not only that the two domains are not physically separated, but that also academical ply and other resources such as the library are easily accessible. However other measures are also necessary in order to amalgamate theory and practice. The areas of reflection and clinical supervision as a means of reducing the gap shall be discussed in the following paragraphs.Reflection and learningSchn (1983) in his book regarding the meditative practitioner states that brooding practice enables a person to learn from both his actions and experiences. Jarvis (2005) maintains that the role of a teacher may include facilitating reflective practice for practitioners in order to crystallize the ideas generated in practice. Moreover, Schn schematic that nu rses reflect upon their actions and through this, knowledge about practice is generated as unlike to just the application of knowledge to practice. Rolfe (1997) supports this statement by asserting that reflective practice is a systematic and thoughtful process that allows nurses going about their workaday work to make guts of their practices. Reflection is a means of identifying areas that need improvement. However, reflection should also take place in instances that went well to identify the key principles that endured to success. Surgerman, Doherty, Garvey and Gass (2000) point out that if reflection is taken away from practice, the practitioner might not be able to learn from these experiences. unfortunately staff shortages and the overcrowding of wards often leave little time for nurses to think (Weaver, rabbit warren Delaney, 2005). However, this should not be an excuse not to engage reflective practice. Reflection on action may be more suitable and should be greatly enco uraged amongst supervisees as a means of making sense of practices universe undertaken. This form of reflection was also used by Florence nightingale as a means of generating knowledge from practice and the start of evidence based practice (McDonald, 2001). Another way would be to organise aggroup reflections. The group may include a mixture of supervisors and supervisees in order to help oneself discussion and the sharing of knowledge (Lee, 2009). The process of reflection is also very useful in helping students and qualified staff also to develop critical thinking skills. Further on, a problem resolving attitude may be instilled, which is a valuable tool for the nurses in their career (Jarvis, 2005) thus leading to the development of a competent practitioner. The contemporaries of ideas from reflection is not sufficient. The greatest challenge is to put these ideas into practice. Clinical supervisors can be an plus in helping students to engage reflective practice whilst he lping them articulating and implementing the ideas generated.Clinical supervisionWong and Lee (2000) define the roles of clinical supervision as to help students develop their clinical skills, help to bridge theory and practice and assist students with their socialisation into nursing. McBrien (2006) states that clinical supervision acts as an annex of classroom teaching. In other words, the clinical supervisor works on board the university to maximize the educational activity gained from the ward experience. In the wards, the supervisor, helps to safely monitoring device students, whilst they practice what they have learned in the classroom thus bridging the afore mentioned gap. Supervisors may teach supervisees by being good role models, and help father students acquire knowledge through emulating their behaviour. As supervisees progress the supervisor must then give greater freedom to the student whilst challenging their practices in order to develop their reflective and criti cal thinking skills. Supervisors must be well prepared and supported (Lynch, Hancox, Happell, Parker, 2008). Furthermore, their practices have to be grounded in evidence as supervisees at this stage will healthily challenge what the supervisor is imparting.Supervision takes up different forms in different hands depending on the intent and emphasis of the supervisor (Johns 1996, p.1142). Staff shortages, overcrowding and high patient derangement may result in ward nurses looking at students in an inappropriate manner, especially if supervision was forced on them. Consequently, they may look at students as a burden, an extra duty or a waste of their free time. Moreover, they may view them as an extra mates of hands which can be easily manipulated to do their all(prenominal) bidding. McBrien (2006) warns that faced with such negative attitude student nurses may be be to abandon their learning objectives in order to fit in. Furthermore, nurses may be hostile and uncooperative towar ds their colleagues who are trained clinical supervisors who take on students for supervision in their wards.The clinical supervisor thus has an important role in creating an environment conducive to learning on the wards. This should include measures to make students feel welcome and accepted by the rest of the ward staff in order to safeguard the students self esteem and potential for learning (Franke, Garssen, Huijer Abu-Saad, 1995). Moreover, good relationship is of design importance in obtaining the desired goals in the supervisory process. The relationship between the supervisor and the supervisee is the key for successful clinical supervision (Lynch, Hancox, Happell, Parker, 2008 and Sloan, 1999).The above points strongly indicate that clinical supervisors have to be willing and dedicated to undertake the teaching role in the ward. Supervisors must undergo specialised training. However, in order to move a get along step, full collaboration with the academic body has to be in place. Sloan (1999) utter that on-going training for supervisors helps them to construct their own supervision models, to develop interpersonal skills and facilitate supervisory support besides others. One training module is not enough to last a life-time, hence update courses and hearings should be held yearly. By this means not only knowledge is updated but also an chance for the sharing of ideas is provided. Introducing regular meetings with the academic supervisor ensures not only a bridging of the theory practice gap but also that the desired student goals are made clear and achievable.Unfortunately, the number of nursing students by far outnumbers the amount of clinical supervisors who have been formally trained. This lack of supervisors may be the result of the absence of a good reward system such as monetary or professional. Alternatively, the grapheme of supervision might dismiss with its introduction. This can be due to applicants applying for the rewards, rather than a keen amour in supervision. In this event, a rigid vetting process and performance assessment should be introduced. The concept of collaborative learning has been explored by Jeffries (2005) as a means of compensating for the lack of supervisors. The main advantages were an increased sense of teamwork, student adhere and richer discussions. However, Evans (2009) points out those students who are less eager to participate may confuse within these groups thus limiting the development of their potential. Moreover, large groups may contribute to certain students getting away with not performing duties that they might consider not to their liking (Evans, 2009).An important role that the clinical supervisor must play, which is sometimes overlooked is the development of self awareness. Heath and Freshwater (2000) maintain that the supervisor must help the student to develop an awareness of self, and an acceptance of responsibility for ones own actions. Thus the supervisor must in stil the concept of accountability, which greatly contributes to the development of a competent practitioner. Todd Freshwater (1999) assert that through this process the supervisee becomes less dependent on the clinical practitioner because an natural supervisor is developed. Hence, the supervisee develops a professional conscience whilst becoming more confident to assume more responsibility for ones own learning. When this is achieved, the seed of life-long learning is implanted ensuring that the supervisee will continue to self direct learning even after(prenominal) graduation. Jarvis (2005) states that if this had to be familiar for all students, continuing education programmes could be drastically reduced.Competent practitionersWeaver, Warren and Delaney (2005) explain that nursing care affects a range of health care outcomes namely mortality, morbidity and costs. For this reason, an emphasis is now being placed on high quality care, avoidance of errors, cost effectiveness and elimination of wastages. A competent practitioner is someone who is able to bestow tasks safely on their own. Moreover, competency is defined by the Nursing Council of unsanded Zealand, (2008, p.12) as, the combination of skills, knowledge, attitudes, values and abilities that underpin effective performance as a nurse. Conversely, Lofmark, Smide, Wikblad, (2006) state that competency must be achieved in all areas and not just in clinical and technical skills. Furthermore, it is difficult to find a person who is competent in all areas. Having stated all this, a doubt arises, whether being a competent practitioner is enough to meet these growing healthcare demands.Nurses are faced daily with items that are out of stock, staff shortages and unexpected and unplanned occurrences. In these situations, knowledge and standard practice are not sufficient to meet healthcare demands. Heath and Freshwater (2000) explain that a nurse that goes beyond the competent phase not only can demo nstrate greater technical proficiency but is also able to correct and adapt her actions according to the unfolding situations. Benner (1984) asserts that for competent practice to become proficient, a qualitative change must occur. Benner, Tanner, Chesla, (2009) believe that some nurses may never develop beyond the competent stage. inclined the complex clinical situations that every single nurse is faced daily on the wards, this transition should be avidly cultivated. Improvisations and solutions must be realised in order to ensure that patients still receive good quality care. Drawing up on past experiences, knowledge new or old and utilizing reflection and problem solving skills are a means of coming up with new solutions. The clinical supervisor is an invaluable asset in helping the supervisee to make this transition. This can be done by being a role model, providing meaningful experiences that can be apply in coming(prenominal) practice as well as funding the supervisees in developing their own problem solving skills.A universal responsibilityAlthough an emphasis has been made that the clinical supervisors should be formally trained, every single nurse in the clinical setting should take an recreate in the education of student nurses. These same students will in the future become nursing colleagues and further on nursing administrators and lecturers. Making sure that they receive the best possible education is a means of safeguarding the future of nursing. On a more egoistical note, these same students will be the nurses in the wards taking care of us and our loved ones. Therefore, ensuring that they develop their full potential is a guarantee of receiving excellent quality care to the highest standards. conclusionIt has been established that experience and theoretical knowledge both play a pivotal role in the formation of competent practitioners. The phenomenon of the theory practice divide occurs, when academical knowledge is not successfully adapt ed into the working environment to achieve meaningful practice. In order to bridge these gaps important assets were place namely clinical supervision, experience and the use of reflection. Clinical supervision is a challenging area of nursing that should involve specific training and utmost dedication. Collaboration with the academical supervisors ensures that the goal of achieving competent practitioners is achieved. However, exceptional practice should be the last goal that should be shared by all clinical practitioners in order to safeguard the future of nursing.