Nursing and Patient Led Intervention Case Study

Nursing and Patient Led Intervention Case Study Doris presented wound to left medial malleolus that has been caused by banging her left leg on fire 6 weeks ago. The wound measures 4 cm x 5 cm, filled 90% slough, 10 % granulation on wound bed and had copious odour to exudate. SMART OUTCOME / OBJECTIVE To reduce the size of Doris’ ulcer from the current 4 cm x 5 cm to 2 cm x 3 cm within 6 weeks. NURSING AND PATIENT LED INTERVENTIONS Introduce yourself to Doris and gain consent. Introducing yourself to patient is respectful, polite and important in providing compassionate care. Nursing Midwifery Council (NMC) (2013) emphasises that patients should voluntarily give their valid consent before any intervention or procedure is undertaken. Furthermore, the NICE (2015) guideline states that part of patient-centred care is providing patients with sufficient information about their condition and encouraging them to participate in healthcare decision-making. Assess Doris’ pain prior to cleaning the wound. To reduce discomfort to patient and to structure the assessment for patient’s dressing-related pain and implement effective management strategies immediately (World Union of Wound Healing Societies, 2014; Hollinworth, 2005). Gou and DiPetro (2010) explain that wound healing involves programmed phases and once interrupted, could lead to impairment and delays in wound healing. However, most healthcare practitioners fail to assess levels of pain before cleaning the wound (Baranoski and Ayello, 2008). When pain is unmanaged, this could lead to complications and delayed wound healing (Hollinworth, 2005). Ask Doris if she has any allergies. It is significant on assessment to find out whether patient has any allergies. It assists in making decisions such as prescribing medications and prevent any further allergic reactions and other complications (NICE, 2015). Perform hand washing using the correct techniques pre and post procedure. Hands should be washed before and after patient contact. Adhering to standard precautions is essential in all aspect of patient care (NMC, 2015). According to Rowley and Clare (2011) proper hand washing before patient contact will prevent the risk of acquiring infections. Infection is the biggest risk that can delay wound healing. It also means your patient will be safe from risk of acquiring cross infections whilst carrying out care (World Health Organisation, 2009). Perform and maintain aseptic non-touch technique for all procedure to wound care. The use of aseptic non touch technique reduces risk of patients acquiring infections. The aseptic non-touch technique is suggested when dressing the wound (WHO, 2009). Rowley and Clare (2011) have stressed that aseptic non-touch technique could reduce the risk of hospital acquired infections. Hence, the use of this technique could help reduce the risk of infecting wound. As stated in the study of Guo and DiPietro (2010), infection could disrupt and delay the process of wound healing. Irrigate wound with saline at room temperature. Irrigation is to clean out the wound. Cleansing removes debris and pathogens. However, one major drawback of this approach is that irrigation may accidentally remove areas of newly granulating tissue, thus will delay healing process (Kerstein, 1994). However, the National Institute for Health and Care Excellence (NICE, 2015) guideline states that necrotic material present in the margins of the wound could be sites for bacterial proliferation and should be removed through debridement. The SIGN (2010) guideline, nevertheless, could not find studies comparing debridement and no debridement in venous ulcer management. The guideline examined a number of debridement methods. Additionally, a prospective, double-blind, randomised controlled trial (RCT) (Weiss et al., 2013) suggests that tap water is as effective as normal saline for wound irrigation. There were no significant differences in the infection rates between wounds that were irrigated with tap water and those irrigated with saline solution. On the other hand, using tap water could be as effective and less costly for wound irrigation. The Scottish Intercollegiate Guidelines Network (SIGN, 2010) recommends that leg ulcers should be washed with tap water and dried carefully. Obtain wound swab as needed. Wound cultures is a tool to determine possible infection in the wound bed (NICE, 2012). However, reliability is concerned with consistency and the extent to which results are accurate. There would be a consensus over whether or not to clean the wound before swabbing. Donovan (1998) and Kiernan (1998) all advise irrigation with warmed normal saline to which remove excessive debris and exudate, thus removing surface contamination. Bowler et al (2001) suggest that the laboratory should be informed if the wound is not clean so as to exclude wound contaminants. It must also be noted that antiseptic cleansing solutions must be avoided as the results may be distorted (Cuzzell, 1993; Kiernan, 1998). Assess the wound and document findings on wound assessment chart. Proper wound assessment can significantly influence the intervention and prognosis (NHS, 2014a). In addition to assessment, the patient’s past medical history should also be taken. It allows healthcare practitioners determine the cause of the leg ulcer. The NHS (2014b) states that it is also important to treat the underlying cause of patient’s ulcer to prevent recurring of venous leg ulcer after treatment. Measure Doris wound and take photograph to sit as a baseline for wound care. Measuring wound diameter and taking a photograph would provide information to healthcare practitioners if wound contraction has begun and whether the wound is responding positively to interventions (NICE, 2015). Refer Doris to Tissue Viability Nurse. A specialist nurse such as the tissue viability nurse would help promote wound healing. Tissue viability nurses have extensive knowledge on how to manage acute, chronic or complex wounds (NHS, 2014a). They also provide advice and support for healthcare practitioners, patients and their families or cares (NHS, 2014a; SIGN, 2010). Since they are responsible in supporting wound care management in different healthcare settings, working closely with them would ensure that Doris receive quality care. A tissue viability nurse would also dispense advice on compression bandaging and other interventions to promote wound healing. Dress wound using hydrocolloid dressing. Dressings the wound will create a clean and optimum environment for wound healing (NICE, 2012). Based on the Cochrane Review moist environment promotes wounds to heal more quickly than a dry one (Palfreyman et al, 2006). Meanwhile, wounds left to dry form a scab or eschar which forces migrating epidermal cells to move deeper, prolonging the healing process (Kerstein, 1994). However, it could be argued another drawback of wound dressings that can be sometimes develop sensitivities to ingredients and can be toxic to the wound (Robinson, 2000). Therefore, choice of wound dressings will be dictated by the nature of the wound (Grey, et al, 2006). Wound dressing could be as simple as non-adherent dressing (NHS, 2014a). The NICE (2015) guideline states that there is insufficient evidence to support advanced dressings as more effective than conventional dressings in wound management. Another drawback is caution on removing of an adherent dressing which causes pain and may accidentally remove areas of newly granulating tissue, thus will delay healing process (Kerstein, 1994). Meanwhile, wound like Doris’ that is highly exuding and can be dress and cope with hydrogel dressings to avoid maceration (Jones et al 2006; Kerstein, 1994). Moreover, secondary dressings can be used as well to relieve pain such as hydrocolloid and to absorb more exudate like alginate (NICE, 2012). Educate Doris about the dressings, showering, bathing and how long dressings can be left in place and to contact District Nurse if dressing becomes loose or removed. Patient’s awareness of potential causes of poor/delayed wound healing (Kerstein, 1994). This would enable Doris to receive patient education about wound care and intervention and management. The NICE (2015) guideline states that part of patient-centred care is providing patients with sufficient information about their condition and encouraging them to participate in healthcare decision-making regarding their care. Discourage Doris of rubbing and scratching the wound. Scratching, rubbing and picking the wound can delay healing process and cause further injury to the tissue (Stander et al, 2003). Educate and encourage Doris to eat a balance diet and explain that protein is vital to wound healing and recovery. Optimal nutrition is essential to wounds healing. Informing the patient’s on the importance of good nutrition and improving the patient’s diet if needed is important for good prognosis of wound healing. Educate patient on essential diet for good wound healing e.g. protein (fish, meat, cheeses and eggs) and vitamin c (found in orange juice and vegetables) ( Bale, S and Jones, 2006). According to Dealey (2005) poor wound healing may indicate the patient’s nutritional status needs to be enhanced. If wound healing is poor accompanied by weight loss referral to dietician and prescribing practitioner for further advice and to consider supplemental nutrition for patient. Educate Doris to perform range of exercises whilst sitting. It activates venous pump by mobilising calf’s and feet whilst sitting and improve circulation and aid in wound healing (Callum, 1994). The NHS (2014b) states that it is also important to treat the underlying cause of patient’s ulcer to prevent recurring of venous leg ulcer after treatment. Performing a range of exercise during sitting could help improve wound healing (NHS, 2014b). Give contact number to Doris and instruct to call if there any other concern and arrange follow up visit. Arranging regular follow up to recognise risk factors and prevent further skin breakdown and reduce the risk of recurrence (NICE,2012). Refer Doris for Doppler assessment and for further compression therapy The aim is to identify potential arterial insufficiency that needs treatment and management (NICE, 2012). This will enable to provide information for long term intervention on maintaining integrity of the skin around the wound. Doppler assessment is necessary since this would assist healthcare practitioners in assessing leg ulcers. Although it is not diagnostic of venous ulceration, Doppler assessment could define a safe level for compression bandaging (NICE, 2015; SIGN, 2010). Doppler assessment is also helpful in determining when compression bandaging should not be used or is contraindicated (NICE, 2015). Hence, this assessment remains to be an important tool in reducing tissue damage due to bandage pressure. This type of assessment would provide information on the ankle brachial pressure index (ABPI). If ABPI REFERENCES Bale, S and Jones, V. (2006) Wound Care Nursing: a patient-centred approach (2nd edn). London: Mosby Elsevier. Baranoski, S. Ayello, E. (2008) Wound care essential: Practice Principles. Bowler, PG.,Duerden, BI., Armstrong, DG. (2001) Wound microbiology and associated approaches to wound management. Clin microbial Rev 14:244-69. Callum, N.(1994) The Nursing Management of Leg Ulcers in the Community: A critical Review of Research. University of Liverpool, Department of Nursing, Liverpool. Cuzzell,JZ. (1993) The right way to culture a wound. Am J Nurs 93 (5):48-50. Dealey, C. (2005) The Care of Wounds: a guide for nurses (3rd edn). Oxford: Blackwell Publishing. Donovan, S. (1998) Wound infection and wound swabbing. Prof Nurse 13:757-9 Gou, S. DiPietro, L. (2010) ‘Factors affecting wound healing’, Journal of Dental Research, 89(3), pp. 219-229. Grey, J.E., Enoch, S. and Harding, K.G. (2006) ABC of wound healing: wound assessment. British Medical Journal 332(7536), 285-288. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360405/ [Accessed 26 April 2015]. Hollinworth, H. (2005). The management of patients’ pain in wound care. Nursing Standard 20(7), 65-8. Iglesias, C., Nelson, E., Cullum, N. Torgerson, D. (2004) ‘VenUS I: A randomised controlled trial of two types of bandage for treating venous leg ulcers’, Health Technology Assessment, 8(29), pp. 1-105. Jones, V., Grey, J.E. and Harding, K.G. (2006b) ABC of wound healing: wound dressings. British Medical Journal 332(7544), 777-780. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420733/ [Accessed 26 April 2015]. Kerstein, M. (1994) Overview of wound healing in a moist environment. American Journal of Surgery, 167 (Supp 1a): 25-65 Kiernan,M. (1998) Role of swabbing in wound infection management. Community Nurse 4(6):45-6. Palfreyman, S.J., Nelson, E.A., Lochiel, R. and Michaels, J.A. (2006) Dressings for healing venous leg ulcers (Cochrane Review). The Cochrane Library. Issue 3. John Wiley Sons, Ltd. www.thecochranelibrary.com Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001103.pub2/full [Accessed 26 April 2015]. National Health Service (NHS) (2014a) Venous leg ulcer- Introduction Available at: http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Introduction.aspx [Accessed: 30 April 2015]. National Health Service (NHS) (2014b) Venous leg ulcer- treatment Available at: http://www.nhs.uk/Conditions/Leg-ulcer-venous/Pages/Treatment.aspx [Accessed 30 April 2015]. National Institute for Health and Care Excellence (NICE) (2015) Wound Care Products. London: NICE. NICE (2012) Leg ulcer – venous. Available at: http://cks.nice.org.uk/leg-ulcer-venous [Access 23 April 2015]. NMC (2013) Consent. Nursing and Midwifery Council. Available at: http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/consent/ [Accessed 24 March 2015]. NMC (2015) The Code: Professional standards of practice and behaviour for nurses and midwives. [pdf] London: Nursing and Midwifery Council. Available at: http://www.nmc-uk.org/Documents/NMC-Publications/revised-new-NMC-Code.pdf [Accessed 24 March 2015] O’Meara, S., Cullum, N. Nelson, E. (2009) ‘Compression for venous leg ulcers’, Cochrane Database of Systematic Reviews, 1:CD000265. Doi: 10.1002/14651858.CD0000265.pub2. Robinson, B.J. (2000) The use of a hydrofibre dressing in wound management. Journal of Wound Care 9 (1) 32-34 Rowley, S. and Clare, S. (2011) ‘ANTT: A standard approach to aseptic technique’, Nursing Times, 107(36), pp. 12-14. Scottish Intercollegiate Guidelines Network (SIGN) (2010) Management of chronic venous leg ulcers: A national clinical guidelines. Edinburgh: SIGN. Stander S., Steinhoff M., Schmelz M., Weisshaar E., Metze D and Luger T. (2003) Neurophysiology of pruritus: cutaneous elicitation of itch. Arch Dermatol. 139(11):1463–1470. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14623706[Accessed 23 April 2015] Weiss, E., Oldham, G., Lin, M., Foster, T. and Quinn, J. (2013) ‘Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: A prospective, double-blind, randomised, controlled clinical trial’, BMJ Open, 3(1). Pii: e001504. Doi: 10.1136/bmjopen-2012-001504 Available at: http://bmjopen.bmj.com/content/3/1/e001504.long [Accessed 30 April 2015]. World Health Organisation (2009) WHO Guidelines on Hand Hygiene in Health Care Available at: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf [Accessed 30 April 2015]. World Union of Wound Healing Societies (2004) Principles of best practice: Minimising pain at wound dressing-related procedures. A consensus document. London: MEP Ltd. Available at: http://www.wuwhs.org. [Accessed 26 April 2015].

Facilitating Learning and Assessment in Registered Nurse Practice Essay

In this portfolio I intend to expose the requirement of PP0127 of the process of facilitating learning and develop the skills of assessment as a registered nurse in the clinical practice. Mentoring is a development skill that offers a chance to deliver skill and knowledge by educating new students without any expectations and fears as mention by Huang & Lynch, (1995). I have been in the nursing industry for the past 4 years as a registered nurse. I am working in dialysis unit department as well knows private hospital that has been established for 27 years in Southeast Asia. I has been completed my diploma in nursing in year 2010 as recognized by Malaysia Minister of Government and commenced profession in year 2011. Being one of the senior nurses within my department, I am in charge of orientation of the dialysis department as well as the Environment Safety Health guidelines for the newly employed registered nurse in dialysis unit department. My nurse manager was assigned me to supervise a new registered nurse Miss Rina (pseudonym) in my department. She was graduated from nursing college in year 2013. Rina aged is 21 years old and originated from Malaysia (Appendix 1). Rina is under the mentorship of myself on the track for learning, new skill and establish better practical knowledge of the department. Rina was required to enhance her skills and knowledge in preparation of extracorporeal circuit for hemodialysis (Fresenius machine). A learning contract was also signed by Rina for consent of monitoring assessment (Appendix 2). Identifying Learning Needs, Planning and Managing Students Experiences Honey and Mumford (1992) in their adaptation of Kolb suggested four learning styles which recognized as activist, reflector, theorist and pragmatist in accordance with four-stage learning cycle of having an experience, reflecting on it, drawing applying the lessons learned. Therefore, Rina’s performance was observed prior to the provision of the program period. Rina learns was identified as a reflector learning styles. It is mean reflectors learn through observation, and by thinking about what they have observed, and constructing meaning through the process of the reflection. Specifically, it is expected that at the end of this provision period Rina would be able to: Understand and explain about the procedure Extracorporeal circuit is prepared under aseptic technique Visible air and sterilant are completely removed from the extracorporeal circuit. To provide safe delivery of patients care by ensuring Scope This procedure shall be carried out by clinical staff who have successfully completed the ‘Introduction to Renal Dialysis’ course certified competent Learning outcomes Outline the principles of prepared Extracorporeal circuit Outline the roles and responsibilities of the learner in prepared Extracorporeal circuit Demonstrate competency in prepared Extracorporeal circuit According to Furzard (1995), facilitator is reflected by coaching a learner in positive way to develop the process of teaching in their clinical placement. Mentors are being encouraged to use different way of technique to the learners, so that learners will more crucial and show interest to learn the procedure. It will also make learners to be systematically in the learning process Lister (1990). Fundamentally, as a mentor, I need to apply some theories and principles, to be able to plan and deliver a good lesson for Rina. Therefore, the knowledge will able to meet Rina’s needs and help her to achieve her goals. One of the most powerful theories is Maslow’s hierarchy of basic needs (1962) about motivation (Appendix 3). It is make me understand that my Rina will give up if learning is not take place in the appropriated manner without motivation. Motivation in the work place is important for Rina to achieve her goals. Besides that, physical environment is also important area in facilitating of learning in clinical practice. The process of teaching environment will be arranged in the clinical practice to decrease barriers between mentor and learners (Quinn, 1995). Through these, explanations, discussions and questioning, discussions will be beneficial for Rina to extending her skill and knowledge to perform well in the clinical practice. In these situations both of feel more comfortable and freedom to ask questions and talk openly to clarify the doubts. According to Rogers (1969), the demonstration skills are important within the clinical practice, so that learners will be profession in their skills. I also provided the method of how to prepared the Extracorporeal circuit, and  demonstrate the procedure to Rina. Bloom’s Taxonomy was created in 1956 under the leadership of educational psychologist Dr. Benjamin Bloom in order to promote higher forms of thinking in education, such as analyzing and evaluating, rather than just remembering facts (rote learning). The committee identified three domains of educational activities or learning (cognitive, affective and psychomotor) (Bloom, 1956). This learning helps Rina to develop her knowledge, attitude and skills. According these principles, a learning plan was done in the four weeks’ time (01/01/2014 to 31/01/2014). This is guarantee that appropriate time is provided to Rina to learn and complete the procedure gradually in the due time (Appendix 4). Facilitating Learning and Assessment An orientation program was conducted with Rina to make her feel comfortable and explain the plan about what are the expectations, responsibilities and attitude throughout the assessment. It is helps Rina to reduce her stress and anxiety. As a mentor, I will be providing her more confident and responsible to guide learners to avoid doing errors (Jeffery E.Auerbach). Rina has her basic knowledge on dialysis. Her requirements that she needs to achieved in her provision period was: To provide safe delivery of patients care by ensuring Definition of priming extracorporeal Why extracorporeal prepared under aseptic technique Why visible air and sterilant are completely removed from the extracorporeal circuit Complications if present of sterilant in extracorporeal According to Tomlinson, C. A. (1999), learners are will be act more effectively by visualize, perceiving and feel the sensations while performing procedure. Learners will be learning new things every day and gaining experience in daily activities. Visual learner is a learning style that easy to understand the contents from the aids and organizers. Rina was benefits from visual aid as a visual learner. Therefore, learning subjects like ideas, concepts, data, mind mapping and other information are related with images and techniques were presented via slide show to facilitate Rina’s learning. The teaching methods described by Collins and colleagues in the ‘cognitive apprenticeship model’ (Collins et al. 1989) are highly  specific and designed to foster situated learning and thus can be assumed to enhance learning in clinical practice. Collins et al. (1989) proposed six teaching methods promoting situated learning by helping students to acquire both cognitive and meta-cognitive skills and focus their observation of expert performance in practice so as to facilitate the development of their own problem-solving skills. Additionally, these methods foster the autonomy of students’ learning processes by encouraging students to formulate personal learning goals. In this study we will explore the use of the six teaching methods (modeling, coaching, scaffolding, articulation, reflection, and exploration) of the cognitive apprenticeship model as well as the role of the learning climate. As mention by Albert Bandura, learning is a process of observing people’s attitude and trained to develop learners as a role model in future. Apart from that, learners will be captured by listening and observing of the performance in their clinical practice as a learning point to achieve their goals. Rina’s attitude was identified by visualized and perform the job skills before carried out a task. This learning method was given a positive perception for her because visual learners are expert at observing and perceiving details. During the assessment periods, Rina was required to observe my demonstrations of the procedure, how to prepare the correct technique of preparation of extracorporeal circuit (Appendix 5). The process of learning as a mentor will be develop by understanding and gaining information of the procedure before task has been performed to the learners. Therefore, learners will be more confident and awareness to handle the procedure appropriately. Mentors are inspiring to be attentive to identify learners learning skills before guidance’s are being carried out, therefore difference types of learners has different type of learning skills that are be performed during working environment. Besides that, by observing learners performances through demonstration will be identify their understanding of the procedure. To be an effective mentor, mentors are encouraged to be prepared as a role model to a learner as suggested by Eric Parsloe, (1999). Rina was required to implement the procedure accurately after the demonstrations were given by me. These demonstration practices will be emphasize to develop her skills. It is also encourage and motivate her with adequate knowledge, thought process and supportive environment. Scaffolding has been defined by Wood, Bruner, and Ross (1976) as an â€Å"adult  controlling those elements of the task that are essentially beyond the learner’s capacity, thus permitting him to concentrate upon and complete only those elements that are within his range of competence. This method are supporting as well as providing comfort for Rina throughout the practice training. Learners are encouraged to think critical thinking and to clarify their doubt clearly in their professional as they will be prioritized on their learning practice and speak clearly to understand their needs. These critical thinking process will be enhance challenging for learners to interconnect their learning and procedure as they hands on with real equipment as mention by Chitty, (2001). As a mentor I arranged some questioning section for Rina to stimulating and clear her doubts better understanding. According to Bulman & Schutz (2008), mentor and learners are reflected by experiences one other to evaluated their performance in daily and upcoming practices for improvement. Through reflection, I was identified Rina’s strengths and weaknesses. It will be beneficially for me to make effectively and competently to guide Rina to improve and develop her skills as a professional registered nurse during the training periods. Kolb’s experiential learning theory offers the career counselor a meta-model with which to structure career exploration exercises and ensure a thorough investigation of self and the world of work in a manner that provides the client with an optimal amount of learning and personal development. During the third week of Rina’s training program, Rina was required to assist the senior registered nurse in preparing extracorporeal circuit. By this way encouraging Rina to implement her skills and providing safe deliver care. Rina’s performance was observed by me and another senior registered nurse to determine if she is able to handle and solve problem independently. While assessment, both formative and summative assessment were completely to assess the outcomes of learning skill of Rina. Instantly, competency checklist is important for learners to evaluate their level of understanding of the procedure so that learner will be more conscious on what they have being thought to perform according to the procedure as suggested by Yorke, (2003). Formative assessment is a feedback process of given an opportunity to demonstrate Rina’s learning. It is because to determine me to evaluate her response of the knowledge and skills that she received, and make adjustments i n learning plans for Rina in identifies areas need improvement  (Appendix 6). Through the assessment, Rina will be observed to see whether she successfully complete and was able to perform the required responsibilities by performing correct procedures (Appendix 7). Summative assessment is to finalize the feedback and evidence based of learning for learners to complete their assignments which has been thought in their learning process by Hanna & Dettmer, (2004). Summative assessment is evaluation of Rina at the end of the training program to identify the outcome of the program. By this summative assessment, I know the level of Rina understands about performing the procedure. These assessments include an exam (Appendix 8). That examines to grade Rina’s skill on preparing extracorporeal circuit, as well as her ability in the knowledge. Rina will repeat the assessment that she failed to make sure the important skills and knowledge are required at the end of the training program. Providing Ongoing Support and Guidance The Vygotsky, (1978) suggested that, zones of proximal development (ZPD) are identified that, real development progress by each and individually in their career. Mentor will be encouraging to involved learners to resolve problem solving by independently when learner occurs difficult time so that learner will be have a chance to experiences in their lesson. Besides that it also enhances to be a team work among colleagues and proficient on career. Furthermore, by using these techniques of learning Rina will be developing skills and approach through effective ways. Hereafter, it is comfort for Rina to be more confident to proceed the procedure of preparing extracorporeal circuit without any nervous or anxiety throughout the training and after the provision period also. During the provision period, I and Rina meet twice a week for discuss about the problems that she encounter and need further help to improve herself in performing the procedure. On this meeting time, the things of discussion were recorded as mention above (Appendix 4). Additionally, a senior registered nurse Dolly (pseudonym), with 10 years’ experience in dialysis unit department was assigned as Rina’s co-mentor, for the reason that Rina can look for her assistance when I am not around. In Kimble’s original definition he states that behavioral potentiality in learning occurs as a result of reinforced practice (Olson & Hergenhahn, 2009). Learning is a difficult definition to state because  learning is only observable through behavioral changes. Because learning cannot be observed if there is no change in behavior, the definition must contain and emphasize the need for behavioral change and in the textbook’s definition it stresses the importance of experience but leaves the theorist to specify the kind of experience he deems necessary to his research (Olson & Hergenhahn, 2009). Behavior is a key component when discussing the learning process. Without changes in behavior it is nearly impossible to document or record that learning has taken place. Olson and Hergenhahn claim that, the change, based on the definition given, must also be relatively permanent and must result from experience (2009). Thus, I believe that Rina will be able to learn from Dolly by observing how she performs the procedure by her way. Rina also had some discussion with Dolly to clarify her doubts. Through these Rina can improves her skills and perform well with confident. Furthermore, Dolly and I support and guide Rina in the practice area by assessing, evaluating and give positive feedback whenever she do the mistakes in her procedure to encourage her to achieved the knowledge, skills and to make improvements to promote her progress. This is one the framework to support learning and assessment in practice for Rina. Summary of Personal and Professional Development in Mentorship In the conclusion, I have confidence in that I and Rina have benefited throughout the assessment period. Rina was successfully accomplished her target to developing skills and knowledge in the assessment. According to David A Stoddard (2009), â€Å"mentoring involves helping others to discover and pursue their passions, recognize and deal with their pain and sort out their priorities. More than a sound business practice, mentoring is really a stewardship issue. It’s an opportunity to give of ourselves – our experiences, our expertise, and our gifts- and take advantage of opportunities to help someone be all that they can be.† I understand that mentoring is a challenging process for both of us, me as a mentor and for Rina as a learner to teaching and assessing her throughout the provision period. These mentoring processes identify my strength and weakness to progress my personal and professional development in career. Throughout the assessment period I have extended my knowledge and understand how to become a good mentor and has confident to guide learners in different methods for  my future students. I have also known various assessment and teaching strategies through the aspects of NMC standards. Further that, being a mentor is a good opportunity for me to identify my skills and knowledge in my department. It is helps me to developing my skills and knowledge as mentor role. In future, I as a mentor will be more confident in teaching my learner.

New guideline explores professionalism in nursing Essay

Professionalism in nursing is an essential ingredient in achieving a healthy work environment and is enabled by the context of practice ( Registered Nurse Association of Ontario 2007) In nursing profession recognition by the global and society as the professional group is important due to the higher standard of expectation from the society to the nursing career as a caregiver And being a professional in a nursing career is a key to achieve the target and good quality in services provided to society. Why the professionalism is required to the nursing career this is due to demanding of high quality and standard skill ,knowledge and altruism that putting the patient as the first interest, self sacrifice and the right attitude while dealing with the society or patient as a caregiver., showing and proven of the excellence commitment in lifelong learning to improved their skill and development as during in duty nurses should showing their commitment beyond others and should committed to th e community service and the professional organization. The public has the right to get the professional competence from the nurses who are giving the service to them. from the American Nurses Association 2017 (ANA) believe that it is the nursing profession responsibilities to shape and guided any process for assuring nurses competency. Through the quality measurement, research and learning to become professional nurses need to be skillful in their job scope knowledgeable continue to have continued learning education, providing mentoring to guide and monitoring the work done and following by the code and conduct as a key for safeguarding the health and wellbeing to the public.There are few elements of professionalism listed for the nurses as the nursing career is expected growing faster than the average rate of 19 through 2022 according to Bereu Labor Of Statistic.There are 5 critical professional skills to be adapted (Kristina Ericson 2015)the strong and effective communication between physician and nurses is compulsory to convey the right information to relatives regarding patient condition ,medication and others medical concern.paying intention on report and details of patient which is if mislead will became fatal to the patient, an also being flexible to working schedule also part of professional integrity in nu rsing profession as patient to comes first ,another element is critical thinking ,nurses are able to make crucial decision during the critical time by analyzing and determined the best solution for patient. Nurses are required to update the skill and have the desire to improve knowledge and develop skills continues will bring them to the professionalism in a nursing career.the one and important to develop professionalism in the nursing career is mentoring system Mentoring is a crucial part of the nursing organization as there are many nurses need help and guidance from the skillful and knowledgeable staff. This can contribute to career satisfaction and improvement .majority has reported that nurses are participating in mentorship relation.( Bette Marianni 2012) mentoring is something that both mentor and mentee are willing to share knowledge,emotion and feedback after the carried out duties done,this will give impact in professional management and skills among nurses.Studies done by Bette Mariani 2012 stated that nurses who have the willingness and sense of satisfaction in career will contribute to the growth of the profession. Mentor is define as the person who give a younger or less experienced person help and advice over a period of time. ( Cambridge Advance Learner dictionary and Thesaurus).while Riverside Websters ii New Collage Dictionary1995 define mentor as a wise and trusted teacher or counselor. The mentees describe by Merriam Webster is the one who is being monitored by mentor.Mentoring will give benefit to nurses in term and career success and advancement in personal and pr ofessional satisfaction and develop self-esteem and confidence. (Van Olsen 2002) The professional and personal satisfaction develop while in sharing stories, referencing of the problem and finding the solution by the experienced nurses to the mentees will be become a role modeling to the nursing profession and enhance the quality in leadership ( Vance And Olsen 2002). I believed mentoring one of the best way of achievement in nursing professional skills . . Y, did(x(I_TS1EZBmU/xYy5g/GMGeD3Vqq8K)fw9 xrxwrTZaGy8IjbRcXI u3KGnD1NIBs RuKV.ELM2fiVvlu8zH (W )6-rCSj id DAIqbJx6kASht(QpmcaSlXP1Mh9MVdDAaVBfJP8AVf 6Q

Business Enviroment - 656 Words

Market structures In this part of the report I will explain the different type of market structures I will give advantages and disadvantages for all and how they have direct relationship with pricing and output decisions. Monopoly A monopoly in the market structure controls the industry; it is the one and only business in that industry. The entry barriers are very high a somewhat impossible to get in and out of, they have no competition so can set quite high prices depending on the demand for the product and set government regulations. Advantages for Monopoly is the business can make huge profit but as this would be an advantage for the business this would also be a disadvantage as they have control over pricing they will set high†¦show more content†¦With easy entry and exit of the market there are a lot of businesses selling the same product or service at the same prices, businesses in perfect competition are price takers they have little control over the prices of their product as there are so many small businesses in perfect competition none has control over the industry. Disadvantages for perfect competition in the market is no businesses will have an upper hand on their competition with a lack o f product to choose from they are all selling the same product at the same price. An advantage for perfect competition is that the business will know when the consumer’s demands change from which they can respond to their wishes. Monopolistic competition Monopolistic competition in the market structure has many businesses selling similar but none identical products with free entry into the industry businesses are competing against each other. The businesses in this industry have some control over the prices they charge but with none of the company’s being big enough to make a difference to the prices over the whole industry. Businesses must find themselves quickly in the market to know if they are going to profit or loose from their investment. Advantages for monopolistic competition in the market are with no entry barriers disadvantages for monopolistic competition it because they have some power over the market they can rise or lower their prices. Market structure has a direct relationship withShow MoreRelatedEnviroment of Business1170 Words   |  5 PagesENVIRONMENT OF BUSINESS ASSIGNMENT Describe 6 Forces that Operation Managers go for or look out for in the Environment of their Businesses or Organizations. 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