The Evidence Based Practice Cpd Nursing Essay
The complaint letter suggests that the physiotherapy service in question is falling way below the mark outlined by the Scottish Government and subsequently many clinical governance issues have been raised, four of which have been identified for review.
Complaints Procedure
The initial handling of the situation before the patient had even received an appointment was unacceptable. When the patient wished to complain, the admin staff informed the patient the physiotherapist was on annual leave for two weeks and he could phone back then. This was largely unhelpful and suggests poor practice as only one physiotherapist could handle the situation creating an unnecessary delay.The Evidence Based Practice Cpd Nursing Essay. Best practice would have been for the admin staff to deal with the complaint and to inform the patient of the NHS complaints guidelines allowing the patient to raise their concerns early on. The guidelines suggest that prompt investigation and resolution of the complaint will be at local level, aiming to satisfy the person making the complaint whilst being fair to staff and that the issue should be answered within three working days (NHS inform 2012). Had this procedure been followed, the issue could have been resolved quickly and efficiently, providing the patient a positive experience with the NHS. The patient however will feel as though he has been treated unfairly and is likely to view the NHS as unprofessional as well as developing negative perceptions of physiotherapy before even attending therefore impacting on the treatment. By not allowing the patient to complain it has evoked a negative experience leaving the patient waiting with uncertainty.
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Communication/Waiting Time
A major communication breakdown between the referring GP and the physiotherapy department resulted in the patient being placed on a 16 week waiting list for chronic conditions which is unacceptable. Secondly the patient had to phone to obtain this information two weeks after the initial referral which suggests poor correspondence between the physiotherapy department and the patient. This highlights a lack of communication and ineffective team work whereby staff members are not adhering to standards outlined in the Healthcare Quality Strategy (2010). This policy states that in order for high quality health care services to be obtained in Scotland, staff must be caring and compassionate and clear communication and collaboration between clinicians, patients and others is essential for success, none of which has been shown in this case. When the patient raised his concerns the waiting time was reduced to six weeks. The Evidence Based Practice Cpd Nursing Essay. In relation to this it was highlighted in an audit by the CSP (2012) that there is a lack of awareness amongst commissioners of the amount of time taken to refer patients to a physiotherapist, with 73% unable to provide details. A recent census of 6941 adult physiotherapy patients published by the Information Services Division Scotland (2012) found 56% of patients to be seen for a first appointment within 3 weeks. 3% were seen more than 18 weeks from the referral and the median waiting time for a physiotherapy appointment ranges between 2-5 weeks. There however does not appear to be any information related to waiting list times for urgent appointments for physiotherapy within the NHS suggesting as long as targets are being met, some patients who require urgent appointments may be overlooked and may not receive treatment in an immediate fashion. Overall a lack of communication has resulted in the patient having to wait longer for urgent treatment which could have jeopardised his health and resulted in irreversible damage. An increased wait also limits and alters the type of treatment prescribed by the clinician as the condition has progressed from an acute to chronic stage and treatment will likely be less effective with recovery impeded and this is one of the main concerns of the CSP (2013). This raises safety concerns for the patient and emphasizes he is not receiving the best quality of care.
Professionalism
The initial assessment was disjointed and the patient was left standing in his underpants behind curtains which barely closed suggesting there was a lack of care for the patient’s modesty leaving him feeling angry and embarrassed at times. Poor feedback was given to the patient whereby statements such as “a stiff lumbar spine was likely causing the leg pain” and “the pain was probably postural related”. These statements are not definitive answers and may have lead the patient to question if the practitioner was knowledgeable and skilled enough to be delivering the treatment? Throughout the assessment the patient may have lost respect for the clinician and lost all confidence in the physiotherapy service offered. One of the priorities outlined in the Healthcare Quality Strategy (2010) is that staff members continue to show clinical excellence and it is stated by the National Quality Board (2013) that Individual health care professionals, their ethos, behaviours and actions, are the first line of defence in maintaining quality. The Evidence Based Practice Cpd Nursing Essay. The clinician in question has failed to meet not only government standards but the patient’s expectations with little remorse. As a frontline member of staff the clinician has also shown physiotherapy to be unprofessional and he could be subject to investigation not only from the NHS but from the CSP who state in their code of professional values that members should strive to achieve excellence, take responsibility for their actions, behave ethically and to understand how their actions can impact on the physiotherapy profession (CSP 2013).
Evidence Based Practice/CPD
The National Quality Board (2013) suggests clinical effectiveness is high quality care, delivered according to the best evidence as to what is clinically effective in improving an individual’s health outcomes. The patient suggests being given a booklet to read and some exercises to do which were the same as previously prescribed however he was unable to do so due to pain. This emphasizes a lack of insight from the clinician and begs the question if evidence based practice and guidelines were being followed? The NICE guidelines for Low Back Pain (2009) suggest that all patients whose pain persists for more than six weeks must be offered the menu of three types of evidence based treatment which is: physical activity and exercise; manual therapy and acupuncture. If the clinician had taken the patient’s pain and inability to exercise into account then surely another treatment avenue should have been explored? The clinician’s decision was narrow minded, leaving the patient in the same position where exercise was going to have no beneficial effect. There is a large amount of evidence to support the use of manual therapy and by adhering to continuing professional development (CPD) which is a quality assurance standard of the CSP (2013) and by keeping up to date with current literature the clinician would have been able to make an informed decision based on evidence and knowledge.The Evidence Based Practice Cpd Nursing Essay. In this case the clinician has failed to demonstrate why he has chosen just exercise therapy over other modalities suggesting a lack of clinical reasoning and evidence based practice, subsequently delivering poor quality treatment with no beneficial effect to the patient. The clinician has failed to meet standards set by the Government and the CSP and would be held accountable for his actions in a court of law. The clinician could also come under investigation from the NHS and CSP, potentially facing disciplinary action with the possibility of having his licence to practice revoked (CSP Rules of Professional Conduct 2002).
GOVERNMENT POLICIES
Please see appendix on page ? for a detailed proposal outlined to address the complaint.
Complaints Procedure
CAN I HELP YOU? Learning from comments, concerns and complaints (2005) was a guidance document developed by the NHS outlining their complaints procedure. This document states that NHS Scotland is committed to delivering high quality, patient-focused healthcare and to using the views and experiences of the people who use its services as part of a process of continuous quality improvement. This is backed up by Partnership for Care: Scotland’s Health White Paper (2003) which states that a focus on patients must mean a willingness to learn from situations where things have gone wrong or a patient has not received the level of service or care he or she expected. The Evidence Based Practice Cpd Nursing Essay. They suggest that the design of the complaints procedure should aim to strengthen the response to complaints, increase the focus on handling complaints quickly and ensuring that there is a positive and constructive response to patients and the public and that failure to do so could lead to investigation by NHS Quality Improvement Scotland. By advertising the correct complaints procedure it allows the NHS to gather valuable information of patients’ experience and to learn from their mistakes. This then forms the basis for new procedures to improve the service and to avoid future complaints (Scotland’s Health White Paper: Partnership for care 2003).
Communication/Waiting Time
18 Weeks: The Referral to Treatment Standard (2008) policy highlights that shorter waiting times can lead to earlier diagnosis and improved outcomes; reduce unnecessary worry and uncertainty for patients and that faster access to treatment will allow for a rapid return to work. Stretched to the Limit: an Audit of physiotherapy services in England, CSP (2012) found there was considerable variation uncovered around the amount of time patients were having to wait for referrals with NHS Portsmouth confirming that “new appointments take four weeks and urgent within the week” but NHS West Sussex reported some patients having to wait up to 27 weeks to receive treatment. The CSP is concerned about rising waiting times and the effect this has on patients with chronic conditions as there is increased risk the condition will worsen and recovery impeded. To avoid unnecessary communication breakdowns and increased waiting times it is hypothesised that patients should self-refer to physiotherapy via writing or telephone utilising the NHS24 service. In response to the Independent Budget Review, the CSP (2010) highlighted a few figures worth noting. Self-referral to physiotherapy services provides cost efficiencies of up to £2 million compared to GP referral. In the UK 12.25 million working days are lost due to musculoskeletal disorders and Low back pain is the most common musculoskeletal problem affecting an estimated 18 million people, with associated costs of £5bn each year to the economy due to working days lost. The Evidence Based Practice Cpd Nursing Essay. The Department of Health (2008) state that analysis from pilot sites indicate patient benefits of self-referral to be: high levels of user satisfaction and confidence, a more responsive and attractive service to patients with acute conditions offering them wider access, empowering patients to self-manage their conditions and lower levels of work absence. Service benefits include: no increase in demands for services, greater levels of attendance and completion of treatment, lower NHS costs and the scheme was well accepted and supported by physiotherapists and GPs. The self-referral scheme adheres to the Delivery Plan for AHPs (2012-2015) government policy in that Allied Health Professionals are strongly placed to support self-management and enablement as well as reducing unnecessary hospital referrals and admissions therefore reducing costs. The scheme is sustainable, viewed positively by all parties involved and will allow patients quicker access to treatment. This will avoid waste of resources, improve patient outcomes and allow for quicker returns to work decreasing the amount of sick day’s lost and subsequent costs to the government.
Professionalism
The National Quality Board (2013) emphasizes the NHS constitutions values that guide the behaviours of those who work in the NHS: Respect and dignity, commitment to quality of care, compassion, improving lives, working together for patients and everyone counts. NHS Professionals are required by law to comply with these procedures to ensure that patients are treated with a degree of respect and dignity and that the best quality of care is offered. The code of professional values outlined by the CSP (2013) also state that members should be compassionate and caring, show honesty and integrity, show respect for individual autonomy, strive for excellence and promote what is best for the individual. Delivering compassionate care is at the very heart of clinical values and it is the cornerstone of the mutual NHS which was first described in Better Health, Better Care (2007). It is also outlined in the Healthcare Quality Strategy (2010) that people in Scotland have told the NHS that they want staff to be caring and compassionate, showing clinical excellence and that they want to be seen not as receivers of services but as partners in care. The Evidence Based Practice Cpd Nursing Essay.
Evidence Based Practice/CPD
The NICE guidelines for low back pain (2009) state that treatment and care should take into account patients’ needs and preferences and that people with non-specific low back pain should have the opportunity to make informed decisions about their care and treatment in partnership with their healthcare professionals. Information and advice should be provided to promote self-management of low back pain and that patients should be offered one of three treatment options taking into account patient preference: an exercise program, a course of manual therapy or a course of acupuncture. The use of manual therapy is backed up by Aure et al. (2003) who carried out a randomized controlled trial comparing manual therapy and exercise therapy in patients with low back pain > than 8 weeks. The Evidence Based Practice Cpd Nursing Essay.The results highlighted significant improvements in both groups however manual therapy showed significantly greater improvements in all outcome measures especially return to work where immediately after the 2 month treatment period, 67% in the manual therapy group had returned to work compared with only 27% in the exercise group. This clearly demonstrates the benefits of manual therapy especially when a quick return to work is the desired outcome.
Evidence based practice should be developed through CPD and it is integral to ensure that the patient is receiving treatment which has been shown to work and to be clinically effective. The CSP policy statement on CPD (2007), states that members should continue to develop and enhance skills, knowledge and competence both professionally and personally to improve performance at work, with the purpose being to enhance the quality of the service that patients and clients receive whilst striving for professional excellence and ensuring safety to the public. It is also highlighted that adhering to CPD is obligatory through the rules of professional conduct (CSP 2007).
IMPLEMENTING POLICIES/CHANGES TO PROFESSIONAL PRACTICE
Complaints Procedure
It is highlighted that training of staff, initially through induction, is key to making the NHS complaints procedure work effectively (CAN I HELP YOU? Learning from comments, concerns and complaints 2005). The downside is that training is extremely time consuming and expensive. The Kerr report (2005) states that we need to be realistic about staffing and that the NHS consumes a considerable amount of the Scottish executive budget, as such the NHS has a responsibility to search out best value and take decisions that get the best possible return for every public pound spent. A substantial amount of time and money would need to be invested to retrain frontline members of staff to equip them with the skills to handle initial complaints. One problem which may arise is that if more physiotherapists are handling complaints and paperwork then it may significantly reduce the amount of patient contact time in an already under staffed work force which could reduce the quality of care patients are receiving. The Evidence Based Practice Cpd Nursing Essay.
Communication/Waiting Time
Self-referral to physiotherapy is not a new concept however it is still largely unbeknown to the general public and if not marketed appropriately the service could be underutilised. Having a clear marketing and communications plan is important and at a basic level the service could be marketed through leaflets and posters in GP surgeries. Promotion could also include online media, local media and engaging with local councils and community groups (Musculoskeletal Physiotherapy: patient self-referral, CSP 2012). Another issue is that with self-referral via NHS24 there could be inequity of service, with only those patients with access to a telephone and who are able to communicate clearly over the telephone being able to access the service (Foster et al. 2011). It will undoubtedly take time to adapt the service and it is estimated that implementation would take three months to one year with a three month “run” in period which is recommended by the CSP based on the findings of (Holdsworth 2007). Another barrier to implementation is the perception among physiotherapists that waiting lists and the demand for the service will increase, creating substantially more work for clinicians. It is hypothesised however that following the initial rise, the demand will fall to normal levels after three months (Musculoskeletal Physiotherapy: self-referral, CSP 2012). The Evidence Based Practice Cpd Nursing Essay. If implemented correctly the self-referral scheme via NHS24 would be beneficial to both patients and physiotherapists. It would alter professional practice in that patients would be assessed and treated quicker potentially increasing the variety of treatment options delivered and improving patient outcomes. This is backed up by the concerns of the CSP (2013). Physiotherapists would also be practicing autonomously increasing pressure and their responsibility to the patient for which they would be held accountable (Musculoskeletal Physiotherapy: self-referral, CSP 2012). Physiotherapists would be practicing at a higher level with more responsibility and it means that they would be working to the full extent of their education and experience (Kruger 2010).
Professionalism
Ensuring staff members are acting professionally and providing the highest quality of care will be audited by collecting patient data on their overall experience with the NHS. The issue with carrying out an audit is that they take a long time to collect data and the most frequently cited barrier to successful clinical audits is the failure of organisations to provide sufficient protected time for healthcare teams (NICE 2002). Adequate time is required to plan, select criteria to be reviewed and implement the audit. The failure to follow through audit towards improved practice has often been the result of design problems, lack of senior support and commitment. In both cases healthcare staff rapidly lose their enthusiasm when they are unable to see benefit for their patients from the considerable extra commitment needed to mount a worthwhile audit project (NICE 2002). An individual wanting to implement a clinical audit requires many skills, dedication to the cause and adequate time to achieve results.
In terms of professional practice carrying out a clinical audit allows for physiotherapy career progression. It demonstrates commitment in a particular area of interest and allows physiotherapists to network with more senior clinicians in that field of work (NHS 2013). The Evidence Based Practice Cpd Nursing Essay. By implementing this particular audit, it will uncover which areas of practice are falling below the mark outlined by the Healthcare Quality Strategy (2010) and the CSP code of professional values (2013). It will ensure that physiotherapists are acting professionally and delivering consistent high quality care as well as understanding their responsibility to not only the patient but to the NHS and CSP organisations.
Evidence Based Practice/CPD
Many potential barriers have been identified to achieving change in practice and Grol and Wensing (2004) suggest that Individual professionals need to be informed, motivated and perhaps trained to incorporate the latest evidence into their daily work. A previous study by Cabana et al. (1999) based on a review of 76 studies on barriers to guideline adherence, identified salient factors as lack of awareness, lack of familiarity, lack of agreement, lack of self-efficacy, lack of motivation, and perceived external barriers beyond the control of individuals. Using evidence based practice needs to become habitual and we must start by informing individuals and potentially providing incentives for them to do so. The actual role of healthcare professionals is also expected to cause resistance to change. Many quantitative and qualitative studies have shown that failure to implement evidence involves factors at different levels of the healthcare system including: characteristics of professionals and patients; team functioning; influence of colleagues; organisation of care processes; available time, staff and resources; policymaking and leadership (Grol and Wensing 2004). To implement evidence based practice, clinicians must view the idea positively and be motivated to adopt the change.
By learning to implement evidence based practice, clinicians will learn the skills to understand the principles of EBP, recognise it in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence (Dawes et al 2005). This in turn will allow clinicians to provide the best quality of care based on current, valid and reliable evidence. Clinicians are again working more autonomously and it needs to be exercised responsibly (Herber 2005). The Evidence Based Practice Cpd Nursing Essay. There is a responsibility for clinicians to give accurate diagnosis, prognosis and the best quality of treatment based on their current knowledge and evidence.
Within this assignment I will critically reflect on my clinical knowledge to date and consider my future development needs with a focus on my final management placement and future career as a registered nurse, and using the Gibbs model (appendix 1) as a framework will reflect upon my own learning experiences and achievements to date and write an annotated reflection highlighting my development needs from which I will formulate a Personal Development Plan. This undertaking demonstrates my commitment to the need for continuing professional development in order to enhance my knowledge, skills values and attitude needed for effective nursing practice (NMC Proficiency 4.1) and will address deficits in my knowledge and skills and identify any shortcomings within my own or others practice and help me cope with practice related issues experienced within my previous placements. I have chosen Gibbs reflective model as a basis for reflection as I feel it is easily understood and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, conclusion and reflection upon the experience to consider a solution if the situation arose again (Brooker & Nicol 2003). Gibbs model is useful for less experienced staff or students as it directs you and offers an easy framework to use, which supports the introduction of reflection and the transition from student to practitioner (Pearce, 2003). The Evidence Based Practice Cpd Nursing Essay. It has been advocated that reflective practices are a method of bridging the gap between nursing theory and practice, and as a tool to develop knowledge embedded in practice (Chong 2009). Furthermore in reflecting on the way we deliver care we can identify weaknesses, build on strengths and develop best practice (Johns 1996). However, there are those who are sceptical of the practice and the idea of reflection in nursing is ambiguous and confused and not based on discipline related evidence based research (Gustafsson et al 2007). Some studies however, have shown a positive response from practitioners who have attributed reflective practice to changes in their practice (Paget 2000). In consideration of these views my approach to reflection as a means of recognizing strengths and weaknesses in my learning and practice to enable me to make positive changes to my future practice will be unbiased. Therefore my reflective account will include an open and honest description of what I have gained from the experience. The Evidence Based Practice Cpd Nursing Essay.
In conclusion, my main aim is to enhance my professional development by reflecting upon past education and clinical experience using the Nursing and Midwifery proficiencies as a benchmark. Furthermore by utilizing the reflective model I will not only identify my strengths and weaknesses but also recognize potential opportunities or threats which will enable me to prepare for my future development and alert me to any threats allowing me to overcome any difficulties I may encounter. Teekman (2000), states that throughout the literature it is well emphasized that reflective practice is an effective tool to reduce or eliminate the perceived theory-practice gap. I will therefore endeavour to utilize this exercise to transform my theoretical learning into evidence based practice. By doing this I can substantiate my claim to having knowledge of evidence based care to ensure safe practice (NMC Proficiency 2.5).
Reflective Self-Assessment
Gibbs (1988) model begins with asking the question ‘What happened?’ and asks ‘What were you feeling’. This allows me to give an account of the events that occurred, and in order to add significance to the narrative I will relay my feelings about the event directly after explanation about the incident.
During the course of my placement whilst working in an acute psychiatric in-patient ward I was delegated some responsibility for particular patients by senior members of staff. In addition I was often allowed to facilitate both group and one-to-one sessions supervised by a trained member of staff. However, due to other demands within the ward environment staff were often unable to run the groups and one-to-one sessions with the patients could often be time limited.
However, on one particular day I was approached by a patient for whose care I was given responsibility He appeared very agitated and complained that over the previous few days he had become frustrated by the lack of attention he was been receiving from nursing care staff the lack of information he was being given in respect of his care. He also complained that he had been informed that he would have regular access to therapeutic groups and this was not happening. This patient had show a keenness to participate fully in his care to facilitate a quick recovery and discharge from the ward
I was aware that staff had been busy but felt uneasy at his distress and afraid to tell him that staff had been too busy therefore unable to run the groups. In addition I did not feel confident enough to explain his treatment plan. I was quite annoyed though that he had not been consulted or involved in this previously, therefore I consulted with his named nurse voicing my concerns and asked if she could alleviate his concerns. The Evidence Based Practice Cpd Nursing Essay. (NMC Proficiency 2.6) was achieved by my articulating my own emotional and psychological responses to situations with colleagues in a professional manner. By also being aware of my own limitations at the time I achieved (NMC proficiency 1.1) by expressing my concerns for this particular patient. The nurse took him into a quiet room and in my presence explained the situation to him apologising for the apparent lack of attention he had received. She assured him that the therapeutic group would be commencing later that day and allowed him to vent his feelings and concerns about his care and anxieties about his illness. She reviewed his plan of care with him taking account of his wishes and desired outcomes. On listening to how she handled the session, I felt quite inadequate afterwards thinking I should have been able to deal with the situation as I was competent at formulating care plans.
Following the session I decided to approach my mentor to ask to discuss the situation and we agreed that I would take the time to read through the Integrated Care Pathway of each patient under my care and become familiar with their use by suggested I attend and participate in multi-disciplinary meetings. By recognising this I was adhering to the code of professional conduct (NMC) 2008, to consult with a colleague when appropriate and work within the limits of my competence. Moreover, I achieved (NMC Proficiency 4.1) by demonstrating a commitment to the need for continuing professional development and personal supervision activities.
In addition a multi-disciplinary meeting was arranged for the patient and his father and my mentor allowed me to co-ordinate this and provide feedback on his progress in order that I gain experience in multidisciplinary working.The Evidence Based Practice Cpd Nursing Essay. Prior to the meeting I scrutinized his ICP to familiarise myself with his situation and plan of care to enable me to identify his needs and achieved (NMC Proficiency 2.2) by providing relevant and current health information to the patient during the meeting. Rees et al, (2004) informs us that ICP’s are tools which map out the pathway of clinical events and activities for all professionals involved in a specific patient group. The ICP helped clarify my roles and responsibilities as well as improve team working and communication. This enabled me to become more informed and also provide the patient with information on his plan of care which would be carried out throughout his journey from admission to discharge
In attendance at the meeting were the Consultant Psychiatrist, Named Nurse, Pharmacist, Community Psychiatric Nurse, Occupational Therapist and myself. I provided feedback on the patient’s progress to the Consultant Psychiatrist and other team members, and highlighted the patient’s concerns about his treatment demonstrating (NMC proficiency 3.2) by working collaboratively with multi-disciplinary team members to enable the delivery of effective patient care, prior to the patient and his father attending. This provided the Consultant Psychiatrist with an overview of the patient’s mental health and progress to date. The patient and his father were then invited to attend the meeting the patient was given the opportunity to tell the Consultant Psychiatrist how he was feeling and discuss any issues he may have. He was also given the opportunity to talk about his prescribed medication and ask questions which were answered both by the doctor and pharmacist. The pharmacist also gave some advice about his present dose of prescribed medication making suggestions to the doctor about possible changes due to a complaint by the patient that he was experiencing stiffness in his legs. Despite being aware that I had the necessary information about the patients care, on occasion during feedback to the team I looked to my mentor to reassure me that the information I was imparting was accurate. The patient was allowed to discuss his involvement in therapeutic groups he had attended and their benefits. The Evidence Based Practice Cpd Nursing Essay.The patient’s father was also given the opportunity to ask any questions and voice any concerns he may have. Discussion between me, the consultant and patient provided clearer picture of the situation I and felt more at ease having further clarified the process of his care would be while on the ward. I felt more confident and satisfied that the patient was now more at ease and satisfied with his present care and was able to meet (NMC proficiency 2.4) by updating the patients plan of care following the meeting.
The next stage Evaluation Gibbs model ‘making sense of the situation’ and asks ‘What was good or bad’. I was pleased to see a positive outcome which was due to inclusion of the patient in his plan of care and collaboration within the multidisciplinary team meeting which alleviate the patient’s concerns. I was not happy at my own lack of confidence to initially deal with the client’s concerns and the fact that the patient had to complain before being fully involved in his care. Having this awareness of my own emotions and of weaknesses in my practice and consulting with the patient’s named nurse assures me that I am managing myself, my practice and that recognizing my own abilities and limitations (NMC Proficiency 1.1) and resolving this by taking action to improve in this area of practice.
In conclusion, stage five of the Gibbs (1988) model, I feel the more experience I gain in the ward environment and more I learn about ICP’s I can improve patients quality of care and collaborating with other members of the multidisciplinary team I will gain knowledge and confidence to enable me to take that step from being a student to becoming a confident registered nurse and deal complex situations such as described above. The Evidence Based Practice Cpd Nursing Essay.
In the final stage of Gibbs reflective model the question is asked ‘If the situation arose what would I do?’ I will continue to utilize reflective practice to improve on my knowledge and skills and develop my Personal Development Plan to highlight gaps in my knowledge. I will use my personal development plan within my final placement to address my weakness and build on my strengths whilst seeking opportunities for further development taking account of any threats.
Personal Development Plan
I have chosen two areas which I feel are relevant to my future development needs namely Quality Assurance and Multidisciplinary/Agency team working. I will now take each area of developmental need and produce a personal development plan for each.
What is it?
NES (2007) explains that a personal development plan is another name for a plan of action which allows you to set personal goals and identify the best way to achieve them. I feel having a plan of action plan will keep me focussed on my learning objectives and allow me to keep track of my development as I progress in my career as a mental health nurse. In doing this I will continue to meet (NMC proficiency 4.2) by being a good role model, sharing my knowledge and experience with my colleagues to enhance their professional development.
How is it important?
One the recent requirements by the NHS is that all staff working in the NHS should have a professional development plan to ensure that staff continue their professional development and update their knowledge and skills (Kenworthy e al, 2001). In adhering to this I will be accomplishing (NMC proficiency 4.2). Department of Health (2004) state that it should prepare the individual to meet the requirements of their post, including the future interests of both the organization and the individual maintaining a balance between them to enable progression. This will be important when I am a registered nurse and there will be commitment to meet the requirements of my role. The Evidence Based Practice Cpd Nursing Essay.
What are my objectives?
Although both long and short term goals will be reviewed as your life moves forward, they guide you in making day-to-day more effectively (Ellis & Hartlet, 2004). Furthermore, it is important to keep goals flexible and be willing to consider alternative goals and a variety of pathways to one goal.
Short-Term Goals
By setting my short-term goals in two development areas I will enhance my knowledge of both Integrated Care Pathways and Multidisciplinary/Agency working and be more proactive in taking responsibility for specific leadership roles within the multidisciplinary team, as well as initiating individual Integrated Care Pathways. Consequently, in taking a leadership role, I will have accomplished (NMC proficiency 3.3) by delegating duties within the level of my responsibilities and taking responsibility for managing patient Integrated Care Pathways.
More specifically I will identify my short-term objectives within the 2 areas:
Integrated Care Pathways -By the end of my management placement I will have a better understanding of Integrated Care Pathways. I will have completed an ICP document for a specific patient, which will enable me to guide the patient through the nursing process from assessment to discharge competently and confidently. Lastly, I will have learned the concept of variances used to measure the quality of patient care.
Multidisciplinary/Agency working – within my management placement, I will have acquired good knowledge of multidisciplinary/Agency working and be able to competently participate in multi-disciplinary meetings. I will be competent in facilitating multidisciplinary team meetings and have the ability to effectively communicate with members of the multi-disciplinary team. Finally I will have knowledge of any barriers to multi-disciplinary working. The Evidence Based Practice Cpd Nursing Essay.
Medium and Long-term Goals
I will meet both Medium Term and Long Term Goals by procuring employment within a nursing profession (preferably with the National Health Service), and once accomplished my aims will be to develop my practice from a novice practitioner and become an accomplished expert knowledgeable practitioner fulfilling the requirements of my job profile within the Knowledge and Skills Framework. By participating in continuous professional development, achieved by setting objectives within my Personal Development Plan I will have met all (NMC proficiencies) as I will have attained my NMC registration.
How am I going to meet my objectives and why?
Objectives are short-term, direct and rapidly testable (Kerry, 2002). In practice, objectives must be specific and often state the new ability that the learner is seeking to acquire for instance, new knowledge, a practical skill or an attitude. My short-term objectives are to address my weaknesses within both my development areas and this can be achieved by setting these as a priority and focussing on these within my next practice placement. In order for me to meet my objectives within my personal development plan I will arrange regular review with my mentor to gain feedback from supervision and to review my learning contract to see how I am progressing.
Integrated Care Pathways
Through self-directed study and utilising all resources within the ward I hope to enhance my knowledge on integrated care pathways and how it is implemented within the ward setting to improve quality of care for patients. Scottish Executive (2003) highlights that under the new mental health act any treatment given to patients should include meaningful involvement by the patient and carers. Furthermore by being involved in all aspects of the nursing process from assessment to discharge I aim to be more involved in the patient’s journey through the integrated care pathway and empower the patient to participate throughout their journey on the ward.The Evidence Based Practice Cpd Nursing Essay. A well as this, by having responsibility for my own case load I will be able to improve my confidence and be more assertive in making clinical judgements and my decision making skills. I will continue to ensure that my practice is evidence based by continually updated my theoretical knowledge by self-study utilizing relevant academic literature.
Multi-disciplinary/Agency Working
My aim is to improve my collaborative working skills by interacting with other members of the team and identifying what skills each member brings to the team to meet the patients needs. Beer, et al (2008) states that multi-disciplinary teams can be effective if there is good communication between themselves and other teams and shared goals. I aim to participate in multi-disciplinary team meetings and give feedback on my patients’ progress to enable me improve my communication skills, and also participate in joint working with all members of the team on the ward on a daily basis to enable me to become more assertive and a productive team member. It will be important to ensure that the patient is also involved in decisions that affect them. In addition to joint consultation between the multidisciplinary team I am aware of the importance in involvement of the patient in their care for example, by involving them in the process of single shared assessment and care planning. Claire & Cox (2003) highlight the importance of those providing services to explore the experiences, preferences and opinions of service users when assessing their health and social care needs. Finally, Regular consultation with my mentor will assist me in identifying my strengths and area’s which he/she may feel I need to develop in with regards to collaborative working. The Evidence Based Practice Cpd Nursing Essay.
My Future Development Needs
Area of development for Integrated Care Pathways
The purpose of Integrated Care Pathways has been defined in various ways within the literature. Quality Improvement Scotland (2007) highlights the quality assurance aspect indicating that ICP standards will support service improvements in relation to the process of care and outcomes for individuals. It also specifies the patient’s anticipated clinical care pathway and co-ordinates necessary tasks in management of patient care (Chew et al 2007). No matter how it is defined, the outcome for the patient is to improve their quality care through managing the process of care appropriately.
The purpose of Integrated Care Pathways has been defined in different ways within the literature. Caring for patients is an essential part of the nurse’s work, and the quality of the care can be dependent on how far the nurse has come, in his/her professional development (Gustafsson, 2004). My experience of Integrated Care Pathways during my training has been limited; therefore I require improving my knowledge and skills in undertaking and documenting a comprehensive, systematic and accurate nursing assessment of physical, psychological, social and spiritual needs of patients. This will entail further enhancing my knowledge within the requirements of (NMC proficiency 2.3) as part of my development needs. ICP’s have not been implemented within any of my placements in the community or long term ward settings. However, an Integrated Pathway for admission and discharge has been employed within an acute ward setting where I was placed. This has been implemented to standardize practice across every psychiatric admission ward within Lanarkshire (Kent & Chalmers 2006), and to facilitate better co-ordination of discharge planning and facilitate continuity of treatment in the community (NHS Lanarkshire 2007). Quality Improvement Scotland (2007) highlights the quality assurance aspect indicating that ICP standards will support service improvements in relation to the process or care and outcomes for individuals.
Area of development for Multi-Disciplinary Working
Multidisciplinary working is the cornerstone of caring for patients within both a community and hospital setting. I have observed multi-professional collaboration and this seemed a very effective way of providing the best treatment available for patients. Cook et al (2001) identified from several studies that team working enhanced communication channels between different professionals resulting in better co-ordination of care, more timely access to services, and the provision of a more holistic approach to care. The Evidence Based Practice Cpd Nursing Essay. This was my experience when I was involved in the Multi-disciplinary meeting within the acute admission ward. Decision making within the team was enhanced by involvement of the nursing, medical, pharmacist, client and carer which resulted in a more holistic approach to the patient’s care thus improving the quality of care provided. This enabled me to accomplish (NMC proficiency 2.8) by demonstrating that by effective collaboration with the multidisciplinary team I was able to adapt the patients nursing care plan to meet his individual need. However, I am aware that I have had limited experience of working autonomously within the multidisciplinary team and intend to take the opportunity as a management student with delegated responsibility to enhance my knowledge and experience of joint working. In particular I will ensure that I take a lead role in multidisciplinary review meetings as a named nurse. However, I will ensure that I have adequate supervision from my mentor and other senior nursing staff to enable me to perform the role to the level of my responsibilities.
Evaluation
Weaver (2008) states that SWOT is an effective tool for reflection of a person’s values, interests, priorities and effectiveness of their practice by means of self-evaluation. It has also been identified as an effective way of recognizing an individual’s strengths and weaknesses, and examining the opportunities and threats that a person encounters (Pearce 2007). This therefore is an effective tool to evaluate a Personal Development Plan. Makinson (2001) highlights that by preparing a personal SWOT it helps to identify and analyse the current situation, the relevant features, circumstances and resources applicable to a personal development plan. The Evidence Based Practice Cpd Nursing Essay.
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Amar (2003) suggests that the outcomes of learning and the process of learning can be evaluated by identifying learning needs using questionnaires, clinical audit, and patient satisfaction questionnaires. Rucker (2003) stresses the importance of timely feedback as a requisite for effective professional development. For both development areas namely Integrated Care Pathways and Multidisciplinary working I will utilize feedback from my mentor within the ward. However (Mumford 1998) highlights that although a mentor can enhance the acquisition of knowledge this will be dependent on their own level of knowledge. I will therefore supplement this by utilizing the knowledge base of other members of staff I encounter within my next placement area achieving (NMC proficiency 4.1 and 4.2) by sharing my knowledge and experience and identifying any deficiencies in my practice and seeking guidance on this. The Evidence Based Practice Cpd Nursing Essay. This would be achieved by ensuring that my NMC learning objectives were achieved and by ensuring that my mentor was aware of the Personal Developed Plan in (Appendix 3). I will also utilize verbal feedback from the patient as I would be limited in respect of using questionnaires due my student status, time limitations and possible ethical issues. However, in the long term I would hope to utilize this method as a qualified practitioner to ensure that I was achieving my objectives with regard to the quality of patient care. I will also continue to utilize self-reflection as a means of improving my practice ensuring that I continue to set continuous achievable goals using the SMART framework.
Annotation List
4.1 By the development of a personal development plan I identified weaknesses in my practice and demonstrated a commitment to the need for continuing professional development.
2.5 By linking theory to practice and reflecting on my own practice has enabled me develop my skills and evidence base to ensure I carry out safe practice with my patients.
2.6 Consulting with the patient’s named nurse about my concerns demonstrated that I identified and articulated my own emotional and psychological responses to situations with colleagues in a professional manner.
Recognising my own abilities and limitations by carrying out practice in accordance
with the code of professional conduct and consulting with a registered nurse when I
felt the patient was not receiving the best quality of care.
2.2 By scrutinizing the patient’s ICP I was able to promote his health and well being throughout the meeting.
2.4 By updating the patient’s plan of care accordingly I had established priorities of care in partnership with the patient within the framework of informed consent.
3.2 demonstrated knowledge of effective inter-professional working by participation in the multi-disciplinary meeting presenting feedback on the patient’s health status. The Evidence Based Practice Cpd Nursing Essay.
4.2 By sharing my knowledge and skills with my colleagues and utilising my personal development plan to contribute to a climate conducive to learning.
3.3 By taking on a leadership role within my management placement, having responsibility for my own case load, I will be able to delegate duties to others, as appropriate, ensuring they are supervised and monitored.
2.3 By utilising the ICPs within the acute setting I was placed I was able to identify the physical, psychological, social and spiritual needs of the patient, document clinical data and take appropriate action.
2.8 By participating in the multi-disciplinary meeting I demonstrated sound clinical judgement and was able to adapt nursing care to meet the patient’s individual needs. The Evidence Based Practice Cpd Nursing Essay.
