Critical Representation on current scientific knowledge and development

Within this task I am going to critically reflect on my scientific knowledge at this point and consider my future development needs with a give attention to my final management placement and future profession as a rn. I've chosen two areas that i feel are relevant to my future development needs namely Quality Confidence and Multidisciplinary/Firm team working and using the Gibbs model (fig. 1)as a construction will reflect upon my own learning experience and achievements thus far and write an annotated representation highlighting my development needs that I'll formulate a Personal Development Plan. This undertaking demonstrates my determination to the need for carrying on professional development to be able to enhance my knowledge, skills worth and attitude needed for effective nursing practice (proficiency 4. 1) and will address deficits in my knowledge and skills and identify any shortcomings in my own or others practice and help me deal with repetition related issues experienced within my previous placements. I've chosen Gibbs reflective model as a basis for representation as I feel it is easily comprehended and encourages a definite description of the problem, analysis of feelings, evaluation of the experience, conclusion and representation upon the experience to look at a solution if the situation arose again (Brooker & Nicol 2003). It has been advocated that reflective methods are a method of bridging the distance between nursing theory and practice, so that as a tool to build up knowledge embedded used (Chong 2009). Furthermore in reflecting along the way we deliver health care we can identify weaknesses, build on advantages and develop best practice (Myser et al 1995, Johns 1996). However, there are those who are sceptical of the practice and the thought of reflection in nursing is ambiguous and puzzled and not based on discipline related research structured research (Gustafsson et al (2007). Some studies however, have shown a good response from experts who have attributed reflective practice to changes in their practice (Paget 2000, Cooke & Matarasso (2005). In awareness of the views my method of reflection as a way of recognizing advantages and weaknesses in my learning and practice to permit me to make positive changes to my future practice will be unbiased. Therefore my reflective consideration includes an available and honest explanation of what I've gained from the experience

In finish, my primary goal is to improve my professional development by reflecting after past education and specialized medical experience using the Nursing and Midwifery proficiencies as a standard. Furthermore by utilizing the reflective model I am going to not only identify my strengths and weaknesses but also acknowledge potential opportunities or dangers which will allow me to get ready for my future development and warn me to any hazards allowing me to overcome any difficulties I may face. Teekman (2000), expresses that throughout the literature it is well emphasized that reflective practice is a powerful tool to lessen or eliminate the perceived theory-practice space. I am going to therefore endeavour to work with this exercise to transform my theoretical learning into facts based practice. By doing this I can substantiate my promise to having knowledge of evidence based treatment to ensure safe practice (Skills 2. 5)

Gibbs Reflective Cycle


What took place?

Action plan

If it arose again what

would you are doing?


What were you

thinking and feeling?


What else could you

have done?


What was good and

bad about the



What sense ca


you make of the


Fig. 1


Gibbs (1988) model starts with asking the question 'What happened?' and asks 'What were you feeling'. This allows me to give a merchant account of the occurrences that happened, and to be able to add significance to the narrative I am going to relay my emotions about the event directly after description about the incident.

During the span of my placement whilst employed in an acute psychiatric in-patient I had been delegated some responsibility for particular patients by mature members of personnel. In addition I used to be often allowed to help in both group and one-to-one consultations supervised by a trained member of staff. However, scheduled to other needs within the ward environment staff were often unable to run the categories and one-to-one sessions with the patients could often be time limited.

However, using one particular day I used to be approached by a patient for whose attention I was given responsibility He made an appearance very agitated and complained that over the previous few days he previously become annoyed by having less attention he was been getting from nursing care staff the lack of information he was being given in respect of his care and attention. He also complained that he had been enlightened that he'd have regular access to therapeutic groups which was not going on. This patient experienced show a keenness to get involved fully in his health care to facilitate a quick recovery and discharge from the ward

I was aware that personnel had been occupied but sensed uneasy at his distress and afraid to tell him that staff had been too occupied therefore struggling to run the communities. In addition I did so not feel positive enough to describe his treatment solution. I had been quite annoyed though that he previously not been consulted or involved with this previously, therefore I consulted along with his named nurse voicing my concerns and asked if she could lessen his concerns. (NMC Skills 2. 6) was achieved by my articulating my own emotional and mental health responses to situations with acquaintances in a professional manner. By also being conscious of my own constraints at the time I achieved (NMC skills 1. 1). The nurse took him into a noiseless room and in my presence explained the problem to him apologising for the noticeable lack of attention he previously received. She promised him that the restorative group would be commencing later that day and allowed him to vent his thoughts and concerns about his care and attention and anxieties about his health issues. She reviewed his plan of health care with him taking account of his desires and desired benefits. On listening to how she managed the period, I experienced quite inadequate afterwards thinking I will have been able to deal with the situation when i was efficient at formulating care ideas.

Following the time I decided to approach my mentor to ask to go over the problem and we agreed that I'd take the time to read through the Integrated Care Pathway of every patient under my attention and become acquainted with their use by recommended I show up at and participate in multi-disciplinary meetings. By recognising this I was adhering to the code of professional do (NMC) 2008, to consult with a colleague when appropriate and work within the limits of my competence. In addition, I achieved (NMC Skills 4. 1) by demonstrating a committed action to the need for carrying on professional development and personal guidance activities.

In addition a multi-disciplinary conference was organized for the individual and his dad and my coach allowed me to co-ordinate this and offer reviews on his progress to ensure that I gain experience in multidisciplinary working. Prior to the getting together with I scrutinized his ICP to familiarise myself along with his situation and plan of attention to permit 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 scientific occurrences and activities for all professionals involved with a specific patient group. The ICP helped clarify my functions and obligations as well as improve team working and communication. This enabled me to be more up to date and provide the individual with information on his plan of good care which would be carried out throughout his journey from entrance to discharge

In attendance at the reaching were the Advisor Psychiatrist, Called Nurse, Pharmacist, Community Psychiatric Nurse, Occupational Therapist and myself. I provided opinions on the patient's improvement to the Consultant Psychiatrist and other associates, and highlighted the patient's concerns about his treatment demonstrating (NMC proficiency 3. 2)by working collaboratively with multi-disciplinary associates to allow the delivery of effective patient care, before the patient and his daddy participating. This provided the Expert Psychiatrist with a synopsis of the patient's mental health insurance and progress as of yet. The individual and his father were then invited to wait the meeting the individual was given the opportunity to tell the Specialist Psychiatrist how he was feeling and discuss any issues he might have. He was also given the opportunity to talk about his recommended medication and have questions that have been replied both by the doctor and pharmacist. The pharmacist also gave some advice about his present dose of recommended medication making suggestions to the physician about possible changes credited to a complaint by the patient that he was experiencing tightness in his thighs. The individual was permitted to discuss his engagement in therapeutic teams he had attended and their benefits. The patient's father was also given the chance to ask any questions and tone of voice any concerns he might have. Dialogue between me, the advisor and patient provided clearer picture of the situation I and experienced more relaxed having further clarified the procedure of his care would be while on the ward. I noticed more confident and satisfied that the individual was now more at ease and content with his present care and attention and could meet (NMC proficiency 2. 4) by upgrading the patients plan of health care following the meeting.

The next level Evaluation Gibbs model 'making sense of the situation' and asks 'What was good or bad'. I used to be pleased to see a positive outcome that was due to addition of the patient in his plan of care and cooperation within the multidisciplinary team meeting which reduce the patient's concerns. I had not been happy at my own lack of confidence to at first package with the client's concerns and the fact that the patient had to complain before being fully involved with his care and attention. Having this awareness of my own thoughts and of weaknesses in my own practice and seeing the patient's named nurse guarantees me that I am taking care of myself, my practice which recognizing my own abilities and constraints (NMC Skills 1. 1) and resolving this by firmly taking action to boost in this area of practice.

In conclusion, level five of the Gibbs (1988) model, I feel the greater experience I gain in the ward environment and more I learn about ICP's I can improve patients quality of attention and collaborating with other participants of the multidisciplinary team I am going to gain knowledge and self-assurance to enable me for taking that step from being truly a student to becoming a confident rn and deal complex situations such as referred to above.

In the ultimate 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 boost on my knowledge and skills and develop my own Development Intend to highlight gaps in my knowledge. I am going to use my own development plan in my final placement to handle my weakness and build on my advantages whilst seeking opportunities for even more development taking account of any dangers.


I have used both main areas in my recent practice where I have identified both strengths and weaknesses. Although multidisciplinary working and the quality assurance tool Integrated Care and attention Pathways are interlinked they'll be discussed separately to keep up coherence and help in different Personal Development Plans.

I will therefore start by discussing Integrated Care Pathways as an excellent assurance strategy, what I have learned thus far, highlighting my development need, and just why this is important to my practice.

Integrated Treatment Pathways

Evidence Based Rationale

My connection with Integrated Good care Pathways during my training has been limited, therefore I require to boost my knowledge and involvement in undertaking and documenting a comprehensive, systematic and exact nursing assessment of physical, mental, social and spiritual needs of patients. It is necessary therefore require to help expand boost my knowledge and the requirements of (NMC skills 2. 3) within my development needs. ICP's havent been implemented within any of my placements locally or long term ward settings. However, a built-in Pathway for admission and release has been carried out within an serious ward setting where I was placed. This has been put in place to standardize practice across every psychiatric admission ward within Lanarkshire (Kent & Chalmers 2006), and also to help better co-ordination of discharge planning and help continuity of treatment locally (NHS Lanarkshire 2007). The purpose of Integrated Health care Pathways has been described in several ways within the literature. Quality Benchmarks Scotland (2007) highlights the product quality confidence aspect indicating that ICP standards will support service improvements with regards to the procedure or health care and outcomes for individuals.



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