When a nurse graduate takes his/her first placement, the transition poses a number of challenging tasks. Research shows, the burden of the transition shock is so high that less than 50% of practicing nurse will recommend anybody to take nursing as career and less than 25% will actively discourage others to take nursing as their career or profession in future. It will not surprise the readers that 30-60% of the new recruited nurses plan to leave their job or change the profession within first year of practice(Michalec, 2013). The above figure indicate towards an ever prolonged issue of transition shock which act as a shock for aspiring nursing graduates and also policy makes and health care institutions. High turn outs due to challenges faced during transition is a preventable issue, yet it is still haunting freshly graduated nurses during their initial placement(Penbrant et al, 2013). The present article will present a critical reflection on graduate learning and how it might help in future placement. As per ANMC it is prime role of a nurse to provide best care, take accountability of actions and must be professionally competent. Research suggests reflection in nursing practice provides a platform to meet these guidelines which justifies the article. The main objective of this article is to provide a critical reflection on graduation studies and how it is going to help in our future practice and how challenges will be faced based upon such study.
I was enrolled in mental health program which is a three year study course. The essay addresses different management issues faced during the graduation study and will discuss how the knowledge and skills gained during the three year study will help in future as a practice nurse. During my graduation study, in the first year I was placed in an acute ward, then moved to a rehabilitation unit, community hospital addressing disability children health issues, and last placement was in a mental health unit where I am privileged to interact with geriatric mental patients. All though from each and every placement I got real time issues and faced with difficulty, the last placement was an eye opener which eradicated age long misconceptions and doubts. The problems faced during the placement were not getting enough support from my seniors or other nurses in the ward. I assume this was the hurdle which prevented me understanding the underlying problems in different units and problems of patients too. According to Reeve et al(2013) , students (second degree) must be helped by their educators in order to develop positive coping strategy. Educators have the potential to provide the best platform to their students which will help them in understanding the rigor of the profession. Thus, I hope if I would have been helped by my peers and seniors my understanding of real problems would have been much easier. The second issue faced during my first year placement was incorrect use of terminology in my hand over and notes. Nursing handover and notes are very important for maintenance of safety of patient. These are basic parts of nursing communication which improves safety, and ensure continuum of care. The communication during that period was poor due to my poor understanding of problem as a whole. Due to poor in communication skills in real time, I failed to manage things properly and ended with scolding from seniors and staff nurse. Research suggests initial discouragement and harassment leads to negative impression and perception by the students which can eventually lead to leaving the profession(Dawson et al, 2014). The support from staff and seniors are extremely essential for a novice to withstand such high pressure. Although, very less support was there during my initial days, I did some research into communication after second year of course. The main reason was supportive teaching and helping staff. With the support from my friends and peers, I was able to apply communication strategy learnt during second year. In the meantime, the college arranged a six day simulation program for improving therapeutic relationship with patient. As per my view, this was the turning point which fine-tuned my communication skills. In a recent research carried out by Ramm, Thomson and Jackson (2015), conducted an open ended survey to find out the effect of students involved in peer teaching and assessing method. The research found positive response from students as well as facilitators and it concluded peer teaching and assessment principles can help nursing students in preparation for their future role. This supports inclusion of simulation in nursing course which helps in increasing the confidence of novice nurses. Simulation programs not only helps to improve communication skills by erasing fear and building confidence but also it prepares final year nurse students to get prepared for their future roles. In 2014, Liaw et al conducted a significant evaluation study where they evaluated a simulated professional learning environment (SIMPLE) among 94 final year students. The study reported significant improvement by the graduate nursing students for future practice nurses. This supports simulation based educational process helps in preparing novice or beginners to practice in a real time environment. During my simulation classes of second year, practicing nurses from different domain participate interactively in passing practical knowledge to students. This was also supported by the research study carried out by Liaw et al.
Similar to the above research, another study conducted by Foronda et al in 2014 suggested simulation based exercise helps in preventing anxiety among student nurse and improvement in communication skills. The simulation exercise gave students how to communicate with the patient, what information needs to be retrieved in what manner, and what to recommend to physicians before physicians recommend or administer medications. Therefore, research suggests simulation based class room study gives much confidence to students as they tend to learn things in a virtual clinical scenario.
Applying research into practice helped me a lot during my placement sessions in second and third year.
The placement during first year was full of mistakes, but later it improved by relating theory and skills learned to practice. The theories learned if applied with analysis can give better insight into a problem. Thus, after first half of first year I was no more a novice rather I gained much knowledge on communication and management. The second year placement was in a mental health unit where dementia patients are treated. It gave me a platform where my thought process changed and gained momentum which made me more confident in my field. Working in this setting gave me more exposure and showed different aspects of nursing. I was experiencing an improvement in my personal and professional skills where I was able to tailor interventions as per patient needs. The planning skill which was lacking during my initial year of placement was improved by that time. I was planning shifts, dealing with mental patients with improved communication (Brown, Stevens and Kermode, 2012).
I was assigned a depressed patient from business sector. Although I was working under supervision at that time, with slow and steady communication I came to know due to some internal issues, the client left which made his business shut down. In order to improve his depression sessions I planned to open angel investor account and gave him few ideas how he can start fresh. As we were taught about holistic approach, I thought to give the learned skill a try. I asked one of my senior to arrange a session with the pastor and the client felt very happy. Although I was not aware of the fact, this has been well documented under emotional intelligence of nurse. As per Freshwater and Stickley( 2004), emotional intelligence is yet to be put into the curriculum which has the power to translate the nursing education. In 2013, Boswell and group carried out a retrospective study on journal entry about student’s interest towards spirituality. They found students embraced spirituality with positive sense during their study and if it is included in the study curriculum it can help them while treating patients in future (Beauvias et al, 2011). Thus holistic approach was found to be perfect and it gave positive results.
Thus reflecting upon graduation study while transitioning towards professional nursing, many internal and external hurdles came into limelight. The current education system is insufficient to meet the need of nursing students especially in terms of help and support. The challenges faced during study also revealed the gap between theory and practice which will affect nursing skills as a fresh graduate nurse and might put health care safety in a problematic situation. Nevertheless, when students learn through simulation it enhances their confidence and motivates them to apply the learned skills or theories in practice. Similarly, not everything can be taught through curriculum study, students have to do through research while studying their course curriculum. Studying evidence based literature will help students to address clinical situations in future. Although classical nursing education has been changed, the education system needs to be more practical in terms of having good quality nurse in clinical scenario. Reflection on three year nursing course gave an important view on future scenario.
Beauvais, A. M., Brady, N., O'Shea, E. R., & Griffin, M. T. Q. (2011). Emotional intelligence and nursing performance among nursing students. Nurse education today, 31(4), 396-401.
Boswell, C., Cannon, S. B., & Miller, J. (2013). Students' Perceptions of Holistic Nursing Care. Nursing education perspectives, 34(5), 329-333.
Brown, J., Stevens, J., & Kermode, S. (2012). Supporting student nurse professionalisation: The role of the clinical teacher. Nurse education today,32(5), 606-610.
Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S., & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC nursing, 13(1), 11.
Foronda, C., Gattamorta, K., Snowden, K., & Bauman, E. B. (2014). Use of virtual clinical simulation to improve communication skills of baccalaureate nursing students: A pilot study. Nurse education today, 34(6), e53-e57.
Freshwater, D., & Stickley, T. (2004). The heart of the art: emotional intelligence in nurse education. Nursing Inquiry, 11(2), 91-98.
Houghton, C. E., Casey, D., Shaw, D., & Murphy, K. (2013). Students’ experiences of implementing clinical skills in the real world of practice. Journal of clinical nursing, 22(13-14), 1961-1969.
Liaw, S. Y., Koh, Y., Dawood, R., Kowitlawakul, Y., Zhou, W., & Lau, S. T. (2014). Easing student transition to graduate nurse: A SIMulated Professional Learning Environment (SIMPLE) for final year student nurses. Nurse education today, 34(3), 349-355.
Michalec, B., Diefenbeck, C., & Mahoney, M. (2013). The calm before the storm? Burnout and compassion fatigue among undergraduate nursing students. Nurse education today, 33(4), 314-320.
Pennbrant, S., Nilsson, M. S., Öhlén, J., & Rudman, A. (2013). Mastering the professional role as a newly graduated registered nurse. Nurse education today,33(7), 739-745.
Ramm, D., Thomson, A., & Jackson, A. (2015). Learning clinical skills in the simulation suite: the lived experiences of student nurses involved in peer teaching and peer assessment. Nurse education today.
Reeve, K. L., Shumaker, C. J., Yearwood, E. L., Crowell, N. A., & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students' educational experiences. Nurse education today, 33(4), 419-424.
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