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Conceptual Reflective Framework

The model used in the reflection is the Kolb's Learning Cycle developed in 1988. The cycle reflects the process of how individuals, organizations, and teams do too, as well as understanding experiences and modifying behavior (Kolb, 2014).

Gibbs reflective cycle focuses on an accurate description of an incidence, analyzes feelings, experience evaluation, analysis on the significance of the experience and a conclusion.

It also gives an outline of the consideration of other options and the reflection on what the practitioner would do again in case the incidence happens (Tesh & Kautz, 2017).

Learning Objectives

  • To perform, under minimal supervision, independent and safe transfers for patients
  • To establish a good relationship with the elderly clients in the hospital.
  • To analyse the daily routine and activities of the elderly.

Human Resources

The following resources will help me achieve me attain my learning objectives

  • I will learn from a mentor who is an experienced nurse.
  • Observing Registered Nurses and therapists.
  • Practice with fellowship students.
Learning Objectives

The chosen clinical learning need is providing care for the aged people who are admitted in the aged care hospitals. This area of clinical learning was chosen because of several reasons which included that there are shortage of professional nurses especially the registered nurses who are involved in providing care to the aged individuals in the aged healthcare facilities(Donald et al., 2013). It also seen sometimes that the professionals behave in a reluctant way regarding the healthcare of the aged population. A study revealed that about 15 per cent of the population of countries which belonged to the Organisation for Economic Co-operation and Development (OECD) were under the age group of 65 or over. It was expected that this number would go up to 22 per cent by the end of 2030 (Goodwin et al., 2014). With the increase in the life expectancy of the population above 65 years of age, there is an increased need for quality care to be provided to them. Older age is generally associated with elevated incidences of multiple chronic conditions along with a number of cognitive and functional impairments (Hwang et al., 2013). Therefore the health workers continue to make demands in this area and it continues to rise like the aging population increase. This is the gap that is present in this aspect. There is a broad scope of skills such as; mental health, along wth orthopedics, physical therapy, cardiology, social work and many others (Wilkes, Cowin, & Johnson, 2015). Therefore working in this field provides an opportunity in order to exercise the skills that are gained through the educational experience. This project focusses to improve the skills of nursing through working on a specific clinical field in order to address the problems of nursing. The specific area that will be given emphasis deals with the care of the older adults especially those in the aged health facilities.The objectives that will be achieved through this clinical learning involves performing of patient transfer under minimal supervision for the patients placed in aged care unit. The objective will also include establishing of a good relation with the aged patients who are suffering from mental illness. The final objective would include analysis of the daily routine and the activities of the elderly. The importance and the evidences of the objectives from literature will be discussed in the paper.

The purpose of this project is to establish a clinical learning that is based on a problem of clinical practise which has been encountered in the field of provision of care to the aged people, especially in the aged care facilities.

Chosen Clinical Learning Need

The benefit of implementing this clinical learning is to improve my skills as a nurse through the achievement of the objectives that has be determined. While working as a nurse I have often faced situations where the care that should be provided to the aged individuals has been neglected, especially in terms of mental health care. Therefore such experiences made me consider the chosen skills that I have decided to work upon. Through the development of my skills, I will be able to better communicate and be able to provide quality care to the elderly individuals having mental problems. This is beneficial since some studies show that most of the nursing curriculum lacks the development of a positive relationship between education and gerontological care.The nurse student curricula needs to involve management of the acute conditions along with management of the chronic conditions which generally prevails in the case of the older patients(Chi et al., 2016).

The implications of learning this skill is related to the chosen area since most of the aged people residing in the aged care facilities are likely to undergo mental disorders as is perceived through several studies. A 50 percent of those living in aged care facilities have depression and anxiety or both the disorders, where below 50 percent of aged individuals enter the residential with a pre-existing depressive condition.Most studies show that the nurses often lack proper education and training that is required to provide service to the older adults in cases of chronic health management along with provision of long term care (Brownie &Nancarrow, 2013).

The primary objectives will include performing safe transfers of patients under minimal supervision and in an independent manner in the aged care unit. It will help me learn how to handle the patients with mental health in the unit responsibly.

Secondly, I would like to establish a good relationship with the elderly clients who have mental illnesses in the hospital. I would use therapeutic nurse-client relationships as learned in class to develop the relationships.

Thirdly, I would like to learn how to analyze the daily routine and activities of the elderly. It will help me perfect my skills as a learning nurse.

The skill that will be obtained through this clinical learning will involve a broad scope of skills including mental health, cardiology, orthopedics,social work, physical therapy and many others. The major skill that will be developed is the handling of the patients who are suffering from mental health issues.

Benefits of Implementing Clinical Learning

In order to develop this skill and attain the objective, I will be observing and evaluating the clients. This will help me to be able to attend to their needs, in addition to medication progress. I will also take up any course of action as directed by my supervisor. I will also be making and keeping health records on information from the nursing point of view. Implementation of the above mentioned interventions will be helpful since the prevalence of psychiatric morbidity in medical inpatients is quite high. Additionally the negative effect of depression along with the cognitive impairment on rehabilitation has been well documented in literature(Prestmo et al., 2015). The interventions will help promote improvement in physical function. Studies show that older people in nursing homes or the residential homes tend to suffer from agitation and challenging behaviours, in addition to behavioural management. Proper management ofdrugs use tends to have a beneficial impact on the mental state of the aged patients (King, Roberts & Bowers, 2013). In spite of the recognised health standards of best practise that required for the care in older people, most of these individuals are seen to receive low quality of care standards that is below the acceptability level. The nurses should be able to provide transitions in care along with effective identification of the potential risks and the gaps present in care.

For attaining the objective of safe patient transfer in the aged care unit, it is very important to involve communicate in an effective way to inform about the status of the health of the older patient along with proper evaluation of the nursing transfer documents, identification of the patient and transfer characteristics that are associated with the existence of nursing transfer documents for the aged patients (Goddard et al., 2013). However these are often not followed by the nurse professionals who are involved thereby leading to situations involving incompleteness and lack of accuracy that is an essential information during the transfer of older people (King, Roberts & Bowers, 2013). For attaining skills I worked along with a team and learned from them. I took a time frame of 3 to 4 weeks to attain this objective. I faced certain barriers like lack of communication however it was resolved.The above mentioned intervention have been recognised as evidence based since it includes the pharmacologic treatment along with psychosocial therapies. The barriers that present themselves on the path of the implementation of these interventions involve the undetected and inadequately treated nature of the disorders (Brownie&Nancarrow, 2013). I will try to attain this objective by observing the other registered nurses and also the therapists. I will try to learn from them how to prepare a proper clinical handover chart along with learning how to communicate efficiently with the other nurses during the transfer. Additionally practise with my fellow nursing students will help me to improve this skill. For this i will maintain a health record of the information from the view point of a nurse.

Implications of Clinical Learning

In terms of establishing a good relationship with the elderly patients who are suffering from mental illness, the role of the nurse should be to focus on the whole care continuum. The role of the nurse often includes assessments along with building of care and treatment plans and linking clients with other programs and services. Communication plays an important role in providing patient centered care to these aged people(Potter et al., 2013). For attaining skills I worked along with a team and learned from them. I took a time frame of 3 to 4 weeks to attain this objective. I faced certain barriers like lack of communication however it was resolved. Onset of symptoms of depression occurs in the late phases in the case of older adults, therefore the elderly patients often end up receiving less adequate course of therapy in comparison to the younger adults.Very few older medical patients who are suffering from depression receive drugs of antidepressants in the hospital. In order to overcome these barriers the access of care should be made easy for the older adults(Chen et al., 2015). There is a need to address the important patient along with the provider and the barriers of health system to care. This skill I will try to learn from my mentor who will be training me in patient centred nursing practise that will improve my communication skill and therapeutic relationship with the elder patients especially.  I will also try to engage myself in the available courses of patient centred care, as will be directed by my supervisor.

Finally in accordance to the last objective, analysis of the daily activities of these older individuals are required since engagement in the social activities  is an indicator of the quality of life of these aged individuals along with their well-being in the aged care facility environment. The activities also reflect the cognitive and the functional dependence of the elders therefore this is important to analyse their daily activities in order to provide optimum care according to the prevailing situation(van der Steen et al., 2014).For attaining skills I worked along with a team and learned from them. I took a time frame of 3 to 4 weeks to attain this objective. I faced certain barriers like lack of communication however it was resolved. Organizational barriers along with financial barriers should also be improved by improving the collaboration between providers in primary care. There should be development of long-term care and recruitment of specialty providers of mental health care in order to overcome the shortages of care giving professionals who have appropriate training and expertise in addressing the geriatric mental health(Kiersma et al., 2013). This skill mainly requires practise therefore I will continue to improve this skill by practising with my fellow nurse students. I will observe the clients and assess their medical progress in order to improve my skills and attain this objective.

Attaining Learning Objectives

I have undergone the process of learning for a period of 3-4 weeks as per the requirements of the course of nursing. I have focused on achieving my objectives like performing safe transfers, analyzing routine chores in the mental health unit for the aged as well as establishing good relationships with the aged care patients.  Nursing practice requires an ample amount of time to learn. The difference and gap between theory and practice, the selected time frame will be adequate for me.

After achieving these objectives I experienced a sense of satisfaction as I was always passionate about helping the aged people to obtain elevated quality of health care services. During this process I have been working with then other nurses who mentored and guided me to attain my desired learning goals. I also worked along with a multidisciplinary team comprising of other registered nurses and therapists along with my fellow students. This experience improved my view towards the nursing practice along with increasing my knowledge and skill. Working with the aged individuals made a change in my perception. I learned how to develop patience and be responsible while on my duty.

Conclusion

From the above discussion it can be concluded that in order to provide optimum care to the older adults it is required for the nursing student to develop a positive relationship between education and gerontological care. Through the learning process I was able to improve my care giving skills as a nurse to the older people who are suffering from mental illness and was able to provide better care to the aged individuals especially in the aged care facilities. From this I learnt to perform under minimal supervision independent and safe transfers for patients in the aged care unit. It also helped me learn how to handle the patients with mental health in the unit responsibly. Ilearnt how to establish a good relationship with the elderly clients who have mental illnesses in the hospital. I tried to use therapeutic nurse-client relationships as learned in class to develop the relationships. I also learned how to analyze the daily routine and activities of the elderly. It helped me to perfect my skills as a learning nurse. All the objectives were attained within the desired timeframe. In terms of career progression now I am surer about my skills that I have learnt. I am now more confident about my profession which will help me to shine in my chosen profession. Through this I was also able to make a choice regarding my specialization area that is gerontological care.

In future I would be trying to implement other interventions as well in order to improve my skills and provide increased quality of the health services to the aged patients. I would try to implement a more patient centred care to these individuals so that they will be able to open up freely with me while I am involved in providing care. Apart from communication, I will also try to provide a more wholesome approach to the care by designing and implementation of care pans and by evaluating those nursing care plan. I will also strive to set SMART goals in order to meet the needs of the patients.

References

Brownie, S., &Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8, 1. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540911/

Chen, A. M., Kiersma, M. E., Yehle, K. S., &Plake, K. S. (2015). Impact of the Geriatric Medication Game® on nursing students' empathy and attitudes toward older adults. Nurse education today, 35(1), 38-43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250437/

Chi, M. J., Shyu, M. L., Wang, S. Y., Chuang, H. C., & Chuang, Y. H. (2016). Nursing students’ willingness to care for older adults in Taiwan. Journal of Nursing Scholarship, 48(2), 172-178. Retrieved from https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/jnu.12197

Donald, F., Martin?Misener, R., Carter, N., Donald, E. E., Kaasalainen, S., Wickson?Griffiths, A., ...&DiCenso, A. (2013). A systematic review of the effectiveness of advanced practice nurses in long?term care. Journal of Advanced Nursing, 69(10), 2148-2161. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/jan.12140

Goddard, C., Stewart, F., Thompson, G., & Hall, S. (2013). Providing end-of-life care in care homes for older people: A qualitative study of the views of care home staff and community nurses. Journal of Applied Gerontology, 32(1), 76-95. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25473926

Goodwin, N., Dixon, A., Anderson, G., &Wodchis, W. (2014). Providing integrated care for older people with complex needs: lessons from seven international case studies. London: King's Fund. Retrieved from https://hsprn.ca/uploads/files/Providing-Integrated-Care-for-Older-People_KingsFund_Jan_2014.pdf

Hwang, U., Shah, M. N., Han, J. H., Carpenter, C. R., Siu, A. L., & Adams, J. G. (2013). Transforming emergency care for older adults. Health Affairs, 32(12), 2116-2121. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.0670

Kelly, D. M., Kutney-Lee, A., McHugh, M. D., Sloane, D. M., & Aiken, L. H. (2014). Impact of critical care nursing on 30-day mortality of mechanically ventilated older adults. Critical care medicine, 42(5), 1089. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993087/

Kiersma, M. E., Chen, A. M., Yehle, K. S., &Plake, K. S. (2013). Validation of an empathy scale in pharmacy and nursing students. American Journal of Pharmaceutical Education, 77(5), 94. Retrieved from https://www.ajpe.org/doi/pdf/10.5688/ajpe77594

King, B. J., Roberts, T. J., & Bowers, B. J. (2013). Nursing student attitudes toward and preferences for working with older adults. Gerontology & geriatrics education, 34(3), 272-291. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659195/

Kogan, A. C., Wilber, K., &Mosqueda, L. (2016). Person?centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1-e7. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13873

Liu, Y. E., Norman, I. J., & While, A. E. (2013). Nurses’ attitudes towards older people: A systematic review. International Journal of Nursing Studies, 50(9), 1271-1282. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12242

Pines, J. M., Mullins, P. M., Cooper, J. K., Feng, L. B., & Roth, K. E. (2013). National trends in emergency department use, care patterns, and quality of care of older adults in the United States. Journal of the American Geriatrics Society, 61(1), 12-17. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12072

Potter, G., Clarke, T., Hackett, S., & Little, M. (2013). Nursing students and geriatric care: the influence of specific knowledge on evolving values, attitudes, and actions. Nurse Education in Practice, 13(5), 449-453. Retrieved from https://www.sciencedirect.com/science/article/pii/S1471595313000322

Prestmo, A., Hagen, G., Sletvold, O., Helbostad, J. L., Thingstad, P., Taraldsen, K., ...&Johnsen, L. G. (2015). Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. The Lancet, 385(9978), 1623-1633. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25662415

van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., ... & Koopmans, R. T. (2014). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative medicine, 28(3), 197-209. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23828874

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