HNB3209-Community Practice Portfolio

I had the opportunity to complete my community placement in the West care medical centre located at Melton. This is one of the most outstanding Medical Centres, providing a range of different Healthcare services all across Victoria. As illustrated in their official website, the West care Medical Centre had been providing quality Healthcare services to the people of Melton since 1989 (Westcare.net.au, 2018). The mission and vision of the medical centre is established on the belief that Melton deserves exceptional health facilities with optimal accessibility, and the organisation has been successfully able to achieve this outcome with decades of hard work and dedication. It has to be mentioned in the context that the west care medical centre despite being privatized, is run entirely by the groups of principal doctors, who also are the owners and founders of the organization. Hence, the west care medical centre is free of the influence of corporate industrialization and consumerism. Hence the care services provided by the west care medical centre is compassionate, empathetic and equally accessible for different socio-economic strata. There are various range of services provided by the organisation, including health assessments, minor surgeries, pregnancy and maternity care, wound management and care, primary GP care, travel medicine and last but not the least, mental health care services along with dentistry and physiotherapy (Westcare.net.au, 2018). Hence, it had been a great experience for me to work in this organization for me which helped me to build my professional competence and skills.

General practice can be considered as the first point of contact in the health care scenario, it is the first pedestal of the primary health care scenario and undoubtedly it entertains the demand from the target patient populations as well. The general practice environment as a result is the most important sectors of the healthcare industry and the practice nurses can be considered as an integral part of the general practice environment (Fallatah & Laschinger, 2016). For my clinical placement that I completed in the estimate medical centre, I was placed under the supervisor of the practice nurse itself. Practice nurses are the nursing professionals that are associated with a varied range of care activities, which also requires the practice nurse to have a thorough understanding and knowledge of the concept of community and primary health care. Hence, the Practice nursing perspective had always been a sector of professional practice that intrigued me immensely. Fortunately, I had the opportunity to complete the community placement under the supervision of the practice nurse. She had been very warm and supportive with me and I have learned a wealth practice knowledge and expertise from her.

 

 

Considering the professional responsibilities of a practice nurse, it has to be mentioned that there is a varied range professional skills and expertise knowledge that a practice nurse has to have in order to be able to address the differential care needs of the varied range of patient populations that arrive at GP or primary care clinics. As discussed by the authors, the practice nurse has to attain a diverse range of clinical and specialist skills so that they can collaboratively practice in the general practice environment. As discussed by Fallatah and Laschinger, (2016) in their article, the patients come with multifactorial health issues to the general practice environment, and addressing these needs requires multidisciplinary care approaches and interventions. Hence, the practice nurses need to have entry level knowledge in different multidisciplinary care sectors to provide safe and effective care.

As mentioned by the office in the article the general practice nurse is at like an indispensable elements of the Primary Health Care team. in certain cases the practice nurses in the general practice environment might be observed to share their duties between different people, however, in other cases especially in smaller general practice environment a practitioner's has to juggle a number of different responsibilities in order to meet the different job roles and responsibilities. although the exams roles and responsibilities of a practice nurse differs from the organisational structure and hierarchy of the facility that with practice nurse is associated with, the key roles and responsibilities that a practice nurse in a clinical practice scenario will have include patient assessment including blood Sampling and physical assessment, minor and major wound management, vaccination, maternal and child health, child immunization and advise, family planning and women health advice, male and female health screening, sexual health services, and lastly health promotional advice such as smoking and alcohol cessation. The entry level educational requirements for a practice match to start clinical practice includes a registered degree in child adult on Mental Health Services along with disability aid services. as discussed by the authority in the, professional training and experience can help a practice nurse apply for further senior so such as a senior practice nurse practitioner and advance tax practitioner which are job knows that provide greater autonomy, it has been mentioned that practices need to acquire and built their knowledge and skill set in order to grow in the professional fees and better senior positions within the facility (Pasila, Elo & Kääriäinen, 2017). 

 

On the other hand the Fallatah and Laschinger (2016), have argued that the job roles and responsibilities of a practice nurse has changed drastically in the last decade with the advancement of general practice environment all across the world. along with the assistance provided such as primary care practices which is for life won't management health promotion and screening and surgical assistant the practice nurses and now given the opportunity to English and practice in nurse led clinics which are far more autonomous and have a significant impact on improving the help improve the Health promotion and preventative status of the community that it is serving. Hunter fast we mention that practice nurses are by far the first point of contact of the patience while they are availing the Primary Health Care. The nursing competencies the practice nurse is also required to have includes soft skills that that will help and engage with the patient's properly and Asha they taking the most compassionate and effective communication approach. As discussed by the Pasila, Elo and Kääriäinen (2017), practice nurses required to have a tremendous ability to effectively communicate in English the patients and build a rapport with them so that they feel comfortable and secure to share their health issues. along with that perseverance and resilience are also very important aspects of the skill set that a practice nurse will have to stay in order to ensure providing compassionate and effective care to the.
On the other hand the treatment nurse is mostly a wound care nurse who has a different set of job responsibility and roles. They provide less detect medical care mostly work under the supervision of a registered nurse. The job roles and responsibilities and mainly associated with want management suggest changing bandages provide wound care and monitoring the vital signs of the patient with basic preliminary patient assessments. The role had been mainly created to reduce the burden of nursing staff shortage and provide as much effective care that can provide to the patients by enhancing the nurse to patient ratio. It has to be mentioned that the treatment nurses have also been reported to assist in patient diagnosis by monitoring and recording vital signs, temperature, blood pressure, heart rate and other health indicators as well (Tarnowski, Bateman, Stanger & Phillips, 2017). Along with that, it has to be acknowledged in this context that these nurses also can legally administer prescription medications to patients, insert and monitor catheters and IV lines and administer injections. Lastly, providing supportive care is also a very job role for the treatment nurses such as helping patients recover during illness or after surgery. Hence, from the experience of completing the clinical placement with them and the literature search for this essay, the differences and similarities in the job roles and responsibilities of this particular nursing profession can be clearly identified. First and foremost, it has to be mentioned that the practice nurses entertain considerably higher level of autonomy and specialized practice scope than the treatment nurses. The practice nurses are a significant division of the primary health care scenario and are associated with patient assessment, patient care, and patient education and advocacy in the general practice environment. On the other hand, the treatment nurses are associated with just providing entry level assistance to the patient in wound care, monitoring vital signs and sometimes providing medication under the guidance of a registered nurse. The treatment nurses are not required to give any medical advice, guidance, patient education and other primary care services such as maternal and child health, sexual health and women health (Pasila, Elo & Kääriäinen, 2017). Hence, the requirement for expertise knowledge and skills are also limited in case of the treatment nurses.
 

 

GBTI is an acronym that stands for lesbian, gay, bisexual, and transgender & and Intersex communities. This is a community that is associated with considerable stigmatization and trauma due to the social taboos and traditional conventions still dominating the society. It has to be mentioned that even in the Australian society which entertains stark cultural diversity, such unconventional social groups are stigmatized and isolated which can reflect on the health care aspects as well. On a more elaborative note, the impact of stigmatization and bullying is one of the most important contributing factors behind the lack of spontaneous help seeking behaviour among the socially backward or marginalized populations (Klein et al., 2018). On top of it, the impact of unequal and stigmatizing behaviour by the care providers in the healthcare facility can have a supremely detrimental impact on the mental and emotional health of these backward groups. There is nothing evidence that suggests the care facility to be equal in both accessibility and approach for socially isolated population groups and the health care professionals play a fundamental role in thus process. On a more elaborative note, the communication approach of the care provider can make or break the perception of the individual belonging to the socially backward populations such as the LGBTI communities. It can not only enhance the health seeking behaviour among the socially backward class but it can also impact the holistic aspect of Health and wellbeing of the patients such as the emotional psychosocial which will also help accelerate the recovery process. On another note have respect for compassionate non-judgmental approach taken for the socially backward classes, especially for LGBTI community that has experienced considerable social stigma, it can also improve the level of cooperation with the professionals as well, in turn improving the health and recovery status of the patients. Hence, it is very important for the health care providers to have a non-judgmental and equal approach for all cultural and social backgrounds.

 

The organization where I had been given the opportunity to complete my community placement experience had a notable equal approach to LGBTI community, along with certain additional efforts to improve their care experience. First and foremost, all the staff respected and honoured the rights of each of the patient’s effectively regardless of their social, cultural, or as in this case, sexual identity. One of the most fundamental policies of the west care medical centre had been the fact that no individual is denied access to medical assessment and clinical based on any determinant of health including gender, race, culture, religion, age, socioeconomic status and sexual orientation or preferences. Hence, the LGBTI communities were also treated with equal respect and were by no means denied access to any of the services. Dignity and confidentiality is also treated as a mandatory norm of practice in the facility, the details shared by the patient was treated with utmost privacy and confidentiality; additional efforts were also incorporated to ensure protecting the dignity of the culturally diverse group, such as the LGBTI communities. Transparency is also a very important core beliefs of the west care medical centre, each of the patients are given complete rights to review their personal health records at any time. Along with that the privacy protection policy of the facility is also shared in an open access format in the internet allowing absolute transparency (Westcare.net.au, 2018).
Furthermore, as discussed by the Klein et al. (2018), the LGBTI community might also have certain cultural, traditional and personal restrictions or limitations, the breach of which can be reflected as violation of respect and trust for the community. Especially for the invasive treatment or assessment procedures as well, the LGBTI communities, most importantly the culturally diverse ones can lead to ethical constraints and reduced patient satisfaction. As per the west care medical centre, the patients regardless of their social position, are given the choice to refuse a treatment or assessment procedure. The care providers can attempt to provide education and advice explaining the need for the treatment or the assessment, the ultimate decision making procedure is given completely to the patient, and it has to be mentioned that it is a very important aspect of culturally and socially appropriate care. Hence, for the socially diverse community of the LGBTI, the west care medical centre provides equality along with compassion which has inspired me further to develop practice skills and expertise so that I can also provide equity and justice based yet compassionate care to all social groups.

For the nursing students to be able to complete critical practice in challenging care scenarios, it is very important for the clinical placement experiences to be successful and effective for the learning aspects. For my clinical practice under the practice nurse I had also encountered certain challenging experiences which has improved my practice drastically. In the last part of the essay, I would attempt to reflect on my experience of clinical practice which has undoubtedly helped me immensely in my professional growth taking the assistance of the Gibbs reflection framework (Barksby, Butcher & Whysall, 2015).
 

 

I would like to mention in this context that I had been given the opportunity to work under the practice nurse and it had been an excellent opportunity for me. It has to be mentioned that the approach and communication of the supervisor has a distinctive impact on ability of the nurses to develop practice. The practice nurse that has been assigned to me had been mostly associated with wound care and management which is a health issue which is prevalently and predominantly present health care issue present in the general practice environment. I have learned a variety of different types of wound management and the kind of supplies to be used for different wound management techniques for different patents with different care needs. The experience also helped me understand how to implement the theoretical knowledge in practice and engage in proper therapeutic communication with the patients.

Feelings:
First and foremost, I would like to mention that this had been an excellent opportunity for me to engage in clinical practice in the real life care scenario. I had been both ecstatic and nervous while going through the clinical placement. However, the supervisor that has been assigned to me had been very open and frank who helped me come to terms with the pressure of real world clinical practice. Along with that, it has to be mentioned as well, that this had been an excellent opportunity for me to learn the different wound management techniques. Although I had been very nervous in carrying out the actual wound cleaning and dressing, the supervisor had been kind enough to help me through the different stages of the wound management through a hands on experience. I also would like to mention that I had been very nervous regarding how to engage with the scared and distressed patients during the wound management, and I also went through a minor breakdown when I encountered a patient getting agitated while dressing her wound. However, my supervisor stepped in and assured the patient of my expertise and knowledge which eased my nervousness and also increased my confidence. Overall, this had been an excellent experience for me which helped me grow as a graduating nurse.

Evaluating the factors that worked tremendously well in this experience, I would have to mention my excellent experience with the supervisor nurse in my placement. She had true transformational leading style and she helped me learn a variety clinical practice skills along with certain tips to handle the patients more effectively. Her rapport with me helped me overcome whatever challenges I encountered while completing my placement. Considering the negative factors that did not work effectively in this experience, my nervousness, lack of proper effective communication skills and expertise in how to communicate with distressed patients and how to reassure them had been issues that I faced. While I was given an opportunity to carry out the wound management after observing the supervisor nurse do it several times, I still encountered considerable challenges in applying the theoretical knowledge in practical situations.

Clinical placements have a strong influence in shaping the professional skills of a nursing professional and also providing the nurse to hone the skills that they have attained in their education degree so that it can be applied in the clinical practice safely and successfully (Levett-Jones, Pitt, Courtney-Pratt, Harbrow & Rossiter, 2015). This experience had been an excellent opportunity for me to identify the strengths and weaknesses. First and foremost, I identified perseverance and resilience had been my core strengths, my communication with the patients were also credible. However, when the patients became agitated, my confidence seemed to falter and my communication a d approach also become affected further worsening the situation. On the other hand confidence and assertive composure in practice regardless of the chaos in the situation which is a key skill that the nurses have to attain had been my weakness, which needs efforts to improve. Lastly, the gap between theory and practice also restricted me from performing effectively, which is a common challenge for most transitioning nurses (McInnes, Peters, Bonney & Halcomb, 2015). However, with dedicated efforts to improve these skills, I hope to be able to overcome these issues effectively.
Action plan:
In the clinical placement experience, I have identified a few key weaknesses which needs to be improved for my professional growth such as the confidence, assertive communication and crisis management. In this case I would be enrolling in continuous professional development programs to improve these soft skills. Along with that, to address my gap between theory and practice, I would be joining certain workshop and trainings to improve the skills further (Halcomb, Stephens, Bryce, Foley & Ashley, 2017).

On a concluding note, the clinical placement helped me recognize various room for improvement in my professional competence. I am grateful for the support of my supervisor as well, who not only completed her job role but also helped me personally to identify my strengths and weaknesses. It can be hoped that in the future, I would be able to successfully employ the skills and expertise that I have acquired in my future practice. 

 

Barksby, J., Butcher, N., & Whysall, A. (2015). A new model of reflection for clinical practice. Nursing Time, 111, 34-35. Retrieved from file:///C:/Users/LAPTOP_MP0251/Downloads/The_RELECT_Model_Nursing_Times.pdf

Fallatah, F., & Laschinger, H. K. (2016). The influence of authentic leadership and supportive professional practice environments on new graduate nurses’ job satisfaction. Journal of Research in Nursing, 21(2), 125-136. doi: 10.1177/1744987115624135

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2017). The development of professional practice standards for Australian general practice nurses. Journal of advanced nursing, 73(8), 1958-1969. doi: 10.1111/jan.13274

Klein, D. A., Malcolm, N. M., Berry-Bibee, E. N., Paradise, S. L., Coulter, J. S., Keglovitz Baker, K., ... & Frederiksen, B. N. (2018). Quality primary care and family planning services for LGBT clients: a comprehensive review of clinical guidelines. LGBT health, 5(3), 153-170. doi: 10.1089/lgbt.2017.0213
Levett-Jones, T., Pitt, V., Courtney-Pratt, H., Harbrow, G., & Rossiter, R. (2015). What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience?. Nurse Education in Practice, 15(4), 304-309. doi: 10.1016/j.nepr.2015.03.012

McInnes, S., Peters, K., Bonney, A., & Halcomb, E. (2015). An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of advanced nursing, 71(9), 1973-1985. doi: 10.1111/jan.12647

Pasila, K., Elo, S., & Kääriäinen, M. (2017). Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies. International journal of nursing studies, 71, 17-27. doi: 10.1016/j.ijnurstu.2017.02.021

Tarnowski, G. J., Bateman, T., Stanger, L., & Phillips, L. A. (2017). Update of licensed practical nurse competencies in Alberta. Journal of Nursing Regulation, 8(2), 17-22. doi: 10.1016/S2155-8256(17)30094-7

Westcare.net.au. (2018). Westcare Medical Centre | Outstanding General Practice in Melton Victoria. [online] Available at: https://westcare.net.au/ [Accessed 30 Sep. 2018].