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Process Of Facilitation In Clinical Context

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Question:

Describe a Clinical Practice Issue. Critically analyse Material Including relevant research articlesto Support an argument for how an understanding of Adult learning theory may assist the Facilitation of Practice Development within a Clinical Context. How might the role of Facilitation assist when approaching this Practice Issue?
 
 

Answer:

Facilitation in clinical context is the process of providing support to clinical staffs or group to achieve beneficial change in professional practice. It is an important tool to bridge the gap between theory and clinical practice. This mean of practice development helps to address the quality of care and advance health care practices. The role of a clinical facilitator is to address the challenges faced in delivering care to patients in specific scenario. The understanding of the adult learning theory supports the facilitation of practice development in clinical context (Taylor et al. 2013). The application of adult learning theory in practice development is realized due to strong positive results such as increased engagement in learning, favorable outcome, development of learning orientation and increased application of learning in professional context (Zepeda et al. 2014). The essay particularly deals with the clinical issues of challenges faced by nurses in wound management and explains the importance of adult learning theory in the facilitation process to address clinical issues in practice.

One of the important clinical issue facing nurses and clinician in clinical setting is related to the management of wound and promoting wound healing. Complete wound healing is not achieved due to variety of issues such as effect of ageing, presence of systemic diseases or arterial inefficiency. In basic nursing practice, wound healing is not just about infection control and dressing wounds, it also involves promotion of therapeutic nutrition, psychosocial support, hygiene and comfort (Corbett 2012). Nurses fail to implement best healing practices because they focus just on clinical factors associated with wound management and fail to identify psychosocial and educational factors of patients in wound healing. Besides this, there are significant advancements in wound management in clinical practice, which means nurses need to acquire new knowledge about wound etiology and pathology (Gillespie et al. 2014). Hence, lack of focus on wound management among nurse and poor standardization of best practice standards creates issues for nurses in daily practice.

 


Due to the rise in complexity and cost of wound care, it is necessary that nurses implement wound care practices based on best practice guidelines.  The limitation and clinical issues faced by nurse in wound management can be strengthened by means of appropriate facilitation process in practice development. Seeking help by practice development facilitators helps to address challenges in clinical care environment and enhance theory-practice application. Practice development is achieved by means of a facilitator who assists nurses in bringing positive change in nursing action and practice for the benefit of the patient (Dogherty et al. 2013). The facilitation and practice development process can be successful by means of effective utilization of adult learning theory. Different types of adult learning theories are based on different response of adults in the learning process. Adult learners bring experience to the learning environment and it is student-centred, problem-oriented and collaborative approach to learning and education (Merriam 2015).

An individual responds to information during the learning process in many ways. The two primary approaches used in adult learning theory are the behaviorist approach and the cognitive approach. Behaviorist theory is related to establishing connection between stimuli and response.  On the other hand, cognitive theory deals with the manner in which individual processed information in their mind. In relation to the facilitation process to address clinical issues faced by nurse in wound management, the Kolb’s experiential learning model can be adapted in the facilitation and learning process. It is mainly concerned with the internal cognitive process of a learner and the trigger to develop new concepts in practice is triggered by new experiences. Learners have a concrete experience and the reflection process helps them to formulate abstract concept and generalize them in practice setting. The understanding is further strengthened by means of evaluating the implications of the new knowledge in new situations. This action facilitates development of concrete experience and the learning process continues in this way. Learner with different learning preference can gain competitive advantage in different quadrants of the Kolb cycle (Taylor and Hamdy 2013). Hence, when nurses are engaged in direct experience with patients along with an emphasis on reflection, the use of experiential learning model like Kolb’s facilitates development of clinical skills in nurses (de Oliveira et al.  2015).  

The first stage of the Kolb’s learning cycle is the concrete experience stage in which a new experience of a situation is encountered. As adult learning is a form of problem-based learning, critical thinking skill is necessary during the facilitation process of practice development. Therefore, in the first stage a participant tries to learn by the exploration of the problem (Husebø et al. 2015). For example, the main clinical issues faced by nurse during wound management are related to the timing of the removal of a dressing after the operation or surgery. In the post-operative period, it is unclear to nurses whether incision must remain covered or showering may have an impact on wound healing. While some guidelines lays stress on longer dressing periods to prevent risk of contamination, other studies suggest limited benefits of longer dressing. There is lack of standardization of best practice in wound care among nurses (Gillespie et al. 2014). Hence, in the clinical nursing context, the presence of this kind of clinical issue provides a basis for observation and reflection on the problem.

 


Due to the concrete experience of nurses (clinical issue faced in wound care) in clinical setting, they need to move to the second stage of reflective observation to facilitate new practice development. It mainly involves reflecting on a particular experience (DeCoux 2016). In case of the clinical issue of wound management, a nurse may engage in critical thinking practices regarding the reasons for wound injury among them.  The achievement of critical thinking skill is a necessary skill for nurses as critical and reflection and experiential learning promotes practice development and facilitation process in nursing (Hakim et al. 2014). In the second stage of Kolb’s learning cycle, reflective observation helps in the apprehension process of the experience. By this means, nurses can make sense of the concrete experience on a variety of perspective. For instance the causal factor behind challenges in wound healing can be addressed by means of thorough observation of the clinical issue, analyzing all the physiological parameters of wound healing and identifying the anomalies in current practice. A nurse themselves or a facilitator can help to collect current data on best practice for wound healing and then plan the action needed to stabilize the situation (DeCoux 2016).

The third stage of learning according to Kolb’s learning model is the abstract conceptualization stage in which the reflection process leads to the modification of the existing abstract concept. It involves coming to the conclusion about any experience by means of using ideas and logic to understand the situation or a problem in a professional or clinical context (Chmil et al. 2015). Therefore, to reduce the practice gap in nurse’s knowledge regarding acute wound care, they key modification process will be required in practice. In the abstract conceptualization phase of learning, the reason for clinical issue in wound management practice can be identified. This may include developing the ability to perform accurate wound assessment on a regular basis to ensure that any complications in wound healing is readily identified. It will be an effective step not just to increase the recovery process but also to reduce the cost associated with treatment. The role of facilitators will be crucial in this stage to make it clear to nurse regarding the recommended time period for removal of dressing and the appropriate clinical procedure of wound assessment (Gillespie et al. 2014).

The final stage in the learning procedure for practice development includes the active experimentation stage in which the learner applied the new skills in actual setting to observe the outcome. If the hypothesis is proved in future situations, it leads to a new experience and new set of skills in professional practice. In the active experimentation stage, different theories are tested to evaluate the outcome and modify the plan of care (Kolb 2014). In relation to the clinical issue of wound management practices in nursing, the active experimentation process can be done by developing a plan of changes to facilitate development of updated skills in wound care. It may involve conservation of not just structural integrity of wound in patients, but also conserving the social and personal integrity of patients. Hence, main care priority in wound healing will involve restoring the body structure by preventing physical breakdown, fostering awareness of patents and restoring the patients sense of identity (Leach 2006). Nursing facilitators might also help in skill development of nurses sharing knowledge regarding the current practice guidelines for wound healing. It will be an effective approach reduce variation in practice and improve the quality of care. A wound care specialist nurse might also help nurse in gathering information related to wound care. Any barrier to the implementation of the best practice guidelines must be identified at the first instance to increase the pace of facilitation process (Qader et al. 2015).  

 


The explanation of the methods to engage a nurse in reflective learning practice to address the clinical issue faced in wound management reveals the important of adult learning theory in a learning environment. The responsibility of both the learner and an educator is crucial to support facilitation of practice development (Dogherty et al. 2013). The facilitator can also promote the learning process in learners by identifying their unique learning style. The four relevant styles of learners include the accommodator, the diverger, the assimilator and the converger. Their manner of collecting and processing information is different and knowledge about this learning styles helps in better assimilation of new experience in participants (Riding et al. 2013).  The experiential learning model under the adult learning theory facilitates theory based nursing practice by means of application of relevant theories and guidelines in clinical scenario. The research by Schumacher et al. (2013) also suggest that adult learning theories can be applied in medical education to enhance professional skills of clinical staffs. Furthermore, the efficiency in the facilitation process can be achieved if the educator can identify specific learning characteristics and styles of nursing staffs while planning educational programs for them.

The role of practice development facilitators is important in a critical care environment to help clinical staffs learn the skills of theory-practice application and time management in clinical practice. The challenges and difficulties seen in today’s health care organization is not just due to lack of skills and knowledge in staff, it is also due to disengagement of staffs from workplace cultures. This further aggravates the problem of delivering evidence-based care in clinical practice. Hence, facilitation process helps in the implementation of not just technical practice development, but also emancipatory practice development. This process is implemented by facilitators who engage individuals and team to combine their creative imagination with practice skills to achieve favorable outcome. This method of facilitation-based learning encourages transformation of individual staffs and increases their competency in clinical practice (Heyns et al. 2017).

 


The essay summarized the importance of facilitation process in practice development in relation to specific clinical issues. The essay explained the specific clinical issue of nursing challenges faced in wound management and wound healing in clinical setting. In relation to developing new skills and practice to promote effective wound healing, the use of relevant adult  learning theory was regarded as an appropriate tool to facilitation practice development in nurses. The use of adult learning theory is important to support facilitate practice development because it illustrates the most effective ways in which a learner can interpret a situation or a problem, and plan changes in care plan or strategies. Apart from reflective, behavioral and cognitive theory related to learning, the experiential learning style is considered appropriate to modify the competency of staff in wound care. By the use of the Kolb’s learning cycle and understanding of difference preference and learning styles of learners, key limitations in practice can be addressed. Hence, best use of available evidence and clinical guideline is achieved by means of critical learning skills and active experimentation of the planned strategies in professional context.

 

Reference

Chmil, J.V., Turk, M., Adamson, K. and Larew, C., 2015. Effects of an experiential learning simulation design on clinical nursing judgment development. Nurse educator, 40(5), pp.228-232.

Corbett, L.Q., 2012. Wound care nursing: professional issues and opportunities. Advances in wound care, 1(5), pp.189-193.

de Oliveira, S.N., do Prado, M.L., Kempfer, S.S., Martini, J.G., Caravaca-Morera, J.A. and Bernardi, M.C., 2015. Experiential learning in nursing consultation education via clinical simulation with actors: action research. Nurse education today, 35(2), pp.e50-e54.

DeCoux, V.M., 2016. Kolb's learning style inventory: A review of its applications in nursing research. Journal of Nursing Education, 29(5), pp.202-207.

Dogherty, E.J., Harrison, M.B., Graham, I.D., Vandyk, A.D. and Keeping?Burke, L., 2013. Turning Knowledge Into Action at the Point?of?Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence?Based Practice. Worldviews on Evidence?Based Nursing, 10(3), pp.129-139.

Gillespie, B.M., Chaboyer, W., Allen, P., Morely, N. and Nieuwenhoven, P., 2014. Wound care practices: a survey of acute care nurses. Journal of clinical nursing, 23(17-18), pp.2618-2627.

Hakim, E.W., DScPT, M.S., Marilyn Moffat, P.T., Elaine Becker, P.T., Bell, K.A., Manal, T.J., Schmitt, L.A. and Cathy Ciolek, P.T., 2014. Application of educational theory and evidence in support of an integrated model of clinical education. Journal of Physical Therapy Education, 28, p.13.

Heyns, T., Botma, Y. and Van Rensburg, G., 2017. A creative analysis of the role of practice development facilitators in a critical care environment. Health SA Gesondheid, 22, pp.105-111.

Husebø, S.E., O'Regan, S. and Nestel, D., 2015. Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), pp.368-375.

Kolb, D.A., 2014. Experiential learning: Experience as the source of learning and development. FT press.

Leach, M.J., 2006. Wound management: using Levine's conservation model to guide practice. Ostomy/wound management, 52(8), pp.74-80.

Merriam, S.B., 2015. Adult Learning Theory: A Review and an Update. Culture, Biography & Lifelong Learning, 1(1), pp.59-71.

Qader, A., Ali, S. and King, M.L., 2015. TRANSCULTURAL ADAPTATION OF BEST PRACTICE GUIDELINES FOR OSTOMY CARE: POINTERS & PITFALS. Middle East Journal of Nursing, 9(2).

Riding, R. and Rayner, S., 2013. Cognitive styles and learning strategies: Understanding style differences in learning and behavior. Routledge.

Schumacher, D.J., Englander, R. and Carraccio, C., 2013. Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. Academic Medicine, 88(11), pp.1635-1645.

Taylor, D.C. and Hamdy, H., 2013. Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), pp.e1561-e1572.

Taylor, E.F., Machta, R.M., Meyers, D.S., Genevro, J. and Peikes, D.N., 2013. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. The Annals of Family Medicine, 11(1), pp.80-83.

Zepeda, S.J., Parylo, O. and Bengtson, E., 2014. Analyzing principal professional development practices through the lens of adult learning theory. Professional development in Education, 40(2), pp.295-315.

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