This assignment objectively looks at my developmental trajectory with growth in adult nursing from the novice level, advanced beginner and through to the competent practitioner level.

University Degree Subjects allied to Medicine

This assignment objectively looks at my developmental trajectory with growth in adult nursing from the novice level, advanced beginner and through to the competent practitioner level. During the duration of my three years of nursing training I have come to realise the obligation on myself as a student and future staff nurse to build the theory and skills base expected of qualified nurse. I shall look at how my learning evolved in the domain Helping role/caring skills on the basis of the Novice to Expert Model (Benner, 1984) but only as far as my current level, competent practitioner. I shall briefly give the rationale for choosing this domain and also illustrate the reflective practice approach I have utilised during my training. Nursing consists of a unique relationship between patient and nurse whose nature is a vital component of health care and that quality of nursing care can have a great impact on patients, affecting their feelings well-being and health The reason for me to choose this aspect of care is the motivation to improve my nursing practice in this domain of nursing arising from a need to consider my practice in a thoughtful and critical way in meeting the individual needs of my patient. Caring is central to human expertise, to curing and to healing and in that manner is a fundamental way of being in the world (Webb, 1996). I feel if I understand this key relational expression of human concern I would be better equipped to help my patients.

As a nursing student the portfolio is used in assessment of my learning and competence in the nursing education. In this holistic approach to competence I have been taught to utilise reflection as a basis of developing my professional judgement, using Kolb's (1983) experiential learning cycle. Reflection in my course has been a way to empower me to become fully cognisant of my knowledge and actions to sustain myself in practice, nursing experiences, personal and professional development (Street, 1991).from image to action reflection in nursing practice. Deakin University Press Geelong). The portfolio approach has integrated well with me as an adult learner. Most of our learning is self-directed; I am recouping my past experiences as a rich source for learning, my eagerness to acquire new skills as I tackle real life tasks and problems. Garrison (1991) (cited in Burns & Bulman, 2000) asserts that learning through reflection is a learning technique mostly suited to the adults who have a wealth of past experience and an intellectual maturity to cope with autonomy, differing perspectives and shifting ideas. This reflection can be reflection-in or reflection-on action (Schon, 1987). Though the formal training I am receiving now as a student nurse is providing me with the technical knowledge needed to provide competent care to patients it has also proved to be a good start building competence and am using it for any professional and personal development.

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According to Benner (1984) the novice practitioner is characterised by rigid adherence to taught rules or plans, has little situational perception and does not possesses any discretionary judgement. On my first clinical placement, as is evident from the clinical assessment tool (CAT), I was overwhelmed by the ward environment. I came on to the ward only armed with not so much developed theoretical knowledge from university lectures. I felt the gap between theory and practice on the clinical environment (Clifford, 1993). I found myself helpless “realising my own knowledge and skills limitations I worked my mentor and adopted a questioning approach” (Mawema, 2001). My concept of “caring” as it were, was to meet any physical requirements of patients, like helping patients to the toilet, giving patients proper food, bed making. I found myself being more of a “doer” with very limited interaction with patients. I was not confident of myself and neither did I have the necessary communication skills in the to interact with patients. The nurse should have skills to give the best care and feel confident when performing them (Kapborg, 2003). The guidance from my mentor and other resources on the ward assisted me in bridging the theory and practice gap. I was given an opportunity to gain knowledge and experience in clinical and technical skills. Under the guidelines of a mentor I collected objective data according to guidelines and rules obtained from nursing education and in orientation. Because of my limited knowledge and skills my room to manoeuvre or be involved with patient was limited and inflexible. However I benefited from working under the direct supervision of my mentor. This enable me to grow in confidence and was able to utilise appropriate interpersonal skills to develop relationships with people, valuing them as individuals, including establishing and maintaining effective communication with patients. The novice nurse uses this objective data and seeks assistance in making clinical decisions (Severensson, 1996). This stage of my training was beneficial in that I developed the skills of observing qualified nurses relating with patients, developed the asking approaching for rationale of any actions they did and most importantly it put to bed my pre-placement fears. On completion of this module, students should be able

My clinical placements at Advanced beginner level where on a coronary ward and in theatre. According to the model by Benner (1984) Advanced beginners, are guided by policies, procedures, and standards. They are building a knowledge base through practice and are most comfortable in a task-oriented environment. As is evident in my CAT I have grown in confidence and am connecting to patients by listening to their thoughts and fears and communicating concern. Benner (1984) asserts that by caring nurses can establish a condition of trust where help can be given and received. Now I feel like the patient’s advocate and make sure that the patient experiences the care positively and is treated with dignity. The benefits of observing and participating in care with my mentors I have now learnt the nursing process enabling me to be aware of emotional and psychological aspects of care and hospitalisation. By utilising a reflective approach to my nursing education I have over the years slowly become intuitive. Experience of observing interventions of qualified nurses and also doing them under supervision now enables me decisions or give interpretations on the basis of my gut feeling. These have made me more assertive and grow in confidence in my interaction with patients and colleagues

I am now able to connect with patients on a level as fellow human beings not just as “bed number X”. The patient should be treated sensitively as human beings and receive help and understanding when dealing with illness experiences. On the coronary unit a patient who had just been reviewed by a doctor called me by his beside and wanted me to explain what the “doctors were on about” . When the nurses show empathy and understanding and are available as fellow beings the patients will feel being cared for.. I have held patients' hands and been a shoulder to cry on when patients needed it. I have listened to patients' fears and worries - I find this aspect of nursing a privilege and part of my duties as a future nurse. The experience I gained at this stage of my training made me aware of my responsibilities towards my patients

The competent practitioner, nurses integrate theoretical knowledge with clinical experience in the care of patients and families (Benner, 1984). At this stage I have gone quiet high on the learning curve. Even though am still supervised I can care for patients independently The theory and practice gap is no longer as pronounced as it was as a novice. Care is delivered using a deliberate, systematic approach, and practice is guided by increasing awareness in patterns of patient responses in recurrent situations (Moir, 1996). As I come to the end of my formal nurse training but lacking in professional experience, the experience I have gained is starting to form the foundations of a framework that can guide my future decisions and actions. If the nurse is to provide safe and secure care they should know what is correct and proper when conducting their tasks, as well as being knowledgeable about different physiological aspects of nursing of nursing and how to act. I have also come to realise that it is imperative to be knowledgeable about patient rights and also conduct oneself in an ethically sound manner. This is dealt with at length in the CAT. As the patients’ advocate I believe I have covered a bit of ground in health promotion. I have now developed and am still developing a repertoire of positive statements and argument, as well as my own style of communicating with patients. Now as a competent practitioner I have acquired the necessary technical knowledge as well as some experience in recognising when patients are in need of help and take the appropriate intervention.

I have clearly illustrated on the basis of clinical placements over the three-year period that caring means incorporating involvement and interaction, rather than just being physically present as was the case at novice level. Integrating the ability to communicate, listen, being with and assisting patients has resulted from the combination of training, experience and reflection on those events I have observed during the course of my training so far.

Reflection on this course has enabled me to begin to construct a personal database of knowledge, which informs and enriches my future professional practice. The modern nurse is a life long learner. As a newly qualified nurse I shall eager work with my preceptor and get on board all the possible hands on experience during the transitional period from student nurse to a full fledged nurse. As a practising nurse I shall endeavour to continue with ongoing reflection of events that occur with patients. I shall also put my name forward to under go continuing education that can further my knowledge. Carper (1978) identified four types of knowledge :aesthetic, empirical, personal and ethical. No single form of knowledge is more superior to any other or should they be judged against each other. Aesthetic knowledge helps understand the human experience and insights into human condition, the lived experience of an illness whilst empirical includes both knowledge acquired through practice, experienced by self (experiential) and intuition.

REFERENCE

Benner, P. (1984). From Novice to Expert. Adison-Wesley. Menlo Park. Ca.
Burns, S. & Bulman, C. (2000). Reflective practice in nursing: the growth of the professional practitioner (2nd. Ed.) Blackwell Science. Paris.
Carper, B. (1978). Fundamental patterns of knowing nursing.
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Kolb, D.A. (1983). Experiential learning: experience as the source of learning and development.
Mawema, T. (2001/2002/2003). “The helping role/caring skills”. CAT/PAT. Middlesex University. London.
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Webb, C. (1996). “caring, curing, coping: towards an integrated model.”. Journal of advanced nursing. 23(5). P. 960-968