Importance of Expanding Knowledge Throughout Nursing Career

Professional development

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Continuing Professional development is where health care professionals maintain and develop a range of learning activities throughout their career to ensure competency and ability to practice safely, effectively and legally within their field of practice (Health and Care Professions Council 2014a). This essay will discuss a range of ethical, cultural, legal, managerial topics and their theory basis, highlighting the importance of expanding knowledge and experience throughout my career, in order to continually develop as a professional.

Demonstrate moral reasoning and the application of legal frameworks in the discussion of ethical issues in healthcare practice

Ethics are the collective belief and value system of communities, social and professional groups (Reeves and Orford 2003). Such ethical values can determine a healthcare professional’s behaviour through internally motivated standards for example goals of nursing can be based on a moral goal, value of seeking good and doing right (Raines 1994). Similarly, moral reasoning is when an individual uses moral goals and values to inform their decisions, attitudes and behaviour. Nevertheless, legal frameworks are also in place to protect the public when the moral reasoning of healthcare professionals produces poor care or harm (Wheeler 2012).

During our PD2 (Professional development 2) Problem based learning (PBL) we saw an example of how health professionals’: morals, ethics, beliefs and values, have negatively affected patient care (See Appendix 1) due to the ethical principles of autonomy, benefice, non-maleficence and justice Beauchamp and Childress being breached (2001). The physiotherapist who refused to treat the patient, the head of rehabilitation and, the clinical manager who chose not to act on the physiotherapists’ decision, caused maleficence to the patient as they didn’t receive the care required. Justice and autonomy were also overlooked as the patient was treated unfairly, having their freedom and rights taken away. Subsequently, under the Human Rights Act 1998, the patient is permitted to have recourse to the UK courts; as authority have not respected their rights. Furthermore the Equality Act 2010, describes those diagnosed with HIV as disabled, thus they’re entitled to protection against discrimination; which the patient experienced in this situation (UK Gov 2014).

Furthermore, it is the Nursing and Midwifery Code (NMC) and the Health Care Professionals Councils’ (HCPC) responsibility to protect the public, thereby determining the professional standards which nurses and physiotherapists must work to (Wheeler 2012). However, in this situation the healthcare professionals have not adhered to the codes, for example the HCPC code of conduct, performance and ethics states that ` You must act in the best interests of service users` (HCPC 2014b) where instead, the healthcare professionals have adapted a judgemental and biased attitude as a result of their own morals and beliefs. The NMC (2014) states that, `you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions` therefore as health professionals they can be held accountable by the law, endangering their fitness to practice and professional registration (Reeves and Orford 2003).

The breaches of UK legislation and nursing conduct means the health professionals involved would have no place in the law courts, with the Bolam test also in place to recognise the medical negligence. Furthermore the philosophical concept of rule utilitarianism means that the law courts would focus on the codes of practice which have been prescribed as the optimum set of rules within healthcare practice, further highlighting the misconduct of the healthcare professionals. Utilitarianism within other situations however could be criticised as rule utilitarianism is willing to cause more suffering than happiness to avoid violating a generalised rule (Mason and Whitehead 2005).

This situation highlights the importance of selectiveness of personal, moral and, ethical values when in practice. Furthermore, it also highlights the negative and positive impact of moral reasoning, where the act of whistleblowing has a positive impact on patient care. I feel that as a developing health professional I should increase my knowledge of the law and continue to abide strictly to my code of professional conduct, to ensure I practice in a reasonable, responsible and rational manner when ethical issues arise.

Discuss factors of cultural competence and ethnicity and identify your particular learning needs to enable you to help a named minority group of your choice overcome inequalities in healthcare.

Cultural competence is the understanding of; values, beliefs, traditions and customs of diverse groups. Ethnicity is defined as; a social group of people who identify with each other based on common experiences, such as cultural heritage, language and religion (Ingram 2011). Diverse multi-ethnic groups require diverse healthcare needs, challenging health professionals to be culturally competent in order to provide appropriate care (Patel et. al 2007).

During our PD2 PBL a scenario (See Appendix 2) highlighted the importance of being culturally competent in order to meet the healthcare needs of a culturally diverse community. Josepha Camphina-Bacote, 1998 developed;’ The Process of Cultural Competence in the Delivery of Healthcare Services model’, which views cultural competence as an ongoing process through Health Professional Development striving to effectively work with the cultural context of the client by seeing themselves as ‘becoming’, rather than ‘being’ culturally competent. The model focuses on the constructs of; cultural awareness, knowledge, skill, encounters, and desire which can be applied to the PD2 situation when discussing improvements in cultural competence of the health professionals involved (Camphina-Bacote 2002).

A number of inner-cities throughout Britain are experiencing a growing population of multi-ethnic groups, in 2011, 3.9% of Sparkhill were classed as having a multiple ethnicity, compared to 2.3% of Englands’ Population. 21.7% of Sparkhills’ population had no member of their household with the first language being English compared to 4.4% of the population of England. These statistics highlight the importance of cultural competency for healthcare professionals working within Sparkhill due to the various values, beliefs, and languages they will encounter.

In order to be culturally competent, Camphina-Bacote (2002) recognises that healthcare professionals need to gain cultural knowledge on health-related beliefs, values and traditions so they will be able to recognise how patients interpret and understand their illness (Lavizzo-Mourey 1996), determining the required actions for the patient to receive appropriate care. For example Muslims have Salat; obligatory Muslim prayers performed five times each day, healthcare professionals working in Sparkhill need cultural knowledge on this practice to avoid arranging clinics or appointments during these times which would result in patient absence, thus absence of patient care.

Furthermore Camphina-Bacote (2002) recognises the need for cultural awareness; the act of reflecting and exploring personal cultural and professional background involving recognition of prejudices, stereotypes and assumptions which could affect the care delivered to patients. When reflecting on my own cultural competence I feel that I know little about the values and traditions of other cultures, as highlighted by an incident on placement; a lady refused to remove her religious attire when asked to put on a theatre gown. I was unaware of the patients’ culture and the importance of the dress to her. Additionally the trust holds its own policy on religious attire; I was unsure how to handle the situation and stepped back. On my reflection ability of clinical situations I feel that I should increase my cultural knowledge and awareness on trust policies in order to make sure patients in my care do not receive unfair, discriminatory treatment based on their culture to further develop as a professional.

Identify a particular theory of change, outline briefly and discuss it critically showing how it may be useful/helpful to bring about service improvement in your work as nurse or physio

Healthcare revolves around increasingly ambiguous and turbulent times, where culture innovation of change is essential in order to meet the changing healthcare needs of the population and the advancements in research and technology (Broome 1990).

In our PD2 PBL groups we looked at a scenario (See Appendix 3) which suggested a need for change in the way care was delivered on the ward. These changes could be implemented through using models of change such as the Plan Do Study Act (PDSA) four stage model. The first stage `plan’, highlighting the change to be implemented, `Do’ stage is the action of carrying out the change, `study’ stage, collecting the data before and after the change and reflection upon it. The final stage `Act’ is the full implementation of the change or the plan of additional changes (National Health Service 2008).

The PDSA model can be applied to any healthcare setting and allows multidisciplinary involvement. The model allows the use of measurable goals so that the effectiveness of quality improvement can be reviewed throughout (Nakayama et al 2010). Wonderlich (2007) recognises how the model uses a simple `bottom up’ approach to change with the ongoing PDSA cycle or repetition of the PDSA process allowing continuous small scale improvement. Testing on a small scale; for example, implementing change on the stroke ward within the scenario and learning from it before advancement to service improvement on a broader scale within the trust reduces risk making it a highly effective, recommended model which is used frequently. The model however requires leadership from a professional with adequate stature; clinical director, to ensure tasks are communicated across teams. These tasks also take priority in order to be completed; meaning without effective leadership some healthcare professionals may not be committed (Nakayama et al 2010).

An alternative model is Lewins three stage theory of change; `unfreeze, moving and refreeze’. Although, Lewins model previously dominated change theory, as a core basis for many models due to its history, it is now often overlooked by modernised approaches such as the PDSA cycle or the NHS change model (NHS Change Model 2013). Further criticism of Lewins model is that it takes a top-down, management-driven approach to change, in scenarios such as the one looked at in our PBL groups where frontline health care staff such as staff nurses will be the agents of change upon the ward meaning Lewins approach to change would be inappropriate (Burnes 2004).

As I develop as a professional I feel it is important that I continue to increase my knowledge on the process of change, service improvement and the models which can support this. Through my role as a Student Nurse I am part of the healthcare system and therefore, in the position to bring about change.

What do the concepts of group and group dynamics mean to you? Using your theoretical understanding of the notions of groups and group dynamics, critically discuss your own contribution and that of your peers in problem based learning.

Groups are defined as a number of people who share objectives, identity and a frame of reference. The way the group acts and responds to changing situations is defined by group dynamics. Within the PD2 model we were separated into sets of fifteen people, each set forming a group due to our shared purpose and goal of being developing health professionals who wish to complete the module (Forsyth 2010).

Group establishments such as these can be outlined by Tuckman whi developed a model in 1965 explaining his theory of group development through 4 stages. `Forming’ , the first stage; a team make contact, develop trust and agree on similarities or common goals. Second stage; `Storming’, differences in opinion are expressed meaning power, control and resource issues are identified and communication skills developed. In the `Norming’ stage, decisions are made through negotiation, group roles and problem solving processes which are agreed. Finally the group works collaboratively producing effective results; ‘Performing’ stage.

Although one of the most commonly used models for group development, it consists of a number of criticisms; not all groups will follow these stages so clear cut, theorists also argue that groups often repeat stages throughout their time rather than completing each cycle once as Tuckman suggests. It could also be argued that the stages should not stop at ‘Performing’ and should consider the stages of evaluation and reflection (Tuckman 1965)(Forsyth 2010)(Elwyn and Greenhalgh et al. 2001).

This evaluation and reflection process was used within our PD2 groups including evaluating our own contribution. Within our group there was minimal interaction between members, with evident subgroups; all nursing students sat together, separated from physiotherapy students. Subgroups often occur due to previously established connections in social and emotional bonds and can affect the group dynamics; for example a physio may dismiss a comment from a student nurse due to the isolation caused by the subgroups. However our group facilitator evaluated the dynamics of the group throughout the sessions emphasising the possibility of the Hawthorne Effect (Forsyth 2010) as participants knew they were being evaluated, so may not have taken on their natural role.

On reflection I feel that if I was involved in another group I would encourage a mix of group members who have no established connection in order to create cohesion, improve team work, the group dynamics and group outcomes. I would also recommend that the group are kept unaware of the facilitator’s evaluation to prevent the Hawthorne effect and encourage members to take on a natural role in the group.

Moreover, researcher Belbin (1981) recognises nine different roles within groups which can be adapted by the members; bringing skills and expertise to the group and affecting the groups’ dynamics as roles are influenced by personality and self-perception. However Belbins roles include criticisms that they’re limited to management groups, although, the identified weaknesses and positive qualities of the roles are transferrable to other groups such as those within healthcare (Belbin, 1981).

In order to reflect on our contributions within the PBL groups we carried out Belbins’ self-perception inventory which allowed me to recognise my roles; `The company worker’ and ‘The complete-Finisher’. Before I was unsure as to what my role was within the team, but I agree with the self-perception inventory findings and feel that I can now build on my suited roles when participating in future groups allowing for professional development.