Nursing is a profession that requires extensive education, skills, special knowledge and preparation to handle the vast and dynamic challenges. Having an orientation towards serving a big organization such as a large metropolitan hospital, a professional is also required to acquire relevant knowledge pertaining to the roles one is interested in taking in terms of research, adhering to all the nursing code of ethics, to be guided as well as to be incorporated under the umbrella of a professional organization and finally be autonomous. Management of a critically ill patient demands considerable skills from a vast disciplines involved in patient care.
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Intensive care is potentially traumatic for patients in emotional, social and psychological terms thus requires more than the skills acquired in college/university in admitting a critically ill patient in the intensive care unit and also nursing and monitoring their progress. There is need for continuous reassessment and monitoring of any deviations of vital signs from normal parameters and thus prevents secondary complications. With these high pressure conditions one is always challenged on any decision that is made and would be forced to either maintain the same decision or change the former decision to a new decision that would help benefit the patient, not forgetting that the patient comes first and being the patients advocate it is always important to make the right decision for the patient. In most of the cases, the patients admitted in the intensive care units are unconscious and are not able to participate in discussions about their health or diagnostic investigations and treatments, decision making and advocacy will finally rests with the relatives and staff.Critical thinking challenges the mind and helps make fast and right decisions in the shortest time possible to either save a life or prevent a complication.
Short term goals
Working in a large metropolitan hospital is one of the main objectives that are incorporated in the agendas as a nurse in three years time and particularly in the intensive care unit. Although the intensive care is associated with stresses for the nursing personnel working in there, I tend to regard this as a motivational challenge as opposed to a burden. Circumstances that are characterized by mentally challenge, pressure conditions and fast paced are some of the initiatives that are bound to boost my profession in the trauma and critical care setting. It is the challenges as well as acquiring knowledge and critically planning that will act as my basis in my future professional career in intensive care unit. In critical nursing, a nurse is specifically deals with problems that are life-threatening to humans. It is in these settings that a nurse is required to administer complex assessment, interventions and high-intensity therapies to their patients that reflect some of my aspirations as a nurse working in an intensive care, in three years time.
As a critical care nurse, knowledge is attained from a specialized body, experience and skills. In addition to this, the nurses incorporate these attributes as guidelines in the provision of care to patients, their families and generally in creating a surrounding that consist of healing, humane conditions and caring. In relation to working in a large metropolitan hospital, some of my short term goals would include completion of a three year undergraduate degree that would entail making use of the skills and theory acquired in the undergraduate degree. In addition to this registration as a division 1 nurse in critical care is also one of the main objectives and goals to be achieved. To sum it all, enrolling and later on completion of a post graduate qualification is one the main goals that has to be achieved and especially if it pertains to critical care and trauma nursing.
Securing a position in a large metropolitan hospital offers a wide range of experience in the skills one is interested in thus competency is achieved having gained the necessary skills and knowledge in performing various nursing activities. It does not only offer competency but also improves the professionalism since its combination with studying and completing the graduate studies achieves one important goal of staffing in an intensive care i.e. the staffs should be at a higher professional training level than the general wards to offer the optimum care.
Gaining experience in all aspects of emergencies the Cardiac care, Intensive care and all emergency departments is important but the bottom line should always be that all professionals working in these areas should be familiar with and skilled or trained in cardiopulmonary resuscitation (CPR). All these are skills of basic life support and are essentially practical ones which must be learnt and practiced regularly using the skills lab where you can practice using manikins or perform it under supervision after duration of time, where one would just observe the skills and learn from them so as to practice later.
Attributes and skills of successful nursing
Despite the profession one is affiliated to, there are particular professional skills as well as attributes that are required in order to successfully undertake what is entailed in the specific professional one is affiliated to. Some of the questions that need to be asked in order to understand what attribute and skills that are required in order to achieve a successful career in critical care nursing include; what are the characteristics and qualities of a critical health nurse?, Are these characteristics in born or learnt? And does critical care nurse require a right personality? These and many other questions act as the pillars of understanding what it entails in order to achieve a successful carrier in critical care nursing. Successful skills and attributes that are related to critical care nursing do not involve physical nursing such as taking blood and giving injections but rather involve problem solving and information giving. The skills involved in critical care nursing are best attained through practicing as opposed to reading them from the books and manuals. Across the globe, nurses are attributed as health care providers with a variety of skills. It is through the globalization of the knowledge entailed in nursing that has resulted to nurses acquiring essential skills, judgment and knowledge to monitor patients extensively, interpret as well as synthesize information using scientific knowledge, provide therapy to patients and plan for negative or positive outcome (Holzemer and international council of nurses, 2010, p. 57)
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Therapeutic clinical skills and generic interpersonal skills
The therapeutic clinical skills incorporate a vast of specific skills that are used by critical health nurses in their bid to attend to their patients. These skills results to interpersonal skills that include: engagement skills that are essential in developing therapeutic relationship with the patient; challenging skills that are essential in confronting the patient and problem solving skills that are essential in terms of assisting the patient in attaining the solution to their problem.
Generic interpersonal skills are a set of skills that involves engagement, relationship building and communication. These skills are reinforced by personal attributes such as respect, compassion and empathy. These skills cannot be attained through book or manual reading despite the fact that the books help in attaining the theory concept of the skills. The generic interpersonal skills are mainly associated with therapeutic relationship. This is in terms of the commencement of the relationship to its end (Pryjmachuk, 2011, p. 59).
Team working and effective communication
As a graduate midwife, it is crucial that team working is regarded with the absolute importance it deserves in the nursing professional. Midwives’ roles are interrelated as part and parcel of a team of professional, within which each and every professional contributes skills that are essential to overall care of women and their loved ones. According to the code of professional conduct, registrants are required to work hand in hand with others for the sole reason of upholding the health standards of the patients, their families and the community at large. The rules and standards that are incorporated in the midwives professional requires that, in case the condition of any woman or baby deviates from normal, the midwife should refer the matter to the appropriate health professional. On the other hand effective communication is essential in the interaction that exists between the midwife and woman. It is crucial that the midwife/ nurse understand the cues she is providing to the woman of which falls within the care she is providing (Baston et al, 2009, p. 7).
Competence is a skill that is associated with knowledge and judgment in the line of duty of a midwife professional career. The skill is attributed in developing safety and effectiveness in professional duties of a midwife. Over the years midwives are attributed to maintaining as well as developing competence especially in the education they have acquired in midwifery. The practice in midwifery takes place in a context of progressing change in terms of sensitivity responsiveness and relevance (Lewis, 2010, p. 59). According to Chang and Daly, currently competency standards are grouped to 10 different categories whose responsibilities involve 4 domains. At university level, competence is regarded for skill development (Chang and Daly, 2008, p. 17).
Relevance of the skills to the three year goals
Therapeutic clinical skills and generic interpersonal skills, team working and effective communication, and competency are attributes and skills that incorporated in the health sector for the sole reason of ensuring that health professionals, which include the nurses provide standard health services. In their day to day professional life, nurses are bound to interact with different type of people. In the course of these interactions the nurses are supposed to communicate effectively as well as relate efficiently with them. In relation to this, nursing is regarded as a social profession and thus, nurses are supposed to be socially competent. In addition to this, the nurses are hence forced by social circumstances surrounding them to be skilled in the art of relationship development, interpersonal communication and socially competence. In relation to the goals set, it is the responsibility of the nurse to competently communicate with the people they are attending to for the sole reason of attaining relevant as well as crucial data for clinical assessment. According to the professional codes and standards of practice, nurses possess the ability of therapeutically relating with their patients beyond the passive recipients of care. Interpersonal relationships are regarded as vehicles through which subjective experiences of patients are responded to by the nurses. The nurses’ concern, commitment and care are expressed through these interpersonal relationships (Stein-Parbury, 2009, p. 3).
Nurses reflection on aspects of their practice
According to Hannigan, “Reflection is regarded as reviewing experience from practice so that it may be described, analyzed, evaluated and consequently used to inform and change future practice. Reflective practice in nursing context is defined as a thoughtful, critical and innovative practice. ” This however is totally different from a ‘thoughtful’ practice in the sense that, a reflective practitioner is regarded as a person with the ability to problematize different scenarios of professional performance for the sole purpose of converting the same scenarios to become learning scenarios. The whole concept of leaning that is associated with reflection, is of importance as it is the basis upon which reflection is incorporated into nursing education. Reflection on action or reflection on practice is also referred to as a cognitive post-mortem, which indicates that the nurse or medical practitioner revisits a situation with a clear aim of learning and exploring from the situation. It is through guided reflection that realization, caring and effectiveness can be achieved as it is part of development and professional education (Hannigan, 2001, p. 280).
In the modern world, nurses are progressively attaining information on the effect of improving and evaluating their practice in terms of political, structural and social perspectives of the practice. As change becomes evident around us, it is crucial for nurses as well as other medical practitioners to be able to respond as well as analyze new challenges in a proactive way. It is through critical thinking that nurses can achieve reflective skills that are essential in provision of care despite the ever changing environs and also achieve to become a critically reflective practitioner. According to Bowden, a critical reflective practitioner is “a type of nurse or category of nurse who thinks critically about and reflects on their practice.” In other words, a critically reflective practitioner can be described as a nurse, who makes use of the questioning approach, who is ever evaluating, who don’t take things for granted and perceives situations in a practical manner all in the aim of handling the future situations properly (Bowden, 2003, p. 28).
In the modern perspective of thinking in nurses, it entails that nurses need to be educated in a different manner in order to develop their sensitivity, critical thinking, autonomy and open-mindness. This hence could be achieved by reflective education. Nurses as well as other professionals have embraced reflection literature thereby making it grow even more. According to Bulman, the reflection literature is regarded as a vehicle through which nurses’ use in communicating as well as justifying the importance of practice and the knowledge that pertains to it (Bulman, 2004, p. 1).
Schon’s dimension of reflective practice indicates a long standing interest that exists in design in terms of environmental, interpersonal and physical context. Schon’s work is based on John Dewey’s work on which the doctoral dissertation has been attained from (Redmond, 2006, p. 33).
Reflection-on-action and reflection-in action
Reflection in action and reflection on action, both are characterized by creation of relation in terms of past experiences as well as situations. The relation in question is attributed to strategies, ideas, opinions and goals of the learner. The major difference between these two types of reflection mainly surrounds the time in which the action took place in relation with the reflection. Reflection on action is regarded as the activities that took place in past actions and are reflected by the learner. This therefore indicates that the action that is in question must have taken place and cannot be changed by taking insights in terms of reflection of the account. On the other hand reflection in action is regarded as reference to cognitive processes that are associated with knowledge application as well as experience that is appropriate for assessing and controlling the progressive task. In relation to this, reflection is regarded to be directly associated and intertwined with the action that is taking place (Koper, 2009, p. 291). According to Swanwick, reflection in action incorporates three activities which include: reworking and reframing of the problem in different dimensions, identifying the problems position in the schema i.e. use of existing experience and knowledge, and comprehending the implications and elements that are present in the problem including its solution and its aftermath. In terms of reflection on action, the process entails thinking back of the major activities that took place in an action with the aim of ascertaining what caused the unexpected and its effect to the future practice (Swanwick, 2010, p. 21)
Guided reflection is attributed s as a process of self in-inquiry that enables the practitioner attain and effective as well as desirable practice within which a reflexive a spiral of being is achieved. This kind of process is regarded as developmental process due to its immense value to the practitioner. In guided reflection, research and teaching is mainly fused to become one main activity. As the basis of any reflective curriculum, it is the practitioner’s daily practice that can be attained in terms of its complexity in terms of its meaning in a reflective lens (Johns and Joiner, 2002, p. 3).
In terms of relating to the patient in a therapeutic manner, nurses tend to make use of the interactions for the sole aim of benefiting his or her patients. In this case, the nurse will have made use of oneself as a therapeutic agent, within which the nurses make decisions in the process of their interactions. Self understanding which is incorporated in self reflection provides an understanding upon which the nurses regard themselves as common human beings who are prone to failures and success, thus indicating room for patient’s attention. In relation to this self-understanding is regarded as a crucial ingredient in the structuring of a nurse in terms of a therapeutic agent. Nurses still have room for developing their potential in terms of self reflection through acceptance of input from other people.
Having background information on the required skills and knowledge, the experience earned from the relevant departments will challenge the mind and help in better judgment on the future expectations. A post graduate course would enhance a better carrier offer, increase the level of expertise and form the basis of the nursing profession. Clinical and professional leadership and development may need to be provided by a critical care nurse specialist who is able to offer the best and quality nursing care to the patients. Management and administration of a professional leads to reduction of mortality rates and improves efficiency.
Communication is regarded as any means that is used by nurses for the sole purpose of exchanging information in terms of data or feelings between various people. In nursing communication is carried out when there is transfer of information between the nurses themselves or nurses with the rest of the staff or with the patients or community at large. It can also be interpersonal communication, or intrapersonal communicational talk with one self. In all these the communication pattern must pass through the communication process where the sender, message, receiver are in one line so that a respond can be elicited.
Nursing as a profession and as a carrier involves therapeutic communication which promotes understanding relationships between the nurse and the clients. There many techniques involved in the therapeutic communication in which reflecting is considered to be one of them. This is whereby after the client has communicated to the nurse the nurse tries to direct the ideas, feelings, the questions or the content back to the same client to help them come up with their own ideas and feelings about a certain situation. This helps the patients/clients to open up more and realise that they themselves are more empowered than they thought they were since they give solutions to their problems but in an aided way.
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