The purpose of this essay is to critically analyse an aspect of professional development and by using relevant reflection techniques to evaluate the development of this skill. The area of clinical practice which will be examined is wound management and the role in which reflection can be used to emphasize the progression of the skills required, improving knowledge base and fundamentally the techniques used to promote safe and evidence based practice. Wound management is an essential part of nursing practice (Gray & Cooper 2001). Additionally, Cutting (2010) states that nurse should have a sound knowledge base when assessing and carrying out the management techniques required. Reflection is a crucial skill and a development technique nurses should utilize to enable them to learn from their past experiences and put what’s been learned into practice to strengthen their clinical approach in future (Jasper 2006). Moreover, by using reflection this essay will deliver further evidence for the need to reflect and enhance skills in this area of practice. By using the chosen reflection tool the essay will provide a logical breakdown of how the skill has been developed and the personal progress within wound management. I will discuss how over my time in university and by combining theories and practical skills has allowed me to build on an essential skill. In conclusion it will be evident the way in which by reflecting on events can enable improved and increase of evidence based knowledge base.
Reflection is a human quality we actively integrate into everyday living and as Johns (2009) explains it allows us to appreciate experiences and how we apply any desired changes. With consideration to implementing this into education and learning, a significant figure was an American philosopher John Dewey (Bulman & Schutz 2004, Brown & Libberton 2007). He provided regulations to enable the understanding of the significance of reflection within study and personal development. Many healthcare policies and frameworks have promoted the development of this work with the focus on delivering safe practice for service users and reflection therefore, plays a fundamental part of nursing education (Timmins 2006). The Department of Health (DOH 1999) developed integrated frameworks for the enhancement of knowledge and development for their staff with a section dedicated to nurses. The framework expects nurses to build on previous understanding, skills and experience within their nursing performance. This framework is further developed within the Nursing and Midwifery Code of Professional Conduct (NMC 2008) who provide guidelines for nursing practice. They state that nurses have a responsibility to take part in suitable learning events which enable them to advance and sustain safe practice. Rycroft-Malone et al (2002) and Priest (2007) support the effectiveness for a nurse in actively applying techniques such a reflection to identify gaps in their knowledge to ensure evidence based practice is put into practice. In contrast Pearsons (2004) earlier work argues that the approaches being used to progress and implement evidence based practice were not successful. In agreement Tagney & Haines (2009) state that nurses are not fully prepared to successfully integrate theory into their clinical practice. Developed therefore over a period of time, were reflective models which Jasper (2003) states allowed nurses to easily clarify their experiences and subsequently understand and explore their actions.
For the objective of this essay the model that will be used is the Gibbs Model of Reflection (1988) (Appendix 1). This model was chosen due to its ability to simply identify a chosen skill and methodically distinguish the learning opportunities and offers a link between the transferring of theory into practice (Hull et al 2005). McCabe & Timmins (2006) argue that the Gibbs cycle of reflection induces the user to concentrate on negative aspects of their practice rather than understanding the positive support of all development. In contrast Bulman & Schutz (2004) and Wilding (2008) describe that the model has the capability to adapt simply to any circumstances and allows the user to clearly translate the knowledge in which they are reflecting. Other models of reflection were studied to ensure the strength of the selected one for the area of development. John’s model (1998) was structured within a clinical environment and promotes the user to supply valid account for the development of clinical skills. Jasper (2003) explains the model comprised of a series of questions similar to Gibbs cycle, but seizes to offer a clear link between theory and practice. A second model which was also taken into account was Bortons (1970). This model is predominantly proposed for students as it allows novice reflectors to suitably recognise their thoughts and feelings within their chosen area (Hull et al 2005). This model was ruled out due to the required level of depth of writing essential for this essay. Gibbs cycle (Appendix 1) consists of six stages that guide the user through the stages of the reflective cycle by asking a chain of questions, this allows the user to structure and easy interpreter guidelines. The model uses a basic approach to reflection and assists the user to provide initially a clear report of the situation or skills being considered and an analysis of feelings connected with the area of development are given. The skills or situation is then evaluated to highlight their existing level of skills, to the skills the user needs or wants to develop. After the main part is finalised the user concludes what they could have done to better the situation and therefore an analysis is then offered on how the situation has enabled development of skills (Bulman & Schutz 2008). Gibbs (1988) then encourages the user to develop an action plan to enable additional development of the area of interest or skill, this further promotes the NMC Code of Conduct (2008) for life long learning. For the following main body of this essay, Gibbs model (1988) will be used to analyse how I have advanced my skills and knowledge base in wound management.
My basic introduction to wound management was within the clinical stimulation laboratories which took place within our first semester in first year at university. Before this point I had no knowledge base or previous experience of wound dressings, management or assessment. Within these classes we were given the chance to practice bandaging, cleansing and assessment skills that would be used within our clinical placements. In conjunction with these practical skills, we received academic lectures from tissue viability nurses which concentrated on standards of care management required and the importance of accurate assessment. One assessment tool explained was abbreviated as TIME. TIME presents a logical and systematic method to the assessment (Young 1997). It was at this stage I appreciated how my poor knowledge base would begin to improve as my first placement was given to me, care of the elderly.
In first year of university my lack of knowledge was a main issue for me. With this in mind I developed an action plan (Appendix 2) which enabled me to examine my areas for development and allow me to recognise the exact learning outcomes I wished to attain and the resources I required to utilise. With the support and aid of my mentor within placement I was given tasks to deliver basic wound care to patients within the clinical area. These learning opportunities interconnected with my action plan enabling the development of my understanding and skills within wound management. Throughout various other clinical placements I have had many chances to advance on my skills, however in my second year community placement I was participating in the care of a patient with a complex wound. The key issue which I felt arose from this opportunity was the ability for me to start connecting theory to practice when selecting suitable dressings and assessment tools. Due to the care being provided on a daily basis until required it allowed my skills to develop and I was able monitor the progression of the wound and the success of the interventions specific to this patient. Following this placement I worked on a personal reflection (Appendix 3) to enable me to identify my strengths and weaknesses so I could transfer my evolving skills into all aspects of my future practice. My management placement in third year has been the revolving point in my three years of developing my wound management abilities. It took place in a surgical orthopaedic ward with high levels of wound management skills being vastly important to the patient’s recovery process. The main subject which arose within this placement was my capability to provide rationale for my care with regards to assessment and treatment of wounds. This clinical environment also offered me a new method to wound care. This approach was providing a holistic approach to my care delivery which included ensuring that accurate hydration of patients skin care was carried out for patients. After this placement I commenced a personal reflection (Appendix 4) to allow me to acknowledge the skills I had developed and highlight areas for development.
Over the last three years my response and feelings related to wound management has changed significantly. When originally being taught wound management within university I felt hesitant in my ability, astonished at the degree of some wounds and concerned my lack of knowledge within this area of nursing care would interfere with me within placement. Having the chance to construct an action plan and work closely with my mentor in first year consequently allowed me to increase my confidence in this area and gave me the basis to identify evidence based practice.In second year my feelings had changed to becoming more assertive in my ability and understanding of wound management. I still remained hesitant in caring for some wounds however; I had the ability to accurately recognise the resources needed to correctly provide wound management gave me assurance. My feelings connected with my practice in third year were entirely different. From using the reflection from second year I developed and became more aware of the role I played in effective wound management. I also was enhancing my ability to holistically care for patients with wounds. One significant lecture in first year by the tissue viability nurse specified we had to care for the patient as a whole and not just the wound a person has; this statement strengthened my practice in third year. This new method gave me confidence in providing rationale for care I was providing; I felt that I was finally achieving the skills required by a registered nurse.
Through the use of reflection over my three years of study it has allowed me to identify strengthens and weaknesses within my clinical practice. My action plan from first year highlighted my poor knowledge base. This allowed me to develop ways in which my I could expand my knowledge being taught in university, by integrating policies and guidelines such as Scottish Intercollegiate Guidelines Network 50 (SIGN 2008) into my studies. This guideline delivers promotion of national guidelines and local protocols which can assist practitioners to ensure their practice is evidence-based and their poor knowledge can be upgraded (Finnie 2000). Within second year it was clear my lack of confidence primarily in caring for complex wound could have made caring for the patient in the precise way impracticable. Through using a holistic and patient cantered method when carrying out care and building a professional relationship with them made this possible. Sources in this subject states that a mixture of evidence based and patient centred approach discussed by Cutting (2008) who describes that the nurse must determine if the technique they are using is of the best importance to the patient and cover all aspects of patient needs. This topic is further studied by Toy (2005) and Solowiej et al (2010) who supported that nurses should fully implement all areas of a holistic approach when planning and caring for wounds. In third year my area for development which became noticeable was taking control and being self confident in my practice. In the beginning this was complex due to the specialised area of wound care and necessary requirements of nurses within the area to be highly experienced. I was fortunate to have a very experienced and skilled mentor to pass on her understanding and perception into practice in this region. Closely working with my mentor allowed me to subdue the areas of limitation and weakness within my nursing practice. Literature within this area reveals a qualitative study carried out by Roberts (2008) explored how students learned from one another, a large portion was devoted to the early skills developed by students came from working directly with their clinical mentors. This study strengthened the need for me to work closely with my mentor to develop vital skills.
As the above reflection highlights, a main issue to evolve in my experience of wound management in first year was my poor knowledge. I had never encountered complex or even basic wound care so having the competence to develop the teachings from university into my clinical practice was of great benefit. University teachings had offered us with a basis of knowledge; it was then the student’s responsibility to further develop all features of this skill. Through the use of applicable learning materials such as developing action plans was of great advantage to me as it helped highlight areas that required strengthened and development. This is reiterated in work by Hackney (2008). He explains that by use of reflection and developing action plans will improve care and initiate professional and self development. Nursing education emphasises heavily on using this area of development which is further discussed by Bulman & Schutz (2004) who state that reflective education allows the student to rationalise their actions and identify areas for development. Further into my practice it became clear that that linking theory to practice was an important skill which guarantees practice is evidence based. Literature within evidence based practice allowed me to make this fundamental skill clearer to me with Tagney & Haines (2009) clarifying that if nurses recognise with the recourses which are accessible the care of patients will be of the greatest level and nurses can be assured in the care they provide. Assessment formed a crucial area within second year that helped to further develop my ability to make use of evidence based practice. In order to make sense of the experience in second year a older yet significant piece of work by Young (1997) provided outstanding basis for me on assessment and documentation highlighting that this skill is vital for nurses to accurately plan and implement the care required. In relation to assessment, second year gave me an insight into how nurses are deskilling themselves by relying on tissue viability nurses. In some clinical environments I came across nurses relying too heavily on the information and suggestions from specialised nurses rather than utilising recourses which were available and using their own skill and knowledge. A recent study by Huynh & Forget-Falcicchio (2005) suggested that nurses are not using their full ability, skills and knowledge when it comes to wound care and that their approach should be part of the holistic care they provide. Finnie (2000) emphasises the requirement for nurses to incorporate clinical guidelines into their practice. By examining this area of literature whilst on placement and applying it within my practice has allowed me to recognise the importance of guidelines and policies. With help from my theoretical teachings and clinical placements I know the care I provide will always be up to the standard necessary. With my final placement and the main issue discussed being the ability to provide rationale for my practice, relevant literature has allowed me to simply translate and understand this area of development. Timmins (2006) and Wilding (2008) further made it possible for me to identify that the development of this skill was a vital part of my educational training. Towards the end of my placement my mentor gave me the opportunity to discuss the need for me to work autonomously in my practice. My mentor was invaluable in allowing me and explaining to me the importance of holistic care. Since this was explained to me I have been enthusiastic in applying this in my clinical practice and also relating it to my part-time job within a care home.
In conclusion it has become apparent that by the use of Gibbs model of reflection (1988) has allowed me to accurately investigate and explore how over my last three years of study my skills in wound management have developed. I discovered that by researching the evidence based practice guidelines and recommendations within my early experiences of wound management, my skills enhanced. By following the Gibbs model recommendations in developing action plans enabled me to highlight my weaknesses and allowed me to develop in these areas. My concerns of my lack of confidence soon began to settle by using techniques promoted within the model. Concluding what I have learned in my second year and the development of the skill it became evident that linking the teachings from university and from clinical practice made an impact in the way I carried out these procedures as my confidence increased. From the process of recognising a knowledge shortage, action planning and reflecting on practice began a process of self learning that will only further my professional development. The first reflection specified the role in which I was starting to play in wound management. Within third year practice is aimed at working autonomously and having the ability to provide rationale for my approaches and care, using reflection was of great benefit to me. Furthermore, by completing this assignment it has given me further understanding into the importance of reflection. Johns (2002) recognises reflection as a valuable and life long tool in developing healthcare practice, in agreement Jasper (2003) further explains that by using reflection nurses can provide high quality of care and be confident in their actions.
Barton, T. 1970, “Reach, Toucon”, Practice Nursing, Vol. 8, no. 13, pp. 27-30.
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