Demonstrating Achievement of Learning Outcomes in Nursing

Demonstrating Achievement of Learning Outcomes in Nursing Analytical summary of portfolio to demonstrate achievement of the learning outcomes This essay is primarily aimed at analytically reviewing the portfolio that I have assimilated in the recent past. It effectively is a record of a number of key episodes in my student career. The portfolio itself documents a number of different aspects of events in my practice whereas this essay sets out to take an overview of the aims, goals and achievements that have been set and the degree to which they have been achieved. (Green J et al. 1998) The portfolio opens with a statement of intent as far as the original preparation was concerned. Although I have addressed the issues of professional requirement I have also approached the project form the viewpoint of my own personal benefit. I appreciate that this tool gives me the ability (amongst other things) to review my professional development and to document my evolution through my time as a student nurse. During its preparation I have therefore always kept in the forefront of my mind the eight learning goals enumerated in this statement. Reflections on academic and clinical experiences Continuing professional development and lifelong learning Decisions about the quality of my work Effective critical thinking Reflection on professional growth Empowerment to take responsibility for my own learning Development towards being a critical, reflective practitioner Document achievements (Pearce, R 2003). In terms of an analytical assessment of this portfolio, one should consider the work of Knowles and others in the field of adult education (Knowles, M. 1984 a ). Knowles’ theory of andragogy highlights the necessity for the adult student to appreciate the need to know something and the fact that adult students learn most effectively through experience and adaptation (Knowles, M. 1984 b ). Although not explicitly expounded by Knowles, the adaptive process is helped to a considerable degree by the process of reflection. As such my experiences have been recorded in a series of case studies and other investigations, and the process of adaptation has been illustrated through the mechanism of reflective practice. (Palmer in Bulpitt Martin 2005) The move towards evidence based practice has been one of the most noticeable aspects of the various changes in emphasis in practice in most areas of medically related work in recent years. (Berwick D 2005). I have been at pains to consider the evidence base which supports the various areas that I have either worked in or examined. To illustrate this point, let us consider the section presented on the subject of moral reasoning and health care law. This chapter examined a wide spectrum of ethical issues and associated moral dilemmas. Ethics is an area which in some respects is universal but in others is determined by local issues which include environment, culture and belief systems. (Kuhse Singer 2001) The evidence base for the various views expressed is presented and documented. An analytical assessment of this piece would have to include the fact that it only covers a small area of the whole potential issue. There is no apology for this, as the whole area of ethics is vast and the literature on the subject is extensive. It was not considered appropriate to do more than present an overview of one area. But the elements of this area are covered and presented with the important guiding principles that form the evidence base being set out, such as Bolam and the professional guidelines together with specific examples such as the precedent of the Charlotte Wyatt case. The evidence base element is also demonstrated in the clinical spectrum and I can cite the case study on Mrs Y (an MRSA infection case), as an example which not only allowed me to examine the issues of evidence (citing Pennington) but also to reflect and learn from the experience. (Taylor, E. 2000). It is always possible to criticise writing as not being totally inclusive of all of the available evidence and clearly such a criticism could be levelled at my work. In defence, I would suggest that much of the private reading and research that I have done that has helped to inform me in my professional life does not appear in the portfolio on grounds of expediency. In addition one is aware that the evidence base is constantly changing as new work is published and assimilated into the pool of accepted medical knowledge. (Sackett, 1996). In the case study that I presented relating to Angela, the evidence base played a large part in both the study, the learning experience derived from it and also the actual presentation of the evidence. I suggest that it is obvious that I clearly spent a great deal of time researching the various elements of the case and presenting them in an authoritative and evidence based fashion. I believe that this gives the work a greater credibility and also a greater learning potential for myself. (Holland K et al. 2003) Reflection is a large element in this portfolio. I make no apology for this as I have found reflective practice to be an invaluable learning tool and as can be seen in the substance of the portfolio I have used it extensively. It should be noted that although I have recorded a number of instances of reflective practice using the Gibbs model, (Gibbs, G 1988) it is a technique that I frequently use in my daily practice. Stockhausen, (L. 1994) makes a differentiation between reflection on practice and reflection in practice. I think that his analysis is both valid and relevant. Reflection on practice is a retrospective process that encompasses those processes that allow reflection at a stage after the event, and allow for modification in processing and response mechanisms to be employed when a similar situation is encountered for a second time. Reflection in practice refers to a dynamic process that occurs at the time of an action or intervention and is a shorter and more truncated process than the previously cited example. It is accepted however, that such a shorter process may not have the intellectual validity of a more protracted process. I have used both mechanisms both in the portfolio and also in my daily practice the case study of Angela demonstrates my ability to reflect on practice and the case study (year 1 chapter 3) shows that I am also quite able to use reflection in practice. As such I think that the portfolio is representative of my abilities in a clinical situation. I note that I frequently return to the concept of self assertiveness in my analysis of a situation. This is an area which is difficult to promote as a student nurse as one is hampered by both inexperience and lack of seniority. As I have progressed through my training, I feel that the process of reflection has helped me to identify situations where I can usefully be more self assertive, either to put forward my own point of view based on my own knowledge and beliefs, or to act as the patient’s advocate in situations where I believe that the patient’s best interests may not have been fully considered. (Koole S. L. et al. 19990 This element of self assertiveness has another and more profound implication. There is an implied responsibility incumbent on all healthcare professionals to disseminate and knowledge or experience that they may have to their professional colleagues. The element of learning and teaching comes within this remit. (Yura H et al. 1998). I fully recognise that, as a student, I have not been in a position to consider the possibility of teaching, as my own knowledge base has been dependent, at least in part, on the benevolence and knowledge of others. I am aware however, that as my own knowledge base has increased, I have been better placed to offer opinions and to add specialist knowledge into situations that are appropriate. I believe that this aspect of my training and development has also bee clearly demonstrated in the portfolio. For example, I can cite the section on basic life support that is presented in the portfolio. Having completed this element of the course, I now feel empowered to pass this specific knowledge on in areas where I encounter people (both patients, carers or other professionals) who may not have this type of specific knowledge at their fingertips. (Fawcett J 2005) I have little doubt that, as my professional knowledge increases, I shall be able to assume this role in a greater variety of areas and help to play my part in the future education of both patients and aspiring professionals. A large proportion of the portfolio documents my assessment of the impact of policy on the current mechanisms of health care delivery. The entry relating to equality in the health management of minority groups could be considered typical in this regard with a review of the issues of the Care Standards Act (CSA 2000) and the Disability Discrimination Act (DDA 1995). This particular case study was a major learning experience for me as it was by doing this analysis that I became more professionally aware of the possibilities for overt and covert discrimination both in terms of sexuality and disability and the need to be fully aware of these possibilities and to take positive steps to ensure that they do not colour my professional activities. There is a great deal of literature on the subject of discrimination in its widest applications and a critical analysis of my work could reasonably conclude that such a large area is underrepresented in the overall portfolio. This particular critici sm could clearly be levelled at virtually any work in this area and I am aware that I have had to make a judgement in this (and many other areas) where the line of balance between presenting all of the arguments both in favour and against a particular topic, can be drawn in the interests of both expediency and practicality. It would have to be conceded that even it the portfolio were 100 times as long as it is, it could not reasonably be expected to cover all of the arguments in the area. A sensible overview has had to be taken and I would suggest that the finished article is the product of these two opposing considerations. Some elements of the portfolio are specific and detailed case studies. I again refer to the case study of Angela, a 58 yr old lady with anal cancer. I cite this is being particularly informative for me as it not only is a demonstration of my research into the many issues that were impinging on this case but also in my ability to follow Angela through her illness trajectory (Newell et al. 1992) and I was able to reflect at length on the issues that she faced as her diagnosis was faced and the treatment. The major learning issue here, which is probably applicable to virtually all areas of professional work, is that effective communication is one the most important skills that the professional nurse can acquire. Effective communication can help to deal with some of the elements of the sequelae that can arise in this situation such as depression as well as the more positive aspects such as empowerment and education of the patient. (Mason T et al. 2003). This particular case study also highlights the need to assess and assimilate the social (and other) elements of the patient’s case. The reductionist school would have us regard the patient as a set of symptoms and nursing problems to solve. Although reductionism can be a useful analytical tool to assess the most appropriate forms of treatment, it can be criticised for removing the human angle from the professional assessment of the patient. (Jacobs, B B 2001) I have always been a staunch advocate of the holistic approach to patient care and reductionism is diametrically opposed to this viewpoint. (Thompson C 1999) I believe this is demonstrated in my presentation of the socio-economic situation as it pertains to Angela. The consideration that her mother lives alone and has a Yorkie dog to contend with is all part of the overall spectrum of consideration for Angela, as her hospitalisation will effectively impair her mother’s ability to both survive independently and also to care for her dog. These are vital and important elements in a patient’s care and should realistically be incorporated into the decision making process that evolves from the patient management considerations. (Hewison, A. 2004). I hope that this particular essay demonstrates my ability to pursue a logical and rational approach to decision making based on a strong evidence base and a holistic care plan. In terms of my own professional development, this portfolio represents a number of â€Å"snapshots† in my trajectory through the undergraduate course. It has helped to focus my attention on a number of specific issues, some were specified by the tutors and some were self determined. It is a feature of adult education that learning in one area often opens up possibilities for research and interest in other related areas.(Merriam S B 2001) I have certainly found this to be true, as my reading on one issue will frequently be punctuated with explorations into other areas that may be related. This may not necessarily feature in the portfolio itself, but will inevitably add to the knowledge base that I have accumulated throughout my undergraduate career. This comment is not intended to be viewed as a weakness but is presented as a strength. It has to be said that the portfolio does not fully reflect the professional development that I have been able to achieve and is not intended to do so. It should be more critically seen as a record of the stages of my development and some of the areas that have been actively explored. I am aware that it is in the nature of a professional career in nursing that every interaction with patients and staff brings the possibility of new learning experiences. (Hogston, R et al. 2002). It is my hope and belief that this portfolio illustrates the fact that I have taken advantage of these possibilities as they have presented themselves to me. I believe that I have grown in professional stature and competence as a direct result of having had the experience of completing it. In viewing the work there are a number of areas in which the portfolio could be considered deficient. The very act or recording and writing is itself a trophic and dynamic process (Meleis A. 1991) and thereby records a process of evolution from my early days as a nursing student to the present. It can be therefore seen that some of the earlier entries lack the degree of maturity and knowledge that the later entries clearly have. I do not believe that this is actually a deficiency as, to a large extent, this documentation of process is one of the major functions of the portfolio. I believe that I learned a great deal relating to the processes of effective reading, efficient research and informative presentation during this process which I believe are just some of the less well publicised attributes of the modern nurse every bit as much as the clinical skills and knowledge that is perhaps more generally accepted as a core requirement. (Clarke J E et al. 1997). It would appear to me that a critical assessment of the portfolio would also have to include the realisation that some of the earlier elements are clearly not as sophisticated nor perhaps as informatively written as the later ones for this very reason. The very fact that I have been able to take a critical overview in this particular essay, to a large degree, underlines the point that I would not have been able to write an essay of this nature when I started on my undergraduate career but I feel that I have now been enabled to assimilate sufficient knowledge to reflect critically on the learning process and to comment on it. With the benefit of hindsight, I feel that if I had appreciated the importance of the evidence base in discussions at an earlier stage in my education, I believe that I would have placed a greater emphasis on it in my earlier writing. As I have observed earlier however, it is this learning evolution coloured by experience which is perhaps one of the greatest benefits that can be both seen in and derived from a portfolio such as this. It is the act of research, reading and then the committing of analytical concepts to paper, which is a fundamental learning stimulus of the adult student. Looking forward, I believe that the experiences that I have derived from compiling this portfolio will stand me in good stead for my future professional career, not only in terms of the factual knowledge that it contains but also the conceptual methodologies that it represents and that I have now been able to experience, evolve and put into practice. (Kazdin A E 1998). I now more fully appreciate the need for critical analysis and evidence based practice particularly if I wish to enhance my professional status by imparting good practice and knowledge onto other colleagues in due course. References Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005 ; 14 : 315 316. Clarke J E Copcutt L 1997  Management for nurses and Healthcare Professionals.  Edinburgh: Churchill Livingstone 1997 CSA 2000  Care Standards Act. (2000).  Government White Paper  HMSO : London 2000 DDA 1995  Disability Discrimination Act. (1995).  Government White Paper HMSO : London 1995   Fawcett J 2005  Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories, 2nd Edition  Boston: Davis Co 2005 ISBN : 0-8036-1194-3 Gibbs, G 1988  Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Gilbert T 1995  Nursing : Empowerment and the problem of power  Journal of Advanced Nursing 21 (5) : 865-871 Green J, Britten N. 1998  Qualitative research and evidence based medicine.  BMJ 1998 ; 316 : 1230-1233 Hewison, A. 2004  Management for Nurses and Health Professionals: Theory into practice. Blackwell Science: Oxford. 2004 Hogston, R. Simpson, P. M. 2002  Foundations in nursing practice 2nd Edition,  London: Palgrave Macmillian. 2002 Holland K, Jenkins, J Solomon J, Whittam S 2003  Applying the Roper-Logan-Tierney Model in Practice Churchill Livingstone 2003 ISBN 0443071578 Jacobs, B B 2001  Respect for Human Dignity: A Central Phenomenon to Philosophically Unite Nursing Theory and Practice through Consilience of Knowledge. Nursing Models of Care  Advances in Nursing Science. 24 (1) : 17-35, September 2001 Kazdin A E 1998  History of Behaviour Modification: Experimental foundations of contemporary research.  Baltimore: University Park Press. 1998   Knowles, M. 1984 a .  The Adult Learner: A Neglected Species (3rd Ed.).  Houston, TX: Gulf Publishing.   Knowles, M. 1984 b .  Andragogy in Action.  San Francisco: Jossey-Bass 1984 Koole S. L. ; Smeets K. ; Van Knippenberg A. ; Dijksterhuis A 1999  The cessation of rumination through self-affirmation  Journal of personality and social psychology (J. pers. soc. psychol.) ISSN 0022-3514 Kuhse Singer 2001  A companion to bioethics  ISBN : 063123019X Pub Date 05 July 2001 Mason T and Whitehead E 2003  Thinking Nursing.  Open University. Maidenhead. 2003 Meleis A. 1991  Theoretical thinking: development and progress. 2nd edition.  Philadelphia : Lippincott Company, 1991. Merriam S B 2001  Andragogy and Self-Directed Learning: Pillars of Adult Learning Theory  New Directions for Adult and Continuing Education Vol 2001 Issue 89 Ppg 3-14 Newell and Simon. 1992  Human Problem Solving.  Prentice-Hall, Englewood Cliffs: 1992. Palmer 2005  in Learning about reflection from the student Bulpitt and Martin Active Learning in  Higher Education.2005 ; 6 : 207-217. Pearce, R 2003.  Profiles and Portfolios of Evidence.  Cheltenham: Nelson Thornes 2003 Sackett, 1996.  Doing the Right Thing Right: Is Evidence-Based Medicine the Answer?  Ann Intern Med, Jul 1996 ; 127 : 91 94. Stockhausen, L. 1994  The Clinical Learning Spiral: A Model to develop Reflective Practitioners.  Nurse Education Today 14, 63371. 1994 Taylor, E. 2000.  Building upon the theoretical debate: A critical review of the empirical studies of Mezirow’s transformative learning theory.  Adult Education Quarterly, 48 (1) , 34-59. Thompson C 1999  A conceptual treadmill : the need for middle ground in clinical decision making theory in nursing  Journal of Advanced Nursing Volume 30 Page 1222 November 1999 Yura H, Walsh M. 1998  The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. ############################################################### 3.7.06 PDG Word count 3,549

Review of Related Studies Essay

A lot has been written about what supply management is, and how it relates not only to similar terms and to concept like purchasing, procuring, and sourcing, but also to concepts like management, logistics, and supply chain management. Most authors differentiate purchasing, procurement, sourcing, and supply management as follows: they start by stating that purchasing includes operational activities that are carried out more or less exclusively by one department, namely the purchasing department. The sequence of activities here usually starts with the need identification and ends with the tracking of purchasing activities. Procurement is then defined as being broader in scope and including some activities of strategic relevance. According to Dobler/Burt (1996), procurement includes not only purchasing but also tasks that are strategic in nature. The same logic is then applied to supply management as figure 1 shows. See on page 38 for the figure. Monczka/Trent/Handfield(1998) use the terms purchasing and procurement interchangeable throughout their book. In their view, purchasing and procurement are functional activities that â€Å"most often refer to day-to-day management of material flows and information†. They also define sourcing â€Å"a cross functional process that involves member of the firm other than those who work in the purchasing department, the sourcing management team may include members from engineering, quality, design, manufacturing, marketing, accounting, strategic planning, and other department† Kaufmann (1995) describe sourcing; â€Å"an integrative management approach to designing all supplier relations in the sense of a total relationship management† Arnold (1997) uses the term supply management as an umbrella term for the concept of procurement, materials management, and logistics. According to him, the latter includes inbound logistics, and internal logistics, as well as outbound logistics. Tempelmeier (1995) defines purchasing as contract-centered (as opposed to logistical activities implying the physical movement of goods). He defines procurement as all activities aiming at supplying the company with needed inputs. Corsten (1995) the process of purchasing denotes the act of acquiring the property right of the procurement goods. He defines procurement in a similar way as Tempelmeier. Sourcing is the process of planning and handling outside sources. He defines supply management as procurement with a strategic focus that acts proactively and contributes significantly to company performance. Koppelmann (1995) uses the term Procurement Marketing for nearly exactly the same set of activities as Dobler/Burt do for supply management. There is also some discussion about the types of purchases that fall under each of the definitions. International authors like Dobler/Burt (1996), Monczka/Trent/Handfield (1998), and van Weele (1995) restrict the scope of purchasing, procurement, sourcing or supply management to materials, services, and capital equipment. They do not include the supply of the company with financial resources or personnel. German authors like Arnold (1997), Fieten (1986), Pieper/Pfohl (1993), Tempelmeier (1995) argue differently: They say that from a theoretical standpoint all inputs have to be considered. Some of them like Arnold and Pieper/Pfohl however, pragmatically restrict the scope of purchasing, procurement, or supply management to materials.

Environmental Factors And The Development Of Schizophrenia

Environmental factors are crucial to the development of schizophrenia. A traumatic experience in early childhood can cause schizophrenia in the future for example sexual or physical abuse. It carries over to adulthood. According to some studies, the age of the father contributes to the risk of schizophrenia. The older the father the greater the risk because of the â€Å"genetic mutation in the sperm that can be passed on.† (Berkshire Health System, 2014) History of Treatment Upon archeological discovery, bodies found with holes drilled into the skull from the fourteenth and fifteenth century. It is believed that it was an attempt to cure the demons by allowing them to escape. CITE During the middle ages, when the church ruled, mental illness was considered a punishment from god. Those suffering would be directed to the church for confession and prayer for forgiveness. It was during this time when Weyer proposed the idea of an unsound mind. During the 18th century, the mentally ill were normally cared for by family or loved ones. In acute situations, were they jailed or institutionalized. Social reformers began protesting against the detention of the mentally ill in jails. The conditions they were in were degrading and inhumane (Glazer, 2014). In 1752, the Quakers in Philadelphia dedicated the basement in the Pennsylvania Hospital for the disturbed. There were rooms with shackles attached to the walls to serve the few mentally ill pat ients. Later, their unit expanded and theShow MoreRelatedDevelopment of Schizophrenia660 Words   |  3 PagesEarly theories regarding the development of schizophrenia hypothesized that a large percentage of the onset of the psychotic disorder was due to genetic predisposition (Leboyer et al., 2008; Tsuang, Stone, Faraone, 2001). Meehl (1962) theorized that schizotaxia, a genetic predisposition for schizophrenia, inevitably results in schizotpy, the physical materialization of schizophrenia. Other early theories suggested that 80% of the likelihood of developing schizophrenia could be attributed to geneticsRead MoreEssay about Genetics and Schizophrenia1632 Words   |  7 Pagesdiscuss whether schizophrenia is genetically inherited disorder. There will be an understanding to what schizophrenia is with a brief description in the introduction. This essay will also talk about weather schizophrenia is genetically inherited or weather it is a biological (Inherited) disorder. It will also include weather schizophrenia is cause by other factors such as social factors, environmental, pre natal, childhood and neurobiology. 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Childhood schizophreniaRead MoreBIOPSYCHOSOCIAL MODELS FOR SCHIZOPHRENIA1117 Words   |  5 Pagesï » ¿ Biopsychosocial Models for Schizophrenia Karolyn LaPre 11/15/13 Psy 305 Instructor: Arthur Swisher This paper will explore one of the most severe mental disorders, schizophrenia, with the goal of providing an actualized understanding of this disorder, including its etiology, course, epidemiology, diagnostic and treatment. Schizophrenia is characterized by an unadaptive pattern of general though and emotions, including delusions, auditory hallucinations

Capital Punishment The Right Step Toward Equity

There are immense contrasts in the way individuals see capital punishment. Some contradict it and some concur with it. There have been numerous studies attempting to demonstrate or invalidate a point with respect until the very end punishment. Some have viewed capital punishment as an obstacle, and some have viewed it as state endorsed kill and not edified. Capital punishment has been ascribed to social orders for a long time. All the more as of late, as we turn out to be more acculturated, capital punishment has been addressed to be the right step towards equity. Over the span of this paper I will audit the advantages and disadvantages of the utilization of capital punishment as we, Americans, know it. Capital punishment is a very dubious subject.No one knows who s correct or who s wrong-it s fifty percent hypothesis and fifty percent research. It s only a considerable measure of contemplations and convictions from individuals who have added until the very end punishment buildup. Wh o s privilege and who s off-base? That is the issue. To start with I have to highlight quickly into to the historical backdrop of capital punishment to completely comprehend why individuals feel the way they do about capital punishment. All countries on the planet have had capital punishment and had authorized it from numerous points of view. It was utilized as a part of most cases to rebuff the individuals who infringed upon the laws or benchmarks that were anticipated from them. AShow MoreRelatedThe Illegalization Of Capital Punishment1441 Words   |  6 PagesBrianna Pulido Ms. Ingram American Literature 14 April, 2015 The Illegalization of Capital Punishment The Death Penalty, also termed capital punishment, is the legal process in which a person is put to death by the federal or state government based on having committed one of 43 capital crimes, such as first-degree murder, espionage or treason. 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