对于这项任务，我要证明我的自我管理的认知和与预先登记的水平的标准，我的实践（NMC 2008）。我会选择两个管理技能，以协助实现相同的，这将是时间管理和决策都有一个轴承的护理管理。我会为我的选择和分析性能的理由我将采取和个人发展计划（PDP）确定地区发展创造了。我将提供理论依据和相关文献来支持我的讨论。我将在一个明确的和结构化的格式，参考相应的分配。我会反思学习获得的吉布斯反射模型，并结束我的任务。保密性和匿名性将由NMC保持（2008）。Nursing 代写 Knowledge to Enhance Quality of Care in Adult
社区内的结构，以确保护理提供给那些在最需要的是基本的病人护理。患者需要进行审查和评估，每一次访问，以优化恢复。这两个组件直接与护理管理，并通过通信固定的。Nursing 代写 Knowledge to Enhance Quality of Care in Adult
For this assignment I shall demonstrate my perception of self management and that of my practice in accordance with the Standards of Proficiency for Pre registration (NMC 2008). I will select two management skills to assist in the attainment of the same, which will be time management and decision making both of which have a bearing on care management. I will provide a rationale for my selection and an analysis of my performance will be undertaken and a Personal Development Plan (PDP) created for identified areas for development. I will provide theoretical evidence and relevant literature to support my discussion. I shall present this assignment in a clear and structured format, referenced accordingly. I will reflect upon the learning gained using the Gibbs Reflective Model and conclude my assignment. Confidentiality and anonymity will be maintained as directed by NMC (2008).
My management experience took place in an affluent urban area with a significant multi-cultural population. The office is situated in the heart of the town centre within a busy office complex and shared by multi – professional teams of District Nurses, Matrons and Social Workers; all working in unison to provide holistic care to a community with a wide range of medical, surgical, and palliative problems.
The rationale for the aspect of role transition for the selection of Care Management is I believe important, and has particular relevance to community care. Time management is based on the importance of organization and
structure within the community setting to ensure that care is provided for those in most need which is fundamental to patient care. Patients need to be reviewed and assessed on every visit to optimize recovery. Both these components relate directly with care management and are under pinned through communication.
Role transition is very important and can be defined as “changing direction from one state to another and functioning in a different manner” (Hunter and Lops 1996 cited in Amos, 2001, p.36). The transition from the role of student to that of professional nurse is very important and can be fraught with great excitement or apprehension for the student, who can be protected or even neglected by the mentor from the stresses and problems that may arise in the clinical environment. What Mooney (2006, p845) described as “the sheltered student life”. This can create a false sense of security for the student and unpreparedness for the challenges that lay ahead. (Brenner) 1982 states that there are five stages within a process he refers to as the social model. The stages range from novice, to advanced beginner, competent and proficient. Transition is congruent within the context of management.
Management can be defined as the achievement of organized goals, getting work done through others (Whitehead, Weiss, Tappen, 2007) through leading, effective planning, coordination and organizing (Schermerhorn, 2010) and involves a number of elements of which include decision making and time management.
Decision making has been defined (Marquis and Huston, 2007) as a complex, cognitive process characterized by the selection of a particular course of action. However, Huber (2010) believes that the skills to make effective decisions can be learned through trial and error. At the beginning of the placement making decisions was an interactive process which took place between me and the patient. The process of generating options and identifying objectives has been outlined by (Yoder-Wise, 2011) who believes that poor decisions are made when objectives are not clearly identified. Communication at this point is very important and a democratic approach allows the client to feel some control over their care.
My patient list would contain a varied range of clients, with differences in culture, socioeconomic background, age, gender and comprehension requiring me to diversify my approach and vocabulary when communicating (Blazer 2008).
One client was a practicing muslin who prayed several times a day, I was able to manage his care effectively by finding out in advance the times he would perform his prayer rituals and try to organize visits around those times. On
occasion it was not possible for me to attend so I would delegate the task to a member of the team. I documented this information into his care plan to ensure other team members were aware. Once implemented, and evaluated the decision had a successful outcome for the client and the team, ensuring optimum use of resources and time Marquis & Huston, 2007. Situations where clinical judgment is required can be considered as a problem -solving activity (Tanner, 2006) and are viewed as actions based on the assessment of patients needs.
A patient had been referred with bilateral leg ulcers and had been house bound for some time. I discussed his immobility which was beginning to depress him and was impacting on his social life and this confidence. After careful analysis of his needs I made a referral to the specialist nurse where a comprehensive review could be completed and an appointment with the social services team arraigned. This case required experienced practitioners within a multi disciplined team I therefore requested that a senior practitioner with the relevant experience take the case. I shall now review time management the second component.
Time management can be defined as the accomplishment of specific activates within the time available (Huber, 2010). Learning to take charge of your time and use it efficiently and effectively is the key to time management (Whitehead, Weiss, Tappen, 2007). However, Huber (2010) argued that effective time management requires skills which one gains through experience and practice he
refers to the time management process as a cycle of analyzing and planning consisting of eight steps starting with analysis and ending with reanalysis. This was particularly relevant to me within my practice. I would plan the route I would take to see my various clients this analysis was part of the cycle referred to by Huber (2010) and was necessary for me to optimize my time. Prioritizing is the decision making process that result in a systematic order to accomplish identified tasks, leading to organization which is necessary for effective time management (Marrelli, 1997)
After visiting my patients I had made a list of all the medication, dressings and paperwork that needed to be ordered for the next visit. Planning is essential to effective time management (Marquis and Huston, 2007) with the list I was able to organize the items into groups, according to their importance. I delegated the task to an experienced practitioner who was familiar with the ordering process. Then I reprioritized the remaining tasks. This scheduling of activity allows flexibility and focuses not on activities and events, but on outcomes which can be achieved in the allocated time (Sullivan, 2009).
During my early attempts to manage my time I was concerned and slightly embarrassed that I would be the last one back from the morning rounds but as time progressed I became more efficient and knowledgeable in my approach. I
was now taking into consideration other variables such as traffic, weather conditions and those clients who were lonely and regarded me as someone to
social with. Unlike my colleagues I was able to spend more time with my patients due to my student status. This allowed me to view every visit to a client as a learning opportunity to be explored rather than an objective to be met.
I will now reflect on my performance using Gibbs Reflective Model (Gibbs, 1988) to demonstrate my progression with example from practice. Reflection can be viewed as a dynamic process (Bulman, 2005). The Gibbs cycle consists of six systematic stages which guide the practitioner through a series of questions to provide a structure when reflecting on a particular experience (Bulman, 2005).
The initial stage focuses on what has happened. I collected my list of patients from the office and planed my route and allocated the time needed to deliver the care required for my patients. I arrived at the patient’s home to change his dressings. Whilst in preparation I realized that several of the items necessary to complete the dressing were not there. I will now reflect on what I felt at the time.
My initial reaction was to question how this could have happened. How was the patient feeling? Why the previous nurse had not ordered new dressings, then, I
thought they may have been ordered, but had not arrived. I began to feel a sense of frustration as I considered my options. I evaluated the situation with a view of
finding a solution. There was a pharmacy 5 minutes drive away. I explained to the pharmacist what had happened and was loaned the necessary supplies which I then ordered when I returned to the office.
Looking back at the incident I was aware of the disruption it would cause to my schedule and I became concerned and muddled, as I began to contemplate how it would be viewed if I was late back to the office but I am sure the right decision was made. The patient’s needs should be the priority.
This experience was good for me because it allowed me to examine my own perceptions and problem solving. Instinctively I wanted to issue blame until I had stopped to analyze the situation and found more than one, possible answer for the mishap. I could have documented that the dressings were not there and arranged a visit another day, but this would not be in the patient’s best interest, or that someone else would come back later but this would not be fair to make that assumption without prior consultation with my colleagues.
Based on my reflection a personal development plan will be developed for future reference. See table 1
What am I trying to achieve
How can I get help
When to ask for help?
Resistance to change (other team members)
Continued development programmed
Speak with line manager
A training course.
Discuss with line manager three to six month
Gaps in knowledge
Criticism from others
Fear of failure
Can’t please everyone
Develop new strategies
The internet or a training courses
Soon as possible
Discuss with my line manager
Feedback from colleagues
Advice from senior staff
Meet with line manager set date
Through feedback from line manager
As a student nurse in the community setting you gain a true feeling of “autonomous practice” situations can arise where decisions need to be made, sometimes without consultation. Making the right decision will be determined by the processes you use and the choices you make.
This assignment has given me an overview of the many issues and considerations needed to be an effective manager. It has allowed me to understand the transition from student to registered nurse in view of what is expected of me by my colleagues and the public. I have also been able to examine my perception of the “registered nurse”, as infallible, perfect in many ways; the stereo typical view held by the patient, their families and the public at large (Mooney 2007).
The perception that being qualified means knowing everything (Mooney, 2007) is the dilemma the student may be faced with during the transition to becoming a register nurse. The quest to maintain standards and protect the public has created an ethos whereby anything less than perfect may be viewed as failure perpetuating the “hush culture” which exists at present (Mooney, 2007). I have learned about the various management concepts and about the importance of analytical process when problem solving, and decision making. I have recognized the necessity of time management not only of me but also for the effective management of the team and those decisions should always be made
for the best interest of the patient. I have improved my knowledge of the Harvard referencing system and have developed a (PDP). This assignment has highlighted the uncertainties and fears that students feel at some point during transition.
One aspect of role transition (care management) was examined, and two management skills, decision making and time keeping were evaluated and analyzed. Effective Communication skills are fundamental to both management elements. A discussion on professional development and progression using examples from practice was the basis for reflection. The development of a (PDP) aimed at identifying possible Weaknesses, Opportunities and Threats was created to assist me in the future development as a subsequent line manager. I believe that this assignment demonstrates an awareness of self management although not comprehensive, yet marks the beginning of the journey.