The Clinical Competencies Essay

The Clinical Competencies Essay

The Clinical Competencies Essay

In my practice experience, there are instances that demonstrate my achievement of the seven NMBA standards. Therefore, this section explores the use of the STAR technique to demonstrate how the standards have been achieved.

Thinks Critically and Analyses Nursing Practice

This first standard entails the application of various thinking strategies integrated with the most appropriate available evidence to make decisions and offer quality and safe nursing practice. This competency was demonstrated when one of my patients, who had been ailing from stroke for a long time, requested that her treatment be stopped because she was not “experiencing change.” I took my time to check the records and realized that the patient has been improving from the data on evidence-based stroke management. My task was to convince the patient that she still had a chance to improve and eventually lead a better life. I knew it would not be simple, so I had to use the best possible strategies that could help. To help the situation, I had to swing into action and talked to the patient, and from the talk, I noted that she valued and respected one of her sisters who could come once in a while to visit. I called the sister, and during our meeting, I explained to her the situation, and she agreed that she could talk to the patient to give the treatment process a chance. Expectedly, the patient listened to us more because her sister had approved of the process. The result was that the patient agreed to continue with the medication and was able to be discharged from the hospital a few weeks later and far much better condition.

Engages in Therapeutic and Professional Relationships

This second standard requires that a registered nurse engages in collegial generosity in connection to respect and trust in professional relationships. This standard was achieved mainly through professional relationships. While attending to one of my patients, I noted that I had a challenge explaining various nursing processes to patients, especially those who were inquisitive. On the other hand, another colleague was so good at it that I liked listening to her talk to the patient at times. Therefore, I realized I needed to improve in this aspect so that I could attend to my patients better. So I approached the nurse and discussed my desires, and asked how she could help me. We embarked on an informal training on how to talk to the patients relevantly and how to handle their questions without going against the nursing ethics and the hospital rules. After a period of two months of working together, I had a substantial improvement as I was able to talk to the patients better and explain various care aspects appropriately.

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Maintains the Capability for Practice

The third competency requires that an RN becomes accountable and responsible for making sure that they are safe and timeously responding to the well-being and health of others and self in connection to the capability of practice. This competency was achieved through the provision of education and information that enhances control over health. In an instance, I noted that one of the nurses had a change of behaviour at work; she could sometimes arrive a bit late and was always moody, withdrawn and quiet. This change in behaviour was impacting negatively on her performance and health. I realized I needed to come in and help the situation. So I requested that as part of the action, we should meet perhaps after work in another environment and have a chat. Our first meeting was not as I expected as she refused to divulge anything. I insisted for weeks and requested another meeting. Fortunately, after changing tactics and being more compassionate, she indicated that she was having a terrible time; she lost some possession and was fighting to save her marriage from crumbling.  I spoke to her and reminded her what such a stressful situation could cause to her health, especially mental health. I then advised her on how to manage the situation better. Two weeks after talking, I noted that she was coming back to her former self and was once more productive at work.

Comprehensively conducts Assessment

This competency relates to accurate analysis of data and information and communication, the same as the basis of practice. This competency was achieved when attending to a ten-year-old child who was admitted to the facility with burns. When attending to this patient, I realized that he had scars on various parts of his body. The scars were from various falls and cuts. I immediately thought that the cause of the current burns and scars were related. So my task was to find out why the child has had such scars and the current burns and if there is anything that can be done. So I interviewed the mother about their home setup and even asked if we could go together. I realized that the home and its arrangement had several hazards pausing danger to the child. I suggested that the hazards be removed before the child could go back home. The parents agreed and eliminated the hazards, which helped the child to lead a better life from injuries.

Develops a Plan for Nursing Practice

This is also one of the most important competencies related to a registered nurse responsible for the nursing practice plan and communication. This was also accomplished in the clinical setting by coming up with a plan to implement an intervention. In one of the facilities, there was a worrying trend where patients were continually getting infections whenever they used indwelling catheters. It was apparent that action needed to be done. I was therefore tasked with formulating a plan on the best way to encounter it. From the literature, I realized that a care bundle would mostly be appropriate. The care bundle included hygiene such as hand washing before placement of catheters, using catheters when their use cannot be avoided and using them for the shortest time possible. I had to formulate a budget for every single item that was required to fully implement and accomplish the task. We then implemented the same after considering all the documentation and budget aspects. Within a period of three months, such incidences considerably dropped by twenty-five per cent.

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Provides Safe, Appropriate and Responsive Quality Nursing Practice

The sixth competency is related to the provision of ethical, quality and goal-directed actions. These are offered to help in achieving the agreed outcomes and goals that take into consideration the people’s nursing needs. This competency was also achieved in the care setting by identifying and reporting a potential risk that could lead to below standard practice. I noted with concern that a few nursing staff were not comfortable with the new system for dispensing and administering medications to patients, which could lead to serious medication errors. The task was to identify strategies that could be used to address the situation without the staff taking offence. I then talked to them about how comfortable they were with the new system. Even though some did not admit it, the majority agreed that they were struggling, so I discussed the possibility of some training with the manager. After one week, a training session was organized in which everyone was required to participate. The result was a better use of the system to serve the patients better.

Evaluates Outcomes to Inform Nursing Practice

This is the last competency, and it relates to the registered nurse taking the responsibility to evaluate practice while basing on outcomes, plans, goals and priorities. This competency was demonstrated in a situation that required patient monitoring. When attending to one of the patients with asthma, we created a care plan, gave the patient the prescribed medications, and informed the patient to visit again after two weeks. However, within one week, the patient was back in the hospital and complaining that the medications did not have the desired impact. In collaboration with the physician, we agreed to change the medication and dosage, hoping that the symptoms would be better. However, the patient was soon back in the hospital. So we needed to assess the situation and note the problem. It was evident that the patient had several triggers in the home environment, so we advised that they eliminate them or change residence. It was easier to change residences to another neighbourhood which was better. The patient then started getting better, responded well to medications, and was never admitted to the emergency department again.

Video Presentation: Communication and Teamwork Skills

In my nursing journey, I have noted that communication skills and teamwork skills are important. Situation: In one of the clinical placements, there was a serious need to improve working conditions for the unit nurses. The unit manager was authoritative and was not willing to consider any other person’s opinion. Apparently, everyone was keeping quiet because of fear. Task: I realized that someone had to come out and talk. Action: I, therefore, approached the unit manager and shared my thoughts and what other staff were feeling about the whole situation. The manager was surprised that I could discuss such while others were shying off. I communicated vividly to her and suggested that we have a meeting to share our experiences and grievances. When the meeting was called, almost everyone was free to talk and speak their thoughts. Result: After the talk, the work environment was more conducive hence improved productivity.

Team skills were also developed in one of the clinical placements. I noted that individuals have different strengths and weaknesses. Hence team work makes people more strong as individuals are able to cover for others’ weaknesses. Situation:  Our facility needed to come up with an educational material to teach patients with diabetes about self-care management practice. Task: We had a short time to deliver the work as there was an urgent need to improve the patient’s ability and knowledge of self-care practices. Action: So we divided the work among five of us, with each person taking a section of the material. Result: Dividing the work into portions enabled us to do it faster and deliver it to the facility in time. The material was quickly integrated into one and used for training the patients.

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Reflection

Various activities go on during a clinical nursing placement. While some are simple, others can be challenging to solve. One way of reflecting on such events is through the use of Gibb’s reflective cycle. The reflective cycle has six different phases, including description, feelings, evaluation, analysis, conclusion and the action plan (Ardian et al., 2019).

Description

One of the challenging situations I experienced was a workplace conflict. One of the nurses from our unit had to face disciplinary action due to the non-completion of duties assigned. As one of the senior staff, she did not take it kindly as some of the staff on the committee were far much younger than her. Just before the meeting, I heard her complain that she hates facing disciplinary committees, especially if she knows she is innocent. From the meeting, for convenience and improved productivity, It was decided that some of the duties be taken off her assignment to other junior staff. The implication is that her allowances were also reduced. Therefore, in most cases from then, she was in conflict with the nurse who took some of her duties.

Feelings

I felt sorry for her, but I was also shocked at how far she could go in frustrating the junior nurse. I also felt that such cases should not be allowed to reach this far but should amicably be solved. The implication is that in my capacity, I should always strive to ensure that I participate in conflict management.

Evaluation

The unit manager solved this conflict through a meeting where both nurses and the rest of us shared their thoughts, and the culprits agreed to work harmoniously. While it was solved, I feel it took too long to be solved. Therefore, there was a need to call that meeting earlier enough. This situation was difficult since it involved one of our senior nurses who should be giving directions and leading by example. The situation was also difficult since it was slowing down the unit’s operations and workflow as the two nurses were in collision and conflict most of the time. I believed that it was a delicate situation that needed a lot of careful handling.

Analysis

Such a situation relates to my studies as any conflicts among classmates should be solved well in time to enhance productivity. Conflicts are known to derail an individual’s performance and make people lose focus. It is, therefore, important that conflicts are solved through established avenues and strategies. Another perspective I can use to analyze the situation is through the use of the Atkins and Murphy model. In this model, a situation is first described, followed by feelings and knowledge analysis. The relevance of the knowledge is then evaluated before identifying any new learning that occurred. Finally, an action or new experience follows (Ingham-Broomfield, 2021).

Conclusion

If I was directly involved, I would have let the duties be reassigned and concentrated on the tasks remaining to give them my best and offer optimum performance. If I was the junior nurse, I would first try and sit down with the senior nurse to solve the issue together. If that does not help, I would then invite colleagues to help through medication.

Action Plan

In a case similar situations arise in future, I would try various conflict resolution strategies such as negotiation and mediation. Fortunately, I now possess sufficient new knowledge on conflict resolution that can allow me to make better choices and perform better actions. One of the steps I would take to improve the technique of conflict resolution is reading about the strategies and watching relevant videos depicting various conflict resolution processes. I can use a timeline of two months to reassesses my development.

References

Ardian, P., Hariyati, R. T. S., & Afifah, E. (2019). Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills. Enfermeria Clinica, 29, 588-593. https://doi.org/10.1016/j.enfcli.2019.04.091

Ingham-Broomfield, B. (2021). A nurses’ guide to using models of reflection. The Australian Journal of Advanced Nursing, 38(4), 62-67. https://doi.org/10.1016/j.colegn.2016.03.002

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NURBN3032 Task 1b: Individual ePortfolio Weight: 25%

This task aims to prepare students for applying for paid roles in the nursing profession. To complete this task students are asked to complete a professional ePortfolio that can be later be used in response to real employment opportunities upon graduation.

The ePortfolio
Students will be required to use Mahara ePortfolios to create a professional ePortfolio assist in applying for graduate nursing program applications. Note that all components of this task are required to be completed regardless of whether you are intending to apply for a graduate program or not, as this ePortfolio can be used as a tool for gaining future employment and as a means of documenting ongoing professional growth, knowledge and skills post-graduation.

This assessment is designed to assess students’ ability to satisfy the requirements for a graduate position application. It also assesses students’ ability to apply the principles of ‘getting job ready’ as taught in the NURBN3032 course.

This task should be treated as a real job application. Lecturers will provide feedback on students’ ability to present themselves professionally, and they will be assessed on how they demonstrate their professional growth and development through their ePortfolio.

The portfolio should provide evidence of achievement of relevant competencies at the level expected of a third-year student nurse. It should demonstrate growth and development as a student and evidence of how students have monitored their progress in meeting personal and professional learning objectives. Students need to include in their ePortfolio anything that demonstrates their personal and professional growth, knowledge and/or skills as an active learner and reflective practitioner. This might take the form of volunteer work, personal mentoring experiences, or previous work experience (i.e., demonstrate your transitional skills that are relevant to nursing).

Students are required to develop an ePortfolio that includes the following:

Item (s) Information / Examples
Individual photograph The photograph provided should not be a ‘selfie’ for social media. It should be professional in nature – i.e., please consider grooming and attire and note that wearing your university or a work uniform is not considered acceptable for this task. It must be of an appropriate size to be easily viewed in the ePortfolio.
Note that the photograph does not need to be taken by a professional photographer.
Competency Documentation 1. Include copies of the your Australian Nursing Standards Assessment Tools (ANSAT) and/or Clinical Assessment Tools (CAT) from your second and third year placements (where applicable).
2. Outline any previous nursing-related short courses or training that you may have undertaken (i.e. BloodSafe, Hand Hygiene, etc).
Note that attachments of certificates/competency documentation is also required. These should be added to the ePortfolio.
Clinical Competencies Using your practice experience, demonstrate your achievement of the NMBA Standards (the STAR technique is required here).
There are seven (7) standards, so there should be seven (7) short statements (200 words (+/- 10% each) demonstrating how you have achieved them.
Video Presentation Using the STAR technique, you are required to produce a video presentation using Kaltura or similar of no more than five minutes duration, which addresses the following:
1. An example from clinical placement which shows how you have developed the communication skills that are required of a professional nurse.
2. An example from clinical placement which shows how you have developed the teamwork skills that are required of a professional nurse.
Note, your video presentation must include a brief personal introduction , an outline of the presentation content, and appropriate closing language for the viewer to cue the end of the presentation.
Students are to dress professionally, as if attending an interview, and should consider the environment in which the video is being recorded. The background should be neutral in colour and tone, and extraneous sounds should be minimised.
Note that wearing your university uniform or a work uniform is not considered acceptable for this task.
Reflection The reflection should be based on Gibbs’ reflective cycle and present a challenging situation that you have personally encountered during a nursing clinical placement (approx. 700 words). This challenging situation, might for example be a medication error or workplace conflict.

Note that references are required within your reflection as per normal scholarly practice. You are required to incorporate relevant literature within the ‘analysis’ section of your reflection. See the following resources: ……
https://studyskills.federation.edu.au/wp-content/uploads/2020/06/reflective- writing_gibbs_2020.pdf
https://studyskills.federation.edu.au/assessment/written-tasks/reflective-journal/
A copy of the Gibbs’ reflective cycle and sample reflections are located within the assessment section in Moodle. These are not to be copied, but are provided as examples for you to consider. You are encouraged to provide personal experiences from your student nursing placement.

Grading
The minimum possible score for this rubric is 0 points and the maximum score is 100 points (65 points for content; 15 for video presentation; 15 points for formatting/layout) which will be converted to represent the 25% weighting applied to the task. Intermediate scores will be converted and rounded to the nearest available grade.
Late submission penalties apply as per the Course Descriptor.

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Learning outcomes/attributes
This assessment task relates to the following learning outcomes and attributes as per the course descriptor: Learning Outcomes: K2; K4; S3; S4; A1; A2
Graduate Attributes: GA1 Thinkers; GA2 Innovators; GA3; Citizens; GA4 Communicators; GA5 Leaders

Marking Guide
High Distinction Distinction Credit Pass Fail
Photograph 5 marks Excellent professional photograph provided. Very good professional photograph provided. Good professional photograph provided. Fair attempt at a professional photograph provided. Poor example of a professional photograph provided / No photograph provided.
5 marks 4 marks 3 marks 2 marks 0-1 marks
Clinical Competencies NMBA Standards

40 marks Excellent understanding of all seven (7) standards which are extremelly clearly and concisely outlined with excellent identification of situations and/or examples. Very good understanding of all seven (7) standards which are very clearly outlined with good identification of situations and/or examples. Good understanding of all seven (7) standards which are somewhat clearly outlined with limited identification of situations and/or examples. Fair understanding of some of the standards which are adequately outlined with some identification of situations and/or examples. Limited or no understanding of the standards which are inadequately outlined with limited or no identification of situations and/or examples.
32-40 marks 28-31 marks 24-27 marks 20-23 marks 0-19 marks
Competency Documentation Short courses & ANSAT/CAT
10 marks ANSAT/CAT from second or third year provided. ANSAT/CAT from second or third year provided. ANSAT/CAT from second or third year provided. ANSAT/CAT from second or third year provided. ANSAT/CATs not provided.
Excellent clinical competencies which are clearly evidenced through extensive use of supporting documentation. Very good clinical competencies which are evidenced through effective use of wide extensive use of supporting documentation. Good clinical competencies which are evidenced through adequate use of supporting documentation. Fair clinical competencies which are evidenced through limited use of supporting documentation. Poor clinical competencies which are inadequately evidenced through the use of supporting documentation
9-10 marks 7-8 marks 6 marks 5 marks 0-4 marks
Video Presentation Professionalism, structure & timeframe Excellent professional- quality video, with no background distractions. Very good professionallevel with no background distractions. Good attempt at professionalism and/or some background distractions. Fair attempt at professionalism and/or many background distractions. Poor attempt at professionalism and/or many background distractions.
5 marks
Audio and visual components clear. Audio and visual components clear. Audio and visual components mostly clear. Audio and visual components partly clear. Audio and visual components unclear.
Presentation completed within allocated timeframe of 5 minutes (+/- 10%). Presentation completed within allocated timeframe of 5 minutes (+/- 10%). Presentation went over or under the allocated time (+/- 10%) by no more than 1 minute. Presentation went
over or under allocated time (+/-10%) by more than 1 minute. Presentation did not occur or went over or under allocated time (+/-10%) by more than 2 minutes.
5 marks 4 marks 3 marks 2 marks 0-1 marks
Video Presentation
Communication

5 marks Excellent, clear and identification of a situation demonstrating your ability to communicate effectively. Very good identification of a situation demonstrating your ability to communicate effectively. Good identification of a situation demonstrating your ability to communicate effectively. Fair identification of a situation demonstrating your ability to communicate effectively. Poor identification of a situation demonstrating your ability to communicate effectively.
Excellent use of STAR technique. Very good use of STAR technique. Good attempt at use of STAR technique. Fair attempt at use of STAR technique. Poor use of STAR technique.
5 marks 4 marks 3 marks 2 marks 0-1 marks
Video Presentation
Teamwork

5 marks Excellent, clear and concise use of STAR technique thorough identification of a situation demonstrating your ability to effectively work within a team. Very good identification of a situation demonstrating your ability to effectively work within a team AND
Very good use of STAR technique. Good identification of a situation demonstrating your ability to effectively work within a team AND
Good attempt at use of STAR technique. Fair identification of a situation demonstrating your ability to effectively work within a team AND/OR
Fair attempt at use of STAR technique. Poor identification of a situation demonstrating your ability to effectively work within a team AND/OR
Poor use of STAR technique.
5 marks 4 marks 3 marks 2 marks 0-1 marks

High Distinction Distinction Credit Pass Fail
Reflection 15 marks Excellent, clear and concise discussion including all six (6) elements demonstrating excellent reflective practices. Very good discussion including all six (6) elements demonstrating substantial reflective practices. Good discussion including all six (6) elements demonstrating moderate reflective practices. Fair discussion including all six (6) elements demonstrating minimal reflective practices. Reflection contains less than six (6) elements OR
Poor/no reflective practices demonstrated.
Excellent identification of own strengths and weaknesses in what was understood/ learned. Excellent reasoning provided. Very good identification of own strengths and weaknesses in what was understood/
learned. Excellent reasoning provided. Good identification of own strengths and weaknesses in what was understood/learned.
Excellent reasoning provided. Fair identification of own strengths and weaknesses in what was understood/ learned. Excellent reasoning provided. Poor/nil identification of own strengths and weaknesses in what was understood/learned.
Excellent reasoning provided.
13-15 marks 11-12 marks 9-10 marks 7-8 marks 0-6 marks
Submission
Layout & creativity 10 marks Excellent, proficient and creative use of a range of functions – layout, files, text, multimedia, and images – to enhance readability and content presentation. All links/files open or view with ease. Very good use of several functions – layout, files, text, multimedia, and images – to enhance readability and content presentation. Most links/files open or view with ease. Good use of a range of files, text, multimedia and/or images to enhance readability and content presentation. Most links/files open or view with ease. Fair use of a range of files, text, multimedia and/or images and layout to enhance readability and content presentation. Some links/files difficult to open or view. Poor use of a range of files, text, multimedia or images or layout to enhance readability and content presentation, and/or many links/files difficult to open or view.
9-10 marks 7-8 marks 6 marks 5 marks 0-4 marks
ACADEMIC REQUIREMENTS
Writing style, expression & formatting Excellent level of articulation and expression, with clear and concise sentence and paragraph structure, and no spelling or grammatical
errors. Good level of articulation and expression, with clear and concise sentence and paragraph structure, and minimal spelling or grammatical
errors. Moderate level of articulation and expression, requiring sentence and paragraph structure to be more concise, and/or few spelling or
grammatical errors. Minimal level of articulation and expression, with some sentence or paragraph structure unclear, and/or a number of spelling or grammatical
errors. Poor/inconsistent level of articulation and expression, with considerable sentence or paragraph structure errors, and/or numerous spelling or
grammatical errors.
5 marks
Submission conforms to all presentation requirements as set out in Course Descriptor. Submission mostly conforms to presentation requirements as set out in Course Descriptor. Submission conforms to some of the presentation requirements as set out in Course Descriptor. Submission conforms to few requirements as set out in Course Descriptor. Submission conforms to none of the requirements as set out in Course Descriptor.
5 marks 4 marks 3 marks 2 marks 0-1 marks