Royal College of Surgeons Ireland

School of Nursing & Midwifery

Academic Year 2016-2017

Student ID Number 15111288

Programme: Post Graduate Diploma (Neonatal

Intensive Care Nursing)
Module: Advanced Reflection and Competence
Part 2
Submission Date: 05th May 2017

Submission First, Repeat etc.: First

Actual Word count (not inc. references) 1868

Date Submitted: 05th May 2017

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submit for assessment for the module above is entirely my own work and has not been

submitted as an exercise for assessment at this or any other University”

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Contents
Introduction ............................................................................................................................................ 3

Analysis (what sense can you make of the situation) ............................................................................. 3

Conclusion (what else I could have done) .............................................................................................. 4

Action Plan (if it rose again what would I do?) ....................................................................................... 5

PORTFOLIO .............................................................................................................................................. 5

Core Concept of Clinical Nurse/Midwife Specialist (CNS/CMS) .............................................................. 7

Conclusion ............................................................................................................................................... 8

References .............................................................................................................................................. 8

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Introduction

We tend to reflect our own actions as a nurse, by re-examining and asking ourselves if we have

done everything we could. Reflections is all about learning from experience which improves

and develop knowledge and skills needed for effective leadership. This is the continuation of

part 1 of my assignment on the concept of reflection. I had applied Gibbs (1998) cycle model

on my reflective writing, and had already discussed the incident I was involved in, I had also

described what had happened, and expressed the feelings of what I was thinking. In this part 2

assignment, I will proceed to discuss the analysis, conclusion and action plan of the incident,

the final three steps of Gibb’s cycle. I will also explore the use of professional portfolio and

personal development. The clinical Nurse/Midwife Specialist (CNS/CNMS) core concept and

a conclusion is going to be presented.

Analysis (what sense can you make of the situation)

Carper’s (1978) four patterns of learning, which are empirical, personal, ethical, and aesthetic

will be used. The empirical is open identified as the science of nursing with the foundations

based on experience and observation skills, instead of logic. With my experience in neonatal

intensive care unit, I had developed good observation skills to be able to perceive or notice

when a baby was becoming unwell. My intuition prompted me that something was wrong and

my concern was acted upon when I informed the consultant about the situation. The expert

nurse would have had the skills, knowledge, and confidence of her own practice to be more

insistent and assertive (Benner, 1984). O’Connor (2008) stated that intuition is a skill that

develops subconsciously over time, as a product of experiences, gained or increasing

experience from something that cannot be taught. Intuition is an important tool to the scope of

nursing practice and its application must be acknowledged I was aware that Kate was showing

early signs of Necrotising Enterocolitis (NEC) as evidence of pallor, lethargy, though

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abdominal distension is not present but frequent desaturations, apnoea and bradycardia

especially during feeding (Gregory et al, 2011). I knew from studies and literature that NEC is

one of the most serious abdominal inflammatory disorders of infants which is born less than

one kilogram and is fatal in forty to fifty percent (Gardener et al, 2011). I advocated for Kate

by implementing intuition and accurate physical examinations, observation and carry out

prompt and efficient referrals to each and every person involved. Despite Doctor Yousef did

no other action aside from his examination, I am still not convinced that Kate is well.

(Mantzoukas et al, 2004) stated that doctors often for scientific evidence prior to taking action

on nurse’s concern. My interactions with parents is another situation which I believe makes

Karla and Michael (Kate’s Parents) understand what had happened to Kate. I gave them a

simple explanation of early detection of NEC. I remain on their side while the doctor is

explaining what had happened. I stand next to them and give my support. Implementing

holistic, family-centred developmentally supportive care and open communication with parents

in this stressful event and experience is accounted and considered essential (Obeident et al,

2009).

Conclusion (what else I could have done)

On reflection I realised that being able articulate and advocate on behalf of my patient is

essential to her welfare. There was nothing more I could’ve done with regards of the care I

gave to Kate. With my effective clinical skills, I carried out quickly necessary actions needed

in professional ways. Though Doctor Yousef (Paediatric Registrar) told me to continue to feed

Kate and to continue close observation which I doubted and listened to my instinct to get the

opinion and approval of Doctor Angel (Neonatologist Consultant). According to the UKCC

(1996) professional responsibility is involve with assessing the interest and welfare of the

patient in difficult circumstances, applying professional comprehension, intuition, and skills to

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make a good conclusion and decision. Ethical knowledge is described by Carper (1978) as

having the capacity to make choices for oneself in support of others along the clinical situation.

When caring for Kate I inclined as her advocate by means of the ethical principles of non-

maleficence and beneficence by taking action in advance before she became clinically ill.

(Bryzkzynska 1984) stated that “analysing neonatal nurses ethical practice and role as

advocate, it is important to remember that whatever is being discuss or debated, at the heart of

the argument is fragile life”. As highlighted by (Carper 1978) Aesthetic knowledge is having

skill of being able to comprehend and respond appropriately to an incident. Empathy is a key

component in a static knowledge along with the knowledge from another person’s experience.

On parent’s support, I spent time and explained to Karla and Michael the importance of early

detection of Kate’s condition (evolving NEC). I stayed with them while Doctor Angel

explained and updated Kate’s condition.

Action Plan (if it rose again what would I do?)

My actions towards Kate will still be the same if similar situations will occur as guided by my

scope of practice. I will continue to advocate for my patient (ABA 2000). On the other hand,

(Black, 2011) stated that the most alarming aspect of the work of healthcare professionals is

giving information that is traumatic, upsetting or otherwise distressful to parents. In this

situation parents will always be frightened of what will be the progress, outcome of their baby.

As Kate’s nurse, I will continue to provide moral support to parents and will explain her

management simply so as they may understand, offering lots of opportunities to ask questions

and repeat questions if necessary. To earn or further enhance future trust to Kate’s parents

(Nurse and Midwives bill 2010).

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PORTFOLIO

A portfolio is a supplementary record in nursing, it gives confirmation of precedent experiences

and maintains a firm and purposive document of proficient development and education

(Hillard, 2006). Additionally, it can be used as a tool to achieve self-evaluation and feedback.

To evaluate nurse’s competence, experiences and action through critical thinking, advocacy

informative conversational skills to cope with challenges (Johnson et al, 2007). It’s primary

aspiration and aim is to show advancement and improvement of knowledge, development, and

proficient competence. Jasper (1998), stated that a portfolio can enhance as an active working

document that advocate continuing practice. (Joyce, 2005) stated that nurses are responsible

to update professional portfolio, it’s professional autonomy and accountability (An Bord

Altranais, 2005). Portfolio can enhance a living important working credential and record that

helps advance practice (Jasper, 1998). Through portfolio, students are encouraged to be more

responsible in their educational attainment and skills development. (Harris et al, 2001).

Affirmed that a portfolio is a profile that visualize and describe an experience in educational

or developmental situation. It motivates and encourages nurses to think critically and reflect on

their decision making and plan of action. On the other hand, (Duffy, 2008) asserted that

portfolio development is not an easy task but a beneficial skill to gain knowledge. (Smith et al,

2005) stated that nurses are still unwilling to carry out tasks, though it is beneficial, but it is

time consuming and difficult. (Hillard, 2006) concluded that although it is time consuming it

is a rewarding process. A portfolio can be utilized by the nurses to advance their clinical

experience and reassured personal development and training (Joyce 2005). The purpose of

portfolio is to enhance practice while incorporating the concept of nurse/midwife specialist

which ensures that the patient care is at its optimum and nurses providing care have adequate

training and education. These concepts of clinical specialist role are education and training,

patient advocacy, clinical focus, audit, consultancy and research, National Council for the

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professional Development of Nursing and Midwifery (2002). While reflecting and writing my

experience about the incident I was involved in, I have found it to be beneficial for myself and

for my patient. My experience of reflection enhanced me more, to be matured professionally.

The experience made me vigilante of the impact of clinical incidents and significance of self-

reflection. (Vasalos et al, 2005) promoted self-reflection as means of enabling personal growth

and development by developing self-awareness, we will feel capable and competent in our

nursing intervention, thus to enhance patient care.

Core Concept of Clinical Nurse/Midwife Specialist (CNS/CMS)

The formal name as CNS was identified first in Ireland in 2000. (Wickham, 2011) a strong and

strategic approach to the development of CNS post is necessary to ensure the availability of

critical dimension of these posts within the Irish health service. Though the implementation of

the CNS/CMS framework, Ireland is now at a stage where the criteria of experience and

education care are fundamentals for the roles. (Doody et al, 2011). The National Council for

the Professional Development of Nursing and Midwifery recognized the developing role of

CNS/CMS as a higher diploma level with specific core concepts of practice including Clinical

focus, patient client advocate, training, education, audit, and research. While all concepts are

all relevant practice. The CNS/CMS role of act as a client support by presenting clients with

other health providers, it involves good communication and an applicable plan of action. It is

the responsibility of the CNS/CMS to update their continuing professional development and

facilitate staff development by attending study days. The CNS/CMS must review and check

the nursing and midwifery practice to improve the quality of practice care and to keep up to

date with current research and to ensure practice is evidence based, finally the essential function

of the CNS/CMS is consultation with multidisciplinary team to advance patient concern and

management. In this practice of reflection, I have considered the role of the patients support

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and advocate utilizing the ethical principles of non-maleficence and beneficence by taking in

action in advance before my patient became clinically ill. I am not convinced with the result of

examination of Doctor Yousef (Paediatric Registrar) and discussed my clinical observation to

Doctor Angel (Neonatologist Consultant) and suggested to check blood gas. The patient’s

advocacy is fundamental to nursing. Nurses believe that they have an ethical obligation to

advocate for their patient (Negarandeh et al, 2008).

Conclusion

On reflection I realised that being able to articulate one’s opinion is very important especially

when it comes to the welfare of the patient. It is important to understand that nurses are

accountable in their decisions about patient care and related nursing issues. According to the

UKCC (1996) professional responsibility is involved with assessing the interest and welfare of

the patient in a difficult circumstance, applying professional comprehension, intuition, and

skills to make a good conclusion and decision. Realising the process of reflection is vital, and

more than necessary consideration of skills required to engage in reflection is outstanding and

dominant (Benner, 1984). As the neonatal intensive care nurse, we frequently take up the role

since our patient are defenceless and will not be able to decide for themselves. Caring for

patients is an important part of a nurse’s responsibility and the quality of care can be dependant

and relying on how good the nurse has come on the fields of nursing professional development.

I am more aware of the need of further education and training which enables nurses to become

more competent, accountable, and effective practitioners.

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References

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Benner P. (1984) From Notice to Expert: Excellence and Power in Clinical Nursing Practice,

Addison – Wesley, Menlo Park, California.

Benner P. & Tanner C. (1987) Clinical Judgement: how expert nurses use intuition. American

Journal of Nursing 87(1), 23-31.

Black B.P. (2011) Truth telling and severe foetal diagnosis: a virtue ethics perspective. Journal

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