In order to answer the question asked this essay will select one clinical. skill, in which competency has been acquired and reflect upon how the necessary level of competence for this stage of the programme was achieved. The clinical skill chosen was the measurement and recording of temperature. The definitions of skills and competencies will be considered and their implications for a student nurse. The essay will outline the rationale for the choice and consider the value of becoming a reflective practitioner.
It will describe the model of reflection chosen, develop the process and reflect on the implications for future learning, in terms of knowledge and skills acquisition. Farley and Hendry (1997) suggested that a skill should bring together both theory and practice and that it was important to understand the rationale that underpinned the action. Furthermore, The Nursing and Midwifery Council (NMC) (2004:13) defined competency as, “possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision.
Therefore, it may be argued that it is vital for a nursing professional to be able to carry out a fundamental clinical skill, such as measuring temperature, competently. The clinical skill I have chosen to reflect upon is the measuring and recording of a service user’s temperature. The rationale for this choice was the fact that the determination of a patient’s temperature is a very important diagnostic tool within the children’s branch of nursing, which will be a key skill to my professionalism as a registered nurse.
An accurate measurement of temperature is a vital part of a baseline assessment when a child is admitted to hospital. Hockenberry, Wilson, Winkelstein and Kline (2003:180) emphasised that, “The rapid and accurate assessment of a child’s temperature can be of great significance to the outcome of a medical condition. ” Additionally, the determination of a patient’s temperature may aid diagnosis since it may be an indicator of the presence of many febrile conditions or the existence of infection, including post operative.
Since it is essential that a nurse should be competent in this clinical skill, it was considered to be a pertinent skill to reflect upon. In order to present a reflective account of how I achieved competency in the clinical skill of measuring and recording a temperature, this essay will consider the value of reflection to my professional development. Martin (2004:412) defined the value of reflection:- “It is an essential part of the learning process that will result in new methods of approaching and understanding nursing practice. ”
Consequently, a process of reflection will enable me to evaluate my strengths and weaknesses and help me to develop an effective approach to life long learning. In order to do so I will follow the model of structured reflection developed by Smith and Russell (1991). I will describe how I learned to be competent in the skill, explain how it occurred, the underlying theories, how it will develop my learning processes and what I learned about my professional development as a student nurse. I was first introduced to the underpinning knowledge, relating to the skill, during a lecture.
I did not do any independent background reading prior to the lecture. I feel that I would have been better prepared had I done do and have had a better understanding of evidence based practice. For example, during the lecture I learned about the evidence based practice underpinning the different routes of temperature measurement in children. I learned the theory cited by Dougherty and Lister (2004) regarding routes for temperature measurement and the fact that the rectal route is no longer appropriate.
Furthermore, Hockenberry et al (2003) cited research by Kai (1993) which suggested that 37 out of 42 parents interviewed, expressed concerns regarding the rectal route that included fear of hurting the child, anxieties about being accused of committing sexual abuse, difficulty comforting the child, and concern for the child’s feelings. These concerns may also apply to healthcare professionals. Had I done more background reading on the subject, I would have learned of this research and been better prepared to learn about the topic.
The lecture was followed by an observational practical session in the skills laboratory, backed up by supporting literature. During the practical session we observed a demonstration of the skill then we split into pairs and practiced using oral, ear and ancillary routes, under supervision from my Guidance Facilitator. Practicing with my peers presented no challenge because the subjects were co-operative, although I acknowledged that carrying out the procedure in a clinical setting, with young children, may present me with difficulties.
Benner (2001) postulated on the stages that novices pass through on their way to the acquisition of competence, she stated that beginners have had no experience of the situations in which they are expected to perform, therefore competence of this skill can not be perfected until the student is in the clinical setting. The next step of the learning process was to perform the clinical procedure in my placement. I was placed in a baby surgical ward catering for infants aged from 0 – 2. My designated mentor demonstrated the procedure whilst I observed.
However, I felt nervous and apprehensive and not confident that I could carry out the procedure unsupervised. During the initial interview with my mentor, K, I explained how I felt and together we drew up an action plan using my portfolio to address the issue. During the first week K suggested appropriate background reading, such as Trust Policies, journals, internet resources and best practice guidelines. She suggested researching normal ranges, appropriate to age, and familiarising myself with the observation tools and the documents used to record measurements.
She implied that by following these action plans I would gain professional confidence and competency. During week two I practiced recording results on appropriate documentation and having gained knowledge of evidence based practice, K supervised me whilst carrying out the procedure. Another important part of becoming competent in the skill, was the use of appropriate interpersonal skills and developing partnership with parents. I explained to parents that I was a first year student nurse and reassured them that I knew what I was doing.
I found parents to be supportive and co-operative because I had gone out of my way to gain their trust. I found that adopting a sense of humour and being honest with the parents helped me to gain their trust and to break down barriers. When I did carry out the procedure unsupervised, having gained background knowledge, I could recognise and respond to measurements that fell outside the normal range. I presented the recorded evidence to a staff nurse for appropriate action.
Gaining competence in the clinical skill boosted my confidence and I was ready to meet the next challenge in my career as a student nurse. However, NMC (2004) cautioned that it was important to acknowledge the limits of your professional competence and recognise when to ask for help. In conclusion, this reflective exercise has been a valuable learning experience, it has enhanced my professional development and has made me realise the value being a reflective practitioner.
The process has increased my self awareness by encouraging me to recognise and evaluate my strengths and weaknesses. One weakness highlighted has been my lack of independent preparation, such as studying background research when a new topic is introduced. I have learned the importance and rationale for reviewing and becoming familiar with evidence based learning and of linking theory with practice. I learned the importance of being honest and treating service users with respect.
On reflection, I consider that my strength is that I am mature enough to have gained the confidence to recognise when I need help and when and whom to ask for support. NMC (2004:9) stated that, “you must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those actions in which you are competent. ” I feel this quotation from the professional code of conduct encapsulates what I have learned from completion of this reflective exercise.