B740 Nursing

Introduction

After the successful completion of the module, it is likely that a better understanding would be achieved about the role of Assistant Practitioners in the healthcare system. The practical knowledge based module is helpful in covering a range of knowledge and skills that would help in practising in present health and social sector. The specialist module would permit the application of learning to the work context and individual learning needs. Through the module, one can monitor own develop and identify the needs of skill development and competency enhancement. The portfolio of evidence is a reflection of work based learning and increases student knowledge and skills to optimal level. The present folder of evidence is a summative assignment as a part of the module. It has been made to include a mapping grid, that demonstrates how each piece of evidence is related to the required learning outcomes for the module; a learning contract; an evaluation and revised learning contract; an explanation of the key principles practitioners need to understand for achieving safe practice in the four skills identified in the learning contract. This is related to the role of an Assistant Practitioner, and the principles include all underlying physiological, psychological and sociological issues.

Communication

The possible shortfall of appropriately skilled and trained staff for meeting the healthcare demands of the rising population in the 21st century has been the driving force behind the changes in government policy and the introduction of assistant practitioners into the healthcare service sector. The benefits of employing assistant practitioners into healthcare organisations have been marked to be multi-faceted, the reason being the wide range of skills demonstrated by these professionals. Effective communication role played across the clinical setting by the professionals is perhaps the most crucial and significant factor in relation to their employment (Allen, McAleavy and Wright 2013).

Arnold and Boggs (2015) have opined that communication is the sharing of information between a patient and a healthcare professional through non-verbal and verbal messages. A relationship is thereby created between the two individuals based on which the effectiveness of the care process can be determined. Communication is integral to the relationship an assistant practitioner needs to develop with all stakeholders in the clinical setting he works at. It is essential that professionals keep the emphasis on the communication to patients, assist them with the required information and demonstrate active listening. As per the authors, effective communication skills need to encompass acknowledgement, reflection, summary, empathy, educational guess and interpretation. An assistant practitioner must have clarity and transparency while communicating. Exploring cues and using appropriate body language is crucial. With minimal prompts and appropriate pauses, the patient can be given scope to convey all thoughts and feelings. While delivering information, it is to be given out in small amounts and with clear terms. Sensitively checking the impact of the information on the concerned person is also beneficial. Asking for permission and negotiating while communicating is an ethical approach (Moore et al. 2013). Promoting strong communication is complex, demanding and challenging to a considerable extent since the nature of the work health professionals execute. Organisations can consider giving communications skills training so that assistant practitioners can be supported for delivering optimal quality care. The benefits of communication are to be understood by all, that is, better patient physical and mental outcome. In addition, professionals might themselves feel confident about their roles when they demonstrate effective communication skills.

According to O’hagan et al. (2014), assistant practitioners need to work in different departments within the clinical setting and therefore come from individuals coming from diverse backgrounds. Diversity in terms of patients with different choice, preferences and beliefs are commonly recognised by these professionals who need to demonstrate an individualised approach towards each of the service user. The significance of effective communication skills, therefore, comes into the limelight against this context. Providing optimal quality and dignified care remains at the core of the practice of an assistant practitioner, and it is the responsibility of the practitioner to work in an interdisciplinary team along with other professionals. It is desired that assistant practitioners communicate effectively with others irrespective of their discipline, grade and gender as this influences the care and dignity shown. While carrying out assessments, an assistant practitioner needs to ensure that all conflict resolution is adhered to while communicating with the patients. Communication is therefore about a two-way exchange of psychological and social thoughts along with physical complaints.

Silverman et al. (2016) highlights that by having in-depth knowledge of the potential barriers to effective clinical communication, an assistant practitioner can minimise the chances of mis communication and misinterpretation of clinical information. As highlighted by the authors, communication might be hampered due to physical and environmental factors, such as service users with cultural differences, disabilities and language and ethnic barriers. While working in an environment that has individuals from different background, it is common to come across tensions arising as a result of one’s own values and that of others. It can be frustrating under such conditions and it is essential that one respects the patient’s confidentiality in such circumstances. Riley (2015) in this regard highlights that barriers are to be overcome at urgent level soon after their recognition. Challenges might be from the patient side or from the side of the assistant practitioner. Environmental factors can include noise, absence of privacy. Anxiety and fear related to being weak, being judged and emotional turmoil are vital barriers. In adition, communication cues blocked by other professionals and difficulty in expressing and explaining feelings might be challenges faced by health care professionals. Assistant practitioners need to remember that lack of support, conflict between staffsis and high workload must not become the driving factors for poor communication with patients. It is expected that they put forward best efforts to minimise the potential impact of the cited barriers on their way of communication and manage the clinical responsibilities efficiently.

Understanding equality and diversity in the work place

Thurgate (2016) has opined that promotion of equality and diversity in the clinical setting is an integral part of responsibilities of a healthcare professionals. Equality refers to the assurance that all individuals in a setting get equal opportunities, irrespective of their lifestyle, background or abilities. Diversity is defined as the appreciation of differences between individuals and respecting their cultures, beliefs and values. According to the authors, diversity and equality are essential components of care, and good practices ensure that service providers provide care that is accessible to all and fair and justified. Individuals are to be treated as equals and must be given respect and dignity that they deserve. The differences between the individuals in terms of ethnic background are to be celebrated, and it is to be mentioned in this regard that diversity and equality must not be viewed as a bonus benefit to the care setting, rather, it is to be perceived as an integral constituent. Assistant practitioners must place equality and diversity at the heart of their practice. They must strive to ensure that the diverse needs of the patients are met. Further, they are to be given equal access to the care services provided. Promotion of equality and diversity is primarily associated with prevention of discrimination, in active or passive form (Driffield 2016).

Health care professionals must demonstrate the skills for understanding equality and diversity in the clinical setting they work in. Upon successful implementation of these skills care providers are concerned about the feelings, thoughts and self-perception of the patients. Treating all individuals with equal importance make them feel valued and increases their sense of being worthy. Respecting the diversity of the individuals, both patients and other care givers, places a care professional in a respectful position. The behaviour and attitude of the professionals, organisational culture and physical environment, all contribute to enhanced patient outcomes. When respect for the ethnic and linguistic background is shown, patients feel confident, valued and comfortable. This is turn enhances the clinical decision making process. Under circumstances wherein the care providers do not acknowledge the cultural differences patients feel devaluated and lack comfort and control. They might be facing embarrassing or unwanted situations. Dignity in a health care setting applies equally to those who have the capacity as well as to those who lack it. Every human being has the equal worth as individuals and is to be given the treatment as if they have the interest to behave in association to their value. An assistant practitioner must treat all individuals with dignity (Matthews et al. 2015).

For becoming an efficient assistant practitioner, one must recognise and report discrimination, and understand the potential results of discrimination. Being able to respond to the specific needs of the diverse patients, carers and service users is essential. The social, cultural and personal backgrounds of individuals are to be respected while communicating. Communication with the patient must be in a sensitive manner that acknowledges the values and belief systems they have embedded within themselves. Being accountable for providing diversity and equality practice is a key skill of assistant practitioners. Supporting the empowerment of patients and fellow professionals enable them to take part in their health improvement (Jackson et al. 2015).

Johnson et al. (2016) highlight that good diversity and equality practice involves a number of imperative approaches. Communicating with individuals in a manner that is accessible to them is perhaps the most important of them all. Reasonable adjustments can be made in the way that service delivery considers the traditions and customs of the patients. It is noteworthy that many patients prefer referring to traditional alternative medical interventions for healing purposes. Acknowledging them an including them when and where appropriate is a good step. Understanding the role that religious beliefs have in the experiences of patients is an attribute all practitioners must exhibit. It is expected that an assistant practitioner would have an in-depth exploration of the background of a patient before engaging him in a therapeutic communication. Obtaining a robust knowledge foundation about ethnic groups and cultural groups can become a part of continual professional development. Cultural skill can be demonstrated by collecting cultural data regarding the presenting problems of the patients cared for. Cross-cultural interactions are the foundation of appropriate care delivery. Health care organisations must continually motivate and inspire assistant practitioners to fit into place in becoming culturally aware, knowledgeable and skilful. When practitioners become familiar with cultural encounters, they become competent professionals (Education 2014).

Assessment and Care Planning

Assessment and care planning are an essential responsibility of an assistant practitioner. A professional must have the motivation to enhance and strengthen the skills relative to assessment and care planning practice so that they can take the accountability of delivering optimal quality health care. Conducting a comprehensive assessment is crucial, and professionals must understand the science and art of carrying out a successful assessment. Application of critical thinking skills and analytical skills in conducting patient assessments take the centre stage. Fundmental care planning encompasses focus, goals interventions and evaluations. A health care professional must have the understanding of the benefit and rationale of carrying out an effective nursing assessment. The components of a successful assessment, such as mental, psychosocial, functional and physical domains are to be critically analysed. Experience, judgment and knowledge together can foster patient care. Determining patient-centred care plans aligned with the set guidelines and standards is an attribute of a competent care provider (Ackley et al. 2016).

The most important role that a healthcare provider plays in the due course of his practice is probably carrying out patient assessments. The rationale for this statement is that based on the assessment, the care plan is to be devised. Underpinning legal, ethical and professional implications, surrounding health, the professional must consider carrying out assessments. Schmidt et al. (2015) opine that while carrying out assessments, it is to be kept in mind that health is a state of complete social, mental and physical well-being, and not just the absence of any infirmity or disease of any form. Different dimensions of well-being are to be related to health while carrying out patient assessments. This would encompass all phycological, physcialogical and social issues. Recognising the best interests of the patient is the key to carrying out a successful assessment. Professionals can utilise any one or a set of tools present for carrying out assessments that provide a structured format encompassing all essential element of a clinical assessment. The expertise, knowledge and skills of the professional would influence the extent to which the assessment is successful. Systematic assessment frameworks are known to enhance the interaction between patients and clinicians, thereby strengthening the therapeutic relationship between the two. Clarke (2016) in this regard highlights that the 6Cs are to be considered while carrying out a patient assessment. These refer to care, compassion, competence, communciation, courage and commitment. A patient-centred approach is resting on these principles forms to be the best assessment in alignment with the patient needs. While carrying out the assessment, professionals must consider making attempts to know the needs and problems faced by patients as without necessarily understanding these aspects it is not possible to construct a care plan. The skill pertaining to systematic assessment is associated with the clinical reasoning in adjunction with empathy and compassion.

According to Stojan, Clay and Lypson (2016) patient-centred approach is desirable in care planning in order to promote the health and well being of all patients. The aim of providing an appropriate care plan to the patients is to cover the complete picture of health issues of the patient. A care plan suited to the patient’s needs have to be focused on the lifestyle, medical history, personal preferences and presence of allied health conditions. The care plan has to be accurate and relevant and must be made after gathering validated medical data. Proper judgements are to be made before setting up a care plan.

A care plan needs to have cultural, social, spiritual, emotional, physical and psychological dimensions in it. The patient’s perspective of own traditions and customs are to be given importance while making the care plan. The patient needs to be helped in understanding the differences between traditional healing approaches and modern therapeutic approaches so that the best decision is taken care regarding care regimen. It is noteworthy that a patient who is a staunch believer in traditional healing medicines would consider taking westernised medicines when he has the complete knowledge of how these medicines are more beneficial than traditional medicines. It is, however, important to show respect to the patient’s own preferences by acknowledging their importance. It is through making observations and involving the patient in the care planning process that clinical judgements can be justified and the perceptions of the care professionals are validated. Effective care planning is integral to the quality, continuity and safety of patient care. Care plan that meets the well-being and health needs of an individual related to function and structure of psychological and physiological systems are core to healthcare posts in every care setting (Giger 2016).      

Biomedical investigation and intervention

Biomedical interventions are the medical and physical treatments, like electroconvulsive therapy (electroshock), drug therapy and surgery, that are considered for treating psychological or mental disorders. The advent of modern health treatment approaches has considered mood stabilisers, antidepressants and antipsychotics as the common forms of treatment (Dearing et al. 2013). As per the authors, health care professionals play a pivotal role in how biomedical investigation is carried out in a healthcare system. The indispensable role of professionals in the delivery of biomedical intervention cannot be ruled out. Providing such form of interventions usually involve communication with patients who have psychiatric issues. Professionals, therefore, need to address the lack of social skills, perseverative behaviour, shyness, lack of eye contact, delayed speech, delayed fine motor skills, inflexibility with movement, sudden changes in mood and integration issues.

The biomedical model of clinical practice has been known to influence the healthcare delivery system to a great extent, and this approach is used for systematically addressing the wide range of health issues faced by patients. Advanced skills, specialised knowledge and evolving technology often are found to exert a detrimental impact on the healthcare professionals who experience some for of tension resulting in questioning the role they play in a care environment. Nurses need to realise that biomedical interventions and technology can reduce the perception of care and limit the interactions made with the patients and the connections and bond established with the patients (Doenges et al. 2016).

DiCenso, Guyatt and Ciliska (2014) have pointed out that nurses are to investigate any arising uncertainties arising while navigating biomedical interventions so that their approach towards care is appropriate. Nurse are often found to be grappling with integration of theoretical knowledge learnt previously with the realities presented by clinical practice. Professionals might find themselves in a challenge between practice and theory out of which they are found to appreciate the value of integration of a biomedical approach to care in practice. According to the researchers nurses often recognise adequately that the relationship established with the patient holds strong value. They must, therefore, establish a therapeutic relationship, diminishing the distance with the patient, increasing emotional proximity and embedding an essence of compassion.

A biomedical approach can influence patient care extensively since the emphasis is put on an evidence-based practice that has measurable outcomes. Care professionals are not supposed to be unenthusiastic and unwilling to carry out the integration of the biomedical model into practice since through this method nurses are provided with the chance to expand their problem solving and critical thinking abilities. Care givers are always under pressure to include assorted knowledge including lifesaving measures, equipment and technology as a fundamental element of holistic care. A biomedical approach can hardly be successful in capturing the lived experience of being ill as technology does not have the potential to replace the empathy and closeness human touch comes with. Thus, for completely understanding and integrating holistic care, care providers are to integrate diverse paradigms known to be a part of the expanded knowledge they have. A proper patient-carer relationship an thereby be established (Clair et al. 2014).

Practising care delivery based on science puts the professionals in a place signifying care extending beyond empirics. More significantly, biomedical investigations and care approach are not to be considered to empower care since the dignity, subjectivity and individuality of the patient hold prime importance in holistic care. Care professionals must serve as advocates, speaking for the patients when they are not in the position to do so, and must challenge the status quo often with immense hope and positivity. Under circumstances when medical treatments are considered that are aggressive in nature, care givers, like nurses, must be responsible for turning futile situations in favour of the patients. Biomedical approach overshadows humanistic care; however, nurses are to ensure holistic care through pedagogic strategies and concerted learning environments. Refinement, reflection and mindfulness of spiritual and emotional experiences can act as the foundational stone for holistic care. The authors reiterate that under situations when care givers put the focus on measurable outcomes, the patient becomes invisible. Technology enslaves caregivers under such conditions. A sense of security is to be provided to the patients through individualising care and understanding their physiological needs. The patients’ psychological, emotional, cultural and spiritual needs are to be fulfilled at all costs.  This is what it takes to be a competent health care professional, with meaningful connections with the patients and empowering them at all stages of illness. They can successfully meet all the existential requirements of those who are always entrusted to the care of service professionals.

Conclusion

At the end of the portfolio, it would be beneficial to summarise the achievements and self-evaluation related to the competency portfolio. The module has been a useful resource to support own learning and development within the domain of Assistant Practitioner. The role that such a professional plays are now clear, along with the competency standards and practice requirements. Upon completion of the Competency Portfolio, a  vocational focus has been placed on the continual learning process. It has served as equipment for gathering knowledge and skills relevant to employment in the particular area. A pathway for life-long learning has been created, and an opportunity is taken up to acquire progress to the relevant field. The learning has recognised the value of potential to gain knowledge through activity. Through the making of the portfolio, chances have been provided to get involved in new experiences and develop skills for becoming an effective and competent Assistant Practitioner.

Future skill enhancement and competency development would be crucial, and future learning needs to be given prime importance. Continual learning would be at the core of future learning process. Learning process through reflection on experience would be the pinnacle of professional learning. In addition, feedback would be taken from peers and tutors on a regular basis to understand the progress of skills and knowledge. This is to be done for at least six months. Taking part in online learning sessions and webinars would also be a beneficial approach. Sessions held by experts across the domain help in accumulation of further knowledge that can be linked with clinical practice. Such sessions can be attended once a month on a long-term basis. Constructing a Personal Development Plan can be a suitable approach for identifying further needs of learning, and they can be addressed after setting up objective goals.

References

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Allen, K., McAleavy, J.M. and Wright, S., 2013. An evaluation of the role of the Assistant Practitioner in critical care. Nursing in critical care, 18(1), pp.14-22.

Arnold, E.C. and Boggs, K.U., 2015. Interpersonal relationships: Professional communication skills for nurses. Elsevier Health Sciences.

Clair, W.S., Reid, D., Shaw, S. and Ramsbotham, J., 2014. Evidence-Based Health Practice. Oxford University Press.

Clarke, C., 2014. Promoting the 6Cs of nursing in patient assessment. Nursing Standard, 28(44), pp.52-59.

Dearing, J.W., Smith, D.K., Larson, R.S. and Estabrooks, C.A., 2013. Designing for diffusion of a biomedical intervention. Am J Prev Med, 44(1S2), pp.S70-S76.

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