Needing Support – The nurses’s role

Necessitating Support – The nurse’s function.

This essay will get down by analyzing the construct of competence in professional pattern. It will so continue to reflect upon the student’s competence by loosely using Gibb’s theoretical account ( 1988 ) in relation to a chosen accomplishment which is relevant to the attention of a patient who has a chronic status ; viz. blushing through a transdermal endoscopic gastrostomy ( PEG ) feed tubing.

The Nursing and Midwifery Council ( NMC 2005 ) defines being competent as:

Possessing the accomplishments and abilities required for lawful, safe and effectual professional pattern without direct supervising ( p. 13 )

In order for competences to be demonstrated and hence assessed, they need to be stated in specific footings and for this ground it can be argued that they may be excessively inflexible. Neary ( 2000 ) developed a theoretical account of ‘responsive competence’ , which takes into history variables within a given state of affairs. These include being antiphonal to single patient demands and covering with unpredictable results. In other words, appraisal of competence demands to let for the dynamic and switching position of day- to-day patient attention.

Competence is a modern-day issue because of the National Health Service ( NHS ) Knowledge and Skills Framework ( KSF ) alongside Agenda for Change ( Albarran et al 2006a ) . KSF provides a model for placing the competences that an single requires in order to be an effectual practician within a specific NHS station. KSF is said to be the key to the success of Agenda for Change, a revised wage system within the NHS that involves the re-evaluation of current occupation functions ( Morris 2006 ) . Concern is expressed by Albarran et Al ( 2006b ) that these developments will hold the consequence of cut downing pattern to constituent parts which can so be delegated to anyone who is deemed component to execute these skill elements. This could take to a deficiency of brooding and critical accomplishments which should be portion of the individual’s holistic attack towards their pattern. Reducing pattern to constituent parts could impact upon the ability of a practician to be flexible and adaptable, as discussed within the old paragraph.

Harmonizing to the model developed by Benner ( 1984 ) , which is still in usage as an assessment tool ( Cronin and Rawlings- Anderson 2004 ) , the nurse practician should construct upon competence towards going an expert, which includes the ability to be brooding every bit good as competent, as discussed within the old paragraph. This implies that ‘competency’ is about accomplishing a minimal criterion of safe pattern which can be developed farther so that criterions of excellence are attained.

To briefly summarize this portion of the essay ; it could be argued that it is hard to avoid the usage of competences in order to supply a quantifiable agencies of analyzing and measuring pattern. It is besides indispensable that a practician possesses a degree of competency in order to pattern safely. However the usage of competences may take to a reductionist attack which has the consequence of restricting the range of pattern in relation to higher degree accomplishments such as contemplation and critical analysis.

This essay will now continue to use Gibb’s theoretical account in order to supply a brooding analysis of a chosen nursing competence relevant to the attention of a patient who has a chronic status. For this ground, the first individual will be used. In order to admit the individualism of this patient, she will be referred to as Annie ; her name has been changed in order to guarantee namelessness. Gibb’s theoretical account of contemplation involves a cyclical procedure with the undermentioned phases: Description ( What happened? ) ; Feelings ( What was I believing and experiencing? ) ; Evaluation ( What was good and bad about the experience? ) ; Analysis ( What sense can I do of the state of affairs? ) ; Conclusion ( What else could I hold done? ) and Action Plan ( If it arose once more, what would I make? ) .

The chosen accomplishment is blushing through a transdermal endoscopic gastrostomy ( PEG ) feeding tubing. A PEG involves a eating tubing being passed surgically through the abdominal wall into the tummy. The tubing should ever be flushed through earlier and after each medicine disposal and before and after each provender ( Clemitshaw et al 2005 ) . Annie was an 84 twelvemonth old lady who had antecedently had a cerebrovascular accident ( CVA ) , besides referred to as a shot. A CVA is a loss of encephalon map ensuing from the break of blood flow to the encephalon ( Small et al 2003 ) . CVA is a major cause of disablement among older people ( Atwal 2005 ) and is associated with the oncoming of dementedness, which Annie besides presented with. Equally good as the CVA impacting her mobility, she was besides left with dysphasia ; trouble with get downing ( Mitchell and Moore 2004 ) . This state of affairs was non resolved, as it can be with some CVA patients, so it became necessary to execute a PEG, in order that Annie could have nutrition.

I flushed the tubing following direction from a registered nurse, and was supervised throughout the process. With mention to the ‘feeling’ phase of Gibb’s theoretical account, I felt nervous, as the process seemed to be rather complicated, and because I was being observed. Although it was non clear whether Annie was able to understand me, I still spoke to her and explained what I was approximately to make. I wore baseball mitts and an apron as portion of the Trust’s policy in order to protect myself. In order to forestall cross- infection, I washed my custodies. I ensured that the measurings on the tubing corresponded with the arrangement markers in the patient information enchiridion. This is to guarantee that the tubing is in the right place. Throughout the process I ensured that I did non travel the tubing more than necessary in order to avoid fring it. Using a clean syringe I drew up 30 milliliters of unfertile H2O. I closed the clinch on the PEG tubing, and so unfastened the big adapter of the Y connection situated at the terminal of the PEG tubing. I so attached the syringe to the largest gap, unfastened the clinch and gently pressed the speculator in the syringe until it was emptied. I so closed the clinch, removed the syringe, refastened the Y adapter and eventually opened the clinch. It was besides of import that I recorded the process in Annie’s attention program. This is so that her fluid input and end product can be accurately monitored. On contemplation, I felt that it was good that I spoke to Annie throughout and treated her with self-respect and regard ( Birrell et al 2006 ) I did nevertheless, find it rather hard to retrieve all the phases of the process and required some suggestion. Again utilizing Gibbs theoretical account, I thought approximately ways in which I could maximize my larning chances in relation to clinical processs. I think that I could hold read more about the process beforehand and be cognizant of the principle for each phase of the process. It is of import to go to all the relevant talks and to pattern processs where possible within a safe environment, such as a clinical accomplishments research lab. I could hold made more observations of registered nurses blushing the PEG tubing, and made notes of my observations, associating these to theoretical input e.g. from talks, text editions and process paperss. Finally, in order for me to derive assurance and competency in executing this process it would be necessary for me to be supervised farther, and I needed to joint this to my wise man, and other nurses that I worked with.

In decision, contemplation and analysis of the chosen accomplishment highlights the importance of understanding the principle for each phase of a process. Competence is gained through a learning procedure that involves direction, observation, supervising, pattern and contemplation. A cardinal constituent of competency in relation to clinical processs is safety. However there are besides higher degree accomplishments that can heighten a nurse’s competency, such as contemplation, critical analysis and the ability to be flexibly antiphonal to the demands of single patients.


Albarran J, Scholes J and Williams C. Developing Expertise in Critical Care Nursing.Blackwell Publishing. 2006. pp. 165, 166

Atwal A. Occupational Therapy With Older People. Blackwell Publishing. 2005. p. 94.

Benner. P. From Novice to Expert, Addison Wesley 1984

Birrell J, Thomas D and Jones, C. Promoting Privacy and Dignity for Older Patients in Hospital. Nursing Standard.20 ( 18 ) 2006, pp 41-46

Clemitshaw A, Oxley D, Bryant C, Todorovic V, Sayer J, Bolton R. Management of Patients Following Insertion of a Percutaneous Endoscopic Gastrostomy ( PEG ) . Doncaster and Bassetlaw Hospitals NHS Foundation Trust. 2005 p. 7

Cronin P and Rawlings- Anderson K.Knowledge for Contemporary Nursing Practice.Elsevier Health Sciences. 2004. pp.32-35

Gibbs G. Learning by Making: A usher towards learning and larning methods. Oxford: Further Education Unit. Oxford Brookes University 1988.

Small N, Pellegrino T, Henry G and Jagoda A. Neurologic Emergencies: A Symptom-Oriented Approach. McGraw-Hill Professional. 2003. p. 81.

Mitchell E, Moore K. Stroke: holistic attention and direction.Nursing Standard.18 ( 33 ) 2004, pp. 43-52, 54-55

Morris G. Twenty-first Report on Nursing and Other Health Professions 2006. The Stationery Office. 2006. p.4.

Neary M Responsive appraisal of clinical competency: portion one.Nursing Standard15 ( 9 ) 2000. pp. 34- 36

Nursing and Midwifery Council. The NMC Code of Professional Conduct: criterions for behavior public presentation and moralss. NMC 2004. p. 13.

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