Critical Analysis and Reflection

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Introduction

This paper seeks to effectively provide an analysis of the critical thinking and reflection and how they are used in the re-assessment and re-analyzing of the different situation that need attentive examination and this is to be done on the basis of how, why and when facts and nursing distortions mix up. The objective of this paper would be achieved on the basis of how it makes learner to be able to handle situations professionally and give out desired results on the grounds of the company’s set strategies and objectives (Ashby, 2006). In this paper, I reflect on the clinical application of my major: gaining more confidence in the assessment of patients who are coming in for admission in a psychiatric setting.

Course Description

In respect to this study, the main words to be discussed under this section as the key elements to the study are buzz phrases like; critical thinking and critical reflection of the study practice. In accordance to these phrases, Scriven’s definition has been adopted to provide additional help to the definitions. According to his views, critical thinking is an intellectually disciplined process that vigorously and skillfully conceptualizes, relates, examines, manufactures and appraises information collected from scrutiny, experience, reflection, reason and information dissemination as a guide to belief and action (Scriven and Paul 2004). This skillful conceptual application is a very crucial concept that learners and clinical professionals in their day to day operations.

In respect to reflective practices, Duffy’s description was been adopted as a tool for intentional mental processing that is normally used in complex situations aimed at fulfilling objectives and purposes that are set presently or in future. Reflection affords ways through which nurses could assess practice as an individualized improvement process (Duffy 2007). I was able to establish that a reflective process was active, persistent and carefully judgment of any belief or form of knowledge.

Purpose of the clinical learning need

Nursing study is one of the essential requirements in the global society as human beings are faced with different health challenges that nobody can naturally tell the source and appropriate diagnosis without undergoing g nursing study. Nursing learning consists of a wide range of medical fields ranging from simple diseases to very complicated ones such as psychiatric infections that require neurosurgeries (Alsop & Ryan, 1996). The key aspects that will be looked at in this study would be learning of nursing as a career profession and working under nursing.

The core plan and accreditation of the education of nursing units is mainly for three key reasons. The first step in acquiring the nursing skills and knowledge is through attending of the nursing classes where learning on the basis of the nursing units is undertaken. There is an international set of the nursing units that students undertake in their nursing syllabus while at school in different academic levels as far as nursing profession is concerned (Aitken, 2003). The initial accreditation of the units of nursing education seeks to contact the ACEN in order to begin the appropriate process of candidacy. As part of the learning process in nursing, the units of the nursing education will be assigned a professional staff member in order for him/her to mentor the students during their study.

The service of mentoring is provided mainly to facilitate a self-review faculty and general planning. The readiness of the program to be applied for is determined by the faculty of the administrative and program officers of the organization that takes role of governorship. This is when the student initial accreditation and candidacy application can be done. The decision of undertaking the nursing study at any international or even national nursing should be done on the basis of an in-depth program of self-study in relation to the accreditation standards of ACEN and the appropriate Criteria (Ashby, 2006). As long as the commission of ACEN grants accreditation to any program, all graduated students or those students that graduated after the coming of the accreditation cycle at the time which they visited site was performed will be fully recognized as international graduates of nursing program that is accredited.

Purpose of the academic learning need

The field in which I am, there are many challenges and in order to be able to tackle them, there is need for one to have knowledge in addition to skills gained through clinical learning as I have indicated in the above section (Baumgartner, 2001). Knowledge is gained by going through the academic learning process effectively and orderly. By effectively and orderly, mean covering the whole syllabus that is covered in the respective courses through going done. The academic learning process requires that an individual must successfully cover the course syllabus at one level, attain a degree certificate and be allowed to undertake the next level.

The most technical and challenging part of it all is where I had to go in the laboratory or theater to attend to a psychiatric patient lying in a bed. In most cases when you learn in class, you enjoy and almost forget that it will come to such a time of real action. Critical thinking and reflection really help in such like cases, because you personal conscience might mislead you when you are overcome by fear and terror (Pierce 2008). This time calls for relaxing, focusing and mentally taking yourself back to theory in academic learning.

Therefore, I realized that in psychiatric field, doctors encounter challenging situations such as a patient suffering from psychiatric problem being out of control but the key to handling any of such challenges relies on you understanding during the academic learning. I being a doctor, I require skills, experience, and knowledge that are acquired in academic learning. Therefore, based on this, it can be confirmed that there is a greater need for academic learning for all types of medical professionals (Riddell 2007). Critical thinking and reflection on what is learned in academic field is the key to the application of the knowledge learned in academic institutions.

Literature Review:

I searched for the literature material that provided detailed information about the need for academic and clinical learning in nursing and found many reasons as to why I need academic and clinical learning for my career (Aitken, 2003). The fact that nursing profession and medical sectors are the key sectors in human life has made many people to write a lot of information about why the learning in nursing is highly required. The historical books I found in the field provided that the health and disease problems that our ancestors went through are the key reasons for the introduction of academic and clinical learning in the field (Duffy 2007).

I found out that the main source of the nursing knowledge that I use has its origin in the academic learning that I undertook and continue undertaking. It opens my brain and enlightens me on the key procedures and concepts to be used in my field. On the other hand, the experience and ability that enables me tackle situations that are challenging and sometimes seems to be impossible come from clinical learning (Meltzer 2008). The literature material further confirmed that only academic learning or clinical learning as a single learning discipline does not make one fit and ready to handle all challenges in the medical field. Therefore, these two aspects of study are rendered crucial and very important in perfecting any medical relate career like mine.

Scholarship work had identified four features that were critical in order to guide student’s reflection activities. Students are advised to find the right guide, develop a reflective framework, be aware for what might unfold and take a deeper reflection on the holistic situation. Whenever there is the right guide, it facilitates the process of keeping the right guide, other than the problem solving process. I realized that the former work done by preceding practitioners provided points of reference for my skills which I read in medical newsletters and journals.

The experiences I read formed my resource base for advice, information, challenging experiences for self evaluation and discovery (Duffy 2008; Yorke 2006). I later on fathomed that being proactive in any field of study especially like the case of nursing, majorly prepared me to be open to new ideas devoid of inherent prejudices in me. As a learning practitioner revisiting past experiences showed me reflective of processes that entrenched my comprehension of new skills that I had learned beforehand (Lindberg 2007).

In my critical analysis I came across a study that determined whether critical thinking had any effect on job performance. Nursing practitioners were asked whether they experienced satisfaction while serving in the Intensive Care Unit (ICU). The findings showed that critical thinking and reflection were linked to job satisfaction. The findings also indicated that the scale of satisfaction among nurses went up after they got involved in thought reflection. I also came to understand that the nurses had a chance to gain insight into how they worked and improved their self worthy (Vinjie and Mittelmane 2007; Yorke 2006; Smith et al 2009).

When seeking employees most employers placed emphasis on attributes, skills, knowledge and attitudes. Self efficacy, critical thinking and reflection skills were the most sought after in employees (Smith et al 2009). The new trend in pedagogical methods was towards is expansion of teaching beyond academic knowledge. It focuses on skills that are necessary to find the way to successfully and satisfactorily improve the professional practice (MCMahon, Patton and Tatham 2003).

Program student learning outcome

Reid defined reflection as a process of appraising experience to be able to portray, analyze, assess and inform about a learning process (Reid, 1993). In this discussion, I seek to contextualize situations of professional performance so that I can learn, grow and develop in professional practice. This process of reflection is important to me so that I can assess myself within the context of experience to be able to gain experience towards problem solving (John, 2000).

The reason why self-reflection is important is because it brings within me transformational learning which can be gradual and life changing (Baumgartner, 2001). In order for reflective learning to be realized, one must reflect by going back and pondering over past events, new insights indifferent dimensions of the situation. This tool is very vital in the approach one can give to issues related to the patient care. The primary care which is part of the reflective model is very important in that it helps the patients manage their conditions and enables them to offer informational kind of assessment, behavioral and also emotional kind of support they could be in need of from their next of kin (Alsop & Ryan, 1996). One can be able to make some sort of reflections on how the patient feels and may decide to give the necessary help that can enable them get better without necessarily undergoing intensive care and treatment.

My process of self-reflection and critical thinking begun during my placement to a hospital institution psychiatry unit charged with the role of assessment of patients and forwarding them to the lead physician. At this moment, I realized apart from the theoretical knowledge within me, I needed something else without which I felt empty. This was self confidence which enabled me to face various challenges and situations of in-coming patients. The process begun at 8.00 a.m. in the morning to 5.00 p.m. for about 7 hours, but to me what mattered most was the self reflection process of how I behaved before patients, what should be done and how it should be done.

Curriculum (The Situation)

What led to the main challenges that are mainly faced in the nursing profession happens in a case where a patient code-names as Maria Crowley for the purpose of this assignment comes in a medical firm for treatment (Mishler 2006). The hardship is mainly experienced when Maria who is a patient goes before a nursing officer while undergoing severe depression and when the doctor observes her keenly, he realizes that she has already given up in life and does not appreciate her environment and people anymore (Clayton, et al, 2005). The doctor faces a hard time trying to convince her that she should have hope and that the medication she is given will help her if she concentrates and pays attention to the doctor’s prescriptions.

Before leading her to the psychiatric laboratory for further assessment, there arises need to conduct armature appraisals though amid mixed confusion, surprise, empathy and helplessness for lack of knowing what to ask or say in the middle of the session. For once, I ran short of supportive resources for the patient. My physiological state at this moment had a big impact on providing information for myself efficacy and confidence. My mood states of anxiety, stress, confusion and helplessness instilled concerns of vulnerability to poor performance. However, upon deeper reflection I concluded that I had all the resources at my disposal all I needed was confidence and self efficacy (Chen, Gully & Eden, 2004). I needed to tell myself beyond any reasonable doubt that I could do it just as my mentor.

When the lead psychiatrist took over all I could do was to take notes in my reflective diary. I could gather from the conversation that ensued that Maria had had a nasty past where she lost her family in a grisly road accident. She lost her husband, four kids and a sister. A year later she had not been able to overcome the trauma she underwent. She complained of seeing her family crashing and hearing cries of pain anywhere (Alsop & Ryan, 1996). She had difficulty with sleep, focus and at was unable to perform any task. This had caused her a job as high school teacher. Community workers on duty spotted her in the streets and admitted her to the mental institution for check up and possible treatment from acute depression.

Patients were already in low self esteem hence needed an environment of support and encouragement (Gardner and Pierce 1998). A health care provider who possessed high confidence levels in the areas of communication and clinical skills because it had an effect on patient outcome expectancies. When there was confidence in the nurse it enabled her/him to assess patient’s concerns and make right decisions. Whenever some success was registered t contributed to me robust belief in my personal efficacy (Bandura 1997). At the same time, failure undermined self efficacy and self confidence. My confidence influenced my critical thinking and my performance and communication skills.

Alignment of the Course by Assessments, Outcomes, and Standards

Effect of My Personal Needs on Professional Development: Another important aspect was that my needs affected my professional development. Having less confidence was not good for me. This tied down my abilities to handle the situation at hand. On the contrary, wanting to perform well or above board made me to be over-confident (Hecimovich & Violet 2009; Rose, Ruktalis & Schuckit, 2005; Chen, Gully & Eden 2004). This was a limitation to me because I could end up believing to be right even when committing medical errors. By engaging in critical thinking, self confidence I became aware of sound judgments that provided my basis for solving problems in a more rational way.

Application of a Reflective Model: The case of the reflective model is very vital in analyzing the effective mode of learning. I combined various skills in application of the reflective model. Effective learning came about with many tactics taking shape in the session. Through observation of how the lead psychiatrist handled the session was a critical stage. Paying attention to challenging areas while taking notes into my diary became handy, as I could gain new insights and have a third eye on the how I could have done it better. I adopted Kolb’s learning cycle which emphasized on experiential learning (Proctor & Rosen, 2004). For Kolb concrete experience phase is crucial since you relate to what happened, how you did it or would have done it and how you applied your ideas in the situation. In Maria’s case I discovered limiting mood states that tied down my potential. I needed positive resources of self efficacy and self confidence.

Another important phase according to Kolb’s cycle is reflection. This involved reviewing the experience in my mind and exploring what I did, what others said while taking lessons and noting in my reflective diary. In the abstract, conceptualization phase, I went further to understand what happened in the session by asking from my mentor, colleagues and more research leading to discovery of new ideas about how things are done. The last phase involved active experimentation that was concerned with trying out new ideas that I gathered from my past experience and reflection process (Sackett, Straus &Richardson, 2000).

Selection of Critiquing Tool: From my experience and what I observed from my mentor, reasoning in nursing could comprise of eight elements of thought which is consistent with Paul’s findings. The elements aid the learner in selection of the right tools. Purposeful thinking could be determined by the problem or issue at hand. One needs to understand what the thinker is trying to figure out (Aitken, 2003; Bittner, 1998). Other elements could be the overall end goal: frame of reference or held world view; held assumptions; central concepts and ideas; evidence or data; various interpretations or inferences and the eventual consequences that follow based on decisions we take (Eastbrooks, 1998).

The Strengths and Weaknesses of the Methods and research Process used.

Data collection methods relied mainly on observation techniques. Observations are sometimes guided by perceptions and attitudes that are inherent in us. Observations are experiential and far more enriching to the learner (Alsop & Ryan, 1996). The main weakness of this method is that it is subject to many individual interpretations hence makes it difficult to standardize findings. Secondary literature provided mainly scholarly contributions to the topical issue. The process of reflection has been criticized for advancing held beliefs and practices. There lies the cultural risk and personal risks that are involved. Not all people feel empowered by the reflective process (Paul, 1990).

Conclusion and Recommendation:

I learned that as a nursing practitioner I needed to understand the right questions for the right situation. Studies are consistent on the fact that critical reflection increased job satisfaction and reduced nursing turn-over rates. I also found congruence in the fact that employers were therefore in pursuit of employees that exhibit such skills in their career. Institutions of higher learning had adopted critical reflection as part of their curriculum compulsory for all nursing students (Ashby, 2006). Furthermore, on more reflection, self efficacy and confidence for a nursing learner was a crucial aspect to forming the right attitudes and mood states required for better performance. Mentorship, supervision and individual observations were critical experiential tools essential for self discovery.

References

Aitken LM. (2003) Critical care nurses’ use of decision-making strategies. J Clin Nurs. (12):476–83

Alsop A & Ryan S (2006) Making the most of fieldwork education: A practical approach. Stanley Thornes, Cheltenham

Ashby, C. (2006). The benefits of reflective practice. Practice Nurse. 32 (9), 35-7.

Alvesson, M. & Sköldberg, K. (2000) Reflexive Methodology: New Vistas for Qualitative Research (London: Sage Publications).

Acheson D. (2008) Independent Inquiry into Inequalities in Health Report. London, HMSO,

Atkinson AB. (2010) On the measurement of inequality. Journal of economic theory, p. 2: 244±263.

Beaglehole R, Bonita R. (2008) Public health at the crossroads: which way forward? Lancet, New York, p, 351: 590± 592.

Baker, S. (1990) Reflection, Doubt, and the Place of Rhetoric in Postmodern Social Theory, Sociological Theory, 8 (2), 232-245.

Barnett, R. (1994) The Limits of Competence, Knowledge, Higher Education and Society (Buckingham, SRHE and The Open University Press).

Barnett, R. (2000) Realizing the University in the age of supercomplexity (Buckingham: The Society for Research into Higher Education and Open University Press).

Biggs, J. (2003) Teaching for Quality Learning at University (2nd edn) (Buckingham: Open University/SRHE).

Birch, M. & Miller, T. (2000) Inviting intimacy: the interview as therapeutic opportunity, International Journal of Social Research Methodology, 3, 189-202.

Bleakley, A. (2009) From reflective practice to holistic reflexivity, Studies in Higher Education, 12 (3), 315-330.

Bolam, B., Gleeson, K. & Murphy, S. (2003) “Lay person” or “Health expert”? Exploring theoretical and practical aspects of reflexivity in qualitative health research, Forum: Qualitative Social Research, 4 (2), Art. 26.

Boud, D., Keogh, R. & Waller, D. (2005) Reflection: Turning Experience into Learning. Kogan Page: London.

Boud, D. & Walker, D. (2009) Promoting reflection in professional courses: the challenge of context, Studies in Higher Education, 23 (2), 191-206.

Brockbank, A. & McGill, I. (2008) Facilitating Reflective Learning in Higher Education (Buckingham, Society for Research into Higher Education/Open University Press).

Brookfield, S. (2007) Developing Critical Thinkers: Challenging adults to explore alternative ways of thinking and acting (Milton Keynes: Open University Press).

Brookfield, S. (1993) Self-directed learning, political clarity and the critical practice of adult education, Adult Education Quarterly, 43(4), 227–242.

Burawoy, M. (1998) Critical sociology: A dialogue between two sciences, Contemporary Sociology, 27 (1), 12-20.

Bandura A. Self-efficacy: the exercise of control. New York: W.H Freeman; 1997.

Baumgartner LM (2001) An update on transformational learning. New Directions for Adult and Continuing Education, p. 89:15-22. Jossey-Bass, San Francisco.

Colbourne, L. & Sque, M. (2004) Split personalities: Role conflict between the nurse and the nurse researcher, Nursing Times Research, 9 (4), 297-304.

Chen G, Gully SM, Eden D. General self-efficacy and self-esteem: toward theoretical and empirical distinction between correlated self-evaluations. J Organ Behave. 2004; 25(3):375–95.

Duffy, A. (2008). Guided reflection: a discussion of the essential components. British Journal of Nursing. 17(5), 334-339

Duffy, A. (2007). A concept analysis of reflective practice: Determining its value to nurses. British Journal of Nursing. 16, (22), 1400-1407

Murray CJL et al. U.S. (2005) patterns of mortality by county and race, Harvard School of Public Health and National Center for Disease Prevention and Health Promotion, New York, Cambridge

Antonovsky A. (2007) Social class, life expectancy and overall mortality, New York, Milbank Memorial Fund quarterly, p. 1967, 45 (2): 31±73.

Marmot M et al. (2007) Social inequalities in health: next questions and converging evidence. Social science and medicine, New York, John and Peter Publishers, p. 44: 901± 910.

Whitehead M (2009) The concepts and principles of equity and health, International journal of health services, Washington DC, Cambridge Publisher, p. 1992, 22: 429± 445.

Feinstein JS. (2013) The relationship between socioeconomic status and health: a review of the

Literature. Milbank quarterly, New York, p. 71 (2): 279± 322.

Kaplan GA, Lynch JW. Whither studies on the socioeconomic foundations of population health? American journal of public health, Washington DC, p. 87: 1409±1411.

Wagstaff A et al. (2011) On the measurement of inequalities in health. Social science and medicine, New York, p. 33: 545±557.

Manor O et al. (2007) Comparing measures of health inequality. Social science and medicine, Washington DC, p. 45: 761±771.

Mackenbach JP, & Kunst AE (2008) Measuring the magnitude of socioeconomic inequalities in health: an overview of available measures illustrated with two examples from Europe. Social Science and Medicine, p. 44: 757±771.

Sen A. (2007) On economic inequality. Oxford, Clarendon Press, New York. P. 13, 346

Valkonen T. (2009) Problems in the measurement and international comparisons of socioeconomic differences in mortality. Social science and medicine, 1993, 36: 409±418.

Appendices:

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