Reflection of Care Management

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This assignment will reflect on and critically analyse my personal and professional development in the domain of care management over the last three years. It will additionally outline how I plan to continue to develop in this domain once I have qualified as a registered nurse. My development so far will be analysed from the perspective of the skills, knowledge and values required of a registered nurse. Through this reflection I hope to confirm that my practice meets the standards for entry onto the nursing register as outlined by the nursing and midwifery council ((NMC) 2008). Due to the nature of this assignment and for the purpose of reflection, as supported by Fulbrook (2003), I will adopt a narrative approach that conveys thoughts, feelings and experiences that examine my nursing practices, and support it with professional commentaries. Biber et al (2002) agree with the use of first person narrative for reflection in academic writing. Care management, according to Weety et al (2001), is a process of collecting information through assessment, to enable the nurse to make a series of clinical judgements and subsequent decisions about the nursing care each individual needs. Fedoruk and Pincombe (2000) explain that modern health care settings are complex and the registered nurses’ ability to effectively manage care requires highly developed skills. Peate (2006) suggests skills in prioritisation and delegation are essential to care management. This is supported by Sitivier (2004) who adds the ability to effectively manage care will impact on staff, resources and the setting and achieving of goals. In order to structure my reflections I will use the Rolfe et al (2001) framework for reflective practice model which is based around Bortons’ (1970) developmental model. Pryce (2002) states this is a simplistic cycle composed of three questions which asks the practitioner; what, so what, now what. Through this analysis I will give a description of the situation which then leads into scrutiny of the situation and construction of knowledge that has been learnt throughout the experience. Subsequent to this, ways in which to personally improve and the consequence of my response to the experience will be reflected on. Burton (2000) states this model of reflection can stimulate reflection from novice to advanced levels. This directly connects to Benner’s (1984) model of skill acquisition which offers a framework to define the development from novice through to clinical expert. I will use Benner’s stages of clinical competence, which incorporates the Dreyfus and Dreyfus (1986) model of skill acquisition to provide evidence and define how I progressed in the development of care management skills. The Dreyfus and Dreyfus (1986) model posits that in the acquisition and development of a skill, a student passes through five levels of proficiency: novice, advanced beginner, competent, proficient, and expert. In my initial placement I worked on an elderly care ward and I had no previous experience of managing care. I had experience of being a functional nurse as I had worked as a health care assistant on a hospital ward for several years before starting the nurse training programme. Kozier et al (2008) describe functional nursing as a mode of organising by being task-orientated which is defined by Corning (2002) as being focused on getting specific things done, rather than paying attention to the whole situation surrounding the patient. On my first day my mentor and I went through the daily task orientation; serving breakfasts, helping feed those unable to feed themselves, assisting with personal hygiene and then recording vital signs of each patient. This schedule of events is a prime example of rule-governed behaviour according to Dracup (2004), as the rules, in this example being task related, are context-free and independent of specific cases; they can be applied universally to all elderly care wards. I had past experience of this task...
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