Participation Reflection & Self-Evaluation
This semester has been full of reflective moments for me. I found the content provided many opportunities to bring the learnings into my practice. This is a short analysis of my participation in this course, highlighting several moments that brought me personal and professional learning.
Most memorable post
Unit 5 was the most memorable week for me, I enjoyed the online conversation with Taylor and Farrah as they had questions on my post and it provided me the chance to engage more with them and talk about the decolonizing of nursing. Here is the excerpt from Unit 5:
Thanks Taylor for your nice comments, and yes I love to try and simplify the core concepts to help me ensure that my foundation is based on the correct principles in most all I do. Sometimes I think we complicate things from the start and the basics of what we are trying to achieve are lost in all the jargon, and pathways we create. That’s why I was drawn to the simple video. I love to chat up my learnings from my course work during my workday from time to time, and I am trying to motive some of my nurse colleagues to hop on the Master's learning train, and these simple conversations to spark the learning is very helpful.
Now for your thought-provoking question, How does the concept of continuous learning in your practice correlate with the concept of decolonizing nursing theory?
When I think of 'decolonizing' nursing theory, I think of the concept of 'undoing' some of the things I have learned over the years, to ensure that my practices is current, relevant, inclusive, socially just, and not based on previous biases that I am not aware of. We have seen in the readings this week, you don't know what you don't know, that truth is the same in this situation, we sometimes don't know the biases we bring to the profession if you have not been exposed to the impact of your approach. As a nurse you don't willingly harbor up biases or colonized ideas that we have been taught, we cannot know what we don't know, which is why it is important to be committed to continuous learning and model that for our staff.I think of the impact of Indigenous families around reconciliation, as Canadians we have become aware of the impact of residential schools and the harm that caused so many people. Part of our movement towards reconciliation is that we acknowledge this and work to ensure it does not happen again. For some parts in my province, residential schools is something never seen or heard of, does this make this event any less because some people cannot relate or understand? The answer is no, we need to see the impact of this on our people and do our part to make sure that does not happen again. I use this example to show how I see the decolonizing of nursing theory. I believe we need to work from the basis of self-reflection, and be committed to ensuring our work as a nurse is not showing any bias of race, social status, gender or any social inequity. We can only ensure we are contributing to the decolonizing if we are always seeking to expand our knowledge. This personal growth allows us to be leaders and help ensure we are being expansive and fair and just in our practice. If we stopped learning, we are at risk of being stuck, or 'colonized' and that lack of self-awareness can cause our practice to not be what is should be. Hope this long explanation makes sense and helps you see how view this issue.
Most Substantive post
My example of a substantive contribution to the course would be in unit 6 forum. This week had me reviewing the Code of Ethics and it was quite timely as I needed to refresh my own knowledge on the Code and its impact on day to day nursing in my regular job. This is the post I am referring to:
What happens when scarcity of resources threatens your values and principles of nursing?
Health care is faced with issues of recourses in many ways. There is the obvious human resource issue that is facing the country however there is also supply chain issues that are facing hospitals as the pandemic has impacted access to items such as PPE, medications, and other products we need to provide care. When items become scare, it creates fear in the staff, managers, and patients. Nurses get used to having supplies at their fingertips and when that changes the stress level rises. I think back on the basic mask, there was a time it seemed masks were everywhere, and no one ever thought of a day without them. Then Covid came along, we had to ration masks for staff, 2 per 12-hour shift. That was it. This was very stressful to enact, and more stressful to be the face of as we coped with covid. The vulnerability in the nurses faces as we passed out the rationed PPE, was morally stressful and beyond anything I had seen in health care. Vryonides, S.,(2015), speaks of the impact of rationing on the nurses philosophy of care, I can relate to the inner conflict and mental torment of how it felt to balance self-protection and provide safe care. Another example that comes to mind around the human resource piece is when we change the model of care delivery and introduce skill mix into a predominantly RN unit. The addition of LPN and PCA is distressing for the nurses involved and it conjures up many conversations around ensuring the patient is not denied a level of care because we change the providers.
Health care is facing challenging times in human and physical recourse management, the largest message I see in our role, is to ensure we model our values as a nurse and have our actions line up with our Code of Ethics.
Vryonides, S., Papastavrou, E., Charalambous, A., Andreou, P., & Merkouris, A. (2015). The ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nursing Ethics, 22(8), 881-900. doi:10.1177/096973301455137
Code of Ethics Discussion: Be Accountable
As I re-read the Code of Ethics document, I found myself focusing on the Accountability section. There is so much discussion in our workplaces now on Just Culture and Accountability. The lines are slightly muddied and staff as well as managers struggle with seeing the differences. Just Culture is key for us to look at errors in health care and ensuring we look at overall systems improvement to promote safety in the workplace. Accountability on the other hand is the responsibility we have to show up and follow the policies and provide care that falls within our scope of practice. Every day in my role I am faced with patient incidents, errors in the workplace, where I am part of the review team that looks to the system to see if we contributed to the error or if the nurse has practiced outside policy or scope. This week I have three meetings in my calendar in follow up to incident reports and this section resonated with me.
When I look at the “Being Accountable” section in the Canadian Nurses' Association (2017). Code of ethics for registered nurses, it says that nurses are accountable for their actions and answerable for their practice. This is the guide for any further discussion and helps me when meeting with nurses involved incidents. In my meeting this week on a case of miscommunication at the change of shift, this reminder around nurses remaining with the person receiving care until another nurse is available provides me with the confidence that my approach to the issue is correct. Nurses are accountable for their practice and need to reach out to their supervisor to discuss concerns.
I had forgotten the section where nurses need to be aware of signs in their colleague who may not be able to preform their duties. This reminder is also very timely for me and I will take this away as my sharable learning for this week with my leadership team. Too often nurses are not good to each other, many articles have been written on nurses eating their young, and this section services as a reminder to us all to ensure that mutual respect exist within the nursing world. Gillespie, G. L et al (2017), speaks of a program to help prepare student nurses to navigate the prevalence of lateral bullying in the nursing workforce and hope to arm the next generation with the tools to help stop this 30 yearlong issue.
Canadian Nurses' Association (2017). Code of ethics for registered nurses. CNA.
Gillespie, G. L., Grubb, P. L., Brown, K., Boesch, M. C., & Ulrich, D. (2017). "Nurses Eat Their Young": A Novel Bullying Educational Program for Student Nurses. Journal of nursing education and practice, 7(7), 11–21. https://doi.org/10.5430/jnep.v7n7P11
What Keeps nurses up at night?
As I watched the video, I was finding myself reflecting on what has kept me up over the years, and how that mental list has changed over the years. In my early career I would think of my documentation and wondered if I charted the vital signs if I gave and signed for all the medications and if all the orders were taken off correctly. These were the issues that cause me to double check my way out of a shift which even meant me staying later if needs me to ensure I could not be worried. As my career progressed and positions changed, I began to lose sleep over my patient’s suicidal behavior, the families that I knew were having conflict and I would wonder If my assessment was accurate and I would worry about the possibilities of unanticipated stress on their mental health. I remember feeling a lot of fear. Then I became a manager, and the issues changed again, but I still at times lose sleep. I have lost sleep over short staffing levels, delays in assessments of patients by physicians, and incidents that have caused patient harm. I worry about access issues for patients, and the support for the staff in high stress patient situations.
Over the years, my list has changed but the themes to me are the same. The worries are based in my desire to provide safe care, and that I as a nurse am doing all I need and should be doing to benefit the patient. The ethics of ensuring my practice is reflective of a competent nurse is at the core of the self reflection.
Johns Hopkins School of Nursing (2014). What keeps nurses up at night
Reflection
I feel I have contributed to the course and have been posting regularly in the thread’s week to week. I have tried to engage and answer questions posed on my posts and provided feedback on others. In the early weeks of the course, I remember having a discussion on the nurse in social media, and I tried to address the dark nursing humor that one of my classmates found notable in the person they were highlighting. I did bring up the importance of us as nurses to promote nursing in a positive light on social media platforms and be cautious about promoting the dark side of nursing humor that we all might smile at in private but has not place in our public stance on nursing. I tried to post early and check back regularly to comment on posts when asked a question or to provide feedback or encouragement to my classmates.
Most impact on my current role and future practice
There were many new nurses in this class, and I found that reading their opinions on what it is like to be a nurse in the front line in this current environment left an impression on me and it has changed me. Their willingness to share how tired they have been, and how the pandemic has changed their views of nursing has made me sad. I felt grateful for the many years of nursing practice I had before any of the utter exhaustion of working in a covid environment happened. I have many memories to pull me from the frustrated days, and that became evident to me when we were commenting on the video in unit 7. I saw the clip where the nurses were caring for a very sick patient and the caption read, at the end of a 12-hour shift. I instantly went to the fact that the nurse was able to go home and be with their family/ leave the hospital/have life outside this patient’s room. However, 2 of my classmates, saw the tiredness of the nurse, the extended shifts, the nurse missing out on personal activities and saw the scenario completely different than I did. Perhaps it was my health administrator lens, or perhaps it was the patient centered care lens that I work by, but the lesson to me was that I need to ensure I remove my bias and be able to see all situations from all sides. My current role as a regional manager is probably where I will end my career and retire from this position however its important while I am still here that I see the work life from the new nurses eyes. I do see a future for me after I retire in Accreditation, or consultation work around patient safety. I feel that this will fit with my life plan as a start to wind down but still be contributing to the profession and keeping myself present in nursing practice.
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