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INTRODUCTIONThis essay is a reflective account on the progress i made while studying for my diploma nursing in Nigeria, BSC top up in London and also from experience while working as a health care assistant in nursing homes and hospitals. The aim of this essay is to reflect on my previous learning and the development of graduate abilities as it is a starting point for my learning and developing my practice (Jasper, 2003) and how I plan to continue my professional development in the future. It also aims to explore the use of communication and interpersonal skills in clinical practice. Reflection can be described as a process of reasoned thought. It enables the practitioner to assess self critically and their approach to practice (Fleming, 2006). The identity and dignity of patients used will be confidential. This is in accordance with the NMC code of professional conduct (2008). ⦁Critically reflects on appropriate, sensitive, compassionate and effective interpersonal and communication skills with a variety of people and settings In order to reflect on the progress that I have made so far in my previous learning and in practice, it is important to give some background with respect to what I was like before I started. After my diploma in Nursing, which was 3yrs in Nigeria, i got a job in the government sector after working in a private hospital for about 4 months. Prior to commencing the job at the government hospital, I was not a particularly loud or assertive person and at times questioned whether I was suited for Nursing, despite my love for Nursing. I needed to improve, so I applied for the BSC top up Nuring at the University of Sunderland, London campus. At the commencement of the course, I was still unsure and apprehensive about what to expect from the course, what would be required of me for the course and being in a foreign land alone with no one to guide and be there for you. I underestimated the transition process from being a staff nurse to being a nursing assistant in a foreign land and how much impact this would have on my professional development (MacNeil, 1997). In practice I mentored and supported students, and I therefore felt these skills were transferable to higher education. In principle, these skills were transferable, but the level at which these needed to be adapted has impacted on my transition. My role as a staff nurse in Nigeria was diverse and includes: facilitating learning, supporting and mentoring students. I found it difficult to demonstrate professionalism and competence in all aspects while also adjusting to the new role as a nursing assistant in London. This is in agreement with Anderson (2009, p.203) that said that the human experience associated with entering a new community of practice is a dynamic, developmental process with associated emotional work, critical tasks, and a diffusion through role boundaries to assume the new identity with values and knowledge base for the new role.As an international student with experience only in Africa, I had lacked confidence due to the accent and little communication skills. Throughout my BSC Top up course, I gradually developed strength and confidence in all the transferable skills, such as communication, effective learning, teamwork and information technology. These skills were gradually developed during my coursework, working in nursing homes and hospitals and interacting with various people from different backgrounds. I felt confident about my listening and speaking skills which were impeded by my upbringing, accent and being a newbie in the country. In the case of upbringing, as a Nigerian, it is forbidden to look at elders while talking with them, it shows signs of disrespect and being rude. I had to overcome this culture shock while studying for my BSC and communicating more with people. My first learning stage was the novice level because i had no experience or skills to practice in the situation in which they i am expected to perform (Benner 2001, p20). The transition process and the ability to cope and adapt may be dependent on the individual’s personality. At this stage of my learning, I had limited knowledge and understanding of the patient condition as well as the environment in which care is delivered. This made me anxious and nervous. My culture (which forbids me from addressing an elder by name or look them in the face) inhibited my ability to communicate effectively with patients and various members of staff. My knowledge regarding the patient’s illness or disease process was lacking. You mainly know about your patient on handing/taking over shift routine and when the nurse tells you what to do. Hence I did not know how to assess or carry out patient admissions or pain assessments. For example, when patients complained of pain, I always informed the nurse instead of carrying out a pain assessment to identify factors which may be contributing to the pain.⦁Critically analyses the role of lifelong learning and personal development as an essential precursor to developing honesty, integrity and competent professional practice My personal development builds on my awareness (Moon 1999, p14). Learning is a lifelong process of discovering what is not known and recognition of learning needs is the basis for further development. Learning personally, keeps my brain active, keeps me away from boredom, and fulfilled. It helps me to know who i am, what i am, where i am, what i should be and what my aims are (Jayaram, 2010). The importance of lifelong learning can’t be underrated regardless of any situation. From my workplace to my learning place (uni) and down to my interpersonal situations, my knowledge and abilities remains a factor between my outstanding succes or mediocrity. Learning and development is central to one’s living and survival.As a nursing assistant, we play many roles in healthcare, but one of them is being sensitive. Though patients may only see their doctors/the nurses for a few minutes at a time, patients interact with healthcare assistants constantly. From bringing a cup of tea/water to doing observations and other nursing care. As patients are being frightened and full of questions on arrival at the hospital, so are they eager to return to their normal lives. We help them to allay their fears, answer their questions honestly, direct to them to the appropriate channel if i am unable to. Through lifelong learning, i enjoyed practising my gained experience in clinical skills such as history taking, admission and discharge documentation, conflict resolution, bladder scanning, blood glucose check and more. Practising these skills minimizes fear and anxiety.In reflecting on my professional development, I consider that my skills and competencies have developed significantly and that my level of responsibility has developed to reflect this. The knowledge, skills and experience i had while studying and working boosted my self-esteem, critical thinking skills, ethical behaviour and confidence. I am able to act fast in critical situations and also being assertive always. The use of simulation while being trained for CPR, manual handling, first Aid and more enabled my skills to improve in a safe, non-threatening clinical setting. Although, i was not given the opportunity for decision-making, the nurse i work with ask for suggestions and ideas on how to deal with situations.Time management is a constant and dynamic process. Time management goes together with good prioritization skills. As humans, we do not invent time, but we learn about the concept and social institution of time (Elias, 1992). The value of nursing practice from practitioners’ view was explored to identify the importance of time to patients care and how nurses manage their time (Waterworth, 1995). As a nursing assistant, there is constant demand of my attention and time, making it difficult to identify my exact priorities. ⦁Critically evaluate and reflects on own ability to demonstrate a professional image in behaviour and appearance As a nursing assistant, I should ensure that my ethical and moral standards are compliance with the ethical guidelines as well as with the ethical traits expected of me by the society. My skills and attitudes towards the profession should be incorporated and maximized to improve and deliver quality care through skilled professionalism and right attitudes towards work. Without the right attitude, I would not react effectively to patient care, a situation that may jeopardize the entire nursing profession. As a new employee in one of the NHS trust i once worked, i was asked to make a bed for admission of new a patient. While i was going to get the bedding, Mr John (not real name) called and asked for breakfast. He complained of not taking his diabetic medication early and he was starving. However, we were informed his blood glucose was low, and he was adviced not to take his medication.I suggested the staff nurse to ask another nursing assistant to make the bed while i go make breakfast for Mr John, she declined, and asked Mr John to exercise patience, that the hostesses will be with him. I came back with the bedding and observed that he was sweating profusely and having signs of hypoglycaemia, i immediately pressed the emergency buzzer, checked his blood sugar which was very low. While we were (other teams) reviving Mr John, the expected patient was wheeled in, the nurse i was working with was furious with me, and she told me that i needed to improve on my time management. This left me questioning her after the incident which was the priority, the patient or the bed? Besides, there are other unoccupied prepared beds on the ward. Although I felt bad for not speaking up to the nurse about the issue as professionally and personally, I made the right choice. I was concerned about the patient and felt I could not leave him to die in a painful manner. She brought it to the attention of the nurse -in-charge of the ward. I defended myself, reminded them of the Nursing and Midwifery Council (2015) Code, that all registered nurses and midwives must abide by the professional standards which are to: prioritise people, practise effectively, preserve safety and promote professionalism and trust. She advised I should keep up with skills for safe and effective practice, especially when faced with challenges, when working without direct supervision, and i should work within the limits of my competence.This incident made me feel i needed to improve on my time management skills because I chose to attend to Mr John. I decided I needed to research into the meaning of ‘time management’ as I thought that my time management skills were fine. Always on time for my shift and I plan the jobs I needed to do and prioritise them. This experience made me question how I was prioritising my workload at present. I chose to attend to Mr John in ensuring he was safe. I felt that this was the priority in this situation. As an accountable nursing assistant, i choose to make the care of people my first concern, treating them as individuals and respecting their dignity (NMC, 2008a).NMC code of conduct and the lifelong learning document requires one to be able to recognize when further learning and development may be required. The NMC’s PREP (2001, p7) requires registered nurses to keep up to date with new development and to go for courses that are relevant to the practice area so as to ‘deliver care based on current evidence, best practice and, where applicable, validate research when it is available (NMC 2002, p5). ⦁Critically evaluate previous learning experiences which have sought to provide evidence-based solutions to problems or questions On reflection, the Top-up course helped me to recognize the importance of all aspects of communication, both verbal and nonverbal, such as body language, touch, facial expression, and eye contact. It showed me how crucial nonverbal communication can be in expressing meaning. During one of my shifts at the Kings College Hospital, A&E department precisely as an healthcare assistant, I put into practice my communication skills which enabled me to interact with people from different cultures and backgrounds. For example, while I was taking Mrs A.’s (not real name) observation as a nursing assistant, I observed through facial expression that a patient was in pain. I asked her what the problem was. Initially, she didn’t want to tell me, saying I was not the nurse. I had to tell her that in as much I was not a nurse, I am the nurse’s assistant. I am to inform her if there is anything happening on the ward or with the patients while she is attending to other patients, and that if she was unable to attend to the patients, she will call for an assistant. She had to tell me she was in pain. I immediately reported it to the nurse in charge. After this, I made her comfortable and continued on my observation rounds with other patients. From this scenario, I have learned that good communication skills are important in delivering health care services. Good therapeutic communication can help to relieve patient pain and anxiety.Working as a nursing assistant in accident and emergency and the Acute Medical Unit is a challenging task that has drawn on my skills across a wide range of areas. It has also however been a very rewarding area to work and I feel it has significantly developed my core skills and will provide a robust basis to further my professional development. I also believe that my experience at these hospitals has enabled me to develop the wider generic skill set required of built environment professionals, particularly in terms of multidisciplinary working, mediation, and leadership. This will provide a strong basis from which to develop my future career within the sector and effectively respond to change.⦁Construct a developmental plan to address identified learning needs, reflecting on limitations of own knowledgeThe above scenario about Mrs A, I believe i achieved one of my learning needs, which is an effective communication. Despite Mrs A inability to express herself due to pain, i was sensitive to observe her countenance and actions, thus, extending assistance to her. I was able to interpret her message of not being comfortable nonverbally. Care of people should be the priority of all care provider (NMC code, 2010), language shouldn’t be a hindrance in deivering quality intervention to aid quick recovery (Andrews and Boyle, 2008). As emphasized by Jeggels et al (2013), support from senior colleagues are paramount to provide professional guidance to learners (including students and newly employed). This support enabled me to apply knowledge and skills in my clinical setting to facilitate the transformation from the novice learner to an expert.When I was newly employed, I was being shadowed by older employees of the trust, usually, another band 2 on the ward. My performance was being observed, feedback was given on what i could do better and where i need improvement. Also, how i communicate and how patient centred i am in delivering care. As a student and a nursing assistant, feedback is important at the end of each educational session or shift. One of the ways is usually at the end of every shift, or when I need clarifications. Sometimes, complains from the nurses i work with help me to identify my learning needs. I also ask for feedback about my strengths and weaknesses, about my skills and knowledge, about my abilities as a team player and even attitude. I am proactive about this, i usually assess information when needed. I also request for trainings where I am lacking the necessary skills. This enables me to deal with identified issues or challenges at work. Attending trainings, seminars, and interviews also enabled me.I know that I had strong written skills but could not communicate verbally with a high level of confidence (i quess due to accent). At the same time, some of my learning needs were weak listening power, and difficulty with managing time constraints. All these showed that I had put more efforts during my course so that my personal and professional development competencies were developed and I was able to achieve my aspiring career goal effectively. My inability to demonstrate acquired interpersonal and transferable skills were conquered during my learning and working process. Ability to communicate effectively, respect others’ opinions and beliefs, being assertive, improved use of IT, a good team player, flexible and able to adapt in challenging situations.Being in a group during course assignments, we worked together as a team, everyone’s opinion was appreciated (Belbin, 2007). We listened to everyone’s ideas, gave suggestions where necessary and try to avoid conflict (Mackay, 2007). I gained confidence whenever my opinions were appreciated. As stated by Clegg & Barkley (2006), Horn (2010), good interpersonal skills creates positive outcome in the work setting and communication increases rapidly with increased participation and commitment for all levels. This was applied while carrying out my group assignment, thereby creating a conducive environment for learning.Another learning needs I had no knowledge about was the stress management skills. An incident occurred while working at the A&E department. I was to be on shift with another nursing assistant, unfortunately, she called in sick. Of course I panicked, the workload was much on me, at the same time, I looked at it as an opportuintty to be an independent worker and a future nurse-in-charge of a ward. I had the signs of stress all over me, it is a sudden challenge, but with determination, I was able to do my job as a nursing assistant. I didn’t realise I did very well, but on hand over, I was commended by all, and advice I go for the in-house stress training course. Learning through a literature research during an assignment, dissertation, preparing for exams, self directed learning, and social networks has taught me how to use search engines using keywords in order to find relevant articles. Carrying out literature review has given me an insight into what research involves, how research can be carried out and the different methodology that is used. I now understand that academic articles are peer reviewed before being published in reputable journals. Exams, group discussions, In conclusion, as technology is growing in an exponential rate, so should our personal and professional development. Things have been discovered faster due to technology. What I learned in nursing school 10 years is already obsolete. I am at risk in endangering my patients if I don’t update my skills as they are becoming more outdated. In order to improve myself, my capabilities and potential, I had to undergo various learning processes. Learning is not limited to the classroom alone, although, I had to undergo a top-up degree course to keep up my skills updated by self-studying, networking and asking questions with other colleagues, in-house training/certification, care certificate course and also seeking advanced degree(PGDIP). As rightly stated by Argyris (1985) it is a conscious effort which is within and locked by the individual. No one can develop anyone but themselves. Overall, the course was worth it and the group assignments were good as it stimulated team work. This is vital and resourceful, especially while working in NHS Trust that requires working together as a team. I have learnt to listen attentively, respect and appreciate everyone’s suggestions and feedback. I have gained more than enough knowledge and insights about Nursing