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SID-1525377INTRODUCTION: In this reflective account essay ,I will be describing nursing skills and knowledge ,using Driscoll’s model of reflection .There are different model of reflective essay for instance Gibbs Model, Kolb Model, Schon model, I choose Driscoll model because, according to Driscoll’s (2007),there are three processes when reflecting on one’s practice. They are what ;providing a description of the event ,So what; what you have learned; giving an account of how you felt at that time and what you have learned from this experience and finally Now what; your proposed actions for the future and how you are going to implement what you have learned reviewing the experience. The application of Driscoll’s reflective cycle will enable me link theory to practice. Professionalism in nursing is an essential ingredient in achieving a healthy environment and is enabled by the context of practice .Professionalism is achieved through demonstrating an accountable ,knowledgeable, visible and ethical nursing practice and maintaining a professional presence. The values are important in professional nursing practice and health care as they support all aspects of professional practice, including decision making(professional values in nursing,2014).According to (NMC,2017) professionalism in nursing and midwifery is realised through purposeful. Reflection is an ongoing practice within the field of nursing .Reflection means that thought of significant aspects of an experience are reconsidered and other explanations are contemplated .Reflection has the opportunity to enhance clinical reasoning while having a positive impact on patient care. Reflection can occur within the experience or by looking back at the experience. Schon(1991)identifies these as reflection-in-action and reflection-on-action. Reflection -in-action refers to knowing what to do and making a difference within a given situation .Reflection-on-action means examining some of those ‘in the moment’ decisions for the possibility of other choices and ways of acting ,and how these insights might shape and develop future practice .Reflective practice requires careful consideration of knowledge and ideas .This requirement has been updated by the NMC(2008),which makes clear that reflection on the outcome of any type of learning is essential to maintaining knowledge, skills and competence as a nurse(Reflective Practice in Nursing,2013). WHAT? During my placement, I had the opportunity to shadow the Registered Nurse .Our patient Mr X ,I will use a pseudonym to protect his identity following the patient confidentiality(NHS England,2016).He was 66 year old man, who was recently admitted with Atrial Fibrillation .However, in only one ECG(Electrocardiograph) with Atrial Fibrillation then reverted to sinus rhythm with intravenous Metoprolol according to the (NICE, August 2014,Arrhythmia Management in Resuscitation Council Guidelines 2015).Mr X was also diagnosed with Acute Coronary Syndrome and Troponin was positive .The patient was given ACS(Acute Coronary Syndrome) treatment ,which involves Aspirin, Ticagrelor and Fondaparinux(NICE, August 2014).Mr X had had an Angiogram and Percutaneous Coronary Intervention was performed due to blocked coronaries After 5days of hospital stay Mr X was made medically fit by the cardiologists ,on discharge the doctors didn’t considered Atrial Fibrillation and the TTA(TO Take Away) was done with all the medications for secondary prevention of ACS(Acute Coronary Syndrome).The staff nurse who was doing the discharge procedure for Mr X realised the need for the Anticoagulant at the time of the discharge and reported immediately to the ward manager and also to the doctors who wrote the discharge letter and got rectified. If the anticoagulant was not added Mr X might had gone to the serious complications such as stroke(NICE 2017,NHS (Atrial Fibrillation Complications, April 2018).The nurse here has demonstrated he excellent professional skills, critical thinking and Accountability(NMC,2015).Thus, I have selected this scenario as it shows how the nurse was considerate and knowledgeable. Atrial Fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate. In Atrial Fibrillation, the heart’s upper chambers(atria) contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the heart’s efficiency and performance .Atrial Fibrillation happens when abnormal electrical impulses suddenly start firing in the atria. people with atrial fibrillation are more at risk of having stroke(NHS,2018),because the people with Atrial Fibrillation increases risk of blood clots forming in the heart, which can lead to stroke. Use the CHA2DS2-VASC stroke risk score to access stroke risk in people with Atrial Fibrillation(NICE,2014).Drug treatments include anticoagulants to reduce the risk of stroke and antiarrhythmics to restore or maintain normal heart rhythm or to slow the heart rate in people who remain in Atrial Fibrillation. Anticoagulant such Apixaban ,Dabigatran etexilate , Rivaroxaban or a Vitamin K antagonist is administered(NICE.2014),to prevent stroke. Accountability is an essential component of professional nursing practice ; accountability is also a essential component of Patient safety. The nurses are accountable to the patients and their family members because of this nurses should hold themselves accountable for patient advocacy, continuity of care ,lifelong learning ,to colleagues ,the nursing profession and their organization .Accountability relies on both clinical expertise and effective communication skills .Excellent clinical skills allow the nurse to identify the risk that affects the patient outcome and effectively overcome it in a timely manner. These skills help the entire team to provide the best care .The nurses should ensure that the patients receives safe and high quality care .As professionals ,nurses are accountable for continually learning about how to use the best evidence available for patient care(Renae Battie, Victoria M Steelman ,2014). Accountability is the key to increasing trust, reducing fear and improving morale and performance and should be the basis of establishing a culture of trust, support and dedication to excellence. All healthcare professionals may be held personally accountable for their practice, in specific cases and more generally in how they have maintained their knowledge and skills. Accountability to and for practice may, however, only really be meaningful if referrals are made for investigation by a regulatory authority, if inspection and audit is effective in detecting and rectifying concerns, and if those organisations to whom reports must be given can exercise meaningful influence in response, perhaps through the use of sanctions(Braye and preston-shoot,1999 in Professional Accountability in Social care and Health,2012).SO WHAT? On reflection I felt that my mentor has effectively used critical thinking in this scenario. Clinical skills in nursing are obviously important, but critical thinking is at the core of being a good nurse. Critical thinking is an essential component of nursing since a nurse is always by profession, confronted with complex situations, which demand accurate judgements, clinical decision-making and a continuous learning process. Facione (1990) defines critical thinking as a purposeful self-regulatory judgement. Halpern (1989) defines it as a purposeful goal directed thinking(The Journal of Nursing,2007). The skills that are important for effective critical thinking are as follows INTERPRETING: Understanding and explaining the meaning of information, or a particular event. ANALYZING: Investigating a course of action, that is based upon the data. EVAULATING: to assess the value of the information that you got and to know whether that information is relevant, reliable and credible. In nursing, critical thinkers needs to be Precise, Complete ,Logical ,Accurate, Clear and Fair .Learning to think deeply, creatively, and effectively helps a nurse to care for the patients and serve as their advocates; it also helps a nurse to become more astute in making own life choices. Thinking critically is a practical process (Miller and Babcock,1996) . Critical thinking will develop self- confidence and foster self-actualization both personally and professionally. Functioning blindly on the orders of someone else is no longer acceptable. Instead ,we must be cognitively engaged and participate fully in decision making .Critical thinking skills are essential to resolving health care situations and to discussing controversial issues in a thoughtful, fair-minded manner(Miller and Babcock, 1996). Critical thinking is essential process for safe ,efficient and skilful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning. McCarthy (1992) argues” that you should think critically because doing so is efficacious” .Understanding how you think is an important aspects of developing critical thinking skills. Paul(1990)described four types of critical thinking :critical thinking, uncritical thinking ,sophistic critical thinking, and fair- minded critical thinking. Critical thinking describes the process used by a person who is aware of their own thought processes and try to be more precise, accurate ,relevant, consistent and fair .Uncritical thinking is the least desirable type which is often unclear, imprecise, vague and unreflective. Sophistic critical thinking refers to subtly deceptive reasoning, which uses logical reasoning principles to serve the vested interest of the thinker. Fair-minded critical thinking is the most desirable type of thinking ,which applies logical reasoning principles in situation both when it serves the thinker and when it does(Miller and Babcock,1996).Clinical Judgement , a concept which is critical to the nursing can be complex ,because the nurse is required to use observation skills, identify relevant information ,to identify the relationships among given elements through reasoning and judgement .Clinical reasoning helps to understand the patient problem and aids to plan and implement interventions, evaluate outcomes with reflection and learning from the process(McCartney,2017). Everyone in the NHS should be committed to standards of excellence and professionalism so that services are focused on the patient experience and characterised by quality and effective care(NHS Constitution,2009).It is the right of each individual to treated in the NHS with professional standards of care by appropriately qualified and experienced staff in organisations which are characterised by safety and quality, and which are effectively monitored. The NHS constitution makes commitment to staff ,which repeat provisions in employment and discrimination legislation and it also covers a safe working environment ,professional development, involvement in decision-making, and the right to raise a grievance(Kline and preston-shoot,2012). I also felt that the nurse here has showed the ability to apply evidence based practice .Evidence based practice is important as it aims to provide the most effective person centred care ,with Patient outcomes. patient expect to receive the most effective care based on the best available evidence. The two important vital skills to provide appropriate care for the patients are, first: the ability to examine the evidence related to a proposed course of treatment, and second: the ability to apply that evidence in practice.

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