Nursing Education Critical Evaluation (Coursework Sample)

Introduction
Nursing education has emphasised on critical thinking as a fundamental nursing skill for the last five decades. Critical thinking has been defined as a self regulatory judgment that utilizes instruments such as analysis, inference, interpretation and description of the methodological, conceptual or evidential considerations upon which judgement is based. Critical thinking is not only essential to nurses in the clinical teaching it also helps in enhancing nursing care and improving accountability. It is in other words a self-monitoring tool. This paper looks into clinical teaching skills practiced by the author in the recent past. A discussion is made using the 5R critical evaluation method to show the strengths and the drawbacks of what I did. Clinical teaching evaluated in a step by step manner using the 5R reflective model helps to structure strengths, drawbacks, thoughts and feelings in an organized manner and hence assists in self-monitoring and learning.
As mentioned earlier this paper looks into a clinical skill that I have learned and become quite proficient in practicing. I will utilize the 5Rs reflective model to discuss what I learned during my patient insulin teaching session. As mentioned above the reflective framework I have chosen to use for this discussion is the 5R model. The 5R model stands for the following: Reporting, Responding, Relating, Reasoning, and Reconstructing. The 5Rs model helps guide reflections through allowing one to organize his or her thoughts in a structured manner (Zuber-Skerritt, Fletcher & Kearney, n.d.). The model will be utilized in this paper to facilitate deeper thought and to link theory to practice where it allows. The discussion will also entail the theory behind the practice and the evidence base for the skill. A summary and conclusion will be given in the end which will show how the teaching has affected my ability to formulate teaching plans that will enable better learning environments and experiences. The clinical skill that I will be discussing is about teaching patients how to administer insulin injections (Oermann, n.d.).
The first stage of the 5Rs model of reflection entails the description of events (Zuber-Skerritt, Fletcher & Kearney, n.d.). I had to teach diabetic patients about insulin injections, what they are, how to properly utilize insulin injections, the proper steps of injecting insulin and the signs of the wrong injection of insulin. First of all, I had to come up with a teaching plan based on the patient population and the clinical site (Oermann, n.d.). It is known that insulin injections are administered to patients with diabetes mellitus, and quite a significant proportion of them are elderly. Second, I identified learning needs that were to be focused on helping patients to properly manage their glucose levels and stop any complications from occurring. I had to come up with a way to teach what insulin injections are in terms that were simple enough to be understood by the patients (Oermann, n.d.). All while I was under the guidance of my teaching plan that was modified to meet the abilities, learning styles and developmental stages of the patients attending the classes (Fry, Ketteridge & Marshall, 2003). I used a combination of PowerPoint presentations, handouts, discussions, videos and demonstrations to make my points (Fry, Ketteridge & Marshall, 2003). One of the most important areas I covered during my teaching session was the side effects that one would experience in the case of an overdose. I listed over 15 symptoms that could help one to quickly realize that they had overdosed and to take the appropriate action. The lesson took about 3 hours. On this session, I was being observed by two senior nurses. One of them was my mentor. I was being guided wherever I stuck or seemed not to be giving my best. During one of the demonstration, I asked for a volunteer from the attendants. I drew up the drug formulation from the vial and was ready to give the injection. One of the nurses said it was not a must to use a sterilizing wipe to cleanse the site while the other interrupted and insisted it was necessary. I did choose the opinion of the former and went ahead to administer the injection without the alcohol wipe. At the end, I gave the attendants and patients an opportunity to ask questions. During this session, one of the patients had posed a question regarding site rotation because of the pain she experienced when administering the injection. After warning her that my opinion should not be taken in place of her general practitioner’s advice, I suggested that she could switch the site of injection if she felt any discomfort at the site she usually administered the insulin formulation as long as it was one of the recommended sites that included: the thighs, the abdomen, shoulders, upper arms and buttocks (gluteus muscle) (Rosdahl & Kowalski, 2008).
The second stage of the 5Rs critical reflection model is responding (Zuber-Skerritt, Fletcher & Kearney, n.d.); which is a discussion of a general evaluation of my performance, what worked and what did not (Fook & Gardner, 2007). The second stage also involves discussion of what were my feelings were about the entire teaching session. There were quite a number of things that worked in the insulin teaching session including the use of various types of media which helped better communicate the points that were being made. One of the other key points of the teaching session was the Q and A session at the end (Fry, Ketteridge & Marshall, 2003). This session helped patients to have their concerns addressed. Working to minimize any medical jargon also worked to my advantage as patients were helped to learn about essential medical facts about even complex medical conditions and concepts (Vincent, 2010). The teaching session was also organized in such a manner that the patients could easily see the progression of the steps to inject insulin (Jamieson, McCall & Whyte, 2007). Even though, the teaching session was generally good, some other aspects required improvement. For instance, being cognizant of the fact that I was under the watchful eyes of 2 senior nurses and that the diabetes patients were eager to learn, I felt quite anxious, self-conscious and quite nervous. This made me not to, at times, appear sure of the information I was giving. However, with time and under the guidance of the registered nurses, I was able to calm myself down and to feel relaxed during the latter parts of my teaching session. I felt relieved. However, when one of the patients asked a question about the use of the sterilizing wipe, I got stuck. I felt quite confused because clinical concepts I was aware of insisted on the utilization of alcohol wipes, yet I had been quite lazy during the teaching demonstration (of all places), to omit the use of the wipe (Makely, Austin & Kester, 2013). I also became quite concerned about the consistency of practice of some of the senior nurses who despite years of training and practice had seemingly become less careful. I also felt that part of my teaching was quite not brief enough and might have brought about instances of "information overload" whereby a lot of information is shared but very little is retained by the recipient. One of the other facts that I thought didn’t work quite well for the presentation was the duration it took. Three hours is a lot of time for many patients (Donovan & Bransford, 2005). In fact even for normal lecture lessons three hours is on the extreme upper end. The fluctuations of the "attention curve" mean that many patients’ attention and therefore ability to learn and retain new facts goes to its lowest point in the middle of the class (Arum & Roksa, 2011). And if this low point lasts for more than one hour then there is a lot of time wasted where people are not effectively learning.
The third stage of the 5Rs critical reflection framework is relating; which is a discussion of how my teaching session relates with other professional and personal experiences. And also what were my areas of strength and my areas of weakness during the session (Zuber-Skerritt, Fletcher & Kearney, n.d.). In other words, this stage requires the reflector (me), to state what was good about the event and also what was bad about it. I was already aware of the theory that the utilization of cleansing wipes was not consistent and not a must in administering injections in cases where the patient appeared clean (physically), and an aseptic method had been used by the nurse along with thorough hand washing (Scaife, n.d.). Other authors Clayton and Willihnganz (2013) had also argued that utilization of alcohol wipes to cleanse the skin could cause it to harden. The two, however, recommended in their guideline the use of cleansing wipes since patients are frequently immune-compromised. The authors, however, also gave proof that showed using alcohol wipes to cleanse the skin was not usually necessary. Thus, my actions during the demonstration of the insulin injection were not that far-off, and they were not careless per se. This clinical experience led me to think deeply about my mentality towards clinical theory/literature and how it is applied to practice. According to Aukrust (2011) a learner is usually a just a passive recipient of knowledge, he however further implies that the best way of learning is through activity since it engages one’s all senses. This is crucial since learning through practice or sharing information with others can help one to understand clinical aspects better. After the experience, I also felt that I needed to learn some more about insulin injections.
Reasoning is the fourth stage of the 5Rs critical reflection framework (Zuber-Skerritt, Fletcher & Kearney, n.d.). This stage is about explaining how clinical literature, theory, and studies ...