Date of Learning Log: 06/10/2023
Time: 09:30-16:00
Learning Activity 1: Behavioural Change and Motivational Interviewing
This session covered topics related to behavioural change, the role of nurses, political influences, unhealthy behaviours and lifestyle changes, behaviour change models, and motivational interviewing techniques to empower individuals to make lifestyle changes. The learning outcomes were to understand the rationale behind making healthy lifestyle choices. It also provided knowledge on behavioural change and models to explain these changes. Additionally, the session taught us that, as nursing associates, our roles can influence behaviour change using motivational interviewing techniques, and we practised these skills by presenting in front of the class.
Motivational interviewing is an effective technique that can help individuals to identify their strengths and aspirations. This approach aims to inspire motivation to change and encourages independent decision-making, empowering individuals to take on the challenge of making positive changes in their lives. Motivational interviewing has been proven to promote behavioural change in various healthcare settings, improve relationships between clinicians and patients, and increase efficiency in achieving better health outcomes. The principles of motivational interviewing include directing, guiding, and following.
Learning Activity 2: Clinical Judgement and Decision-Making
In this learning activity, we covered clinical judgement and decision-making. We discussed how we used clinical judgement in nursing practice and analysed the influence on abilities to make clinical decisions. The topic consists of identifying ethical considerations in the decision-making process and the principles of shared decision-making. We then explored the barriers and facilitators to shared decision-making and determined how shared decision-making is an advocate through policy and law.
In this session, we defined what we understand about clinical judgment. I stated that, to my knowledge, clinical judgement is one of the critical attributes of professional nursing; it refers to the process by which nurses make decisions based on nursing knowledge – evidence, theories, disciplinary knowledge, clinical reasoning, and critical thinking. It is based on evidence ranging from observations of patients to research studies. Clinical decision-making converts clinical judgment to performing the right nursing interventions when addressing health problems. We also discussed the importance of assessment in clinical judgment and the importance of accurate assessments. The nursing intervention will be delivered safely and effectively by gathering accurate assessments. We also looked at patient assessment and care planning models by Howatson-Jones et al. (2015) and ASPIRE (Wilson et al., 2019).
Clinical judgements are influenced by several factors such as experiences, intuition, person-centred care, shared decision-making, research, evidence-based care, time, resources, etc. We also discussed Tanner’s model of clinical judgement; it is a model that identifies the process of clinical judgement that reflects the way nurses think in practice. The process develops from noticing, interpreting, responding, and then reflecting. It also discussed the benefits and criticisms of the clinical judgment model.
Shared decision-making enables service users to control their care, resulting in better and more cost-effective outcomes. It ensures that individuals are supported to make decisions right for them. Shared decision-making is a collaborative process through which a clinician helps patients decide on their treatment. There are ethical and legal perspectives in shared decision-making. Healthcare professionals have duties of beneficence and non-maleficence; they must respect the service user’s autonomy, and offering shared decision-making is a legal requirement. The law requires that healthcare professionals ensure service users know of any risks involved with their treatment and if alternative treatments are available. During this part of the learning activity, we also discussed and identified different models of shared decision-making, how to fully inform service users, and how to support individuals in making decisions. We also explored different types of decision aids and how they can be beneficial to educate individuals regarding the health problems or treatment discussed. When the decision is made, it must be recorded through documentation or electronic medical records. It should be accessible to the service users as well as health professionals. Documents are used for different purposes, such as legal records of the shared decision, coordinating care, etc. These barriers are time, resources, standardised approach to practise, attitude, lack of decision aids, service users refusing involvement or inability to be involved and decision-making capacity.
KSB ADDRESSED:
Knowledge:
| K2 | Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health |
| K3 | Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and well-being required to meet people’s needs for mental and physical care |
| K4 | Understand the principles of research and how research findings are used to inform evidence-based practice |
| K5 | Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care |
| K9 | Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people |
| K11 | Understand the factors that may lead to inequalities in health outcomes |
| K14 | Understand the importance of health screening |
| K18 | Understand and apply the principles and processes for making reasonable adjustments |
| K34 | Know and understand strategies to develop resilience in self and know how to seek support to help deal with uncertain situations |
| K39 | Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives |
| K40 | Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services |
| K43 | Understand the influence of policy and political drivers that impact health and care provision |
Skills:
| S1 | Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements |
| S3 | Recognise and report any factors that may adversely impact safe and effective care provision |
| S4 | Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop professional knowledge and skills |
| S7 | Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges |
| S9 | Develop, manage and maintain appropriate relationships with people, their families, carers and colleagues |
| S10 | Provide, promote, and where appropriate advocate for, non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments |
| S18 | Apply knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions |
| S19 | Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent |
| S21 | Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes |
| S24 | Perform a range of nursing procedures and manage devices, to meet people’s need for safe, effective and person-centred care |
| S25 | Meet people’s needs for safety, dignity, privacy, comfort and sleep |
| S41 | Monitor and review the quality of care delivered, providing challenge and constructive feedback when an aspect of care has been delegated to others |
Behaviour:
| B1 | Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences |
| B2 | Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice |
| B3 | Be adaptable, reliable and consistent, show discretion, resilience and self-awareness |