Clinical Practice in Action Module: Reflections on Cardiology and Stroke Placement

This portfolio of learning is the assessment for Clinical Practice in Action Module 7LM0156 which is divided into four parts. The student reflects on their experiences during their clinical placement in cardiology and stroke, highlighting the importance of teamwork and communication in healthcare.

MSc Cardiology and Stroke
Clinical Practice in Action Module

This portfolio of learning is the assessment for Clinical Practice in Action Module
7LM0156 which is divided into four parts:
Part 1: Reflection on Practice
During your time on placement, you are required to keep a reflective diary. This
should consist of the following:
1.1. An Initial Statement: This should contain your concerns and expectations
before the start of the placement, includes targets for learning whilst on this
placement; what do you hope to experience and learn? (200 words)
When I got the information about the clinical placement at Hospital, I got very
excited as I was going to acquire hands on clinical experience of my field of
specialization and also get to know and experience the clinical procedures
here in UK and also the style of practice. My targets for the placement were
initially to have a good clinical skills and technique approach, be it the patient
interaction, how to use the best specific treatment, counselling, and also pe a
part of MDT team. Also, I was eager to see how the roles and responsibilities
being entitled to a specific person and how interprofessional behaviour, help
in refining a clinical approach. My concerns were, how will I be able to cope
up with the entire structural work pattern and understand everything that is
important to me for my clinical future as a health practitioner. Also there was a
covid19 pandemic crisis, which may result into less number of patients
coming to health department, which can directly effect our learning to a
certain extent.
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Learning Log
You are required to record key aspects of your observational placement experience.
It is not necessary to describe what you did every minute of each day. A brief
description of your experience & first thoughts. DO NOT mention any staff or patients
by name (confidentiality must be maintained at all times)
Learning Log Details
Day 1 On my first day of placement, I arrived at the cardiology department
where I was welcomed by the staff of medical education team. I was
hesitant in the beginning, but they were very cordial to me. My initial
thought was that in a period of 5 hours, the senior cardiologists were
given only 5 cases of perfusion scan. My point of comparison here
was my service in Karachi, where in a period of 2 hours, doctors
looked at more than 10 such cases. It was a very wholesome
experience for me.
Day 2 In first session of second day, I attended the cardiology ward round
with one of the consultant cardiologists at the hospital. I observed
multiple patients with different requirements. I learned how to
manage the procedures and medication regarding these patients
based on their medical condition and urgency of situation. Further, I
learned when and how to discharge the patient on maximum
medication. During the round there were healthy discussions related
to each patients’ conditions and requirements.
During second session, I attended catheterization laboratory. I saw
one angiography and one angioplasty. One of the senior doctors
who was performing procedure explained to me indicators of
angiography and the side effects of procedure. I learned how to take
consent from the patient before the procedure and how to explain
the patient after the procedure.
Day 3 On day three during first session, I attended multidisciplinary team
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online meeting with one of the senior consultants. I was amazed by
the idea of using technology to connect professionals at smaller
clinics with senior consultants in a large hospital. This I realized
allowed expertise of senior consultants to positively impact patients
who visited smaller clinics. It also helped reduce burden on large
hospitals.
The topic discussed was heart failure management, I learned about
the management of heart failure patients, maximisation of
medication, regular follow up from patients and seasonal
vaccinations.
Day 4 During the first session that I attended in the Stroke ward, I had a
healthy discussion with the team about different cases. I noticed
from early on that the treatment provided in Pakistan to the patients
was similar as in UK, however a lot more care and counselling is
provided to the patients in UK.
Day 5 In first session of day five, I attended Transit Ischemic Attack (TIA)
OPD. The OPD was conducted through telephone due to pandemic.
It was my first experience of conducting an online OPD. I learned
management of acute and chronic patient and how to adjust the
treatment according to symptoms and investigation.
In second session, I attended MDT meeting on thrombolysis
(seminar). I learned about the benefits of thrombolysis within and
after window period for acute stroke patients. Further, which patients
will get more benefits by this treatment.
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1. Final Review after the placement:
Record your overall thoughts about this placement and any differences between
organisation of care and patient services in the country where you practice and the
NHS.
Take into account the whole placement and the outcomes you wanted to achieve.
(Word limit 500 words)
I thoroughly enjoyed the five days of my placement. Despite pandemic, I
visited the hospital from 9 am to 5 pm every day. The consultants and the
staff on duty were extremely nice. They would explain all procedures being
carried out in great depth. I have worked in hospitals of two other countries,
and my one clear observation was that a lot of stress was being placed here
on patient care. Doctors would spend a lot of time in counselling the patient
from the first encounter and all the way to the end of the treatment. The
consent of patient was sought at every step of the treatment. A lot of the time
calls with patients were scheduled for a post treatment follow up. They were
well informed of the side effects of the medication that they were consuming.
Moreover, I was really impressed by the extent of quality health care provided
to the patients. The entire life of the patient from their routine to food and
environment was attended to. I also attended a loop recorder placement OPD
where I observed five cases. I learned how to explain the patient the purpose
to use the loop recorder (the device). Further, learned how to explain the
patient about usage of device at home and how to send ECG tracing online to
hospital for diagnosis purpose. I also attended Stroke OPD with a Stroke
Consultant. The OPD was conducted through telephone due to pandemic. It
was the first time ever that I witnessed OPD being conducted on phone. It
was a fresh experience for me. I was also amazed to know that OPD was
related to patients who had recovered, and it was a follow up call on their
health. I also learned management of chronic patient and how to adjust the
treatment according to symptoms and investigation.
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Further, I learned how to investigate patients and management of treatment
as per symptoms. Further, I learned about physiotherapy requirements and
home care required for these patients once discharged. I also attended
emergency department with one of staff on duty. I learned how to attend any
emergency case and requirements related to admission. I learned how to
investigate patients and management of treatment as per symptoms. Further,
I learned about physiotherapy requirements and home care required for these
patients once discharged. I have also able to learn understanding of empathy,
understanding patience towards individual who are seeking help from service
providers and quality of team working while practising in health care
organisation. I achieved learning in regards with person centred care which
should be provided to each individual in order to cope from illness. I have
learned to be punctual that can help me in my daily schedule as well. I am
able to learn technical skills through recording details of patient’s medical
history while serving services in my workplace. The use of technologies is
essential learn as it may utilise within each sector. I am also able to enhance
my communication skills through health care settings.
Overall, it was a very good learning experience. It invigorated in me what I
love most about the work – taking care of patients and making them healthier.
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Part 2:
Students are expected to undertake an:
2. Exploration of a particular aspect of professional practice: observed during
clinical placement that has potential to be developed in your own clinical setting
to improve management of patients e.g., clinical decision making, inter
professional team working, specialist practice, organisation of services, patient
advocacy (1000w)
2.1. Identify the area of practice you wish to explore and state why?
The area which I would like to explore in the health care sector that is
teamwork. As per my opinion, the team formulation has determined place that
has from top to bottom and also across each department of health care
sectors. As the teamwork It highly aims on the patient's medical history and
help them to provide best practise to enhance their health factor. Each team
members are termed to be built for users’ satisfaction and to improve work
procedures and to improvise performances of services. Decision making is a
essential part in team working. Most of the better opportunities for best
outcomes and for achieving goals lies in the domain in group decision making
process. It may provide ample of opportunities to each individual to share their
ideas and views. I have observed that through this process there are
numerous of strategies can be developed and areas can be improvised.
Sometimes, the team decision making may accomplish and conquer the goals
and objective by group agreement whereas, in few conditions when there is
disagreement of even one member of a group, then the solution becomes
harder to attained. The group decision making that involves number of
interventions and critical thinking of an individual and it may also promote
recovery of a person (Youthful, 2015). Also, in clinical placement, there are
essential areas which should be prioritize through health care professionals.
These areas play an important role in health care culture. The group critical
decision making also makes an individual so precise and attentive while
taking a decision where the situation being complex and critical for health care
professionals to decide what is best for patient. It is ability that may be helpful
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to overcome such conditions, where the chances of ethical dilemma might
develop and that is resolved through decision which is team based.
In order to overcome from these situations in medical filed, skill of team based
critical thinking is being implemented. It can make a person professional in
nature and being professional makes an individual to work systematically and
an individual becomes role model for others (Jaeger et al. 2019). According to
my observation, team based critical decision making is significant to improve
performances and help them to attained desired goal. Behaviour and action of
an individual comes after. The professional behaviour is directly linked to
safety and security of patients. The quality of care is provided by health care
professionals which include the dignity and respect towards each patient and
in this communication is also play a vital role. (Youthful, 2015).
Group Critical decision making may also involve the benefits of health of an
individual. It can also promote the recovery of health as well as it may also
include intervention which should be used to foster the recovery. The group
critical decision making can involve the strategies and methodologies that are
in favor of patients. It is used in chronic illness and long-term illness. The
group critical decision must establish when it appears that none of
methodologies promoting the welfare of a person. Hence, the exploration may
also characterize as new techniques and new treatment plans that can be
useful for patients.
The health care profession is termed to be difficult that also that may involve
the circumstances in which an individual may their own skills in order to carry
out best solution for any consequences. In this situation, the most wanted
skills which should be there in a trainee is decision making skills. The team
based decision-making skills that are used in chronic illness situation where
there are chances an ethical dilemma can be developed. Finally, that practical
performer speculation isn't only a managing theory of how people should
make decisions about for the present circumstance prosperity direct, however
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then again is an explaining model of how people select team-based decisions
and legitimize their exercises (Jaeger et al. 2019).
Other factor I would like to observe the communication skills of a person in a
team. It is well known that communication is significant in health care
profession. It may be helpful in establishing the trust among team members
and also empathy and can promote to establish a healthy and positive
environment. (Jaeger et al. 2019) Effective communication skills also make
transparency with team members may help to attained positive outcomes for
service user.
I like to observe teamwork quality in order to work in system and to improve
and provide best service to an individual it is required that the teamwork plays
an important role in the management and make a system to work in
systematise way. It can also provide support to each other for tackling a
difficult and risky situation. The teamwork can also improve performance and
can help each other to provide a better result. These are get-together of
individuals who are seen to, 'deliberately open themselves to prosperity risks
rather than regularly avoiding them, and consequently require more
unmistakable observation and rule, when perceived these get-together and
individuals then become subject to various prosperity progression or
'prosperity improvement' drives (Guzik and Bushnell, 2017).
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2.2. Identify the strengths and weakness of your selected area of
professional practice?
The selected area of professional practice that I have chosen is teamwork.
The strengths and weaknesses of which are mentioned below:
Strengths
Synergy
When a group determines any decision together by number of practices such
as group discussion, questionnaire, collaboration, each group members are
termed to recognise more effective and complete decision and also its
judgement should be keener.
Sharing Information
The group decision can take places that in account a board range of scope
that are attained through shared information since each one of member of
group can contribute his or her ideas, views, and expertise. Sharing
information within group can promote understanding, justify issues as well as
also facilitate movement that can mould toward a collective decision making.
Weakness
Diffusion Of Responsibilities
It has been observed by my personal experience that there are numerous of
conceits may arise while conducting a group decision making due to some
expectational group members. Sometimes people may generally diffuse to
perform their responsibilities and to obey rules for their decided roles.
Time consuming
As compared to individual decision making, group decision making can be
more time consuming. It may take time to reach out a solution in which all
group members may agree. Group decision making also takes time to excite
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any determined strategies which have been decided through groups in order
to improve problematic areas.
Being dominated
Group decision making may get dominated by one or few members in a
group. During my practice I have observed that the group decision making
can be suppressed and can be moulded towards one person's will.
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Part 3: Critical Review
Retrospective Review: You are required to undertake a reflective analysis of an
observed patient consultation during your placement. This review should consider
what could be learnt from this patient interaction and how it could be applied in your
own workplace. (Total this section; 1000w) You may wish to discuss with placement
staff or academic staff several patient interactions so that you make an informed
choice.
3.1 Describe the patient interaction and why it was important to you?
The interaction with individuals that I observed and remembered about a girl
who accidental met an accident with fire, walks into room in a critical situation.
The girl's hand was affected by the incident as she informed, she lives alone
her apartment. While cooking she accidental catches fire and to safe her face,
she covered her face from the hand. As she was in pain and feeling a lot
burning feels on her hand. To asst her the health care professionals took this
incident seriously and took her to emergency room and started to assist her
and tried to ease her pain through premedical equipment. As for the safety
and record of an individual the photograph of he wound and personal details
were recorded by them. After the application of premedical interventions, she
was asked to go for further treatment, and took her to emergency room. The
patient interaction is good to develop as it can build a bond and also promote
the ability to collect knowledge and information in order to provide accurate
and exact required treatments and diagnosis. The good communication with
doctor- patient debits enough potential to help and also regulate emotions of
an individuals, to provide facilities and also medical information, also
promotes a better identification of needs and demands of patients and also
numerous of expectations. The effective communication that are requited on
health care sector are generally through bedside manner or pattern.
Moreover, After the completion of process, the other clinical professionals
asked her not to allow wound from the atmosphere contact. As per the studies
reference, it has been stated that interaction as well as communication may
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affect an individual recovery and may address and include each precaution
which should be followed in pandemic. The report may reflect there is
potential hazards and risk that can affect heart patients due to effects of
coronavirus that may also lead an individual to mortality. (Guzik and Bushnell,
2017). A critical number of these reasonable performer notions uphold and
enlighten the Coronary Heart Disease National Service Framework.
assumptions show themselves in an obviously problematical manner to
manage the progression of 'hazardous' prosperity direct change which
downplays the effect of culture, habits and the material reason of get-together
socialization. This indiscreet practicality moreover subverts the viability of the
National Service Framework method other. (Jaeger et al. 2019). The social
mental and sociological composing consider the to be of 'trust' as contained
through two estimations, the deliberative or prudent and the enthusiastic or
non-normal.
3.2. What have you learn from this experience?
One of the major thing that I have attained to learn from this situation is to how
health practitioners can make an individual's anxiety, distress and uneasy at relief
and ease by the implementation of collective team-based decision and how a variety
range of treatment and diagnosis can be provided to patients off and injuries by
clinical decision making approaches. It has been learn by me that clinical decision
making basically depend on the approach and the behavior towards individual who
are at their peak of pain. Formulating the capacity to suffer the pain which can be
eased in a hour, self-control and also implementation of clinical skills into where it is
in demands. Addition to this, I have also analyzed that clinician stay at constant
pressure to give their best in the practice and its a self test of abilities to ensure that
the services which being provided through are best for individual's safety and
security. Formulation of self supremacy, debiting concrete patience and dealing with
situation along with ease and patience and application of my best effective clinical
skills into services are the key components. In the practice, my colleague dictated
her that it is normal burn and it can be ease through primary ointments such as
bacitracin and silver sulfadiazine (Silvadene). Although it was serious injury because
it ruptured the epidermis till hypo-dermis, as this was serious injury but she appeared
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in chronic pain so each one of health professionals lie in regards with injury. Another
learning I have achieved to learn that heath practitioner should be broad minded and
should be ready to take suggestions from his or her colleagues as it can provide a
wide range of solution that are best for individuals to assist. Practitioners should be
strong supporter who should be attentive and initiative take responsibilities on his or
her shoulder when it is required. Moreover, treating each patients equally and having
a good communication skills. Sometimes the combination of good mentality as well
as good communication skills might work in administration of an individual and may
accomplish the task of easing their pain. Also, through last scenario, got to know
that it is important to keep the records and details of each patient for both doctors as
well as patients and legal purpose.
3.3. How could this learning be applied to your own workplace
setting? (Consider do you face similar issues or are they different,
please explain why?)
The learning, I have attained from my placement, can indeed be implemented
in my workplace. For example: skills which have attained the use of technological
tools such as maintaining and recording individuals history, tele-recorder, quick
primary interventions, diagnosis, spontaneous making decision throughput decision
making, problem-solving skills and management which can make health practitioners
work and associated pressure on ease. The fire incidents are common and I have
learnt how an individual should be eased by communication, which primary tools will
be efficient for assistance and how to overcome it with brief. The critical thinking
skills can be applied to evaluate best service for an individual and also uses of
technology can be applied into my clinical settings in order to maintain and keep the
records updated. I also learnt different skills related to development of interpersonal
skills which are useful in development of clinical skills. Major responsibility of mine in
clinic was to develop knowledge about understanding a patient’s needs in a precise
manner. It was a major opportunity for me to learn photo dynamic therapy for
medical treatment. The placement session in the clinic did not go well because of the
pandemic and whole day we were doing telephonic conversation with patients. We
were given clear instructions to enter or perform any health setting related to clinical
treatment. I can use these learning as from the 'sensible performer perspective,' and
which is the level at which sensibility is no doubt seen by system makers, contains
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the going with assumptions: all exercises are particular choices; individuals can
perceive terminations and means to achieve these completions; individuals are
impelled to pursue their own self-picked goals when making decisions about
methodologies/direct; individuals will reliably pick a blueprint that has most
noteworthy individual utility, that is it will provoke singular satisfaction; individuals
have the data about the potential results of their exercises when they choose.
(Khandwalla, et.al. 2016)
3.4 Consider the wider implications for practice and organization of
specialist services and make firm recommendations to improve this.
The recommendation suggested is that the individual's feedback is important
to capture so that it is more effective to recognize the problematic area which
can be improvised through effective strategies. This can also include
opportunities to obtain patients’ feedback to provide a quality care and
support individuals to underpin poor care when required. It can also provide
understanding and determination how the services and quality of care should
be managed that have potential to provide services to everyone who are
present with in organization. It may also demonstrate what interventions are
required in organization, whether there is communication gap, lack of
workforce or lack of resources. That is, people are objective orientated who
have choices accessible from which they can choose a strategy fitting to
meeting these objectives (Khandwalla, et.al. 2016). The social help delegate
can help patient with any monetary concerns she may have, make
arrangements to guarantee a sufficient social encouraging group of people,
and fill in as an extra wellspring of passionate help. The actual advisory or
exercise expert can help in giving proposals about exercises and in the
improvement of an activity or restoration program (Li, et.al. 2016).
Lastly the quality which has been observed that the person-centred care to
everyone. The person-centred care should be provided by health care
professionals to minimize the risks and maximise the health sustainability in
an individual. The person-centred care can involve numerous of strategies
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and intervention which should be knowledge by an individual. (Guzik and
Bushnell, 2017) The joining of dividing duties with responsibility among
colleagues in medical services frameworks offers extraordinary advantage. Be
that as it may, by and by, shared obligation without great collaboration can
bring about impending dangers for patients. For instance, helpless
correspondence between medical care experts, patients and their guardians,
has arisen as a typical justification patient making a lawful move against
medical services supplier. Clinical mistakes, "close to misses" and other
unfavourable occasions may likewise happen because of deficiency of
correspondence among colleagues even in a well rational group. In addition,
absence of intentional group care can likewise prompt pointless waste (Guzik
and Bushnell, 2017).
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Part 4: Critical Reflection
Please write a critical review using the following questions as triggers: (2300 words).
You are expected to critically reflect on differences / similarities between clinical
practice in your placement and clinical practice in your own working environment
4.1 What were the key factors influencing clinical decision making in your
observed placement?
The studies reflected that the key factors such as strong commitments,
self confidence, equipped knowledge, organizational infrastructure, facilities
which re being provided, complexities, behavioural aspects of co-workers,
ongoing supervision and feedback attains through individuals, authorities,
autonomy, effective communication skills may help to facilitates decision
making and are essential key factors. The one evident incident at the time my
placement was patient's interaction, she was at work while working with other
mates, as she was asked two questions in regards with her treatment, where
she wants to opt the treatment either at our residency placement of hospital or
at the place of residency. It has been confirmed that the infrastructure can
affect the surroundings of atmosphere and the facilities which are provided to
an individuals that are also much important in the administration of patients.
After each counselling session patients were asked it sit and wait, meanwhile
the consultant opinion was attained as this is much important and take into
consideration, this is a classic example of team based approach. The
intricacy of present-day medical care, which is developing quickly goes about
as a main impetus behind the change of medical care specialists' from being
soloists to individuals from groups who share a typical point. Today, as the
two clinicians and patients coordinate new innovations into their
administration cycle, the general velocity of progress in medical care
frameworks will keep on speeding up (Berrouschot, et.al., 2016). This
resultants the bias of a person can be excluded and accurate best positive
outcome in terms of benefits of well-being of an individual. There is need to
manage and develop effective collaborative partnership so that
interdisciplinary teams can manage the functioning. There is an essential
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aspect for dermatological treatment which is utilization of learning, educating,
and providing care to patient in effective manner. I think that practice of
nursing is involved in specialized areas, and they must be addressed
properly. I learn many things during my internship program to learn clinical
learning in a precise manner.
4.2 How were roles and responsibilities for patient management divided in
this placement?
Each person in clinical department are being assigned for definitive role and
responsibilities. As there was reception desk where initially patients welcomed,
take appointments of health practitioners, register their confidential and
personal information. There were 2 nurses which are recruited for the
responsibilities at the time of my placement. One was assigned for the
monitoring o the department, another two nurses were assigned for the photo
therapy room and emergency room who can able to illustrate the treatment t
the patients at mean time. Another nurse was assigned to look and supervise
each participants. Thus it is team based approach and management for each
individuals.
4.3 How did health care teams demonstrate inter professional working in
your placement?
Inter professional working in the dermatological department was very
essential to be team oriented, where one contributes another collectively and
together and working in partnership with same agenda and motive. The
collaboration of each nurses and doctors may debits the effective treatment
that may result and contributes in good care and satisfied care of individuals.
The evidence I have attained by my placement, dermatologist nurses and
doctors were working in team, guiding each other that can help to them to
provide ultimate care and help in the best of individual's health. There was
patients who were suffering from extreme burning sensation, so doctors and
nurses suggested to take primary intervention that can help to ease the pain
of individual.
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4.4 Critical Reflection: how well were the indicators of Good Medical
Practice (General Medical Council (2013) met during your observational
placement and how does this compare to professional standards and
practice in your own workplace?
General medical council is a public figure that in trusted with the job in order
to protect individual's safety and security and can able to provide valuable support to
medical education across UK.
Knowledge skill and Performance
Being the health practitioners it must to keep latest information and should be
enhance each required skills of effective professionals practice. The knowledge of
updates policies and good communication skills should be mandatory part of helath
professionals. Dermatology nursing is specialized in nursing care, and it emphasizes
upon health at different divergent. I have analyses different concepts of dermatology
nursing such as detection, assessment, treatment, prevention, and education of the
skin disease. I have concluded that there is need for managing skin diseases. There
are different aspects like providing, coordination, improvement of quality of life. I
have to engage health care consumers, communities and professional membership
for managing the treatment process efficiently.
Safety and Quality
While working in health care setting it is important to ensure that each individuals
should achieve quality of care and services and it is important process to review the
healthier community should be there around us. Foe the similar reason it is prime
duty of doctors to lift up the standard of living of individuals. One of the major thing, I
have told at the time of my placement that I do not have to write my notes in-front of
patients and also at the tie of pandemic people were bin attaining assistance through
telephonic medium and also our head nurse asked not to shop up if someone
undergoes in minor symptoms of coronavirus flu.
Communicating partnership and teamwork
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One of thee major effective tool that can be observed in health care setting is to
making conversation. It is a key components that can make all things easier and can
help to establish transparency and positive environment within workplace. Also
maintaining dignity of patients and having a friendly approach towards is much
important that I have experienced in my placement.
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References
Book and journals
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