Revised Portfolio Plan for Nursing

This portfolio plan focuses on increasing knowledge of effective leadership and implementing infection control measures in the emergency department. It includes activities such as developing a concept map on effective leadership attributes, attending an online course on aseptic technique, reviewing literature on personal protective equipment, and giving a presentation on healthcare personal vaccinations.

Running head: NURSING
Nursing
Name of student:
Name of university:
Author note:

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Revised Portfolio Plan
1. Develop increase knowledge of effective Leadership in emergency department.
Linked SCP learning objectives: F, A
Linked professional standard (s) and relevant domain: (1.1)
Activity 1.1: Devise a concept map that illustrates about attributes effective leaders in
emergency department.
Justification 1.1:It will give me a thorough overview of the qualities of effective leader in
emergency department.
Evidence 1.1: Concept map.

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Reflection- I was interested in designing the concept map about attributes effective
leaders in emergency department. I carried out research with the available resources as the
context of the study. I then devised the concept map as per my understanding. The activity gave
me the opportunity to learn about the importance of leadership in clinical settings and the

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attributes hat a professional is to demonstrate. Though I understood the underlying concepts of
leadership attributes, I fail to relate certain attributes to real life clinical settings. Leadership in
critical settings has huge implications for ensuring patient safety and high quality care delivery.
Professionals are to demonstrate appropriate attributes as per the need of the hour (Blais 2015). I
conclude that there is a need of learning more about how different leadership traits can be
applied in emergency care settings. I plan to consult more literature for enhancing my
knowledge.
Activity 1.2: Give presentation about positives and negatives of leadership styles in nursing for
classmate in 25 May 2018.
Justification 1.2: To gain knowledge and understand different form of leadership style.
Evidence 1.2: Presentation, and I will attach evaluation form and the feedback from my
classmate, and I will use Gibbs reflective cycle to reflection my activity.
The positive feedback that I received was that I spoke in an appropriate tone and volume.
I did not take long pauses while speaking and my flow of speaking was maintained throughout.
The negative feedback that I received was that I did not maintain eye contact with my
audience. This had a negative impression since I was not able to communicate with my audience
appropriately.
Reflection- I was responsible for providing a presentation to my peers on the positives and
negatives of leadership styles in nursing. I was nervous for the presentation and could not
prepare well for the day. My feelings however changed once I started on with my presentation
and became more relaxed. Through my presentation I brought into focus that positive leadership

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style brings in motivation among members to deliver their best, while negative leadership style
creates environment not supportive of setting objectives. Negative attitudes when spread through
the unit lead to reduction in productivity. On the other hand, positive leadership styles instill a
sense of commitment towards patient care(Porter-O'Grady and Malloch 2016). Working in the
emergency setting demands a dynamic nursing approach through which nurse leaders can engage
in an inspire varied roles. Due to the demanding and ever changing healthcare environment,
identification and development of a suitable leadership skill is vital. The concept of leadership in
the nursing context is a complex and multi-dimensional phenomenon, and research concludes
that there is no universally accepted definitionof the most suitable leadership style(Sharkey and
Lefebre2017).The presentation ended without any major challenges. I was given the feedback
that though I spoke in a clear manner and was consistent throughout, I did not maintain eye
contact with my audience. This hampered the communication established with the audience.
Analysis of the situation brings into focus that students need suitable communication skills for
taking part in oral presentations (Billings and Halstead 2015). Translation of theory into practice
is crucial, and thus such communication skills are pivotal in nursing education (Forbes et al.
2016). I conclude that I should have been more confident and positive about the presentation.
Maintaining an eye contact would have helped me to embrace the support of my audience. In
future, I plan to maintain eye contact with my audience to facilitate the presentation delivery.
Communication of international students with peers is crucial that can be promoted through such
scenarios. The subject learning objective to be fulfilled is “Consolidate and synthesize
knowledge to enhance communication skills enabling the transfer of complex knowledge, ideas
and concepts across a variety of practice settings”.
Activity 1.3: Create concept map about different leadership style in nursing.

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Justification 1.3: To understand and gain knowledge about different leadership style in ED that
will provide more quality in work.
Evidence 1.3: concept map.

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Leaderships in nursing
Authoritarian leadership
Employees are not involved
and only the leaders take the
decisions.
The employees are less
motivated.
Retains power
Exhibits high level of control
Works in chaotic
emergency
departments
Participative leadership
Communicates the decision
back to the peers.
Facilitates active
conversations
Encourages subordinates to
share the ideas.
Laissez-faire leadership
Leaders provide no
direction or supervision.
Changes does not occur
much
Quality improvement is
mainly reactive.
Low level of control
Self aware
Self control
Mainly used by the new
and the inexperienced
leader.
Exhibits control as per the situation
Works well in settings with
experienced nurses.
High level of control Low level of control
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Reflection- Through this activity I was exposed to the different styles of nursing leadership
and the traits of each. Designing the concept map was not a very challenging tasking as my
received the support of my peers. I got to learn about the different learning styles and this gave
me the opportunity to compare between the different styles. I was interested to understand the
applicability of different leadership styles as per the needs. The main focus was on authoritarian
leadership, participative leadership and Laissez-Fair leadership styles. Though I perceived
Authoritarian leadership as the most significant one to be applied in emergency department, the
arguments against it were also noteworthy. A healthcare setting demands input from all
professionals. The viewpoints of all members in a team are to be integrated in the decision
making processes directed towards optimal patient outcomes (Blais 2015). In future I shall take
feedback from the educators about the usefulness of Authoritarian leadership. My future practice
would be guided as per the knowledge received.
2. Develop in depth knowledge of implementing infection control measures in the ED.
Linked SCP learning objective: A, B
Linked professional standard (s) and relevant domain: (1.0)
Activity 2.1:Attend online course about Aseptic technique in 16 May 2018.
Justification 2.1: to increase understanding of aseptic techniqueand that provide high quality of
care in emergency department and decrease the infection.
Evidence 2.1:Online module, and I will attach the certificate and I will use Gibbs reflective cycle
to reflection my activity.

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The online course on Aseptic technique was valuable for increasing my knowledge on
how to provide safe care delivery in clinical settings. The key concept of the course was to
understand how healthcare professionals can prevent spread of infectious diseases across
settings. At the end of the course I was better informed to reduce spread of infection by receiving
suitable training and information. The course topics covered were at basic and easy-to-
understand levels. I believe that in future I would be better able to reduce the risk of infections
such as ventilator-associated pneumonia and catheter-associated urinary tract infection.
Reflecting on the experience I would like to mention that taking part in the online course
about aseptic technique was a valuable one. The course was successfully completed by me as I
engaged in learning more about the topics taught. The experience was an interesting one as I got
to know many things that I previously did not know. It was however challenging to understand
certain aspects being taught to us. The experience of engaging in online course was different
from regular offline courses. I faced challenges in communicating with the educator as the
responses received were late. Certain doubts that I had were also left unqualified. Online course
often present challenges in regards to the learning style of the learner (Billings and Halstead
2015). Overall, I believe taking part in the course was a positive consideration. In future, I would
ensure that I communicate well with my educator and receive clarifications on my doubts. The
subject learning objective to be fulfilled is “Appraise research evidence to develop and improve
nursing practice for optimal patient outcomes”.
Activity 2.2: Review the literature on the relevance of the importance of Personal Protective
Equipment(PPE) in the emergency department.

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Justification 2.2: To increase knowledge about this equipment and to know the correct way to
wear it in emergency department.
Evidence 2.2: Literature review
The purpose of the present literature review was to understand the rationale for using
personal protective equipment in the emergency department of a clinical setting. Suitable articles
were included in this review the inferences drawn from which would be the basis for future
professional practice change.
Author and title Year Aim Research
methodology
Main findings

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Visentin et al.
Use of personal
protective
equipment
during infectious
disease outbreak
and nonoutbreak
conditions: a
survey of
emergency
medical
technicians
2009
To assess the
knowledge of and
barriers to the use
of personal
protective
equipment for
airway
management
among emergency
medical
technicians
(EMTs) during
Severe Acute
Respiratory
Syndrome
(SARS).
Cross-sectional
survey. Main
outcome measures
included the
frequency of
personal protective
equipment use
and, as applicable,
why particular
items were not
always used.
Personal protective
equipment is not
always used by
professionals.
Reasons are
nonavailability,
judgment of
nonnecessity or
technical
difficulties.
Wang et al.
The effect
of personal
protective
equipment on
emergency airway
management by
emergency
physicians: a
2016 Evaluate the effect
of PPE on
physician’s
performance of
emergency airway
management
Intervention study.
40 emergency
physicians were
recruited.
Wearing PPE is
limited in
postintubaiton
care. the airway
management
practice is not
influenced by PPE.

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mannequin study
Lu et al.
Viral load and
outcome in SARS
infection: The role
of personal
protective
equipment in the
emergency
department
2006 Evaluate the
effectiveness of
PPE against
infection in
emergency
department
Case study. 16
patients in a SARS
clister were
studied.
Although absolute
protection against
SARs was not
achieved, lower
exposure to virus
was noted that
leads to lower risk
of secondary
infection.
Kim et al.
Influence of
personal protective
equipment on the
performance of
life-saving
interventions by
emergency
medical service
personnel
2016 To assess the
efficacy of a
randomized
crossover
stimulation for
comparing
performance of
life-saving
interventions in
repetitive
simulation of
single-rescuer
resuscitation
wearing level-C
Success rate and
completion time of
intravenous
cannulation and
endotracheal
intubation was
compared
Performance level
of life-saving
interventions were
decreased when
PPE was used.

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PPE
From the literature review it was understood that PPE has the potential to reduce risk of
suffering secondary infections in emergency units. The reasons behind non-adherence to PPE
guidelines are varied. Professionals must gain knowledge of how to appropriately use PPE for its
optimal functioning and reduction of risk of infection spread. It is advisable that professionals
engage in continual learning to understand how PPE is to be used in the most appropriate
manner.
Activity 2.3: I will give presentation to classmates about healthcare personal vaccinations in
emergency department.
Justification 2.3: that will assist me to gain more knowledge about vaccine which use in
emergency department.
Evidence 2.3: Presentation and I will attach form evaluation of the feedback from my classmate
in 19 May 2018, I will use Gibbs reflective cycle to reflection my activity.
The positive feedback that I received from peers is that the presentation was an
interesting one with adequate utilization of charts, relevant diagrams and pictures. The flow of
information was also in a logical manner and a comprehensive approach was taken while
preparing the presentation.
The negative feedback that I received was that I did not make eye contact with my
audience while presenting it. I was also nervous at times and that was reflected when I spoke
with less confidence at certain instances.

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Reflection- I took up the valuable opportunity to present to my classmates my knowledge
on healthcare personal vaccinations in emergency department. I was responsible for presenting a
comprehensive overview of the topic. I feel I had done well in the assignment and was able to
achieve the aim of the task. I was unhappy that I could not show confidence while presenting the
task and this led to a poor impression. However, what made me satisfied is that I could present
information in a logical and comprehensive manner, an aspect that is expected from all nursing
students. Effective public speaking is a practical skill that needs confidence and patience.
Nursing students must be capable of arranging ideas, memorizing them and deliver oral
presentations (Morton et al. 2017). Healthcare personal vaccination was an interesting topic to
research about. Due to their contact with patients or infective material from patients, many HCP
are at risk for exposure to vaccine-preventable diseases. The most important vaccinations that are
to be considered for the professionals are Hepatitis B, Influenza, Meningococcal, Varicella,
Measles-Mumps-Rubella (MMR) (del Campo et al. 2011).Employers and professionals equally
have a shared responsibility to ensure that there is prevention of occupationally acquired
infections and they avoid causing harm to patients by taking reasonable precautions to prevent
transmission of vaccine-preventable diseases (Corace et al. 2016). I conclude that I need to learn
improving my public speaking skills. In future, I would be consistent in connecting to the
audience and present a structured content. The subject learning objective to be fulfilled is
“Consolidate and synthesise knowledge to enhance communication skills enabling the transfer of
complex knowledge, ideas and concepts across a variety of practice settings”.
3.Develop knowledge about pain management in patient in emergency department.
Linked SCP learning objective: A, D, B, E

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Linked professional standard (s) and relevant domain: (1.0), (5.0)
Activity 3.1: Attend online course about Patient Controlled Analgesia - Adult Pain
Management that identifies and explains specific analgesia use in ED.
Justification 3.1: To understand the pharmacology about analgesia which use in emergency
department.
Evidence 3.1:Online model in 16 May 2018 and I will attach the certificate, I will use Gibbs
reflective cycle to reflection my activity.
The certificate course was a great learning experience that gave me more clear ideas
about analgesia medications in pain management and the relevant nursing implications. It is
known that nurses are often required to address adult pain in different settings. What I have
learnt from the course is that person-centered administration of analgesia is of prime importance
in emergency settings. This is due to the fact that such medicines have severe side effects
depending on the patient’s condition. In future I would ensure that an accurate patient assessment
is carried out before administration of a certain medication.
I undertook the online course about Patient Controlled Analgesia - Adult Pain to
understand the pharmacology about analgesia which use in emergency department. I gained
increased information on the subject as a result of completion of the course. I felt satisfied by the
method used for teaching by the professional. This helped me in understanding the content that
was being taught. In pharmacology, it is ideal to develop clear concept of the knowledge gained
so that care delivered on the basis of it is safe and accurate (Blais 2015). I conclude that
participation in the course was fruitful. In future, I would like to take part in similar courses for
ensuring professional development.

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Activity 3.2: Create an annotated bibliography that identifies the importance of reduction of
anxiety in the emergency department by Cognitive-behavioral therapy (CBT).
Justification 3.2: To understand the cognitive-behavioral therapy and indication the important
of it to reduce pain in emergency department.
Evidence 3.2: Annotated bibliography
Otte, C. 2011. Cognitive behavioral therapy in anxiety disorders: current state of the
evidence. Dialogues in Clinical Neuroscience, 13(4), pp.413–421.
A rich pool of studies has undertaken examination of effectiveness and efficacy of
cognitive behavioural therapy (CBT) in treating adult anxiety disorders. In present time, many
meta-analysis have been undertaken to review the evidence of CBT in anxiety disorder. CBT has
been used against panic disorder, social anxiety disorder, and generalized anxiety disorder.
Overall, the efficacy of CBT has been demonstrated in randomized controlled trials and
naturalistic settings also point out the efficacy. However, more research with accurate
methodology and strengths are needed at the earliest for estimating the impact of the therapy.
The present paper was a quantitative literature review of existing randomized placebo-controlled
trails and trials in naturalistic treatment settings. Suitable statistical data were included
wherever possible to highlight the study results.Another feature of the paper is that the
association of CBT with various conditions is distinctly presented in different section,
making it convenient for the readers to understand the information.The limitation of the
review was that some original studies included in the review had methodological weakness.
Nevertheless, the meta-analysis was fruitful in confirming the effectiveness of CBT. The
conclusion section appropriately summarizes the key points and brings forward implication
for future practice.

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Kehle, S.M., 2008. The effectiveness of cognitive behavioral therapy for generalized anxiety
disorder in a frontline service setting. Cognitive behaviour therapy, 37(3), pp.192-198.
The aim of the study was to assess the generalizability of CBT in a frontline
service setting for addressing generalized anxiety disorder. 29 patients presenting to clinics were
given CBT. Upon completion of the treatment it was found that there were significantly lesser
expressions of depression and worry. Though frontline settings are quite different from RCT
settings, there was a large decrease in depression and anxiety that was self-reported. It would be
appropriate to understand the factors that contributed to the smaller than expected effect sizes of
the study’s treatment. First is the length of the treatment. Secondly, the therapist might have
contributed to the effectiveness of the treatment. Moreover, the high level of dropout is also to be
considered. Nevertheless, the study contributed to the existing pool of literature regarding
provision of a conservative test of effectiveness of CBT. It is implied from the study that future
research such as clinical trials are required with more internal validity for determination of the
particular variables that have a negative effect on the outcomes.
Kaczkurkin, A.N. and Foa, E.B., 2015. Cognitive-behavioral therapy for anxiety disorders: an
update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), p.337.
The present paper is a literature review that aimed at providing updated empirical
evidence on CBT for anxiety disorders. The aim of the present article was to provide a
comprehensive overview of the two most important CBT methods that is cognitive therapy and
exposure therapy, in treating anxiety disorders.Cognitive behavioral therapy has been well
studied for its efficacy in stress disorder and anxiety. Anxiety disorder treatment is to encompass
both imaginal exposure and in vivo exposure. Greater functioning is achieved in anxiety patients
when CBT is delivered. The mode of action is provision for relaxation that has a positive

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stimulation on the brain. While most of the research papers included in the review was recent,
certain papers were published long back. It would have been better if more recent articles were
included in the review paper.
Activity 3.3: Care of patient in Emergency department who has severe abdominal pain and
assess comprehensive pain assessment.
Justification 3.3: To analyses pain assessment and to assess the cause of pain.
Evidence 3.3: Case study
A 45 year old woman presented to the emergency department with intermittent
abdominal pain presenting for few months.
Signs
She was feeling nausea and reported to have vomited thrice since morning. The vital
signs were recorded that indicated underweight at 55 kgs, normal heart rate 82 bpm, low
respiratory rate at 10 bpm and normal oxygen saturation at 97%.The abnormality found in the
initial assessment was that she had moderate tenderness in the right upper abdomen.
The laboratory results showed that there was increased inflammation. Sonography was done that
indicated the presence of echinococcal cyst in segment VIII of the liver. No cysts were found
when CT scan was done. Clinical findings and serological tests confirmed the diagnosis of E.
granulosus infection.Such an infection is caused by cyst-like tapeworm larvae growing in the
body. It involves the liver or the lungs, but can be found in other organs of the body also. Pain
and severe discomfort in the upper abdominal region, nausea, vomiting occur as a result of the
growing cysts. The patient was accordingly shifted to the surgical department.

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Reflection- My role as a nurse at the emergency department was to carry out pain assessment for
the patient. I had the knowledge that acute abdominal pain is a representation of a wide range of
conditions that might be self-limiting or benign. I had taken initiative to first identify the location
of the pain. Accordingly I had engaged in other pain assessment methods. I was having the gut
feeling that the patient had been suffering from some form of infection. My instinct was based on
my knowledge on the subject.
Outcome
The outcome of the assessment was successful and I was satisfied with the mode of care
delivered.
Evaluation
Evaluation of abdominal pain needs an approach dependent on the chances of suffering the
disease, patient history, laboratory tests, and physical examination and imaging studies. The
location of the pain is crucial since it determines the need of further investigation (Blais et al.
2015). Ultrasonography is recommended for assessing abdominal pain suffered on right upper
quadrant (Morton et al. 2017).
Conclusion
In conclusion, I was able to demonstrate my skills and knowledge in caring for a patient with
abdominal pain. In future, I would engage in learning more about patient assessment techniques
so that I can better care for patients and guide them to suitable intervention.

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References
Billings, D.M. and Halstead, J.A., 2015. Teaching in Nursing-E-Book: A Guide for Faculty.
Elsevier Health Sciences.
Corace, K.M., Srigley, J.A., Hargadon, D.P., Yu, D., MacDonald, T.K., Fabrigar, L.R. and
Garber, G.E., 2016. Using behavior change frameworks to improve healthcare worker influenza
vaccination rates: a systematic review. Vaccine, 34(28), pp.3235-3242.
del Campo, M.T., Miguel, V.J., Susana, C., Ana, G., Gregoria, L. and Ignacio, M.F., 2011.
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Blais, K., Hayes, J.S., Kozier, B. and Erb, G.L., 2015. Professional nursing practice: Concepts
and perspectives (p. 530). NJ: Prentice Hall.
Forbes, H., Oprescu, F.I., Downer, T., Phillips, N.M., McTier, L., Lord, B., Barr, N., Alla, K.,
Bright, P., Dayton, J. and Simbag, V., 2016. Use of videos to support teaching and learning of
clinical skills in nursing education: A review. Nurse education today, 42, pp.53-56.
Kim TH, Kim CH, Shin SD, Haam S. Influence of personal protective equipment on the
performance of life-saving interventions by emergency medical service personnel. Simulation.
2016 Oct;92(10):893-8.
Lu, Y.T., Chen, P.J., Sheu, C.Y. and Liu, C.L., 2006. Viral load and outcome in SARS infection:
the role of personal protective equipment in the emergency department. Journal of Emergency
Medicine, 30(1), pp.7-15.
Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic
approach (p. 1056). Lippincott Williams & Wilkins.

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Visentin, L.M., Bondy, S.J., Schwartz, B. and Morrison, L.J., 2009. Use of personal protective
equipment during infectious disease outbreak and nonoutbreak conditions: a survey of
emergency medical technicians. Canadian Journal of Emergency Medicine, 11(1), pp.44-56.
Wang, C.C., Chaou, C.H., Tseng, C.Y. and Lin, C.C., 2016. The effect of personal protective
equipment on emergency airway management by emergency physicians: a mannequin study.
European Journal of Emergency Medicine, 23(2), pp.124-129.
Porter-O'Grady, T. and Malloch, K. eds., 2017. Leadership for evidence-based innovation in
nursing and health professions. Jones & Bartlett Learning.