University

Reflection

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Lecturer’s Name and Course Number

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Reflection:

Articulation of personal thoughts and actions is known as reflection. For nursing

specialists, it has another meaning which focuses on the interaction with their working environs

and working partners in order to have an understanding of their own behavior and actions. This

provides the nursing specialists an opportunity to chart out their future course of action while

building on their existing capabilities which ultimately develops their professionalism and adds

to core working values. Reflection has two sub-categories: the reflection-on-action and the

reflection-in-action.

Reflection-on-action

The most known and common form is this one. When the happenings in the recent past

are examined by pondering upon those events, the reflection-on-action takes place and through

this articulation the nurse practitioners are able to develop better and effective professional ways

for the future.

Reflection-in-action

This is the pinnacle of nursing specialists' professionalism as through this, their actions as

well as the actions of the colleague are examined. Reflection-in-action is usually developed with

nursing practice. It often is the result of experience and skills that the CNS goes through the

process of Reflection in action.

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Reflective practice:

In the realm of nursing, Reflective practice has turned into a key issue and is consistently

mentioned (Gustafsson, Asp, & Fagerberg, 2007). Due to deep interest in reflective practice, it

has been a topic on which various research studies have been carried out to have more

understanding (Smith and Fagerberg, 2007) so that the existing gaps between the theory of

nursing and its practice can be overcome and the knowledge embedded in practice can be

developed. This is a continuous cycle which blends nursing experience and the reflection on

those experiences.

Importance of Reflective practice:

For long, advocates within the medical profession have recommended reflective practices

as a valuable tool to bridge the gap that exists between nursing practice and nursing theory. For

the nursing specialists, it helps update their skills and professionalism and in the case of nursing

specialists involved in rehabilitation of older persons, it helps enable them to identify their

strengths and area of development. Reflective practice helps in making the use of opportunities

that helps the nursing specialists get the feedback of their impact on the older patients and their

families.

The practice of 'Being Available':

The core therapeutic practice is the nurse specialist's being available to others

(patient/family) in order to guide them to find meaning in their health-illness experience so as to

make the best decisions about their health/lives, and to appropriately assist them to meet their

health needs.

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Being reflective:

Most of the time the nursing specialists’ involved with the care and rehabilitation of old

age persons feel that the only thing they lack is a little time to live their own personal life, let

alone give some reflection to it. But every problem has some solution, hence by following the

below mentioned actions the nursing specialists can overcome this phenomenon:

Feedback

Coming in different forms from many other people, it is something which has direct

connection with the professionalism, skills and capabilities that the nursing specialists have;

including their behavior. Had it not been for the feedback from other, both negative and positive,

the nursing specialists would not have been what they are. Feedback comes from other people in

many different forms, both verbal and non-verbal. We receive feedback from others about our

behavior, our skills, our values and the way we relate to others, and about our very identity. It

can be argued that we are who we are because of the feedback we receive from others. For this

reason, feedback is central to the process of reflection.

They should not be afraid to ask relevant persons as to how these people perceive and

think about them. Just by requesting a little feedback for someone who is known to a nursing

specialists, can provide them with valuable and honest information about them. These feedbacks

are not to be accepted as a whole, but at least some consideration might be given about them

(Chornick, 2008).

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The learning curve

The nursing care specialists should ask themselves as to what they have learnt in a whole

working day. If they find something that had upset them, they should think of ways to overcome

such incidents in future. It is the best process through which nursing care specialists develop new

skills and capabilities and develop their reflective skills.

Acknowledging strengths

The nursing care specialists should make some time available to ponder upon the various

things that have been very satisfying. This should not be done to just celebrate one's success, but

to improve them.

Ponder upon experiences

The best way towards a successful method for developing the clinical nurse specialist

practices is to recall some recent past happening in which the nursing specialist was involved

with someone else. Pondering on what the other players did and what the nursing specialist

actions were at that moment, about what was said and done, can help develop skills and practices

(Marrs, & Lowry, 2009)

Empathy

Reflecting on the recent interactions that turned into a conflict of some kind may help. By

adopting empathic position and trying to think of being at the place of that person with which

this uncalled for incident happened, can be tremendously helpful to analyze the specialist's own

perspectives.

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Diary of events

Writing all reflections in a diary including remarks can be helpful in the long run when

the specialist needs to have some future plans, as through this diary the specialist can easily

compare what happened and what could have been averted. Although it looks like a huge task

yet it can be helpful in deciding priorities.

Planning future to develop nursing skills

The best outcome of reflective process is planning the future after making sense of

reflective practices. Planning to make some critical changes the behavior of nursing specialist is

at times very effective for the development of nursing practices; especially for those who are

involved as a clinical nurse specialist for the rehabilitation of older persons.

Competencies

It is mandatory that clinical nurse specialists have a considerable expertise within a

specific practice realm and can be accessible to patients or older people in need of rehabilitation.

Posts like these have already been founded successfully in the health care realm, especially in

America and the UK. Hence nurses in general have different perceptions of the role and the

rewards (Hamric, Spross, & Hanson, 2009). Technology has advanced so much that it has turned

complex to manage them properly in health care disciple, the intricate surgical operations and

methods have made the nursing specialists' job even more demanding hence there is an acuity of

patient care delivery. Today the old age rehabilitation centers are not meant just for patients with

chronic diseases or with mental disorder syndromes, it also accommodates old age patients who

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have serious fall or injury and require the services of a competent CNS in the rehab center. The

rehabilitation centers provide inpatient rehabilitation services in an environment which looks

more like residential, rather than a clinical setting. These old age rehab centers can be either

located in a hospital premises or a specially built housing which is assisted with nursing care and

living facilities. Rehab centers offer twenty four hours care and treatment and the patient's

progress is also consistently monitored. Sometimes, when a person's medical condition is such

that all the services including treatments required could not be offered in an alternate setting,

then it calls for an acute inpatient rehabilitation. Rehab centers provide all sorts of treatments

which is mandatory in rehab centers in America, these consists of treatments for restoring

communication capabilities, mobility improvement, training to use wheel chairs and walkers as

well as carrying routine chores like taking a shower and dressing besides all care and holistic

support is given to manage emotional support which is common with such patients. Hence a

CNS has functions which go much beyond the functions of a common nurse, the reason why

they are called CNS.

The American Nurses Association has defined clinical nurse specialists (CNSs) as

follows:

"The clinical nurse specialist is a clinical expert who provides direct patient care services

including health assessment, diagnosis, health promotion and preventive interventions and

management of health problems, in a specialized area of nursing practice. The clinical nurse

specialist promotes the improvement of nursing care through education, consultation, research,

and in the role of change agent in the health care system" (ANA, 2009, p. 3).

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Therefore the urgency and need for clinical nursing care specialists with an advanced

knowledge and skill is the demand of all health care organizations, especially rehabilitation

centers. CNS with the ability to work with other medical and Para-medical staff, organize,

manage and coordinate the care of patients either in hospitals or rehab centers are a major

requirement by all health care institutions (Martin, Hamilton, Sutton, Ventura, Menacker, et al.,

2009).

For a clinical health care specialist, it is often tough to truly describe their role as their

roles are consistently changing in order to face the challenges posed in the health needs of an

equally changing patient population across the globe. To measure the impact the clinical health

care specialists make on patients outcomes, is difficult due to the role ambiguity. Various nursing

care specialists can be found in such streams as, psychiatric, gerontology, oncology, pediatrics,

cardiovascular, neuroscience, old age rehab, dementia, diabetes besides others (Scherer, Bruce,

& Runkawatt, 2007).

The professional nurses who are registered and have earned graduate preparation at the

Master's level are known as the CNS. The dire need of nurses having wide knowledge and broad

expertise, those who can get involved with other members of the staff to asses, chart out future

course of action, implement the plan and evaluate the results for the patients, is always present.

Developments never stops, it is an ongoing process in all parts of profession including nursing

specialists.

The core competencies

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It is centered upon and within the nursing’s disciplinary perspective and the caring about

those relationships which help facilitate the process of healing and health. This core is delineated

specifically in the philosophic and theoretic foundations of nursing (Gordon, 2007).

As a specialist nurse, it the duty of every CNS to make sure that all the members of the staff

along with students remain focused on the wellbeing of the patients, but it does not mean that

small tasks like dressing of clothes and washing of utensils should also be included in their task.

When a patient is healthy enough to do it, it is better to let him or her do it because patient

motivation helps in more ways than one. To make them think that they are now better than the

day they were brought, triggers the healing effect which is completely psychological and

emotional.

Scope of Practice

APN education is about getting to know about nursing well. Numerous researches were

conducted to ascertain and classify the phenomenon of mental concern to the nurses; these

studies have been fruitful in the understanding of the scope of nursing practice. According to a

regulatory framework, the scope of practice is determined by focusing on population, while other

initiatives delineate the substantive basis of nursing (NANDA. 2009). Reflective practice is all

about the relationships and the caring of individual needs as well as to the emotional and

personal feelings which often make an impact on the learning curve of reflective practice.

Trueta adds:

“Faith, beauty, peace, music, baths, exercises, sports, competitions and one or two light drugs:

that was the only medicine known to our forefathers . . .” The modern rehabilitation is build

around this idea today (Trueta, 1963, p. 346)

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Roles of a Clinical Nurse Specialist

The clinical nurse specialist or the CNS has four crucial roles which demand great focus

and skills, these are, a clinical expert professional, an educator, a nursing consultant and a

researcher. ((Scherer, Y. K., Bruce, S. A., & Runkawatt, V. 2007). A CNS blends all these four

ingredients into her practice thus creating diversity and flexibility in a medical environment

which is multifaceted. Besides these crucial roles, a CNS has other roles like providing

integrated care to the old age persons who either have one or various aliments or are bed ridden

due to age problems, it is also necessary for a CNS to act as a mentor and supervise the quality of

care in order to improve it. Neo natal and pediatric care are also the roles which a clinical nurse

specialist has to play (Gallo, A., Angst, D., & Knafl , K. 2009). It is mandatory to complete a

four year nursing degree program in order to be a clinical nurse specialist; she also must have

one year nursing experience. Today the role of CNS is undisputed, whether it is in a hospital,

clinic, rehabilitation centre or in research or managerial post in any health care organization

((ANA. 2008). Care for the old people is nicely provided when the environment is

multidisciplinary. A comprehensive, multidisciplinary care and management are the

requirements of the older people who either suffer from various age factor afflictions, or

disabling conditions or are in dire need of specialist care which can only be given by CNS.

Clinical nurse specialists are of different types based on their choice and expertise, like

CNS in community health, old age rehabilitation, acute care, occupational health, oncology,

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psychiatric, infectious diseases and geriatric etc. CNS role in old age rehabilitation is very

crucial. Old age rehabilitation is basically a very creative and client centered process involving

flexibility to adopt changes in certain seen or unseen circumstances. Just like the physically fit

but medically unfit people, the disabled people should also enjoy the same care and the social

model of disability considers what changes would be necessary so that people are facilitated to

live ordinary independent lives (APRN, 2008). This is programmed to help the client get

maximum or considerable level of functioning thus help minimize any handicap from physical

impairment. It is a shared activity between client, care and professionals who recognize the

individual contribution of all concerned.

Henderson recommends that the holistic nature of CNS should be always ‘rehabilitators

par excellence’. Holism is the basis of a nursing care specialist practices especially those who are

engaged in the old age rehab centers. Roper, Logan and Tierney’s model utilizes a

dependence/independence continuum which explains how a disabled person might be able to

achieve that can be expected of only from a healthy persons (Pearson, L. 2009). For those CNS

who work within the rehab, it is important to understand development of others in a healthcare

organization, because it reduces rivalry within groups in a team and also expands

interdisciplinary practice especially within a modern rehab center. Trying to understand how and

why someone's specialty has come from, and then trying to follow that, is a way to improvement

and development of professionalism. The CNS at Gerontological rehabilitation centers uses

holistic caring approach while providing care to the elderly and the disabled. They make it their

duty with absolute devotion to provide the best level of physical and psychological care for the

well being of the old aged persons.

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