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For centuries it has always been the tradition of mankind to regard their working environment not only as their source of income but also as a learning aorta in hope for a better future. As mankind becomes modernized, the standard expectation of self competency in the workplace has tremendously increased. Am a State Registered Nurse, graduated with a diploma in 2001 and have been serving in the healthcare profession for the past 10 years. My working environment in the medical ward has its own flow of rules and routine that one has to comply.
In this ward, the hierarchy of employees is determined by seniority. Every new ward staff or students that come for practical experience here will be given ample orientation regarding the rules and regulation, job ascription, ward layout and guidelines regarding the working procedure and workplace. As a clinical instructor, my responsibilities include scheduling the duty roster, giving orientation, supervising, assessing and evaluating the students while they are on clinical practice. My working unit is a 31 bedded ward, where it is divided into 3 sections.
The first section has 3 beds which usually admit high dependency care patients, section 2 accommodates 16 patients and the last section admits 14 patients at a time. This medical ward is a centre for referred medical cases from the rounding area, thus the admission census is always high. The implementation of ward or rather bed sectioning, is to facilitate in the admission of patients. It also helps in the placement of staff for the rotating shifts. Every section has a specified in-charge nurse and patient care assistants.
This is to ensure that the patients in that particular section will receive sufficient nursing care. At every shift, specified role assignment is being directed to every staff on duty. Usually there is an overall in-charge nurse and a medicine nurse, in- charge nurse for every section and runners. It is a good practice to assign certain beds to a specified nurse. This will enable the patient to have better care and also the nurse is able to prioritize and plan for the specified patient under her or his care.
In my ward, the Matron and Sister have good relationship between their staff, doctors and also to students. Good relationship also contributes to the continuous workflow of the ward. For the updating and upgrading of skills and knowledge, my ward will organize weekly discussion of selected patient’s treatment or cases. The hospital organization also organizes lectures and demos on selected health management topics once a week for all the staffs.
Besides lectures and demos, my ward also provides a conference room with computers and internet access for the doctors, nurses, students and other ward staffs. My ward also provides mentors for junior nurses or newly qualified staff nurses that come to the ward. SOP or standard operating procedures and ward policy are readily available in the conference room for reference at all times. All ward staff are required to read all the available policies and standard operating at least once every 4 months. This is to ensure that all the ward tiffs are always updated of any changes that might occur(s).
Sufficient basic medical equipments such as EGG machine, cardiac monitoring machine, portable x-rays machine, portable nebular machine, automatic and manual blood pressure machine, blood glucose analyzer machine (TXT) and infusion pumps has made a strong impact in considering this ward as an conducive learning environment. Evidence shows that having sufficient equipments create learning opportunity. My ward has different level of staff and job descriptions. It is difficult to standardize all the learning process because of the differences.
For newly qualified nurses and student nurses who are posted in the ward, Jeans (1993) says that they will be too occupied in familiarizing with the new settings. Therefore, the ward sister will assign a senior nurse or another equally qualified staff to be their mentor. Mishandled (1987) also believes that the anxiety feeling of a new staff of a department will drag the learning and adoption process. This statement show that present staff of a working environment should always support each other as peer support is important in a positive learning experience.
Learning as stated by Jarvis (1983) can be in the form of experience, skills or attitude by study. In the workplace setting Rainbow at el (2004) says that it can be expansive or more restrictive as a learning environment. Chances for the workplace as a learning environment are when there is minimal framework. It will provide opportunities for improvement. For healthcare professional, learning in all three domains as defined by Erect and walker (2002) which are cognitive, affective and psychosomatic is crucial.
Learning generally takes place when a person teaches, study or gain skills and knowledge through experiences. It is also known that there are a variety of staffs, students or environmental factors that affects learning. Wind-chill (1999) stated that those factors were: embarrassment or uneasiness, no interest, poor teaching, unpleasant past teaching experience, personal indifference’s between student and teacher, lack of motivation, no self-esteem and tiredness or illness. Observed that the in my ward, there are many formal and informal learning.
Formal learning takes places when the weekly discussion among the doctors and ward staff regarding the available cases in the ward, teaching a new staff hill doing the patient care, staffs attending and organizing in-service training and by observing the senior nurses or mentors doing certain procedure. The informal learning opportunities occurs when the ward staff learn something new from a certain patient’s condition and brief discussion regarding patient’s condition during handovers. Informal chat while staffs are having the break is also another informal learning.
Most of us would not realize that by sharing experiences is also another way of engaging the 2nd person to an informal learning session. Since the conference room is readily available most of the time, when staffs updates procedures and clinical guidelines folders or resources, he or she is having an informal learning session. Internet access in the conference room will provide and informal learning for those who uses it. Therefore the learning process in this unit is formal and informal. There are three main learning theories; behaviorism, humanist and cognitive. Each of these theories has its own criteria.
In my ward, all the three main learning theories apply. Instructors, mentors or ward sister are often in full intro this is one typical behaviorism because if a staff does good, he or she will be rewarded and this will motivate the staff to do better. Hartley (1998) emphasizes four key principles – activity, repetition, reinforcement and learning is important for a behaviorism. In the ward, I as a clinical instructor will demonstrate a procedure for the learners. One learner then will return demonstrate. If the learner performed well, he or she should be acknowledged and it will build the learner’s self- esteem.
With frequent practice of the procedure, skills will be developed and reinforced by awarding rewards in terms Of praises. By the end Of the session, learning will be achieved when the objectives were achieved. Before making any decision, the ward sister will always call for a meeting and upon discussion a decision will be made. This is the cognitive learning theory. Hartley (1998) highlighted the key principles of cognitive learning. They are – instruction should be well organized, structured, prioritize perceptual facts and one must have knowledge.
In the ward, there are certain protocols regarding the tidiness and ways of keeping documents. If the materials are ropey arranged, it would be easier to remember. When a problem occurs, it should be properly understood by all staff or learners because cognitive learners will only attend to selective environment aspect. Since there are multicultural staff and patient in the ward, the humanist learning theory should be implemented because every person is different. Measles hierarchy of needs best defines the humanist learning theory. Physiological needs must be meet before proceeding to the next level.
The ward staffs needs enough rest, food and sleep to enable optimum functioning. Next level is safety needs. If the ward staff felt their working environment is safe, it would encourage them to work longer. Level three is the feeling of being loved and belonged. When the relationship between the ward staff is positive, everyone will work in harmony. Self-esteem needs involve the desire for achievement and competence of doing certain things. When the forth level is achieved, then self-actualization is attained with the full use of a staff potentials and credibility. Learning styles differs from one person to another.
It is also defined as an individual’s unique ways to acquire knowledge, which is often based on trenches, weaknesses and preferences. There are three styles of learning auditory learning, visual learning and kinetic learning style. In auditory learning style, the learner enjoys listening and paying attention. A visual learner needs information being demonstrated, by observing charts and visual aids or by watching videos or slide presentations to aids in his or her learning. It is often carried out in classrooms or rooms that have multimedia equipment including charts, diagram and other visual aids to help a visual learner gain more knowledge.
The kinetic learner is more to practical aspects. They learn by doing which is through movement and action. Touching, feeling, exploring and doing experiment is good for the kinetic learner. These learners are the active types. Since there are multicultural and different backgrounds staffs in the ward, all the 3 types of learning style do apply. As a clinical instructor, before teaching or demonstrating a procedure, I will need to prepare my lesson according to types Of learners. This is to ensure that all of my learner will be able to learn according to their own style.
In my ward, I am fortunate to have a very competent ward sister. I consider her as my role model. Although there have been no definite definition of a role model, Kerry and Mess (1995) defined a mentor as a role model, teacher, counselor, an encourager and friend. The role model also maintains a continuous caring relationship. Gopher (2008) also listed the characteristics of a person who qualifies as a mentor. Among listed are; patient, knowledgeable, is good at interpersonal skills, a role model, honest and humble, and approachable. My role model is always open for any discussion related to our workplace.
She also often made the effort to talk with the attends in her ward no matter how busy the ward is. As a ward sister, she has good relationship with not only her immediate staffs but also to other staffs from different department. As stated by Farewell (1982) and Amelia (1 987), the ward sister has the most influence towards the nurses’ attitude. This strongly highlights the need to maintain maximum professional standards at all time. When there is a good role model in a setting, staffs of that setting will always refer the role model for advices regarding ward matters or maybe sometimes personal matters.