In this essay I will be discussing how the evidence from my portfolio demonstrates that I have achieved one specific proficiency. ‘A professional portfolio is a collection of carefully selected materials that document the nurse’s competencies and illustrate the expertise of the nurse. ’ (Oerman, 2002). The proficiencies are based on the NMC 2013 code of practice.
I will be exploring how the proficiencies principles were attained and how my evidence connotes the achievement- the evidence I have provided is from my placement in semester 5, it was based within a drug community treatment team.
I will also concur what else I could have done to improve my portfolio evidence, then develop an action plan for future placements. The proficiency I shall be discussing is 3. 1. 5- manage risk to provide care which best meets the needs and interests of patients, clients and the public, from domain three.
For this proficiency I have selected three pieces of evidence to support that I have accomplished the principles that underpin the proficiency; all three pieces of evidence were assessed at bondy level four, as all three pieces were done with minimal supervision (Bondy, 1983) shown in appedix V.
All of the the pieces of evidence shows elements of risk management which is a fundemental area for nurses to monitor in order to help to protect our clients from harm (NMC 2013).
It is important that we address client’s potential risks and seek to eliminate them in the client’s best interests. Risk management is described as; ‘a process to raise the quality and safety of services… it is a particular approach to improving the quality of care’ (Currie et al 2003).
However, although it is important to try to eliminate potentially harmful situations from happening, we should also have the ‘positive risk taking’ attitude rather than risk assessing everything and disabling our clients.
Positive risk taking involves weighing up potential benefits and harms of a situation and developing an action plan that reflect positive outcomes of taking a risk and the priorities of the client (Morgan, 2000). The first piece of evidence [appendix I] is a reflective writing piece on ‘Increasing a Clients Methadone’, ‘Reflection is the examination of personal thoughts and actions… to obtain a clearer picture of their own behavior’ (Somerville, 2004).
Also read anout pros and cons of total quality management
My evidence connotes the attitude of positive risk taking as it explains how the risks of increasing the clients methadone were considered and how they would be monitored to continue to manage the risk of the client overdosing or developing any physical conditions; ‘the decision was made by weighing up the therapeutic risks… the decision was made in the beneficience of the client rather than looking soley at the medical model for a decision. ’ (appendix I). I have considered the clients benefits from taking this risk but also managed the risk as I have formulated an action plan so that the risk does not escalate.
I have clearly shown knowledge of risk management as I have used key positive risk taking principles; empowering client with their resposibilities; ensured client went for a ECG scan every 3 months to monitor their condition in case of any change, supported the client to do this and ensured that the client understood the consequences that this risk taking may have on their life; which were all shown in this reflective piece of evidence (Morgan, 2004). My second piece of evidence [appendix II] is ‘Lone working’, this piece of evidence is also a reflective piece. Appendix II clearly covers 3. 1. as within the reflection I discuss how I addressed potential risk of overdose as the client had been taking amitriptiline that combined with benzodiazapines and methadone may result in fatality (BNF 2013). I dicuss how I managed the risk by highlighting the risks with the client, I then utilised motivational interviewing techniques; to empower the client to make the correct decision. Motivational interviewing is a key skill used within drug and alcohol services. NICE (2013) discuss in their guidelines, to help empower clients professionals should utilise opportunist techniques, rather than techniques that simply tell a client what to do.
My third piece of evidence [appendix III] is a work product and a description. this work product covers proficiency 3. 1. 5 as it discusses the risks that the client may endure due to their current health, behaviour and lifestyle choices. it also formulates an action plan if any factors that would escalate the risk may occur; allowing us as health care professionals to protect the client to manage risk (NMC, 2013). As this is a work product it conveys that I have the skills to carry out a risk assessment on clients in a correct way; thus evidencing I have key skills and knowledge to manage risk.
The limitations of achieving this proficiency are that when working with clients who are substance misusers, they are constantly taking risks because of this lifestyle. This can be hard to manage at times as a health care professional as we can not control a client’s choices. this is why it is important to thoroughly manage positive risk taking. I feel that I have done this throughout my evidence, however on reflection I could have discussed my skills and knowledge further, so that it is more clear that I understand the principles of risk management.
I also feel that I could have given more variation of evidence for example included further work products to support my reflective accounts. The strengths I feel my evidence shows to achieving this proficiency is that, I have explained my role in risk management thoroughly and have also used good resources to the reasoning behind my interventions as the health care professional; as I critically reflected on my experiences through looking at the rationale behind my actions of risk management.
Barker (2010) advocates that critical appraisal evaluates the worth, value and quality of the evidence. I also feel that in order to manage risk I engaged with clients to find out their own best interests; turning this into over all goal. Clearly shown in appendix I as the client did not want to stop taking amisulphride, but still wanted the methadone increase.
During this assignment I have shown my competence to achieve the proficiencies principles and motives at a level four bondy level (Bondy, 1983) in accordance with the NMC standards, this is conveyed in my evidence which is attached in the appendix. I have also recognised my strengths, which I will continue in my next placement, such as my communication skills, my use of reflective appraisal. I also identified the limitations that are shown in my evidence; lack of range in evidence and lack of depth about principles of risk management. Which I will incorporate into my action plan:
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