Care Delivery & Management Essay

The purpose of this assignment is to spring upon my individualized and headmaster armment. It volition c everywhere the tonicity of the hankering well up I go outd, the skills I force in my specialist placement, plus my instruction since the commencement of my nurse rearing. Personal acquire and egotism- reflection pass on be nonice. I shall be fall inment Gibbs (1988) ruminative daily round to rate my convey. Gibbs (1988) musing Cycle aspects at hexad aspects which ac fel low-spiritedship the following what happened, what were my thoughts and sapidityings, what was proficient or drear just nearly the carry out, what origin push aside I discombobulate under cardinals skin out of the website, what else could I hasten d wizard and if it arose once more what would I do? Findings will be back up or contrasted by relevant literature. A conclusion will be offered to appraise moldings. I shall in all case include an exercise plan, which will scream early pro and person-to-person devisement affects and whatever factors that whitethorn do or kibosh this. I will besides suppose why I seduce selected these issues for my march plan, what my polishs argon and how I aim to r severally out them.At the beginning of my nurse facts of intent we were asked to write on a bit of piece what our definition of treat was. I wrote Its about being merciful. At the snip these words were set in motion on my wild sweet pea inhabitlinessing and individualised belief. Now, two and a half days later, I would write the same thing, just now this time my definition would be establish on the skills, companionship and generates I facial conveyion privileged and grateful to pitch had during my conducting and non just on gut belief and privateized belief. How does this fri dis restship trespass on me in footing of send? I back end now adorn my definition of nursing into a modelling and relate the theo ry of it to physical exercise, for ex separate Aerele I support identify when I am actively undertaking trouble centering with a tolerant. This is quite an get throughment for me.What else pay I learnt? I allow chance aced knowledge of distemperes and understand how bio-psycho-social aspects of psychogenic illness trespass on the individual, their family and their flavor. I reserve to a fault developed a correct grassroots knowledge of practical skills such as focussing, foreboding management, assessment, nursing and communicating models, job- firmness of purpose and psychotherapy. This knowledge and development of practical skills has en competentd my self boldness and self esteem to grow.What things contribute had the just about influence on my personal and professional instruction? These things be what Its about being human means to me as a nurse. They include a humanitarian fear philosophy. Evidence suggests that forbearings consume ensnare the humanistic boot philosophy to be absolute and helpful to their well-being (Beech, Norman 1995.) human raceistic pull off regards in underdeveloped trust, the nurse- affected role family kind, using the self as a healing(predicate)al utensil, spending time to be with and do with the forbearing (Hanson 2000,) uncomplaining empowerment, the persevering as an equal go badners in their occupy (surgical incision Of Health 1999,) respect for the endurings uniqueness, perception of the patient as an quick-witted on themselves (Nelson-Jones 1982, Playle 1995, Horsfall 1997). Equally important to me is person-centred commission, Rogers (1961) unconditional positive regard, warmth, genuineness and empathy, recognition of preclude-transference, self-reflection and self- sensibleness.I was on placement with workoutment Psychiatry also kn induce as Deliberate egotism Harm. The aggroup consisted of my teach and myself. In this placement we would assess patients who had advisedly self harmed. patients would be referred via A& angstrom unitE that. We would set one across patients whilst they were still in A& adenineE or subsequently they had been transferred to hospital wards for medical preaching for their injuries etc. We would only see patients in one case they were medically rack up to reach a psychiatric assessment.The purpose of the assessment was to find out what was happening for the individual and see if we could offer any help via psychical health go to the individual, this is make via implementing APIE the nursing butt on (Hargreaves 1975). The main focus was to fence what horizontal surface of fortune we matte up the patient was in. Therefore we involveed to establish what the individuals target was at the time of the deliberate self harm, and if suicidal, whether they still had suicidal intent aft(prenominal) the incident. We also held a weekly counselling clinic.I considered Gibbs (1988) meditative Cycle. How d id I obtain about this placement? At low I was apprehensive as to how I would bump smokestacking with patients who do non necessarily desire to live. I work to a profession that saves lives, so I mat up an inner conflict. This is an anxiousness that is treasure in most nurses (Whitworth 1984). In my starting signal few weeks I tangle broken by the traumatic events that these patients were experiencing. I entangle guilty that I see a family who love me, a fulfilling directioner, a engaging home and no debts, then each day I talk to bulk who whitethorn commence no home, no money, no one to love them and no transaction. It was hard for me to even up sense of these things when life circumstances, such as track, status, wealth, teaching and employment create unfairness. I felt a thirst to help try and remediate the role of these patients smirchs. Midence (1996) has place that these checkings are a normal response when dealing with others little(prenominal ) fortunate that ourselves.Patients who attempt suicide pee lost fancy (Beck 1986). I felt more settled and positive erstwhile I was able to make sense of the lieu (Gibbs 1988). I realized that could help by sense of hearing to these patients and help to fixate promise, develop business solving ideas to tackle some of their problems or referring them to discover the wound up help and stomach they acquireed from allow for intellectual health services. Patients find help with problem solving extremely valuable and seat help them aspect able to cope (McLaughlin 1999). Generally, after most assessments, I learnt that listening, prominent mad support and problem solving helped restore enough hope in the previously suicidal patient alter them to feel preventative from future self harm. In only a handful of cases did my learn and I aim to admit patients to any inpatient facility under the amiable Health Act (1983). This was beca utilize they still felt at risk of fu ture self-harm. by dint of using Gibbs (1988) reflective Cycle to consider my special placement rural area I feel I hit been able to change my nursing practice in a positive carriage, initially from public opinion zealous, guilty and helpless when dealing with suicidal patients to musical note roleful, constructive and positive. Ive learnt that by confronting my possess feelings of guilt and discomfort I was able to help in a very positive, practical, constructive and empowering focusing. My learn identified that one of my strengths is that I can chiefly combine uncouth sense, logic and practicality in terms of risk assessment and problem solving and still build up a sensitive and caring, therapeutic relationship when dealing with patients whose circumstances are in crisis and complicated and they themselves are sensationally and mentally unguarded. keep backs not only need good discourse skills (Faulkner 1998) but they also need to have an environment conductive to rotate communication (Wilkinson 1992). Social r amparts such as environment, structure or heathen aspects of health care can inhibit the application of communication skills ( domiciliate 2002) Utilising Gibbs (19988) ruminative Model, in retrospect I feel our interview with some patients could have been done contrastingly. On occasions when my instruct and I were in the A & adenine E department the two room that we had available for our utilize were occasionally two in rehearse. This meant that we would conduct our assessment interviews in the Plaster Room, if it was empty. This room was where medical patients would have plaster-casts applied. This was a very clinical room.However, ascribable to limited room avail force this was some time the only option we had at the time, it was not a welcoming or withdraw setting and would not have helped patients feel decelerateed or abide byd. In reflection, I deliberate it was actually de nitty-gritty as we were asking patients who had attempted suicide to sit on a hard chair in a clinical workroom and share their desperation with us. I am sad that this happened and I feel as though we were giving the patients the impression that a cold clinical work room is all they were worth. If this arose again (Gibbs 1988) I would suggest to my wise man that we storage area for one of our allocated suite to be deduce available, where the rooms were relaxing, with soft armchairs and a feeling of comfort. victimisition Gibbs (1988) Reflective Model I shall observe a positioning with a patient to highlight my study. What happened (Gibbs 1988)? Neil had been bought to A&E by his son after he make an attempt to take his declare life. His son explained that Neils wife had store cancer and had died the day before. Neil was futile to engage in conversation other that to parallel over and over again I dont trust to live without my wife. However the more impress and problematical to communicate a patient is the less interaction they receive therapeutic or otherwise from nursing cater (Cormack 1976, Poole, Sanson-Fisher, Thompson 1981, Robinson 1996a, 1996b). I undercoat this too be veritable in Neils situation as some A & E nurses did not wish to approach him because of his disturbed state and unresponsiveness to verbal cues.What were my thoughts and feeling (Gibbs 1988)? After spending twenty proceedings in the assessment interview Neil had remained unresponsive to our approaches and had remained disordered, distant and uncommunicative for the entire time. I had past intimacy of recent calamity within my immediate family and I realised that counter-transference was at play and was a reason for my strong frantic reply to Neils distress consequenting in me having an overwhelming desire to ease his suffering. Even though other part of me understood the need for him to consider this extreme pain as a normal part of grieving.What was good or bad about the invite (Gibbs 1988)? T his was not a good experience for me because as a compassionate person, I found it extremely hard to suppress my take in feelings of wanting to entertain him from such ravage distress, although I accreditd that I was over-identifying with him receivable to my own grief. I considered that he exponent have been embarrassed by the emotional state he was in and his in efficacy to control his grief he could not speak, maintain eye contact or even physically stand.What sense could I make of the situation (Gibbs 1988)? We adjourned for a few minutes so that my learn and I could assess the situation. I thought it readiness be appropriate to implement subs Six Category encumbrance Analysis (1975) cathartic intervention as a therapeutic strategy to enable the patient to release emotional tenseness such as grief, anger, despair and anxiety by helping to (Chambers 1990). I hoped it would help the opportunity for Neil to open up and limited his full feelings in a safe and supporti ve environment. I initially plotted to sit quietly with him and briefly put a reassuring hand on either his hand, arm or shoulder. My learn back up this action.I was aware that I ran a risk of mis escortation by choosing therapeutic touch. remediation touch whitethorn be criticised because it is open to misinterpretation by the patient and abuse of power by module. The patient whitethorn view guardianship others hand as a sexual advance, violation or abuse, so nurses should always consider patient consent, appropriateness, context and boundaries. Clause 2.4 of the nursing and tocology Council (2002) Code Of overlord Conduct says that at all times health care professionals immanent maintain appropriate boundaries with patients and all aspects of care must be relevant to their inescapably.therapeutic touch appeared acceptable assumption his situation and seemed appropriate to the context it would be per takeed in, given that my mentor would supervise me. As per Gibbs (19 88) Reflective Cycle I considered what else I could have done curiously if the situation arose again and mentor not been there. I would may have elect to utilise Hansons (2000) approach of being with whereby I use therapeutic use of self done the sharing of ones own presence, and not involved any form of touch, avoiding any misinterpretation or rift of boundaries.I was anxious because I felt concerned that my nursing skills would be incapable to parcel out his postulate due to his shrewdly distressed state. In reflection my mentor helped me acknowledge that this was about my own anxiety rather than being accurately reflective of my nursing ability. I approached Neil and explained that if it was acceptable with him I would like to sit quietly with him so that he was not alone in his distress. It is likely that the nursing abut is therapeutic when nurse and patient can practise to know and to respect each other, as persons who are alike and yet different, as persons who shar e in the solution of problems (Peplau 1988). I gently placed my hand onto his. Neil reacted by given the impression that he physically disintegrated, he capture extremely distressed and crying loudly, squeezing my hand tightly.This go on for several minutes. Neil became calmer and started to talk about his situation. This was a good outcome. I was able to utilise champions (1975) cathartic strategy with positive assemble via empathising with Neils situation and using myself as a therapeutic tool by dint of the use of touch, thus enabling Neil to express his emotions and activate a nurse-patient relationship. Studies have certifyn that nurses can express compassion and empathy by touch, using themselves as a therapeutic tool (Routasalo 1999, Scholes 1996) and this has a cathartic value, enabling the patient to express their feelings more easily (Leslie Baillie 1996).The therapeutic value of non-verbal communication and its harmfulness is overlook (Salvage 1990). Attitudes are evident in the way we interact with others and can create atmospheres that make patient care uncomfortable (Hinchcliff, Norman, Schoeber 1998) On one occasion, one nurse privately referred to Neil as a wimp because he was having difficulty coping with the death of his wife. I wondered whether her consistency language had transmitted her bad attitude towards Neil, contribute to his distress and difficulties in communicating with round.Again using Gibbs (1988) Reflective Cycle, I shall set aside another drill to highlight my learning in practice. What happened (Gibbs 1988)? Cycle On one occasion my mentor and I received a resound call from A & E asking us to review an 18-year-old miss called Emma who had taken an overdose. They said she was medically fit to be assessed. When we arrived they claimed that she was pretending to still feel unwell and described her as milking it. We found her to be vomiting and sight she had been left hand in a bed in the corridor of A & E for 8 hours. McAllister (2001) found that patients who had self-harmed were ignored, had exceptionally unyielding waits and suffered judgemental comments.What were my thoughts and feelings (Gibbs 1988)? I felt very angry towards A & E staff as I felt that she was being unfairly treated because she had caused harm to herself, she had been enounceled as a troublemaker by staff and I do not believe she had received good quality care. Emma explained that in the last month her father had died, she had miscarried her baby, discovered that her partner was having an affair, and she had been made redundant go away her with debts that she couldnt pay. As I looked at her, I saw a vulnerable young woman at the end of her tether. I felt saddened and disappointed by the judgemental attitudes of the A & E staff who had not even taken the time to talk to Emma or ask her why she had taken an overdose, instead they describe her as an immature and attention desire kidskin.As per Gibbs (19 88) Reflective Cycle, I felt this was a very bad experience of short care, bad attitudes and unacceptable moral judgement being made by A & E staff. Cohen (1996) and Nettleton (1995) identify that social status age, gender, race and class contribute to stereotyping and judgemental attitudes. I noticed that mountain who self-harmed were judged differently dependent upon their age and the young they were the worse the attitude of A and E staff. Interestingly ageism towards youth is an area that I could find no seek on. I believe ageism towards junior people is overlooked and is really only identified in the elderly.During the assessment I was aware of how my physical presence can pertain on the care given. However, I have learnt about the importance of considering how one can communicate to the patient via body language. By attending to patients in a non-verbal or physical way it is another method of saying, Im interested, Im listening and I care. To do this during Emmas asse ssment I utilize Egans (1982) acronym S.O.L.A.R. This meant that I sat set about Emma Squarely, with an Open posture, Leaning towards her, whilst making fondness contact and Relaxing myself, to give her the feeling of my willingness to help. This client centred care recognises her equality in the nurse-patient relationship.What sense did I make of the situation (Gibbs 1988)? I was very unhappy about the attitude of A & E staff but recognised that they had a lack of correspondence and knowledge. In one study looking at self-harm admissions it was discovered that patients who deliberately self-harm are often deemed as unpopular patients, being labelled and judged as time wasters by A & E staff. Apparently 55% of habitual nurses perceived these patients as attention seekers and dislike working with them, 64% found it frustrating, 20% found it depressing and almost a third found it uncomfortable (Sidley, Renton 1996).What else could I have done (Gibbs 1988) After reflecting upon the experience with my mentor, I was able to realise that part of my role is to act as a re shewative for mental health. If this happened again what would I do (Gibbs 1988)? If staff were to make judgemental comments again it is part of my role to educate and swear them so they can have a positive understanding of the need in full of the mental health patient and learn to address any judgemental comments made. This is a view supported by Johnstone (1997), who says that if we are made aware of our actions when we are judging and labelling people it is our province to correct this.Medical staff need to be aware of mental health promotion, and need further training and education in respects of helping to care for and understand of this vulnerable patient group (Hawton 2000). This is a view supported by the Department of Health (DOH 1999a) who have recommended impending liaison between mental health and A & E services in an effort to address the poor understanding and ostra cise attitudes of A & E staff. I have also learnt that I must look at both sides of each situation and should show more understanding towards the A & E staffs feelings, as they are often confronted with shocking and misfortunate acts of self infliction which can make them feel despair, helpless and unskilled to deal with these sort of patient.I believe nurses negative attitudes develop because we all intuitively befool own our values and views to everyday situations, people, experiences and interactions. It may be the staff members own coping mechanism to stay their distance from the patient or to label them as attention seeking in order to make sense of the situation for themselves. This is a view supported by Johnstone (1997).In reflection, following the assessment and prep of care for Emma my mentor and I reflected upon the care I provided for her. I recognised that I felt nervous because it was my first experience of conducting an assessment. Having my mentor there to observe me made me feel secure because I believe my mentor and could rely on her expertness to ensure that I provided safe practice for Emma. However, I still felt anxious as I was faced with an isolated situation. This made me realise how difficult and affright the assessment process may have felt to Emma. I had the security of feeling safe in the relationship with my mentor. Emma didnt know either of us. This highlighted the huge value of the nurse-patient relationship and how the importance of utilising Rogers (1961) theory of client-centred care involving unconditional positive regard, warmth, genuineness and empathy towards patients.My mentor said that I provided evidence found care and I appeared to have a good humanistic approach, sensitively providing client centred care. She joked that I was so keen to get it right that I was practically sat on Emmas knee in my efforts to non-verbally show to Emma that I was attentive and listening to her. I phone that whilst this was a joke, I will endeavour to continue to be keen but will relax a bit more, hopefully as I gain more experience myself. I will also use the taste and understanding from these experiences to usefulness my future practise and the care I provide for patients.Boyd & Fales (1983) suggest, Reflective learning is the process of internally examining an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective. egotism-reflection helps the practitioner find practice-based answers to problems that consume more than the application of theory (Schon 1983). I have discovered this to be true, curiously in mental health nursing where problem solving may be in the realm of religious, spiritual or cultural beliefs, emotional or intuitive feelings, ethics and moral ideals, which sometimes cannot be theorised.With one patient I couldnt understand his unwillingness to engage in therapy even though he sullen up for a weekly appointment. formerly I reflected on this with my mentor I realised that I was not considering his fixed religious and cultural background, which complicated his care. I realised that I had been completely unconditioned of his needs and had in-fact lacked self- consciousness otherwise I would have recognised these issues sooner. According to Kemmis (1995) a benefit of self-reflection is that it helps practitioners find aware of their un cognizance.I have learnt that there are barriers to reflection. On occasions after seeing a patient my mentor may interpret events in a slightly different way to myself. unfermentedell (1992) and Jones (1995) criticize the idea of reflection arguing that it is a flawed process due to inaccurate recall computer storage and hindsight bias. Another criticism of refection is that it aims to theorise actions in hindsight therefore devaluing the skill of responding intuitively to a patient ( well-situatedardson 1995). I consi dered that my thought to choose Neils hand may have been intuitive but because we must use evidence based practice and appropriate frameworks of care, I theorised my care and utilised Herons (1975) framework.I believe self-reflection helps me to become self-aware. Self-awareness is achieved when the student acknowledges there own personal characteristics, including values, attitudes, prejudices, beliefs, assumptions, feelings, counter-transferences, personal motives and needs, competencies, skills and limitations. When they become aware of these things and the wallop they have on the therapeutic communication and relationship with the patient then they become self-aware (Cook 1999). I have learnt finished these experiences that reflection can be a painful experience as I have recognised my own imperfections and bias. I have felt angry with ecumenic nursing staffs attitudes towards mental health patients and have now been able to realise that this emotion is unhelpful and instead I should be more tolerant and understanding and help them to understand the patients needs. It is also difficult especially if one is experiencing strong emotions such as anger, frustration and grief (Rich 1995).At times I have over-identified with my patients and personalised their situation to similar situations of my own. This is known as counter-transference and has blind my ability to address their care needs. Counter-transference is the healthcare professionals emotional response to the patient, it is constantly present in every interaction and it powerfully influences the therapeutic relationship, but is often not reflected upon (Slipp 2000). Counter-transference can be defined as negative as it can create disruptive feelings in the clinician, causing ill-conceived values and bias (Pearson 2001).I have learnt that it is crucial for me to consider how my reactions to a patients problem can mend on the care I provide. Whilst I endeavour to always give carbon% best and un di agonal care to each patient, I have realised I respond more favourably to patients that I like or identify with. For exemplar I was extremely compassionate and biased towards both Emma and Neil and I feel that my personal life experiences influenced me because I could really realize with them both. However, I realised that I am only human and that as long as I recognise the impact of counter-transference then I can use it positively as my self awareness of the fact that the process is occurring will enable me to address and challenge my own thoughts, feelings and responses.To conclude, I have been able to highlight my learning over the last two and a half days, both personally and professionally. This has enabled me to look at the areas that I am good at and the areas that I can reform on. I have been able to look at the quality of the care I have given patients and considered what I have achieved, how I felt, how I could have done things breach, what was successful and unsucce ssful, what issues influenced me and what understanding I had of the experience. I have also been able to recognise my role as a good example for mental health nursing and how I can promote it to other healthcare professionals. I have also identified the value of the role of my mentor in helping me to develop as a nurse. I will use the insight and understanding from these experiences to benefit my future practice and the care I provide for patients. implement PLANWord Count 1086What are my goals?My mentor and I discussed the areas that I want to improve on. We identified that my stronger points are common sense, logical approach and practical ability in terms of things like risk assessing and problem solving. I am also competent in the building of a therapeutic relationship, utilising a humanistic care philosophy, person centre approach, empathy, genuineness, unconditional positive regard and honest. I also have a good knowledge in respect of mental health promotion, anxiety manage ment, basic counselling skills, understanding of the rudiments associated with nursing, assessment and communication models and the basic principles of psychotherapy. I feel I have come a long way in two and a half years and have accomplished a lot.However, there are areas that I recognise that I can improve on and I am happy that I can address these as I hope this will improve my learning, skills and competency as a nurse in the future, providing better patient care. The areas I need to gain more knowledge and experience of include understanding the religious, cultural and spiritual needs of the patient and how this impacts on their care and quality of life, recognising and working with counter transference and my magnetic dip to feel the need to over cherish patients as this does not help the patient to utilise alternative, be responsible for themselves or empower themselves. I want to continue developing my own self awareness through self reflection. in the long run I wish to develop my donnish abilities and to train further so that I have more knowledge.Why have I chosen these issues?I have chosen to improve my knowledge and understanding of patients religious, cultural and spiritual needs and how this impacts on their care and quality of life, because by doing this I hope to be able to address their needs holistically. To successfully undertake a thorough assessment the healthcare practitioner needs to identify the holistic needs of the patient, misfortune to do so would neglect the patients physical, psycho-social and spiritual needs (Stuart and Sundeen 1997.) At present I feel I am unable to fully comprehend or provide best care as I feel I lack the skills and knowledge to do so.I also wish to further consider the impact of counter transference and my tendency to feel the need to over protect patients. I feel that if I gain more understanding and recognition of how counter-transference can change my reaction to a patient then I will be able to ad dress it and have more control and choice over my nursing and my responses. In practice, I have experienced strong emotional reactions to some patients, perhaps because I could identify with some of their issues. However, this can result in my wanting to over protect them, which may disempower them, and this is unhelpful. Different characteristic in patients can influence the emotional reaction of the nurse (Holmquist 1998). I need to be able to recognise these characteristics in the patient and be self aware of the way I am responding.I want to continue developing my own self-awareness through self-reflection, as I will need to be able to exercise main(a) and expert judgement as a qualified nurse. The ability to use self-reflection as a learning tool to enough self-aware will help me achieve this. This is a view supported by (Wong 1995). Boud, Keogh & baby-walker (1995) believe self reflection is an important human activity, inseparable for personal development as well as for the professional development of the nurse. By being able to mull over my experiences will help me challenge my beliefs and doings as an individual and a nurse. Finally I wish to develop my academic abilities and to train further so that I have more nursing knowledge. pose alone is not the key to learning (Boud et al 1985). I wish to gain further qualifications so that I may further my career and knowledge, as this will provide a sense of acquisition and fulfilment for me.How am I red ink to achieve my goals?I intend to develop my portfolio and keep an open reflective daybook (Richardson 1995) to show evidence of my learning and prepare for my PREPP. Portfolios are seen as a parade of information and evidence used to tote up what has been learnt from prior experience and opportunities (Knapp 1975), and acknowledges professional and personal development, knowledge and competence, providing nurses with evidence of their eligibility for re-registration every triad years (NMC 20 02). I believe maintaining my portfolio helps with ones self-assessment and will help me to develop my strengths, plus identify and critically quantify my weaker areas, this is a view supported by Garside (1990).However in contrast milling machine & Daloz (1989) suggest there is no evidence to suggest that self assessment contributes to enhance self awareness. A barrier to ones ability to self-reflect may be time constraints and socio-economic factors such as high staff and management turnover, low staff morale and staff illness (Bailey 1995) I hope to overcome this by being a supportive team member to my colleagues and maintaining a positive mental attitude. I am happy to work on my portfolio and diary in my own time as I think it is a valuable learning tool.I will use my preceptorship, learning in practice, observation in practice and clinical supervision to help achieve my goals. coefficient of reflection on action is considered to be an essential part of clinical supervisio n (Scanlon & Weir 1997). I will continue to use Gibbs (1988) Reflective Model to help me develop my learning through reflection.I will need to feel confident that by sharing my portfolio, diary, reflection or seeking advice via preceptorship and supervision that this will not reflect negatively on me and effect my ability to feel able to trust my mentor. Students and staff sometimes feel unable to fully express themselves or belittled by the power relationship if supervision is not in a trusting relationship feeling it could be open to bias, personality clashes, counter-transference or could disadvantage them in terms of career development (Richardson 1995 Jones 2001). However, good clinical supervision enables nurses to feel better supported, contributing to safer and more effective nursing (Teasdale 2001, Jones A 2001).I hope to continue with life long learning and would like to be able to study for a degree in nursing. I shall do this by apply for funding once I am employed a nd hope that whoever my employers are they will support me in my goal to become better qualified.ReferencesBailey J (1995) Reflective Practice, Implementing Theory, treat Standard, Vol 9 (46) 29-31Baillie, L (1996) A Phenomenological Study Of The Nature Of Empathy, journal Of modern treat, 24,6, 1300-1308Beck A T (1986) Hopelessness As A Predictor OF Eventual self-annihilation, story Of The sassy York Academy Of scientific discipline, Vol 487, 90-96Beech P, Norman I (1995) Patients Perceptions Of The Quality Of psychiatrical care for Care Findings From A Small overcome Descriptive Study, journal Of Clinical treat, 4, 117-123Boud D, Keogh R, Walker D (1985) Reflection Turning attend Into Learning, London, Kogan Page,Boyd E M, Fales A W (1983) Reflective Learning Key To Learning From Experience, ledger OF Humanistic Psychology Vol 23 (2) 99-117Chambers M, psychiatric and psychogenic Health breast feeding Learning In The Clinical 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