Graduate Certificate Nursing Education Learning of Anorexia

Graduate Certificate Nursing Education

Learning of Anorexia Nervosa & Handling Its Patients

Final Learning Report

DESCRIPTION OF OBJECTIVES & THEIR STATUS

Drafting a learning contract and adhering to it along with constant support from my supervisor, was an effective activity which constituted of four weeks. every objective had a milestone plan and necessary measures which were required to be taken for achieving them. Self-expectation after reaching these goals was also documented in order to have a clear picture of my proficiency level in the developing knowledge of Anorexia Nervosa after this activity. The primary objective was to have clear understanding of Anorexia Nervosa, its causes, symptoms and possible treatments. Furthermore, second main objective was to deal with patients having this disorder and their families. These two major goals encompassed the rest. Through reading of the concerned topic were performed and were brought into practical application. Furthermore, efforts were made to achieve a certain level of interpersonal skills required to be proficient as a nurse. Demos, visas and quizzes were given to the supervisor various times and logs of these activities were also maintained to ensure documentation of every activity. At the end, a written testimonial was shared by me supervisor for achievement of the objectives set as per learning contract.

INTRODUCTION

This report is based on the learning contract shared by me with my senior, SUPERVISOR NAME XXX, on 26th May 2012. The report entails the objectives that I have and the description about how they are achieved. Each objectives is discussed one by one and contains the details of my understanding about the subject matter.

DESCRIPTION OF OBJECTIVES & THEIR STATUS

OBJECTIVE 01:

My first objective was to increase some background knowledge about the a variety of substances clients use, as well as the medications they have taken earlier. For this particular objective, my expected outcome was to understand pertinent materials and be able to Ask questions to staff members and clients.

For this particular objective, the methods used by me were Observing my supervisor and constant debriefing with him. Furthermore, written assessments were part and parcel of it. This practice of constant observation and feedback was accompanied with constant readings of the concerned reading material which includes Journals and articles on Anorexia Nervosa. Given in the bibliography, are the details of various journals that I read about this particular syndrome, its symptoms and cures. This thorough reading along with the frequent question / answers sessions with my supervisor helped me out in gaining a clear understanding of AN (Fassino et. al, 2001).

Where this activity continued for four weeks, I was also involved heavily in the assessment of new and existing patients. Thorough observations of patients' charts and questions / answers sessions with them, helped in understanding the various stages of AN. Also, how different medicines and treatment methods are used at different stages of AN, was also the subject matter that I was concerned about and this particular activity helped my achieve my target.

For final evaluation of this objective's achievement, I had an hour long session with my supervisor which constituted of a viva session with him. Secondly, I was asked to analyzed the charts of few patients in this session and the correct answers proved that I have developed an ability of patients' assessment on my own. Furthermore, after this session, my supervisor instructed me to read and assess patients charts and answer patients' queries in his presence.

OBJECTIVE 02:

Improve information retrieval from the patients' chart was my second objective as mentioned in the learning contract. For the achievement of this objective, I took undertaking of reading more relevant literature and trying to perform patients' diagnosis in the presence of my supervisor. At the end of this activity, the outcome was to be able to extract accurate information from the patients chart and be able to give recommendations about the further treatment. For achievement of this objective, the role of the supervisor was to share the schedule which would help me prepare for charts review and determination of treatments. Also, frequent supervising sessions with the senior during which I could ask questions that I had during the diagnosis sessions, were also planned and executed.

This activity continued for four weeks. Along with reading the research materials regarding Anorexia Nervosa, I also took additional guidance from other seniors available as to how to understand and diagnose patients' current state correctly. While diagnosing patients' current stage while going through charts, I was instructed that I need to have complete understanding of the relevant terminology related to Anorexia Nervosa and also understand how each applies to different stages of AN.

For this purpose, I went through medical dictionaries available on web and institute's library and tried to understand their meanings and relevance with the stages of the syndromes. This activity was once again well-supported by the sessions that I had with my supervisor. For this particular activity, I had a session planned with senior on every 5th working day at the time assigned by my supervisor. A written test regarding these terminologies was taken at the end of fourth week. Results can be taken from my supervisor.

OBJECTIVE 03:

The third objective involved the risk assessment of the patients. For risk assessment, my objective was to be able to Extract information related to patient's current status by studying patient's chart and give recommendations for suitable plan, Understanding the relationship between Body Mass Index and the relationship between high risk and anorexia, performing physical examination with the specialists, Understanding the outcomes of the bold tests, and Understanding and evaluating the results of ECG (Golden et. al, 2008).

For this goal, I was required to Perform thorough readings about Anorexia Nervosa, understand its causes, symptoms and the relationship between the risk level and patients current status. Study case studies which will help me gain insight about what the level of Sodium and Potassium in the bold tests indicate about Patient's AN. Furthermore reading more about ECG and perform frequent analysis on its outcomes, Understanding the basics of SUSS, low core temperature and Taking frequent guidance from the supervisor, were the tools used.

For this objective, reading literature about the tests involved was a pre-requisite. Therefore, along with reading journals and articles about AN, studying more about its indicators as per the tests results was also required. For this purpose, I took out patients' histories as available in institutes records and perform a correlation between my understanding of the syndrome and the contents of their test reports. After frequent analysis, I was able to perform the risk assessment individually. For examination purposes, few reports were shared with me by my senior at the end of fourth week and I did the analysis in front of him. There were some errors in the initial viva; therefore similar activity was repeated after fourth day of first viva and as mentioned by the supervisor, the results were satisfactory.

OBJECTIVE 04:

Part of my leaning contract was to learn and display an attitude which involved taking enough initiatives during my employment as a nurse. Since I had Difficulty in showing initiatives, therefore To become an effective team member by knowing where I can assist them and what needs to be done without being instructed about it, was part of my learning a professional. The techniques used to exhibit this attitude was by Handling. The flow of patients without always looking for instructions and constant prompting.

For this objective, my efforts started with keeping a log of patients I handled individually on daily basis. This involved handling the flow of new patients as well as answering the queries of the old ones. Handling already admitted patients in the absence of my supervisor was another technique of showing initiative. To avoid any mistake, communication to the supervisor was done after answering the queries of the patients or performing their daily examination independently. Another part of showing initiatives was to ask for individual cases and nursing suits from my supervisor. Adding to the list of assigned duties not only helped me gain professional proficiency but also helped in getting rid of my hesitation which I had earlier while dealing with my seniors, patients and peers.

The log which was maintained for this purpose was also shared with my supervisor on bi-weekly basis and nature of patients handled was also discussed. Furthermore, a session of question / answers was also conducted to ensure that this particular activity is also helping me in getting insight of Anorexia Nervosa. Furthermore, I was assigned with the task of conducting orientation for new nurses and I was also appointed for giving preliminary orientation session of Anorexia Nervosa to the students of first year batch.

OBJECTIVE 05:

Another objective of learning contract was to understand adult learning theory by enhancement of experiences given by nursing experiences and take personal responsibility about it. The basic outcome which was expected after achieving this objective was to Have thorough knowledge of the subject matter which will supported by giving right answers of the concerned questions.

For this purposes, researches involving adult learning theories were studied. It was established that Typical adult learning theories encompass the basic concepts of behavioral change and experience. From there, complexities begin to diverge specific theories and concepts in an eclectic barrage of inferences. Furthermore, there are "four invariant stages of cognitive development that are age related" (Merriam & Caffarella, 1999, p. 139). According to the authors, Piaget contends that normal children will reach the final stage of development, which is the stage of formal operations, between the age of twelve and fifteen. According to a literature review by Owen (2002), humanism, personal responsibility orientation, behaviorism, neobehaviorism, critical perspectives, and constructivism are all important facets of, and perspectives on, adult learning theory. The most common treatments of the research of these areas of self-directed adult learning are learning projects, qualitative studies, and quantitative measures. Collins (1991) explores adult learning as the interactive relationship of theory and practice. In basic terms, the adult learner studies a particular theory and then puts it into practice when presented with the opportunity to do so. Thus, the understanding of an adult learning theory can prompt practice and practice can prompt adult learning theory revision.

The given literature also helped me establish that there is a limited coherence found in between these learning theories; therefore in order to identify these differences and gain clarity on them, queries were shared with the supervisor who cleared them well. Furthermore, while analyzing the state of the patient, effort was made to apply adult learning theories. Differences between patients at different chronological stages were analyzed and compared with the teachings of these theories. For further leaning, behavior differences between colleagues were also analyzed and discussed with the supervisor.

OBJECTIVE 06:

This objective surrounded around describing the importance of dietary plans to the patients. Since Anorexia Nervosa is a highly dysfunctional and hazardous disorder which forces patient to reach the state of starvation, it was highly difficult to convince the patient regarding restoring a healthy diet . The first step in treating patients with AN is to establish a good therapeutic alliance with the patients by respecting their realities and their rhythms of change, which are very slow because of their absolute denial of their thinness (Colton & Pistrong, 2004).

Also, the impact of chronological stages was also considerable while performing this activity. Since AN appears usually during adolescence which itself is a complex biopsychosocio-cultural period causing mental distress. Part of achieving this objective was to understand the causes of this syndrome which can vary in different patients. Furthermore, understanding the cultural differences that patients had, was also an important factor in handling such patients (Couturier & Lock, 2006).

Efforts were made to develop suitable interpersonal skills for achieving this target. For this purpose, reading of the suitable reference material was done to acquire suitable knowledge about handling such patients. Furthermore, while orientation was required to be given to these patients, I did review exercises with my colleagues and demo orientations were given to them. Initially, this exercise of orientation was performed in the presence of my supervisor to ensure that hazards of AN are communicated well to the patients. Feedbacks from the supervisor were taken at the end of these sessions which were documented in the log maintained for this purpose and its findings were considered while preparing for the next one (Fox, 2009).

One important part of this objective was to handle patients from different cultural backgrounds. Medical counselors and nurses while treating patients from different cultural backgrounds may face a lot of difficulties. There is a clear distinction between what a mental illness can be in the eyes of science and how it can be seen by the patient. This brings responsibility on the shoulders of the counselor to bring the patient and science on the same page. And while doing so, counselors may have to face number of difficulties. This cross-cultural difference may develop a discrepancy between the views of the medical practitioner and the patient. For this purpose, I studied the concept of cultural competence. This required to develop an understanding that first of all, the nurse is expected to develop and exhibit a deep value for cultural diversity. Being aware of the dynamics when people from various social and cultural backgrounds correspond to each other, will help the burse understand the behavior of various cultures towards each other. Secondly, the nurse is expected to move away from theory and take practical measures to meet the diverse needs of the patients (George, 1997). Thirdly, it is important for the counselor to conduct cultural competence self-assessment time and again to gain insight about his competence level (Betancourt et. al, 2003). Furthermore, language barriers and communication styles, are the factors which are important to be considered before actually initiating the treatment. Furthermore, where families are part of the counseling sessions, a family member who can act as an interpreter may appear helpful. However, this does leaves a room for the counselor to gain familiarity with the key terms of the particular language so that the patient feels comfort. Furthermore, mode of communication should also be considered during communication.

Having sound knowledge of the values of the patient is also of significant importance. Gaining familiarity with negative cultural or ethnic stereotypes, male-female roles etc., interactions between individuals and general family cultures, is also part of acquiring cultural competence. Where the nurses are expected to be well-versed with the application of basic behavioral theories, familiarity with the RESPECTFUL Counseling Cube, will prove equally beneficial. This multidimensional cube gives thorough consideration to religion and spirituality (R), economic class background (E), sexual identity (S), psychological maturity (P), ethnic and racial identity (E), chronological stage (C), trauma (T), family background (F), unique physical characteristics (U), and geographical location (L) (Dander & Daniels, 2001). Gaining an understanding of these areas helped me greatly to gain an understanding of patients background.

By the end of fourth week of this activity, a list of patients who were handled by me independently was maintained and their current diet intake was analyzed. The outcomes were shared with my seniors and it was established that out of fifteen patients, twelve showed a healthy diet intake which established the achievement of this target.

OBJECTIVE 07:

Having discussions with family to turn the treatment into family centered care, was another task which required special effort by me (Carlton & Pyle, 2007). It is an established fact that family care can increase the benefits of the treatment exponentially. However, there is always a higher probability that the patient does not have suitably cordial relationship with his family members, or the family members are not willing to invest time and effort into patients' treatment (Ma, 2008). Overcoming these barriers required exceptional interpersonal skills as it was directly related to altering human behavior. sharing patient's state with his/her relatives and then gaining their support was the core objective of this activity (Dallos & Danford, 2007).