In order to full fill the requirements for learning outcome (LOC) 6 I will compare my first placement with my experiences from following placements. This will allow me to reflect on my progression as a paediatric nurse.

Schon (1991) identified 2 sub categories of reflection, reflection on action and reflection in action and I have decided the most appropriate method of reflection for the purpose of the LOC, is reflection on action.

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This is reflecting after an event has happened or in my case, my progression from the beginning of my training until now.

My chosen tool of reflection is Gibb's reflective cycle (1988). Kitchen (1999) describes this model as useful for the less experienced reflective practitioner. Ghaye and Lillyman (1997) also have supporting favour of this model as it aims to incorporate feelings, knowledge and action in one cycle of learning. I, therefore, feel this is the most appropriate model for me and as Johns (1995) explains, the purpose of reflection is to promote the practitioners understanding and learning about his/her lived experience. This model will therefore help me to achieve this type of understanding and learning from my past experiences.

Description

The first experience I remember was the handover from the night staff to the morning staff. I can remember thinking the language used could not be English. I had no idea what they were talking about!

I followed my mentor around like a 'lost sheep' and felt very nervous, as everything was unfamiliar and new. I was curious about this new environment and asked lots of questions in an attempt to gain an understanding of what I was suppose to be doing. However, I went home believing I had learnt nothing and felt very frustrated, confused and extremely tired from trying to absorb so much new information.

As the weeks passed and I settled in, I began to relax and I started to feel like I fitted in on the ward. Every day brought with it, new experiences and with each new experience, came the feeling of apprehension.

However, I got on very well with the staff and I had many new learning opportunities, which boosted my confidence.

There was one thing that frustrated me the most and that was doctors. They made me feel intimidated and I became scared of them. This did not improve as my placement progressed.

I, however, interacted well with patients and their families and thought this may be the result of having my own children and knowing how to talk to children and what interests they may have.

By the end of the placement my clinical and cognitive skills were beginning to take shape. I was becoming familiar with the nursing terminology and how the ward was run. I also started to recognise how theory was integrated into practice, it was all beginning to make sense.

When I reflect back to my first placement and compare myself from where I was to where I am now, I can see a very different picture. I feel I have become a lot more confident and have learnt a lot more knowledge about nursing. The knowledge I have learnt helps me to progress in new learning opportunities. I have found I am no longer scared to try new things and push myself where ever possible. I feel this is the only way to get the most out of a placement and also earn respect from the other members of the multidisciplinary team.

My fear of Doctors is still prevalent but I no longer shy away from them. I have started to make a conscious effort to initiate a conversation or ask them questions.

The nursing language is a lot more comprehensive; however, each new placement brings with it more unfamiliar terminology that I have to learn in order to understand what is being said. Also, each placement, so far, has been in a different area i.e. medical ward, surgical ward etc... This means, I have to start at the beginning of the learning curve on each new placement, as each one focuses on a different aspect of care.

However, although they may be different wards, there are still similarities of care that I am familiar with i.e. drugs, writing in cardex's etc... This prevents me from feeling totally lost.

I am on a specialised unit at present and although it is not an area of nursing I want to go into, I still work every shift to its maximum. Through having this attitude I have found I have gained the trust of the other nursing staff and through this I have been given my own patients to look after. It is, therefore, up to me to make sure they receive the care and attention that is required; ask qualified staff if I am unsure about any thing; handover my patients to the next shift; write in cardex's and reassure parents and explain the aspects of care their baby is receiving.

This responsibility has made me think for myself and use theory learnt from policies, the ward philosophy and other literature. I have even become aware that I am 'reflecting IN action'. This is brilliant, as I am very conscious that if something does not go quite right and the reason why is pointed out, I know how not to do it next time. For example, I tried passing a nasal gastric tube but my positioning was wrong and therefore would not go down. My mentor explained what I was doing wrong and the next time I tried, bearing in mind what I had been told, it went down easily!

As can be seen I have come a long way from my first placement, I feel I have gained more knowledge and experiences' which have enabled me to develop a professional attitude and become a lot more confident in my clinical practice.

Feelings

My first placement, during handover, I felt totally overwhelmed by the unfamiliar, long and complicated words being used. I thought I would never know their meanings and could not see myself ever using such terminology.

I remember feeling frustrated, as the staff knew I was a first year student on my first ever placement, but nobody was explaining what they were talking about.

During the first few weeks, I felt like I spare part, constantly following my mentor around, not knowing what to do. This made me feel totally inadequate and apprehensive about everything. I tried to resolve this by asking lots of questions in order to gain knowledge so; perhaps I could do something useful.

The frustration and confusion, at times, made me feel very emotional, as I really wanted to fit into my role as a 'learning nurse'.

Akinsanya (1987) found that in general student nurses' may feel this way due to a lack of knowledge and preparation.

I tend to agree with this, as I really did not know what to expect or what was expected of me.

As my placement progressed I worked under different mentors and was given many learning opportunities to fulfil my role as a student. This gave me an enormous sense of self satisfaction which boosted my confidence.

My frustrations stayed with the doctors, I tensed up when a doctor even glanced my way. I started to avoid them; they made me feel inferior and not worthy to be in their presence. I thought I would become use to them, but I did not. I did not know how to interact with them which left me feeling vulnerable.

My confidence in other areas of the placement, however, was creating a developing 'new me'. I felt a sense of achievement at the end of each shift and I felt I was becoming a valid member of the team.

However, I still go through the initial apprehension and bewilderment at the start of a new placement which brings the familiar feeling of feeling 'lost'.

Abraham and Shanley (1981) emphasise that students starting a new placement frequently feel these types of emotion as they are not familiar with the ward routine.

However, I have found I tend to settle into the ward routine quicker than I previously did. I feel excited at the prospect of trying something new for the first time. However, I have to tell myself to slow down in new situations, as I need to reflect on my new experiences, in order to make sense of them (Mezirow, 1981).

The responsibilities given to me on my current placement (my own patients) has given me a huge confidence boost, not only do I feel worthwhile, I feel trusted. This has helped me to become more efficient in putting theory into practice and has had positive effects for me as I am realising how important reflection is and the effects it is having on my personal development.

Good Points.

As I reflect over my progress as a student nurse, I have learnt about many aspects of care and how the psychological well being of patients and their families is as equally important as the medical treatment they receive.

I feel my recognition of how evidence base implements practice, is enabling me to develop my clinical skills. This is therefore, allowing my confidence to grow and I am able to apply myself to new situations, with the willingness to learn.

I have come to realise that it does not matter if something does not go quite right the first time and this is due to my developing reflective approach, regarding new situations. I have learnt how to take constructive criticism on board and apply it to a similar situation next time.

I feel I am able to ask questions, in order to gain knowledge and understanding of a clinical procedure. If I still feel apprehensive, I have found the wards have a range of books, plus their policies and procedures, available for me to read. Therefore, I can reinforce what I have learnt on the ward, which enables me to make sense of a procedure and I am able to carry it out next time with confidence, that previously I would not have had.

I like the way I feel at the end of my placements, as I have become familiar with the ward's routine; the staff and have developed a deeper understanding of a different aspect of care.

I can also recognise the limits of my abilities and am mature enough never to jeopardise this. I have learnt that although I am not accountable for my actions, regarding the NMC code of conduct, I am accountable for my actions to the university and the law. This is one of the reasons why I am constantly asking questions and ask for supervision when I feel uncertain about any procedure.

Bad Points.

Although I feel my confidence is developing, I still tend to be hard on myself which frustrates me.

When I am in a new situation I lack knowledge and understanding and I find it hard to implement my previously learnt skills. This adds to my frustrations, as I know I am capable and this temporarily sets me back.

When I reflect back over the situation, I realise that this frustration is only short term and once I become familiar with a new experience, I can become involved and feel part of a team.

My initial feelings at the start of my training, of feeling useless are typical of my nature, as I tend to want too much too soon. This, again, causes unnecessary confusion.

Analysis.

My initial feelings of bewilderment in the first handover I had ever experienced were due to my lack of knowledge and understanding. This combination was and is the cause of all my initial feelings as I get to know the staff; ward routines and new skills.

I feel I have been hard on myself and should accept these feelings rather than getting frustrated with them. They are, according to Miles (1989), natural feelings and only time and experience will diminish them.

I felt that members of staff (on my first placement) should have explained things to me. However, on reflection, it was down to my own initiative to ask the questions in order to gain the answers to expand my knowledge. This I did and eventually my confidence began to grow as I learnt the meaning of the 'alien' terminology and gained new clinical skills.

When I try to make sense of why I felt totally intimidated by the doctors, I maybe feel it was, according to Skinner (1987) a conditioned response, from me. I initially felt uncomfortable in their presence due to their status and because I retained that feeling, each time I saw a doctor, the feeling returned.

However, I am becoming more confident with them and realise I must overcome this fear as I will, in the future, be working closely with them.

I also realise that I need to avoid feeling inadequate in unfamiliar situations which sometimes causes me to rush in, as I am so eager to learn. I recognise that I do have a compulsive nature and feel I need to curb this eagerness in order to absorb what is happening in a situation.

As already stated, I need to make sense of a situation first before rushing in 'blind'.

I have acquired more knowledge and confidence since I have recently been given my own patients and responsibilities. This has helped me to stop doubting my capabilities and reflect on my experiences positively.

I have learnt how to analyse a situation with a view to improve it next time, this I feel is a sign of maturity along with physical and mental growth - which I did not have at the beginning of my training. I am starting to realise that it is impossible to know everything and my knowledge and skills can only improve over time.

Conclusion

I feel at the start of my training I should have read more on reflection and used the internet as a source of research to find out about other student's experiences. I have since found information sites that actually give similar encounters of other students' experiences of unfamiliar territory. This may have put me at ease instead of thinking I was totally incompetent.

I also could have read literature from books and journals, in order for me to familiarise myself with drug names; nursing procedures and medical conditions. This may have alleviated some of the pressure I was putting myself under.

I also could have devised a learning diary, so I could look back over the weeks and see for myself the progression I was making. This may have boosted my confidence, as I initially thought I was not learning anything, however, when looking back, I obviously was.

The problems I faced with the doctors could have been made easier if I actually stood up to my fear and perhaps pushed myself to go with them on ward rounds.

Since my first placement I have become a lot more professional about this, I still dread them, but I act in a much more professional manner, after all they are only human.

In general I should not have expected too much too soon. I have come to the conclusion that I can only learn things properly by observing and listening before attempting to practice a clinical procedure. I have begun to appreciate this now and tend to take a step back in order for me to take on board what is being said and done.

Action Plan

If I could start my training over again I think I would prepare myself for paediatric nursing by reading available literature. This would enable me to gain some background knowledge, in regards to the NHS and government guidelines regarding this specialised area of nursing.

I have admitted to myself that I went into nursing without realising the enormous pressures that come with it and because of this I have been very critical of myself.

I would also control my impulsive nature which I am in the process of doing. It has taken me a while to realise that 'Rome was not built in a day' so to speak. I cannot possibly know everything and by acknowledging this, I am not getting as frustrated anymore as I use reflection to analyses situations, in order to put events into perspective.

Apart from those two issues, I would not change anything else; I feel I am finding out who and what I am and by using this reflective cycle I can see that my personal progression is constantly moving forward.