Competency through Integrative Learning

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           Integrative learning is a topic that was introduced to me through my experience with Graduation with Leadership Distinction (GLD). This refers to how someone can be educated in different ways since there are multiple avenues of learning to obtain knowledge. Extra studies through research, experiences, and comparing/contrasting knowledge to other topics are foundations of integrative learning. It is important that students, in my opinion, consider the idea of integrative learning. Despite that this concept was introduced to me through GLD, it applies to students in any discipline of study. Being competent leads to proficiency and nursing students should strive toward this, since competence can equate to excellent care. The amount of knowledge that is available when incorporating integrative learning can lay the foundation for becoming a more equipped and experienced nurse. While proficiency applies to other professions, it is especially true for nursing. There is a significant amount of effort with becoming competent because of the large skill sets required to have a comfortable routine with consistent care.

            Competency is achieved by reaching a level of experience and skill to adequately perform care for patients. Taking the initiative to learn has built an inner level of confidence in me that would be missing if I did not pursue other ways to learn. I feel that incorporating my faith into practice is a unique way for myself to identify the best ways to provide for patients. This additional study and education helps to not only strengthen my faith but also permits the patient to receive great care at the same time. Integrative learning demonstrates that nurses can learn more and become a better employees based on the competency ladder outlined in the From Novice to Expert concept by Patricia Benner. This concept was something I researched out of class after the interest I gathered from a Clinical Reasoning nursing course (NURS 314) I was enrolled in the Fall of 2017. According to Benner, there are five levels or “rungs” to the competency ladder in order of experience. The levels include novice, advanced beginner, competent, proficient, and expert. The main goal is to achieve status of a competent nurse, but there are two more levels that follow. Becoming an expert nurse is essentially a title that is given after many years of experience but searching for more knowledge through the integrative learning can help the progression.

           In my NURS 314 course, I was introduced to critical thinking concepts. Considering competency, to think critically and to expand our knowledge beyond what books tell us, helps to identify the troubles and barriers to learning that many can experience in their careers. When a nurse can incorporate tools for critical thinking and using proper nursing judgement to solve patient complications, this can produce effective results and result in competent care. Critical thinking requires extra efforts to find solutions when there is a problem. I feel this is a definitive component to integrative learning. The extensive awareness of a specific focus, like nursing, promotes opportunities to perform successfully in the career. This new way of learning helps me to develop the skills I will need to pass through each competency level as a nurse without facing consistent hardships of trial and error.

            I have been told by nurses in my clinical rotations that it can take up to a couple of years to truly get the routine and experience needed to gain recognition of “proficiency” in nursing. It takes initiative and motivation to develop proficiency for nursing care. At first, I felt that gaining employment as a nurse tech at the hospital was all that it would take, but I have learned that this was only a piece to the puzzle. After working as needed at the hospital and becoming familiar with the clinical environment, I could evade the nerves deriving from just being in a setting like a hospital. Communication was required from me when I worked as nurse tech since I interacted with every patient on the unit I was assigned. All of this helped me gain familiarity with the simple skills beyond the physical skills needed for patient care. Being a traditionally shy individual for most of my life, I relied on God to help me develop the therapeutic skills I felt I needed to talk to patients. God ultimately helped me produce confidence in my communication skills  and allowed me to use them in an effective way. Sometimes having therapeutic communication can be just as important as providing medication for the physical issues since focusing on the emotional well-being is critical.

           I participated as a student nurse in a free flu shot clinic on the Lancaster campus with a member of the nursing program faculty, and clinical instructor, Dr. Leigh Pate. In this beyond the classroom experience, I worked with Dr. Pate and other nursing students by traveling around campus and consenting students for free flu shots. In addition, I had the opportunity to administer the flu shots. When I was a freshman and sophomore at USCL, I participated in research with Dr. Courtney Catledge, the director of Lancaster’s nursing program. This initial interest in research led me to assisting with another research study on campus. As a part of helping with this study, I also was required to know how to properly consent students before they participated in the study. Both beyond the classroom experiences taught me that when I take initiative to learn and seek further knowledge, my potential for competency expands. When I learned about consenting from the involvement in research on campus, that helped me to understand the techniques for obtaining consent from patients regarding medical procedures. I have noticed that the social aspect is more fluid and working with the subjects in research has translated to nursing care. There is a huge correlation to the integrative learning through these two experiences that leads to competent care.

           In my Nursing Care of Children (NURS 425) course, we practiced simulations in our lab on the Lancaster campus. After these experiences, I was able to practice my skills in the Simulation Lab in Columbia with paid actors. This time not only was I focused on the care for the patient, but I also had to incorporate the use of communication to the family members of the “patient”. The young adolescent patient was a mannequin that was undergoing an asthma attack, so I (along with three other students) had to find the causative agent and treat the patient. The patient also had a mother in the room (the paid actor), who was in distress.  Therefore, as a team, we had to not only treat the patient, but also console the mother.

           Applying these skills in simulations is the next best thing to actual care of patients. This simulation experience served as a skills check-off. For the flu shot clinic, however, the skills required to perform the injections were new to me and provided me with a more of the hands-on experience that I desired. Working with human subjects in research has taught me that I am able to detect the quality of care I have been molded into providing. After seeing the positive expression from patients and their receptiveness to my performance motivates me to keep learning. While I am still on the low rung of the competency ladder, demonstrating the skills and seeing early success gives me great encouragement. I now know that it is not be enough to practice on a mannequin or be verbally told how to perform skills such as these. Integrative learning is key in many different areas of nursing, and despite my early concerns of applying skills on real patients, stepping up to learn these skills has helped me in the long run. Applying my faith will also help me understand more ways to approach therapeutic communication and providing competent care as I progress as a registered nurse.