Practicum In Nursing Profession.

INTRODUCTION

Nursing teams from health services that receive practicum students in their nursing management practicum programs – formally offering nursing practice activities –, are essential for professional training, as the support and recognition of these professionals can help students face challenges while progressively assuming the role of a nurse. In this logic, it is important to have people with organizational profile characteristics, particularly in a university hospital that integrates teaching, research and health care, aiming to obtain quality in care provision and in the learning-teaching process.Practicum In Nursing Profession.

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Concerns about these aspects arose from the experience of the authors in their teaching activities for the nursing program of a public educational institution located in southern Brazil. It specifically refers to the practice under the Nursing Management program (180 hours), in its eighth phase, corresponding to the semester before the last semester of the program, according to the syllabus in force on the occasion of data collection. An initial theoretical module about management themes prepared the students for practice, offering two options for them to choose from: primary health care or hospital health care. This study focused on the latter, and the practicum program took place from Monday to Thursday, from 7 am to 1:15 pm.Practicum In Nursing Profession.

Based on the direct and indirect teaching supervision in medical-surgical units, concerns about the nursing team that receives the practicum students arose for discussion. On the one hand, the lack of attention, patience and empathy shown by the nursing team is a barrier during the practicum programs, making students insecure and significantly affecting the learning process, a condition already identified in a prior study. International studies suggest that positive relationships between nursing professionals and students foster knowledge sharing and ensure a successful learning process and quality training.Practicum In Nursing Profession.

On the other hand, this issue has to be addressed, as the insertion of students also affects the dynamics of nursing teams, forcing them to reorganize their own work to provide attention to students, without affecting patient care. It demands from nursing professionals preparation to deal with different student profiles and interpersonal relationships, versatility skills, patience, openness to dialog and the ability to plan, delegate and share decision making. Although other actors are directly or indirectly involved in this process, this study focused on the impact of nursing management practicum students to nursing teams that receive them in medical units of the hospital, seeking to detail some aspects of this topic. Another recent study provided an overview on practicum in the teaching-learning process, from the perspectives of different actors, such as professors who supervised students during nursing management practices.Practicum In Nursing Profession.

Therefore, considering that the relationships between practicum students and nursing teams significantly influence the learning process and have an impact on the work process on which care quality relies, the following question arose: What do the nursing professionals of a university hospital think about the insertion of students in their work routine? The objective of this study was to learn the perceptions of nursing professionals of a university hospital regarding the interactive process with nursing management practicum students m, during the program practices. This article is the result of a master’s degree dissertation for the Graduate Program in Nursing of the Federal University of Rio Grande do Sul, originally entitled “Perceptions of nursing professionals of a university hospital on the integration of trainees into the team”_{.Practicum In Nursing Profession.}

This study is expected to awaken reflections on best practices when considering both the training of future nurses and the teams that receive practicum students, without overlooking care quality during practicum programs.

Regarding the focus of this investigation based on the Pichon-Rivière’s theory on Operative Groups, which explains group phenomena and shows that a group can be mobilized to work operatively. In this perspective of group dialectics, a group is defined as “a limited number of people, connected by time and space, who coordinate their actions by a mutual internal representation, which proposes, either in an explicit or implicit manner, a task that constitutes its purpose”^(9:242).Practicum In Nursing Profession.

A task, in this perspective, has two dimensions: the explicit refers to the objective that drives the group, that is, something that is conscious, such as a performing a job, making a change or studying; and the implicit, which is characterized by basic anxieties caused by the attempt to reach a goal, which can often be an obstacle to such achievement. Both conditions have been highlighted in other studies. Every group, when performing one task, presents a lower or higher degree of resistance amidst basic anxieties caused by fear of loss and attack. When not properly resolved, the fear to lose stability (power, space, recognition) triggers depressive anxiety and fear of attack in an unknown situation, feeling apprehensive about opposite opinions and reprehension from other group members, leading to paranoid or persecutory anxiety. With the resistance that develops, individuals involved face psychical and emotional barriers called epistemological obstacles, which interfere with one’s perception of reality, and do not allow to distinguish what is real from what is imagined.Practicum In Nursing Profession.

It should be noted that such obstacles are experienced by all group members: nurses, nursing technicians and practicum students, but each of them experiences these situations in a particular way, with different levels of intensity and meanings. At first, the nursing team may be resistant to the insertion of students, assuming they will destabilize and impact their status quo, as they require attention and involvement. On the other hand, the students, when facing the challenges of a new context, may also feel mobilized by the needs of patients and the expectations of the nursing team regarding their performance. However, in a dialectical perspective, this situation can be overcome, as there are moments for pre-task, task and project in the group process.Practicum In Nursing Profession.

In the pre-task period, defensive techniques prevail, driven by basic anxieties, in order to postpone the elaboration of the fear of loss and attack. The task consists in approaching and developing anxieties, rupture of stereotypes and incorporation of thinking, feeling and acting, on the movement toward goal achievement. The project results from the task and allows the group to plan for the future. It is at this moment that students and nursing professionals are able to interact and establish a joint work project aiming to meet the healthcare needs of patients who are under their supervision. However, in the dialectical understanding, it is a movement forwards and backwards in which the group oscillates among advances, setbacks and new advances, a move that supports the qualitative leaps in the theory-practice development.Practicum In Nursing Profession.

When postulating this logic, the group is assumed as a model of interaction that involves the members in a two-level integration: the subject’s vertical condition and the group’s horizontal condition. Verticality is related to the life history, experiences, individual aspect of each member; and horizontality refers to group sharing, the common denominator that unifies it.Practicum In Nursing Profession.

Therefore, the operative group is considered an important framework to explain aspects that are inherent to the interactive process of nursing teams with students, which provides a critical understanding of their reality, based on concrete experiences.Practicum In Nursing Profession.

In this case, following a medication overdose with Benadryl in a bid to commit suicide, a male patient aged 14 years is admitted into the Intensive care unit. This happened after the parents of his girlfriend claimed their daughter was still young to date and that the patient claimed he could not survive without her. The parents of the client are divorced and the mother says that the father of the client does not have any physical custody of the 14-year-old. Practicum In Nursing Profession.The father also requests the hospitalization of the son, whereas the mother wants the discharge of the boy. The mother behaves in a bad way and threatens the nurse if her son is not released.

I would oppose the client’s voluntary involvement on the grounds of this situation because he is a threat to himself. I would also seek the best interest of the boy, which would be to examine him and provide advice that is ideally given in an in-patient context. In addition, if he is discharged without efficient oversight, he may hurt himself or be a threat to anyone else (Betz & Boudreaux, 2016). He may, for example, seek another suicide or commit murder for a contrary view to the girlfriend’s parents.Practicum In Nursing Profession.

My State Laws on Involuntary Commitment

According to the Florida Mental Health Act, a person is entitled to be admitted and assessed involuntarily. A law enforcement officer, doctor, a mental health professional, or a state judge can mandate the involuntary commitment (Celso, Pracht & Cuffe, 2015). However, compelling evidence should be given that the person has a psychiatric illness or poses a threat to himself or others and often neglects himself. After being deemed medically healthy by a medical practitioner, the person may be admitted for up to 72 hours (Celso et al., 2015). The Florida Mental Health Act specifies that because the patient is a threat to himself, he must be entitled to an involuntary commitment. Additionally, proof should be given to prove that the client threatened to kill himself (Celso et al., 2015). In this scenario, the proof involves Benadryl medication and a suicide note claiming that without his girlfriend, he could not stay alive, and that was the motive for wanting to commit suicide.Practicum In Nursing Profession.

Moreover, my suggestion of involuntary hospitalization has been verified by an analysis of the Florida state statutes on the involuntary commitment during a mental crisis. Because the patient was a threat to himself, the suggestion opposed the client’s voluntary commitment. This is in accordance with the Florida Mental Health Act, which specifies that if a person harms himself, he can be involuntarily committed.Practicum In Nursing Profession.

Actions If the Client Is Not Eligible for Involuntary Commitment

           I would inform the client’s parents of the advantages of accepting the offer for a voluntary commitment if he is not entitled to be involuntarily committed. This would be by presenting them with proof that suicide among adolescents in the US is increasingly rising (Zhang et al., 2015). I will also remind them that if they do not undergo proper care and therapy, people with a history of suicidal attempts are very likely to harm themselves or other people. Moreover, I would remind them of the medical measures that the boy would undergo while admitted and the advantages of each procedure for the client.Practicum In Nursing Profession.

I must first obtain informed consent from the legal trustee before instantiating care for the client in an event where he is not entitled to involuntary commitment (Betz & Boudreaux, 2016). I would offer treatment details, including the administered treatment, the explanation, side effects, optional treatments, and the projected therapeutic duration. Furthermore, I would educate both the client and the parents of the rights of the client, including the right to quality healthcare, privacy, and the right to protection of individual possessions.Practicum In Nursing Profession.