This assignment is a reflective account on nursing skills that I was assigned while on placement in an Organic Mental Health In-Patient Ward, presented with physical conditions and early stages of dementia. The three skills I want to base my essay on are Subcutaneous Injections, Physiological skill – limited to measurement of blood pressure, Blood Glucose Testing. A brief definition of reflection will be attempted and the importance of reflective account as a student nurse. The Gibbs (1988) reflective cycle has been chosen as a framework for reflecting on my chosen clinical skills as it is simple, clear, precise and incorporates all the core skills of reflection appropriate for first placement.
Debatably, the Gibb’s model is concentrated on reflection on action, but with practice it could be used to focus on reflection in and before action; allowing for description, analysis and evaluation of the experience to help practitioners or student nurse in my case to make meaning of experiences and scrutinise best practice. The model enables the practitioner to gain instant insights into areas that I have they been ignorant and made valuable judgement or conclusions to formulate viable action plans for future practice development. Jasper (2003) sees reflection as an act of promoting the development of autonomous, qualified and self-directed professionals. In other words, reflecting in this perspective is deliberately engaging a practice to enhance the quality of service delivery by the health professional.( practice is synonymous to improvement). When the student reflects, they analyse past incidents to promote learning and improve safety in care practice. Subcutaneous (SC) Injection Technique
The first clinical skill I want to reflect on is Subcutaneous Injection (SC), administered in the fatty layer of tissue under the skin, and this technique is chosen when continuous absorption of the drug is required, for example inslulin, Heparin , Fluids and other substances (Hunter, 2008) . I chose this skill as most of the elderly In-Patient that were admitted on the Ward also presented or diagnosed with type 1 or 2 diabetics and were prescribed insulin which they needed to take before meal. The first stage of Gibb’s model states that the event should be described, prior to my administering SC, I have watched my Mentor on several occasions administering SC injections, my mentor printed injection technique guidelines (NMC, 2007) for me to read and explain the procedure during our reflection time before she talked me through the process of giving SC injections and how to obtain consent from the Patient.
The guidelines I read, highlighted the importance of maintaining aseptic procedure; hand hygiene before commencing and following the administration, gloves must be worn (Pratt et at 2007), sharps disposed immediately to avoid blood-borne viruses such as Hepatitis B and C and HIV from contaminated blood on needles (http://www.diabetes.org.uk/) ; patient pre-existing conditions to prevent contraindications, patients prescription chart checked to check correct route, correct dosage of medication, expiry date, hands washed with soap and water to prevent infection, positive patient identification then record the administration on the appropriate chart to avoid any duplication of patients treatment (Dougherty and Lister 2009). The patient was called into the medication room and my Mentor explained to him that I am a student Nurse on the Ward who has been observing Qualified Nurses carryout SC Injections, that I have confirmed my confidence to administer SC, that she will supervise me carry out the process, the Patient agreed and I thanked him for accepting and the opportunity.
I washed my hands and wore hand gloves. Before the patient was called into the medication room, I have assembled the equipment: syringe and insulin vial and had examined the insulin for lumps, crystals and discoloration, check the expiring date and prescription, medication log, sharp container, sterile guaze pad and alcohol pad. The Royal Marsden Hospital Manual suggests that before administering injections the skin should be cleansed with an alcohol wipe for 30 seconds and allowed to dry in order to prevent any contamination; however, it has been questioned that the alcohol in the wipe was causing irritation to the skin or prolonged use may cause skin hardening (Hunter 2008). Whilst the patient was ready, I pulled the plunger, fill the syringe with air volume in proportion with the amount that is prescribed, drew desired amount with bottle held upside down to get the right dose, checked dose with syringe at my eye level and tapped the syringe to remove bubbles and removed the needle from the bottle.
The Patient confirmed he preferred his abdomen for SC injections. The Patient loosened his belt and raised his shirt to allow me access, I showed the patient the syringe and dosage as it is the practice when administering insulin on the Ward. Because the patient is on the big side, I thrusted the plunger slowly into the skin with great force at 90 degree until all insulin has been injected, waited for 5 seconds before release and disposed off the syringe in a sharps container without re-sheathing the needle; to avoid needle stick injuries (Potter 2010). Gibbs second stage of reflection is about my thoughts and how I felt while carrying out the process. Initially, I was very nervous even before I started because I thought the Patient will object to my administering the SC coupled with the fact that I was being supervised and my Mentor kept quiet and watching The Patient was understanding and later said he had confidence in me and knew I could do it and my mentor also said, that was good first attempt and exhibited professional demeanour in my communication with the patient as I was telling and seeking consent at every stage; I was relieved and was able to give more SCs during that placement.
The confidence I built in my first placement helped in the second clinical placement where I administered Depot injections to Service Users in the Community. The third stage of Gibbs’ is evaluating where the practiced skill went well and not so well in the process and experiences. Looking back to my first experience of administering SC, I was able to follow the procedure and drew the insulin very well and remembered to thrust at the appropriate site without causing the patient any pain but was not too organised because I was a bit nervous, I did not assemble all the required equipment, had to excuse myself whilst the patient was already in the medication room. According to Burnard (2002), he posited that is a passive recipient of received knowledge that learning through activities engages all our senses, I was so concentrated was that I did want to make avoidable mistakes. Gibbs (1988)
Model encourages the reflector to make analyse of the components of their experiences in the fourth state; maintaining aseptic procedure is paramount to avoid contamination of equipment, infection control and protect against needle stick. The reflector guided against this by washing hands and putting on gloves before starting the procedure. Although Workman (1999) suggested that wipes is not necessary to reduce local infection at injection site as this may harden skin however if skin is visibly dirty, washing the area is necessary for decontamination (Nicol et al 2004). As the Patient was assisted with personal hygiene that morning, the injection site was clean, and there was no need for the reflector to use the wipes. On injecting the site, I did not draw back the plunger because SC sites have lots of fatty tissues as it is unlikely that blood vessel will be pierced, (McAskill and Goodhand, 2007). The reflector practice was appropriate in the administration of insulin. In conclusion on the fifth stage of Gibbs (1988) model, I had conscious drawbacks in the manner with which I administered the SC injections as a novice and nervous student nurse but became more confident as I was allowed to carry out the process whenever I am on duty.
I could have been more organised and ready but I gave myself to the Patient who knew that he was my ginning pig but thank goodness that it was not too bad experience as he commended me, became more confident in administering SC and this knowledge I transferred to my 2nd placement in administering of Deport Injection. Gibbs (1988) require action plans as I progress in drug administration, I will research more about the process and procedure of administering different types of injections to gain more confidence irrespective of the type of injections am assigned to administer to patients as their safety, precautions against mistakes should be paramount. Self-awareness and analysis are key component in reflection, and reflection is an essential skill which needs to be acquired, developed and maintained; being self- aware allows us to take control of the situations we find ourselves in, thus becoming less vulnerable (Wilding 2008). I realised I was very vulnerable; I will work on my nerves and become a more confident and work professionally in the future.
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