Reflection on growth of competency in Clinical Skill

Reflection on growth of competency in clinical SkillFor this essay I am sack to think over upon a clinical skill I gain be baffle competent in during my training. I will use a reflective sit around to discuss how I undertook the skill. I will excessively discuss the rational and research behind the skill. The role model of reflection I do chosen is Gibbs (Siviter, 2004). The Gibbs model of reflection every last(predicate)ows the skill to be critically analysed. This is achieved by using the following sub headings description, feelings, evaluation, analysis, conclusion and an action plan (Siviter, 2004).The skill that I will reflect on in this essay is the administration of an intramuscular Injection (IM). An IM is an injection deep into a pass (Dougherty Lister, 2008). This r let one is often chosen for its quick absorption rate and often medication squeeze outnot be effrontery via other routes. The reason I have chosen to reflect on this skill is because I have had many o pportunities to perform this skill, and at my current practice placement this is the most commonly used system of drug administration. I have undertook many IMs at this placement but I am going to reflect on the for the first time one I undertook which was the administration of Hydroxocobalamin commonly known as vitamin B12 (BNF, 2007) translationDuring a morning clinic with the practice nurse, I was asked if I would like to administer an IM on the next affected role, which was a 26 year old lady who has been suffering from crohns disease which can cause B12 deficiency overdue to lack of vitamin and mineral absorption (NACC, 2007). I agreed and she briefly went through with me how to do an IM as it had been a while since I had last done one. I called the patient in and asked her to sit down. The patient had come in for her first injection of B12. I chatted to the patient asking her how she was and if she had any concerns. I because gained admit asking her if it was ok for me as a student to administer it under the supervision of the practice nurse. The patient responded with you have got to learn I then(prenominal) prepared the equipment which included two harrys, a sharps encase, a while of gauze and the medication. I checked the prescription with the practice nurse, and then checked the ampoule against the prescription. I then drew up the medication with one needle disposing of it in the sharps box and attached the other needle. I then proceeded to administer the medication, after completing the procedure I disposed of the needle in the sharps box and documented it in the patients notes. later the patient had left the nurse explained to me I had done it all objurgate except I had gone in too far so if the needle broke it would be hard to get it out and that I didnt aspirate to check if I had gone into a vein.Thoughts and feelingsAfter I was asked if I wanted to do the IM I felt very anxious as it had been more than than 6 months since the last ti me I had administered one. But she explained the procedure to me which relieved some of my anxiety. When I first met the patient I was feeling allot more nervous as the patient was roughly my sequence and I havent had much experience of caring for the younger person. After the procedure when I was told I was disparage for not aspirating I felt annoyed as I was sure I had read that aspirating was no lasting necessary.EvaluationOverall I feel that the clinical skill went well as a whole. I followed the instructions from my mentor and what the research has suggested other than feeling a little anxious I performed the skill confidently and correctly. What I feel was bad about the experience is with my communication, which reflecting on I deliberate was lacking. I communicated with the patient prior to the skill and after the skill, but during I felt I to the highest degree forgot on that point was a patient on the end of the needle. I was so focused on acquiring the skill remedi ate and not causing any pain I didnt talk to the patient passim the whole thing. Another point that I feel was bad is, I forgot to wear an apron. My mentor never mentioned anything about this although I do feel I should have worn one as its an aseptic technique and its part of the (DOH, 2006) guidelines.AnalysisThe reason why an IM injection was chosen is because B12 can only be administered via IM (BNF, 2007). I gained informed consent off the patient as this is part the NMC guidelines. (NMC, 2008) As patients have the right to decline discussion. After gaining consent, I then checked the medication against the patients chart to ascertain the following Drug, Dose, date, route, the severity of the prescription and the doctors signature. This is done to make sure the patient receives the correct drug and dose (NMC, 2008) I then washed my hands using Ayliffes six step technique to reduce the risk of infection and seat gloves on as part of DOH 2007 Guidelines . The site that I cho se was the mid deltoid site. Hunt (2008) Suggests that this is the ruff site to use as its easy to access whether the patient is sitting, standing or lying down, it also has the advantage of being away from major nerves and blood vessels. Although Roger (2000) states that only 2ml at most can be injected into the deltoid. I was able to proceed with this site as B12 comes in a 1ml dose (BNF, 2007). I asked her if she would prefer to sit or lie down, she said she rather sit, this was ok with me as I am not very tall and found this a comfortable power for me. As the patient was corroding a short sleeve top I asked her to move it up slightly instead of removing it so allowing her to maintain her privacy and dignity. I then assessed the injection site for suitability checking for any signs of infection, oedema or lesions. This is done to promote the effectiveness of administration and reduce the risk of cross infection (Woorkman, 1999). Holding the needle at a 90 degree angle it is q uickly pushed into the muscle. Workman 1999 says this ensures good muscle penetration. I inserted the needle leaving approximately 1/2cm exposed as Workman, (1999) says this makes removing it easier should it break off. At this point I decided not to aspirate as per research (DOH, 2006). After inserting the needle I allowed it to remain at that place for 10 seconds. As Woorkman (1999) suggest that leaving in situ for 10 seconds allows the medication to diffuse into the tissues. After 10 seconds had past I swiftly removed the needle and applied pressure according to Dougherty Lister (2008) this helps keep the formation of a haematoma. Immediately after carrying out the skill I disposed of the needle into a rigid sharps container. To ensure health and safety is maintained and the used sharps dont present a danger to me or other staff members as stated by MRHA (2004). After the procedure I documented it indoors the patients notes as per NMC guidelines and to provide a point of refe rence if there ever was a query regarding the treatment and to prevent duplicate administration (NMC, Guide lines for records and record keeping, 2005). After the skill I discussed with my mentor that late(a) evidence suggest that aspirating is unnecessary. According to Workman (1999) the reason for aspirating is to confirm that the needle is in the correct position and to make sure that it has not gone into a vein. The most recent and up to date evidence, says that ingestion is only necessary if using the dorsoglutealsite to check for gluteal artery entry (Hunter, 2008). But positive guidance from the World Health Organisation and the Department of Health (DOH, 2006) (WHO, 2004) suggest that this site should no longer be used, thus making aspiration unnecessary. By not aspirating it makes the procedure simpler and less chance of wayward events. Furthermore pharmaceutical companies are making less caustic preparations and in smaller volumes. I discussed this with my mentor and sh e agreed but stated that it is PCT constitution to aspirate, and she would have to happen to follow this practice until the policy was amended.ConclusionUsing the Gibbs model of reflection has allowed me to thoroughly analyse the event and allowed me to explore my feelings. I have found out despite the evidence being constantly up to date that not all practitioners knowledge is as up to date, and that trusts are equally as slow to adopt new ideas within their policies and that nurses are governed by policy more than current research. I have also learned that there is a great deal of evidence behind such what on the outside seems to be a simple technique and what I thought I was doing correctly may not always be the case.Action planI do not doubt I will be carrying out IMs for a long time in my career. I will not be doing much other than in the future as the evidence is underpinning my practice. I will not put the needle in as far as I did on this occasion. In the future I will co ntinue not to aspirate, unless local policy indicates otherwise. In addition I will communicate with the patient throughout the entire skill and not just at the start and end of. Whats more from this event I have realised that learning never stops and what I know now may not be relevant tomorrow.