Clinical Skills Reflection: Gibbs Model

Clinical Skills Reflection: Gibbs Model 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 muscle (Dougherty & Lister, 2008). This route is often chosen for its quick absorption rate and often medication cannot be given via other routes. The reason I have chosen to reflect on this skill is because I have had many opportunities to perform this skill, and at my current practice placement this is the most commonly used method of drug administration. I have undertook many IMs at this placement but I am going to reflect on the first one I undertook which was the administration of Hydroxocobalamin commonly known as vitamin B12 (BNF, 2007) Description During a morning clinic with the practice nurse, I was asked if I would like to administer an IM on the next patient, which was a 26 year old lady who has been suffering from crohns disease which can cause B12 deficiency due 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 then gained consent 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 prepared the equipment which included two needles, a sharps box, a piece 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 medicatio n 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. After the patient had left the nurse explained to me I had done it all correct 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 feelings After I was asked if I wanted to do the IM I felt very anxious as it had been more than 6 months since the last time 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 age and I havent had much experience of caring for the younger person. After the procedure when I was told I was wrong for not aspirating I felt annoyed as I was sure I had read that aspirating was no longer necessary. Evaluation Overall 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 believe was lacking. I communicated with the patient prior to the skill and after the skill, but during I felt I almost forgot there was a patient on the end of the needle. I was so focused on getting the skill right and not causing any pain I didnt talk to the patient throughout 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. Analysis The 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 treatment. After gaining consent, I then checked the medication against the patients chart to ascertain the following: Drug, Dose, date, route, the validity 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 put gloves on as part of DOH 2007 Guidelines . The site that I chose was the mid deltoid site. Hunt (2008) Suggests that this is the best 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 delto id. 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 position for me. As the patient was wearing a short sleeve top I asked her to move it up slightly instead of removing it thus 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 quickly 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 all owed it to remain there 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 prevent 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 within the patients notes as per NMC guidelines and to provide a point of reference 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 recent 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 aspiration is only necessary if using the dorsogluteal site to check for gluteal artery entry (Hunter, 2008). But official 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 adverse events. Furthermore pharmaceutical companies are making less caustic preparations and in smaller volumes. I discussed this with my mentor and she agreed but stated that it is PCT policy to aspirate, and she would have to continue to follow this practice until the policy was amended. Conclusion Using 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 plan I do not doubt I will be carrying out IMs for a long time in my career. I will not be doing much differently 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 continue 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.

Grease v. The Breakfast Club: Finding Yourself Essay

The films â€Å"Grease† and â€Å"The Breakfast Club† feature the same strong theme: finding your identity. This theme is universal through many books, movies and even real life. The fact that these two films were filmed so far apart, â€Å"Grease† being filmed in 1959 and directed by Randal Kleiser and â€Å"The Breakfast Club† in 1985 directed by John Hughes, shows that this is a strong theme that sticks throughout the industry. These films have many characters that can be compared to one another. The main characters are Claire Standish (played by Molly Ringwald) and Sandy Olsson (played by Olivia Newton-John) and John Bender (played by Judd Nelson) and Danny Zuko (played by John Travolta). The girls are your typical high school â€Å"girlie-girls† and the guys are your typical high school â€Å"macho men†. There is also a couple of less important characters in the films that can be compared such as Andy Clark (played by Emilio Estevez) and Kenickie (played by Jeff Conaway). They’re the kids who think they’re the big man on campus and better than everyone else. The first obvious comparison is the leading ladies of the film. Sandy Olsson was a sweet, quiet girl when she first arrived at Ridell High. She felt pretty sure of herself entering the school, but when she joined a new group of friends and realized Danny Zuko’s real personality, she realized that she was not really the type of person that she wanted to be. With the help of her new friends, Sandy changed herself completely. On this path of discovery she was totally transformed in her looks and personality. She went from shy and unnoticed to sexy and confident. After the transformation, there was an occurrence that made her realize that she was just fine the way she was and didn’t need to change for anyone. In that time, she lost her true self trying to be something she wasn’t and then discovered at the end that she was always who she really wanted to be and no one could change her. Clair was a stuck up, pretty, popular girl at her school. No one took her seriously. Stereotypical â€Å"pretty† girls are usually ditzy. That is just what people assumed of Claire. After she got stuck in detention with an unusual group of kids, kids she would normally have never interacted with, she slowly began to come out of her shell. Being in that new group of people was a way for her to let her true self out without worrying about people judging her. As the group of detention goers got closer and got to know each other better, it became apparent that Claire was not just a stupid, mean, pretty girl with lots of money. She was nice and smart. Her day in detention brought out her true identity, and let her along with everyone else discover who she really was. The next comparison is between Danny and John. Danny Zuko was the leader of the T-Birds, the schools big gang of popular guys. He was the heartthrob of the school and his name was coming out of people’s mouths left and right. The word around the street was that Danny Zuko was a tough, badass guy and he didn’t care about anything besides himself, his T-Birds, and looking cool. It was a little hard to disprove this though because that is exactly how Danny acted in front of everyone. He was the epitome of a macho man. The only time that he was his true self was during a summer before school when he fell in love with Sandy. He let his soft side show with her, but as soon as school started again, he was back to his old ways. This caused him to lose Sandy, and this in turn cause his realization that he was his true self with her and he wanted to be that again to make her happy. By the end of the movie, Danny has transformed himself into the nice sweet jock that he thought Sandy would love, only to realize that Sandy had transformed herself for him also, and they both discovered that they liked themselves and each other just the way they were. A similar character to Danny would be John Bender. He was his school’s typical macho man who wouldn’t take anything from anyone or let anyone tell him what to do or how to behave. That is how he landed in detention. At the beginning of the film, he kept up greatly with his badass rep. But throughout the film, the kids in detention became closer and they all got to know one another. The true side of John Bender that came out was that his life at home was pretty tough and that caused him to have a rough exterior. The kids in detention as well as the audience saw past that though as the film progressed. The was a part of the film where all the kids were about to get caught leaving detention and John sacrificed his own self to save the rest from getting in trouble again. This showed that he was compassionate and not so self-centered afterall. After breaking down his rough outer shell, the kids in detention saw who John Bender really was, and why he acted the way he did. Som e of that was understandable and they all became friends. John let his true identity shine to everyone. As far as theme goes, the theme of both â€Å"Grease† and â€Å"The Breakfast Club† were pretty generic. The way they were showed though made them more interesting than other films. Showing the journey of discovering your identity through multiple characters gives the film viewers more to relate to and helps people to enjoy the movie more. Whether you’re the badass, the jock, the popular girl, the geek, the psycho, or the shy girl, you can relate to one of these films. Finding your identity is something that every person has to go through in their lives. That makes the theme universal. These two films correlate well with each other to show that you will always find yourself, it may be harder or easier for different people, but in the end you will be able to find your true identity and be happy with the person you are, and be accepted by others.

How the health and social care practitioner own values, beliefs and experiences Essay

The health and social care practitioner values, beliefs and experiences can influence their delivery of care by what they believe in and what they see as acceptable. It is important as a health practitioner to treat service users equally and to never allow their personal beliefs to affect their role of work. For example giving someone else a special treatment because you like them better and treating a client differently because they do not have the same religion/belief. Treating a service user badly because of their race or their personality is against the practise. The Human Rights Act 1998, The Equality Act of 2010, The Sex Discrimination Act 1975, Equal Opportunities Act 2004 are all legislations that link with equality and diversity. All these acts should be met every individuals needs and should be followed. This should allow all service users to be treated equally regarding their race, gender, religion, disability, sexual orientation, age and belief. It is a health care practi tioner’s duty to provide everyone a non-bias service to every individual’s beliefs. 3.2 Describe how person-centred practice is used to support individuals. Person centred planning is a way of discovering how a person wants to live like now or in the future and to identify what is required to make that possible. It’s a way of helping everyone to think about what is important to them and what services and support they want. Person centred planning can be helpful in answering people these questions. It’s also useful to people in organising their life in a way that is useful for them. For example David’s story it’s about making sure they meet David’s needs. They use person centred planning for David in order for them to communicate with him and give him the best quality of care. Person centred practice is used to support individuals by doing things that people see when using health and social care services as equal. Person centred skills that are enforced to support individuals are used for several reasons, for example lives of individual’s that are supported are improving and are developing. This means by letting their family at the centre of their decisions and working alongside them to their best interest. Person-centred care is not always about providing information to people. It’s about values, considering peoples desires, and seeing Person-centred care is not just about giving people whatever they want or providing information. It is about considering people’s desires, values, family situations, social circumstances and lifestyles; seeing the person as an individual, and working together to develop appropriate solutions. 3.3 Discuss impacts of person-centred practice on individuals. An impact of person-centred practice on individuals meets people’s needs and expectations Person centred approaches is shared decisions making and self-management support to enable people to be more active and defining the outcome that is important to them. It focuses on individual’s personal needs, wants and what they desire the most. This means putting people’s needs first. Person-centred practice might have an impact on individuals because they have a potential to achieve meeting people’s needs and expectations. It might have an impact on them by deciding the treatment and support that is best for them and also managing their health and care. 3.4 Describe ethical dilemmas that may arise when balancing individual’s rights and duty of care. A possible dilemma would be that an individual wants to do something but you think it might be a risk to their duty of care which means you have to do everything you can to keep them safe but, you have to respect the individual’s rights and choices. And if you try and stop the individual from doing something from something they want or from doing something they want to do then you are taking away their independence. Another dilemma that may arise will be confidentiality. If something confidential is mentioned to a colleague or a member of the team and it involves safeguarding and the client might be at harm then, they have to break that confidentiality and pass on the information.

Daddy Essay - 1199 Words

As a poet Sylivia Plath has been renowned for her style of writing and the power she evokes from her ideas in her poems. The themes of her poems tend to be of a negative nature with war, death and the problem of patriarchal societies as such topics. One of Plaths most famous pieces of poetry is Daddy. The poem focuses on Plaths father, a man who left her at an early age resulting in a burning hatred on her behalf for him. Daddy is an example of Plaths dark and gloomy work and also displays her common poetic devices of vivid imagery, metaphors, similes and irregularity throughout her poems. Ideally everybody deserves to grow up with two living parents, however Plath was not given this opportunity as her father died when she was only†¦show more content†¦As a race, the Jews arguably went through the most suffering in World War II. Millions fell victim to an attempt of ethnic cleansing ordered by Hitler. However Plath believed her suffering from the loss of her father was just as great as what many Jewish people went through. In the poem the persona uses several similes, a common technique of Plath, in the seventh stanza. An engine, an engine Chuffing me off like a Jew. A Jew to Dachau, Auschwitz, Belsen. I began to talk like a Jew. I think I may well be a Jew. The similes within this stanza position the reader to see the great degree of suffering the speaker went through, as it is compared to the torment and anguish millions went through during World War II and in turn, sympathy is drawn from the reader as everyone deserves to grow up with two living parents. When the persona describes her father, she again draws upon war imagery in the form of the Nazi soldiers and Hitler himself. The description given is in the ninth stanza. I have always been scared of you, With your Luftwaffe, your gobbledygoo. And your neat moustache And your Aryan eye, bright blue. By comparing her father to Hitler, the speaker creates a parallel in that Hitler was responsible for the lives of so many Jews. In parallel, her father is like Hitler and she is like Jew, hence positioning the reader to see how the speaker believed it was growing up without a father that caused her toShow MoreRelatedFiesta 1980† and â€Å"Daddy† Essay814 Words   |  4 Pagesâ€Å"Fiesta 1980† and â€Å"Daddy† Both poems are about memories of the relationship with their father. However, the experiences are very different. The children presented in â€Å"Fiesta 1980† by Junot Diaz and â€Å"Daddy† by Silvia Plath suffers an internal struggle because of their fathers. In â€Å"Fiesta 1980† there is a chance to improve the relationship where as in â€Å"Daddy† there is no hope because the father is dead. 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