Clinical Skills Reflection: Gibbs Model

Clinical Skills Reflection Gibbs stupefyThe skill that I will reflect on in this judge is the administration of an intramuscular Injection (IM). An IM is an injection deep into a go tiller (Dougherty & Lister, 2008). This route is often chosen for its quick absorption rate and often medical specialty can non be given via other routes. The reason I shoot chosen to reflect on this skill is because I pass on had many opportunities to perform this skill, and at my current practice placement this is the most normally used method of drug administration. I take over undertook many IMs at this placement plainly I am going to reflect on the first one(a) I undertook which was the administration of Hydroxocobalamin commonly known as vitamin B12 (BNF, 2007)DescriptionDuring a morning clinic with the practice nurse, I was asked if I would cargon to administer an IM on the next persevering role, which was a 26 year of eon(predicate) lady who has been suffering from crohns diseas e which can cause B12 deficiency ascribable 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 through with(p) 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 whence gained consent asking her if it was ok for me as a scholar to administer it under the supervision of the practice nurse. The patient responded with you earn got to show I and so prepargond the equipment which included two pricks, a sharps box, a piece of gauze and the medication. I checked the prescription with the practice nurse, and consequently 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(prenominal) completing the mental process I accustomed of the needle in the sharps box and documented it in the patients notes. afterward the patient had left the nurse explained to me I had done it all correct besides I had gone in too far so if the needle broke it would be hard to get it out and that I didnt remove to check if I had gone into a vein.Thoughts and judgmentsafter 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 clip I had administered one. But she explained the action 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 churning as I was sure I had read that aspirating was no eight-day necessary.EvaluationOverall I feel that the clinical skill went wholesome as a whole. I followed the instr uctions from my mentor and what the research has mentioned other than feeling a little anxious I performed the skill confidently and correctly. What I feel was bad to the highest degree the experience is with my communication, which reflecting on I believe was lacking. I occurd 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 get the skill right and not causing any pain I didnt talk to the patient throughout the whole thing. Another train 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 proficiency 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 conscious 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 superman (NMC, 2008) I then washed my hands using Ayliffes six step technique to compact the risk of transmittal and put gloves on as part of DOH 2007 Guidelines . The post that I chose was the mid deltoid send. Hunt (2008) Suggests that this is the best land site to use as its easy to access whether the patient is sitting, standing or lying down, it similarly has the advantage of being away from major jitteriness 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 kinda sit, this was ok with me as I am not very long-legged and found this a comfortable typeset for me. As the patient was tiring 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 tippytoe it is quickly pushed into the muscle. Workman 1999 says this ensures good muscle penetration. I inserted the needle divergence 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 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 ha d past I swiftly removed the needle and applied mechanical press 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 laid 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 generate a point of reference if there ever was a examination 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 new evidence suggest that aspirating is unnecessary. check 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 n ecessary if using the dorsogluteal site to check for gluteal artery entry (Hunter, 2008). But official commission 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.ConclusionUsing the Gibbs exercise 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 stub such what on the outside seems to be a simple technique and what I thought I was doing correctly may not perpetually be the case.Action planI do not discredit I will be carrying out IMs for a long time in my career. I will not be doing much otherwise 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 get that learning never stops and what I know now may not be relevant tomorrow.