Personal Reflection On Practicing A Clinical Skill

Personal Reflection On Practicing A Clinical Skill This essay will discuss a clinical skill in which I have become competent in practicing. I will use a reflective model to discuss how I have achieved the necessary level of competence in my nurse training programme. The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan (Gibbs 1988). The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill. A conclusion to the essay will then be given which will discuss my reflection skills, acknowledge my competence and show my personal and professional development. The clinical skill I have chosen to reflect on within this essay is the administration of Intramuscular (IM) injections. I have chosen this as within my first clinical placement this was a widely used method of drug administration and I became involved in the process of IM injections. I therefore researched the topic of IM injections and my knowledge within this area developed. The first stage of Gibbs (1988) model of reflection requires a description of events. I was asked to administer a drug to a patient via IM injection. I had observed this clinical skill on a variety of occasions and had previously administered an IM injection under supervision. On this occasion I was being observed by two qualified nurses, one of which was my mentor. The drug had been drawn up and was ready to be administered and the patient consented to have a student administer the injection. My mentor was talking me through the procedure step by step and informed me that I should use an alcohol wipe to cleanse the injection site, when the other nurse interrupted and said that this was not necessary. This was in front of the patient, who then requested that the alcohol wipe was omitted as on previous occasions this had caused a stinging sensation. My mentor said that this was acceptable and I continued to administer the injection, omitting the use of the alcohol wipe. On the previou s occasions when I had administered IM injections I had not cleansed the site and had never been instructed to adopt this practice. I am now going to enter into the second stage of Gibbs (1988) model of reflection, which is a discussion about my thoughts and feelings. I was aware of being under the supervision of two qualified nurses and this made me feel very nervous and self conscious. Once my mentor questioned my practice, concerning skin cleansing, I became even more aware of feeling nervous and under pressure. The patient was present and I did not want the patient to feel that I did not know what I was doing. I thought that as I had been observed carrying out this clinical procedure on many other occasions then my practice must have been seen to be correct. I was now feeling very confused about the use of alcohol wipes in the administration of IM injection. I was also concerned that the practice of the qualified nurses was so inconsistent, which led me to evaluate the whole process. Evaluation is the third stage of Gibbs (1988) model of reflection and requires the reflector to with state what was good and bad about the event. I was aware that research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean and an aseptic technique is adopted, along with stringent hand washing by the nurse. It has also been noted that the use of cleansing with an alcohol wipe can cause skin hardening (Mallet Dougherty 2000). The trust policy was to follow guidelines published by the Royal Marsden Hospital (Mallet Dougherty 2000). The Royal Marsden (Mallet Dougherty 2000) advocate the use of skin cleansing wipes, however it is stated within their guidelines that they adopt this because their patients are often immunocompromised, and give evidence of previous studies which indicate that skin cleansing is not normally necessary. Therefore my practice was within the trust proto col. This experience made me think about my attitude towards literature and how it is applied in practice. Burnard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses. The site used in the IM injection was the gluteus maximus, this the most commonly used site for the administration of IM injections (Greenway 2004, Workman 1999). The gluteus maximus area is both thick and fleshy with a good blood supply (Watson 2000). It is located in the hip area and forms the buttock (Watson 2000). It has been noted by Watson (2000) that the gluteus maximus is near the sciatic nerve and Greenway (2004) suggests that this presents a risk of threat of injury in the administration of IM injections. When I administered the IM injection to the patient, I injected into the gluteus maximus muscle, as the evidence stipulates this is best practice. Stage four of Gibbs (1988) is an analysis of the event, where Gibbs encourages the reflector to make sense of the situation. I will do this by exploring the skill and looking at the evidence underpinning it. An IM injection is the administration of medication into the muscle; there are many reasons why drugs are given via the IM route (Workman 1999). These include a rapid absorption rate, the conscious state of the patient, and the drug effect being altered by ingestion (Mallet Dougherty 2000, Workman 1999). Workman (1999) suggests there are four considerations in giving an injection, the site of injection, the technique, the equipment and the route. On my clinical placement, an orthopaedic outpatient centre, IM injections were administered on an almost daily basis. However Hemsworth (2000) comments that IM injections are rarely used in certain specialities and suggests that, in this case, nurses current practice in IM injections may not be up to date with recent research findings. Through evaluation of the event in question I have become more aware of different practices concerning the use of alcohol wipes in skin cleansing. I am aware that both practices have been researched, but as I develop professionally I am developing my own skills and will not cleanse the skin in future unless the trust policy dictates so or the patient requests me to do so. There is no clear evidence in this area but I will use the literature which is available to justify my actions, and therefore give evidence based care. The reason my mentor suggested using the alcohol wipe could be that she has been qualified for a long time, and practices have changed. In this scenario I have learnt from experience and through experience (Burnard 2002). Following this incident in practice I will now be more prepared to challenge the views of others in relation to my clinical practice. In conclusion, stage five of the Gibbs (1988) model, I am aware that all nurses do not use evidence in the same way and may use different methods but as long as my practice is safe and evidence based then I can practice safely. My future practice will depend on the area in which I am working and I aim to find out the trust protocol concerning clinical procedures before I commence any procedure Within my action plan my aim is to research further into the theory of using alcohol wipes in the administration of IM injections. I am also planning to have a discussion with the qualified nurses on the subject of skin cleansing. In conclusion my reflection skills have developed through the production of this essay. Using a model of reflection has helped me to structure my thoughts and feelings appropriately. My level of awareness concerning evidence based practice, and its importance, has been enhanced with the use of critical reflection. My competence, within this clinical skill, has been further developed and I now feel that my personal and professional development is progressing. Using this reflective model has helped me to realise that my learning is something which I must be proactive in. Furthermore as a student nurse I have recognised that reflection is an important learning tool in practice.

Langston Hughes’ “Mother To Son” Essay

An Explication of Langston Hughes’ â€Å"Mother to Son† Langston Hughes once stated in his own words that his whole purpose for writing was, â€Å"to explain and illuminate the Negro condition in America.† In the poem â€Å"Mother to Son†, he denotes his belief on racism in America. In â€Å"Mother to Son†, a mother is giving advice to her son about life from her perspective and experiences. She wants her son to keep striving on what he believes and to have a more prosperous life than what she had. Langston Hughes was born in Joplin, Missouri in 1902. He lived with his grandmother for most of her life but often stayed with his mother in Cleveland, Ohio. He grew up in poverty and was exposed to racism in his youth. However, he believed that things would change and his culture must press on. By 1929, he was a well know poet during the Harlem Renaissance, the growth of African-American art and literature in Harlem, New York. He promoted the African-American culture and supported the Civil Rights Movement. Hughes used poetry to express himself and has written over sixty poems. One of them being â€Å"Mother to Son†, which expresses how the blacks must stand tall and believe in a better future. Starting with the title, â€Å"Mother to Son†, allows the reader to trust that the poem is going to be about a mother and a son. Just by reading the title, the reader may wonder what type of poem this is going to be. It shows a sense of leadership because a son sees his mother as an authoritative figure, someone who he can trust, someone who he has a bond with. Mothers are usually a figure who nurtures and molds their children into the right path. This gives the reader a hint that the poem is a poem were, the mother, in some way or another is molding or guiding the son into the right path. In the very first line, â€Å"Well, son, I’ll tell you:† gives the reader a good idea in which direction the poem is taking. At this point, the reader can trust that the mother is going to give some kind of advice as mothers frequently do. As the reader moves on to the second line, â€Å"Life for me ain’t been no crystal stair,† Langston creates imagery for the reader by using a crystal stair as a metaphor to symbolize the mother’s life in contrast to the crystal stair. Crystal has connotations of beauty and visual smoothness.  It is also a valuable piece of stone that only the wealthy could purchase in high volume such as that of a crystal stair. The crystal stair is very important to the body of the poem. Without this metaphor, the poem probably would not have the same effect on how the reader interprets it. Moving on to the third sentence, â€Å"Its had tacks in it, and splinters, and boards torn up, and places with no carpet on the floor-Bare.† The tacks and splinters could represent pain or scars left from the mother’s past. The boards that were torn up could represent imperfection; a struggle or permanent loses and voids in her life. â€Å"No carpet on the floor-Bare† could mean that the mother has nothing left to show for her life. Her life as a youth could have been stripped from her through slavery. So she wants her son to make something of himself despite the criticism and racism he is challenged with. The poem doesn’t state specifically to the reader where the setting takes place but there are two hints Hughes gives that leads the reader into the assumption that the South is a primary focus. First, the poem was written in 1922, which was a time of the Harlem Renaissance. Second, the mother is speaking the words of the poem in a Negro dialect, which forces the reader to assume she’s black. With these two facts, the reader can reasonably come to the conclusion that the mother has probably dealt with the racism and prejudges from the white culture. The 1920’s were a time of struggle for many blacks and Negro rights since slavery was abolished in 1865 by the 13th Amendment. By reading the history of the poet, Langston Hughes, the reader has a general idea that his own mother could have been a slave or had grown up during the time that slavery was being abolished and the 13th, 14th, and 15th Amendments came into effect. This was also during a time when Congress had passed several laws to protect Negroes’ civil rights. In contrast, many whites disregarded the newly won rights of Negroes. (World Book Encyclopedia. Civil Rights. Field Enterprises Educational Corporation. Chicago. 1977. P.468) Like many other Lyrics, â€Å"Mother to Son†, is expressing the thoughts and feelings of a single speaker and is written in first person point of view. In the very first line, â€Å"Well, son, I’ll tell you†, Hughes demonstrates to the reader that this is going to be a first person point of view. Readers can see that the  mother is the central character in this poem because the reader is focused on her next word as she describes her view of life. The mother speaks her thoughts and feelings for the entirety of the poem but the boy doesn’t speak at all. This is called a dramatic monologue. Langston’s attitude toward life in â€Å"Mother to Son† is slightly unpleasant but solemn and trustworthy. The reader gains a sense of sympathy for the mother as she tells her son about her misfortunes from the past. In â€Å"Mother to Son†, a mother is urging her son to keep striving with assurance to have a more prosperous life than she had. Langston Hughes was born in Joplin, Missouri in 1902. He was a well-known poet during the Harlem Renaissance. He believed strongly in his culture and he had faith that things would change for the better. The title itself gives the reader a sense of insight on what the poem is going to be about as it clearly uses â€Å"Mother†, an authoritative figure in which a son would trust and look up to for guidance. On the other hand, a mother’s own instinct is to her child into the right path. Langston clearly demonstrates this in this piece of poetry. Langston also uses imagery for the reader by using the crystal stair as a metaphor. The setting is not specifically stated but Langston has granted a couple of clues for which the reader can rely. The date the poem was written and the word choices he uses lets the reader know that the setting is probably in the South. Langston’s background gives the reader the idea that he may have reflected on his mother’s past and the events that follows slavery abolishment in 1865 when he began writing, â€Å"Mother to Son.† This poem was written as a Lyric. Like many other lyrics, it was written in first person point of view and the poet used a dramatic monologue when the mother speaks of her thoughts and feelings, whereas, the boy doesn’t speak at all. Although, Langston shows a slightly unpleasant attitude in his tone, he is solemn and trustworthy. The reader gains a sense of sympathy for the character of the mother

Factors That Can Be Protective Against Ptsd - 1751 Words

What is meant by the term ‘’resilience’’ with regard to response to stressful events? One resilience factor is ‘hardiness’, discuss how this factor can be protective against PTSD. Stress is a widely studied phenomenon, as stress is an experience that every individual go through in their everyday lives. According to Baum (1990), stress can be defined as a â€Å"negative emotional experience accompanied by predicable biochemical, physiological and behavioural changes that are directed towards adaption either by manipulating the situation to alter the stressor or by accommodating its effects.† Everybody is affected by stressful events in different ways, some are better at coping than others, this is because everyone is individually different. This is where resilience to stressful events comes into place. Resilience helps to explain the ability to adapt in the face of tragedy, hardship, trauma, adversity and a continuation of significant life stressors. Bonanno (2002).There are many factors that influence people’s resilience to these life events, for example personality traits, optimism, lows of control, hardiness and social support. In this essay th ere will be a focus on hardiness as it is a main factor for overcoming mental illness. Especially for PTSD which is heavily influenced by stressful life experiences. Stress has a big impact on people’s mental and physical health, the way in which people cope with stress can protect them from illness. Throughout life, people are facedShow MoreRelatedAssessment And Treatment Of Combat Related Posttraumatic Stress Disorder Essay1598 Words   |  7 Pagesdisabling trauma. The purpose of this literature review is to address the issue of posttraumatic stress disorder (PTSD), address the symptoms linked to PTSD, and the methods used in the assessment of posttraumatic stress disorder with emphasis on military combat-related PTSD. 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The Marquis de Lafayettes Triumphant Tour of America