Professional Practice Accountability and Reflection - Essay Example

Professional Practice, Accountability, and Reflection: Nursing Assignment Introduction: In my clinical placement, I had been assigned a patient with pressure ulcers. This is an elderly female of age 63, obese, diabetic, and having osteoarthritis of severe grade. The patient’s identity will remain undisclosed due to ethical reasons. For purposes of convenience, this patient will be termed in this journal as Joanna. This is a reflective journal on my care of Joanna. This reflective journal will highlight professional practice and accountability in practice. Although this is an academic assignment, I have chosen the practice area of wound dressing since I identified that wound dressing is a technique, and this involves high level of professional involvement and meticulousness to impart this. Apart from the principles of wound infection, wound nature, and principles of sterility, a thorough understanding of the physiology of the particular variety of wound is necessary so a standard care can be delivered to the patient. If all the principles are followed in a rigorous manner, there is no reason why a difficult wound would not heal; therefore, wound dressing has implications in patient outcome. I have observed that my skills in wound dressing have improved with practice and repeated dressings of the same wound while the patient was under my care. This indicates that practice of the principles improves the standard of the care particularly applicable to wound dressing, and the care standards may be strengthened, that is, practice may be strengthened. I have decided to reflect on my wound dressings with Joanna since reflection is a process that critically analyzes the care provided, and it would help me to find out my weaknesses and strengths. Not only that, this process of reflection would enhance my future practice (McCormack B, Manley K, Garbett R., 2004). Definitions: The professional practice of nursing, midwifery, and health visiting takes place in a context of continuous change. New researches are taking place continuously, and the evidence base of practice and learning is being enhanced in a rapid manner. Therefore, new developments and continuously being introduced in practice, influenced by factors, such as, government initiatives and improvements in medical and nursing science. Professional nurses cannot hope to practice safely, efficiently, and effectively being constantly accountable to the fact whether standards of practice have been met or not unless they engage in continuing professional development mainly to maintain up to date knowledge base to underpin that practice and to facilitate the regular and ongoing monitoring and evaluation of their own practice. Therefore, professional development in nursing is defined as a system of continuous learning where value is placed on personal and professional growth and development. Emphasis is placed on orientation, in-service education, continuing education, formal education, and career development. There are opportunities for competency based clinical advancement along with resources to maintain and advance competency(McCormack B, Manley K, Garbett R., 2004).. Although it may seem unusual to describe competency indicators as being important to the nurse’s role as a promoter of health, the truth is that these competency indicators are essential to the practice role of the professional nurse. These indicators demonstrate that the standards of nursing practice are being maintained and that safe, competent care is being delivered. There are several measures that can be used as indicators of nursing competency and accountability. Most providers apply a competency and accountability check list of practice nurses in the clinical area. For example, a medical-surgical area nurse would communicate and obtain information while respecting the rights of privacy and confidentiality of information. This highlights the competency area of the caring nurse where she takes care of the patient’s rights also by treating each person with consideration, dignity, and respect at all the times. Depending on duration of the practice, a nurse will be either inexperienced or be in the range of being an expert. This expertise depends on exposure and practice. The nurse must identify and meet the patients’ needs regarding communication. The nurse would be able to provide accurate information to the patient and family to obtain informed consent. The nurse must be able to assess the patient competently. In doing so, the nurse performs and documents biophysical assessments according to the patient’s age and condition. Based on these the nurse develops a plan of care for each patient that includes intervention, evaluation of the response to intervention, and documents these. While doing all these, the nurse must remember that these must conform to standards, and not meeting standards affects her accountability(McCormack B, Manley K, Garbett R., 2004).. Reflective and Critical Analysis of Wound Dressing: My patient had a chronic skin wound. This is a wound that has failed to proceed through the healing process in an orderly or specified time frame not leading to anatomic or functional closure of the breach of the skin. On examination, this was a wound that was located in the left ankle area just above the medial aspect of the left medial malleolus. On rough assessment, the wound was superficial in that it has just encroached the deep dermis. The muscle or the joint capsule was not exposed. The size of the ulcer was roughly 3 cm x 2 cm with a pink sloughy base with exudation on presentation. The margin of the ulcer was thick and slightly everted with pink fleshy granulation tissue. The patient has diabetes, is a smoker, and has osteoarthritis. Evidence of literature suggests that the risk of developing a lower extremity chronic skin wound increases with age, smoking, obesity, and certain diseases, such as, diabetes, atherosclerosis, and arthritis. The patient’s vascular condition clinically appeared intact, although it needed more meticulous assessment of the vascular status of the patient. The three most common types of lower extremity chronic skin wound are venous, arterial, and diabetic. Diabetic management for rigorous glucose control was instituted, and the patient’s blood sugars were controlled. These wounds differ in pathology, yet in general represent late stage manifestations of systemic vascular conditions. Usually, as it is the case in this patient, these wounds are permanent, progressive and disabling. Lifestyle behaviours such as smoking, physical activity, and foot care contributes to development of such wounds, and modification of those behaviours cause them to heal. Wound dressing can take effect only when other contributing parameters are taken care of (Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA., 2006). Dressing Technique: While developing a care plan for the wound dressing, apart from the techniques of dressing, a consideration to persistent infection as indicated by the exudates at the base of the wound was important. The impact of microorganisms on chronic wounds leads to non-healing. Therefore, it is important that the factor of control of microorganism is included in the dressing plan. The microflora of the leg and foot wounds is usually polymicrobial. Staphylococcus aureus and coagulase-negative staphylococci have been the predominant organisms isolated from lower extremity wound. The early use of antibiotic is advocated in such cases even if there is no clinical sign or symptom of infection. Since topical antibiotic solutions provide high local concentration of antibiotics irrespective of vascular supply, in this case, I chose to use povidone iodine hydrocolloid. Silver sulfadiazine and chlorhexidine digluconate increases healing rate; therefore, I chose to use silver sulfadiazine cream after wound cleansing with normal saline (Bouza C, Muñoz A, María J., 2005). The dressing was done on a daily basis. I used to bring the patient to the dressing room, and I used to wear cap, mask, and gown for this after a thorough hand surgical hand washing. I used to wear a pair of sterile gloves. A sterile dressing set used to be used in all the dressing sessions. The left leg would be elevated from the level of the bed, and the initial step would be to remove the dressing of the previous day. The patient would be given one ampoule of diclofenac injection, and thorough normal saline wash of the wound and the surrounding skin would be undertaken. A sterile gauze swab soaked in normal saline would be used to lightly scrub the wound base to remove all the slough and exudates and to break any pockets of exudates if there be any. This would cause bleeding in the granulation tissue, and this would is then ready to be painted with povidone iodine solution. The surrounding skin would then be painted with the same solution. Special attention would be pain to the wound margin all round, and rubbing with a povidone iodine soaked sterile gauze would promote bleeding there. This was necessary because the wound would heal from the margin (Iglesias C, Nelson EA, Cullum NA, Torgerson DJ. VenUS I, 2004). A healthy bleeding margin would promote a quicker healing. After this a silver sulfadiazine paint would be given on the wound base with low adherent dressing with a bandage over that dressing. This was done every day for 7 consecutive days, when it was revealed that the wound has reduced to a size of 1 cm x 0.5 cm. It could be considered as a great progress for this patient in comparison to her condition at admission. I used to document the progress of healing and the process of the dressing everyday after the dressing session. Strength and Weakness: This process of dressing is definitely a process where I could explore my knowledge on different aspects of chronic wound care. The academic learning becomes strengthened when there is an opportunity to apply the learning in the practice field. In my opinion, the process of the dressing became more perfect as the days advanced, and my mentor took care of the accuracy of the process by instructing me. When on the seventh day, I found that I could follow all the instructions from the mentor and could connect the evidence-base with practice, that is, I could derive the explanations of all my steps, it appeared that I have learned the process totally, and this would help me in my future practice that can build upon the professional development that occurred in this care process. Reference Bouza C, Muñoz A, María J., (2005). Efficacy of modern dressings in the treatment of leg ulcers: a systematic review. Wound Repair Regen;13:218-29. Iglesias C, Nelson EA, Cullum NA, Torgerson DJ. VenUS I, (2004): A randomised controlled trial of two types of bandage for treating venous leg ulcers. Health Technol Assess; 8(29):iii. McCormack B, Manley K, Garbett R, editors. Practice development in nursing. Oxford: Blackwell Publishing Ltd, 2004. ISBN 1405110384 Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA., (2006). Dressings for healing venous leg ulcers. Cochrane Database Syst Rev: CD001103. 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