Nursing Skills Issues - Essay Example

?Critical Reflection In accordance with the Nursing and Midwifery Council of Conduct (NMC, 2008), I will protect the confidentiality of the individuals referred to in this critical analysis. Introduction This critical analysis covers two basic skills which I was able to apply during my placement. Wound care and discharge planning shall be evaluated in this analysis. This essay will assess, evaluate, and outline action plans which will enhance my future clinical practice. This paper will also prompt me to apply my analytical skills and performance in the various areas of practice. Gibbs (1988) model will be applied in this critical reflection. This model is meant to establish a specific assessment and analysis of my actions and feelings about the situation. His model includes six phases which are meant to study my actions at each stage of the practice and with each intervention. It is also meant to teach me what I did wrong and what I can do to improve my practice (Jasper 2003). These phases include: description of the event, feelings, evaluation, analysis, conclusion, and the action plan (Jasper 2003). Critical analysis skill 1: Wound dressing Description To protect the patient’s identity in accordance with the NMC Code of Conduct, this patient shall be referred to as Wilson. He was admitted into the hospital after a three inch gash on his arm became infected. Based on my role as a nurse in instances of wounds and infection, my mentor instructed me to clean the patient’s wound. I did so under my mentor’s direct supervision and guidance. Before I dressed his wound, I first asked for his permission. While cleaning the patient’s wound, I asked the patient how he was feeling, and if he felt any pain from his wounds. I also explained the process of dressing his wound, and why I was doing it. Before I dressed his wound, I first washed my hands aseptically with soap and running water, drying my hands well on a sterile towel. I also prepared all the materials I would use to clean the wound. I also closed the door to his room to afford privacy and helped him to sit-up to a comfortable position on the bed. I placed paper towels underneath his wounded hand and placed all the materials I would need on a tray placed on a table adjacent to the bed. I opened the dressing packs and dropped them on to the sterile tray. The dressing pack included the mepore, the gauze, and the cotton balls. The alcohol was placed on the table, along with the saline solution, the iodine and the alcohol. I opened and put on sterile gloves and started cleaning the wound. I initially used normal saline solution and followed it up with iodine to clean the wound; and later, I dressed the wound with mepore and gauze. I then secured the gauze with a plaster. Feelings I felt very calm and confident while cleaning and dressing Wilson’s wound because I had previous experience carrying out the procedure and I knew what to expect, how to carry out the process aseptically, and I had my mentor guiding and supervising my actions. Since I acted calm and competent, Wilson was very cooperative throughout the procedure. He did not display any anxiety or agitation. My mentor also prevented me from making any mistakes in the process, encouraging me and reminding me of the aseptic measures I had to apply in order to prevent infection. As a result of the support and of my competence in the activity, the patient also felt safe in both our hands. Evaluation Before I carried out the procedure, I asked for the patient’s consent first; this is part of the ethical code of conduct and is essential to the respect owed to the patient (Hannon and Clift, 2010). Patients have the right to autonomy, in other words, they have the right to decide the direction of their care; therefore, their consent is essential before any intervention is carried out (Hannon and Clift, 2010). This consent is a contract between the health provider and the patient for the provision of care and the NMC clearly states that it is important to secure such consent before any care is administered in order to ensure patient awareness of interventions at all time (NMC, 2008). Consent also involves the process of communicating and transmitting information to the patient, and with more information on the part of the patient, they can make a more informed decision about their care (Hannon and Clift, 2010). By closing the door to the patient’s room, I was able to ensure privacy for the patient. Privacy is also related to maintaining patient respect and dignity (Chalmers, 2003). Respecting the patient’s dignity is a crucial aspect of care because it prevents feelings of shame and embarrassment on the part of the patient; and makes him feel respected as an individual and as a person (Chalmers, 2003). Nurses are the main health professionals who can ensure that this privacy is maintained because they spend more time with the patient as compared to any other health professional. It is incumbent upon them to ensure dignity and improved health outcomes (Chalmers, 2003). Part of treating patients with dignity is about establishing empathy for the patient, making them feel like their feelings and opinions matter and that these feelings are worthy of consideration in relation to their care. Analyses There are various options in cleansing wounds, including normal saline solutions, tap water, iodine, and commercial wound cleansers (Milne, et.al., 2003). Normal saline solution was used to clean Wilson’s wound because it has antiseptic and purifying qualities and also can save on cost and time. Iodine has cleansing properties and, more importantly, antibacterial properties which help clean wounds and secure the area against infection (Khan and Naqvi, 2006). Tap water can also be used to clean wounds, especially in instances where much dirt is in the area of the wound. This is also an inexpensive option for wound cleansing, and the fact that it is often widely available and easily accessible is a major benefit in its use (Mattu, et.al., 2010). In the community setting where normal saline solutions may not as easily be accessed, tap water is highly recommended (Milne, et.al., 2003). Its benefits are also similar to normal saline solution in terms of wound cleansing and improvements in healing rate. The fact that normal saline was used for Wilson’s wound is therefore a favorable decision. Commercial wound cleansers including iodine and clens dermal wound cleanser can also be applied in more thorough cleansing processes, especially in instances when the wound is already previously infected (Mattu, et.al., 2010). However, other authors like Milne, et.al., 2003) express concerns on the toxic cell effects of these commercial wound cleansers and the fact that they can destroy regenerating cells and therefore delay wound healing. Other wound cleaning techniques can also be applied for Wilson’s injury, including the clean technique which involves the process of keeping the wound free of dirt, stains, or marks (Wound, Ostomy, and Continence Nurses Society, 2011). Clean technique includes processes applied in order to eliminate the number of microorganisms in the wound or to eliminate the risk of transmitting microorganisms from person to person. Clean techniques include the processes of handwashing, keeping a sterile field, using gloves and sterilized equipments, and preventing any contamination of the sterile field (Wound, Ostomy, and Continence Nurses Society, 2011). Clean techniques often apply to patients with high risk for infection and those who are receiving routine cleansing processes on a regular basis (Wound, Ostomy, and Continence Nurses Society, 2011). This technique was already applied in the case of Wilson when I used hand washing techniques, kept the sterile field clean, and when I used gloves. Through this process, the risk of infecting the wound was reduced. Conclusion Aseptic measures in wound cleaning and in implementing nursing interventions include specific skills and interventions carried out under carefully managed conditions. The goal in this case is to reduce infection risks and to eliminate any bacteria buildup in the client’s wound. Various cleansing options are applied in order to clean and dress the wound and prevent entry of bacteria into the wound. These options were identified and discussed above. With the application of the appropriate cleansing options for patients, quality nursing care in the health setting is made possible. Wound management is crucial in order to facilitate healing, and reduce the psychological impact of any injuries. Action Plan The skills and the data I was able to gather from this experience allowed me to be more reflective and cautious in my actions and practice as a student nurse. The importance of aseptic techniques in nursing care has long been emphasized by our teachers, and I was able to apply such technique in the case of Wilson. I have also become more confident in wound cleaning and in the application of aseptic techniques. I am also confident that I would be able to carry out the same process in the future with minimal and even without any supervision or assistance. Critical analysis 2: discharge plan Description This situation will discuss my experience in establishing a discharge plan for a 23 year old patient following a bout with flu. The patient shall be referred to as Mr. X in order to protect his identity. When the staff was informed by the physician that the patient was ready for discharge, I was tasked with preparing his discharge plan. Before preparing such plan, I reviewed the patient’s chart, including his home situation (living arrangements), his cognitive and comprehensive ability, as well as his work. I also checked the final doctors’ orders and nurse’s notes in order to establish a possible basis for his discharge plan. I also checked the date of his follow-up check-up. I checked his weight and also his food habits, noting that he was slightly overweight, living alone, smoking, drinking excessively, and was working at an IT company for long hours. After noting all these details, I prepared a list of medications, indicating the dose for each medication. I also prepared a list of precautions and health education details I needed to discuss with the patient. I also noted the date for his follow-up check-up and arranged such appointment with the attending physician. After these preparations, I made a final assessment of the patient, making sure that he was healthy enough to be discharged. I then gave the patient a list of his medications and reminded him of his follow-up check up with his doctor. I then proceeded to discuss the various precautions he needed to take in the next few days following his discharge, including his risks for reinfection. I also discussed health concerns like being overweight, as well as smoking and excessive drinking. He acknowledged that these were lifestyle changes that he needed to consider in the near future. He also expressed that he would finish his medications and check in with the doctor for his follow-up check-up. Feelings This was my first time to make discharge notes and a discharge plan so I was very much anxious and did not have much confidence in carrying out the task. I felt that I might say the wrong thing to the patient, especially in terms of health education recommendations. I felt that in preparing the discharge plan that this was a way for me to test and improve my skills in this aspect of nursing. I was also worried that I might forget to express some details to the patient and might not get another opportunity to express these before the patient is discharged. However, the staff nurse supervising me was able to evaluate my discharge plan, make suggestions and additions to the plan. This helped reassure me of the efficacy of the plan and it gave me confidence in approaching the patient and discussing the plan with him. After finishing the discharge plan and after discussing its details with the patient, I checked if he understood everything. He said he did and he understood that it was important for him to take his medicine, to rest for a few days, and to see his doctor after three days. Evaluation The staff nurse who reviewed my discharge plan indicated that I was more or less able to establish a complete and efficient discharge plan for the patient. She only made minor changes to the plan by reminding me to indicate suggested time for intake of the patient’s medication (Jack, et.al., 2009). She also reviewed with me the importance of indicating which medication was supposed to be taken before and which one was supposed to be taken after meals (Jack, et.al., 2009). During the discharge planning, I needed assistance in coming up with suggestions for the patient on what actions he can take after being discharged. This included increased water intake, relaxation activities, and a healthy diet (Turisco and Harmon, 2010). The staff nurse also suggested that the patient needed to be taught about the signs of reinfection he had to observe and what he can do if any of the signs would manifest (Timby and Smith, 2004). The risk of readmission is often common especially if the patient does not take adequate precautions after his discharge; in some instances, the reinfection can cause a worse manifestation of the disease (Timby and Smith, 2004). It may even take longer to manage. The favorable aspects of this experience was that I was able to note important details I need to discuss with the patient who is about to be discharged. I was also able to gain more confidence in making a discharge plan. Before the experience, I did not have much opportunity to establish a discharge plan for an actual patient. In school, we were actually given a list we needed to accomplish for the discharge plan, but applying it to the patient was another matter. I knew he was eager to leave, so I eased into my discussion with him, allowing the details of the discharge plan to flow naturally. It helped that I was able to establish a healthy rapport with him during his care and he was more receptive to suggestions (Boyd, 2008). Analysis I was able to accomplish the details of the discharge plan by rechecking the plan with the nursing staff. I also checked literature and information about flu and the possible risk factors and dangers which each patient can encounter with the disease (Moore, et.al., 2007). I also checked each medication prescribed to the patient, reviewing their contraindications, side effects and adverse reactions (Moore, et.al., 2007). I also reviewed the discharge plan checklist of the hospital in order to ensure that I was not forgetting anything. Prior to the preparation of the discharge plan, the latest laboratory results of the patient were reviewed, including the doctor’s notes clearing the patient’s condition as well as his discharge orders. Doctor’s orders are important to use as the discharge plan is being prepared because this would help provide a basis for the plan and would help prevent readmission and ensure patient compliance with the plan and with any follow up check-ups or medication (Coleman, et.al., 2006). The importance of checking latest laboratory results before discharge is also a way of ensuring that the patient can really be cleared for discharge and that his disease has already been managed before discharge (Coleman, et.al., 2006). It was also important to study each medication which was prescribed to the patient in order to ensure that the patient understood the dosage for each medication, and the possible reactions he may receive from each medication (Makaryus and Friedman, 2005). Side-effects or adverse reactions which are not properly explained to patients can cause them much anxiety. It can also discourage them from complying with the medication regimen, thereby opening them to an even greater risk for readmission (Makaryus and Friedman, 2005). Teaching the patient possible signs of reinfection is also an important aspect of the discharge plan because early detection of these signs would help ensure early management (Makaryus and Friedman, 2005). The fact that the patient is living alone is also an important consideration since there is no one who can monitor for the manifestation of such signs. Teaching the patient about these signs is therefore important (Greenwald, et.al., 2007). Early management of reinfection or of any other disease is an important element of nursing and disease management. It can help prevent complications and reduce medical costs of treatment (Greenwald, et.al., 2007). Reminding the patient of his follow-up check-up is also a crucial aspect of discharge planning because it can help in the comprehensive management and monitoring of the disease and of the patient. It can also help prevent any reinfection and ensure early management of possible reinfection (Shepperd, et.al., 2004). Follow-up check-ups can also assist in the monitoring of any complications which may be an offshoot of the disease. Sometimes, complications of diseases do not manifest immediately (Shepperd, et.al., 2004). Follow-up checks and monitoring can ensure early detection of these complications, as well as their early management. Discussing other elements of health education with the patient is also an essential element of discharge planning. Considering lifestyle changes with the patient have been acknowledged by the patient himself (Greenwald, et.al., 2007). Health education involving lifestyle changes are important additions to the discharge plan, especially if the patient already has risky behavior which serves as current and future dangers to his health. Health education on the benefits of diet and exercise for the overweight or obese is one of the main teachings nurses can impart to their patients (Paasche-Orlow, et.al., 2006). The concepts of diet and exercise, including a diet and exercise plan can be discussed with patients in order to eventually encourage them into considering such options. In the case of Mr. A, health education of smoking and excessive drinking needs to be undertaken. Smoking is a major health risk as its continued use can cause cancer and heart diseases; excessive drinking can also lead to cirrhosis of the liver as well as heart diseases. Instructing patients about these risks can motivate them to quit smoking and to drink moderately (Paasche-Orlow, et.al., 2006). In the immediate aftermath of the patient’s flu, avoiding smoking and excessive drinking is also important in order to prevent any health complications. Conclusion Discharge planning refers to the plan which is formulated in order to ensure the adequate and efficient transition of the patient from the hospital into his home or into the community. By formulating a complete and efficient health plan, I was able to ensure that the patient would be discharged carrying with him adequate information about his disease, his medications, and the precautions he needs to take in order to make a full recovery. It can sometimes be difficult to fully explain the details of the discharge plan with the patient, however by being patient and through a good rapport with the patient during the communication process, it is possible to ensure the efficient fulfillment of the discharge plan. For this patient, I was able to establish a comprehensive and efficient care plan, one which the patient was able to adequately understand as an essential part of his continued care. Action Plan I have come to the realization that in establishing a discharge plan, there are various details which need to be remembered and taken into account. I was also made aware that getting the patient to be engaged in a plan can be quite a challenge for nurses, especially as the patients are just eager to go home. However, with patience and confidence, it is possible to achieve the essential goals of the discharge plan. I was also able to understand that the discharge plan is still part of the continued commitment which nurses and health personnel have to their patients. It is also part of preventive care. 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