Reflective Practice in Nursing - Research Proposal Example

Name: Tutor: Title: Reflective Practice in Nursing Course: Date: Reflective practice Description of practice During my clinical placement, I developed a great interest in drug administration using Intramuscular (IM) technique since this was the method that was widely used. Due to this interest, I participated in the practice of IM injections. I was requested to administer an IM injection to a patient. Since I was keen on this clinical technique on various occasions and had administered the injection previously under my mentor’s supervision, I knew I was now competent on this skill. During this incidence, I was under two nurses’ supervision, my mentor included. Before drug administration, my mentor informed me that I have to clean the site of injection using an alcohol swab, but her colleague said the use of alcohol swab was unnecessary. This made me feel unsure about swabbing or not swabbing and was afraid that the patient might doubt my competence given that I had obtained his consent to administer his drug. My mentor then said it was acceptable to carry out the procedure without swabbing the injection site. Previously, I had performed this procedure without cleansing the injection site and no one had instructed me to adopt the practice of alcohol wipes. As a result, I researched on the use of alcohol wipes prior to IM injection so as to enhance my knowledge in this topic. Literature Review IM injections are reported to be frequently employed procedure of nursing with an approximated twelve billion administered yearly all over the world. According to Lawrence (1994), studies show that in current years, developing demands have been put on medical practitioners particularly nurses to implement care that is evidenced-based. Several healthcare environments are tackling this by developing guidelines and policies concerning injection administration which exclude or include the issue of infection control like skin cleansing before injection (Hoffman, 2001). Nurses within clinical practice are questioning the significance of preparing skin before IM and are positioned in the dilemma of what to be done in course of evidence base that is unclear or open to various interpretations. This is what I felt when the nurse and my mentor differed a bit on whether I should use alcohol swab or not. Although my mentor said it was appropriate not to swab which made me want to know why that was appropriate yet I know that cleansing an injection site prior to injection helps in reduction or prevention of infection. According to a research conducted to evaluate the importance of skin preparation before IM injection, findings indicated that patients who were injected intramuscularly without skin preparation did not show any infection whether local nor systemic. Another finding also indicated that patients who whose area of injection were swabbed did not show any infection (Hoffman, 2001). This therefore means that there is no harm in injecting patients intramuscularly without swabbing the area of injection provided the skin is not soiled. Due to this finding, it was then recommended that routine preparation of skin was not necessary and questioned the hypothesis that there could introduction of infection through the needle from skin that is unsterile. Alcohol swabs before injection decreases bacterial counts on skin by more than 82%, although disinfection like this is not essential to prevent infection at the site of infection (Workman, 1999). A study showed that when numerous injections were administered without swabs of alcohol no infection took place. Other research coincides with these findings and recommends that usually there was inadequate skin contamination to bring about infection after injection exclusive of skin disinfection and that cleansing skin was a needless procedure. Further study has endorsed the significance of making sure that the patient’s skin is physically hygienic and that providers of healthcare maintain excellent standards of hygienic hands before the procedure. Scientific proof to encourage the use of water and soap for cleansing skin is inadequate, but it has been recommended that the substantial act of washing removes temporary flora which might infect the skin (Hoffman, 2001). According to Liew & Archer (1995), a study conducted by World Health Organization (WHO) to review best practice with respect to the prevention of IM injection associated infection, WHO established and recommended that it is needless to swab clean skin using a disinfectant prior to IM injections. This is because clean skin has normal flora that can prevent infection thus swabbing the skin using alcohol only introduces bacteria to the blood stream since alcohol removes the normal flora on the skin. Contrary to these, a number of researchers have advocated for the cleaning of injection site so as to reduce infection risk. A number of investigations have cautioned use of alcohol swab in post IM injection because the material of cleaning might be tracked along the path of the needle causing irritation. Swabbing the site of injection using 70% saturated alcohol swab in a period of 30 seconds and allowing alcohol to dry in 30 seconds is important in reduction of amount of pathogens (Lawrence, 1994). Allowing the injection site to dry averts stinging in case alcohol is tracked into the tissues at the time of needle entry. Integrating Theory and Practice I think that although a lot of researchers regard disinfection of skin as needless, their methodologies of research have been frequently questioned. Hence there exist doubts concerning the consistency of their findings and whether they need to be generalized. Nurses should consider medico-legal repercussions and they need to constantly follow the standards and guidelines suggested by their health authority with respect to cleansing of skin before injection. Since the nurses were aware that there is no harm in administering IM injection without swabbing the injection site using alcohol, they were certain that the patient I was administering the injection to would not develop any infection following a reflective practice (Atkins & Murphy, 1994). And since the patient said that on previous IM injections, he experienced a feeling of stinging when alcohol swab was used to cleanse injection site prior to injection, he made me know that alcohol at the site of injection can follow the path of the needle hence causing irritation. There is implication that it would be tricky to defend a local sepsis case which occurred due to an injection without skin disinfection. The organisms typically responsible for bringing about abscesses at IM site include haemolytic streptococcus pygenes and staphylococcus aurous. These organisms are basically pathogenic in nature. Even so, the need to get rid of them from the skin prior to jabs has been questioned during a few years. One of the studies cautions that without disinfecting skin that is contaminated with road dust or soil could lead to inoculation of bacteria that is gram positive, spore-forming and anaerobic (Lawrence, 1994). The bacteria are said to survive for indistinct periods in road dust or soil and might lead to tetanus and gangrene. Argument remains concerning the need for cleansing skin because a conclusion was made that routine preparation of skin prior to injection was needless and has no essential effect in decreasing risk from skin flora of the patient. Nursing is a practice that calls for team work so as to deliver quality healthcare to patients. Lack of team work may lead to confusion in clinical procedures which may eventually lead to clinical mistakes that can be avoided. Since I had appropriate theory on skin preparation prior to injection, I knew that use of alcohol swabs to cleanse the site of injection could help reduce infections whether local or systemic (Ghaye & Lillyman, 2000). After preparing the drug for injection, my mentor reminded me that I had to swab the injection site which I found to be fine with me. But her colleague who was also a registered nurse claimed that it was an unnecessary procedure which made them agree on not swabbing the site. After extensive reading on whether the site of injection should be cleansed prior to injection, I discovered that several authors have different opinions on this matter. This confirmed to me that the nursing fraternity is placed on uncertain situation on whether the practice of swabbing is appropriate or not. These findings have made me question what should be actually considered within the clinical setting considering that one of the nursing practices is to carry out an infection free procedure. This hence leaves nurses in an uncertain situation of whether to carry out this custom practice or not. Even though the literature is distant from perfect, many Australian inpatient and community surroundings continue to support the practice of cleansing the site of injection. Since I have a good knowledge on the importance of reducing the risk of infection in hospitals and particularly at the site of injection, I also think it is essential to cleanse the injection site so that risks of infection could be minimal. As a nursing student, I think practicing what is right is very crucial since patients can sue incompetent nurses. Additionally, hospitals need to offer their medical workforce with a clear general precaution guideline which can aid to decrease infection and reflective practice should be encouraged by nurses (Larrivee, 2000). Conclusion My clinical placement made me learn a number of things. For instance, how some topics like swabbing or not to swab the site of injection prior to injection particularly, IM injection can be very debatable. This has made me research more in order to clearly know what needs to be done in the correct way. Because of my extensive research, I still strongly believe that swabbing the area of injection before injection is essential since it reduces the number of pathogens. And as discussed above, defending a case where an injection was administered with no consideration of swabbing the site of injection with alcohol could be very hard. Therefore it is important that hospitals stipulate a clear guideline on infection control. Latest information regarding infection prevention should be provided to health workforce in hospitals so that everyone becomes acquainted with what they should do. Nurses responsible for training student nurses need to be updated on developments in control of infection and safety via medical workshops and conferences so that an incident like mine where nurses have different views on certain procedures cannot take place again before patients. Bibliography Atkins, S & Murphy K. 1994, Reflective Practice, Nursing Standard, Vol. 8, Issue 39, pp 49-56. Ghaye, T & Lillyman S. 2000, Caring Moments the Discourse of Reflective Practice, Mark Allen Pubs, Dinton. Hoffman, PN. 2001, Skin disinfection and acupuncture, Acupuncture in Medicine, Vol. 19, Issue 2, pp 112-6. Larrivee, B. 2000, Transforming Teaching Practice becoming a Critically Reflective Practitioner, Reflective Practice, Vol. 1, Issue 3, pp 293-308. Lawrence, JC. 1994, The use of alcoholic wipes for disinfection of injection sites, Journal of Wound Care, Vol. 3, Issue 1, pp 1-14. Liew, J & Archer GJ. 1995, Swabaholocs? (Letter) Lancet, Vol. 345, Issue 8965, pp 1648. Workman, B. 1999. Safe injection techniques, Nursing Standard, Vol. 13, Issue 39, pp 47-53. Read More