Reflection Free Essays

This essay will reflect upon an incident in practice when I administered a drug to a child. I will use Gibbs reflective model (Gibbs 1988)(see appendix 1). This model of reflection will be applied to the essay to facilitate critical thought and relating theory to practice where the model allows. We will write a custom essay sample on Reflection or any similar topic only for you Order Now Discussion on the incident will include the knowledge underpinning practice and the evidence base for the administration of the drug. A conclusion to the essay will then be given which will discuss my knowledge and competence of the incidence being reflected upon. The drug that I have chosen to reflect upon is Fragmin (see Drug Profile 1 Appendix 2) which was administered as a parenteral subcutaneous injection to a 14 year old girl, who shall remain anonymous for the purpose of patient confidentiality in accordance with the regulations of the NMC (2008). I have chosen to reflect on this drug as it was the first injection I had given during my training which encouraged me to further develop my knowledge within this area. The first stage of Gibbs model (1988) of reflection requires a description of events (see Appendix 3). The next stage of Gibbs (1988) reflective cycle is related to thoughts and feelings aroused during the event which I can use to reflect upon (see appendix 4). The third stage of Gibbs (1988) model of reflection encourages exploration of both positive and negative experiences encountered and I have chosen a few that I propose to discuss further within this reflection. Throughout the incident the correct hospital policy was followed by my mentor in relation to preparing and administering an injection. However I was not familiar with this policy which could have negatively affected my practice as Grey (2008) suggests, that when administering medication by the parenteral routes, familiarization with local drug administration policy is essential. The patient’s initial refusal of the injection into the abdomen made me think about the child’s rights in refusing to consent to the administration of a medication as I was aware that the law states that anyone under the age of 18 is a child (Children Act 1989, section 105) and as such there are certain matters with which they are not able to make their own decisions. The patient’s refusal to allow me to use the abdomen as an injection site also made me question my knowledge base on this subject, as I did not know where I would have injected in the abdomen if consent had been given. I also realized at that point that I have no knowledge on why different injection sites are used and for what purpose as studies suggest that the selection of the injection site will vary depending on the size and age of the child (Cocoman, 2008). It was only through my mentor’s guidance that I felt confident on allowing the change of the site. Stage four Gibbs (1988), is the critical analysis. After reflecting on this incident I will now analyse what I feel are the most important aspects by looking at the evidence underpinning it. References Cocoman, A. , Barron, C. (2008). ‘Administering subcutaneous injections to children: what does the evidence say? ’ Journal of Children’s and Young People’s Nursing, 2 (2), pp: 84-89 Gray, T. , Miller H. (2008) ‘Injection technique’, The Foundation Years, 4 (6), pp: 252-255 Royal Cornwall Hospital NHS Trust: ‘Medicines Policy’ Available at: http://www. rcht. nhs. uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Pharmacy/RulesAndGuidanceOnOrderingStoringAndAdministeringMedicines. df (accessed on 30/05/2011) Appendices Appendix 1 This model of reflection incorporates description, feelings, evaluation analysis, conclusion and an action plan (Gibbs 1988). Appendix 3 I was asked if I would like to administer a subcutaneous fragmin injection under supervision, to a 14 year old girl . The medication was in a pre-prepared syringe in the clean prep room by following local hospital policy. However, on inspection of the injection, I did question the need for the air bubble within the syringe but was assured by my mentor that it is normal to find an air bubble in a pre-prepared syringe and to leave it there for administration. The medication was checked by another staff nurse in accordance to local policy and my mentor and I approached the patient. The patient was lying in bed with no relatives present and I asked consent before administration. The patient became a little distressed at this point and refused to have the injection in her abdomen saying it was too painful, however she did consent to me using her upper arm for the site and after onfirming this with my mentor I proceeded to administer the medication with no further complications. Appendix 4 My initial feeling after being asked to administer the Fragmin injection was apprehension, as I had not administered an injection before in practice. As I was administering it under the supervision of my mentor this made me feel very nervous and self conscious, however I also acknowledged the fact that I should appear confident and at ease in front of the patient as she was herself showing signs of distress. After the patient’s initial refusal I began to doubt my competence of skills and considered asking my mentor to take over, however my mentor put me at ease by explaining that if the patient consented, then it would be fine to proceed with the injection in the upper arm. After the administration, the patient thanked me for not hurting her which immediately boosted my confidence and left me feeling extremely content with the knowledge that I had performed my first injection correctly. How to cite Reflection, Papers Reflection Free Essays To understand why having MET meetings are Important, and the Importance they have on effective patient care. Structure Membership Attendance0Technology (availability and use)physical environment of the meeting venue Preparation for MET meetings Organization/administration during MET meetings Clinical Decision Making Case management and clinical decision-making process Team-workingÃ'ËœPatient-centered care/co-ordination of service Team Governance Leadership’s collection, analysis and audit of outcomes Clinical governance Professional development and education of team members Development and training. So what? MET meetings happen weekly on the ward, usually Fridays as this Is when the appropriate staff are available and patient’s are usually eager to be discharged before the weekend. We will write a custom essay sample on Reflection or any similar topic only for you Order Now MET meetings can happen for various reasons, such as; change in the patient’s care plan or new diagnostic information. In my case, the MET meeting was to promote discharge, and ensure all professionals caring for the patients were up to date and aware of the care the patient was receiving at the present time. When It has been determined that a patient Is medically ready for discharge, the lath care team must determine the most appropriate setting for ongoing care. Determinants of the appropriate site of care Involve medical, functional, and social aspects of the patient’s illness. The patient’s acute and chronic medical conditions, potential for rehabilitation, and decision-making capacity must be taken into account. A multidisciplinary team (MET) is composed of members from different healthcare professions with specialized skills and expertise. The members collaborate together to make treatment recommendations that facilitate quality patient care. Multidisciplinary teams form one aspect of the provision of a streamlined patient journey by developing individual treatment plans that are based on ‘best practice’. Multidisciplinary teams aim to address treatment that is focused on both the physical and psychological needs of the person suffering with the orthopedic condition or illness. The MET meeting took place on the ward, and all members of the team were aware of the time the meeting was taking place so avoid any delays and confusion. I was asked by my Mentor ( ward manager) If I wanted to fill In her he care we were at with the patients on the ward and what further implementations we felt were needed to promote the patients discharge. Then what? To start off the meeting, I was asked to discuss with the other professionals information about each patient, what they had firstly come to the ward with, what care they were receiving from the nurses, what the doctors had put into place to promote their health, and if they needed any further input from the members in the team present. It was important that I discussed all relevant information with the there professionals to ensure the appropriate care plans were in place and the patients discharge wasn’t being delayed. Throughout this discussion with the MET members, I was able to give them an estimated discharge data, and also if I felt their intervention was needed. For example; Patient A was awaiting a physiotherapist assessment before going home to ensure that they were safe and felt comfortable with their physical needs (embroiling) at home. In another patients circumstances, they were awaiting a bed at a community hospital. At this stage, the bed managers in prevention is required. The role of the bed manager was to allocate beds around the different hospitals and ensure that when a bed was made available, the patient was able to go. The medical necessity of continued hospitalizing is primarily determined by the presence of an acute health condition of sufficient severity that ongoing diagnostic or therapeutic intervention, or careful monitoring, is required. However, patients often appropriately remain in the hospital when these criteria are not met, due to the lack of a suitable alternative setting to provide necessary care or other social factors. Mature discharge or discharge to an environment that is not capable of meeting the patient’s medical needs may result in hospital readmission. In addition, early hospital discharge may not lead to overall cost-savings if it results in need for more intense subsequent healthcare utilization, including emergency department or nursing facility visits, a s indicated by one observational study comparing patients who received hospital care from a primary care physician with care by a hospitals The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge. This is why it is most important that patients are discharged from hospital safely, confidentially, and any package of care they require is put into place. Discharging patients from the hospital is a complex process that is fraught with challenges. Preventing avoidable rationalizations has the potential to profoundly improve both the quality-of-life for patients and the financial well-being of healthcare systems. In order for the patient to be deemed safe and ready for discharge to home or to a on-acute environment (rehabilitative, transitional, or chronic care), I took into account the following aspects; Patient cognitive status. The nature of the patient’s current home and suitability for the patient’s conditions (egg, presence of stairways, cleanliness). Availability of family or companion support. Ability to obtain medications and services. Availability of transportation from hospital to home and for follow-up visits. Availability of services in the community to assist the patient with ongoing care. Approximately three-quarters of hospitalized patients are able to return to their mom environment following discharge. For discharge home, patients, with help from family or other caregivers if available, should be able to; Obtain and self-administer medications. Perform self-care activities. Eat an appropriate diet or otherwise manage nutritional needs. Follow-up with designated providers. Now what? Discharge planning is the development of an individualized discharge plan for the patient prior to leaving the hospital, to ensure that patients are discharged at an appropriate time and with provision of adequate post-discharge services. Such leaning is a mandatory part of hospital accreditation. Once the patient had been made medically fit for discharge, and all members of the MET were happy for the patient to be discharged, I was then able to commence their discharge process. The discharge process usually requires the following; DES completion by doctors, medications sent to pharmacy and explained to patient, any family/friends made aware of patients discharge, and ensuring any transport is booked for the patient. A challenge I found when carrying out discharge, was the patients medications. The first tepee is having an accurate medication list at hospital discharge, which depends on the following: From my placement, I have gained important knowledge on the following: Having an accurate pre-admission medication list. Having an accurate list of medications being taken by the patient at the time of discharge. Having knowledge of what medication changes were made during hospitalizing and the reasons for the changes. An example from my placement is; Was a proton-pump inhibitor (PIP) initiated for stress ulcer prophylaxis and therefore no longer required, or is ongoing PIP therapy necessary for treatment of an ulcer? How to cite Reflection, Papers Reflection Free Essays Reflection about the learning modules and simulation Chapter 8 This module was very Informative. The module provided detail Information In regards to the history and the organizations of the courts. Looking back on the primitive days leading up to modern day court system the same elements still exist. We will write a custom essay sample on Reflection or any similar topic only for you Order Now The best module I liked was the courtroom rules. In this module, it showed the key player and their roles. Now I have a better understand as to what each duty is. I learned the difference between grand Jury and trial Jury. Grand Jury, may consist of up to 23 Jurors, and serve for a particular period and may serve on multiple Juries at one time. They handle cases that are high-profile. They are able to require testimony and tangible evidences. This juror is used to bring an indictment protects law enforcement from accusation of bias. Trial Juror consists of 6-12 Jurors, serve only for the duration of the trial and decides the facts of the case with very strict and controlled procedures by the Judge. In addition to the module. The video was helpful because It describes a typical day of a judge. The video was like a real life experience working as a judge, prosecutor, and a defense attorney. In the second video, relating to issue 1: The affect of the backlog of cases on the court, she discussed how long it takes to complete one case, approximately 15 hours. She also describes how CO Simpson case moved fairly quickly through the court processes the courts. The activities were very helpful. They were like a refresher at the end of the reading and knowledge check. I enjoy these activities because It a good interaction tool with learning and having fun at the same time. How to cite Reflection, Papers Reflection Free Essays My Reflection Essay Being the billionth paper that I wrote in this class, I thought my observational essay was pretty good. It had decent wording in it, consisted of many different techniques of writing, and was just overall well written. To write this paper, I started a week in advance. We will write a custom essay sample on Reflection or any similar topic only for you Order Now I went to my dad’s house and sat in his office for about 5 hours writing the entire paper, while taking a few breaks of course! The office was totally quiet, which is one factor that I require in order to write a wonderful paper The easiest part of the assignment was thinking of ideas for the paper. They came to me immediately. The hardest part was putting those ideas onto paper. Transferring ideas into writing is one of the hardest things I have ever encountered in school. Some of the strengths in my paper include the different styles that I used, the wording, and the length. My wording sometimes sounds like words coming out of my mouth, and not just a dull sentence. The length of the paper is not too long and not too short, which makes it easier for someone to read it without losing interest. Some weaknesses about my paper are the lack of details and the plain-and-simple style that I sometimes slipped up and used. Details can be added, but the styles are hard to change. My plain and simple style can be told apart from my other styles, and it stands out in some papers, but not very much in this one. My Cats ideas were extremely helpful in process of writing my reflection essay. It saved me a lot of time. I used her ideas and combined them with mine to improve my paper. After writing this paper, I have found that I am no longer a terrible writer. I have matured a whole lot over the past summer, and perhaps have caught back up with my fellow classmates. I think my paper is basically ready for my portfolio. A few minor changes may need to be made, such as adding a few more details where needed, and maybe change some of the wording, but other than that I think it is ready. How to cite Reflection, Papers