Reflection-Subcutaneous Injection As Clinical Teaching

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Reflection-Subcutaneous Injection As Clinical Teaching

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For this task you are required to write a 1500 word reflective essay. In your essay you need to:
My topic: subcutaneous injection as my clinical teaching
apply the Gibbs Reflective Cycle to reflect on a time when you facilitated a clinical teaching activity for peers, students, patients or others in the working environment, referring to literature related to learning, teaching, assessment, evaluation and feedback
Provide recommendations for practice and professional development

Answer:

Subcutaneous injection as my clinical teaching
In this self refelction essay I will use the gibb’s reflective cycle to describe my experiences and how the experience have affected me and have helped me to learn to enhance my professional practice and how the experience had been useful in my clinical teaching practice.
Description
I was assigned to demonstrated clinical teaching activity before my peers about the correct procedure for the application of subcutaneous injection in a patient within a clinical setting. It has to be mentoned that clinical teaching was being performed within a real life clinical setting with a real patient (Mayhall, 2012). A subcuranous injection is normally used for administering anticoagulants like heparin or insulin. Since I was demonstrating my clinical teaching skills, I made it sure to mention the types of medications that are notrmally administered subcutaneously. After that the patient was brought to the room where I have arranged all the equipments required for the administration of the subcutaneous medicine. I greeted the patient cordially and informed him about the medicine that has to be administered (Cassileth, Zupkis, Sutton-Smith & March, 2012). I provided enough scope for my peers to get a view of the entire procedure. One of them was also making a video recording for the future evaluation. The patient had an abdominal surgery and thus chose her arm for the administration of the injection. I chose an appropriate needle for the administration of insulin. I performed hand hygiene techniques before the administration of the medicine. The upper hand was chosen as the site of injection . appropriate size of needle was chosen or the application of medicine. I made it sure observe the previous sites of the injecton. Rotation of the injection site is necessary to prevent scarring. Howver, I held the syringe uprighy and pulled the plunger down adjusting the dosage of the medicine. I swabbed the injection site with the help of an alcohol pad. The I slowly injected the medicine in to the skin at an angle of 45 degree. The plunger is pushed all the way dwn and was held for about 10 seconds. I released the pinched skin and removed the needle. I finally discarded the injection in a puncture resistant discard can.

Feelings
Although I have perofmed this procedure for a number of times , but I still felt nevous while carrying out the procedure, as my demonstraton skills and the teaching techniques would be evaluated for clinical teaching process and I would also feel a bit embrarrased if any error occurs in front of my peers. Furthermore subcutaneous medicine administration is not amechanistic task and has to be done in strict compliance with the prescription and nursing guidelines. I have always learnt that the administration of an injection skilfully enables the patient to experience less pain and also prevents unnecessary complications.
SC injection involves deposition of the medicines in to the loose connective tissue under the epidermis. The rationale for the application of subcutaneous medicines is that these tissues does not have a rich supply of blood vessels and thus the medicines are absorbed slowly. Before the application of the injections, some precautions should be taken care off. The preexixting condition of the patient sould be assessed for preventing the contraindications, patient prescription charts should be checked for assessing the correct route, dosage (Jin etc al., 2012).

Evaluation
It can is really difficult to administer injections and explain the procedure at the same time. Hence, it is necessary to educate the student about the procedure practically before showing a practical demonstration as it help the learners to relate it to the practical work. Secondly while adminsitating the injection I forgot to pinch the skin slightly. It was a mistake on my part as patient felt discomfort while the injection administration and there was a minor bleeding occurring . I felt that for such a mistake the injecton could have been introduced in to the muscles.
I was mindful about performing the hand hygiene and doing the entire process asceptically. Nurses are responsible for the correct administration of the medication in an asceptic technique (Khan, Ahmad&Mehboob, 2015).
The choice of the injection site is entirely based on clinical judgement basd upon the patient condition and the assessment. Initially I had decided to give the subcutaneous injection on the abdomen but became mindful that since the patient had undergone an abdominal surgery, abdomen might not be the ideal site for the application of insulin. While the application of the subcutaneous insulin, it has to be administered in to the fatty tissues below the skin as if it is injected in to the muscles, it will be absorvedtooquickily by the body (Landers, Abusalem, Coty & Bingham, 2012). Apart from this I have talked to the patient for seeing how she was feeling or if she was comfortable with thw way the inhjection has been administered , I was delighted to reciebe positive feedback from my patient. Collection of feedback from patients helps thwe health care professionals to learn the satisfaction level of the patients, by obtaining suggestions for improving the practicefeedback (Ivers et al., 2012). After the the clinical teaching process, I have also received feedback from my peers, who were observing my teaching, who have expressed that I need to work more on my interpersonal skills tcommuniacate to the students and the patients easily.

Analysis
According to the Singapore codes of professional standards, it is the duty of the nurses to provide a safe environment to the patient (Singapore nursing board.2018). I have realised that in order to become a clinical instructor I have to gain more confidence and would have to understand what kind of a learner are the students. While performing the clinical teaching activity in front of the nurses I have realised that a prior teaching class was necessary before a live demonstration of the activity. This demonstration has helped me to understand that things like application of the evidence based practice is an important approach that should be adopted by the nurses to raise their competency skills. This has also taught me that things like hand hygiene, proper disposal of the injection to prevent the needle stick injury are extremely important in a clinical setting.
Conclusion
In conclusion it can be said that the overall experience was positive as per the feedback of the patient and peers. This experience has been special for me as it was my first simulation in front of my peers and thus being able to reflect and understand my own feelings about the administration of the injection as well as obtaining the feedback from the patient and the peers have given me the chance to evaluate the experience, so that my techniques could be enhanced to provide a better care to the future patients. I believe that I have developed more confidence which will help me to become a good clinical educator in near future.
Action plan
From the incident that took place while demonstrating the application of a subcutaneous injection, I have realised that I need to develop my interpersonal skills and should gain more confidence while conducting a teaching. I intend to brain storm through the research journals and articles to develop mote knowledge about the scientific procedures and the associated guidelines for medication administration. I should also develop my knowledge against proper learning techniques that would help me to teach my students, patients or peers in future. Research helps in the application of evidence based skills in nursing (Melnyk, Gallagher?Ford, Long&Fineout?Overholt, 2014).

Summary
In this reflective essay I have discussed about my clinical teaching experience about the administration of the subcutaneous medicine. I was assigned to demonstrate my teaching in front of my peers who were recording my performance for the evaluation. I was allocated to demonstrate the application of insulin subcutaneously to a patient who had undergone an abdominal surgery. During the entire procedure, I made sure to abide by all the clinical guidelines of medication administration such as choosing the correct patient, route and dosage. I have performed the necessary hand hygiene techniques that is required before the conduction any invasive procedure. I also took consent from the patient before the procedure. Everything went well except that I forgot to pinch the skin slightly before the application of injection, which caused a bit discomfort in my patient and the medicine could have been absorbed in the muscles. I also got a bit nervous while teaching my peers which might have affected the teaching process. However, I strongly believe that nurse are liable to provide a safe patient care and should always be mindful about each and every procedure. Furthermoreself-reflection in this essay will also be helpful to avoid any future mistakes and to analyse critically what could have been done to avoid the mistake (Mann, Gordon & MacLeod, 2013).
Recommendations
In clinical teaching the educator should be acting as the role model for the students (In this case, the peers). He/she should be able to articulate the concept used for the student assessment and should clearly explain and demonstrate the clinical materials.Hence . befor the procedure, it was necessary to take a class discussiong about the techniques and the guidelines for the application of the injections thoroughly and then demonstrate how they can be used in real clinica; conditions (Ivers et al., 2012). Further more after demonstrating the subcutaneous injection with the real life student, the students (My peers) can be evaluated by letting them do the entire procedure on a manikin. In my case I can obtain feedback from the patient and my peers. As a clinical teacher I should provide the rules targeted to the learner’s level of understanding. Furthermore, the it is necessary to develop more confidence on my part and to practice the procedure several times for different situations to gain accuracy.

References
Cassileth, B. R., Zupkis, R. V., Sutton-Smith, K., & March, V. (2012). Informed consent—why are its goals imperfectly realized?. New England journal of medicine, 302(16), 896-900.DOI: 10.1056/NEJM198004173021605
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., …& Oxman, A. D. (2012). Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 6(6).
Jin, J. F., Zhu, L. L., Chen, M., Xu, H. M., Wang, H. F., Feng, X. Q., …& Zhou, Q. (2015). The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection. Patient preference and adherence, 9, 923.doi: 10.2147/PPA.S87271
Khan, H. A., Ahmad, A., &Mehboob, R. (2015). Nosocomial infections and their control strategies. Asian pacific journal of tropical biomedicine, 5(7), 509-514.https://doi.org/10.1016/j.apjtb.2015.05.001
Landers, T., Abusalem, S., Coty, M. B., & Bingham, J. (2012). Patient-centered hand hygiene: the next step in infection prevention. American journal of infection control, 40(4), S11-S17.https://doi.org/10.1016/j.ajic.2012.02.006
Mann, K., Gordon, J., & MacLeod, A. (2013). Reflection and reflective practice in health professions education: a systematic review. Advances in health sciences education, 14(4), 595.DOIhttps://doi.org/10.1007/s10459-007-9090-2
Mayhall, C. G. (2012). Hospital epidemiology and infection control. Lippincott Williams & Wilkins.https://books.google.co.in/books?hl=en&lr=&id=y-wKh8oIdn8C&oi=fnd&pg=PT78&dq=infection+control+while+invasive+techniques+in+hospital&ots=w9DO7F6VJ8&sig=M5284uSjUrSqvLIJI9D5GzProOA#v=onepage&q=infection%20control%20while%20invasive%20techniques%20in%20hospital&f=false
Melnyk, B. M., Gallagher?Ford, L., Long, L. E., &Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.https://doi.org/10.1111/wvn.12021
Singapore nursing board. (2018).Nursing guidelines and Standards .Access date: 24.9.2018. Retrieved from :https://www.healthprofessionals.gov.sg/snb/advanced-practice-nurse

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