The ability to become reflective in practice has become a necessary skill for health professionals. This is to ensure that health professionals are continuing with their daily learning and improving their practice. Reflective practice plays a big part in healthcare today and is becoming increasingly noticed.
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Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). So throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement at a day unit.
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O’Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, and conclusion. (Gibbs 1988). The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill, that I have learnt and supporting this with available literature.
The first stage of Gibbs (1988) model of reflection requires a description of events. I was asked to administer a drug to a patient named in hereafter as Mrs. A for confidentiality purposes (NMC 2008).I had observed this clinical skill on a number of occasions and had previously administered medication under supervision. On this occasion I was being observed by two qualified nurses, one of which was my mentor. The drug had been dispensed and was ready to be administered and Mrs. A consented to have a student administer the medication. My mentor talked me through the procedure step by step, and informed me that they have struggled with Mrs. A and her compliance with medication before so I should keep an eye and ensure that she swallows her medication and that she does not keep it her mouth.
The medication that Mrs. A is on is Clozapine. The decision to use clozapine is not taken lightly because of the potentially life threatening side effect. An awareness of side effects is important to primary care practitioners because they have most contact with the patients.
I learnt that using anti-psychotics is just a component of a holistic approach to a patient with psychotic illness and that care should also include psychological treatments and social care. Mrs. A does not have any issue with the drug it self but with the staff, as she is in a very psychotic state. Service users have requested strategies from services providers to manage the risk of using psychiatric medication to inform their choice about which psychiatric medication to use (DOH,1999). However evidence suggests that, there is choice, but generally by practitioner experience (Hamann et al. 2005). In non compliance of medication I had to encourage Mrs. A to make her choice to take the medications and that it was in her care plan and as part of her treatment. A nurse who has built a good relationship with a patient by informing and empowering them will be in a strong position to have a non judgmental conversation with them about the importance of adherence (Mc Lellan. 2009).
My thought and feelings
I was aware of being under the supervision of two qualified nurses and this made me feel very nervous and self conscious and I had to ensure that I was doing everything correctly and that I made no errors. Once my mentor questioned my practice, concerning if I knew the side effects of the drug I was about to administer, I became even more aware of feeling nervous and under pressure. The patient was present and I did not want the patient to feel that I did not know what I was doing. So I had to ensure before administering that I was giving the medication to the right patient and at the correct dose that it was at the right time and route. All of these had to be done to guarantee that I am competent in my ability to administer medication under the supervision of a registered nurse. This also gave me the opportunity to carry out this task in order to achieve this so I could get it signed off by my mentor in my essentials skills cluster.
The nurse patient relationship is by many considered the core of nursing. This can be done to build a good relationship and rapport with patients (Framer.et al 2001). When I was first orientated to the ward, I took it upon myself to read the patients notes so that I had more insight to the patients and their illness and index offences if any. After this I went and introduced myself to the patients because it is vital that the patients are aware of who I am and my status if I am to provide nursing care for them. (Berlo, 1960) puts great emphasis on dyadic communication, therefore stressing the role of the relationship between the source and the receiver as an important variable in the communication process.
Administering medication and how this combined with care, compassion and communication forms the bases of a holistic approach to care, and with the knowledge I got from supporting literature formed the foundation of my learning and practice. Burnard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses.
Reflective practice is becoming an essential skill that is incorporated into clinical practice and CPD and it is therefore important that the nurse understand the role and the potential of reflection. Different ways to reflect in practice can be approached; however, there are evident barriers to reflection within a care setting including time because of the busy environment a hospital encompasses or lack of motivation if the vast majority of health care practitioners are not undertaking it. The NHS has to implement ways in which all healthcare professionals can reflect in their practice to enhance patient care, as one of the NHS’s main aims is to improve the care of patients.