Reflections On Personal Clinical Experience

INTRODUCTION

A clinical reflection is a tool that enables me as a nursing student to learn from my clinical experience and actions. It can enable me to improve on the poor choices I made before, therefore is so important form to write a clinical reflection for every clinical visit. It can be used on many levels; to reflect on a specific incident, a moment in time even, and the actions, thoughts, and feelings associated with that moment, or can be used to help create an understanding of a more general period, by breaking down, considering, analyzing and critiquing the who, what, why, when and how of the events of that time(Gibbs, 1988), It can be used to reflect on situations as they occur ( reflection in action ) and on events from the past (reflection on action (Schön, 1983). Additionally, it can be used to recognize new skills and articulate planned new approaches. All of these mechanisms are thought to improve a nurse’s practice.

OBJECTIVES

By the end of the clinical visit I should have:

• Practiced my dressing skills and wound management.
• Improved my communication skills and learn how to have patient-client relationships
• Improved my injection skills.

DESCRIPTION

I was allocated to Julia Molefhe clinic situated at Mogoditshane block 9 along Mogoditshane road behind rainbow private school. The services provided there are maternity and delivery, sexual reproductive health, Child welfare care, infectious disease control center, dressing, injections, screening, consultation, dispensary, and HIV testing. Block 9 clinic is one of the considerable clinics divided into the above-mentioned units, it offers 24 hours services.

ACTIVITIES

INJECTION

I was able to practice injection skills. Mostly I practiced injection using ceftriaxone and Benzathine penicillin, this was mostly injected IM in the dorsolateral muscles .during my practice I issue that I don’t make silly mistakes which can endanger patient health. This is to avoid complications which may include muscle atrophy, injury to bone, sterile abscess, pain, and nerve injury (Hunter, 2008; Ogston-Tuck, 2014). Aspiration during injection is one of the important techniques for injections. This is to make sure that am not injected into the blood vessel. The lack of blood in the syringe confirms that the needle is in the muscle and not in a blood vessel. If blood is aspirated, I had to remove the needle, discard it appropriately, and re-prepare and administer the medications (Perry et al., 2014). I also practiced documentation. I made sure that I tally in the chart book and sign in the patient card after administering the injection. Documentation is important because it helps other health providers to be sure that the patient has been given the medication. Rapport is also crucial for health providers; I also worked on improving on it in a recent week because I realized that in the first weeks I was not doing the rapport, I was just reading the history from the patient card and offering injections at the patient card and give medication without saying anything to the patient. I used the five rights as it also important when dealing with injections.

DRESSING

I can carry out wound management of different wounds. Dressings aid in preventing infection. They are meant to stop bleeding and absorb excess secretions so the wound can begin to heal. The different types of wound management I practiced include; Hydrocolloid which is commonly used for burns, pressure ulcers, and venous ulcers, Hydrogel which is used for wounds with little secretions, and infected wounds, and Alginate which is used for wounds with high amounts of wound drainage, lastly using a cloth which mostly used for minor injuries(Doillon CJ,1986). I had a chance to clean different wounds mostly using normal saline and dress with iodine solution. For some of the wounds like burns, I used Vaseline gauze. I learned how to comprise in the dressing room by the time when the is a shortage of material e.g. last week he was a shortage of alcohol for cleaning the dressing room for blood spills, alternatively used savlon instead so that patient can be helped on a clean dressing room because it is an antiseptic.

EXPERIENCES

From the injection room, I had a couple of experiences with different drugs I administered because after the visit I went out to learn more about the medication and its side effects. The first drug was Ceftriaxone drug which is used to treat certain infections caused by bacteria such as gonorrhea (a sexually transmitted disease), pelvic inflammatory disease, meningitis, and infections of the lungs, ears, and skin, urinary tract, blood, bones, joints, and abdomen. Ceftriaxone injection is also sometimes given before certain types of surgery to prevent infections that may develop after the operation. Ceftriaxone injection is in a class of medications called cephalosporin antibiotics. It works by killing bacteria.is side effects include pain, tenderness, hardness, or warmth in the place where ceftriaxone was injected pale skin, weakness, shortness of breath when exercising, and diarrhea. Penicillin G benzathine injection is used to treat and prevent certain infections caused by bacteria. Penicillin G benzathine injection is in a class of antibiotics called penicillin. It works by killing bacteria that cause infections. Penicillin also have side effects just like ceftriaxone, they include; nausea vomiting pain, swelling, lump, bleeding or bruising in the area where the medication was injected.

In the dressing, room I have learned how suturing is performed. Last week there was a situation of a man who from 2m high stairs to the ground. The man had a laceration on his head and he was sutured by the doctor. I was willing to observe the technique even though I felt like is a bit complicated. I also had a chance to observe how wound diagnosis is written from patient cards. I learned new wound care skills using metronidazole Flagyl which shows me that am progressing in my learning. Metronidazole flagyl is also an antibiotic.

RESPONSES / REFLECTIONS

In recent weeks, I think my skills in both injection and dressings are exceptional because I now feel comfortable around everyone in that facility both staff and patients. Can do the procedures without being anxious and this helps me to offer care to the highest degree which is satisfying. In the injection room, the patient and staff always congratulate me because the patient always tells me that my injection is not too painful like other nurses. This on its own gives me the motivation that I followed a career where I will be willing to help people. Am enjoying going to the practice every day because am willing to learn new things every time. As I was observing, most of the youth are in treatment for sexually transmitted infections which I think is a serious issue in the country and something need to be done about it. Some public teaching and also mass media should be used to address this kind of issue. In overall I think I have been able to build up my confidence and work on my communication skill and am comfortable doing any of the procedures in wound care and also in injections at the different sites using different medications and doses. I need to work harder on learning how to care to perform wound care for patients with catheters and learn how it is inserted just to acquire skills.

I also had some incidental learning which is wound management of diabetic ulcers. it was my first clinical experience dealing with this type of wound. I learned that a diabetic foot ulcer is an open wound or sore, commonly located on the bottom of the foot, in a patient with diabetes. Two of the most influencing factors are nerve damage and blood circulation issues that are common among diabetic patients. Diabetic wounds should be protected from bacteria as part of wound care, and they should not be left. The wound should be washed well with saline and antibiotic ointment should be applied to keep the wound moist and coved with a bandage to control drainage and protect it.

RECOMMENDATION

Nurses should be encouraged to educate patients where necessary not just to give service without making them aware of the procedures and side effects they may encounter, as this can improve service delivery. As for us as students, nurses should be encouraged to always be willing to teach us the right of doing things and give guide and motivations as this can make us better nurses of tomorrow. University should change their curriculum and make sure that they allocate much time to practicing hours so that they learn more every week.

REFERENCES

1. Doillon CJ, Silver FH. Collagen-based wound dressing: Effect of hyaluronic acid and fibronectin on wound healing. Biomaterials. 1986
2. Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford: Oxford Polytechnic.
3. PERRY, A.G& POTTER, P.A (2014).BASIC NURSING Theory and practice.
4. Schön, D. (1983) The Reflective Practitioner: How professionals think in action. London: Temple Smith