Essay, Pages 4 (788 words)
The clinical skill I have chosen to reflect on is the administration of Intramuscular (IM) injections. I will use a reflective model to guide me in my reflection. The Gibbs reflection cycle features, description, feelings, evaluation, description, conclusion and an action plan (Gibbs 1988). The first stage of Gibbs (1988) is description of events. On my clinical placement I had the opportunity to administer a drug to a patient via IM injection under the supervision of my mentor.
I had already observed this skill on various occasions and previously had the opportunity to administer IM injections in previous placements.
My mentor was talking me through the process as this was the first time I have performed the skill with her supervision. When the mentor got to the step of using an alcohol wipe to cleanse the area of the injection site the patient said he did not usually get that done. He continued to say that an alcohol wipe had been used once before and had caused him an unpleasant stinging sensation and he would rather it was not used.
The previous times I had administered IM injections, I had cleansed the site with alcohol wipe, and therefore I asked my mentor for some guidance in this situation. My mentor confirmed that it was acceptable to administer the injection without using the alcohol wipe and I continued with the injection. Feelings are the next stage of Gibbs (1988) cycle. My thoughts and feelings about this situation was that I felt a little nervous as I was under the supervision of my mentor for the first time doing this skill.
However as I had already had the opportunity to administer IM injections before, I felt I was competent to carry out that skill. When the patient had said he did not usually have the alcohol wipe used, I began to doubt my practice. I knew I had previously used this in my practice, but began to question myself if it was correct. As the patient continued to say he had previously had an unpleasant stinging sensation when the alcohol wipe had been used I began to think that the person who had administered that injection did not allow skin to dry properly before administering the injection.
If the skin is not dry the cleaning is ineffective and the antiseptic may cause the irritation by being injected into the tissue (Downie et al. 2000). The patient requested that the alcohol wipe not be used on this occasion and this left me feeling confused. I knew he has the right to patient autonomy and without his consent I could not carry out this procedure. As a nurse you are accountable for gaining consent and maintaining the patients right to be autonomous . Hawley (2007) states that autonomy means a persons right to make their own decisions in life, as long as they do not harm anyone else.
I was unsure of the risks of not using the alcohol wipe and had to seek guidance from my mentor. Evaluating this situation made me realise that questioning your own practice is a good way of keeping up to date with evidenced based practice. The Royal Marsden manual of clinical nursing procedures (Dougherty & Lister 2004) advocate the use of skin cleansing wipes, it is however stated within their guidelines that they adopt this for patients who are immunosuppressed, and also give evidence of previous studies which indicate that skin cleansing is not normally necessary.
Research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean and the nurse has adopted an aseptic technique as well as stringent hand hygiene. The fourth stage of Gibbs cycle (1988) has made me become more aware of different practices concerning the use of alcohol wipes in skin cleansing. I understand that both practices have been researched, and as I develop professionally I will not cleanse the skin in future unless the local policy states to do so or the patient requests me to.
The evidence in this area is not clear therefore I will use any literature which is available to allow me to justify my actions, and deliver safe evidence based care. In conclusion, I have learned that not all nurses use evidence in the same way and may use different methods. I understand that as long as my practice is safe and evidence based then I can practice safely. My action plan would be to continue to keep updated with any new research and evidence of using alcohol wipes in the administration of IM injections. This will help me to keep my practice safe and up to date.