In this essay, I will discuss a clinical skill that I have become proficient in as a student nurse. To explain how I have attained the required level of competence in my nursing training program, I will employ a reflective model. The reflective model of choice is Gibbs model (Gibbs 1988), which encompasses description, feelings, evaluation, analysis, conclusion, and an action plan (Gibbs 1988). By using this model, critical thinking is encouraged and the connection between theory and practice can be established.
The following discussion will cover the theoretical foundation and evidence supporting the clinical skill. The essay will conclude by reflecting on my skills, recognizing my proficiency, and charting my personal and professional growth. The focus of this essay is to reflect on my experience administering Intramuscular (IM) injections during my initial clinical placement, as it was a frequently utilized method of drug administration.
As I researched IM injections, my understanding of this topic grew. According to Gibbs (1988) model of reflection, the first step is to describe the events. I was responsible for administering an IM injection to a patient. I had previously witnessed this clinical skill multiple times and had also administered an IM injection under supervision. However, on this particular occasion, I was being observed by two qualified nurses, including my mentor. The drug had been prepared and the patient agreed to let a student administer the injection.
During the procedure, my mentor was guiding me and emphasized the use of an alcohol wipe to clean the injection site. However, another nurse, in front of the patient, disagreed and claimed it was unnecessary. The patient then expressed their preference to skip the alcohol wipe due to prior discomfort. Understanding this, my mentor approved the decision and I proceeded with administering the injection without using the alcohol wipe.
During previous instances, I had given IM injections without cleaning the site and had never been told to do so. Now, I am moving on to the second stage of Gibbs (1988) model of reflection, which involves discussing my thoughts and emotions. I felt anxious and self-conscious because I knew I was being supervised by two experienced nurses. My nervousness and pressure increased when my mentor questioned my technique regarding skin cleansing.
The patient was present and I wanted to ensure they didn’t think I was incompetent. Since I had performed this clinical procedure before, I believed my technique was correct. However, I became perplexed about the proper use of alcohol wipes during IM injections. Additionally, the inconsistent practices among qualified nurses made me question the entire process. In evaluating the event, which is the third stage of Gibbs (1988) model of reflection, it is important to identify both positive and negative aspects.
According to Workman (1999), the use of skin cleansing wipes during IM injections is not necessary if the patient is physically clean and aseptic technique is used. Additionally, the nurse should practice stringent hand washing. Mallet and Dougherty (2011) have observed that the use of alcohol wipes for cleansing can lead to skin hardening. The trust policy dictated adherence to the guidelines provided by the Royal Marsden Hospital (Mallet & Dougherty 2011).
The Royal Marsden (Mallet & Dougherty 2011) recommend the use of skin cleansing wipes. However, their recommendation is mainly based on the fact that their patients are often immunocompromised. They also mention previous studies which indicate that skin cleansing is generally not required. Therefore, I decided to adhere to the guidelines provided by the trust. This experience prompted me to reconsider my approach towards literature and its practical application. According to Burnard (2002), learners usually passively absorb knowledge, but active learning engages all our senses.
The gluteus maximus muscle is often used for intramuscular (IM) injections because it is thick, fleshy, and well-supplied with blood (Greenway 2004, Workman 1999, Watson 2000). It is located in the hip area and makes up the buttock (Watson 2000). However, it should be noted that injecting into the gluteus maximus carries a risk of injuring the sciatic nerve (Greenway 2004).
In my situation, I followed proper procedure by administering the medication into the gluteus maximus muscle. According to Gibbs (1988), stage four involves analyzing the event, so I will examine the skill and its supporting evidence. IM injections are given in the muscle for various reasons such as fast absorption rate, patient consciousness, and alteration of drug effects caused by ingestion (Mallet & Dougherty 2000, Workman 1999).
According to Workman (1999), giving an injection involves considering the site of injection, the technique, the equipment, and the route. In my clinical placement at an orthopaedic outpatient centre, IM injections were frequently given. However, Hemsworth (2000) suggests that certain specialities rarely use IM injections, and implies that nurses’ current practice may not align with recent research findings.
After evaluating the event, I have gained a greater understanding of the various approaches to using alcohol wipes for skin cleansing. I acknowledge that both practices have been studied, but as I progress in my career, I am cultivating my own abilities and will refrain from cleansing the skin unless it is mandated by the trust policy or requested by the patient. Although there is no conclusive evidence in this field, I will utilize the existing literature to support my decisions and provide evidence-based care.
My mentor may have suggested using the alcohol wipe because she has extensive experience and practices have evolved over time. I have learned from this experience and gained knowledge through practical application (Burnard 2002). As a result of this incident in my professional practice, I will be better equipped to question the perspectives of others in regards to my clinical practice. To conclude, in stage five of the Gibbs model (1988), I acknowledge that nurses vary in their use of evidence and employ different methods. However, as long as my practice is both safe and evidence-based, I can ensure safety in my profession.
My future practice will depend on the area in which I am working and my goal is to determine the trusted protocol for clinical procedures before starting any procedure. In my action plan, I intend to conduct further research on the use of alcohol wipes in administering IM injections. Additionally, I plan to have a discussion with qualified nurses regarding skin cleansing. Overall, this essay has helped me develop my reflection skills. Utilizing a model of reflection has allowed me to organize my thoughts and emotions effectively.
The use of critical reflection has enhanced my understanding and appreciation for evidence-based practice. It has also helped me improve my competence in this clinical skill, and I feel that my personal and professional development is advancing as a result. Reflecting using this model has made me realize the importance of taking an active role in my own learning. Additionally, as a student nurse, I have recognized the significance of reflection as a learning tool in practice.
