The reflective model that I have chosen to use is Gibb’s Reflective Cycle (1988).
Gentamicin is an antibiotic administered via intramuscular (IM) injection before a catheter is removed, in order to prevent infection. I was asked to draw up and administer Gentamicin to a patient via IM injection. I had observed this clinical skill on a variety of occasions and had previously administered an IM injection under supervision. On this occasion I was being observed by a qualified nurse. I had drawn up the drug and was ready to administer it and the patient consented to me administering the injection. I asked the patient turn onto their side so that I could access the injection site (the gluteus maximus). I then used an alcohol wipe to cleanse the injection site, and the nurse interrupted and said that this was not necessary. On previous occasions I had always cleansed the site because I had been taught this practice at University. I found that when I asked other qualified nurses on the ward, their opinions varied as to whether you should cleanse the site or not.
The nurse instructed me not to cleanse the site in front of the patient. This made me feel self conscious and made me wonder whether the patient would now be doubting my practice. I thought that as I had been observed carrying out this clinical procedure on many other occasions then my practice must have been seen to be correct. I felt confused about the use of alcohol wipes and was concerned that the practice of the qualified nurses was different. I wanted to research this topic further.
Research by Workman (1999) suggests that the use of skin cleansing wipes prior to injection is inconsistent and not necessary if the patient appears to be physically clean and an aseptic technique is used along with thorough hand washing by the nurse. Whilst researching I found that Mallet and Dougherty (2000) agree with the use of skin cleansing wipes. However they adopt this when patients are immunocompromised and show evidence of previous studies which state that skin cleansing is not normally necessary.
The site used for the IM injection was the gluteus maximus, which is most
commonly used for IM injections (Greenway 2004). This site is located in the hip area and forms the buttock. It is thick and has a good blood supply. This site is near to the sciatic nerve and Greenway (2004) advocates that this presents a risk of injury to the patient if the IM injection is administered in the wrong site.
When analysing why medication is given via the IM route, I found many reasons. These include rapid absorption rate, the drug effect being altered by ingestion and the conscious state of the patient. (Workman 1999). Workman (1999) proposes that there are four main considerations to make when giving an injection, these include: the site of the injection, the technique used, the route and the equipment used. On my placement, IM injections were administered on a daily basis prior to removal of catheters. On the other hand, Hemsworth (2000) states that IM injections are rarely used in some specialities and that may be the reason for nurses’ current practice not being up to date with recent research findings.
Through my research I am now more familiar with different practices relating to the use of alcohol wipes in skin cleansing. As I develop professionally, I am developing my own skills and techniques that are backed up with evidence and research. I will not cleanse the skin site in future unless I believe the patient is not physically clean or the patient requests me to. I have found no clear evidence for supporting skin cleansing. In future, I will use the research I have found to suggest that skin cleansing is not normally necessary in order to justify my actions and provide evidence based practice. I will now be prepared to question my views and the views of others with regards to my clinical practice.
In conclusion, I can see that not all nurses use recent evidence alongside their practice and that nurses use different methods of practice. I will always make sure my clinical practice is evidence based and up to date so that I can practice safely. In future, I aim to find out the trust protocol for the procedure before I carry out a clinical procedure. I feel that my competence within this clinical skill has been developed with my research and I feel that my personal and professional development is progressing
because I have been proactive with my learning.
My action plan is to research further into the use of alcohol wipes prior to the administration of IM injections and I am planning to discuss this subject further with my tutor and lecturers at University.
