Reflective clinical practice critique Essay Example

  • Category:
    Nursing
  • Document type:
    Essay
  • Level:
    Undergraduate
  • Page:
    4
  • Words:
    2978

Hand Washing Individual Self Assessment

Overall comment

From the average rating of 3, which is the competent to expert position, it is obvious that I assessed myself as proficient in regard to the skill of hand washing. The self assessment show that I posses deeper understanding of the hand washing skill, besides indicating that skill practice was performed in a fluid articulate and preventative manner (Di Chamberlain ). While it appeared from the self assessment that I am proficient in hand washing skill as evident by my reported compliance with the hand washing guidelines and my satisfaction at lack of visual evident of dirt after the hand washing, evidence of dirt when my hands were held under the microscope indicate that I had probably overestimated my hand washing skill level. Such an overestimation in personal assessment is evident in various studies that have demonstrated that nursing students overestimate their knowledge and skills, and often find it difficult to give an objective account of their performance, and usually report an improbable level of compliance (Cole, 2008, p. 386).

Discussion about how the skill is performed

Hand hygiene has been recognized as one of the single most effective measures that can be applied to prevent hospital acquired infections (Cole, 2008, p. 380). According to the United states Center for Disease Control (CDC), hand washing is one of the best methods that can be used in decontamination of hands as compared to hand hygiene using alcohol-based rub especially when hands are visibly soiled, visibly dirty, on exposure to organisms that other agents may have poor activity against such as anthrax causing organism clostridium difficile (Lynn, 2011, p. 127).

Hand washing skill is performed in steps as identified in the Crisp and Taylor (2008, p. 698) hand washing guideline attached in Appendix 4. Lynn 2011, p. 128, also identifies the hand washing process in steps with the first step being gathering of necessary supplies. Second, one should stand in front of the sink without allowing clothing to touch the sink during the washing procedure since the sink may be contaminated and clothes may be contaminated by the sink, jewellery should be removed to allow for proper cleansing especially since microorganisms may accumulate in areas under jewellery, water should be turned on and the force adjusted to avoid splashing as such water may be contaminated. Temperature should be adjusted and warm water is preferable as it is less likely to remove oils and open pores in skin thereby providing areas where organisms can lodge themselves in chapped skin. The next step involves wetting the hands and wrist areas while keeping the hands lower than elbows so that water flows from the cleaner areas, the forearms to the more contaminated areas, the hands and the fingertips (Lynn, 2011, p. 128). The soap bar should be rinsed before applying to all the areas of the hand and rinsed after use to remove lather that may carry microorganisms. Wash hands through firm rubbing and circular motion from the palms to back of hand, areas between fingers, each finger, wrists, knuckles and forearms and to at least an inch above the contaminated area or above the wrist if there is no visible contamination. Friction loosened dirt and aid in dislodging organism that may be lodged within fingers while cleaning the less contaminated areas after hands are clean aids to prevent the spread of microorganisms from hands to forearms and wrists (Lyn, 2011, p. 128). The friction motions should last at least 15 seconds or more depending on the extent of contamination. Fingernails of opposite hand should be used under the finger nails as microorganisms may remain under the nails where they may grow and spread to other persons. The hands should be rinsed thoroughly with running water flowing toward fingertips to rinse microorganisms and dirt into the sink. Hand should then be dried using a paper towel starting from the fingers and moving towards the upper towel through patting to prevent chapping. The paper towel should be discarded and another clean towel used to turn off the faucet in order to protect the clean hands from contact with soiled surface. The towel should be immediately discarded without touching the other clean hand. Use of oil free lotion to keep skin soft and prevent chapping after patient care is complete while avoiding use of oil based lotions due to their effect leading to deterioration of gloves.

How it felt critiquing myself

Self assessment and self criticism was at first difficult as it seemed as if I was passing judgments on my own skill and aptitudes. However, I was confident that with all the knowledge and skill on the hand washing and following the guidelines on hand washing then it would be easy to rate myself objectively based on my performance and especially on how well I followed the guidelines. I presumed there would be little possibility of error in judgment or information processing errors. Cole (2008, p. 381) recognizes that students may overestimate their skills and knowledge resulting in failure and difficulty in giving objective account of the performance and resulting to reporting of improbable compliance levels resulting to self serving judgments that occur due to information processing errors.

What I felt about critique/good or not so good

I felt the critique allowed me to see the hand washing activity in a wider perspective while aiding me to internalize the hand washing process by noting the areas that I had failed to address effectively. I felt the reflective process enabled me to understand the process of hand washing in a deeper manner than I initially understood and to further internalize the importance of the hand washing process in nursing. I felt the critique provided me with an opportunity to increase my competency and become an expert in hand washing.How you could have done skill better (reconstruct).

I would have done the skill better by ensuring that I consulted widely on the hand washing skills to identify areas of concern that may not have been outlined in the criteria set in the guidelines. This would have provided me with more knowledge on how to solve the problem of hand washing considering differences in hand washing standards as recognized by the World health Organization. I would also have done the skill better if I had drawn from past experience as past experience is recognized as an important element in learning skills including hand washing skills (Cole, 2008, p. 308).

Wound dressing assessment of another student

Overall comment

I assessed the wound dressing of another student and rated the student as competent in regard to the skill of wound dressing as evidenced by a score of 3 on all parameters identified in the guideline. The assessment showed that the student possessed proficiency in the skill of wound dressing and shows that the skill was also performed in a fluid articulate and preventative manner.

How the skill is performed

Wound dressing guidelines were followed appropriately with the first step involving checking documentation and ordering for the dressing change procedure. This was followed by collection of all the equipment as outlined in the guideline. The process also involved cleaning of the dressing trolley with alcohol wipes to disinfect the equipment and collection of all the appropriate dressing equipment that include dressing pack, 2xsaline, tapes, dressings, sterile scissors, disposable bag and gauze swabs. The next step involved explaining the procedure that would be followed in changing the clients dressing and the reasons why the dressing should be changed while gaining consent from the client at the same time. There was evidence of an understanding of the nursing theory behind the task of wound dressing including guidelines provided by the ANMC. The client’s pain level was checked besides identifying the need for medication. This was accompanied by an evident adherence to the ANMC (2005) code of ethics for nurses in Australia guidelines that indicates that nurses must respect the clients right to autonomy and in making informed decisions and for nurses to gain consent from clients. The task performance observed the safety of the patient as outline in the ANMC (2005) code of ethics for nurses in Australia value statement 6. Use of infection control measures and adherence to standard measures also indicated that staff safety and patient safety were maintained. This involved hand hygiene, appropriate proper cleaning technique applied to the task. Patient privacy was also observed with all elements of the task conducted in a professional manner ensuring that the patient was not only reassured but comfortable. The client was instructed to call the bell that was placed within reach and report any discomfort. The patient’s room was tidied and equipment safely removed from the patient’s room, extra dressings returned and rubbish disposed as required. All the necessary documentation was carried out and excellent skills and knowledge were displayed throughout the exercise.

How it felt critiquing a colleague

Critiquing a colleague was easier than criticizing self. I felt that I was holding the colleague at higher level of standards and strictly checked the colleagues adherence to the guidelines presented on wound dressing attached in Appendix. I utilized various nursing standards and nursing knowledge to assess the colleague on the performance of the wound dressing skill. I was excited by the level of proficiency depicted and this provided an avenue to reflect and learn from the colleague’s performance which is supported

What I felt about critique

I felt that the critique accurately presented the proficiency and mastery. I felt that the critique adequately took into consideration nursing practices and codes of conduct. Specifically, the critique utilized the national competency standards outlined in the 2006, Australian Nursing and Midwifery Council, National Competency Standards for the Registered Nurse. For instance, in conducting the assessment, issues concerning effectiveness of nurses such as use of evidence-based nursing care were identified. This was evident through various steps in the wound dressing skill performance such as through hand washing to prevent illnesses for individuals. Provision and coordination of care including nurse’s duty of care to patients was also evident as the wound dressing was carried out following assessments of the extent and type of wound. Through ensuring confidentiality and privacy of the client, the colleagues showed respect for the standards 2.6 of the National Competency Standards for the Registered Nurse (2006, p. 4).

How I would have done the skill better

While I rated the colleague as proficient in the skill, I observed that there are things that I would have done better. For instance, I observed that the colleague struggled with some sections of the guideline and while finally the steps were carried out correctly, I felt that in a similar situation, I would have sought clarification as supported by section 2.5 of the National Competency Standards for the Registered Nurses (2006, p. 5) that require that persons should seek clarifications when questions, directions, and decisions are not clearly understood.

Colleagues Assessment of Administration of nebulizer medication

An assessment on administration of nebulizer medication by a colleague rated my level of skill performance as average of 3 indicating that I am competent and an expert in the administration of nebulizer medication. The rating further indicate that I posses deeper understanding of the administration of the nebulizer medication besides indicating that the skill was performed in a fluid articulate and preventative manner (Di Chamberlain, ). While I believe that I am proficient in the skill, I felt that the rating was overrated considering the challenges that I was evidently experiencing in the process of administration. However, my effectiveness at solving these challenges may have contributed to the high colleagues rating.

How the skill is performed

Administration of nebulizer medications follows various steps that are identified in the guideline attached as Appendix 2 adopted from Lynn, 2011, pp. 266-267. The steps involved include first checking the medication chart for administration chart documentation for administration orders and find out whether the patient has any allergies. The expiration date for medicine is checked in line with guideline under the Standards for registered nurses requiring observation of safety standards for clients (National Competency Standards for the Registered Nurse, 2006, pp. 4). Medication is also checked on whether it should be administered with sterile or saline water. The next step involves collection of all appropriate equipment including syringes, blunt drawing up needle, nebulizer tubing and administration chamber (Lynn, 2011, p. 267). This is followed by an explanation of the procedure to the patient including the reasons why the patient needs the nebulised medication besides getting consent as outlined in the ANMC (2006) national competency standards for the registered nurses, domain 2.4 while at the same time ensuring that the rights of the individuals are observed. Informed decisions which reflect an understanding of nursing theory behind the task should be evident and this includes an understanding of the ANMC guidelines. An understanding of the relationship between theory and practice should be demonstrated as outlined in ANMC (2006) national competency standards for the registered nurses domain 7.1 requiring comprehensive and evidence based nursing care aimed at attaining identified outcomes. Assessment of unusual factors such as adventitious lung sounds, SaO2 and PEFR and recording if unusual for patient follows. The patient is supported upright by pillow if necessary. The next step involves checking the dryness and cleanliness for nebulizer and cleaning and drying if necessary, checking medication order and inserting solution to be nebulised to nebulizer respectively. Diluting solution is added where necessary, nebulizer locked before checking whether to use air or oxygen in administering the medication. The nebulizer is connected to air oxygen tubing and the medication order is checked against patient armband and verbally (Lynn, 2011, p. 267). The nebulizer is connected to supply tubing of air oxygen and the flow is set to 8L/min while checking for misting at the same time. Nebulizer is placed over the patient’s mouth and nose and a snug ensured. A mask is placed over patients face attached with elastic straps t ensures it’s secure. Aerosol treatment is conducted for 7 minutes, which is the recommended time for the treatment. The patient is requested to breathe normally and tapping of the nebulizer facilitates mixing of the medication. Finally the patient is given a bell and informed to call for assistance if required. The nebulizer is turned off after the recommended time of 7 minutes and the mask removed from patients head and face, the patient is offered face washer and towel to use in cleaning and drying of face and mouthwash to gargle. Documentation of post bronchodilator peak flow is performed 5 to 10 minutes after medication. Residue is discarded, the nebulizer is cleaned and dried and discarded if over 24 hour limit. The exercise post procedure involves covering the patient, ensuring that bell is within reach and ensuring that the patient is comfortable. Other activities include washing hands and signing medication orders besides documenting any adverse effects of medication (Crisp and Taylor, 2009, p. 266-269).

How it felt being critiqued

Initially, I was nervous with the whole idea of being assessed but slowly gained confident. The feeling of being watched over as I performed the task bothered me for a short while but slowly I forgot that I was being assessed and concentrated on the task. I felt confident in my abilities to carry out the task effectively and this probably contributed to the level of immersion that I exercised in performing the task. The critique offered me an opportunity to reflect on my abilities and performance in the particular skills. Such reflective practice is recognized as a central theme in development of professionalism in nursing and especially in bridging nursing theory and practice. Forneris and Peden-Mcalpine (2007, p. 410) suggests that a reflective contextual learning intervention is critical in improving novice nurses critical thinking skills and I felt the critique offered such an opportunity.

What I felt about critique/good or not so good (Deconstruct)

Although I was confident about my level of knowledge of the skill, my level of experience in performing the task was low thus making me a bit worried on whether I was adequately prepared to perform the task. The critique thus affirmed that I was good or better than I would have expected to be judged by the colleague. This positively reinforced my belief in my proficiency and inspired me in regard to my abilities and potential to become a professional nurse. I also felt that my knowledge and ability to proficiency of the skill was enhanced in the whole process while I became more aware of the knowledge that I posses and also what I do not know as supported by Funnel et al, 2009, p. 222 that reflection involving the process of recalling events is crucial in assessing ones mistakes and assisting nurses to seek and understand various practices.

How I would have done the skill better (Reconstruct)

Nonetheless, I felt that it would still have been possible to perform the skill in a better way than I did. For instance, I felt that I would have consulted when faced with the challenge of instructions that I found difficult to comprehend initially. Although I managed to carry out the instructions, I felt it would have been better if I had consulted as recommended in the nursing standards ANMC (2006) national competency standards for the registered nurses. I also felt that I would have been more relaxed in the whole process, which was not fully possible as I was aware that I was being assessed.

References

Lynn, P 2011, Taylor’s clinical skills: a nursing approach, 3rd edn, Lippincott, Williams 7 Wilkins, Philadelphia, PA.

Crisp, J & Taylor, C 2008, Potter & Perry’s Fundamentals of Nursing, 3rd Edition. Elsevier Australia, pp. 698 — 701).

ANMC, 2006.

Funnell, G, Koutoukidis & K, Lawrence 2009, (eds.) Tabbner’s nursing care theory and practice, 5th edn, Elsevier, Australia