Building The Skill To Administer Intramuscular Injections

Building The Skill To Administer Intramuscular Injections The aim of this essay is to reflect on how I have become competent in a particular clinical skill. The clinical skill I have selected is administering intramuscular (IM) injections. I will provide a rationale for choosing this skill and use appropriate literature to demonstrate my knowledge underpinning this skill. Although there are five sites for administration of IM injections, for the purpose of this essay I will discuss only two of the sites. Firstly, the dorsogluteal (DG) site as this is the site I used when giving IM injections in line with the local trust policies and procedures. Secondly I will discuss the ventrogluteal (VG) site, as recent literature has shown this site to be the safest to use when administering IM injections. I will then reflect on my learning and how I have become competent in this area. There is a need for nurses to be skilled in the administration of intramuscular injections in the learning disability field. The National Institute for Health and Clinical Excellence (NICE) (2006) suggests that when de-escalation and intensive nursing techniques have failed to calm the patient and they are at risk of harming themselves or others, then rapid tranquillisation should be used as a last resort. Although oral tranquilisation will be offered first, due to the high state of aggression, agitation or excitement the patient may be unable to give their consent. Therefore the 1983 Mental Health Act and the guidance on Consent to Treatment (DH 2002) must be followed. Consequently, rapid tranquilisation will be achieved by the administration of medication through IM injection to control severe mental and behavioural episodes and to calm the patient quickly. Greenway (2006) suggests that IM injections are generally likely to happen in association with the administering of antipsychotic medication in the form of depot injections and/or rapid tranquilisation, for managing mental illness and/or challenging behaviour for people with a learning disability. Greenway also implies that there will only be a small number of learning disability nurses that will actually use the skill of administering IM injections after they have qualified, due to a decline in depot administration. However, the Nursing and Midwifery Council (NMC) (2004) identifies that the role of the learning disability nurse is forever changing and the administration of injections will depend on the client group and the practice areas in which they work. They recognise that it is a key challenge for learning disability nurses to update their knowledge and maintain competence in a skill that they may use infrequently. Irrespective of this, the clinical procedure should be develope d and maintained in line with evidence based practice, regardless of how often it is used. The administration of IM injections is a vital component of medication management and is a common nursing intervention in clinical areas. Less pain to the patient and unnecessary complications can be avoided by the nurse being skilled in the injection technique used (Hunter 2008). The National Patient Safety Agency (NPSA) (2007) notes that the injecting of medication is complicated and patients can be put at risk. Incompetency, lack of training and varying knowledge levels of nurses were factors highlighted in errors made around injecting medicines. Adhering to the aseptic technique during preparation and administration of the injection, and inspecting the injection site for any signs of skin deterioration are vitally important to prevent infection and complications (Dougherty 2008). Alexander et al (2009) describe the correct way to give an intramuscular injection in the DG site using the Z tracking technique. Using the thumb or the side of the non-dominant hand stretch the skin taught over the site of injection maintaining the tautness during the procedure. With a darting motion, insert the needle at 90 degrees to the skin, 2-3mm of the needle should be exposed at the surface and the graduation marks on the syringe barrel must be visible throughout. Use the remaining fingers of the non-dominant hand to steady the syringe barrel, whilst using the dominant hand to pull back on the plunger to aspirate. If blood appears all equipment should be discarded and the procedure should be started again. It is safe to carry on if no blood appears. The plunger should be depressed at a rate of 1ml per 10 seconds to give the muscle fibres time to expand and accommodate the drug. After a further 10 seconds remove the needle and then release the traction on the skin. The injection site may be wiped with dry gauze if need be. A plaster can be applied if the patient requires and if they have no known allergy to latex, iodine or elastoplasts. Controversy lies around the site area chosen for administering the IM injection. Although the DG site is the traditional choice by nurses for the administration of IM injection there are risks associated with this site of injection. The DG site is situated in the upper outer quadrant of the buttock and is often landmarked by visually quartering the buttock horizontally and vertically, then repeating this action in the top right hand square. Evidence shows that the use of this site for IM injection can run the risk of injury to the sciatic nerve and the superior gluteal artery (Small 2004). Additionally it can cause skin and tissue trauma, muscle fibrosis and contracture, nerve palsy and paralysis as well as infection (Zimmerman 2010). The belief by nurses that the VG site is hard to landmark suggests reluctance on their part to change a practice they are competent in. Although once nurses have become familiar with location of the VG site and the surrounding anatomy, they will become confident in using this site (Greenway 2006). Hunter (2008) suggests to locate the VG site the nurse should place the palm of her right hand on the patients left hip (the greater trochanter), then make a v by extending the index finger to the anterior iliac spine. The injection is given in the middle of the v in the gluteus medius muscle. Administering IM injections using anatomical features leads to a more specific and correct way of carrying out the procedure. In contrast to the DG site, the VG site has no major complications associated with the administration of IM injections. Zimmerman (2010) also strongly advocates the use of the VG site. Although there appears to be a lack of current evidence for choosing the VG site rather than the DG site for rapid tranquilisation during restraint of a patient. Because of the nature of the situation during this procedure, safety for all involved has to be considered. Local policies should be utilised for specific guidance on positioning the patient safely and for use of specific holds needed to allow the VG site to be landmarked and the injection administered. The VG site can be used if the patient is prone, semi-prone or supine (Greenway 2006).However, following a literature review of damage to the sciatic nerve from IM injections, Small (2004) recommends that the VG site should be chosen over the DG site for IM injection. Zimmerman (2010) concurs with this, strongly advocating the use of the VG sit e for IM injections of more than 1ml in patients over the age of seven months. More evidence for choosing the VG site is a study carried out by Nisbet (2006) showing that the subcutaneous fat level of the DG site is significantly higher than that of the VG site. It also showed that penetration of the target muscle at the DG site was only 57 percent meaning the remainder of the injection would deposit into the subcutaneous fat leading to a deficit in the uptake of the drug. Emerson (2005) reports an increased risk of obesity in people with a learning disability. In one study 90 percent of adult females and 44 percent of adult males had fat deposits in the DG site area that were one inch deeper than the shorter IM needles would reach (Zaybak et al, 2007). The VG site has a shorter distance to the targeted muscle and is a safe alternative choice for the administration of an IM injection, Greenway (2006), Small (2004) and Zimmerman (2010) suggest it is time for professionals to rethink the site of IM injections in people with a learning disability. I will now discuss how I have become competent in carrying out this clinical skill and to do this I will use a reflective model. Reflection is a way in which nurses can bridge the theory-practice gap. The process of reflective practice allows the nurse to explore, through experience, reflection and action, areas for developing their practice and skills. It is an important part of gaining knowledge and understanding. The use of a recognised framework allows for a more structured approach when reflecting upon practice (Johns, 1995). I have decided to use Gibbs (1998) Reflective Cycle, as it provides a straight forward and structural framework and encourages a clear description of the situation, analysis of feelings, evaluation of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what the nurse would do should the situation arise again. In describing what happened in learning this skill the theory of experiential learning can also be used as a framework. The theory of experiential learning was developed by Steinaker and Bell (1979). The Experiential Taxonomy highlights 4 levels of learning that the nurse will go through in learning a new skill i.e. exposure and participation, identification, internalisation and dissemination. During exposure there is a consciousness of the event and the nurse will have observed a competent practitioner carry out the task. In this case I had an awareness of needing to be able to administer IM injections competently due to the client group involved. In my first week of placement I observed a qualified nurse administering PRN and depot IM injections several times while the nurse talked me through the procedure step by step. As she was demonstrating the procedure and talking me through it my thoughts and feeling at the time were that I would not be able to remember all the steps needed to administer the IM injection safely and I was also feeling anxious about potentially causing pain and/or injury to the patient. Participation involves the nurse becoming part of the experience. After observing the practice I participated in the drawing up of the injection and then administering it. Identification involves the nurse becoming competent in the skill. On reflection as soon as I started on placement I realised that I would have to gain as much experience as I could administering IM injections, not just the actual procedure of giving the injection but also the knowledge to underpin this skill. Internalisation occurs when the new skill becomes part of everyday routine. Several weeks into my placement I felt that I had eventually become competent in administering IM injections, my anxieties began to lessen and I started to feel more confident that I was becoming proficient in carrying out the procedure. I found that the more times I carried out the procedure the better I felt about it. Dissemination involves the nurse being able to influence others and showing others how to carry out the skill. Although this was only my second placement I feel totally competent in carrying out the task. I also feel that I have a good understanding of the underpinning knowledge involved. Therefore I feel I would be able to teach others how to do this. On reflection I do not think I would have learned this skill any other way, I have realised that initial anxieties about carrying out a new task are usual. But I will have to remember this will pass as I practice more and become more experienced. I have also realised through reflection the importance of having underpinning knowledge in relation to clinical skills and understanding why we do things rather than just simply learning how to do them. In conclusion, this assignment has explored one clinical skill in which I have gained competence. A rationale was provided in that IM injections are an important part of everyday life for the client group involved. IM injections are considered to be a routine procedure, it is a valuable and necessary skill for nurses. To provide safe practice and ensure accurate and therapeutic drug administration, the nurse should use clinical judgement when choosing the injection site, understand the relevant anatomy and physiology, as well as the principles for administering an IM injection. By using a reflective model and theory in relation to experiential learning I have discussed my own personal and professional development in terms of my knowledge and skill acquisition in this area of clinical practice.

One Minute Manager Essay

The one minute manager is a short story which explains the three management procedures or techniques that a manager needs and can use to be the superlative manager that he can be. It begins with a man probing for an effective manager anywhere and everywhere throughout the world. He comes across many of these managers but they are either harsh or pleasant. These harsh managers have the company operational but their employees are not pleased. The nice managers have their employees happy but their company is gone astray. He notes that the managers attentiveness were in result and people. Virtuous manager’s interests are in the outcomes and the people. He, at the end of the day, heard about a spectacular manager who lived nearby in a town. He came in contact and they both set a date when they could meet and discuss certain things. He found it incongruously strange that he had any time available except Wednesday mornings. When they met, he asked him if he hold regular meetings with his subordinates. The manager replies that he does hold meetings every Wednesday morning. They discuss the problems they had, what needs to be accomplished, and develop plans and strategies for the upcoming week. Those decisions were made both by him and the people in the organization. The manager further explains that he does not like to participate in his subordinate’s decision making. The purpose of his organization is efficiency and getting results. He also explains that they are productive because they are organized. The manager believes that you can only get results through people. So, this explains it all; he is a result and people oriented manager. He is interested in both results and his people. They go â€Å"hand in hand† he says. He keeps his people feeling worthy about themselves because that is when they make progress and more comes out of it. â€Å"People who feel good about themselves produce good results.† This was written on a plaque on the manager’s desk. He believes that when people feel great about themselves, it is the fund amental of getting the most output. Efficiency is not only the quantity of work being done, but also the quality of it. Quality is giving the people the service they really want. Quantity is how much of that product you actually have.  The greatest way to receive both quality and quantity is through people. The man asks the manager to describe what kind of manager he thinks he is. He replies by saying â€Å"I am a One Minute Manager†. The manager then explains that it takes very little time for him to get immense results from people and he is sent to three people. The first person he meets with is Mr. Trenell. Through this visit with him, the man identifies the first secret of being a One Minute Manager. The first secret is One Minute Goal Setting. Mr. Trenell further explains that it is the foundation of a One Minute Manager. He explains that the One Minute Manager always ensures that you know what your responsibilities are and if the tables turn, what you are being held responsible for. This reduces confusion of what the managers think you should do and what you think you should be doing. Every one of his subordinates has to write down each goal on a separate paper no more than 250 words. He does this to make sure everybody is clear on what they should do and to occasionally check the progress. The One Minute Manager believes that 80% of the results come from 20% of the goals. The point of One minute Goal Setting is to avoid the surprises of not knowing what your work is to do and what is to be expected from the beginning. One Minute Goal Setting does not just help you to understand what your responsibilities are but also to make your performance standards clear. The manager shows the employees what he expects of them. Mr. Trenell further explains his experience on his first few days of working and how the manager got him to think the way he does and allow him to make his own decisions. One Minute Goal setting is basically just agreeing on your goals, writing down your goals with no more than 250 words, read and proof read your goals, look at your performance and see whether your behaviour counterparts your goals. The second secret of becoming a One Minute Manager is One Minute Praising. Mr. Levy, the second person he speaks to, explains to him what this secret is about. He said that it would be a lot easier for him to do well if he got crystal clear feedback from the manager on how he was doing. The manager wants him to succeed, help the organization, and to enjoy his work. He would, in no ambiguous terms, tell him when he was doing well and when he was doing poorly. Mr. Levy pointed out that the manager is always in close contact. He observes his subordinates works and activities very closely and he would make them keep a record of their progress that they should send to  him to look over. This was to make the manager see that he was doing something right and praise him for it. The manager also says that â€Å"to help people reach their full potential and to see them doing something right† is the motto for the One Minute Praising. Mr. Levy explained that other organizations spend most of their time pointing out what is wrong rather than praising what was right. The manager of the organization they are in focus more on the positive than the negative. When the manager praises you, it is no more than a minute and he usually makes contact with you by placing his hands on your shoulder or touching you in a pleasing way. He says â€Å"the more consistently successful your people are, the higher you rise in the organization†. When the manager praises you, he looks you right in the eye and tells you what you did right and how he felt about it. Praising always need to be immediate. One Minute Praising works well when you tell them face to face how they are doing, what they did right, how good you feel about that action, encourage them to do more of the same, and shake hands or make contact in a way that is clear that you support their success in the organization. After he went to see Mr. Trenell and Mr. Levy, he went to Miss Gomez instead of Miss Brown. He asked Miss Gomez if they had the best equipment and if the manager loses a lot of people. Miss Gomez replied and said that they don’t have the best equipment and that people that leave the One Minute Manager get their own operation because they don’t need a manager. After a while, he noticed that Miss Gomez was busier and more unorganized than the manager actually was. The next morning he went to see Miss Brown to find out what the third secret was to becoming a One Minute Manager. The third secret was One Minute Reprimands. This is when a subordinate makes a mistake and the manager responds quickly. As soon as he has knowledge of the mistake he will come to see you and confirm the actualities. He looks you in the eyes and tells you what you did wrong and how he feels about it. The Reprimand takes about 30 seconds. After he tells you how he feels, he gives it a minute to let it descend into you. The minute manager does not tackle the person but their behaviour. When the Reprimand is over, Miss Brown says that the One Minute Manager has taught them the value of being able to laugh at themselves when they make a mistake. It helps them to make progress with their work. The one minute reprimand works well when you tell people beforehand how they are doing in  the organization. The Reprimand includes two halves. The first half is to Reprimand immediately, tell people what they did wrong, tell them how you feel when they did wrong, and to stop for a few seconds of scratchy silence to let them feel how you feel. The second half is to shake hands, or touch them to make them know you are on their side, remind them of how much you value them, reaffirm them of how you think of them, and realize that when the Reprimand is over, that it is actually over and there is no turning back. The manager, after all of those meetings, explained all the secrets to the man after meeting with Miss Brown. He explained in detail why you set One Minute Goals, One Minute Praising, and One Minute Reprimands. One Minute Goals are there to ensure that your employees know what you are asking of them and the goals they need to achieve within the organization. You give One Minute Praising to ensure the employees of their right doings and to encourage them to enhance their performance. You give One Minute Reprimand to tell them what they did wrong and that they can do better. Finally, the man got a job at the manager organization as a One Minute Manager.

What You Dont Know About Short Essay Writing Topics

What You Don't Know About Short Essay Writing Topics What is Actually Going on with Short Essay Writing Topics If you just have a few paragraphs to compose your essay, you will probably only have room for one major point of supporting evidence. It isn't as demanding as other kinds of academic papers, but nevertheless, it can provide you an overall insight on writing providing you with the fundamental skills of information gathering, creating an outline, and editing. If you're stuck and cannot discover a means to shorten your essay, try out the necessity test. A superb start is a guarantee of succeeding. Understanding Short Essay Writing Topics Despite the fact that you pay for homework, we provide those options free of charge. Writing an outline is critical especially when you were assigned an extensive topic. Just about any topic you're teaching in class may be the topic of a paragraph. Even in the event the deadline is truly tight, feel free to get hold of our managers. The Basics of Short Essay Writing Topics When it has to do with writing an argumentative essay, the most essential matter to do is to select a topic and an argument you may really get behind. You are able to define a notion in your short essay. Each topic is broken into subtopics that you should prepare. Hopefully, that is sufficient college essay topics for you to make an outstanding option, but should you need more proposal argument essay topics, take a look at the remainder of the materials on the Custom-writing. The huge difference between a lengthier essay and a quick essay is simply thatthe length. The very first impression matters, even when you're writing short essay. You might feel the burden you're placed under is unfair, but I am fearful that you're mistaking the aim of the essay writing. Writing a narrative essay is all about telling a story using your initial voice. What Everybody Dislikes About Short Essay Writing Topics and Why Writing is among the most effective modes of self-expression, and it is likewise an amazingly effective approach to help your students sort out all their ideas and feelings. Writing practice shouldn't be boring! Students lead busy lives and frequently forget about an approaching deadline. Students that are near the beginning of their English studies aren't likely to possess the tools to compose a five paragraph essay or take an essay exam. Short Essay Writing Topics Options There's, naturally, a limit on the range of pages even our finest writers can produce with a pressing deadline, but usually, we can satisfy all the clients seeking urgent assistance. 1 way of making certain that you're able to communicate clearly and to the point is via accurate and beneficial use of advanced vocabulary. Writing seems to you the absolute most complex portion of an academic pathway, let alone when it has to do with writing according to a certain task with plenty of restrictions. You should have your reasons, and our principal concern is that you find yourself getting a great grade. What to Expect From Short Essay Writing Topics? An essay outline is a set of ideas and ideas applicable to the subject issue. The style of a generic college essay also has to be consistent, in other words, keeping the exact same register formal from the start to the end. While every section of an essay is critical, it's important to remember that it's in the introduction where readers get to determine whether they ought to be reading the remainder of yo ur composition or not. A superb interview essay should create the reader feel as though they're the person who's asking the questions. To put it differently, the essay should say how you intend to get ready for class. Short essays are still spend the sort of formal essay because the parts will need to get included in it. Narrative essays don't have such arguments. Inside my experience, descriptive essays are only difficult in regards to deciding just what things to write about.

Essay about Response To Smileys Critique of Huckleberry...

Smiley has missed the point of Adventures of Huckleberry Finn and has depressed the book to a fractions of its ideas. She sees the book as a failed social commentary on racism and enabling the reader to avoid responsibility. A Short sighted sentiment from Mrs. Smiley, but Mark Twain has a light directed elsewhere. He lights out the territory of social improvements by vexing the reader to view from different vantage points. Huckleberry Finn deals with the issue of racism. Racism, however, is only a single scourge of society. The book is suggesting social change in any form it may take (and it takes quite a few). Racism is only a readily available example that people where already taking notice of, easy pickings for mister†¦show more content†¦While Twains book was rubbing Mrs. Smiley the wrong way, she grew critical of American Literature all together. She pondered about the definition of American Literature and concluded that â€Å"we have lost the subject of how various groups who may not escape to the wilderness are to get along in society†. This notion, valid as it may be, is in the end a moot point. It is just not possible for a vast majority of the people to escape to the wilderness due to the various social relations that reside. Few of us can be in Hucks situation, to not have a family or a place to call home, a rather lonesome position, but an advantageous one for sailing down the Mississippi. Huck is lucky to have a friend such as Jim to sail along side him, because the trip could have been a quite deal more lonesome. Escaping to the wilderness can be just as unattractive as being restricted by society. Like Huck dashing towards the towns and fleeing straight back to the river, we always dream of the opposite of what we already have, but never truly reaching an equilibrium. What, then, is even the point of romantic freedom if it but an illusion? We can take the alluring aspects from the illusion and learn from them. It isnt the illusion that we want, for it has its own problems like an angry town victim to a scam or a wreckage filled with robbers, but the thought experiments from it which brings us a step closer to a perfect world.