These questions are not allocated marks towards the clinical reasoning report. They are guiding questions to assist with knowledge recall in preparation to write the clinical reasoning report.
1.What causes a concussion and what might be the natural progression of a concussion if left untreated.
2.What are the defining signs and symptoms of concussion.
3.Identify Mia’s predisposing risk factors for concussion and the associated risks.
4.What neurological assessments can be carried out on a patient with a sports concussion?
The prime objective of writing this reflective essay is to demonstrate a deeper understanding of my perceptions and attitude towards an incident that occurred during my clinical placement, related to administration of injection and its safe disposal (Allan and Driscoll 2014). The discussion will appraise the concept of handling instruments such as, needles, syringes, and sharps while delivering care to a patient, in order to prevent injuries or adverse effects. This essay will comprise of an analysis of the placement incident using the Driscoll’s model of reflection (Bulman 2013). A rationale will also be provided for the incident and the steps that I can implement in future.
What- During my undergraduate nursing practice at the University, I had the opportunity to begin my professional experience placement at an urban hospital where the tutor and the lecturer had emphasised on learning the appropriate management of sharps. Sharps refer to all forms of biomedical instruments that have the capability of lacerating or puncturing the skin (Ford 2014). We were taught about the adverse effects of these bio-hazardous wastes and told that they must always be carefully handled. Moreover, I also learnt from the lecturer that needles and syringes must never be recapped for disposal, and must be placed in sharp disposal containers. Furthermore, we were also asked to access the website governed by the Australian Government that had safety guidelines for handling sharps. However, I encountered a problem during my placement.
The registered nurse (RN) who was supervising me asked me to administer insulin injection to a patient. Following injection of insulin, I realised that I had forgotten to bring along a disposable tray/kidney dish. This made me panic. Upon realising my problem, I was advised by the RN to recap the needle. However, being aware of the serious health complications associated with needle recapping, I decided not to listen to her commands. This made the RN angry and disappointed and she began shouting at me. This added to my distress and made me tremble while recapping it. The needle accidentally punctured my left thumb and made the RN infuriated at the possibility to spread of disease to my body.
So what- Initially I was extremely sceptical to administer insulin to the concerned patient since I was well aware of the fact that incorrect administration of insulin can result in serious and/or transient hyper or hypoglycaemia, diabetic ketoacidosis and glycemic excursions (Ji and Lou 2014). My anxiety can be attributed to the fact that I became conscious of the guidelines that needs to be followed during handling and disposal of sharps. My further distress was caused when I realised my mistake of not bringing along a kidney dish for the disposal of the needle. It is a well-known fact that standard measures that need to adhered to, for avoiding sharp injuries include proper handling of sharp devices and discarding them in a way that is able to prevent injury to all (Department of Health 2018). Furthermore, upon being asked to recap the needle, I became more anxious. Prior clinical knowledge had helped in gaining a sound understanding of why recapping needles are dangerous. The instructions provided by the RN were in clear contrast with my values and thinking since during recapping the needle might pierce the cap and stab the finger in which it is held. Furthermore, a cap that poorly fits on the top of the needle might slip off and stab the finger (Phillips et al., 2013). The conversation with the RN made me feel concerned, upset and apprehensive. This could be attributed to the fact that while accessing the government website during the PEP, it was learnt that hepatitis C, hepatitis B and HIV are commonly acquired from needle-stick injuries (Education.qld.gov.au 2012). Moreover, the website also stated that midwives and nursing professionals are found at a high rate for sharps and needle-stick injuries, which in turn increases their exposure to blood-borne diseases.
Thus, I interpreted that the RN was not adequately following the sharps safety guidelines that must be practiced in clinical settings. This further made me interpret that the RN did not abide by the codes of professional practice that are imperative for any healthcare professional. The standard 6 proposed by the NMBA states that all RNs are entitled with the duty of providing and delegating ethical goal-directed care services to all service users. Some of the elements of this standard are delivery of safe, comprehensive and quality practice, delivery of effective and timely directed services, and practicing in accordance to the relevant guidelines, standards, policies and regulations (NMBA 2016). The incident made me realise that there was failure in the part of the RN to show adherence to the competency standards. Moreover, she did not abide by the B.13 guidelines for ‘Handling and Disposing of Sharps’, as enforced by the Australian Government. The guidelines clearly emphasise on the fact that following use of scalpel, blades, needles, and other sharp instruments, they must be discarded in appropriate containers that are labelled, leak and puncture proof (Australian Government 2018).
I was not able to make any connection with the information that I had acquired during the PEP training sessions, with the instructions provided by the supervising RN. This can be attributed to the fact that the RN failed to act according the role and responsibility that she was entitled with. Her commands were directly opposing the clinical practice guidelines and standards. Furthermore, when she began to shout on finding me not obeying her directions, it added to my nervousness. This made my hand tremor and accidentally while recapping the needle, it pierced my left thumb skin. Missing the cap and stabbing the hand in which a needle is held is one major adverse impact of recapping needles. Upon finding this, I was rebuked and reprimanded and the RN suggested conducting a blood test of the patient to identify the disease that I might acquire due to the injury. While she used slang words for addressing me, I was extremely upset and could not related it to the concept of care that is often associated with an RN’s role.
There were several ethical considerations in this case scenario. The four basic principles of medical ethics comprise of justice, autonomy, beneficence and non-maleficence (Parahoo 2014). However, in this case scenario, the RN directly did not do justice to the patient by directly stating that there might be the possibility of some disease getting transmitted from the patient to me. Furthermore, non-maleficence requires the nurses to conduct a procedure in a way that is not imposing a harm on either the patient or any other individual involved in the scenario. However, her constant orders to recapping the needle posed a threat to the health and safety of the patient, me, and any other person who might have come in contact with it.
There was failure on my part as well in not bringing along a disposable dish. The recommendations state that the person using a sharp must hold the responsibility for immediately disposing it in a safe manner and must throw or discard it in approved sharp-containers (kidney dish) (Australian Government 2018). Thus, my negligence was a major ethical violation where I failed to follow the standard guidelines and resulted in a situation, where piercing of the needle directly threatened my health and safety. Another ethical consideration was my acceptance of the RN’s commands, after her constant scolding and admonishment. Even though I was being reprimanded by the RN, it was my responsibility of showing accordance to my prior clinical knowledge and safety guidelines, by not taking efforts to recap the needle.
Now what- The role of a healthcare professional is highly challenging, as well as rewarding. I understood that all medical incidents and procedures have their downsides and merits. In all circumstances, I will take efforts to avoid the recapping of needles and plan for their disposal and safe handling. My new perspectives focus on the fact that henceforth, I would always carry a disposable tray and put the uncapped needles inside them. Furthermore, I would also immediately report all sharp-related and needle-stick injuries promptly to ensure that an appropriate follow-up is received. However, even if such incidents occur in future practice, and requires recapping of needles, I would try using a pair of tongs, one-hand scoop procedure or a recapping device for the same. I would stick to the recommendations of not recapping needles by holding the cap in one hand. This learning experience would prove beneficial in my future practice by providing me the opportunity of gaining a deeper understanding of the roles and responsibilities that are expected from me.
Conclusion- Thus I concluded from the event that it is imperative for a healthcare professional to maintain and respect the competency standards for an effective and safe delivery of healthcare services. Disposing of needles and sharps in puncture-resistant and rigid containers, immediately after they are used is a critical duty of all healthcare professionals and must be followed in order to avoid any occupational exposure to contagious diseases due to needle-stick injury. Moreover, I would also learn the application/administration of safety-engineered devices that have built-in features which reduce the injury risks associated with sharps. My future goals focus on learning the use of needleless and retractable devices.
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