An Assignment on reflection of clinical skills in nurses
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A practising nurse must be equipped with the necessary practical and communication skills to improve the quality of care to the patients. Reflective practice has been defined as an unstructured technique for directing understanding and learning and a self-regulated process often employed in the health and teaching professions. Reflective practice is a learning approach taught to professionals from various disciplines with the goal of improving communication skills and decision-making abilities (Adamson, 2015). Reflection on one’s personal experiences helps them to identify areas that were well and those that need improvement, and reflection has implications for nursing practice.
In this example of reflective nursing practice, I will implement Gibbs model of reflection (Ardian, 2019). Models of reflection were developed that encourage reflection and personal and professional development. The clinical skill I have chosen to reflect on in this reflective report is the administration of vaccines. Vaccines are administered intramuscularly in most cases. The most common sites for vaccine administration are the Deltoid muscle of the arm and the anterolateral aspect of the thigh or the Vastus lateralis muscle. The deltoid is the chosen site for most adults, and the Vastus lateralis for infants and children (Irvine, 2020).
The first stage of Gibbs reflective cycle is the description of events. I was asked to administer a vaccine to an adult patient through intramuscular injection. I often witnessed intramuscular injection administration and administered one under supervision. This time, I was instructed to administer the vaccine under the supervision of two nurses, one of them being my guide. As I was given the instructions, I was told to wipe the area with spirit.
Regarding my feelings, I was feeling very nervous since two nurses were observing me. At one point, I was questioned about gloving and degloving in front of the patient. The questioning made me even more self-conscious since I did not want the patient to feel that they were being administered by someone who lacked clarity about the procedure.
Evaluation marks the third stage of Gibbs reflective cycle, wherein the positive and negative aspects are discussed. The intramuscular injection site was the deltoid muscle of the arm. Injecting vaccines and drugs intramuscularly into the deltoid muscle is a long-standing nursing practice. The deltoid muscle is the preferred site for intramuscular injections in adult patients because it requires minimal exposure of the client’s body, is generally socially acceptable, and is easily accessible to the professional administering the injection. Deltoid intramuscular injection is a treatment that nurses worldwide conduct millions of times each year. Yet, there is surprisingly little empirical information in the nursing and allied health literature to help the nurse or inform nursing student education. I felt this was a positive aspect as I was trained in this aspect.
Two techniques are commonly used for administering intramuscular injection into the deltoid muscle: bunching and flattening. The “bunching” technique involves the nurse pinching or squeezing the deltoid muscle between the non-dominant thumb and forefinger before injection to enhance its size and reduce the possibility of reaching the bone.
The “flattening” technique is used before injection when the nurse spreads or stretches the skin overlaying the deltoid muscle between their non-dominant thumb and fingers to compress subcutaneous tissue and increase the possibility of injecting into muscle mass (Davidson, 2013). Since the patient was of a healthy build and a one-inch needle was available, the bunching technique was used, and the vaccine was injected into the deltoid muscle.
The next stage deals with analysing the situation; the reflector tries to make sense of it by analysing the evidence. Intramuscular injections are employed to deliver vaccines and medicines deep into the muscle. Since muscle tissue has an abundant blood supply, medicines delivered into muscle are quickly absorbed into circulation. Intramuscular injections do not pass through the digestive system, and medicines or vaccines are not altered (Thomas, 2021).
Injecting vaccines into the anterolateral aspect of the thigh, Vastus lateralis, or Deltoid muscle enhances the immune response of the vaccine. The considerations for administering vaccines include the length and gauge of the needles to ensure vaccine efficacy without causing adverse reactions (Launay, 2017).
By this exercise, I have become more aware of the variations and the considerations of intramuscular administration of vaccines. One must consider the site, needle length, gauge, age and build of the individual for administering intramuscular injection. I need to consider these aspects in the future when I am assigned to administer intramuscular injections for children or those with a different build. In addition, I need to improve my gloving practice to maintain hygiene and quality. In addition, this experience has taught me to communicate with patients while administering vaccines to distract them and reduce pain.
In conclusion, in the fifth stage of Gibbs, I realised that I need to keep learning about the considerations of intramuscular injections and apply the knowledge gained on different patients, for they differ by build, age, anxiety levels and pain tolerance. The same applies to my action plan, the sixth and the last stage of Gibbs reflective cycle.
To conclude, writing this reflective report has enhanced my skills of reflection in nursing. Using Gibbs reflective model has enabled me to analyse the positive aspects, the negative aspects and the areas that need improvement. My level of awareness regarding the injection technique and variations has increased. This activity has made me feel more confident and competent. Using this reflective model has made me acknowledge that I need to be proactive about my learning. Furthermore, as a student nurse, I have understood that reflection is crucial in practice.
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References
- Adamson, E., & Dewar, B. (2015). Compassionate Care: Student nurses’ learning through reflection and the use of story. Nurse education in practice, 15(3), 155-161. https://doi.org/10.1016/j.nepr.2014.08.002
- Prima Ardian, Rr Tutik Sri Hariyati, Efy Afifah, Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills, Enfermería Clínica, Volume 29, Supplement 2, 2019, 588-593. https://doi.org/10.1016/j.enfcli.2019.04.091
- Irvine, D. J., Aung, A., & Silva, M. (2020). Controlling timing and location in vaccines. Advanced Drug Delivery Reviews, 158, 91-115. https://doi.org/10.1016/j.addr.2020.06.019
- Davidson, K. M., & Rourke, L. (2013). Teaching best-evidence: Deltoid intramuscular injection technique. Journal of Nursing Education and Practice, 3(7), 120. https://doi.org/10.5430/jnep.v3n7p120
- Kathy S. Thomas (2021), Intramuscular Injections for COVID-19 Vaccinations. Journal of Nuclear Medicine Technology March 2021, 49 (1) 11-12. https://doi.org/10.2967/jnmt.121.262049
- Launay, O., Lewis, D. J., Anemona, A., Loulergue, P., Leahy, J., Scire, A. S., … & Podda, A. (2017). Safety profile and immunologic responses of a novel vaccine against Shigella sonnei administered intramuscularly, intradermally and intranasally: results from two parallel randomized phase 1 clinical studies in healthy adult volunteers in Europe. EBioMedicine, 22, 164-172. https://doi.org/10.1016/j.ebiom.2017.07.013
