The aim of this essay is to indicate on how I have become competent in a specific medical skill. The clinical skill I have decided on is administering intramuscular (IM) injections. I will give a rationale for choosing this skill and use appropriate literature to show my knowledge underpinning this skill. Although there are five sites for administration of IM shots, for the purpose of this essay I am going to discuss only two of the websites. Firstly, the dorsogluteal (DG) site as this is actually the site I used when providing IM injections based on the local trust insurance policies and procedures. Second of all I am going to discuss the ventrogluteal (VG) site, as recent books has shown this site to be the safest to make use of when administering IM shots. I'll then think about my learning and exactly how I've become competent in this field.
There is a dependence on nurses to be skilled in the administration of intramuscular shots in the training disability field. The National Institute for Health insurance and Clinical Brilliance (NICE) (2006) suggests that when de-escalation and intense nursing techniques have didn't calm the individual and they are vulnerable to harming themselves or others, then swift tranquillisation should be utilized as a last resort. Although dental 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 Work and the guidance on Consent to Treatment (DH 2002) must be implemented. Consequently, rapid tranquilisation will be performed by the supervision of medication through IM injection to control severe mental and behavioural episodes and to relax the patient quickly.
Greenway (2006) suggests that IM injections are usually likely to happen in association with the administering of antipsychotic medication in the form of depot injections and/or swift tranquilisation, for controlling mental condition and/or challenging behavior for individuals with a learning impairment. Greenway also means that there is only going to be a tiny variety of learning disability nurses that will in actuality use the skill of administering IM injections after they have qualified, scheduled to a decrease in depot supervision. However, the Medical and Midwifery Council (NMC) (2004) recognizes that the role of the learning disability nurse is forever changing and the supervision of shots will be based upon the client group and the practice areas where they work. They recognise that it's a key challenge for learning impairment nurses to revise their knowledge and maintain competence in a skill that they may use infrequently. Irrespective of this, the scientific method should be developed and looked after in line with evidence established practice, it doesn't matter 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 individual and unnecessary issues can be prevented 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 in danger. Incompetency, insufficient training and varying knowledge levels of nurses were factors outlined in problems made around injecting drugs.
Adhering to the aseptic approach during preparation and supervision of the injections, and inspecting the shot site for any signs of pores and skin deterioration are vitally important to prevent contamination and complications (Dougherty 2008).
Alexander et al (2009) identify the correct way to provide an intramuscular treatment in the DG site using the Z monitoring technique.
Using the thumb or the side of the non-dominant side stretch your skin taught over the site of injection retaining the tautness during the procedure.
With a darting motion, put in the needle at 90 certifications to your skin, 2-3mm of the needle should be revealed at the surface and the graduation grades on the syringe barrel must be obvious throughout.
Use the remaining fingertips of the non-dominant side to stable the syringe barrel, whilst using the dominating hand to pull back on the plunger to aspirate. If blood appears all equipment should be discarded and the task should be started again. It is safe to carry on if no bloodstream appears.
The plunger should be stressed out for a price of 1ml per 10 moments to provide the muscle fibres the perfect time to expand and cater to the medicine.
After a further 10 seconds remove the needle and then release the grip on the skin.
The injection site may be wiped with dried gauze if you need to.
A plaster can be employed if the individual requires and if indeed they have no known allergy to latex, iodine or elastoplasts.
Controversy lies around the website area chosen for administering the IM injection. But the DG site is the traditional choice by nurses for the supervision of IM injections there are dangers associated with this site of injections. The DG site can be found in the top outside quadrant of the buttock and is often landmarked by aesthetically quartering the buttock horizontally and vertically, then repeating this step in the very best right palm square. Evidence demonstrates the use of this site for IM injection can run the risk of problems for the sciatic nerve and the superior gluteal artery (Small 2004). It also can cause skin area and tissue trauma, muscle fibrosis and contracture, nerve palsy and paralysis as well as disease (Zimmerman 2010).
The belief by nurses that the VG site is hard to landmark suggests reluctance on the part to improve a practice these are proficient in. Although once nurses have become familiar with located area of the VG site and the surrounding anatomy, they will become positive in using this web site (Greenway 2006). Hunter (2008) advises to find the VG site the nurse should place the hand of her right hands on the patients still left hip (the greater trochanter), then make a 'v' by extending the index finger to the anterior iliac vertebrae. The injections is given in the middle of the 'v' in the gluteus medius muscle. Administering IM injections using anatomical features causes a far more specific and accurate way of undertaking the task.
In distinction to the DG site, the VG site does not have any major complications from the supervision of IM shots. Zimmerman (2010) also firmly 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 fast tranquilisation during restraint of an individual. Because of the type of the situation during this method, safety for everyone involved should be considered. Local plans should be utilised for specific help with positioning the individual safely and securely and for use of specific supports needed to permit the VG site to be landmarked and the injections given. The VG site can be utilized if the patient is susceptible, semi-prone or supine (Greenway 2006). However, following a literature overview of harm to the sciatic nerve from IM injections, Small (2004) advises that the VG site should be chosen on the DG site for IM shot. Zimmerman (2010) concurs with this, highly advocating the utilization of the VG site for IM injections of more than 1ml in patients over the age of seven a few months.
More proof for choosing the VG site is a study carried out by Nisbet (2006) demonstrating that the subcutaneous unwanted fat level of the DG site is significantly higher than that of the VG site. In addition, it confirmed that penetration of the mark muscle at the DG site was only 57 percent indicating the rest of the injection would deposit in to the subcutaneous fat leading to a deficit in the uptake of the medicine. Emerson (2005) accounts an increased threat of obesity in people with a learning impairment. In one research 90 percent of adult females and 44 percent of males had fat deposits in the DG site area which 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 it is a safe option choice for the supervision of any IM injection, Greenway (2006), Small (2004) and Zimmerman (2010) suggest its about time for pros to rethink the site of IM injections in people with a learning disability.
I will now discuss how I've become capable in undertaking this scientific skill also to do this I'll use a reflective model. Representation is a way in which nurses can bridge the theory-practice gap. The procedure of reflective practice allows the nurse to explore, through experience, representation and action, areas for producing their practice and skills. It really is an important part of increasing knowledge and understanding. The usage of a recognised construction allows for a far more structured approach when reflecting upon practice (Johns, 1995).
I have decided to use Gibbs (1998) Reflective Circuit, as it offers a self-explanatory and structural construction and encourages an obvious description of the problem, analysis of emotions, evaluation of the experience, analysis to seem sensible of the experience, conclusion where other choices are believed and reflection after experience to examine what the nurse would do should the situation occur again.
In talking about what took place in learning this skill the theory of experiential learning may also be used as a framework. The theory of experiential learning originated by Steinaker and Bell (1979). The Experiential Taxonomy highlights 4 degrees of learning that the nurse will go through in learning a fresh skill i. e. visibility and participation, id, internalisation and dissemination.
During exposure there's a consciousness of the event and the nurse will have noticed a competent specialist carry out the work. In cases like this I had an awareness of having to have the ability to administer IM injections competently due to the client group engaged. In my first week of placement I observed a professional nurse administering PRN and depot IM injections many times while the nurse spoken me through the procedure detail by detail. As she was demonstrating the task and conversing me through it my thoughts and sense at that time were that I would not be able to bear in mind all the steps had a need to administer the IM shot safely and I got also feeling troubled about potentially leading to pain and/or problems for the patient. Contribution includes the nurse becoming area of the experience. After observing the practice I participated in the pulling up of the treatment and then administering it.
Identification requires the nurse becoming capable in the skill. On reflection when I started on positioning I realised that I'd have to gain all the experience as I possibly could administering IM injections, not just the actual method of providing the injection but also the data to underpin this skill.
Internalisation occurs when the new skill becomes part of everyday activities. Several weeks into my position I felt i experienced eventually become qualified in administering IM injections, my anxieties commenced to lessen and I began to feel well informed which i was becoming proficient in carrying out the task. I found that the more times I completed the task the better I thought about any of it.
Dissemination entails the nurse being able to impact others and showing others how to handle the skill. Although this was only my second positioning Personally i think totally qualified in carrying out the task. I also feel that I've a good knowledge of the underpinning knowledge involved. Therefore Personally i think I would have the ability to educate others how to do this.
On reflection I do not think I'd have learned this skill some other way, I've realised that first anxieties about conducting a new job are standard. But I am going to have to remember this will complete when i practice more and become more experienced.
I also have realised through reflection the importance of having underpinning knowledge with regards to scientific skills and understanding why we do things somewhat than simply simply learning how to do them.
In summary, this project has explored one professional medical skill in which I have gained competence. A rationale was provided in that IM injections are an important part of each day life for your client group engaged. IM injections are considered to be always a routine procedure, it is a valuable and necessary skill for nurses. To provide safe practice and ensure appropriate and therapeutic medication supervision, the nurse should use professional medical judgement when choosing the treatment site, understand the relevant anatomy and physiology, as well as the rules for administering an IM injection. By by using a reflective model and theory in relation to experiential learning I've discussed my very own personal and professional development in terms' of my knowledge and skill acquisition in this area of professional medical practice.
