Gibbs' reflective cycle has 6 phases. They are usually given the following headings:
1. Description
2. Feelings
3. Evaluation
4. Analysis
5. Conclusion
6. Action Plan
As part of my International Nurse program, I am required to make a reflective essay. This essay is based on my experience in medical placement in the Operating Theater. The aim of this essay is to go over my learnings about the importance of team briefing, ideas of asepsis, and Surgical Handscrubbing, as well as experiences throughout my location. I've come to choose the Gibbs reflective platform because of this for I feel that through this platform I could better point out in a organized manner the explain the incidents, thoughts, and how I managed learn.
Learning Result 1: Team Short and WHO Surgical Protection Checklist
In June 2008, the planet Health Firm (WHO) implemented another Global Patient Safety Problem, 'Safe Surgery Preserves Lives', to lessen the incidence of surgical deaths across the entire world. The initiative was developed to strengthen and improve the commitment of professional medical staff to address protection issues within the medical setting. This included bettering anaesthetic safety methods, ensuring right site surgery, avoiding operative site infections and improving communication and teamwork within the team. The WHO Surgical Basic safety Checklist is a primary set of safety checks, discovered for bettering performance at basic safety critical time items within the patient's intraoperative care and attention pathway. It is for use in virtually any operating theatre environment, including interventional radiology with the expectation that it could be adapted to fit local practice. The three steps in the checklist (sign in, time out, sign out) aren't designed as a tick container exercise, but as an instrument to initiate significant and purposeful talk between relevant customers of the clinical team to increase the basic safety of surgery.
According to the National Patient Safety Firm, NHS, there are five steps to safer surgeries.
Namely Briefing, Sign in, Time out, Sign away and Debriefing.
During my position, I was designated to circulate in theatre two. Among the five working theatres our hospital has. The there is only one circumstance. Patient Keiser (not the true name). 63 calendar year old man consented for female Total Knee substitution under basic anesthesia using a Zimmer "NexGen" Knee system. I was nervous since it was a major circumstance and I would have to be quick with my actions and be concentrated. I did so my reading each day before therefore i had an idea of about the series of the operation.
Before the individual was escorted to the theatre, the surgical team alongside the anesthesia team had a team simple. Inside the briefing the individual details, laterality of site were confirmed as well as medication allergies, number of staff and availability of implants were all talked about. Everything went easily. The patient was then escorted to the anesthetic room and extra checks, verifications, and the sign in was done in the anesthetic room. The patient claimed that he previously a nickel allergy and that he would get minor rashes when in touch with the metal property. The ODP (Working Department Employees) the person who is in charge of supporting the anesthetist and initiating the WHO Checklist was fully aware of this metallic allergy as it was also mirrored in the treatment plan and preassessment. The occurrence occurred when the ODP and anesthetist didn't notify the scrub team about the specific allergy because they thought a nickel allergy experienced no significance. They were only worried about medication allergies. So they extended and put the patient to rest with propofol and other anesthetic realtors. The patient was then brought in the theater with use of the trolley and placed easily on the Operating table. The scrub team on the other palm was almost done setting up the field and assembling equipment necessary for the procedure. When everything was ready. Being the circulating nurse, Then i continuing the WHO checklist and initiated the Time-out. The consent, patient confirmation and allergy symptoms were then examined but this time the ODP prepared the team about the nickel allergy. The surgeon proceeded to go ballistic! And purchased that the individual be woken up. There was a heated discourse between the plastic surgeon and anesthetist and it they eventually had to wake the individual up. It was then explained to us by the doctor that the System and implants to be utilized during the operation had an extremely small ratio of nickel present in its components which could cause a effect if used to the individual. He was irritated because it was the second time it just happened to him and he didn't want to undergo all the paper works again. The individual was taken to restoration and woke up in a minute. The doctor then described the incident and regrettably the procedure was terminated. The opened sterile instruments, equipment, and consumables were all put to waste materials.
As I analyzed what occurred, the mistake plainly rooted back again to the team short. There were vital information that the anesthetic team recognized about the individual that had not been shared to the scrub team because they didn't view it as important. I personally think every allergy, be it medication, steel or items should be studied into consideration. It was a major case and the team had to learn everything relevant. I realized how important the team short was. Often I would observe other teams not taking the team short seriously. They might just air flow through it as though was just some unimportant routinely work. Following the incident I learned a whole lot and the view I needed on the team briefing and the value of the WHO checklist greatly changed. It really is a very important tool in guaranteeing a safe, effective and successful procedure. I now plan to practice a thorough team simple as well as executing a proper WHO checklist. You never know, passing up on one important simple fact could suggest a life of a patient.
Learning Outcome 2: Basic principle of asepsis:
Asepsis can be defined as the lack of pathogenic microorganisms that cause disease. It then may also be known as clean strategy (Phillips, 2013). However, removal of an infection is the purpose of asepsis, not sterility. (Ayliffe et al. 2000) claim that there are two types of asepsis: medical and surgical asepsis. Medical or clean asepsis reduces the amount of organisms and prevents their spread; operative or sterile asepsis includes strategies to eliminatemicro-organismsfrom a location and is also practised byhealth treatment workersand nurses in operating theaters and treatment areas.
There are several guidelines of surgical asepsis. Although each is equally important, I have become more careful and alert of specific principles more often than others. One rule I've chosen to talk about with is a basic principle stating that folks who are sterile details only sterile items or areas. (guide) It could seem as a very simple principle to check out but it could be sometimes difficult to imbed inside our system. Should it be a scrub role or circulating role this is one of the key things one should always remember.
I got one occurrence during placement concerning this. It happened during an early on shift of your busy Friday. There have been 52 functions to be done that morning. Individuals were on the go. For quite a while now I have been with an orthopedic team but this time I was assigned with my coach to assist a list of over 6 cataract extractions with ocular zoom lens implantation. She was to scrub and I was to aid with the circulating role. Coming into this list I hadn't assisted a cataract removal in the last 4 years. My knowledge was very minimal although I recognized the purpose and roughly the amount of time needed to surface finish the procedure in general but I did so not know much about the fine instruments needed, products and setup of the Centurion Perspective. Everything was new to me and I believed much pressured to deliver and I was uncomfortable knowing I possibly could make errors. As the procedure began my coach scrubbed in and she was too active to guide me thoroughly at the moment. The physician and scrub began asking me to position the machine based on the surgeon's preference. I used to be reprimanded for being slow-moving and hesitant because the surgeon was prepared to start. After finally attaching the plugs, ft. pedals as well positioning the Centurion Machine above the patients head, the surgeon located sterile plastic covers over each of the handles of the device. These sterile plastic grips where used as a sterile field so the surgeon can hold the machine. Like the principle areas, only sterile people should touch sterile things and the other way around for unsterile. Already being reprimanded I used to be nervous that I'd make another oversight and unfortunately I did so. The surgeon required me to reposition the device yet again to his choice but this time around I unconsciously forgot my key points and touched the sterile take care of and I compromised the sterility of the field. The medical expert wanted for another sterile deal with and the case was delayed.
I experienced very bad understanding that I knew the principle but nonetheless it just slipped my brain and I dedicated one which compromised the operation someway. Following the incident I realized what I needed to do and exactly how to position the machine successfully and quickly. I already realized the most well-liked position and provides needed. I simply would have to be more focused, less troubled and hesitant and become more confident this way I'd not make faults of that level. The first circumstance finished and I could effectively circulate on the remaining instances with carefulness, confidence, concentrate and efficiency.
Learning results 3: Surgical Hand scrubbing
Microorganisms copy from the hands of health care providers to patients; this is an
Important factor in regards to to health-care associated microbe infections (i. e. nosocomial). Epidermis is a major source of microbial contamination in the surgical environment. Even though scrubbed members of the operative team are putting on medical gloves and gowns, their hands and forearms are to be cleaned preoperatively to significantly decrease the quantity of microorganisms (AORN 2006)
According to the WHO Suggestions on Hand Cleanliness in Health Care, Surgical palm scrubbing is the operative hand prep with antimicrobial soap and water performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin area flora (2009, World Health Firm). You will find two methods of scrub procedure. One is a numbered stroke method, in which a certain range of brush strokes are chosen for each and every finger, palm, back of hands, and arm. The choice method is the timed scrub, and each scrub should last from 3 to 5 minutes, depending on center protocol (Deborah Gardener 2011). Within the operating theatres there are three most probable routes of illness transmitting between successive/sequential medical patients are via the air, from equipment, or from environmental surfaces. Journal of Clinic Infection (2002)
I have always believed and understood the importance of keeping our hands clean even since I was a little young man. This is a practice taught to me by my parents. As I studied nursing in my country I got eventually to know more about it and how it was properly practised in the wards and theatre settings. During my placement I would always observe my mentor carefully before gowning and gloving. I understood the importance on this. She would use repetitive strokes on the hands and biceps and triceps to further remove any microorganisms. She would be very meticulous and patient while stroking her hands and arms with soap and an antimicrobial agent but as Ive observed, along with most of the scrub nurses, together with my mentor did not use brushes when doing operative hands scrubbing despite brushes being available just at the side of the scrubbing area. This made a big question mark in my brain and I was really confused. I wanted to know why they didn't bother to work with the brushes. THEREFORE I made a decision to research about it.
There was a study that compared surgical palm scubbing with and without the utilization of brushes. Two groups were involved during this analysis. One group to scrub without a brush and another group to scrub with brushes. According to Life Research Journal 2014, the result revealed that the group which used brushes had marginally higher bacterial counts, this could imply that brushes traumatize your skin creating an environment where bacterias thrived. Whereas using no scrub brush led to no skin surface damage and significantly lower bacterial count up. (AORN journal, 2004. 79: p. 225-30). Based on this research, I used to be amazed on how the uk healthcare setting up applied evidence centered practice. I applied this research findings to by domain flipping scrub. I discovered more about because of research and from that point in time on I have already been scrubbing without by using a brush. Medical site microbe infections (SSIs) are the second to third most frequent site of healthcare associated attacks. When providing health services, it is essential to avoid the transmitting of infections all the time. (Engender Health 2001). I applied this research findings to the way i scrub. I learned more about because of research and from that minute on I have been scrubbing without by using a surgical clean.
