Identifying Learning Needs in Nursing

Introduction

Nurses have key role to effectively care for individuals of all age groups, races, communitiesfor the promotion of their health and well-being andto aim topreventillness or cope with disability. For this purpose, student nurses require effective training and knowledge regarding the various ways in whichpatients are to be caredfor. Tis may bethrough effective administration of medication and other aspect ofcare. However, thestudent nurse, in second year placement ona medical ward, found that she lacked proper knowledge regarding the administration of insulin injections to diabetic patients. This lack of knowledge resulted her facing barriers to providing proper care to the patients, in turn negatively affecting their health. Therefore, this essay is going to critically analyse two recent articles regarding different recommendation to be followed for improving knowledge and skills regarding theadministration of insulin injectionsto diabetic patients, by the student nurse. The Rolfe reflective model which was proposed in 2011 isused to critically reflecting onthe consequences of learningto improve knowledge and skill. This is required to ensure that the practices suggested by the Nursing and Midwifery Council (NMC, 2015): that nursing needs to be effective and evidence-based, are followed. In this context, seeking nursing dissertation help can be beneficial for addressing gaps in knowledge and enhancing overall care practices.

Identifying a specific learning need

My learning need was identified while acting as a student nurse during my second-year placement on a medical ward where I was allocatedto look after a patient with type-1 diabetes mellitus. During the shift, I was asked by my mentor to administer an insulin injection to the patient which was due. However, I lacked knowledge regarding where and how to administer the injection and the angle at which the needle is to be maintained for administering the injection. Thus, I asked my mentor to show me how to administer the injection; but my lack of practical knowledge and training led me to feel nervous and reluctant to administer the injection. Furthermore, I felt frustrated and disappointed at not being able to properly understand and have information about administering insulin medication which also led me to decline, when asked by my mentor again to administer the injection to the patient later in the day.

The correct administration of insulin medication to diabetic patients helps to improve their blood glucose level to within anormal range (Lind et al.,2017). This helps to decrease the daily requirement of insulin and control blood sugar effectively The insulin injection works by moving sugar from the blood to other tissues of the body where it is to be used for producing energy, and the injection also stops the liver from producing extra sugar (Beck et al. 2017). Thus, I realised that I require proper training and information regarding the way to effectively administer an insulin injection to the diabetic patients to meet their needs and to ensure good control of their blood sugar level. Moreover, this is required to improve my personal development regarding nursing services which would help me in future to promote better health and well-being of patients under my care.

Critical Analysis

In order to develop evidence-based knowledge regarding the proper administration of an insulin injection, two recent articleshave been identified,oneof which is the study byAdhikari et al. (2018) and the other by Dagdelen et al. (2018). In the study by Adhikari et al. (2018), the key findings are that while administering an insulin injection, the nurses are at first required to wash their hands and wear gloves to avoid contaminating the patients. Moreover, before administering the insulin injection to patients, nurses are required to clean the insulin injection site and check for air bubbles in the bottle as well as in the syringe. Furthermore, the injection administration site on the patients is to be identified based on the fat content under the skin so that assumption can be made regarding the length of the needle to be used for effective administration of insulin medication. The proper angle of the needle is to be maintained so that the medication is administered in right layer of the muscle to get properly absorbed in the body to show its reaction. The study is ethically executed as the researcher gained ethical approval from the hospital by presenting the objectives, observation and protocols of the study. Moreover, observations gained in the study are systematically processed and informed with proper data ensuring reliability of the study (Heale & Twycross, 2015).

In the study by Dagdelen et al. (2018), the key findings inform that the abdomen is the major site of insulin injection among patients, rather than other parts of the body. The site where the insulin injection is to be administered is noted in the study to be selected on the basis of fat content underlying the skin in individuals. The 8mm needle was commonly used among the participants in comparison to a 4mm needle for administering insulin injection. Furthermore, the study informs that reuse of needles for insulin injections are more common in the rest of the world in comparison to Turkey. The ethical considerations in the study were effectively abided by, by maintaining anonymity of the participants and the investigators got approval of their research from the Ethics Committee. The study is reliable and valid in nature as all the data gathered was informed in details without any form of manipulation and the authenticity of the data was judged properly before publication of the article (Leung, 2015).

The diabetes nurses and observant patients have long known that the administration technique involved with an insulin injection is critical and thus proper awareness and information regarding the technique is required. In the articles by Dagdelen et al. (2018) and Adhikari et al. (2018), both have understood the importance of having knowledge regarding insulin injection and have noted various techniques or skills to be adopted for the proper administration of injections to patients. In the study by Adhikari et al. (2018), the researcher stated that prior to the administration of insulin injection nurses are required to clean their hands or wear gloves. This is to minimise cross-infection of hospital diabetic patients by microorganisms as a result of poor handling. As mentioned by Kalra et al. (2018), cleaning of hands or wearing gloves is recommended for nurses while injecting medication to reduce chances of contamination of the injection site. This is because unwashed hands and without gloves on hands increases chances of transfer of microorganisms leading to infection of the patients. Thus, the information to use gloves and clean hands before insulin injection administered by the nurses is vital. However, in comparison, the study of Dagdelen et al. (2018) no information was mentioned whether or not any such protocol are being executed by nurses in Turkey or Rest of the World while administering insulin injection.

In the study by Adhikari et al. (2018), it is mentioned that nurses are required to check for air bubbles while preparing insulin injection. This is because the researcher stated that the presence of air bubbles in the injection while administering can cause a lower dosage of administration of insulin than required to the diabetic patients. It is evident from the study by Dubois (2013), where the researcher mentions that presence of air bubbles in the syringe while administering insulin displaces the amount of insulin required by the patients, thus administering lower insulin to the individuals. While compared with the study by Dagdelen et al. (2018), no such information regarding air bubbles or cleaning the insulin vial is mentioned or recommended while preparing for administration of the insulin injection. In comparison to Dagdelen et al. (2018) where it is not stated that the injection administration site of the patient is to be cleaned with alcohol swab to prevent infection, it was mentioned in the study byAdhikari et al. (2018). The site where the injection is to be administered should be cleaned to avoid infection, is also noted by Theofanidis (2017). Thus, it is essential that the site of injection be cleaned prior to the administration of insulin by the nurses to prevent infection (www.nhslanarkshire.org.uk, 2014).

The study by Adhikari et al. (2018) informs that the recommended angle of the needle is 45º for a subcutaneous insulin injection using an insulin pen and should be administered by lifting the skin while using a 6mm or longer needle. In contrast to this, Dagdelen et al. (2018) informs that 90º angle of the needle is to be used in case of any needle size and the angle may change based on the fat or tissue content at the injection site, but it is the most frequently (83.5% patients all over the world) used angle for insulin injection. The study of Dagdelen et al. (2018) notes that the angle of the insulin injection is to be determined by considering the needle size, fat content at the site and location of the site where the injection is administered. The needle size required must be considered to ensure the angle of injection so that damage to the subcutaneous tissues of the body is avoided and proper administration of insulin is achieved (Mahony et al. 2018). However, no such information about changing the needle angle based on fat, tissue layer or site is mentioned in the study of Adhikari et al. (2018) for administering insulin to diabetic patients. The administration of insulin injections at 90º for adults is mentioned by the NICE guidelines and they also inform that while using needles longer than 8mm the angle required to be changed to avoid injecting the insulin in the muscle where they cannot be effectively absorded by the body (NICE, 2015). Therefore, the mentioned 90ºangles of the needle are to be considered while administering insulin injections to adult patients as it is mostly approved.

The study by Dagdelen et al. (2018) has stated that an 8mm needle is the best to be used while administering insulin to the adults. This is because it helps to properly inject insulin in the right layer of tissues in the body. However, the study of Adhikari et al. (2018) has stated that a 4mm needle is best for administering insulin to adults and whena 6mm needle, it is to be used, the insulin is to be administered by lifting the skin. However, needle size of 8mm is perfect to be followed for administering insulin is informed by NICE guidelines (NICE, 2015). This is also evident as Davel et al. (2014) and Diabetes Forecast (2013) informs that most people have a skin thickness of 2.8mm which allows an 8mm needle to be perfectly injected into the subcutaneous layer of the individual. Any needle longer than that is going to create chances of damaging the intramuscular layer of the patient, causing pain and distress (Diabetes Forecast, 2013; Davel et al. 2014). Thus, the 8mm needle size is considered the best to be used while injecting insulin in elderly patients.

In the study of Dagdelen et al. (2018), it is mentioned that the popular injection sites include a combination of thigh/abdomen/arm and thigh/abdomen/arm/buttock. This site of location for insulin injections is mainly relevant when the shallow subcutaneous depth of the muscle is analysed for insulin injection by the nurses. In contrast, no such specific injection site was informed to be selected for administering insulin injection in the study of Adhikari et al. (2018), and it informs that mostly the site is chosen in a haphazard manner. The Diabetes Organisation, UK, mention that the four key areas of insulin injection are; abdomen, thigh, buttock and upper arms, as there is a considerable amount of flesh in the region which helps the body to easily absorb insulin. Moreover, in these sites few nerves are present thus making it comfortable and less painful for the patients to inject insulin. Furthermore, the sites are to be rotated during each insulin injection (Frid et al. 2016). Thus, this informs that the best areas of administering insulin injection are abdomen, thigh, buttock and upper arms as suggested by Dagdelen et al. (2018) rather than all over the body in a haphazard manner.

The study by Adhikari et al. (2018) states that the injection site of the patients is to be checked to ensure the site is clean and is devoid of inflammation, swelling, lipoatrophy or lipohypertrophy. This is because injecting insulin in a site with lipohypertrophy reduces absorption capacity of the insulin which leads to an elevated level of prostaglandin glucose. As mentioned by Famulla et al. (2016), lipohypertrophy is referred to as the lump under the skin which is caused by many subcutaneous insulin injections resulting in accumulation of fat in the same area where re-administration of insulin reduces insulin absorption capacity. This is mainly found in cases of type-1 diabetes patients who require multiple injections on a regular basis. Thus, the examination of the site must be considered while administering insulin injection to diabetic patients to help them avoid facing degenerative tissue conditions or increased pain while injecting insulin. In contrast to this information, the study by Dagdelenet al. (2018) has not mentioned anythingabout examination of the site of insulin injection in patients for swelling, lipoatrophy, or other issues.

In the study of Adhikari et al. (2018), it is stated that the nurses are required to let the syringe or insulin pen remain injected more than five seconds after insertion to ensure the insulin is effectively administered to the patient. However, in the study byDagdelenet al. (2018), no such timings are informed for the needle to be remained inserted. However, the study of Miller et al. (2015) and NICE guidelines (2015) informed that the action to keep the needle inserted for some time or nearly 10 seconds is required so that the insulin from the injection is allowed to be administered in full dose to the patient. Thus, the information from the study of Adhikari et al. (2018) is to be followed while giving an insulin injection. This is because it is mentioned by Kitchlew et al. (2016) that letting the needle stay for some time after the insulin injection helps to ensure complete delivery of insulin to the patient. Furthermore, the study by Theofanidis (2017) notes that the injection sites, after administration of the insulin injection, are to be checked for bleeding, pain, torn skin, early symptoms of lipodystrophy and others. This is to ensure effective interventions can be taken at an early stage to avoid further complicationsto the patients while taking the next phase of insulin injection. Moreover, the site of injection is to be massaged gently after insulin injection to ensure relief to the patients.

In contrast, no post-injection procedures are mentioned to be followed in the study of Dagdelenet al. (2018). The post-injection studies of examining the site and massaging the site are vital in insulin injection as it ensures authenticating the successful administration of insulin administration through injection to the diabetic patients (Theofanidis, 2017). Thus, the post-injection procedure is to be followed by nurses to ensure complete and successful administration of insulin injection. In the study of Adhikari et al. (2018), it is been mentioned that the needle reuse is not recommended and the survey executed by them also informed that smaller number of nurses reuse needle. However, in the study of Dagdelenet al. (2018), it is seen that in most cases needle reuse was seen for insulin injections. As asserted by Frid et al. (2016), needle reuse in insulin injection is to be avoided as it results in infecting the sites of injection administration in the patients. Thus, reuse of the needle is to be avoided in insulin injection administration.

Critical Reflection

The extensive readings from the two articles and the supporting studies have informed about different techniques and procedures to be followed to successfully administer an insulin injection to diabetic patients. I have identified that I need to maintain clean hands and wear gloves while administering insulin injections and need to clean the site of injection with alcohol so that I can be able to minimise cross-infection. As mentioned by Shah et al. (2016), microorganisms which cause infection are quickly administered into the body in insulin injection and may cause deterioration in health as they are able to directly connect with the blood vessels and subcutaneous tissues of the body. Thus, if I fail to maintain proper hygiene while administering insulin injections, I understand that it could cause deteriorated health impact on the patient. I also identified that the insulin injection is to be given to the patients at a 90º angle to elderly patients and at a 45º angle to patients who are thin and to children. This is because it helps the needle to directly reach the subcutaneous layer of the skin where the insulin if administered properly, is easily absorbed by the body to control the blood sugar level in an effective manner. As argued by Tong et al. (2015), the inability to maintain a proper angle of the needle during insulin injection causes damage of internal tissues of the body as well as resulting in pain to the patient. This creates a hindrance in being unable to control the blood sugar level in a proper manner. Thus, to avoid tissue damage or pain, along with effective administration of insulin to control blood sugar, the correct angle of the needle is to be maintained.

The reading of the papers informed me that I need to maintain 8mm needle size to administer insulin injection to patients, as more than this size would cause tissue damage to the patients. Moreover, the areas where insulin injections are to be administered by me are the abdomen mainly, along with buttock, thigh and arm. The locations are to be changed regularly to avoid swelling, lumps, lipoatrophy or lipohypertrophy. This is because the swelling or lipoatrophy or lipohypertrophy causes reduced insulin absorption if the insulin is injected in those sites which results in the patient havinga higher level of postprandial glucose (Gentile et al. 2016). I also identified that I need to keep the needle injected for more than five seconds in the skin of the patients to ensure the proper dosage is administered to the individual. Moreover, any air bubbles in the syringe must be avoided while administering an insulin injection. This is because presence of air bubble causes a lower dosage of insulin to be administered to the patients (Theofanidis, 2017). The reuse of needles is to be avoided to prevent the patient from unnecessary infection. The implementation of this information is going to help me become confident and effective in administering insulin injections to the type-1 diabetic patient I am presently caring for. Moreover, the leaning can be applied in the future to inform other student nurses with proper reasons regarding importance of each procedure to be followed in insulin injection administration. Further, the learning is going to help me provide better quality services without the help of my mentor to the patients for the promotion of their well-being and good health.

Conclusion

The above discussion informs that while acting as a student nurse during the second-year placement at the medical ward I found that I lack the knowledge of offering insulin injection. This is found when my mentor asked me to offer insulin injection to the type-1 diabetic patient I was caring. The incident made me frustrated and disappointed which led me to develop knowledge by analysing two articles along with other supporting evidence regarding the way to administer insulin injection with efficiency. I learned that prior to insulin injection I require to clean my hands or wear gloves so as to avoid cross-infection. Further, the site of insulin injection is to be cleaned with alcohol to avoid infection to the patients and need to be devoid of swelling, lumps, lipoatrophy or other signs. I learned that the insulin injection is to be administered at 90ºangle to the adults and 45 º angles to the children and people who are thin in nature for effective insulin delivery. I also learned that the needle size is not to be more than 8mm and the needle is to be kept in the skin for some time and then removed to ensure the insulin dosage is properly administered. Moreover, no air bubbles are required to be retained in the syringe while injecting insulin so that the patients have required dose of insulin to help them properly control blood sugar level. The needle reuse for insulin injection is to be avoided.

References

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