Reflective Practice in Nursing

Introduction

In nursing, reflective practice is important because it enables the nurse to determine the impact of their care procedure along with strength and weakness of skills in care required to be improved for future quality support to the patient (Esterhuizen, 2019). In this assignment, a reflection regarding my clinical experience of safe medication administration and care delivery to a patient who is suffering from Primary Angle Closure Glaucoma and undergoing Laser peripheral iridotomy is to be discussed. For this purpose, Gibb’s reflective cycle is to be used (Harerimana, 2018). This is because the model helps to reflect on practice while making sense of the situation to understand what went well and the action that is to be improved for better future performance (Harerimana, 2018).

The six stages of Gibb’s reflective cycle are as follows:

Description

A patient named Peter (the pseudonym used to maintain confidentiality) was enlist under my care for safe medication administration and care delivery to undergo Laser peripheral iridotomy. Peter expressed anxiety regarding the procedure of laser iridotomy and doubt about his vision improvement. Thus, I acted with empathy and maintained open communication in a polite manner with Peter. The administration of 2% of pilocarpine is required for patients before undergoing Laser peripheral iridotomy as it helps to cause miosis, constriction of the pupil, lower thickness of iris and facilitates perforation to ensure drainage of fluids in the eye to resolve the block (Yunard et al., 2019). Before the administration of pilocarpine, its requirement to be used is explained to Pter with the help of evidence which helped him to remain calm during the pilocarpine administration. As a Laser assistant for Peter, I also provide him the information regarding side effects of pilocarpine such as headache and pain in the eyebrows. in informed him the restriction to be maintained which is avoiding to drive within 6 hours after the administration of the medication.

After the administration of pilocarpine, Peter’s eyes become red which made me anxious regarding him as I also remembered I forgot to check his ocular pressure before the medication administration and thought my careless could have led to hindered medication dose administration to Peter. However, I controlled my emotion and consulted the physician who assured the redness of the eye to be normal after the medication administration but asked me to be careful to execute a proper assessment of the patient before any medication administration. The expiry date for pilocarpine is usually 24 months from manufacture and it is administered directly as a drop on the eye by tilting head backwards while looking up (Yunard et al. 2019). The procedure was explained to Peter so that he understand the reason of actions followed while adiministering the medication. Mopreover, the expery date of piloicarpine is reviewed to ensure it is fit for administration.

Feelings

As laser assistant, before the execution of pilocarpine administration to Peter, I was feeling confident and self-assured to execute the action effectively without causing any error. During the situation, while I was administering pilocarpine to Peter, I was feeling effectively accomplished in executing the procedure. However, after the situation, I felt lack of confidence in administration of safe medication to patient and felt I failed to show enhanced accountability at work. I also feel the consulting physician due to my hindered action of not measuring the ocular pressure of Peter before administration of pilocarpine consider me to be careless and incompetent to make safe medication administration.

Evaluation

The positive aspect of the situation is that as an assistant practitioner I was able to act in an effective way to calm the anxious patient. This is important as anxious patients are seen to show non-compliance in care due to fear and lack of trust in the carer or nurse (Wongkietkachorn et al., 2018). The other positive aspect was that I was able to access informed consent and effectively mentioned the side-effects along with restriction to be followed on administration of the medication pilocarpine to Peter. It is important as knowledge of side-effect and restrictions of medication leads the patients to understand the actions to be avoided and adversities to be faced with the medication use making them act in a conscious way to accept the care (Cifuentes et al., 2018). The other aspect that went well was that I mentioned my error at work without fear of retribution which helped the consulting physician to have the opportunity in taking any additional action if required for safety of Peter. It helped me to follow Duty of Candour that mentions health professionals to always remain open and honest with the patient (GMC, 2021). The role of assistant practioner in medical administration is effectiove adminster dise of medication. They while acting as a part of the MDT have the role report any concern and seek assistance from the team mmebers to resolve the error (Garvey, 2019). However, as an assistant practitioner I was unable to show effective accountability, enhanced knowledge of all side-effects of medication and expressed over confidence in administrating medication withiut consulting the doubts with MDT that could have cause medication error for Peter.

Analysis

The aspect of making Peter remain calm went well because I maintained enhanced open communication with him to resolve all his queries that were making him anxious. The open communication is important because it assist enhnaced discussion of facts between professionals and pateints leading to create confiddence among pateinst to speak their concern to be resolved (). Moreover, as an assistant practitioner I showed effective empathy which made him feel compassion leading Peter to develop awareness that he is effectively care which lowered his anxiety. The ability to mention side-effects and restriction related to pilocarpine administration to Peter went well because I was aware of the way the medication delivery process would make patients to react and way they are to be calmed with effective action in the situation. The ability to mention my error executed in care went well because I understand the guidelines of NMC Code that mentions nurses in case of wrong action are to reveal the action so that effective safety protocol for the patient can be used if required (NMC, 2018). However, my poor accountability at work for medication management, poor knowledege of side-effects and lack of prior health diagnosis required for medication administration made me to remain anxious in the situation. It also raised error in care by skipping the diagnosis process needed for safe dose of pilocarpine administration to Peter. The common error faced in medication administration are wrong dose deliveryand wrong medication administration which can be minised by effectively following the prescription while administering medication (Chen et al., 2019).

Conclusion

The above discussion concludes that I as an assistant practitioner has effective ability to show empathy, maintain open communication and manage care for the patient. However, I lack enhanced knowledge of the side-effects of medication and expressed over confidence at work due to which effective prior diagnosis required for safe pilocarpine administration was not achieved for Peter.

Action Plan

In order to deliver the same care in future, I would try to avoid being over confident at work regarding any care or medication administration. For this purpose, I would learn the guidelines of medication administration more thoroughly and question care strategies to understand their need and implement them in care. Further, I would involve in medication administration training procedure to develop better insight and knowledge of all the side-effects of medication so that I can more informatively deliver facts to patients regarding the side-effects and restriction of any medication along with avoid unnecessary medication administration error.

References

Chen, Y., Wu, X., Huang, Z., Lin, W., Li, Y., Yang, J. and Li, J., 2019. Evaluation of a medication error monitoring system to reduce the incidence of medication errors in a clinical setting. Research in Social and Administrative Pharmacy, 15(7), pp.883-888.

Cifuentes, M., Del Barrio‐Díaz, P. and Vera‐Kellet, C., 2018. Pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in Sjögren syndrome: a double‐blind randomized controlled trial. British Journal of Dermatology, 179(5), pp.1056-1061.

Esterhuizen, P., 2019. Reflective practice in nursing. Learning Matters.

Garvey, V., 2019. The role of the assistant practitioner within the multidisciplinary team. British Journal of Healthcare Assistants, 13(4), pp.185-189.

GMC 2021, Duty of Candour, Avaliable at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/candour---openness-and-honesty-when-things-go-wrong/the-professional-duty-of-candour [Accessed on: 17 November 2021]

Harerimana, B., 2018. Reflective Practice for Professional Development Among Nursing Instructors. Teaching Innovation Projects, 8(1).pp.56-90.

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 20 October 2021]

Wongkietkachorn, A., Wongkietkachorn, N. and Rhunsiri, P., 2018. Preoperative needs-based education to reduce anxiety, increase satisfaction, and decrease time spent in day surgery: a randomized controlled trial. World journal of surgery, 42(3), pp.666-674.

Yunard, A., Oktariana, V.D., Artini, W. and Prihartono, J., 2019. Comparison of intraocular pressure and anterior chamber angle changes between pilocarpine and laser peripheral iridotomy. Journal of current glaucoma practice, 13(1), p.32.

Looking for further insights on Reflective Journey of a Student Nurse Expansive Learning? Click here.