Description

I was given the task to perform the duty of providing care to the patient Antonio Cabrini, who was the 72 years old. Patient has undergone a surgery and doctor has prescribed 0.2 ml of Heparin. Heparin is often prescribed for the patients, who are at risk of forming Deep vein thrombosis (DVT). (Kesieme et al, 2011). I introduced myself to the patient and gained constant, also explained to him about the procedure and medication that I would be administered to him. As nurse to build therapeutic relationship. (Kornhaber et al, 2016). I followed five moments of hand hygiene. According to the guidelines provided by (World Health Organizational behaviour, 2010). Therefore, I put on the gloves and then I double checked the medication on the drug chart, followed by six rights of medication, checking for the allergies.I. chose the woundless area, cleaned it with the alcohol swab and administered the medication through subcutaneous injection. I disposed the equipment in the sharp container.

Feeling

During this procedure I was very nervous and was feeling the lack of confidence. However, I realise that administration of Heparin is very important after the surgery, which can result in damaging some nerves and reducing the blood flow This condition can result in causing blood clots in the deep vein and give rise to serious condition of Deep vein thrombosis (DVT) (Kesieme et al, 2011). DVT can be problem for the patient that can increase the chances of morbidity and mortality. As a nurse I understand that my practice should be within my scope of practice (Registered nurse standards for practice, 2016). Improper administration of the medication can be the risk of post-operative complications would have increased. the skill of administering the subcutaneous injection is important for me because this skill is widely used in clinical practice (Walsh and Brophy 2011). Therefore, it was important for me to regain my confidence, which helped me in administering of heparin through subcutaneous injection successfully. I effective assessed my patient and was appreciated by teacher.

Evaluation

Conducting the right technique of administering a subcutaneous injection is very important for the positive outcome of my skill practice. The evidence base practice has informed that appropriate clinical judgement and critical thinking skills are required (Berman et al, 2014). The process of injecting heparin subcutaneous injection worked well, following the guidelines and working under the scope of my practice. I also knew that correct injecting technique is very important therefore, I placed he injection in ‘dart like position’ forming the 90-degree angle (Ogston-Tuck, 2014). Another aspect of the good skills outcome is the detailed and effective understanding principles and using the correct equipment. The peer review and teacher had some positive and some negative feedback. While choosing the correct site of the injection and understanding that subcutaneous injection requires slow and sustained absorption of the medication (Berman et al, 2014). According to evidence the absorption of heparin is slow in the Vastus lateralis, which was the preferable site for administering the subcutaneous injection. Negative aspects of administrating Subcutaneous injection that did not go well was choosing the correct size needle with appropriate length, I forget to use the needle that should be 25gauge needle (Ogston-Tuck, 2014). However, some of the other steps that worked well were following proper procedure, by ensuring the correct site, correct medication with correct quantity and correct technique of administering medication through subcutaneous injection.

Analysis

While analysing my personal experience, I realised the importance of following the correct procedure and guideline for injecting subcutaneous injection with heparin medication. As evidences state that administration of injection is a common procedure that I as nurse must perform. (Ahmadi et al, 2016). I analysed the significance of choosing the correct site selection for administrating of injection associated with pain and bruising. haematoma, pain also induration at the injection site (Pourghaznein, Azimi, & Jafarabadi, 2014).

Therefore, I required to practice the skills and choose the correct needle to penetrate the subcutaneous tissue without penetrating the muscle (Ogston-Tuck, 2014). I need to improve my own skills and concentrate on choosing the needle of correct length for the effective treatment and for expecting positive health outcomes.

Evidence based practice is very important for me to understand the risks and complications associated with subcutaneous heparin injection. I need to use my knowledge management and the skills of effective injection technique in order to prevent the tissue trauma, pain and bruising and can also support in effective absorption of medication (Yi et al, 2016). Before administrating the injection, it is important that health history and social factors taken into consideration of the patient. (Berman et al, 2014).

Conclusion

In the conclusion I can say that this reflective practice helped me to concentrates on my strength and weaknesses that I can use to improve my practice. Through this reflection, I learned that I have a good understanding of the patient health condition. I also know evidence-based knowledge that helped me to perform the activity in effective manner. Reflection also helped me to develop the skill of personal learning that will help to improve my skills and abilities to improve my knowledge and. reflecting on my own practice for understanding strength and weakness l (Qalehsari, Khaghanizadeh, & Ebadi, 2017). I require to practice more on choosing the correct equipment’s and needles in order to avoid complication..

Action Plan

I need to improve my skills and abilities of injecting subcutaneous injections by Understanding my knowledge as identified by (Qalehsari, Khaghanizadeh, & Ebadi, (2017). I will use my skills and interactions. I will also involve myself in identifying the new learning opportunities and engaging myself with patient care (Davis, Taylor, & Reyes, 2014). I have understood that subcutaneous injection technique requires the knowledge, skills and effective understanding towards the various indications of injection (Ogston-Tuck, 2014). Therefore, I would improve on developing my skills and working under the framework of safe practice to ensure patient safety and positive outcomes.

References

1. Ahmadi, M., Ahmadi, R., Saadati, Z., & Mehrpour, O. (2016). The Effect of Extended Injection of Subcutaneous Heparin on Pain Intensity and Bruising Incidence. Electronic physician, 8(7), 2650. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014505/#__sec17title Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., ... & Parker, B. (2014). Kozier & Erb's Fundamentals of Nursing Australian Edition (Vol. 3). Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?id=wMWaBQAAQBAJ&pg=PA934&lpg=PA934&dq=hand+hygiene+guideline+before+administering+injections.+Australia&source=bl&ots=FEk8qI64ls&sig=T0X9p1Q1O6ZCdxlrrsCt3xoXFJM&hl=en&sa=X&ved=0ahUKEwjyy8r-o9zaAhXDtY8KHYnBB_4Q6AEIoQEwCQ#v=onepage&q=hand%20hygiene%20guideline%20before%20administering%20injections.%20Australia&f=false Davis, L., Taylor, H., & Reyes, H. (2014). Lifelong learning in nursing: A Delphi study. Nurse education

today, 34(3), 441-445. Retrieved from: https://www.nurseeducationtoday.com/article/S0260-6917(13)00139-1/abstract Kesieme, E., Kesieme, C., Jebbin, N., Irekpita, E., & Dongo, A. (2011). Deep vein thrombosis: a clinical review. Journal of blood medicine, 2, 59. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262341/
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4. Pourghaznein, T., Azimi, A. V., & Jafarabadi, M. A. (2014). The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin. Journal of clinical nursing, 23(7-8), 1105-1113. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.12291
5. Qalehsari, M. Q., Khaghanizadeh, M., & Ebadi, A. (2017). Lifelong learning strategies in nursing: A systematic review. Electronic physician, 9(10), 5541. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718860/Registered nurse standards for practice. (2016). Nursing and Midwifery Board of Australia.
6. Retrieved from: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
7. Walsh, L., & Brophy, K. (2011). Staff nurses’ sites of choice for administering intramuscular injections to adult patients in the acute care setting. Journal of advanced nursing, 67(5), 1034-1040. Retrieve from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2648.2010.05527.x World Health Organization. (2010). WHO best practices for injections and related procedures toolkit. Retrieved from: http://apps.who.int/iris/bitstream/handle/10665/44298/9789241599252_eng.pdf;jsessionid=11E7860F8452CF82B63534D76AF5475C?sequence=1 Yi, L. J., Shuai, T., Tian, X., Zeng, Z., Ma, L., & Song, G. M. (2016). The effect of subcutaneous injection duration on patients receiving low-molecular-weight heparin: Evidence from a systematic review. International journal of nursing sciences, 3(1), 79-88. Retrieved from: https://www.sciencedirect.com/science/article/pii/S2352013215300405