Reflection on a Significant Incident from Practice

This essay will reflect upon an incident in practice when I administered a drug to a child. I will use Gibbs reflective model (Gibbs 1988)(see appendix 1). This model of reflection will be applied to the essay to facilitate critical thought and relating theory to practice where the model allows. Discussion on the incident will include the knowledge underpinning practice and the evidence base for the administration of the drug. A conclusion to the essay will then be given which will discuss my knowledge and competence of the incidence being reflected upon.
The drug that I have chosen to reflect upon is Fragmin (see Drug Profile 1 Appendix 2) which was administered as a parenteral subcutaneous injection to a 14 year old girl, who shall remain anonymous for the purpose of patient confidentiality in accordance with the regulations of the NMC (2008). I have chosen to reflect on this drug as it was the first injection I had given during my training which encouraged me to further develop my knowledge within this area. The first stage of Gibbs model (1988) of reflection requires a description of events (see Appendix 3).
The next stage of Gibbs (1988) reflective cycle is related to thoughts and feelings aroused during the event which I can use to reflect upon (see appendix 4). The third stage of Gibbs (1988) model of reflection encourages exploration of both positive and negative experiences encountered and I have chosen a few that I propose to discuss further within this reflection. Throughout the incident the correct hospital policy was followed by my mentor in relation to preparing and administering an injection.

However I was not familiar with this policy which could have negatively affected my practice as Grey (2008) suggests, that when administering medication by the parenteral routes, familiarization with local drug administration policy is essential. The patient’s initial refusal of the injection into the abdomen made me think about the child’s rights in refusing to consent to the administration of a medication as I was aware that the law states that anyone under the age of 18 is a child (Children Act 1989, section 105) and as such there are certain matters with which they are not able to make their own decisions.
The patient’s refusal to allow me to use the abdomen as an injection site also made me question my knowledge base on this subject, as I did not know where I would have injected in the abdomen if consent had been given. I also realized at that point that I have no knowledge on why different injection sites are used and for what purpose as studies suggest that the selection of the injection site will vary depending on the size and age of the child (Cocoman, 2008). It was only through my mentor’s guidance that I felt confident on allowing the change of the site. Stage four Gibbs (1988), is the critical analysis.
After reflecting on this incident I will now analyse what I feel are the most important aspects by looking at the evidence underpinning it. References Cocoman, A. , & Barron, C. (2008). ‘Administering subcutaneous injections to children: what does the evidence say? ’ Journal of Children’s and Young People’s Nursing, 2 (2), pp: 84-89 Gray, T. , Miller H. (2008) ‘Injection technique’, The Foundation Years, 4 (6), pp: 252-255 Royal Cornwall Hospital NHS Trust: ‘Medicines Policy’ Available at: http://www. rcht. nhs. uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Pharmacy/RulesAndGuidanceOnOrderingStoringAndAdministeringMedicines. df (accessed on 30/05/2011) Appendices Appendix 1 This model of reflection incorporates description, feelings, evaluation analysis, conclusion and an action plan (Gibbs 1988). Appendix 3 I was asked if I would like to administer a subcutaneous fragmin injection under supervision, to a 14 year old girl. The medication was in a pre-prepared syringe in the clean prep room by following local hospital policy. However, on inspection of the injection, I did question the need for the air bubble within the syringe but was assured by my mentor that it is normal to find an air bubble in a pre-prepared syringe and to leave it there for administration.
The medication was checked by another staff nurse in accordance to local policy and my mentor and I approached the patient. The patient was lying in bed with no relatives present and I asked consent before administration. The patient became a little distressed at this point and refused to have the injection in her abdomen saying it was too painful, however she did consent to me using her upper arm for the site and after onfirming this with my mentor I proceeded to administer the medication with no further complications. Appendix 4 My initial feeling after being asked to administer the Fragmin injection was apprehension, as I had not administered an injection before in practice. As I was administering it under the supervision of my mentor this made me feel very nervous and self conscious, however I also acknowledged the fact that I should appear confident and at ease in front of the patient as she was herself showing signs of distress.
After the patient’s initial refusal I began to doubt my competence of skills and considered asking my mentor to take over, however my mentor put me at ease by explaining that if the patient consented, then it would be fine to proceed with the injection in the upper arm. After the administration, the patient thanked me for not hurting her which immediately boosted my confidence and left me feeling extremely content with the knowledge that I had performed my first injection correctly.

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