Reflection on growth of competency in Clinical Skill

Reflection on growth of competency in Clinical Skill For this essay I am going to reflect upon a clinical skill I have become competent in during my training. I will use a reflective model to discuss how I undertook the skill. I will also discuss the rational and research behind the skill. The model of reflection I have chosen is Gibbs (Siviter, 2004). The Gibbs model of reflection allows the skill to be critically analysed. This is achieved by using the following sub headings; description, feelings, evaluation, analysis, conclusion and an action plan (Siviter, 2004). The skill that I will reflect on in this essay is the administration of an intramuscular Injection (IM). An IM is an injection deep into a muscle (Dougherty Lister, 2008). This route is often chosen for its quick absorption rate and often medication cannot be given via other routes. The reason I have chosen to reflect on this skill is because I have had many opportunities to perform this skill, and at my current practice placement this is the most commonly used method of drug administration. I have undertook many IMs at this placement but I am going to reflect on the first one I undertook which was the administration of Hydroxocobalamin commonly known as vitamin B12 (BNF, 2007) Description During a morning clinic with the practice nurse, I was asked if I would like to administer an IM on the next patient, which was a 26 year old lady who has been suffering from crohns disease which can cause B12 deficiency due to lack of vitamin and mineral absorption (NACC, 2007). I agreed and she briefly went through with me how to do an IM as it had been a while since I had last done one. I called the patient in and asked her to sit down. The patient had come in for her first injection of B12. I chatted to the patient asking her how she was and if she had any concerns. I then gained consent asking her if it was ok for me as a student to administer it under the supervision of the practice nurse. The patient responded with you have got to learn I then prepared the equipment which included two needles, a sharps box, a piece of gauze and the medication. I checked the prescription with the practice nurse, and then checked the ampoule against the prescription. I then drew up the medicatio n with one needle disposing of it in the sharps box and attached the other needle. I then proceeded to administer the medication, after completing the procedure I disposed of the needle in the sharps box and documented it in the patients notes. After the patient had left the nurse explained to me I had done it all correct except I had gone in too far so if the needle broke it would be hard to get it out and that I didnt aspirate to check if I had gone into a vein. Thoughts and feelings After I was asked if I wanted to do the IM I felt very anxious as it had been more than 6 months since the last time I had administered one. But she explained the procedure to me which relieved some of my anxiety. When I first met the patient I was feeling allot more nervous as the patient was roughly my age and I havent had much experience of caring for the younger person. After the procedure when I was told I was wrong for not aspirating I felt annoyed as I was sure I had read that aspirating was no longer necessary. Evaluation Overall I feel that the clinical skill went well as a whole. I followed the instructions from my mentor and what the research has suggested other than feeling a little anxious I performed the skill confidently and correctly. What I feel was bad about the experience is with my communication, which reflecting on I believe was lacking. I communicated with the patient prior to the skill and after the skill, but during I felt I almost forgot there was a patient on the end of the needle. I was so focused on getting the skill right and not causing any pain I didnt talk to the patient throughout the whole thing. Another point that I feel was bad is, I forgot to wear an apron. My mentor never mentioned anything about this although I do feel I should have worn one as its an aseptic technique and its part of the (DOH, 2006) guidelines. Analysis The reason why an IM injection was chosen is because B12 can only be administered via IM (BNF, 2007). I gained informed consent off the patient as this is part the NMC guidelines. (NMC, 2008) As patients have the right to decline treatment. After gaining consent, I then checked the medication against the patients chart to ascertain the following: Drug, Dose, date, route, the validity of the prescription and the doctors signature. This is done to make sure the patient receives the correct drug and dose (NMC, 2008) I then washed my hands using Ayliffes six step technique to reduce the risk of infection and put gloves on as part of DOH 2007 Guidelines . The site that I chose was the mid deltoid site. Hunt (2008) Suggests that this is the best site to use as its easy to access whether the patient is sitting, standing or lying down, it also has the advantage of being away from major nerves and blood vessels. Although Roger (2000) states that only 2ml at most can be injected into the delto id. I was able to proceed with this site as B12 comes in a 1ml dose (BNF, 2007). I asked her if she would prefer to sit or lie down, she said she rather sit, this was ok with me as I am not very tall and found this a comfortable position for me. As the patient was wearing a short sleeve top I asked her to move it up slightly instead of removing it thus allowing her to maintain her privacy and dignity. I then assessed the injection site for suitability checking for any signs of infection, oedema or lesions. This is done to promote the effectiveness of administration and reduce the risk of cross infection (Woorkman, 1999). Holding the needle at a 90 degree angle it is quickly pushed into the muscle. Workman 1999 says this ensures good muscle penetration. I inserted the needle leaving approximately 1/2cm exposed as Workman, (1999) says this makes removing it easier should it break off. At this point I decided not to aspirate as per research (DOH, 2006). After inserting the needle I all owed it to remain there for 10 seconds. As Woorkman (1999) suggest that leaving in situ for 10 seconds allows the medication to diffuse into the tissues. After 10 seconds had past I swiftly removed the needle and applied pressure according to Dougherty Lister (2008) this helps prevent the formation of a haematoma. Immediately after carrying out the skill I disposed of the needle into a rigid sharps container. To ensure health and safety is maintained and the used sharps dont present a danger to me or other staff members as stated by MRHA (2004). After the procedure I documented it within the patients notes as per NMC guidelines and to provide a point of reference if there ever was a query regarding the treatment and to prevent duplicate administration (NMC, Guide lines for records and record keeping, 2005). After the skill I discussed with my mentor that recent evidence suggest that aspirating is unnecessary. According to Workman (1999) the reason for aspirating is to confirm that the needle is in the correct position and to make sure that it has not gone into a vein. The most recent and up to date evidence, says that aspiration is only necessary if using the dorsogluteal  site to check for gluteal artery entry (Hunter, 2008). But official guidance from the World Health Organisation and the Department of Health (DOH, 2006) (WHO, 2004) suggest that this site should no longer be used, thus making aspiration unnecessary. By not aspirating it makes the procedure simpler and less chance of adverse events. Furthermore pharmaceutical companies are making less caustic preparations and in smaller volumes. I discussed this with my mentor and she agreed but stated that it is PCT policy to aspirate, and she would have to continue to follow this practice until the policy was amended. Conclusion Using the Gibbs model of reflection has allowed me to thoroughly analyse the event and allowed me to explore my feelings. I have found out despite the evidence being constantly up to date that not all practitioners knowledge is as up to date, and that trusts are equally as slow to adopt new ideas within their policies and that nurses are governed by policy more than current research. I have also learned that there is a great deal of evidence behind such what on the outside seems to be a simple technique and what I thought I was doing correctly may not always be the case. Action plan I do not doubt I will be carrying out IMs for a long time in my career. I will not be doing much differently in the future as the evidence is underpinning my practice. I will not put the needle in as far as I did on this occasion. In the future I will continue not to aspirate, unless local policy indicates otherwise. In addition I will communicate with the patient throughout the entire skill and not just at the start and end of. Whats more from this event I have realised that learning never stops and what I know now may not be relevant tomorrow.

Body Image Essay -- Weight Health Body Image Essays

Body Image   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  "Just Be" is a familiar slogan to the current American culture. It is the slogan of a well-known designer, Calvin Klein, who, in his advertisements, supposedly promotes individuality and uniqueness. Yet, Calvin Klein, along with all known designers, does not have overweight or unattractive people on his billboard ads, on his runways, in his magazine pictures or on his television commercials. Moreover, the movie, music and the mass media corroborate with the fashion industry in setting and advertising a certain standards for a physical ideal of a human body. Such propaganda promotes the public into depriving themselves of needed nutrition and generates eating disorders within people in order to fit the set standard of the physical ideal. The negative attitude towards overweight population of the modern society is a sociocultural phenomenon. Yet, historically the negativity towards excess in weight was not constant. If one examines the artwork as relatively recent as the works of the Renaissance period, it can be witnessed that women who were somewhat "chunky," were considered beautiful and they were painted and sculpted. "Fleshy" men and women are in the masterpieces of such artist as Michelangelo, de Vinci, Rafael, Goya y Lucientes and etc. Love handles, fat deposits and skin folds were regarded as attractive and were applauded. Cleopatra, for example, was praised for her beauty, yet by modern standards she would be considered overweight. Aphrodite, the goddess of love and the image of perfection, is also viewed as overweight and thickset in the contemporary society and would not be painted or sculpted as "heavy set" as she has been created previously. Nonetheless, she was painted in accordance with the timely regar ds of beauty. Thus, it   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2 may be observed that during that time frame, as well as during most of the historic periods, the full figured body was preached as normal and ideal and was, though not as intensely and as high-tech, commercialized to the public and society.   Ã‚  Ã‚  Ã‚  Ã‚  The change in the beauty standard has been observed since 1970's, when beauty pageant contestants, actresses and models began to continuously show a decrease in weight. The analysis of the weight of advertised models, contestants and playboy centerfolds showed that over sixty perc... ...Archives of General Psychiatry. 56, 468. Field, Alison E., Cheung, Lilian, Wolf, Anne M., Herzog, David B., Goltmaker, Steven L., & Colditz, Graham A. (1999) "Exposure to the mass media and weight concerns among girls" Pediatrics. 103. Harrison, Kristen (1997) "Does interpersonal attraction to thin media personalities promote eating disorders?" Journal of Broadcasting and Electronic Media. 41. Henriques, Gregg R., Calhoun, Lawrence G. & Cann, Arnie. (1996) "Ethic differences in women's body satisfaction: an experimental investigation." The Journal of Social Psychology. 136, pp. 689-697. Lovejoy, Meg. (2001) " Disturbances in a social body: Differences in body image and eating problems among African American and White women." Gender & Society. 15, pp.239-261. MacDonald, Rhona. (2001) " To diet for" British Medical Journal. 322, pp. 1002. Mulholland, Amy, Mintz, Laurie B. (2001) " Prevalence of eating disorders among African American women." Journal of counseling Psychology. 48, pp.111-116. Stice, Eric (1998) "Modeling of eating pathology and social reinforcement of thin-ideal predict onset of bulimic symptoms." Behavior Research and Therapy. 36

Explain what is work force planning and what are the steps that involve in work force planning Essay

Work force planning is a continuous process and one of the important activities in an organization. The work force planning process starts by analyzing the company’s strategy. The result of this analysis is then taken to forecast the required demand for labor and how this is likely to be supported. Thereafter the human resource plan would be implemented which aims to deliver the right number, the right people for the business. There are 8 steps that are followed in work force planning; 1. Work force planning- Where, when and how many people are going to be needed. A company would gain many advantages if it acts strategically, proactively, correctly and efficiently. Also by thinking how it affects the strategy of the organization. For Ex: some companies in USA do not think in strategic manner. They will just meet up in a bar and just discuss how many people are required without thinking much ahead. This would lead to failure. 2. Candidate profiling- This means who do we need, what is the profile of that person that we are looking for, what should be the competency, what are the soft skills or hard skills that the company is looking at of a person etc. This comes through the process of bench marking, profiling, work of science. The company also has to really understand the position of the company, and what advantages it gives the company. It also involves predicting the person’s success in doing the job. 3. Employ branding- It involves the organization culture, which has things like how do we speak to our candidates, how we look after them, how do we brand ourselves etc. This is part of the strategic process of the organization. It matters as to how our organization differs from other company brandings how do we compete with them by this branding etc. 4. Source the Candidate- Most companies don’t source the right candidate. They don’t use the right way, or don’t brain the right people. As a result the wrong, candidate would remain in the organization and it becomes a burden to others and the department. Sourcing means how does a company go to the market and do the sourcing of candidates and how do they define it, company’s approach of doing it. How does the company strategically go to the market, consistently over time, where when the company needs it, ensuring that all the potential candidates that has the skill background the company is looking for is been approached. 5. Screening and Assessing –screening is looking at the hard skills and assessment is looking at the soft skills. 6. Selection- This is processes of bring down the number 100,200 odd applicants to a small number by assessing through different demarcations. A methodology should be outlined in doing so. 7. Retention- after hiring them how do we keep them. The best talent acquisition strategy, the talent management strategy is to grow people. Ex: onboarding/ orientation process, 360 degree review, training initiatives, career path, career development, exit interviews, leadership development strategy, work place study strategy, are the components of what we look at after hiring somebody to keep them engaged and to make them part of the organization. 8. Technology- HRIS, time attendance, background checks etc to make that process automated. This should be given least HR time, as much attention should be given to people aspect as this can operate fully outmodedly.

Report on International Ethical Issues - 2719 Words

Report on International Ethical Issues February 20, 2010 TABLE OF CONTENTS 1). Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦3 1.1 Background and learning goals of the report †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦3 2). Introduction to Dell Inc†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 2.1 Background of Dell Inc. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 2.2 International activities of Dell Inc. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 3). International ethical issues facing Dell Inc. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 3.1 Employment Practices†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 3.2 Environmental Pollution†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 4). Apply relevant theories of ethical decision-making†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 4.1 Supplier Responsibility†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 4.2 Environment†¦show more content†¦* Transportation The finished products are transported to customers once finished. As Dell has promised, customers will receive their orders generally within 7 working days. International Ethical Issues Facing Dell Dell’s plants are being built all over the world, and problems have arisen as a result of this expansion. Among these problems, international ethical issues in developing countries have sparked a heated debate. Here we are going to elaborate on the following international ethical issues facing Dell Inc. Issue One: Employment practices. When working conditions in a host nation are clearly inferior to those in a multinational’s home country, what standards should be applied? Is it ethical for a multinational to gain profit by using suppliers that conduct unethical but not illegal behaviors in the host nations? In the 1990s, many multinationals, Apple Inc., Nike, Wal-Mart and including Dell, found themselves involved in the storm of protests when reports revealed that some sweatshops existed in their suppliers. 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