A critical analysis of my clinical practice and reflection

A critical analysis of my clinical confide and reflectionIntroductionThis assignment will discuss the development of my victor skills, learning opportunities, and activities that have developed and benefited my learning experiences. I will aim reflection and referrer back to written work in my portfolio this will unify the theory to go for and will show a continuous improvement in the knowledge and beneathstanding that I have gained in preceding organizations, according to Beskine (2009) give from clinical placements are fundamental in allowing scholars to establish the theory learned at university into practice under the supervision of an experienced teach.As registered nurse I essential be able to explain any bring through or decision made, this tush be seen end-to-end my portfolio as I have tried to give up any action mechanism or decision I have made through secernate based knowledge and research findings, according to Richards and Edward (2003) who have stat ed that humankind trust and confidence in the profession is dependant on its practitioners be seen to exercise their accountability to ensure that the interests of the forbearing is respected. The Quality Assurance influence (1997) has defined a portfolio as a structured and deported fulfill under sequestern by an individual to reflect upon their own learning, per contriveance and achievements when training for their individualized educational and guardianshiper development.As a registered nurse my goals will be to further my life long learning and gain as many another(prenominal) skills as possible to enable me to carry extinct my practice safely and with competence. The secernate of this shall be shown through the ongoing development of my portfolio, which will pose opportunities for growth in my personal and master life. jibe to Nursing midwifery Council (NMC) 2004, It is necessary to show motivation and commitment through the development and planning of your own learning. There will in like manner be discussion on the clinical skills laboratories (CLS).Main BodyThe Students rational for choosing the topic of compression cover for branch ulcers was the shock, when she realised that the estimated cost to the NHS in managing tholepin ulcers is 300-600 million a stratum. (Simon et al 2004) In the UK alone, it has been estimated that between 80,000 and 100,000 people will have had a complication ulcer at one time or another, with near remaining unhealed for more than 10 years. (Walker Adderly 2007). Managing fork ulcers similarly places a considerable drain on health resources, with district nursing placego between 25-50% of their time treating patient roles with ramification ulcers (Casey 1999), according to Briggs and Closs (2003), a large distinguish of the nurses work laden especially in the community is taken up with this t pick up, as people get older they are at affixd insecurity of developing arterial and venous incompe tence, which is the underlying ca riding habit of branch ulceration, alter life expectancy means the number of people with ulcers is likely to alternate (Franks and Moffatt, 2007).The learner noticed this more on her final 14 workweek management placement with the community nurses half of her time spent with the nurses was taken up with changing compression fastens. Reflecting back, the student looked at her logs from first year Appendix 1 and noticed that the treatment of pin ulcers has not switchd dramatically in these old three years, that the students perception knowledge and understanding of this condition has. consideration provides a framework upon which individuals can modify both perception and conduct based upon experience (Dewey, 1933 Schn, 1983). It is in any case considered to be a central interpreter of developing expertise (Sternberg, 1999).When the student first went to a community placement in 2nd year, she along with her instruct attended a patient wi th leg ulcers, Appendice2 she assisted the nurse when she muteed the patients leg, using tap water, the leg was dried and a mixture of 50%50 w/w cream (Ointment containing 50% w/w Liquid Paraffin BP and 50% w/w White Soft Paraffin), was employ below the stifle of the leg, then watched as the district nurse, applied a modified form of compression cover.The student and her classmates had practiced this procedure in CLS labs, week three, alimony of the patient with degenerative wounds the labs are designed to ensure flexibility of use in providing an environment where clinical skills learning can be facilitated to support a diversity of clinical learning experiences and environments. Every year the NHS pays come out of the closet about 400 million in settlement of clinical heedless(prenominal)ness claims. It is increasingly recognised that up to as much as 70 -80% of medical error could be attributed to poor technical skills those most at take chances of committing errors are inexperienced practitioners. Creating simulated scenarios allows us to practice our skills and reach mistakes in a safe environment (Engle 2008).The nurse explained that there where contrastive causes for the ulcers and overly different dressings and compression therapies. The student also looked up the pathophysiology, and the psychological effects of the condition, linking theory to practice, rakeing journals and articles the student got an overview of the disease, failing venous valves give out to billet pooling in the veins. This is confirmed by the use of a Doppler ultrasound, which tests the liquify of blood in the leg. Cells and fluid, from the blood leak into the surrounding tissue, causing oedema. blushful blood cells, leak into the tissue and break down, resulting in brown detection of the skin known as, haemosiderin. Further tissue damage occurs when white blood cells clump together to cause inflammatory reactions. Congestion in the veins results in subdued blo od flow. Tissues do not receive adequate fare and the skin becomes dry, flaky and itchy. Lipodermatosclerosis can also occur, ca employ by fibrosis of the fatty tissue, qualification the leg hard and woody to touch, this makes the skin fragile and scratching or trauma may lead to ulceration of the leg and a chronic wound that could take weeks or months sometimes years to heal (Stud 2009).According to (RCN 2006), (SIGN 26, 1998) compression bandage therapy is the gold ensample treatment for venous leg ulcers. The bandage types are classified depending on the degree of sub bandage pressure they exert on the limb, the highest pressure is up to 40mmHg at the ankle (resting pressure), gradually reducing to about 17mmHg just below the knee Anderson (2008). Achieving this improve depends mostly on the patients willingness to accept clinically effective finagle many of the patients whole tone that they cannot carry on with the treatment as the compression bandaging is uncomfortable.T he graduated compression starts with the highest pressure at the ankle, this press outs the lower leg as the calf muscle changes shape on move, but the muscle movement is constrained by the compression bandage with the effect of increasing the squeeze on the veins in the legs, as the muscle movement is concentrated inbound and if the vein is relatively intact it will more likely tight with the extra pressure from the compression (Anderson 2008). This movement may prevent the backflowing of blood as the calf muscle is strong and the speed of the venous blood is increased it could mean that the white blood cells are less likely to clump together thus reducing inflammation in the blood vessel (Oduncu et al 2004).Using compression this way, will increase flow, reduce venous reflux and ankle oedema, therefore improving the microcirculation and support the healing process (Board and Harlow 2002). As the flow improves nutrients reaching the skin once again will improve the sensitivity and dryness of the skin. The compression therapy is not a cure it may be a lifelong process where the patient has to be properly supported.The patients psychological well be is also monitored, (Jones et al 2008), studies carried out show that patients with chronic leg ulcers suffer from depression and feel socially isolated, they restrict their social lives because of the exudates and odour leaking through the bandages. In many cases the ulcer will heal with relative ease once the oedema is under control approximately 12 weeks (Moffat et al 1992). Larger ulcers may take months or years to heal, (Palfreyman et al 2007) effective treatment should help reduce the symptoms and quality of life for the patients, this is why a holistic approach is infallible to ensure the patients psychological needs are also met this in publish may encourage compliance on the patients part.The student is now in her final placement which is back in the community, she has her own case load of four patien ts. One of these patients has a leg ulcer, she wears compression stockings, plot of ground this is not a chronic ulcer great care still has to be taken, as the recurrence rate of venous ulcers is high, hosiery helps to reduce the risk and prolongs the time in a healed state (Bradley 2001).The student also went out with the district nurse who is mentoring her, she allowed her, under her direct supervision to wash and apply the dressings to one of her clients who has a chronic leg ulcer, it is recognised that students must be given opportunities to participate in various clinical skills, the NMC (2006) requires mentors to be able to support student nurses develop nursing competencies, while being maestroly accountable for the student, and also provide support and assessment while on placement.Prior to undertaking the wound dressing, the student had to demonstrate an apprehension of the theoretical and practical aspects underpinning the procedure of compression bandaging to the ment or. This was done by the student reading journals on wound care, looking up articles on the internet, and then discussing them with her mentor. The clients fancy was given, this allowed the student to carry out the procedure. The student read the last entry in the care plan to see what dressings where used previously. Then she gathered all the equipment that she would need, Towels, cream, water, a dressing depending on how adult the leg would depend on what dressing was used. The bandaging comes in outfit form and is priced according to size from 5.65 to 10.58 (Scottish drug tariff 2007).Reading the care plan the student knew that this patient has had a chronic venous leg ulcer, for about 6 weeks, the measurements were taken at every dressing change to see if the ankle circumference has changed due to the reduction of oedema. The leg was nude down, it was very wet and smelly, the dirty dressing then went into the bag provided and devoted of in the bin. The leg was washed with Ep aderm Cream, this is very effective in moisturising the leg it counteracts the loss of essential oils from the skin.As the student knew that her mentor was going to ask her to perform the occupation, she looked up her reflective diaries in her portfolio and read back on them to see how she carried out the procedure then, and how she felt about carrying them out. According to Redfern and take away (1997), portfolios offer an important contribution in the form of a in small stages method that reflects practice.The student had written an account of her past experience in the first year log, as she had not used a feigning of reflection it was difficult to remember how she felt carrying out the procedure, she did describe the task well enough but the feeling and evaluation would have been useful, how did she feel about the task, was the wound really odorous, was the patient satisfied with the outcome, would she have carried out the procedure the same way, coming back to the present ta sk the action plan would have been very handy.Gibbs model for reflection (1988), the student has applied this model to most of her work throughout the three years of placements, but at the beginning of her training she did not, she now realises that using models of reflection in essays and practice portfolios gives written evidence that shows critical thinking, and relates theory to practice. Using the sixer stages of Gibbs reflective model, description, feelings, evaluation, analysis, conclusion, action plan, by using this model the student can analyse her learning experience, and present this as evidence against NMC standards. The student also looked out and read tissue viability journals and wound supplements and searched the internet for wound care information. Current governmental policies have called for all professional groups to work inside a framework of evidence-based practice (EBP) which is underpinned by continuing professional development. The means of all this is to ensure that all health care professionals operate within a framework of clinical governance that assures clinical competence and grooming of quality health care. (Basford and Slevin, 2003).Once the leg was washed and dried a hydrocolloid dressing was applied, this helps absorb some of the exudates, the student then applied the woollen padding using a simple spiral technique with a 50% lick, this helps to protect bony prominences and pads the ankle out. The third step is a light conforming bandage, the foot is flexed to 90 degrees and the bandage is applied from the toes to the knees also using a simple spiral technique with a 50% overlap. The forth step is applying the cohesive bandage, the student made sure the mentor was happy with what was done so far before carrying on she also asked the patient if he was alright, then keeping the foot flexed to a 90 degree angle the bandage was applied with a 50% overlap and a 50% stretch, ensuring the heel was completely covered.The student felt wide-awake about carrying out the final stage of this procedure because of the implication, for instance if the dressing was too tight it may cause trauma to the leg, but the mentor supervised all the way through the procedure, when the bandaging was finished the student felt that she had carried the task to the best of her ability, there was a feeling of expiation the bandage looked neat and secure the patient offered no complaints. When the student had asked his consent he told her that he would say immediately if he felt uncomfortable, because of the exudates the bandage would only be on for two days not a week as is the usual time in between dressing. The patient will be holistically re-assessed each week and his progress constitutioned, the student make full in the patients care plan and her mentor countersigned, as a student nurse preparing to register with the NMC you have both a legal and professional duty of care. This should be demonstarted in your ability to kee p a record and full account of any assessment and care that you have intend for or provided (NMC 2004).The student didnt think she could have done any better, she was happy that he mentor allowed her to carry out this procedure, a little jade about the 50% overlap and stretching the bandage, but was confident in her practice, the task went smoothly. The student will continue to reflect and study leg ulcers and compression bandaging to further her knowledge.The mentor observed the student playacting the task, under direct supervision, she assessed that the student was working to the correct and appropriate standard for her level of training, this will be recorded in the students assessment practice record and signed. While in practice mentors are assessing students against the NMC standards of proficiency, they are not only assessing their practical skills, but their knowledge levels and attitudes which underpin their practice (Richards and Edwards 2003). remnantIn this assignmen t I have disscused the learning opportunities and the activities that have helped develope my professional development in the area of compression bandaging for the care of leg ulcers. I have shown that reflection and reference to previous work and instruct materials have developed my skills, confidence, knowledge and intuition in the care of managing leg ulcers and applying the appropriate dressings and therefore linking my theory to practice. I have shown the ability to justify reasoning for any actions or decisions which I make through evidence based practice, knowledge and research findings.For my professional development and future practice I will continue to futher my life-long learning and gain as many skillls as possible to enable me to carry out my practice safely and with competence. The evidence of this shall be shown through the ongoing development of my portfolio which will constitute opportunities for growth in my personal and professional life.