Development of Nursing Skills in Oral Care Placement

Development of Nursing Skills in vocal C atomic number 18 attitudeINTRODUCTIONThis essay is going to focus on the nursing skills that I developed during a period of placement subterfuges and in the community, placing emphasis on oral like, converse and bed bath. It forget tabuline the fundamental aspects of clinical nursing skills that I devote begun to acquire. This will oerly highlight the breeding processes which took place and how it helped me to enhance my k presentlyledge, and ethical values in rate to switch back quality and safety of cargon. Using other sources of current literature, I will up worry a broody bewilder to discuss how I maintain achieved the necessary level of tuition outcome. By utilising this model I commit to demonstrate my k instanterledge and understanding in relation to these skills as rise up as identifying argonas with scope for learning.Reflection is the process of reviewing an consume in pose to describe, analyse, measure and so inform learning virtu completelyy bore (Reid 1993). on that point are legion(predicate) meditateive models that I could reach used, including Johns (2004), Driscoll (2000), Atkins and Murphy (1994), Kolbs (1984), and Gibbs (1988).However, Gibbs (1988) model of reflection was selected, as a framework, be grounds it focuses on different aspects of an cons consecutive and tout ensembleows the pupil to revisit the event fully. By contemplating it thus, I am fit to evaluate it and guided to where future development work is required.Skill 1 Oral CareDescriptionI was part of a placement simulation group which went to the multi-skills laboratory to get along delivering and receiving oral hygiene. I was assigned a colleague to brush his teeth victimization a toothbrush and paste. I put on gloves to prevent contamination (NICE 2003). Seeking his consent, I undertook a briefvisual assessment ofhis mouths health. I then put him in a comfortable position so that he could toler ate the wash. Thereafter, I cleaned on the whole-round the mouth, gums and tongue. I finished off by helping him to scour his mouth with mouthwash. I treatedmy first mate as though he was physically unable to hold the brush himselfto scrub his own teeth, unless he was able to intercommunicate with me and was able to assist me in terms of spitting and gargling with water supply at the end of the cognitive operation.FeelingsWhen first communicate that I was expected to undertake this task I mat anxious and interested. I was aware that I had non brushed anyones teeth outside of my family forward and that the mouth is an intimate and soulal part of the organic structure which is non ordinarily exposed to anyone other than me or the dentist. I was concerned much than or less how my partner (whom I did non know well at that stage) would react to me examining his mouth. Writers fox described such intimate physical assessments as creating a potentially intrusive situati on (Lewis 2006, Sturdy 2007) which might cause the uncomplaining to tonus uncertain and inadequate. I was also concerned that my own foreboding was overlap by my partner who also calculateed embarrassed and awkward at the time.This anxiety was increased when during the procedure my partner began to cough as though distressed. This caused me to look hesitant active continuing- a situation recognised by Millon (1994) as a common response for venerationrs to such an experience, although I persevered with his cooperation. When the task was complete I felt comfortable with my performance overall.EvaluationWhat was good about the experience was that, despite being aware that this government agency is practically delegated to health care assistants (Kelly et al 2010), I was able to deliver a fundamental component of essential nursing care (Essence of Care 2003) quite utilely. The experience helped me to appreciate that oral care provides any nurse with an ideal luck to undertake a thorough physical, emotional and cognitive assessment of a patient role (DOH, 2001). I was satisfied delivering this aspect of care without harming the patient as no injuries were sustained (having I checked his mouth prior to and after cleansing). Also, I was pleased to progress to an opportunity to amend my conference skills through with(predicate) the delivery of this skill and to understand the impact that this might have on the development of a therapeutic kindred with future patients. From my colleagues reaction and feedback, I mum how feedback is an big learning tool. Despite my discomfort during the labor movement of this task, the experience highlighted the potentially interlacing problems I might have to solve in the provision of care need to patients for whom I may not have had contact with before.AnalysisAdministration of this clinical skill filld under winning an assessment of my colleagues mouth before delivering any care in order to help determine the approximately appropriate means of delivering oral care. Malkin (2009) asserts that this is a critical component of the procedure and was one I was keen not to vault. The World Health Organisation (WHO 2010) describes a healthy mouth as being free of chronic mouth and facial pain and in the situation described this is the condition I establish my partners mouth to be in. I was therefore happy to proceed with cleaning his teeth as instructed. I selected to use a soft bristled toothbrush and toothpaste. The use of these adjuncts are described by galore(postnominal) writers as being the most appropriate in terms of removing plaque and preventing trauma to the gums (Holman et al 2005,McCauliffe 2007).Despite this it has been determine that they are also most often not selected by nurses who appear uncertain about most effective evidence based practice ( McAuliffe 2007).ConclusionClearly, mouth care is important and that, nurses have a role in assessing and maintaining it (Malkin, 2 009).The task identified the role of the nurse in providing cost increase to the patient whilst delivering oral care. His weakness created a sense of dependency upon me and necessitated the economic consumption of good communications skills on my part to complete the task properly. It has raised my awareness the effects of nursing interventions on others within my practice. military action intentAt the moment, I read more books a day than practice. My object is to be proactive in the future by promptly break up through total participation and doing more practices by skirmish my teeth on regular basis. I would consider brushing others also and allowing them to brush mine in order to force familiar with areas that are often not well attended to. Keeping up to date with evidence based principles of practice will be maintained through the scrutiny of journals that refer to this aspect of care.I will take care to remember my feelings when providing and receiving oral hygiene befo re delivering it to patients in the future. Recognising the potential for confusion and awkwardness I will ensure that I treat the patient with sensitivity and discretion at all times.Skill 2 converse SkillsDescriptionI accompanied my mentor to attend to a credit with R, in persuading him as a non-compliant patient, in taking his medical specialty. He had refused to communicate with anyone, and had been violent and very suspicious of nursing interventions in the past. He would not open his door and started shouting. When he appeared quiet he let us in. I thought it would be nice for him to have some fundamental interaction after seeking his consent. I pulled up a chair adjoining to my customer so that I was closer to him and was at a kindred eye level. I engaged him in a conversation about football. When I mentioned Arsenal, he became interested in the conversation. I realised he was a fan of the club and told me more about the club. I listened attentively, pendulous and con tri just nowing. I ceased this as an opportunity to explain the need for taking medical specialty and side effects of non-compliance. He understood and pledged to take his practice of medicine daily. He took some to our surprise.FeelingsThroughout the whole experience I felt terribly nervous as I knew I was being judged on how well I could achieve the skill. My initial perception was that R was a knotty patient and considered withdrawing but I felt emotionally concerned about clashing a professional obligation. I understood that I owed him a duty of care (NMC, 2008) and simply withdrawing was not professional in my view.EvaluationI was pleased to have an opportunity to improve my communication skills through which, I was able to convince him in taking his medication without confrontation. It was good that I sat in the chair next to him and did not just stand over him to show I valued him and that I was not in a hurry. I used good body language and facial demoions as stated by E gan (2002). I understood the impact that this skill might have on the development of a therapeutic relationship with future patients. Ironbar et al (2003) stresses that, therapeutic relationships can be stressful. This requires insight, self-awareness and ability to cope effectively with stress. The downside was that the patient initially felt that I was being nasty as I was persistent in having him take the medicine. Also, I found it difficult to communicate with the patient initially because I did not understand his condition. Barker (2003) reports of how in recent times empathy has been shown to alter nurses to investigate and understand the experience of persons experiencing a state of chaos as a consequence of psychiatric order.AnalysisThere are many reasons wherefore somebody may refuse to communicate. Wilkinson (1992) cited in (Kluijver et al, 2000) defined communication as an open two-way communication in which patients are informed about the nature of their disease and t reatment and are encouraged to express their anxieties and emotions. Sheldon, (2009) expands this further by saying in nursing communication is a sharing of health-related information between a patient and a nurse, with twain participants as sources and receivers. The nature of health care demands expertise in interviewing, explaining, well-favoured instructions and advising (Williams, 1997). In this instance, this was exactly what I did. The use of therapeutic communications in nursing, particularly empathy, is what enables therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter into and understand the world of another person but also be able to communicate this understanding to him. Nurses should be aware that patients, who are paranoid and suspicious of provide interventions as was the subject area of patient R, might not readily accept support from staff. OCarroll et al (2007) contended th at in our professional roles, nurses do not have the same picking as we do in our personal life by withdrawing from difficult relationships. I began to feel tearful, but then quickly reminded myself that there moldiness be a reasonable ex contriveation for him refusing to communicate or aid with everyone. I felt my client needed a plectrum and freehanded him a choice will give him back some of his freedom when he could be feeling helpless and vulnerable and his self-esteem could be decreased (Child Higham, 2005) as his cooperation could be inhibited.The need to build therapeutic relationship with the patient is paramount in gaining trust and respect (Rigby and Alexander, 2008). McCabe (2004) argues that the use of effective interpersonal skills, a sanctioned component of nursing, must be patient centred. If I had been tense and negative, my client would not have enjoyed the conversation and would have felt uncomfortable and rushed (Kozier, et al 2008).ConclusionCommunication is without suspect the medium through which the nurse-patient relationship takes place. The skills of active earshot and reflection promote better communication and encourage empathy building. Caring for acutely mentally under the weather patients requires of the nurse sensitivity, conveying warmth and empathy. Engaging meaningfully and actively listening to patients collects them perceive the practice as valuing rather than punishing, therapeutic rather than custodial. communicating with patients is in itself nursing and therefore should be encouraged at all levels of nursing care. I feel my caring skill went well, because we were both relaxed and comfortable. As no problems occurred, I would do most things the same again.Action planMy goal for the future is to develop my knowledge by reading about long term conditions like schizophrenia so as to give me insight into those conditions before administering care. If patients appear distressed, I would get other members of staff to help give reassurance to them. I will also use reflective discussions with mentors and peer groups about managing similar situations. Finally, I will be taking the initiative and not being timid about challenging situations- the more times I meet the challenge, the better equipped I become at learning to manage them.Skill 3 Bed johnDescriptionI was asked with a colleague to bath a dummy patient during a placement simulation.The procedure was outlined by the proofreader present. I prepared the trolley with soap, bowl of warm water, soap and towel.I explained why I was going to give him a bath and gained consent. I force the curtains to maintain patients privacy and dignity at all times. I process my turn over, put on apron and gloves to prevent infection and contamination and bathed him all round (front, back and sides including crevasses and folds) using separate towel for the private area. I covered the patient with the bath blanket to prevent chilling for his comfort. Whilst carrying out the bed bath I assessed his disrobe condition for any sores or broken tegument.I treated the patient as if confined to bed or he is too unwell to attend to his own hygiene needs but able to communicate with me and reassured him everything was alright.FeelingsBefore starting, I had many emotions running through me. I expressed that I did not have much confidence in performing the task. This was because I (1) lacked experience, (2) was concerned that I would not perform to the patients expectations and (3) was still trying to adjust to the laboratory environment. I therefore felt embarrassed that my lack of confidence was so distinct to present subscriber and colleagues. I later felt calm but a little apprehensive due to this. Despite all these, I persevered and finished the task successfully.EvaluationWhat was good of this experience was that, I upheld the account of the profession by maintaining it (NMC, 2008) as I did not speak over the client nor did I ignore hi m at any point during the procedure The instructions about what I needed to do was clear and I understood it and this give him the utmost respect, comfort and safety. By washing my hands thoroughly before coming into contact with the patient, Pirie (2010) explains that micro-organisms are easily outback(a) through the process of hand washing. With supervision and comments from the lecturer present, I ideal the task without harming the patient. Thomas et al, (1997), explains that, supervision is an important development tool for all learners.What was not good about this experience was when I redressed the client without allowing the client to choose the dress which I will prevent happening again. Nurses are taught to include family members where possible, keeping them well informed constantly about the condition and health care which is taking place. This helps make families feel more comfortable and also enables them to gain a clear picture of what is going on.Again, the lecturer was concerned that I appeared to lack confidence, and explained that, being able to express opinions distinctly and confidently was essential in my future career as a nurse. In the lecturers view, the only way to develop confidence was to participate regularly which Bulman Schutz (2008) confirms.AnalysisSkin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided (Voegelli, 2010). . Bathing involves actions to keep the skin clean and is essential for healthy skin (Dougherty Lister 2008). There are essentially two bed bath options available for todays health professional. Option one is the traditional soap and water bed bath which is labour intensive. Option two is the use of pre-packaged specialiser bed bath wipes that come already impregnated with skin-friendly cleansers and moisturizers (Massa, 2010). Bathing is an intimate exercise which requires physical assessment. Writers have describ ed such intimate physical assessments as creating a potentially intrusive situation (Lewis 2006, Sturdy 2007) which might cause the patient to feel uncertain and inadequate. I was prepared not to overlook this area.The use of curtains and screens helped maintain the persons dignity and self-esteem (Child Higham, 2005). Despite this, dignity is rarely defined and there are few guidelines that nurses may use in their practice to safeguard individual patients dignity (Dignity in care (DOH 2006).It is true that healthcare assistants and auxiliaries can perform bed bathing and attend to patients hygiene needs there are also important roles for the registered nurse, as it is often during the bathing of a patient that the nurse/patient relationship develops (Downey et al, 2008). In addition, the observation of a patient during the process of bathing provides excellent opportunities to make more detailed assessment and observation of the patients condition and progress (Pegram et al 2007) .ConclusionWithout doubt, provision of bed bath clients is to promote personal hygiene and to give them a sense of well-being and allows the caregivers to monitor changes in the clients skin condition (Evans, 2001). My reflective experience was very basic although a bargain of the experience was preparation, planning and assessing which prevented the experience from going badly in anyway. I will also ask if they want to brush their teeth so that they feel more comfortable and also help prevent dental consonant decay or any sores from developing around the gums. I now feel confident and comfortable enough to assist bathing people.Action planIf a situation like this was to arise again I think I would like to try to take out more time to talk to the client about how they are feeling and involve him at every stage of the activity. I also feel that it is important for me to work alongside more experienced members of staff to be able to learn more whilst on my placements. I think it is w orth play up that as this procedure was carried out on a manikin, it did not reflect proper nurse / patient interaction and that I will now need to try and develop this skill and what I have erudite from it to the wider clinical context when assisting patients who really do need help meeting their hygiene needs. I have learned something about giving the patients choice but it really wont be until I apply this skill into practice that I will receive feedback about how effective Ive underinterpreted the task, from the person that really matters or is in the best place to help me evaluate my actions, that person being the patient.CONCLUSIONAdministering oral hygiene, bed bathing and how these are combined with care, compassion and communication forms the basis of a holistic progression to care, and with the knowledge I got from supporting literature formed the foundation of my learning and practice. This experience has undoubtedly enhanced my critical thinking as a nurse and prepare d me to move forward in my development and practice as a caring and competent nurse. I see myself as being in the right job which offers many opportunities for development and to improve upon my knowledge and skills. I have clearly demonstrated that by using a reflective model as a guide I have been able to break down, make sense of, and learnt from my experience during my placementsIn spite of above, the processes of learning I went through are more complex than Gibbs suggests. It is not as cyclical as this model implies and I found myself jumping or combining some stages, before coming back. However, it has taken me out of my comfort zone, challenging my thinking.