Nursing is the critical job functions as it is patient centric approach and is directly related to quality of care and safety for service users. It is the responsibility of health care organisation to recruit the best practitioners in order to maintain quality of health and care practices. The report will focus on 4 examples of different clinical practices, that is, female catheterization, under water seal drainage, complex wound management and intravenous medication. However, to develop critical understanding over clinical practices, the portfolio will outline description of all 4 cases with the activities which are performed correctly. This analysis will assist in analysing the improvement measures with specific motive.
However, the four skills in study will be based on specific category that is catheterization will be focused on insertion of Foley catheter. Water seal drainage will be related to service user with Coronary artery bypass grafting surgery. Intravenous medication will be focused on antibiotics and complex wound management will be focused on diabetic patients. Thus, the analysis of research will be based on secondary evidence where views of different author on clinical practices will be discussed.
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1. Female Catheterization
Female Catheterization is a critical process as it is related to insertion of medical devices in human body through surgical process in order to treat diseases. My experience on second week of placement is related to Foley Catheter insertion of 65 years old aboriginal woman. The discomfort of woman was analysed when she refused to take treatment from male nurse and therefore, I raised my hand to proceed with insertion process. The process was new and I was doing it for the first time. Therefore, one registered female nurse joined me for the process. The service users were anxious and uncomfortable but it was my responsibility to calm her before proceeding in order to make further process smooth. I came up with catheterization trolley which has Foley catheter of two sizes that is 12 and 14. In addition, there was antiseptic solution, catheter bag, 10 ml of syringe with sterilised water, lubricant, catheterization pack and sterile gloves (Urinary Catheterization,2017). The best part of process was sizes of catheter which assisted me in easy insertion as per comfort level of women.
However, I realized that before insertion, it is important to clean perineal and vaginal area in order to reduce the chance of infections. In addition, supervisor nurse helps me in opening labia for insertion of tube. With the help of RN nurse, I was able to inflate balloon with 10 ml syringe of sterile water. The lady was trying to interrupt the process with her hand as she was feeling pain and was uncomfortable. But, on the other hand, I managed successfully insertion of catheter and I felt relieved when I saw urine output dropping in catheter bag.
In accordance with entire process, the best part was support from supervisor nurse which helped in making insertion simpler, because the lady was feeling uncomfortable at time of catheterization. Apart from this, from the discussion, it can be said that eliminating participation of male nurse was an effective choice because it helps in comforting aboriginal women for the Foley Catheter insertion. However, all the activities in process were performed correctly because of catheterization trolley which has all clinical instruments which are required to perform process effectively. Like, cleaning of perineal and vaginal area help in reducing the chances of urinary infection of lady. Moreover, use of sterile gloves helps to maintain safety from accidents when giving Foley treatment.
It is important to improve female catheterization process because the process is critical as well as complex for which it is important for the practitioners to first comfort patients. Apparently, it is important to assign duty females nurses for Foley Catheter. This will assist the health care organisation in protecting interest and safety of services users. In addition, it will help in making process simpler because the insertion by female nurses leads to less interruption of patients.
According to McClurg and et.al., 2018,it has been analysed that Female catheterization is the clinical practice which is related to facilitating direct drainage of urinary bladder. In accordance with this, it is important to follow step wise process in order to maintain patient’s safety and appropriateness of clinical services. As per the views of Inserting an indwelling urinary catheter in a female patient, 2004, it is important for the practitioner to first focus on cleaning the vaginal area. Further, it is important for the nurses to ensure safe from inflammation and abnormalities before insertion of Foley Catheter. The most common part of entire process is cleaning of areas with swab sticks in order to prevent contamination. The process is conducted in two ways where the catheter is inserted in and out for immediate drainage whereas, there are situations when catheter is left inside body for short term drainage. The short term drainage clinical practices is named as self-retaining device which is done for chronic urinary retention.
Shlamovitz and et.al., 2016, has outlined equipment required for successful female catheterization that is disposable sterile gloves, curtains, lube, cotton balls with container, forceps (2) and pre-filled 10ml syringe with sterile water which is used to inflate the balloon. It is important for the nurses to use sterile specimen container for collecting urine sample. In addition, the basic requirements are sterile water, adhesive tape, urine drainage bag and chlorhexidine 2% aqueous solution. Apparently, it is important for the practitioner to make use of small size of catheter which helps in maintaining adequacy in urine drainage. Like; 12 to 14 for females draining clear urine.
2. Under water seal drainage
Underwater seal is an effective clinical tool which is used to prevent backflow of air and fluid into peural cavity. In this setting, it is important for the nurses to ensure hand hygiene, use of sterile gloves, secure drain with the help of tubing, and securing all internal connection with cable ties.
At time of seventh week of clinical practices, I came across the case where 14 year old aboriginal girl Jane was presented in hospital for chest drain. She was suffering from severe chest pain, dry cough fever, difficult in breathing and persistent hiccups. Physicians allotted me duty in surgical ward for learning skills by supporting him in intercostal catheter insertion. However, I was focused on checking equipments for catheter trolley which comprise, Intercostal Catheter for 14 year old girl, tube adaptor of two different sizes, suction, sterile gloves in order to prevent contamination and infections, mask and sterile towels. Further, I was asked to make check list for equipments required for surgery such as, 1% lignocaine + 1:100,000 adrenaline 5mL ampoule, antiseptic solution, scalable blasé, 5ml/10ml syringe, black silk or nylon with needle size 3.0 x 2 and Sleek and Tegaderm x 2 (Chest Drain Management,2016).
However, to conduct process in ensured that girl is sitting in strain position with 45 degrees of angle. Further, I ensured that anaesthetic is infiltrated from tissue down to pleura. By using artery forcep physicians made blunt dissect, down to pleural. Further, I cleaned pleural spaced with the helps of sterile gloves. UWSD is attached to tube to chest level of girl by physicians. The profession ensured secure connection of UWSD by waiting for swinging of water in tube connection.
The surgery was successful and the major part of surgery was dissection and placement of tube to secure connection with UWSD. In addition, the arrangement of equipment was performed effectively which helps in reducing clinical and medication errors.
As per the experience of surgery, it can be said that there are various improvement measures which needs to be considered at the tie of under water seal drainage which is an critical situation. Further, hand hygiene and time management in surgery plays an important role in managing safe patient care (Asti and et.al., 2018). In order to manage theses practices it is important for the nurses to ensure scheduling of clinical equipment according to their requirement in surgical procedure. The motive behind this learning is to ensure safe management of equipments and nursing practices in order to prevent infections and misplacement of clinical tools.
As per the views of Hofmann and et.al., 2018, it has been analysed that drainage in chest is a critical situation which requires urgent surgery where chest tube in placed in chest wall to prevent backward flow of air, blood and oxygen. The author has discussed about the nurses' responsibility which is to care for patients chest tubes after being inserted in order to secure clarity of plural drainage system. However, Chest Tube Care Nursing Care of Chest Tubes Clinical Nursing Skills,2017, has discussed about hand hygiene of care workers which plays a vital role in maintaining quality of patent care and safety. In accordance to this, it is important for the nurses to was hands with soap and warm water before coming in touch with patient in surgical unit.
3. Intravenous medication
Intravenous medication is direct medication in which the medicines are given in form of liquid directly into veins. It is done in emergency situation in order to prevent patient from serious allergic reaction, acute pain, etc.
During clinical practices, I was assigned duty for the young aboriginal male Mr A, who was suffering from serious bacterial infection that ispneumonia. As per the seriousness of case, it was important to give IV antibiotic medication. He is 35 years old and is in serious need of medication for which doctors asked to hospitalize him for proper medication. Further, I was asked to enable his intravenous setting as he was unable to take oral medication. It is the situation where his liver was unable to break the enzymes of medicines for managing flow in blood streams.
As per the case, I focused on two clinical setting that is IV infusion and drip infusion where IV fusion will assist in managing flow of medication in blood stream within determined time. It is the method where the flow of medication in from catheter will be continued with the helps of gravity. Further, drip infusion is related to catheter setting which will connected via tube to solution drip. For the entire setting, supervisor who helped me in holding patient because Mr A was struggling from pain and discomfort. In addition, the registered nurse helped in managing timely dosage with set timing of antibiotics. The antibiotics of pneumonia comprise ampicillin 2 g IV q6h, Azithromycin 500 mg IV q24h plus, Levofloxacin 750 mg IV q24h (McMullan and et.al., 2016). With continuous 10 days of IV medication Mr A recovered and shifted to outpatient department for general observation.
In accordance to intravenous setting for antibiotics, I feel the best part of setting was prescription where all the dosage and timely was clearly stated by physician. Prescription assisted in managing safe IV setting for Mr A. Further, the help by registered nurse assisted in keeping check over patients' dosage and timing of drip.
Improvement measures are the best part of clinical setting as it helps in determining the need of changes as per the experience. However, as per clinical practices it is important to improve dispensing related errors which comprise risk of mismatch of syringes and insertion of catheters (Intravenous Medication Administration: What to Know,2018). The motive behind improvement IV management is to ensure safety of patients from contamination and infections.
As per the views of Klockars and et.al.,2017,it has been identified that intravenous medication is the clinical setting where the catheters are inserted in veins to enable medication directly into blood streams. The IV medication setting is directly concerned to dangerous complication such as phlebitis, extravasation injury, thrombosis and bacterial infections. However, the intravenous setting is based on financial costing, recovery of patients, inconvenience to service users and duration of patients stay. Apart from this, Geraets and et.al., 2014, has discussed about the safety of clinical setting at the time f IV medication where it is important for the health practitioner to manage tools of medication such as cotton bottom, sterilise water, syringes, catheters, tubes etc. Management IV medication tools is the best practice which helps in reducing medication and clinical errors at the time of managing patient care.
4. Complex wound management
Complex wound management is a critical clinical situation where the injuries of person reaches to damaged tissue. It is the situation where the injuries can be infections of patients. The wounds can be dangerous in various situation such as injuries of diabetic patient, left wound amputated or packed dressing which leads to clotting of blood or restricts blood circulations.
With third weak of clinical practices I was assigned duty for managing complex wound of diabetic woman Mrs. B who is 62 years old and she is long termed insulin dependent. She was presented in hospital for treatment with hyperbaric oxygen therapy as she had multiple ulcers on her calves, lower legs and shins. The sizes of wounds varied and largest measured wound was of 45mm in length and 32 mm in width. The odour of wound is minimal but as per the pain scale it was analysed that she was suffering from acute pain which was rates as 5 in 1 to 10 pain \scale. In accordance to her wound the focus was to establish the level of oxygen present at the wound bed on air at surface pressure.
The recording of women were of 15 minutes in room air with 67mmHg and 68mmHg at 1ATA to normal the level of oxygen within the tissue in order to normal the wound and pain experienced by lady. Further the reading and administration of air was increased by 338mmHg and 308 mmHg at 1ATA which helped in improving her wound with the helps of hyperbariac treatment. She was presented in hospital for 30 treatments for daily. However, with continuous treatment for two months she was moved to outpatient department and where her she was asked to take oxygen treatment twice a week. This denoted the improvement in her wounds with the help of dressings to antibiotics and hydrocortisone injection and hyperbaric treatment (Everett and Mathioudakis, 2018).
In accordance to clinical practice, it has been analysed that treatment of complex wound in case id diabetic patient is a critical responsibility because the wounds of diabetic patients are sensitive and hold major risks of infection and contamination. The injuries are risky for individual health because it is directly related to tissues which can infect blood of human body. In accordance to situation of Mrs. B, the hyperbariac treatment and regular dressing was the effective practice which assisted in successful healing. However, the regular dressing caused little discomfort and pain to Mrs. B but at the end it reduced the risk of infection in tissues which could have been life threatening.
However, as per complex wound management of Diabetic patients I realized that it is an critical situation for which it is important for the practitioner to maintain safety of atmosphere around the person. The wounds are highly risky and get infected to minor changes due to increased sugar level of patient (Bitto and et.al., 2018). Therefore, as per complex wound management it is important for the nurse to use safety dressing clinical tool like cotton balls to clean wound in order to prevent infections. The rationale behind improving clinical setting as per wound of diabetic patient is to ensure safe and quality care to patient.
According to Guest, Fuller and Vowden, 2018,it has been analysed that complex wound management is a comprehensive approach, where it is important to attain healing within 4 weeks of injury by standard care. Further, systematic evaluation of patients wound with appropriate care plays a vital role in preventing risk of blood infection. The wounds of diabetic patients are deep and damages tissues. Damaged tissue of patients is the critical situation which is contagious and infectious for person itself. In addition, the wounds of diabetic patients takes time of recover in comparison to normal person. On the other hand, Frykberg and et.al., 2017,has stated that diabetic patient suffering from ulcers is the situation which needs to treated with hyperbaric treatment where the individuals is treated in presence of air pressure. Under this, clinical setting it is important for the health practitioner to ensure timely dressing and hyperbaric treatment in order to provide oxygen to injured tissue. Thus, adequate supply of oxygen to wound is the best therapy which assist the nurse in managing successful recovery of service users.
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The report summarized about different nursing practices in different medical situations. It derived skills of health practitioners in different medical situation like intravenous medication of antibiotics, complex wound management for the patient suffering from diabetes. Further, it discussed about medication during, Female Catheterization and Under water seal drainage during coronary artery Biapass grafting surgery. In addition, to develop critical understanding over skills the report outline secondary research review of authors from which it has been analysed that it is important for health care practitioners to ensure safe and quality patients care. Thus, the report concluded by determining improvement measures for each skills in order to set effectiveness in medicall and clinical practices of nurses.
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- Asti, E. and et.al., 2018. Transhiatal chest drainage after hybrid Ivor Lewis esophagectomy: Proof of concept study. Journal of Laparoendoscopic & Advanced Surgical Techniques.28(4).pp.429-433.
- Bitto, A. and et.al., 2018. Activation of the EPOR-β common receptor complex by cibinetide ameliorates impaired wound healing in mice with genetic diabetes. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 1864(2). pp.632-639.
- Everett, E. and Mathioudakis, N., 2018. Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences.1411(1).pp.153-165.
- Frykberg, R.G. and et.al., 2017. A prospective, multicentre, openâ€label, singleâ€arm clinical trial for treatment of chronic complex diabetic foot wounds with exposed tendon and/or bone: positive clinical outcomes of viable cryopreserved human placental membrane. International wound journal. 14(3). pp.569-577.