A critical analysis of my clinical practice and reflection

A critical analysis of my clinical practice and reflection

This essay is a critical analysis of my clinical practice and reflection. Study it to gain knowledge that you can use to create excellent reflective essays.

Introduction

This project will look at how I’ve grown as a professional, as well as the learning opportunities and activities that have shaped and benefited my education. I’ll use reflection and refer back to written work in my portfolio to connect theory to practice and demonstrate a steady improvement in the knowledge and understanding I’ve gained during previous placements.

Clinical placements, according to Beskine (2009), are critical in allowing students to put theory learned at university into practice under the supervision of an experienced mentor. As a registered nurse, I am required to be able to justify any action or decision I make, as evidenced by my portfolio, where I have attempted to justify any action or decision I have made using evidence-based knowledge and research findings.

According to Richards and Edward (2003), public trust and confidence in the profession is dependent on practitioners being seen to be accountable for ensuring that the patient’s interests are respected. A portfolio, according to the Quality Assurance Agency (1997), is a structured and supported process by which an individual reflects on their own learning, performance, and achievements in order to plan for their personal educational and career development.

As a registered nurse, my objectives will be to continue my lifelong learning and acquire as many skills as possible in order to practice safely and competently. This will be demonstrated through the continued development of my portfolio, which will identify opportunities for personal and professional growth.”It is necessary to show motivation and commitment through the development and planning of your own learning,” the Nursing Midwifery Council (NMC) stated in 2004. The clinical skills laboratories will also be discussed (CLS).

Body

Reflection on Learning Opportunities and Activities

When she learned that the estimated cost to the NHS in managing leg ulcers is £300-600 million per year, the Student’s rationale for choosing the topic of compression bandaging for leg ulcers astounded her (Simon et al 2004). It is estimated that between 80,000 and 100,000 people in the United Kingdom have had a leg ulcer at some point in their lives, with some remaining unhealed for more than ten years (Walker & Adderly 2007).

Leg ulcer management is also a significant drain on health resources, with district nurses spending 25-50 percent of their time treating leg ulcer patients (Casey 1999). According to Briggs and Closs (2003), this task accounts for a significant portion of the nurse’s workload, particularly in the community. People who are older are more likely to develop arterial and venous incompetence, which is the underlying cause of leg ulcers. As people live longer, the number of people with ulcers is likely to increase (Franks and Moffatt, 2007).

The student became more aware of this during her final 14-week management placement with community nurses, where she spent half of her time changing compression bandages. Looking back at her first-year logs, the student noticed that while the treatment of leg ulcers has not changed significantly in the last three years, the student’s perception, knowledge, and understanding of the condition has. Reflection provides a framework for people to change their perceptions and behaviors in response to their experiences (Dewey, 1933; Schön, 1983). It’s also regarded as an important part of gaining expertise (Sternberg, 1999).

When the student went to her first community placement in her second year, she and her mentor took care of a patient with leg ulcers. She was especially helpful when the nurse washed the patient’s leg with tap water. The leg was dried, and a 50/50 w/w cream was applied below the knee of the leg (ointment containing 50 percent w/w Liquid Paraffin BP and 50 percent w/w White Soft Paraffin). The district nurse then applied a modified form of compression bandaging, which she observed.

This procedure had been practiced by the student and her classmates in CLS labs, week three, “Care of the Patient with Chronic Wounds”; the labs are designed to ensure flexibility of use in providing an environment where clinical skills learning can be facilitated to support a variety of clinical learning experiences and environments.

The NHS pays out around £400 million in clinical negligence claims every year. It is becoming increasingly recognized that poor technical skills may account for up to 70% to 80% of medical errors; those most at risk of making mistakes are inexperienced practitioners. We can practice our skills and make mistakes in a safe environment by creating simulated scenarios (Engle 2008).

The nurse explained that ulcers could have a variety of causes, as well as different dressings and compression therapies. In order to connect theory and practice, the student looked up the pathophysiology and psychological effects of the condition. The student was given an overview of the disease, which involves the failure of venous valves, which causes blood to pool in the veins. The use of a Doppler ultrasound, which measures blood flow in the leg, confirms this.

Oedema is caused by blood cells and fluid leaking into the surrounding tissue. Red blood cells leak into tissue and break down causing haemosiderin, a brown staining of the skin. When white blood cells clump together and cause inflammatory reactions, more tissue damage occurs. Blood flow is reduced when veins become clogged. The skin becomes dry, flaky, and itchy as a result of insufficient nutrition to the tissues.

Lipodermatosclerosis can also occur, which is caused by fatty tissue fibrosis, making the leg hard and woody to the touch. This makes the skin fragile and scratching or trauma can cause ulceration and a chronic wound that can take weeks, months, or even years to heal (Stud 2009).

Compression bandage therapy is the gold standard treatment for venous leg ulcers, according to (RCN, 2006) (SIGN 26, 1998). The bandage types are categorized by the amount of sub-bandage pressure they exert on the limb; the highest pressure is up to 40mmHg at the ankle (the resting pressure), gradually decreasing to about 17mmHg just below the knee (Anderson, 2008). The willingness of the patient to accept clinically effective care is critical in achieving this healing; many patients believe they cannot continue with the treatment because the compression bandaging is uncomfortable.

The graduated compression begins at the ankle, which squeezes the lower leg as the calf muscle changes shape with movement, but the muscle movement is restricted by the compression bandage, increasing the squeeze on the veins in the legs, as the muscle movement is concentrated inward and if the vein is relatively intact, it will more likely close with the extra pressure from the compression (Anderson, 2008).

Because the calf muscle is strong and the speed of venous blood is increased, this movement may prevent blood backflow. It may also mean that white blood cells are less likely to clump together, reducing inflammation in the blood vessel (Oduncu, et al., 2004).

Compression in this manner improves microcirculation and speeds up the healing process by increasing flow and reducing venous reflux and ankle oedema (Board and Harlow 2002). As the flow improves, nutrients will be able to reach the skin again, reducing sensitivity and dryness. Compression therapy is not a cure; it could be a lifelong process that requires the patient’s full support.

The psychological well-being of the patients is also monitored (Jones et al 2008). Patients with chronic leg ulcers suffer from depression and feel socially isolated, according to studies, and they limit their social lives due to exudates and odor leaking through the bandages. Once the oedema has been controlled for about 12 weeks, the ulcer will usually heal relatively quickly (Moffat et al 1992).

Ulcers that are larger may take months or years to heal (Palfreyman et al 2007). Effective treatment should help patients reduce their symptoms and improve their quality of life, which is why a holistic approach is required to ensure the patient’s psychological needs are met, which may encourage patient compliance.

The student is now in her final placement, which is in the community, and she is responsible for four patients on her own. One of these patients is suffering from a leg ulcer and is wearing compression stockings. Even though this is not a chronic ulcer, great caution must be exercised because venous ulcers have a high recurrence rate. Hosiery reduces the risk of infection and extends the time spent in a healed state (Bradley 2001).

The student also went out with the district nurse who is mentoring her, and she allowed her to wash and apply dressings to one of her clients who has a chronic leg ulcer under her direct supervision. It is widely acknowledged that students should have the opportunity to participate in a variety of clinical skills. Mentors must be able to assist student nurses in developing nursing competencies while also being professionally accountable for the student and providing support and assessment while on placement, according to the NMC (2006).

Prior to beginning the wound dressing, the student had to demonstrate to the mentor an understanding of the theoretical and practical aspects of compression bandaging. This was accomplished by the student reading wound care journals, searching the internet for articles, and discussing them with her mentor.

The consent of the client was obtained, allowing the student to perform the procedure. The student looked at the previous entry in the care plan to see what dressings had been used. She then gathered all of the necessary equipment. Towels, cream, water, and a dressing, which would be determined by how bad the leg was. The bandaging is sold in kits and ranges at price from £5.65 to £10.58 depending on the size (Scottish drug tariff, 2007).

The student recognized that this patient had a chronic venous leg ulcer for about 6 weeks after reading the care plan. Every time the dressing was changed, measurements were taken to see if the ankle circumference had changed due to the reduction of oedema.

The leg was stripped down, it was very wet and smelly, and the dirty dressing was placed in the bag provided and thrown away. Epaderm Cream was used to wash the leg, which is very effective at moisturizing the skin and preventing the loss of essential oils.

Because the student knew her mentor was going to ask her to complete the task, she went back through her portfolio and read her reflective diaries to see how she carried out the procedure at the time and how she felt about it. Portfolios, according to Redfern and Hull (1997), make a significant contribution by providing a step-by-step method that reflects practice.

The student had written a first-year log entry about her previous experience; however, because she had not used a model of reflection, it was difficult for her to recall how she felt while performing the procedure; she did a good job of describing the task, but the feeling and evaluation would have been helpful; how did she feel about the task? Was it true that the wound reeked? Was the patient happy with the result? Would she have done things the same way this time? Returning to the current task, the action plan would have been extremely useful.

Throughout her three years of placements, the student has applied the Gibbs model for reflection (1988) to the majority of her work, but she did not do so at the start of her training. She now understands that incorporating models of reflection into essays and practice portfolios provides written evidence of critical thinking and connect theory to practice.

The student can analyze her learning experience and present it as evidence against NMC standards by using the six stages of the Gibbs reflective model: description, feelings, evaluation, analysis, conclusion, and action plan. The student also searched the internet for wound care information and read tissue viability journals and wound supplements.

According to current government policies, all professional groups must work within an evidence-based practice (EBP) framework that is supported by ongoing professional development. The goal of all of this is to ensure that all healthcare professionals work within a clinical governance framework that ensures clinical competence and high-quality care. (According to Basford and Slevin, 2003).

A hydrocolloid dressing was applied to the leg after it had been washed and dried. This aids in the absorption of some of the exudates. The student then used a simple spiral technique with a 50 percent overlap to apply the wool padding, which helps to protect bony prominences and pad the ankle out. A light conforming bandage is the third step. The foot is flexed to 90 degrees, and the bandage is applied using a simple spiral technique with a 50 percent overlap from the toes to the knees.

A critical analysis of my clinical practice and reflection
Compression bandage for leg ulcers

The cohesive bandage is applied in the fourth step. The student double-checked that the mentor was satisfied with the work so far. She also asked the patient if he was okay before continuing. The bandage was applied with a 50 percent overlap and a 50 percent stretch, keeping the foot flexed at a 90-degree angle to ensure the heel was completely covered.

The student was hesitant to complete the final stage of this procedure because of the implications, such as the possibility of leg trauma if the dressing was too tight, but the mentor supervised the entire procedure. When the bandaging was completed, the student felt she had done her best to complete the task.

There was a sense of fulfillment because the bandage was neat and secure, and the patient had no complaints. When the student asked for his permission, he told her that if he felt uncomfortable, he would tell her right away. Because of the exudates, the bandage would only be worn for two days, rather than the usual one week.

Every week, the patient will be re-evaluated holistically and his progress will be recorded. The student completed the patient’s care plan, which was countersigned by her mentor. You have a legal and professional duty of care as a student nurse preparing to register with the NMC. This should be demonstrated by your ability to keep a detailed record of any assessments and care you have planned or provided (NMC, 2004).

The student didn’t think she could have done any better, and she was grateful that her mentor let her perform the procedure, despite her reservations about the bandage’s 50 percent overlap and stretching. Despite this, she was confident in her abilities. The task went without a hitch. To expand her understanding, the student will continue to reflect and explore leg ulcers and compression bandaging.

The mentor saw the student do the work. She determined that the student was working to the proper and suitable standard for her training level. This will be noted and signed in the student’s assessment practice record. Mentors examine students in practice against the NMC competence criteria, evaluating not only their practical skills but also their knowledge, levels, and attitudes that support their practice (Richards and Edwards 2003).

Conclusion

I have highlighted the learning opportunities and activities that have aided in the development of my professional competencies in the domain of compression bandaging for the treatment of leg ulcers in this assignment. Reflection and reference to past work and training materials have improved my competence, confidence, knowledge, and intuition in the management of leg ulcers and the application of suitable dressings, demonstrating that theory is related to practice.

Through evidence-based practice, knowledge, and research results, I have shown the capacity to provide reasons for any actions or judgments I undertake. For the sake of my professional growth and future practice, I will continue to pursue life-long learning and acquire as many skills as possible to allow me to carry out my work safely and competently. This will be shown by the continual development of my portfolio, which will identify chances for personal and professional development.

Frequently Asked Questions (FAQs)

1. What is the golden standard for the treatment of venous ulcers?

Compression bandage therapy is the gold standard treatment for venous leg ulcers, according to (RCN, 2006) (SIGN 26, 1998)

A critical analysis of my clinical practice and reflection
Nurse Portfolios

2. Why do nurses need portfolios?

Portfolios, according to Redfern and Hull (1997), make a significant contribution by providing a step-by-step method that reflects practice.

3. What are the four stages of reflection?

The student can analyze her learning experience and present it as evidence against NMC standards by using the six stages of the Gibbs reflective model: description, feelings, evaluation, analysis, conclusion, and action plan. The student also searched the internet for wound care information and read tissue viability journals and wound supplements.

A critical analysis of my clinical practice and reflection

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