Saturday, March 30, 2019

Gibbs reflective cycle

Gibbs reflective musical rhythmGibbs reflective cycle has 6 stages. They atomic number 18 usually given the following headings1. Description2. Feelings3. rating4. Analysis5. Conclusion6. Action PlanAs part of my oversea Nurse program, I am required to make a reflective essay. This essay is based on my experience in clinical post in the Operating Theatre. The aim of this essay is to discuss my learnings rough the importance of squad instruct, principles of antisepsis, and Surgical Hand itchbing, as well as experiences throughout my placement. I moderate come to select the Gibbs reflective framework for this for I smelling that through this framework I kindle better express in a systematic manner the describe the concomitants, feelings, and how I was able learn. training Outcome 1 Team Brief and WHO Surgical Safety ChecklistIn June 2008, the World Health Organization (WHO) implemented a game global persevering Safety Challenge, Safe Surgery Saves Lives, to fall the in cidence of running(a) deaths across the entire world. The initiative was developed to streng so and improve the loading of clinical staff to address natural rubber issues within the operative cometing. This include improving anaesthetic safety rules, ensuring correct land site surgery, avoiding surgical site infections and improving communication and police squadwork within the police squad. The WHO Surgical Safety Checklist is a center set of safety checks, identified for improving performance at safety critical term points within the uncomplainings intraoperative c be pathway. It is for habit in both operating theatre environment, including interventional radiology with the expectation that it crowd out be adapted to fit local practice. The three steps in the checklist (sign in, period out, sign out) are not intended as a tick box exercise, precisely as a tool to novice meaningful and purposeful conversation amid relevant members of the clinical team to improve the safety of surgery. check to the National Patient Safety Agency, NHS, in that respect are fin steps to safer surgeries.Namely Briefing, patsy in, Time out, Sign out and Debriefing.During my placement, I was assigned to circulate in theatre both. whizz of the five running theatres that our hospital has. The on that point was tho one slip-up. Patient Keiser (not the real name). 63 year old male consented for a autochthonic Total Knee replacement under general anesthesia employ a Zimmer NexGen Knee system. I was nervous be driving it was a major(ip) case and I compulsory to be quick with my actions and be foc calld. I did my reading a day before so I had an melodic theme of almost the sequence of the operation.Before the patient was escorted to the theatre, the surgical team in concert with the anesthesia team had a team brief. In the briefing the patient details, laterality of site were confirmed as well as medication allergies, number of staff and availability of i mplants were all discussed. E actuallything went smoothly. The patient was whence escorted to the anaesthetic(a) room and additional checks, verifications, and the sign in was done in the anaesthetic(a) room. The patient claimed that he had a nickel allergy and that he would compass mild rashes when in contact with the metal property. The ODP (Operating Department Personnel) the person who is amenable for assisting the anesthetist and initiating the WHO Checklist was fully aware of this metal allergy as it was as well reflected in the care plan and preassessment. The incident happened when the ODP and anesthetist failed to inform the scrub team about the specific allergy because they thought a nickel allergy had no significance. They were only concerned with medication allergies. So they proceed and put the patient to sleep with propofol and other anaesthetic agents. The patient was then brought in the theatre with use of the trolley and placed safely on the Operating table. The scrub team on the other open was near done preparing the battlefield and assembling equipment needed for the operation. When every(prenominal)thing was industrious. Being the circulating nurse, I then continued the WHO checklist and initiated the Time-out. The consent, patient verification and allergies were then reviewed but this time the ODP informed the team about the nickel allergy. The sawbones went ballistic And coherent that the patient be woken up. There was a heated discussion among the surgeon and anesthetist and it they eventually had to wake the patient up. It was then explained to us by the surgeon that the System and implants to be used during the operation had a very small percentage of nickel present in its components which could cause a reaction if used to the patient. He was angry because it was the second time it happened to him and he did not want to go through all the newspaper works again. The patient was brought to recovery and woke up in a a coup le of(prenominal) minutes. The surgeon then explained the incident and unfortunately the operation was cancelled. The opened unproductive instruments, supplies, and consumables were all put to waste.As I analyzed what happened, the mistake cl archeozoic rooted back to the team brief. There were vital information that the anesthetic team knew about the patient that was not taked to the scrub team because they did not see it as important. I personally think every allergy, be it medication, metal or objects should be taken into consideration. It was a major case and the team had to cheat everything relevant. I realized how important the team brief was. Often I would observe other teams not winning the team brief seriously. They would just now breeze through it as if was just some unimportant routinely work. After the incident I well-read a lot and the view I had on the team briefing and the importance of the WHO checklist drastically changed. It is a very important tool in ensur ing a safe, effective and successful operation. I now plan to practice a thorough team brief as well as executing a proper WHO checklist. You never know, missing out on one important fact could mean a life of a patient.Learning Outcome 2 Principle of asepsisAsepsis can be defined as the absence of pathogenic microorganisms that cause disease. It then can also be referred to as clean technique (Phillips, 2013). However, settlement of infection is the goal of asepsis, not sterility. (Ayliffe et al. 2000) suggest that there are two types of asepsis medical and surgical asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread surgical or impotent asepsis includes procedures to eliminatemicro-organismsfrom an heavens and is practised bywellness care workersand nurses in operating theaters and treatment areas.There are several principles of surgical asepsis. Although all are equally important, I scram come to be much cautious and alert of specific principles more often than others. One principle I read chosen to share with is a principle stating that People who are sterile touches only sterile items or areas. (reference) It may seem as a very ingenuous principle to follow but it could be at times knockout to imbed in our system. May it be a scrub use of goods and services or circulating role this is one of the key things one should unendingly keep in mind.I had one incident during placement relating to this. It happened during an early shift of a busy Friday. There were 52 operations to be done that morning. Everyone was on the go. For some time now I have been with an orthopedic team but this time I was assigned with my learn to assist a list of over 6 cataract extractions with ocular lens system implantation. She was to scrub and I was to assist with the circulating role. Coming into this list I had not assisted a cataract extraction in the last 4 years. My knowledge was very minimal although I knew the purpose and r oughly the length of time needed to finish the procedure in general but I did not know much about the fine instruments needed, supplies and set up of the Centurion Vision. Everything was new to me and I felt much pressured to deliver and I was uncomfortable knowing I could make mistakes. As the operation began my t from each one scrubbed in and she was too busy to guide me thoroughly at the moment. The surgeon and scrub started asking me to position the form according to the surgeons preference. I was reprimanded for being slow and hesitant since the surgeon was ready to start. After finally connecting the plugs, foot pedals as well positioning the Centurion instrument above the patients head, the surgeon placed sterile plastic covers over each of the feedles of the machine. These sterile plastic handles where used as a sterile field so that the surgeon can hold the machine. Like the principle states, only sterile people should touch sterile things and the other way somewhat f or unsterile. Already being reprimanded I was nervous that I would make some other mistake and unfortunately I did. The surgeon wanted me to reposition the machine yet again to his preference but this time I unconsciously forgot my principles and touched the sterile handle and I compromised the sterility of the field. The surgeon put across for another sterile handle and the case was delayed.I felt very bad knowing that I knew the principle but still it just slipped my mind and I committed an error which compromised the operation someway. After the incident I knew what I needed to do and how to position the machine efficiently and quickly. I already knew the preferred position and supplies needed. I just needed to be more focused, less anxious and hesitant and be more confident this way I would not make mistakes of that degree. The first case finished and I was able to effectively circulate on the rest cases with carefulness, confidence, focus and efficiency.Learning outcome 3 S urgical Hand rubMicroorganisms transfer from the pass of health care providers to patients this is anImportant factor with wish to health-care associated infections (i.e. nosocomial). Skin is a major source of microbial contamination in the surgical environment. Although the scrubbed members of the surgical team are wearing surgical gloves and gowns, their hands and forearms are to be cleaned preoperatively to significantly reduce the number of microorganisms (AORN 2006)According to the WHO Guidelines on Hand Hygiene in Health Care, Surgical hand scrubbing is the surgical hand preparation with antimicrobial soap and wet performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin flora (2009, World Health Organization). There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The option method is the timed scrub, and e ach scrub should last from three to five minutes, depending on facility protocol (Deborah Gardener 2011). In the operating theatres there are three most probable routes of infection transmission between successive/sequential surgical patients are via the air, from instruments, or from environmental surfaces. diary of Hospital Infection (2002)I have ever felt and tacit the importance of keeping our hands clean even since I was a little boy. This was a practice taught to me by my parents. As I analyze nursing in my country I got to know more about it and how it was properly practised in the wards and theatre settings. During my placement I would always observe my mentor thoroughly before gowning and gloving. I knew the importance of this. She would use repetitive strokes on the hands and arms to further remove any microorganisms. She would be very meticulous and patient while stroking her hands and arms with soap and an antimicrobial agent but as Ive observed, along with most of the scrub nurses, together with my mentor did not use brushes when doing surgical hand scrubbing despite brushes being available just at the side of the scrubbing area. This made a big question saphead in my head and I was really confused. I wanted to know why they didnt bother to use the brushes. So I fixed to research about it.There was a study that compared surgical hand scubbing with and without the use of brushes. Two groups were involved during this study. One group to scrub without a brush and another group to scrub with brushes. According to Life lore Journal 2014, the result showed that the group which used brushes had slightly higher bacterial counts, this could mean that brushes traumatize the skin creating an environment where bacteria thrived. Whereas utilise no scrub brush resulted in no skin damage and significantly lower bacterial count. (AORN journal, 2004. 79 p. 225-30). Based on this research, I was astonied on how the United Kingdom healthcare setting applied recount based practice. I applied this research findings to how I scrub. I lettered more about because of research and from that moment on I have been scrubbing without using a brush. Surgical site infections (SSIs) are the second to third most common site of health care associated infections. When providing health services, it is essential to prevent the transmission of infections at all times. (Engender Health 2001). I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a surgical brush.

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