Reflection On The Management Of Care

Reflection On The focus Of CareThis essay ordain present a reflective diary describing the different care requirements of forbearings from trine different knob gatherings chthoniangoing mathematical process. I will describe the care of one of the thickening groups and subsequently compare and severalize the differences in their needs. This reflection will explore the strategies and skills for management employ in the delivery of care to these individuals and demonstrate the aggroup- on the job(p)(a) skills necessary for an effective working birth in the clinical setting. I will show an appreciation and misgiving of how to identify mea for sures to shelter and victuals shocks to pass on optimum conditions for healing associated with online evidence-based practice. The modified version of Driscolls (2000) reflective framework will be used. The descriptive part of the journal can be found in App displaceix1.These three invitee group will include the following baby George 1 year old child., Helen 35 year old female and Damian 70 year old male. All names of the three clients groups mentioned are anonymous to maintain whackient confidentiality (HPC, 2008)SO WHATDuring the process of care to the above client groups I shared the teams desire to realise the best possible subject for tout ensemble(prenominal) of the perseverings. Interdisciplinary patient care requires commons values, a common vision, and an understanding of teamwork with the ultimate goal of serving three difference clients group with wisdom (Ray, 1998).I also wanted to demonstrate recognition of the needs for Helen, Damian and George, and trust that they should be regarded as valued human beings who deserve the best care. Kumar and Hutton (1998) states that the responsibility of the subject area personnel lies in maintaining the asylum comfort and welfare of the patient from the time he arrives in the firm until the time he departs.In theatre surroundings one of my r ole was to act as Helen, Damian and George root on through their journey thus ensuring that their dignity and rights was in the forefront of running(a) care (Wicker and ONeil 2006). Damian, George and Helen were of different age and had different surgery, according to their needs, their right to dignity, privateness and respect remained the same and the high standard of care delivered reflected that. In this emplacement George and other clients group privacy and dignity perioperative always been maintained and a w tree branch blanket has be used to cover the child and other clients group until surgery commences (Woodhead et al. 2005).As a student ODP, I was trustworthy for the delivery of high standard of care for three different clients groups. The wellness Professions Council (2008) states that registered practitioners must be able to work, where appropriate, in partnership with other professionals, support staff, client users and their relatives and carers. Whilst Helen was on the dodge I checked consent, wrist circuit and operative side with the scouring practitioner, the surgeon and the rest of the team to fasten that right patient is presented for the correct procedure that all details and instruction are available, and that preoperative prepa dimensionn is complete (Torrance and Serginson 1999). An agreed preoperative WHO check controversy has been make by one of my colleagues to introduced ourselves and discuss our client so that we assimilate a shared understanding of the patient condition and the operative challenge (or that it whitethorn be a straightforward procedure with no anticipated problems) (Wilson and walker 2009).Evidence based practice has call on an historic part of the property required duncical down the peri-operative environment. All theatre practitioners are required to play along open their professional practice up to date and there is also an change magnitude expectation for the practitioner to develop researc h based practice and to keep informed with regards to relevant research findings (Hind and Wicker 2000).The knowledge and skills were very master(prenominal) aspects for effective working relationship in the theatre to maintain safety environment individually for each of the discussed group. health professionals should strive to ensure character and safety for those in our care (RCN, 2003).For Helen and Damian I ensured the temperature was 22C and made sure that the heating plant device (Bear hugger) was placed over the top of their body to maintain and manage their body temperature. Because of the potential morbidity associated with hypothermia and hyperthermia, it is important to admonisher body temperature and to plant measures to maintain temperature as close to normal as possible (Townsend et al. 2004). besides carried for George, I adjusted room temperature to 25C and w weaponing device was also applied. Children have a higher surface area to body weight ratio compared with adults, and so they lose heat more rapidly. Neonates and preterm babies are particularly suggestible to hypothermia (Bingham et al. 2008).Torrance and Serginson (1999) state that the theatre practitioner needs to be aware of and monitor safety with regard to safety alter and positioning of the patient, rack relief, pelt preparation, asepsis, diathermy, swabs, needles and instruments. Transfer of and positioning Helen, Damian and George for the orthopedic surgery onto the operating table was carried come come in of the closet by the theatre team with extreme care and with regard for both(prenominal) previous injuries or limitations of conjunction movement (Torrance Serginson 1999). We were aware ab egress the implications of brusk movement in the above clients. Injuries can range from transient aches and stock and minor skin abrasions to paralysis and even loss of life (Beckett, 2010).Pressure know gels was provided to protected Helen and others clients aligned with pressure ulcers caused by long-term procedures. Unrelieved pressure on a unique(predicate) area of the body will run into the blood supply to the skin and underlying tissues causing that area to become damaged (Hampton and Collins 2004).Equipment was selected appropriate to the age and individual requirements of each client. George compared with others groups of client required appropriately sized equipment which was used of all times, e.g. diathermy plates, arm boards, specific pediatric table attachments for positioning (Woodhead et al. 2005). I made sure that unfruitful field consisting the scrub team, trolleys and the draped patient was maintained. Packets were opened and uninspired items passed to the scrub practitioner in a manner that did not compromise the sterile field. As I was circulating I noticed that asepsis (or uninventive technique) was important and it involved all the practical measures taken to avoid ingress microbes to a susceptible site ( such as instrume ntation, theatre ventilation, and non touch technique), or to kill or remove them from that site (such as skin sterility and shock cleansing) (Quick and Thomas 2000). Aseptic technique was used during all invading procedures for Helen,Damian and George in preventing surgical site transmittal from microbial contamination.During all groups of client operations the scrub practitioner used non-touch technique by locomote sharp instruments such as blades or sutures on receiver so that the operating surgeon may lift them as opposed to freeing by hand (Pirie, 2010). Instruments were placed in the neutral zone by the scrub person and then picked up by the surgeon or the assistant, and vice versa (Gruendemann and Magnum 2001).Once Helens operation was completed, I handed the necessary displease impregnations to the scrub nurse. This also forms a part of the circulating role. It is therefore important that the scrub person or surgeon ensures that the correct dressings were requested t o optimize wound healing. Bentley (2004) suggests that effective wound management and use of appropriate dressings should be based on an understanding of the healing process. Wound healing consists of tetrad phases that overlap these are inflammatory, destructive, proliferation and maturation (Nazarko, 2002).The steps in the wound patch process include inflammation around the site of injury, angiogenesis and the development of granulation tissue, repair of the connective tissue and epithelium and ultimately remodelling that leads to a vulcanised wound (Gunnewitch and Dunford 2004).The roles of surgical dressings are primarily to stem bleeding, absorb exudates and provide mechanical and bacterial protection for the newly formed tissues (Aindow and Butcher 2005). As Dealey (1994) highlights, the surgeon is responsible for inflicting the wound, although the bulk of the responsibility for ensuring that the wound heals without complications falls with the nurse. Lay-Flurrie (2004) ur ges that theatre practitioner should have a good knowledge of the dressing properties characteristics and an sentiment of whatis to be achieved. The use of an inappropriate dressing may result in damage to the friable and delicate tissue underneath (Lay-Flurrie, 2004).During this surgery I also learnt that the needs of each individual clients wound at any particular time after the surgery need to be prioritized as it may differ while it progresses through the healing process. The hospital where I was on placement used two main types of dressings for postoperative wound management, these fall under the following categories, fabrics and films. (Aindow and Butcher 2005).The wound dressing used for Helens right shoulder arthroscopy was Mepore (fabric) for a dry small incision compared with Damians nub hip replacement the surgeon used Opsite (film) for larger incision. Mepore incorporates pads to absorb the exudates produced by newly formed wounds. However while they form an effective parapet when dry, they can facilitate bacterial ingress when wet (Aindow and Butcher 2005).Opsite provides a barrier which prevents the contamination of the wound with extrinsic bacteria, including MRSA. As the wound is visible, dressing removal is unnecessary to inspect the wound. This further minimizes trauma and the danger of accidental wound contamination (Aindow and Butcher 2005). Ennis and Meneses (2000) state that, many chronic wounds such as pressure ulcers, take months and sometimes years to heal, becoming stuck in the inflammatory and proliferate phase of wound healing.Additional measures to reduce the risk of infection should be taken these include avoiding unnecessary exposure of the joint implant for Damians surgery. Therefore it should not be removed from packaging until required. commodious handling of the implant should be avoided (Eppley, 1999, citied by Radford et al.2004). DOH (2003) state that, wound care has a large impact on the total do drugs budget and it is important that limited resources are used wisely and effectively. The simple purpose of wound cleansing is to remove organic and inorganic rubble before the application of a wound dressing, thus maintaining an optimum environment at the wound site of healing (Morrison and Wilkie 2004).Blunt (2001) agrees that wounds should be cleaned to remove overseas bodies, such as debris, excess exudates, necrotic tissue or cast off all of which could become a focus for infection.NOW WHATWhile working as a member of the multidisciplinary team, the importance and value of teamwork has become spare to me throughout my training and I have learnt how good communication, skills and working together ensures effective patient care for the three different client groups undergoing surgery.I have been able to establish and maintain a safe working place by improved confidence which has led to an improvement in my competence.I believe that I have become a valued member of the theatre team by antici pated with the scrub team by passing appropriate instruments, sutures and wounds dressing to protected Helen and other clients from the infection and covered to maintain them dignity.It also demonstrated my ability to explore and critically analyze own responsibilities in the following area identify measures to protect and support wounds to provide optimum conditions for healing.The experience described enabled me to reflect deeper on my ability to support different groups of patients and as a result my trueness to achieve the best patient outcome.References1. Aindow, D.Butcher M. (2005) Tissue vability supplement. The British Journal of nurse, 14 (19), p.2. Beckett,A,E.(2010)Are we doing enough to prevent patient injury caused by positioning for surgery?Online.Available at http//findarticles.com/p/articles/mi_m0748/is_1_20/ai_n48711688Accessed 11 March 2010.3. Bingham, R. Lloyd-Thomas, A. Sury, M. (2008) Hatch Sumners Textbook of paediatric anaesthesia. 3rd Edition .Oxford Oxfor d University Press.4. Blunt J. (2001) Wound cleansing Ritualistic or research-based practise ? Nursing Standard, 16 (1), p.33-36.5. Department Of Health (2003).Supplementary prescribing by nurses and pharmacists within the NHS in England. Online. Available at http//www.doh.gov.uk Accessed 19 February 2010.6. Driscoll, J. (2000) Practising clinical supervision. Edinburgh Balliere Tindall7. Ennis, W. Meneses, P. (2000)Wound healing at the local level The stunned wound. Online. Available athttp//www.ncbi.nlm.nih.gov/pubmed/10732639 Accessed 18 February 2010.8. Gruendemann, B. Mangum, S. (2001) contagion prevention in surgical settings. Philadelphia W.B Saunders.9. Gunnewicht, B. and Dunford, C.(2004)Fundamental aspects of tissue viability nursing. WiltshireHA Healthcare.10. Health Professions Council (2008) Operating Department Practitioners. Standards of proficiency. London HPC.11. Health Professions Council (2008) Standards of conduct ,performance and ethics.Online.Available at http/ /docs.google.com/www.hpc-uk.org/assets/documents/July2008.pdf+Standards+Of+ take up+,Performance+and+Ethics.Accessed01 March 2010.12. Hind, M., Wicker, P. (2000) Principles of perioperative practice. London Churchill Livingstone.13. Lay-Flurrie (2004)Wound management to encourage granulation and epithelialisation. Professional Nurse, 19 (11), p.26-28.15. Meltzer, B. (2001) A guide to patient positioning. Online. Available at16. Morison, L, G. Wilkie, O, K. (2004) Chronic wound carea problem-based learning approach.London Mosby.17. Nazarko, L. (2002) Nursing in care homes. second ed. Oxford Blackwell Science.18. Pirie, S. (2010) Introduction to instruments. Online.Available athttp//findarticles.com/p/articles/mi_m0748/is_1_20/ai_n48711689/.Accessed 1 march 2010.19. Quick, C.Thomas, P. (2000) Principles of Surgical Management. Oxford Oxford University Press.20. Radford, M. County,B. Oakley, M. (2004) forward-moving Perioperative Practice. Cheltenham Nelson Thornes Ltd.21. Ray, M, D. (1998) Shared borders achieving the goals of interdisciplinary patient care. American Journal of Health-System Pharmacy, vol. 55, issue13, p.1369-1374 AJHP Online.Available at http//www.ajhp.org/cgi/content/abstract /55/13/1369 Accessed 6 March 201022. gallant College of Nursing (2003) Clinical Governancean RCN resource quide.LondonRCN.23. Scott, E.Earl, C.Leaper, D.Massey, M.Mewburn, J.Williams, N (1999)Understanding perioperative nursing. Nursing Standard, 13(49), p.49-54.24. Torrance, C .Serginson, E. (1999) Surgical Nursing.12th Edition. London Harcourt Brace and Company Limited.25. Townsend, M, D. Beauchamp, D .Evers, M. Mattox, K. (2004) Sabiston standard of surgery.the biological basis of modern surgical practice.17th Edition. Philadelphia Elsevier Saunders 2004.26. Wicker, P. ONeil, J. (2006) Caring for the perioperative patient. Oxford Blackwell Publishing.27. Wilson, I. Walker, I. (2009) The WHO Surgical base hit Checklist the evidence. The Association for Perioperative Practice,19 (10), p.362-364.APPENDIX 1WHATDuring my placement in the orthopaedic theatre, I took the role of the circulating person for the first operation on the list that day. Helen (pseudonym) was 35 years old woman, and was having right shoulder arthroscopic surgery. onward Helen arrived in the theatre, I took great care to ensure the operating room had been cleaned and had all the equipment and instrumentation for the procedure available. I adjusted the temperature in the theatre to 22 c and humidity between 40-50% .Next I helped the scrub nurse with gowning and gloving. I followed aseptic technique and opened relevant sterile packs, pouring lotions and I did the first swab, instrument and needle count with the scrub person so it was recorded on the board.When Helen arrived into the operating room on a trolley, I made sure there were enough members of staff to safely transfer the patient from the trolley onto the operating table using a pat slide ensuring that the patients dig nity was maintained. The anaesthetist took responsibility for the patients head, neck and airway, and co-ordinated the team as the patient was turned. Helen was placed in the left lateral position with her arm placed in traction for better access to the shoulder joint. Before the transfer I ensured that the doors were closed and patient was not exposed unnecessarily and during the positioning of Helen my role included a final check, to make sure that patient was appropriately covered and ensured pressure reliving gels were placed under her left shoulder, buttock and heel.Whilst Helen was being transferred from the trolley onto the operating table capable padding was provided and body alignment was maintained. She was secured with a strap and the lower arm adjacent to the head. I checked the patient consent, patients wrist band and surgical side with the scrub practitioner the surgeon and the rest of the team. The WHO checklist was read out loudly by one of my colleagues to identify any problems and concerns from anaesthetic and surgical side (blood loss, ASA grade).Additionally, a pneumatic compression system (flowtron boots) was employed prophylactically against deep vein thrombosis, the diathermy plate electrode was attached and bear hugger a patient calefacient device was positioned.When draping was completed I adjusted the light and assisted with connecting the supervise equipment, and positioning the diathermy machine and suction tubing around the operating table so that they did not compromise the sterile field .I ensured that electrical cables were secured. I completed the patient care plan, and filled out the pathology form for the prototype ensuring that the form bore the patients label containing details of the patients name, address, date of birth, NHS number and patient number.During the surgery I anticipated the needs of the surgical team, especially carrying out the instructions given by the scrub person. I counted needles, blades, and instru ments and compared the count with the board.One of the theatre practitioners measured and informed the surgeon and anaesthetist about blood and melted loss recording it on the board. Under the direction of the scrub practitioners I collected the patterns into the specimen containers, labelled with the patients label which included the name of the specimen which was confirmed with the surgeon. I did the final count of the swabs, needles and blades and instruments then handed the surgeon the necessary wound dressing.Once the wound was appropriately dressed all team helped to remove the patient drapes and transfer her to the supine (position lying on the back) on the trolley. Using a blanket I covered the patient. I signed the operations register with the scrub practitioner at the end of the operation.When Helen had gone to the recovery, I started to clean and prepare the theatre for the next case.