This submission will focus on the nursing health care that I gave in one placement simulation and two consecutive shifts on location, placing emphasis on oral good care, medication management and communication. It'll outline the essential aspects of clinical nursing skills that have taken place in my own setting. This can also highlight the training process occurred and exactly how it helped me to enhance my knowledge, and moral values in order to provide quality and basic safety of health care. Using other resources of current literature, I will use a reflective model to go over how I've achieved the required degree of learning result. By utilising this model I hope to show my knowledge and understanding in relation to these skills as well as figuring out areas with opportunity for learning. Representation is the process of reviewing an experience in order to spell it out analyse, evaluate and so inform studying practice (Reid 1993). Gibbs (1988) style of reflection will be utilized as a framework, because it is targeted on different aspects of an event and allows revisiting the event totally. By contemplating it thus, I am in a position to enjoy it and led to where future development work is necessary. For confidentiality purposes the patient's real titles will not be used and you will be described patients as B and R. This is based on the (NMC, 2008) requirements to keep confidentiality at all times. A diary is supported in this assignment as an appendix within the time of the procedure. The reflective model I've chosen to use as advice is Gibbs (1988). The care and attention of a patient's oral cavity sorts an important component of assisting hygiene needs yet is a nursing skill which is not necessarily afforded the interest it completely deserves (Evans, 2001) Information I was part of an location simulation group which visited the multi-skills laboratory to practice delivering and receiving oral hygiene. I was assigned a colleague to brush his teeth by using a toothbrush and paste. I put on gloves to prevent contamination (NICE 2003). Seeking his consent, I undertook a short visual evaluation of his mouth's health. Then i put him in a comfortable position so that he could tolerate the wash. Thereafter, I cleansed all-round the mouth, gums and tongue. I completed off by aiding him to rinse his oral cavity with mouthwash. I cured my partner as though he was physically unable to contain the clean himself to scrub his own tooth, but he could talk to me and was able to assist me in conditions of spitting and gargling with water by the end of the task. Feelings When first prepared i was expected to undertake this task I felt stressed and concerned. I used to be aware that I hadn't brushed anyone's tooth outside of my children before and that the mouth is an seductive and personal area of the body which is not usually exposed to anyone other than myself or the dental office. I was worried about how my partner (whom I did not know well at that stage) would respond to me evaluating his mouth. Writers have described such romantic physical assessments as developing a possibly intrusive situation (Lewis 2006, Sturdy 2007) which might cause the patient to feel uncertain and limited. I used to be also worried that my own anxiety was distributed by my partner who also made an appearance embarrassed and uncomfortable at the time. This panic was increased when through the procedure my spouse began to cough as if distressed. This triggered me to feel hesitant about carrying on- a situation recognized by Millon (1994) as a response for carers to this experience, although I persevered along with his cooperation. When the duty was completed I sensed more comfortable with my performance overall. Evaluation What was good about the experience was that, despite being aware that this role is often delegated to healthcare assistants (Kelly et al 2010), I was able to deliver a simple element of essential nursing care and attention (Essence of Care 2003) quite effectively. The experience helped me to appreciate that oral care provides any nurse with an ideal opportunity to undertake a thorough physical, psychological and cognitive assessment of a patient (DOH, 2001). I got satisfied delivering this facet of good care without harming the individual as no injury were sustained (having I examined his mouth area prior to and after cleaning). Also, I used to be pleased to come with an chance to improve my communication skills through the delivery of this skill and also to understand the impact that this might have on the introduction of a therapeutic relationship with future patients. From my colleague's response and responses, I comprehended how feedback can be an important learning tool. Despite my soreness during the starting of this job, the experience outlined the potentially complex problems I might have to solve in the provision of care and attention needs to patients for whom I might not have had contact with before. Analysis Supervision of this medical skill involved executing an diagnosis of my colleague's mouth before delivering any care to be able to help determine the most likely means of delivering oral care. Malkin (2009) asserts that is a crucial component of the task and was one I had been keen not to overlook. THE EARTH Health Company (WHO 2010) identifies a healthy mouth area as being free from chronic oral cavity and cosmetic pain and in the situation described; this is actually the condition I came across my partners mouth area to maintain. I had been therefore happy to continue with cleaning his teeth as instructed. I picked to employ a soft bristled toothbrush and toothpaste. The usage of these adjuncts are explained by many authors as being the most appropriate in conditions of removing plaque and protecting against trauma to the gums (Holman et al 2005, McCauliffe 2007). Not surprisingly it's been identified they are also most often not chosen by nurses who look uncertain about most reliable evidence based practice ( McAuliffe 2007). Realization Clearly, mouth care and attention is important and that, nurses have a role in examining and maintaining it (Malkin, 2009). The duty recognized the role of the nurse in providing encouragement to the patient whilst delivering oral care and attention. His weakness created a feeling of dependency after me and necessitated the utilisation of good communications skills on my part to complete the task properly. It has raised my awareness the consequences of nursing interventions on others within my practice. Action Plan At this time, I read more books per day than practice. My goal is to be proactive in the foreseeable future by promptly opening up through total involvement and doing more routines by brushing my tooth on regular basis. I would consider cleaning others also and allowing them to brush mine in order to become familiar with areas that tend to be not well taken care of. Keeping up as of yet with evidence established concepts of practice will be managed through the scrutiny of publications that make reference to this aspect of care. I am going to take care to remember my emotions when providing and obtaining oral health before delivering it to patients in the foreseeable future. Recognising the potential for humiliation and awkwardness I'll ensure that I treat the individual with awareness and discretion all the time. Administration of medicines is an integral element of nursing care (Audit payment, 2002, ). Therefore, you are accountable for the supervision of medicines. Description I shadowed my coach during the process of dispensing medication and knew that my role as students nurse, each registered nurse is accountable for his/her practice. As students it is important to get consent from the patient before any care is given that i did. I visited the treatment room with my coach and ready for medication for morning. During the process of medication there are important nursing process steps to check out. Firstly, I checked order, assessing client, label medication, provide information to your client, check the medication when dispensing and record in the patients prescription chart. Patient R was present and I offered him a glass of water combined with the Clozapine 300mg in another cup. Before I came up in contact with the individual, I read their records and the medication they are simply on. This provided me the baseline if the patients adhere to medication and the reason why they do not comply. Emotions The schedule for prescribing medication may vary in various specialized medical settings. Although I've participated dispensing medication, I sensed nervous and didn't want my patient to see this as a weakness. (Butler, 1991, ) warns us that when our self-talk is negative, we are carrying around toxic environment for ourselves everywhere you go we go. My coach needed the role to encourage me by ensuring that I was doing fine, discussing me throughout the types of procedures of medication management. I had brief knowledge about medication and this gave the opportunity for my coach to question my understanding of the right medication dosage, time, way, right patient and right medicine. My role as a Nurse is to record and survey deterioration improvement and takes appropriate action for his treatment to service. Patient R sensed that he did not need medication because he's not mentally unwell. This was a hurdle because he had no insight and it leads him to deteriorate with compliance. Analysis This practice includes organizing, checking and administering medications, updating understanding of medications, monitoring the effectiveness of treatment, reporting unfavorable medicine reactions and coaching patients about the drugs that they acquire (NMC, 2008). The (NICE, 2008, ) recommendations state concepts for the administration of medicines that treatment and care and attention should consider patients' needs and tastes and patients should have the opportunity to make enlightened decisions about their treatment and treatment, together with their healthcare specialists. The staff reviewed his display to healthcare pros in the Muti-disciplinary team (MTD) if they could change his medication time and dosage as he presents lack of desire and sedation. People who have schizophrenia must have the possibility to make informed decisions, including move forward decisions and progress assertions, about their treatment and treatment, in partnership with their healthcare pros. (NICE, 2008, ) That is the value of communication working as a team within the MDT. Analysis Administrating medication medication is one of the very most critical nursing obligations for both legal reason and basic safety patients. Hand cleaning was important standard protocol the infection control coverage as hands are way to obtain infection and hand cleansing would break the string of an infection. Patient R is on Clozapine. The usage of this atypical antipsychotic licensed to individuals who are immune to or intolerant of other antipsychotic drugs due to the potentially the utilization of adequate dosage of two different antipsychotic agent. Clozapine can lower the number of white blood skin cells that help fight illness (BNF, 2008, ). Before initiating Clozapine, patients must have a history and physical exam. For instance, if the individual has a history of cardiac disorder, it's important that you have regular blood exams. The real reason for it is because, if white bloodstream cells count comes below accepted lower limit are categorized as "Red alerts" medication must be withdrawn, and other prescriber in the foreseeable future wishing to restart medication are aware of the patient's haematological record. Once weekly I would opt for the individual to the Clozapine center to have blood test done and to screen his potential area effects of psychiatric drug treatment. Patient R was delivering various side results sedation, drowsiness making him less encouraged to escape foundation for his medication departing him to forgetting the mornings. Summary. . . Not absolutely all non-compliant choose to reject medication; it might be because they forget to take them and this may be cognitive bafflement. Intolerance of varied side results is the most common cause of clients discontinuing medication use (Taylor et al 1997). It is important to remember that the symptoms can fall into a variety of categories, so patient prefer to be told their identification and what's incorrect with them (Blenkiron, 1998, ). This area was one of my weaknesses, and I asked my mentor the importance of the Clozapine center and how it is associated with regular bloodstream monitoring. I learned that to be able to wait regular visits, all patients must have normal leucocytes and different counts. Action Plan Communication Information At this juncture I was being detected and supervised by my coach to work with a 45year old Caucasian man, with a examination of paranoid schizophrenia and on section 37/41 of the Mental Health Work 1983. He has recently offered chaotic behaviour, auditory hallucinations, delusions as well as violent and threatening behaviour. Each day I would do my observation of the patient and make an examination of how he shown himself to see if he previously taken care of his personal hygiene and activities of daily living. Regarding to (Greenwood, et al 1999), patients who are in medical center satisfaction with information are found to be missing. Feelings As a student nurse my role and responsibility by the (NMC, 2008, ) is that you need to respect and support people's privileges to accept or drop treatment and health care. I noticed that Patent R found it difficult to awaken and take his medication, which was problems that personnel nurses struggled with time to time. (Watson, 1995, ) emphasise that caring communication is holistic, considering the whole person and demonstrating value for the client's advertisement people. Evaluation Listening is the main communication skill in medical. (NICE, 2004), emphasis that communication between professional medical specialists and patients is vital. I learned that if patients are encouraged to have treatment choice, they have to have information about the recommendation given before committing themselves. That is why it's important that patients must be central to and include in their good care. For the patients to have the ability to do this, it needs the nurse to make use of communication skills effectively, to develop therapeutic nurse-patient romantic relationship in which the patient feels secure enough to reveal and discuss issues they find central to them and from jargon. Examination During the switch I communicated with other associates of the team on any significant occurrences or any concerns with the patient. By the end of the shift I saved what the individual had done with the day and I provided handover to the personnel who were overtaking the next transfer. This was very important because it would ensure continuity of good care and reduces any problems or omissions. A good example of effective communication links to medication is to provide instructions and offer training involving evaluation and synthesis of the learner's experience. In mention of my patient (Gamble, 2004), illustrates when a person has mental health problem it make a difference the individual cognitive process, their beliefs, notion and outward habit. If Patient R discontinues Clozapine he'll become psychotic again and generate a turmoil leaving the community and his family in distress. Conclusion. I developed my knowledge by providing leaflets about Clozapine, encourage to wait to the medical clinic centre that they will explain the professionals and negative aspects of Clozapine. Action Plan. . Basic Conclusion I determined that some patients felt uncomfortable with immediate question so it was important to use (Bein and Miller 1992), Start ended question. The outcome if the client-nurse relationship is determined by the nurses capacity to engage the client in decision making and share the control and power in the relationship (Roberts, et al 1995, ). I sensed that their were barrier to communication as I felt that some of the staff's attitudes made me feel like I was not part of the team and sometimes lead if you ask me no having the ability to give my views on problems with respect to patients. Although I am aware that nurses do not use information just as and may use different methods in specialized medical settings. I sensed that employed in partnership with the patient and other health professionals can enable time to build supportive and empathetic romance as an important part of care and attention. (NICE, 2008, ). The procedure of learning I went through is more complex than Gibbs advises. It isn't as cyclical as this model suggests and I found myself jumping or incorporating some stages, before coming back. However, they have considered me out of my safe place, challenging my pondering.