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Development of Nursing Skills in Oral Care Placement

INTRODUCTION

This essay will concentrate on the nursing skills which i developed during a amount of placement simulations and in the community, placing focus on oral care, communication and bed bath. It will outline the fundamental areas of clinical nursing skills that I have begun to obtain. This will likely also highlight the training processes which took place and how it helped me to enhance my knowledge, and ethical values in order to deliver quality and safety of care. Using other resources of current literature, I will use a reflective model to discuss how I've achieved the required degree of learning outcome. By utilising this model I hope to show my knowledge and understanding with regards to these skills as well as identifying areas with scope for learning.

Reflection is the process of reviewing an event in order to describe, analyse, evaluate therefore inform studying practice (Reid 1993). There are plenty of reflective models that I possibly could have used, including Johns (2004), Driscoll (2000), Atkins and Murphy (1994), Kolb's (1984), and Gibbs (1988).

However, Gibbs (1988) model of reflection was selected, as a framework, since it focuses on different facets of an event and allows the learner to revisit the function fully. By contemplating it thus, I am able to enjoy it and guided to where future development work is required.

Skill 1: Oral Care

Description

I was part of your placement simulation group which visited the multi-skills laboratory to apply delivering and getting oral hygiene. I used to be assigned a colleague to brush his teeth using a toothbrush and paste. I put on gloves to avoid contamination (NICE 2003). Seeking his consent, I undertook a brief visual assessment of his mouth's health. Then i put him in an appropriate position so that he could tolerate the wash. Thereafter, I cleaned all-round the mouth, gums and tongue. I finished off by helping him to rinse his mouth with mouthwash. I treated my partner as if he was physically struggling to contain the brush himself to scrub his own teeth, but he could talk to me and was able to assist me in terms of spitting and gargling with water at the end of the procedure.

Feelings

When first informed that I was expected to undertake this I felt anxious and concerned. I was aware that I had not brushed anyone's teeth beyond my family before and that the mouth is an intimate and personal area of the body which is not usually subjected to anyone apart from me or the dentist. I used to be concerned about how precisely my partner (whom I did so not know well at that stage) would react to me examining his mouth. Writers have described such intimate physical assessments as creating a potentially intrusive situation (Lewis 2006, Sturdy 2007) which can cause the individual to feel uncertain and inadequate. I was also concerned that my very own anxiety was shared by my partner who also appeared embarrassed and awkward at that time.

This anxiety was increased when during the procedure my partner started out to cough as though distressed. This caused me to feel hesitant about continuing- a predicament recognised by Millon (1994) as a typical response for carers to such an experience, although I persevered with his cooperation. When the duty was completed I felt comfortable with my performance overall.

Evaluation

What was good about the knowledge was that, despite paying attention that role is often delegated to healthcare assistants (Kelly et al 2010), I was able to deliver a fundamental element of essential nursing care (Essence of Care 2003) quite effectively. The knowledge helped me to appreciate that oral care provides any nurse with a great opportunity to undertake an intensive physical, emotional and cognitive assessment of a patient (DOH, 2001). I got satisfied delivering this aspect of care without harming the patient as no injuries were sustained (having I checked his mouth prior to and after cleansing). Also, I had been pleased to produce an chance to improve my communication skills through the delivery of this skill and to understand the impact that might have on the introduction of a therapeutic relationship with future patients. From my colleague's reaction and feedback, I understood how feedback can be an important learning tool. Despite my discomfort during the undertaking of this task, the experience highlighted the potentially complex problems I might have to solve in the provision of care needs to patients for whom I may not have had connection with before.

Analysis

Administration of the clinical skill involved undertaking an assessment of my colleague's mouth before delivering any care in order to help determine the most likely method of delivering oral care. Malkin (2009) asserts that this is a critical component of the procedure and was one I had been keen never to overlook. The World Health Organisation (WHO 2010) describes a healthy mouth to be free of chronic mouth and facial pain and in the problem described; this is the condition I found my partner's mouth to maintain. I got therefore pleased to proceed with cleaning his teeth as instructed. I selected to use a soft bristled toothbrush and toothpaste. The usage of these adjuncts are described by many writers as being the most appropriate in terms of removing plaque and protecting against trauma to the gums (Holman et al 2005, McCauliffe 2007). Despite this it's been identified that they are also most often not selected by nurses who appear uncertain about most effective evidence based practice ( McAuliffe 2007).

Conclusion

Clearly, mouth care is important which, nurses have a role in assessing and maintaining it (Malkin, 2009). The task determined the role of the nurse in providing encouragement to the individual whilst delivering oral care. His weakness created a feeling of dependency upon me and necessitated the utilisation of good communications skills on my part to complete the duty properly. It offers raised my awareness the effects of nursing interventions on others within my practice.

Action Plan

At as soon as, I read more books per day than practice. My aim is to be proactive in the future by promptly opening up through total participation and doing more practices by brushing my teeth on regular basis. I would consider brushing 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 up to now with evidence based principles of practice will be maintained through the scrutiny of journals that refer to this aspect of care.

I will need care to remember my feelings when providing and getting oral hygiene before delivering it to patients in the future. Recognising the potential for embarrassment and awkwardness I am going to ensure which i treat the individual with sensitivity and discretion all the time.

Skill 2: Communication Skills

Description

I accompanied my mentor to attend to a consultation with R, in persuading him as a non-compliant patient, in taking his medication. He previously refused to communicate with anyone, and have been violent and incredibly suspicious of nursing interventions before. He would not open his door and started shouting. When he appeared quiet he why don't we in. I thought it would be nice for him to have some interaction after seeking his consent. I pulled up a chair next to my client so that I was closer to him and was at a similar eye level. I engaged him in a conversation about football. ONCE I mentioned Arsenal, he became considering the conversation. I realised he was a fan of the club and told me more about the club. I listened attentively, nodding and contributing. I ceased this as an chance to explain the need for taking medication and side ramifications of non-compliance. He understood and pledged to take his medication daily. He took some to our surprise.

Feelings

Throughout the whole experience I felt terribly nervous as I knew I was being judged how well I possibly could achieve the skill. My initial perception was that R was a hard patient and considered withdrawing but I felt emotionally worried about meeting a professional obligation. I understood that I owed him a duty of care (NMC, 2008) and simply withdrawing was not professional in my own view.

Evaluation

I was pleased to have an opportunity to improve my communication skills by which, I could convince him in taking his medication without confrontation. It was good that we sat in the chair next to him and did not just stand over him showing I valued him and this I was not in a rush. I used good body gestures and facial expressions as stated by Egan (2002). I understood the impact that this skill may have on the development of a therapeutic relationship with future patients. Ironbar et al (2003) stresses that, therapeutic relationships can be stressful. This requires insight, self-awareness and ability to deal effectively with stress. The downside was that the patient initially felt which i had been nasty when i was persistent in having him take the medicine. Also, I found it difficult to talk to the patient primarily because I did not understand his condition. Barker (2003) reports of how recently empathy has been proven to enable nurses to investigate and understand the experience of individuals experiencing a state of chaos because of psychiatric order.

Analysis

There are many reasons why somebody may won't communicate. Wilkinson (1992) cited in (Kluijver et al, 2000) defined communication as an open two-way communication where patients are informed about the nature with their disease and treatment and are encouraged to express their anxieties and emotions. Sheldon, (2009) expands this further by saying in nursing; communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers. The nature of health care demands expertise in interviewing, explaining, giving instructions and advising (Williams, 1997). In this situation, this was precisely what I did. The use of therapeutic communications in nursing, particularly empathy, is exactly what permits therapeutic change and should not be underestimated (Norman and Ryrie, 2004). Egan (2002) argues that empathy is not just the ability to enter into and understand the world of someone else but also be able to communicate this understanding to him. Nurses must be aware that patients, who are paranoid and suspicious of staff interventions as was the case of patient R, may not readily accept support from staff. O'Carroll et al (2007) contended that inside our professional roles, nurses do not have the same option as we do inside our personal life by withdrawing from difficult relationships. I began to feel tearful, but then quickly reminded myself that there should be an acceptable explanation for him refusing to communicate or cooperate with everyone. I felt my client needed an option and giving him a decision will give him back a few of his independence when he could be feeling helpless and vulnerable; and his self-esteem could be decreased (Child & Higham, 2005) as his cooperation could be inhibited.

The need to construct therapeutic relationship with the individual is paramount in gaining trust and respect (Rigby and Alexander, 2008). McCabe (2004) argues that the utilization of effective interpersonal skills, a basic component of nursing, must be patient centred. EASILY have been tense and negative, my client would not have enjoyed the conversation and would have felt uncomfortable and rushed (Kozier, et al 2008).

Conclusion

Communication is without doubt the medium through which the nurse-patient relationship occurs. The skills of active listening and reflection promote better communication and encourage empathy building. Caring for acutely mentally unwell patients requires of the nurse sensitivity, conveying warmth and empathy. Engaging meaningfully and actively hearing patients makes them perceive the practice as valuing rather than punishing, therapeutic rather than custodial. Communicating with patients is in itself nursing and for that reason should be encouraged in any way degrees of nursing care. I feel my caring skill went well, because we were both relaxed and comfortable. As no problems occurred, I would do most things the same again.

Action plan

My goal for future years is to build up my knowledge by reading about long-term conditions like schizophrenia to be able to give me insight into those conditions before administering care. If patients appear distressed, I'd get other members of staff to help give reassurance to them. I will also use reflective discussions with mentors and peer groups about managing similar situations. Finally, I am taking the initiative and not being timid about challenging situations- a lot more times I meet up with the challenge, the better equipped I become at learning to manage them.

Skill 3: Bed Bath

Description

I was asked with a colleague to bath a dummy patient throughout a placement simulation.

The procedure was outlined by the lecturer present. I prepared the trolley with soap, bowl of warm water, soap and towel. I explained why I would give him a bath and gained consent. I drew the curtains to keep up patient's privacy and dignity at all times. I washed my hands, put on apron and gloves to prevent infection and contamination and bathed him all round (front, back and sides including crevasses and folds) using separate towel for the private area. I covered the patient with the bath blanket to avoid chilling for his comfort. Whilst carrying out the bed bath I assessed his skin condition for just about any sores or broken skin. I treated the individual as if confined to bed or he's too unwell to wait to his own hygiene needs but in a position to communicate with me and reassured him everything was alright.

Feelings

Before starting, I had many emotions running right through me. I expressed that I did not need much confidence in performing the duty. This is because I: (1) lacked experience, (2) was concerned that I would not perform to the patients' expectations and (3) was still endeavoring to change to the laboratory environment. I therefore felt embarrassed that my insufficient confidence was so obvious to provide lecturer and colleagues. I later felt calm but just a little apprehensive for this reason. Despite each one of these, I persevered and finished the duty successfully.

Evaluation

What was good of the experience was that, I upheld the trustworthiness of the profession by maintaining it (NMC, 2008) as I did so not speak over the client nor did I ignore him at any point through the procedure The instructions about what I had a need to do was clear and I understood it and this give him the utmost respect, comfort and safety. By washing my hands thoroughly before coming into contact with the individual, Pirie (2010) explains that micro-organisms are easily removed through the procedure of hand washing. With supervision and comments from the lecturer present, I completed the task without harming the individual. Thomas et al, (1997), explains that, supervision can be an important development tool for those learners.

What was not good about this experience was after i redressed your client without allowing the client to choose the dress which I will prevent happening again. Nurses are taught to include family members where possible, keeping them up to date constantly about the condition and health care which is taking place. This can help make families feel convenient and also enables them to get a clear picture of what is going on.

Again, the lecturer was concerned i seemed to lack confidence, and explained that, having the ability to express opinions clearly and confidently was essential in my own future career as a nurse. In the lecturer's view, the only path to build up confidence was to participate regularly which Bulman & Schutz (2008) confirms.

Analysis

Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided (Voegelli, 2010). . Bathing involves actions to keep carefully the skin clean and is essential for healthy skin (Dougherty & Lister 2008). There are essentially two bed bath possibilities for today's doctor. Option is the traditional soap and water bed bath which is labour intensive. Option two is the utilization of pre-packaged specialist bed bath wipes that come already impregnated with skin-friendly cleansers and moisturizers (Massa, 2010). Bathing is an intimate activity which requires physical assessment. Writers have described such intimate physical assessments as developing a potentially intrusive situation (Lewis 2006, Sturdy 2007) which can cause the individual to feel uncertain and inadequate. I had been prepared never to overlook this area.

The use of curtains and screens helped keep up with the person's dignity and self-esteem (Child & Higham, 2005). Not surprisingly, dignity is seldom defined and there are few guidelines that nurses could use in their practice to safeguard individual patients' dignity (Dignity in care (DOH 2006). It really is true that healthcare assistants and auxiliaries can perform bed bathing and attend to patients' hygiene needs; there are also important roles for the rn, as it is often during the bathing of a patient that the nurse/patient relationship develops (Downey et al, 2008). Furthermore, the observation of a patient during the process of bathing provides excellent opportunities to make more detailed assessment and observation of the patient's condition and progress (Pegram et al 2007).

Conclusion

Without doubt, provision of bed bath clients is to market personal hygiene also to give them a sense of well-being and allows the caregivers to monitor changes in the client's skin condition (Evans, 2001). My reflective experience was very basic although a lot of the experience was preparation, planning and assessing which prevented the experience from going badly in anyway. I'll also ask if they want to brush their teeth so that they feel more comfortable and also assist in preventing dental decay or any sores from developing surrounding the gums. I now feel confident and comfortable enough to aid bathing people.

Action plan

If a predicament such as this was to arise again I believe I would like to try to take out more time to speak to the client about how these are feeling and involve him at every stage of the activity. I also believe that it's important for me to work alongside more capable members of staff to be able to learn more whilst on my placements. I think it will probably be worth highlighting that as this process was completed on a manikin, it did not reflect proper nurse / patient interaction and that I am going to now need to try and develop this skill and what I have learned from it to the wider clinical context when assisting patients who really do need help meeting their hygiene needs. I've learned something about giving the patient's choice but it really will not be until I apply this skill into practice that I am going to receive feedback about how effective I've undertaken the duty, from the person that really matters or is in the best place to help me evaluate my actions, see your face being the individual.

CONCLUSION

Administering oral hygiene, bed bathing and exactly how these are coupled with care, compassion and communication forms the foundation of your holistic method of care, and with the data I acquired from supporting literature formed the building blocks of my learning and practice. This experience has undoubtedly improved my critical thinking as a nurse and prepared me to go forward in my own development and practice as a caring and competent nurse. I see myself to be in the right job which offers many opportunities for development and to improve after my knowledge and skills. I've plainly demonstrated that by utilizing a reflective model as helpful information I have been able to breakdown, make sense of, and learnt from my experience within my placements

In spite of above, the processes of learning I went through are more complex than Gibbs suggests. It is not as cyclical as this model implies and I came across myself jumping or combining some stages, before coming back. However, they have taken me out of my safe place, challenging my thinking.

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