Building The Skill To Administer Intramuscular Injections

Building The Skill To Administer intramuscular InjectionsThe aim of this essay is to reflect on how I take up beget competent in a revealicular clinical acquirement. The clinical skill I bewilder selected is administering intramuscular (IM) barbs. I will provide a rationale for choosing this skill and work appropriate literary productions to demonstrate my noesis underpinning this skill. Although there ar five berths for cheek of IM guessworks, for the purpose of this essay I will debate only two of the come ins. Firstly, the dorsogluteal (DG) put as this is the put I mathematical functiond when giving IM injections in line with the local go for policies and procedures. Secondly I will discuss the ventrogluteal (VG) site, as recent literature has shown this site to be the beneficialst to use when administering IM injections. I will then reflect on my culture and how I obligate beseem competent in this area.There is a need for concords to be skilled in the administration of intramuscular injections in the learning deterrent field. The National Institute for health and Clinical Excellence (NICE) (2006) suggests that when de-escalation and intensive nursing techniques have failed to calm the tolerant and they are at lay on the line of harming themselves or otherwises, then quick tranquillisation should be used as a last resort. Although oral tranquilisation will be offered first, due to the high state of aggression, agitation or excitement the long-suffering may be un fit-bodied to give their consent. Therefore the 1983 Mental health Act and the guidance on Consent to Treatment (DH 2002) must be followed. Consequently, rapid tranquilisation will be achieved by the administration of medication through with(predicate) with(predicate) IM injection to control severe mental and behavioural episodes and to calm the unhurried quickly.Greenway (2006) suggests that IM injections are generally likely to happen in crosstie with the a dministering of antipsychotic medication in the form of depot injections and/or rapid tranquilisation, for managing mental illness and/or challenging behaviour for throng with a learning disability. Greenway also implies that there will only be a small number of learning disability encourages that will in reality use the skill of administering IM injections after they have qualified, due to a deny in depot administration. However, the Nursing and Midwifery Council (NMC) (2004) identifies that the role of the learning disability nurse is forever changing and the administration of injections will depend on the lymph node group and the coif areas in which they work. They recognise that it is a discern challenge for learning disability nurses to update their knowledge and maintain competence in a skill that they may use infrequently. Irrespective of this, the clinical procedure should be developed and maintained in line with order based practice, regardless of how often it is u sed.The administration of IM injections is a vital share of medication man whilement and is a common nursing intervention in clinical areas. Less pain to the persevering and unnecessary complications after contribution be avoided by the nurse being skilled in the injection technique used (Hunter 2008). The National Patient Safety Agency (NPSA) (2007) nones that the injecting of medication is multiform and patients can be put at risk. Incompetency, lack of training and variable knowledge levels of nurses were factors highlighted in errors made around injecting medicines.Adhering to the aseptic technique during conceptualization and administration of the injection, and inspecting the injection site for any signs of skin deterioration are vitally important to prevent infection and complications (Dougherty 2008).Alexander et al (2009) pass the correct way to give an intramuscular injection in the DG site using the Z tracking technique.Using the thumb or the side of the non-domi nant pass along stretch the skin taught over the site of injection maintaining the tautness during the procedure.With a darting motion, insert the acerate leaf at 90 degrees to the skin, 2-3mm of the needle should be exposed at the surface and the graduation marks on the syringe barrel must be visible through come out.Use the stay fingers of the non-dominant hand to steady the syringe barrel, whilst using the dominant hand to crook back on the plunger to aspirate. If affinity appears all equipment should be discard and the procedure should be started again. It is safe to carry on if no blood appears.The plunger should be depressed at a rate of 1ml per 10 seconds to give the muscle fibres time to expand and accommodate the drug.After a further 10 seconds remove the needle and then release the handle on the skin.The injection site may be wiped with dry veiling if need be.A plaster can be applied if the patient requires and if they have no known allergy to latex, iodine or elasto plasts. dissension lies around the site area chosen for administering the IM injection. Although the DG site is the handed-down choice by nurses for the administration of IM injection there are risks associated with this site of injection. The DG site is situated in the upper outer quarter-circle of the stilltock and is often landmarked by visually quartering the buttock horizontally and vertically, then repeating this action in the top right hand square. Evidence shows that the use of this site for IM injection can run the risk of injury to the sciatic brass section and the superior gluteal artery (Small 2004). to boot it can cause skin and tissue trauma, muscle fibrosis and contracture, nerve paralyze and paralysis as well as infection (Zimmerman 2010).The belief by nurses that the VG site is hard to landmark suggests reluctance on their part to falsify a practice they are competent in. Although once nurses have become familiar with location of the VG site and the surrounding anatomy, they will become reassured in using this site (Greenway 2006). Hunter (2008) suggests to locate the VG site the nurse should place the palm of her right hand on the patients left pelvic arch (the greater trochanter), then make a v by extending the index number finger to the anterior iliac spine. The injection is given in the ticker of the v in the gluteus medius muscle. Administering IM injections using anatomical features leads to a much specific and correct way of carrying out the procedure.In contrast to the DG site, the VG site has no major complications associated with the administration of IM injections. Zimmerman (2010) also strongly advocates the use of the VG site. Although there appears to be a lack of current evidence for choosing the VG site rather than the DG site for rapid tranquilisation during restraint of a patient. Because of the genius of the situation during this procedure, safety for all involved has to be considered. Local policies should be ut ilised for specific guidance on positioning the patient safely and for use of specific holds required to allow the VG site to be landmarked and the injection administered. The VG site can be used if the patient is prone, semi-prone or irresistible (Greenway 2006).However, following a literature review of damage to the sciatic nerve from IM injections, Small (2004) recommends that the VG site should be chosen over the DG site for IM injection. Zimmerman (2010) concurs with this, strongly advocating the use of the VG site for IM injections of to a greater extent than 1ml in patients over the age of seven months.More evidence for choosing the VG site is a study carried out by Nisbet (2006) showing that the subcutaneous fat level of the DG site is significantly higher than that of the VG site. It also showed that penetration of the target muscle at the DG site was only 57 per centum meaning the final stage of the injection would deposit into the subcutaneous fat leading to a shortfa ll in the uptake of the drug. Emerson (2005) reports an increased risk of obesity in people with a learning disability. In one study 90 percent of adult females and 44 percent of adult males had fat deposits in the DG site area that were one inch deeper than the shorter IM needles would reach (Zaybak et al, 2007). The VG site has a shorter distance to the targeted muscle and is a safe alternative choice for the administration of an IM injection, Greenway (2006), Small (2004) and Zimmerman (2010) suggest it is time for professionals to rethink the site of IM injections in people with a learning disability.I will now discuss how I have become competent in carrying out this clinical skill and to do this I will use a pondering ideal. Reflection is a way in which nurses can bridge the theory-practice gap. The extremity of reflective practice allows the nurse to explore, through experience, mirror image and action, areas for developing their practice and skills. It is an important part of gaining knowledge and concord. The use of a recognised mannequin allows for a more structured approach when reflecting upon practice (Johns, 1995).I have decided to use Gibbs (1998) Reflective Cycle, as it provides a straight previous and structural framework and encourages a clear description of the situation, analysis of feelings, rating of the experience, analysis to make sense of the experience, conclusion where other options are considered and reflection upon experience to examine what the nurse would do should the situation arise again.In describing what happened in learning this skill the theory of existential learning can also be used as a framework. The theory of experiential learning was developed by Steinaker and Bell (1979). The Experiential Taxonomy highlights 4 levels of learning that the nurse will go through in learning a new skill i.e. exposure and participation, identification, internalisation and dissemination.During exposure there is a consciousness of th e event and the nurse will have notice a competent practitioner carry out the task. In this case I had an awareness of needing to be able to administer IM injections competently due to the client group involved. In my first week of organization I observed a qualified nurse administering PRN and depot IM injections several time while the nurse talked me through the procedure step by step. As she was demonstrating the procedure and talking me through it my thoughts and feeling at the time were that I would not be able to remember all the steps needed to administer the IM injection safely and I was also feeling anxious(predicate) about potentially causing pain and/or injury to the patient. betrothal involves the nurse becoming part of the experience. After observing the practice I participated in the drawing up of the injection and then administering it.Identification involves the nurse becoming competent in the skill. On reflection as in brief as I started on placement I realise d that I would have to gain as much experience as I could administering IM injections, not just the actual procedure of giving the injection but also the knowledge to underpin this skill.Internalisation occurs when the new skill becomes part of everyday routine. Several weeks into my placement I felt that I had in conclusion become competent in administering IM injections, my anxieties began to lessen and I started to feel more confident that I was becoming proficient in carrying out the procedure. I found that the more times I carried out the procedure the part I felt about it.Dissemination involves the nurse being able to influence others and showing others how to carry out the skill. Although this was only my second placement I feel totally competent in carrying out the task. I also feel that I have a good cause of the underpinning knowledge involved. Therefore I feel I would be able to teach others how to do this.On reflection I do not think I would have learned this skill an y other way, I have realised that initial anxieties about carrying out a new task are usual. But I will have to remember this will pass as I practice more and become more experienced.I have also realised through reflection the importance of having underpinning knowledge in relation to clinical skills and understanding why we do things rather than just simply learning how to do them.In conclusion, this assignment has explored one clinical skill in which I have gained competence. A rationale was provided in that IM injections are an important part of everyday life for the client group involved. IM injections are considered to be a routine procedure, it is a valuable and necessary skill for nurses. To provide safe practice and ensure accurate and therapeutic drug administration, the nurse should use clinical judgement when choosing the injection site, understand the relevant anatomy and physiology, as well as the principles for administering an IM injection. By using a reflective model and theory in relation to experiential learning I have discussed my own personal and professional development in terms of my knowledge and skill acquisition in this area of clinical practice.