Saturday, January 25, 2020

The Objective Structured Clinical Examination

The Objective Structured Clinical Examination This essay will discuss my experience of having undertaken the Objective Structured Clinical Examination (OSCE) where I was asked to write and carry out particular clinical skills testing my competence and knowledge. I will use a reflective model to discuss my experience of having undertaken the OSCE and my thoughts about the feedback I received. The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection includes: description, feelings, evaluation, analysis, conclusion and an action plan (Gibbs 1988). The model will be applied to the essay to help me access what happened, make sense of it, and learn through my own experience by relating theory to practice and backing it up with evidence. The clinical skill of which I was tested on within the OSCE I have chosen to reflect on within this essay is the mechanism of labour. I have chosen this because midwives use the theory of the mechanism of labour to assess progress during labour, and to explain events during labour. Understanding the mechanism of labour has direct implications for midwifery practice (midwifery.org, 2001), so therefore is very important for me to understand and implement in my own practice. The first stage of Gibbs (1988) model of reflection requires a description of events. I was given a scenario which stated that I was looking after a patient called Jane who had been admitted to labour ward in labour. I was asked to demonstrate the mechanism of labour with the doll and pelvis provided and asked to describe my actions and speak clearly while carrying out the process. Once I had read the scenario I grabbed the doll and pelvis and sat down on the chair provided and placed the dolls head in the pelvis in the transverse position. Then stated that fetal axis pressure and cervical dilatation increases causing the fetus to enter the pelvic cavity and head rotates 1/8 of a circle to lie in the oblique of the pelvis putting the doll in a right occipitoposterior position. With maternal effort in the second stage the baby descends along the curve of carus and is born by extension. When the head is born it restitutes to be in line with the shoulders. The dolls head was born face t o symphisis pubis. Then the shoulders descend and turn with the next contraction to lie in the anterior posterior diameter of the outlet. The head rotates externally and with this there is internal rotation of the shoulders. The baby is then delivered by lateral flexion with the next contraction. Once I had completed my explanation, I was given a second attempt to go through it again. So I did and unknowingly corrected a few mistakes I had made. I am now going to enter into the second stage of Gibbs (1988) model of reflection, which is a discussion about my thoughts and feelings. Even though this assessment was formative, I was aware that it would show my lecturers as well as myself the level of my competence I had in understanding the mechanism of labour. I knew I would find explaining the mechanism of labour difficult as it contains a lot of information which needs to be explained in an orderly way. I was being examined by Swi Ong a senior lecturer at Middlesex University who is also my link lecturer at chase farm hospital. Being watched made me feel very nervous and under pressure to get it correct. Once I finished my explanation, I was asked to have a second attempt, my first thought was to focus my thoughts as I could hear myself muddle my explanations of events on my first run. After my second attempt I was pleased with myself as I focussed more and corrected some mistakes I had made in my initial attempt. Once I had c ompleted this section of the OSCE, I was not down hearted about my performance but took it as a learning experience which would help me access my own ability and help show areas which I need to improve on. Evaluation is the third stage of Gibbs (1988) model of reflection and requires the reflector to state what was good and bad about the event. Once I had received my feedback from I was aware that research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean and an aseptic technique is adopted, along with stringent hand washing by the nurse. It has also been noted that the use of cleansing with an alcohol wipe can cause skin hardening (Mallet Dougherty 2000). The trust policy was to follow guidelines published by the Royal Marsden Hospital (Mallet Dougherty 2000). The Royal Marsden (Mallet Dougherty 2000) advocate the use of skin cleansing wipes, however it is stated within their guidelines that they adopt this because their patients are often immunocompromised, and give evidence of previous studies which indicate that skin cleansing is not normally necessary. Therefore my practice was within the trust protocol. This experience made me think about my attitude towards literature and how it is applied in practice. Burnard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses. The site used in the IM injection was the gluteus maximus, this the most commonly used site for the administration of IM injections (Greenway 2004, Workman 1999). The gluteus maximus area is both thick and fleshy with a good blood supply (Watson 2000). It is located in the hip area and forms the buttock (Watson 2000). It has been noted by Watson (2000) that the gluteus maximus is near the sciatic nerve and Greenway (2004) suggests that this presents a risk of threat of injury in the administration of IM injections. When I administered the IM injection to the patient, I injected into the gluteus maximus muscle, as the evidence stipulates this is best practice. Stage four of Gibbs (1988) is an analysis of the event, where Gibbs encourages the reflector to make sense of the situation. I will do this by exploring the skill and looking at the evidence underpinning it. An IM injection is the administration of medication into the muscle; there are many reasons why drugs are given via the IM route (Workman 1999). These include a rapid absorption rate, the conscious state of the patient, and the drug effect being altered by ingestion (Mallet Dougherty 2000, Workman 1999). Workman (1999) suggests there are four considerations in giving an injection, the site of injection, the technique, the equipment and the route. On my clinical placement, an orthopaedic outpatient centre, IM injections were administered on an almost daily basis. However Hemsworth (2000) comments that IM injections are rarely used in certain specialities and suggests that, in this case, nurses current practice in IM injections may not be up to date with recent research findings. Through evaluation of the event in question I have become more aware of different practices concerning the use of alcohol wipes in skin cleansing. I am aware that both practices have been researched, but as I develop professionally I am developing my own skills and will not cleanse the skin in future unless the trust policy dictates so or the patient requests me to do so. There is no clear evidence in this area but I will use the literature which is available to justify my actions, and therefore give evidence based care. The reason my mentor suggested using the alcohol wipe could be that she has been qualified for a long time, and practices have changed. In this scenario I have learnt from experience and through experience (Burnard 2002). Following this incident in practice I will now be more prepared to challenge the views of others in relation to my clinical practice. In conclusion, stage five of the Gibbs (1988) model, I am aware that all nurses do not use evidence in the same way and may use different methods but as long as my practice is safe and evidence based then I can practice safely. My future practice will depend on the area in which I am working and I aim to find out the trust protocol concerning clinical procedures before I commence any procedure Within my action plan my aim is to research further into the theory of using alcohol wipes in the administration of IM injections. I am also planning to have a discussion with the qualified nurses on the subject of skin cleansing. In conclusion my reflection skills have developed through the production of this essay. Using a model of reflection has helped me to structure my thoughts and feelings appropriately. My level of awareness concerning evidence based practice, and its importance, has been enhanced with the use of critical reflection. My competence, within this clinical skill, has been further developed and I now feel that my personal and professional development is progressing. Using this reflective model has helped me to realise that my learning is something which I must be proactive in. Furthermore as a student nurse I have recognised that reflection is an important learning tool in practice. Description; Feelings; Evaluation; Analysis; Conclusion; Action Plan

Friday, January 17, 2020

Corrections Accreditation and Privatization Essay

Accreditation means to meet requirements. Corrections are a system of agencies likes jails and prisons. So corrections accreditation is just that. Correction systems need to meet requirements all the time to maintain accreditation to hold a higher standard. Corrections accreditation has a positive effect on the professional develop of corrections officers. Because the standards for accreditation change every year, this means that the officers have to go through more things to become credible. By learning new things they set higher standards. Accreditation improves the management of the facility, raises accountability and credibility for the staff and administration, and makes for a safer environment for everyone. To plan for better correctional officer professionalization and accreditation the industry leaders can make it harder to get that position. They can make the training harder and make them go through new training or refresher courses every so often. Most times these officers let things slide they should not, which leads to lower credibility for the institute if they are caught because such things need to be reported. A correctional officer job is not one to take lightly because they are not glorified babysitters. They need the extra training and they should have to meet certain physical criteria so if in a position they need to get out of they have the smarts and ability to do so. Privatization is basically the private operations of prisons and jails. This affects state and federal because privatized systems do not have to follow the same guidelines as the others. The privatized systems can also go for profit, non-profit or charitable organizations whereas state and federal prisons depend on tax money to operate. Privatized prisons are held accountable and this is measured and monitored just as in state and federal prisons. They do not cut corners so in many ways they are more secure and safe compared to state and federal prisons. The privatized prisons offer effective inmate programs just as do the state and federal prisons. They also hold to the safety standards that state and federal prisons do.

Thursday, January 9, 2020

Why Compare Kincaids Girl and Olsens I Stand Here...

Why compare Tillie Olsen’s â€Å"I Stand Here Ironing† and Jamaica Kincaid’s â€Å"Girl† Daughter and mother relationship is an endless topic for many writers. They meant to share the bond of love and care for each other. Nevertheless, in the real world their relationship is not as successful as it ought to be. The stories â€Å"Girl† and â€Å"I Stand Here Ironing† are examples of this conflict. The author of the short story â€Å"Girl† Jamaica Kincaid was born and raised up to the age of seventeen in Antigua, a former colony of Great Britain. In her short story â€Å"Girl†, Kincaid presents the experience of being young and female in a poor country. The story is structured as a single sentence of advice that a mother gives to her daughter. The mother expresses her†¦show more content†¦According to Davis-Yuval â€Å"intersectionality† refers to the interaction between gender, race, and other categories of differ ence in individual lives, social practices, institutional arrangements, and cultural ideologies and the outcomes of these interactions in terms of power. My aim is to analyse where gender, race, class and ethnicity are interconnected in both â€Å"Girl† and â€Å"I Stand Here Ironing† and what are the â€Å"outcomes† of these intersections. To do that I will have to analyse the question: how people experience subjectively their daily lives in terms of inclusion and exclusion; discrimination and disadvantage; specific aspirations and specific identities. Furthermore, I will have to pay attention to people’s â€Å"attitudes and prejudices towards others† as well as to the way they see themselves and their communities. I will present the images, symbols, texts and ideologies as their representations. Both stories explore the issues of inclusion and exclusion. On the one hand, the characters are members of national societies, respectively the character s of â€Å"Girl† are members of the black Antiguan society and the characters of â€Å"I Stand Here Ironing† are members of the American society. They are included in these societies; however they suffer exclusion due to their, as Yuval-Davis calls that, â€Å"naturalized† social division. In â€Å"Girl† the mother and the daughter are born black and that predetermines their position in the

Wednesday, January 1, 2020

Pros And Cons Of Visual Communication - 1904 Words

Section 4 Project Visual Communications: is it relevant in the current age? This is my essay on whether or not visual communications is relevant in the current age which includes the pros and cons of visual communications, how it could be done differently or how it could be improved, whether or not the training is cost effective and what equipments are available for visual communications and possible new equipments which could be used in the future. Is visual communications relevant in the current age? Visual communications has been around for hundreds of years and is a massive part of the Royal Navy and the RFA, however over the last few years Visual comms throughout NATO has been used less frequently and better more efficient ways†¦show more content†¦Therefore visual communications is reliable when other methods of communications are unavailable or restricted. When carrying out visual communications you are also not limited to what you can send. When sending plain text use the prosign â€Å"DESIG† then put in the text that is required. Interco pennant means signals taken from BR69 Therefore not restricted to signals only from the Vol II. Flashing light is a lot easier by night than it is by day. Some negative facts about visual communications is unless the ship you are trying to communicate to is in visual range then you will not be able to communicate with anyone. Therefore it is a very limited resource as to when and where you can use it. Also with flaghoists the ship you are communicating with would have to be within 1000 yards to clearly be able to see the flaghoist and decode the message therefore making it a very inefficient way of communicating. There are also other things to take into account when using VS to communicate with other ships; weather. 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