Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O’Shea 1999). So as a student nurse this became our duty and something that we practiced and become competent in carry out as explained in figure 1, we were also faced with the challenges of administering medication. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I wasn’t competent enough to dispensing a certain drug it would be in my responsibility to speak up and let the registered nurses know, so that I could shadow them and have the opportunity to learn and then in future be able to practice and administer.
The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, and conclusion. (Gibbs 1988). The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill, that I have learnt and supporting this with current literature.
The first stage of Gibbs (1988) model of reflection requires a description of events. I was asked to administer a drug to a patient. I had observed this clinical skill on a variety of occasions and had previously administered medication under supervision. On this occasion I was being observed by two qualified nurses, one of which was my mentor. The drug had been dispensed and was ready to be administered and the patient consented to have a student administer the medication. My mentor was talking me through the procedure step by step, and informed me that they have struggled with this patient and her compliance with medication before so I should keep an out and ensure that she swallows her medication and that she not keeping it her mouth.
The Medication that this patient is on is Clozapine. Clozapine is indicated for patients with treatment resistant schizophrenia, or those who are unable to benefit from other antipsychotic medicine, as they cannot tolerate the side effects. The decision to use clozapine is not taken lightly because of the potentially life threatening side effect of neutropaenia, which requires regular blood tests to ensure its safe use. In addition, there is the risk of developing paralytic ileus and some cardiac abnormalities. (WLMT).
In addition to that statement if a patient on clozapine white blood cells count falls below accepted lower limit are classified as “Red alerts” medication must be withdrawn, and any other prescriber in the future wishing to restart medication are aware of the patients haemotological history. Adverse drug reactions are the main limiting factor on using anti-psychotics, for this reason prescribers should keep dosages to a minimum required for efficacy starting at a low dose with gradual upward titration. An awareness of side effects is important to primary care practitioners because they have most contact with the patients, patients with long term monitoring falls within their remit. Clozapine is an atypical antipsychotic, and atypical anti-psychotics are considered of choice both accurately and for maintenance in schizophrenia. Clozapine holds a unique position among the atypical due to its ability to improve negative as well as positive symptoms (delusions, hallucinations). (Morris, D).
During the process of administering anti-psychotics I learnt that using anti-psychotics is just a component of a holistic approach to the patient with psychotic illness and that care should also include psychological treatments and social care. The patient at such does not have any issue with the drug it self but with the staff, as she is in a very psychotic state she is very paranoid and non compliant with medication this is closely monitored by staff and as stated in figure 1 I have to prompt her to ensure that medication is complied with. Service users have requested strategies from services providers to manage the risk of using psychiatric medication to inform their choice about which psychiatric medication to use. (DOH 1999). However evidence suggests that, there is choice, but generally by practitioner experience. (Hamann et al. 2005). In non compliance of medication I had to encourage the patient to make their choice to take the medications and that it was in their care plan and apart of their treatment. A nurse who has built a good relationship with a patient by informing and empowering them will be in a strong position to have a non judgmental conversation with them about the importance of adherence. (Mc Lellan. A 2009).
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. I was aware of being under the supervision of two qualified nurses and this made me feel very nervous and self conscious and I had to ensure that I was doing everything correctly and that I made no errors. Once my mentor questioned my practice, concerning if I knew the side effects of the drug I was about to administer, I became even more aware of feeling nervous and under pressure. The patient was present and I did not want the patient to feel that I did not know what I was doing. So I had to ensure before administering that I was giving the medication to the right patient and at the correct dose that it was at the right time and route. All of these had to be done to guarantee that I am competent in my ability to administer medication under the supervision of a registered nurse. This also gave me the opportunity to carry out this task in order to achieve this so I could get it signed off by my mentor in my essentials skills cluster.
The nurse patient relationship is by many considered the core of nursing; this can be done to build a good relationship and rapport with patients. (Framer.J.Kramer.S, 2001). When I was first orientated to the ward, I took it upon myself to read the patients notes so that I had little insight to the patients and their illness and index offences if any. After this I went and introduced myself to the patients because it’s vital that the patients are aware of who I am and my status if I am to provide nursing care for them. (Berlo 1960) puts great emphasis on dyadic communication, therefore stressing the role of the relationship between the source and the receiver as an important variable in the communication process. So to provide patients with adequate care it’s important that there is effective communication, that the patients is aware of everything, and that the nurse provides care and compassion in the delivery of care. There is evidence that our ability to use language actually affects the thoughts themselves, the words we can command, and the way that we put them together affects:
what we think
how we think
whether we are thinking
So as a student nurse I was made aware that words can have an impact on care provided and the way in which these words are delivered can have an even greater impact. As explained in figure 1, when I was admitting a patient on to the ward I had to make certain that I was communicating effectively, making certain that I was delivering information in ways that were easy to understand refraining from uses of jargon, and that I was showing compassion to the patient as this could be a time of high anxiety for them, reassuring them that they are in great hands and offering them tea were among the things I did to exercise my care and compassion skill. so my main aim was to make the care of people your first concern, treating them as individuals and respecting their dignity, and working with others to protect and promote the health and well being of those in my care, their families and careers, and the wider community. (NMC 2008). However I tried to use different forms of communication to convey information from my patients’, for instance as stated in figure 1, when I had my 1-1 personal time with my patient I would use (Bein and Miller 1992) the use of open and ended questions and active listening, so that I could comprehend everything I was being told so that when I came round to me providing comprehensive and accurate written report based they would reflect everything that was being. Studies show that during interpersonal communication only 7% of the message is verbally communicated by the words used. Of the 93% non-verbal communication: As a result I learnt to pick up non verbal signals “Even if someone decides to say nothing they are still communicating” (effective communication skills). All of which skills I can adopt to engage with patients and to help with my development in nursing.
Evaluation is the third stage of Gibbs (1988 ), here I will the explain the importance of administering medication and how this combined with care, compassion and communication forms the bases of a holistic approach to care, and with the knowledge I got from supporting literature formed the foundation of my learning and practice. Burnard (2002) suggests that a learner is a passive recipient of received knowledge, and that learning through activity engages all of our senses.