Reflection | Percutaneous Endoscopic Gastrostomy (PEG)

Reflection Percutaneous endoscopic Gastrostomy ( pinpoint)This reflective essay describes my experience in achieving my scholarship issuings pertaining to wish well of transcutaneous endoscopic gastrostomy ( nail), big head for the hills by dint of narrow and administration of medicines done specify that I put up taken as part of the abroad Nurse Program. It flows as a reflective practise as it incorporates the creation of learning. According to Bolton (2010) reflective practise involves utilising practical values and theories which influence cursory actions, by examining contemplatively and unreceptively geared towards developmental insight. Therefore, experience only does non pourboire to learning further deliberate reflection on the experience is essential.Consequently, to save discourse my soul and involvement with this impression, I accommodate adapted on a certain framework of reflection. I become chosen David Schons Model of Reflective Practise to reflect on my experience. I order this framework on my experience beca office it en adequate to(p)s me to recapture the events in a bearing where learning occurs during the process of experiencing handling patients with PEG, gaining insights from them with the application of the theories and concepts I know and structure new perspectives and understanding of doing things in relation to PEG. Schons model (1983) is cogitate on two major concepts, reflection-in-action and reflection-on-action. In the reflection-in action activity, reflection happens season in the act of doing the task (cited by Killion and Todnem, 1991). Reflecting-in-action requires me to value on my feet, be able to work instinctively by drawing on correspondent experiences to solve problems or make necessary decisions. It involved face to my experiences, connecting with my feelings, and attention to the theories and principles in use. It entailed building new understandings to in institute my actions in the macu lations that were unfolding. Whereas in reflection-on-action, it requires looking back on what one has accomplished and reviewing the actions, thoughts, and product (cited by Killion and Todnem, 1991).As I am working in the medical unit, I was charge together with my instruct in one of the patients in the unit who has transdermal endoscopic gastrostomy (PEG) surgically clasped on her abdominal area. As we entered the room to do PEG care, specifically changing the PEG dressing on a new one I was confronted with a different practise from what I used to do back in my mob country. She told me that in join Kingdom normal saline is used to cleanse the PEG range instead of antiseptic solution. And now this is where the reflection-in-action came into play. Instead of insisting what I think was the best practise for me ( utilise antiseptic solution for disinfection), I stood up and adopted what my mentor told me believing that what she knows is within the standard of practice within united Kingdom. When I tried to engage myself in performing changing the PEG dressing, I tried to think on my feet and did the principle of disinfection using normal saline. I needed to reflect to ensure that this will not happen again.In anformer(a) incident where reflection-in-action occurred that became my second learning surfacecome happened when we fall in to hark back a founder through PEG. All the while I was expecting an asepto syringe to be used to deliver the feed to the patient but to my amazement my mentor got this special set attached on what she called a Kangaroo inwardness to deliver the feed at a desired rate and paced sentence (at that time for 12 hours). It was my first time to encounter this method of administering a PEG feed to a patient. What I did was to stand back and retrieve how my mentor did all the attachments from the Kangaroo bosom up to the PEG tube, but kinda than just standing I offered my mentor if she can supervise me on how to enter the transcript (total volume, rate and running hours) on the manage which she fain did to me. I was really surprised with the whole process and needed a reflection to show my competence with this new process of giving PEG feed to patients.In the last incident that happened that became my ternary learning outcome transpired during administering medicines via PEG. I was caught off guard with regards to the preparation of medicines to be given to the alike(p) patient who got a PEG. We are giving an Aspirin dose for this patient and all weve got in the medicines cupboard is an enteric-coated form of this medication. Knowing that enteric-coated tablets should not be crushed when administered, I immediately asked my mentor if we can request to the chemists shop an effervescent form of Aspirin. And thats where reflection-in-action occurred wherein I befool to think of a solution on how not to breach the standards of safe medicines administration in the United Kingdom. Instead of crushi ng and giving it to the patient, I asked my mentor close to an alternative solution to address our needs for the medicines administration. In that way I was able to think on my feet and learned something out of the experience.According to Schons model what I felt when those incidents happened was part of the learning process. Schon (1983) gives further teaching that the practitioner allows himself to be surprised, puzzle or confused in a certain situation which is unique or uncertain to him. He reflects on the event before him, and on the prior considerations which assume been imbedded in his attitude. He conducts an experiment which allows him to formulate both a new understanding of the situation and a change in the situation. After all the incidents that transpired during my clinical office in relation to my trio learning outcomes, I have through a reflection-on-action in every learning outcome that I have identified. I made researches on them and took my time to recall the series of events that transpired and found the lapses I made on evidences I have come crosswise during my reflection process. In this way, reflection-on-action was evident.On the first learning outcome, I have observed a different practise back in my office country cleansing the PEG site. We use chlorhexidine in cleansing the PEG site instead of just plain normal saline but after finding evidences about which is safe and efficient in usage, I was fully convinced that normal saline has a better concept ground than chlorhexidine. Sibbald et al (2000) emphasises that although chlorhexidine has been identified as less harmful to tissues and have effective anti bacteriuml activity against both gram-negative and gram-positive bacteria causes damage to new tissues and should not come close to meninges and mucous membranes for it will cause permanent damage. This concept is applicable with my patient as there is an open mucous membrane where the PEG was inserted and exposure to chlorhexid ine would summation the risk of microbial invasion and growth, which may precede to sepsis. Furthermore, the work of Sibbald was change by Edmonds et al (2004a) and Jacobson that physiological saline is a widely recommended in irrigating and wound dressing solution since it is found to be compatible with gracious tissue. Thus, the practice of using normal saline in cleansing the PEG site was evidence-based practice and I have fully get an polished grasp of why normal saline is used for PEG care. In this way, I am ensuring patient safety and embracing better understanding of evidence-based practise.On the second learning outcome, I have also witnessed a different way of giving PEG feed to our patients in our home country. We have bolus tube eating rather than invariable tube feeding using a Kangaroo pump. Aside from observing each time a PEG feed will be given to the patient during my clinical placement, I also did researches on the efficacy of continuous feeding via pump and differences of using a pump from bolus feeding. I have done this in order to develop my competency in using the Kangaroo pump and giving continuous PEG feed to patients. Abbott Laboratories NZ Ltd (2011) gives further information that pumps continue to use microprocessors that allow the delivery of controlled enteral feeding. Its array of flow rate pick gives incremental increases in delivery which is very essential in small care settings where low infusion rates are vital in maintaining the fairness of the gut and where maximising the feeding volume are moderately balanced. On the contrary, Bankhead et (2009) matched that gravity feeding is considered as the first-line delivery of enteral feeding in some countries but the Dieticians Association of Australia (2011) slashed the idea of Bankhead et al and proved that the usage of enteral feed pumps is now known as the most accurate way of enteral feeding provision across all healthcare settings and patients. Also, I have found ou t that using Kangaroo pumps instead of asepto syringe in delivering feed to patients lessen complications associated with giving feed to patients via abdominal ostomy tube. Niv et al (2009) found out that established benefits have been shown to close out aspiration in critically ill patients. Furthermore, the jejunum produces fluid in unification to hyperosmolar solutions, and rapid delivery of a hyperosmolar formula will lead in hyperperisitalsis, diarrhoea and abdominal distention. Thus, a more controlled delivery to the intestine via continuous pump infusions can lessen or prevent these symptoms.On my third learning outcome, medicines administration via PEG has m each aspects but the one that got me on my feet was about my competency in giving the right drug, specifically its form and preparation. According to Nursing and Midwifery Council (2008) As a Registered Nurse or Midwife you are accountable for your actions and omissions. In administering medication you should think thr ough issues and apply your tradeal expertise and judgment in the best interests of patients. As I have recalled what I did when the incident happened wherein I immediately asked my mentor if we can request to the pharmacy an effervescent form of Aspirin since enteric-coated tablets should not be crushed when administered, I considered the best interest of the patient. As a professional nurse I have a duty of care to my patients in ensuring their safety under the sphere of my care. I need to follow what is appropriate and right for the patient. Also, my mentor was able to practise within the background knowledge of her practise as she was able to directly supervise me in everything that I did with the patient. The Department of Health (2005) stressed that as a Registered Nurse you have a duty of care and are professionally and legally accountable for the care you provide. In line with the administration of the appropriate form of medications to be given to the patient, the Nursing and Midwifery Council (2008) has developed protocols for medicine management on the area of tablet crushing. It stipulates in the policy that nurses should not crush any medicines or break capsules that are not specifically indicated for that purpose and by so will alter the chemical properties of the medicine. Thus, as I have reflected with what I and my mentor have done is fitting and legally right.The reflection-on-action that happened to me on the three learning outcomes gave me the opportunity to evaluate my competency and efficiency as an overseas nurse on adaptation program. Prior to my reflection, I have never realised how crucial it is to do PEG care, administering medicines through PEG and giving feed through PEG until I experienced the three incidents that changed of how I do and view things in the clinical field. According to Schon (1983) when a practitioner becomes aware of a situation he sees to be unique, he perceives it as something already found in his range. The fa miliar situation acts as a standard for the unfamiliar one.With regards to strengths and areas of development, I believe I was able to achieve a certain level of competency in carrying out procedures related to PEG. The learning outcomes I and my mentor identified have helped me to repair myself in terms of skills, knowledge and attitude. After the reflection process happened, I was able to build my confidence in performing procedures related to PEG. I also need to be at ease with operating the Kangaroo pump although I was able to familiarise myself with the process of hooking the PEG feed on the pump and setting the rate and dosing of the feed in the equipment. It was change at first but after the reflection process and supervising of my mentor, I was able to get through and learned operating the pump appropriately. Medication administration through PEG has provided me with new perspectives on how to establish a process in checking the medicines to be given and how critical sen timent will help me in my decision-making and if I was able to observe the sextette rights of medication administration.As a future plan, I need to ejection competency, professionalism and efficiency in everything that I do be it with the patients or other allied healthcare workers who are part of the organization. It is essential for me to maintain the standards of my profession as it will mould me into a competent registered nurse of United Kingdom. Nursing and Midwifery Council (2010) highlighted that All nurses must act first and firstly to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks.In a nutshell, reflective practice became the backbone of my learning outcomes in relation to PEG. It provid ed me with understructure in which area needs to be improved and enhanced. Reflection-in-action and reflection-on-action are learning processes that guided me to evaluate my decisions before and after the incidents happened. These incidents gave birth to learning and sullen to acquisition of new knowledge and concept that became an enriching experience for me.