Gibbs reflective cycle

Gibbs reflective cycle Gibbs’ reflective cycle has 6 stages. They are usually given the following headings: 1. Description 2. Feelings 3. Evaluation 4. Analysis 5. Conclusion 6. Action Plan As part of my Overseas Nurse program, I am required to make a reflective essay. This essay is based on my experience in clinical placement in the Operating Theatre. The aim of this essay is to discuss my learnings about the importance of team briefing, principles of asepsis, and Surgical Handscrubbing, as well as experiences throughout my placement. I have come to select the Gibbs reflective framework for this for I feel that through this framework I can better express in a systematic manner the describe the incidents, feelings, and how I was able learn. Learning Outcome 1: Team Brief and WHO Surgical Safety Checklist In June 2008, the World Health Organization (WHO) implemented a second Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’, to reduce the incidence of surgical deaths across the entire world. The initiative was developed to strengthen and improve the commitment of clinical staff to address safety issues within the surgical setting. This included improving anaesthetic safety practices, ensuring correct site surgery, avoiding surgical site infections and improving communication and teamwork within the team. The WHO Surgical Safety Checklist is a core set of safety checks, identified for improving performance at safety critical time points within the patient’s intraoperative care pathway. It is for use in any operating theatre environment, including interventional radiology with the expectation that it can be adapted to fit local practice. The three steps in the checklist (sign in, time out, sign out) are not intended as a tick box exercise, but as a tool to initiate meaningful and purposeful conversation between relevant members of the clinical team to improve the safety of surgery. According to the National Patient Safety Agency, NHS, there are five steps to safer surgeries. Namely Briefing, Sign in, Time out, Sign out and Debriefing. During my placement, I was assigned to circulate in theatre two. One of the five running theatres that our hospital has. The there was only one case. Patient Keiser (not the real name). 63 year old male consented for a Primary Total Knee replacement under general anesthesia using a Zimmer â€Å"NexGen† Knee system. I was nervous because it was a major case and I needed to be quick with my actions and be focused. I did my reading a day before so I had an idea of about the sequence of the operation. Before the patient was escorted to the theatre, the surgical team together with the anesthesia team had a team brief. In the briefing the patient details, laterality of site were confirmed as well as medication allergies, number of staff and availability of implants were all discussed. Everything went smoothly. The patient was then escorted to the anesthetic room and additional checks, verifications, and the sign in was done in the anesthetic room. The patient claimed that he had a nickel allergy and that he would get mild rashes when in contact with the metal property. The ODP (Operating Department Personnel) the person who is responsible for assisting the anesthetist and initiating the WHO Checklist was fully aware of this metal allergy as it was also reflected in the care plan and preassessment. The incident happened when the ODP and anesthetist failed to inform the scrub team about the specific allergy because they thought a nickel allergy had no significance. They were only conc erned with medication allergies. So they continued and put the patient to sleep with propofol and other anesthetic agents. The patient was then brought in the theatre with use of the trolley and placed safely on the Operating table. The scrub team on the other hand was almost done preparing the field and assembling equipment needed for the operation. When everything was ready. Being the circulating nurse, I then continued the WHO checklist and initiated the Time-out. The consent, patient verification and allergies were then reviewed but this time the ODP informed the team about the nickel allergy. The surgeon went ballistic! And ordered that the patient be woken up. There was a heated discussion between the surgeon and anesthetist and it they eventually had to wake the patient up. It was then explained to us by the surgeon that the System and implants to be used during the operation had a very small percentage of nickel present in its components which could cause a reaction if used to the patient. He was angry because it was the second time it happened to him and he did not want to go through all the paper works again. The patient was brought to recovery and woke up in a few minutes. The surgeon then explained the incident and unfortunately the operation was cancelled. The opened sterile instruments, supplies, and consumables were all put to waste. As I analyzed what happened, the mistake clearly rooted back to the team brief. There were vital information that the anesthetic team knew about the patient that was not shared to the scrub team because they did not see it as important. I personally think every allergy, be it medication, metal or objects should be taken into consideration. It was a major case and the team had to know everything relevant. I realized how important the team brief was. Often I would observe other teams not taking the team brief seriously. They would just breeze through it as if was just some unimportant routinely work. After the incident I learned a lot and the view I had on the team briefing and the importance of the WHO checklist drastically changed. It is a very important tool in ensuring a safe, effective and successful operation. I now plan to practice a thorough team brief as well as executing a proper WHO checklist. You never know, missing out on one important fact could mean a life of a patient. Learning Outcome 2: Principle of asepsis: Asepsis can be defined as the absence of pathogenic microorganisms that cause disease. It then can also be referred to as clean technique (Phillips, 2013). However, elimination of infection is the goal of asepsis, not sterility. (Ayliffe et al. 2000) suggest that there are two types of asepsis: medical and surgical asepsis. Medical or clean asepsis reduces the number of organisms and prevents their spread; surgical or sterile asepsis includes procedures to eliminatemicro-organismsfrom an area and is practised byhealth care workersand nurses in operating theaters and treatment areas. There are several principles of surgical asepsis. Although all are equally important, I have come to be more cautious and alert of specific principles more often than others. One principle I have chosen to share with is a principle stating that People who are sterile touches only sterile items or areas. (reference) It may seem as a very simple principle to follow but it could be at times difficult to imbed in our system. May it be a scrub role or circulating role this is one of the key things one should always keep in mind. I had one incident during placement relating to this. It happened during an early shift of a busy Friday. There were 52 operations to be done that morning. Everyone was on the go. For some time now I have been with an orthopedic team but this time I was assigned with my mentor to assist a list of over 6 cataract extractions with ocular lens implantation. She was to scrub and I was to assist with the circulating role. Coming into this list I had not assisted a cataract extraction in the last 4 years. My knowledge was very minimal although I knew the purpose and roughly the length of time needed to finish the procedure in general but I did not know much about the fine instruments needed, supplies and set up of the Centurion Vision. Everything was new to me and I felt much pressured to deliver and I was uncomfortable knowing I could make mistakes. As the operation began my mentor scrubbed in and she was too busy to guide me thoroughly at the moment. The surgeon and scrub started asking me to position the machine according to the surgeon’s preference. I was reprimanded for being slow and hesitant since the surgeon was ready to start. After finally connecting the plugs, foot pedals as well positioning the Centurion Machine above the patients head, the surgeon placed sterile plastic covers over each of the handles of the machine. These sterile plastic handles where used as a sterile field so that the surgeon can hold the machine. Like the principle states, only sterile people should touch sterile things and the other way around for unsterile. Already being reprimanded I was nervous that I would make another mistake and unfortunately I did. The surgeon wanted me to reposition the machine yet again to his preference but this time I unconsciously forgot my principles and touched the sterile handle and I compromised the sterility of the field. The surgeon requested for another sterile handle and the case was delayed. I felt very bad knowing that I knew the principle but still it just slipped my mind and I committed an error which compromised the operation someway. After the incident I knew what I needed to do and how to position the machine efficiently and quickly. I already knew the preferred position and supplies needed. I just needed to be more focused, less anxious and hesitant and be more confident this way I would not make mistakes of that degree. The first case finished and I was able to effectively circulate on the remaining cases with carefulness, confidence, focus and efficiency. Learning outcome 3: Surgical Hand scrubbing Microorganisms transfer from the hands of health care providers to patients; this is an Important factor with regard to health-care associated infections (i.e. nosocomial). Skin is a major source of microbial contamination in the surgical environment. Although the scrubbed members of the surgical team are wearing surgical gloves and gowns, their hands and forearms are to be cleaned preoperatively to significantly reduce the number of microorganisms (AORN 2006) According to the WHO Guidelines on Hand Hygiene in Health Care, Surgical hand scrubbing is the surgical hand preparation with antimicrobial soap and water performed preoperatively by the surgical team to eliminate transient flora and reduce resident skin flora (2009, World Health Organization). There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol (Deborah Gardener 2011). In the operating theatres there are three most probable routes of infection transmission between successive/sequential surgical patients are via the air, from instruments, or from environmental surfaces. Journal of Hospital Infection (2002) I have always felt and understood the importance of keeping our hands clean even since I was a little boy. This was a practice taught to me by my parents. As I studied nursing in my country I got to know more about it and how it was properly practised in the wards and theatre settings. During my placement I would always observe my mentor thoroughly before gowning and gloving. I knew the importance of this. She would use repetitive strokes on the hands and arms to further remove any microorganisms. She would be very meticulous and patient while stroking her hands and arms with soap and an antimicrobial agent but as Ive observed, along with most of the scrub nurses, together with my mentor did not use brushes when doing surgical hand scrubbing despite brushes being available just at the side of the scrubbing area. This made a big question mark in my head and I was really confused. I wanted to know why they didn’t bother to use the brushes. So I decided to research about it. There was a study that compared surgical hand scubbing with and without the use of brushes. Two groups were involved during this study. One group to scrub without a brush and another group to scrub with brushes. According to Life Science Journal 2014, the result showed that the group which used brushes had slightly higher bacterial counts, this could mean that brushes traumatize the skin creating an environment where bacteria thrived. Whereas using no scrub brush resulted in no skin damage and significantly lower bacterial count. (AORN journal, 2004. 79: p. 225-30). Based on this research, I was amazed on how the United Kingdom healthcare setting applied evidence based practice. I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a brush. Surgical site infections (SSIs) are the second to third most common site of health care associated infections. When providing health services, it is es sential to prevent the transmission of infections at all times. (Engender Health 2001). I applied this research findings to how I scrub. I learned more about because of research and from that moment on I have been scrubbing without using a surgical brush.

John Locke and the Un-Equal Distribution of Wealth Essay

It is stated by John Locke that in the state of nature no man may take more then he can consume. â€Å"? make use of any advantage of life before it spoils? whatever is beyond this is more than his share and belongs to others. Nothing was made by God for man to spoil or destroy. (Locke 14)† Locke then goes on to say, â€Å"God gave the world to man ? for their benefit and the greatest conveniences of life they were capable to draw from it, it cannot be supposed he meant it should always remain common and uncultivated. He gave it to the use of the industrious and rational- and labor was to be his title? (Lock 15)† Both of statements can stand alone, each could be argued. For starters, it is not only selfish to take more then you ever will be able to use, it is just stupid, and if you make it with your sweat, why shouldn’t it be yours to keep or profit from. The only problem is, that one of these statements is the head of a starving serpent, and the other its delicious tale. It is hard to believe the head could stay alive without devouring the tale. We should start this argument at the head and work our way down. If John Locke were alive today he would be a lawyer. Not just any lawyer though, a big business lawyer working for a company like Enron. He would try to justify the destruction caused by overly rich, overly powerful people, with statements such as ones that will follow. When first reading Locke you might think, † Hey, this guy sounds like a lawyer. † but soon you would realize, lawyers sound like this guy. Because anyone claiming God is a capitalist with a straight face has to be a bit slippery. Which brings us to the head of the serpent. In Locke’s opinion the idea of fair unequal distribution of wealth came about with the creation of money. Before money, things could not be saved fairly. Over stocking by some would lead to spoilage, and leave others with nothing. Once money was introduced though, this allowed the accumulation of wealth, without waste, so Locke says â€Å"? thus came in the use of money- some lasting thing that men might keep without spoiling, and that by mutual consent men would take in exchange for the truly useful but perishable supports of life. (Locke 20). † Now one man could have, † ? a disproportionate and unequal possession of the earth? (And) ? fairly possess more land than he himself can use the product of? (Locke 22)†. The word â€Å"fairly† in that last statement should jump off the page. When speaking on the state of nature Locke’s main concern is spoilage or waste of commodities, but with the introduction of money he sees this problem solved. When in fact a floodgate for spoilage and waste is opened. Today the market is flooded with products, and products supposed to be better then the other product, the leading brand, and the other leading brand. Combine this with the introduction of digital property such as television and the Internet, all other forms of mass media marketing, and we have a whole new concept of hoarding and spoilage. Today we have companies taking up more then their â€Å"fair† share of the world, and practically forcing their goods down our throats. It’s not that we need or actually think Doritos are the best. It is just the fact that they are practically spilling off the shelves of every single store across the globe, and if they were actually made from biodegradable ingredients, they would spoil by the boatload. Just because these companies’ do not let the products go to waste in their possession, does not mean that they are not fully aware that a large portion of everything produce will end up in the garbage. Then we have to think of the environment, Martha Stewart, and wars over oil. Is it not waste and spoilage when a one hundred pound woman drives her six-ton S.U. V to K-Mart for yet another useless ceramic kitten, while someone’s family member is pumped full of shrapnel while trying to secure her next tank full over seas? All the while burning enough fuel to heat a small home, as she passes by a man without one. The God sent industrious producers of this vehicle is to blame. They know what is at stake, and what is to gain. But more importantly, they know what to waste and just how to waste it. How could they be wrong, â€Å"He gave it to the use of the industrious and rational? â€Å"? Didn’t He?

A Dolls House - 1973 Production with Claire Bloom

Analysis Of The Book Elena Vanishing, By Elena Dunkle...

Critical Eating There are many different psychological illnesses in the world, each with different causes. While eating is an key function of life, some people may be doing harm to their body with their eating habits. Eating disorders occur when a person has a bad relationship with food and can be deadly. The book Elena Vanishing, by Elena Dunkle and Clare B. Dunkle, gives a better understanding of the background of eating disorders and many reviewers are impacted by the book’s vital message. Many people are unaware of the background of eating disorders. Women are more likely than men to develop an eating disorder and they usually develop in childhood before the age of 20 (Ross-Flanigan 1). Women as well as men can develop an eating disorder; it is just more likely for a woman to develop one. Eating disorders are usually developed in adolescent or childhood years when a person is influenced the most. Also â€Å"Eating disorders are psychological conditions that involve overeating, voluntary starvation, or both. Anorexia nervosa, anorexic bulimia, and binge eating are the most well-known types of eating disorders† (Ross-Flanigan 1). Many people assume that an eating disorder is when a person staves themselves; they do not realize that it can involve overeating as well. Some eating disorders also involve purging, but not all. People with an eating disorder fear gaining weight even when they are severely underweight. They do not lack an appetite (Ross-Flanigan 1). Th ese people are