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This paper particularly focuses on my experience of learning from reflection on giving intramuscular (IM) injections, using Gibbs’s (1988) reflective model. I demonstrate how practice anxiety, as a student nurse, can be dealt with through effective mentoring. I chose the seminal theory of Gibbs reflection on practice, as it illustrates six significant stages; description, feelings, evaluation, analysis of the incident, conclusion and an action plan Ghaye and Lillyman (1997). Gibbs cycle is used throughout the process of reflecting on the incident to help me make sense of my practice and understand what l could do differently to enhance good practice. I use my experience from a placement simulation as I could not be on actual placement due to unforeseen circumstances.
Reflection is a process through which healthcare practitioners and students can learn from experience and use the knowledge to inform and improve practice Schon, (1983). The ability to reflect on one’s actions is particularly imperative in clinical practice and discourse. As Jarvis (1992) asserted, there is no consensus on the definition of reflection as it is a broad concept. Reid (1993, p305.) define reflection as; “a course of action reviewing an occurrence of practice to describe, analyse, evaluate and so inform learning about practice” Schon (1983) identified two types of reflection which are; reflection in action, which takes place during the event where the practitioner may not be aware that it is happening and reflection on action, which takes place after the event. Jasper (2003) concluded upon the vitality of reflecting on action, as it transforms experience into knowledge which enhances good clinical practice.
During my first placement simulation, I practised giving intramuscular injection, is the best tolerated form or injection, and the safest way of injecting medication into a patient Shepherd, (2002). Within the first week of my placement simulation, I was offered the opportunity to practise administering an injection on a dummy. However, as a student, I was cautious and anxious, feeling that I was not competent enough. I discussed my concerns with the lecturer who was empathetic and helped formulate a plan to conquer my doubts. The plan involved a step-by-step conversation of the procedure of administering intramuscular medication, preparing the medication on numerous occasions and practising the injection technique on a dummy. Throughout these stages I was given the opportunity to discuss any questions, feelings or concerns that arose. Once confident enough to do so, under the supervision of the lecturer, I administered an IM injection to a dummy. I recorded my intervention in a reflective journal. After giving the injection, I was given feedback and the opportunity to discuss my feelings which was valuable and of significance.
As a novice, I never really enjoy giving injections, but after my second practise, good compliments from colleagues and lecturer my confidence increased. Most importantly, l kept thinking, if l gave the injection to an unwilling patient, how awful would I feel? I reminded myself, ethically, what is it like to carry out a therapeutic procedure that inflicts pain on another human being? All these challenges came to my mind before giving the injection. I began to feel quite anxious and nervous, wanting to delay the procedure for as long as possible hoping my anxiety would decrease. I believe the build up of nervousness beforehand is common, particularly for beginners like me. I prepared the injection using the necessary mathematical calculations, picked the right syringe and the right injection for the procedure. I then administered with my lecturer observing my technique, confidence and competence.
My preliminary anxiety about administering the injection was normal but as a student nurse, I ought to learn the technique and procedure of IM injections. This anxious behaviour could be explained in relation to the Johari’s Window (Luft 1969). As in Johari’s window, before being confronted with having to administer injection, I experienced an ‘unknown area’, whereby my fears and anxieties were anonymous to me and to others [my lecture]. Because I lacked self-awareness regarding these anxieties, I was unable to begin addressing my anxieties around administering the injection. This made me continue to avoid this area of practice, and as a result I did not develop this clinical skill before this incident. By the end of the incident, my feelings were known to me and others [my lecturer]. By disclosing my anxieties and fears to my lecturer and receiving feedback, my awareness of these issues increased. My lecturer commented on what l did right, wrong and what l could have done differently. Resultantly, I was able to address my feelings, areas of strengths, weaknesses and begin to develop the skill of administering injections.
Department of Health (2008) identified lecturers as qualified nurses, who facilitate learning and supervise students. Mentoring also involves the assessment of the student in the practice setting NMC (2008). The interaction between mentor/lecturers and students is answer to minimise practice anxiety and professional intervention is often required to reduce any anxieties. This was resonant in my experience with my mentor while carrying out this procedure. Critically reflecting and understanding my feelings around giving the IM and after the procedure makes me think and evaluate what l ought to do differently in the future. This will enhance my technique and practice while also benefiting patient care. I am now aware of my competence as my mentor highly commended on my confidence, technique quality and the communication that l maintained with her throughout the procedure.
The description given in this paper is a general and subjective one that attempts to address my feeling and experience of giving the IM. It also aims at indentifying patterns and schemes in the experience of individuals in a similar context of giving IM for the first time. I believe, my experience will help educators to better understand the meaning of the anxiety that is observed as students undertake the act of giving their first injections. It will also help other students reflect and come to understand the meaning of that experience and not feel overwhelmed by this crucial initial experience.
I created an action plan to improve my practice and set out a course of action should a similar incident occur? Recording an entry in a reflective journal enabled me to record areas of practice that I want to develop and will allow me to track my progress regarding the administration of IM injections (Jack and Smith 2007).I also developed listening skills. Stickley and Freshwater (2006) argue that effective communication, which involves active listening, is an essential nursing skill, because of its beneficial effects on the patient’s experience.
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