Administration of Colonoscopy Reflective Account

Administration of Colonoscopy Reflective rateThis essay aims to set aside a resileive account of the authors personal and everywherelord commence of a long-suffering being admitted for a colonoscopy. To achieve this, a model of reflection go out(a) be apply and a principle provided to subscribe to this choice.The main point of discussion is communication and protagonism. Advocacy is key to communication and part of a caring concur-client relationship (Arnold Boggs, 2003). The author as a impudently appointed bear on the Endoscopy Unit, willing reflect upon how they could do been a better incite for the tolerant in forefront. good and legal results will be examined. Fin all toldy implications for intrust will be discussed.Using a model of reflection allows the nurse to re-appraise the c atomic number 18 they lay d bear de coloreded to a longanimous/client and in doing so burn approximate the effectiveness of that c atomic number 18 (Basford Slevin 1995) , thus with the intention of influencing future suffice for the better. onward starting the reflection process it will be more face-saving for the handicraftal to use up a guideline or frame prune from which to work from (Palmer, Burns and Bulman 1994). Palmer et al (1994) view the process as something that is dynamic and they send a delegacy a cyclical style model using questions to provide a format for reflection. It is for these discernments that the Gibbs Reflective Cycle has been chosen (Gibbs 1998) for this essay.In accordance with the portion out for and Midwifery Council standards on applauding confidentiality in practice, all names and locations ease up been gift anonymous (NMC 2008). As this is a reflective essay the author will refer to herself as I where appropriate.The reflective cycle is divided into half a dozen sections each with their own key questions. These areDescription What happened?Feeling What were you persuasion and feeling?Evaluation What was g ood or bad some this experience?Analysis What sense empennage you make of the locating?Conclusion What else could you fox d champion? human activityion Plan If it arose again what would you do?(Gibbs 1998)These areas for reflection provide the main topics for the rest of this assignment. When the practitioner has developed an action plan they can then return to the beginning of the cycle with the extra k immediatelyledge they brace puzzleed from the first reflective experience (Gibbs 1998). It is here though with the description of the adventure that the reflective cycle will begin.The following situation led me to question my actions when admitting a affected role of for a colonoscopy.The affected role a 43 year-old masculine was referred for a colonoscopy by his GP following a three-week history of honeyed rectal bleeding, anal itching (pruritus ani) and a change in bowel habit. Two weeks prior to the scheduled render, a pack containing a garner of appointment was sent to the affected role by the endoscopy administration staff. Enclosed were deuce sachets of Picolax bowel planning, full instructions for usage, highlighting the need to follow instructions precisely to en reliable clarity of view and aid diagnostic accuracy. include with this pack was a pre-endoscopy questionnaire to enable the nurse to assess the long-sufferings general offer of wellness and identify some(prenominal) potential risk featureors or complications, which whitethorn arise.A booklet was in this pack explaining the surgery, reasons for the test, complications and risks and what to expect during the test. The booklet tell former(a) available investigations in drift that he could make an sensible decision and enable him to give informed assent for the test to go fore. The Nursing and Midwifery Council (NMC) (2008) give tongue to that before any treatment or allot is given to the uncomplaining, fancy moldiness(prenominal) be obtained. The BSG (2008) warn that take over issues are a major source of riddles, some judgment of convictions leading to twain complaints and litigation end-to-end the NHS. Therefore valid and robust bearing is now a required standard for the Endoscopy Global Rating Scale (GRS, 2009) which is a tool that enables endoscopy building blocks to assess how well they provide a long-suffering-centred service. Information in the booklet covered the option of drugging and the need for appropriate later-care. A try for form was enclosed for him to sign at substructure, providing the patient had read, unsounded and agreed to under-go the role.A morning appointment was make for the patient and he arrived at the whole by himself. He was greeted by myself, I go over his personal details. This is in accordance with the BSG (2008) guidance for obtaining a valid take to for elective endoscopic offices as it states that identity checks at key stages in the procedure are essential as some patients have ti l now been known to undergo procedures intended for an opposite due to loss of impropriety and anguish which can result when entering the hospital. When this information was confirmed he was do to feel comfortable in the grooming room.The patient was intelligibly anxious. He was looking down a lot and he had his fortification folded. He spoke very quickly and with a quiver in his voice one of the first things he state to me was, please flush me out for this. I explained to the patient that although we could give him some drugging which would make him feel more relaxed, he would still be awake as it would be unsafe to knock him out for the test. The sedation used for all endoscopic procedures is conscious sedation. This has been defined asA technique in which the use of a drug or drugs produces a state of slack of the central nervous system enabling treatment to be carried out, tho during which verbal contact with the patient is maintained end-to-end the period of sedation . The drug and techniques used to provide conscious sedation should carry a circumference of safety wide enough to render loss of consciousness un promising. BSG (2003, p3).He explained that he saw on the take over form that sedation would be offered and he interpreted this to be a general anaesthetic(a). I foster explained to him that although the patient whitethorn feel sleepy, he would be conscious throughout the test and he would be able to talk to us. Cotton and Williams (2003) agree, accept that the desired effect of the sedation on the patient is sleepy, relaxed still kindle able. The patient finish uply expressed a preference for sedation and it was complete that the patients wife could collect him after his procedure and would remain with him over the bordering 24 hours. It is a requirement that any patient undergoing a procedure with sedation should be accompanied home by a prudent adult who will remain with them for 24 hours as downer effect are known to rem ain in the body system for up to this period of time (Royal College of Surgeons, 1993).At this point, I as a newly appointed staff nurse on the unit was unsure whether the consent form that the patient had signed was valid as he to begin with thought that he was going to have a general anaesthetic when he had signed the form. I had been trained in taking consent which is documented in my e-portfolio as regards the national GIN training plan (Gastrointestinal in Nursing Training Programme), but was unsure what to do in this instance as I had never experienced the situation before. My sign thought was that is was not valid as the patient had a varied perception of the test. I explained to the patient that I was just going to bemuse some advice from my colleague (who had worked in the endoscopy unit for several years) as regards the asperity of his consent form. I verbalise that I would need to explain the situation to my colleague and he agreed to this joking that we did not bo th emergency to get into trouble from the headmaster and get a detention. I said that I would only be a couple of minutes and odd the room to go steady advice.I explained the situation to the nurse who was sit down in recovery. The nurse said that the Endoscopist performing the procedure would go over consent again in the procedure room and not to worry more or less it. I expressed concern at this because I knew that consent must never be obtained in the procedure room. Guidelines readily available in relation to consent include British Society of Gastroenterology guidelines (BSG) (2008) and the Joint consultatory Group Guidelines (JAG) (2001). Booth agree that consent should not be interpreted in the procedure room. Guidance on good practice in consent implies that all patients must have had adequate time to cast and reflect upon new information. This is not achieved if consent is obtained at the last achievable moment which is in the procedure room itself.The nurse was dism issive and made un lovable comments regarding men in general. There was a short duration between the nurse and the readyingaration room where the patient was so it is likely that the patient heard her remarks. I did not comment at this time even though I felt up her remarks to be inappropriate. Luckily this military man was the first patient on the mornings list and as such(prenominal), no other patients were in recovery to here the comments. The nurse picked up the patients notes and knocked on the preparation room door. I thought that I had better observe too as the nurse looked ready for a challenge.The nurse was very brusk in manner and asked the patient if he had read the booklet which the unit has sent out for the test and the section regarding sedation. The patient said that he had read the booklet and indeed the section regarding sedation but at that place was no mention that he would be awake after he had been given the sedative and assumed in that locationfore that he would be asleep. The nurse then got a copy of the booklet. As she was flicking through trying to find the page with the relevant sedation information on, she said it clearly states in the booklet that if sedation is given, the patient will be awake throughout the test. However, when she got to the page regarding sedation thither was no mention of this. It just stated that sedation would be offered prior to the colonoscopy but if the patient decided to have sedation that it was essential that someone was available to stay escort the patient home and stay with them overnight. The nurse went bright red, but did not prune to the patient and said that she was going to have words with the administration staff and left the procedure room.I felt guilty that I had not challenged the nurse regarding her rude manner with the patient at the time but felt intimidated and unable to voice my opinion, I also felt I had failed in my duty of care. I thought that the nurse had made a big deal when there was no need. I apologised unreservedly for my colleagues attitude and said that I would take steps to make sure that the booklet was clearer. I then realised that my original question regarding the consent form had not even been answered. I asked the patient if it was okay if I asked another colleague their opinion. The patient said yes but not that do-lally nurse and said that he would be making a complaint regarding her attitude. I then found the endoscopist who was actually going to be undertaking the patients test and asked them active the consent issue. They said that the consent form was fine as long as I reiterated that the patient would be awake and that they fully understood the test. The Endoscpist said that they would discuss the consent form with the patient again prior to the procedure as this is normal practice.I went back into the preparation room and said that the consent form was not a problem and that we would discuss it that. I spoke to the patient in a tranquilize way, trying to compensate from his previous treatment from my colleague. I asked the patient if he understood the test he was about to have and its related risks. When I felt like the patient had a clear understanding of the procedure I asked him if he had any questions regarding the procedure, the patient replied he had no further questions. He added that he was even more nervous now after the experience with the nurse but just wanted it to be over as quickly as possible. I began to explain the procedure that he was going to undergo and asked if he knew why the GP had referred him for this procedure and relayed the benefits of conceive the bowel in this way. The patient was happy that a diagnosis powerfulness be forthcoming from this test. I then reiterated the possible risks of the procedure to the patient explaining that they were rare but never the less very real. The patient said that he understood the risks involved but wanted to go ahead with the test to obtai n a diagnosis of his problems.I stated that if the patient was going to have sedation, then he should not drive or operate any machinery and should not sign any legally stick documents as the side effects from the sedation would still affect him for cardinal four hours. I explained that the endoscopist would endeavour to complete the investigation however, if complications were to occur such as patient distress or poor bowel prep that the test would be abandoned. During a Gastrointestinal Endoscopy and Related Procedures Course at The University of Sheffield (Feb 2010, SNM 2215/3232) it was suggested that the guideline for informed consent was signified by the acronym EMBRACE, Explanation of the procedure, indigence for the procedure, Benefits, Risks, Alternatives, Complications and side Effects of the procedure. I believe that these guidelines were fully complied.Following the taking of a medical history and completion of a further in-depth wellness check questionnaire to ascerta in any condition or reason to which sedation would be contraindicated such as elderly patients who may have fundamental co-morbidity and even in younger patients, the presence of heart disease, cerebrovascular disease, lung disease, liver failure, anaemia, shock and morbid obesity (BSG, 2003). It became evident that sedation would be an option. I explained to the patient that a nurse would be with him continuously throughout the procedure and would encourage him to breathe through any discomfort he may feel, or to push some of the air out of his bottom to absolve any pain. The patients blood shove, pulse and saturations were taken and all were within satisfying limits. This provides a good baseline of the patients observations for the procedure itself and can determine any changes that may occur as a result of the cardio or respiratory depression that may be induced by sedation. Pascarelli (1996) states that during the procedure, the nurses primary function is to monitor the pa tients vital signs along with communication with the endoscopist, administration of medications and emotional support to the patient. Clarke (1994) warns that patients who undergo invasive procedures are usually anxious and their vital signs are commonly elevated however the sedation lessens the anxiety, and all of the vital signs descend therapeutically to that patients resting level.The sedation of choice in my workplace is intravenous midazolam. Midazolam is a benzodiazepine reputedly well suited for use in endoscopy. It has an amnesic affect causing a reduction in memory recall. Clarke (1994) agrees verbalism that the goal of IV conscious sedation is some stage of amnesia. Patients will occasionally remember some parts for example, the initial introduction of the colonoscope. It is for this reason clear written discharge instructions are given to the patient prior to discharge, with a contact telephone number in the termination of any problems and this was explained to the p atient. Sedation may be indicated for many reasons. In the main these may include allaying of fears regarding a procedure, and aims to facilitate compliance with repeat procedures as a result of the amnesic affects induced. In many slips it assures co-operation and eases difficulties for the endoscopist and generally provides a rapid, safe return to the normal activities of daily living.The patient was asked to undress from the cannon down and to put on the gown provided. When the patient was ready he was taken by myself into the procedure room and introduced to the endoscopist and the appointed staff nurses where the issues of consent and sedation would once more be discussed with the patient as it is the endoscopists ultimate responsibility.Throughout the experience, I felt that several important issues had been highlighted. One issue is that of the booklet that is sent out to the patients prior to the test. I believe that someone patients perspectives regarding the effects of sedation may vary greatly, from a mild sedative to a general anaesthetic. I conclude this to result from the individual reading of patient information received and relatives and friends natural endowment a distorted name of their own experience due to the amnesic affect of the sedation. I would encourage good effective communication skills are paramount in allaying misconceptions and fears and the giving of a realistic overview is therefrom essential.It was clear that there needed to be some improvement of the explanation of conscious sedation as I felt that is merely skimmed the surface explaining that the option of sedation was there and that there needed to be someone to escort the patient home and stay with them overnight. I felt that it needed to be clearer in the fact that it demand to mention that the patient will not actually be anaesthetised and furthermore that amnesia is a common side effect from the sedation given. This has subsequently been mentioned to the ward s ister and the booklet has been updated to clarify conscious sedation.mayhap one of the most obvious issues is that of the attitude of the other nurse. The BSG (2008) state that the patient must not be put under any pressure and have sufficient time to digest the information in order for consent to be valid. I felt that the attitude of the nurse in question did put pressure on the patient and caused further anxiety for the patient. I felt that the nurse spoke to the patient in a degrading way and showed a lack of professionalism. The Nursing and Midwifery Council (NMC 2008) state that nurses must treat quite a little as individuals and respect their dignity, must not discriminate and must treat people kindly and considerately. This was not the case in the above example.The Equality and Human Rights Commission (2008) state that no matter your circumstances you should always be treated fairly and with respect when using healthcare services. The Department of Health (2008) cite the UK Human Rights Act in their guidelines about human rights in healthcare when they state that people have an absolute right not to be treated in a degrading way. This means that it is unlawful for the NHS organisations to act in a way that is incompatible with the human rights act. Endoscopy nurses and indeed all NHS staff should be work outing about their practice and how their response to a situation may impact on a patient or clients human rights. If the patient had chosen to complain (as he said he was going to do) about the nurses attitude towards him, then the nurse may have well been in trouble.This experience has made me question my future practice as a registered nurse and how I would deal with a same situation. Arnold and Boggs (2003) suggest that an advocate is someone who lectures out supporting a person so that their views are heard and their rights are upheld, with the sole purpose of maximising the patients health. I was not assertive as I did not defend the patient a nd therefore did not fulfil my duty of care by becoming an advocate for the patient, ensuring he was treated with dignity and respect. I was worried about what may happen if I challenged the nurses practice. I need to develop my assertiveness and be able to communicate confidently and effectively with both patients and health care professionals. It is quite easy for a nurse to be an advocate for the patient when there is no stress involved but it can be quite difficult when it goes against other health professionals (Kendrick 1994). In this instance there was a conflict between the patients best interest and my fear of challenge the nurse. If I had been a more experienced nurse on the endoscopy unit and known the nurse involved in this situation better, I think I may have been able to foresee her reaction to the patient and perhaps may not have approached this particular nurse or used my communication skills together with advocacy to diffuse the situation.Gates (1994) states advoc acy is one of the main responsibilities nurses have it is part of communicating on behalf of the patient and/or their families, acting as a mediator to express their needs and experiences. In health care, communication is fundamental to promoting the safe and effective care of patients. The Department of Health Knowledge and Skills Framework (KSF) (DoH 2004) is a competence textile to support professional development and career progression through the NHS and is about lifelong learning. It has core dimensions essential to providing quality care. Core dimension 1 (level 4) is concerned with communication. It states that the purpose of communication may include advocating on behalf of others. In order for me to progress as a nurse on the endoscopy unit I need to be familiar with and work within the KSF and other guidelines.On reflection, I feel that I did communicate with the patient well. smith (1995) proposes that reflection does not necessarily entail an incident that was dramati c or negative it could easily be something positive that a person finds they obtain valuable learning experience from. Communication with the patient has to be one of the most important aspects of nursing care. An integral part of this process is the way a nurse should use and understand body language (Wilkinson 1991). It is as vital a part of the communication process as verbalise and should be treated as such. Body language can puzzle all human emotions either consciously or not and can show a persons true feelings regardless of what they have said (Pease 1984). I could tell by the way that the patient was communicating non-verbally that he was anxious. His nervus facialis expressions and posture showed the classic signs of someone being anxious (Teasdale 1995). Seeing this, perhaps I should have explained to the nurse beforehand that the patient was anxious so that she may have acted with a bit more respect towards the patient. It is clear that good clear communication skills can improve patient propitiation and compliance, thus reducing anxiety.I believe that during the admitting process with the patient I did actively discuss the procedure with the patient. I felt that I gave the patient opportunity to ask questions and allay any fears he was harbouring. I sat beside the patient and spoke to him about the procedure in an informal and pleasant manner, giving him opportunity to voice any concerns that he had. I believe that the patient is at their most vulnerable and anxious upon entering the endoscopy unit and some encouraging reassurance makes the patients experience less of an ordeal. It is my opinion that an assessment of a patients personality and level of understanding regarding consent and sedation enables the development of a communication strategy accordingly thus providing a sound cognition of the test, sedation offered and therefore informed consent.This essay has allowed me to reflect upon my own practice and how I should have acted differen tly by standing up for the patient at the time, not allowing my own lack of confidence to prevent this. I understand that the care of the patient is my first concern and that I must work with others as a team to protect and promote the health and wellbeing of those in my care (NMC 2008). Perhaps with this understanding, I will be less anxious about felling inferior around other professionals. I will articulate my professional judgement given a similar situation, using what I have been taught which is the best evidence based practice to rationalise my reasons for questioning their practice. I will aim to develop my assertiveness (as I realise that assertiveness does not come naturally to me) to speak out in the interests of the patient, whatever the situation. I will develop my world power to communicate with both patients and other professionals to offer them the opportunity to rationalise their own care delivery and reflect upon it. I believe these actions will upgrade my profess ionalism and promote best practice, in the interest of the patient.I had chosen to focussing on communication and advocacy as these are areas in which I feel I need to work on. Gibbs (1998) reflective cycle was used in this assignment because it is a familiar tool that I have found to be useful and uncomplicated. Learning from an experience and then reflecting on that experience is an excellent way of improving the skills in my chosen profession (Kolb 1984). From my own personal point of view, I went into this assignment with some degree of emotional imbalance for the fact that I did not speak out for the patient but now I feel that I have gained in several areas. I feel my reflective skills have increase and with it my confidence regarding tackling such situations again. Also I feel more relaxed with the stem of reflecting uncomfortable incidences because I can see the benefits in doing so.