Reflection | Percutaneous Endoscopic Gastrostomy (PEG)

Reflection | Percutaneous Endoscopic Gastrostomy (PEG) This reflective essay describes my experience in achieving my learning outcomes pertaining to care of percutaneous endoscopic gastrostomy (PEG), giving feed through PEG and administration of medicines through PEG that I have taken as part of the Overseas Nurse Program. It flows as a reflective practise as it incorporates the concept of learning. According to Bolton (2010) reflective practise involves utilising practical values and theories which influence everyday actions, by examining contemplatively and unreceptively geared towards developmental insight. Therefore, experience only does not lead to learning but deliberate reflection on the experience is essential. Consequently, to further discourse my understanding and involvement with this concept, I have adapted on a certain framework of reflection. I have chosen David Schon’s Model of Reflective Practise to reflect on my experience. I directed this framework on my experience because it enables me to recapture the events in a manner 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 building new perspectives and understanding of doing things in relation to PEG. Schon’s model (1983) is focused on two major concepts, reflection-in-action and reflection-on-action. In the reflection-in action activity, reflection happens while in the act of doing the task (cited by Killion and Todnem, 1991). Reflecting-in-action requires me to think on my feet, be able to work instinctively by drawing on similar experiences to solve problems or make necessary decisions. It invol ved looking to my experiences, connecting with my feelings, and attending to the theories and principles in use. It entailed building new understandings to inform my actions in the situations 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 assigned together with my mentor in one of the patients in the unit who has percutaneous 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 home country. She told me that in United Kingdom normal saline is used to cleanse the PEG site 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 (using antiseptic solution for disinfection), I stood up and followed 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 another incident where reflection-in-action occurred that became my second learning outcome happened when we have to give a feed through PEG. All the while I was expecting an asepto syringe to be used to deliver the feed to the patient but to my surprise my mentor got this special set attached on what she called a Kangaroo pump to deliver the feed at a desired rate and paced time (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 observe how my mentor did all the attachments from the Kangaroo pump up to the PEG tube, but rather 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 pump which she gladly did to me. I was really surprised with the whole process and needed a reflection to establish my competence with this new process of giving PEG feed to patients. In the last incident that happened that became my third 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 same patient who got a PEG. We are giving an Aspirin dose for this patient and all we’ve 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 pharmacy an effervescent form of Aspirin. And that’s where reflection-in-action occurred wherein I have to think of a solution on how not to breach the standards of safe medicines administration in the United Kingdom. Instead of crushing and giving it to the patient, I asked my mentor about 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 Schon’s model what I felt when those incidents happened was part of the learning process. Schon (1983) gives further information 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 have 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 placement in relation to my three learning outcomes, I have done 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 based the lapses I made on evidences I have come across 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 home 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 antibacterial 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 chlorhexidine would increase the risk of microbial invasion and growth, which may precede to sepsis. Furthermore, the work of Sibbald was strengthened 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 human tissue. Thus, the practice of using normal saline in cleansing the PEG site was evidence-based practice and I have fully get an excellent 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 feeding rather than continuous 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 selection gives incremental increases in delivery which is very essential in critical care settings where low infusion rates are vital in maintaining the integrity of the gut and where maximising the feeding volume are fairly 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 out 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 prevent aspiration in critically ill patients. Furthermore, the jejunum produces fluid in conjunction 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 many 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 through issues and apply your professional 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 with in the scope 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 familiar 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 improve 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 complicated at first but after the reflection process and supervision 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 thinking will help me in my decision-making and if I was able to observe the six rights of medication administration. As a future plan, I need to project 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 foremost 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 provided me with basis 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 turned to acquisition of new knowledge and concept that became an enriching experience for me.

Excellence Is Not an Accomplishment

Topic No. 1: Excellence is not an accomplishment. It is a spirit, a never-ending process. A very famous line by Lawrence M. Miller. In order to develop excellence as a leader we must be willing to acknowledge that developing it is not an accomplishment – it's a never-ending process. It's a process full of many awesome moments and many lonely days. It's fun and exciting one day and then the next day we wonder why we ever wanted to lead in the first place. Many of us secretly fantasize about being a greeter at Walmart or on any other platform .Being a leader isn't easy – it requires commitment for the long haul. It's not something we can just accomplish and then move on. Being a leader requires hard work, sacrifice, commitment and a willingness to grow ourselves. The leaders I admire most are the ones who give selflessly of themselves and make personal development a priority. I can not give of myself as I leader if I do not first take care of myself. Great leaders balance personal development and organizational development.Both are important and one without the other does not work. As I have observed great leaders, I find they all have some things in common. â€Å"Be a yardstick of quality. Some people aren't used to an environment where excellence is expected. † ~ Steve Jobs Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence, but we rather have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit. ~ Aristotle

The Basic Facts of Persuasive Essay Topics Sports

The Basic Facts of Persuasive Essay Topics Sports What You Should Do About Persuasive Essay Topics Sports Starting in the Next 8 Minutes Children should have the ability to use cellphones in school. Kids ought to be able to vote. Pets help to lessen stress levels. They should be allowed in school. New Ideas Into Persuasive Essay Topics Sports Never Before Revealed There's no limit to what you are able to write about sport, and there are a lot of perspectives that you might be requested to employ. The social issues linked to sports ought to be the obligation of the sports management and not players. Your choices are endless. In fact, it's called soccer just in the USA and the remainder of the world calls it football. The incredible thing about sports is there are so many. It is possible to be subjective about sports generally or specify on a specific sport. Choose a sport and argue that it's the ideal sport. Persuasive Essay Topics Sports Help! The thesis will reveal the reader precisely where you stand. There are several persuasive essay topics to select from to finish your high school or college assignment. Some students might find it difficult to compose an essay since they have not done it before or since they aren't aware with a specific structure. Persuasive essays are one form of essay that will be easily applied to the subject of sports. A persuasive essay ought to be thoroughly based on cold-hearted arguments, even though it might interest emotions also. Overall, you can observe that writing a persuasive essay isn't a brain surgery. Always bear in mind an ideal persuasive essay ought to be persuasive. When it has to do with sports, picking a topic can be an enjoyable undertaking or it may be a nightmare waiting to occur. On the flip side, it can become an intimidating task, especially whenever you're not sure whether your choice is good. Sure, with this kind of an enormous number of topics to pick from, picking just one may be challenging. Freedom of choice is excellent. You got a couple of ideas during the brainstorming process, so hunt to learn more about them. The matter of athletic fitness ought to be dealt which much more strictness. On the flip side, if you decide on a tough topic then your capacity to fill out the work will be much harder. The Debate Over Persuasive Essay Topics Sports If you're given an essay on the topic you can have hundreds of events to select from such as curling to polo. Although having the ability to write persuasively can look like a tricky thing for children to learn, remind them that everyone has valid opinions. The very first thing you've got to realize searching for an ideal topic is that your opinion is the thing that matters the most. Obviously, it's the topics you may have a tiny laugh about! One involves the idea of mental resources to which I have alluded in several different columns, regarding reading and mathematics together with writing. Our qualified academic experts will help you to find an ide al persuasive essay topic according to all of your requirements and compose a custom-tailored model answer. Students are accustomed to the simple fact which their professors give them with the assignment's topic. You, naturally, search for other topic examples. For this reason, you've got to come across enough substantial evidence for the specific topic. When you're choosing an essay topic, it's important to select one that has a lot of information and statistics to strengthen your standpoint, nor exaggerate any info you have chosen to write about. Take notes concerning all prospective topics you'll be able to consider. You could be requested to approach a sports essay from a number of perspectives. Typically, you wouldn't have the ability to write about a whole sport in only 1 essay even when you wished to. When you have topics to pick from, it is essential that you choose one which you can write about comfortably. With our pool of writers, you will have plenty of essay topics on sports to select from. Students ought to be permitted to pray in school. School tests aren't powerful. Children should be asked to read more. They should not be allowed to play computer games. It may b e intriguing to talk about the significance of sports in student's life and handle a few of the problems that college students face in college. Though people believe education is a correct and will make society, generally, a better place for everybody, others feel there's no legitimate way to provide a free college education as colleges would still have to be funded (likely through tax dollars). All students need to have a year studying abroad. Many students think that it is a waste of time.

The Mindset Of The Racist South - 879 Words

In order to understand where the mindset of the racist south, you need to have an understating of the ideas of White supremacy and what it is pulled from. The Groups that formed from the ideals of white supremacy. White Supremacy, the idea of a racial group being better than others. The idea was born when the British started expanding westward. One thing that is was a big part of white supremacy is that people were categorized. They were categorized by skin color, head shape, religion, and education. People may think that the ideas of white supremacy did not start with the birth of the US. In reality all of these ideas and ways of life were pulled from theories and facts that at that time were concrindred to be factual. What they pulled†¦show more content†¦With the laws put into place and the southern feeling that the north is not respecting them after they lost the war. The white south responce to the freed slaves and their rights was to form groups who would scare them and their white supporters. The groups that rose from the ashes of the destroyed south were know as terrorist groups. In response to the new laws the major white supremacist group that formed was the Ku Klux Klan, the KKK were the main group who cause the most pain for the freed black and their supporters. To understand why they did what they did you need to know how they started. They were formed the winter of 1865 by six retired Conferdit shoulders. They form this group in the town of Pulaski, Tennessee, when they were forming they had to decide on what to be called. This is when KKK came to be, the KKK went for the name because of the meanings of the words. Ku Klux was pulled from the greek word of kuklos that has a meaning of circle brotherhood, and klan meaning family. When they first started they were a peaceful group, what they would do is get into their white clothes and walk the street at night and say they were the ghosts of dead confederate soldiers. Thats is why their uniform is the way that it is. There was more than one way to tell if a white southerner was in the KKK. Along with the uniforms they had they also used secret handshakes. All of the main members were past confident