Reflective Essay on Subcutaneous Injection as Clinical Teaching

This reflective essay discusses the author's experience in demonstrating clinical teaching on the correct procedure for the application of subcutaneous injection in a patient within a clinical setting. The author uses the Gibbs reflective cycle to describe their experiences and how it has helped to enhance their professional practice. The essay also covers the importance of hand hygiene, proper disposal of the injection to prevent needle stick injury, and the need for prior teaching before a live demonstration. The author also provides an action plan and recommendations for future clinical teaching.

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Running head: REFLECTIVE ESSAY
REFLECTIVE ESSAY
Name of student:
Name of university:
Author note:

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REFLECTIVE ESSAY
Reflective essay
Topic- : subcutaneous injection as my clinical teaching
In this self refelction essay I will use the gibb’s reflective cycle to describe my experiences
and how the experience have affected me and have helped me to learn to enhance my
professional practice and how the experience had been useful in my clinical teaching practice.
Description
I was assigned to demonstrated clinical teaching activity before my peers about the
correct procedure for the application of subcutaneous injection in a patient within a clinical
setting. It has to be mentoned that clinical teaching was being performed within a real life
clinical setting with a real patient (Mayhall, 2012). A subcuranous injection is normally used
for administering anticoagulants like heparin or insulin. Since I was demonstrating my
clinical teaching skills, I made it sure to mention the types of medications that are notrmally
administered subcutaneously. After that the patient was brought to the room where I have
arranged all the equipments required for the administration of the subcutaneous medicine. I
greeted the patient cordially and informed him about the medicine that has to be administered
(Cassileth, Zupkis, Sutton-Smith & March, 2012). I provided enough scope for my peers to
get a view of the entire procedure. One of them was also making a video recording for the
future evaluation. The patient had an abdominal surgery and thus chose her arm for the
administration of the injection. I chose an appropriate needle for the administration of insulin.
I performed hand hygiene techniques before the administration of the medicine. The upper
hand was chosen as the site of injection . appropriate size of needle was chosen or the
application of medicine. I made it sure observe the previous sites of the injecton. Rotation of

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REFLECTIVE ESSAY
the injection site is necessary to prevent scarring. Howver, I held the syringe uprighy and
pulled the plunger down adjusting the dosage of the medicine. I swabbed the injection site
with the help of an alcohol pad. The I slowly injected the medicine in to the skin at an angle
of 45 degree. The plunger is pushed all the way dwn and was held for about 10 seconds. I
released the pinched skin and removed the needle. I finally discarded the injection in a
puncture resistant discard can.
Feelings
Although I have perofmed this procedure for a number of times , but I still felt nevous
while carrying out the procedure, as my demonstraton skills and the teaching techniques
would be evaluated for clinical teaching process and I would also feel a bit embrarrased if
any error occurs in front of my peers. Furthermore subcutaneous medicine administration is
not amechanistic task and has to be done in strict compliance with the prescription and
nursing guidelines. I have always learnt that the administration of an injection skilfully
enables the patient to experience less pain and also prevents unnecessary complications.
SC injection involves deposition of the medicines in to the loose connective tissue
under the epidermis. The rationale for the application of subcutaneous medicines is that these
tissues does not have a rich supply of blood vessels and thus the medicines are absorbed
slowly. Before the application of the injections, some precautions should be taken care off.
The preexixting condition of the patient sould be assessed for preventing the
contraindications, patient prescription charts should be checked for assessing the correct
route, dosage (Jin etc al., 2012).

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REFLECTIVE ESSAY
Evaluation
It can is really difficult to administer injections and explain the procedure at the same
time. Hence, it is necessary to educate the student about the procedure practically before
showing a practical demonstration as it help the learners to relate it to the practical work.
Secondly while adminsitating the injection I forgot to pinch the skin slightly. It was a mistake
on my part as patient felt discomfort while the injection administration and there was a minor
bleeding occurring . I felt that for such a mistake the injecton could have been introduced in
to the muscles.
I was mindful about performing the hand hygiene and doing the entire process
asceptically. Nurses are responsible for the correct administration of the medication in an
asceptic technique (Khan, Ahmad&Mehboob, 2015).
The choice of the injection site is entirely based on clinical judgement basd upon the
patient condition and the assessment. Initially I had decided to give the subcutaneous
injection on the abdomen but became mindful that since the patient had undergone an
abdominal surgery, abdomen might not be the ideal site for the application of insulin. While
the application of the subcutaneous insulin, it has to be administered in to the fatty tissues
below the skin as if it is injected in to the muscles, it will be absorvedtooquickily by the body
(Landers, Abusalem, Coty & Bingham, 2012). Apart from this I have talked to the patient for
seeing how she was feeling or if she was comfortable with thw way the inhjection has been
administered , I was delighted to reciebe positive feedback from my patient. Collection of
feedback from patients helps thwe health care professionals to learn the satisfaction level of
the patients, by obtaining suggestions for improving the practicefeedback (Ivers et al., 2012).
After the the clinical teaching process, I have also received feedback from my peers, who
were observing my teaching, who have expressed that I need to work more on my
interpersonal skills t communiacate to the students and the patients easily.

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REFLECTIVE ESSAY
Analysis
According to the Singapore codes of professional standards, it is the duty of the
nurses to provide a safe environment to the patient (Singapore nursing board.2018). I have
realised that in order to become a clinical instructor I have to gain more confidence and
would have to understand what kind of a learner are the students. While performing the
clinical teaching activity in front of the nurses I have realised that a prior teaching class was
necessary before a live demonstration of the activity. This demonstration has helped me to
understand that things like application of the evidence based practice is an important
approach that should be adopted by the nurses to raise their competency skills. This has also
taught me that things like hand hygiene, proper disposal of the injection to prevent the needle
stick injury are extremely important in a clinical setting.
Conclusion
In conclusion it can be said that the overall experience was positive as per the
feedback of the patient and peers. This experience has been special for me as it was my first
simulation in front of my peers and thus being able to reflect and understand my own feelings
about the administration of the injection as well as obtaining the feedback from the patient
and the peers have given me the chance to evaluate the experience, so that my techniques
could be enhanced to provide a better care to the future patients. I believe that I have
developed more confidence which will help me to become a good clinical educator in near
future.
Action plan
From the incident that took place while demonstrating the application of a
subcutaneous injection, I have realised that I need to develop my interpersonal skills and
should gain more confidence while conducting a teaching. I intend to brain storm through the

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REFLECTIVE ESSAY
research journals and articles to develop mote knowledge about the scientific procedures and
the associated guidelines for medication administration. I should also develop my knowledge
against proper learning techniques that would help me to teach my students, patients or peers
in future. Research helps in the application of evidence based skills in nursing (Melnyk,
Gallagher‐Ford, Long&Fineout‐Overholt, 2014).
Summary
In this reflective essay I have discussed about my clinical teaching experience about
the administration of the subcutaneous medicine. I was assigned to demonstrate my teaching
in front of my peers who were recording my performance for the evaluation. I was allocated
to demonstrate the application of insulin subcutaneously to a patient who had undergone an
abdominal surgery. During the entire procedure, I made sure to abide by all the clinical
guidelines of medication administration such as choosing the correct patient, route and
dosage. I have performed the necessary hand hygiene techniques that is required before the
conduction any invasive procedure. I also took consent from the patient before the procedure.
Everything went well except that I forgot to pinch the skin slightly before the application of
injection, which caused a bit discomfort in my patient and the medicine could have been
absorbed in the muscles. I also got a bit nervous while teaching my peers which might have
affected the teaching process. However, I strongly believe that nurse are liable to provide a
safe patient care and should always be mindful about each and every procedure.
Furthermoreself-reflection in this essay will also be helpful to avoid any future mistakes and
to analyse critically what could have been done to avoid the mistake (Mann, Gordon &
MacLeod, 2013).

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REFLECTIVE ESSAY
Recommendations
In clinical teaching the educator should be acting as the role model for the students (In
this case, the peers). He/she should be able to articulate the concept used for the student
assessment and should clearly explain and demonstrate the clinical materials.Hence . befor
the procedure, it was necessary to take a class discussiong about the techniques and the
guidelines for the application of the injections thoroughly and then demonstrate how they can
be used in real clinica; conditions (Ivers et al., 2012). Further more after demonstrating the
subcutaneous injection with the real life student, the students (My peers) can be evaluated by
letting them do the entire procedure on a manikin. In my case I can obtain feedback from the
patient and my peers. As a clinical teacher I should provide the rules targeted to the learner’s
level of understanding. Furthermore, the it is necessary to develop more confidence on my
part and to practice the procedure several times for different situations to gain accuracy.

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REFLECTIVE ESSAY
References
Cassileth, B. R., Zupkis, R. V., Sutton-Smith, K., & March, V. (2012). Informed consent—
why are its goals imperfectly realized?. New England journal of medicine, 302(16),
896-900.DOI: 10.1056/NEJM198004173021605
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., ...&
Oxman, A. D. (2012). Audit and feedback: effects on professional practice and
healthcare outcomes. Cochrane Database Syst Rev, 6(6).
Jin, J. F., Zhu, L. L., Chen, M., Xu, H. M., Wang, H. F., Feng, X. Q., ...& Zhou, Q. (2015).
The optimal choice of medication administration route regarding intravenous,
intramuscular, and subcutaneous injection. Patient preference and adherence, 9,
923.doi: 10.2147/PPA.S87271
Khan, H. A., Ahmad, A., &Mehboob, R. (2015). Nosocomial infections and their control
strategies. Asian pacific journal of tropical biomedicine, 5(7), 509-
514.https://doi.org/10.1016/j.apjtb.2015.05.001
Landers, T., Abusalem, S., Coty, M. B., & Bingham, J. (2012). Patient-centered hand
hygiene: the next step in infection prevention. American journal of infection
control, 40(4), S11-S17.https://doi.org/10.1016/j.ajic.2012.02.006
Mann, K., Gordon, J., & MacLeod, A. (2013). Reflection and reflective practice in health
professions education: a systematic review. Advances in health sciences
education, 14(4), 595.DOIhttps://doi.org/10.1007/s10459-007-9090-2

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REFLECTIVE ESSAY
Mayhall, C. G. (2012). Hospital epidemiology and infection control. Lippincott Williams &
Wilkins.https://books.google.co.in/books?hl=en&lr=&id=y-
wKh8oIdn8C&oi=fnd&pg=PT78&dq=infection+control+while+invasive+techniques
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e&q=infection%20control%20while%20invasive%20techniques%20in
%20hospital&f=false
Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., &Fineout‐Overholt, E. (2014). The
establishment of evidence‐based practice competencies for practicing registered
nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to
improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on
Evidence‐Based Nursing, 11(1), 5-15.https://doi.org/10.1111/wvn.12021
Singapore nursing board. (2018).Nursing guidelines and Standards .Access date: 24.9.2018.
Retrieved from :http://www.healthprofessionals.gov.sg/snb/advanced-practice-nurse