Nursing Assignment: Reflective Analysis of DVT Prophylaxis Performance

This nursing assignment presents a critical reflection on the administration of deep venous thrombosis (DVT) prophylaxis through subcutaneous injection. The reflection follows Gibb's Reflective Cycle, detailing the student's experience with a patient undergoing umbilical hernia surgery. It covers the preparation, procedure, and disposal of the injection, along with the student's feelings of nervousness and subsequent confidence gained through positive feedback. The evaluation highlights the importance of proper technique, including angle and duration of injection, and adherence to aseptic practices. The analysis emphasizes the nurse's responsibility for safe medication administration and the need for continuous learning and skill improvement, referencing NMC standards and evidence-based practice. The conclusion underscores the importance of self-awareness and reflection in identifying areas for growth. An action plan is outlined, including observing role models, practicing proper techniques, maintaining a reflective diary, and seeking feedback to enhance competence in subcutaneous injection skills.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author note

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Description
I was assigned to a patient named Antonio who underwent the umbilical hernia surgery
and is prescribed by the physician for the administration of deep venous thrombosis prophylaxis.
I was working with the patient for postoperative care and was supposed to give medication
through subcutaneous injection. Medication involves anticoagulant heparin 5000units as
mentioned in the patient’s drug chart (ampules contained 25000units/ml and volume 0.2 ml). I
had donned my gloves prior to injection, after performing five moments of hand hygiene. Before
injecting I had wiped the skin of the patient with alcohol and left for 30 seconds to dry. After
injecting on the abdomen through syringe I had kept it for less than 10 seconds. Later I have
disposed the injection without re-sheathing. I had pre-planned the steps to be followed and was
mindful enough to follow the guide. Therefore, I could well perform the given assessment, even
though nervous initially.
Feelings
Before performing the skill I was too nervous. I had administered the injection too quick
as per my peer feedback. It may be because of my nervousness. It made me feel anxious about
the outcome of the injection on the patient. It made me doubtful about the impact of the
medication, on the recovery of the patient. Heparin was important for the patient as it prevents
the harmful blood clots inside the veins after the surgery. Proper medication administration
ensures a smooth blood flow through the vessels (Pourghaznein et al., 2014). If I had not injected
properly, the blood clots would remain in the veins, causing post operative complications.
Learning this skill was important for me as it was an integral part of my profession as per the
“nursing and midwifery council's (NMC) Standards for Medicines management”

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(Nursingmidwiferyboard.gov.au, 2018). However, I regained my self-confidence as I have
received positive feedback from my teacher. As per his feedback my injecting skill was very fast
and I have performed the assessment very well. I was confident while performing the assessment
according to my teacher. I plan to be more confident next time. I believe the positive outcome
was due to adherence to clinical guidelines.
Evaluation
The positive outcome of the skill assessment is the learning the right technique of the
administering medication subcutaneously. Mastering the skill requires professional judgment and
sound knowledge of anatomy. It worked well as I have learnt about the four considerations while
injecting the medication. It includes technique used, route of administration, equipment used and
site of administration (Pourghaznein et al., 2014). I had used 45 degrees angle and introduced the
needle at raised skin fold. However, to ensure the efficacy of medication in subcutaneous layer,
90 degree angle is preferable (Cross et al., 2017). I have performed well because the wiping skin
with alcohol ensured aseptic technique. Immediate disposal of injection was necessary to prevent
needle stick injury and exposure to blood borne infections (Pourghaznein et al., 2014). However,
I should have kept the injection for 10 seconds before removing. This aspect did not work well
although administration was successful.
Analysis
As I was analysing the future practice needing this skill, I had realised that the nurses are
responsible for safe medication and adopting the right injecting skills will prevent complications.
A poor competence of this technique may lead to intramuscular administration of the injection
and reduced absorption of the medication (Pourghaznein et al., 2014). I realised that I need to

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master this skills even more and required further practice. It is because; I am responsible to
adhere to NMC Standards for Medicines management (Nursingmidwiferyboard.gov.au 2018).
Nurses can make rational decisions using evidence based practice. Nurses must continue with
lifelong learning to know what is safe for patients (DiCenso, Guyatt & Ciliska, 2014). Therefore,
I should also learn the right technique of injecting the medicine such as the appropriate angle.
The patient’s history may influence the injection decision. It includes body mass index, renal
impairment, age, sex and presence of any other comorbidity. The past medication related factors
and single checking of medicine must also be considered (Cross et al., 2017). According to
Pourghaznein et al. (2014), there is a direct relation between the injection duration and injection
site on “pain and bruising” of subcutaneous injection of heparin. Therefore, duration is an
important factor for injection.
Conclusion
In conclusion, I need to change my learning style for new experiences and flourish on
new challenges. Understanding the personal learning style will help develop the learning ability
and partake in new opportunities during placement (Hallin, 2014). I need to identify my personal
strengths and weaknesses as a nurse. It was because of this critical refection that I have identified
the need of improved competence in subcutaneous injection skills in regards to duration of
injection, the need to consider appropriate degrees of angle for injection, and other patient elated
factors. Without reflection it would not have been possible to understand the importance of
considering these factors for injection.

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Action plan
I would improve my learning by observing role models as suggested by Liljedahl et al.
(2016). I would observe my mentors carefully before taking my turn on injection activities. I
would practice injecting the medication for 10 seconds and use an angle of 90 degrees. I will
maintain a reflective diary to evaluate my performance, strengths and weaknesses as nurse. I
would also collect feedback from my mentors and peers, on my improvement in this skill.
According to Horton-Deutsch & Sherwood (2017) nurses can become experts by reflecting on
personal clinical encounters. It is useful to improve practice. Thus, I would learn safe medication
practice and injection style. My strategy is to go for experimental learning as it is the strategic
approach to learning while in clinical placement (Pai, 2016). Therefore, I would like to work
with different patients and try to overcome my nervousness. It would increase my confidence for
future practice. I would collect feedback from patent on affect of my injection such as pain or
any discomfort (Pourghaznein et al. 2014).

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References
Cross, R., Bennett, P. N., Ockerby, C., Wang, W. C., & Currey, J. (2017). Nurses’ Attitudes
Toward the Single Checking of Medications. Worldviews on Evidence
‐Based
Nursing, 14(4), 274-281. DOI: https://doi.org/10.1111/wvn.12201
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences. Retrived from:
https://books.google.co.in/books?
hl=en&lr=&id=bHqjBQAAQBAJ&oi=fnd&pg=PR29&dq=Nurses+can+make+rational+
decisions+using+evidence+based+practice&ots=M3HmIgBoYM&sig=c7gNVbCJHJMl7
rxy5FbXRJFw270#v=onepage&q=Nurses%20can%20make%20rational%20decisions
%20using%20evidence%20based%20practice&f=false
Hallin, K. (2014). Nursing students at a university—a study about learning style
preferences. Nurse education today, 34(12), 1443-1449.
DOI: https://doi.org/10.1016/j.nedt.2014.04.001
Horton-Deutsch, S., & Sherwood, G. D. (2017). Reflective practice: Transforming education and
improving outcomes(Vol. 2). Sigma Theta Tau. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=JMcmDwAAQBAJ&oi=fnd&pg=PP1&dq=nurses+to+follow+reflective+
practice&ots=kpKQx7Rqf4&sig=FCHWvaoAfHkP3yMXT0_yukjS--
4#v=onepage&q=nurses%20to%20follow%20reflective%20practice&f=false

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Liljedahl, M., Björck, E., Kalén, S., Ponzer, S., & Laksov, K. B. (2016). To belong or not to
belong: nursing students’ interactions with clinical learning environments–an
observational study. BMC medical education, 16(1), 197. DOI:
https://doi.org/10.1186/s12909-016-0721-2
Nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia - Professional
standards. [online] Nursingmidwiferyboard.gov.au. Available at:
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx [Accessed 25 Jan. 2018].
Pai, H. C. (2016). An integrated model for the effects of self-reflection and clinical experiential
learning on clinical nursing performance in nursing students: A longitudinal study. Nurse
education today, 45, 156-162. DOI: https://doi.org/10.1016/j.nedt.2016.07.011
Pourghaznein, T., Azimi, A. V., & Jafarabadi, M. A. (2014). The effect of injection duration and
injection site on pain and bruising of subcutaneous injection of heparin. Journal of
clinical nursing, 23(7-8), 1105-1113. DOI: https://doi.org/10.1111/jocn.12291