Detailed Reflection on OSCE Venepuncture: Nursing Practice Analysis

This report presents a detailed reflection on a student's experience performing a venepuncture during an OSCE (Objective Structured Clinical Examination). The student describes the procedure, including patient interaction, equipment preparation, site selection, and blood sample collection. The reflection uses Gibbs' reflective cycle to analyze the experience, identifying both successful aspects and mistakes made, such as omitting informed consent and hand hygiene steps. The student evaluates their performance, highlighting areas for improvement, and provides an in-depth analysis of the importance of each step in the venepuncture process, referencing relevant literature. The report concludes with an action plan that focuses on building confidence, staying updated on best practices, and enhancing patient communication to improve future performance and ensure patient safety. The student emphasizes the importance of ethical considerations, such as informed consent, and professional standards in nursing practice.

Running head: REFLECTION ON OSCE VENEPUNCTURE
REFLECTION ON OSCE VENEPUNCTURE
Name of the Student:
Name of the University:
Author Note:

1REFLECTION ON OSCE VENEPUNCTURE
Description
Venepuncture and obtaining blood is an important procedure in the health care and can
assist in the diagnosis, treatment and care of the patient (Brooks, 2017). During my placement in
the X hospital I was assigned to carry out the procedure of venepuncture from a patient. As I
entered the room of the patient, I greeted the patient cordially and confirmed the patient
identification by tallying the full name, the DOB and the hospital number. After that I explained
the rationale for the procedure to the patient and also informed him about the possible risks. I
went through the past medical history of the patient. In the treatment room I prepared the
equipment such as the tourniquets, needles, blood bottles, chlorohexidine, and cotton balls on an
equipment trolley. I made it sure to decontaminate the hands with warm water and soap before
touching the equipment. Once I was at the bed side of the patient, I positioned the arm of the
patient under a pillow with the inco pad. I applied the tourniquet, selected the suitable vein,
removed the tourniquet and cleaned the site with an alcohol swab and allowed to air dry. Again
applying the tourniquet a traction is placed on the skin below the site of the puncture, the needle
is inserted and with the bevel at an angle of 30 degree (Gabriel, 2012). The sample bottles are
attached in turn to fill up to the required level and inverting each bottle once after the filling. The
tourniquet is released, a cotton wool is placed over the puncture site and the needle is withdrawn
slowly. The needle is disposed off in the sharps bin (Brooks, 2017). Direct pressure is applied
over the site for a minute and was secured with the help of a tape. Ensuring the patient is
comfortable, I removed my gloves and decontaminated by hand once again. Finally I thanked the
patient and left the bedside.

2REFLECTION ON OSCE VENEPUNCTURE
Feeling
Although phlebotomy is a very basic procedure, but errors in phlebotomy might lead to
repeated sampling and delay in the diagnosis and might also jeopardise the safety of the patient. I
was a bit nervous about the procedure as I had to perform this in front of my supervisor.
Although I was well aware of each of the steps as I have performed them repeatedly with a
mannequin but situations becomes complex when you are dealing with a real patient. I was
anxious that I might not get the perfect vein or I might miss the hand hygiene steps, or I might
forget to ask for consent from the patient. Inappropriate insertion of the needles might cause pain
to the patient (Brooks, 2017). Hence I was a bit perturbed about the perfect choice for the
insertion site. Initially I was having a problem in finding an appropriate vein; hence I thought I
might have attached the tourniquet in the wrong place.
Evaluation
One of the mistake that I have conducted in this procedure that although I have informed
the patient about the procedure but have skipped the etiquette of obtaining consent from the
patient before touching him for the collecting the blood samples. Another major mistake that I
have performed during the procedure is that, I have maintained the five moments of hand
hygiene before arranging the equipment but missed it when I was at the bedside of the patient.
Right after the mistake I realised that I have missed such an important step. This can be due to
the fact, that I was very nervous during the procedure. However, I believe that I need to develop
more confidence while carrying out such procedures as being forgetful or nervous might
jeopardise with the safety of the patient. Nevertheless, I believe that other than these two steps, I
correctly conducted the procedure starting from interacting with the patient, selecting the
appropriate vein, application of the tourniquet to drawing of blood. I was also mindful about

3REFLECTION ON OSCE VENEPUNCTURE
disposing off the sharps in puncture proof containers. Improper disposal of sharps might lead to
transmission of nosocomial infections (Elhassan & Dixon, 2012).
Analysis
While conducting the procedure, I have learnt one thing that no matter how competent
you might be or how many times you have performed this technique, one should be careful as
each of the steps has got some rationale behind it. For example, informed consent is an essential
step in nursing involving the preservation of the patient integrity and dignity by disclosing all the
information about the treatment (Hughes, 2012, Kinnersley et al. 2015). Again 5 moments of
hand hygiene is an important step to avoid infections at the injection site or transmission of
infections within the health care staffs (Elhassan & Dixon, 2012).
Site selection for the process of venepuncture is an important aspect as inappropriate site
selection might lead to inappropriate collection of samples. The optimal site for conducting the
venepuncture is the antecubital fossa- the cephalic, basilica and the median cubital veins
(Buowari, 2013). Furthermore holding the needle at 30 degree also ensures correct insertion of
the needle in to the vein.
I believe that I had been mindful in informing the patient about the risks as this can give
rise to infections or hematoma or phlebitis (Elhassan & Dixon, 2012). I believe that that I had
rightfully checked the past medical history of the patient as venepuncture might bring
complications for blood clotting disorders, arterio-venous fistula or lymph node removal
(Buowari, 2013).

4REFLECTION ON OSCE VENEPUNCTURE
Conclusion
Using the Gibb’s reflection model has allowed me to analyse the event thoroughly and
discover my feelings. As per the findings, and despite the evidence being updated constantly,
health care professional’s knowledge is always not updated. Even the nurses are governed by the
policies more than current evidences. I have also learned that what might look to be simple also
requires detailed concentration and what I was doing correctly might not be the case always.
Action plan
Analysing my strengths and the weaknesses I have realised that I should develop my
confidence level more in order to avoid the avoidable mistakes in the procedure. I believe in
lifelong learning and hence intend to remain updates in every possible ways about the current
guidelines about phlebotomy and application of intravenous medications, the probable risks that
might arise and would learn to understand their pathophysiology or the way those conditions
could be avoided. I will also participate in active communication with the patient throughout the
procedure in order to keep him/her distracted. A nurse should have a clear understanding of the
different ethical codes of ethics and professional standards in order to avoid that breach of the
ethics like informed consent, patient advocacy, self-reflection to enhance the skill of clinical
reasoning and critical thinking (Glen, 2017). A nurse should be able to keep the interest of the
patient in the first place throughout his/her professional career (NMC., 2016). I intend to handle
more critical cases in future to improve my professional practice.

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References
Brooks, N. (2017). Venepuncture & Cannulation: A practical guide. M&K Update Ltd.
Buowari, O. Y. (2013). Complications of venepuncture. Adv. Biosci. Biotechnol, 4(126128), 38.
Elhassan, H. A., & Dixon, T. (2012). MRSA contaminated venepuncture tourniquets in clinical
practice. Postgraduate medical journal, 88(1038), 194-197.
Gabriel, J. (2012). Venepuncture and cannulation: considering the ageing vein. British Journal
of Nursing, 21(Sup1), S22-S28.
Glen, S. (2017). Problem-based learning in nursing: A new model for a new context. Macmillan
International Higher Education.
Hughes, T. (2012). Providing information to children before and during venepuncture. Nursing
Children & Young People, 24(5).
Kinnersley, P., Phillips, K., Savage, K., Kelly, M. J., Farrell, E., Morgan, B., ... & Blazeby, J.
(2013). Interventions to promote informed consent for patients undergoing surgical and
other invasive healthcare procedures. The Cochrane Library.
NMC., (2016). Standards of proficiency for registered nurses.Access date: 5.10.2018. Retrieved
from:https://www.nmc.org.uk/standards/standards-for-nurses/