Reflection of nursing practice: injection administration

In this essay I intend to reflect upon the first time I administered an injection. To assist me in the process of reflection I will use De Bono’s Six Thinking Hats (1985) methodology of thinking. Although, traditionally, this method is used in business and management, I feel that it is applicable to nursing as it has enabled me to dissect my thinking. De Bono suggests that we need to practice deliberate thinking as opposed to reactive thinking if we really want to progress ideas and reach sensible conclusions (1985). It was with this in mind that he devised the six thinking hats.

The six thinking hats each have a different, significant colour and indicate different thinking processes. The white hat stipulates stating the facts. The red hat states thinking of emotions and feelings. The black hat is identification of error whilst the yellow hat is identification of the positive aspects of the event. The green hat is an opportunity to think about what has been learned from the event. Finally, the blue hat allows you to evaluate the event and state how you would do things the next time. In this written discussion I will ‘wear’ each hat to enable me to reflect upon and unpick the event.

The white hat is concerned with the facts of the event. I was asked to administer a vitamin b injection. It was an intramuscular (IM) injection, administered into the arm of an 86 year old lady. This was the first time I had ever given an injection. I asked for background knowledge on administering an injection and the nurse stated that talking me through the event would be sufficient information. A qualified nurse had already drawn up the drug. I was observed throughout by two registered nurses, and one talked me through the technique. There was also another student nurse present. The nurse stated that I had inserted the needle just a little bit too slowly, she suggested that, next time, I use a controlled thrust, similar to a dart throwing action.

The red hat allows you to explore the emotions and feelings experienced prior to, during and after the event. I was excited at the prospect of administering my first injection and was fairly confident that I would be able to do so safely. But at the same time I felt very nervous. I felt under pressure having three people watching me. When I was handed the syringe, I suddenly felt very daunted. I felt that I was hugely responsible and was very aware that I could cause a lot of damage if I made any mistakes, and I was concerned that I could cause pain to the patient. This latter thought completely wiped out the confidence I had felt just moments before. Immediately after I had administered the drug, all I felt was relief that it was over and done with. I was disappointed that I had inserted the needle too slowly and wished that I had had the opportunity to practice on an inanimate object. I felt guilty that I had possibly caused more pain than necessary.

The black hat is a negative assessment of the event. I think that I went into the event without having had enough preparation, as I had no knowledge on safe injection techniques. I have since read several articles on this topic and feel that I am more aware of what is involved when giving an IM injection. I think that there were too many people present whilst I was giving the injection as this put me under immense pressure and added to my nerves. The biggest mistake I made was inserting the needle too slowly. With an IM injection it is paramount to enter the skin firmly with a controlled thrust (Workman 1999).

The yellow hat allows you to speculate positively on the event. I think that on the whole I administered the injection fairly well, considering it was my first time. Things that I did particularly well include communicating with the patient, informing them of the procedure in order to prepare them and enable them to participate where necessary. Also, following insertion of the needle, I aspirated the syringe. Hemsworth suggests this is good practice as it allows blood to appear, indicating whether a blood vessel has been accessed by mistake (2000).

The green hat enables you to identify what has been learnt throughout the event. Firstly I have learnt that it is paramount to practice safely. Patients put a lot of trust into their nurse and I think it is important to not abuse that trust and to ensure you respect the patient by completing the procedure knowledgeably, safely and to the best of your ability. I have learnt that nurses have a great responsibility and that this shouldn’t be taken lightly. I have also gained a basic knowledge and understanding of how to give an IM injection. I have gained an awareness of the complications of giving injections intramuscularly and now have a knowledge base to develop.

The blue hat provides an opportunity to evaluate the event and state how you might do things differently in the future. Personally, I feel that I did well in giving my first injection. I feel much better prepared for when I give another IM injection. Next time I will ensure that I have a sufficient knowledge base to perform the procedure safely. Also, if I am well informed I will be able to share that information with the patient, this will empower the patient and enable them to participate and be prepared. Where possible I will limit the number of observers to reduce the pressure on myself and to provide privacy for the patient. I hope that I will maintain good communication with the patient and maintain an attitude where I don’t take these procedures lightly. I will certainly take the emotions I have experienced and the things I have learnt with me throughout my practice.

I think that the use of De Bono’s method of thinking has enabled me to reflect on this event in an effective way. The act of ‘putting on’ different hats has enabled me use deliberate, conscious thinking. It has enabled me to pull apart the different elements of the event and think about them separately in order to achieve a tangible outcome.

References:

De Bono, E (1985). Six Thinking Hats. London:Penguin.

Hemsworth, S (2000). Intramuscular injection technique. Paediatric Nursing, 12(9) 19-20

Workman, B (1999). Safe injection techniques. Nursing Standard. 13(39) 47-53