Procedure And Incidents During Placement

Procedure And Incidents During Placement This reflective piece will be about a procedure that took place whilst on placement and will look at infection control whilst doing an aseptic non-touch technique (ANTT). Using Atkins and Murphys 1993 model of reflection (Rolfe, G et al 2001). I have used this model as it helped me become aware of my actual thoughts and feelings regarding the situation, and more focused when analyzing it. Description I visited a lady who had bilateral leg wounds that needed to be dressed daily, the leg dressings that had been put on the day before were heavily exudated, the lady who I am going to call Jane to protect her identity as per NMC 2004 was adamant that she had kept her legs raised. The nurse that I was working with said that she would dress the legs this time and when I visited again I would do the dressings. The nurse opened the sterile packaging of gloves and placed it on the floor, this was to be her sterile field. The dressings and bandages that she required were opened and placed onto the sterile field and the nurse placed an apron over her uniform. The sterile gloves were put on and she proceeded to remove the dressings that were on Janes legs, once the dressing had been removed these were placed into the waste bag. The nurse then proceeded to assess the wound and then redress it without changing her gloves, by not changing her gloves which were originally sterile these will now have become contaminated by handling the soiled dressing and would contaminate the new dressings and the wound. Stage One Whilst watching the nurse change the dressing this made me question what I had been taught in University about ANTT. The procedure that we were taught in university is from The Royal Marsden 2008. This made me feel uncomfortable and question that the patient would be at risk from healthcare associated infections (HCAI). Stage Two The reason for aseptic technique is to maintain asepsis and helps to protect the patient from HCAI it also protects the nurse from any of the patients body fluids and toxic substances (Department of Health (DOH) 2005). Elderly people are more at risk of infection which is caused by organisms that invade the immunological defence mechanisms as there immune systems are less efficient ( Calandra 2000) ANTT is used to ensure that when a healthcare professional handles sterile equipment only the part of the equipment that will not contact the wound is handled (Preston 2005). When doing the ANTT procedure this involves ensuring that consent has been gained from the patient and they are aware of what the procedure will be, the environment and the equipment is prepared, hand-washing takes place, personal protective equipment is used and a sterile field is maintained. In a Primary Care setting one of the biggest problems is infection that enters the body through a tear in the skin, this may b e through a leg ulcer. A small number of microbes are sufficient enough for an infection to be caused, this may then be difficult to treat with antibiotics and what may have been a trivial problem may end up becoming a significant problem (DOH 2007). Nurses should assess the risk of transmission of infections from one person to another and plan their nursing care accordingly before they commence any form of action (Chalmers Straub 2006). Hand washing prior to ANTT has been found to be the most important procedure for preventing infections, hands can be the biggest route of transmission of infection if not washed correctly (Akyol et al 2006). There have been recent studies that show that hand washing is rarely carried out in a satisfactory manner and 89% of staff misses some part of their hand surface during hand washing (Mcardle et al 2006). Handwashing should be done prior any procedure, this can be achieved by three different methods:- Soap and water this is effective in removing physical dirt or any soiling and micro-organisms liquid soap is more efficient than a soap bar (Ehrenkrantz, 1992). Anti-microbial detergent which is effective in removing physical dirt and is more effective than soap in removing micro-organisms (Ehrenkrantz, 1992). Alcohol based hand rubs, these are not as effective as the above in removing dirt or soil but are more effective in destroying transient bacteria (Storr, J, Clayton-Kent, S, 2004). An aseptic procedure should be done in a clean environment and any equipment used should be sterile and disposable or decontaminated after each use and the nurse should ensure that the equipment is free from dust and any other soilage (DOH 2003). Whilst the nurse does ANTT procedure it is essential that her hands, even though they have been washed, do not contaminate the sterile field or the patient, this is achieved by the nurse using sterile gloves she needs to be aware however that gloves can be damaged during use and may no longer be sterile (Kelsall et al 2006). The aim of wearing sterile gloves is to reduce the risk of cross-infection from nursing staff to patients and to also reduce the transient contamination of the hands by micro-organisms from one patient to another (infection control Nurses Association (ICNA) 2002). The ICNA recommend that before a patient is treated a comprehensive risk assessment is taken to determine the most appropriate glove type for the task to be undertaken. Its been suggested that sterile gloves are only necessary if the nurses hands come into contact with the patients sterile body area, they argue that non-sterile gloves provide adequate infection control if hands decontamination has been done effectively (Hollinworth and Kingston 1998). Factors that need to be considered when making the choice between aseptic or clean technique for wound care is the setting where the dressing is to be done, the immune status of the patient, this is influenced by age, medication, type of wound, location and depth of wound and the invasiveness of the procedure (APIC 2001). Hartley (2005) reports that aseptic technique is not being carried out to a high standard and this could be related to the theory-practice gap or complacency in the professional field. Improving the skill based care needs to be the main focus on post -registration education this includes which gloves to choose, maintaining a sterile field with the risk of non-touch technique and also developing assessment protocols (Preston 2005). Stage 3 During my time on placement I cleaned and redressed a lot of wounds and I ensured that I used the Aseptic non touch Technique that was taught to me whilst at University. I ensured that I gained the consent of the patient prior to any procedure taking place and also maintained the clients privacy and dignity whilst carrying out the procedure. Whilst being on placement I have learnt that staff change the dressing on wounds using the aseptic non-touch technique differently to how I was taught in university but when questioning them why they do something a certain way they have a rationale for it. I will continue to clean and redress wound in the way I have been taught and believe that this is the way forward in fighting wound infections.

Alfred Adler Personality Theories

Alfred Adler was a little baby boy born on the suburb of Vienna on February 7, 1870. He almost died of pneumonia when he is five years of age. At this age he decided to become a physician. (Ewen, Robert,p. 5) . Alfred was an intelligent, sociable and a very active boy. He was n average student of a University. He finished his medical degree in the University of Vienna in 1895.Alfred’s wife was Raissa Timofeyewuna Epstein, a social activist and a very intelligent woman and blessed with four children. (Ewen, Robert, p. 15) at first Alfred Adler become an ophthalmologist and soon changed it to  his general practice..He encountered clients like circus people. Because of these clients he realized that the strength and weaknesses of the performers made him develop into organ inferiorities and compensation. (Levine, Robert Alan,p. 10)He becomes a physician or a doctor in the Australian army. Because of this experience he comes up to a concept of social interest. This concept makes every human to realize that they must survive and change in their own ways. Contribution to the field of Psychology of Personality Alfred Adler’s motivating force is striving for the perfection. Adler believe that this is the desire of people have to fulfill their potential in order to come up their ideal.Agression drive which refers to the reaction of people have, as well as their drives. Compensation is another term used by Adler which means striving to overcome. In the masculine protest, Adler emphasized that the boys have a high esteem than girls. It means that men are better than women. Boy’s have the capacity to do all great things and women don’t have. Just because they do have the power, education, talent and motivation needed to do all the excellent work. And the last one is the striving for superiority.It is the desire to be better not for his own but to better than others. (Ewen, Robert, p. 22) Adler’s approach â€Å"individual psychology† was contributed to psychology. Adler developed a different personality types like the getting or leaning type, in this type people are anti-social and have a low activity levels. Next is the avoiding type, are people who hate to be rejected. People have a low social contact and afraid of rejection. In this type, people always aware to their actions and behavior. They are very careful on what actions or decisions should be made.Ruling dominant are people who are willing to manipulate situations and people. And the last one is the social useful type, people in this type are very sociable and active. Instead of discussing about a person’s personality Adler also talk about lifestyle. According to Alfred Adler, lifestyle refers to how you live your life, how to handle problems and interpersonal relations. It means that lifestyle of people help them realize their selves, how to handle their problems and how to communicate to other people. Application of Personality Theories to W ork Place Alfred Adler’s theory of personality is very useful because it can help people act properly.People always think positively so that they can perform better and resulting to an excellent performance. They can carry all the problems that they will be encounter and they can find a better solution for that. People will always aim high and give excellent effort to perform their jobs. Personality theories application is said to be a positive theory, make people a goal oriented, positive thinking, problem solver ,and help to make people an excellent one in terms of their work and in their life. Life style approach of Adler refers how to live life, how to handle problems and interpersonal relations. According to Alfred Adler â€Å"The style of life of a tree is the individuality of a tree expressing itself and molding itself in an environment.We recognize a style when we see it against a background of an environment different from what we expect, for then we realize that ev ery tree has a life pattern and is not merely a mechanical reaction to the environment. † Base on this approach we can conclude that every person’s behavior and personality usually based on their life pattern and their environment . Personality theory can help a lot to the work place because individual here has a good life pattern and environment.People are willing to achieve goals and always want to excel in their own specializations. Problems are disregarded and always find solutions for it Because of this positive personality of people ,they become very successful and fulfilled. BIBLIOGRAPHY Ewen, Rowen B. , 1998, An Introduction to Theories of Personality Mahwah, New Jersey.Ewen, Rowen B. , 2003, An Introduction to Theories of Personality Mahwah, New Jersey.Levine, Robert Alan, 1982, Culture, Behavior, and Personality New York.Schinka, John A. , 1997, Introduction to the Special Series-Personality Assessment Instruments.

The Spontaneous Vaginal Delivery Health And Social Care Essay

Intrapartum cervical lesions are frequent, but merely a minority of them is clinically important and conditions future gestations and/or bringings. We report one such instance in which cervical lacrimation occurred upon the initiation of labour, without cervical os distension, ensuing in vaginal bringing of the foetus and sever postpartum bleeding. Case: A 39 year-old G2P0 adult female, with a history of a voluntary break of gestation by cervical distension and curettement 13 old ages ago and no implicative symptom of attendant cervical stricture, was admitted for labour initiation at 41 hebdomads of gestation. Attesting a posteriorly oriented and closed neck, we gave vaginally 2.5 milligram of prostaglandin E2. In the absence of important cervical alterations, 50 microgram of misoprostol were vaginally applied the following twenty-four hours. The patient initiated contractions with neck shorting, but the cervical os remained closed. Two hours subsequently, a healthy male neonate was vaginally delivered and the placenta was removed spontaneously. Showing an intense postpartum hemorrhage, the patient was observed when a big posterior cervical tear was visualized while the original cervical os remained unopened. The haemostasis was achieved by lesion fix utilizing a uninterrupted sutura. Decision: The instance supports that the adult females with a history of cervical intercession should be carefully approached in the instance of labour initiation, even when the process is non associated with evident complications. In this scenario, relentless rigidness of the cervical os in malice of cervical shorting may bespeak the hazard of cervical lacrimation.IntroductionCervical hurts represent important morbidities associated with vaginal bringings [ 1 ] , peculiarly in the instances of nulliparity, hasty labour, operative vaginal bringing and cervical surgical intercessions such as cervical cerclage during gestation [ 2 ] . Initiation of labour has besides been associate d with an addition in the rate of cervical harm [ 3 ] . We report a instance of intrapartum cervical lacrimation without cervical os distension that occurred upon prostaglandin initiation of labour in a adult female with a history of voluntary break of gestation by cervical distension and uterine curettement. The cervical tear resulted in self-generated bringing of the foetus through the lesion and postpartum bleeding successfully treated by the lesion sutura.CASE PRESENTATIONA 39 year-old Portuguese adult female, G2P0, with a singleton and uneventful gestation was admitted to our establishment at 41 hebdomads of gestation for labour initiation. Her past obstetric history revealed a voluntary break of gestation at 6 hebdomads, realized by cervical distension and curettement, without complications, 13 old ages ago. There was no implicative symptom of attendant cervical stricture since the patient?s catamenial rhythms were regular with normal catamenial hemorrhage after the process. A dditionally, the current gestation was spontaneously conceived. Neither relevant medical conditions nor abdominopelvic surgical intercessions were reported. Cervical appraisal on admittance revealed a 15 millimeter long, posteriorly indicating neck of stiff consistence with a 5 millimeter broad external os and cephalic presentation at S-1. Due to unfavourable cervical features, 2.5 milligram of prostaglandin E2 ( PGE2 ) were vaginally given for cervical maturation. In the absence of important cervical alterations and detecting normal CTG records, 50 microgram of misoprostol were vaginally applied the following twenty-four hours. The patient initiated labour 4h subsequently, co-occuring with self-generated rupture of membranes, cervical shortening, while the external os remained 5 millimeter dilated. The patient received consecutive anaesthesia. Two hours subsequently, a healthy male neonate was vaginally delivered deliberation 3355 g, with Apgar score 10/10. After the self-generated placental remotion, an intense vaginal hemorrhage drew attending. The scrutiny demonstrated that original cervical os remained closed and a 4 centimeter deep , posterior cervical tear was observed ( from 9 to 4 o'clock, Figure 1 ) , without extension to the vaginal fornix. The lesion had provided a gate out to the foetus and gave the beginning to the bleeding. The intuition of a important lesion of the uterine principal was rejected by the designation of the tear boundary lines, no clinical marks of peritoneal annoyance and ultrasonographic verification of the absence of free fluid in the abdominopelvic pit. The cervical tear was repaired utilizing uninterrupted vicryl suturas. After the intercession, the drainage of uterine discharge through the natural os was verified. The patent received oxytocin perfusion ( 20U ) and 2g of cefazolin. The bleeding resulted in a decrease of the hemoglobin degree from 12.9 to 10.7 g/dL, therefore the patient was besides medicated with day-to-day Fe addendum p.o. Having an uneventful postoperative class, the patient was discharged on twenty-four hours 3 postpartum and referenced to the hospital?s units f or puerperal alteration and household planning. Degree centigrades: UsersDusanDesktopDelivery through a Cervical TearDiapositivo1.JPGDISCUSSION AND CONCLUSIONClinically important lesions of the neck occur in 0.2 – 1.7 % of vaginal bringings ( R ) . Cervical cryings have been often reported with instrumental bringing, peculiarly when forceps was engaged. However, big cryings, such as the lesion that we witnessed, developed under the consequence of induced uterine contractions, miming a full distension and taking to fetus bringing beside an unopened cervical os, are ultimate rareness. A self-generated bringing through a cervical tear with an integral cervical os was antecedently reported in a patient with a history of cervical intraepithelial neoplasia treated with a loop electrosurgical deletion process ( LEEP ) and upon the labour initiation with PGE2 [ 4 ] . Differently, in other reported instances, big cervical cryings coexisted with partly [ 5 ] or to the full dilated necks [ 6 ] . In our patient, prostaglandins were besides used for cervical readying as a standard method. Although no old cervical injury was documented, the history of cervical distension and curettement used for the expiration of predating gestation opens up possibility of subclinical cervical hurt. Despite the fact that a high per centum of patients with a history of cervical distension and curettement have a favourable result of future pregnancies/deliveries, the process is associated with an increased rate of postpartum bleedings [ 7 ] . We believe that old cervical hurt, although clinical ly soundless, should be considered, since the initiation drugs were applied in a accustomed and safe mode while no other obvious predisposing factors existed. Similarly to the instance of patient submitted to LEEP, presumptive cervical tissue change did non let distension of the external os due to fibrosis and indirectly weakened the nearby cervical section when exposed to prostaglandin-induced contractions. Alternatively, the intrinsic cervical os stiffness in our patient can be taken into history, doing the above tissue prone to rupture. Regardless of etiology, the realisation of a cesarian subdivision after the initial and unsuccessful tentative of labour could forestall this complication. Nevertheless, the diseased significance of ascertained cervical response, de facto, is non recognizable in the clinical pattern every bit easy as in the theory. In decision, the adult females with a history of cervical intercession necessitate a particular moderateness in the instance of labour initiation, even when the process is minimally invasive, like cervical distension, and non associated with evident complications. The instance shows that in such a parturient, cervical shorting with relentless rigidness of the cervical os should be peculiarly valorized and carefully approached since it may bespeak the imminency of cervical rupturing aside a closed os. At the visible radiation of comparatively high rates of both instrumental gestation break and subsequent labour initiation, the possibility of this rare event should non be overlooked due to the serious maternofetal effects that it can condition. Conflict of Interests: The writers declare no struggle of involvements. Consent: Patient has given her consent for the instance study to be published.

The Ineffectiveness Of The Death Penalty - 892 Words

The Ineffectiveness of the Death Penalty People want to feel safe wherever they go, whether it is in their family’s,friend’s or even an acquaintance’s home, and shopping malls, hotels or wherever others go and not be scared by others. Often there are crimes every day and many fear that they don’t want to be involved in it. Often criminals appear nonchalant about what happens to them no matter what they did and their crimes. They don’t seem scared. The death penalty is ineffective at deterring and in some cases, a waste of resources such as money. The deterrence theory is what most people like to believe is to work as intended, to keep others from doing crime though it still happens. People still do crimes nowadays and there are usually some cases on the news of murder, killings and other heinous crimes so in which in this the following will talk about its effectiveness in deterrence, and the death penalty deterrence theory and is it worth the price to keep the death penalty around. 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