APPRECIATION

Alhamdulillah, thanks to God, I was finally able to complete my practical

reflection according to the time set by the college and the Advanced Diploma in
Perioperative Nursing instructor.

First of all, I would like to thank Mrs. Fazimah binti Ahmad as my supervisor
instructor who motivated me to complete this assignment.

Infinite thanks also to the Hospital Seri Manjung party and staff who have given
me the opportunity to practice what I have learned in college. I can't forget this
experience.

I am also grateful to my family and friends who helped and contributed directly and
indirectly to completing this task.

These small tasks have given me lessons and experiences that I will probably
never forget. At the same time, it can help improve the quality of patient care and
safety in the future.

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1.O INTRODUCTION

Reflection is an essential attribute for the development of autonomous,

critical, and advanced practitioners (Manzoukas, S. & Jasper, M.A., 2004).

According to (Chong, 2009), “Reflective practice should be a continuous cycle in

which experience and reflection on experience are interrelated”. Reflective

practice is the ability to examine one’s actions and experiences with the outcome

of developing their practice and enhancing clinical knowledge. The reflective

practice affects all levels of nursing, from students to advanced practice nursing

students, as well as practicing nurses.

Reflective practice can be defined as the process of making sense of

events, situations, and actions that occur in the workplace (Boros, 2009)

(Oelofsen, 2012). Reflective practice is essential for improving service quality,

providing much-needed support to staff, and facilitating team members’

professional development.

There are a large number of models of reflective practice available for

nurses to choose from Ghaye & Lilyman, 2006, Driscoll, 2000, Gibbs, 1988 and

many more. In my reflective practice diary, I will use Gibbs’s theory. Gibbs’

reflective cycle is a popular choice for reflection. The model includes 6 stages of

reflection and it includes description, feelings, evaluation, analysis, conclusion,

and action plan.

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 The purpose of this assignment is to gain a significant understanding of the

concept, model, process, and skills of reflective practice to be applied to nursing

practice. In this assignment, I will reflect on the coordinated roles of the scrub

person from my practice experience as an operation theatre nurse.

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2.0 REFLECTIVE PRACTICE REPORT

2.1 DESCRIPTION

My reflection is on an elective case for laparoscopic cholecystectomy keep

in view open cholecystectomy of a female surgical patient happened one month

ago. She was our second case on the list on that day in Surgical Operation Room.

We managed to obtain the required surgical instruments and proceed with the

case. The anesthetic nurse assisted in general anesthesia and ensured the

patient’s vital signs were monitored throughout the procedure.

The scrub nurse set up the sterile table as close as possible to the surgical

procedure. The specific instrument for the surgery was a ‘cholecystectomy set’.

The special instrument for laparoscopic is in a laparoscopic set. In the beginning,

everything was according to the operation procedure. When the time before trocar

should be inserted, a surgeon must give Local Anaesthesia (LA) before the incision

is made. There are four ports of trocar that should be made by the surgeon before

laparoscopic can proceed. The incident in my reflective case is scrub nurse used

only one kidney dish to put used syringes and used a scalpel blade to make an

incision. I thought Scrub Nurse M will use a different kidney dish for the next port.

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2.2 FEELINGS

I was alarmed by this, as I expected Scrub Nurse M will used a different

kidney dish for sharps. At that time I was querying why Scrub Nurse M don’t use

two kidney dish for LA and blade since there are still another unused kidney dish.

I feel unsecured since during trocar port insertion I saw used syringes with a needle

in there uncap and used the blade on the kidney dish. I’m scared to ask because I

felt Scrub Nurse M was more experienced than me as I was a junior staff there,

and I don’t want to embarrass myself too.

The incident make me regret that I did not act to ask Scrub Nurse M why

she did not separate the kidney dish that contain the blade and syringes with a

needle for LA. The operation of laparoscopic cholecystectomy was converted to

open cholecystectomy. The surgeon and scrub nurse M allow me to assist in open

cholecystectomy. However, I am thankful that during the operation no injury

happened.

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2.3 EVALUATION

This experience remind me sometimes people made mistake or decision

without thinking about the effect of what happens if something goes wrong. The

positive effect of the event, I am more careful when doing procedures, especially

when handling sharp items. As a senior scrub nurse, she must show the correct

way and good examples to junior nurses. What I learned from the incident, was

the importance of acting assertively with colleagues, in a sensitive manner, in order

to safeguard patients and other surgical team members from needle stick injury or

any other injury.

I will be more responsible about every action I take. This issue just ends in

the Operating Room. No one takes action to report to the nurse manager. No one

bothers about this issue. Maybe because no injuries happened.

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2.4 ANALYSIS

Operating theatre are the site of more sharps injuries happen than any other

place in the hospital. Approximately 100, 000 sharps injuries occur in UK hospitals

each year. It has been estimated that 4% of healthcare workers sustain 1 - 6.2

sharp injuries each year, and 27% of all percutaneous injuries are sustained in the

operating theatre. Of these, 43% were due to suture needles with scalpel injuries

contributing the majority of the remainder(18% according to Wilson,2013). Sharps

may include but are not limited to scalpel blades, suture needles, known as

atraumatic hypodermic needles, guide wires with connectors and drain trocars.

According to Rothrock (2019), the perioperative team should use a neutral zone

as a location on the surgical field on which sharps are placed in a predesigned

sterile basin or tray, from which the surgeon or assistant can retrieve them.

According to Griffith (2019), here is some steps and procedure to follow in

the neutral zone. And the step is :

1. If it is necessary to pass a sharp during a procedure, it should not be passed

hand to hand. A clearly defined ‘neutral zone must be established. Sharps may be

left in the neutral zone until they are needed again during the procedure or promptly

disposed of.

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2. The neutral zone should be identified by the surgeon and scrub practitioner

before the skin incision. This can be a basin, magnetic pad, or area within the

aseptic field.

3. No touch techniques should be used to minimize the handling of sharps by

gloved hands. Suture packets should be used to manipulate atraumatic.

Instruments should be used to pick up sharps that have fallen off the aseptic field.

Scalpels should be handled safely at all times, using instruments to load where

necessary.

4. Situational awareness should be maintained at all times with verbal notification

each time a sharp is located in the neutral zone.

5. The neutral zone should only have one sharp in at a time.

6. Sharps placed in the neutral zone should be orientated for easy retrieval by the

surgeon.

7. Double gloving is recommended practice to reduce percutaneous exposure

should gloves become perforated. Perforation indicator system gloves are

recommended.

8. Standard precautions should be used. Personal Protective Equipment should

be used including protective eyewear, masks, and gloves.

9. Sharps disposal containers should be recognizable, visible, and in proximity to

the point of use.

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10. Sharp containment devices should be used to confine or contain sharps to a

specific area of the aseptic field. This enables the scrub practitioner to monitor and

be accountable for the sharps for counting purposes until the patient leaves the

area.

11. Best practice is that instruments should be used to retract tissue, not hands.

This is to reduce the chance of sharps injury.

In my experience, the scrub nurse already breaks the neutral zone rule

number 5 and 6. It is the neutral zone have two sharp in at a time and sharps

placed in the neutral zone are not orientated for easy retrieval by the surgeon.

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2.5 ACTION PLAN

My action plan for this situation is to ensure that all scrub nurse must follow

the principle of handling sharps in a proper way. It is important for everyone to be

aware of sharps injuries and know how to handling with sharps during operation.

I hope in the future I will be able to prevent this action from happening again.

The Head nurse manager can provide and organize continuous nursing education

and educate scrub nurses on this issue and how important to follow the rule. All

principles must be followed by all scrub nurses to prevent something bad happen

in the future.

All nurses must remind each other whenever they do a mistake. It is

because sometimes people tend to forget which one is the right thing to do,

especially when in an uncontrolled situation or in chaos.

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3.0 CONCLUSION

As conclusion, keeping a reflective practice also allows nurses to draw out

valuable insights and focus on areas that need changes or improvements. In a

study conducted among nursing students at LaGuardia Community College in New

York, the reflective practice was found to have a positive influence on the overall

progress of the students in the clinical nursing course. The reflective practice

helped nurses to develop an awareness of their strengths, temporary limitations

as well as potential applications of their knowledge.

Throughout nursing practice, certain situations may require nurses to make

quick and efficient decisions. In such situations, critical thinking is important

because nurses should be able to assess situations quickly and confidently and

make the best care decision based on each scenario. The connection between

reflection and critical thinking has been established in a number of studies. In

nursing, the concept of critical thinking includes reflection of thoughts and

recognition of various solutions to problems. Writing a reflective practice can help

nurses develop critical thinking skills, which is an integral component of the nursing

process.

From this assignment, I learned that reflective practice is important in the

process of learning, knowledge, and in future experience. Doing this reflective

practice can help me to develop my critical thinking, and what should I do if in

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future I am faced with this same situation again. Everyone learns from their own or

other mistakes. Whatever it is don’t let the mistake ruin our life, our carrier, and

most important others’ life.

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REFERENCES

Boros, S. (2009). Exploring Organizational Dynamics. London : Sage.

Caldwell, L. & Grobbel, C.C. (2013). The Importance of Reflective in Nursing.

International Journal of Caring Sciences, 319-326.

Chong, M. (2009). Is Reflective A Useful Task For Student Nurse? . Asian

Nursing Research, 3(2), 111-119.

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods.

Oxford: Brookes.

Griffith, K. (2019). Sharps handling during invasive procedures in the operating

theatre or procedures room. University Hospital Plymouth London.

Manzoukas, S. & Jasper, M.A. (2004). Reflective Practice And Daily Ward
Reality A Covert Power Game. Journal of Clinical Nursing, 12, 925-933.

Moss, R. (2015). Sharps-Related Injuries in the OR. Ansell Cares.

Oelofsen, N. (2012). Developing reflective practice: a guide for health and social
care students and practitioners. Banbury: Lantern Publishers.

Rothrock, J. (2019). Alexander's Care of the Patient in Surgery (19th ed).

Elsevier: Canada.

Wilson, J. (2013). Sharps Injuries in the Operating Theatre: A Practice Guide to

Further Reducing the Risks. Healthcare Infection Prevention Specialist &
Reader in Healthcare Epidemiology at the University of West London, 8-
11.

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