Operating Theatre Practice Reflective Assessment

Activity 1
Register nurses who work in the operation theatre where they are trained to care patient before, during and after surgery. There they gain both classroom learning and hands on experience.
Strengths:
“Strengths-based learning is the process of acquiring knowledge or skills by applying what makes you strong. Put simply, it is new learning that builds on past success.” (Dunedin, 1960)
There is strength that is available in my private hospital such as the library, it is to provide better understanding example as Berry and Khons books. The staff or student to get will be able to get information regarding the surgical field. Question and answer are also given by the nurse instructor regarding what procedure is done by the student or staff. Each week every staff has their own date given by the nurse manager to do presentation. Presentation can be done any topic regarding the surgical field. Internet access is also available to acknowledge staff or student to find out information. Staffs are also been sent for fire safety program and advance cardiovascular life support to be able to perform during emergency.
Challengers:
In every job there are challengers that will give us experience to procedure further. Moreover, in my department as well there is a popular reason of staff shortage. It will be difficult for the any staff to go for training due to no replacement. Too many new learners will also increase the stress level to the mentor because she or he could not handle by observing each student and more mistakes will be done by the student example during the surgical field even though the student or staff are been though to perform swab count but due to lack of supervision mistake may occur. Working long hours in the operation will lead to stress and tiredness to the staff due to dragging of cases. Next day the particular staff couldn’t perform well and more error will occur example medication error during general anaesthesia. There are also some of the surgeon will complain about the staff performance to the nurse manager this will prevent the staff to be assign with the particular surgeon again by the nurse manage end up the staff finally couldn’t learn the way of the surgeon operate. During the school holidays there will be increase number of cases in this period most of the staff and student will have though time to perform their theory session only rushing to finish the cases, end up no improvement in knowledge.
Opportunities:
The main opportunities working in the operation theatre is the willingness for the staff and surgeon to except the particular person with the way she or he perform their duties. There are the learning methods that are available such as the internet and library. Log books are provided for the new staffs to make sure they are able to learnt each skill during the probation period. By practicing they will learn faster other than only memorizing, and observing but this actually also depending individually.
Barrier:
There are the barrier between the staff and the working environment, depending on the staff. Some person will encounter difficult in communication in understanding their task given due to different language. If proper orientation is not given to the new staff they will be lack of confident in performing their duties. Teamwork can also lead to barrier example how the person getting along with each other to achieve goal to improve the quality of life and the outcome. Mentor is also a very important person in the practice area to organize and coordinate student learning, supervising student and providing feedback if they are lack of knowledge the junior staff will not be guided in a proper way to provide good service to the patient.
Activity 2
My main strengths
As a professional in practice:
I have been working the private hospital since year 2008.I has completed my operation theatre practice and diploma in nursing sponsor by the private hospital. I have also done my fire safety program, advance cardiovascular life support and standard people practice course. I am also trained in the central sterile supply department, catheterization lab, general anaesthesia, circulating and also scrubbing.
Area for improvement and action plan:
I would like to improve in my scrubbing area to do better in the orthopaedic cases and neurologic cases because usually for this cases special instrument and machine are required. For the orthopaedic case mostly screws, plating and on loan instruments will be use from other company such as Johnson and Johnson or Stryker depending on type of surgery. Moreover, for the neurologic cases different machine are use example selector which is to suck the tumour from intracranial. The instruments that are used are tumour forceps, brain retractor or dora retractor.
Action plan:
I have to scrub neurologic and orthopaedic cases more often. I also must do note book and prepare presentation to be presented with other staffs to exchange idea and knowledge.I can also ask for the instrument broacher from each company so I will be more familiar with the instrument and able to handle in future.
As a learner:
As a learner there have been dreams for me to increase my knowledge and experience. I would strictly love to continue my degree in nursing because education is the most useful thing to the people, especially as a result of complex nature of the day. After completing degree I will happily go forward to continue my master in nursing. I also would like to go for the AO trauma course to be more familiar with the types of fracture.
Areas for development and action plan:
I would like to increase my education level because education is important to national development in that it allows to further progress in the nation. Education promotes better ideas for management and experience. I would also like to more into the management site. The AO trauma is important to make sure I am able to manage fracture and also will be trained in the techniques for management of common fracture .In my action plan I must first apply degree in a university which the program has been approved by the Ministry of Health and Malaysia Nursing Board and also an affordable price. Which currently I am studying and happy with it, I would also like to continue my master here. For the trauma course that I wanted to attend I must apply though internet and inform my nurse manager about it once the application is open I can go it is only for 3 days course.
As a mentor or educator in practice:
As a mentor having a interpersonal and professional working relationship to support the learning environment. Organizing and coordinating the learning activities by supervising the student or new comers. Assessing the student’s skill, attitudes and behaviour enable me to provide the evidence of achievement.
Areas of development and action plan:
Coaching involves regular discussion between the mentor and mentee to improve their performance example develop a plan to improve the employee skill and knowledge. Counselling is a discussion to help the mentee to sort out problems. Teaching with revolves soft skills which can be build such as focus on communication skills, interpersonal skills ,problem solving and professionalism. Show them why they should develop a career plan and help them see their future role in the organization
Activity 3
I am working in one of the private hospital more than 2 years, I am trained in the operation theatre and also completed my certificate as a trained theatre technician. My hospital is a place to learn and practice all the facilities of learning are available and practical there is superb but there are also areas of improvement .When I was a junior I had an experience that I learn from it. It was a spine endoscopic surgery which was done by a new surgeon, assisted by a junior staff nurse, this surgery was a new procedure in our place using scope for disectomy. The junior staff did very well , the surgery went smooth and at the end when the skin already stitch then the scrub nurse noticed that one of the patties is missing when the patient was already on the trolley extubated, on the way to recovery. The junior nurse got scared and immediately she informed the surgeon. Once again the patient was push back in to the operation room, incubated the patient and he reopen the surgery site, there was patties retain in the patient. This was a major mistake because final count was not done before closing and this is considered as a medical error.

From the experience above, I would like to reflect upon three areas for improvement using the Gibbs Model of Reflection. At that time, I felt that the induction program was not done properly because the scrub nurse didn’t count the patties. It was a bad experience for the staff because it was her first time doing Endoscopic Disectomy. On the other hand, this experience also though her about the important of proper patties count. At the situation the scrub nurse was so nervous and anxious because was her first time scrubbing with a new surgeon. In my view, I decently think that the induction program that usually done only for 2 months should be increase to at less 4 months to make sure the new comers absorb the input and also know the important of counting the swab or patties before, during and before closing the skin to prevent retain of foreign body.

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The scrub nurse was also new staffs who were left all alone with no supervision. It was very unfair for the nurse manager to do such an assignment with no any senior staff. From the positive site, the staff is trained to be alone to build her confident level and the negative site without supervision error happens which is also unfair to the patient. To prevent any error in future the nurse manager must assign senior staffs who are able to bring a new staffs and guide in a proper manner.
Furthermore, I also suggested the nurse manager to prepare a competency checklist because the staff was not given any chance but immediately inform to scrub for the case. She was also new staff afraid the nurse manager would get angry if she refused it. From this experience, everyone and even I realized that if the staff was done a competency checklist by her mentor or senior staff, we can identify which area she is weak and does she knows the important of patties count.
In future I hope this incident will never occur again, during the investigation was done towards the junior nurse no senior or even the nurse manager stood by her. Everyone was just blaming the junior staff from that situation I did the analysis where the mistake happened. I even suggested to the nurse manager for improvement of these three areas before we could blame the junior staff but finally she was sent to the recovery area and no more scrubbing again.
am I.I also felt that the nurse manager was so unfair to us for not giving us any senior staff. I also felt miserable because i didn’t remind her about the count and even didn’t perform the patties checklist.There was also no