Learning Outcome Peg Feeding Nursing Essay

Learning Outcome Peg Feeding Nursing Essay In this reflective essay I am going to discuss a learning outcome in which I have become competent to practice. To reflect on my learning outcome I am going to use Gibbs reflective model (1988). The Gibbs reflective model is a well known and used model in reflective practice. It consists six steps which I will describe step by step as my essay will progress. In the nursing care process it is a responsibility of a nurse to provide holistic care to the patient who is under our care. Our focus is to enable them to cope, prevent, solve or alleviate the problem from which they are suffering and not able to carry out their normal life. Our aim is to help and teach patients how to meet their daily needs in other ways. The learning outcome I have chosen to reflect is PEG feeding which is an alternative way to provide nutrition to a patient who is not able to obtain nutrition through the mouth. The first step of Gibbs reflective cycle is a description of the event. One service user in my placement area whom I will call Mrs. P to maintain her confidentiality (NMC 2008) is suffering from progressive supranuclear palsy, a condition in which as the condition progresses patient losses abilities i.e. Swallowing, speech, maintaining balance, eye movement. As a result of this condition she developed dysphagia and it was not possible to maintain her nutrition via oral intake. Thus, multidisciplinary team and family decided to place her on PEG feeding. PEG tube is more appropriate than nasogastric tube for long term feeding as it avoids delays in feeding and discomfort associated with displacement (National Collaborating Centre for Acute Care 2006). During my placement one of the nurses asks me to go and give her water through the PEG tube. Although I did it before in my country I was familiar with it but I didnt practice for a long time and as I have seen the condition of Mrs. P. I wasnt confident to carry out the task. I discussed it with my mentor and we decide that I can take it as a learning outcome during my training to make myself competent with PEG feeding skill. As I am going into the second stage of Gibbs reflective model (1988) in which I will discuss about my thoughts and feelings. When the nurse asked me to give the water via PEG tube, at first I was feeling myself stupid to ask for help thinking that what impression I will make on that nurse. This feeling came into my mind as a result of a thought that I am a registered nurse in my country so I should know this. But I lost my confidence when I went in Mrs.Ps room and observed her condition i.e. Slurring speech, problem with balance, mobility problem and pain in her neck. So I decide to ask the nurse to perform the task and I also observed it. While she was giving her feed, I found that she was coughing a lot and wasnt comfortable. Which I thought was due to her position and the nurse explained me and justify my thought that it is because of her condition. I was not satisfied with her explanations and as a supervised practice nurse I wasnt able to oppose her. I decide to read more about the PEG feeding and discussed it with my mentor. The third stage of the Gibbs model (1988) of reflection is an evaluation which requires the practitioner to consider the good and bad things about the event. The patient should be positioned where the patient can sit up as much as possible in a supported midline position (Dougherty and lister 2008) while giving PEG feeding. The nurse who gave feeding didnt correct Mrs. Ps position as she was in a semi upright position. Furthermore, before starting and at the end of the feeding, she didnt clean the tip of the tube. The tip of the tube should be cleaned daily with water and a small brush (Loser et al.2005). However, the good practice I observed that nurse informed the procedure to Mrs. P which is important according to the NMC (2008) to make her understand the procedure and give her consent. In addition, to avoid tube adhering to the stoma skin rotate it 360 degree (Bumpers et al, 2003). The other important thing my mentor discussed with me was administration of medication through the PEG tube. According to BAPEN (2003a), never add medication directly to the eternal feed to avoid interaction between medicine and feed and flush the tube after administration to avoid tube blockage. During the discussion about PEG feeding with my mentor I found that other things to consider with PEG feedings are management of the tube, patient position and checks to carry out before feed and it is very important to avoid complications. In my placement area only Mrs. P has got PEG tube. So my mentor discussed with me that there are many indications for PEG tube insertion according to the patients conditions so it is important to learn about the specific needs of that patient before performing the procedure. She discussed some scenario cases with me to understand more about it. This helped me to understand different aspects of the PEG tube The next stage of the Gibbs reflective cycle (1988) is an analysis of the event where reflector has to make sense of the event. I will analyze it by exploring the skill and looking into the evidence. The PEG feeding is a method of giving nutrients to maintain an optimal nutritional support (National Collaborating Centre for Acute Care 2006). Clinical trials have proven that there are very rare complications with PEG tubes, such as leakage (Riera et al. 2002). Through evaluation of this event I have been competent to give PEG feeding and care of the tube. The reasons for Mrs. Ps coughing explained by the nurse was from her daily experience working with her which could be right but what I found from the references was different and evidence based. So I learned from experience and through experience (Burnard 2002). It has boosted my confidence to challenge others views regarding my practice. According to stage five of Gibbs model (1988), I conclude from that every nurse does not find the same evidence based reasons for the problem but if I am practicing safe and based on evidence then my practice is safe. In the future I will make sure that I am confident and competent to perform the task and have evidence based explanation of the situations. From this particular learning outcome I have learned about a PEG feeding procedure and the care of the PEG tube The last stage of Gibbs reflective model (1988) is the action plan. My action plan for the future practice is to read more references and literatures regarding PEG feeding. There will be many different conditions regarding PEG tube in my future practice so it is necessary for me to look for more information on this particular subject to make myself excel. I also request my mentor to book me for a study day to learn more about this skill.

Character of Nicholas in Chaucer’s Miller’s Tale Essay

Nicholas, with his outrageous sense of humour and eager pursuit of love, functions as the charming, likeable hero in Miller’s Tale. He is introduced as â€Å"hende Nicholas†, and his conduct does not at all answer to the usual sense of the adjective which implies great courtesy, but its suggestion of approval is repeatedly invoked as the Miller refers to his hero by this formula. We learn at once that he is knowledgeable and of his interest in astrology. This is seen as a respectable branch of learning, but Nicholas is aware of its power to impress others, while he is able to supplement his income by weather-forecasting. He is also helped financially by friends. The imaginary flood of which Nicholas tells John shows us his cunning, his confident attitude, his inventiveness and especially his contempt for the stupid tradesman: ‘Don’t worry about that,’ said Nicholas, / ‘His time’s been badly wasted, if a scholar / Can’t get the bet ter of a carpenter.’ (lines 191-193) In spite of this, however, the Miller presents the astrologer in a way that makes the audience like Nicholas. He does this by making John seem deserving of punishment for his unwise marriage and subsequent jealousy. Nicholas’s youth and attractiveness makes us less critical of his boldness, and the comic manner of the tale’s telling makes his conduct seem less worthy of censure than would be the case with real people. Nicholas seems a more appropriate partner for Alison than does John, and the Miller’s repetition of the formula â€Å"hende Nicholas† encourages us to be more sympathetic. However, it is important to note that Nicholas does not escape his daring plan without any consequences. His over-confidence and lack of prudence earn him a punishment appropriate to his offence, and in keeping with the farcical spirit of the tale he is â€Å"scalded in the towte† by his rival, who mistakes him for Alison. Thus, Nicholas may be the character that has the audience rooting for him by being likeable and providing good laughs, but his charming yet arrogant attitude does not prevent him from suffering the consequences of his actions. The Canterbury Tales [Oxford guides to Chaucer]. Oxford: Clarendon Press, 1989.

An Analogy of a Plan Cell to a Country

An Analogy of a plan cell to a country nucleus/governement/primie minister/parliament house- they are the control centre of the city or cell. They both control what goes on in the city or cell. the nucleus contains all the DNA or important information, of the whole cell. it is the control centre and it gives out orders that the cells have to carry out. the president in a country know it's important information, he gives out laws that have to be carried out by the people and leads the country mitochondria-power plant- this is the ‘powerhouse' of the cell or city.The mitochondria and the power plant both provide the energy for the city or cell to use. mitochondria breaks down food molecules and convert them to energy for cells. power plant generate and supply energy for the country. Cell Membrane/national security, military, Border Security- the Cell membrane or police/ Border Security controls entry of what goes in and out of the cell or city Vacuole/ Stores/warehouses+ water tr eatment plant + Garbage dump- a vacuole can contain many different types of fluids in it and it also has many different functions. You can read also Thin Film Solar CellThe vacuole can be a storage room which contain fluids and material solutions like plant pigments. It has can also be a garbage dump which contains its wastes. Furthermore the vacuole can be a water tower which stores water in it. vacuoles store materials for the cell. stores around the country. it stores necessay materials such as food and clothes for people Ribosomes/ Food producing factory (protein factory)- the ribosomes and food producing factory are both where the production of proteins occur. ribosomes produce protein from information from the dna given by the nucleus. restuarnts cook and give out food that contain proteinEndoplasmic Reticulum/ highways, roads and vehicles traveling them- the transport of substances within cells or cities occur through these. it assembles materials and export them from the cell. companies that trade and export materials from the country also may package and prepare them to be sent of . Golgi Apparatus/ Foo d Packaging Company- the Golgi Apparatus and Food Packaging Company both package materials for export. Chloroplasts/ Solar power panels- the chloroplast and the solar power panels both can capture the radiant energy of sunlight and transform it into useable energy.

Accounting Scandals. ENRON, WORLDCOM - 1894 Words

ENRON Enron shocked the world from being â€Å"America’s most innovative company† to America s biggest corporate bankruptcy at its time. At its peak, Enron was America s seventh largest corporation. Enron gave the illusion that it was a steady company with good revenue but that was not the case, a large part of Enron’s profits were made of paper. This was made possible by masterfully designed accounting and morally questionable acts by traders and executives. Deep debt and surfacing information about hiding losses gave the company big problems and in the late 2001 Enron declared bankruptcy under Chapter 11 of the United States Bankruptcy Code. The Enron scandal, revealed in October 2001, eventually led to the bankruptcy of the Enron†¦show more content†¦Securities and Exchange Commission (SEC) charged the company with massive accounting fraud and quickly obtained court order barring the company from destroying financial records, limiting its payments to past and current executives, and requiring an independent monitor. Hearings were held by the House Committee on Financial Services on July 8th and by the Senate Committee on Commerce, Science, and Transportation on July 30th. Several company officials have been indicted. The fundamental economic problem confronting WorldCom is the vast oversupply in the Nation’s telecommunications capacity, a byproduct of overly optimistic projections of Internet growth. WorldCom and other telecommunications firms faced reduced demand as the dot–com boom ended and the economy entered recession. Their revenues have fallen short of expectations, while the debt they took on to finance expansion remains high. As the stock market value of these firms has plunged, corporate management has had a powerful incentive to engage in accounting practices that conceal bad news. The Accounting Maneuver In its June 25th statement, WorldCom admitted that the company had classified over $3.8 billion in payments for line costs as capital expenditures rather than current expenses. Line costs are what WorldCom pays other companies for using their communications networks; they consist principally of access fees and transport charges for messages for WorldCom customers. Reportedly, $3.055