Introduction
The video presented by Zenn (2013) describes the most common types of sutures in a rather engaging and informative way. Being a specialist in an emergency room department, I have frequently observed professionals performing sutures. However, this video lesson was useful in explaining the detailed process of suturing simply.
Suture Skills
A nurse must know the relevant autonomy and understand the fundamental structures before choosing suturing as the most appropriate method of wound closure (Bonham, 2016). Also, it is necessary to prepare all the equipment required for the procedure. In the majority of departments, there are pre-packed suture sets that consist of the following items: a container for cleaning agents, a needle holder, scissors, toothed and non-toothed forceps, sterile gauze swabs, sterile drapes, and suture material (Bonham, 2016). Other essential tools are a syringe and a scalpel. Before suturing, a nurse should assess and clean the wound. If there is bleeding, it should be soaked up with sterile gauze. To avoid future contact with the surrounded skin, sterile drapes are used (Bonham, 2016). Finally, it is crucial to make sure that the patient has received anesthesia, and that it has worked.
A simple interrupted suture is used when a team consisting of many specialists is working (Zenn, 2013). During this procedure, it is important to make a minimum of three thrown before finishing the suture. Simple interrupted sutures are used in thoracic and cardiovascular surgery to prepare large effective opening areas and eliminate the occurrence of the prosthesis (Tabata et al., 2014). A simply buried suture is employed before when putting deeper sutures in before putting the skin sutures in (Zenn, 2013). It is crucial to bury a suture, so it starts deep and goes superficial, ending up in the dermis and leaving no hole in the skin. On the other side, the procedure is the opposite way. It goes superficial at first, and then deep (Zenn, 2013). Simply buried sutures are used to avoid scars (Yang et al., 2018).
A vertical mattress suture is used when a wound is hard to close or when there is much swelling already present or expected (Zenn, 2013). This suture is frequently employed in cosmetic surgery. However, it has proved to be less effective than a set-back suture, the latter bringing more positive cosmetic outcomes (Wang et al., 2015). A horizontal mattress suture may be explained as a succession of two simple sutures (Zenn, 2013). Upon exiting the needle on the first pass, it is reinserted in the way that makes the re-entry mark parallel to the exit mark. The ending point is parallel to the original entry mark (Bonham, 2016). This suture is rather time-efficient (Zenn, 2016).
Another time-saving suture is a figure-of-eight one. By performing it, it is possible to make twice as few knots, thus finishing the work faster (Zenn, 2013). According to Traullé et al. (2015), a figure-of-eight suture is a speedy method of closure that can be employed as an effective substitute for common compression techniques to prevent bleeding in the process of high-intensity anticoagulation. A half-buried horizontal mattress is used in cosmetic surgery to avoid post-suture holes. When performing this type of suture, it is necessary to start a horizontal mattress on one side and remain within the dermis on the opposite side in a subcuticular manner, and then come back on the other side as in a simple horizontal mattress. This method results in having suture marks only on one side of the wound (Zenn, 2013).
The most common type of suture used to close incisions is simple running. This suture begins with an instrument tie (Zenn, 2016). It is necessary to take ninety-degree bites and be consistent in what concerns the distance between stitches. It is also required to guarantee enough tension along the incision. By doing so, it is possible to achieve the most favorable cosmetic outcomes. In the end, another instrument tie is performed (Zenn, 2016). A simple running locking suture is similar to the previous type, but it requires locking each suture before making another one. This approach is useful when a specialist is working alone, and no assistance in holding the suture is available. Thus, the suture holds itself (Zenn, 2016). The most complicated suture is subcuticular (Zenn, 2016). This method leaves no external signs of suture at all. The instrument tie is hidden deep in the wound, and all the other operations are also hidden. The effect of this suture is the most cosmetic closure of all.
Conclusion
Judging from the video and my professional experience, I realize the importance of learning how to suture. The aim of suturing is to minimize the possibility of infection by connecting the apposing tissue margins (Al-Mubarak & Al-Haddab, 2013). With the help of efficient suturing, it is possible to eliminate functional loss, enhance the process of healing, and provide the best cosmetic outcomes. Therefore, this video is highly useful for specialists who endeavor to develop their professional skills and enrich their knowledge.
References
Al-Mubarak, L., & Al-Haddab, M. (2013). Cutaneous wound closure materials: An overview and update. Journal of Cutaneous and Aesthetic Surgery, 6(4), 178-188.
Bonham, J. (2016). How to suture a wound. Nursing Standard, 31(8), 42-46.
Tabata, M., Shibayama, K., Watanabe, H., Sato, Y., Fukui, T., & Takanashi, S. (2014). Simple interrupted suturing increases valve performance after aortic valve replacement with a small supra-annular bioprosthesis. The Journal of Thoracic and Cardiovascular Surgery, 147(1), 321-325.
Traullé, S., Kubala, M., Doucy, A., Quenum, S., & Hermida, J.-S. (2015). Feasibility and safety of temporary subcutaneous venous figure-of-eight suture to achieve haemostasis after ablation of atrial fibrillation. Europace, 18(6), 815-819.
Wang, A. S., Kleinerman, R., Armstrong, A. W., Fitzmaurice, S., Pascucci, A., Awasthi, S., … Eisen, D. B. (2015). Set-back versus buried vertical mattress suturing: Results of a randomized blinded trial. Journal of the American Academy of Dermatology, 72(4), 674-680.
Yang, J., Kim, K. H., Song, Y. J., Kim, S.-C., Sung, N., Kim, H., Lee, D. H. (2018). Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture. Obstetrics and Gynecology Science, 61(1), 79-87.
Zenn, M. (2013). Suture skills course – Learn best suture techniques [Video file]. Web.
Combining Nurse Leader With Advocacy
Introduction
The Nurse Manager Skills Inventory is a useful assessment form that helps nurses understand their strengths and areas for improvement. The division of practices and qualities of a nurse provides a clear overview of skills that a nurse needs to acquire or reflect upon.
Personal and Professional Accountability
The identified strengths relate to personal growth and development and ethical behavior and practice (competent experience/skill). As I pursue education advancement in order to make my career planning more relevant and possible, the development of my skills and expertise is a crucial aspect of the path to becoming a professional. I believe that not only annual but also bimonthly self-assessments are necessary to track one’s progress. Ethical behavior is an integral part of my practice and approach to patients; I do not only fully integrate it but also pay attention to new methods researched by nursing professionals in ethical practice to understand how I can improve mine.
Professional association involvement and certification are the weaknesses I identified (novice experience/skill). Involvement in professional associations and the acquisition of memberships is difficult for nursing professionals with little experience in the field. Both these areas require a significant investment of time, finance, and experience. Nevertheless, I aim to improve my expertise in these areas by adding them to my development plan.
Career Planning
The identified strengths relate to knowing your future and positioning yourself (competent experience). I understand that with the aging population in the USA, the need for nurses will continue to increase, and as some rates of diseases are growing steadily (e.g., cancer, mental illnesses, etc.), my task is to acquire skills necessary for competent practice in these areas. I do not exclude scenarios that involve a narrower specialization because it guarantees flexibility in the ever-changing healthcare environment. Knowing your role is more difficult as core competencies remain the same from hospital to hospital but little specifics of practice might change. Thus, I need more expertise in this area to understand how my skills related to job requirements and whether I would benefit from additional talents.
Personal Journey Disciplines
Action learning and reflective practice often depend on each other; I use both in my practice to evaluate and reflect on decisions I make and forecast what impact they will have on the team and the patient (competent experience/skill). Shared leadership and council management are difficult to develop as my experience in leadership and communication with other leaders is relatively scarce (novice experience) (NMLP, 2006). Additionally, I have not yet engaged in the promotion of shared leadership.
Reflective Practice Reference Behaviors/Tenets
The majority of skills outlined in the content area are essential for competent nursing professionals. I actively support diversity, use multiple perspectives on a case or issue (and share them with others), discover the potential in myself and colleagues, use reflective learning at work, and therefore can conclude that my expertise in these skills in closer to competent. However, it is difficult for me to cope with ambiguity and create a constant state of learning in it as it interferes with the translation of experience to practice. In such an environment, both the development of the emotional self and the creation of balance becomes almost impossible (novice experience).
Change in the Workplace and Personal Goal
As a highly reflective person that sees potential in others and relies on ethical behavior, I will draw the management’s attention to changes in practice that are necessary to improve patients’ satisfaction with services (e.g., provide additional training about the prevention of hospital-acquired infections to nurses, emphasize the importance of patient-centered approach, etc.). Small changes are often based on personal reflections, but they can significantly improve the system as a whole (Morton, Fontaine, Hudak, & Gallo, 2017). I plan to advocate for better appreciation of different professionals and stress the need for opportunities for them to develop their potential. This potential development will not only increase their commitment but also positively influence the hospital, resulting in better patient outcomes and the reduction of burnout rates among staff. Action learning is useful in addressing urgent issues and translating this experience to others for the overall practice improvement in the organization.
A personal goal for my leadership growth is the ability to accept and work in the ambiguity of our environments (NMLP, 2006). Although I understand that healthcare professionals cannot control every aspect of their work, it would be easier for me if it was possible. To develop this skill and flexibility, I aim to learn to accept the lack of control over the workplace environment and base my decision-making on available information, using the lack of details as an opportunity rather than a barrier (Broadbent, Moxham, Sander, Walker, & Dwyer, 2014). I also plan to evaluate my professional plans more often to understand how flexible I am and what changes these plans might require (even if I do not aim to change them). Learning to be flexible is the best skill one can use when addressing workplace ambiguity. Listening to the advice of others is also an option as it requires changes and adaptation.
References
Broadbent, M., Moxham, L., Sander, T., Walker, S., & Dwyer, T. (2014). Supporting bachelor of nursing students within the clinical environment: Perspectives of preceptors. Nurse Education in Practice, 14(4), 403-409.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: A holistic approach. Philadelphia, PA: Lippincott Williams & Wilkins.
NMLP. (2006). Nurse manager skills inventory. Web.
Aggression Reduction And Social Behavior
Abstract
Aggressiveness is a genetically determined characteristic of humans. However, it should be reduced to avoid other people and self-injury. Punishment is a widely used method to prevent aggressive behavior. However, it was demonstrated in several studies that the conception of punishment is not an effective approach to decrease aggressiveness. Other methods, such as self-awareness and empathy development, are also used to lower the level of anger and to avoid aggressive actions. Self-awareness is important for personal feeling analysis which is the key to the anger release. It is also important to express anger and other feelings in a mild way to avoid aggression. Empathy is an innate human quality that could be developed. It could be described as an ability to understand other people’s feelings and motivations. This understanding provides an opportunity to reduce aggressiveness.
Introduction
Aggression could be defined as “intentional behavior aimed at doing harm or causing physical or psychological pain to another person” (Aronson, Wilson, Akert, & Sommers, 2016, p. 408). Harm could be an initial goal of aggression or an instrument to achieve another particular purpose. Aggression is considered to be genetically determined behavior which is important for humanity to survive. However, a high level of aggression could lead to negative consequences for both an individual and a social group. Thus, a person should be able to control and reduce aggression to be successful in society. While punishment is the commonly used approach to preventing aggressive behavior, self-awareness and empathy development are underestimated but more effective techniques to achieve this goal.
The Conception of Punishment for Aggression Reduction
Punishment is a widely used measure to reduce aggression. It is applied in families when parents punish their children for inappropriate behavior or violence toward others. In families, the shout benefits restriction, and corporal punishment could be used to reduce the aggressiveness of children. Punishment is also used in the criminal justice system as a measure to prevent further adults’ crimes. For this, a fine, jail, or the death penalty are used, depending on the seriousness of a crime (Aronson et al., 2016).
According to MacKinnon-Lewis, Lindsey, Frabutt, and Chambers (2014), children who experience corporal punishment and strict discipline in the family are more likely to demonstrate aggressive behavior toward their schoolmates and friends. As a result, these children start to be treated as aggressive by their teachers and other children which leads to the further increase of the aggression level. Besides, recent investigations in the area of criminal justice showed that the fear of punishment does not reduce the crime rate (Aronson et al., 2016). Thus, it could be stated that punishment might not be an effective measure to reduce aggression among the population.
The conception of punishment seems to be reasonable: “punishing any behavior would reduce its frequency” (Aronson et al., 2016, p. 399). However, as it was shown above, this measure might not be effective. The possible explanation of its ineffectiveness could be next: the punishment does not clarify what should be done. It just underlines that the current behavior is inappropriate without the reasons explanation. Besides, in some cases, punishment is the initial goal of a crime or aggressive behavior. For example, an older child could hit a younger one with the purpose to get the mother’s attention even in the form of a punishment (Aronson et al., 2016). Therefore, more effective measures to prevent aggressive behavior could be examined and applied.
The Self-Awareness and the Aggression Decrease
Anger could be considered as the most common reason for an aggressive behavior. It is a strong feeling which should be released. However, current social behavioral standards do not approve the feeling, in particular, anger expression. Thus, according to Aronson et al. (2016), “keeping our feelings bottled up and expressing them are both harmful” (p. 403), and some alternative solution should be found. The self-awareness and mild feelings expression could be the solution.
If some situation leads to the anger increase, it is important to understand the inner core of negative feelings and to explain a problem calmly and argumentatively. For example, a wife could be angry at her husband because he did not help her to clean the house but was watching TV the whole weekends. However, the real reason for her anger and the real problem of their relationship might be the lack of attention. Thus, instead of shouting about the lack of help in cleaning it is better to explain real woman’s feelings such as the loneliness and anxiety. This calm and argumentative conversation might lead to some positive results.
Free writing could be named as a possible approach to self-awareness and inner feeling understanding. Free writing is a popular technique which is used in many psychological practices. The idea of it is that a person should write freely and without thinking for the given period of time (for example, for ten minutes) or the given length of paper (for example, three pages). This approach helps to express an inner voice of a personality and to understand real feelings and their reasons (Krueger, 2015). It also might help to release the anger and to find a possible solution to a problem (Aronson et al., 2016).
Empathy versus Dehumanization
Dehumanization is a mental process when a personality refuses to consider other person or group of individuals as humans. “Success at dehumanizing the victim virtually guarantees a continuation or even an escalation of the cruelty” (Aronson et al., 2016, p. 181). Nazi crimes against Jewish people could be considered as an example of the process of dehumanization influence on the aggressiveness.
Empathy is a natural ability of humans and some other animals to understand feelings of others. According to the Aronson et al. (2016), the empathy development could prevent aggressive behavior of an individual. It could be stated that if a person puts oneself on other people’s places and understand their feelings and motivation, it leads to the significant decrease of the level of aggression and anxiety. Special psychological training could be focused on the empathy development. However, to achieve this goal a conversation remains highly important. Only an argumentative conversation allows expressing own feelings and understanding the feelings of another person.
The mentioned above situation with the marriage couple could be considered as an example of the empathy importance. Instead of fighting, they could have a conversation. A wife could express her feelings of loneliness and anxiety and ask her husband’s reasons for not helping her. These reasons could be various: he could be too tired, or he did not want to interfere. Understanding of the situation might lead to the cooperative solution finding.
Conclusion
It could be concluded that several methods for the aggression decrease could be used, and the punishment, self-awareness, and empathy increase are among them. Punishment might be widely accepted but less effective than other two approaches. The self-awareness and inner feelings understanding are highly important for the anger release and aggressive diminishment. Another possible solution to the problem of high aggressiveness is the empathy development. In general, psychological approaches are more effective measures for the aggressiveness decrease.
References
Aronson, E., Wilson, T. D., Akert, R. M., & Sommers S. R. (2016). Social psychology (9th ed.). New York, NY: Pearson Education.
Krueger, A. (2015). Whose voice is it anyway? Implications of free writing. Current Writing: Text and Reception in Southern Africa, 27(2), 103-110.
MacKinnon-Lewis, C., Lindsey, E. W., Frabutt, J. M., & Chambers, J. C. (2014). Mother–adolescent conflict in African American and European American families: The role of corporal punishment, adolescent aggression, and adolescents’ hostile attributions of mothers’ intent. Journal of Adolescence, 37(6), 851-861.