Critical Incident analysis of a clinical setting

The purpose of this essay is to reflect and critically study an incident from a clinical setting whilst using a model of reflection. This will allow me to analyse and make sense of the incident and draw conclusions relating to personal learning outcomes. The significance of critical analysis and critical incidents will briefly be discussed followed by the process of reflection using the chosen model. The incident will then be described and analysed and the people involved introduced. (The names of the people involved have been changed to protect their privacy) and then I will examine issues raised in light of the recent literature relating to the incident. My essay will include a discussion of communication, interpersonal skills used in the incident, and finally evidence based practice. I will conclude with explaining what I have learned from the experience and how it will change my future actions.

In accordance with the 2002 Nursing and Midwifery Council, the clients’ details and placement setting has not been disclosed in order to maintain confidentiality.

Critical incidents are snapshots of something that happens to a patient, their family or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Rich & Parker 2001). Reflection and analysis of critical incidents is widely regarded as a valuable learning tool for nurses. The practice requires us to explore our actions and feelings and examine evidence-based literature, thus bridging the gap between theory and practice (Bailey 1995). It also affords us the opportunity of changing our way of thinking or practicing, for when we reflect on an incident we can learn valuable lessons from what did and did not work. In this way we develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). Critical incidents ???

“To be self aware is to be conscious of one’s character, including beliefs, values, qualities, strengths and limitation. It is about knowing oneself” (Burnard 1992).

I am going to use Gibbs (1988) Reflective Cycle. This because Gibbs is clear and precise allowing for description, analysis and evaluation of the experience helping the reflective practitioner to make sense of experiences and examine their practice. Taking action is the key; Gibbs prompts to formulate an action plan. This enables the reflective practitioner to look at their practice and see what they would change in the future, how they would develop/improve their practice.

Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future. The cycle starts with a description of the situation, next is to analysis of the feelings, third is an evaluation of the experience, fourth stage is an analysis to make sense of the experience, fifth stage is a conclusion of what else could I have done and final stage is an action plan to prepare if the situation arose again (NHS, 2006). Baird and Winter (2005, p.156) give some reasons why reflection is require in the reflective practice. They state that a reflect is to generate the practice knowledge, assist an ability to adapt new situations, develop self-esteem and satisfaction as well as to value, develop and professionalizing practice. However, Siviter (2004, p.165) explain that reflection is about gaining self-confidence, identify when to improve, learning from own mistakes and behaviour, looking at other people perspectives, being self-aware and improving the future by learning the past. In my context with the patient, it is important for me to improve the therapeutic relationship which is the nurse-patient relationship. In the therapeutic relationship, there is the therapeutic rapport establish from a sense of trust and a mutual understanding exists between a nurse and a patient that build in a special link of the relationship (Harkreader and Hogan, 2004, p.243). REFRENCE ON CONFRONTATION!!

Description

My reflection is about one patient whom I code her as Mrs. Adam, not a real name (Appendix I) to protect the confidentiality of patient’s information (NMC, 2004). In this paragraph I would describe on the event takes place and describe that event during my clinical placement. I was on a surgical ward nursing Mrs Adam under supervision of my mentor when during ward round I was asked to remove Ms Adams wound dressing so the doctor can assess the wound, therefore I removed it using aseptic technique and cleansed the wound. I stayed with the patient whilst my mentor attended to another patient. When the doctor arrived from visiting another patient I observed that he came directly to Ms Adams without washing his hands or using alcohol gel and was wearing loose watch and I was concerned this would infect Ms Adams wound. At that moment I was thinking to speak up and say something however I dismissed enough courage to confront the doctor and thought it was too late as the doctor already started examining Ms Adams.

Feelings

In this paragraph, I would discuss on my feelings or thinking that took place in the event happened. I was shocked that the doctor did not wash his hands or use alcohol prior examining Ms Adams especially with all the infection control guidelines and protocols in place. In spite of this I did not have confidence and felt intimidated due to the fact the doctor was more knowledgeable and experienced than I was as a first year student, also I did not want to make him feel uncomfortable. Furthermore I did not want the patient to feel alarmed and worried by challenging the doctor whilst Ms Adams was there.

However soon after I had a word with my mentor and told her what I observed and she then recommended that together we confront the doctor, therefore the next day my mentor spoke to him in private and she asked him if before examining Ms Adams whether he washed his hands. The doctor seemed stunned by this conversation but admitted he did not wash his hands. He responded by justifying his actions and saying he was busy and was in a rush to remember. My mentor discussed the significance of infection control and hand hygiene and then the doctor promised her that he would make sure he follows the protocols and cleanses his hands prior examining any patient in the future.

Evaluation

This event was difficult and challenging for me as I felt disappointment for my lack of confidence in not confronting and challenging the doctor prior him examining Ms Adams, on the other hand I felt content in the way the doctor responded so positive and optimistic. Consequently I observed that doctor has now changed his practice as a result of this incident. I have learnt from this incident the importance of acting assertively with staff members in a sensitive approach in order to safeguard patient’s health.

Analysis

Nurses have a responsibility to safeguard and promote the interests of individual patients and

Clients (NMC 2004). This responsibility include ensuring that his or her knowledge and competencies commensurate with the task being undertaken.

Infection is responsible for increased morbidity and mortality, thus a comprehensive knowledge of infection control precautions and basic microbiology should be a fundamental requirement of all healthcare professionals.

Hands must be decontaminated before every episode of care that involves direct contact with patients’ skin or food, invasive devices or dressings. Current expert opinion recommends that hands need to be decontaminated after completing an episode of patient care and following the removal of gloves to minimise cross contamination of the environment (Boyce and Pittet, 2002; Pratt et al, 2001)

Hand hygiene is a crucial factor in the control of HAI because hands can easily transfer micro-organisms from one area or patient to another. Despite strategies promoting hand hygiene there still seems to be difficulty persuading staff to adopt good practice (Shuttleworth, 2004). Doctors are the worst offenders. According to NHS figures, 25% of them fail to follow basic hand-washing procedures, compared with 10% of nurses and 15% of ancillary staff. From The Sunday Times December 21, 2008

Royal College of Nursing (RCN, 2009)Studies show that uniforms may become contaminated by potentially disease-causing bacteria, including Staphylococcus aureus, Clostridium difficile, Although it has been suggested that uniforms act as are servoir or vector for transmission of infection in hospitals, no evidence is currently available linking the transmission of bacteria to patients (Wilson et al., 2007).However, it is important to note that all clothing worn by all staff (for example, doctors, therapists and cleaners) has the potential to become contaminated via environmental micro-organisms, or those originating from patients or the wearer, and that nurses uniforms are not unique in that respect. This reinforces the need to ensure all clothing worn by staff in all clinical areas is fit for purpose and able to withstand laundering.

Advocacy ranges from activities on behalf of patients, such as hand washing and proper identification before treatments, to arguing that an early discharge will harm her patient’s recovery.

According to Arnold and Boggs 2003) assertive nurse is able to stand up for the rights of others as well as for his or her own rights”. Some benefits of assertiveness identified by Rungapadiachy (1999) include being respected for being honest and fair, developing a sense of self respect and having the ability to establish good interpersonal relationships with others

Becoming more self-aware seems to be a very important concept to nursing practice. Driscoll (2000, p17) states that reflective learning will help you become more self-aware in your clinical practice.

As the student nurse caring for Mr Khan under my mentor’s supervision, this also applies to my own practice as a student nurse.

Conclusion

In hindsight I feel I should have confronted the doctor at that moment and acted sooner. I also should have made sure the doctor washed his hands prior examining the patient. I realise how I put Ms Adams heath at risk. Following conversation with my mentor acknowledged that I need to develop the confidence to challenge the practice of colleagues, understanding pressures that may be under but ensuring that their practice does not put patients at risk.

If a nurse observes a practice or procedure she believes to be wrong, advocating for her patient demands she speak out even if that practice was carried out by her superior. This is not always easy and may have a cost for the nurse.

I realise that I need to be supportive to colleagues, understanding the pressures that they may be under, but ensuring that their practice does not put clients at risk.

Action Plan

My action plan is always to work as part of a team, learn more about how best to communicate in order to contribute to good nursing care. I will aim improve and develop my assertive skills when working with staff members to ensure health and safety of patients is maintained. Therefore I will make this a goal for learning in my next placement and discuss with my mentor to work out strategies for how I can achieve this.

If a situation arises again like this particular one I have learned that

I have also gained knowledge on the effectiveness communication

How does it work out? What happens next time you are in a similar situation?