Nursing Critical Event Analysis - Essay Example

?Nursing Critical Event Analysis Introduction This reflective essay will be recollecting a critical incident I witnessed while in placement same months ago. The model I will be using is the Gibbs reflection model. The Gibbs reflection model seeks to understand the feelings that I experienced, and also allows for the evaluation of an incident in terms of what was bad or good about it. The Gibbs model also includes an analysis of the critical nursing situation and then the suggestion of an action plan that will deal with the issue if it should arise again. I will use this model because it allows for the entertaining of critical thoughts as the nurse in question seeks to use theory in a practical way in her assignments. Description of the Event What was the context surrounding the event? The incident I will write about took place during the first week of my placement at a local hospital and involved a patient known as Mr. Smith. Mr. Smith, who lived in an elder’s home nearby, had been rushed to the hospital when he started to experience breathing difficulties. Mr. Smith has in the past experienced a number of strokes that left him partially paralysed. He also has a lot of difficulty in swallowing and cannot speak clearly. At the care-giving home, Mr. Smith is dependent on his care-givers to perform personal duties such as bathing and eating. My mentor, a registered nurse who was given the responsibility of catering to Mr. Smith’s needs, asked me to accompany her to his ward. In the previous week, she had discussed various ways in which a nurse can feed an elderly patient with swallowing difficulties without harming him or her while ensuring that the patient consumes enough food. I was quite eager to start my placement duties and did not imagine that anything would faze me. I followed my mentor, who was carrying a large bowl of pureed carrots, down the quite corridor and into Mr. Smith’s room. There were many things that I had expected, but Mr. Smith’s visage was deeply alarming to me. What were the consequences of the actions taken for the patient and others involved? The patient started to cough loudly, with streams of what seemed to be phlegm issuing from his mouth and nose. At first, I was quite nauseated; and began to try and focus my attention on other things in the room. My mentor spoke sternly to Mr. Smith and informed him that he would eat the food brought to him even if he did not like it. There was not much struggle, but it was obvious that Mr. Smith was not happy about his meal. Reflection How were others feeling, what were the other perceptions involved? My mentor also appeared to be somewhat frustrated. She fed Mr. Smith calmly; but when he turned his face and made throaty noises, she put down the bowl and turned his face before feeding him. She did not speak, but I could sense her annoyance. My mentor was not saying anything to me during the episode of forced feeding- causing me to feel uncertain and somewhat flustered. Remaining calm even when operating under pressure is what contributes towards making good will decisions on how best to handle troubled or anxious patients (Chaloner 2007). I loudly observed to my mentor that Mr. Smith appeared to be coughing a lot possibly because of the forced feeding. Without looking up, my mentor mumbled that there was no other way to get food into Mr. Smith’s body and that coughing was a normal thing for him and should not worry me. Why did I and/ or others respond like they did? Critical reflection can help a student nurse to develop listening skills that will help him or her to become a better clinician (Dye 2006). My initial thoughts when my mentor began to feed Mr. Smith were of fear. I thought that I would be forced to watch him choke into unconsciousness; what with the way he was coughing. Also, I had not thought that I would be given responsibility for such an elderly patient. What values or beliefs were important and underpinned actions or ways of thinking by those involved in the event? I wanted to prove to my mentor that I could handle the situation and was qualified to be a nurse; I also did not want Mr. Smith to view me as a weak-willed nurse because some student nurses had informed me that such nurses were given the hardest time by patients. Moreover, I wanted Mr. Smith to feel that he could trust me to make the best decisions for him. Patients are constantly exposed to unpleasant check-ups that confirm to them that they are not in charge of their own bodies. What others factors influence the way in which I interpret the event /situation / practice observed? I have always been squeamish about handling bodily fluids. I enrolled for a nursing degree even with the knowledge that I would somehow have to find a way of combating my fears. Moreover, in my theoretical studies had learned that empathy from a medical practitioner can contribute towards the development of a relationship based on mutual trust between a nurse and a patient (Oelofsen 2012) How do past experiences inform my view / assessment / perception of the event? My sister, who is a registered nurse, had the same phobias as I did, and she was able to overcome them. She encouraged me to fight my fears in order to get the career of my dreams. My mother and her sister are nurses; and I have always admired their dedication to their work responsibilities. My family members encouraged me to trounce my fears even if I was at first revolted by what I saw. What knowledge did or should have informed you e.g. what concepts [are] important for a deeper understanding of the event? To encourage myself, I went through my college notes on how to deal with difficult patients during feeding, and also spoke with my mother about how she dealt with such patients at her workplace. I also remembered that in nursing, medical practitioners are required to treat their patients with dignity and seek to understand them rather than force them into actions they may not understand (The Canadian Nurses Association - Code of Ethics for Registered Nurses 2008). The next day, my mentor escorted me to Mr. Smith’s room. On uncovering the pureed food, my patient began to cough just like he had on the day before when I witnessed him being fed by my mentor. I bit my lip and avoided Mr. Smith’s eye as I filled the spoon with food. Mr. Smith turned his head and began groaning loudly and shaking his head with a shocking amount of violence. At first I thought that he was experiencing a kind of seizure. Just at that point, the matron walked into the room; bumping my mentor in the process. She laughed when she saw what I was trying to do and yanked the bowl from me before berating the patient for a short while. Then she began to feed a very reluctant Mr. Smith who ate in spite of his dislike of the food. I was left feeling quite uncomfortable and ridiculous. I was quite angry with Mr. Smith for ‘showing me up’ in front of my mentor and the matron. What does the literature say about the concepts arising from the event / situation / practice observed to support your understanding and depth of reasoning? According to (Zarezadeh 2009), reflective practice can spur the development of respect and trust between a nurse and patient (Zarezadeh 2009). Nurses have a duty to desist from adding to the discomfort of a patient and seek to use their professional skills to discover the patient’s preferences as concerns treatment and patient care. I did not learn how to feed Mr. Smith that night either. It took a lot of stamina and perseverance to develop a relationship with Mr. Smith before he would accept for me to feed him without much of a fuss. What application/s have you made from the literature to inform the event / situation or practice? This entire learning experience was critical for me because I was so eager to be a good and efficient nurse. I also learnt that it is very important to remain calm even when patients are in bad moods because of one thing or another. It seemed to me that my patients would adjust their outlooks when I portrayed a positive attitude in spite of the problems I was facing (Cuevas 2008). What quality evidence is there to support your findings and reasoning of the event? Nursing can be challenging because different patients express themselves in different ways (Chabelli 2007). This means that in some cases where the patient’s actions are unfathomable, nurses have to use their communication as well as reflective skills to understand the essence of what their patients are trying to express. According to (Whittaker, 2009) therapeutic communication essentially describes the exchange of ideas between the patient and the nurse with the aim of accomplishing mutually held goals (Whittaker, 2009). In this particular case, Mr. Smith at first communicated through angry noises and later body language. Facial expressions are a basic method of expressing emotions, while eye contact can be used to convey interest. Mr. Smith’s partial facial paralysis also made it harder to read his true feelings. What ethical and / or practice guidelines are important for the event / situation practice observed? It is important for a nurse to reconcile herself with his or her feelings before handling patients with difficulties (Jansonn, Pilhammar, and Forsberg 2009). This will make the nurse become more comfortable around the patient and be ready to listen to the patient’s problems without ascribing the wrong feelings to them in order to find speedy solutions. It was at first uncomfortable being around Mr. Smith because I did not know what to do or say to assuage Mr. Smith’s obvious anxieties. I also learned that reflecting on a patient’s needs as well as present situation can contribute towards finding the best way to administer the necessary treatment without infringing on the dignity of the patient (Yildrim, Ozkahraman, and Karabudak 2011). What are the alternatives for this event e.g. for the patient outcome, practice or situation? How is your approach informed by literature / evidence for practice? Elderly patients who are prone to memory lapses can be quite difficult to handle. Many times, this is not intentional and merely shows that they are confused and probably perplexed about their conditions. According to (The Canadian Nurses Association - Code of Ethics for Registered Nurses 2008), restraints may only be used as a last alternative after all other measures have been exhausted. Usually, negotiating with the patient and exhibiting empathy towards his or her situation allows the patient to calm down enough to be treated. In addition, there are non-verbal behaviours that nurses can use to assure patients, such as those suffering from speech impediments, that their needs are understood. Some important non-verbal tendencies include prolonged eye contact, close proximity, touching the patient in a comforting way, clarification, speaking through a calm and soothing voice, and validating the patient’s feelings. What new understandings / ways of knowing of the event have you gained? I have acquired a new perspective on how to deal with elderly as well as immobilised patients as a result of my experience with Mr. Smith. I now realize that nurses are provided with more decision making opportunities than even their superiors where the care of patients is concerned in medical facilities (Jerico, Peres, and Kurcgant 2008). If I were to come across another situation such as that which I experienced with Mr. Smith, I would adopt a positive attitude towards the patient in spite of obvious problems. Patients tend to benefit when their nurses demonstrate positivity and care because they feel that someone who is professionally trained is in control. I also understand better how comforting and reassuring the presence of a mentor can be for a student nurse’s first experiences (Price 2004). How has this analysis impacted your decision making, what would you change and why? I have realized that any lack of communication can result in a lack of trust between the patient and the medical practitioner. This can be very harmful to the patient’s health because he or she might begin to feel that the nurse does not have his or her best interests at heart. There have been incidences where the health of a patient deteriorated because the patient was hiding the medicines given by a nurse or medical worker that he or she did not trust. Usually, nurses have preconceived ideas about what their patients are like even before going to treat them. I have found that reflecting on each of my patients after encountering them for the first time helps me to develop a more balanced and objective view about their presented mannerisms, as well as to be more sympathetic to their condition. Reflection helps a nurse to be able to remain objective and come up with the best ideas on how to treat even the most difficult patient (Dye 2006). What other changes would I make because of my analysis and how is this informed by theory? Even though this is an extreme reaction, it is not uncommon when relations between patients and medics are not constructive. In future, I will be sure to first look for the best ways through which to engage my patients even before discussing with them their preferred methods of treatment. I will also seek to consider the cultural practices of my patients when considering how best to deal with the complications exhibited by the patients (Mantzoukas and Jasper 2004). References Chabelli, M.M. (2007) ‘Facilitating critical thinking within the nursing process framework: a literature review’, Health SA Gesondheid, vol. 12 no. 4, pp. 70- 88, viewed 30 Jul 2013 from . Chaloner, C. (2007) ‘An introduction to ethics in nursing’, Nursing Standard, vol.21, no. 32,pp. 42-46. Retrieved from http://nursingstandard.rcnpublishing.co.uk/archive/article-an-introduction-to-ethics-in-nursing Cuevas, H. (2008) ‘Using reflection as a nursing intervention’, Clinical Nurse Specialist - Wolters Kluwer Health |Lippincott Williams & Wilkins, vol. 22, no. 3, pp. 122-123, viewed 30 Jul 2013 from . Dye, D. (2006) ‘Enhancing critical reflection of students during a clinical internship using the self-S.O.A.P.’, The Internet Journal of Allied Health Sciences and Practice, vol. 3, no. 4, pp. 1–6, viewed 30 Jul 2013 from . Jansson, I., Pilhammar, E. & Forsberg, A. (2009) ‘Obtaining a foundation for nursing care at the time of patient admission: a grounded theory study’, The Open Nursing Journal, vol. 3, p. 56, viewed 30 Jul 2013 from . Jerico, M.C., Peres, A.M., & Kurcgant, P. (2008) ‘Organizational structure of nursing services: reflections on the influence of the organizational power and culture’, Rev Esc Enferm USP, vol. 42, no. 3, pp. 559-66, viewed 30 Jul 2013 from . Mantzoukas, S. & Jasper, M. (2004) ‘Reflective practice and daily ward reality: a covert power game’, Journal of Clinical Nursing, vol. 13, no.8, pp. 925-933, viewed 30 Jul 2013 from . Oelofsen, N. (2012) ‘Using reflective practice in frontline nursing’, Nursing Times, Vol.108, no.24, pp. 22-24. Retrieved from http://www.nursingtimes.net/Journals/2012/06/08/v/f/l/120612-PrDisc-reflect.pdf Price, A. (2004) ‘Encouraging reflection and critical thinking in practice’, Nursing Standard, vol. 18, no.47, pp. 46-54, viewed 30 Jul 2013 from . The Canadian Nurses Association - Code of Ethics for Registered Nurses. (2008) Nursing Practice Standards, viewed 30 Jul 2013 from www.nurses.ab.ca/Carna-Admin/Uploads/new_nps_with_ethics.pdf>. Whittaker, R. (2009) ‘Narrative explorations in clinical health psychology’, The International Journal of Narrative Therapy and Community Work, no. 2, pp. 48-55, viewed 30 Jul 2013 from http://www.theinstituteofnarrativetherapy.com/Narrative%20explorations%20in%20clinical%20health%20psycholgy.pdf Yildirim, B., Ozkahraman, S. & Karabudak, S.S. (2011) Critical Thinking in Nursing Process and Education. International Journal of Humanities and Social Science, vol. 1, no. 13, pp. 257-261, viewed 30 Jul 2013 from http://www.ijhssnet.com/journals/Vol_1_No_13_Special_Issue_September_2011/34.pdf . Zarezadeh, Y. (2009) ‘A model for using reflection to enhance inter-professional education’, International Journal of Education, vol. 1, no. 1, pp. 1-9, viewed 30 Jul 2013 from . Read More