Nursing Critical Event Analysis - Essay Example

?Nursing Critical Event Analysis Introduction This reflective essay will be about an event that happened during my first week of placement at a localreferral hospital. Christopher John ‘s reflective model is ideal for my essay as it gives a systematic structure that is filled with a number of questions that can assist medical workers to investigate the meaning of different experiences (McClure 2005). This model also allows for medical practitioners to use reflection in examining their own thoughts and actions when reacting to or catering to the needs of patients. Description of the Event What was the context surrounding the event? During my first week of placement, a young couple came into the emergency room with a young boy in tow. From the resemblance alone, I could tell that the boy was their son. They looked around the room in a confused manner and then stared at my mentor and I. We both began to approach the young family. My mentor turned to the parents and began asking questions about why they were there. At that moment, a noisy group of people entered the emergency room and rushed towards us. The young couple did not answer my mentor’s questions, but turned to the group and began to converse loudly in a foreign tongue. My mentor tried to stop the cacophony but was unable to. The hospital’s security guards strode towards the noisy crowd and began to sternly signal for everybody to remain silent. The young couple which was now at the centre of the small crowd suddenly turned to their small boy who had been silently observing everything, and delicately began to remove his sleeve from his hand. My mentor suddenly reared back in shock and stopped their action by grabbing both of their hands. I craned my neck to see what had upset her and, to my shock, saw a number of purplish blisters across the boy’s arm which is a characteristic of an iron burn. On seeing the blisters, the small crowd began to gesticulate towards my mentor and I while shouting in an unintelligible language. My mentor slowly carried the boy away from the hysterical small crowd, leaving the security guards to deal with the disgruntled people. I followed my mentor who immediately ran cool water over the second degree burn. During this time, my mentor was trying to speak to the little boy who shyly began to answer in the form of small gestures. At this point, the parents ran past the security guards and came towards us. I turned to them and began to question them about the incident. They could not speak clear English, and made signs of ironing while pointing at their boy. My mentor asked for the hospital worker who is from the same ethnic background as the boy to be located and brought to assist with communication efforts. What were the consequences of the actions taken for the patient and others involved? Once the worker reached the emergency room, he began to interpret what the boy’s parents were saying as I helped my mentor to apply an antibiotic ointment on the burn. My mentor knelt so as to be on the same level with the boy when asking questions. She asked simple open-ended questions which the boy could reply to with ease. She also used a soft tone of voice so that the child would not be further upset. Then she turned to the parents and indicated for the hospital worker to inform them that the boy would remain for observation. She also asked for the workers to be informed that this was necessary so that further infection would be prevented, so that the parents would agree to leave the boy in the hospital. In reality, she wanted to ask more questions about the accident. Even though the child remained silent, nodding or shaking his head when questioned, his parents and seeming relatives were still talking in moderate tones outside the door. The revelation that the boy would be admitted brought some protests from a few people, but, in general, others were in agreement with this decision. Reflection How were others feeling, what were the other perceptions involved? I could see that my mentor was deeply disturbed by the scattered blisters on such a young child’s arm. I was also shocked by this situation; as were other emergency room workers, as was evidenced by the number of medical practitioners that congregated in the room for a few minutes. The parents and relatives of the boy were also distressed and also appeared to be frustrated by the fact that they could not communicate well. Why did I and/ or others respond like they did? Even though hospital workers are not often shocked by problems of their patients because they deal with wounds on a daily basis, the mutilation or wounding of a child still brings forth many feelings in even the most jaded medical practitioner. In this case, these feelings were exacerbated because of the medical practitioners’ inability to understand what the parents of the child, or the child himself was saying. In addition, the more than ten relatives who came charging into the emergency room alarmed the workers, some of whom later stated that they came to the emergency room because they had thought that there was a bomb scare or critically injured local celebrity. What values or beliefs were important and underpinned actions or ways of thinking by those involved in the event? In removing the patient away from the small crowd, my mentor actually succeeded in calming the situation a bit while also finding a way to communicate with the child. According to Chang and Daly, intuition on how to handle such stressful situations can actually serve to generate a shared sense of understanding between the patient and nurse (Chang and Daly 2012). It also allows the inexperienced nurse to take quick action in a situation in order to prevent the situation from worsening. Even though the little boy did not appear to understand what my mentor was saying at first, he developed enough confidence in her to answer through gestures. In addition, her consideration of his feelings when she removed him from the tumult of the small crowd appeared to foster some kind of understanding between the two of them. What others factors influence the way in which I interpret the event /situation / practice observed? I believe that my mentor used more insight than evaluation in the situation when she chose to remove the boy from the company of his kinfolk in order to speak to him alone. According to (McClure 2005), the process of making a decision that is not controlled by mentors or other hospital authorities actually helps a new nurse to develop more self confidence. How do past experiences inform my view / assessment / perception of the event? I have helped nurses in the past in treating burn wounds in some capacity. According to (O’Brien and Neal 2010), public medical facilities are the perfect environment for new nurses to be able to function with self determination in making nursing decisions. Even though I was unprepared for the presentation of burns in such a young child, my mentor’s actions in taking control of the situation spurred me into working in concert with her. What knowledge did or should have informed you e.g. what concepts [are] important for a deeper understanding of the event? According to (McClure 2005), when trained nurses reason, they actually take eight factors into consideration. Critical thinking has to do with attempting to understand or solve problem or comprehend an idea (McClure 2005). This calls for the nurse to view matters from their patient’s perspectives and understand why they think as they do. For instance, in this situation, my mentor endeavoured to understand how the young patient was feeling and how he had acquired the burns even though she could not understand him well. In kneeling, she was ensuring that she would be able to maintain good eye contact with him while he made gestures to explain what he thought she was asking. When the interpreter’s skills were put to use, my mentor asked open ended questions that encouraged the boy to speak more freely. At one point, when the boy was admitted, my mentor sent for a white board and markers so as to ask more questions of the boy without using the interpreter. She explained to me that her reason for doing this was to prevent the possibility of any information being kept from her in order to protect the family name. There are cultures that do not encourage openness with people that are perceived as strangers (Bryant-Lukosius and Dicenso 2004). 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 (Levett-Jones and Bourgeois 2011), it is important to be open to considering all forms of possible communication when assessing a patient who does not speak the local language. In this case, my mentor’s decision to question the boy further was the correct action to take. The little boy would reveal that the hot iron was actually aimed at his mother when it hit him. The worker had stated that the boy was saying that he caught his hand on an upturned iron that had not been turned off, earlier in the emergency room. However, using the white board, the little boy made gestures that denoted a throwing motion from his father towards his mother. According to (Levett-Jones, Lathlean, Higgins and McMillan 2009), the self confidence of nursing students can be greatly increased by a relationship with a mentor who is deeply invested in the well being of patients. My mentor’s actions to learn more about the boy’s accidents showed me how a nurse ought to react even in controversial situations such as conflict in the home. What application/s have you made from the literature to inform the event / situation or practice? This experience has taught me that a nurse can communicate with young and old patients easily even in the absence of a common language (Minnesota Public Health Nursing Practice Council 2011). All people need to be reassured that the nurse has their best interests at heart before starting to reveal different things about their lives or current situations. Once this trust is gained and a relationship between patient and nurse is established, gestures, and types of non-verbal communication become as efficient as verbal communication in providing information (Mann, Gordon, Mac 2009). What quality evidence is there to support your findings and reasoning of the event? According to (Pearson 2009) a friendly and encouraging mentor can help a student nurse to develop more self confidence when dealing with patients by affirming the nurse’s actions. I took my cues from my mentor when handling the little boy as a patient because of the care with which she has mentored me and also because of the concern that I saw her exhibit for the boy. It has also been suggested, in the recent past, that there are aspects of nursing that may be garnered in a non-academic background (Roberts 2009). I feel that my mentor’s intuitive response to the little boy when he first came to the emergency room was one of those reactions that came due to an inherent feeling that she would not likely get the true account of events from the adults. Her suspicions were confirmed when even a stranger to the family- who was the hospital worker who served as an interpreter- adjusted the truth so that the family was not shown in a bad light and child social services would not be involved in this case. What ethical and / or practice guidelines are important for the event / situation practice observed? When young children are presented with mutilations or suspicious wounds, all medical facilities as well as practitioners have a duty to try and uncover any past history that may be connected with the incident (Timmins 2006). This is because children can be abused and then coerced to be silent about it. 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? Many medical facilities have policies that support informing Child Services authorities of suspicious cases of wound in children (Whitton, Allan, Basak, Mewburn, Joint, Pavey and Wiktovska 2007). Moreover, there are other times when counselling services can be arranged between the parents of the affected child and a hospital authority so as to speak further on ways in which future accidents can be prevented within the home (Evidence Scan 2012). How has this analysis impacted your decision making, what would you change and why? I have realised that nursing is a profession in which the nurse is always learning new things. I have also learned that relating with patients is not merely about speaking with them about the things they are experiencing, but it is also about being with them a source of comfort when they undergo painful experiences. Communication through non verbal gestures is almost as efficient as verbal communication in informing patients or medical workers about different things. Reflecting on experiences such as the one I encountered during my first week of placement is what contributes to a nurse’s professional development (White, Laxton, Brooke 2010). What other changes would I make because of my analysis and how is this informed by theory? In future, I expect that I shall make use of more reflective methods to seek breach the gap between theory and practice in my daily duties. According to (White, Laxton, Brooke 2010), this can enhance a nurse’s experience so that he or she learns to deal with patients with different needs and who are from varied backgrounds. References Bryant-Lukosius, D. & Dicenso, A. (2004) ‘A framework for the introduction and evaluation of advanced practice nursing roles’, Journal of Advanced Nursing, vol. 48 , no. 5, pp. 530–540, viewed 15 Aug 2013 http://aipsq.com/_pdf/Bryant-. Chang, E. & Daly, J. (2012) Transitions in Nursing: Preparing for Professional Practice, Elsevier, Sydney, viewed 15 Aug 2013 . Evidence Scan. (2012) ‘Quality improvement training for healthcare professionals’, The Health Foundation Inspiring Movement, pp. 6-37, viewed 15 Aug 2013 . Levett-Jones, T. & Bourgeois, S. (2011) ‘The clinical placement- an essential guide for nursing students’, School of Nursing and Midwifery, vol. 37, no. 2, pp. 266, viewed 15 Aug 2013 . Levett-Jones, T., Lathlean, J., Higgins, I. & McMillan, M. (2009) ‘Staff- student relationships and their impact on nurse students’ belongingness and planning’, Journal of Advanced Nursing, vol. 65, no. 2, pp. 316-324, viewed 15 Aug 2013 . Mann, K., Gordon, J. & Mac, A. (2009) ‘Reflection and reflective practice in health professions education: a systematic review’, Advance in Health Science Education, vol. 14, pp. 595–621, viewed 15 Aug 2013 . McClure, P. (2005) Reflection in practice, School of Health Sciences, University of Ulster, viewed 15 Aug 2013 . Minnesota Public Health Nursing Practice Council. (2011) ‘Relevant challenges and considerations for public health nursing practice’, Minnesota Department of Health: Office of Performance Improvement, viewed 15 Aug 2013 . Pearson, H. (2009) ‘Transition from nursing student to staff nurse: a personal reflection’, Paedriatic Nursing, vol. 21, no. 3, pp. 30-32, viewed 15 Aug 2013 . Roberts, A. (2009) ‘Encouraging reflective practice in periods of professional workplace experience: the development of a conceptual model’, Reflective Practice, vol. 10, no. 5, pp. 633–644, viewed 15 Aug 2013 . Timmins, F. (2006) ‘Critical practice in nursing care: analysis, action and reflexivity’, Nursing Standard, vol. 20, no. 39, pp. 49-54, viewed 15 Aug 2013 . White, P. , Laxton, J. & Brooke, R. (2010) ‘Reflection: Importance, theory, and practice’, University of Leeds, viewed 15 Aug 2013 . Whitton, A., Allan, L., Basak, C., Mewburn, J., Joint, M., Pavey, L. & Wiktovska, J. (2007) ‘Sensitive disposal of all fetal remains -Guidance for nurses and midwives’, Royal College of Nursing, viewed 15 Aug 2013 . Read More