Using a Model of Reflection in Action - Essay Example

Reflection Using Rolfe et al Model of Reflection Introduction: I am a nurse placed in the Medical-Surgical ward, and I have been assigned under my Mentor, who is a staff nurse in this ward. This is a very busy ward, and since I am inexperienced, this is sometimes very confusing for me. Although it is exciting to be working here, this flurry of activities may cause many critical incidents, which may accentuate further due to lack of knowledge. This is a reflective account of a critical incident in my placement during a drug round in one evening. This incident relates to a patient who was admitted to this ward the day before with cellulitis of the left lower leg, and she has been on treatment since then. This reflective account does not contain the real identity of the people involved for ethical and confidentiality reasons (Jasper, 2003, 1-31). I will use the Rolfe et al model of reflection in this reflective account from the point of view of a student nurse (Rolfe et al., 2001, 1-61). After checking the prescription and drugs, the medications were supposed to be administered to the patient. I saw that the patient has been prescribed 250 mg of Flucloxacillin. It was found that there was no 250 mg capsule on the trolley, a 500 mg was found. The staff checked and dispensed 500 mg and asked me to go and give it to the patient and said, “Just give her that, it’s the same stuff.” Although I was an observer for learning and training, I was surprised by the instruction of the staff, since as far as I knew there is no reason to violate the prescription. I felt very bad that she tried to convince me about the dose by saying that it was same. I was keen to know whether it would be right to dispense 500 mg when the prescribed dose is 250 mg. I was trying to corroborate my classroom learning of the effects of higher dose and was wondering whether this is violation of the code. I am a trainee, so I had not much of an action to take rather than pointing out the error. Next medication was “Cure-it-all.” I have never heard about this drug and asked her when she dispensed that. I felt I should know about it since I am going to give it to the patient. I was stuck because I was thinking about any possible adverse effects of this unknown drug? I again asked her again why this is being given to this patient. Staff was irritated this time, and she replied that she does not know. I was upset that she was supposed to be knowing this, rather than helping me to know about this, she was forcing me to go and give it to the patient. I was frustrated since I knew the duties of a nurse for administration of a drug, and with me asking once again, rather than asking somebody else, she gave up saying that she does not know and had not had a clue as to why and what it was for, and she ordered me to give it to the patient without question since I was just wasting time. Very reluctantly, I proceeded with the “Cure-it-all” to the patient, but just before giving, I stopped and started thinking (Krahenbuhl-Melcher, 2007, 379-407). I was learner, and I desired to learn practice as per standards. I am required to make care of the people the first professional concern, so as to protect and promote health and wellbeing of their patients. As a student I think, all concerned must know about the medication, its dosage and regimens, adverse effects, contraindications, why it is being used, and what can go wrong, and knowing these could save the patient in case of an error or a critical incident during a drug round (Ampt and Westbrook, 2007, 157-167). In nursing, it is important to apply knowledge and an appropriate repertoire of skills for safe nursing practice. This incident is an example of unsafe nursing practice in two counts, giving an unknown medication and giving a dose that had not been prescribed. As a nurse, she needed to contribute to public protection by creating and maintaining a safe environment through the use of quality assurance and risk management strategies. According to NMC, the administration of medicines is an important aspect of professional practice for a staff. It should be performed with a strict compliance with the written prescription which was not done in this case. It also requires thought and exercise of professional judgment. The patient was identified, but any allergies were not checked. The therapeutic uses of the medication was not known by the staff administering it. Since it was clear in this scenario that it was not known what a "cure-it-all" was or why it was used, there was no provision of knowing its normal dosage, side effects, precautions, and contra-indications. This does not comply with NMC standards of practice. In this situation it was also required to contact the prescriber or other authorized prescriber in this situation, and a clear and accurate record of this was needed to be made by withholding medication for the time being. Perhaps this "Cure-it-All" has been acquired over the internet, and hence as per standards, this medication should never be administered. Although the student is required to cooperate and collaborate the my mentor, the student raised a legitimate question as per the standards. Moreover, a student should never be delegated to administer medication without supervision. The staff also needed to report this incident of 500 mg of flucloxacillin as soon as possible, and the actions must be documented. There is a necessity to be open and honest and to act with integrity, since my future profession would need to be accountable, so also of others involved including that of my mentor. Although I know, I am required to work as a part of the team; I also must learn how to manage risks for Mrs. Jones due to this event. Although my action invoked irritation in my mentor, I was not feeling very comfortable in violating dose prescribed due to the worry of some adverse effects due to overdose to Mrs. Jones. My actions were directly violating the NMC codes and standards (NMC, 2008, 1-7). This just stopped me, and I started thinking. Patient safety is supposed to be a priority in healthcare, and safe management of medicines is a key component of better health. Although majority of the medication incidents are harmless, these are preventable, and if prevented that can prevent severe harm or death of the patient. I would have known the drug, its indication, and adverse effects before using it. What I understand is wrong dose was given to the patient, and the reasons are huge work pressure, reluctance to check, and lack of a system that could corroborate the dose (National Patient Safety Agency 2007, 5-12). Getting stuck is not the solution, so what I did was I proposed the staff to check the dose and the drug and requested her to phone up the physician or the pharmacy, despite being pressed with time. I persuaded her by saying that this is a preventable problem, and in case the error is clarified, Pharmacy may as well supply us the 250 mg capsule, and then we can use it (Venkatraman and Durai, 2008, 1). This would improve the patient’s care within standards for safety. She agreed, and we first phoned up the doctor who told the dose should be 250 mg, and pharmacy supplied the capsule that was administered to the patient. I felt better, and when I asked the staff, she also said so. In my stage of profession, I chose to risk my relationship with my mentor for the safety and interest of the patient, but the staff did not overpower me, she ultimately complied with my plan. The learning from this incident is ample in the sense apart from reiterating the importance of verification, knowledge about the drug administered is important to comprehend the implications of a dosing error, which can easily be preventable, and this reflection model can be used in future practice to solve such problems. As a student, this learning will certainly help me in future practice to prevent more such errors, in that when a practitioner, I can practice within the clinical area for ensuring that standards for medicine administration fall within the requirements of the code. For any patient, I must have enough homework to understand the prescription and should have knowledge of the common indications, side effects, and dosages of the medications prescribed, and in case of doubt, I must take a quick decision to contact the prescriber. Reference List Ampt A, Westbrook JI 2007 Measuring nurses time in medication related tasks prior to the implementation of an electronic medication management system Studies in Health Technology and Informatics 130. 157-167 Jasper M. (2003) Beginning Reflective Practice:: Foundations in Nursing and Health Care. Nelson Thornes,Cheltenham, UK. 1-31 Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S 2007 Drug-related problems in hospitals: a review of the recent literature Drug Safely 30 (5) 379-407 National Patient Safety Agency (2007) Safety in Doses: Medication Safety Incidents in the NHS, 5-12. available at www.npsa.nhs.uk accessed on 29/09/08 NMC, (2008). The Code. Nursing & Midwifery Council. London P. 1-7. Rolfe, G., Freshwater, D., Jasper, M., (2001). Critical Reflection for Nursing and the Helping Professions: A Users Guide. Palgrave, Hampshire, UK Venkatraman, R. and Durai, R., (2008). Errors in Medicine Administration: How Can They Be Minimised? British Journal of Perioperative Nursing. Accessed from http://www.redorbit.com/news/health/1432251/errors_in_medicine_administration_how_can_they_be_minimised/ on October 2, 2008, P 1 Read More