A critical incident analysis and reflection

The reason for this essay is to reflect and critically study an incident from a clinical setting whilst using a style of reflection. This will allow me to analyse and seem sensible of the incident and draw conclusions relating to personal learning outcomes. The importance 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 individuals involved introduced and i quickly will examine issues raised in light of the recent literature associated with the incident. My essay includes a discussion of communication, interpersonal skills found in the incident, and finally evidence based practice. I'll conclude with explaining what I have learned from the knowledge and how it'll change my future actions. The Gibbs model (1988) of reflection cycle will be attached as appendix 1 and description of incident will be attached as appendix 2.

In accordance with the 2004 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 maybe it's a situation where someone has suffered for some reason (Rich & Parker 2001). According to Hogston and Simpson (2002) reflection is "a process of reviewing an experience of practice in order to raised describe, analyse and

evaluate, therefore inform studying practice". Wolverson (2000) includes this can be an important process for any nurses desperate to enhance their practice. This may be investigated using a reflective nursing model.

I am going to use Gibbs (1988) Reflective Cycle. This because Gibbs is clear and precise allowing for description, analysis and evaluation of the knowledge helping me to seem sensible of experience and examines my practice. However Ghaye and Lillyman (2006) state that it is miscontructed as ideal for only negative experiences. On the other hand they emphasise that this its strengths lies with the incorporation of knowledge, feelings and action in a single learning cycle. Taking action is the key; Gibbs prompts to formulate an action plan. This allows to look at my practice and discover what I'd change in the foreseeable future, how I'd develop and improve my own practice.

Gibbs (1988) consists of six stages to complete one cycle which can improve my nursing practice constantly and learning from the experience for better practice in the future. The cycle starts with a description of the problem, next is to analysis of the feelings, third is an evaluation of the knowledge, fourth stage is an analysis to make sense of the knowledge, fifth stage is a conclusion of what else may i did and final stage can be an action intend to prepare if the problem arose again (NHS, 2006). Baird and winter (2005) give some reasons why reflection is require in the reflective practice. They say 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) explain that reflection is approximately gaining self-confidence, identify when to boost, learning from own mistakes and behaviour, looking at other folks perspectives, being self-aware and enhancing the near future by learning the past. In my own context with the patient, it's important for me to increase the therapeutic relationship which is the nurse-patient relationship. Inside the therapeutic relationship, you have 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). Asserive


This is attached as appendix one.


In this paragraph, I would discuss on my feelings or thinking that took place in the event happened. I had been shocked that the doctor didn't wash her hands or use alcohol prior examining Ms Adams especially with all the infection control guidelines and protocols in place. Regardless of this I did so not need confidence and felt intimidated because of the fact the doctor was more knowledgeable and experienced than I used to be 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 developed a word with my mentor and informed her what I observed and she then recommended that together we confront the doctor, therefore the next day my mentor spoke to her in private and she asked her, if before examining Ms Adams whether she washed her hands. The physician seemed stunned by this conversation but admitted she didn't wash her hands. She responded by justifying his actions and saying he was busy and was pretty quickly to keep in mind. My mentor discussed the importance of infection control and hand hygiene and then the doctor promised her that she'd make sure she follows the protocols and cleanses her hands prior examining any patient in the foreseeable future.


This event was difficult and challenging for me when i felt disappointment for my insufficient confidence in not confronting and challenging the physician prior him examining Ms Adams, on the other hand I felt content in the manner the doctor responded so positive and optimistic. Consequently I observed that doctor has changed his practice consequently of the incident. I have learnt out of this incident the importance of acting assertively with workers in a sensitive approach in order to guard patients health.


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

Clients (NMC 2004). This responsibility include making certain his / her knowledge and competencies commensurate with the task being undertaken.

Infection is in charge of increased morbidity and mortality, thus a thorough understanding 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 judgment recommends that hands need to be decontaminated after completing an episode of patient care and following a removal of gloves to minimise cross contamination of the surroundings (Boyce and Pittet, 2002; Pratt et al, 2001).

Hand hygiene is a crucial factor in the control of hospital-acquired infection (HAI) because hands can easily transfer micro-organisms in one area or patient to another. According to Shuttlewood (cited in Beckford-Ball, Hainsworth) states that despite strategies promoting hand hygiene there still seems to be difficulty persuading staff to adopt good practice. 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 YOUR Sunday Times December 21, 2008

Royal College of Nursing (RCN, 2009)Studies also show that uniforms could become contaminated by potentially disease-causing bacteria, including Staphylococcus aureus, Clostridium difficile, Although it has been suggested that uniforms become 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's important to note that all clothing worn by all staff (for example, doctors, therapists and cleaners) gets the potential to become contaminated via environmental micro-organisms, or those from patients or the wearer, which nurses uniforms are not unique due to that. This reinforces the need to ensure all clothing worn by staff in every clinical areas is fit for purpose and able to withstand laundering.

Advocacy ranges from activities with respect to patients, such as hand washing and proper identification before treatments, to arguing an early discharge will harm her patient's recovery. According to Arnold and Boggs (2003) assertive nurse can operate for the rights of others as well as for his or her own rights. In case the complaint is justified then equally the nurse has duty to see the physician of what has transpired because she or he has a duty to promote high standards of patient care and this includes confronting co-workers when the nurse believes their standards to be less than enough (Rumbad, G 1999). As the student nurse looking after Ms Adams under my mentor's supervision, this also pertains to my own practice as a student nurse.


In hindsight I feel I should have confronted the physician at that time and acted sooner. I also should have made sure the doctor washed her hands prior examining the patient. I realise could put Ms Adams heath in danger. 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 will not put patients at risk.

If a nurse observes a practice or procedure she believes to be wrong, advocating on her behalf patient demands she speak out even if that practice was completed by her superior. This isn't always easy and could have a cost for the nurse.

I realise that I have to be supportive to colleagues, understanding the pressures that they might be under, but making certain their practice does not put clients vulnerable.

Action Plan

My action plan is always to work as part of the team, learn more about how best to communicate in order to donate to good nursing care. I will aim improve and develop my assertive skills when working with workers to ensure health insurance and safety of patients is maintained. Therefore I'll make this an objective for learning in my next placement and discuss with my mentor to work out approaches for how I can accomplish that.

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