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Critical incidents and our behaviours.

What is crucial incident? Critical incident has been described in various ways with respect to the mother nature of the incident and the environment or setting up where it took place. Tripp (1993) identifies critical occurrences as a "commonplace events that take place in usual professional practice" Happenings may relate to range of issues amongst which issues of communication, romantic relationships, moral values and ethical beliefs, knowledge, culture or feelings. The definition I love best is a critical incident need not be a remarkable event, but it can be an incident which includes significance for us. It is a meeting which made us stop and think, or one that raised questions for us. One that may have made us question an element of our beliefs, values, frame of mind or behaviour. It is an event which for some reason has had a substantial effect on our personal and professional experience and learning (MU).

Curiosity is a simple human sentiment. The psychologist William McDougall suggests that "The instinct of attention is at the base of many of man's most wonderful achievements. . . ". As humans most of us hold the drive to find logical explanation of resided situations and our encompassing. We do this though endeavoring to examine or reflect on our experiences. Matching David A. Kolb (1984) representation is an inseparable area of the learning process. This is actually the part where by analysing given event we boost our knowledge, enrich our practical experience and prepare for new and challenging situations.

Different frameworks have been developed to assist the introduction of critical representation. Most prominent will be the types of Kolb (1984), Gibbs (1988), Atkins and Murphy (1994), Johns (2000), Rolfe et al (2001) and Lister and Clean (2007). Lister and Clean clarify that "critical event analysis is rolling out as a tool to assist critical reflection in practice, in health insurance and social work". It has been used to allow students to spell it out and explore issues from their practice (Nygren and Blom 2001), (Montalvo 1999).

PoDAIT describes that "Critical Incident Research is an method of dealing with difficulties in each day practice. " which "As reflective practitioners we have to pose problems about our practice, refusing to accept 'what is'. We have to explore situations which take place in day-to-day work in order to comprehend them better and discover alternative ways of reacting and responding to them. " Therefore it is safe to summarize that critical incident analysis can permit professionals to think about their practice and also to make clear and justify it.

Account:

During my placement at a south London CMHT I put short time of working with the duty team. This was when I and the MH nurses Q achieved Miss X for an initial assessment.

Several days following Miss X's analysis her circumstance was discussed at a specialized medical review with one of the team consultants DR G and it was made a decision that the medication dosage of her medications is to be altered. When I up to date her GP of these I was advised that her medications have already been changed and that the dose is different from the one given on her recommendation. This created the necessity for reviewing Pass up X's case second time. Within the in the meantime Dr G kept the team and was changed by Dr V.

By that time I had finished my period of obligation work and even though I had registered all information on the internal database and this Miss X was still a obligation client I used to be asked to provide her circumstance at Dr V's next medical review. I needed no objections as I had understanding of the client, and especially as Q was not present. With the review was chosen that Dr. V will offer Pass up X another visit. I recorded the results on the internal databases and also reported to Q who been on duty transfer. I also up to date him of the need for Pass up X to be notified of her appointment.

On the agreed appointment date Neglect X didn't attend and when contacted by mobile she stated that she was not notified of it. Dr V asked me to offer her a new appointment for the following week. I put no obligation to liaise with the Miss X or do any work on the situation as she was a responsibility consumer and I no longer had formal participation with her. Nevertheless, I notified her of the new appointment did both over the telephone and in writing.

When the next appointment came up Dr. V asked me to wait the examination with her. I was not necessary to, however I accepted. I determined that while Pass up X would be more more comfortable with a familiar person during the meeting, I'd have good learning opportunity joining an evaluation conducted by one of the team consultants.

When Miss X showed up I launched Dr V to her. Through the assessment Miss X said that her medications havent helped and this she cannot deal. During the assessment she was wringing her hands and became tearful. Dr. V discovered that Pass up X was not taking her medications at the appropriate time and that sleeping in the afternoons could be adding to Miss X's difficult evening sleep. Through the diagnosis Dr. V recommended that she can suggest Miss X a variety of sleeping aid medications. However, by the end Miss X's medications weren't modified and she was advised to keep with her current ones, but to take them at the prescribed times. Dr V educated Miss X that she will offer her a follow-up appointment in two weeks time, in order to examine her progress and also to change her medications as and when necessary.

Following the assessment I went to the duty personnel and asked those to come for an upgrade from Dr. V. Two of these were occupied and the third one Z who is a MH nurse was dismissive. As I could not get anyone from the duty team to come I visited the doctor's office for final discussion and prepared to record the results of the assessment and any decisions on the inner databases. While we were discussing Neglect X's action plan Z moved into the office. It was jointly arranged that Neglect X will be offered follow up appointment in fourteen days time.

Later in your day Z came if you ask me and asked me whether I've recorded the session in the work diary. I educated her that I've not as my understanding was that is consultant's visit rather than a work one, which is normally not recorded in the duty journal. Nevertheless, she insisted that I really do so. WHEN I recorded the appointment in the journal, which I entirely on Z's table, Z came up and asked me never to make the session for the agreed particular date but for the day after. She explained that the appointment fell on the day that ought to be free from duty appointments. I was obviously confused as the time frame was chosen by Dr V and the other 2 prior sessions were both booked for the same day of the week without that being a problem. Z said that she has spoken to Dr. V regarding the appointment already. While looking to be helpful, having been given ambiguous information and the actual fact that Miss X was not my client to begin with, I made a decision to step back again and asked Z to clear any dilemma with Dr. V.

On the following day during Dr. V's professional medical review meeting Z presented Pass up X's case with suggestion on her behalf to be discharged back to GP. To my big delight Dr. V agreed with the suggestion. The rest of the team approved her decision silently. As the team got moved onto talking about other client I did not want to interrupt and didn't speak out before end. Having considered the distressed and tearful condition in which Neglect X presented, during the two assessments, her information of feeling hopeless and without support, and her earlier suicidal ideation, I asked if we're able to have another look at her case as well as perhaps offer her yet another session before discharging her from the team.

Dr. V said that she acquired reconsidered her yesterday's decision and assert that Pass up X offered low risk; therefore she didn't require further input from a expert. In rule I arranged that Miss X may well not have to be seen by way of a advisor. Nonetheless, I still noticed that it could have been appropriate and a good example of good practice for a member of the team to see Neglect X before discharging her, especially after she was informed to anticipate further support. Z recommended that I should take the case on. I described that without my position tutor's authorization I am unable to accept any new customers. Z recommended that keeping her as a customer for a supplementary fortnight puts pressure on the obligation team and suggested that as option to face to face appointment I could call the client. I agreed to that, but highlighted that anticipated to my university student capacity I'd still have to be supervised by the team member. Among the senior social staff commented which i "will be given credit towards my competencies", for advocating for your client. My request was kept unanswered and Z said that she'd deal with the truth. Following the achieving another person in the team also a MH nurse spoke to me and said that I should not have raised this question and contested the decision made by the consultant.

I provided my practice assessor with a written report of the problem however, it never proceeded to go any more.

I tried to look at the whole process and the results from Miss X's perspective and attempted to explore her thoughts.

Removal of formal and informal power barriers between your su and s providers

Did not feel just like I could change the decision and talking with the cons. Wouldn't normally have been benefitial.

I was amazed if not even surprised by the consultant's decision. Previously I had detected (noticed) a certain level of indecisiveness as whether to suggest different medication s or not have offered a variety of different meds however didn't stick to any of her own suggestions. Reflecting on that we tried out to justify her behavior accepting the actual fact that across the diagnosis different new information came up to light. (reflected on her actions and decisions made)

Power dynamics, my university student and consultant

Being acquainted with the details ot the case I believed it was morally and ethically unjust to stay silent and not bring the matter up

Being assertive however, not argumentative

(being diplomatic)

in this example my believes and ideals clashed with the decision taken That which was the right thing to do. Keeping in mind my status in the team as learner on position, without extensive interpersonal work experience and not familiar with the energy dynamics within the team I used to be double minded concerning whether expressing my disagreement by suggesting an alternative ways to the problem and in this manner challenge the decision used by the expert or to continue to be silent. In this example the final decision about the attention of the patient had been made. I (thought) was aware that once the decision was made speaking in private with the participants would not be constructive or bring positive results.

Learning

No one loves being challenged so when this happen some people may become self-protective and protected to simply accept others' views which may also impair future joint working. It is important to spotlight that by challenging certain decision it is only your choice being challenged and not the person. After all the joint goal is the wellbeing of your client and not showing who's right or incorrect.

Be aware of office power dynamics and be conscious that some pros may be firmly opinionated and confronting their views on a specific matter must be made with treatment and in non confrontational procedure. Sensitively methodology and issue others opinions make an effort to (prevent from taking place) diffuse costed emotionaly situations (to be diplomatic) When analysing a crucial incident, it is useful to consider questions such as:

  • Why will i view the situation like that?
  • What assumptions have I made about the client or problem or situation?
  • How else may i interpret the situation?
  • What other action could I have taken that may have been more helpful?
  • What will I do easily am confronted with an identical situation in the foreseeable future?

Refs:

Atkins, S & Murphy, K (1994) Reflective Practice Medical Standard 8 (39) pp49-54

Evans, D. (1999) Practice Learning in the Caring Professions, Aldershot, Ashgate.

Gibbs G (1988) Learning by doing: A guide to teaching and learning methods. Oxford Further Education Product, Oxford.

Johns C. (1995)Framing learning through representation within Carper's important ways of knowing in nursing. Journal of Advanced Nursing 22 p. 226-234

McDougall W. (2003), "An Benefits to Community Psychology", Courier Dover Publications

Rolfe G. , Freshwater D. , Jasper M. (2001), Critical Reflection in Nursing and the Helping Professions: a User's Guide. Basingstoke: Palgrave Macmillan

(M. U. )(http://www. monash. edu. au/lls/llonline/writing/medicine/reflective/2. xml)

KOLB D A (1984) Experiential Learning: experience as the foundation of learning and development NJ: Prentice-Hall

ProDAIT - http://www. prodait. org/approaches/cia/ [accesed. ]

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