Reflect on an incident and explore and discuss research and theory with my understanding of the incident.

University Degree Subjects allied to Medicine

Robena Selby 16/06/07

Introduction

The aims and objectives of this assignment are to reflect on an incident and to explore and discuss research and theory with my understanding of the incident. Within this study the client referred to will be called Mr Bloggs, this is in order that his real name is protected and that his confidentiality will be maintained, in line with the UKCC code of conduct (1992). This contributes to one of the four NMC outcomes (Professional/ethical practice). My critical incident took place at a local Hospital during my thirty weeks placement.

In order to help me with my reflection I have chosen Gibbs (1988), as the model to help guide my reflective process. This is an iterative model with six stopping points, using these stopping points as headings; I will be able to reflect fully on the incident. So, what is reflection? According to Reid (1993), “reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice”.

Description

Mr Bloggs was admitted to my allocated placement in an acute medical ward and he came in with an alcohol problem. He was found in the street unconscious with bruises all over his face down to his arms. He had been drinking heavily which made him aggressive. They put him into the side ward, as it appeared as if he could be harmful to the other patients. As I began my shift I could see he was becoming agitated. It was a bit chaotic in the ward, staff nurses were rushing around, and doctors were preparing for the ward round. I sat at the nurses’ station with a piece of paper in my hand preparing for hand over. Mr Bloggs came and sat beside me and looked annoyingly at one of the staff nurses. As the staff nurse was quite busy, she did not have enough time to assess him. I was not aware that this had made him more agitated. I tried to ignore him, as he was walking up and down the ward corridor and sometimes disappearing. My colleagues had to keep finding him and leading him back to his bed.

Time went by, and the afternoon staff took over. One staff nurse did the drug round, and he was trying to communicate to Mr Bloggs to eat his lunch, as he needed it for his medication. He refused to eat and went to the gentleman’s bay. The staff nurse continued his drug rounds and he bumped in to Mr Bloggs again. The nurse tried to persuade him to eat his dinner up, as he needed it. Mr Bloggs refused to eat his dinner again and demanded to have some alcohol. The nurse explained to him that he was not allowed to have alcohol in the hospital. This made him more frustrated and increased his violent behaviour. Tadd (1998) states that staff can sometimes experience other powerful emotions, such as anger and resentment, towards an aggressive client. Others can be emotionally affected by heightened feelings of fear and suffer a loss of confidence in their own ability to cope. He was more aggressive verbally and within few minutes he attacked the nurse. I was shocked and could not move when I saw what had happened. The emergency bell alarmed and everybody rushed into him. I then managed to go to them and tried to help pull him away from the nurse. His family arrived to reassure him. The nurse was hurt, and was bleeding. The nurse was also shocked, as he had not expected this to happen. I then found that Mr Bloggs had been transferred to another ward.

Feelings

This is a preview of the whole essay

Feelings

Reflecting on the incident I felt that I did not act in the best interest for the safety of all the staff and patients on the ward, including myself. I knew that Mr Bloggs had a history of violence and aggression, but I did not do anything to prevent the incident from happening. According to Braitewaite (2001) people become aggressive when their needs are not met, and aggression is a way of relieving frustration. This is equally true for this incident when Mr Bloggs demand for alcohol was not met, therefore attacking the staff nurse because of frustration. I was not able to protect the staff nurse from Mr Bloggs, which I should have done. If I only had said to the nurse in charge that Mr Bloggs was very agitated and could become violent, perhaps the incident could have been avoided.

It is suggested that reflection can be used as a tool to facilitate learning through practice, this involves not only taking action in practice but also learning from practice through reflection (Palmer, Burns and Bulman, 1994). I felt that I was not taking action because I did not pass the information through to the nurse in charge.

Evaluation

Reflecting on the incident I feel that I did not act as a professional ‘student nurse’ which I should have done. Simon, Howe and Kirschenbaum (1978) argued that many people are unaware of their own value system and therefore have difficulty in knowing how to make decisions about how to act. I could have avoided the incident by speaking out and making staff aware of Mr Blogg’s feelings. According to Burns and Bulman (1994) self-awareness is a foundation skill built upon reflective practice. It underpins the whole process of reflection. It is also an essential for developing good interpersonal skills and building therapeutic relationships with patients (Burns and Bulman, 1994). This contributes to the NMC outcomes (Care Delivery).

In regard to my reflection this was not applied, which lead to Mr Bloggs’ frustration. This could also be due to the fact that I am still a student and without the experience to act and decide professionally. From the start I should have acted in a professional manner and reported Mr Bloggs to the nurse in charge. I should have said to the staff nurse to communicate with Mr Bloggs to see if he had any worries. Aggleton and Chalmers (2000) state that through communication that agreement can be reached on the means of achieving agreed ends. If I had used better communication skills this could have prevented this incident from happening. Having experienced this type of incident, I now know that I should be more aware to act as a professional ‘student nurse’ in the future.

Analysis

I chose this incident to reflect upon because I thought it’s important to show that in the field of nursing, there are many things, which should be acknowledged. Qualified nurses are expected to deal with many situations. In reflection of this incident, I feel that Mr Bloggs should not have been isolated in the side room, even though he had an alcohol problem. He should have been assessed effectively to establish his reasons for drinking excessively. The staff team should have taken action and given appropriate intervention related to his problems. This contributes to the NMC outcomes (Care Management). According to Lockhart (1997), many nurses feel it is not within their role to question patients about alcohol or to give patients advice about drinking levels. “The main reason often quoted is lack of time; many nurses felt it would take too much from an already pressured working day to implement any type of intervention for this patient group” (Proctor 2003). He should have been treated equally by the staff team rather than not being given enough priority because of his alcohol problem. Tadd (1998) states that one of the golden rules of ethics is that we should treat clients or patients the same way that we would like to be treated. I felt that Mr Bloggs did not get equal rights such as enough attention from the staff team. It may be because he was labeled as a “trouble maker”. Stockwell (1972) found that nurses viewed some patients as ‘unpopular’ and spent less time with them. Sometimes nurses considered patients as not belonging in the ward and therefore having no right to be there (Stockwell 1972).

In addition, staff should have been encouraging Mr Bloggs to take the medicine and not left on the table. Maybe if Mr Bloggs had taken the medicine he may have been more relaxed and not acted in this way. Cooper (2000) stated that sometimes the symptoms of alcohol could resolve rapidly as the effects of drugs or alcohol wear off.

On reflection with Mr Bloggs problems if I had been approachable the incident could have been avoided. The lack of communication between Mr Bloggs and myself made him more isolated. Hewison (1995) highlighted the power dimension inherent in the nurse-patients relationship that constituted a barrier to open communication. The lack of experience to deal with this situation made me realise that I have to act to the best of my knowledge to avoid this incident happening again.

Conclusion

I feel that I have not acted in a professional manner, which I should have done. Considering that I knew the patient’s history of violent behaviour, I did not take into account what the patient was capable of. I felt concerned that I did not protect the staff nurse from the patient by not allowing myself to act in a professional manner.

Overall I have found it is very important to act in the best knowledge as you can, to prevent any circumstances arising. I have been able to identify my weaknesses that can now turn into strengths. I feel now that I have learned a lot from this experience, that will hopefully make me a better professional student nurse, leading me into being a qualified nurse.

Action Plan

Reflecting on this incident I feel that I could have managed it differently by being more confident and having the courage to speak out to the nurse in charge. According to Wondrack (2001) fear and feelings of guilt often accompany emotions, which spring from a lack of confidence in how to resolve the situation. I have now learned from experience that if this incident arises again I would be able to deal with the situation more professionally. The incident has been a challenge for me, which has taught me a lesson and made me more determined to be part of the nursing profession. Using Gibbs reflective cycle has helped me make more sense of the situation and put things into perspective. It’s made me realise how I can put this learning experience to positive use in my future practice as a nursing professional. This contributes to the questions four NMC outcomes (Personal/Professional development).

References

Aggleton, P. and Chalmers, H. (2000). Nursing Models and Nursing Practice, 2nd Edition, Palgrave.

Braithwaite, R. (2001). Managing Aggression. Community Care. London, Routledge.

Burns, S. and Bulman C. (2000). Reflective Practice in Nursing. The Growth of the Professional Practitioner. 2nd Edition, Blackwell Science.

Cooper, D. (2000). Alcohol Use. Radcliffe Medical Press Ltd.

Gibbs, G. (1988). Learning by Doing. A Guide to Learning Methods. Further Education Unit. Oxford Polytechnic. Oxford.

Hewison, A. (1995). Nurses Power in Interactions with Patients. Journal of Advanced Nursing, 21: 75-82.

Lockhart, T. (1997). Problem Drinkers in Accident and Emergency. Health Promotion Initiatives. Accident and Emergency. Nursing; 5: 1, 16-21.

Palmer, A., Burns, S. and Bulman, C. (eds) (1994). Reflective Practice in Nursing. The Growth of the Professional Practitioner. Backwell Science, Oxford.

Proctor, D. (2003, March 04). Alcohol-Related Health Problems in General Hospitals. [Online] Available: [September 29, 2004].

Reid, B. (1993). But we’re doing it Already. Exploring a Response to the Concept of Reflective practice in order to Improve its Facilitation. Nurse Ed Today. 13:305-309. Cited in Ghaye, T. and Lillyman, S.(2003). Learning Journals and Critical Incidents. Reflective Practice for Health Care Professionals. Biddles Limited, Guildford, Surrey.

Simon, S. ,Howe, L. and Kirschenbaum, H (1978). Values Clarification. Ed, New York. Cited in Burnard, P. and Chapman, C. (2003). Professional and Ethical Issues in Nursing. 3rd Edition. London, Bailliere Tindall.