I felt very angry. The initial stages of this incident endangered an awareness of uncomfortable thoughts and feelings. This was followed by disbelief when the surgeon first looked in the wound and said that the tape was not there whereas both my colleague and I had the feeling that the tape was still there. Even after the surgeon told us otherwise, we both continued to feel this. Benner (1984) suggests that the expert nurse is the one with a wealth of experience, which both me and my colleague had. The fact that the surgeon dismissed so readily the suggestion that the tape was in the wound, began to be extremely irritating and we felt, irresponsible. Acting as the patient’s advocate, we continued to urge the surgeon to not to close the wound without proof of the tape’s whereabouts. After all, the patient was in no position to speak for himself.
The whole experience was terrifying as I felt helpless. Feelings of my colleague and myself were justified as the surgeon just wouldn’t listen. He based his decision on the fact that he had looked for the tape in the wound and could not find it. Schon(1983) drew attention to the fact that nurses generally make decisions and later actions, based on experience. The sad fact remained that I had to be more assertive to get the surgeon to finally remove the tape.
To analyse this incident, I have referred to Carper (1978) who identified four patterns of knowing, namely the empirical, the personal, the ethical and the aesthetic. I also learnt the importance of communication between members of the multi-disciplinary team. The feeling that I had to take on the role of the patient advocate in this incident accords with the reflection in action which Schon(1983) described. Schon(1983) also draws attention to this as the way some practitioners deal with situations of uncertainty, instability and uniqueness. This has also made me question my self-awareness as a competent nurse. The author also reminds us that without self-awareness we are blind, and because of this blindness, probably less effective is our delivery of care. Our holistic care of the patient in the incident could perhaps be described as the art of our nursing.
The incident has changed my way of thinking and practice: What if I had approached this problem in a different way, would there have been a different outcome? If I had not been assertive, the patient would still have had the tape inside him resulting in possible physical damage (AORN 1990). Dainow (1986) highlights the fact that sometimes this appears to be more effective and the underlying message is that one must win at all costs. That is certainly how I felt at the time.
If a similar situation arose, I would try to be assertive in a different way. I would try to speak to the surgeon privately, and would certainly be assertive sooner. Johns(1995) states that a trust in one’s own beliefs can tip the balance between decision and indecision, and that this trust can be developed through reflection. The incident has had an effect on my practice in that I have become a more assertive practitioner, but that is easy to say-on reflection!
AORN Journal 1990 Recommended Practices: Sponge, Sharp and Instrument Counts. 51(3) Mar 838-844
Benner P. 1984 From Novice to Expert. American Journal of Nursing. 82. 1-1008. 402-407
Boyd E, Fayles A 1983 Reflective Learning: Key to Learning from Experience. Journal of Humanistic Psychology, 23 (2) 99-117
Carper B 1978 Fundamental Patterns of knowing in Nursing. Advances in Nursing Science, 1 (1) 13-23
Dainow S 1986 Believe in Yourself. Nursing Times, July 49-51
Gibbs, G 1988 Learning by doing: A guide to teaching and learning methods, Oxford Further Education Oxford Polytechnic
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Schon D 1983 The Reflective Practitioner. London. Temple Smith.