During the course of your work day, noticing the nature of interactions and their
Outcomes” (Reflective practice for nurses and midwives). Reflection is an important
human activity in which people recapture their experience. “ One may also reflect on
practice while one is on the midst of it. This process involves both reflections in action
and reflection in practice (Johns and Freshwater 1998). Schon states that reflection in
action consists of on the spot surfacing, criticising, restructuring and testing of
intuitive understanding of experience phenomenence (Schon 1983) P.241.
“Reflective learning involves assessment and re-assessment of assumptions and
critical reflective occurs whenever underlying premises are being questioned”.
(Williams 2001) P.29.
In choosing Gibbs reflective model it would be illustrated in the six headings
Which guide me through my reflective process. These headings include:
- Description – what happened?
- Feelings – what were you feeling?
- Evaluation – what was good or bad about the experience?
- Analysis – what sense can be made of the situation?
- Conclusion – what else could you have done?
- Action plan – if the situation arises again what would you do?
Description:
This critical incident took place during my first six-week placement on the ward
(Eleanor east). My rationale for this critical incident is because of the impact it had on
me. I did not know that the side effects of surgery (hip replacement) could result in
D.V.T (deep vein thrombosis), which could be very critical physically and mentally.
To protect patient confidentiality the patient’s correct name will not be used. A critical
Incident is defined as “ a learning technique that breaks an event down into its main
Components for the purpose of reflective analysis” (Richard Hoystonard and
Penelope Simpson). On November 23rd, 2004. Carol was admitted to hospital for a
right hip replacement surgery operation which she had successfully, the following
day when we reported for duty, during handover the staff were informed that carol
has developed DVT, which is the formation of a thrombus in a deep vein. It usually
affects the veins in the legs. It is a contributing factor to development of a DVT in a
hip or knee replacement operation. The medical team confirmed her diagnosis
on the ward round following various scans and blood test results. After the ward
round I could hear someone crying as I was walking through the corridor, as I went to
investigate who was crying I found Carol in a most distressing and anxious state. I
tried calming her down and asking her what the problem was, She told me that she
would die because she had a blood clot in her vein. I reassured her by telling her she
Is not going to die because she would be given treatment. I told her I would ask the
staff nurse to come and explain what happens next and to give her more information
about her condition. I also offered her a cup of tea, which she accepted. On my way to
get Carol a cup of tea, I explained to the staff nurse how upset and anxious Carol was
about her condition and asked if she could possibly explain and re-assure her. I was
very surprised by the staff nurse’s attitude, in a very abrupt manner the staff nurse
replied to this by saying that she had a heavy workload and when she has time she
would go to Carol. I then suggested if it would be possible just to explain to Carol that
she would be coming to speak to her in say 10 minutes or what the case may be. In
my return to Carol I informed her that the staff nurse would be speaking to her shortly
about her condition and asked her if she needed me to contact anyone on her behalf
for example a relative or friend. She asked me if I could contact her daughter which I
did, Carol was happy when I told her that her daughter would be coming to visit her. I
was also instructed to apply the intermittent pneumatic compression device on legs
which is attached to the machine. First I gained permission and explained the process
before applying the device. Intermittent pneumatic compression (IPC) is an
established method of DVT prophylaxis with no risk of haemorrhagic complications
(Geerts et al 2001). There is a variety on the market ranging from calf and thigh cuffs
to foot pumps (nursing times). Carol had to have continuous oxygen and hourly
observations such as temperature, pulse, blood pressure, and respiration, with heparin
injections which increases the action of anti thrombin and inhibits the actions of a
number of coagulation proteins. Because of Carol’s traumatic and anxious state, she
constantly needed reassurance and to be kept informed which was given to the best
of my ability and within my limit. It was obvious that Carol was finding it difficult
coping with her crisis and therefore needed reassurance throughout. Among the
changes some people face are the experience of ill health. This is critical because it
brings not only the possibility of pain and loss of function, but also changes in the
concept of the self as a whole person. (Henry .A. Minardi 1977).
Having completed the shift and reflecting on the days event Carol’s feelings of
anxiety and worry was understandable. I thought had there been more effective
communication between staff and the client could relieve the stress and anxiety to the
client and relatives should be kept more informed. I was astonished how
unprofessional the staff were. As Burnard (1995) suggested that to become self aware
is to learn conscious use of self, we become like agents and are able to choose to act
rather than feeling acted upon. If we are blind to ourselves we are also blind to
choices. It is important that all professionals act in a professional manner according to
the NMC code of conduct (1992).
My evaluation of this incident was the lack of communication between the staff
and patients. I could not see that it was for the patient’s moral. However, after
reflection I thought how effective and vital communication is in all of our lives. It was
an experienced for me to learn from. Clamp (1984) argues that “underpinning all
nursing action is needed for effective communication”.
By analysing the whole situation, I realised how much pressurised and heavy
workloads nurses are faced with when they are short staffed. Also if Carol had
attended her pre-assessment clinic she could have had her blood tests which would
have given the medical team an idea of her condition and therefore could have had
treatment earlier hence prevention of DVT.
In conclusion and reflection upon the incident I felt my approach in interpersonal
communication was the correct one and has also made me confidence that the
decision I took at the time was necessary even though my role as a student nurse
imposed certain restrictions on my actions. My action plan is always to work as part
of a team, learn more about how best to communicate in order to contribute to good
nursing care. I would also like to do more research on DVT and if the situation arises
again I would know what to do.
BIBLIOGRAPHY:
(1.) Psychological bulletin vol 51, P.327-358.
(2.) Kilty, J (1983) experience learning human potential project
(3.) Johns & Freshwater (1998) transforming nursing through reflective
practitioner, how professionals think in action. Basic books New York p.241.
(4.) Reflective practice in nursing. Sue Schutz (2004) 3rd addition.
(5.) Reflective practice a guide for midwives and nurses Beverly J Taylor (2000).
- The prevention and treatment of deep vein thrombosis, Nursing times volume 100 no: 29 20-26 July 2004.
- Professional conduct nursing and midwifery council, April 2002
- Learning through incidents studies in the development and use of critical incidents in the teaching of attitude in nursing London, Clamp C (1984).
Number of pages: 7
Number of words: 1,643
Number of paragraphs:137
Number of lines: 310
