Critical Incident Analysis Nursing Assignment

particular Incident Analysis Nursing AssignmentReflective Analysis of a Critical IncidentThis paper recounts a critical breast feeding misadventure and reflects on the associated superior, moral and legal issues. The object lens is to critic all in ally reflect on what happened with a descry to distil central out lessons to improve my future answer and provision of maintenance. No personally identifiable details near the key players or context are included, thitherby assuring their confidentiality. This accompanying was selected beca procedure it demonstrates the ship set upal in which individual slueors can compound and translate a comparatively simple matter into a grave crisis with bleak results. It goes to the heart of nursing practice, and requires introspection into the ways we dis germinate our responsibilities.Description of Critical IncidentI was a Registered Staff Nurse completing the ut roughly phases of a 12-month obstetrics program in the labour defend of a 500 make do teaching hospital. The ward comprised sections for admission, stage 1 populate (active labour), hypertension (pre-eclamptic) room, sales pitch room and a post-delivery observation area (temporary holding. My objective was to do unafraid adroitness marks (by completing 40 deliveries and suturing) to complete the program.This particular day I enquired around deliveries and heard of a case that was secure endingthe nonmigratory pay off was suturing the diligent. I was hopeful of participating in the last-place stages to make up marks so I went to incite. Upon entering the delivery room I saw a lot of blood on the floor, so I asked the doctor what was happening. He stated everything was okay. I observed the patient lie on the bed, and asked her if she was fine. She replied yes. The patient looked pale and washy-more so than the stress of just delivering.I left the room and called the consultant who was doing ward rounds on a nonher ward with students. I a lso informed the file midwife about the situation. The charge midwife went to ascertain what was happening. The doctor again upholded that everything was fine, and there is no problem. I assessed the patients vital signs, and found them to be abnormal. Right then, the consultant came into the room and started an intervention. The patient was adjournn to the operating theatre for exploration to stop the bleeding. laterwards two hours of transfusing blood products and packing the uterus, the patient was transferred to the intensive finagle unit. She passed away(p) three hours later. The husband was told that there was a complication, and all efforts to stop haemorrhaging were unsuccessful.infirmary policy states that a midwife should assist doctors with any procedure be d sensation in the labour ward. This was non the case. The kid was delivered by a midwife. The doctor was asked to do the suture because of pretend difficulties (cervical lacerations). This situation was n on considered to be life threatening. The midwife left to attend to opposite patients on the reside ward. The doctor was asked to call if and when he needed help. The doctor acted on his own, and doubly ref utilize to ack forthwithledge the worsening situation. The patient died, and the family suffered as a consequence. The study attached to the family did non reflect all the facts of the incident. The hospital reprimanded the doctor and he was not allowed to see patients without supervision. He resolutionually completed his specialization course and now practices obstetrics and gynaecology in anformer(a) jurisdiction.Stakeholders InvolvedMerriams dictionary defines a stakeholder as person(s) entrusted with the stakes of bettors or some mavin who is involved or affect by a course of action. In this case, a range of persons were at a time and indirectly involved, and a family will have to live with the loss of a loved one.The patient expected to deliver a healthy baby, be w ith her family, and raise her child. She is no longer with them. The resident doctor made choices, and has to ingest with the consequences of those decisions on a personal (moral and honorable) and professional institution. We cannot be sure what options were deliberated, nor the unconscious process used to arrive at the final choices. The consultant obstetric/ gynecologist juggled antithetic tasks and ultimately intervened, but without success. The charge midwife and the midwife who delivered the baby are also a party to the incident they attended other matters on the ward-no doubt also considered urgent and important.This incident raises various professional, ethical and moral dilemmas. The actions of these persons raise questions about the avocation of solicitude fork upd, and the professionalism that guided the choices and judgements they demonstrated. My objective at the time was to earn skilled marks. My view is that the hospital itself can also change from this experie nce.No one expected the solutions that manifested. Hospital policy was contravened. The family accepted the paraphrased version of events. The doctor received a reprimand. I do not recall any action for the breach of policy.Theoretical settingA critical incident is one that can cause a person to pause and contemplate events that occurred, and in so doing, give them some meaning. This can be positive and experiential, and is a probable source for self, assembly and institutional instruction and improvement (Gibbs 1988, Duffy 2007).Thinking critically requires us to nominate problems and base assumptions and clarify the issues involved. Subsequently, we whitethorn raise questions whose answers whitethorn result in changes (Vacek 2009). Critical incident analysis challenges us to evaluate the main facts and use these to gain a deeper reasonableness of what happened (Fornasier 2008). In so doing, we deconstruct the all told incident into its component parts.Reflection is a thoug htful, deliberative process to gain deeper understanding of what happened by encouraging us to challenge how we feel, think and behave. This is the basis for individual change and improvement (Andrews et al, 1998 Merriam Webster). Using a critical incident as a way of reflecting involves the identification of behaviours that may be ministrant or unhelpful in a given situation. This process of incorporated debriefing can help the institution and the health care providers to commit incidents, prevent their reoccurrence, and enhance the standard of care delivered to the public (Gibbs 1988).Key veer ProfessionalismA profession is a chosen, paid occupation requiring prolonged fosterage and formal qualification (Webster). A number of professionals are involved in this case. For myself, at first, I did not know what to do I was just thinking about the patients safety when I saw the enormous heart and soul of blood of the floor. In the moment, I forgot about the chain of command I byp assed the charge support and called the consultant directly. Reflecting on the incident, I should have called the charge nurse and she may have better tidy sumled the situation as it unfolded. Further, I assessed the vital signs after passing the room to communicate with the consultant. It could be argued that I should have completed a fuller assessment of the patients vital signs forward progressing through with(predicate) the chain of command-rather than taking the patients perspective that all was okay despite a gut feeling that something was wrong. Was the patient making a precept statement? Did she have seemly information and the capacity to objectively iron out the situation? Did I, in that moment misread the gap in understanding of what I saw and what the patient said? I would maintain that my actions were easy intentioned and had the desired impact to bring additional visions to remedy the situation and carry on her life.Clearly, the great power to remain calm under stressful flock is a valuable characteristic. This cannot be taught or learnt in the classroom, and certainly not through a fatal trauma.The patient is no longer with us. Did she have enough information to make an informed decision about the quality of care she was receiving? Could the patient be fair expected to be informed or to request a different type of intervention in the good deal? We will never know.The resident doctor was asked to suture a suspected lacerated cervix alone-and to ask for help if needed. Doctor maintained all was under control even as I assessed the situation was worsening. Questions may be asked about the doctors assessment of the initial and unfolding circumstances and, the information communicated to the patient, who related she was fine. I have no doubt the doctors objective was to assist the patient, and, within the wording and spirit of the Hippocratic Oath, to use their own ability and skill to help the woman in the best way. However, did the doctor pop off at his/her responsibility to recognise an emergency, a worsening situation, and the limitations to their skills and capabilities? In so doing, did the doctor do more harm than good? In the final analyses, was the doctor acting in the patients best interest?The consultant did what was (probably) most the critical thing an initial intervention and then emergency functional exploration with a full squad of specialists to ascertain the problem and master the situation. Could the consultant have done more? This is unlikely in the circumstances. Yes, the consultant could have been called earlier, but that is not their fault.Did the charge midwife and midwife err in leaving the Doctor to complete the suture alone? How does one balance the need for a small amount of midwives to attend to different patients at various stages of labour, when a potential danger is at hand with a post natal mother? How do we reconcile these resource constraints with hospital policy (requirin g a midwife to be present at all times)? In this situation, how do we make a decision about providing quality care and attention to labor women, versus attending to a pass off mother? Is it less or more professional to establish labouring women unattended to care for a mother with what is considered to be non-life threatening violate?The Hospitals official explanation of what happened was maternal complications. This lacked credible details that are cover in the legal discussions below.Key progeny MoralityWas the hospital truthful in its communication with the patients family? To the outsider, the answer seems a resounding no Does macrocosm a teaching hospital bring luxuriouslyer levels of risk to patients-by truth of having younger and less experienced doctors? Does this lessen their responsibility to the patient? Or does it require a higher standard of care and great precautions?In this situation, did the hospital fail in its duty to the public by having a higher ratio of patients to staff? Is it unreasonable to expect the nursing jail cell to reasonably and safely provide a high quality of care to the number of patients on the ward at that time? Did the institution and its team fail by adjudicateing to provide service for too many patients at this time? Did the policy foresee and cover these matters?Do these issues put the nurse and their professional obligations at odds with hospital and public policy? Does this meshing put the nursing (and other members of the medical team) at a disfavor?What of the publics rights and responsibilities? How do we honour and respect these charters in the circumstances described? each patient wants to be seen, receive a high quality of care, with negligible chances of complications-certainly not death.How does the Midwife make based a decision about who to treat and how to allocate scare human resources? In a high stress understaffed environment, can we reasonable assess who is at greater risk and more deserv ing of care? Can we reasonable assert that honesty, justice and respect for the patients rights can lead us to a intention of where our duty lies?It is my view that the while some parties in this case may be able to justify their actions (midwives, consultant), others would find it a deontological challenge (resident, institution). In this case, the outcome of the incident dictates that the actions of key caregivers at critical decision moments were not optimal (wrong/unethical) because the consequences do not match the means/process.Key Issue LegalityNo known legal proceedings arose from this incident. However, it may be argued that a judicious reading of the circumstances by a family dispose to litigation could have asked many questions about the unfortunate circumstances reference in this incident, and maybe have a case in a court of law. For example, it could be argued that the patients legal rights were not met, regarding professional standard of care provided by the resident doctor and the absence of a midwife passim the procedure. Further questions may be raised about the quality, experience, judgement and electrical capacity of the first attending doctor. And ultimately, questions could be asked about the checks and balances (levels of safety) within the institution that increase the situation.Additional issues may arise in considering whether or not the patient was reasonably informed about the unfolding circumstance, associated risks, and given the opportunity to de jure consent. It could be argued that the doctor acted unilaterally (paternalistically) to the patients disadvantage. Alternately, the patient could not have reasonably rejected treatment in the circumstances. Therefore a detailed discharge would be required of what a reasonable professional would do in this situation. The hospital reprimand is an indication that the resident doctor could/would have failed the Bolam footrace of respectable medical opinion thereby paving the way f or litigation.The above could also lead to the question about the initial consent, and whether or not there was a full explanation of risks and likely treatments in the event of complications.In a legal context, the issue is whether or not the key stakeholders acted professionally and morally, and more importantly, in the course of their duty, whether they neglected or failed to provide a reasonable care of duty to the patient.Summary and DiscussionMy view now-I was not asked or debriefed at the time, nor did I reflect critically then-is that the circumstances and outcomes dictate that the team and members thereof acted less than professionally, and their judgements and actions were not finely fit, leaving them in a an unethical and morally compromised position. The patient was owed a duty of care, which was not provided by all involved at the critical moments after delivery. So although all parties worked from a position of beneficence, obliging to do good for all patients at the time, there is a deontological failure in justifying their actions.On this occasion, hospital policy was not adhered to, and there was reasonable cause for this. The outcome reinforces the view that the consequences do not match the means. But this has to be balanced with the contending demands on the team. The midwives, in leaving the doctor to attend to the patient, expected to be called if needed. They were professionally and morally obliged to give reasonable care to the other patients. It would be difficult to squarely blame them for an act of omission that caused/ turn harm for the patient.This is not to ascribe blame squarely at the resident doctor. There are factors at play that would have influenced their action-in keeping with training-while endeavouring to collar and manage the situation. Maybe, for example, there was consideration of the human resource constraints and not abstracted to burden fellow colleagues. Maybe the doctor was confident in acute what was required in the circumstance. However, the rapidly deteriorating situation was soon beyond the doctor, and there was no recognition or acceptance of the need for additional help. Surely, if the final outcome was positive, the consequences would have justified the means. However, in this case, the means and end were weak links.The circumstances and situation in the ward on that day were critical to the team too many needs, and too few hands. The staffs were in a compromising position by having to deal with too many situations. This should never be the case if we are to deliver a reasonable duty of care in circumstances where humans can never full assure medical outcomes in certain emergencies.In this incident, on this day, a number of factors compounded a bad situation and led to fatal outcome-which never had to be the case. The midwife made a decision to leave the doctor to suture the lacerated patient the doctor attempted to do the job without recognising or seeking help. My actions quick ened the intervention of the consultant, who ameliorated the situation, but to no avail. completion and ReflectionHaving participated in this course, I can now reflect critically on this incident and confirm the ways in which a regeneration of professional, legal, ethical and administrative policy must work together in order to deliver assured quality healthcare. This is especially important in high stress environments where critical decisions must be quickly made-with the potential for unforeseen results.As professionals we must strive to be calm when things take a turn for the worse. This is not a reason to abandon or lose the ability to think critically, and stay true to our ethical, moral and professional duty while meeting the expectations of our employers. Indeed, we will at times find ourselves in situations that test this resolve, and require us to make rapid decisions and attempt to innovate to meet circumstances. This latitude is welcomed, but must be used with caution to ensure that the final outcomes can hold up to the exam of our peers.Finally, it is critical to reflect and analyse our actions and experiences in order to evaluate what works, what does not work, the reasons for these, and the ways to manage future events should they recur. This is useful whether or not one is reprimanded or at the end of litigation case (institution). It is from these collective experiences and learning that we can improve policy, and enhance the profession.