Reflection on a Critical Incident


Aim of the activity”.

Critical incident is defined by Tripp (1993) “as an incident which has
happened and

Are produced by the way we look at the situation. It is an
interpretation of the

Significance of the event”

The reason for this essay is to reflect on a critical incident
experience during my six

Week placement as a student nurse, on an orthopaedic ward, in my
opinion the

incident chosen has made an impact on me due to the fact those side
effects of surgery

can be very critical to patient’s lives, as would be demonstrated in
the critical incident

chosen (D.V.T). Deep vein thrombosis.

There are various reflective models written by various theorists and
they include:

Atkins and Murphy (1993)

Stephenson (1993)

Johns (1998)

Gibbs (1988)

For this critical incident the model I have chosen to use is Gibbs
(1988) reflective

model as a guide because it is more understandable and will reflect
more clearly on

this critical incident. It is widely known that experience alone is
met adequate

enough to guarantee that any learning takes place, so it is important
that integration of

past experiences with new experiences occurs. This is done through
the process of

reflection. (Kilty 1983, Kolb 1984, Burnard 1985).

“To be self aware is to be conscious of one’s character, including
beliefs, values,

qualities, strengths and limitation. It is about knowing oneself”
(Burnard 1992).

“It underpins the entire process of reflection because it allows
people to see

themselves

in a particular situation and honestly observe how they have been
affected by the

situation and to analyse his or her own feelings.” (Chris Bulman and
Schultz).

“Through reflection you develop skills in being able to watch yourself
in action,

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:

(1.) Description – what happened?

(2.) Feelings – what were you feeling?

(3.) Evaluation – what was good or bad about the experience?

(4.) Analysis – what sense can be made of the situation?

(5.) Conclusion – what else could you have done?

(6.) 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).

(7.) The prevention and treatment of deep vein thrombosis, Nursing
times volume 100 no: 29 20-26 July 2004.

(8.) Professional conduct nursing and midwifery council, April 2002

(9.) Learning through incidents studies in the development and use of
critical incidents in the teaching of attitude in nursing London,
Clamp C (1984).