Critical incident analysis
Introduction:
A critical incident can include various situations but normally during the day and life of a nurse, everyday situations can also bring their problems. I will refer to an incident where a simple catheter injection which could have been simple to an experienced nurse was left to me, a trainee who was rather inexperienced (An Bord Altranis 2000).
Description of incident:
One day on my day shift as a nursing student, I was assigned by a staff nurse to perform a nursing skill such as catheter insertion to a patient. She (the nurse) did not give you information or instructions on how to do it. She just said “Dave, would you do the catheter insertion for patient A in bed 12, thanks” and off she went somewhere. This demonstrated clear lack of support from staff. As a nursing student with less experience I was extremely worried to perform the task assigned but had to do it (Batey, Lewis 2002).
It was a demanding interaction as the patient was in constant pain throughout and occasionally even became delirious but I managed to actually calm him down considerably. The consequences for the patient were that he managed to calm down and relax and after the insertion was made, he was sedated and safely rested with the tube inserted accordingly (Batey, Lewis 2002). There were no legal ramifications as the patient was consulted throughout the procedure and was in complete consciousness so he was totally aware of what was being done to him.
Analysis:
When faced with such a critical situation, one has to think rather fast and my quick actions in administering immediate treatment and calming the patient definitely were beneficial to the task on hand. With hindsight I would not have done anything differently although perhaps I would have attempted to talk to the patient more before beginning treatment (An Bord Altranis 2000). I followed the usual practices adopted in similar situations in the incident, well tried and tested during my training period as a nurse. I definitely feel that my work throughout the incident will enable me to carry out similar tasks with some success.
After some soul searching and post incident analysis, I did feel slightly in shock with the whole procedure of catheter insertion (An Bord Altranis 2000), but still I felt that I coped pretty well in the situation. I don’t feel I could have been better prepared before the interaction as I took all my training and the lessons I had learnt during nursing school to the situation with some success. There are always alternative actions to take in such situations which could include heavy sedation and other similar drastic measures but I honestly feel that my method was the best in this situation.
Evaluation:
The interaction was very positive in the sense that the patient was considerably calmed and was not acutely conscious of his situation which could have caused him to panic. My actions could be described as empathizing and these are exactly matched with my beliefs to provide quality and emphatic nursing assistance at all times and as much as humanely possible.
I felt that I administered all the treatment which was necessary in a short space of time and that I interacted with the patient rather well although at times, he seemed to be descending into delirium which made it slightly more difficult to handle my task appropriately (An Bord Altranis 2000). The action was completely according to professional nursing standards and as already expected there were no legal ramifications to the incident at all.
The factors which I found most demanding about the incident were the fact that the patient was initially rather difficult to control since I was not totally conversant with the procedure of catheter insertions. Normal ethical policy guidelines were used to ensure that all treatment administered was in accordance with standard nursing practice.
Action Plan:
If faced with a similar situation, I don’t think I would do anything differently than that which was attempted here. First of all, upon being faced with procedure of catheter insertion or a subcutaneous injection I would first follow all procedures accordingly after reading up on the procedure, speak to the patient to calm/him her down and set their mind at rest and finally perform the operation (Sharp, Wilcox, 1995). After that, quick decisions have to be taken on what emergency treatment should be administered to ensure that the victim/s are sedated accordingly and are made to feel as comfortable as possible. After initial treatment, procedures should be put in place to make the patient as comfortable as possible. After this is successfully achieved, one should make a post treatment assessment and consult with hospital doctors and/or consultants what treatment needs to be carried out for recovery of patient (An Bord Altranis 2000). A post treatment report should also be drawn up to ensure that all ethical considerations were followed and that medical staff treating the patient after the accident will be informed on procedure followed and how any after effects are to be tackled, and how these are to be treated.
Conclusion:
Traumatic accidents are always difficult situations to handle and this particular case was definitely no exception. It is important to follow standard nursing guidelines in situation such as these as explained by Affara F.A. and Styles M M, (1987, 1993). Naturally ethical considerations are also crucial and as demonstrated in this case, these were handled quite well as the patient was constantly being informed on what was going on as well as experiencing the best treatment possible throughout the whole case. The need for a properly thought out action plan in accordance with nursing training is also demonstrated in such a case.
The World Health Organization in Nursing Practice (1996) stipulates several guidelines on how nurses should carry out their duties when faced with critical situations such as serious accidents. This was amply demonstrated in this situation which called for some experience but also for common sense and a properly thought out strategy and action plan which was implemented to the letter. Obviously one also has to take into consideration the legal ramifications of all these procedures as they could result in some nasty post-incident litigation if something goes wrong. However I am satisfied that everything was thoroughly and carefully done according to proper legal practices and ethical ramifications with the result that the difficult situation was brought to a successful conclusion.
References
International Council of Nurses ICN Position Statement. Unpublished cited in Affara F.A
and Styles M.M. Nursing Regulation: From Principle to Power. Geneva: ICN. (1987), (1993)
Lewis F.M. and Batey M.V. Clarifying autonomy and accountability in nursing service: Part 2. Journal of Nursing Administration October, 10-15. (1982)
Sharp K.J., Wilcock S.E., Sharp D.M.M. and MacDonald H. A Literature Review on
Competence to Practice. Scotland: National Board for Nursing, Midwifery and Health Visiting for Scotland (1995).
World Health Organisation Nursing Practice. Geneva:WHO (1996)
An Bord Altranais (1994) Guidelines for Midwives. Dublin: An Bord Altranais.
An Bord Altranais (2000) The Code of Professional Conduct for each Nurse and Midwife. Dublin: An Bord Altranais.
Batey M.V. and Lewis F.M. (1982) Clarifying autonomy and accountability in nursing service: Part 1. Journal of Nursing Administration September, 13-18.
Council of European Communities (1980) Council Directive (80/155/EEC) concerning the
coordination of provisions laid down by law, regulation or administrative action relating to the
taking up and pursuit of the activities of midwives. Brussels: Council of European Communities.
