This assignment will look into firstly what can be defined as a critical incident in the eyes of the modern health care system. Then discussion into such a critical incident experienced by a student nurse in an accident and emergency department. Looking into the importance of infection control in line with the incident and ethical issues regarding patient consent and refusal of treatment and finally the legal issues behind consent.
The are numerous definitions as to what a critical incident is:
"Any situation that results in an overwhelming sense of vulnerability or loss of control." (Solomon),
"Any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later." (Mitchell).
"...a factual incident, which may be defined as an observable and integral episode of human behaviour. The word "critical" means that the word incident must have a discernible impact on some outcome; it must make either a positive or negative contribution to the accomplishment of some activity of interest" (Pollit & Hungler 1995)
Many situations can be critical incidents. What may be a critical incident for one person may not be for another. It depends on the perception of vulnerability, control over the situation, and the personal meaning of the incident. This does not mean that they are acute or major incidents or experiences, but that they stand out as being memorable and therefore having some potential for learning. Critical incidents are sudden and unexpected often disrupt your sense of control may involve the perception of life injuring threat involve you physically and or emotionally.
It is a common misconception for student nurses to think, "...it doesn't bother the other nurses, so it shouldn't bother me. If it does bother me, it means that I am weak and not cut out to be a nurse." in reality Part of the reasons people become nurses is because they can empathize with others, and can experience emotional reactions. Like everybody else, extraordinary situations can affect nurses. Critical incident stress is a normal reaction to abnormal situations. However, as you gain more experience you will be better able to handle situations with more control.
One such critical incident was experienced by a student within an accident and emergency department. The incident in itself was not life threatening for the patient the consequences of the outcome could have been.
John smith (changed name for the purposes of confidentiality) a 64-year-old widower was brought into the A&E department by his son with lacerations to the left shoulder and forearm after a fall. On arrival, it was noted that he was inebriated. After seeing the triage nurse john was escorted to a cubical for a more thorough examination of his shoulder. On removal of his T shirt it was noted by the staff nurse that he had a colostomy bag fitted which was over full and leaking from one side. As the shoulder laceration was quite deep and would need thorough examination and closure by a doctor in the A&E department's clean theatre, it was necessary to change the colostomy bag to reduce any risk of introducing infection to the clean field within the theatre and thus increasing the risk of infection to the shoulder wound. After it was explained to him fully what needed doing and why he became very uncooperative and refused to change his bag for himself or have his bag changed by the nursing staff, giving no explanation for why he didn't want it doing other than it was his job and he would do it when he got home. It was at this point after discussion with his son it was decided that his lack of cooperation was down to his inebriated state. Determining he had diminished responsibility due to his inability to fully understand the implications of his actions.
It would be necessary to...