Critical incidents are snapshots of something that happens to a patient, their family or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Rich & Parker 2001). Reflection and analysis of critical incidents is widely regarded as a valuable learning tool for nurses. The practice requires us to explore our actions and feelings and examine evidence-based literature, thus bridging the gap between theory and practice (Bailey 1995). It also affords us the opportunity of changing our way of thinking or practicing, for when we reflect on an incident we can learn valuable lessons from what did and did not work. In this way we develop self-awareness and skills in critical thinking and problem solving (Rich & Parker 2001). Therefore, to ensure his reflection was productive, in terms of encouraging synthesis, analysis, critical thinking and evaluation, along with guidance on the reflective journey, I chose Gibbs (1988) reflective model as a framework for my reflective practice on a clinical incident happened in my organization. Gibbs model of reflection incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan. I have chose this Gibbs (1988) model because I believed his cyclical process provides a structured analysis, highlighting the reflective journey as a continual process, in which reflective skills grow and develop as new situations arise and the context of practice changes.
It is a Sunday morning; I was on duty as an on call manager for the day. I have been called by a junior nurse from maternity ward to set a peripheral line for her patient under her care. As a junior nurse she is not confident to set a line by looking at patient condition that is very weak. Without delaying, I went to visit that particular patient to help my nurse.
This patient is a 40 years old Malay lady, who had done Total Abdominal Hysterectomy and Bilateral Salpingo-Oopherectomy (TABHSO).According to the nurse in charge; after the operation patient had small bowel syndrome due to complication raised during operation.Patient general condition was very weak and lethargic. Her oral intake was poor too. The consultant in charge has started treatment on Total Parental Nutritional (TPN) daily for 18 hours. This TPN is given via a peripheral line for about two days. Other than that they also use the same line to infuse other intravenous medication (antibiotic). According to the nurses, they have suggested to the consultant to put central venous catheter (CVC) since the patient have many intravenous (IV) medication to be infused. The consultant refused putting CVC and according to him it just for few days only. He doesn’t want to incur cost and prevent potential complication of CVC insitu.He just ordered the nurses to transfused TPN via peripheral line. Without further arguing the nurses just follow his instruction. They didn’t do closed monitoring of the particular hand with peripheral line for any early sign and symptom of IV line complication. So at the end on that day (Sunday), the line is blocked due to thrombopheblitis
Initially the nurse in charge didn’t acknowledge me about this patient condition and the purpose of setting a peripheral line which is basically to transfuse TPN.I was thought that as usual to give intravenous medication or solution. When I looked at the patient, she looks so weak and lethargic in other word look like a septicemia patient. I was wonder; how can a patient who had done TABHSO in this situation! When I assess her hand, I was shocked to look at her hand skin condition (previous on cannula), which looks swollen and skin blue black in colour – Thrombophlebitis and patient complain of pain when touch. I query how it could happen to this patient. Then I notice at patient bed site there was a balanced TPN solution is hanged. I wonder, “Is this solution been given via peripheral line”!...
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