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Critical Incidence Analysis II

Adult Health Nursing II
Ijaz Arif
March 29, 2010
Submitted to;
Sir Afsar Jan
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Context of the incidence

“Follow effective action with quite reflection. From the quite reflection you will come
even more effective action.” (Peter F. Drucker).
Practicing standard actions and reflecting our actions will enable us to improve quality of
care provided to the patients. Documenting the care provided and patient’s condition is
essential in nursing which will help us in different aspects. While neglecting
documentation will create problems for nurses and patients as well. This is
documentation which help us providing essential care, according to patient’s need.
The incidence I have chosen to analyze happened in Bilal Hospital Rawalpindi. One of
the patients was administered Intra Venous Normal Saline continuously and there was no
written record of the amount administered. The Intake and Output of the patient was not
mentioned.

What happened?

During my clinical at Bilal Hospital, I was assigned in male ward. Students were assigned
in three groups with respect of nursing counters. Faculty advised us to attend the doctors
and nurses rounds to the patients. It was our special assignment to accompany staff in
rounds and the procedure of handing over patients to next shift. So I was visiting patients
in the company of Supervisor and other staff members. We visited a female patient with
the diagnose of Urinary Tract Infection. She was continually administered IV fluids and
strict maintenance of intake and output. During discussion and checking file, the
Supervisor identified that there is no record of intake and output of last ten hours.
Supervisor interrogated the night shift nurse about the mishap but she was unable to
satisfy her. She tried to gave reasons but in vain. Supervisor became angry and rebukes
her in front of staff and patient. She has neglected an important issue in nursing care. A
panic was created in patient’s room.
I selected this scenario for Critical Incidence Analysis for many reasons. Documentation
is an important factor of nursing. In case of intake and output negligence of
documentation becomes very crucial. Intake and output gives an indication of prognosis
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of patient’s health. Secondly the behavior of the staff in front of patient and attendants let
me think over it.

My thoughts and feelings

We were doing a routine round of the patients and the sudden panic made me nervous
initially. The dispute between supervisor and the staff confused my mind. I was
wondered about the staff’s behavior in front of patient.
When I came to know the exact situation, I was surprised. I was astonished that such an
important thing is being neglected. Documentation can give us the signs of improvement
or worsening of patient’s condition. But what is happening over here? It made me think
over my profession. Nurses are considered as angels of health. It made me sad that what
we are doing over here beside the expectations of others. Such mishaps are disgracing the
nursing profession. I became furious on myself that what a profession I have joined?
Where patient’s health id often neglected. I took pity on patient. Patients are helpless
people in our hands. “It may seem a strange principle to enunciate as the very first
requirement in hospital, that it should do the sick no harm” (Florence Nightingale).
Patients trust on us and there health is in our hands. If we are not able to improve their
health, at least we should reduce risk to their lives.

Reflection

Reflection is to rewind the incidence at different angles and think on different aspects of
the whole situation. Certain ideas came in my mind after analyzing the whole situation.
There were a number of factors regarding this event including busy environment, poor
practices and the most important in these is negligence and careless behavior of the nurse.
I analyzed the panic of the staff in patient’s room. Either the staff is trained or worked in
such an environment where such things are given no importance. They don’t care of their
behavior that they are disgracing their profession in front of patient. Either the excess
workload has made them peevish or they start reasoning with each other.
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Documentation is an important principle of nursing. Accurate and timely documentation

is necessary in patient’s care. Accurate documentation helps in handling any situation.
“Lack of documentation is becoming a problem for acceptance.” (Wietse Veneme). A
written proof can help legally. No one will accept nurse’s proof without documentation.
Neglecting the documentation of Intake and Output has many possibilities. One
possibility may be the weak inter-staff communication. Neglecting such things during
handing over can lead to such mishaps. Either the staff is unaware of the importance of
maintaining the record of Intake and Output. Intake and Output is such thing which gives
the signals of improvement or worsening of patient’s condition. I further analyzed the
situation in different aspects. Either it is the excess workload which didn’t allowed the
nurse to asses the patient and document his condition.
The most useful and effective thing I found useful is that how communication and
behavior of the nurse affect the image of nursing profession. We can improve our
professional image through our caring attitude and behavior.

What I have learnt from the incidence

The incidence was helpful in my learning in different points. The most important I have
learned the effectiveness of proper communication between the staff. Effective
communication could avoid such mishaps. Other thing is the way of communication
between nurses in front of patient. I learnt that nurses should be polite and patient. The
importance of proper assessment was understood. Such mishaps could be avoided by
doing proper assessment at the time of changing of shift. The vital role of accurate
documentation was highlighted in my mind. Documentation of Intake and Output helps
in determining the health status of the patient.

How can I use this learning to improve my future practices?

This incidence opened my mind and changed my expectations of ideal environment. This
incidence let me know the importance of behavior of staff. Ensuring polite and friendly
behavior among staff members and with patient nicely improves the patient’s health and
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the standard of care provided to the patients. I will improve my communication skills;
ensure gracious and sociable behavior to enhance the image of my profession.
Beside this the importance of documentation opened my mind. I will assure accurate and
time based documentation to avoid such mishaps. Documenting the care provided and
patient’s response will enabled me to provide perfect care to the patient. Indirectly it will
improve patient’s health.
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References

Ethical Decision Making in Nursing 2nd Edition Gladys L. Husted and James H. Husted.
www.thinkexist.com.
Nursing Malpractice 2nd Edition by Petricia W. Iyer.