Reflection learning from critical incedent


I was working as Lecture’s Assistant in nursing school. One day, I was performing my job task which was assessing students during training in hospital. I was in a medical ward where I had six students after ward round. Head nurse asked me about all medical procedures that were supposed to be conducted in the day to enable student’s observation. Head nurse said that a patient need wound dressing on which I asked for permission so that my students can attend this procedure. Subsequently I accompanied with my students, I told them to observe carefully the nature of procedure so that it can be discussed after the procedure will end. Equipment was prepared by a nurse, she wore sterile gloves and started to remove old dressing while using aseptic technique, and finally she cleaned the wound so the doctor can assess the wound. The doctor stated that the patient need debridement necrotic tissue. She searched for scalpel within the equipment available but she did not find it. She left patient’s room with gloves on, after coming back from store room she didn’t change gloves and started debride the wound following that the doctor asked her to apply ointment into wound and applied specific type of dressing. She left the room with gloves for second time to bring the dressing. that made me concerned as this would infect patient’s wound. At that moment I was thinking to speak up and say something however I didn’t find enough courage to confront the nurse and thought it was too late as she already started applying the dressing. After the procedure ended all the students noticed that the nurse did not change gloves twice.

The entire experience left me with mix of shocking and Frustration. It was shocking for us as all nurses are required to be aware of infections control procedure. Frustrating, because I thought that the clinical observation plays a significant role in enrichment and reinforcement of what was taught at school.

After the incident I spoke to head nurse and told her what I observed and discussed the significance of infection control and hand hygiene. Head nurse assured me that she will speak to the nurse and would make sure she follows the protocols and guidelines prior to conducting procedure for any patient in the future. This event was hard and challenging for me because it made me disappointment about my action that I spoke with head nurse rather than confronting the nurse when she was dressing the wound. Because I was as tutor not as staff nurse in hospital. In addition, I have not any power to direct guide that nurse who made the mistake, I did not want to make her unconformable and make conflict front of patient and students. Nevertheless, I felt satisfied in a way the head nurse responded positive. I have learnt from this incident the importance of acting assertively with staff or students in order to safeguard patient’s health.

My reaction at the time of incident was under the influence of shock I was not believing myself that a nurse could possibly do something like this as never witnessed before in life. The decision to talk about the issue with the head nurse was justified because it is about health and safety of patient. A nurse can commit a mistake on account of lack in safety procedures due to lack of knowledge, supervision and other human factors such as physical environment and demands (Driscoll, 2000; Jane,C.and Julia,C. 2009). However, the error in health care not entirely based on lack of knowledge but could be rising from lack of organization process such as culture and workload (Reason, J.2000; Johnstone, M. and Kanitsaki, O. 2007: World health organization , 2011). Health care worker need to be aware and understand of human factors which lead to enhance patient care (WHO, 2011). In medical profession nurses are required to ensure patient’s safety and are required to adopt procedure that could minimise health risks for patients by ensuring that their respective work is in the limit of their competence. Therefore negligence on my account on above mentioned incident is like being part of the mistake. The mistake that was committed by nurses could have been realised by her if a senior such as head nurse would talk to her in association with some logical reasoning of this mistake). Learning through reflection in clinical area enables nurse to become more self-awareness (Driscoll 2000).

On the other hand, nurses have a significant role in management of clinical risk which improve patient safety patient as well as the patient has a right to receive high quality of care and right treatment by ensure patient free from risk which is part of nursing duty (Ranger,C.and Bothwell,S. 2004;Johnstone, M. and Kanitsaki, O. 2007).

After analysing the issue I have realised that it was basic but significant lack of professionalism by the nurse, she didn’t follow the standard procedure for controlling infection. A nurse should take precautionary measures in which gloves are required to be removed if for some reason nurse has to leave treatment room (NHS Professionals 2010). According to Ecker and Carroll (2005), cited in Peter, J. et al (2011) there are 2 million infections and 90,000 deaths per year occurred of nosocomial infection according to US report. Therefore, knowledge of infection control precautions should be an essential requirement of all healthcare professionals.
I have realized that if this kind of incident occurred again I should have to be more active and should have to bring the issue in the notice of nurse who is committing the mistake as the mistake can bring the life of patient in danger. More over encourage patient safety and training program to ensure nurse practice safe care (WHO, 2011).



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