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Critical Incident Analysis Nursing Assignment

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Reflective Analysis of a Critical Incident This paper recounts a critical nursing incident and reflects on the associated professional, moral and legal issues. The objective is to critically reflect on what happened with a view to distil key lessons to improve my future practice and provision of care. No personally identifiable details about the key players or context are included, thereby assuring their confidentiality. This incident was selected because it demonstrates the ways in which individual errors can compound and translate a relatively simple matter into a grave crisis with fatal results. It goes to the heart of nursing practice, and requires introspection into the ways we discharge our responsibilities. Description of Critical Incident I was a Registered Staff Nurse completing the final phases of a 12-month midwifery program in the labour ward of a 500 bed teaching hospital. The ward comprised sections for admission, stage 1 room (active labour), hypertension (pre-eclamptic) room, delivery room and a post-delivery observation area (temporary holding. My objective was to gain skill marks (by completing 40 deliveries and suturing) to complete the program. This particular day I enquired about deliveries and heard of a case that was just ending–the resident doctor was suturing the patient. I was hopeful of participating in the final stages to earn marks so I went to assist. Upon entering the delivery room I saw a lot of blood on the floor, so I asked the doctor what was happening. He stated everything was okay. I observed the patient lying on the bed, and asked her if she was fine. She replied yes. The patient looked pale and weak-more so than the stress of just delivering. I left the room and called the consultant who was doing ward rounds on another ward with students. I also informed the charge midwife about the situation. The charge midwife went to ascertain what was happening. The doctor again asserted that everything was fine, and there is no problem. I assessed the patient’s vital signs, and found them to be abnormal. Right then, the consultant came into the room and started an intervention. The patient was taken to the operating theatre for exploration to stop the bleeding. After two hours of transfusing blood products and packing the uterus, the patient was transferred to the intensive care unit. She passed away three hours later. The husband was told that there was a complication, and all efforts to stop haemorrhaging were unsuccessful. Hospital policy states that a midwife should assist doctors with any procedure being done in the labour ward. This was not the case. The baby was delivered by a midwife. The doctor was asked to do the suture because of suspected difficulties (cervical lacerations). This situation was not considered to be life threatening. The midwife left to attend to other patients on the busy ward. The doctor was asked to call if and when he needed help. The doctor acted on his own, and twice refused to acknowledge the worsening situation. The patient died, and the family suffered as a consequence. The information given to the family did not reflect all the facts of the incident. The hospital reprimanded the doctor and he was not allowed to see patients without supervision. He eventually completed his specialization course and now practices obstetrics and gynaecology in another jurisdiction. Stakeholders Involved Merriam’s dictionary defines a stakeholder as person(s) entrusted with “the stakes of bettors” or someone who is involved or affected by a course of action. In this case, a range of persons were directly and indirectly involved, and a family will have to live with the loss of a loved one. The patient expected to deliver a healthy baby, be with her family, and raise her child. She is no longer with them. The resident doctor made choices, and has to deal with the consequences of those decisions on a personal (moral and ethical) and professional basis. We cannot be sure what options were deliberated, nor the process used to arrive at the final choices. The consultant obstetric/gynaecologist juggled different tasks and ultimately intervened, but without success. The charge midwife and the midwife who delivered the baby are also a party to the incident: they attended other matters on the ward-no doubt also considered urgent and important. This incident raises various professional, ethical and moral dilemmas. The actions of these persons raise questions about the duty of care provided, and the professionalism that guided the choices and judgements they demonstrated. My objective at the time was to earn skilled marks. My view is that the hospital itself can also change from this experience. No one expected the outcomes that manifested. Hospital policy was contravened. The family accepted the paraphrased version of events. The doctor received a reprimand. I do not recall any action for the breach of policy. Theoretical Context A critical incident is one that can cause a person to pause and contemplate events that occurred, and in so doing, give them some meaning. This can be positive and experiential, and is a potential source for self, group and institutional learning and improvement (Gibbs 1988, Duffy 2007). Thinking critically requires us to identify problems and base assumptions and clarify the issues involved. Subsequently, we may raise questions; whose answers may result in changes (Vacek 2009). Critical incident analysis challenges us to evaluate the main facts and use these to gain a deeper understanding of what happened (Fornasier 2008). In so doing, we deconstruct the whole incident into its component parts. Reflection is a thoughtful, deliberative process to gain deeper understanding of what happened by encouraging us to challenge how we feel, think and behave. This is the basis for individual change and improvement (Andrews et al, 1998; Merriam Webster). Using a critical incident as a way of reflecting involves the identification of behaviours that may be helpful or unhelpful in a given situation. This process of structured debriefing can help the institution and the health care providers to identify incidents, prevent their reoccurrence, and enhance the standard of care delivered to the public (Gibbs 1988). Key Issue: Professionalism A profession is a ‘chosen, paid occupation requiring prolonged training and formal qualification’ (Webster). A number of professionals are involved in this case. For myself, at first, I did not know what to do: I was just thinking about the patient’s safety when I saw the enormous amount of blood of the floor. In the moment, I forgot about the chain of command: I bypassed the charge nurse and called the consultant directly. Reflecting on the incident, I should have called the charge nurse and she may have better handled the situation as it unfolded. Further, I assessed the vital signs after leaving the room to communicate with the consultant. It could be argued that I should have completed a fuller assessment of the patient’s vital signs before progressing through the chain of command-rather than taking the patient’s perspective that all was okay – despite a gut feeling that something was wrong. Was the patient making a rationale statement? Did she have enough information and the capacity to objectively weigh the situation? Did I, in that moment misread the gap in understanding of what I saw and what the patient said? I would maintain that my actions were well intentioned and had the desired impact: to bring additional resources to remedy the situation and preserve her life. Clearly, the ability to remain calm under stressful circumstances is a valuable characteristic. This cannot be taught or learnt in the classroom, and certainly not through a fatal trauma. The patient is no longer with us. Did she have enough information to make an informed decision about the quality of care she was receiving? Could the patient be reasonably expected to be informed or to request a different type of intervention in the circumstances? We will never know. The resident doctor was asked to suture a suspected lacerated cervix alone-and to ask for help if needed. Doctor maintained all was under control even as I assessed the situation was worsening. Questions may be asked about the doctor’s assessment of the initial and unfolding circumstances; and, the information communicated to the patient, who related she was ‘fine’. I have no doubt the doctor’s objective was to assist the patient, and, within the wording and spirit of the Hippocratic Oath, to use their own ability and skill to help the woman in the best way. However, did the doctor fail at his/her duty: to recognise an emergency, a worsening situation, and the limitations to their skills and capabilities? In so doing, did the doctor do more harm than good? In the final analyses, was the doctor acting in the patient’s best interest? The consultant did what was (probably) most the critical thing: an initial intervention and then emergency surgical exploration with a full team of specialists to ascertain the problem and contain the situation. Could the consultant have done more? This is unlikely in the circumstances. Yes, the consultant could have been called earlier, but that is not their fault. Did the charge midwife and midwife err in leaving the Doctor to complete the suture alone? How does one balance the need for a small amount of midwives to attend to different patients at various stages of labour, when a potential danger is at hand with a post natal mother? How do we reconcile these resource constraints with hospital policy (requiring a midwife to be present at all times)? In this situation, how do we make a decision about providing quality care and attention to labouring women, versus attending to a recovering mother? Is it less or more professional to leave labouring women unattended to care for a mother with what is considered to be non-life threatening wound? The Hospital’s official explanation of what happened was ‘maternal complications. This lacked credible details that are covered in the legal discussions below. Key Issue: Morality Was the hospital truthful in its communication with the patient’s family? To the outsider, the answer seems a resounding no! Does being a teaching hospital bring higher levels of risk to patients-by virtue of having younger and less experienced doctors? Does this lessen their responsibility to the patient? Or does it require a higher standard of care and greater precautions? In this situation, did the hospital fail in its duty to the public by having a higher ratio of patients to staff? Is it unreasonable to expect the nursing cadre to reasonably and safely provide a high quality of care to the number of patients on the ward at that time? Did the institution and its team fail by attempting to provide service for too many patients at this time? Did the policy foresee and cover these matters? Do these issues put the nurse and their professional obligations at odds with hospital and public policy? Does this conflict put the nursing (and other members of the medical team) at a disadvantage? What of the public’s rights and responsibilities? How do we honour and respect these charters in the circumstances described? Each patient wants to be seen, receive a high quality of care, with minimum chances of complications-certainly not death. How does the Midwife make based a decision about who to treat and how to allocate scare human resources? In a high stress understaffed environment, can we reasonable assess who is at greater risk and more deserving of care? Can we reasonable assert that honesty, justice and respect for the patient’s rights can lead us to a determination of where our duty lies? It is my view that the while some parties in this case may be able to justify their actions (midwives, consultant), others would find it a deontological challenge (resident, institution). In this case, the outcome of the incident dictates that the actions of key caregivers at critical decision moments were not optimal (wrong/unethical) because the consequences do not match the means/process. Key Issue: Legality No known legal proceedings arose from this incident. However, it may be argued that a judicious reading of the circumstances by a family predisposed to litigation could have asked many questions about the unfortunate circumstances referenced in this incident, and maybe have a case in a court of law. For example, it could be argued that the patient’s legal rights were not met, regarding professional standard of care provided by the resident doctor and the absence of a midwife throughout the procedure. Further questions may be raised about the quality, experience, judgement and capability of the first attending doctor. And ultimately, questions could be asked about the checks and balances (levels of safety) within the institution that compounded the situation. Additional issues may arise in considering whether or not the patient was reasonably informed about the unfolding circumstance, associated risks, and given the opportunity to legally consent. It could be argued that the doctor acted unilaterally (paternalistically) to the patient’s disadvantage. Alternately, the patient could not have reasonably rejected treatment in the circumstances. Therefore a detailed test would be required of what a reasonable professional would do in this situation. The hospital reprimand is an indication that the resident doctor could/would have failed the Bolam Test of respectable medical opinion – thereby paving the way for litigation. The above could also lead to the question about the initial consent, and whether or not there was a full explanation of risks and likely treatments in the event of complications. In a legal context, the issue is whether or not the key stakeholders acted professionally and morally, and more importantly, in the course of their duty, whether they neglected or failed to provide a reasonable care of duty to the patient. Summary and Discussion My view now-I was not asked or debriefed at the time, nor did I reflect critically then-is that the circumstances and outcomes dictate that the team and members thereof acted less than professionally, and their judgements and actions were not finely balanced, leaving them in a an unethical and morally compromised position. The patient was owed a duty of care, which was not provided by all involved at the critical moments after delivery. So although all parties worked from a position of beneficence, obliging to do good for all patients at the time, there is a deontological failure in justifying their actions. On this occasion, hospital policy was not adhered to, and there was reasonable cause for this. The outcome reinforces the view that the consequences do not match the means. But this has to be balanced with the contending demands on the team. The midwives, in leaving the doctor to attend to the patient, expected to be called if needed. They were professionally and morally obliged to give reasonable care to the other patients. It would be difficult to squarely blame them for an act of omission that caused/worsened harm for the patient. This is not to ascribe blame squarely at the resident doctor. There are factors at play that would have influenced their action-in keeping with training-while endeavouring to contain and manage the situation. Maybe, for example, there was consideration of the human resource constraints and not wanting to burden fellow colleagues. Maybe the doctor was confident in knowing what was required in the circumstance. However, the rapidly deteriorating situation was soon beyond the doctor, and there was no recognition or acceptance of the need for additional help. Surely, if the final outcome was positive, the consequences would have justified the means. However, in this case, the means and end were weak links. The circumstances and situation in the ward on that day were unfavourable to the team: too many needs, and too few hands. The staffs were in a compromising position by having to deal with too many situations. This should never be the case if we are to deliver a reasonable duty of care in circumstances where humans can never fully assure medical outcomes in certain emergencies. In this incident, on this day, a number of factors compounded a bad situation and led to fatal outcome-which never had to be the case. The midwife made a decision to leave the doctor to suture the lacerated patient; the doctor attempted to do the job without recognising or seeking help. My actions quickened the intervention of the consultant, who ameliorated the situation, but to no avail. Conclusion and Reflection Having participated in this course, I can now reflect critically on this incident and confirm the ways in which a variety of professional, legal, ethical and administrative policy must work together in order to deliver assured quality healthcare. This is especially important in high stress environments where critical decisions must be quickly made-with the potential for unforeseen results. As professionals we must strive to be calm when things take a turn for the worse. This is not a reason to abandon or lose the ability to think critically, and stay true to our ethical, moral and professional duty while meeting the expectations of our employers. Indeed, we will at times find ourselves in situations that test this resolve, and require us to make rapid decisions and attempt to innovate to meet circumstances. This latitude is welcomed, but must be used with caution to ensure that the final outcomes can hold up to the scrutiny of our peers. Finally, it is critical to reflect and analyse our actions and experiences in order to evaluate what works, what does not work, the reasons for these, and the ways to manage future events should they recur. This is useful whether or not one is reprimanded or at the end of litigation case (institution). It is from these collective experiences and learning that we can improve policy, and enhance the profession. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

Relationship Between Transformational And Transactional Leadership Skills Education Essay

This paper will evaluate the relationship between transformational and transactional leadership skills in principals of kindergarten through eight grade schools. Seven various sources containing journals and studies have been critiqued and delineated. The discovery from these articles is that principals with transactional and transformational qualities lead effectively. The ultimate goal of a principal is to create a safe learning environment where students are able to learn to their highest potential. The focus of this paper is to explore grade schools ranging from kindergarten through eight grades and to provide the reader with ample qualities of an effective transformational and transactional leader. Problem Statement Recent studies suggest that kindergarten through eighth grade students in the United States are struggling to meet standards and are falling behind (Lucas

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Points: 60, 1000 words or 2-page single space. Times Roman, font size 12International managers encounter varying market conditions in the global marketplace hence they need to develop creative management strategies and functional tactics in order to achieve sustainable growth/performance. Based on this background information, you’re required to collect primary data by interviewing informant(s) from for profit or nonprofit organization (e.g., NGOs) in a selected emerging market country of your choice.Find below sample interview questions:a) Compared to your home country, what is the most surprising aspect of managing people in country?;b) Can you talk about your company’s current organizational structure in country?;c) What is the story of your experiences of successful/unsuccessful management practice in country;d)Tell me a story about your experiences managing a team of individuals who come from different tribes and ethnicity in country;e) Can you please share your experiences about the following aspects of management in country: collaboration, negotiation, motivating employees, language barrier, technology usagef) Do you have any other comments/experience in country that you would like to share with me?
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The American Way of Death: Process Analysis in Writing Descriptive Essay

Process analysis writing is a kind of work that requires giving certain instructions in order to introduce or describe something, or take some steps. This form of writing is widely used in numerous literary works and other pieces of writing like newspapers, weblogs, etc. With the help pf process analysis writing, writers get one more opportunity to make some reliable piece of advice and use illustrative examples to show that correct following may lead to quite positive outcomes. The American Way of Death is one of such literary works, the author of which uses process analysis writing form and focuses her attention to the details, inherent to funerals. It is necessary to underline that process analysis aims at presenting of the steps in the chronological order and helping other people to complete significant or just obligatory processes. The writers, who are eager to use process analysis form of writing may also achieve the purpose and just explain how things under consideration happen and what outcomes should be expected. There are several types of process analysis: informational (describe how the things happen) and instructional (offer the instructions to follow). (McCall 13) If a person wants to know more how to cook something or arrange just a perfect meeting, he/she should certainly pay attention to process analysis writings in order to find out a good piece of advice, analyze the example, and clear up what should be done in order not to feel sorry for something that has been already done and could be done never. The American Way of Death is a kind of research, conducted by Jessica Mitford, the author, where certain directions within funeral industry. In 1963, this book appeared for the first time and changed many people’s points of view considerably. Without any doubts, death is something that you know about for the whole life, but cannot comprehend why it comes one day and takes the most significant person in this life. To help readers overcome difficulties and be ready to funerals, Mitford describes several ways of how any funeral instructions may take advantage of friends and relatives of a dead person. As a true process analysis writing, The American Way of Death concentrates readers’ attention on funeral industry, its secrets, and important details. To my mind, it is an informative type of process analysis, as the author prefers to describe some events and use more and more real life examples. “I want to help them grieve properly.” (Mitford 10) This very phrase may serve as a kind of motto for this paper. Get your 100% original paper on any topic done in as little as 3 hours Learn More The author does concentrate on details and does not want to create some general situations. She does not afraid to criticize funeral industry, paying attention to both emotional and financial losses, which are so inherent to the Americans. The witty manner of writing, chosen by Mitford, cannot leave indifferent any reader. It is better to be ready to fight and win in the battle that may happen between people and funeral industry. When one person loses somebody he/she loves much, depression is not the best way out. Hilarious attitude to funerals cannot but help many people to be strong and be the winners in this battle against funerals and in this life. Process analysis writing is a frequently used form that lots of writers prefer to use in order to create worthwhile projects. The American Way of Death turns out to be a good example of such type of writing and provides its readers with another chance to look at funerals in another way and cope with all the difficulties in this life. Works Cited McCall, John. How to Write Themes and Essays. Peterson’s, 2003. Mitford, Jessica. The American Way of Death. Vintage, 2000.

Paper assightment

Paper assightment.

Link (Links to an external site.)Look over all the articles and select two that appeal to you. Do not select videos.Paper Format: Papers should be written in essay form with the following paragraph structure. Follow the guideline below. Each paragraph should have a topic sentence and end with a concluding sentence. Proofread for grammar, spelling and punctuation. Use the following paragraph structure for your essay.Paragraph 1: Introduction. Begin with general comments about what is creativity and why is it important in everyday life. Incorporate ideas from the following articles listed in Canvas in this module: What is Creativity? and Why is Creativity Important in Everyday Life? Then, include the title and author of both articles you have selected from the 99U website. Develop a thesis statement about the importance of creativity and whether creativity is something everyone can do.Paragraph 2: Summarize the main ideas of article #1 you have selected from 99U. Give some specific examples from the article. What are the main points? What conclusions does the author make?Paragraph 3: Critique article #1 from 99U. Give your personal response to the author’s main ideas. In your opinion what were the strong points or the weak points. Are there any relevant ideas the author did not bring up? Do you think the ideas promote creativity in everyday life? Are the ideas relevant to you? Give examples of ways you could incorporate this information into your life.Paragraph 4: Summarize the main ideas of article #2 you have selected from 99UParagraph 5: Critique article #2 from 99UParagraph 6: Conclusion. Compare the two 99U articles. What are the pros and cons of each article? Which article do you prefer or think has the best ideas in terms of developing everyday creativity? Although they may both present valid ideas, choose one article that appeals to you more and give your reasons why. In general, do you think a person can modify their behavior or attitude to enhance creativity and make things happen?Length: Papers should be 800-1000 words. 12 point font.Papers will be graded on:1) Adherence to the topic assignment and instructions listed above.2) Content and original thinking3) Clarity and organization4) Grammar, spelling and punctuation
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