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Introduction

Medication errors are pretty standard in healthcare settings. Errors are usually produced by flawed systems, methods, and situations that cause people to commit errors or fail to avert them. It will be seen in terms of wrong medication administration, delayed doses and wrong routes. Apart from this, the second most common issue that exists in healthcare is the development of pressure injuries. It will increase the risk of infection and intake of medication in the patient population. Lastly, communication seems to be a key player in healthcare settings that overcome the rate of errors. In this reflection, the mentioned three incidents have been explained using Gibb’s reflective cycle. 

Reflection 1: Medication errors

Description

My first experience with medication errors came relatively early in my career. The incident involved a 45-year-old man diagnosed with intestinal blockage, and I was the nurse in charge of the administration of the prescribed medications. But after the administration, the patient reported pain in the abdomen region within a few hours. The doctor took a quick glance at the prescription and told me to crosscheck the dosage of N-acetylcysteine, to which I discovered that the dosage administered through injection was 100 ml more than the prescribed dosage.

Feelings

The moment I came to terms with what could have happened to the patient, I was apologetic and embarrassed by my involvement in a potentially serious error. I felt disappointed with myself due to my carelessness and negligence, apart from the inconvenience that the patient had to go through as a result of this. In addition to this, I was also concerned about any possible investigation regarding the incident and its possible implications affecting my career. 

Evaluation

The vast sea of emotions was triggered primarily by concern for the patient, accompanied by frustration and the pressures in which nurses work, which ultimately make a person more vulnerable to errors and the fear that leads to comprise in patient care and safety This is accompanied by emotional and physical distress to the patient (Hammoudi et al., 2018). For example, the storage of full-strength medications in hospital patient-care units, despite being poisonous unless diluted to a specific concentration, has resulted in fatal errors (Carver et al., 2022). 

Analysis

The professional's choice to disclose a future medication error may be influenced by the response that happens following the reporting of medication errors. Other factors include the inability to communicate, negligence in checking medical records, poor professional relationships, and dialogue between clinicians and the patient/family, particularly the absence of skilled mediators wherever necessary; all contribute to medical errors (Ryder et al., 2017). Transparent communication following a medical error involves telling the patient about the incident, discussing it with co-workers, and reporting it to the institution (Bell et al., 2017). 

Conclusion

Through this experience, I realised the importance of being vigilant and observant while providing patient care and giving utmost priority to the safety and well-being of the patient at all times.

Action Plan

For my future practice, firstly, it would be crucial to pay utmost attention to prescriptions and medication dosages in future. Secondly, it would be equally important to pay attention to the doctor’s instructions and develop an approach of non-negligence. In addition to this, the most important of them all was the fact that even a single moment of careless or inattentive behaviour could result in fatal consequences, sabotaging the career of a medical professional along with the reputation of the organisation or institution (Alrabadi et al., 2021).

Reflection 2: Pressure Injuries

Description

My experience with the handling of pressure injuries involved Mrs. S, a 52-year-old woman who had developed a pressure injury after hip surgery. She had a big, blackish-purple wound on her left hip. The skin was intact, but it was highly discoloured. It was a grade 4 pressure wound as there were total thickness, skin loss and necrotic tissues covering it.

Feelings

At first sight, it made me sad and anxious. Seeing this sore develop while I was watching made me feel horrible because I always try to take good care of patients. I became even angrier with myself when I realised the patient was in pain. I was desperate to discover what went wrong and how to avoid it occurring again.

Evaluation

A patient who is at risk of getting a pressure ulcer should be evaluated within six hours after being admitted, according to NICE guidelines (Nightingale & Musa, 2021). The fact that nurses are constantly occupied throughout shifts was another point that was highlighted. As a result, they depend on support workers for information about the patient's status, which prevents them from adequately assessing patients' pressure injuries on a frequent basis (Teo et al., 2019). Nurses need to have a fundamental grasp of pressure ulcer prevention, healing, and therapy. They should also be informed about a variety of risk assessment techniques to evaluate patients for the chance of getting pressure ulcers (Sumarno, 2019). 

Analysis

The National Health Service (NHS, 2021) mandates that nurses engage in suitable learning and performance activities to uphold and improve their competence. The use of pressure-relief cushions and mattresses, pressure-area skin care, particularly for those with incontinence, and ongoing examinations are further components of management and prevention. The Norton scale, the Branden scale, and the Waterlow scale could have been used for performing assessments as they could have been able to stop the patient's ulcer from getting worse (Gurkan et al., 2022). Dressing is another crucial therapeutic step for ulcers in grades 3–4. Lastly, without an evaluation, nursing care is incomplete. (Amir et al., 2017). 

Conclusion

This whole experience taught me that I need to keep learning and getting better. Even though I felt terrible about what happened to Mrs. S, it made me want to be more careful and do a better job in the future.

Action Plan 

There could be a lot of things that could be helpful for future practice. Firstly, personalised care plans should be made for patients who might get sores, with things that can help prevent them. There should be a system to remind healthcare workers and nurses to make sure they move patients and check their skin at regular intervals. There should be sufficient training related to the management and prevention of sores from happening. Lastly, there should be appropriate communication and collaboration between medical care personnel to ensure quality patient care and health outcomes (Ayello et al., 2017).

Reflection 3: Communication Gap

Description

The hospital received a 60-year-old diabetic patient with an inflamed diabetic foot ulcer. A below-knee amputation was determined to be necessary after a multidisciplinary team evaluated and spoke with the patient. I noticed the patient's extraordinarily sombre and unhappy appearance when I was retrieving the information. 

Feelings

I was alarmed and, in some ways, incapable when I noticed the man's grief. I thought that no amount of sympathy or words could diminish his suffering. I was a little surprised by the multidisciplinary team's inability to cope with the discussion and their abrupt exit as well. I didn't feel capable of handling the situation, and I was not convinced if my presence was the best line of approach.

Evaluation

The ability to reassure patients and show compassion is a critical skill that nurses occasionally fail to recognise. The incident also demonstrates a lack of coordination between the team and nursing personnel. To ensure that the patient's mental distress following the surgical procedure was minimised, interaction was necessary. I had to experience the circumstance in order to understand that therapeutic dialogue is essential to a comprehensive attitude to providing care (Ghahramanian et al., 2017).

Analysis

The process of breaking unpleasant news to patients can be difficult for some medical professionals, and they may feel unprepared mentally. Patients who experience extra stress, have less psychological adjustment or have poorer health outcomes may be adversely affected by a lack of competence in this area. The way the news is presented can also affect how well patients comprehend the condition and stick to their treatment plan. Due to the adverse outcomes, a number of protocols and methods for breaking bad news and handling the fallout were established (Miller et al., 2022).

Conclusion

I was able to recognise the situation's true significance for nursing therapeutic interaction and the need to apply it to my clinical job. Learning to provide psychological assistance and handle the consequences of bad news is an important nursing skill that affects how satisfied patients are and their health outcomes.

Action Plan

In my clinical practice, I'll aim to be more understanding and place higher importance on nurse-patient communication. I make an effort to provide patients with emotional support as well as psychological care, particularly if they have just received distressing news. Because of this, I won't minimise the importance of interaction between nurses and patients for patients' physical and mental well-being. I'll use vocal and nonverbal clues in the future to express my concern and overall be more sympathetic (Akyirem et al., 2022).

Conclusion

In conclusion, reflective practice is a cognitive skill that calls for a deliberate attempt to consider a circumstance while being conscious of one's own beliefs, attitudes, and behaviours. It helps nurses to gain information from experiences and put the expertise to use to improve patient care outcomes. Furthermore, it fosters a grasp of the field as well as the demands and worries of patients. 

References

Akyirem, S., Salifu, Y., Bayuo, J., Duodu, P. A., Bossman, I. F., & Abboah‐Offei, M. (2022). An integrative review of the use of the concept of reassurance in clinical practice. Nursing Open, 9(3), 1515-1535. https://doi.org/10.1002/nop2.1102

Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., & Al-Faouri, I. (2021). Medication errors: A focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78-86. https://doi.org/10.1093/jphsr/rmaa025

Amir, Y., Lohrmann, C., Halfens, R. J., & Schols, J. M. (2017). Pressure ulcers in four Indonesian hospitals: Prevalence, patient characteristics, ulcer characteristics, prevention and treatment. International Wound Journal, 14(1), 184-193. https://doi.org/10.1111/iwj.12580

Ayello, E. A., Zulkowski, K., Capezuti, E., Jicman, W. H., & Sibbald, R. G. (2017). Educating nurses in the United States about pressure injuries. Advances in Skin & Wound Care, 30(2), 83-94. https://doi.org/10.1097/01.ASW.0000511507.43366.a1

Bell, S.K., White, A.A., Yi, J.C., Yi-Frazier, J.P. and Gallagher, T.H., (2017). Transparency when Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. ((2018)). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038-1046. https://doi.org/10.1111/scs.12546

Carver, N., Gupta, V., & Hipskind, J. E. (2022). Medical error. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/28613514/

Ghahramanian, A., Rezaei, T., Abdullahzadeh, F., Sheikhalipour, Z., & Dianat, I. (2017). Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication. Health Promotion Perspectives, 7(3), 168. https://doi.org/10.15171/hpp.2017.30

Gurkan, A., Kirtil, I., Aydin, Y. D., & Kutuk, G. (2022). Pressure injuries in surgical patients: A comparison of Norton, Braden and Waterlow risk assessment scales. Journal of Wound Care, 31(2), 170-177. https://doi.org/10.12968/jowc.2022.31.2.170

Miller, E. M., Porter, J. E., & Barbagallo, M. S. (2022). The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis. Palliative & Supportive Care, 20(3), 433-444. https://doi.org/10.1017/S1478951521001243

National Health Service. (2021). Pressure ulcer core curriculum. https://www.england.nhs.uk/wp-content/uploads/2021/09/Pressure-ulcer-core-curriculum.pdf

Nightingale, P., & Musa, L. (2021). Evaluating the impact on hospital acquired pressure injury/ulcer incidence in a United Kingdom NHS Acute Trust from use of sub‐epidermal scanning technology. Journal of Clinical Nursing, 30(17-18), 2708-2717. https://doi.org/10.1111/jocn.15779

Ryder, H.F., Huntington, J.T., West, A. and Ogrinc, G., (2019). What do I do when something goes wrong? Teaching medical students to identify, understand, and engage in reporting medical errors. Academic Medicine94(12), 1910-1915. https://doi.org/10.1097/ACM.0000000000002872

Sumarno, A. S. (2019). Pressure ulcers: The core, care and cure approach. British Journal of Community Nursing, 24(Sup12), S38-S42. https://doi.org/10.12968/bjcn.2019.24.Sup12.S38

Teo, C. S. M., Claire, C. A., Lopez, V., & Shorey, S. (2019). Pressure injury prevention and management practices among nurses: A realist case study. International Wound Journal, 16(1), 153-163. https://doi.org/10.1111/iwj.13006

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