Critical Incident Analysis in Nursing Practices
Features of the Incident
According to Polit and Hungler (1993), incident management is described as an immediate response by an organized team per the stipulated plans in response to an emergency or disruption of a business activity. An incident is any event that has caused injury or loss or has the potential to cause harm. Its severity can only be prevented by use of the facility’s normal management systems. According to Hendricks et al (1996), a potential incident increases the chances of an event occurring, but on the actual sense nothing happens. Potential incidences are either unsafe acts or unsafe conditions.
Whenever one commits unintended act, the scenario is called unsafe act. If a person does not allow to or makes the area of the scene out of bounce, then it is referred to as unsafe condition. A good example is a female student who happened to incur some serious burns after an explosion of an autoclave as she was on duty. The student was in a field attachment at one of the food processing firms in California. She was sterilizing some of the used media in her exposure to improve her theoretical learning skills in the college.
On the explosion of the machine, the victim’s fellow colleagues called for an emergency evacuation of the victim since she had serious burns on her face. Besides that, the laboratory room was also in fire, and the fire needed to be stopped from affecting other buildings.
Initial Response to the Incident
According to Lian (2001), incident management is described as an immediate response by an organized team per the stipulated plans in response to an emergency or disruption of a business activity. An incident covers safety, environmental and economic loss. On the explosion of the machine, the victim’s fellow colleagues called for an emergency evacuation of the victim since she had severe burns on her face. Besides that, the laboratory room was also in fire and the fire needed to be stopped from affecting other buildings. The go team that was sent made an immediate response to save the scene.
Fortunately, the fire brigade had arrived which had stopped the fire from spreading by switching off the power supply to the institution. The go team conducted interviews from other colleagues trying to understand what had happened. Luckily, the victim was capable of talking after a first aid was given to her. She was rushed to the hospital, and she was admitted since the doctors said that her condition needed intensive management. The lab had some CCTV’s which had been set. They were used to show everything that had happened since the events had already been uploaded in the firm’s database.
Whenever an emergency help is required for a certain incident, the experts known as the go team, should first conduct an investigation to gain information of what had happened, when and how. This is followed by evacuation of the incidence (Jay, 1995). Experts were allowed to make an investigation on how serious the incident was. Later, they came up with concrete information from the eye-witnesses, documents, interviews and the way the scene of incident looked like. This was then followed by time line development on how they were going to solve the problem. Problem was encountered while the patient was under treatment.
There was poor communication between doctors who treated her between ICU high-dependency units. This is because the patient was taken to high-dependency unit attached to the ICU. She was in the ICU for about one month due to complications that related to skin surgery due to burn. Also, the patient had a tracheotomy for that she could breathe continuously with her airway requiring regular suctioning due to shocking of smoke. She was conscious and able to communicate with her doctor and family members, but at times she seemed withdrawn and unresponsive to the environment. She had significantly decreased sensation in her skin due to the trauma. Later, after feeling well for few days she was readmitted to the ICU again after experiencing a respiratory arrest in the ward.
In the first place communication was good because the emergency service responded quickly without delay. First aiders worked together with the family of the student. Her family was given all the necessary information to identify what happened and how it happened. Her family was concerned and observed a commitment and acceptance of responsibility, accountable of steps being taken to prevent a reoccurrence of the same incident.
The information gathered was analyzed and presented to the firm. The information after the investigation was clearly shared among the staff and family. It was discovered that the student had set wrong temperatures and pressure for the machine when conducting sterilization. Instead of setting the temperatures at one hundred and twenty one degree Celsius at a pressure of one atmosphere, the machine was set at one hundred and sixty seven degree Celsius at two atmospheres. It was also discovered that the student conducted the steam sterilization for more than twenty five minutes.
Further analysis showed that there was no technical supervision of the student as she conducted the experiment. A former staff who had earlier worked in that firm revealed that a similar case had occurred, but luckily enough they were around to rectify everything before things went out of hand. After the first aid and treatment, the patient was able to communicate on what had happened; the treatment she received was good, and she was engaged in the treatment process.
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Key Issues Outlined from Incident
There was miscommunication of treatment between ICU and HDU staff members who were treating her. They felt angry because their work was wasted. Reasons were that the ICU staff had spent one month weaning the patient off the ventilation and giving her intensive nursing and medical care, but they were back to where they had started. Family members were bitter as they thought she was discharged prematurely.
There was a need to blame someone in the ward staff. According to Page and Meerabeau (2000), in business of reflecting potential harms and confronting challenges that have cherished, beliefs and ideas come into conflict with peers as a product of new insight reflection will offer them. This means that by challenging doctors and nurses on the way they practice their craft, the patient will receive potential better quality care and improved outcomes.
According to Russell (1998), negative clinical experiences like the above incident easily make the family of the patient angry and frustrated. This is because health care system has the inability to meet the needs of people that it is supposed to serve. He states that the effectiveness of the health care system related probably with the ability of the nurses and doctors to work as a team. Also, patient should not blame the nurses and doctors when they do mistakes or because of their own fault. Doctors and nurses should have a good channel of communication when attending to the same patient to prevent confusion of the disease being treated. Patient should be engaged in the treatment by saying what he or she feels to avoid misunderstanding of treatment.
Incidence practices are a potential way of learning and also a proper mode of survival. This is because they challenge the concept of learning as a once and for all experience. Incident analysis is a way to effective increase of self-learning and teaching elements for professional growth in experience. Furthermore, it is a critical way of improving nurses’ professional standing. Through this incidence nurses’ knowledge, skills and attitude grounded in practice were changed. Critical incident analysis should be used as a tool for developing interpersonal skills and self-awareness. It should be a valuable educational element to ensure students from nursing draw past experiences and make use of them, not only facilitate learning from clinical practices but also towards bridging the gap between theory learnt in class and practice.
New Knowledge and Skills Acquired, and Application to Future Practice
When there is any case of burn, casualty should be laid down with care. Burnt area is protected from contact with the ground or any material that may cause any harm if possible. In case the burnt area is still hot, it should be flooded with cold water or a suitable cold liquid until the pain ceases. Place injured part under slowly running cold water for some time to ensure that the heat is sufficiently withdrawn from the area. If no cold water available, use any cold harmless liquid such as milk (Hannigan, 2001). Casualties are not supposed to be over cooled to prevent hypothermia. Any jewelry, watch, belt, shoes or other constricting clothing should be removed gently from the casualty injury area before it starts swelling.
Cover the injured area with a sterile or clean dressing without breaking any blisters or any lose skin. In case of any blister break, cover the injured area with a dry non-adhesive dress to prevent bacterial infection. Arrange for transfer to hospital from the area of accident. Monitor the casualty health carefully. Other new learnt knowledge and skills applicable in the future include; how to save life by ensuring that the casualty has a clear airway by removing clothes that are clinging to him or her. Treating injuries in order of their damage and preventing further injuries from the casualty by moving them gently to the area of destination. Sending for medical aid or transporting casualty to heath facility by calling for assistance to the ambulance and doctors. Staying with casualty while waiting for help or transporting them for medical help in medical facilities.
How to access the situation helping the casualty until a more qualified person arrives. This is by obtaining as much information as possible about the emergency and assessing for any danger that may happen to first aider. Use bystanders when in a crowd of people to call for help in emergency services. Give the location of the emergency, phone number from which the call will be made, a brief report of what happened, the number of people involved, the condition of each victim and help that has been given so far and lastly, never hang up until asked all the questions. Also, diagnosis of the patient is very crucial (Hannigan, 2001).
When casualty is conscious ask him or her what happened, where is pain, loss of sensation, weakness or whether there is any dizziness or difficulty in breathing. If unconscious, listen to the breathing and access airway and circulation system. Smell victims breathe and try to find out anything unusual on the breath or surrounding. Then take casualty to the hospital to a doctor for further help by giving out report explaining the history, signs, symptoms and help that was provided to the casualty before.
Future Learning Needs
Laboratory rules and regulations state and recommend that all students should get full supervision whenever performing any experiment. Laboratory rules and regulations should be taught to students for safety purpose when handling any machine. Proper communication should be employed to avoid misunderstanding between patient and nurses. Teamwork is a key to success hence; every person should be included in the excise of treatment. Lastly, nurses and doctors should describe ways in which patients/families can partner in the incident analysis process in order to build trusting relationships.
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