Reflective Report: Critical Incident in Nursing Practice - Maldives

This report presents a critical incident reflection from a nursing student working in a hospital in the Maldives. The incident involves a severe road accident case where the patient's treatment was delayed due to administrative processes requiring family member identification. The report explores the nurse's feelings, evaluation of the situation, and a detailed analysis using Gibbs' reflective cycle, focusing on ethical dilemmas, training needs, and contingency arrangements. The ethical dilemma centers on the conflict between following hospital policies and providing immediate patient care. The analysis also highlights the need for improved training and adjustments to hospital policies to ensure timely treatment and better patient outcomes. The report concludes with a call for changes in administrative procedures and staff training to prevent similar situations in the future.

Nursing

Table of Contents
CRITICAL INCIDENT AND REFLECTION................................................................................1
INTRODUCTION TO INCIDENT.................................................................................................2
FEELINGS.......................................................................................................................................2
EVALUATION................................................................................................................................3
ANALYSIS......................................................................................................................................3
CONCLUSION................................................................................................................................7
TASK 1............................................................................................................................................1
Why are you here? What are you aiming for?............................................................................1
TASK 2............................................................................................................................................1
Time management and learning style.........................................................................................1
TASK 3............................................................................................................................................2
Learning style..............................................................................................................................2
TASK 4............................................................................................................................................3
Library and searching database...................................................................................................3
TASK 5............................................................................................................................................3
Evidence based practice and different types of literature...........................................................3
TASK 6............................................................................................................................................4
Critiquing literature.....................................................................................................................4
TASK 7............................................................................................................................................4
Progress in developing referencing skills...................................................................................4
TASK 8............................................................................................................................................4
Reviewing essay .........................................................................................................................4
REFERENCES................................................................................................................................6

CRITICAL INCIDENT AND REFLECTION
Critical incident means activity, situation or circumstances which give very good or bad
result on end results. These incidents can be positive or negative, so there are possibilities of
good or works result on outcome.
Reflection means similar image as present in opposite side. In context of projection,
reflection means performing task by putting oneself in particular situation and then sharing view,
thoughts, experience etc. related to it (Butterworth and Faugier, 2013).
With the help of reflective report, reader can understand situations in effective manner.
This gives idea about various activities such as what actions that have been undertaken in order
to improve it and they are able to explain pints in more depth. This helps to give clear description
about portrayed situation.
There are some disadvantages of reflection such as over thinking, difference in
perception, critical evaluation, time consuming, etc.
There are three different models of reflection which are Graham Gibbs, Donald Schon,
David Kolb. In this report, Graham Gibbs reflective cycle is used.
Illustration 1: Graham Gibbs reflective cycle
(Source: Graham Gibbs reflective cycle, 2017)
1

This model is used because this provides systematic learning and knowledge of particular
event. This helps to provide appropriate conclusion after considering all aspects. In this model
there are following steps- initial experience, description, feeling, evaluation, analysis, general
conclusion, specific conclusion, personal action plans.
INTRODUCTION TO INCIDENT
As I am working as nurse in a hospital, Maldives, there are several patient with which I
have to deal. I am associated with emergency ward of hospital at Maldives. I face various
accidents cases such as fire broke out, road accident etc. every day (De Groote and Raszewski,
2012). I dealt with an road accident case which was very pathetic and the condition of patient
was very serve when he was admitted to hospital. This individual got hit with mini truck because
driver of truck was driving wrong side at night. Truck got tilted because it was overloaded. The
person was an adult who was severely injured. He got severe brain injury, blood was clotting
from his head, hands, legs. He was fractured because of crack in 16 bones. Some of onlookers
admitted him to hospital and no one of them was aware of any of his acquaintances or family
member. It was tough to contact his family members and relatives because of lack of sources.
Afterwards on the basis of his vehicle number, respected parties were informed. He was not
treated by hospital admin because patient's paper work was on hold. This is because his family
members were not present at hospital at the time he was admitted to hospital.
FEELINGS
The situation of the patient was miserable as there were no individual who was ready to
take responsibility of person. Due to lack of treatment, patient paralysed and ultimately died.
Because adult was under truck, so his body was severely injured from various places. In hospital,
treatment of such person was refused because as there were no identification of family member
with him as per legal norms and onlookers refused to sign medical papers, hence his treatment
got late as his family member did not arrive by that time. Because of night, there was no doctor
to operate him. When I was dressing with him as nurse my hands were shrivelling. At that time, I
feel very bad because that patient urgently needed the treatment and administration of hospitals
first need his family member in order to complete paper work (DiCenso, Guyatt and Ciliska,
2014). As per my opinion, this was not right in that consequence and according to me, these legal
norms should be manageable and amendable. Hence, due to lack of proper treatment and care,
the person died in the hospital. As per the nursing ethics, this is not ethical for a hospital if a
2

person die cause of late treatment and dearth of proper care. In such cases, ethics are main prior.
When patient need treatment administration department was waiting to complete paper work and
then treatment will start. Because of overloaded truck he was late admitted to hospital and
severely injured. This act of admin department of hospital is unethical.
EVALUATION
There is requirement of different aspects which are important for performing operations
in effective and efficient way. Being nurse, I was not so associated with administration
department of hospital, hence in this case, I wasn't able to make administrative decision while
incident was incurring (Fawcett and Desanto-Madeya, 2012). There are few people who waited
for his parents to hand over safely and provide help to them. This could be better if people signed
documents at hospital. So timely treatment of patient can start. Being nurse, my actions to this
situation was effective because with doctors I was also dressing patient though admin department
refused to admit without legal formalities. I have done this because my conscious does not allow
to wait for patient's parents. I acted best as per moral and ethics. I felt that being professional
does not mean that one only need to follow rules and regulations but fulfil one's duties and
comply ethics while performing acts.
THEME 1 ETHICAL DILEMMA
THEME 2 TRAINING EDUCATION TO PROFESSIONALS
THEME 3 ARRANGEMENT FOR CONTINGENCIES
Literature Search Strategy
In order to conduct this research, there is requirement of different aspects which are
important and relevant for conducting research. Online sources, newspaper, books and journals
are used to pursue this research. These days, there are many cases are happening which provides
knowledge related to cases. As there is differences in perception on workforce, then with the
help of online sources, upgraded information can be attained.
ANALYSIS
THEME 1 ETHICAL DILEMMA
Ethical dilemma means decision making ability of person whether to select professional
practices and ethical behaviours. This situation arise when there are two ways and candidate has
to choice one. As in my case where I am working as nurse, there is ethical dilemma whether to
treat patient or to follow official policies of hospital. In this case, I had to breached my
3

confidentiality and there were possibilities of violation of ethical policies. There are some
situations arise where person can not speak against its workplace policies. In the above
undertaken case, I am working in organisation as a nurse (Hayman and et. al., 2012). As per my
mentioned case, my ethics did not allow me to wait for patient's family but as per my workplace
ethics and policies, I was not able to aid him before paper work. So this was the biggest ethical
dilemma that standard my work. From this event, my ethics and principles got affects as I am not
able to perform work according to my moral.
As in society, being a nurse, I have to deal with various situations where ethics does not
allow me to perform such work. Hence, in order to deal with such situation, I have to work
according to official policies (Hockenberry, Wilson and Rodgers, 2016). About in above
discussed case, patient was severely injured that doctors should have not waited for paper work
formality. Later, the manager and staff determined to treat patients breaching hospital ethics. In
this situation, more improvement can be done if administration department also support this
patient. Due to lack of timely treatment, patient got affected with paralysis. This situation would
have not raised if admin department would have admitted the individual. In this situation, I
faced dilemma that whether I should to go with my ethics and first aid patient or follow official
policies or I should comply my organisation ethics. As per situation of sufferer, doctors also
make policies which are effective and significant for maintaining good situation of workers.
There is requirement of alteration in official policies of hospital, so patient can be treated
properly.
There is difference in perception of every individual to deal with certain situation. In this
case, there were some staff members which feels that policies of hospitals are correct. Because in
case of any miss-happening, there are possibilities that family member may file case. Police must
also performed their operations frequently, so they could identify family member's of sufferer. In
this case of accident, there was requirement of practitioner educational need (PEN) to comply in
regard of performing business practices to handle this case in more appropriate manner curing
patient more appropriately and finely (Holloway and Galvin, 2016). Doctors and nurses are stuck
with case because of ethical dilemma between work place policies or their morale. There were
two situations in front of everyone whether to go with hospital policies because they are working
their as staff or to provide first aid to him. Hence, in such case, this is hard to determine which
4

ethics should be complied and nurse has to make decision as per the consequences so as the staff
did.
From the above case ethical dilemma is shown because there is difference in inner feeling
and professional responsibility of doctors and nurse. As per this there if doctors perform job
responsibility, then they must not provide treatment to patient. While that the same time, if they
treat patient then their job may be in danger. In order to deal with this situation doctors and nurse
provide treatment to patient so he could saved.
THEME 2 TRAINING EDUCATION TO PROFESSIONALS
Training is one of the effective way through which performance of employees can be
improved at work place. As per the requirements of employee and demands of organisation, this
is fundamental for company to coordinate proper training to introduce worker with new skills
and knowledge and deal with their imperfection shaping their views. This helps to perform
commercial activities in more effective manner. There are different methods through which
training can be provided to workers at hospital such as classroom training, transfer, job rotation,
conferences, seminars, etc. that can be employed as per the consequences and different
requirements of company (Keating, 2014).
As per accident case, while I was dressing sufferer as nurse, my hands were shriving. The
present my personal nursing skills which lack proper training. In order to overcome this, hospital
administration need to focus on training program which can help to perform commercial
operations at hospital. If hospital had provided appropriate knowledge to their employees and
nurses, I would be able to provide that patient first aid in more effective and suitable manner. As
per improvement in technical aspects of hospital, the training method which was most suitable
had to be adopted. There were possibilities that some staff were not ready to learn new
techniques, then in this case administrations has to strict their performance appraisal policies. As
per case, I analysed that if appropriate training is provided then this is effective and significant
for treating patient in well manner. Above discussed case shows that patient was admitted to
hospital at night, at that time there were no doctors so in this case, if worker or nurses would
have provided proper training along with the subordinate level staff, then treatment of patient
could have be done in appropriate way. In order to operate him, there were no such efficient
doctors and compounder did not have sufficient knowledge. With the help of training, it could
have been easier to provide emergency treatment to individual.
5

Research is appropriate and effective because there is situation at the time due to critical
situation of patient my hands shrivel (Kennedy, Barnsteiner and Daly, 2014). But if training
would have performed then I would have able to work confident and with use of latest
equipments. In medical line, confidence is one of the most component which helps to perform
critical operations, several treatments of patient. Not only training but practical implementation
is also important. This helps to deal with contingencies emerged at workplace.
This similar case was happened in a hospital when there was no doctor to deal with
situation. In this situation, nurse operate that patient and able to save his life. This is because they
provide training to their staff. They have time to time training program and under doctor's
presence they perform their training to practical knowledge such as operations of patients. This
provides confidence to nurses and they are able to work in contingency. This makes brand of
image of health care organisation in industry.
Nurse are not able to work with new and latest technique. This is because they are not
able to provide treatment in case doctors are baemnt. This is not good for brand image of health
care sector also. Hence there is need of training to workers, so they can perform operations in
best and appropriate manner.
THEME 3 ARRANGEMENT FOR CONTINGENCIES
There are different contingencies emerge at workplace while working an organisation
that need to cope up as per distinct consequences. Hospital is other name of contingency. There
are possibilities that patient may come at any time and in any situation. Here, different situations
can arise at hospital and a doctor and nurse is liable to perform their duties at any cost. When I
saw this case, I felt that there must be some flexibility in plans and policies of hospital. This
helps to deal with situations in more ethical manner (Kimberly and Manchikanti, 2012). As per
case, if organisational policies of hospital were flexible then there were good policies that person
may able to live life. This helps admin department of hospital to deal with changes and actions
are taken to provide treatment. There are some rigid policies of hospital which affects working
style of hospital. But at the same time, there must be some contingencies in which administration
department can keep morale and ethics first.
Doctors were not allowed to take care patient if paper work was not complete, in this
situation administration must had provided treatment under class of contingency. This helps to
6

save life of sufferer. As medical line was the industry where contingencies arise frequently and if
alternate was not using then case may occur to death.
Hospital has some policies in which they can cure patient and this helps to save life. In
this case, they did not ask for paper work and good treatment can be provided. There was one
case of road accident then in this case administration department of Hospital, UK does not wait
for patient's family member and police verification case in order to treat patient. This
contingency policy helps to maintain balance between official policies and ethics and morale at
work place.
Apart from this, there must be 24*7 doctor at hospital which works in order to deal with
such situation. Patient must not deprived of treatment because of absence of doctors. There is
much scope in medical sector, so practitioners must be part of hospital which enhance their
practical knowledge and hospital does not deprived of doctors (Kitson and et. al., 2013). There
must be arrangement of ambulance which are important for transporting patient from spot to
hospital. This service must be fast and frequent and drivers must have knowledge how to drive
safely.
At hospitals, there are many contingency which arise because of emergency of patient.
There must be provision of ICU on wheels, compounder in ambulance, etc. These facilities help
patient to perform work according to external market and this gives enhancement to sales and
revenues. Health care sector must focus on customised services so they can satisfy customers
through services according to their budget.
RECOMMENDATION
There is discussion about a case in which patient is suffering from pain but still doctors
do not take care because of no paper work. Then in this case Gibb's Reflective cycle will use
again. In such case, management of organisation must provide appropriate first aid till
completion of paper work. As recommendation, proper training must provided to nurse and
compounder, so in case of emergency they can provide treatment to them. If same case arise,
management of hospital must permit doctors to provide treatment and then further actions are
taken in order to contact relations of patients. This helps to keep balance between official
activities and personal dilemma. Hence patient can also treated with optimal services within
specified time.
7

CONCLUSION
As per above discussion, it is clear that in medical sector, ethics are most important
component. I have learnt that being professional in medical line, humanity is one of the basis
component. I have learnt that apart from, professional educational, morale of doctors has to be
build. With this I am able to deal with client in more ethical manner. This helps me to deal with
situation by balancing my professional and morale equally. In future I am able to perform
operations my profession work with more deliberately and this helps me to enhance my
knowledge in enhancing case. After this case whenever any similar incident happen, then
primary treatment is given to patient before paper work. This helps a lot to save life of sufferer
and this provides blessing from society. After from morale ethics, this is beneficial for brand
image of hospital also. Reflection is important because it provides knowledge about current
situation and it provides knowledge about personal experience of candidate also. This also
provides good image in industry and I am able to pursue my clinical sector in efficient manner.
8

TASK 1
Why are you here? What are you aiming for?
 I selected nursing as my educational field because my father is a surgeon doctor and his
medical practices inspires me to opt for the same field. I am attracted toward this stream
since childhood and I tried to gain knowledge about the diseases and their treatment as
well as precaution from my father (LeMone and et. al., 2015). These conversations has
developed my interest toward becoming a nurse. I want to become a nurse because it is
my passion and I want to serve the society.
 I have some knowledge regarding the medicine and symptoms which is required while
having conversation with patient. This will be very beneficial during my study or while
practising. Apart from this my communicational skills are good which is very essential
for a nurse while communicating with patients. As bag communication skill may creates
misunderstanding that may be riskier for a patients health as well as career of a nurse.
TASK 2
Time management and learning style
 Since, I am working in a clinic along with my studies so I find it difficult to provide
proper time to my studies at home. Therefore major barrier to my studies is lack of time
which distract me while studying. On the other hand, I also resides in another city and
because of which I also have to mange each and every thing by own. So these are the
major barriers which affect my study at home. In order to overcome this, I decide to make
a schedule which help me in studying at home effectively (LoBiondo-Wood and et. al.,
2013). No, I am not agree to plan study at home with anyone as I don't get time from my
job and this plan may hamper their work.
 SWOT analysis
Strength I am hard working and have good communicational skills that help me in
building therapeutic relationship at work place. I have caring nature and also
feel empathy toward others which are required within a nurse.
Weakness I some time find difficulties in managing a balance between work and life. I am
sensitive kind of person and loose confidence in front of patient who is more
injured.

Opportunities There are lots of job opportunities for me after the completion of education of
registered nurse. This degree will give a meaning to my job or career as well
as I get an opportunity to serve others.
Threats Major threat is that higher staff level will reduce the chances of getting
opportunity at work. Another major threat is that when number of patient
increases work become more stressful and shift time may also get extended.
Recommendations :- To overcome these issues, I decided to assign time for my each task so
that I can develop a balance between my job and life as well as I can also manage my work when
patients are more. This help me in operating my work without any stress (Munhall, 2012). Apart
from this I can also ask my seniors for guidance which help me in improving my skills and
competencies that automatically build up my confidence.
TASK 3
Learning style
VARK is a model which describes various learning styles such as visual, auditory, reading &
writing and kinaesthetic learning. From these learning styles I prefer auditory as well as reading
and writing learning style for studying. As both the styles are very beneficial for me because in
auditory learning style I attend seminars and lectures which involves two way communication
and I can solve my queries by asking questions. Another learning style is reading and writing for
which I use to visit libraries for collecting study material related to my course. I use to read
books and journals for gaining knowledge and to write down my notes to use it for further
preparation.
Pros:- By attending seminars for auditory learning will help me in updating my knowledge as
these presentations are given by experienced persons which provide us practical example to clear
our concepts. Another benefit is that we can memorise the concepts through reading books
which we learned through lectures.
Cons:- Major drawback of reading & writing learning style is that books may not be of current
edition which leads to explosion of information that is not valid currently (Oermann and et. al,
2016). Auditor explanations is not clear till we go through the visual example of it.
In order to move away from comfort zone, I required to develop the skill of critical
thinking as for becoming a nurse it is very essential to be prepare for each situation and take
2

correct decisions. So critical thinking will help in being adoptable to changes and also help them
in judging the situation and take appropriate decision.
TASK 4
Library and searching database
While searching the database regarding my study I came to learn about various sources
through which I can collect information to enhance my knowledge. These sources are books,
journals, internet etc. Apart from this I also get to know that what methods should be opt for
sorting the data according to our requirement (Parahoo, 2014). While searching and collecting
this database I came up through various difficulties such as proper informations are not available
in journals content present is just the abstract of whole topic. Another difficulty faced by me is
that books that are available in library are not of latest edition. So in order to overcome these
difficulties I decided to search the latest information and recent editions over internet. This help
me up to a great extent in enhancing my knowledge and I have learnt various changes that are
bring within the nursing practices by government. Apart from this I also get to learn about
various other things which are not available in books and very essential for performing nurse
practices.
TASK 5
Evidence based practice and different types of literature
Research refers to process of systematically investigating about a particular topic or
problem in order to establish facts and bring out a conclusion. Resaerches are of two types which
are as given below:
Qualitative research :- This research is generally conducted to gain knowledge about
underlying reasons, motivations and opinion. It help in developing an idea or hypothesis for
potential quantitative research
Quantitative research:- It refers to the structured way of gathering and analysing the
data obtained from different sources (Polit, 2013). This data is collected by using statistical,
computational and mathematical tool for deriving the result.
In order to conduct this research and collect information, there are two sources available
that are explained below:
3

Primary data :- It refers to the information collected by a researcher which is fresh and
is never collected by any other person before. It includes sources like survey, interview or
experiment.
Secondary data :- It refers to the data which is previously being researched by some
person and is now access to fulfil the information need of current research. Common source of
collecting secondary data is libraries, internet search, journals, government public services etc.
TASK 6
Critiquing literature
From this research and literature review I find out about various growth opportunities for
me in this field and various methods through which I can improve my skills as well as
knowledge. I also learnt about various benefits which I will get while pursuing my course in the
university (Ricci, 2013). Apart from this I also came to known about the practical lectures
provided by universities that help me in clearing my concepts by visualizing them practically. In
addition to this I also find out about various concepts that I must go through and learned about in
order to bring efficiency in my work.
By using this literature I also came to know about the methods through which I can set
my goals and objectives that further guide me to perform actions. It also help in deciding my
action plan through which I can improve my skills and abilities for becoming a effective nurse.
TASK 7
Progress in developing referencing skills
The study material and other sources provided are prove to be very beneficial for me as it
help in enhancing knowledge regarding my course and career. It help me identifying the various
growth opportunities in nursing filed which I can opt for my further progress in this field. By
using these sources I came to known about the changes that have taken place in this field. Further
it also helps me to know about various course in this sector that I can opt for developing my
career.
TASK 8
Reviewing essay
No as such there was no such major issue which arise in performing research. But at few
points I feel that due to lack of resources I am not able to perform work in appropriate way
(Yoder-Wise, 2014). There is less of time, so I am not able to collect proper and effective
4

information. As I was working in team. My team was very effective and hard working, so
positive outcomes can be gained. There is use of newspapers, books which is little tough task.
Because there are some books which are not readily available. I am able to attain goals in
appropriate manner.
5

REFERENCES
Books and Journal
Butterworth, T. and Faugier, J., 2013. Clinical supervision and mentorship in nursing. Springer.
De Groote, S. L. and Raszewski, R., 2012. Coverage of Google Scholar, Scopus, and Web of
Science: A case study of the h-index in nursing. Nursing outlook. 60(6). pp.391-400.
DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Fawcett, J. and Desanto-Madeya, S., 2012. Contemporary nursing knowledge: Analysis and
evaluation of nursing models and theories. FA Davis.
Hayman, B. and et. al., 2012. Story‐sharing as a method of data collection in qualitative
research. Journal of Clinical Nursing. 21(1‐2). pp.285-287.
Hockenberry, M. J., Wilson, D. and Rodgers, C. C., 2016. Wong's Essentials of Pediatric
Nursing-E-Book. Elsevier Health Sciences.
Holloway, I. and Galvin, K., 2016. Qualitative research in nursing and healthcare. John Wiley
& Sons.
Keating, S. B. ed., 2014. Curriculum development and evaluation in nursing. Springer
Publishing Company.
Kennedy, M. S., Barnsteiner, J. and Daly, J., 2014. Honorary and ghost authorship in nursing
publications. Journal of Nursing Scholarship. 46(6). pp.416-422.
Kimberly, A., is a Nursing, C. D. M. and Manchikanti, L., 2012. Results of 2-year follow-up of a
randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in
central spinal stenosis. Pain Physician. 15. pp.371-384.
Kitson, A. and et. al., 2013. What are the core elements of patient‐centred care? A narrative
review and synthesis of the literature from health policy, medicine and nursing. Journal
of advanced nursing. 69(1). pp.4-15.
LeMone, P. and et. al., 2015. Medical-surgical nursing. Pearson Higher Education AU.
LoBiondo-Wood, G. and et. al., 2013. Study Guide for Nursing Research-E-Book: Methods and
Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Munhall, P., 2012. Nursing research. Jones & Bartlett Learning.
Oermann, M. H. and et. al, 2016. Study of predatory open access nursing journals. Journal of
Nursing Scholarship. 48(6). pp.624-632.
Parahoo, K., 2014. Nursing research: principles, process and issues. Macmillan International
Higher Education.
Polit, D. F., 2013. Statistics and Data Analysis for Nursing Research: Pearson New
International Edition: Do I Really Need This Stuff?. Pearson Higher Ed.
Ricci, S. S., 2013. Essentials of maternity, newborn, & women’s health nursing. Wolters Kluwer
Health| Lippincott Williams & Wilkins.
Yoder-Wise, P. S., 2014. Leading and managing in nursing-E-Book. Elsevier Health Sciences.
Online
critical incident. 2018. [Online]. Available
through:<https://dictionary.cambridge.org/dictionary/english/critical-incident >.
6

7