Nursing Reflection on Ethical Dilemma Using Driscoll's Model

This reflective journal entry details a nursing student's experience during a clinical placement in a busy urban hospital, focusing on an ethical dilemma involving a needle-stick injury. The student reflects on the incident, where a lack of proper equipment (kidney dish) led to a stressful situation and a conflict with a senior RN over needle recapping. Using Driscoll's reflective model (What? So What? Now What?), the student analyzes the ethical and professional implications of the event, including the violation of non-maleficence, the impact of the RN's unprofessional behavior, and the student's own anxiety and actions. The reflection highlights the importance of adhering to professional standards, managing emotions, and reporting unethical conduct. The student concludes with a plan for future practice, emphasizing preparedness, assertive communication, emotional control, and reporting mechanisms to ensure ethical practice and personal safety. The assignment references relevant guidelines and standards from the Australian Government Department of Health and the Nursing and Midwifery Board of Australia.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
Ethical values are highly crucial for any healthcare providers. The focus concerns to the
right as well as wrong of actions and thus bound the decision-making process of a health care
service user, determining the ultimate consequences of those actions. Reflection while
conducting nursing is highly crucial factor that attribute for the development of ethical, critical,
autonomous and advanced practitioners. Amongst a good number of reflective models, the
Driscoll’s reflective model can be considered as an effective framework that helps nurses to
enhance their practise while providing best patient based approach. In the following paragraph, I
will reflect on of my experience while handling needle during the clinical placement on my PEP
in an Urban hospital with the help of the Dricoll’s reflective cycle.
Discussion
What?
While working on my PEP (Professional Experience Placement) in a busy Urban
Hospital as my first placement, during my practice unit, I had been given the responsibility of
providing insulin through injection to a healthcare service user. In my practice unit, I have been
taught by my lecturer that needles after giving an injection should never be recapped. Instead it
should be placed in a kidney dish and disposed directly from the dish to a designated sharp
container. During my PEP, I was successfully able to inject insulin. However, while dispose the
needle, I notice that I had not brought a kidney dish to the bedside. As a result I stated panicking
since I was not aware of the location of closest sharp container. The RN with whom I was pared
with was quite critical in case her order was not followed. She instructed me to recap the needle.
However while I refused, she screamed at me to do the same. I got anxious and destressed and as

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a result of this, while trying to recapping the needle, I accidentally punctured the skin of my
thumb while recapping the needle. As a result of this, the RN became furious and she involved
the patient in the situation and stated a sample of his blood will be taken in order to test for any
blood borne diseases transmitted by me.
So What?
The strictness and critical behavior of the RN with whom I was pared made me a little
anxious initially. While, given the responsibility of giving insulin injection to the patient, I was
highly confident and have done it successfully. But, when I noticed that I have forgotten to bring
the Kidney dish where the used needle needed to be disposed, I started panicking. At that time, I
became extremely nervous and perplexed. As a nurse, I am supposed to bring all the necessary
utensils with me before giving injection to the patient. My inability to perform this, made me
ethically vulnerable. According to The pharmacy Guidelines of Australia (2019), needles after
usage should be handled very carefully and should never be disposed in a general waste bag or
recapped (Australian Government Department of Health. 2019). Instead it should be disposed in
a specialized disposal container that is meant specifically for sharp objects (Johnson, Sanchez
and Zheng 2016). Hence, at that point of time, I was highly bewildered about my next course of
action. Since, the place was completely new for me, I was unaware of the location the sharp
disposal container. My nervous expression was noticed by the RN a d soon I was instructed to
recap the needle. This had put me into ethical complexity. As per the Australian Government
Department of health (2019), it is unethical to recap a syringe after blood has been drawn with
the same. I was well aware of the fact that that used needles should be eliminated instead of
recapped. Hence while being instructed by the RN to recap the needle, I initially refused initially.
This is because, as per the The Nursing and Midwifery Board of Australia (NMBA) (2019),

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Standard 1.3, it is the responsibility of a nurse to recognize his or her duty, while abstaining from
any unsafe or unprofessional behaviour, even if persuaded by the colleagues (Nursing and
Midwifery Board of Australia. 2019).
However, while I was been pressurized by the RN to recap the needle, I was highly
traumatized. I was unsure of how to perform in such situation. Since, the RN was my senior, I
gave into her information and opt for recapping the needle. Being highly nervous, anxious and
performing the task with an ethical dilemma, in my mind, my hand was shaking and I ended up
pricking the needle in my thumb. This action was what I was trying to avoid throughout the
whole incident while trying not to recap the needle. Direct contact of the used needle with my
skin made me vulnerable to a good number of diseases.
The information given to me by the RN had challenged my professional values to a great
extent. First of all, the instruction given to me by the RN, that is, to recap the needle challenged
my professional value and had put me in an ethical dilemma. This was clearly against the
professional standards since recapping needle can make the individual performing this act
vulnerable to get pricked by it wwhich can lead to potential exposure to hazardous chemicals,
drugs, or infectious biological agents. Initially after hearing the instruction, I felt to stick to my
professional ethics. However, while I was asked for the second, I got highly nervous. At that
point of time I was in an ethical dilemma where I was not able to understand if am supposed to
abide by my senior or stay strict to my professional value. When the RN screamed at me, I found
it highly unprofessional. Being my first job, I could not help panicking and give up to the
instruction of the RN. The consequence of being nervous was pricking myself with the needle,
which I think was very unprofessional of me. However, the next action taken by the RN was
ethically incorrect. As per my opinion, it is professionally unethical to insult a co-worker,

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subordinate or client in the workplace. The RN, called m ‘inbecile’ and involved the patient into
the scenario. I found this action to be highly disgraceful from her side and demotivating for a
new trainee nurse like me.
I figured out three ethico-legal complexities that affected me at that point of time.
Amongst the 6 chef ethical principles of nursing, in this scenario, the principles of non
maleficence has been exploited. First of all, it was my responsibility to bring the kidney dish
with me while giving insulin injection to the patient. My forgetfulness resulted in nervousness
which is unexpected from a professional nurse. Secondly, Since the RN was senior to me, I was
supposed to follow her instruction. However, since the instruction given by her was
contradictory to the nursing professional values, I was unsure of how to react in such situation.
The instruction of RN violated the principle of non malefience , since it states no nurse should
opt for an action that arm the patient involved or others in society. Thirdly, I got nervous and
anxious while, I was being displayed unprofessional behaviour, was being screamed at and was
insulted in front of the patient. Here, the action of the RN was highly unprofessional and hence it
needed to be reported.
I future, I will be mindful of checking all the required materials that I will need before
giving injection to a patient secondly, in case of being pressured by my senior for recapping, I
will politely let him or her know that since it is against the professional standard, I will not be
able to perform the same. Instead, I will ask them the location of the disposal container so that I
can dispose the needle safely (Freshwater, Walsh and Esterhuizen 2017). Thirdly, I will be
mindful of having co troll over m own emotion. Instead of being nervous and anxious in critical
situation, I will act professionally and calmly. And last of all, I will directly report any

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unprofessional behaviour conducted by my superior, to the higher authority instead of following
the same.
Now what?
My conclusion after going through the scenario, includes I needs to check my anxiety and
nervousness in case of adverse situation and act as per the professional standard. In case, being
instructed to deviated from the same, I will refuse in a polite an professional way. As per the
NMBA standard 1.1, any unprofessional behavior conducted by a nurse is considered to be
violations of the legislation for standardize care for the heath care service user (Sajadi et al.
2017). Hence, after going through the scenario, I concluded that, in case, I come across any
unprofessional behavior conducted by my senior or colleague in future, I will neither get nervous
or anxious and follow their instruction or get demotivated, nor will I revert back in an
unprofessional way. Instead, I will report the whole scenario to my higher authority so that
professional steps can be taken against such unprofessional behavior.
Another thing that I must keep in mind is to ensure making a check list of all the
requirements before giving injection to the health care service users. In order to grab an efficient
control over my nervousness, I will train myself by watching educational videos. This reflection
provided me with a new perspective of action in the workplace. This has been highly helpful,
since the knowledge I gained after going through the scenario will help me to effective tackle
such adverse situation and protect my ethical values as well as my physical wellbeing in future.

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Reference List
Australian Government Department of Health. (2019). Current needle and syringe waste
disposal practices. Access Date: 9th August, 2019. [Online]. Retrieved from:
https://www1.health.gov.au/internet/publications/publishing.nsf/Content/illicit-pubs needle-
audit-review-toc~illicit-pubs-needle-audit-review-lit~illicit-pubs-needle-audit-review-lit-cur
Freshwater, D., Walsh, E. and Esterhuizen, P., 2017. Models of effective and reflective teaching
and learning for best practice in clinical supervision. Clinical Supervision in Practice: Some
Questions, Answers and Guidelines for Professionals in Health and Social Care, pp.76.
Johnson, M., Sanchez, P. and Zheng, C., 2016. Reducing patient clinical management errors
using structured content and electronic nursing handover. Journal of nursing care quality, 31(3),
pp.245-253.
Nursing and Midwifery Board of Australia. (2019). Code of Ethics for Nurses in Australia.
Access Date: 9th August, 2019. [Online]. Retrieved from: file:///D:/PPT%20Materials/code%20of
%20nurse%20australia.pdf
Sajadi, M., Goudarzi, K., Khosravi, S., Farmahini-Farahani, M. and Mohammadbeig, A., 2017.
Benson's relaxation effect in comparing to systematic desensitization on anxiety of female
nurses: A randomized clinical trial. Indian journal of medical and paediatric oncology: official
journal of Indian Society of Medical & Paediatric Oncology, 38(2), pp.111.