Critical Evaluation of the Management of Incident in Practice Report

This report provides a critical evaluation of an incident in a healthcare setting, focusing on the management of the situation, leadership displayed, and the incident's impact on healthcare provision and workplace relationships. The analysis utilizes the Gibbs reflective cycle model to examine managerial and leadership decisions, communication models, and psychological theories like observational learning and social contagion. The report highlights the importance of mentorship, coaching, and supervision in preventing and managing critical incidents, emphasizing the need for effective communication and leadership skills at all levels within a nursing unit. The evaluation covers transactional and transformational leadership styles, analyzing their effectiveness in the context of the incident. The report concludes with lessons learned and recommendations for improved incident management in healthcare settings.

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Running head: Critical Evaluation of The Management of Incident in Practice
CRITICAL EVALUATION OF THE MANAGEMENT OF AN INCIDENT IN PRACTICE
Institution
Name
Submission Date

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Critical Evaluation of The Management of Incident in Practice
INTRODUCTION
This paper is based on the incident described in Appendix A. It will focus on providing
an analysis of the events described in the incident focusing on the management of the situation,
the leadership displayed by the relevant individuals and authorities as well as the impact of the
incident both in the context of healthcare provision and workplace relationships in practice.
Management skills among the nursing staff are important in ensuring efficient
functioning of the nursing unit and the entire medical institution in question. The management
skill applied will determine how urgent matters arising are treated and impact or consequences
contained. Often urgent matters arise that needs to be addressed immediately without waiting for
a board meeting to present the issue (Kongstvedt, 2001) This is especially amplified in the
medical field where the pace of addressing an issue could make the difference between life and
death. However, medical institutions, just like other institutions have decision structures that are
to be followed before any final course of action is considered. Balancing the urgency of an issue
and adherence to decision policy as well as staff welfare and client welfare requires proper
management skills.
Leadership provides a sense of direction and guidance for the people being lead. In the
setting of a nursing unit at a medical institution, this means that the way a person in a place of
leadership handles a situation informs how the whole unit will handle such situations should they
arise. The person in leadership is generally an example of how things should be done in an
institution. The leader other than being an example for the staff that works under them, they
should also be a source of inspiration and motivation for the staff (Constable & Russel, 1986).
Decisions that are made all have consequences, positive or negative. In the medical field,
decisions are critical aspects of the practice, with accurate decisions being vital for the
functioning of the institutions. Managerial and leadership decisions should thus be made with
care to avoid both negative ethical and medical implications (Bach & Ellis, 2011).
This paper will investigate and evaluate the psychology behind the managerial and
leadership decisions made in the context of the incident described in Appendix A. This will be
achieved by applying the Gibbs (1988) reflective cycle model. The outcomes will provide

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Critical Evaluation of The Management of Incident in Practice
insight into the expected skills, both managerial and leadership, required to handle critical
incidences in the medical field (Day & Antonakis, 2012).
1. PERSONAL REACTION TO THE INCIDENT
The events in the incident in Appendix A, which took place during my placement,
represent a situation requiring good crisis management skills to contain the matter. This was an
incident that could have resulted in the junior nurse losing their job. The senior nurse may also
have faced suspension instead of dismissal owing to their position. However, all this would come
after the patient sued the medical institution for neglect and incompetence (Bass, 1985).
Although the head nurse eventually managed to bring the situation under control, more
would be expected from the two nurses in handling the matter better without needing the
intervention of a superior. The crisis management skills should not only be expected of the top
management in the medical institution, but rather, from every member of the staff. This lacked in
two lower levels in our incident of interest. The junior nurse could not manage to address the
concerns of the patient objectively without self-bias (Bass & Riggio, 2006).
The senior nurse on the other hand failed in analyzing the situation entirely to give an
objective solution. The senior nurse only managed to offer support to the junior nurse as
expressed by Constable and Russell (1986), such support can help in neutralizing the negative
effects associated with the work environment of nurses. What the senior nurse failed in, is in the
balancing of this support and the welfare of the patient. The quick conclusion by the senior nurse
could point to more of bias than support for the junior nurse. This bias can prove fatal and costly
if the grievances by the patient were legitimate.
In this case, the head nurse showed failure in the ability to inspire proper management
skills to her unit. This is despite having being able to diffuse the situation in time. In the occasion
of the absence of the head nurse, the unit would lack individuals capable of handling the
situation. Murray and Main (2005) present the argument of the senior and more experienced
nurses being role models to the less senior and less experienced nurses. The incidence proves
that this has not happened in the institution.

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Critical Evaluation of The Management of Incident in Practice
The grievances raised by the patient may or may not have been legitimate, an in such a
case the handling of the event should have in such a manner that would lead to further
investigation of to ascertain the legitimacy. But the handling of the situation in the incident was
only a containment mechanism but not a solution. This could be understood as an urgent decision
that leaves space for the decision policy of the medical institution to take charge of the matter
(Burns, 1978).
2. ANALYSIS OF INCIDENT
a) Communication Analysis
Gavi (2013) categories communication into three models: Linear communication,
Interaction communication and Transactional communication. In our incident of interest, we can
see all the three models of communication being applied.
The communication between the patient and the junior nurse goes through all the models
of communication. It starts off as linear then interactional before escalating into a transactional
model, at which point the senior nurse joins in. The conversation between the head, the two
nurses and the patient is interactional with the patient and nurses giving their side one at a time
after which the head nurse responds (Ghaye & Lillyman, 2007).
The type of model used in communication determines whether the information intended
to be passed on will be effectively passed on or not. All the models of communication are
effective in passing information depending on the context it is being used in.
The linear model of communication is a one-way communication channel where the
sender of the message delivers the message without expecting a response or immediate response
from the receiver(s) of the information as described by Shannon and Weaver (1949). This model
can be passively authoritative and dictatorial in the workplace environment. It can be equated to
giving orders that can’t be questioned. When the head nurse calls for a meeting of all the nurses,
she uses a linear model which is the most appropriate model in that context, but also leaves room
for the aspect of dictatorship in the part of the head nurse (Bondas, 2006).

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Critical Evaluation of The Management of Incident in Practice
The interaction communication model is described by Gavi (2013) as a double linear
model with the feedback activated. This model allows for the receiver to respond to the message
from the sender. This presents an excellent communication model that can be helpful in the
context of a work environment. Here the information can be passed from the management to the
staff and feedback equally given by the staff. This would forge a good working relationship in
the institution in question. This feedback would also allow the management to improve the
welfare of the staff. The head nurse successfully uses this communication model in mediating
between the two nurses and the patient. The model assists the nurse to prevent further worsening
of the situation.
The transaction communication model is model where messages and feedbacks happen
simultaneously. Gavi (2013) remarks that “In the Transactional Model, receiver and sender can
play the same roles simultaneously” (Gavi, 2013). This is the communication model that is used
during the confrontation between the patient and the junior nurse, when they both shout at each
other; this depicts the biggest disadvantage in this model of communication. Very little
information is passed during transactional communication in a crisis. The nurse and patient can’t
understand each other and come to a reasonable conclusion on how to solve the problem. This
model would however be ideal in a face to face conversational context that does not involve
arguments (Sullivan & Decker, 2009).
b) Leadership Analysis
Leadership skills can be viewed into ways as explained by Burns (1978); transactional
leadership and transformational leadership. In his definition of transactional leadership Bass
(1985) builds on the concepts Burns (1978) remarking that it is a form of leadership where the
leader focuses mainly on how to improve the performance marginally and how to reduce
resistance to given actions. Bass (1985) then defines transformational leadership as leadership
concerned with raising the awareness of subordinate staff, clients or followers to issues of
consequences (Burns, 1978) (Bass, 1985).
The two above leadership styles contrast in their effectiveness, while transactional is
aimed at achieving short-term goals and quickly moving onto the next goal, transformational
aims at making having a lasting impact that is not restricted with time (Gopee & Galloway,

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Critical Evaluation of The Management of Incident in Practice
2009). A transformational leader works towards creating a culture and instilling certain
principles among the staff or followers. This thus makes transformational leadership preferable
in places where the activities are long-term. A nurses’ unit in a medical institution would fall into
this category of long-term activities. The unit is not a temporary team that is set-up to be
disbanded later. Instead it is a unit that is meant to be cohesive and working together over a
prolonged period, in some instances entire careers (Gopee & Galloway, 2014).
In the context of our incident of interest in Appendix A, there is failure in leadership in
the structure of the nurses’ unit; the senior nurse displays poor judgment in mediating between
the patient and the junior nurse since the head nurse, who is the leader of the unit, fails in
cultivating mediating skills into the staff. The junior nurse fails in solving the situation amicably
due to lack of a role model figure to emulate. This scenario brings focus to the trickle-down
effects of leadership. The same transactional leadership skills displayed by the head nurse are
carried downwards by the senior nurse, with interest being solely on immediate results (Adair,
2002).
c) Psychological Analysis
The incident in Appendix A reveals two theories of psychology; Observational Learning
Theory and Social Contagion Theory. In Observational Learning Theory, individuals take up
behaviors or tendencies from other individuals through observing them and replicating those
actions when they find themselves in similar situations.
In our case, the way the head nurse managed to contain the situation between the two
nurses and the patient can be observed and replicated by other nurses that witnessed the incident.
This sets a good example for the other nurses and will go a long way in making the unit a more
efficient unit (Rolfe, et al., 2011).
In the Social Contagion Theory, the behavior of a single individual in a group spreads to
the rest of the group through their interactions. In the incident in Appendix A, the manner of
handling of the matter by the two nurses could easily become the norm. This is since the two
nurses are in direct conduct with the other nurses as opposed to the head nurse. This increases the
likelihood of Social Contagion occurring (Kuhnert & Lewis, 1987).

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Critical Evaluation of The Management of Incident in Practice
3. LESSONS LEARNT FORM INCIDENT
Through the incident in Appendix A, we can observe that mentorship, coaching and
supervision are crucial for the functioning of the medical institution. All which lack in the
institution, with mentorship and coaching from the head nurse the subordinate staff would have
better handled the situation just as the head nurse eventually did (Kongstvedt, 2001).
Regular supervision from the head nurse would have prevented the whole incident from
occurring in the first place. It however managed to bring out leadership skills from the head
nurse which can be emulated by the rest of the staff through the Observational Learning Theory.
Another positive from the incident is in the innovative way the head nurse managed to mediate
the situation by providing a feedback channel for the service rendered by the nurses. This
feedback will not only help settle the patient’s concerns, but also help in improving the quality of
service delivery, by grading the service delivered.
4. ALTERNATIVE WAYS OF HANDLING THE INCIDENT
The alternative approach can be broken down into three parts to represent instances when
another option would have been taken to help prevent escalation of the situation.
a) The Junior Nurse Level
The junior nurse would have avoided a confrontation with the service user by offering to
direct them to a more senior nurse to handle her concerns. This would have prevented the
altercation from happening having provided the patient with a solution in the process.
b) The Senior Nurse Level
The senior nurse is expected to be more experienced and therefore better placed to handle
such situation, this was however not the case. The senior nurse would have approached the
matter as a mediator and try to get both sides of the account of events leading to the heated
exchange. This would have been followed by offering an objective solution to the service user
complaints and achieving reconciliation between the patient and the nurse. Reconciliation would
avoid two main things (Parkin, 2009). Firstly, other nurses will not be intimidated by the patient

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Critical Evaluation of The Management of Incident in Practice
and would thus be willing to serve her should need to be for the junior nurse to be replaced.
Secondly, the other patients in the ward that witnessed the incident would not have a negative
perception of the junior nurse and would not object to being served by the junior nurse (Marquis
& Huston, 2012).
c) The Head Nurse Level
Despite successfully containing the situation, the head nurse made several errors that
could otherwise be avoided. By wholly taking the patient’s side and appearing to scold the two
nurses, the head nurse might have demotivated the staff. This demotivation can easily spread to
the whole unit (from the Social Contagion Theory), thereby putting the entire unit at risk of
being demotivated and underperforming. A better approach would have been hearing the sides
separately. This would help solve the issue at the same time assure the staff of the head nurse’s
support and confidence. Using transactional communication instead of transactional during the
meeting after the incident would have been a better communication channel allowing the
subordinate nurses a chance to provide solutions and points of view. These solutions and points
of view would help the head nurse in making a better decision regarding the way forward on the
matter (Mullins & Christy, 2013).
CONCLUSION
We can conclude that a combination of good leadership skills, managerial skills and
communication skills can help in handling any situation that may arise in a medical setting. It
can also be concluded that having qualities transformational leadership and a preference for
transactional communication would better place a leader in creating an institutional culture that
goes along with the leader’s principles and vision for the institution. The leader should also be
able to provide a balance between maintaining the staff self-esteem and scolding a staff member
to avoid losing the client or the staff in the process of containing a staff-client conflict.
The Gibbs (1988) reflective cycle model also provides us with evidence that psychology
plays a significant role in the determining group dynamics in the context of nurses’ workstations.
The two theories inform on the possibility of both good and bad behaviors being spread in a
group, in this case the nurses’ unit (Murray & Main, 2005).

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Critical Evaluation of The Management of Incident in Practice
References
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Erlbaum Associates.
Bernard, B. M., 1985. Transfromational Leadership Theory;Changing Minds. s.l.:s.n.
Bondas, T., 2006. Paths to nursing leadership. Journal of Nursing Management, 14(5), pp. 83-85.
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Critical Evaluation of The Management of Incident in Practice
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Critical Evaluation of The Management of Incident in Practice
Appendix A
For the incident described below, the actual names of the nurses and the medical service-
user will not be used in keeping with the confidentiality code of conduct.
The events occurred during the recovery period of the patient, middle-aged lady, who had just
undergone a heart surgery. The patient complained that the junior nurse assigned to provide her
with the primary care was incompetent. Further accusing the nurse of not giving her recovery the
priority it deserved, stating that the nurse appeared irritated by her. This prompted the nurse to
respond explaining that she treats all patients the same way and does so within her mandate. The
response caused an angry reaction from the patient who continued to demand the nurse give
reasons for treating her with contempt. The exchanges got heated at the insistence of the patient
to be provided with reasons.
A senior nurse attending to another patient nearby came to intervene but quickly sided
with the nurse. This made the patient angrier, turning the situation into chaos with everyone
shouting. The whole commotion attracted the attention of the head nurse who came into the
ward. The head nurse urged everyone to calm down, before listening to all the sides. The head
nurse apologized to the patient and promised to provide feedback forms on quality of service.
The head nurse later called a meeting for all the nurses, citing the incident and asked everyone to
maintain composure in such situations.