University Nursing Assignment: Reflective Report on Incident Analysis

This nursing assignment presents a reflective report on an incident involving an elderly patient with auditory impairment and mobility issues. The student, a nursing student, utilizes Gibbs' reflective model to analyze the incident where the patient fell in the bathroom. The report details the description of the event, the student's feelings, an evaluation of the situation, an analysis of the contributing factors, and a proposed action plan for future practice. The student reflects on the importance of fall prevention, the need for improved communication, and the significance of adhering to nursing standards and safety protocols. The report also emphasizes the value of continuous learning, seeking feedback, and the importance of holistic patient care, including the use of assistive devices and the provision of a safe environment. The assignment highlights the challenges faced in managing elderly patients and the need for proactive measures to ensure patient safety and well-being. The student also includes a discussion on the NMC codes of professional standards and their role in ensuring patient safety.

Running head:NURSING ASSIGNMENT
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Name of the Student
Name of the university
Author’s note

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Introduction
Reflective practice is the ability to reflect on the actions and involve in the process of
continuous learning. For the midwives and the nurses reflection is one of the core element of
professional development for all the health professionals. Without reflective practices, self-
growth and learning becomes difficult and job satisfaction of the health care professional might
be affected. In this paper, I will use Gibb’s reflective model to reflect in an incident during my
placement. This model of reflection can either be a stand-alone experience or a situation that
anyone goes through frequently. The importance of Gibb’s reflection lies in the fact, that it helps
the reader to discuss the feelings and about the experience. Self-evaluation assists the learners to
learn about their own strength and the weaknesses (Bulman and Schutz 2013). One of the section
of the Gibb’s reflection, consisted of care plan. An action plan and a care plan would give an
account of suggestions that one do to develop professional practice.
Description
During my placement I was in allotted in care of an 86 years old patient, named Iris. The
lady had poor eye sight and had auditory impairment. She used a hearing aid. The patient had
restricted mobility and we had to use wheelchair for moving her from one place to another. The
incident took place, as I was doing the preparation for the cleaning and grooming of the old lady.
I had to transfer her from the bed to the bathroom near to the shower seat. Since the patient
suffered from auditory impairment, I communicated with her in a loud and clear voice. I helped
the patients to get up from the wheel chair to the shower seat, as she was seated carefully in the
shower seat, I left her to fetch the bathrobe, which I had forgotten. I was mindful and alerted the
patients to remain seated unless I return. As I went to fetch the robe, I heard a sharp cry from the

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washroom. I rushed to the bathroom and to my horror, Iris was lying on the floor. I immediately
came forward for help hoping that she hasn’t suffered from a serious injury as he had fall on the
bath mat. It was difficult from my end to pick her up as she was heavy. I called out for help and
after one of my supervisors arrived, Iris was picked up and was made to sit on the wheelchair.
After the thorough physical assessment, it was confirmed, that Iris had not suffered from any
serious injuries. The matter was escalated to the higher authorities, where I had to provide
detailed explanation of the reason for the fall.
Feelings
I was extremely scared when I heard the sharp cry of pain. I was well aware of the fact,
that the patient has past history of falls and multiple falls can have a degrading effect on the
health. The consequences of fall can be bone fractures like fracture of the thigh bone, hip, femur
and spine, pain and delayed healing (Terroso et al. 2013). Fall in adults delays hospital discharge
and use of more hospitalization resources including blocking of beds. The most severe
consequences of falls can be death. One of the important risk factor for fall is the limited access
to the health and the social care services. It also tends to increase the health care costs (Terroso et
al. 2013). Hence, I was nervous and anxious as of what would happen, if the elderly person
received any serious injury as of any kind of internal injury. I was well aware of the fact, that
nurses play an important role in the prevention of falls. I was not sure as I clearly mentioned Iris,
not to move alone in the bathroom, but she must have missed it due to her auditory impairment.
I felt that I should not have left this frail patient alone, and would have given a call to
some other nurse to fetch me the bathrobe of the patient. I felt that this sort of a mistake is grave
mistake and could have even cause impairment in the patient. I was perturbed by the fact as of

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what the other nurses or my supervisor would think about me, when they discover about this
incident. It is not that I was not aware of the nursing standards that needs to be followed. I was
quite well aware of the rules or the guidelines. Another difficulty that I faced, was to pick up the
patient. I must say, that what we learn is much different than what we actually experience in our
real life. I feel that I need more training about the handling of frail patients, such as transferring
them from a wheel chair to the seat. I was anxious, as I thought that even if the patient is not
injured, such an incident would surely hamper my professional life. The entire incident left me
panic –stricken, till I came to know that the elderly patient was in sound health. However, I was
much relived finding the fact, that the administrators have actually acknowledged my situation
and it was also due to the patients’ verdict who said that it was entirely her fault that she had
tried to get up from the wheelchair, despite of knowing about his impairment.
Evaluation
I would definitely, say that the situation had been challenging for me and kept me in
distress. My mindfulness was lost. As I took feedback from the patient, she admitted that she had
suffered from a fall, entirely because of her own negligence. She also gave feedback that, I made
a clear communication clearly with the patients and she had never faced any difficulty with me,
except the fact, that I should take more training in handing elderly patients with restricted
mobility. Another positive thing about this incident is that I become more aware of my actions.
Following this incident, I have learnt much about the handling of elderly patients and about the
various measures to prevent falls. I have gathered much knowledge about the positioning of the
patient. Following this incident, I spent time in studying about patient transfer from bed to
stretcher. There are standard guidelines for transferring patients from one surface to the other
(Karlsson et al. 2017). I also got this opportunity to interact with my mentors, who taught me

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about the correct method of mobilizing patients or the fall prevention strategies. My mentors
acted proactively to teach me about the hospital guidelines and the way, I can improve my
practice. One of the most important thing which I have learnt from incident is proper assessment
of falls in patients who are more prone to falls. I have realized that I need to pay more attention
to the needs of the patient. I learnt about the use of the various assistive devices that can be used
in patients to prevent falls.
Analysis
Following this incident, I have realized that preventing falls in elderly patients had been a
challenging situation to all the health care professionals, especially in a setting where the
strength of the workers are low to accompany each and every patient at the same time. From now
onwards, I should ensure that I enquire about the various fall risk factors in all the patients.
Identification of specific factors helps the nurses to implement particular preventive measures.
The risk factors should also include the age, weakness on one side, the use of a walker or a cane
(Lee, Lee and Khang 2013). I have realized that while managing elderly patients, it is necessary
to orient patients to the bed, location, surroundings, the bathroom location, call bell and the
tripping hazard in the surrounding environment (Dellinger 2017). I should say, that I was well
aware of the situation of Iris, and it would have been a clever step from my part to not take this
patient in the bathroom at all. She could have been given a sponge bath or a bed pan could have
been provided at the bedside. Besides, I should also bring to the notice that there were absence of
any grab bars in the bathroom. Provision of such aids known as the grab bars are necessary to
prevent falls in wet floors (Requejo et al. 2018). Although this situation is not associated with
any assistive aids, yet I feel that I should have enough knowledge about this to avoid such
circumstances in future. I have already mentioned that Iris used a hearing aid , which she has not

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been wearing, while she was in the bathroom due to which she could not get my instruction to
wait for me to go and attend her. It was my duty as a nurse to have close watch that the patients
are getting access to their assistive devices or had been using them. The nurses should have
enough knowledge about the use of assistive devices and to keep a note, that they are being
utilized (Pfortmueller, Lindner and Exadaktylos 2014). According to the outcome 6 of the NMC
codes of professional standards, nurses are legally as well as ethically obligated to understand
and apply the principles of health and safety regulations and maintain a safe work and care
environment (NMC 2017). Hence, I believe that it is my duty to work in compliance with the
local and the national framework for the assessment, management and reporting of the risks,
ensuring that proper actions are being taken.
Conclusion
In conclusion, it can be said that I should be more mindful while handling elderly patients
who are more prone to falls. The suggestions and the feedback shared by my peers and the
mentors had been much useful in getting an insight to my weaknesses that has to be worked
upon. I have also received training and have been taught about the ways patients should be
transferred from wheelchair to chairs or bed and vice versa. The needs or the interest of the
patients should always be kept at the first place. Along with this, I have also learnt about
preserving their integrity by providing them with personal space, yet monitoring, such that they
don’t get injured. I have also decided that I would also escalate things to higher authority, if the
bathroom conditions are poor such as wet floors, or absence of hand rails or bars for preventing
falls, in order to fix them. A holistic approaches needs to be taken for the physical as well as the
mental wellbeing of the patients.

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Action Plan
My action plan would focus on patient safety and wellbeing and on my own professional
development. I reconcile this incident every day and make sure that such mistakes are not
repeated. I believe in the power of knowledge and as I have brainstormed through fe evidence
based literatures, I have realized that theoretical knowledge is also needed in order to implement
them to practice. For example, I have learnt about the fall risk assessments, which I believe will
help me to reduce the number of fall incidence. I intend to indulge in lifelong learning, as it
provides the nurses with critical thinking and problem solving skills that are highly required in
the profession of health care professionals for resolving several issues that they might encounter
while taking care of the patient (Qalehsari, Khaghanizadeh and Ebadi 2017). I also consider
lifelong learning to be important as the type of treatment that is being done today will surely not
remain the same in due course of time. Hence, in order to remain updated with the current
guidelines and standards, it is necessary to continue with lifelong learning. I would also
undertake a course in health and safety and manual handling. Maintaining reflective journal is
another important element of nursing (Paterson and Chapman 2013). I would continue to seek
feedback from my seniors and mentors for improving my practice and also to develop a habit of
maintaining a reflective journal, which will not only assist me to identify the gaps, but will also
serve as a report care for my future professional development.

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References
Bulman, C. and Schutz, S. eds., 2013. Reflective practice in nursing. John Wiley & Sons.
Dellinger, A., 2017. Older adult falls: effective approaches to prevention. Current trauma
reports, 3(2), pp.118-123.
Karlsson, M.K., Magnusson, H., von Schewelov, T. and Rosengren, B.E., 2013. Prevention of
falls in the elderly—a review. Osteoporosis International, 24(3), pp.747-762.
Lee, A., Lee, K.W. and Khang, P., 2013. Preventing falls in the geriatric population. The
Permanente Journal, 17(4), p.37.
NMC, (2017).Future nurse: Standards of proficiency for registered nurses. Access date:
13.1.2020. Retrieved from:https://www.nmc.org.uk/globalassets/sitedocuments/education-
standards/future-nurse-proficiencies.pdf
Paterson, C. and Chapman, J., 2013. Enhancing skills of critical reflection to evidence learning in
professional practice. Physical Therapy in Sport, 14(3), pp.133-138.
Pfortmueller, C.A., Lindner, G. and Exadaktylos, A.K., 2014. Reducing fall risk in the elderly:
risk factors and fall prevention, a systematic review. Minerva Med, 105(4), pp.275-81.
Qalehsari, M.Q., Khaghanizadeh, M. and Ebadi, A., 2017. Lifelong learning strategies in
nursing: A systematic review. Electronic physician, 9(10), p.5541.

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Requejo, P.S., Furumasu, J. and Mulroy, S.J., 2015. Evidence-based strategies for preserving
mobility for elderly and aging manual wheelchair users. Topics in geriatric rehabilitation, 31(1),
p.26.
Terroso, M., Rosa, N., Marques, A.T. and Simoes, R., 2014. Physical consequences of falls in
the elderly: a literature review from 1995 to 2010. European Review of Aging and Physical
Activity, 11(1), p.51.