Reflective Practice: Analyzing a Clinical Incident Using Rolfe's Model

This reflective essay critically analyzes a clinical incident involving a medication error observed during a nursing placement in an Australian hospital. Using Rolfe et al.'s reflective model (What? So what? Now what?), the essay explores the situation where a registered nurse administered the wrong medication to a patient and subsequently failed to report the error. The reflection delves into the observer's (student nurse) feelings, actions, and ethical considerations in light of the Nursing and Midwifery Board of Australia (NMBA) standards. It further examines potential improvements in future practice, including adherence to the 'six Rs' of medication administration, enhanced communication, and critical thinking. The essay concludes by emphasizing the importance of reporting medical errors and advocating for patient safety, highlighting the role of ethical conduct and continuous learning in nursing practice. Desklib provides access to similar solved assignments and resources for nursing students.

A reflective practice experience.
Introduction.
The essay is a reflective essay and its main purpose is to provide a critical reflection of the
incident that happened in an Australian hospital. The assignment will start by providing an
overview of what a reflective nursing practice is all about. After there a description of the
importance of reflection will follow. Following this, I will then describe the Rolfe et al.'s (2001)
reflective model. According to Joyce-McCoach & Smith (2016), they described it as a teaching
model for the health professionals that are learning the reflective practice. The model is based on
three simple questions. What? So what? And Now what?
The first question outlines the problem, it mentions what the writer observed happening and
thought it was wrong according to the code, ethics, and standards of NMBA. it then describes my
role as an observer in that situation. Was I trying to achieve anything or not? It also involves the
actions I took in the scenario, the response of the others whom we were together with, the
feelings the situation evoked for the performer of the event, myself as a student and the others as
well. then it finalizes with what was bad or good about the situation.
The answers to the second question describe whatever was going through my mind when
this event was happening. It also requires other knowledge I can bring to the situation, it can also
be answered by the actions I could have done to make the event better. It then asks my
understanding of the situation and finalizes with the broader issues that rose from the scenario.
Then we have the last question, “Now what?” this one is answered by the actions am yet to
do to make things better or resolve the situation. It can also be answered by an outline of the

broader issues that need to be considered if the action has to be successful. And, finally the
consequences of the action.
I will, therefore, use the above-stated model to reflect on a clinical scenario that happened on
my presence and I had the thoughts of being it done better next time following the codes, ethics,
and standards of a registered Australian nurse.
The model
It was one of the afternoons that I got amazed when I saw one of the registered nurses in
practice standing still and shocked, she was looking again at the vial in her hand. Realization
kicked in when she realized that she had administered midazolam to an old male patient
approximately 60-70 years at a dosage of 5 mg instead of administering metoclopramide. The
registered nurse then threw the vial and administered the metoclopramide as well without
notifying anyone. I had the feeling of tension and I started thinking of exacerbation of the drug
adverse reactions due to the administration of wrong medication. Polypharmacy leads to
exacerbation of the drug’s side effects compared to a single drug administered especially in the
children or the old age due to the drug-drug interactions (Dai et al., 2016). The actions I took is
that I informed my fellow colleagues about the action and they got scared too. They felt sorry for
the situation though they never seemed to be bothered as they considered it as among the
common mistakes Registered or new nurses in the field do. This is according to the different
literature that has been describing the mistakes that nurses do while in their field of practice. On
my side, I didn't find it obvious now that I had gone through the code of ethics and standards of
Australian nurses that are normally prepared by the Nurses and Midwifery Board of Australia.
The board normally outlines the standards of a registered nurse. And having in mind that the
major goal of the board is protecting the public by ensuring that the nurses provide quality

services to the consumers (Scanlon et al., 2016). I, therefore, had to take further action, so I
evaluated the situation and noted that the good side was that with regards to the safety of
medication the probability of occurrence of a catastrophic medication error can be minimized by
checking multiple processes in effect. However, on the other side, it was bad for the patient as
she would experience multiple drug effects. It was also a bad decision for the nurse as she
refused to report the error to the treating doctor and the patient as well. The error was also not
documented, this was inappropriate because documentation could have revealed what caused the
occurrence of the error. This could have also alerted the other healthcare practitioners so that
they become keen next time they were not in a position of repeating the same mistake. The
information charted helps the other medical practitioners understanding what is going on with
the patient. Moreover, it is through communication that nurses communicate with other
healthcare providers noting down what was done for the patient (Wager, Lee, & Glaser, 2017).
This is the time I realized that professional nurses make mistakes and never report. To make
the situation better I could have reported the incidence to the nursing in charge for further
evaluation of the side effects. However, whatever was going through my mind during the event
was all about the punishment that the nurse would go through after I reported the case. She could
have lost her job and she could incur further expenses because of the same. When I will be
working in the future, I will be in a position of considering the six Rs for correct drug medication
to avoid any error. According to Edwards, & Axe (2015), the right medication is among the 10
‘R's of safe multidisciplinary drug administration. And if by any chance the error occurs, I will
be quick in responding and I will monitor the patient for the next six hours after the
administration of the wrong medication. I will inform the patient and the nursing supervisor in

charge. I will ensure I develop critical thinking skills and be in a position to think critically and
think fast outside the box (Azizi-Fini, Hajibagheri & Adib-Hajbaghery, 2015).
Another action that I will take is caring for those who would have been involved in such kind
of situations by any chance. I will, therefore, develop effective communication with my fellow
healthcare providers to help in managing the patient appropriately. This is because effective
communication promotes a connection between the healthcare providers (Arnold, & Boggs,
2019) and this aids in improving the patient's health status. I will be in a position of respecting
their values and believes. I will understand that the patient comes first as outlined by the
standards of a registered nurse in Australia (Nursing and Midwifery Board of Australia, 2015). I
will consider myself in a position of respecting the patient's wishes.
After the incidence, I realized that I am supposed to bring other knowledge to help prevent
such kind of event from happening once more. And the knowledge I can bring is about the code,
ethics, and standards of an Australian nurse that were revised were endorsed by the Nursing and
Midwifery Board of Australia in November 2015 (Cashin et al. 2017). The standards provide
guidance to all the nurses in practice in the whole of Australia and the code of ethics applies to
all nurses that have been registered by the board. These are the qualities that define what a great
nurse is and those qualities are the ones which I tend to bring up in this case scenario to prevent
future happenings of the same event. The new knowledge is as follows; A good nurse is one who
has solid communication skills (Adams, Mannix & Harrington, 2017) especially when it comes
to listening and speaking. The nurse should be in a position of advocating their clients (Douglas
et al 2014) when they don't get the expected care from the other healthcare providers. This is
because patients mostly look at nurses as their advocates and being sympathetic to the patient
improves patient care (Parnell, 2014).

Some of the serious actions that need to be taken is reporting such kinds of situations to the
respective authority department and nursing administration as well. such nurses that are involved
in such kind of events, they don't perform according to their codes of ethics and standards and
should, therefore, be punished of such kind of negligence and lack of seriousness in working
areas. Actions including to sue them should be considered because this will prevent the other
nurses from repeating the same mistakes. Such kinds of scenarios put the patient at risk. They
may end up exacerbating their side effects thus lowering their quality of life and well being of
which is contrary to the nursing codes which states improving the quality of life and well being
of the patient.
Conclusion.
In conclusion, medical errors are among the many mistakes that registered nurses, or new
nurses in the field of practice do. Some of the errors are reported while others are not. This
reflective essay has therefore outlined an incidence of medication errors that I happened to
observe being done by one of the registered nurses in one of my clinical placements. The context
has therefore used the Rolfe et al., model in reflecting the case scenario. The model comprised of
three questions that are further divided into different parts to bring the final general meaning of
what I observed, what did I do about the observation I made and how am I going to make a
change in the field in future when I will be practicing.

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