Nursing 1: Transforming Professional Practice Through Medication Error

This essay presents a reflective analysis of a medication error experienced by a nursing student in an Intensive Coronary Care Unit (ICCU). The student recounts an incident involving a Dobutamine infusion where a syringe pump malfunctioned, leading to an overdose. The essay then delves into professional socialization, exploring how the student's beliefs, values, and reliance on technology influenced the situation. It examines the theoretical underpinnings of socialization, including the attainment of skills, knowledge, and ethical standards. The analysis highlights the role of reflection and interaction in shaping professional identity and the importance of self-awareness in recognizing limitations and uncertainties. The essay further discusses the impact of workload, staff-patient ratios, and high-level technology on medical errors. The student confronts the issue, reflecting on the conflict between clinical exposure and biomedical science, and the challenges of ambiguity in medical practice. The paper emphasizes the need for critical thinking, empathy, and a humanistic approach to patient care to prevent future errors and improve patient outcomes. The essay concludes by highlighting the importance of continuous learning and vigilance in nursing practice.

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TRANSFORMING PROFESSIONAL MEDICAL ERROR MEDICAL ERROR
PRACTICE THROUGH REFLECT
By Student's Name
Course Code and Name
Professor’s Name
University Name
City, State
Date of Submission

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Describe
Professional socialization is the procedure developing and internalizing an expertise identity
through attainment of skills, knowledge, beliefs, norms, values, and ethical standards so that
someone can realize a professional role. Professional socialization entails social learning
theory, which is the interaction of social and mental worlds’ resulting in a vigorous
adaptation procedure that is ever changing. Professional socialization influences development
of certain occupational personality. Socialization is relative culturally; individuals from
diverse roles, nationalities are socialized diversely. Primary socialization takes place in
childhood while secondary socialization entails being socialized to the larger community,
includes professional socialization and is a life long process.
My work has been that of a nurse of a multicenter hospital in the Intensive Coronary Care
Unit (ICCU) in my first year of competent nursing. One day when I was working in a night
shift, an older man aged fifty-eight years was admitted in the Intensive Care Unit having a
problem of mid-left ventricular failure. According to the order of the physician, I was
directed to treat the patient by injecting Dobutamine three milliliters at every hour using a
syringe, pump. Moreover, I was directed to administer other medications also. After some
time, because of a power supply that was interrupted, there occurred a shutdown of all
machines. However, within a small period, all the power returned, and all devices were now
performing usually. I detected that the syringe pump of the patient was alarming, and I had to
go and restart the pump without checking at the flow rate of the pump. After I had done this, I
was engaged with other patients, which made me busy. Within some time, the patient began
to vomit and showed some discomfort. My colleagues and I rushed to the side of the patient
and started to roll around the eyes. I discovered that the flow rate for injection dobutamine
was adjusted from three milliliters per hour to eight milliliters per hour. Abruptly, I halted the
injection for a while and tried to settle the patient. I decided to call the technicians to inspect

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the pump of the syringe, after which they realized that some errors had taken place inside the
pump.
Values and beliefs
I had adequate certainty to handle the patient. Furthermore, at that time the patient was
almost in a good condition. In the Intensive Care Unit setting, every day we utilized syringe
pumps, and thus I managed it very easy. At numerous times, the alarm was generated when
the supply of power was affected and it functioned automatically again. My conviction was
that technology was perfect. Thus, I did not any worry in that scenario. Nevertheless, when
the patient became unstable, I was tensed. I did not comprehend what transpired to him.
Rapidly my eyes were stuck in the pump of the syringe. The adjusting of the flow rate gave
me a shock. Following this, a great dose of medication was given to him. Abruptly, I
switched it off. My colleague looked at me with an anxious face and my hands were
shivering. I thought as if I had undertaken a crime. My coworker gave me offered me
emotional support to me since she comprehended that I was scared greatly. After the instance,
she enlightened me that I ought to be very conscious and vigilant when the process was
undertaken. Because of my overconfidence, I chose not to follow the policy of the hospital.
The hospital assumption is key to ensure things are right and everything should be reviewed.
Unluckily, my belief in the technology was wrong.
Inform (Analysis)
According to socialization theory, the procedure of developing and internalizing a
professional identity through attainment of attitudes, skills, knowledge, ethical standards and
norms in order to accomplish a role that is professional. Socialization theory can be described
as the attainment of skills, knowledge, values, attitudes, and roles linked with the medical
error practice of a specific profession. The existence of different health-associated jobs

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insinuates that every discipline is exclusive in the fundamental normative and cognitive
framework into which its caregivers are trained, inducted, and credentialed. We can contrast
diverse subjects with acting and culture grounded on existing suppositions concerning
suitable behavioral, epistemological, and normative grounds of action. The attainment of
exclusive modes of dressing and demeanor, patterns of language and behavioral norms are all
demonstrations of what is referred to as professional socialization.
Reflection and interaction are critical elements in the process of socialization as stated before
professional identity is created through reciprocal interaction between environment-whether
individuals or other institutions and self. The debate is designed into the education procedure
of a profession. Collaborations with patients affect the evolving nature of the identity of the
practitioner. Most significantly, as the practitioner heads past the time of formal education,
socialization does not seize but progresses with the start of diverse environments of working,
new colleagues, supervisors, patient, unforeseen problems, challenges and dilemmas that
challenge the practitioner in any field of health care.
The influencing influences of these modern environments and experiments on the person rely
on the level of self-reflection that he has reached. Similarly, as identities of a profession arise
from struggling with the challenging moral problems and conflicts that are explained as the
skillfulness of professional medical error practice. The professional judgment character
which is emergent in a reflective practitioner relies on the person’s capability to contend
deliberately with those grey areas of medical error practice in which the specific focus to be
undertaken is not vivid since the condition is shrouded in value conflicts, moral ambiguity or
ethical dilemmas. A caregiver can be on 'auto-pilot' concerning scientific skills and
knowledge according to his discipline commands. However, to ultimately be reflective, he
must be deliberately come to grips and acknowledge with ambiguities, uncertainties, and
limitations of the real medical error practice. This predicament is usual in clinical medical

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error practice with older people, due to the complicated interrelationships among their
functional ability, health, and quality of life.
Current studies into the phenology of medical error practice, proposes the significance of
clinical stores in bringing to light the meanings and descriptions of patient care predicament
as explained by providers of health care-thus illuminating the fundamental value conflicts and
value confronted in professional medical error practice with older patients and offering
awareness into the nature of work as a reflective caregiver. Such stories demonstrate how
responsibility and authority are theorized in the care/ provider recipient association, and they
show that personal explanations of illness and health cannot be detached from social and
moral concepts. Predicaments in recommending the extent of behavior change, evaluating
risk and making choices concerning placements are instances of gray areas in medical error
practice where it is unfeasible to get simple scientific answers to multifaceted, complex
catastrophes (Sargeant, 2019, pp173).
Significantly, the utilization of stories in studying and revealing these complex queries and
their responses – the domain of the reflective caregiver-demonstrates the power of
autobiographical and biographical procedures not only in comprehending the process of
aging as underwent by a person, but also in investigating the complex elements of medical
error practice for a number of health care professionals. A comprehension of the process of
socialization of these professionals must comprise an examination of their training and
education as it forms their strategy to both their elderly patients and themselves.
The medical practitioner, as a doorkeeper to the system of health care, is a crucial provider
for older people. Still, the common ground of unfortunate ageism and medical error practice
of several physicians together forms a dissonance between the voice of the patient and that
one of the practitioner. Medical education and its associated procedure of socialization can be

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visualized as locked in an unequal struggle between two diverse systems of values, one more
humanistic and social-ecological, and the other more scientific and reductionist. The prior
involves disintegrated concern for society and patient, faith in the rational solution of medical
catastrophes, and dedication to the community of science and competency in medical error
practice. Due to this values, this orientation disregards the behavioral, social and individual
aspects of illness, dismisses ethical matters as minor issues of opinion not dependent to a
discourse that is rational and relegates social and familial dimensions of medical error
practice to the periphery. The more humanistic viewpoint on medical error practice
contemplates the behavioral and social approaches to be as pertinent biological, emphasizes
caring as much as curing, selects students for training on the grounds of their interest and
social concern in individuals, and contemplates the community and not just the hospital-as an
appropriate place for undertaking education on medicine.
Increased workload in the ICU contributed to the issue of medical error in my practice. With
increased number of patients that I was expected to serve, I became overburdened by the
tasks leading me to cause a medical error when treating the other patient. Increased workload
leads to some lack of concentration to one customer thus giving little attention when treating
a patient. Moreover, low staff patient ratio was another contributor to the medical error in my
practice. Since the number of patient that we are required to treat are many than the number
of staffs that are available, the staffs available are forced to strain so much therefore leading
to such medical errors occurring. Staff-patient ration in the Intensive Care Unit settings is
1:4 . Information from the organization of Irish midwives and nurses states that Irish nurses
are overburdened, caring for between twenty and sixty percent more patients than in the
United Kingdom colleagues. Thus, it is very hard to handle all patients with a lot of care. One
third of the medical errors that affect during the phase of nurse administration: giving
medication to patients is thus an activity that is of high-risk. The low staff patient ratio results

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in delivery of health services that are of poor quality. In my scenario, I had a mistake during
the process of administering medication.
High-level technology also contributed to this issue of medical error in my practice. The
machines that were being used in the ICU were of high technology being my first year; it
became hard for me to comprehend all the operation of the syringe pump. This resulted in the
medical error in my practice.
Confront (Self Awareness)
Medical education as a process of socialization can be attributed as one crowded with
conflict: pressure between clinical exposure to actual patients versus basic biomedical
science, the actual residency and internship period versus the medical school experience, and
concern and attachment versus objectivity and detachment (Pescosolido, 2016, pp17). These
thematic divisions exemplify diverse periods of the process of medical socialization, and they
help to form it in ways that I will debate desensitizes and dehumanizes its practitioners'
items'- making them less attuned to the complex and unique clinical requirements of older
individuals with multifaceted health challenges.
Some studies propose that students of medicine are preselected for particular qualities that
upset their capacities to be sensitive and empathic to the concerns and needs of other people.
For instance, it was detected that medical students in the first year graded particular values
very contrarily than students in psychology and nursing. A 'logical life' and exciting were
grated greatly by students of medicine as compared to the other two groups, whereas a 'polite'
and 'a world at peace’ were graded as less significant by students of the other two disciplines.
This exposes a more rational and self –centered viewpoint on the part of the student of

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medicine, in comparison to the more other-focused values as visualized as significant by
psychology and nursing students.
Medical student’s selection may be more significant than training in swaying their capacity to
bear ambiguity in the medical error practice. Current technological medicine has generated
many instances that are problematic and ambiguous ambiguity tolerance would seem to be
pleasing in coming up with practitioners that are reflective relaxed with the moral conflict-
filled, gray areas of medical error practice (Noland and Carmack, 2015, pp 1234). Possibly
the most crucial dehumanizing and desensitizing time in medical education is the period of
residency. The transition from the school of medicine –where there exists the caring idealism
in caring for the entire patient to residency, where medical error practice and time limitations
require strict constraints on clinical medical error practice- as one of the values dissonance
and 'reality shock.' No place is this discontinuity, and its long-term impacts visualized vividly
than in the observer –participant study on the residency and internship period of training.
A medical error practice that is goal-oriented includes both these standpoints by coming up
with a new, more positive clinical model to substitute the old one according to challenges
perceived by the health care provider- one stressing diseases, deficits, and disorders. These
current clinical models possess a considerable capacity to foster the older people care, who
despite problems of chronic health, have specific objectives in maintaining their quality of
life and independence.
Medical students are known to come up with mechanisms of coping so that they can endure
in the environment that is frustrating of the acute care hospital. Through psychologically and
physically separating themselves from families and their patients, residents and interns can
deal with the strains and stresses of an environment that significantly demolishes the
motivation and idealism that may have formerly pulled them into medicine. Some of the

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'getting rid of patients’ approaches involve passing the patient 'down the hierarchy’ to the
junior member who is least experienced in the team- medical students and interns. These
roles are usually those linked with patient care or education operations. Moreover, some
functions of patient-care were passed parallel to social workers, whose official responsibility
was recognized as 'getting rid of the patient'-drawing patients from settings of acute care as
early as possible. A further method of for isolation was reducing the concentration of
association, explicitly regulating the taking history of the patient with a focus on a rich
collection of data (Feldman, 2016, pp 433). The capacity to gradually condense and narrow
the amount of information required for a comprehensive history was studied as part of the
process of socialization as the practitioner in training progressed through the period of
residency.
The nature of the discourse and language between the patient and the doctor is significant as
the most considerable component in the very foundation upon which medical objectives are
established and in medical care. Language analysis methods are utilized in the medical
interview, illuminating a significant gap in culture between the scientific-technological
domain of the practitioner and the life world of the patient. The two different voices of the
patient and medicine denote diverse “modes of consciousness” or “provinces of meaning”
that constrain the capacity of a practitioner to appreciate and comprehend the life goals and
real-life concerns of a patient. During the medical history, the patient's reality and life are
delineated into the structures of cognitive medicine, and this reformulation can depersonalize
him and transform the denotation of the patient’s condition. Actualizing the story of the
patient may mask or obscure the fundamental values that are at stake for both the patient and
the practitioner. This trend is strengthened by the tendency of ageist of several physicians to
devalue and objectify patients that are elderly through such expressions as (“get out of my
emergency room”) “gomer” for them.

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The matter of value conflicts and values is severally stated in the nursing literature for
socialization. This matter is intellectualized in three ways, (a) as a clash between
organizational constraints and professional standards (b) as conflicts between what is and
what should be in the medical error practice of nursing –for instance observing patients who
are elderly handled with disrespect, and (c) as the attainment of associated training and
professional identity values. Generally, dealing with conflicts of values is visualized as a vital
segment of the process of nursing socialization and surely, as key to the capacity of nurses to
become sensitive and empathetic to predicaments at the center of the medical error practice of
nursing.
Reconstruct (Evaluation and Synthesis)
Medical error can be described as a breakdown in the process of treatment that has the
potential to or leads to hurting the patient. The method of treatment is a complicated
procedure that comprises dispensing, prescribing, and administration of a drug. This
description does not demonstrate whether the error is caused by the pharmacist, doctor,
patient, or another individual. The triggers errors in medical administration may be perceived
as 'system' or person based. The 'person' strategy to errors of medication is the current
strategy in medicine and is focused on aberrant mental processes, for instance, inattention,
forgetfulness, carelessness, poor motivation, recklessness, and negligence. Conferring
reproach to a person for a behavior that is not safe is more straightforward than focusing on
an organization.
Individually, the association between the acquisition of specific values and the development
of nursing identity was researched by Levinson (2017, pp 253). According to her research
with practitioners that was qualitative, she finalized that an individual’s dignity was the
central value that guided nurses’ medical error practice with patients and formed nurses’

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identity. Other benefits, for instance, integrity, security, being a fellow human, personhood,
autonomy, reciprocal trust, general humanity, and hope- all either emerged from it or were
focused at its maintenance. This is comparable to values that are deliberated by other
researches as being constitutive of the profession of nursing.
The improvement of the capability to visualize the educational process is the entire individual
as an essential result of the educational process of nursing is vividly diverse from that
explained for medical socialization –where objectification, depersonalization, and distancing
are perceived to be the norm. Comparable to the to some of the modern models for medical
error practice before now deliberated, nursing medical error practice models connected to a
comprehension of particular value meanings, priorities, dreams, and hopes of the patient are
starting to appear. For instance, Parse (2012, pp 3), has brought forward a holistic nursing
model, focusing on the crucial unity of people. The concentration here is on personal history
and the lived experience of the individual patient who is elderly exemplifying his or her own
life goals and personal values- as the central part for the caring model.
Collaboration amongst diverse professions of health makes me maintain my theories as
increased significance as medical error practice moves progressively into the domain of not
only life extension and quality of life. Of importance, the value of life deals with the
qualitative aspects of care, comprising meaning, values, preferences, and attributes –all of
which are shaped and created by professional training, life experience, and the association
between the individual and his or her more full social environment. Precisely, the training and
education of health care professionals shape their values, identities, and norms of medical
error practice in particular ways that may either inhibit or enhance effective collaboration and
communication in settings of clinical medical error practice, where these competencies are
necessary for the efficient care of elderly individuals.

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The fundamental standard of the 'system' strategy is that individuals are predisposed to error,
and errors are because of organizational processes and error traps in the place of work. Errors
undertaken by people are conveyed through 'holes' in the layers of 'barriers, defenses,
safeguards, and barriers' of an organization. The availability of holes in one layer does not
usually result to an error; nonetheless, if the holes are arranged for a brief moment, there is a
chance for a mistake to proceed a trajectory through a faulty system and lead to damage to a
victim. The contention of the reason stated that different events typically entail an
amalgamation of latent factors in the working environment and active failures by individuals.
Active faults comprise of ignoring or forgetting a procedure or policy that is established,
while potential factors comprise of inadequate equipment, staffing shortages, and insufficient
lighting.
Guidelines for minimizing medical errors according to DoH emphasize that the ensuing
checks ought to be undertaken before administration of medication: correct medication, to the
right person, in the right dose, at the right time and in the proper route. Nevertheless, an
administration of medicines that is rule-based utilizing the 'five rights' may make nurses to
act give a false assurance that their procedure is safe and make them work ritualistically. The
significant elements leading to medical errors by nurses are personal neglect at eighty-six
percent and factors that are system based such as new staff and heavy workload.
Administering medication is susceptible to failure because it exceeds the technical
mechanical procedure. Agreeing with this view Hafferty and Castellani (2019, pp 448)
uttered that safe medicine is a psychomotor skill and necessitates skills of cognition, for
instance, listening to patients, observation, clinical analysis judgment, critical judgment,
interpersonal and teaching skills and decision making.
Several studies have defined rates in medical error in the setting of a hospital; nevertheless,
data for primary care is comparatively scarce. This is precisely the case of middle and low –