The aims and objectives of this essay are to analyse a critical incident from a practice based situation
I will provide an overview of the incident, and the discussion it provoked during a group presentation. I will then go on to analyse the situation and the effects that it had on the persons involved. In order to help me with my reflection I have chosen Gibbs (1988), as a model to help guide my reflective process. This is an ‘Iterative’ model, with six stopping points, using these six stopping points I will be able to reflect fully on the incident. So, what is reflection?
According to Boyd and Fale (1983) ‘It is the process of internally examining and exploring an issue of concern triggered by an experience which creates and clarifies meanings in terms of self, and which results in a changed conceptual perspective. ‘ Paul (1992) describes critical thinking as ‘It is the art of thinking about your thinking while you are thinking in order to make your thinking better, more clear, more accurate and more defensible. Alfaro-Le Fevre (1995) believes that reflection is a critical thinking process and that critical thinking is reasoning.
Critical thinking is a requirement for nurses to be safe, competent and skilful practitioners (Girot, 2000). It can also enhance personal and professional learning (Atkins and Murphy 1993, Jarvis 1992, Palmer et al 1994), and also empowers practitioners and assists in the development of nursing knowledge. I will refer to the clients as Bill and Ted in order to protect them from being identified and to maintain confidentiality in line with NMC code of conduct clause 5 (2002a). The critical incident discussed took place on a mental health placement and dicusses my encounter with prejudice and breach of confidentiality towards two clients.
Although I am aware that we were supposed to chose a branch specific incident, my branch being adult, I feel quite strongly that my experience of prejudice occurs not only in mental health nursing but also in adult nursing. Description Whilst on my mental health placement I enjoyed talking to the clients. I would spend my breaks with them, drinking coffee and chatting about life in general. It was during one of my coffee breaks that I met Bill and Ted we sat in the clients’ coffee room drinking coffee and talking about things in general.
After spending a pleasant morning with Bill and Ted I returned to the nurses’ office to join the other nurses whom helped to run the establishment. They were curious as to what I had been doing. So, I began to tell them that I had been talking to some of the clients and helping them in their work. I also mentioned to them that I had enjoyed one particular conversation between two of the clients Bill and Ted. The senior nurse gave me a strange look; I enquired as to what was wrong. To which she replied “Do you know anything about these men? “No” I replied “What do you mean? ” she began to tell me that Bill had been detained in a secure unit for killing his landlady and Ted had also been detained in a secure unit for killing his wife. I must admit that when I heard this I was horrified and can remember thinking to myself why didn’t the staff warn me and how stupid of me to sit there and put myself in such a position. At the time I can honestly say that had I known they’re backgrounds I would have probably not spent time with them. Feelings
On reflection of the incident I felt angry and upset with the senior nurse and myself, the clients in question had committed their crimes some years ago and they were both elderly gentleman now. I felt that the senior nurse and myself had not acted in a professional manner. The staff nurse should not have disclosed such information and I should have challenged the senior staff nurse regarding the breach of confidentiality.
All information obtained from the client/patient should be treated as confidential (Clause 5. NMC 2002a) and that in order for the staff nurse to disclose such information consent needed to be obtained from these gentlemen (clause 5. 2 NMC 2002a). If the staff nurses’ reasons were because she still felt that they could cause significant harm to others she should have been able to justify her reasons for her beliefs (clause 5. 3 NMC 2002a), however, no justification was given. I feel that my thoughts of knowing it was wrong for the nurse to divulge such information and my actions of not acknowledging my disagreement with her actions were not concordant.
I feel that this was because of our different roles, I was a mere student nurse and she was a senior staff nurse. Woods (2000) suggests that our behaviour can be influenced by social role expectations. Gross (1996) suggests that social behaviour changes according to the roles we play. Each role has expected behaviours related to it, such as the staff nurse as the ‘mentor’ and the student nurse as the ‘pupil. ‘ Therefore, as the pupil I felt unable to challenge the staff nurses’ actions due to her seniority.
Had the senior nurse told me of the clients past before I met them I would have been reluctant to speak to them because to be quite honest I would have been terrified, mainly because of my lack of knowledge and understanding on mental health illnesses. Therefore, on reflection not only was the senior nurse guilty of being prejudice but so was I. Prejudice means to have ‘pre-judged’ and this can be a good, bad or a neutral judgement (Woods 2000). Prejudice as a negative attitude towards others and can have a detrimental effect on those others and on our interactions with them (Gross 1996).
I feel that there are a few points here that on reflection should have not taken place or that I should have intervened sooner. As mentioned earlier regarding the roles that people take on, I took on the role as the student nurse, which is often seen as ‘under’ that of the staff nurse. This caused me not to challenge the staff nurse. This could have also been because as students on short placements you need to be able to adapt and ‘fit’ in within a team very quickly in order to benefit from the placement. Because of this I was reluctant, as a student to be viewed as a ‘troublemaker. From the start I should have made my thoughts on the situation clear and should have shown more assertiveness. This does not mean to say I would have challenged the nurse in a negative way. I would have perhaps asked if she could explain why I should know such information about the clients Bill and Ted. If there was no justification I could have suggested that maybe it was unfair to disclose such information since it happened many years ago, and that after all these gentleman were quite elderly now and should be able to live their lives without labelling and prejudice.
I should also have referred the nurse to the code of professional conduct as mentioned earlier, as these are a set of standards in which nurses are required to work within (NMC 2002a). Bill and Ted were unaware of their past being disclosed and so on this occasion were unharmed. However, had they overheard the conversation this could have had a devastating impact. Woods (2000) suggests that by labelling a person in a certain way – as a low achiever, murderer or as difficult there is a process by which the label might become true. This process is called the ‘self-fulfilling prophecy. The ‘perceiver’ (the student) then treats the ‘target’ (Bill or Ted) in accordance with the belief which in turn causes the ‘target’ to behave in a way that appears to confirm the ‘perceivers’ original belief. Although the nurse breached confidentiality I do not believe she did it with malice I feel that she was very passionate about her work and clients at times. On reflection I feel she may have told me for the purpose of proving that clients who have been detained in secure units can change contrary to what much of the public and media may think.
On my part, since this situation took place on my mental health placement, I have since encountered a similar experience while on one of my adult placements. A patient was perceived as ‘difficult’, he was well known to the hospital for being unconcordant and verbally aggressive to staff. However, this admission was to be his last admission as he was critically ill, very weak, and dying. Despite him being very weak and subdued, some of the staff related to him from their previous experiences of him on past admissions and appeared to be quite off with him at times
However, I was able to rationally discuss why the patient may have behaved in such a way in the past, suggesting that his behaviour may have been a result of possible life events which led him to behave in such a way. I was also able to address the fact that we are here to care for patients and not to judge them on their chosen lifestyles, attitudes or beliefs. In order to gain valuable feedback about this situation we were asked to present our incident in the form of a presentation.
The discussion was informal, twelve students and one lecturer sat around a table. I verbally presented my critical incident and asked the other members of the group to ask questions and offer comments. Most of the group tended to agree that they would have probably felt the same way about being in the company of clients who had been detained in a secure unit. They also agreed that it was hard to challenge senior members of the nursing profession as a student nurse. The lecturer asked me where I believed my initial fear of these particular clients came from.
To begin with I said I didn’t know but after contemplating the question I remembered my childhood. My father was a prison officer and we lived quite close to the prison in fact I could see the remand centre from my bedroom window. As a child, friends and myself would play ‘pom pom’ quite close to the remand centre with only a large hedge and two twenty foot fences between us (the children and the prisoners). From time to time the prisoners would shout out to the children where we were hiding and inevitably we would be caught.
I can remember as a child going in to my parents one evening and telling them how it was so unfair, as when we were trying to hide the prisoners would give us away and we would get caught. I then proceeded to get a lecture on how I was not to go near the fence and did I know what kind of people they were in prison. The conversation went on and I was told what sort of person ends up in prison and the type of crimes they commit, such as luring little girls such as myself away and these little girls were never seen again.
From the age of three up until the age of 18 I grew up in a community of prison officers and their families who all had very similar beliefs to my fathers. From this I can determine that my beliefs and attitudes towards prisoners were formulated from a very early age. To conclude I feel through critical reflection and analysis of the discussed situation I have learned the importance of analysing the situations we encounter as nurses in order to learn and improve the way situations are handled in future experiences.
I am now finding it easier to be more assertive but I realise that this is an issue I still need to work on. I have increased my ability to rationalise other peoples, as well as my own values, beliefs and actions. From critical analysis I have learned a lot about my own values and beliefs and now have the ability to question myself on, why I believe? and where my beliefs stem from, and have a greater awareness of my interactions with others, and how I also affect others without imposing my beliefs and values upon them.
I have learned that questioning throughout my nursing career, is a fundamental aspect of nursing care, and that this is an ongoing process. As I have progressed through my training I feel that I am becoming more confident and this comes from questioning ‘why? ‘ something is done in a certain way and backing it up with theory. I realise that it is not good enough to only take someone’s word for why things are done but to question, who says it is more effective and beneficial to carry out the action in this way. I now realise that questioning and answers backed up by theory leads to evidence based practice.
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