Critical reflective is an essential component of the portfolio of healthcare. Nurses practicing in today’s rapidly transmuting health care environment are increasingly becoming vigilant of the need to evaluate and ameliorate their practice as well as consider the environment and social factor affecting it (Bettie et al ,1996 ). Reflection is a process that is kenned to avail nurses in the development of obligatory skills and competencies when undertaking training within clinical settings. Broadly, the ultimate aim of reflection in clinical edification is to fortify the development of healthcare professionals who are able to, by their own initiative, enhance the development of further skills through the conscientious and strategic reflection of their experiences and erudition to become reflective practitioners.
World now undergoing rapid in changes via technology, therefore we as nurses consequential must able to analyze and respond to incipient and different challenges in a proactive way and critically. Developing critical cerebrating and reflective skills will avail us to meet the challenges of providing excellent care to patient according to standard required. According to Bulman ( 2004 ), Critical reflection a vital implement for developing quality accommodations, sanctions nurses to be flexible in their approach and to incorporate changes when obligatory. If critical reflection did not take place, the same mistakes will be done continuously without improvement. Besides critical reflection helps us analyze experience and content if there something to learn and improve in future (Chabell & Muller 2004).
Critical reflection can be done by many style but when use a proper model it helps us be organized and help us overcome professional inertia by asking us to look at what we do. John’s model (1994 ) is a model of guided reflection which able us to access, make sense and learn through experiences. Besides that the Gibbs’ Reflective Cycle is also a model that is unique because it includes cognizance, actions, emotions and suggests that experiences are reiterated. While Kolb’s reflective model is a model that is wider and more flexible in approaching and analyzing situation in a critical light to enable future changes (Zeichner and Liston, 1996). In my situation, I choose Gibbs’ model to reflect my experience because found many benefits and it suited my personal experience of cognition. I also think having the right reflective process is a bonus for the patient and me in order to understand emotion status and examining both negative and positive impacts of the event, where learn from it. According to Hilliard (2006) additionally found Gibbs’ model provide with a focus by promoting cognizance of the skills that possessed, thus building confidence and enhancing professional autonomy.
For the first stage of the cycle, I will provide a detailed and concise description of the experience (Lia, 2015). In order that I could use this situation for my reflection as the patient will be referred to as “Mrs X ”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the Code of Professional Conduct (CPCN,1998 ). The incident happened when I was working in Hospital Melaka. At that time, I am a newly employed registered staff nurse in a medical ward in that hospital. At that time I am working afternoon shift. The ward is occupied with 44 bed for female patients. The staff range is four staff nurse per shift and the ward is really busy. On that day I was allocated to take care cubical one. I was taking care ten patient in my cubical. On that day I’m nursing Mrs X, age 55 years old who was diagnose with hypoglycemia with poor oral intake.
When I took over report from my colleague the patient blood glucose was 6.7mmol and intravenous fluid is stop by doctor and she was informed to take orally. Around 5 pm, patient call up me to accompany her to toilet ,so at that moment I accompany the to toilet by walking beside her. I left her alone in the toilet as she said she want to pass motion without saying anything to the patient. I went to continue my daily routine of work without realizing my patient is in the toilet. I really forgot I have left her in the toilet alone. After a while my colleague ask me where is your patient Mrs X, as she wanted to her blood sugar level, out of sudden I realized I left her in the toilet alone and she is not back yet to the bed. The patient decided on walk herself. On the way from the bathroom, she felt dizzy and almost fall but able to saved by me as I ran to attend her. Patient was transferred to wheelchair with support of other staff nurse. Patient were attended start by medical officer for full assessment. Patient general condition conscious and alert, orientated to place, person and time. Her glascow coma scale is full 15/15, both pupil reacting to light.
Patient able to move all her limbs, but patient still had mild bruises at her knee and elbow as hit the wall. Patient vital sign recorded ,blood pressure is, 138/72 mmhg, Pulse 90bpm, respiration rate : 24 minute, oxygen saturation is 98% under room air, Pain score was pain due to bruises she had. Her blood glucose is 3.5mmol, she had another episode of hypoglycemia and sweet drink were given to her. After one hour I recheck her blood glucose was 6.2mmol. Patient were nurse in cot bed, near nurses counter for continues care. All plan is carried out as ordered by doctor. Knee x-ray is done as ordered, and no fracture were seen. Her family member were called up and inform regarding her fall.
Before the incident I was happy because at first my work went well and made me more eager to do the task in the ward, but when this critical incident happened I felled sad and disappointed in myself because I unintentionally risked patient’s health because of circumstances. I also feel very guilty and irresponsible I had cause injury to patient. I also feel failed to give by best nursing care to patient according to standard nursing care.. When falls happen, nurses often become the first victim that expresses enhanced pressure, anxiety, guilt, responsibility, and self-doubt about the quality of care they provide ( Brians ,1991). During my shift I started to blaming myself for the fall and this affected my nursing practice throughout the day.
I have realized how much the patient need go through with pain as she verbalize feeling of pain due to the bruises that she had. In view of patient, the patient feel very scared and worried on the complication because of the fall. Besides that she realize she had lost control, making her feel helpless. She also unable to get around and do the things she liked to do, she reporting feeling dread, frustration, and anger. Her family member are very angry towards me, they scolded me because of my mistake. They are very worried on risk of complication such as fracture that many cause many problem such poor healing to patient. Although I do face a lot of negative feeling at that moment I also felt happy that I have good teamwork as they helped me to go through this incident smoothly. The senior nurse guided me to do my incident reporting to send to on call sister.