Assessment 1 - Essay including a personal reflection PDF

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This essay required us to highlight the importance of critical reflection and evidence based practice. Received a 50/60. ...

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Critical reflection and evidence-based practice positively transform health care settings. Nurses utilise critical reflections to evaluate their values, ethics, and beliefs, enhancing their nursing performance and their self-awareness. Evidence-based practice is synthesising experiences and research literature to promote the coordination of safe and contemporary care. Thus, critical reflection and evidence-based practice are pivotal to accentuate quality nursing practice and ensure patient safety. This essay will examine nursing incident to analyse the nurse’s role and illustrate the impact on the patient, family, and the nurse. A nursing action plan is developed to improve practice, and a personal reflection on the incident is provided.

Critical reflection and evidence-based practice are imperative to prevent substandard incidents occurring in health care contexts. A nurse must comply with guidelines, standards, and other legislation relevant to contexts of practice when making decisions (Nursing and Midwifery Board of Australia [NMBA], 2016). Bibby (2015), reports the case of a 97-yearold grandmother who died from a heart attack as a result of Nurse Lopez violating her duty of care. He states Mrs. Lopez administered three different, crushed oral medications through an intravenous route, without verifying with a second registered nurse. According to Bibby (2015), the post-mortem examination deduced the tablets had probably contributed to the patient’s heart attack. Mrs. Lopez is presently under trial for manslaughter due to medical negligence (Bibby, 2015). Hence, nurses should develop the skill of critical reflection and follow the best available evidence to prevent adverse incidents occurring in clinical practice.

A lack of critical reflection and evidence-based practice can lead to negative implications for the nurse, the patient, and the family. According to NMBA (2012), nurses have a fundamental responsibility for preventing illness and alleviating suffering. In the given

nursing incident, a consequence for the patient was she had passed away (Bibby, 2015). The nurse’s action compromised Principle 7 of the Code of Conduct for Nurses (NMBA, 2018), which advocate nurses use expertise to advance and protect the health and wellbeing of patients. With regards to the patient’s family, they may have lost trust in the health care system. These breached the ICN Code of Ethics for Nurses (NMBA, 2012) Principle 2, which state nurses must maintain personal conduct that enhances the healthcare image and public confidence. The nurse could have a guilty conscience and a loss of confidence in her clinical skills as a result of her negligence. These are highlighted by Jones and Treiber (2018), who state medical errors have an emotional strain on nurses, causing them to experience pain that can be long-lasting. Thus, the absence of critical reflection and evidence-based practice can result in negative consequences for the nurse and healthcare consumers.

The development of an action plan is a fundamental component that promotes evidencebased practice and critical reflection. The Australian Commission on Safety and Quality in Health Care (ACSQHS, 2017), recommends nurses to perform medication reviews, demonstrated by the evidence and best practice. Complying with this standard enables nurses to consult appropriate sources and guidelines when administrating medication. Likewise, Cloete (2015); Saunders and Vehviläinen-Julkunen (2016), acknowledge the importance of evidence-based practice and highlight weak application to best available evidence contributes to medication errors. Nurses could implement programmes for the continual professional development of self and others, this may prevent the incident from reoccurring. Elden and Ismail (2015), state these programmes must maintain quality assurance and performance improvements. These could be through enhancing the knowledge of staff on clinical pharmacology, therapeutics, and safety principles for medication administration. It is important for nurses to strengthen their communication skills as poor

communication is a significant factor in the development of errors among nurses (World Health Organisation, 2008). Through effective communication, nurses can undertake a double-check of medication to verify drug information (Schwappach, Pfeiffer &Taxis, 2016). According to Jones and Treiber (2018), double-checking of medication permits nurses to reexamine the five medication rights which are: the right time, patient, medication, route, and dose. Therefore, the development of an action plan encourages the integration of critical reflection and evidence-based practice to ensure safe care.

The Rolfe’s model was used to guide my reflection process to examine how I felt and to critically evaluate the nurse’s action in the incident (Rolf, Freshwater & Jasper, 2001). Reading the incident, I felt disturbed and ashamed to be a student nurse as the incidence could have been prevented, and instead, a life was lost. The nurse acted inappropriately and administered the medication through an incorrect route, without verifying with a second registered nurse. Mrs. Lopez may have been distracted thinking about the daily tasks she had to complete following administering medication to Mrs. Anderson. To avoid the incident from occurring, the nurse should have applied critical reflection to review her reasons and decisions before administering medication. Standard 1.2 of the Registered Nurse Standards for Practice (NMBA, 2016), state nurses must reflect on their knowledge, actions, and experiences, to develop their practice. To engage in safe practice, the nurse should have complied to the South Eastern Sydney Local Health District (2018), policies and guidelines on a nurse’s scope of practice and reviewed the Monthly Index of Medical Specialties (MIMS, 2019) to administer the oral medications safely. These are reiterated by NMBA (2018), who state nurses must perform within their scope of practice, which is determined by their experience, training, education, and qualifications, in accordance with institutional

policy. Hence, critical reflection and evidence-based practice are vital when developing a personal reflection on the incident. To conclude, critical reflection and evidence-based practice ensure safe and quality patient care. The nursing incident illustrated the nurse’s negligence to critically reflect and comply with evidence-based practice when administrating medication. These resulted in the patient losing her life, and consequently, it may have led the family to lose trust in the health care system. As a result, the nurse may have suffered from personal and professional implications. To minimise the risk of similar errors, a nursing action plan was suggested by examining evidence-based practice, continual professional development, and effective communication. A personal reflection on the incident and the importance of critical reflection, with evidencebased practice, was highlighted. Thus, critical reflection and evidence-based practice pave the way for heightened safe and improved nursing practice. Regular training programmes on critical reflection and evidence-based practice would empower nurses with the confidence required to undertake activities in a variety of healthcare contexts.

References Australian Commission on Safety and Quality in Health Care. (2017). National safety and quality health service standards (Medication Safety Standard No.4, p.29-31, 2nd ed.). Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/ National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf Bibby, P. (2015, February 22). Sydney grandmother who died after nurse’s error was already ‘at death’s door’, a court hears. The Sydney Morning Herald. Retrieved from https://www.smh.com.au/national/sydney-grandmother-who-died-after-nurses-errorwas-already-at-deaths-door-court-hears-20150222-13lim1.html Cloete, L. (2015). Reducing medication errors in nursing practice. Cancer Nursing Practice,14(1), 29-36. doi: 10.7748/cnp.14.1.29.e1148 Elden, N. M. K., & Ismail, A. (2015). The importance of medication errors reporting in improving the quality of clinical care services. Global Journal of Health Science, 8(8), 243. doi: 10.5539/gjhs.v8n8p243 Jones, J. H., & Treiber, L. A. (2018). Nurses’ rights of medication administration: Including authority with accountability and responsibility. Nursing Forum, 53(3), 299–303. doi: 10.1111/nuf.12252 MIMS Australia. (2019). MIMS online. Retrieved from https://www-mimsonline-comau.ezproxy.uws.edu.au/Search/Search.aspx Nursing and Midwifery Board of Australia. (2012). ICN code of ethics for nurses. Retrieved from https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfor nurses_%20eng.pdf Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards.aspx

Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. Retrieved from http://www.nursingmidwiferyboard.gov.au/ Codes-GuidelinesStatements/Professional-standards.aspx Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection in nursing and the helping professions: A user’s guide. Basingstoke, England: Palgrave Macmillan. Saunders, H., & Vehviläinen-Julkunen, K. (2016). The state of readiness for evidence-based practice among nurses: An integrative review. International Journal of Nursing Studies, 56, 128–140. doi: 10.1016/j.ijnurstu.2015.10.018 Schwappach, D. L. B., Pfeiffer, Y., & Taxis, K. (2016). Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses experiences. BMJ Open, 6(6). doi: 10.1136/bmjopen-2016-011394 South Eastern Sydney Local Health District. (2018). SESLHD framework for policies, procedures guidelines and business rules. Retrieved from https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDHB%20 019%20-%20SESLHD%20Framework%20for%20Policies%2C%20Procedures %2C%20Guidelines%20and%20Business%20Rules_0.pdf World Health Organisation. (2008). Medication errors . Retrieved from https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643eng.pdf;jsessionid=E63F1E47B54EE260245F9C12CE6DE56E?sequence=1 nurses_% 20eng.pdf...