Introduction
Reflection is an incredibly transformative process in nursing practice, demonstrating our commitment to continuous professional development. In this article, I will utilize Gibbs’ reflective cycle to analyze a significant incident from my practice in the emergency department, examining how it impacted both patient care and my professional growth.
The Situation
While working in the majors area of the emergency department, I was caring for a patient who had recently received a diagnosis of stage four lung cancer with spinal metastases. He had presented to the emergency department with back pain, and his Macmillan nurse was concerned about potential spinal cord compression. Following the doctor’s assessment, an MRI scan was scheduled.
Upon meeting the patient, I completed the necessary nursing assessments, including blood pressure measurements, and ensured both he and his wife were comfortable with tea and biscuits. The patient had been prescribed 20mg of PRN oral morphine, though his wife had been administering smaller doses of 2.5-5mg at home, with the most recent dose given approximately one hour before arrival.
The Incident
After discussing pain management with the patient, we agreed to administer morphine before his MRI scan. However, due to the high workload in the department, I became involved with another patient’s care before I could deliver the medication. Unfortunately, the patient was taken to the radiology department without receiving the planned analgesia.
The situation deteriorated when the patient returned from the scan department visibly distressed. He reported that a staff member had abruptly lowered his bed without warning, causing him significant pain. Consequently, he was unable to tolerate the scan and expressed his desire to leave the hospital.
My Response and Feelings
I immediately apologized for both the missed analgesia and the poor handling he experienced in the radiology department. I assured him that I would file an incident report to prevent similar occurrences in the future. I also suggested an alternative plan: staying for his planned admission and returning to the scan later with adequate pain relief and proper escort to ensure appropriate movement and handling.
The incident left me deeply affected. I felt I had failed the patient during an already challenging time in his life. The lack of proper communication between departments and the impact of high workload on patient care were particularly concerning. Most significantly, I felt profound sorrow for the patient and his wife, knowing their experience had fallen short of the care standard they deserved.
Analysis and Evaluation
My initial assessment and communication with the patient were thorough and appropriate. However, I failed to communicate the care plan effectively to the area coordinator, who subsequently sent the porter without ensuring the completion of pre-scan preparations. This breakdown in communication directly impacted patient care.
The incident highlighted several systemic issues within our healthcare setting. As noted in the NHS improvement framework (2016), high-pressure environments with poor leadership often result in decreased empathy, compassion, and reduced quality of care. The NMC Code (2018) section 1.1 clearly states our responsibility to treat people with kindness, respect, and compassion – a standard that wasn’t met in this case.
Learning and Action Plan
This reflection has led to several important actions and learning points:
- A formal incident report (DATIX) was submitted to ensure departmental learning and service improvement.
- The need for better communication between nurses and area coordinators was identified, leading to the implementation of bedside handovers rather than large group handovers in the majors area.
- Moving and handling practices in the radiology department were flagged for review, with recommendations for mandatory training updates.
- Personal practice improvements include:
- Better prioritization of pain management
- Enhanced communication with area coordinators regarding patient readiness for procedures
- More assertive escalation of workload concerns when patient safety might be compromised
Conclusion
This reflection has emphasized the crucial role of effective leadership in maintaining high standards of patient care, particularly in high-pressure environments. It has also highlighted the importance of maintaining professional standards across all healthcare roles, regardless of registration status. Through this experience, I have gained valuable insights into improving patient care and departmental communication, reinforcing the value of reflective practice in professional development.
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