Anu Mathew

As I have been mentioning throughout the past reflective journal entries that, it’s only through mistakes that each one of us would learn new and different things. Having  had an experience in the past of due to my error,  I learned many things which were new to me and which where learned in the past but I couldn`t make it as effective has it would have to be like for the communication skills and confidence that I needed to have made more better. But it is only after a mistake that I was able to concentrate on these factors. Not only did I find it good by the error which took place but also the other staffs that used to work there had to take up compulsory education of effective communication, confidence and also the need of critical thinking when it was needed. Even though I felt like a fool after the critical incident it made feel good after sometime because only committing a mistake brought in new learning experience and I was thanked and appreciated by my colleagues and doctors for bringing about a new experience in communication skills and confidence. Personally I have learned effective communication and to built up my confidence and also I could bring about effective communication and also professionally I started up looking up different medicine complications, actions and it’s after effects do as I could know the possible chances of situation that I could come up with.

The consideration that I gave in maintaining positive healthy ways of care for self during critical incident was to maintain patience and focus on the problem. Keep myself and other colleagues by obeying safety rules like keep away from any type of metal articles before the patient was given shock. Not pressurizing my fellow staffs into doing something which they were not competent with. Think about the pros and cons on such critical incident, by not getting freaked out welcoming more hazards to the working environment. It has brought into my notice that only when a nurse is not focusing but trying to do a procedure in a quick way they tend get a needle prick or even break an ampoule and get their fingers torn and bleeding making way for another disaster. So it is important to do every nursing procedure with appropriate care and in a steady manner and for that it is always necessary to plan in before and getting articles ready that to break a sterile field or by asking others to help you. Planning is a very essential role played for the betterment of a procedure and its safety.

The role of a journal for personal and professional growth is very important because has mentioned it’s only through mistakes that everyone learns. So a reflective journal like the past ones I have been doing is not only going to help through my professional life but also other student nurses or nurses for that matter by reading the reflective journals they could bring about the uses of effective communication, confidence, competent and also different approach to critical thinking which could be effective for them. If every nurses go through a new reflective journal it could bring about new learning experience bringing in new ways of practise and better ways of learning. A reflection of practise makes it better for one`s self and others at the same time.

Through my learning experience I have been able to concentrate and the best ways of communicating and keep my confidence level higher because the knowledge has increased. As the saying goes knowledge is power and the power builds up your confidence and brings out competence. From my point of view only through experience and handling many situations will I be able to think more efficiently

If some else or if any another person rather than me had to go through the same situation, they would have thought may be, entirely different than what I had thought and did in the situation or, if they were thinking what I was going through they probably would do the same foolish act because nurses need to have a time balance and management as it is necessary to manage the patients care in a time frame. Not only a nurse has to take care of an emergency situation but also, deliver care to the rest of the patient who are under treatment so eventually they would ask the help of others who were present in the situation to help with the other patients care rather than spending time thinking what has to been done. So as if they go through the same process as I did, they probably would panic because it is a dangerous situation, caused due to lack of communication and negligence for which they have to be answerable and also, they would be aware from next time to keep proper communication and also not to jump into a conclusion of sharing the workload to one another so quick or just keep up the knowledge of other patients vitals and care status as well at the same time.

Others those who were in the situation would have thought that I had taken such a drastic decision for no use, creating nothing but added up work and danger for the other patient involved because of trying to ease up my work load. They would have thought because of the whole situation had caused so much tension and another emergency situation that I could probably do one work at a time rather than trying to do multi tasking. They would also try not to make the same mistake in their lifetime because, a small error or lack of concentration could bring about a huge change in a patients care and also make things worse than before. Only through mistakes the person who committed it and the others who have seen try not to commit the same mistake all over again.

If at all a deliberation is given on the reasons behind how people could be aware of the same event differently. I would say always have a higher level of concentration of what is happening in a department. Multi tasking is one of the best stuff a nurse should have. Before administrating a medicine think of the reactions and actions of the medication. Only after making sure about the condition of a patient, administer a medication. Do not over or under estimate a situation. Be prepared for the worst, so as we could be ready to react to the situation if at all one arises. Always have a good understanding of the patients vital signs so we could reflect ourselves, if at all someone was going to administer an medication to think what reactions could happen administrating medicines to a patient. Be it medication or as simple as fluid or diet which could simply cause a choking process, making situation worse. So being alert and orientated is the better than handling a situation completely to another staff without knowing what is going on there.

Only after this incident I have been able to be very communicative and also have a better understanding of medications actions and reactions. Always keeping in mind the tiniest mistake could cause the worst scenario. Be alert and active in whatever procedure`s and the conditions of the patients assigned. Keep a time management to myself of how I could finish my job rather than thinking of how I could finish my job with the help of others.

As mentioned in the last reflective journals that I have written it was a communicational error which had occurred and also there is no point in blaming each other for the mistake that has happened because it’s only from mistakes that anyone could learn. As far as the situation was under control and has not gone out of hand to settle it down it is always good to have a reflection on what had happened and to rectify the error so that it would never ever happen again at least not the same mistake has same as to that what has happened. I have always tried to refresh my current practice and knowledge regarding emergency situations and also taken special efforts in learning about disaster management situation in a hospital setting so as I could always be alert and effective in my job.

Being a nurse is a very hard job because you always have to consider all the loop holes that could be present due to your own lack of negligence or for that matter from your colleagues. So as far it goes communication skills should be effective and also plays an important role. Communication error causes a lot of problems, so always talk loud and clear, be it about patient condition or a matter that has to be sorted out. Communication not only brings good rapport with colleagues but also with the patients as well. From many books that I have read the researchers always states that a nurse should always be listening and also attending to what others need to say with empathy only then will there be a focused care.

After that incident I have not only made difference in my communication skill but also have entertained the staffs with me to talk clearly and also in a slow pace rather swallowing and spitting off words between conversations. They have always thanked me for what I have taught them and also the ways of communication was so precise that no one would ask a single question back because even while handing over a patient or receiving a patient certain questions would be asked and answered, as only when questions are doubts are cleared and assuming things were a big no in our department.

As far my concern if the incident had been taken place again it would be an excellent error of lack of communicational skills. Not only administering medicines and taking care of patients are vital but also fulfilling the communicational gap between any instances is the focus on getting quality care of patient and also for the staffs themselves. Ego at certain times plays a role in not asking question or even assuming things which is a deadly matter. It doesn`t matter how many years you have worked in the field or how many less hours you have worked in the establishment all that matter is the best quality and effective care a patient could get out of you and the health care system for which communication is the most important factor. There should utterly be no communication gap between the co workers and also between the patients as they would know better than you at times why a medicine is taken for them and their effectiveness. A patient is the one who suffers and heals and only by have a good rapport with them will you be able to know what’s happening with them.

To conclude, asking questions wouldn`t hurt but if you lack communication you lack your professional quality. Good communication gives best health results. It is a very important matter that all undergraduate nursing students to become an excellent registered nurse. Not only helping yourselves but also the dignity of the entire nursing profession.

The positive elements that I traced on later with the incident are that, I had to be vigilant on all the patients care and clinical observations. There is no point in blaming the inexperienced staffs, as it was my fault. My ignorance and negligence was the key to the whole catastrophic situation. It was a turning point in my career history. There is no point of being upset because after all it was a turning pointing in my life.

From then on that day I have understood the value of effective communication and also confidence is the best two things which could be useful in completing the nursing process and better care of the patients.  There were also good outcomes not only for me but also for the other nurses who ever involved in the situation. The nurses always in our department kept communicating in all situations and emergency. The new staff and experienced staff used to get educated in the department at the end of every shift. As a leadership quality, I had taken the initiative of conducting educational session for 15 minutes which was always encouraged by couple of doctors and senior staffs in a group. 

I never understood the importance of communication, I always had a lack of communication with my co-workers and all the others involved but after this instance I have always kept good communication rapport with doctors, paramedics and my co-workers because only then I had understood the importance of communicating in my profession. I knew that to avoid further mistakes in my nursing career as a registered nurse I had to have the key to, which was effective communication. Generally of the time I hesitated to talk with doctors and other staff members due to my lack of communication skills. After this incident I clearly understood the importance of communication in my profession. It has made me able to avoid many mistakes in caring of a patient in my career after that incident.

From my understanding health care system is one of the areas which use a lot of short forms and different kind of words. And I understood that if I don’t communicate properly I will never understand the meanings of these words and it would surely affect my duty of care and that’s the last thing I would like to happen. I learned a lot of about communication skills from my seniors and doctors. I myself also watched a lot of videos regarding the health care communication and also understood the different types of ways we could communicate effectively. 

Not only communication but also what I understood is that confidence is one of the key factors to become a good professional nurse.  In the nursing profession, confidence is very essential for assessment, planning, evaluation and critical thinking. From my own experience in the I.C.C.U department I was many times doubtful about the signs and symptoms which is associated with the disease condition because everything should be quick in acute care setting, but because of my lack of confidence I wasn`t sure. This also made me understand that the importance of confidence in health care profession as a registered nurse.  As a result, I tried to gain more confidence with the help of my senior colleagues and doctors. I always used to clarify my doubts with them and studied many things which helped me gain confidence. To earn me more of confidence I started learning about the different disease conditions and management of chronic diseases especially cardiac arrest. I used to refer to cardiac books which made me gain more confidence in my nursing profession.

To put up in a nut shell, now I feel confident on my duty that will help me to be vigilant in future. From that incident I have understood good communication skills and confidence helps me to identify patient needs and also helps me to prioritize care. In my future nursing placements, I will use all the chances to improve my communication skills to prevent communication associated care mistakes.

From my personal nursing career experiences, it was before 3 years, I was assigned to work as a shift In-charge in the intensive cardiac care unit. There were 4 patients assigned to me and 4 staffs for helping me from which 2 staffs were registered nurses with an experience of 2 years and the other two were new to all the procedures and had experiences of fairly 1 months in our department. All the four patients were stable at the time of hand over. It was expected to be a normal day but unfortunately or fortunately it all turned upside down in just a fraction of a second.

As soon as the handover was taken, I handed over two patients for two nurses, who consisted of one experienced and one barely experienced. They had done all the observations and everything was going in a decent manner, suddenly, sitting at the central computer station I noted that the patient in the second bed was going into a cardiac arrest. The oxygen saturation and cardiac output was decreasing in fast pace, I alerted the other staffs who were engaged in starting medication rounds, we got into a team of three with the newly experienced staff keeping an eye on the other 3 patients. We had to do all emergency procedure and even the doctor had come in and eventually I was focused at only this patient and when the situation was getting worsen and the doctor was planning to ventilate the patient. While I was busy making arrangements for ventilating the patient I noticed that the other two barely experienced nurses where in doubt of starting medications for the other patients. It just didn`t make me realise of the pros and cons of, if they started medication administration without an experienced staff supervising them, so I requested them to administer medications to the other 3 patients.

This is where I made the ultimate worst decision. Within a couple of minutes, there was another patient going into cardiogenic shock. The blood pressure kept decreasing. Now it was bizarre having two patients in the same kind of situation. When I questioned the new staff I found out that she had administered hypertensive drugs without checking the B.P before administering it. I knew I was in a big trouble of losing my job or the worst letting the patient die due to my negligence. But fortunately there was no fatalities both the patient did survive the emergency situation, I had understood where I made a wrong decision and also I knew that I could handle a emergency situation.

 I have gone through circumstances where in I have committed negligence or lack of attention to minute matters which have led me into a difficult or emergency situation. But even though none of the emergency situation has been fatal there was one situation which was very critical. It not only shocked me but also taught me a good lesson in my life. It also made me realise that only through mistakes that are made one could understand his/her weaknesses and strength of life. From my personal point of view I believe that a person, who knows his weaknesses best, is the most skilled person. Even though I was alert and had taken my job seriously and always looked situations through all negative and positive aspects. A decision made by me, made me more strong and also made me  think at all times about all the possible facts which could may be lead into a problem or critical situation. I give attention to all the minute information’s from then on. No information is less or more.