Prabha Mary Gregory John

                                          Reflective journal - Part E

My incident was the patient, Mrs Higg get aggressive and she attacked the nurse because she was neglected by staff and her needs were not met. As a nurse we should need to know how to handle this situation properly. As I am a student nurse, I never been face like this type of incidents so I was so panic and I didn’t know that what have I do to prevent this incident. The Enrolled nurse who worked with me has got many years of experience but she couldn’t avoid this from happening. She told to me, during her nursing field she hasn’t been experienced like this physical threatening. Registered nurse also couldn’t control him because the situation was worse when she came to the patient.

I was very unhappy in that day because I felt guilty because no one could avoid this incident from happening. When I reached to home I read the book which explaining the care and management of aggressive patients. I researched some journal articles  about the management of aggressive patient. One week after this incident the nursing management arranged an education programme which make clear the action we have to do immediately to save the patient as well as staffs from these sort of threatening events or incidents. Continuous professional development programmes in nursing field needs to be attended which improves our knowledge and skills in nursing profession. Now I can handle the situation confidently after observing the nurse and going through the theory. I will not forget this incident ever. I will improve my skills by researching on the conditions, observing others action, critically thinking and reflecting on the procedure. By referring to the evidence based journals I would be able to improve my knowledge and skills on how to work according to current evidence based practice. Reflective journal helps in professional as well as personal development. With reflective journal we can think critically on the incident and incorporate changes when the same incident happens next time.

Evidence from the acute care setting suggests a relationship between nurses’ work environment, patient safety, and quality of patient care. A positive work environment is one that supports nurse autonomy and control over the work environment. It is an environment with strong and visible nursing leadership, organizational support, peer support, and positive physician collaboration Prevention is the identification of risks that can arise in the organization and the development of policies and procedures which can contribute to reducing the risk of critical events occurring and/or minimising the effects. The people who work in an organization should understand the policies and procedures in that particular organization in order to prevent the risk factors. Documentation is very important in the nursing field. Accurate documentation is egal and confidential which gives all information about the patient.   Once Mrs Higg, the patient in my critical incident, settled down the RN and EN documented all about this incident and informed to the management. Accurate documentation protects the nurse as well as the patient.

From this incident, I am able to identify my weakness which will turn into strengths. The reflective journals and professional development education sections helps me to improve my skills and knowledge in nursing profession. If the same incident happens again in the future, I will be more confident in speaking out. I think it is very important to do the best and act prudently to prevent an incident like this in the future. I have learnt a lot from this experience. This would make me a better professional student nurse, which will lead me into being a qualified nurse.

                                                                  PART D

The incident was that the patient became more aggressive and refused to take tablets because the staff neglected his needs. According to my view, the incident was a life-threatening and it needed to be immediately resolved to prevent further reactions from the patient. Each person has his or her own point of view about patient care. Some staff gives more attention and care to others but some staff doesn’t. In this critical incident, the enrolled nurse did not handle this situation properly. She thought that she could manage this incident by herself, so she did not call the registered nurse until the situation became worse. The enrolled nurse has not given much consideration for the patients’ needs and she did not listen to him properly. She also did not try to give him the medication again even if the patient refused to take the tablets. If the enrolled nurse had informed RN about it at the beginning, the incident could have been prevented. But when the RN came, the patient became aggressive and tried to attack the nurse. The RN tried to calm him down but could not succeed. The only thing she could do in that situation was to ring the emergency bell and called his family. Somehow she managed the situation properly.

When the patient started to disturb others and not listening,   I thought to take him to his room or to a comfortable area to communicate with him about his problem. I told about this to the EN. As it was a busy time and she was the only person allocated in that area, she told me to ignore him. As a nurse, I should not have done that but in that situation I obeyed her. I wanted to inform the RN, but the EN refused to inform about it to the RN and she told me that we could handle it. Since I am only a student nurse, I stepped back from my decision. She may think negatively about my action because she is an experienced nurse and I am only a student nurse trying to give directions to her to handle the situations. When the RN came, I helped her to call the family and then I rang the emergency bell. I think the registered nurse observed and thought about my actions positively because I didn’t step back and tried to involve actively managing the situation.

Different people have different perceptions about patient care. It depends upon the nurse- patient ratio, time management, adequate resting period for the staff etc. In this incident, the enrolled nurse was busy in the ward.  She did not have enough time to talk to the patient. I know that the patient has the right to refuse medication but it is the duty of the nurse to explain the importance of taking medications and encourage him to take it. Since the nurse was very busy, she did not bother about to do the right things for the patient. But in the case of RN, at least she tried to make an interpersonal relationship with the patient in that last moment. But the patient was really aggressive at that time so she couldn’t stop his behaviour.

From this incident, I am able to identify my weakness which will turn into strengths. If the same incident happens again in the future, I will be more confident in speaking out. I think it is very important to do the best and act prudently to prevent an incident like this in the future. I have learnt a lot from this experience. This would make me a better professional student nurse, which will lead me into being a qualified nurse.

Even if I had taken the time to talk to the patient, the incident may still have occurred. Staff can sometimes experience other powerful emotions, such as anger and resentment, towards an aggressive client. Others can be emotionally affected by heightened feelings of fear and suffer a loss of confidence in their own ability to cope. If the nurse talks to him properly or in a friendly manner, perhaps the severity of this incident could be reduced.

In this incident the nurse avoid Mr. Higg to listen his needs even after he came to stand in the nurses’ station for a while. It made him more aggressive. He should have been assessed effectively to establish his reasons for drinking excessively. The staff team should have taken action and given appropriate intervention related to his problems. Many nurses feel it is not within their role to question patients about alcohol or to give patients advice about drinking levels. The main reason often quoted is lack of time; many nurses felt it would take too much from an already pressured working day to implement any type of intervention for this patient group. He should have been treated equally by the staff team rather than not being given enough priority because of his alcohol problem. I felt that Mr Higgs did not get equal rights such as enough attention from the staff team. It may be because he was labeled as a “trouble maker”. The enrolled nurse thought that she can manage this situation alone, so she did not inform to the Registered nurse until the situation became worse. Lack of communication between enrolled and registered nurse caused ending up in a bad situation. In addition, staff should have been encouraging Mr Higgs to take the tablets. If he had taken the medicine he may have been more relaxed and not acted in this way because sometimes the symptoms of alcohol could resolve rapidly as the effects of drugs.

When he asked for alcohol the nurse straightaway told him that he was not allowed to have alcohol in the hospital. If it is a nice way of talking may be he will not get aggressive behavior. We knew that Mr Higg had a history of violence and aggression. When he started aggressive behavior, as a nurse we have to talk nicely and to give him reassurance. Instead of doing this the nurse did avoid him. It made him more aggressive and he could not control him and he attacked the nurse. If we think and act as a professional manner the incident could have been avoided. When his family came and talk to him, he calm down and he apologized to the staff next day.

If this incident arises again I would be able to deal with the situation more professionally. I will use some nursing interventions which range from preventive strategies such as self awareness, patient education and assertiveness training to anticipatory strategies such as verbal and non verbal communications and the use of medications. I will be able to assess the patient at risk for aggression and violence and intervene effectively with patient before, during and after the aggressive episode. I will talk to the patient in a calm manner and establish a therapeutic alliance with patient. Ongoing self awareness and supervision can assist the nurse in ensuring that patient needs rather than personal needs are satisfied.

Reflecting on this incident I feel that I could have managed it differently by being more confident and having the courage to speak out to the nurse in charge. Overall I have found it is very important to act in the best knowledge as you can, to prevent any circumstances arising. I have been able to identify my weaknesses that can now turn into strengths. I feel now that I have learned a lot from this experience that will hopefully make me a better professional student nurse, leading me into being a qualified nurse.

 Mr. Higg was very restless and wandering around the ward and disturbing other residents and staffs for a long time before the incident occurred. I read his case notes, I came to know that he has the history of excessive alcohol consumption and aggressive behaviors. It was a busy time in the ward, so the nurse was unable to give adequate care or consideration for him. Even though the nurse was busy, as a student nurse it was my responsibility to spent some time with him and give him reassurance. If I did this, maybe I could prevent this situation. When I saw the other nurse was physically assaulted, I was so panic and I could not move to help the nurse.

The positive elements of this incident are, the nurse tried to calm him down, but could not work it out. The nurse asked me to call the registered nurse and to press the emergency button. The emergency bell went and everybody rushed to him. The registered nurse immediately called his family because the nurses failed to calm him down. Another thing is that, family reached suddenly and gave him reassurance. It helped him calm down.

 As a student nurse, what I felt, we could have been done well to prevent this incident.  The nurses should read the case notes and care plans of their patients thoroughly before taking over them. In this way we can reduce or prevent these types of incidents. Staffs should not avoid him when he stands in the nurses’ station and annoying others. He should have been treated equally by the staff team rather than not being given enough priority because of his alcohol problem. Staff should spent some time to talk with the patient to see if he had any worries. We could have avoided the incident by speaking out and making staff aware of Mr. Higgs feelings.  If I had used better communication skills this could prevented from happening. In reflection of this incident, I feel that Mr Higgs should not have been isolated in the side room, even though he had an alcohol problem. He should have been assessed effectively to establish his reasons for drinking excessively. The staff team should have taken action and given appropriate intervention related to his problems. On reflection with Mr Higgs problems if I had been approachable, the incident could have been avoided. The lack of communication between Mr Higgs and staffs made him more isolated. Staff should have to encourage Mr Higgs to take the medicine. May be if Mr Higgs had taken the medicine he may have been more relaxed and not acted in this way.

There was not adequate staffs in the ward where the incident took place. One enrolled nurse and I was there when the incident happened. This is also my responsibility to inform to the registered nurse when he first started this kind of behaviors. But we did not think that this will end up like this. So there was some delay to inform the registered nurse. In this incident RN played some leadership role. But when RN arrived, the situation was very bad and she was not able to prevent the incident. She tried to calm him down and informed his family. If we informed to the registered nurse at the beginning, may be this incident will not happened. In future, if I will be the leader, I will work as team and maintain a good interpersonal relationship with patient as well as staffs. Thus I will know the patients concern and how it can manage effectively.

The lack of experience to deal with this situation made me realize that I have to act to the best of my knowledge to avoid this incident happening again.  This incident made me realize how I can put this learning experience to positive use in my future practice as a nursing professional. I have been able to identify my weakness that can now turn into strengths. I have learned a lot from this experience that will make me a better professional student nurse, which lead me into being a qualified nurse.

The aim of this assignment is to explain a critical incident which I observed in my recent aged care placement. One resident, I named him Mr. Higg admitted as a permanent resident in the nursing home suffering from dementia. According to his history he used to take large amounts of alcohol while he was at home. He had been drinking heavily which made him aggressive. They put him in a room which is separated from other rooms, as it appeared as if he could be harmful to the other residents. As I began my shift I could see he was becoming agitated. It was a busy time in the Nursing home, staffs were rushing around and the doctor came for the rounds. Mr. Higg came to the nurses’ station and looked annoyingly at one of the nurses. As the nurse was very busy, she did not have enough time to assess and talk to him. I was not aware that this had made him more agitated. I tried to ignore him, as he was walking up and down the ward corridor and sometimes disappearing. When the nurse doing the drug round and she was trying to communicate to Mr. Higg to eat his lunch, as he needed it for his medication but he refused to eat anything and he demanded to have some alcohol. The nurse explained to him that he was not allowed to have alcohol in the aged care facility. This made him more frustrated and increased his violent behaviour. He was shouting and asking alcohol again and again very loudly. He was more aggressive verbally and within few minutes he attacked the nurse. I was shocked and could not move when I saw what had happened. The emergency bell went and everybody rushed to him. I then managed to go to them and tried to help them to pull him away from the nurse. One staff rang his family and the family arrived immediately and reassure him. He calmed down when the family reassure him. The nurse was also shocked, as she had not expected this to happen. .

As a student nurse I observed that Mr. Higg was very restless and wandering around the ward and disturbing other residents and staffs before the incident occurred. As a student, I thought that there were a number of reasons of his aggressive behaviour, the staffs were neglected him or his demand for alcohol  and that was not met, therefore attacking the nurse because of his frustration. Another reason was they put him in a separated room which made him unhappy. I feel that Mr. Higg should not have been isolated in a separated room, even though he had alcohol problem. I felt that Mr. Higg did not get equal rights such as enough attention from the staff team. He should have been assessed effectively to establish his reasons for drinking excessively.  Another reason, I felt that lack of nurse-patient relationship that cause barrier of communication.

 Reflecting on the incident I felt that I did not act in the best interest for the safety of all the staffs and residents. Considering that I knew that Mr. Higg had a history of violence and aggressive behaviors I did not take into account what the patient was capable of. But I did not do anything to prevent the incident happening. I feel that I have not acted as in a professional manner, which I should have done.

I have found it is very important to act in the best knowledge as you can, to prevent any circumstances arising. I have been able to identify my weakness that can now turn into strengths. I have learned a lot from this experience that will make me a better professional student nurse, which lead me into being a qualified nurse.