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To help me reflect upon an incidence from my professional experience placement program, I will be using Driscoll’s model of reflection (Driscoll 2019, p. 2). Driscoll’s model entails three phases to aid practice analysis in regards to incident that occurred starting with a brief description of the incident followed by describing what I have learned by showing how I felt at the moment and what I have learned from that experience and finally proposing the plan of actions for the future along with the way of implementing that. This reflective writing will be focusing on the ethical concerns that were breached in an incidence from my PEP.
I have already been taught regarding the significance of appropriate management of sharps in clinical setting. My educator has reinforced it many a times that post injection, recapping of the needle should not be done and rather it should placed in a kidney dish after injecting and dispose it into a designated sharps container directly from the kidney dish. During my clinical placement, the registered nurse with whom I was paired with instructed me to administer insulin injection to one of his patients. Working with sharps is quite critical. As, the major attributes that augments the risk of transmission of infections consists of deep wounds, hollow-bore blood-filled needles, visible blood on devices, the use of a devices to administer in arteries or veins, high viral load eminence of the patients (Akhuleh et al 2019, p. 206). I give injection to that patient and as soon as I was done with injecting immediately I realised that I had forgot to bring a kidney dish. I began to panic as I was new I did not know where the closest sharps container was located. The registered nurse when saw me, she immediately instructed me to re-cap it. I refused, as I knew that recapping needles augments the probability of a needle-stick injury that can potentially result in the transmission of severe blood-borne diseases. Again, I was instructed by the registered nurse to re-cap the needle and then, she started screaming at me to re-cap the needle. I become anxious and as soon as I started placing the cap on the needle, the needle accidently perforated the skin on my left thumb.
In that whole incidence, I felt that first of all, the registered nurse with whom I was paired with breached the duty of care as at that moment she did not care about my emotions and my safety. Percutaneous grievances that occur from sharp medical instruments are the potential cause of blood-borne pathogenic infections (Markkanen 2015, p. 359). Duty of care is considered as an elementary factor of nursing, and it has been considered as one of the most important part of the professional duties of a nurse. This principle states that nurses have a compulsion to avoid any act or omission that could potentially be a reason to harm other people. This means that nurses must predict the potential risks for the people around them and must take care in preventing them from any other coming harm. However, there can be legal implications if the care of duty is overlooked by the healthcare professionals including that of nurses though it can be subjective relating to the situation a person is under like situations of emergency and likewise (Dowie 2017, p. 19).
Secondly, the ethical theory of autonomy was breached as the registered nurse compelled me to do the task according to her thoughts, she asked me to re-cap the injection which is not safe while as per my understanding it should have been disposed straight away without re-capping it. This act was not even unsafe but also breached the autonomy which is the right of every individual. Autonomy refers to respecting the other person’s thoughts and enable the other people to take their own decisions until it is regarding them and is potential of causing harm to themselves. Professional autonomy is the right of nurses it is giving them the authority and power to make decisions along with giving them freedom so that they can work in accordance to their professional knowledge. There is a need for understanding autonomy for clarifying and developing the nursing profession in the quickly changing health care work environments (Skar 2009, p. 15).
Lastly, the registered nurse has done negligence towards me. Negligence can be the recklessness or carelessness attitude towards someone that can potentially cause harm. The registered nurse did not think about it for a second, she was not concerned about the harms and risks that could be generated by that act. There are so many blood-borne infections that are chronic and some of them are even untreatable. This act of not concerning about the safety shows the negligence by the registered nurse towards me. It is everybody’s right to be treated with seriousness and be protected from any harms that can happen. This act has led to the injury that can even cause some serious blood-borne infections.
If the same thing happens in future my possible ways of dealing with this would be first, to build an effective communication with the registered nurse in order to make her understand the potential risks that can take place by such acts. Communication was the primary source of resolution. In nursing relationship approaches or wide-range of communication has been supportive in positive nurse-nurse interactions. If we talk about the basic level, starting with common affability and speaking up to reduce the misconceptions about other nurse set a fundamental foundation for open dialogue. However, identification of positive intention of achieving a patient, team, or family outcome helps in promoting a shared goal that leads in facilitating the knowledge transfer. When encountering conflict or disputes at workplace that seem insuperable, terminating the negative judgments and showing empathy while listening helps in understanding and respecting different perspectives which in turn promotes the knowledge transfer and enhances the decision making ability of an individual. Apologizing and acknowledging any misunderstandings helps in fostering the ongoing communication (Bonnice 2015, p. 17). Though, this could also turn into a conflict and for that my approach will be handling conflict as it is an important skill for anyone to prevent from creating hindrance in employees' professional growth. According to the American Management Association, 2019, for resolving any conflicts at workplace the steps mentioned below can help:
If this also does not work the next and the final move would be reporting to the facilitator and the nurse in-charge and letting them know about the registered nurse doing negligence, breaching the autonomy and duty of care.
This reflection has provided a concise knowledge regarding the ethical challenges that could be faced by the nurses at workplace just like what happened in the given scenario. In healthcare, nurses have been considered as the biggest professional group. They often face the workplace conflicts. Most of the time of their training session consists of demonstration of compassionate, caring, and empathetic behaviour along with preparing them for management and resolution of conflicts a little. It is very necessary to not to breach any ethical consideration of not just of the patients but also of the staff members to protect them from the potential risks. To maintain a healthy work environment, free from any unsafe practices and maximizing the patient care there is a need to establish the positive working interpersonal relationships by building effective communication among the staff members.
Akhuleh, O. Z., Nasiri, E., Heidari, M., and Bazari, Z, 2019, ‘Frequency of sharp injuries and its related factors among high-risk wards staff’, Journal of Nursing and Midwifery Science, vol. 6, no. 4, pp. 204-209.
American Management Association 2019, ‘The five steps to conflict resolution, viewed 14 August 2020 <https://www.amanet.org/articles/the-five-steps-to-conflict-resolution/>
Bonnice, B. 2015, ‘Nurses’ communication skills and response to conflict: impact of new directions, relational skills training’, Scholar Archive, vol. 3, pp. 1-45.
Dowie, I, 2017, ‘Legal, ethical and professional aspects of duty of care for nurses’, Nursing Standards, vol. 32, pp. 16-19, pp. 1-8.
Driscoll, J., Stacey, G., Harrison-Dening, K., Boyd, C. and Shaw, T., 2019. ‘Enhancing the quality of clinical supervision in nursing practice.’ Nursing Standard, vol. 34, no. 5.
Markkanen, P., Galligan, C., Laramie, A., Fisher, J., Sama, S., and Quinn, M, 2015, ‘Understanding sharps injuries in home healthcare: the Safe home care qualitative methods study to identify pathways for injury prevention’, BMC Public Health, vol. 15, pp.359.
Skar, R, 2009, ‘The meaning of autonomy in nursing practice’, Journal of Clinical Nursing, vol. 19, pp. 15-16.
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