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In this paper, I will examine the issues arising within the unit during of the patient transfer procedure. My examination will begin with a description of a clinical event that happen to me – describing environment, events and facts leading to the development of my experience. I will then elaborate, analyse and revise how the issues of common procedure implementation, job satisfaction and psychological effects on my well-being manifested themselves during and after this experience, followed by providing some new perspective and identifying and elaborating recommendations for future revision of my practice. In order to support the detailed elaboration, discussion, analysis and revising of each of the issues I will provide evidence from existing literature. A brief analysis of relevance of this issue to myself both personally and clinically will follow as well as a special section on how the critical reflection on the lessons learned from these events will influence my further practice as a registered nurse.
Looking Back: Clinical Situation Description
In our unit I am always assigned to brief and greet student nurses, provide them with orientation on how things are done here. I usually provide them with policies, rules and describe processes that are important for providing safe patient care. I am also one of the selected few persons who one could approach in order to prepare a short presentation or to be delegated to a conference or an interdisciplinary meeting to get an insights on the technological innovations in our area. I also guide them during patient transfers or so called hand-offs. In nursing practice patient transfers are a crucial element. Incorrectly transmitted information may result in providing inadequate patient care or even placing patients at risk. It is understandable though that we work in a fast pace environment and need to act quickly and follow the routine and can sometimes make mistakes. In all these documented instances of near misses the nurses are either lacking crucial piece of medication applied to a patient, or are simply rushing to get to another case. I am going to discuss one of the events when a patient transfer was not going according to the established procedure and it was witnessed by a student nurse whom I was teaching.
At the time of the event I was assigned a student nurse who I would be guiding from the time the patient is accepted in our unit, throughout the procedure and then being transferred to another floor as a post-op patient. Usually, after each procedure a nurse assigned to the case will stay with the patient and monitor his vitals until patient comes out of anaesthesia, as the surgeon would leave for other assignments. So when we have successfully completed colonoscopy procedure and patient came back from anaesthesia and his vitals were checked and confirmed normal we had to transfer him to another floor. It was done during a lunch time approaching. While transferring the patient to another nurse I have started following a procedure and protocol as trained i.e. mentioning the name, the age, medications, case etc.â€¦but was abruptly stopped by a receiving nurse who seemed to be in a rush who said that “we should skip all these” as “we are doing these cases daily” and that she was “in a rush”. I did not expect that from a decorate nurse and at first, I felt a bit embarrassed and surprised in front of my student nurse whom I was training. College of Nurses emphasizes on strictly following procedures and rules since they hold an important value in patient care (Chang & Daly, 2012). While it is quite common to rely on previous experiences and outcomes nevertheless when someone of a higher rank does not follow the recommended procedure it can create an uncomfortable feelings and in some cases a shock to the newly hired co-workers. Both myself and a new student nurse exchanged looks displaying total dissatisfaction and I insisted on providing the information in the correct way to much visible dismay of the receiving nurse. Later, I have spoken to our charge nurse and the manager expressing feelings of insecurity toward our patients as a result of this experience. Jointly we decided to hold a meeting with all involved to clarify expectations of the patient transfer process. This was both a negative and a positive experience. It taught me a lesson that even facing routine work I must be prepared for unexpected and able to confront surprises.
The key issue to analyse here is the nurse’s deviation from the established procedure and its effect on the patient care and the emotional responses it generates from other parties involved. Several researchers confirm that many nurses sometimes diverge from following their procedures properly (Chard & Makary, 2015). However, there are many additional factors such as agility of existing workflows (Currie, 2002 in Friesen, White, Byers, 2008, ch.34. para: 22 ), ability of a unit to perform as a healthy team, level of support offered by other unit’s personnel and perception of the best practices that are involved in in helping to move patients between units (Friesen, White, Byers, 2008, ch.34. para:22). As I have later approached my educator, charge nurse and manager I was relieved to learn that I at least followed correct steps by insisting to take patient transfer seriously, alerting my supervisor and thus providing on-the-spot training for a new comer how to deal with surprise events. To analyse this further it is important to understand that all of these were a part of a learning process. Transfer of patient is a repeating procedure that needs to be followed accurately and it involves a substantial amount of information gathering, processing and learning (Zielinski, 2012). Incorrect transmission of information will have serious implications for patient’s care. A recent study demonstrated an alarming statistics that 10 out of every 100 near misses events 50% of these events were avoidable (Sousa et.al, 2014 in Banihashemi, 2015). I have learned from literature that we have to accept the fact that information degrades with each patient transfer (Eberhardt, 2014). We also have to take into consideration that nurses work is complex and we make errors when are subjected to stress, being rushed, being interrupted during our communication (Ebright, 2015). Therefore it is important to have a patient-transfer sheets filled up priory to the beginning of the hand-off. Many health care facilities stress the fact that the nurse who transfers care of the patient during the high-task patient transfer is solely responsible to provide vital patient information to the receiving nurse (GPPD, 2015). That’s why at our facility it is also called transfer of responsibility. As I look back at this event I think the only additional strategy I should have implemented was to make sure that receiving nurse would have a patient-transfer checklist handed over to her and not being transmitted verbally the information orally.
Nurse’s learning and practicing never ends. Safeguarding our patients from any adverse events plays a huge role and therefore emotional stability of a nurse is a must (Zielinski, 2012). Emotionally stable nurse can provide better patient care. Referring back to the situation I confirm that I was emotionally distressed, embarrassed in front of my student nurse, felt low about the quality of care we provided and a bit insecure. I thought what if I was the patient to be transferred and same “rushed policy” would apply to me? I think there is an ethical and moral issue here that describes a feeling of insecurity since it is an expected outcome in this situation (Zieber & Williams, 2015). This incident with patient transfer is an exemplification of an event where we could have chosen a different course of action, like “letting it go”, caving under pressure of a decorate nurse, not reporting it to supervisor and thus possibly subjecting our patient to a risk. Therefore, it can serve as a good illustration for critical reflective practice analysis. After discussion with my educator, charge nurse and the manager I thought of preserving my approach but with a slight modification namely propose, design and implement a new patient-transfer checklist based on the SBAR technique. Our hospital decided to implement a Situation, Background, Assessment and Recommendation (SBAR) technique (originally created by the U.S Department of Defence) as a new set of tools for information transmission and improvement of nursing practises during patient hand-off. The SBAR initiative was also result of an understanding that physician-nurse perception of a team work differed significantly and well as methods of communication between nurses of different departments will vary. Therefore designing correct mode of communication was a new perspective for us.
While questioning the relevance of my nursing decision I confirmed an important lesson that patient safety prevails above all, and that patient transfer procedures are designed to be specifically followed since they carry important vital pieces of information. I also realized that there are many other important factors that may influence one’s selection of a course of action. However, it was crucial to understand that ethical and moral dilemmas should not be undervalued since this compromise may later lead to a high-risk situation that could have been avoided in the first place. This critical analysis helped me to be more informed about my nursing practice, tools that are or could be available to me, various barriers to communication, and problems in work environment, failed communications and reasons behind them as well as emotional turmoil that results when faced with issues that challenge my ethical and moral beliefs. It also reassured me that I am on the right path and with proper guidance from my mentors and educators I can make a difference.
In sum, building and demonstrating self-assertiveness, avoiding emotional turmoil, understanding, creating, promoting and correctly using new SBAR checklist, fostering teambuilding and inter-disciplinary collaboration, participating in leadership initiatives and exercising motivated me to be more knowledgeable and prepared to address the issue in a manner that would positively affect my future practice.
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