Healthcare Services Industry - the Process of Caring For the Patient - Assignment Example

Healthcare Services Industry - the Process of Caring For the Patient Introduction In the healthcare services industry, caring for the patient is the primary duty of all healthcare professionals. However, the process of caring for the patient is highly dependent on the individual case. Being that each case may differ from the next, caring for patients is a continuous learning process for healthcare professionals. Every encounter of the healthcare worker with a patient aids in the development of the professional. Each case has a lesson to be learned or a strategy to be adopted for future use. In order to determine what a certain incident may teach the practitioner, a careful analysis of the events and choices made that may have had an effect on the outcome of the incident must be taken into consideration. Each of such factors contributes to how the incident turns out to be. In this paper, a particular critical incident will be analyzed. Critical incidents are defined in relation to the setting or area under consideration because critical incidents occur in various fields and industries. In this paper, the definition of a critical incident in the healthcare setting will be utilized. According to Rolf et al (2001), the term ‘critical incident’ has come to be associated with a ‘life-threatening or dramatic event” Moreover, a critical incident in such setting may be characterized as, “one which led or could have led to harm if it had been allowed to progress.” (Rollins, 2001) Other writers have attempted to define critical incidents. However, the most common notion that is shared by most authors is that a critical incident may cause harm to patients if healthcare practitioners fail to employ the appropriate strategies. However, there are authors that have said that identifying critical incidents are highly dependent on the perception and understanding of healthcare workers and professionals. In most cases though, critical incidents provide healthcare practitioners with much room for improvement and development in their profession and practice. In this light, this paper will analyze the events and decisions that have influenced a particular critical incident most especially the impact on the outcome of the said incident. My reflections in terms of my personal and professional development will be discussed in relation to the chosen critical incident. Finally, this paper will discuss the strategies that may help improve the outcome of future critical incidents of the same or similar nature as the one chosen for this discussion. The Critical Incident I would like to analyze an incident that happened when I was a medical student carrying out my role as a student Operating Department Practitioner (ODP) under a Registered Operating Department Practitioner (RODP). I was on placement in the anaesthetic room within a local NHS trust and in order to comply with the rules of confidentiality, in accordance with the Association of Operating Department Practitioners (AODP), Student Code of Conduct (2005), the patient, if named, will be done so under a pseudonym and only for the purposes of this assignment. Prior to the commencement of the operating list, I prepared and checked all of the equipment required for the first case including the anaesthetic machine. The anaesthetic machine was checked following a printed check list and was dually signed by myself and countersigned by the RODP in accordance with Trust policy. It is also a mandatory requirement of the Association of Anaesthetists of Great Britain and Ireland (AAGBI), that the anaesthetic equipment must be checked in accordance with their recommendations (Association of Anaesthetists of Great Britain and Ireland, 2004). Between checking the anaesthetic machine and the commencement of the list, there was to be a delay due to some confusion as to whether the list would go ahead as the paediatric anaesthetic consultant for this case was no longer available. In the mean time the RODP and I were reassigned to assist with the list in another department. On returning to the operating department (approximately one hour later), we were informed that the list was going ahead as a suitable qualified replacement anaesthetist had been found and that the first patient had been sent for. The patient was a two and a half year old girl who was to undergo an elective tonsillectomy. The child was visibly distressed and required some effort on the part of the anaesthetist to cannulate and induce anaesthesia. This affected me emotionally as I have never been present during a paediatric case and having a child of my own at that age was particularly poignant. Once the child was unconscious, the father was relieved of the child and was escorted out of the anaesthetic room. I began to place monitoring equipment on the patient, as the RODP assisted with the intubation and securing the airway. Once the child’s airway had been secured, the consultant anaesthetist connected the breathing circuit to the endotracheal tube and turned on the sevoflurane. It was at this stage that I noticed the anaesthetist was having trouble ventilating the patient, due to a leak in the circuit, which was very audible. The RODP was trying to correct the problem at the same time being requested by the consultant anaesthetist to continually press the oxygen flush button on the anaesthetic machine, in an attempt to ventilate the patient. During the event, the consultant anaesthetist, attended by the anaesthetic registrar challenged who had checked the anaesthetic machine. The RODP discovered the source of the leakage as an incorrectly seated vaporizer on the port valves of the manifold. The problem was resolved; the patient was ventilated and preceded to the operating room and underwent surgery with no further incident. The misplacement of the vaporizer that led to ventilation problem, led to a tense situation in the anaesthetic room. The girl needed to be monitored, the source of the problem, initially unidentified, built up the pressure and led to harsh exchanges between the RODP, the anaesthetist and the anaesthetic registrar. In such a situation, often, when a life is at stake, human psychology tends to find a source for the cause and attribute the problem to something or somebody. Spontaneous evaluations encourage a blame-validation mode of processing in which evidence concerning the event is reviewed in a manner that favours ascribing blame to the person or persons who evoke the most negative affect or whose behaviour confirms unfavourable expectations( Alicke, 2001) This incident provoked a number of feelings in me. Initially I felt guilt and horrified at my perceived failings - had I really checked the anaesthetic machine correctly? If the problem was not quickly identified, I could have been the cause of further harm on the child. These were the thoughts that were running through my head. Although at the time of checking the anaesthetic machine, I felt confident in my own competence, I may have allowed my actions to become routine and task orientated, rather than detail-oriented. My negligence or oversight could have led to serious medical implications for the girl or worse, cost her life. Pre-operative checking rules and regulations have been laid out by the Association of Anaesthetists of Great Britain and Ireland, and are followed by all the RODPs, ODPs and doctors in both the countries. A deviation, even if unintentional or unconscious, will invite a critical judgement of the superior medical officers in the anaesthetic and operating rooms. I learnt this the hard way, realizing how important it was to stick to the routine checking with alacrity and attention to detail. The incident inculcated in me the value of strictly abiding by the regulations set for pre-operative checking. It made me realize the true value of such checks and the possible irreversible outcomes of the disregard of such rules on the health and well-being of the patient. Reflective Analysis For this incident to be of benefit to my personal and professional development, it is essential to reflect upon the events and emotions of those involved, examining and interpreting the incident in order to learn from those experiences. There are two types of reflective practice, according to (Schon, 1987), reflection-in-action and reflection-on-action and there are a number of reflective frameworks that can be used as a tool to structure the reflective process which the healthcare professional is encouraged to use (Burns and Bulman, 2000). These enable critical incidents to be described, analysed and evaluated in order to promote learning (Cooney, 1999), develop knowledge and expose areas that require development (Driscoll and Teh, 2001). Silén-Lipponen, M., Tossavainen, K., Turunen, H. and Smith, A (2005) also suggest that healthcare professionals be encouraged to use reflection to reduce the incidence of errors during practice. According to Johns (1995), the main purpose of reflective practice is, ““to enable the practitioner to interpret an experience in order to learn from it.” Furthermore, it is described as a process that involves examining individual personal thoughts and actions in daily practice. (Somerville and Keeling 2004) In this regard, it is vital to determine the possible reasons why a certain incident transformed into one of critical nature. In the critical incident discussed, it was the misplacement of the vaporiser that could have severely harmed the patient. There could be two reasons why the vaporizer was misplaced. One was a gross oversight on my part and I must not have checked the equipment minutely before signing the document. Or, when my RODP and I were called away on another operation, somebody could have fiddled with the equipment in our absence, and hence led to the leak in the ventilation circuit. I would like to analyze both the assumptions and see what I can learn from the critical incident sited here. If the case was my oversight, the absence of the usual paediatric anaesthetic practitioner and the lack of decision as to whether the current operating list would be used or not, could have led to the unconscious assumption that this operation might be postponed or delayed. This could have led to a slightly careless approach towards checking the equipment and signing it off. My presupposition that there could be nothing wrong with the machine and the confidence in my own competence led my perception of the checking just as routine, rather than something to be done with extreme care. I am still harbouring feelings of guilt, especially since I have a child and I kept thinking “What if it were my child, would I have been so careless?” A student medical practitioner is just learning his way around the operating room. He\She still needs a printed checklist to confirm that everything is in order. This also means that even with the printed list, I could have overlooked some minor detail, which eventually led to the leak. If it is the second case, then, it could have been that, once the replacement anaesthetist was found, somebody could have rechecked the whole equipment, just to confirm and unsettled the vaporizer. Critical reflection on the incident can provide valuable learning outcomes, which will benefit the medical career of not just the person citing the critical incident, but for future generation of medical students. Critical reflection is a valuable tool by which practitioners whether new or seasoned, may learn valuable lessons that they may apply and practice. It serves as an avenue by which healthcare professionals may continuously improve themselves both professionally and personally. (Plack, 2004) Also, as stated by Barnett (2005), “The reflective process allows practitioners to question and analyse their experiences and actions as a means of developing their knowledge, skills and behaviour, to enhance clinical practice.” Jack Mezirow, in his essay ‘How Critical Reflection Triggers Transformative Learning’, writes, “We very commonly check our prior learning to confirm that we have correctly proceeded to solve problems, but becoming critically aware of our own presuppositions involves challenging our established and habitual patterns of expectation, the meaning perspectives with which we have made sense out of our encounters with the world, others, and ourselves”. I have hence realized that it is important to maintain a record of my actions in the pre - operative situations and to be careful not to take anything for granted. This would help me be immediately aware of any mistakes that can occur on my part. Patient safety is the primary concern, anyway, and what professional bodies like the AAGBI and the Association of Operating Department Practitioners (AODP) keep in mind when they draw up regulations and checklists for pre and post operative care. Moreover, I realized the important role that such professional bodies play and how they could help protect the well-being of patients. The deviation is a serious reflection on a student’s code of conduct. The AODP lays down strict parameters on a student ODP’s behaviour in his\her professional capacity. In this critical incident, I failed to follow the dictum; whilst studying for the Diploma in Higher Education in Operating Department Practice students will at all times uphold public trust and confidence in the profession by maintaining appropriate personal and professional standards of behaviour (AODP Students Code of Conduct: pp 1) The sensitive situation in the anaesthetic room always has an impact on the people working in it. The doctors and the ODPs need to be constantly alert, anticipating problems and preventing them successfully. At such a stage, a vaporizer misplaced leading to a ventilation problem has a profound impact on the psyche of all those trying to prepare the patient for the operation. In my case, while I was struggling with my own feelings of confusion and guilt, the RODP was trying his level best to pump oxygen to the girl as well as find the source of the leak. The anaesthetists were desperately trying to ensure that the little girl come to no harm. Time was crucial, and looking back, I realize it is important to stay focused on the situation at hand, instead of trying to find out who is to blame. I knew, in future, that I could not afford to stay confused and entertain guilt, but try to identify the problem immediately and solve it. A second check after I came back from the other department would have lessened the risk to a great extent. The printed check list was just a guide for me; I could have used my experience to do a further, but minuter check on the equipment. In case of an urgent operation, I think that a check made by two members of the operating department would ensure better that everything is in order. Such cases require careful adjustment to the time constraint. Therefore, there is greater chances for mistakes to be made as time pressure may affect the manner by which one follows procedure. Therefore, ensuring that two people perform the checklist will provide greater assurance that the proper equipment have been checked and are in order. Future Intervention The Atkins and Murphy model of reflection details the method by which a medical practitioner can analyse a critical incident that happened in his\her career. The model requires a description and an analysis of the situation, with proper awareness of any uncomfortable feelings, determination of the knowledge levels and their use in solving the problem and most importantly, an identification of the learning that has occurred. The analysis of critical incidents is crucial to the provision of safe, high quality healthcare services to patients. It is essential to analyse the incident and make decisions about how future similar incidents should be dealt with (Connor J, 2003). As it happened, I can think of a lot of ways in which such a situation could have been prevented. A second, but quick check on the machine, just before the patient is brought in, will override any carelessness on my part. Actually, this would have also ensured that any unseating of equipment parts during my absence would have been corrected. A re-check does no harm anyway. But after the incident, I am always careful to double check the printed list and follow the procedures laid out by the AAGBI before signing the document and getting it counter signed. In case of urgent operations, where there is not enough time for a second check of the anaesthetic equipment, I make it a point to see the first and only check should be thorough. I know now how many critical incidents happen just in paediatric anaesthesia alone. A study conducted by a couple of doctors in Singapore has shown that 10,000 such cases were reported in their hospital alone. Critical reflection and analysis of critical incidents like the one in my experience is necessary to avoid oversights and mistakes on other Operating Department Practitioners and anaesthetists. Primarily, I believe that an important strategy to adopt in the future would be for ODP practitioners to be guided accordingly. This maybe accomplished by furnishing them with guidelines that could be posted in their stations and in areas in which they perform their duties. A checklist posted in the pre-operating room would be greatly valuable for it will allow the staff in the operating department to double check whether they have performed all the necessary tasks and if they followed the proper procedure accordingly. Finally, I think that it would be in the best interests of patients that staff members of the operating department perform checks on the equipment as close to the time of operation as possible. However, it must be guaranteed that completion of the checklist will not be taken for granted simply because of time constraints. Simply put, ample time must be given to ensuring that the equipment necessary for a certain operation are properly checked. This, I believe, would greatly lessen the chances of malfunction of equipment that could be traced back to the checking and verification of the equipment. 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