Nurses are encouraged to evaluate and improve their practice by reflection. In order to help guide my reflection process I am using Gibbs (1988) as the model. This is a six step model which will allow me to reflect on the critical incident and look at ways in which I can strengthen and improve my own practice and that of my colleagues for the future. Within the analysis of the incident the patient will be known as Mr. B. This is in order that his real name is protected and confidentiality maintained, in line with the NMC (2004) which states:
“You must guard against breaches of confidentiality by protecting information from improper disclosure at all times”.
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Informed consent is always needed within every daily activity and individuals should hold the right to decide what happens to one-self. Many people do have the capacity to consent, but others are incapable. The British Society of Gastroenterology (BSG) Guidelines, (2008) would agree as they also believe patients have a fundamental human right to determine what happens to their own bodies. Respect for this right to personal autonomy is a cornerstone of good medical practice.
Mr. B was a seventy four year old gentleman who was seven days following a right hip replacement and had a two day history of fresh rectal bleeding. His past medical history included angina and hypertension. He had no allergies and medication included aspirin, lisinopril, simvastatin, paracetamol and diclofenac. Among the list of medication, two drugs are non-steroidal anti-inflammatory (NSAID’s). The elderly are more susceptible to side effects of these drugs which can cause gastro-intestinal side effects such as nausea, dyspepsia and gastro-intestinal bleeding and ulceration, British National Formulary (BNF) (2005).
Mr. B’s recent HB was 8.4 and previously been transfused with 2 units of blood on the orthopaedic ward. He had been referred to Endoscopy by our Gastrointestinal Consultant of the Day (GOD) with a referral form. His referral form is an assessment of severity of need for Endoscopy and gives a Rockall Score to determine how urgent the procedures are needed, Rockall et al (1996). MR. B’s Rockall score was five so needed an urgent Endoscopy.
Mr. B was on his own bed which was elevated at the head, he had a non-rebreathe mask in-situ delivering 10L oxygen therapy, 2 large bore cannula in-situ but did not have any fluids or blood in progress. My first impression was he looked pale, felt cold and did not look well perfused. I introduced myself and my role to Mr.B who communicated well but I could see he was tired and weak. I explained that he was in Endoscopy and asked him if he understood why he was here and what procedures he would be having.
On recording baseline observations Mr.B was hypotensive 98/50, tachycardia of 110bpm, respiratory rate 18 and saturations of 100% on 10L oxygen therapy. This gave him an Amber score of 3. Our pre-procedure checklist was completed accurately, legible and complete. The checklist ensures you are checking you have the right patient, highlights medical history, allergies and any other risk factors. When the Endoscopist arrived I explained the observations and suggested some IV fluid resuscitation which was declined and I was told “it is not necessary at present”. The Endoscopist introduced them self to the patient in the recovery area. Only verbal consent was obtained as Mr.B was very tired and could not sign his own consent form. He was then rushed into the procedure room. The procedures weren’t explained nor were risks and benefits. When I confronted the Endoscopist about this I was told the patient had...