An analysis of a critical incident related to the care of a patient of a higher

An analysis of a critical incident related to the care of a patient of a higher dependency who is critically ill.


This paper is reflection essay, exploring an aspect of care for a critical ill patient. Baillie (2005), described a reflection as a practice that provides evidence of skills development and increased clinical competence in nurses. The patient involves is a 60 years old female, who presented with shortness of breath and chest pain. The diagnosed was infective Exacerbation Asthma. The reflective diary was impossible to write, as the patient was under our care for a week before she was discharged. Finally, the role of the nurse and my experience of involvement will be addressed. Due to confidentiality purposes, the patient will be referred to as “Mrs A“, (Nursing and Midwifery Council, 2008) (NMC).
Communication plays an essential part in all care delivered; according to Sulley and Dallas (2005), nurses have a role in ensuring that effective communication skills are utilised. Communication is a two way process, is the only means a patient can get information about their illness William (2000). It can speed up recovery; reduce the number of complications stress, pain relief, and fear. Furthermore, requires engagement, empathy, an ability to listen and respond and it also requires time however, there is evidence that it’s not always done well in the health service (Arnold & Boggs, 2004).
According to NMC (2008) nurses have a professional responsibility and accountability where administering prescribed medication and must have a sound knowledge in the medication administered and its side effects. In addition to that Hendrick (2000) states that nurse have a duty of beneficence to their patients and this was done by identifying the needs of the patient and discussing her care with the doctor. Mrs A was prescribed Salbutamol 5mg nebulizers and Atrovent 500mcg,
Benzylpenicillin 1.2g, Clarithromycin 500mg, and Hydrocortisone 100mg infusions was also given as prescribed by the doctor. Mrs A was also instructed to use peak expiratory flow which measures the lung volumes and airflow. Explanation of the medication and how to get It, was explained to Mrs A in order to ensure she understood the need for taking the medication and side effects, of which resulted in better recover .
According Hogun and Award (1992) supports this way of care provision as failure to discuss drug regimes with patients is one of the reason why patients refuse to comply with medication, which further causes relapses of their sickness. According to Shaw (2006), nurses should be aware that a patient, as in Mrs A’s case, the higher the risk due to a decline in drug metabolism and elimination. It was therefore importance to start on low doses and gradually increase the dose if need be and nurses should be aware of the side effects such as nausea and drowsiness of drugs, (Herr 2002).
Furthermore, according to the NMC(2004) nurses must always update their skills and knowledge on current practice, in order to make the right decision and to be aware of any harmful effect the medication may have on the patient. Furthermore, if Mrs A was not using her medication properly it could impact on her exacerbation; therefore, re-educated and ensured the proper use of her asthma medication (Herr 2002). This would cause patient been readmission to hospital.
In conclusion, this reflection explored the an aspect of care for a critical ill patient. The role of the nurse with regards to communication and medication has 3
been mentioned. The Importance of reflection on practice enabled an improvement to professionalism and patient care. In regards with my experience with Mrs A, Looking back I feel confidence in my abilities to conduct an effective assessment; when faced with similar situation in future and I have learned that having knowledge and experience in caring for a critical ill patient is a key to therapeutic.
Arnold, E. and Boggs, K. (2004) Interpersonal Relationships: Professional Communication Skills for nurses. 3rd ed. London: Saunders.
Baillie, L. (2005) Developing practical nursing skills. London: Hodder Arnold.
Hogun, P. and Award, G. (1992) Subjective response to narcoleptics and outcome in schizophrenia: A re-examination using two measures psychological medicine 22, 345-352
Knowles, N. & Charles, C. (2006) Innovation and teamwork: introducing multidisciplinary team ward rounds. Nursing Management 13(1): 28 31.
Lavery, I. (2003) Peripheral Intravenous Canulation and patient consent. Nursing Times 26(17):40-42.
Nursing and Midwifery Council (2008) Code of professional conduct: standards of Medicines Management. London. Nursing and Midwifery Council
Nursing and Midwifery Council (2008) Code of professional conduct: Standards for conduct, performance and ethics. London. Nursing and Midwifery Council
Sully P & Dallas J (2005) Essential communication skills for nursing. London Elsevier Mosby
Strobe, C.(2000) A Guide for Nurses and Midwifery. London, Macmillan Press.
William, D (2000) Communications Skills in Practice: A practical Guide for Health Professionals, London, Jessica Kingsley.
Watson, R., & Tilley, S. (2004) Accountability in Nursing and Midwifery, 2nd edn. Oxford: Blackwell Science.



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