Reflective writing allows individuals to have a deeper understanding of their experiences, particularly critical incidents that had an impact on the

Reflective writing allows individuals to have a deeper understanding of their experiences, particularly critical incidents that had an impact on them. While experiences alone can provide valuable learning lessons, it is through reflection that individuals are able to fully comprehend the lessons gained from these experiences. By looking back at a critical incident, individuals can analyze the situation from different perspectives and consider the various factors that influenced the outcome. Reflective writing is important in the field of nursing as it helps develop critical thinking skills and helps in coping with critical incidents and the emotional impact that comes with it ADDIN EN.CITE <EndNote><Cite><Author>Zannini</Author><Year>2011</Year><RecNum>15</RecNum><DisplayText>(Zannini et al., 2011)</DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1696516728">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zannini, Lucia.</author><author>Cattaneo, Cesarina.</author><author>Brugnolli, Anna.</author><author>Saiani, Luisa.</author></authors></contributors><titles><title>How do healthcare professionals perceive themselves after a mentoring programme? A qualitative study based on the reflective exercise of writing a letter to yourself</title><secondary-title>Journal of Advanced Nursing</secondary-title></titles><periodical><full-title>Journal of Advanced Nursing</full-title></periodical><pages>1800-1810</pages><volume>67</volume><number>8</number><dates><year>2011</year></dates><isbn>0309-2402</isbn><urls></urls><remote-database-name>/z-wcorg/</remote-database-name><remote-database-provider>http://worldcat.org</remote-database-provider><language>eng</language></record></Cite></EndNote>(Zannini et al., 2011).

The Gibbs Reflective model (1988) is one of the tools used for reflective practice. It was developed by Graham Gibbs and is a six-step process that guides individuals to reflect on their experience. It consists of a description of the situation, the feelings or reactions during or after the situation, evaluation of the situation, analysis, conclusion, and an action plan where I will discuss the lessons that I have learned and what will I implement in the future ADDIN EN.CITE <EndNote><Cite><Author>Gibbs</Author><Year>2013</Year><RecNum>20</RecNum><DisplayText>(Gibbs, 2013)</DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1697208477">20</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Graham Gibbs</author></authors></contributors><titles><title>Learning by Doing</title></titles><number>13/10/2023</number><edition>1st</edition><dates><year>2013</year></dates><urls><related-urls><url>https://thoughtsmostlyaboutlearning.files.wordpress.com/2015/12/learning-by-doing-graham-gibbs.pdf</url></related-urls></urls><access-date>13/10/2023</access-date></record></Cite></EndNote>(Gibbs, 2013). In my chosen example, I will be reflecting on an incident which happened to me during my night shift, where communication was lacking, and I will use the Gibbs Reflective model to assist the process.

Description of incident

During one of my night shifts, I was assigned to a first-time postpartum mother and her newborn son. The newborn was healthy, with an Apgar score of 9/10 at birth. Everything seemed normal during my regular patient rounds, but at around 3 am, the mother rang the call bell and I answered. Upon entering the room, I saw the mother distressed, saying that she woke up to breastfeed her newborn, but he looked unwell. Upon assessment, the baby had a weak pulse, appeared cyanotic and had an oxygen saturation reading of 70%. Quickly, I took the baby to the nursery, administered supplemental oxygen, and had a colleague dial the rapid response team.

Upon the arrival of the neonatologists, the babys oxygen level had improved, but the physician asked me to transfer the baby to the Neonatal Intensive Care Unit (NICU) for closer monitoring. When I came back to the unit, I saw the mother in tears, thinking that her baby had passed away and that we were hiding it from her. At that moment it struck me that amidst all the rush trying to help the baby, neither the physician, myself, or anyone in the team, clearly explained the situation to the mother, nor did we take her informed consent prior to transferring her child to the NICU.

Feelings

This situation bothered me for a few days as the look on the mothers face was heartbreaking as she verbalized that she was expecting to be told bad news, until I self-reflected and talked to a colleague about it which made me feel better. Upon realizing that there was a deficiency in our communication, I experienced profound disappointment and embarrassment. As healthcare providers, we had fallen short in ensuring that the mother was adequately informed about her babys condition and the proposed course of action. Furthermore, we failed to involve her in making decisions regarding her childs treatment. I called the neonatologist and urged him to meet with the mother. He was reluctant at first, due to his busy schedule, but he eventually agreed. Fortunately, after the neonatologists explanation to the mother, she was satisfied and grateful that we were prompt in managing the babys condition. She agreed to the physicians treatment plan, and I felt accomplished because had I not intervened quickly, her distress may have impacted on her baby, prolonging recovery.

According to the United Arab Emirates (UAE) Nursing and Midwifery Councils (NMC) code of conduct, collaboration and effective teamwork among healthcare providers is emphasized ADDIN EN.CITE <EndNote><Cite><Author>UAE NMC</Author><Year>2013</Year><RecNum>14</RecNum><DisplayText>(UAE NMC, 2013)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1696361673">14</key></foreign-keys><ref-type name="Legal Rule or Regulation">50</ref-type><contributors><authors><author>UAE NMC,</author></authors><secondary-authors><author>Scientific Committee for Nursing and Midwifery Practice</author></secondary-authors></contributors><titles><title>Nursing and Midwifery Code of Conduct</title><secondary-title>4</secondary-title></titles><section>4.1</section><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote>(UAE NMC, 2013), I believe that we partially demonstrated these principles, as we failed to involve the mother in the decision making, which made us fail as a team. In contrast, I was proud of myself as I was able to effectively identify this, demonstrate leadership and instruct my colleagues on what to do in order to improve the situation.

Evaluation

The UAE NMC Scope of Practice states that, a Registered Nurse is expected to communicate effectively and maintain interpersonal relationships with fellow healthcare professionals, patients, and their families ADDIN EN.CITE <EndNote><Cite><Author>UAE NMC</Author><Year>2012</Year><RecNum>17</RecNum><DisplayText>(UAE NMC, 2012)</DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1696948820">17</key></foreign-keys><ref-type name="Legal Rule or Regulation">50</ref-type><contributors><authors><author>UAE NMC,</author></authors><secondary-authors><author>UAE Nursing and Midwifery Council</author></secondary-authors></contributors><titles><title>Nursing and Midwifery Scope of Practice</title></titles><volume>2.4</volume><dates><year>2012</year></dates><pub-location>UAE</pub-location><urls><related-urls><url>http://www.uaenmc.gov.ae/Data/Files/Nursing%20and%20Midwifery%20Scope%20of%20Practice%202012.pdf</url></related-urls></urls></record></Cite></EndNote>(UAE NMC, 2012). When communication breaks down, the team fails, and the patient is compromised. Not only that, in this situation, the mother is the main decision-maker of her newborn, and she was not given the opportunity to decide on her babys treatment as the neonatologist failed to obtain a proper, informed consent prior to transferring her baby to the NICU. This led to unmet patient needs resulting in low patient satisfaction which eventually affects the organization.

Despite the lack of communication, I believe that the teams response played a significant role in the successful care of the baby. Thanks to our effective efforts, the baby could leave the NICU within a few days and rejoin his mother. All his tests fell within the normal range, and he remained stable with good saturation levels. Interestingly, I had the privilege of being assigned to the mother on the day her baby was reunited with her. Witnessing her overwhelming happiness and joy was incredibly rewarding, and it felt like a well-deserved accomplishment for our team.

Analysis

Effective communication plays a crucial role in healthcare settings as it can impact the patient's health outcomes, patient satisfaction and quality of care provided. Healthcare professionals play a major role in effective communication by conveying reliable information to the patients. In healthcare settings, communication among healthcare providers and patients is necessary to ensure high quality service and patient satisfaction ADDIN EN.CITE <EndNote><Cite><Author>Sasan</Author><Year>2020</Year><RecNum>16</RecNum><DisplayText>(Sasan, 2020)</DisplayText><record><rec-number>16</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1696771622">16</key></foreign-keys><ref-type name="Electronic Article">43</ref-type><contributors><authors><author>Sasan, Rasi</author></authors></contributors><titles><title>Impact of Language Barriers on Access to Healthcare Services by Immigrant Patients: A systematic review</title></titles><volume>15</volume><number>1</number><dates><year>2020</year></dates><isbn>1833-3818</isbn><urls></urls><electronic-resource-num>10.24083/apjhm.v15i1.271</electronic-resource-num></record></Cite></EndNote>(Sasan, 2020).

In a healthcare setting, where a patients life is at stake, accountability is another crucial element among healthcare workers. Healthcare professionals have responsibilities in numerous areas, including effective communication, decision-making and the documentation of information to patients and their families ADDIN EN.CITE <EndNote><Cite><Author>Mathew</Author><Year>2023</Year><RecNum>18</RecNum><DisplayText>(Mathew et al., 2023)</DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1697135929">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mathew, Mary</author><author>Klabbers, Gonnie</author><author>de Wert, Guido</author><author>Krumeich, Anja</author></authors></contributors><titles><title>Towards understanding accountability for physicians practice in India</title><secondary-title>Asian Journal of Psychiatry</secondary-title></titles><periodical><full-title>Asian Journal of Psychiatry</full-title></periodical><pages>103505-undefined</pages><volume>82</volume><dates><year>2023</year></dates><isbn>1876-2018</isbn><urls><related-urls><url>https://browzine.com/articles/559206124</url></related-urls></urls><electronic-resource-num>10.1016/j.ajp.2023.103505</electronic-resource-num></record></Cite></EndNote>(Mathew et al., 2023). Given the inherent stress of critical situations, there is a significant likelihood of communication breakdowns, potentially resulting in a failure of patients well-being. Accountability plays a vital role in upholding patient safety and delivering top-quality care. When a healthcare provider assumes responsibility for their actions and decisions, this can have a positive impact on the overall patient outcome.

According to the Dubai Health A ADDIN EN.CITE <EndNote><Cite><Author>DHA</Author><Year>2019</Year><RecNum>21</RecNum><DisplayText>(DHA, 2019)</DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1697210442">21</key></foreign-keys><ref-type name="Legal Rule or Regulation">50</ref-type><contributors><authors><author>DHA,</author></authors></contributors><titles><title>Guidelines for Patient Consent</title></titles><pages>26</pages><dates><year>2019</year></dates><urls><related-urls><url>https://www.dha.gov.ae/uploads/112021/51f61916-2c36-435a-9ed1-a406b9739cec.pdf</url></related-urls></urls><access-date>13/10/2023</access-date></record></Cite></EndNote>(DHA, 2019). This indicates that parents or legal guardians are responsible in giving consents for medical examinations, care, treatment, and decision making. Parental involvement in the childs care decreases stress levels amongst parents as it gives them a sense of autonomy, leaving the parents satisfied. Aarthun et. al (2019) explain that many parents opt out of involving themselves in their childs care or decision-making as they believe that they lack the competence to decide due to their lack of medical knowledge. In situations like these, it is the healthcare providers role to educate the parents and give them adequate information to promote the parents ability to recognize their role as important and meaningful. In cases where parents continue to struggle with decisions regarding their childs care, the practice of shared decision-making can be employed. This approach involves collaborative efforts between the treating physician and the parents to determine the most suitable care for the child. This not only enhances the parents sense of autonomy, but also ensures the child receives the best possible outcome, as emphasized by Sullivan and Cummings in their 2020 work.

Following the event and with self-reflection, I discussed my feelings with a colleague, and we conducted a debrief. A debrief should have occurred with the team after the baby was transferred. We would have realized then that the mother was not informed of the babys condition. During a debrief, individuals have the opportunity to self-reflect and look back at the event and the decisions made, which increases self-awareness and improves clinical uthority (DHA), when a patient is a minor (any person below 18 years old) or is incompetent (a person who lacks the capacity to provide an informed consent), the informed consent must be obtained from the parent or legal guardian practice ADDIN EN.CITE <EndNote><Cite><Author>Abulebda</Author><Year>2022</Year><RecNum>24</RecNum><DisplayText>(Abulebda et al., 2022)</DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1697221428">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abulebda,K.</author><author>Auerbach,M.</author><author>Limaiem, F.</author></authors></contributors><titles><title>Debriefing Techniques Utilized in Medical Simulation</title><secondary-title>NCBI</secondary-title></titles><periodical><full-title>NCBI</full-title></periodical><dates><year>2022</year></dates><urls><related-urls><url>https://www.ncbi.nlm.nih.gov/books/NBK546660/</url></related-urls></urls></record></Cite></EndNote>(Abulebda et al., 2022). Group debriefing, however, is even more beneficial as it provides the team with a safe space to not only reflect on the negative decisions, but to also acknowledge the positive as well. It encourages a culture of continuous improvement and can be an opportunity to discuss what could have been done differently to improve patient outcomes. Not only that, but it can also be a safe space for the healthcare providers to help them cope with the emotional impact and receive psychological support from their colleagues ADDIN EN.CITE <EndNote><Cite><Author>Verkuyl</Author><Year>2020</Year><RecNum>25</RecNum><DisplayText>(Verkuyl et al., 2020)</DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="2dveea9wfz5x26esez8pfdtofwp5xtfr5ttt" timestamp="1697222289">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Verkuyl, Margaret</author><author>Richie, Sara</author><author>Cahuas, Daniela</author><author>Rowland, Catherine</author><author>Ndondo, Merveille</author><author>Larcina, Theresa</author><author>Mack, Kimberley Sally Horsfall Eaton School of Nursing George Brown College Toronto O. N. M. T. T. Canada</author></authors></contributors><titles><title>Exploring Self-Debriefing Plus Group-Debriefing: AFocus Group Study</title><secondary-title>Clinical Simulation in Nursing</secondary-title></titles><periodical><full-title>Clinical Simulation in Nursing</full-title></periodical><pages>3-9</pages><volume>43</volume><section>3</section><dates><year>2020</year></dates><isbn>1876-1399</isbn><urls></urls><electronic-resource-num>10.1016/j.ecns.2020.03.007</electronic-resource-num></record></Cite></EndNote>(Verkuyl et al., 2020).

Conclusion

Reflecting on the situation made me feel proud of myself for acting swiftly as soon as I realized the child is unwell, but also made me disappointed in myself and the team for not including the parent in the childs treatment. If I was ever in this situation again, I would make sure to tell a colleague to update the parent and take her informed consent as we are trying to stabilize her newborn. Not only that, but I would also make sure the neonatologist speaks to the parents at the earliest to reduce the stress levels and provide autonomy in the decision making. When the patient is safely transferred, I would initiate a debrief with the team to analyze the event and decisions made. This will ensure effective communication between healthcare providers and the patient. I now understand the importance of communication, teamwork and taking accountability, especially during a critical event. I also understand that when communication breaks down, the team fails, and the patient is comprised.

When I endorsed the patient, I made sure to inform the morning shift staff to accompany the mother to the NICU, once everything has settled, so that she will be able to see her child and be updated on the babys condition. This helped the mother feel relieved as she was reassured by the NICU staff that her baby was in safe hands.

Action plan

This critical incident showed the significance of parental involvement in the childs care as it will increase autonomy, ultimately increasing the quality of care. It also made me think of a few points which I would work on or implement. Firstly, I would talk to the hospitals management to arrange and provide regular, mandatory training sessions for all healthcare providers on effective communication among team members, with patients and their families. Although communication is vital among healthcare providers, unfortunately, many of us lack proper training in the chain of effective communication. Hence, I believe that the training courses would be beneficial. Secondly, I would propose the idea of providing simulations that involve critical situations which we experience regularly. This will enhance teamwork skills and communication among healthcare providers. Finally, I would like to introduce debriefing sessions which would be an opportunity as a team to evaluate what went well, what could have been done better and discuss if there is any emotional impact that the situation had on them.

ADDIN EN.REFLIST ABULEBDA, K., AUERBACH, M. & LIMAIEM, F. 2022. Debriefing Techniques Utilized in Medical Simulation. NCBI.

DHA 2019. Guidelines for Patient Consent.

GIBBS, G. 2013. Learning by Doing [Online]. Available: https://thoughtsmostlyaboutlearning.files.wordpress.com/2015/12/learning-by-doing-graham-gibbs.pdf [Accessed 13/10/2023].

MATHEW, M., KLABBERS, G., DE WERT, G. & KRUMEICH, A. 2023. Towards understanding accountability for physicians practice in India. Asian Journal of Psychiatry, 82, 103505-undefined.

SASAN, R. 2020. Impact of Language Barriers on Access to Healthcare Services by Immigrant Patients: A systematic review. 15.

UAE NMC 2012. Nursing and Midwifery Scope of Practice. In: COUNCIL, U. N. A. M. (ed.). UAE.

UAE NMC 2013. Nursing and Midwifery Code of Conduct. In: PRACTICE, S. C. F. N. A. M. (ed.) 4.

VERKUYL, M., RICHIE, S., CAHUAS, D., ROWLAND, C., NDONDO, M., LARCINA, T. & MACK, K. S. H. E. S. O. N. G. B. C. T. O. N. M. T. T. C. 2020. Exploring Self-Debriefing Plus Group-Debriefing: AFocus Group Study. Clinical Simulation in Nursing, 43, 3-9.

ZANNINI, L., CATTANEO, C., BRUGNOLLI, A. & SAIANI, L. 2011. How do healthcare professionals perceive themselves after a mentoring programme? A qualitative study based on the reflective exercise of writing a letter to yourself. Journal of Advanced Nursing, 67, 1800-1810.