Question

write a negative critical incident that you experienced in your geriatric clinical that raises questions for you and has an impact on your learning.

1. Discuss a critical incident you experienced in your practicum. What were you thinking and feeling during this experience?

2. Relate appropriate gerontological nursing competencies to the critical incident discussed above.

3. Analyze what you learned from this critical incident and if you would do anything differently with a similar situation next time.

4. How did this experience enhance your learning about caring for the older adult? What did you learn about yourself, i. e. biases, assumptions, strengths, and areas to improve?

Answer 1

Details of the incidence:

A 75 years old elderly male who suffered a hip fracture from a fall at home. He underwent a hip joint replacement. I was a member of rehabilitation team.

A rehabilitation assessment was to be completed as a part of discharge planning prior to discharge of patient to home. The aim of rehabilitation was to restore normal living and independence for the patient as soon as possible.

After completing home visit to ascertain the type and level of support that the client will need. It was found that the client’s home was unfit rehabilitation. There was no source of heating and ventilation. A small table lamp is the only source of light. The house was filthy with trash bags dumped in the kitchen. There was no food in the refrigerator. The house smelled of urine and bed covers were visibly soiled while the toilet room also needs plumbing.

Guidelines for fall prevention emphasize the need to assess the conditions of the home (home hazard assessment) and make changes (safety interventions and home modifications) to facilitate easier mobility of the service user. When the environment is physically adjusted to the needs of the patient, it will prevent recurrent falls and help in improving mobilisation of the patient. These modifications should be carried out within the agreed time frame between the patient and appropriate members of the healthcare team. Another consideration is that physical modification of the house alone is also not effective in preventing falls without follow up and other interventions for the client.

History collection and assessment clearly pointed out that the patient was living alone and had difficulty maintaining the cleanliness of his home prior to his fall. It suggested that the client need assistance in performing the activities of his daily living. But client explicitly refused need for any help.

Critical Care Incident

The client was allowed to stay at the rehabilitation unit only for six weeks. Since the house needs repair and deep cleaning, this time was not enough for the client to move to his house after his discharge.

The client also refused to have assistants as he feels that he is capable of taking care of himself. He explicitly stated that he does not want additional support to assist him with activities for daily living (ADL) and made a verbal request to the rehabilitation team to help him return to his home.

This incidence was critical as

Whether to respect the wishes of the patient or act in the best interest of the patient.

Patient need to be convinced that he could not immediately return to independent living since his house has to be repaired and a suitable place for him to stay has to be arranged before he can go home. Since the patient was adamant in returning home, we had to decide between acting in the best interest of the patient or respecting patient autonomy.

This means there were two choices

· Either to follow the patient’s wishes of returning him to his home even if it is still not fit for his condition - respect patient autonomy

or

· Convincing him to stay in a temporary shelter - safety of the patient

However, this was difficult to meet both demands together.

On reflection, I began to question how should I offer support to the patient after he expressed that he wants to go home after attending the six-weeks rehabilitation. It is understandable that patients who suffer from a fall do not want to be a burden to others.

On the other hand, I also had to inform the patient about his condition and why he needs to return to a home that is clean and modified for his needs and need of shifting and arranging for safer place meanwhile necessary modifications are done in his house with involvement of patient in the care that addresses all his health needs.

Learning and awareness from the incidence:

I had to consider the best interest of my patient even if he insists on returning to his home immediately after his discharge from the rehabilitation unit.

Patient safety and what is best in his interest should be given the priority when deciding on appropriate interventions for the patient. This is consistent with the ethical principle of non-maleficence and beneficence (do no harm). Since the patient refused to receive additional support for ADL, I became aware that returning him to an unmodified home will increase the risk of recurrent fall.

It became more important after client’s refusal to have a care taker/ assistant to look after his needs and assist him with daily living.

Here I along with social worker and other team members analysed various option and zeroed to transferring the client to a residential geriatric home temporarily until his house has been deep cleaned and modified, got needed approval and shifted the client.

Core competencies for geriatric nurse reiterates that multidisciplinary teams should enable return of clients or patients to their residence and ensure the long-term wellbeing of this group. Our multidisciplinary team followed measures to ensure that the client will return to a home that is safe and modified for his needs.

This reflects values and ethics of patient safety demonstrated by actions of helping the patient to return to a safe environment following his discharge from the rehabilitation unit.