Introduction
Healthcare professionals, including the nurses have to often face clinical incidents that leads to mistakes and errors. No matter how well-equipped an organization is, no organization is free of such erroneous clinical incidents. I am a graduate nurse practising in one of the wards of the district general hospital. I was working under my supervisor who guided me throughout my practice. In this reflective essay I am going to reflect on a clinical incident I experienced during my placement under group supervision. Rolfe’s Reflective Framework will be used for this reflective practice. This framework is commonly used by healthcare professionals like nurses in their self-awareness practice as it is both simple yet effective (Rolfe and Freshwater 2020). The reflective framework consists of three stages. The three stages are ‘what?’, ‘so what?’ and ‘now what?’ (Rolfe and Freshwater 2020). The first stage will discuss the problem or the situation, focussing on the achievements, responses, consequences and feelings. In this stage, I will discuss about the personal incident which had occurred regarding the error in making phone calls. In the second stage I will give an account of what I have learnt about myself, attitudes of others, cultures, thoughts and whether there is requirement of any further improvements (Rolfe and Freshwater 2020). In this section, I will introduce the critical analysis of the situation, eliciting rationales that explain why I behaved in the particular manner and what led to the erroneous incident. In the third stage, I will identify what needs to be done in the future to obtain improved outcomes. This will lead to the development of improved practice and professional disposition (Rolfe and Freshwater 2020). Here, I will give an account of what actions can be taken to avoid such incidents from happening in the future. According the Nursing and Widwifery Council Code of Conduct (2018), I am supposed to maintain confidentiality and anonymity at all times of my practice. To maintain confidentiality, I will not reveal essential details about the patient concerned with the incident.
What?
One day during the shift hours, I was sitting on the chair beside the table after my round when the telephone started ringing. At first, I was hesitant to pick up the call but my senior insisted me on doing so. One of the daughters of the patient had called. As this was one of my initial days during placement, I was a bit nervous about picking up the call. In all the contemplation, I forgot to ask the name of the caller. This made it difficult for me to convey complete information of the patient to the other members of the multidisciplinary team since when I told him that one of his daughters had called and identifying the patient without a name was difficult. It was a mistake on my part. The error in receiving phone calls which I am talking about was an incident that took place in the initial days of my placement. I was always very nervous while comprehending what the person on the other end was trying to convey and this made me careless on the phone call. This was hampering the progress of my career and eventually I was losing a lot of confidence on myself. However, the co-workers, especially my supervisor was supportive enough to not lose hope on me and kept on giving me chances to rectify my mistakes. Thus, slowly with time I have been able to resolve my errors. I was given training on questions that were to be asked during a phone call such as firstly, I was supposed to introduce myself and the ward I was working at, ask the name of the caller, the person the caller wants to communicate with, the reason for calling and other essential information about the caller.
In the Group Clinical Supervision, there was a similar case discussed where one of my peers was asked to make phone call to the daughter of a patient who has just died. The call was received by the husband of the daughter and out of confusion, the nurse had disconnected the call without letting him know about his father in-laws’ demise. When she disconnected the call, she was again asked to call back and inform the man that urgently need to contact the hospital. My peer was asked to do this by keeping communication polite as well as effective. In the group meeting, my peer was asked some questions by the supervisor as to whether she agreed to make the call second time, was she briefed about what to say in the call. I was present in the group meeting. I could relate to her experience of feeling nervous over a phone call. To feel understood and heard, I communicated with my peer and discussed about their experiences of errors in communication.
So what?
Learning to make proper phone calls is one of the important aspects of therapeutic communication (Butterworth, Cutcliffe and Proctor 2005). Effective communication skills in therapeutic nursing helps in bridging barriers of communication which otherwise helps in aiding a good relationship between the patient’s family and the health care professionals providing care (Sibiya 2018). Nurses play a huge role in communicating information to the multidisciplinary team members and to the patient family members. Effective communication between the nurses and the patient ensures positive outcome, patient satisfaction and better prognosis (Indra 2018). The mistake I had committed on the phone call discouraged me to a great extent. For once I felt that I would not receive phone calls anymore. However, as a nurse I should never lose confidence on my abilities as it would hinder me from accomplishing my desired goals of success or giving effective performance. Self-confidence is the main aspect that is reflected in the nurse’s professional competence (Watson 2009). Thus, I decided to learn from that mistake and summoned myself to take up more phone calls in future and not repeat such mistakes again.
Critical reflection in nursing helps in the transformation of thoughts from one situation to another one by having an in-depth knowledge of the situation (White, Fook and Gardner 2006). A nurse should be prepared to face any kind of situations which might arise in her practice setting. The nurses should be able to handle novel clinical situations with confidence and professional skill set. I believe that my lack of confidence in telephonic communication with patients can be attributed to my social anxiety. Every time I communicate over the phone, I put excessive emphasize on how I am performing as a nurse and less on the action of generating information from the patient. Social anxiety in nurses can hamper effective communication leading to miscommunication, misdiagnosis and misunderstandings between care team members (Ghaye and Lillyman 2014). Additionally, I believe that my lack of confidence emerges from the fact that we were never provided with a proper demonstration of how to make an emergency telephonic communication with a patient. In this context, appropriate support and guidance from the supervisor and expert nurses can assist me in developing self-confidence.
From the Group Clinical Supervision, I have learnt a lot of things which has enabled me to widen my knowledge on the ways in which experience can be gained on placement, rectify my issues and learn from my mistakes. I have also learnt somethings about the profession and its practice from the experience that has been gathered by peers who had participated in the discussion. Some of the important things that I have learnt is remaining punctual during duty hours, encouraging every peer to participate in group discussions that can make the care planning process enhanced and informed (Thompson and Thompson 2018). Active listening is one of the crucial skills that must be learnt properly as it is vital for a patient-care which is effective. It properly shows the patients that they are being valued which ultimately leads to establishment of a foundation of trust (Blake and Blake 2019). I have learnt from this discussion forum that maintaining confidentiality of patients is important unless required under any emergency situation. Nursing staffs are required to respect other staff as well as the patients along with the families of the patients. Facilitating communication that is proper in a nursing care setting may lead to better health outcome of patients in the form of improper diagnosis of medication, or errors in medication as well as unattended treatment.
After making the mistake during my first phone call, I became absolutely disappointed because I have always learnt that first impression is supposed to be the last impression. The fact that I have made a mistake made me feel embarrassed and I lost my confidence. However, it was my supervisor who motivated me by telling that people make mistakes and one should learn from them.
Now what?
The group discussion on clinical supervision has contributed a lot to the betterment of my nursing career. It helped me strengthen communication skills in my profession and this skill is considered to be one of the vital skills in practice (De Haan 2012). Communication through phone calls in the ward is the means of conveying and receiving information to and from the patient’s families. I am usually very nervous about picking up phone calls in the ward as I barely hear anything in the conversation. Sometimes I feel nervous while sometimes I become very unmindful. However, my supervisor in the ward always encourages me to pick up the calls and guides me to take down notes in a notepad from the conversation so that I do not miss out anything. It was certain that lack of communication made her do such an action, she must focus on strengthening communication with the family of the patient as well as other staff in an error-free manner.
In this context, my learning goals will include learning to remain mindful and focused on the phone call while gathering patient information, reducing my professional anxiety, increasing my self-confidence, using errors as an opportunity to learn and using a telephonic communication framework to avoid errors. I, as a professional nurse will ensure to tackle such situations by adopting measures to eradicate such lapses. It can be done by methods such as gathering of feedback from co-workers, patients, families and other staffs regarding ways in which communication is flowing in the concerned setting. However, to increase my mindfulness and decrease my anxiety, I will engage in mindfulness meditation every day after work for 30 minutes. I will increase the time span of meditation from 30 minutes to 45 minutes after one month of 30-minute meditation sessions (Mills‐Powell and Worthington 2007). I will use breathing techniques like deep and controlled breathing before picking up a call and remind myself that I will do my best according to the best of my knowledge. Controlled breathing is known to be an effective measure in reducing situational stress (Perciavalle et al. 2017). After every phone call I will ensure to gather feedbacks from my supervisor based on my performance. This feedback will help me improve my practice.
To avoid the errors of phone call making, I will have to be attentive enough from next time onwards to carefully collect each and every information that can be gathered and collected for proper processing of the information. I will note down the areas where I lack efficiency and then I will reach out to my supervisor for help to guide me in those areas (Nice 2017). Henceforth, before making phone calls I will take a briefing of what to say and what to note down so that I do not miss out upon something vital. As for my peer who spoke out about her mistake in the group discussion, she should instil more confidence with dummy practice of making phone calls so that she does not get nervous at times when she is making phone calls to real patient parties.
Conclusion
It can be concluded that mistakes can often occur in any professional setting when a person is inexperienced. However, such mistakes should not be looked down upon and mistakes should be learned from. In my professional practice, I have received support from my coworkers who have been immensely supportive in giving me scopes where I can rectify my mistakes through practice. The Group Clinical Supervision sessions have taught me a lot where I have learnt from inputs given by my peers and supervisor. I wish to achieve success in my professional practice by learning from these sessions which would enable me to become a better nurse so that I can serve patients in an excellent manner.
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