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I was working in an Oncology unit and was assisting in setting up a Patient Controlled Analgesia (PCA) pump. The pump was a different model than I had used in the past, and I was unfamiliar with how to set it up. I was one of four nurses trying to set it up properly by the attached instruction book. I had the most nursing experience, but I did not have any experience with this pump. We had to work fast because we had a postoperative patient in severe pain. The nurse that reported on the patient from the recovery room did not communicate that the surgeon ordered the pump. The recovery nurse did not mention that the patient was in excruciating pain. Another nurse adjusted the settings per the orders as I read the instructions. We were all rushed as the patient’s wife stood outside the patient’s room to complain about how slow we were. We finally completed it, took it to the room, and hooked the patient up to it. I signed off on the settings, and it was finally giving the patient relief. This situation happened an hour before the change of shift.
When I returned the next day, the unit director called me into the office. I had signed off on the PCA medication for the pump, and the settings were wrong. The patient received too much pain medication due to the incorrect settings in the PCA. The patient became nonresponsive. Thankfully someone noticed the settings were incorrect, and there was no further harm to the patient. I was mortified this happened and realized because of the rush, I read the instructions, but I did not watch her set the pump, and I did not check the settings. I signed off on the medication without correctly assessing the pump and the settings.
If this happened today, my process would be different. I would have called the doctor and made him aware that the pain was severe. I would request a one-time dose of medication to relieve the pain, which could take care of the patient and give me time to set up the pump correctly. I would have called the other floors for a nurse familiar with the pump to assist in teaching me how to do it correctly. I would not have signed off on the settings before visualizing the dosages and the intervals.
I had been a nurse for years and knew the correct process for performing a task I had not done before. Instead of depending on those critical thinking skills, I let the feelings of being rushed and the anxiety of the patient being in severe pain override my decision to ensure everything was correct.
Cheragi MA, Manoocheri H, Mohammadnejad E, Ehsani SR. Types and causes of medication errors from nurse’s viewpoint. Iran J Nurs Midwifery Res. 2013 May;18(3):228-31. PMID: 23983760; PMCID: PMC3748543.
Gorgich EA, Barfroshan S, Ghoreishi G, Yaghoobi M. Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Glob J Health Sci. 2016 Aug 1;8(8):54448. doi: 10.5539/gjhs.v8n8p220. PMID: 27045413; PMCID: PMC5016359.
An experience that disrupted my critical thought process, occurred during my second month of being a nurse. I was working on a Med-Surg. unit and one of my patients who was admitted for cellulitis suddenly had a change in mental status. The first thing I noticed was the patient wasn’t acting like herself. After taking a good look at her I noticed that her right pupil was dilated and the left one wasn’t. My critical thinking sprung into action and I immediately thought this patient is having a stroke. Although all the signs were saying yes my lack of confidence hinder my actions at first. It was my first stroke code and being a young nurse, I was afraid of calling it. However, I knew something was wrong so I muscled up the confidence and called the stroke code. I used my clinical judgement after noticing all the symptoms my patient was experiencing. The patient was rushed to CT and all the proper interventions were provided.
If I was to experience the same situation again the way I would overcome any disruption in my thinking would be to take a step back and have confidence in myself and my knowledge. A fundamental way for professional nurses in healthcare institutions to administer safe, accurate, and high-quality patient care is to gain and maintain enough certainty in themselves” (Garcia-Guerrero et al., 2022). Having confidence in yourself and what you do is an essential characteristics to have in order to perform effectively as a nurse. One specific way I would alter my way of thinking when internal forces or variables confront me would be to stay present and not get in my head. Thinking critically is an essential factor for high-quality care with the main focus being patient safety. I am constantly using critical thinking in my practice and there are times that I still question if my decisions are the best ones but I know that the more experience I gain the more confident I will be. “Professional confidence (PC) can affect all aspects of healthcare providers’ clinical performance including the relationship with clients, colleagues, and other healthcare team members, all of which influence the patient care quality” (Makarem et al., 2019).
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