Content area

Full text

 
Headnote

KEY WORDS Reflection, Models of reflection, Operating room nursing

This thought-provoking article describes how a perioperative nurse of twenty years' experience reflected on a critical incident that happened in the hospital where she works, and what she gained from the experience. She also provides us with a survey of the literature pertaining to the processes underlying critical analysis.

The incident

The incident happened around midnight, when a locum surgical registrar, whom I had never met, was operating on a 14-year old boy with a suspected torsion of the testis. The early stages of the procedure were uneventful. However, it was after fixating the testis that the problems began, as it would not go back into the scrotal sac. Even extreme pressure (as I thought) by the surgeon and extending the incision did not help.

I began to question how well the operation was being carried out and asked the surgeon why we were having such problems. He stated that it is often difficult as the testis does not go back into the space you have taken it from. By this time he was attempting to suture the skin, which looked impossible to do as half the testis was protruding. I looked around the operating theatre to see the reaction of the other doctors; they seemed unconcerned.

I felt extremely uncomfortable and worried and informed the surgeon that I was unhappy about assisting in the procedure. He made no eye contact and ignored me. I then asked the three doctors present if they could offer an opinion. Each replied that they had limited experience in surgery and were unable to comment.

I asked the surgeon for assurance that this child's testicle would look normal. Ignoring my question, he suddenly cut the sutures and refixated the testis. The operation was then complete and, in my opinion, successful.

Reflections

Reflection is a complex process involving intuition, experience and knowledge (Benner 1984, Clarke 1986, Schön 1987, Powell 1989, Cioffi 1997) or critical enquiry (Friere 1972, Habermas 1984, Kim 1999). Ultimately practitioners need to make sense of an experience, thereby improving future practice. Atkins and Murphy (1993) identified three key stages in the reflective processes:

* Uncomfortable thoughts and feelings

* A critical analysis of the situation

* Development...

Show less