Reflecting using Gibbs....

I think I'm a good nurse. I have clinical experience, new nurses come to me for advise. I think I learn from my mistakes. I think I am forever learning. Let's see....

A couple years ago I had had a patient named "Glen" who was developmentally disabled.  Glen was in his mid-40's and was admitted for CAP - community acquired pneumonia.  Glen arrived on our floor mid-morning, O2 via NC at 2L, able to communicate and make his needs known.  Glen had a foley catheter in place and was complaining that it hurt “real bad”. I got an order for topical lidocain, hoping for some relief. Nothing helped. Glen kept complaining, louder and louder. I called the wound care nurse for a bedside consult to see if there was anything else we could do. She noticed that Glen wasn't circumcised and his foreskin had not been pulled back into place. She tried to put it back, the charge nurse tried, I tried. Nothing. I investigated and found that the ER nurses had tried unsuccessfully many times to place the foley and ended up calling in a urologist to place the catheter. He hadn't replaced the foreskin. I made a phone call to him, furious, and explained the situation. He seemed uninterested. I left work that day feeling like a failure. My patient had spent the day in miserable pain, ending with an emergency circumcision.



A year later, it happened again. I had a patient, “Joe”, admitted for a somewhat emergent fem-fem bypass. Joe was an alcoholic on the withdrawal protocol with Ativan on board. The NOC RN, a male, had placed the catheter the prior evening. When I came on shift in the morning, Joe was complaining that his catheter hurt 'real bad'. Flashbacks of my experience with Glen raced through my mind as I, somewhat angrily asked the male RN if the patient was circumcised or not. He said he “didn't remember”. Really? I thought – how can you not remember that? Especially coming from a male nurse. I was furious – again.



So here I am, dealing with a repeat situation – I should have learned from the first. Had I doubted the patient because he was dev delayed? I should have been able to recognize the fact that the patient wasn't circumcised but it really is had to tell. I should have questioned the need for the foley in Glen's case – for pneumonia??? In the second situation, I was furious! How could a male nurse not put the foreskin back in place after placing the catheter!!!!! And then tell me he didn't know? I should have learned from the first situation. I should have learned.



Advocate for the patient, believe the patient. Don't let my emotions dictate my actions. Act, don't re-act.



My anger and frustration came out so strongly with my interactions with the urologist and male nurse, no wonder they were immediately on the defensive. If I could do it over again, I would approach them possibly in the SBAR format – situation, background, assessment, recommendation. The outcome of the first incidence really influenced my behavior in the second.
What happened – lack of communication led to a man being unnecessarily circumcised. Lack of communication led to unnecessary pain and suffering for a patient already in pain, scared, facing surgery. Lack of a communication resulted in anger, resentment and disrespect between two colleagues that lasted several years.