Importance of nursing interventions

Reflect on your involvement in an episode of care
which focuses on the importance of nursing
interventions

Administration of the wrong dosage is not a new phenomenon among health care
providers. Often nurses and doctors find themselves administering low or high dosage to patients
ailing from long-term illnesses. I found myself in such circumstances during my attachment as a
student nurse at the local health care facility. I remember that the doctors in charge directed me
to administer medication for patient ailing from congestive cardiac failure, and even after
confirming the dosage; I ended up administering an overdose. This scenario can be well reflected
using the six stages of the Gibbs model namely description, feelings, evaluation, analysis,
conclusion, and finally, the action plan (Barksby, Butcher, and Whysall 2015, p22; McLeish and
Snowden 2017, p.600).

Description

During my attachment as a student nurse in the local health facility, I was on night duty,
and the doctor in charge directed me to administer 0.1mg of digoxin to a Mr. Y ailing from
congestive cardiac failure. I had never applied the drug before. At that particular moment, I was
confident but little nervous. I administered four tabs from the 0.25mg bottle. I crosschecked the
script and tabs with the help of the junior nurse before administering the medication to the
patient. Consequently, we all agreed that the drug is in the right dosage. Mr. Y was unwell, and
thus he was kept under strict monitoring and observations throughout the night. Patients
diagnosed with congestive heart failure require critical care (Francis and Tang 2019, p17)
However, at about 3 am, I suddenly realized that I had administered ten times the amount
of digoxin contrary to what has been stated on the doctors in charge prescription. In response, I

Gibbs’s Model 2
called the nurse in charge and explained everything to her, and she agreed that, indeed, I had
administered an overdose of digoxin. We filled the occurrence in the hospital’s incident register
and informed the doctor in charge of what had happened. Similarly, we reported the incident to
Mr. Y’s relatives. In the morning, I had to see the facility’s matron. After a critical examination
by the physician, Mr. Y did not experience ill side effects from the drug, and therefore he went
on with his full recovery.

Feelings

It was a long night having a busy ward with only two-night staff on duty. Surprisingly, I
was in charge of 20 patients, most of who suffered from chronic illnesses. Mr. Y was seriously ill
and hence needed regular monitoring.  I had interacted with 0.25 mg digoxin tablets before, but I
didn’t know that there were some digoxin tablets of 0.1g that had been recently made. That said,
I was too nervous that the patient might succumb, having administered an overdose. The doctor
examining Mr. Y was also under tremendous strain since the ECG was recording irregular
heartbeats. This made me even more fearful and felt sorry for the patient. It was not my intention
to administer the wrong dosage of the drug, but a high number of patients who needed my
attention were many, thus compounding to confusion. 
Evaluation

 The matron and the doctors never blamed me for the occurrence; neither did they talk ill
about my work. Mr. Y proceeded to attain full recovery, and his relatives were more
understanding and supportive of the situation. The hospital management was kind to me, and the
matron herself was impressed since I accepted that it was my fault. Indeed, I felt terrified and
disoriented about the overdose. I watched Mr. Y all night long for symptoms of a drug overdose,
but luckily, Mr. y was doing fine the next day. 

Gibbs’s Model 3

Analysis

Furthermore, the incident terrified me since I thought I had done everything correctly. I had
crosschecked the dosage with the junior nurse in charge. I had no idea that there were new
digoxin drugs that were blue. I don’t know that prompted me to think about the overdose,
although I was unwilling to administer it. The junior nurse agreed that I had shown her four
white tablets but later said that she thought I knew what I was doing. In retrospect, nursing
practice ought to be exercised with caution to avert such incidents (Mosley 2020, p4; Koshy et
al. 2017, p20). However, I believe it is not an isolated one since I later learned that there had
been a series of such incidents in the facility which have been closely interlinked with staff
misunderstandings, overwork, and fatigue. 

Conclusion

I was so happy and relieved that Mr. Y overcame the overdose, and his relatives
understood. Nevertheless, I felt so sorry for him for subjecting him to overdose. In any case, if he
died, I don’t think I could have been studying nursing. I could have lived with that guilt for the
rest of my life. Errors in medical practice should be avoided at all costs. Human life is precious,
and it is unfair to end it through negligence or careless mistakes.
Action plan

Given the seriousness of the occurrence, I learned to be more careful with drugs and keep
a keen eye to dosage and drug administration. Since then, if I encounter any ambiguousness with
any medication, I usually search it in the reference books before I administer it since it my duty
to make it right. Nursing drug reference books are vital in ensuring that the nurses only
administer the right drugs for a particular condition (Farzi et al. 2016, p 33).

Gibbs’s Model 4
Also, going forward, I have learned the importance of teamwork. If the doctor or the
nurse in charge monitored my activities, I could not have administered an overdose to Mr. Y.
Nurses and doctors ought to work collaboratively for great results. Clinical mistakes are costly,
and most of them result in fatalities (Crewe and Girardi 2019, p3). For this reason, it is essential
to support student nurses and allow them to make mistakes while offering room for improvement
altogether (Li et al. 2020, p74). I will always be consulting when in doubt to avert a similar
incident in the future. I would never want to see another nurse going through what I went
through.
As noted above, it is not enough to have experience for an individual to learn. In the
absence of an in-depth reflection of such experience, it may be quickly forgotten. It is from these
thoughts and feelings emanating from this reflection that enables generalizations that permits
new phenomenon to be addressed adequately. Hence, Gibbs’s model provides an opportunity for
nursing students to learn through reflection and stories. 

Gibbs’s Model 5

References

Barksby, J., Butcher, N. and Whysall, A., 2015. A new model of reflection for clinical
practice. Nursing times, 111(34/35), pp.21-23.
Crewe, S. and Girardi, A., 2019. Nurse managers: being deviant to make a difference. Journal of
Management & Organization, pp.1-16.
Farzi, S., Farzi, S., Alimohammadi, N. and Moladoost, A., 2016. Medication errors by the
intensive care units’ nurses and the Preventive Strategies. Anesthesiology and pain, 6(4),
pp.33-45.
Francis, G.S. and Tang, W.W., 2019. Pathophysiology of congestive heart failure. Reviews in
cardiovascular medicine, 4(S2), pp.14-20.
Koshy, K. et al. (2017) “Reflective practice in health care and how to reflect
effectively”, International Journal of Surgery Oncology, 2(6), p. e20.
Li, Y., Chen, W., Liu, C. and Deng, M., 2020. Nurses’ Psychological Feelings About the
Application of Gibbs Reflective Cycle of Adverse Events. American Journal of
Nursing, 9(2), pp.74-78.
McLeish, L. and Snowden, A., 2017. Reflection on practice: Consultation skills. Nurse
Prescribing, 15(12), pp.600-604.
Mosley, T. (2020) Effectiveness of Guardrails at Reducing Medication Errors inDrug
Administration, ScholarWorks.

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