Academic journal article Creative Nursing

Teaching Ethical Leadership through the Use of Critical Incident Analysis

Academic journal article Creative Nursing

Teaching Ethical Leadership through the Use of Critical Incident Analysis

Article excerpt

Reflection through the use of critical incident analysis is an essential nursing skill that can lead to profound professional growth. Introducing critical incident analysis early in undergraduate nursing education can enhance strategies to identify and reflect on practice strengths, weaknesses, and obstacles. Practicing routine critical incident analysis develops mastery and leads to competence in peer mentoring of this critical nursing process. This article yields insight into the nexus of horizontal violence as a core conflict causing a critical incident, and identifies and evaluates one nursing student's leadership style.

Usher et al. (1999, as cited in Usher & Holmes, 2006) identify reflection as a way for nursing students to create distance from a significant event and facilitate greater insight into the experience. Critical incident analysis goes beyond reflection to dissect the incident and evaluate its components, separately and then as a whole, from different frameworks and positions. Mentors and preceptors must be competent in the art of facilitating novices' reflective practice. Successful employment of critical incident analysis is a catalyst for profound personal and professional awareness and transformation.

This article contains an analysis of the personal leadership demonstrated by a third-year nursing student dealing with a suboptimal clinical environment affected by horizontal violence. The goals of the article are to evaluate the efficacy of the student's ethical leadership intervention and to identify and discuss personal leadership and management goals, insights, and personal and professional development that evolved from this critical incident analysis.

CRITICAL INCIDENT DESCRIPTION

Critical incident analysis was introduced by Flanagan (1954) and has been adapted for use in reflective critical incident analysis in nursing. The critical incident analysis technique is aimed at isolating critical facts and features of an incident, then evaluating the interrelated pieces to identify key influencing factors in order to yield a greater understanding of the whole and reframe an assumption and yield transformation (Brookfield, 1987). Schon (1983, as cited in Jasper, 2003) identifies the most significant reflective actions as retrospective analyses of significant unresolved issues through introspection. The critical incident described in this article was unresolved and traumatic for the student and thus offered a rich reflection opportunity.

The incident unfolded during a clinical placement in a medical-surgical unit. The suboptimal unit environment included significant issues related to substandard nursing care and teamwork. Staff were disrespectful to patients (breaching confidentiality, dignity, and respect) and lacking cultural competence. Patients, students, and other agency staff experienced significant discrimination, marginalization, and prejudice. Staff engaged in overt hostility to each other and formed subgroups that exercised coercive power. In addition, there were multiple breaches in safe medication administration.

By day three of this week-long placement, only one student nurse turned up for the aft ernoon shift -all the other students called in sick. Aft er a non-English-speaking woman was not afforded privacy when using a bedpan and then abandoned by the staff nurse because she was taking so long, the student nurse consulted her instructor. The student knew that what was occurring was ethically and morally wrong and required leadership intervention.

The instructor tearfully asked the student why she had not said anything for two days. The student explained that she was trying to understand the situation by observing the macrocircuits and microcircuits of power. The instructor disclosed that this unit was under organizational rehabilitation and asked the student to speak to the director of nursing about the experience. The student declined, believing that the instructor was in a better position to proceed with the incident. …

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