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Critical incident report for nursing


Are you wondering what reflective writing is about? Do you need help deciding what sort of incident you should select? Are you clear on what a variable is? This series of videos covers how to structure and write a critical incident reflection.

Part 1: The preliminary guide

This video gives an overview of the assignment, some of the pitfalls to avoid and an outline of a sample critical incident.

As a professional, it’s always good to work reflectively, always being mindful of how you impact those around you and trying to see other people’s perspectives and situations. In your future professional life, there will be times when mistakes or disagreements occur and you may be called upon to negotiate or investigate these. If you do, you need to do this keeping emotions in control, taking a situation apart in a scientific way, and understanding what has led to the situation.

If you are in a position of authority, you may be called upon to document an incident in writing, and put in place procedures that will avoid an undesirable situation from happening again.

Before you start anything, you need to identify your incident first. Students often think that this assignment requires an incident that is disastrous or life-changing. Actually, this is not what you need to do, because for one, these things are usually too complex and emotional, and also they are often not based on misunderstandings of any type. You need to select a fairly mundane event, such as a minor conflict with a work colleague, or a harsh exchange with the cashier at the supermarket. What’s important is that you need to be critical, not choose a crisis.

Essentially, the incident that you choose needs to be about a failure to communicate, or a failure to understand each other, or perhaps a failure of the system that has led to a conflict or a difficulty between parties.

Give a minimum amount of detail of what happened, give only what’s necessary to understand the analysis or reflection that will follow. Retelling the story does not achieve a lot, it’s the analysis and reflection that matters. If you feel that you really need to give a more detailed description, put that in the appendix and just use a brief summary in the report itself.

The incident that you select needs to be very specific. Something you can identify at a particular time and a particular place. Once you’ve chosen your incident, you need to unpack the situation.Choose a true situation rather than a fabricated one, because that will make this part much easier. It will also sound more authentic in the end. You need to use a common sense, reflective approach to list everything that contributed to the situation.

For example, I’ve analysed a disagreement that I had at home last week. The blue boxes around the edge are the things that contributed to the situation. You should recognise that many of them involve the variables suggested in your assignments. Variables such as environment where the argument took place, or the different cultural values of the people involved. But remember, your situation is unique. The variables suggested may be relevant or they may not. You need to engage with the situation and really sort out what the variables are of your situation. Some of them may not even be on the list.

Once you’ve pulled your situation apart and analysed what went on, you need to link your thoughts or conclusions to the literature. Remember though, it is a reflective piece, and a reflection is based on your thoughts and feelings first. It is not based on the literature. In a way, this report is a case study, and the case is always central to the writing, be it a patient, or in this assignment, it is an incident.

An essay is based primarily on literature,. however, a case study or a reflective writing piece is not. In this report, you need to make links to the literature in saying what you want to say. But do not let the literature dominate. Let it support what you want to say, or your message will become unclear. Always keep your story and your analysis upfront and central.

Part 2: Incorporating the literature

This assignment involves reflecting on YOUR particular incident, but at the same time you need to integrate relevant information from the literature. This video will provide some guidance of how this can be done.

Let’s return to my situation from the previous video, where I was analysing a disagreement I had with my husband about our teenage daughter going away overnight. Let’s just focus on a few of the aspect variables of this case. First of all, my husband and I bring different ideas to the table about what it means to be a parent. To explore this deeply, I might refer to key terms such as these. These might draw from a wide variety of fields such as psychology and in particular, parenting, of course.

Another aspect of this case is that we’d heard. So our assumptions and perceptions play a big part in this incident. To explore this more deeply, we might talk about adolescents and peer pressure. This may draw from many fields that look at how adolescents think and behave, what detrimental behaviours they may indulging in, and what percentage are actually doing so. Another aspect that I will explore is that my husband grew up in a fairly traditional Greek immigrant family. Now, as a father, he presents many different ideas and values that he was raised in. To explore the differences that this creates, I might need to read something about Greek culture, their social values, and their concepts of honour and gender roles for women. Now, this is certainly not something that you would go looking for before you had your incident worked out.

When you go looking for references, books are a good place to start. They are easier to understand when you first get into a topic, and they will give you the general idea. Their limitations, however, are that they do not go into anything very deeply. They do not have the depth and detail that a research paper needs at university level, and the higher you go in tertiary study, the truer this becomes. Most books are on the shelf for a number of years, as well. In medicine and nursing, there is a need to limit your resources that have been published in the last five years. The reason for this is that the medical field is evolving so rapidly that most technology, techniques, and drugs are completely different even after just a few years. In medicine, five years is a long time.

In other fields however, this is a little more relaxed. In fields such as psychology, or education, ten years would be acceptable, but the more recent the reference, the better it is, of course. So when you select your references, keep the field in mind because the requirements for medical references are quite stringent, and the five-year rule might exclude some useful and appropriate references from other disciplines. Apply your common sense to this, and if unsure, don’t hesitate to ask a lecturer from the field.

The internet is another useful source. But as you know, anyone can create a webpage, so be careful. Look at the fine print at the bottom of the page, which often includes the date the web page was last modified, and make sure the website is controlled by a reputable authority or institutions. Blogs, wikis, and dot com sites which aim to sell things to you are not suitable for academic references.
The best references are peer-reviewed research journals, which you search for and can access through the databases of the library. These are reputable and contain sufficient depth and detail. However, journals – whether they are electronic or paper-based – are not good places to start your research. They usually detail very specific studies that were carried out, and their language and findings are quite specialised. They are something to tackle when one, you have some familiarity to the topic, and two, you know exactly what you’re looking for.

So, what now? Ponder your incident deeply and reflectively. Perhaps discuss it with a friend to get another person’s insights into it, and then write it out all in one go. Forget the references for the time being. This will give you the structure of your critical incident report, and this could be done in a few hours.

After that, read it over and see where your references could inform or expand on some of the things that you have touched on. Since this is largely about communication, change, and personal growth, there are any number of theorists that can give you a structure for analysing your incident. You might like to refer to their categories and analyses when thinking about what went on in your incident. I would, however, use them sparingly, because you would also have to explain their theory, even briefly, and this could chew up a lot of word space.

Part 3: Structures for reflective writing

Avoid a rambling stream of consciousness that recounts what happened when. There is a structure to the writing process as well as the reflective process. View this video to see what you need to think about and say in regard to your incident.

Reflection is a creative process and does not always follow a linear logic in the same way that essays or reports do. However, reflection is still an academic genre of writing and it’s necessary to follow a structure. First and foremost, your reflection still needs to be written in paragraph form - just like any other genre of academic writing, which always requires structured paragraphs. Secondly, the process of thinking reflectively can be structured as well; however, it depends upon the individual and the situation as to how this is done in the end.

A possible framework for a reflective process is the D.I.E.P. model. This is only advisory; however, it does touch on every aspect of thinking reflectively. At the very least it may generate some avenues to explore with your reflection. 

The ‘D’ in the ‘DIEP’ stands for describe. It is necessary that you first describe the situation you’re reflecting on. Do note, however, that this does need to be kept as brief as possible. Describe what you only need to describe so that your reader can follow the rest of your reflection. Recounting the details of your incident does not constitute reflection per se. It would be a mistake to let the description of your incident go beyond a quarter of the word space.

The next part of the structure, is the ‘I’ for interpret. This is where you state the significance of what happened, what does it mean for you, or how does it impact you. A similar situation can occur for two people, but it will affect them differently because they interpret the event differently. 

The ‘E’ stands for evaluation. In this space, you can make judgement on things. This may be on the outcomes of the situation on the people involved in the confrontation, or, most importantly, on yourself and on your own behaviour. Whatever your evaluation of a person or situation is, it needs to be balanced and supported by reasoning. Do not make judgements from a position of blame but rather towards the goal of understanding. And remember, evaluations in the real world are seldom black and white. There will be shades of grey, composites of good and bad, or successful and unsuccessful. 

The ‘P’ in DIEP is for planning, and this is the section where you can look forward towards your reflection. This is where you think about the next time, how the experience has changed you, or exactly what you need to do or want to achieve in the future.

Finally, although reflective writing is another type of academic writing. You are allowed to, unlike other forms, use the pronoun ‘I’. You would not mention yourself in an essay, or a report, however, it is valid to say ‘I feel’, or ‘I believe’ in a reflection. Because this after all, is the focus of a reflective writing. None the less, your lecturer may ask you to write to the third person. Saying, the author thinks or this writer believes. Because this makes the text sound more objective and it may give you a more analytical or detailed stance as well.

Paragraphing is a very important feature in your writing –like any other genre of academic writing. Reflection needs to be structured, logical and clear. It is not written as a stream of consciousness where each idea merges into the next. Ideas need to be identified and separated by paragraphing. And the initial sentence, known as the topic sentence, clearly states the concept to be delivered in each paragraph.

In each paragraph in a reflective writing piece, the following sentences will expand on the ideas stated in the topic sentence. They might be citing the literature relevant to the topic sentence; they might be given to reflection, exploring your feelings and beliefs in relation to the topic sentence. The final sentence is termed to a linked sentence; it can summarise and make sense all of the detail given in the paragraph so far. It brings the information back into context, with the confrontation or misunderstanding you’re writing about. I call it the ‘so-what’ line, right what you would if somebody asked you, “well… so what?”.

Although the linked sentence is not mandatory, it is a very good idea for long paragraphs. It also a very good idea in reflective writing because it makes you anchor your reflections and literature back to the real incident –which is what the assignment is all about.

Part 4: Sample paragraphs

If you are still unsure about what to do, watch how a sample incident can be analysed.

Just to recap, I am reflecting on an argument that was introduced in the previous session. I had had an argument with my husband about our teenage daughter staying out overnight. I identified several of the variables that fit into and exacerbated argument. The one I will focus on here is the notion that my husband and I approach parenting in different ways. In short, what happens in my reflection is that I identify exactly how my husband and I differ in parenting, and. I find some categories in the literature to describe these differences.

Through the literature and further reflection, I realise that parenting differently is not a huge issue and, in fact, it is almost impossible to have complete consensus in parenting styles. I realise that my need to agree with my husband on all issues dealing with my daughter, was making me frustrated, and this probably made the argument worse.

The first paragraph sets the context part of this reflection. No deep reflection is being entered into as yet. The topic sentence highlights the key point of the paragraph. Namely that my husband and I often approach parenting issues in different ways. The first reference I use is quite old, from 1971. But this particular reference is the first time the categories for parenting styles were coined. So, it is considered a classic work in the field. In the next sentence in blue, I relate the information gained in the literature to the present situation.

Remember the incident is central to the writing, so. there is no point in including literature that has little direct relevance to your incident. Always explain how the literature reveals something about the situation, and as I did in the next sentence in black font. Find some literature that describes or expands on your situation. You need to keep a continuous conversation between the literature and the details of the incident. The final sentence in this paragraph is what I call the link sentence. It sums up the point of what I’m saying in the paragraph and it should correspond to the topic sentence at the beginning of the paragraph.

In the next paragraph, once again the topic sentences are in red. This is the cracks of the issue here, then I immediately relate it to what this means in the confrontation we had; and I’ve done this in the blue. Where possible, I relate the literature to my situation as shown in the black text. I then move onto some reflection as shown in the green text section. Here, I explore why different parenting style issue was an issue in the confrontation at all. I finish with the linking sentence which makes sense of this reflection. It brings things down to earth and back to the real world and more importantly the incident that we are analysing in the first place. It also returns to the point established in the topic sentence.

In the next paragraph, the core part of the sentence is shown in red. The key point of this topic sentence is that I always felt that I had to agree on my husband about parenting. In the text in green, I start to move into some analytical reflection, where I look back at my own thinking and possibly question the things that I’d believed. Be sure to explore what you feel and believe. Question it, do not just state it. Dig down deep, and find out why you feel and believe the way that you do. In the black text section, I find some literature that talks about consensus in parenting styles but I need to immediately bring that back to what it tells me about my situation as a I do in the last line in blue. What it does tell me is that, lots of couples exhibit different parenting styles, this sentence is not a linked sentence summing up the paragraph. But it does move the reader onto the next section where I will talk further about having different parenting styles.

In the next paragraph marks a shift in my understanding of the situation. Reading the literature has caused me to reflect further and deeper; and there’s no reason why this cannot feed into the reflective process as well. My realisation is expressed in the topic sentence, shown in red. Namely whatever we do, my husband and I will always be perceived differently. And this is followed by a number of sources that expand and further this idea.

In the final paragraph I have managed to come to some resolution that will move me forward. The final stage of the reflective process can be denoted as the planning phase. This means that we might think about where to next? with the issue; or how this understanding may change our behaviour in the future. You may or may not get to this stage with your reflection of your incident. It’s not completely necessary that you do. Here, however, I have arrived at the understanding that common parenting approaches are not as important as I had previously thought. And as I reflect in green, what I really hope for is to have open communication between the three of us.

The final sentence is the link sentence – it echoes the idea started in the topic sentence by saying that the argument was made worse by my anxiety, which was mostly unnecessary. More importantly it brings the reader back to the incident or confrontation – which is what the assignment is all about. A reflection can go in many directions exploring ideas and feelings surrounding the incident, but, the paragraph will be much stronger if the reflection turns to the incident to clarify how it changes our understanding of the specific incident

So, in summary, although this is a reflective piece it should not be written as a long meandering chain of thought. It requires structure and paragraphing. Just like any other academic writing. So, use topic sentences and use linked sentences in order to bring up the ideas back to the situation. Keep that conversation going between the literature and the critical situation. Constantly relate one to the other, do not discuss literature or a theory that has no impact upon the critical incident.

And finally, reflect deeply and delve into the reasons of your feelings. Do not just identify them, and be open to the literature changing your views and understandings. At first you need to link your reflections to the literature, but this can be a cyclic process where the literature feeds back into your reflections as well. This, however, means that your writing could get quite long, so the key here is to limit the scope of your incident in the first place. Select a simple confrontation, because it is better to reflect deeply on a few variables rather than spreading your focus across a complex matter – making the reflection too broad and too shallow.