CADALIN, Maryelle Deanne R.

BSN III-4
MEDICAL SURGICAL NURSING I
Reflective Journal

1. What values have you learned for the story of the surgeon?
First is his sense of doubt. Things turned out that way all because he doubted because
the first count was incorrect. Although the second count was right, he still had doubts
because of the inconsistency. His sense of doubt led to him being uncertain which then
led to him being meticulous and to double check his patient. Second is his sense of
responsibility. His sense of doubt led him to this like when he immediately ordered xray
for his patient if he did leave behind something inside. Third is his accountability. The
surgeon acknowledged his mistake and also talked to the patient’s relative that he made
an error and explained that they would correct it and ensured that the patient will be safe.
Fourth how he is willing to learn a lesson after he committed an error. He already
mentioned it in the video that most of the people in the medical field are being shamed
especially when errors are being committed. However, he pursued to study literature
about human error and because he have never seen anything like that in medical school, it
was a very new experience to him although it was terrifying because it involved the safety
of the patient but it did not stop him to learn how to become better and even went beyond
to study more to making patient safety better in healthcare institutions.

2. If you are the surgeon in the story what would be your response to the situation
described in the video? How would you approach and manage the situation of a
counting of equipment/supplies that was not consistent? Would you communicate
the error to the relatives/significant other? Explain your answer.
I already believed that what the surgeon in the video did was the right thing and I
would probably do the same. I myself am paranoid to many things and I know that that’s
not a good thing. But I guess this would also help me to have that sense of doubt. Having
sense of doubt is not entirely a positive thing in the field of medicine but I believe this
will hone you to become meticulous in important things which then will help you always
double check or check thoroughly.
If there was an inconsistent count during the surgery, as surgeon, I should ask to do a
recount just in case. The count should be audible and be done concurrently where all
items should be separated but still follow sterility. Causes of safety events are usually
related to errors in practice or communication. If they are unable to reconcile the counts,
 we can the conduct a manual and visual search including the patient, floor, garbage and
linen. If the counts remain unreconciled, the team should then ask for a radiograph to be
taken–when available–and document the results on the count sheet and in the patient's
record, according to the Association of periOperative Registered Nurses (AORN). The
surgeon's primary defense against these cases is to perform a methodical wound exam
before closing the incision to look for any surgical sponges or other items used during the
case. The most common practice for the surgeon is to perform a "sweep" of some kind,
which is an imperfect solution.
The surgeon mentioned in the video that there is science in human error and that it is
inevitable. I think that even though this is unavoidable, we humans can take responsibility
and must be held accountable especially that in the field of medicine, human lives are in
our hands. So yes, I will talk to the relatives/significant other about the error committed
and take responsibility. I will explain it to them in the words that they could understand;
how it happened and what could happen.

3. If you are one of the scrub or circulating nurse which have attended the case, what
could you have done to prevent the situation from happening? How would you
reconcile, justify or explain the correct counting as you have documented in the
chart, but the presence of foreign object left in the patient’s body (a sponge) as
described in the story? Explain your answer.
According to the Association of peri-Operative Registered Nurses (United States), the
first thing that I should do as a circulating nurse or scrub nurse, if there is any discrepancy
in the count is to inform the surgeon and receive acknowledgment from him that there
indeed is inconsistency in the count. If as a scrub nurse, do a manual and visual search,
respectively, of the sterile area surrounding the wound and the remaining of the sterile
field. And as a circulating nurse, conduct search of the nonsterile areas of the room to
locate the missing item. I don’t think I could justify the correct counting that was
documented in the chart, but there was a presence of foreign object left in the patient’s
body. Instead, I should acknowledge my mistake as the perioperative nurse and take
accountability because our patient’s safety was compromised, and it was because of our
negligence. To avoid this and become better, hospitals, or any healthcare institutions
should have and follow institutional policy, where the documentation of count
discrepancy, should also include the measures taken to recover the missing item or
 communications made regarding the outcome. This is more a sound professional practice
and demonstrates that all reasonable efforts were made to protect the patient’s safety.

4. If you are the family member or the patient in the situation, how would you react
and what would you do? Explain your answer.
If it was my loved one who experienced that dreading situation, I think fear is the
emotion I could immediately process. I would first ask the surgeon to explain it to me in
the words that I could understand what is going on and how the situation will be handle.
In the perspective of a patient’s relative/s, I think the reason why they are afraid of
situations like this is because they lack information about it or even if it was explained to
them, they still have a hard time understanding it because some words are foreign to
them. A study by (Kelo, Martikainen, et al., 2013) shows that proper patient education
with the parents shows that parents’ fears subsided after and left hospital with confidence.
If I know about the situation; how did it come to that, how it could be solved, is there
anything I could do as a relative, I think it could calm me down. I also think I would like
to know the legalities if there were anything to happen to my family member, so I hope
there would be a health provider that could act as my advocate.

References:
Association of periOperative Registered Nurses. (1999). Recommended practices for sponge, sharp,
and instrument counts. Aorn j, 70(6), 1083-9.

Bean, M. (2018). Hospitals need more reliable practices to prevent retained surgical items, says
Dignity
Health's SVP of patient safety: Retained surgical items can create numerous financial and
reputational consequences for hospitals, not to mention serious health risks for patients.
Retrieved 10 November 2020, from
https://www.beckershospitalreview.com/quality/hospitals-need-more-reliable-practices-to-
prevent-retained-surgical-items-says-dignity-health-s-svp-of-patient-safety.html

Kelo, M., Martikainen, M., & Eriksson, E. (2013). Patient education of children and their families:
nurses'
experiences. Pediatric nursing, 39(2), 71.

Safety, W. P. (2009). The team will prevent inadvertent retention of instruments and sponges in
surgical
wounds. WHO Guidelines for Safe Surgery 2009, 72-75.