An evaluation of an incident I have encountered working in the healthcare field as a home health aid. The incident in question involves pain patch removal times not being met by a nurse and patient being in pain because of that. Evaluations done on the different choices I had in this situation, as well as pros/cons and ethical provisions involved.

1. My Critical Incident
By: Brook King

2. Step One:
Assessment
THE SCENE: At a patient’s house being trained as
a new HHA/CNA by another experienced aid.
THE PATIENT: Paraplegic with severe chronic
back and nerve pain.
THE ISSUE: The nurse sent to remove and replace
patient’s fentanyl patch did not show up and
company had no other nurse available to send that
day. Patient would have to wait until tomorrow for
another nurse.
Patient now to wait with the extreme pain
until tomorrow since he could not reach to
remove or reapply patch himself.

3. Step Two:
Nursing Dilemma
THE DILEMMA:
This patient is now to sit in pain all day and
night until some nurse is finally available to come
and help him unless the aide(s) present were to
help in some way relieve his pain.
TO HELP OR NOT TO HELP!??

4. Step Three:
Planning
CHOICE ONE:
Ignore the rules set by the company and the
world and help the patient by removing and
reapplying the patch yourself.
PROS:
No guilt about leaving pt.
In pain
Helps the pt. Be relieved
of his extreme pain
CONS:
Breaks not only
company rules but laws
too
Possible legal
consequences if it got
out

5. Step Three:
Planning
CHOICE TWO:
Follow the rules and cover your own butt by
not helping the patient remove or reapply the
patch.
PROS:
No possible legal
trouble
No guilt about
breaking rules/laws
CONS:
Pt. will remain in
pain
Pt. may resent you
for not helping
Pt. may suffer
withdrawal

6. Step Three:
Planning
CHOICE THREE:
Make sure the patient has all necessary
materials to try and remove and replace his own
patch.
PROS:
Helps pt. Help
themself
No possible legal
consequence
No guilt whatsoever
CONS:
Pt. may not be able
to reach
Pt. may put patch in
wrong place or not
remove old one
(Overdose!)

7. Step Four:
Diagram
CHOICE 1:
Ignore rules,
give med patch
PRO: No guilty
conscious.
Helps pt. pain.
CON: Break rules.
Legal
consequences.
DILEMMA:
Giving Meds in
the Absence of a
Nurse
CHOICE 2:
Follow rules,
don’t help pt.
PRO: No legal
consequences.
No guilt on rules.
CON: Pt. pain.
Resentment.
Withdrawal.
CHOICE 3:
Enable pt. To
do on their
own
PRO: Pt. does
himself.
No legalities.
No guilt.
CON: May not
work/reach.
Wrong place.

8. Ethical Principles
Involved:
Ethical Principles:
Beneficence: Do good
In this case, take the best action
possible to do good for and by the patient.
Non-Maleficence: Do no harm
In this case, remaining competent and
not doing anything that could harm pt. Or
yourself. (Not working out of scope of
practice)

9. Ethical Provisions
Involved:
Ethical Provisions:
1. “...practice with compassion…”
Understand and care for the pt. Because you
understand what they’re going through, empathize.
2. “...primary commitment to pt...:”
Committed to taking care of pt. To the best of
your ability and within your scope of practice.
9. “...Nurse values...maintain integrity…”
Maintain the integrity, values, and fidelity of
nursing by doing things ethically.

10. Step Five:
Implementation
MY CHOICE:
I would choose option 3; aiding the patient
in doing the medication administration himself.
WHY?
After looking at pros/cons of all choices, 3rd
seemed most practical, safe, legal and helpful to
pt. And to myself as a healthcare professional.
HOW?
Gather needed materials for pt. To apply
himself, help him find the old patch to remove, and
guide him on the proper way and place to put
patch. Then appropriately dispose of patch.

11. Evaluation: My Evaluation:
I summize that the process in which I would
aid the patient in removing and applying his own
med patch was the best choice in given situation
since it was most practical, doable and safe. Also
the way I came to my final choice helped me
decide on my choice because I evaluated all my
options and weighed the pros/cons to choose the
best course of action in this situation.
For the outcome of the chosen solution, I
feel that too was effective and most helpful to all
parties involved in given scenario Since the pt.
was able to relieve his own pain and us aides were
not working outside our practice/skills.