Reflective Analysis of a Critical Incident Demonstrating Nursing Essay: Navigating Challenges and Rewards

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In the dynamic healthcare environment, nurses often face situations that challenge their skills, knowledge, and emotions. One such critical incident stands out in my memory. Shaping my approach to nursing care and offering insights into my strengths and areas for growth. In any healthcare profession, there is an inherent commitment to always act in the patient’s best interest. This duty is intensified during critical incidents. In the scenario above, the immediate response to initiate CPR was a technical reaction and an ethical decision.

It underscores the commitment to providing care.

Another ethical concern arises when considering the patient’s autonomy. While in dire emergencies, immediate action might be necessary. It’s also essential to be aware of any existing Do-Not-Resuscitate (DNR) orders or other directives the patient may have. It requires a delicate balance between urgency and respect for the patient’s wishes. In my experience, while we acted promptly, subsequent interactions with the family highlighted the importance of being informed about patient preferences. The critical incident showcased the efficacy of prior training. It is imperative to note that the world of healthcare is perpetually evolving. With advancements in medical research, techniques, and equipment, regular exercise is beneficial and indispensable. For instance, introducing newer CPR techniques or more advanced defibrillators necessitates periodic refreshers for all healthcare professionals. Often, training focuses primarily on the technical aspects, but emotional and psychological preparedness is equally crucial. Incorporating modules focusing on building resilience, handling stress, and managing grief can equip nurses with the holistic skills required in their challenging profession. Every incident, especially the critical ones, paves the way for personal introspection. Post the incident. I dedicated time to self-reflection, not just on my actions but also my emotional responses. This introspection was pivotal in recognizing areas for personal development, both as a nurse and as an individual.

  • 1 Seeking Feedback and Engaging with Families
  • 2.1 Areas of Improvement
  • 2.2 Lessons Learned and Future Implications
  • 3 Conclusion

Seeking Feedback and Engaging with Families

One significant step in personal growth is actively seeking feedback. Post-incident debriefing sessions with colleagues, superiors, and even the patient’s family provided diverse perspectives on the event. Such feedback is instrumental in refining one’s approach to care and understanding the broader implications of one’s actions. Engaging with the patient’s family post-incident was a learning experience in itself. It emphasized the importance of clear communication, empathy, and patience. While the primary focus is often the patient, the family’s emotional well-being is paramount. Offering them clarity, support, and understanding can significantly ease their trauma.

Wrapping Up: An Ever-evolving Journey

Nursing, as a profession, is a blend of science and art. While technical prowess is essential, the human touch, understanding, and personal growth define the essence of a nurse. Critical incidents, with all their challenges, are stepping stones in a nurse’s journey, offering lessons that textbooks often can’t. Embracing these experiences and striving for betterment ensures we provide unparalleled care, touching lives and making a difference daily. During a regular night shift, I was responsible for a patient diagnosed with advanced cardiac issues. As the night progressed, the patient’s vitals began to drop. Within moments, I found myself amid an unexpected crisis. Realizing the gravity of the situation, I immediately alerted the on-call physician and initiated CPR. While I had undergone countless training sessions, the sheer immediacy and urgency of the situation tested every ounce of my skills. My team and I worked cohesively, employing every available resource to stabilize the patient. Upon retrospection, several positive elements emerged:

  • Quick Decision Making: Recognizing the signs and responding swiftly.
  • Team Collaboration: Seamless communication and cooperation with fellow healthcare professionals.
  • Application of Training: Effective use of CPR techniques, showing the importance of regular training and refreshers.

Areas of Improvement

While many actions were commendable, reflection allows for the identification of potential areas of enhancement:

  • Emotional Preparedness: Though the situation was managed well, I felt a whirlwind of emotions. Building resilience and emotional stability is paramount.
  • Enhanced Communication: While the team was informed promptly, ensuring that family members were updated promptly and empathetically is crucial.

Lessons Learned and Future Implications

This incident underscored the unpredictability inherent in the nursing profession. Moreover, it reinforced the idea that while technical knowledge is vital, soft skills such as communication, empathy, and teamwork play an equally pivotal role in patient care.

Furthermore, continuous professional development is not just a formality but a necessity. Regular training sessions, workshops, and simulations can bridge the gap between theoretical knowledge and practical application, preparing nurses for such critical incidents.

Critical incidents, while challenging, offer invaluable learning experiences for nurses. Reflecting on these situations provides insights into personal and professional growth areas, ensuring better preparedness for future challenges. Moreover, these reflections foster resilience and adaptability in the face of adversity. Embracing these experiences and the lessons they bring fortifies a nurse’s commitment to providing the best possible care to every patient they encounter.

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Critical Incident analysis of a clinical setting

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Critical Incidents

Critical Incidents

According to Hannigan (2001), a critical incident prompts individuals to reflect on events in order to find meaning. This reflection can be based on either positive or negative experiences. Utilizing critical incidents as a means of reflection involves recognizing behaviors that were especially beneficial or unhelpful in a particular situation. In general, teachers have played a role in everyone’s lives, making a difference in children and shaping them into the future generation.

During my time in primary and secondary school, three significant events have influenced my perspective on teaching. One memory that stands out from my primary school years is my teacher, Miss Cameel. As my Standard Three teacher, she left a lasting impression on me. Miss Cameel’s approach to teaching inspired me to pursue a career in education. Her interactions with students were characterized by patience, care, and understanding, qualities that I greatly admired. Additionally, her teaching style was creative and engaging, making it enjoyable for us to learn and stay focused.

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She treated us like family, which made me appreciate her even more. I have fond memories of impersonating Miss Cameel after school, pretending to teach just like her. As I grew up, my aspiration was always to become a teacher. Another incident that stands out was in Standard five, when my teacher Miss Sherry was known for her strict approach to teaching. She firmly believed that punishment was the most effective way for children to learn quickly, and she applied that method to us.

During our preparation for the SEA Examination, we would engage in practice sessions with past papers. After completing the exercises, Miss Sherry would correct them and physically discipline us for the questions we had answered incorrectly by striking our hands with her long, thick ruler. Consequently, this treatment instilled fear in us and led to a general dislike for Miss Sherry. However, despite the punishment, it ultimately aided our improvement and enhanced our ability to concentrate. Personally, I disapprove of this punitive approach as it fails to represent an appropriate method of teaching and learning. I firmly believe that alternative strategies could have been implemented to address this situation without resorting to harsh punishment.

In form five at Barrackpore West Secondary School, I had a critical incident during my extra lessons involving a young girl named Chanel. Despite being in form one at the same school, Chanel exhibited impolite behavior towards the teacher and used obscene language. Intrigued by her actions, I approached her later to talk. It was then that Chanel disclosed the difficult circumstances she faced at home. She lived in an unfavorable environment without responsible parents to provide guidance. Despite these challenges, Chanel demonstrated intelligence through impressive academic performance. However, her experiences had influenced her attitude towards others.

We communicated and I assisted her in any way possible because she wanted someone to listen and help. Currently, I am attending The University of Trinidad and Tobago (UTT) pursuing a Bachelor’s degree in education. My goal is to specialize in Primary Education. Being involved in children’s lives and making a positive impact is something I truly enjoy. I aspire to be the best teacher possible, following the example set by Miss Cameel. When it comes to children, I am attentive, creative, caring, and patient; being a teacher feels like my calling.

My perspective on punishment varies as I believe it has a detrimental impact on children’s concentration and enthusiasm for school. Instead, I choose to engage in dialogue with my students, offering further explanations or supplementary assignments when needed. I take pleasure in consulting with children and assisting them in developing their independence. These three occurrences have had a favorable influence on my teaching style. Throughout my experience in primary and secondary school, I acquired substantial knowledge about the education sector.

I have a strong fondness for children and enjoy embracing novel challenges in life, therefore I aspire to pursue a career in teaching. It would be a privilege to serve as a role model for my students, as my aim is to motivate them and foster beneficial transformations in their lives. I firmly believe that with determination, anything can be achieved.

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Critical Incident Assignment essay

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Critical Medication Incident Reflection

Introduction.

Reflection is an essential and necessary skill for all health care professionals and is also in line with (NMBA, 2017). Reflective practice ensures continual learning and enables health practitioners to improve their practice as it encourages self-evaluation (Murdoch, 2019). Reflection also aids in discovering beliefs, values, and information ingrained in experiences (Sorrell, 2017). Gibbs’s reflective cycle has been chosen because it is easy to use. Also, encourages a detailed account of the circumstances, assessment of the feelings and experience, analysis to make sense of the experience, conclusion where other options are taken into consideration, and reflection on the experience to consider what one would do if the circumstance arose again (Ardian, Hariyati, & Afifah, 2019). The incident was a miscommunication incident between nurses that resulted in the patient being given double doses. This incident was selected because it made the nurse aware of his shortcomings and those of other team members, which caused him to dwell on the incident and consider what lessons could be drawn from it to avoid repeating the same error.

Additionally, according to Billstein-Leiber et al. (2018), communication is necessary for nursing practice as it underpins quality healthcare, patient satisfaction, and the realization of favorable health outcomes. As directed by the Gibbs reflective cycle, the incidence will be described briefly; the nurse’s feelings and why the incidence is essential to nursing practice will be discussed. Later an action plan will be formulated to ensure the nurse handles the situation better if it occurs again. Confidentiality is essential to reflection; therefore, the patient will be referred to as (Rose, not her real name).

Description

Rose was a 23-year-old female admitted to the hospital for colorectal surgery. Rose’s prescription included a dose of paracetamol three times a day. As the team leader, I was supposed to oversee other nurses and patient care transitions. Therefore I went through hand-over charts between shifts. As I did the PCA checks and obs at 1701 hrs, I noticed there was an IV paracetamol that was still clamped. I cross-checked the medication chart and realized that the paracetamol IV was ticked at 1638 hours. Since it was only 30 minutes later, I assumed my partner had forgotten to unclamp the IV medication, so I unclamped it. After one hour, I noticed the IV, approached me, and told me that the morning shift nurse had left the IV medication unadministered. Hence, she decided to administer oral paracetamol. This is where I realized that the patient had received a double dose of paracetamol. We decided to recommend that Rose undergoes Liver function tests. Rose’s paracetamol levels were slightly raised, but below the treatment requirement, so we monitored her for a few hours. I also went ahead and changed the administration time and indicated in the charts the drugs administered.

I was anxious and worried about making mistakes when assigned the leadership position. However, I was able to overlook the fear and perform my responsibilities. According to Wondmieneh et al. (2020), those who experience medication errors often experience emotional distress and a lack of confidence. When this incident occurred, I felt discouraged and doubted my clinical skills. I was angry that my partner did not communicate that she administered oral paracetamol but indicated in the chart that it was an IV. I felt disturbed and sad about the double dosage. I feared losing my job and facing litigation due to the error. I feel I dealt with the situation with outward calm and in a professional manner that ensured the patient’s safety. In the end, I was very pleased Rose’s situation did not worsen, and she recovered without further complications.

The experience was good because the patient was not seriously affected by the double dosage error. In addition, because my partner and I communicated immediately after the symptoms were exhibited, we could start a reversal treatment immediately; hence the patient did not develop liver sepsis. However, I worked on the assumption in this situation when I could have asked my partner. If I had asked her, the medication error could have been avoided. The patient experienced side effects because of the double dosage. I failed to adhere to all seven rights (7rs), the right patient, medication, dose, route, time, Response, and documentation (Jones & Treiber, 2018). As a result, the patient was negatively affected. Proper documentation of medication can aid prevent medical errors from occurring within the hospital (Wheeler et al., 2018). However, in this case, there was no proper documentation by the morning shift nurse and my partner, which prevented me from assessing relevant information.

In addition, I did not adhere to the recommended medication adherence practice. Hospital staff must report all incidents they observe or errors they make. Therefore by involving the Chief Medical officer, risk man, and Manager, I was adhering to the policies and regulations of the hospital; hence the case was managed efficiently in line with this, and the LFT levels were checked immediately. This was good because the patient was monitored for any evidence of an adverse reaction.

Medical mistakes are rarely the result of careless or inexperienced medical personnel. Instead, they frequently result from a breakdown in the procedures that control how patient care is delivered (Sorrell, 2017). Medication errors often occur in the administration phase (Wondmieneh et al., 2020). Therefore effective communication is essential in this phase. Teamwork requires cooperation, communication, and coordination between members of a team. My partner and I failed to communicate effectively in the team dynamic in this incident, and hence Rose suffered. Shitu et al. (2018) discovered that effective interdisciplinary communication is a prerequisite for providing high-quality healthcare. Rose’s safety was reduced by ineffective communication between staff. Shitu et al. (2018) further suggest that other medication errors can be avoided through effective communication between the nurse and the patient. Involving the patient in medication management could have prevented the double dosage. Rose could have informed me about the Oral medication she had received from my partner.

According to the (NMBA) (2017), when Registered nurse delegates tasks, they should ensure they supervise the practice to ensure that delegated practice is safe and correct. However, as the leader, I failed to adhere to this direction; I did not supervise the work done by my partner. Morover, Hanson & Haddad. (2021) have argued that nurses should not “blindly” give medications; instead, they should seek clarification when needed. In addition, Rodziewicz et al. (2022) advocate for double-checking before medication administration. I, however, administered Rose’s medication blindly, guided by my assumption rather than confirming facts. I should have double-checked with the patient medication chart to ensure that the correct dose of medication is administered to the patient at the right time (Rodziewicz et al., 2022). This medication error was avoidable if I had gone through the patient medication chart carefully before administering it and communicated with my partner before deciding to administer it. Therefore, it can be said that such situations happen due to a lack of communication and lack of proper documentation concerning patient care.

When I realized the patient had received a double dose of the medication, I immediately informed the Chief Medical officer (CMO). I made this decision because nurses have an ethical obligation to help prevent and manage medical errors (Sorrell, 2017). Therefore by reporting, I was putting the patient’s concerns first and fulfilling my ethical obligation. In many circumstances, however, nurses do not report errors because of fear of litigation (Rodziewicz et al., 2022; Sorrell, 2017; Wondmieneh et al., 2020) ). I was aware that the double dose of the medication posed a substantial threat to patient safety. therefore, by testing the LFT levels, I was also fulfilling my ethical principle of Beneficence and Non-maleficence (Sorrell, 2017) by taking the necessary steps to minimize the harm caused by an error. In line with this, I should have informed Rose of the error. For instance, if the levels were significantly raised and I failed to inform her of the error, she may have refused the additional treatment required to reduce the rising levels.

To avoid this situation, I would double-check the medication chart and communicate with the nurse that was supposed to administer the medication. In addition, I would never administer medication that I have not prepared or helped prepare. If there is any uncertainty over any aspect of medication, I should consult with the nurse in charge and, if need be, the prescribing officer. In other circumstances, I would also consider the patient’s current condition when administering drugs. For instance, Rose was not exhibiting any signs of pain in this circumstance, which should have prompted me to ask my partner about the pain medication instead of directly administering it. It is also essential for a nurse to the rationale for the drug administration. Considering the reason for administration would ensure an overdose or medication error is not made. For instance, in this case, the reason for administration was based on an assumption instead of a viable reason.

Action plan

Miscommunication by different parties was the leading cause of medication error in this incident. Therefore if put in a leadership position, I would organize a safety talk around the facility I am posted to ensure nurses are educated on the importance of double-checking medication and making the correct documentation. Drug administration guidelines ensure that nurses will not repeat the same mistake. The nurses would be educated that medication administration should be clearly and accurately recorded immediately. And if a drug was not administered deliberately, it should also be documented. My partner should have documented the unadministered IV and the administration of the oral paracetamol; hence such a proram would educate her. the program would also encourage sharing Stories of Errors rather than keeping mistakes hidden because of fear and hearing other people’s stories. Other staff members can prevent and/or manage healthcare errors by being aware of how others have handled errors or wish they had managed them differently.

In addition, I will undertake an online leadership course to ensure that I am equipped to create an environment where my team members can collaborate and communicate efficiently. I believe the course will equip me with the skills to respectfully hold others within the team accountable. Additionally, I will be more cautious while dispensing medication in my future practice by carefully checking medication charts. I will always follow the medicine checks, time, and seven rights. In a leadership position, I would also design Checklists, Reminders, and Double Checks to reduce medical errors, especially when errors are likely to occur.

Ardian, P., Hariyati, R. T. S. & Afifah, E., 2019. Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills. Enfermería Clínica, 29(2), p. 588–593.

Hanson, A. & Haddad., L. M., 2021. Nursing Rights of Medication Administration. StatPearls.

Jones, J. H. & Treiber, L. A., 2018. Nurses’ rights of medication administration: Includingauthority with accountability and responsibility. Nursing Forum, 53(3), p. 299–303.

Murdoch, M., 2019. How to reflect on your practice for revalidation. Nursing in practice.

Nursing and midwifery board Aphra, 2017. Registered nurse standards for practice. [Online] Available at: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Rodziewicz, T. L., Houseman, B. & Hipskind., J. E., 2022. Medical Error Reduction and Prevention. StatPearls [Internet].

Shitu, Z. et al., 2018. Avoiding Medication Errors through Effective Communication in Healthcare Environment. Movement, Health & Exercise, 7(1), pp. 113-126.

Sorrell, J., 2017. “Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare .”OJIN: The Online Journal of Issues in Nursing, 22(2).

Wheeler, A. J., Scahill, S., Hopcroft, D., & Stapleton, H. (2018). Reducing medication errors at transitions of care is everyone’s business . Australian Prescriber , 41(3), 73–77. https://doi.org/10.18773/austprescr.2018.021

Wondmieneh, A., Alemu, W., Tadele, N. & Demis, A., 2020. Medication administration errors and contributing factors among nurses: a cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing.

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Cisco Talos Blog

Talos discovers microsoft kernel mode driver vulnerabilities that could lead to system privileges; seven other critical issues disclosed.

Microsoft disclosed six security vulnerabilities that are actively being exploited across its products as part of the company’s regular Patch Tuesday security update.  

In all, August’s monthly round of patches from Microsoft included 87 vulnerabilities, seven of which are considered critical. In addition to the zero-days disclosed Tuesday, Microsoft also fixed a security issue that had already been publicly disclosed: CVE-2024-21302 , a vulnerability in Microsoft Office that could result in unauthorized disclosure of sensitive information to malicious actors. Microsoft initially warned about the possibility that attackers could exploit this vulnerability in the wild last week, including being able to reverse older software patches that could re-open them to past vulnerabilities. 

Cisco Talos’ Vulnerability Research team discovered four of the vulnerabilities Microsoft patched this week: CVE-2024-38184 , CVE-2024-38185 , CVE-2024-38186 and CVE-2024-38187 . These are elevation of privilege vulnerabilities in the Microsoft Windows kernel-mode driver that could allow an attacker to gain SYSTEM-level privileges.  

The most serious of the issues included in August’s Patch Tuesday is CVE-2024-38063 , a remote code execution vulnerability in Windows TCP/IP. An unauthenticated attacker could exploit this vulnerability by repeatedly sending specially crafted IPv6 packets to a targeted Windows machine that could enable remote code execution. Systems that have IPv6 disabled are not susceptible to this vulnerability.  

CVE-2024-38063 has a severity score of 9.8 out of 10 and is listed as “more likely” to be exploited. 

Two other remote code execution vulnerabilities, CVE-2024-38159 and CVE-2024-38160 , exist in Windows Network Virtualization, and another, CVE-2024-38140, exists in the Windows Reliable Multicast Transport Driver. All three are considered critical. 

Two of the vulnerabilities already being exploited in the wild are CVE-2024-38178 , a memory corruption vulnerability in the Microsoft Scripting Engine, and CVE-2024-38193 , an elevation of privilege vulnerability in the Windows Ancillary Function Driver. Though they are both zero-days, Microsoft only lists them as being “important.” 

Lastly, we’d also like to highlight two vulnerabilities in the Secure Boot security feature, CVE-2024-38090 and CVE-2024-28918 , which are rated critical and important, respectively.  

A complete list of all the other vulnerabilities Microsoft disclosed this month is available on its update page . 

In response to these vulnerability disclosures, Talos is releasing a new Snort rule set that detects attempts to exploit some of them. Please note that additional rules may be released at a future date and current rules are subject to change pending additional information. Cisco Security Firewall customers should use the latest update to their ruleset by updating their SRU. Open-source Snort Subscriber Rule Set customers can stay up to date by downloading the latest rule pack available for purchase on Snort.org . 

The rules included in this release that protect against the exploitation of many of these vulnerabilities are 63858 – 63861 and 63864 - 63878. There are also Snort 3 rules 300980 – 300988. 

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Related content, largest patch tuesday in 3 months includes 5 critical vulnerabilities.

This is the largest Patch Tuesday since April, when Microsoft patched 150 vulnerabilities.

Only one critical issue disclosed as part of Microsoft Patch Tuesday

The lone critical security issue is a remote code execution vulnerability due to a use-after-free issue in the HTTP handling function of Microsoft Message Queuing.

Only one critical vulnerability included in May’s Microsoft Patch Tuesday; One other zero-day in DWN Core

The lone critical security issue is CVE-2024-30044, a remote code execution vulnerability in SharePoint Server.

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  1. Reflecting on critical incidents

    an incident involving conflict, hostility, aggression or criticism (Fook & Cooper, 2003). an incident which made you think differently, or caused you to question your assumptions or beliefs. Critical incidents may relate to issues of communication, knowledge, treatment, culture, relationships, emotions or beliefs.

  2. A critical incident analysis and reflection

    The purpose of this essay is to reflect and critically study an incident from a clinical setting whilst using a model of reflection. This will allow me to analyse and make sense of the incident and draw conclusions relating to personal learning outcomes. The significance of critical analysis and critical incidents will briefly be discussed ...

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    Critical reflection essay in Social Work (extract) Stages / function Level of reflection The incident occurred during my first fieldwork placement, in a children's service. I was given the opportunity to assist a caseworker, Rose, in her work with the Jackson family - parents: Jason and Mary and their three children [all names

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    Taken with Surprise: Critical Incidents in the Classroom. Kwok Pui-lan Episcopal Divinity School. Abstract. This is part of a collection of essays, which tackles thorny questions related to critical incidents in teaching. By using different pedagogical methods and techniques, each author provokes creative thinking about how to address specific ...

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  7. MNHS: Reflective writing and critical incidents

    MNHS: Reflective writing and critical incidents. Reflection on practice is an important aspect of your ongoing professional learning and development. In your course, this may take the form of a critical incident report. However, the focus is less on the event, incident or experience in itself. What is important is your reaction to it, and how ...

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    The reason for this essay is to reflect on a critical incident experience during my six week placement as a student nurse on an orthopedic ward. To explore an event as a critical incident is a value judgment, and the basis of that judgment is the significance attached to the meaning of the incident. Critical incidents are created or produced by ...

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    a critical incident report is different from that of an academic essay; however, it is still important to present ideas in a systematic and organised way, and to use appropriate language. This example uses sub-headings consistent with the assignment requirements to explicitly organise the report. It is simply written, and avoids use of ...

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    Some examples of critical incidents include but are not limited to acts of terrorism, natural disasters, and armed robberies. An alarm and critical incident response are vital to safeguard lives and property and minimize exposure to indirect liability (Cesarec, Mikac & Spevec,2020).

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    Critical Incident analysis of a clinical setting. The purpose of this essay is to reflect and critically study an incident from a clinical setting whilst using a model of reflection. This will allow me to analyse and make sense of the incident and draw conclusions relating to personal learning outcomes. The significance of critical analysis and ...

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    According to Lanz (2022), the criminal extortion attempt halted 5,500 miles of pipeline responsible for transporting 45% of all fuel to the East Coast's biggest markets. The incident provides an opportunity to evaluate the emergency response capabilities of both public and private stakeholders when critical infrastructure fails.

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    ABN: 12 377 614 012. TEQSA Provider ID: PRV12140. CRICOS Provider Number. Monash University: 00008C. Monash College: 01857J. Authorised by. Chief Marketing, Admissions and Communications Officer and Vice-President. Maintained by. Student Academic Success Webmaster Team.

  20. Critical Incidents

    Critical Incidents. According to Hannigan (2001), a critical incident prompts individuals to reflect on events in order to find meaning. This reflection can be based on either positive or negative experiences. Utilizing critical incidents as a means of reflection involves recognizing behaviors that were especially beneficial or unhelpful in a ...

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    In North Carolina, a battleground state that Democrats hope to win back in November, Vice President Kamala Harris contrasted her approach on the economy with that of former President Donald J. Trump.

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