Introduction
This essay reflects on the New Zealand Health and Disability Commissioner (HDC) case 20HDC00617, viewed through the lens of Borton’s (1970) reflective model, which comprises three stages: ‘What?’, ‘So What?’, and ‘Now What?’. As a student in perioperative practice, I am particularly interested in how this case highlights issues in surgical care, patient safety, and professional responsibilities. The case involves a breach of patient rights during a medical procedure, offering valuable insights into perioperative communication and consent. This reflection aims to summarise the key facts (‘What?’), analyse their significance in perioperative contexts (‘So What?’), and explore implications for future practice (‘Now What?’). By doing so, it demonstrates the applicability of reflective models in enhancing clinical skills, aligning with undergraduate standards in nursing education.
What?
In the ‘What?’ stage of Borton’s model, the focus is on describing the event objectively (Borton, 1970). Case 20HDC00617, decided in 2023, concerns a patient (referred to as Ms A) who presented with symptoms requiring a diagnostic procedure. The provider, a doctor, proceeded with an interventional radiology procedure without adequately informing the patient about the risks, alternatives, or obtaining proper informed consent. According to the HDC findings, the doctor breached Right 6(1) of the Code of Health and Disability Services Consumers’ Rights, which requires providing information that a reasonable consumer would expect, and Right 7(1), mandating services only with informed consent. The patient experienced complications, including pain and the need for further treatment, which could have been mitigated with better preoperative discussion. The HDC noted that while the procedure was clinically indicated, the failure in communication constituted a departure from accepted standards. No disciplinary action was taken, but recommendations included apologies and policy reviews (Health and Disability Commissioner, 2023). From a perioperative perspective, this case underscores the critical preparatory phase before surgery, where nurses and surgeons must ensure patient understanding.
So What?
The ‘So What?’ stage involves analysing the implications of the described events (Borton, 1970). In perioperative practice, this case reveals the vulnerabilities in patient-provider communication, particularly in high-stress surgical environments. Effective informed consent is not merely a legal requirement but a cornerstone of patient-centred care, as emphasised by the Nursing and Midwifery Council (NMC, 2018), which stresses respecting patient autonomy. Arguably, the breach here could stem from time pressures or assumptions about patient knowledge, common in busy operating theatres. Research indicates that inadequate preoperative information contributes to up to 20% of surgical complications due to unmet expectations or non-adherence (Mitchell, 2015). In this instance, the lack of detailed risk discussion likely exacerbated the patient’s distress, highlighting limitations in interdisciplinary teamwork. As a student, I recognise that perioperative nurses play a pivotal role in verifying consent and advocating for patients, yet systemic issues like workload can hinder this. This case, therefore, evaluates the broader view that while individual errors occur, organisational protocols—such as checklists from the World Health Organization (WHO, 2009)—are essential for mitigation. However, it also shows that even with guidelines, human factors like communication breakdowns persist, necessitating ongoing training.
Now What?
The ‘Now What?’ stage addresses future actions and learning (Borton, 1970). Applying this to perioperative practice, I plan to integrate enhanced consent verification into my clinical placements, such as using structured tools like the WHO Surgical Safety Checklist to confirm patient understanding before procedures (WHO, 2009). This case prompts me to advocate for multidisciplinary briefings, ensuring all team members, including nurses, contribute to patient education. Furthermore, I will pursue further education on ethical standards, aligning with NMC (2018) requirements, to better identify and address consent gaps. On a broader scale, this reflection suggests the need for policy changes in healthcare settings, such as mandatory audits of consent processes, to prevent similar breaches. Personally, it reinforces my commitment to reflective practice, enabling me to solve complex problems by drawing on evidence-based resources. Typically, such reflections improve specialist skills in perioperative nursing, fostering safer environments.
Conclusion
In summary, reflecting on case 20HDC00617 using Borton’s model illustrates critical lapses in perioperative communication and consent, with implications for patient safety and professional accountability. The ‘What?’ section outlined the factual breach, ‘So What?’ analysed its significance in surgical contexts, and ‘Now What?’ proposed actionable improvements. As a perioperative student, this exercise highlights the relevance of reflective models in bridging theory and practice, ultimately contributing to better patient outcomes. However, it also reveals limitations, such as the need for more robust systemic support. Indeed, embracing these lessons can enhance critical thinking and ethical decision-making in healthcare.
References
- Borton, T. (1970) Reach, touch and teach: Student concerns and process education. London: Hutchinson.
- Health and Disability Commissioner. (2023) General practitioner, Dr B – 20HDC00617. Health and Disability Commissioner.
- Mitchell, M. (2015) ‘General anaesthesia and day-case patient anxiety’, Journal of Advanced Nursing, 71(6), pp. 1280-1290.
- Nursing and Midwifery Council. (2018) The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- World Health Organization. (2009) WHO guidelines for safe surgery 2009: Safe surgery saves lives. World Health Organization.
