Reflection using Gibbs Reflective Cycle
I undertook a full assessment on a patient with a sacral pressure sore. The patient had limited mobility, dementia and does not speak. I completed the assessment using observation as a primary source. The care assistants were reluctant to engage with the nursing process rendering some specific measurements as ineffectual compromising the eventual Waterlow score.
I conducted the assessment with my mentor and gave a logical explanation how I administered the wound and gave rationale for the dressings I chose. I spoke to the care assistant to reiterate my action plan as it was pivotal to a successful wound healing.
Initially I felt confident. I had observed pressure sores before and I had prior knowledge of dressings and pressure relief. When I discussed about the patient with the care assistant, I ensured we were outside the bedroom as it unprofessional to talk over a client. The health records were of poor quality and had not been updated. When I mentioned this, the carer’s attitude became abrupt and I began to get defensive and made an inconsequential remark, “It does not matter”, just to reengage the carer. This remark I regretted as it undermined my authority and I appeared amateurish. Care records are a legal working document in progress. Poor record keeping will be detrimental to a client’s recovery and must always be challenged. I felt overwhelmed and looked to my mentor to support me.
My role in the nursing process enabled me to evaluate the patient’s wound and give an accurate descriptive account to my mentor. I provided evidence that consolidated my evaluating skills and put my basic wound knowledge into practice, within a safe nurturing environment. I rushed the assessment and regretfully completed it away from the nursing home. I found this frustrating as I could not explore the holistic process in greater depth and it simply became a checklist without breadth to the other client’s needs; dementia and poor communication, which I acknowledged fleetingly.
Payne (2000) identifies that professional partnerships are at risk if a nurse has insufficient knowledge required to perform ethically, thus undermining their own authority. The care assistant knew I was a student nurse and treated me, not as a partner in care but as a learner.
I failed to develop the partnership more and relied on my mentor too much when I conversed with the carer. I was looking for affirmation which was lacking within me. If I had communicated how significant the carer’s role was, this would have earned me more respect and empowered the carer.
Crawford et al (2005) believe empowerment inspires the self determination of others, whilst Fowler et al (2007) identifies listening skills and the encouragement in the participation of care motivates nurses to actively support changes in patient care. Entwistle and Watt (2007) remind practitioners that participation requires communication skills that are not universally possessed so nurses must be flexible in their approach to champion the participation of others. Using these concepts I could have built a rapport with carers, praising them for the care they provide, promoting partnership in care whilst emphasising the importance of the care plan.
I found it difficult to disengage from the patients many problems and only to focus on the wound. When choosing a suitable nursing framework, Roper et al (2000) describe care planning as a proposal of nursing intervention that notifies other nurses what to do and when. This model is used throughout the community and is thought to be a simplistic, easy to use everyday tool that enables nurses to identify actual and potential problems. Page (1995) had reservations about Roper, Logan and Tierney’s model, comparing it to a checklist which, if not used as the authors intended, can be restrictive in clinical practice as fundamental problems can be missed.
I used some of Page’s model as a checklist and not as a holistic assessment due to time constraints, the patient’s profound dementia, poor record keeping and being a novice assessor; however I was directed by my mentor to focus on the wound alone. It could be argued that community nurses working within care homes only prioritise physical needs from adapted assessments, as the care home provides the patient’s psychosocial needs. I identified from the patient’s assessment she was at the end stage of the dependence continuum, but I still recognised the importance of holism when completing the package of care and I identified that the promotion of comfort was as important as healing.
The main strength of my care plan was in identifying specific measurable outcomes exclusive to the client that were adaptable. I used evidence from reputable sources to identify suitable dressings to promote granulation and healing by sourcing up to date journals from the Cinahl and current trust policies. My weakness was relying on my mentor too much to confirm the evidence I collated on pressure care to the carer’s. Prioritising delegation and assertiveness as part of my learning needs I will now create an action plan that will ensure my future mentors will recognise the effort I extol to succeed in practice.
I conclude my implementation of the care plan was successful. The wound healed and the patient was discharged from the community case load. I demonstrated I can assess patients holistically, but require further practice when addressing client and carer concerns. To use nursing frameworks effectively nurses have to create an inclusive partnership with the client, family, professionals and care providers and demonstrate a broad knowledge of basic nursing care. Successful care plans are universal tools that empowerment others, giving them the direction to advocate safe holistic care based on evidence.
To encourage the participation of others I will become conversant in wound care. I will learn to identify the stages of healing by researching the biology of wound care. I will disseminate this to peers, as the sharing of knowledge is a fundamental part of holistic nursing care. As I develop from a supervised participant to a participant in care delivery I will continue to read research and reflect my practice on a daily basis. Creating new action plans that identify my learning requirements will address my limitations and by acknowledging them I will generate achievable goals to become a competent practitioner.
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1. Client pen portrait.
2. Plan of care
3. Wound evaluation
4. Activities of Daily Living
5. Waterlow Pressure Score
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Gibbs Reflective Cycle
Gibbs’ reflective cycle is popular among the experts from various fields. Whether it is the professionals from the healthcare field, education workers and leaders all of them use it. This approach helps these experts in reflection. In other words, they learn things through their own and others’ experiences. It helps them in continuous personal development (CPD). Furthermore, it leads them to perform their roles efficiently.
There are six points you have to consider while using the Gibbs reflective cycle. Let’s have a look at those six stages to get an understanding of the Gibbs reflective cycle:
As the title suggests, here, you have to write the description of what you want to reflect in the write-up. Here, you need to make the reader aware of the background information. This detail is such as who was involved in the incident and what you are reflecting on. It is must for you to feed to the point and relevant. You should not ramble about the things.
In this section, you have to give a thought to the feelings and thoughts you have about the experience. You should try to find out what were your feelings at that time. You have to identify your thoughts from that time as well. Moreover, you should also try to find out how the incident impacted you. It is better if you discuss your emotions honestly. However, you must remember that you are writing an academic assignment. So, it is not ideal for you to get informal while writing.
Next step is the evaluation in the Gibbs’ reflective cycle model. You should give a thought to how were the things when the incident happened. It is also a must for you to find out what was your reaction at the time of the incident. Writing about the other peoples’ reactions will add depth in your writing piece. You should also tell about what you learnt from that experience. Was that experience good or bad for you?
If you went through some difficult phase at that time, then you need to find out whether you were able to solve the issue later. If yes, then how and if not, then why not. It is the section of the assignment where you can give the ideas of the other authors. Furthermore, you should make sure to add the references to the coursework.
It is the most important section of the assignment. Here, you have to give a thought to how you may have helped yourself at the time of the incident. Also, you have to consider the things that troubled you at that time of the incident. In the analysis section, you can do a comparison between your experience and the written work you have read.
Here, you should acknowledge the things you learned from your experience. It is also a must for you to discuss the other things you may have done to handle the incident. It is possible that your experience may be positive. So, you must explain the things you did at that time. Moreover, you should also write why you will use the same techniques again to ensure a better outcome.
While writing the action plan, you should consider the things that can help you to improve next time. It is possible that you may need some training to deal with the similar event in a better way. You should also find out is there any need for you to get advice on the same issue.
Gibbs reflective cycle example
You may have got the proper idea of what is Gibbs reflective cycle and its six stages. Now, let’s move forward and take a look at some examples of the Gibbs reflective cycle. It may help you while writing your academic assignment.
I did a full assessment of a patient who had a sacral pressure sore. The patient was unable to speak. He also had dementia and limited mobility. My primary source was the observation to complete the assessment. My care assistants were hesitant to take up the nursing tasks while handling the patient. It is due to rendering some specific techniques as ineffectual compromising the final waterflow score.
My mentor helped me while conducting this assessment. I came up with a reasonable explanation of the ways I took to heal the wound. Also, I added the rationale for why I chose the particular dressings. To help the patient to recover fast, I asked my nurses to repeat my action plans.
I have had handled the pressure sores patient earlier. I also have had an idea of pressure relief and dressings. So, I felt quite confident. I discussed about the patient with my assistants. At that time, I made it sure to do it outside the bedroom. The reason is that it is unprofessional to discuss the medical things in front of the patient. I found that the carer had not done a good job while keeping the health records. There were no updates on it, and it was of poor quality.
I made an amateurish remark to the record keeper about the poor handling of it. It was unprofessional from me, the carer didn’t like it and i regret it. I give importance to records as good record keeping helps a patient to recover fast.
I was able to evaluate the wound of the patient due to my indulgence in the nursing process. It helped me to give the right description to my mentor. Moreover, I gave some evidence in the report that compliments my evaluating skills. I also used the basic knowledge of the wound I have to treat the patient. I did all of it in the safe environment.
While doing the assessment, I was in a rush and I did it outside the nursing home which I regret. I felt frustrated when I could not reach the depth while exploring the holistic process. This way the checklist became useless as it did not contain all the things required for the patient.
According to the Payne (2000), if a nurse does not have efficient knowledge to perform a job ethically, then the professional partnerships are at risk. Care assistants treated me as a learner. It is because they knew that I was a student nurse.
I could not achieve success when it comes to developing partnerships. While conversing with the carer I relied too much on my mentor. I feel that I lacked encouragement. Now I feel that if had a talk with the carer about her role or something, then I would have earned some respect. It may also have empowered the carer.
Crawford et al (2005) said that a person gets self-determined if you empower him or her. Fowler et al (2007) came up with a theory that listening skills can motivate nurses to work actively. You can get the same results if you encourage the nurses to participate. I may have used these concepts to build partnerships with the carers which I could not. I surely regret it.
It was tough for me to not focus on the different problems of the patient and focus only on the wound. I like the theory that Roper et al developed in (2000). It says that planning is essential for nursing. All the nurses need to have the right idea of what to do and when to do. It is the method that is widely used in the medical field. It helps the nurses to get to the root of actual and potential problems.
The model of Page (1995) doubts the models of Roper. It compares it with the checklist and can prove restrictive if you don’t use it as per the authors want. It may happen as you may miss the fundamental problems.
I had little time, so I did not do the holistic assessment of the Page’s model. Instead, I used it as a checklist. On the top of that, I was a novice assessor handling a dementia patient. Also, record keeping was poor. However, my mentor asked me to focus on the wound only. You may have an argument over the fact that patients get only physical needs fulfilled from the community nurses. Care homes take care of the psychosocial needs of the patient.
While assessing the patient, I found that the patient was in the final stage of the dependency. However, the thing that made me feel good is that I learnt about how significant is the holism. I also found that promotion of comfort and healing has the same importance.
In my opinion, my care plan’s strength was that I identified particular measurable outcomes. These results were of the client who was adaptable. To encourage granulation, I gathered evidence from the reliable sources to find the suitable dressings. I consider too much reliance on the mentor as my weakness. I have made up my mind that now I will make an action plan that will help me to show my efforts to my mentors.
I am glad to say that I implemented my care plan successfully. The patient got discharged as her wound healed significantly. I learnt that I have the ability to assess the patients holistically. However, I need to improve when it comes to addressing patients and carer. I also understood that I have to build deep partnerships with the patients, family and medical professionals to use nursing frameworks efficiently. I also learnt that it is a must for me to gain broad knowledge of basic nursing care.
I understand that I need to get better at conversation and participation. So, I have decided that I will become conversant in wound care. I will research the biology of the wound care. It will help me to identify that stages of healing. I also have plans of sharing this knowledge with peers as it helps in learning more. Furthermore, I will also read various research, and I will reflect it on my practice. I will find it easy to get rid of my limitations when I am aware of what I need to learn. So, I will make plans for the same as well.
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