Essay on Gibbs Nursing Model on Reflection
rodrigo | September 2, 2016
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There are a number of different models of reflection that are utilised by professionals to evaluate past experiences. The two main types of professional reflection are reflection-on-action and reflection-in-action (Somerville and Keeling, 2004). Reflection-on-action encourages individuals to re-live past events, with an emphasis on developing a more effective action plan for any future, similar events that may occur. However, this type of reflection does tend to focus more on the negative aspects of our actions rather than the positive behaviours that were demonstrated during the event that is being reflected upon (Somerville and Keeling, 2004). Reflection-in-action is a deeper and more interactive form of reflection that encourages individuals to observe and reflect on past situations from the point of view of themselves and of others around them at the time of the event. Self-reflection and reflection upon events that happened within a work environment are important for individuals within the nursing profession (Paget, 2001). Reflection allows medical professionals to challenge and develop their existing knowledge, maximising the opportunity for learning and to avoid mistakes that may have been made in the past (Royal College of Nursing, 2012).
The Gibbs (1988) model of reflection suggests that the process of reflection is systematic and follows a number of specific steps in order to be successful. This model of reflection is a type of formal reflection, which draws on research and puts forward a theory as to how most effectively put into practice to process of reflection. The process can be broken down into six key steps:
- Description: this step explores the context of the event and covers fine details such as who was present at the event, where it happened and what happened.
- Feelings: this step encourages the reflector to explore their thoughts and feelings at the time of the event.
- Evaluation: this step encourages the nurse to make their own judgement about the event and to consider what went well and what went less well about the event.
- Analysis: this step delves even deeper into reflection on the event and encourages the nurse to break the event down into smaller episodes in order to facilitate analysis.
- Conclusions: this step explores the potential alternatives that may be used to deal with the situation that is being reflected upon.
- Action Plan: this is the final step in the reflection process. The action plan is put into place in order to deal more effectively with the situation if or when it may arise again.
The Royal College of Nursing (2012) believes the Gibbs (1988) model of reflection to be particularly superior because emphasises the role of emotions and acknowledges their importance in the reflection process. Nursing can often be an emotionally charged career, especially for nurses working in areas such as psychiatric health and palliative care. Therefore, reflection on these emotions and exploration of how to manage them and improve management of them in the future is of particular importance in the nursing profession.
Step One (Description)
A young male patient aged 16 years came into the clinic around three days ago. He complained of low self-esteem and is feeling fed up and depressed because of pimples and spots on his face. The patient was worried that girls would not be attracted to him because of the spots. The consultation took place with just myself present, no other nurses were in the room at the time of the appointment. The consultation lasted around half an hour, during which time myself and the patient discussed the history of his problems with his skin and the emotional distress that the spots were causing him. The patient disclosed that he had begun to get spots at around age 14 when he had started puberty and that it had begun to make him feel extremely self-conscious. The patient described the negative effect that the acne was having. For example, he has been bullied at school and is feeling apprehensive about starting sixth form in September because he believes that he will be the only sixth former with spots. Based on the reasonably lengthy history of the acne, the presence of acne on the face and the negative emotional effect that the acne was having, a three month dosage of oxytetracycline was prescribed for the patient.
Step Two (Feelings)
During the consultation I had a number of feelings. Primarily I felt sympathy for the client because his situation reminded me of my own time as a teenager. I suffered from bad skin from the ages of 14 to about 20 and it severely affected my own self-esteem. In a review of the literature, Dunn, O’Neill and Feldman (2011) have found that patients suffering from acne are more at risk of depression and other psychological disorders. However, the review also found that acne treatment may lead to improvement of the psychological disorder that are so often co-morbid. This made me feel re-assured that prescribing oxytetracycline had been the right thing to do. My own experiences of acne also meant that I was able to relate well to the patient. I also felt some anger during the consultation. This anger was directed at the patient’s peers who had been cruel enough to taunt and tease the patient because of his acne. I also felt regret and guilt. I regretted not referring the patient onwards for emotional support and for not exploring the psychological impact of the acne in more detail. I also felt a sense of pride that this young man had the courage to come to the clinic by himself to seek help for his acne. I remembered how upsetting acne was as a teenager and I remembered that I would have been too embarrassed to have ever gone to a clinic or to have sought help from an adult. In turn, I also felt happiness. I felt happy that this young man had come to the clinic and I felt happy that I was able to help him.
Step Three (Evaluation)
On evaluation, the event was good in a number of ways. Firstly it added to my experience of dealing with young people and in dealing with the problems that are unique to this population of patients. I have not had many young patients during my nursing career and I welcome the opportunity to gain experience with this group. Furthermore, it re-affirmed my career choice as a nurse. During your career you always have doubts as to whether you have chosen the correct path. However, there are points in your career when you feel sure that you have made the right choice. However, there were also some negative elements. Firstly, the appointment was quite short and I am worried that this may have made the patient feel rushed and uncomfortable. After the consultation I did some research into the effects of acne in young people. Purvis et al. (2006) have found that young people with acne are at an increased risk of suicide and that attention must be paid to their mental health. In particular, the authors found that directly asking about suicidal thoughts should be encouraged during consultations with young people. This information only served to make me feel more anxious and I wished that I had bought this up with the patient.
Step Four (Analysis)
On reflection, being able to relate to the patient increased my ability to deal more effectively with the situation. I feel that the patient was able to open up more to me because he sensed my sympathy for him and his situation. Randall and Hill (2012) interviewed children aged between 11 and 14 years about what makes a ‘good’ nurse. It was found that the ability to connect to them was extremely important and so I think this is why the patient felt comfortable opening up to me. On reflection, I am also now convinced that the patient coming to see me was a very positive event. The patient could have chosen to go on suffering and could have chosen not to open up and talk about the problems his acne was causing. In a review of the literature, Gulliver, Griffiths and Christensen (2010) found that young people perceived embarrassment and stigma as barriers to accessing healthcare. Therefore, it could have been very easy for the patient to have avoided coming and seeking help. I felt a range of both positive and negative emotions during the consultation, and I think this re-affirmed for me that I enjoy nursing and enjoy helping others. It is important to genuinely care about patients and to provide them with the best care possible. This would be hard to do if you did not feel empathy for patients. The experience also helped me realise that I need to actively search out training and learning opportunities regarding working with young people with mental health issues.
Step Five (Conclusion)
If the same situation was to arise again I think that I would approach it in a slightly different way. In particular, I would have offered to refer the patient to further support services. During the consultation the patient mentioned that he felt that the spots on his face made him unattractive to the opposite sex. In addition to providing medication to get to the biological and physiological roots of the problem, on reflection I think it would have been beneficial to the patient to have provided information about charities that offer self-esteem and confidence building. Such charities that offer these services include Young Minds (http://www.youngminds.org.uk/) and Mind (http://www.mind.org.uk/). In retrospect, I also believe that I should have given the patient a longer consultation time in order for us to have explored the psychological impact of his acne in more detail. Coyne (2008) has found that young people are rarely involved in the decision-making process when it comes to their consultations. Therefore, giving the patient more time to discuss his problems may have improved his sense of wellbeing as he felt more involved in his care process.
Step Six (Action Plan)
There are a number of elements to my action plan. Firstly, I will make sure that in the future the consultation room has leaflets and information pertaining to mental health problems in young people. This way, young people can access the information if they perhaps feel too embarrassed to talk about it. Hayter (2005) has found that young people accessing health clinics put a high value on a non-judgemental approach by health staff. Therefore, in future I would be sure to be aware of my attitude and make sure that either subconsciously or consciously; I am not making any judgements about the patient. Hayter (2005) also found that young people had serious concerns regarding confidentiality, especially during busy times at the clinic. Therefore, in the future I would be certain to reassure young people that their details and consultations are kept completely confidential. To re-assure young patients, I may ask them to sign a confidentiality form, which I will also sign in front of them. Furthermore, my action plan will include improving my knowledge and awareness of working with young people as a nursing professional. This will allow me to increase the tools and skills I have for dealing with young people with complex needs. During the consultation I felt anger toward the patient’s peers who had teased him. In the future, I will focus on being more objective when dealing with a patient who has been the victim of bullying.
Coyne, I. (2008) Children’s participation in consultations and decision-making at health service level: A review of the literature. International Journal of Nursing Studies, 45(11), pp. 1682-1689.
Dunn, L.K., O’Neill, J.L. and Feldman, S.R. (2011) Acne in adolescents: Quality of life, self-esteem, mood and psychological disorders. Dermatology Online Journal, 17(1). Available at: http://escholarship.org/uc/item/4hp8n68p [Accessed 20 October 2013].
Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Oxford: Further Education Unit.
Gulliver, A., Griffiths, K.M. and Christensen, H. (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), pp. 113.
Hayter, M. (2005) Reaching marginalised young people through sexual health nursing outreach clinics: Evaluating service use and the views of service users. Public Health Nursing, 22(4), pp. 339-346.
Paget, T. (2001) Reflective practice and clinical outcomes: practitioner’s views on how reflective practice has influenced their clinical practice. Journal of Clinical Nursing, 10(2), pp. 204-214.
Purvis, D., Robinson, E., Merry, S. and Watson, P. (2006) Acne, anxiety, depression and suicide in teenagers: A cross-sectional survey of New Zealand secondary school. Journal of Paediatrics and Child Health, 42(12), pp. 793-796.
Randall, D. and Hill, A. (2012) Consulting children and young people on what makes a good nurse. Nursing Children and Young People, 24(3), pp. 14.
Royal College of Nursing (2012) An exploration of the challenges of maintaining basic human rights in practice. London: Royal College of Nursing.
Tags: Gibbs Nursing Model on Reflection, professional reflection, reflection-on-action and reflection-in-action
Category: Essay & Dissertation Samples, Health
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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