Reflective Practice in Nursing Using Gibbs Cycle Case Study

Introduction - Analyzing Clinical Experiences for Improved Care

Reflective assessment allows individuals to identify what students have learned and ensure fruitful engagement in thinking and evaluating how they have learned. Presenting scenario-based reflective learning highlights the lack of knowledge and skill development regarding specific fields of professional practice. Structured presentations of reflective learning are mainly done following a specific reflective model and heather “Gibbs Reflective Model'' has been used to present reflective learning through performing clinical practices. It is highly important in clinical practice to keep patient details as well as scenario details confidential towards ensuring effective clinical practices take place abiding by NMC rules and regulations.

Presenting Reflective work using Gibbs Reflective Cycle

“Gibbs Reflective Cycle” was introduced by Graham Gibb to help with presenting structured reflective scenarios. As per the views of Li et al. (2020) use of the “Gibbs Reflective Cycle” mainly offers individuals to examine experiences and gives it cyclic nature that lends itself particularly well towards experiencing repeated experiences. SIX stages of “ Gibbs Reflective Cycle” as reported by Graham (1988) are as follows -

• Description
• Feelings
• Evaluation
• Analysis
• Conclusion
• Action Plan

Through using the above-presented set of six stages comprised “Gibbs Reflective Model”, I have presented my learning as well as described the scenario that I have experienced below-

Description of the performed clinical scenario

Describing the scenario, the first stage of the “Gibbs reflective Cycle” mainly allows an individual to describe the scenario that has been performed by them and the major to minor activities that have been done. As per the views of Sundgren et al. (2021) describing the performed scenario, the reader can know about the facts that happened and influence the entire learning process one after another. I have worked in a low-secure mental health hospital as a student nurse and I have been reported as working in the reception department. One day, a service user came and asked for a petty cash receipt for collecting his expenses from the Finance department as he wanted to get an easy release of his patient to admission in another hospital. In this case, the required cash receipt has not been prepared and provided to that specific service user on time. I have witnessed service users getting angry and dissatisfied though staff has apologised to them. Code 7 of “The Nursing and Midwifery Council (NMC) 2018” highlights that keeping an appropriate check on people’s understanding from a specific time to time is highly required in order to keep misunderstanding or the degree of making mistakes to a minimum level (). Referring to this I can say that significant miscommunication has taken place between hospital staff and the service user in terms of either the service user has not spoken before the day as required or he has spoken but this was omitted in error.

Feelings gained through experiencing scenarios at clinical practices

Feelings, the second stage of the chosen model named 'Gibbs Reflective Cycle" mainly helps in presenting the feelings realised by individuals in time performing specific scenarios. Herein, I have also felt something in time working at a low-secure mental health hospital as a student nurse. I must say that the time was too crucial for me to acquire knowledge of nursing and at the same time to know the fundamentals of handling critical situations through implementing theoretical knowledge in practice. At first, I was feeling awkward freely speaking with my colleagues and after some time I was feeling comfortable communicating with others to learn the way of managing uncertain challenges regarding patients' conditions that arise there as it is one of the mental health hospitals along with holding the status of being a low-secure one. It was my first time experiencing a service user getting really angry regarding receiving delays in required services on time. I felt kind of bad for the patient and service user regarding not getting proper on-time clinical service and at the same time I thought that some staff at this low-secure mental health hospital are not working following minimum ethical requirements as per “Nursing and Midwifery Council Codes”. It has been mentioned that each and every service user needs to be provided on time required clinical support whether it is minimum or maximum.

On the other hand, during the scenario, I have also seen that there is high requirement of departmental staff at reception where billings, as well as the making of petty to high amount cash receipts, are made as it allows to keep proper tracking on financial records of the mental hospital and at same time also allow financial department to act according to it, especially in case of meeting serious service user requirements.

Evaluation covered what did so well and what not

Based on the scenario that I have witnessed in a low-secure mental health hospital I must say that initial management of each and every patient who holds a high risk to others is done efficiently. As per the views of Vuckovic et al. (2021) patients especially at low-secure mental health hospitals mainly require special care as well as test including security in order to be prevented from leaving as some people in this set come from being charged or legally convicted of a ferocious criminal offence. Besides, secure psychiatric care helps people at low-secure mental health hospitals to overcome issues as much as possible to behave like normal ones. Evaluating that scenario, I can say that the scenario of un-meeting service users' requirement of getting a petty bill so that he can use it to get money for their expenses from the Finance department has gone wrong. On account of this, feeling upset and dashing away from the place of the service user has taken place, which was completely against the codes of nursing as they mentioned in “Code of NMC '' that the initial need of the client on time at healthcare settings needs to be fulfilled effectively. As per my knowledge, this particular user service experience scenario can be justified by “Patient Satisfaction Theory''. As per the statement of Laranjeira et al. (2021) the theoretical mechanism of "Patient Satisfaction Theory '' lies on expectations as baseline and at the same time, patients' satisfaction level is evaluated as significant proportionate to the specified variance between expectations and experience gained by patients. Referencing this theoretical fundamental, by shunting patient perspective into service user perspective, it can be stated that in the witnessed case scenario, the initial need of service user has not been met at first chance though it has been met after some time. Therefore, the gap between service users' expectations to get a petty cash receipt at one chance and experiencing not getting receipt at one chance, on an initial basis has been witnessed by me.

Apart from these, I must say that in the way operational activities have not done so well and I have gained a kind of negative experience, despite it, there have also been some scenarios that I have witnessed gone so well. Experiencing these situations has allowed me to understand ethical clinical practices. I must say that as a student nurse at a low-secure mental health hospital, I have experienced a very cooperative working environment which is able to promote a quality working environment regarding providing quality patient care. Besides, I must say that my learning has gone well and my colleagues have helped me to understand how managerial activities at reception as well as patient management take place in the internal part of organisations. As per the views of Lilienfeld & Basterfield (2020), patients at low-secure mental health hospitals are in high demand of special physical as well as psychological care to behave appropriately. Based on the scenario, I must say that the way staff apologised to the service user has presented ethical evidence regarding behaving with respect to service users. Additionally, getting a petty cash receipt on a prior basis along with getting properly signed shows the staff's concern towards improving the experience of service users. Witnessing this particular scenario allowed me to understand that people are concerned about providing quality service to required people in healthcare settings.

Analysis of performance highlighting self-strengths and weaknesses

Analysing the performed experience allow individuals to understand the potential skill and knowledge they have and how they can utilise them to manage various types of activities., As per the views of Graham et al. (2020), ‘Analysis” fourth stage of “Gibbs Reflective Cycle" helps people to understand the potential to utilise situational requirements and at same time the field of knowledge as well as skill that need to develop to an improved extent in order to manage various types of clinical activities. I must say that I have a strong understanding of situations which at that time has allowed me to understand the situation and allowed me to think about what can be done next. I understood that asking for apologies would be effective and we have done this technique it has become effective for us in managing the upset and kind angry mindset of the service user who has asked for getting a petty cash receipt. Apart from these, from the situation that I have performed, I have learned that showing mutual respect in healthcare settings mainly impacts healthcare outcomes positively.

On the other hand, I must say that I have understood that I lack effective communication skills and that's why being presented with a scenario I have not directly communicated with service users. Besides, being one of the student nurses I have a lack of knowledge regarding recording patient history and then working according to this, though I have significant scope to learn and know more to improve my clinical knowledge which would allow me to be an effective nurse to communicate effectively in order to ensure quality strong communicative bonds. This particular scenario of urgency to develop strong communication skills can be referred to using “Peplau's Interpersonal Relations Theory '' in order to get well-developed. In accordance with author Ardian et al. (2019) "Peplau's Interpersonal Relations Theory '' is one of the most used theories that focus on nurse-client relationships in healthcare settings and through this significant therapeutic process take place. Being a nurse it is very much required for me to establish and adopt the process of therapeutic communication in order to manage various types of nursing activities that are related to the physical, mental as well as emotional well-being of low-secure mental patients.

Conclusion

I must say that in time of seeing the scenario where staff apologising in front of service users, I was feeling quite pleased as I thought this particular incident showing respect to service users might impact clinical perspectives of not only suffered service users but also influenced other witnesses thinking about the service provision done at the internal part of the hospital. In addition, it can be concluded that the evaluation of scenarios has allowed me to understand what has gone well and what has not gone well. Besides, situational analysis that has been presented has remained highlighted potential strengths as well as weaknesses that I have.

Action plan

Action Plan, based on the scenario performed. I have presented as follows -

Table 1: Action plan

The skill that I have included in my action plan would allow me to perform quality nurse activities in terms of continuing therapeutic communications, managing administrative service user activities as well as implementing strategic leadership practices. On the other hand, it would allow me to understand patients' on-time requirements by establishing significant communication with them.

Conclusion

Hence, it can be concluded that most of the presentation of Gibb's reflective model has helped in highlighting the potential knowledge as competencies that have been gained and the way to deal with uncertain arrival of problems at clinical practice. Through using this model analysis as well as evaluation of the clinical performance as well as presenting future action plans have been done. In time of presenting a scenario following this particular model, confidentiality regarding presenting significant information has been taken into consideration.

References

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. Enfermeria Clinica, 29, 588-593. DOI:10.1016/j.enfcli.2019.04.091

Graham, J. M., Waddell, C., Pachkowski, K., & Friesen, H. (2020). Educating the educators: determining the uniqueness of psychiatric nursing practice to inform psychiatric nurse education. Issues in Mental Health Nursing, 41(5), 395-403. https://doi.org/10.1080/01612840.2019.1678081

Laranjeira, C., Afonso, C., & Querido, A. I. (2021). Communicating Bad News: Using Role-Play to Teach Nursing Students. SAGE Open Nursing, 7, 23779608211044589. https://doi.org/10.1177/23779608211044589

Li, Y., Chen, W., Liu, C., & Deng, M. (2020). Nurses’ psychological feelings about the application of Gibb's reflective cycle of adverse events. American Journal of Nursing, 9(2), 74-78. 10.11648/j.ajns.20200902.17

Lilienfeld, S. O., & Basterfield, C. (2020). Reflective practice in clinical psychology: Reflections from basic psychological science. Clinical Psychology: Science and Practice, 27(4), e12352. DOI: 10.1111/cpsp.12352

Nmc.org.uk (2018). The Code. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Sundgren, M. K., Millear, P. M., Dawber, C., & Medoro, L. (2021). Reflective practice groups and nurse professional quality of life. TheAustralian Journal of Advanced Nursing, 38(4), 49-67. https://www.ajan.com.au/index.php/AJAN/article/download/355/140

Vuckovic, V., Carlson, E., & Sunnqvist, C. (2021). ‘Working as a Real Nurse’: Nursing Students’ Experiences of a Clinical Education Ward in Psychiatric Care. Issues in Mental Health Nursing, 42(11), 1038-1047. https://doi.org/10.1080/01612840.2021.1929595