Nursing Reflective Essay Year 2

Gibbs Nursing Model on Reflection

rodrigo | September 3, 2016

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Introduction

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:

  1. 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.
  2. Feelings: this step encourages the reflector to explore their thoughts and feelings at the time of the event.
  3. 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.
  4. 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.
  5. Conclusions: this step explores the potential alternatives that may be used to deal with the situation that is being reflected upon.
  6. 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.

Case Study

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.

References

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.

Related

Tags: Gibbs Nursing Model, professional reflection, reflection-in-action

Category: Essay & Dissertation Samples, Health

Reflection. A mirror into your very soul, or in the case of student nurses, a dreaded word that comes attached with a hefty word count and a massive graded essay. Sadly – for some – reflection doesn’t just end when we graduate. No, reflection is part and parcel of being a nurse and when we get that sought after pin is when reflection really kicks up a gear. Reflective essays are part of life now.

You’re not studying to be a surgeon, but trust me, you’ll be dissecting every thought and feeling in your reflective essay.

I won’t bore you to tears with the ins and outs of why reflection is important (purely because I stand a decent chance of plagiarising myself here) but it is. No one stands a chance of learning new skills unless they think about what could be done better and what needs to be thrown in the bin (figuratively speaking) So, say you’re a student nurse. Say you’ve been tasked with a 3,500-word reflective essay all about something that happened to you in placement. How the heck can you get it started?

Nursing student tips: Which model of reflection is best for my reflective essay?

Gibbs’, Rolfe’s, Driscolls’, Johns’, Kolb and Schon and carry on. Seriously there are a good handful of reflective frameworks that all work in their own ways, all have their pros and cons and all demand their own attention. Some are more about learning while you’re doing things, others are about sorting all the jigsaw puzzles once it’s already happened. Some allow free through to flow like a river made of glitter, others are more like a wander in the Crystal Maze. You need to find what works best for you. I personally love Johns. Why? All the others are general, anyone can use them to reflect from teacher to managers to accountants. Johns is adapted for healthcare and nurses in particular. It makes the job easy by its very design.

Choose a model, then outline all the steps you need to take. That’s the start. STICK TO THIS FRAMEWORK and ensure you keep your heading for your reflection.

Student nurse tips: What should I reflect on in my essay?

You’ll need to take a few pointers from your module leader here. Ours was specifically to revolve around a positive experience in placement. Nothing incriminating. Nothing that’ll leave you questioning whether you should even be alive, let alone a nurse in charge of people’s healthcare. So read the brief and have a think about a patient or two that stick out in your mind.

Create a mind map of: who they are,why they came to need your help (e.g. why they were in hospital, why they needed a community nurse visit), their previous medical history, any family or relatives you interacted with, and why the event sticks out in your mind. Did they say something or do something that helped or hindered your progress? Did treating them make you feel proud? Scared? Overwhelmed? If you can link a tangible feeling to the experience, then you’re on to a winner.

Remember, reflection will be getting all deep and personal about your feelings and beliefs, about why you think and feel that way and why you reacted as such. Ain’t no use writing about something you really have no connection to. Unless you’re a martyr of course.

Nursing student tips: Your reflective essay description a.k.a the critical event

When you start writing your description, it helps to follow a logical template. Plot out each point as a simple bullet list or another mind map. This will be your cue for when you start writing it out.

1. The patient

Introduce us to the main star. For the love of Pete never, ever, ever use their full name or anything that could identify them. Change their gender if you have to, and change their name completely. But start with their age range, their reason for needing care, previous medical history and any other little snippets that give us, the reader, some clue as to what’s going on.

2. The context

Now, start with where you were placed (again, no names), the setting (e.g. community, small local hospital, large regional hospital) and what happened upon handover. What were you told about this person before you even met them? Had you met them before? That’s ok, but what’s changed since? Give the reader insight into how you fit into this story.

3. The event

You might only be talking about giving your first successful IM, or helping someone off the loo. So jump right to that. ‘After completing my nursing tasks for the day, Patient June pressed her call buzzer…’ and take it from there. You don’t need to get bogged down into what you had on your fifteen-minute break or how the consultant lost a set of notes and sent you scrambling to find them. Focus only on the experience, and only on what happened there and then.

4. Feelings

The feelings part comes in the main body of reflection, so try and keep these to a minimum within the actual description itself. If course, if you felt apprehensive about assisting as a scrubs nurse for the afternoon make a brief note in your description, but keep the main crux of your emotional reaction for the reflective cues later. It’s ok to say ‘I helped so-and-so when they fell’ and leave feelings out, as long as you refer to them in the reflective process below.

5. Conclusion

End your description in a neat way. Did you see them again? Did they return home? Did they thank you for helping them? Was the family pleased? A short little sentence just to end the experience nicely for the reader.

Student nurse tips: Getting all emoshe with reflection

Now, this is where it gets very generic because it all depends on which framework you’re using. But as a good rule:

  1. Read back through your description
  2. Note down any feeling, anything you can draw on that will help you analyse why you did what you did.
  3. Note down anything that ma have influenced that feeling.

Example: I helped Patient May to see the importance of drinking more water than she had been to help her blood pressure. This made me feel proud, experienced, and competent.

Now, write WHY you felt that. I felt proud because I gave information in a simple and clear way

I felt proud because I gave information in a simple and clear way, information I had learnt from my bioscience lectures. I felt experienced because I knew I could do it again.
I felt competent because my mentor allowed me to help the lady without supervision.

Whatever. Talk about why you felt that way. For point three, acknowledge the effects others have on your feelings.

I felt scared, but my mentor reassured me which helped me feel a little more courageous. I felt confident, but my patient was nervous about her injection, which made me feel like I wanted to reassure her. Etc.

Student nurse tips: Learning and moving on, ending your reflective essay neatly

Ok, so you’ve talked about the ethics of care, and the importance of the 6Cs. You’ve applied these to your experience, and you know why you felt like you did. You’ve explored the influence other people had on you that led you to act in familiar ways, and new ways. You’ve followed your reflective pathway and now need to figure out how you’ve learnt from the whole shebang.

This is up to you. But if you felt proud, then identify how you could do better next time. How will you improve yourself to help other people? How will you adapt to get a better placement grade? How will your experience help you be a better team player? This is time to focus on the good stuff, and also the stuff that needs a little bit of work. Don’t be too dramatic here, but also don’t say you haven’t learnt anything and you’ll do the same thing next time.

That’s completely missing the point.

So that’s a super quick way to structure your reflective essay. Break it down into bite-sized chunks. Choose the pathway that works for you, and don’t be afraid to change to another if you can’t quite make it stick. If you want something easy to follow, use Gibbs’ or Johns. Create a picture of your patient. Create a simple breakdown of the description. Read through your description and note down your feelings. Note down why you felt that way, what and who influenced you thinking that way.

Before you know it you’ll have worked through all your steps one-by-one. Now, that wasn’t too hard, was it?


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