The Process Of Reflection Nursing Essays

Nursing Reflection Essay

1419 WordsApr 18th, 20116 Pages

Reflection on a clinical Skill

This essay will discuss a clinical skill in which I have become competent in practicing as a student nurse. I will use a reflective model to discuss how I have achieved the necessary level of competence in my nurse training programme. The reflective model I have chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection incorporates the following: description, feelings, evaluation, analysis, conclusion and an action plan (Gibbs 1988). The model will be applied to the essay to facilitate critical thought, relating theory to practice where the model allows. Discussion will include the knowledge underpinning practice and the evidence base for the clinical skill. A conclusion to the essay will…show more content…

My mentor said that this was acceptable and I continued to administer the injection, omitting the use of the alcohol wipe. On the previous occasions when I had administered IM injections I had not cleansed the site and had never been instructed to adopt this practice.
I am now going to enter into the second stage of Gibbs (1988) model of reflection, which is a discussion about my thoughts and feelings. I was aware of being under the supervision of two qualified nurses and this made me feel very nervous and self conscious. Once my mentor questioned my practice, concerning skin cleansing, I became even more aware of feeling nervous and under pressure. The patient was present and I did not want the patient to feel that I did not know what I was doing. I thought that as I had been observed carrying out this clinical procedure on many other occasions then my practice must have been seen to be correct. I was now feeling very confused about the use of alcohol wipes in the administration of IM injection. I was also concerned that the practice of the qualified nurses was so inconsistent, which led me to evaluate the whole process.
Evaluation is the third stage of Gibbs (1988) model of reflection and requires the reflector to with state what was good and bad about the event. I was aware that research by Workman (1999) suggests that the use of skin cleansing wipes is inconsistent and not necessary in IM injections if the patient appears to be physically clean

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The assignment critically discusses a reflective practice with regards to a clinical placement I undertook. In the following critical incident that I encountered I will utilize the Gibbs Reflective Model. Gibbs reflective model is fairly straightforward and encourage a clear description of the situation. Analysis of feelings, evaluation of the experience, analysis to make sense of the experience, conclusion and action plan where other options are considered and reflection upon experience to examine what you would do if the situation arose again (Gibbs 1998).

Unlike many other models (with the exception of Boud) Gibbs model takes in to account the realm of feelings and emotions, which played a part in a particular event. My rationale for using the reflection framework to the clinical encounter is to try and demonstrate my ability to link theory to practice during the process of reflection. I also choose the Gibbs model to help me structure this paper. The model was also chosen to help demonstrate critical reflection within my role of being a student in the practice learning environment. Through my discussion I will also be applying the literature which underpins my experiences in practice.

The way the reflection would be defined and a brief description of the surgical procedure including the complications which can arise will be also discussed. Siviter (2008) points out that by using a model of reflection as a guide the practitioner can find the process of reflecting easier. Johns (2004) cautions that a model could become a prison that the practitioner tries to fit into rather than a tool to make sense of a situation. I would suggest that a model should be used as a framework by which reflection is structured, but not followed as a rigid guide which could hamper the practitioner’s reflective account.

Bolton (2005) supports this by implying that a less structured approach instead of a restrictive framework would be more suited to helping the practitioner develop within the health care. Reflection is a transformational skill acquired through practice Adrienne (2004). John’s et al (2002) claims if an improved and qualitative patient care can be achieved, we should practically reflect. They also mention that the reflection of clinical encounters is crucial to the provision of safe, high quality healthcare services to patients.

Quinn (2000) states that reflection is to recollect a past experience and the feelings it produced. Furthermore Bolton (2005) believes that when using reflection to supplement a learning experience; “Effective reflection and reflectivity does not allow anything to be taken for granted” (Bolton, 2005, Pg 66). McCabe and Timmins (2006) support this view and go further to suggest that if reflection is solely the work of one person with no input from others there could be missing information and a lack of reality.

Reflective practice is the application of the skills of reflection to improve professional practice through self assessment by identifying learning and development needs to modify practice or improve competence (Kottkamp 1996). Reflective practice requires critical appraisal of experiences and the understanding gained through it adds to the individuals knowledge base (Ashby 2006). Wilding (2008) warns that the process of reflective practice within nursing may highlight a lack of skill, which may damage a nurse’s confidence.

To maintain anonymity and protect confidentiality, all identifiable information pertaining to people or places has been made anonymous throughout the reflective portion of this assignment as stated by Health Professions Council (HPC 2008). The incident reflected upon in this essay takes place in a Surgical orthopaedic operating room, to which I was on a clinical placement. I was assigned a mentor to work with me. My patient will be known as Mr Dillon. He was undergoing total knee replacement surgery.

The surgery was going to be done by the Surgeon Mr Mann, who has got a very typical way of doing it. He gave us a specific list of stuff he needed for the surgery. He specifically asked for BIOMED instruments and implants which are a leading manufacturer of surgical instruments. So when my mentor Mary and I were preparing the trays we made sure that everything he wanted was on the trolley. As I was working under supervision of Mary and the Circulating nurse Mark, they were explaining to me about the importance of preparing the theatre according to each surgeon’s preferences.

After all the necessary checking’s and preparations in the anaesthetic room done, Mr Dillon was brought into the theatre after he was given general anaesthesia and Mr Mann started the surgery. Everything was going well until Mr Mann started to fix the tibial implant. As per surgeon’s instructions we had it ready but unfortunately the ‘71’ size he had requested was a bit smaller and he asked for a ‘73’ size. But Mary told him that it is not available in the tray so she asked me to get it from the tray room.

Mark left me to go on my own to the tray room and I could not find it. I was afraid to go back into theatre to tell the surgeon. When I finally went back and told, the surgeon that I could not find it, he started shouting. Mary stepped in and told me to go with Mark so I could see where it was kept. That made the surgeon to calm down. We ran back again and got it. Mary, Mark and I were so relieved. The time taken for such a small incident was almost 10 -15 minutes which was really stressful to the whole team and very dangerous to the patient.

Luckily everything went well and the surgery ended successfully and most importantly Mr Dillon was out of danger and he was transferred to the recovery room. It is essential to analyse the incident and make decisions about how future similar incidents should be dealt with. Reflection, in this instance, is defined as a way of analysing past incidents to promote learning and improve safety, in the delivery of health care in practice Reference With this in mind this essay will critically discuss the theory and practices of medical management of a critical ill patient.

Nevertheless, multidisciplinary medical professionals’ fail in their duty to deliver care and allow bad practice to go unchallenged by constantly not reflecting they tend to fail to improve care. Reference Reflective practice is an important tool in facilitating individuals to explore their own practice and examine the clinical decision making process. It requires practitioners to question their practice thus enabling them to move away from ritualistic regimes to an evidence based approach (Carey 2000). (NMC 2006) supports this by claiming that reflection is mandatory in relation to Post registration education and practice.

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