This essay will discuss examples from practice using a reflective model. I have chosen to use Gibbs model (1988) See Appendix 1, as I feel this framework has a logical progression, ensuring critical thinking and learning on reflection. During this analysis and in order to maintain confidentiality in accordance with the NMC guidelines (Nursing and Midwifery Council 2004) the patient’s will be referred to as ‘Mary’ and “Marie”. The first stage of Gibbs framework is to choose examples from practice which will provoke reflection and critical thinking and describe it as fully as possible. The nursing process and some nursing models will also be explained.
The nursing process according to Siviter (2004) is a planned systematic approach to the planning of care for an individual. There are four key components that need to be considered when completing the nursing process. The first is assessment; which involves collecting information from the patient, patient’s family or other health care professionals to identify any actual or potential problems.
Planning of care, this would be to aim and set a goal to conflict any problems that had been identified through the assessment stage, and ensure that all goals are individualised, realistic, evidence based and achievable for that individual and to include any methods used to meet your goal. Implement, this would be a plan of how you will choose to achieve the goal you have set, and put your plan in to action. Finally you will evaluate your plan of care, was the goal met? If not you reflect and assess for a more achievable goal.
The nursing process gives the nurse involvement and sense of achievement and it makes the patient feel involved and in control of the care they are receiving. Siviter (2004) suggests that the nursing process is a method of making decisions, recording information, and so on. Many nursing models originated in the United States in the 1960s. The purpose of nursing models is to gain information through verbal and non-verbal communication regarding a patient through a framework, and to form a plan of care to benefit that particular individual on the information discovered. Roper, Logan and Tierney’s (1991) model of nursing is based on a framework that uses the twelve activities of living (Appendix 2), these are adapted to create a care plan to meet individuals care needs. Through this framework an insight into the patient’s lifestyle could be discovered and any actual or potential problems could be identified and dealt with accordingly, and where possible to assist the patient to gain a significant amount of independence.
It was identified that there are factors that can influence daily living activities which are biological, psychological, sociocultural, environmental and politicoeconomic Roper, Logan and Tierney (1998). Orem’s model of nursing consists of six universal needs (Appendix 2a). The aim of this model is for the nurse to identify what the patient can and can not do for themselves, and how to help the patient over come these problems, and identify where the patient may need education, information, support or advice to become more independent Siviter (2004). Peplau’s nursing model would see the nurse and patient passing through four phases (Appendix 2c). Peplau emphasizes on the development of a trusting therapeutic relationship between nurse and patient, and to develop a patient’s knowledge and ability to cope and learn the skills they require to maintain health (Siviter 2004 pg 46)
My first example is Mary she came to make an appointment at the family planning clinic where I was undergoing my first placement. Mary had been left severely disabled from a cerebral vascular accident, also known as CVA, this had occurred approximately three years previously; and had resulted in impairment to her speech, weakness of her left side and a personality disorder. Due to her speech impairment some of the staff found Mary difficult to understand, one even admitted nodding and not understanding a word she said. As the staff began to discuss Mary, a number raised their eyebrows and began to quietly mutter between themselves, some of the nursing staff felt uneasy when dealing with Mary as they said they were unsure of how to deal with her.
Later that week Mary came to clinic with some worries about an unusual discharge from her vagina, my mentor spoke to her and said she would take a smear test and some swabs. We helped Mary onto the couch to examine her, and asked her to move up a little, Mary said she could not do this; she was tired and needed help. The nurse sighed in an exasperated manner and then began to use her voice in quite a forceful way, telling her “she knew Mary could make more effort to use her arms as she had seen her do this before and that she wasn’t trying hard enough”. After waiting for Mary to try for a few minutes my mentor said she would get a colleague to help, and left the room.
I proceeded to try and reassure Mary as she seemed very upset; she started to cry, I could immediately see Mary was extremely upset, she was over to one side and visibly crying, I asked her what was wrong, she said the way the staff nurse had spoken to her had upset her as she felt she had needed more help as it was the afternoon and she was tired. I sat with Mary, talked to her and stroked her hand. When Mary had calmed down I went to inform my mentor how upset she had been, as I spoke to her she told me her brother had also had a CVA but she felt it was ‘much worse’ than Mary’s and as a result she felt Mary ‘could do more’ as her brother had, I sympathised with her, but said that maybe not everyone reacted in the same way.
After describing this example from practice, the Gibbs model of reflection moves to the second stage of the cycle, this looks at the thoughts and feelings that I encountered during the example. .I felt disappointed and frustrated with the other members of staff as they didn’t seem to have the time to try to listen to what Mary was trying to say, one experience I encountered was when a member of staff nodded their head as if understanding what Mary was trying to say, then saying directly to me that she hadn’t understood a word that Mary had said. I felt that had she explained to Mary that she couldn’t understand her and had taken the time for Mary to repeat what she was trying to say, it would have been more appropriate than pretending to understand. This according to the Stroke Association (2000) is especially important as the patient can become distressed as they feel that they are speaking normally, when in fact people may experience difficulty in understanding them.
During the clinic I felt uncomfortable when I saw the way other members of staff were communicating non verbally with each other by raising their eyebrows and whispering between themselves, I immediately noticed the facial gestures, interpreted the two actions together and made the judgement that the people involved were discussing something in an unpleasant manner (Kagan, Evans, Kay, 1987). This made me self conscious and uncomfortable. This left me with the opinion that their actions were unprofessional and disrespectful, as I felt it unfair to accuse a patient of something which may or may not be true without first questioning thoroughly.
McQuail (1975) believes that in health care, student nurses carry a relatively low amount of status as they are viewed as a transient addition to clinical environments. I agree with his beliefs, as I felt, as a student family planning nurse that it was not my place to question this matter to staff who had worked in the clinic longer than me and therefore had much more experience than I did, with regards to situations like this.
Gross (1996) argues that during a social influence episode we will try to conform to the group ethos, so that we can feel that we truly belong to that group, I agree with his viewpoint as all of the staff members were of the opinion of the group.Department of Health (DH) (2003) insists that communication with patients should at all times respect their individuality, dignity and rights. I felt the comments by my mentor and other members of staff and the way that they communicated towards Mary were wholly inappropriate and demeaning. I also felt ashamed and frustrated as I did not stop the nurse speaking to Mary in that manner, this again relates to the difficulty I felt in being inexperienced and new to the clinic.
I was also angry as Mary didn’t know why the staff where treating her in this way. The Stroke Association (2001) affirms that in stroke sufferers fatigue is just one of the everyday problems that they may encounter. I agree that patients do tire in the afternoon and this should have been taken into account by the staff treating her. I felt proud of myself that by taking the time to sit and talk to Mary I managed to calm her down and make her feel slightly better, it was also clear to me that as I touched Mary’s hand she was immediately reassured, she felt less isolated and more composed (Kenworthy, Snowley, Gilling, 2005).