Reflection Using Gibbs Cycle for Clinical Simulation in Nursing

Question: Discuss about theReflection Using Gibbs Cycle for Clinical Simulation in Nursing. Answer: Gibbs reflection cycle is a famous reflection framework which was established by Gibb in the year 1988 (Huseb, O'Reg Nestel, 2015). It helps an individual to think systematically and reflect about the different phases of the experience or the task that she had undertaken and thereby help herself to develop the correct ways by which such situations should be handled in the future (Tesh Kautz, 2017). During my placement in the old aged care, I had faced an adverse situation, which I need to reflect so that I never have to go through such situation in the future. Description: While I was working in the old aged care, I had faced a critical situation. A patient 78 years old was admitted to the care after his issue of dementia surfaced. Due to absence of proper carer at home, his family had admitted him to the aged care for proper nursing interventions and maintaining his daily activities of life properly. As he was in his initial stage of dementia, he was not totally forgetful although he had some frequent bouts of forgetfulness sometimes in the day. The main concern was that he had very poor mobility due to his arthritic status which had exposed him to high risk of fall. However he often used to forget about his loss of mobility and tended to walk down on the floor form his bed. Although I tried to make him understand about his condition, he often used to forget about it and tried to walk once I nearly saved him from falling. After many such incidences, I kept him physically restrained to his bed. To this, he complained to his family members and also to t he senior nurse that his autonomy and dignity was not maintained by me. Feelings: After conducting the fall risk assessment test, I realized that he had a high level of risk for fall and hence my primary concern was to reduce his chances of fall. The moment I was away from his sight, he was trying to come down from bed. I was feeling that as a nurse, my primary aim should be maintaining a safe practice for the patient as per the nursing principles of codes of conduct and codes of ethics. I felt that I should follow the principle of beneficence which paid importance to providing safe care to patient above anything else. Seeing no other alternative as per the situation, I felt that physical restraint would be the safest option to prevent him from fall and thereby applied it. Evaluation: The bad aspect of the experience was that I was considered unethical not only by the patient but also by his family members and they also filed a legal case against me. This affected my career and also my self confidence and self image. I felt bad as my purpose for the act was not assessed but I was held guilty for my conduct. The good aspect was that in my internship phase only, I faced a very critical situation which helped me to develop an idea of the challenges that I will be facing in my professional life. I already was a facing a situation of ethical dilemma which many nurses complain of during their professional years therefore the good thing was that I got a taste of such situation and therefore from the next time, I would be highly careful and provide correct logical reasoning and proper evidence based care practice for such critical patients. I also noticed that as I had kept him restrained to bed, his self respect was hurt. He became depressed and no longer communicated wi th me as he felt that tried to bind him because he was unable to take care of himself. This feeling made his lose his self confidence. He became depressive as he developed the thinking that he was no longer independent. Moreover, he tried to break free from the restraints a number of times which left him with bruises. I harmed the patients dignity and autonomy thereby breaching the standard 4 (which states the importance of maintaining the dignity, culture and other values during practices ("Standard of practice, Nursing and midwifery board of Australia", 2017). Analysis: From the entire situation, I understood that I am not enough skilled to handle such situations effectively. I got tensed and nervous during this situation which is not the correct attributes which should be exhibited by a confident healthcare professional. Moreover, I also sensed that I need to work more on my critical reasoning skill and my decision making power so that I can take the correct decisions. I was very unhappy with the entire situation and felt guilty at the same time for not being able to provide the best care to the patient. Although my mentor did not say me anything but I sensed that he expected better performance and reasoning skills from me. I analyzed that I should have developed proper situational awareness for prompt decision making. I should have called the nurse-in-charge and consulted with her before applying restraints. I could have made him understand the importance of restraints in soft tone so that he could understand the importance of the intervention. I should have quickly looked over the other options available at that time, putting restraints as the last resort of interventions. I also understood that I have to go through various journal based evidences so that I can handle such situations more effectively I also failed to maintain standard 6 as I could not offer the safest practice to him as he was mentally and physically harmed by restraints ("Nursing and Midwifery Board of Australia - Registered nurse standards for practice", 2017). Conclusion: After fixing up a meeting with my mentor, I came to know a number of things which helped to enhance my knowledge as a health professional. She instructed me that in such a sensitive situation, she should have first contacted his family members making them aware of the situations. Moreover, I would have also contacted the senior nurse on duty for advice. She told me that physical restraint is not the correct option for such patients as it may harm them physically. Moreover they may also suffer from depression which might also affect his mental condition which would add to his neurological disorders. Therefore, she suggested me to go through more evidence based papers to develop my decision making skills and also attend training classes to identify the critical reasoning skills. Overcoming ethical dilemma by proper logical reasoning would be my main motive. Action plan: When such a situation arises, I would never take physical restraint as the first initiative. I would first summon the nurse manager or the senior nurse and take her advice. I would also immediately call the family members and make them know the situation. I would never leave the patient without keeping anyone in attendance for him as he may hurt himself. Moreover, I would also modify the rooms with proper bedrails, non-skid footwear, keeping bed closer to washrooms, providing with walkers and others. I would rightly maintain the autonomy and dignity of patients as the principles of nursing advice us so that I can save myself from getting in any legal and ethical issues. Gibbs reflection is one of the most effective frameworks that helps in properly describing the events and learn from the faults or the errors that took place in the previous experience. I realized that I had harmed the autonomy and dignity of the patient by applying physical restraints. I was criticized by the patients family members and also by my mentor. I realized my mistake and therefore from the nest time I will properly utilize my critical reason skill and proper decision making ability to overcome such situations and provide safe and ethical care to patients. References: Huseb, S. E., O'Regan, S., Nestel, D. (2015). Reflective practice and its role in simulation.Clinical Simulation in Nursing,11(8), 368-375. Nursing and Midwifery Board of Australia - Registered nurse standards for practice. (2017).Nursingmidwiferyboard.gov.au. Retrieved 24 October 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx Standard of practice, Nursing and midwifery board of Australia. (2017). Retrieved 19 October 2017, from https://file:///C:/Users/user00/Downloads/1798150_1830561517_Nursing-and-Midwifery-Board---.PDF Tesh, A. S., Kautz, D. D. (2017). Using Reflective Practice in a Leadership Course.Nurse educator,42(3), 117-119.