The Gibbs Reflective Cycle and its Parameters

Discuss About The American Medical Of Directors Association.

The Gibb’s reflective cycle could be used for reflection upon the current work place practices and the loopholes associated with the same. The Gibb’s reflective cycle consists of a number of parameters such as description, feelings, evaluation, analysis, and conclusion and action plan. It can be used for understanding the feelings of others while working together in a team. The reflective and shared work environment helps in improving the quality of care. Some of these have been used for evaluation of an exact clinical scenario and reflecting upon the working of the nursing professionals.

In my last placement, as a nursing student in the WE CARE hospital I had come across a number of practical situations and scenario. Some of these have contributed significantly in reshaping my performance as a clinical nurse. I had a vivid encounter during one of mu clinical outings with a patient who was admitted due to hyperglyecemia as the patient had encountered septic shock. On detailed inspection, it was found that the patient had a number of co-morbid conditions such as depression, obesity, cardiac disorder. During the hospital stay of the patient he reported restlessness and difficulty in sleeping. Hence, it was diagnosed that the patient was suffering from acute anxiety disorder.  As a nursing student, my supervisor assigned me the duty of looking after a patient who complained of restlessness. During assigning the duty, the supervisor failed to handle me all the caseloads pertaining to the patient. Therefore, I had to depend upon the knowledge disseminated by word of mouth. In order to relieve the condition of the patient I had administered an oxezepam 100 mg to the patient based upon the instructions given to me by my supervisor the other day during a similar clinical session. However, as a nursing student it was one of the biggest mistakes committed by me, as it was a scheduled drug and could only be given under expert supervision. The patient complained of chest pain and aggravated discomfort immediately after that. On immediately following up the condition of the patient with the doctor I got to know that since the patient was already suffering from cardiac issue, the administration of oxezepam had further resulted in low blood pressure. As mentioned by Douglas  et al. (2014), cardiac complications could be worsened by low blood pressure.

A Clinical Scenario Potentially Leading to Fatal Consequences

Therefore, based upon such an incident I decided to take the responsibility of my nursing care activities much more seriously. This incident brought me face to face with the grave reality where a small negligence form the end of the nursing professional could have resulted in the death of the patient. Hence, I started feeling guilty about the entire episode and started feeling less confident about handling similar trying situations in the future.

From my clinical retrospection I found that I lacked the expertise for taking over cases and handling them efficiently during shift change. In this context, I should have checked with the past medical history of the patient once before the administration of the oxezepam. However, I had only trusted the source of information provided by the nursed attending to the patient.  The only positive thing about the entire situation was that I could report in time and I got sufficient help from few of my supervisors.

From reflection upon the current situation, it  could be  deduced that continuing education for the nursing professionals is beneficial as it  helps in improving the quality of care and preventing the occurrence of untoward incidents in  an acute clinical setting (Tobiano et al. 2016).

I believe I should have made that extra effort to inquire regarding the co-morbid health conditions present in the patient. In this respect, a proper clinical handover should have been conducted by me ensuring that I have collected all the necessary and the required amount of information from the supervisor. Hence, a reinforcement of the nursing basics was required in cam help in management of the clinical scenario effectively (Milne and Adams 2015).

In case such a situation rose again I would better focus upon the documentation process for monitoring of the clinical vital signs before administration of the drug to the patient. In context of any doubt, I will need to discuss the vital signs with the supervisor as well as consider the complications that may arise while carrying out the nursing care interventions and plan. I should also study extensively regrading the diseases and patho-physiology as it will help me in keeping the complications in mind while administering the medicines, which further helps in avoiding clinical risks. As mentioned by Lake  et al. (2016), providing sufficient  training to the nursing professionals and  teaching them regarding the side effects of the medications could  check the rate of untoward clinical incidents.

• Preparing a professional development plan based upon my medium, short and long term goals
• Learn effective documentation techniques as the note taking would help me in management of a practical scenario
• Achieve the entire career goals within a time frame of 6 months to 1 year.

Importance of Continuing Education to Improve the Quality of Care

The provided case study could be reviewed over here in order to understand the situation prevalent   within an acute medical care ward and the bios psychosocial framework which affects the performance of a nursing professional. In this respect, the nurse had given wrong doses of medication to the patient. The patient just returned from the post –anaesthesia department with a low respiratory rate accompanied by low blood pressure. Naloxone was to be given to the patient in doses of 0.2 mg intravenously. The vial had been marked 2 milligrams per 1 ml. However, by mistake the nurse had injected the entire 1 ml vial to the patient. This could have led to lethal consequences including the death of the patient.

Lily had been unable in maintaining an effective work life balance. She was also a mother and had a bad night’s sleep where her baby has kept her mostly awake.  Hence, the fatigued condition had disturbed her mental sanity, as a result she committed mistake by giving an overdose of channels IV medication to the patient.  Hence, a number of factors within the work environment may have triggered the incident such as lack of strong policies. Additionally, the organization failed to revive performance and skills regularly leading to the service gaps (Lavin et al. 2015).

The present error could be reflected upon by the nursing professionals for making the work environment more conducive. It could be done by a number of methods such as continuing professional education of the practising nurse. As commented by Holland (2017), occasional review on the performance of the practising nurse can help in improving the quality of the support and care service provided. Moreover, practical in-house sessions could further help in enhancing the professional standards of practise (Cannaerts et al. 2014).

The only positive aspect of the work environment was that they were extremely quick and responsive in dealing with the patient. Additionally, lily had been quick in reporting to the doctor in charge regarding the condition of the patient and had monitored for the vital signs of the patient which prevented any further lethal consequences. Hence, effective alertness depicted on the sides of the healthcare professionals have been seen to be  beneficial in dealing with the clinical challenges (Vikstrom et al. 2014).

Form the experience the nursing staffs could learn regarding the six basic rights of nursing which would help them in preventing any future errors such as- patient, right time, right medication, right route, right dose and documentation.

Strategies for Coping up with Stressors in Acute Clinical Settings

There are a number of stressors which could affect nursing care practices such as lack of professional knowledge and skill, stress from assignments and workload and stress from daily life.  As mentioned by Peter (2016), stress in practising effectively could arise due to the lack o knowledge. Similarly, chaotic personal life could be equally disrupting for a nursing professional.

In order to deal with the stressors within a cute clinical set up a number of strategies could be undertaken such as enrolling in nursing continuing education programs. Some of these programs could a value to the skills possessed by the nursing professionals.  As mentioned by Morley  et al. (2014), one possessing effective skills have been seen to better cope up with stressful situations. Similarly, personal life issues could be an equally engaging and distractive. Hence, enrolment in employee counselling sessions could help in coping up with the work related stress.

References

Cannaerts, N., Gastmans, C. and Casterlé, B.D.D., 2014. Contribution of ethics education to the ethical competence of nursing students: educators’ and students’ perceptions. Nursing ethics, 21(8), pp.861-878.

Douglas, M.K., Rosenkoetter, M., Pacquiao, D.F., Callister, L.C., Hattar-Pollara, M., Lauderdale, J., Milstead, J., Nardi, D. and Purnell, L., 2014. Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), pp.109-121.

Holland, K., 2017. Cultural awareness in nursing and health care: an introductory text. London: CRC Press, pp.122-145.

Lake, E.T., Hallowell, S.G., Kutney-Lee, A., Hatfield, L.A., Del Guidice, M., Boxer, B., Ellis, L.N., Verica, L. and Aiken, L.H., 2016. Higher quality of care and patient safety associated with better NICU work environments. Journal of nursing care quality, 31(1), p.24.

Lavin, M.A., Harper, E. and Barr, N., 2015. Health information technology, patient safety, and professional nursing care documentation in acute care settings. Online J Issues Nurs, 20(6), pp.75-89.

Milne, A. and Adams, A., 2015. Enhancing critical reflection amongst social work students: The contribution of an experiential learning group in care homes for older people. Social Work Education, 34(1), pp.74-90.

Morley, J.E., Caplan, G., Cesari, M., Dong, B., Flaherty, J.H., Grossberg, G.T., Holmerova, I., Katz, P.R., Koopmans, R., Little, M.O. and Martin, F., 2014. International survey of nursing home research priorities. Journal of the American Medical Directors Association, 15(5), pp.309-312.

Peter, E., 2016. The politicization of ethical knowledge: feminist ethics as a basis for home care nursing research. Canadian Journal of Nursing Research Archive, 32(2), pp.212-312.

Tobiano, G., Bucknall, T., Marshall, A., Guinane, J. and Chaboyer, W., 2016. Patients’ perceptions of participation in nursing care on medical wards. Scandinavian journal of caring sciences, 30(2), pp.260-270.

Vikstrom, S., Sandman, P.O., Stenwall, E., Boström, A.M., Saarnio, L., Kindblom, K., Edvardsson, D. and Borell, L., 2015. A model for implementing guidelines for person-centered care in a nursing home setting. International psychogeriatrics, 27(1), pp.49-59.