Gibbs Reflective Cycle In Nursing: A Crucial Framework

Description

Discuss about the Gibbs Reflection for Cultural Competence in Nursing. 

In this paper I will describe about my experience of taking vital signs from a patient. The event was taking place in a clinical setting. Initially I identified the patient by the help of two patient identifiers and then greeted him warmly to make the situation, conducing for both the patients and me. After that I took consent from the patient and assessed the temperature of the eardrum by the help of ear drum thermometer. I made it sure to cross check the temperature and noted down the document in the vital signs record sheet. After this I asked for the patient’s permission to check his pulses followed by documentation of the results. Throughout the procedure I made it sure that I explain all the procedures and their role to the patient. With this I ended my duty the check the assigned vital signs.

I was a bit perturbed when I entered the room and was constantly under pressure whether everything would go well. I tried to create a non-hostile environment for the patient as I have learnt that building up of a rapport between the patient and the caregivers is one of the important aspect of nursing. I am well aware of the NMBA standards of nursing and always try to incorporate them into practice. I made it sure to find the correct position to obtain the radial pulse and body temperature.  As per the NMBA standard 4, a nurse should be able to conduct assessment comprehensively in a holistic way (Nursing and Midwifery board of Australia, 2016).  I was having a fixed feeling of anxiousness whether I am showing enough care or providing a holistic care of approach or was abiding by the nurse scope of practice.  I ensured that I would handle all the equipment for the vital signs carefully. I felt relieved after taking the signs as I saw the satisfactory smile of the patient.  

I made it sure that I do not force the thermometer into the era or occlude the ear canal. I made sure to identify the patient using he two identifiers. The two patient identifiers helps the nurses to avoid clinical errors such as medication errors, wrong person procedures, wrong discharge plan and enhance the patient care (Lavin et al., 2016). I have chosen to measure the ear temperature instead of taking the oral or the axillary temperature as I have learnt that, it gives an accurate assessment of the body temperature.

Feelings

Additionally tympanic membrane possess the same vascular artery perfusing the hypothalamus that gives an accurate temperature (Jahanpour et al., 2013). Hence I feel that I have chosen the correct way of measuring the body temperature. I had to touch the patient for obtaining the radial pulse. I made it sure that I at least obtain a verbal consent from the patient. According to Judkins-Cohn et al, (2013), the ethical principles of autonomy and justice directly directs to the process of the informed consent is one of the professional codes of conduct of nursing. While obtaining the pulse I made it sure that I use the correct way that is using the pad of my three fingers to gently palpate the radial pulse at the inner lateral list.

A mistake on my part was that I was too slow in obtaining the temperature. I should have kept the thermometer for 2 seconds.

As per the NMBA standard 4, it is the duty of the nurse to use an allied range of assessment techniques that are holistic as well as culturally safe (Nursing and Midwifery board of Australia, 2016). The concept of cultural safety enables a nurse to accept the culture and values of the patient and provide quality care to everybody regardless of the cast and creed (Jeffreys, 2015). It should be mentioned that before the conduction of any assessment it is necessary to make a detailed planning to avoid any clinical errors. As per the nursing standard 4, it is essential to check the signs carefully as these are the essential components of patient care (Nursing and Midwifery board of Australia, 2016). They are the information that are required to take the lifesaving decisions and helps to confirm the outcomes of any treatment (Fridkin et al., 2015). Feedback from the patients are  important aspect of nursing as it assists the nurses to understand the level of patient satisfaction or grievances such that the service could be improved in the future scope of practice (Ross, Barr & Stevens, 2013).

Conclusion

I believe that I need to develop more technical skills and more self-confidence, as self-confidence would help to achieve more autonomous practice in the future, which would ultimately benefit those who are the recipients of the nursing care. According to the NMBA nursing standard 4, a nurse should be able to work in a multidisciplinary team, facilitating a mutual sharing and learning of knowledge (Nursing and Midwifery board of Australia, 2016). According to Porter et al., (2013) self-confidence has been identified as the key component for the effective clinical performance. Hence preparation and skill acquisition is an important aspect to ensure that we the nurses have successful clinical placements, especially in the high areas of the acuity. However, self-reflection would help me to critically analyze the clinical experience that would help the nurse to gain insight to self-practice.

Evaluation

In the future scope of practice I would further develop my interpersonal skills as I have felt that I lack skills in establishing rapport with the patients. I should abide strictly by the nursing protocols while administration of medicines or checking of the vital signs as that would increase my efficiency. I would ensure that I should also be able to interpret the signs correctly. Furthermore I would remain updated by the advancements in the field of the wireless technologies and the new equipment. I would ensure a correct documentation of the clinical information (Khan et al., 2016). According to Fridkin et al (2015), correct documentation of the vital signs helps the nurses during the shift handover and also helps in the administration of medicines. I would learn more about electronic health and safety as that would help in the enhancement of the patient safety and the procedures.  Such a practice would assist in mitigating clinical errors in the future.

This experience will help me in my future clinical placement as I feel that such and in hand experience not only helps me to understand the difference between theoretical nursing and evidence based practice but  has also boosted up my confidence level. This practice would help in developing the interpersonal skills, self-awareness for influencing others towards a positive change which would ultimately cater to the professional development. This reflective practice would further help in the involvement of the person in their work as well as motivate them to improve their care to the patients (Lauren Caldwell RN,2013). Such hand on experiences would give me the ability to examine my own actions and experiences and compare it for improved outcomes.

References 

Fridkin, S., Baggs, J., Fagan, R., Magill, S., Pollack, L. A., Malpiedi, P., ... & Samore, M. H. (2014). Vital signs: improving antibiotic use among hospitalized patients. Morbidity and Mortality Weekly Report, 63(9), 194-200. https://europepmc.org/articles/pmc4584728

Jahanpour, F., Azodi, P., & Zare, N. (2015). A comparative study on temperature accuracy between tympanic, rectal, and axillary sites. Iranian Journal of Medical Sciences, 33(1), 49-53. https://ijms.sums.ac.ir/index.php/IJMS/article/view/1595

Jeffreys, M. R. (2015). Teaching cultural competence in nursing and health care: Inquiry, action, and innovation. Springer Publishing Company.retrieved from: https://books.google.co.in/books?hl=en&lr=&id=kVQICwAAQBAJ&oi=fnd&pg=PP1&dq=Jeffreys,+M.+R.+(2015).+Teaching+cultural+competence+in+nursing+and+health+care:+Inquiry,+action,+and+innovation.+Springer+Publishing+Company.&ots=NdLxZDKYFE&sig=yi2e_77vw8SrProzSBJvHor4op0#v=onepage&q&f=false

Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., & Ward, J. (2013). Ethical principles of informed consent: Exploring nurses’ dual role of care provider and researcher. The Journal of Continuing Education in Nursing, 45(1), 35-42. https://doi.org/10.3928/00220124-20131223-03

Khan, Y., Ostfeld, A. E., Lochner, C. M., Pierre, A., & Arias, A. C. (2016). Monitoring of vital signs with flexible and wearable medical devices. Advanced Materials, 28(22), 4373-4395. https://doi.org/10.1002/adma.201504366

Lauren Caldwell RN, B. S. N. (2013). The importance of reflective practice in nursing. International Journal of Caring Sciences, 6(3), 319. https://search.proquest.com/openview/fbf1c115202a78ca3fb8f354aa7e3111/1?pq-origsite=gscholar&cbl=1606338

Lavin, M. A., Harper, E., & Barr, N. (2015). Health information technology, patient safety, and professional nursing care documentation in acute care settings. Online J Issues Nurs, 20(6). DOI: 10.3912/OJIN.Vol20No02PPT04

Nursing and Midwifery board of Australia, (2016). Registered nurse standards for practice. Access date: 2.6.2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx.

Porter, J., Morphet, J., Missen, K., & Raymond, A. (2013). Preparation for high-acuity clinical placement: confidence levels of final-year nursing students. Advances in Medical Education and Practice, 4, 83–89. https://doi.org/10.2147/AMEP.S42157

Ross, K., Barr, J., & Stevens, J. (2013). Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC nursing, 12(1), 9. https://doi.org/10.1186/1472-6955-12-9