Gibbs

Gibbs' model for patient care and reflection

Question:

Discuss about the Reflection and Practice Gibb’s Model Guides.

Gibb’s model guides reflection when handling a situation. This model is helpful in breaking down the situation into events and personal responses. This reflection cycle is the link between learning from the past and future planning. Gibbs’ reflective cycle prompts nurses to think in a systematic way about each phase of the practice. Experience is very important for learning, however nurse’s should think constantly and reflect on it, for improvement in practice. It is also useful in making sense of particular incidence. Hence, it would be helpful to understand the incidence in better way and there are chances of augmentation in the quality next time. 

This essay is about Mr. X (65 yrs.). He was admitted to the ward two days before due to symptoms of dementia and his erratic and unacceptable behavior towards his family members and friends. I had been for the last 5 years as a residential nurse in the ward for psychological diseases. I usually used to arrive at work by 7 a.m. I used to assist older patients in the ward in their daily activities of the morning session. These include use of toilets and bathroom. This morning also, I was busy with these routine tasks. While performing these activities, I encountered Mr. X. Prior to talking to him; I had spent around 30 minutes in the ward. During this time, he was very quiet and lying on his bed. I asked him, whether he required assistance for the use of the toilet and bathroom. Instead of responding to me, he started abusing me and my colleagues. Suddenly, he got up from his bed and started talking loudly and he was moving his both the hands very fast. He was trying to harm me physically, however I escaped safely. From the previous night he had been enquiring about his wife. However, his wife died three years ago due to a heart attack. He was repeatedly saying that staff members were not allowing him to meet his wife. In this unfavorable situation also I kept my nerves cool and with the assistance of senior staff member, I convinced him. I hold his hand in my hand and requested him to calm down. I requested senior members of my staff to talk to him and clam down him. I did this by listening carefully to him. I did not angry with him. I told him, I wanted to help him. I asked him to be more comfortable. He did not want me to remind his wife, so I agreed.

Initially, I had very complex feelings during the incident. I was rethinking about my language, whether I had used wrong words. I felt embarrassed due to that incidence and I was upset. I felt that, I had disturbed him. I was thinking, he was exhibiting agitated behavior due to me. Due to this incident, other patients in the ward also become disturbed. Other patients might be thinking that I did not give proper treatment to Mr. X. These patients might be thinking, I used arrogant words to Mr. X, hence he became irritated and behaved as he did. My feelings became distressing because, I made him recall his dead wife. I was frightened at the time of incident; however I kept calm at that time and handled the situation in a very professional manner. I did not leave the patient in his agitated conditions (Roberts and Dyer, 2004). My feelings were good and I was satisfied because I gained confidence in handling such a situation effectively. My feelings were completely different from the feelings at the start of incident. The ultimate was positive. Mr. X agreed to use the toilet and bathroom. Completion of these morning session activities of Mr. X was very important because it can help to make him stable and to improve his comfort level (Baillie, 2005).

Encounter with Mr. X and the challenging situation

The good thing about this experience was, I followed nursing standards and values in a very professional and ethical way. The bad thing about the incident was, I got ill-treatment from the patient. Patients misbehaving with nursing and healthcare staff, who were taking so many efforts for physical and mental well-being of the patients. Another bad thing about the incidence was, other patients in the ward also got disturbed due to this incidence.

I could sense that, other people might have handled this incidence with different approach. My approach of handling this incidence was democratic way. I listened his feelings carefully and took him in confidence. Other people might have handled this incidence in more autocratic way. They might have instructed him to perform his routine activities like toilet and bathroom use. Such type of attitude might have exaggerated the situation. This might have lead to disturbance to other members in the ward. Other members of the staff were reacted very positively to this situation. My senior  nursing staff and ward boy had helped me to calm down Mr. X and to take him to toilet and bathroom use. (Corrigan et al., 2005). Other staff members had tried to encourage him and also had tried to improve his belief in  nursing and healthcare staff. They had told him that nursing staff meant for wellbeing of the patients and they would not do anything harmful to him. Hence, he should have complete trust on nursing staff for his fast recovery (Anthony, 2000x; May, 2000). For Mr. X, opportunities of internal recovery process were negligible because due to his age he would not be able to understand consequences of his behavior. Repetitive association between patients experience and social conditions, including efforts and positive attitude of me and other staff members of the ward, had helped in improving condition of Mr. X. Health and nursing staff were confident about the improvement of the patients with psychological illness like Mr. X. This optimistic approach of the staff members had helped in increasing confidence level and hope for recovery of Mr. X (Roberts & Wolfson, 2004; Repper and Perkins, 2003). 

It would be helpful for me handle such conditions in more effective and efficient way. I would improve myself in providing intervention to such mentally ill patients by discussion with senior members of the hospital, studying more studies and involving myself in the number of studies. This incidence had helped me to increase my confidence level in handling more cases of mental and psychological patients. I would do more research on similar types of cases and study it carefully. I would discuss these cases with my seniors to get their view on these cases. I would provide services to such patients by integrating knowledge, skills, research, techniques and experience.       

Conclusion of reflection:

From this event it was evident that there should be provision of separate ward for the mentally ill patients. It would be helpful in avoiding trouble to other patients in the ward. Morevoer, there should be recruitment of specialized staff members in the management of mentally ill patients.  It was good that, me and other staff members had managed case of Mr. X in proper way to calm him. Otherwise, it would have been difficult scenario to control in the ward, if he would have not been controlled by the existing staff members. I, along with other staff members had managed this case of Mr. X because according to our hospital health policy we should not leave patient on his/her condition. It is responsibility of every staff member to obey the rules and regulations of the policy of the hospital. Management should improve this policy by amending the hospital policy. In the hospital policy, there should be provision for inviting expert from the other hospitals in case of emergency (Goel, 2010; Peters, 2016).

Reflection on the experience

I should also work on improving my reflection abilities. I should practice reflection in number of cases. Reflection and assessment of the nursing practice would be helpful to deal with the adverse conditions. It would be helpful for me to face any case without any hesitation. Next time, I would ask fellow patients in the ward to counsel such unacceptable behavior of the patients. Few patients might be comfortable to share their feelings with other patients as compared to the nurse and healthcare staff. It would be helpful for the nurse like me to calm the patient and reduce burden on me. 

I managed the situation effectively and handled the situation according to rules and regulations (Grace, 2013). I handled this situation, in the absence of an expert in the field because in our hospital there is no specialist for mental and psychological health. This incident taught me a lot and it gave me chance to assess myself in handling adverse conditions. I understood that these experience can not be gained in classroom teaching. Rather such real time experiences can teach. I learned that my efficient communication, positive attitude and holistic approach helped me to handle this condition (Thresyamma, 2005). Though, I came across such incidences for the first time, I acquired skills and ability to handle such adverse conditions form my mentor. I used to observe him keenly while handling such conditions.

Due to hospital policy, there was no separate arrangement available for the management of mentally ill patients. Hence, these patients should be admitted in the same ward along with other patients. Most important learning for me from this incidence was that, communication is most important factor for the management of the patients with dementia. Making realization is very important for such patients because these patients used to forget most of the things. Self-awareness had helped me to build communication with the patients. I would practice self-awareness more because it is evident that self-awareness is very useful tool for managing mentally ill patients. For the management of mentally ill patients, it is very much required to understand their feelings and behavior. Self-awareness would helpful to get insight of the mentally ill patients and reflect positively according to their behavior. Self-awareness would be helpful in bringing self-esteem and assertiveness in me. Self-esteem would be helpful for me to communicate confidently with the patients and assertiveness would help me to bring equality in patient relations. These two factors are important in the management of mentally ill patients. If I would have handled this incidence in aggressive manner, Mr. X might have reacted to me more in irritating and aggressive manner. As a result, there would have been irregularity in the completion of his morning session daily activities. This might had lead to the physiological and psychological disturbance to Mr. X. I had handled this situation with person centered care approach. Person centered approach is important aspect of nursing practice in which patients should be managed by considering their views and feelings. Person centered care is also helpful in building trust and confidence of patients with nurse. As a result, patients can understand the reality and cooperate more with the nurse (Colomer and de Vries, 2016).

Handling the situation professionally

Establishing good communication with the dementia patients is a difficult task, however, person centered care had helped me to establish it with Mr.X. In patient centered care there should be consideration of the patient history and family background. I would collect more information about the family members of the patient. Intervention should be provided to the mentally ill patients by considering social, psychological, physical, cultural, sexual and spiritual aspects of patient. There should not be any effect on the self-esteem of the patient. Next time, definitely, I would prefer to give person centered care to such mentally ill patients (Brooker, 2003). However, I should do more research in the person centered care because it can’t be performed by following standard protocol. This practice of nursing can vary from person to person and based on the situation. Mainly four principles should be considered while providing person centered care. These include 1) offering dignity, compassion and respect to the patient, 2) offering coordinated care, support and treatment, 3) offering personalized care, 4) supporting patients to identify their strengths and abilities and assist them on its development, enabling patients to live their independent life. This incidence also had helped me to understand my deficiency in handling mentally and psychologically ill patients. I would definitely take it very seriously and try to improve on this. I would like to implement all the acquired theoretical knowledge in the actual nursing practice in the clinical setting (Jensen and Inker, 2015).

I was conscious to visit him next time. It was in mind that, he might not prefer to take my services because of previous incidence. I was very uncertain about the scenario, when I would visit him next time. There might be possibility that, same incidence might repeat next time also. There might be more aggressive behavior of Mr. X because he already got irritated due to me. He might not be cooperative at all for providing nursing interventions. Mr. X might run away from the ward to avoid me. He might disturb all the other patients in the ward. It might result in disturbance in providing nursing care to all other patients in the ward. There might be physical damage to the instruments and hospital articles due to the aggressive behavior of Mr. X. On the other hand, I also had thought that because of dementia he might have forgotten the incidence. It had given me confidence and moral boost to visit him next time. There were previous instances available, where people with dementia and mental illness had exhibited such behavior. Due to emotional disturbance, such mentally ill patients used to exhibit agitatation and unacceptable behavior. However, actual fact is that such patients never exhibit such behavior intentionally. These patients never desire to disturb other person physically, emotionally and psychotically (Adams and Gardiner, 2005). This type of behavior could have occurred in such patients due to mental and psychological disturbance. Being working in this profession since last five years and involved in the management of number of patients, I was aware of the fact. This knowledge and information had helped me to manage Mr. X in this adverse condition. I could take immediate decision to manage him in a very polite way instead of handling him with aggressive manner. 

Conclusion:

Case of Mr. X is discussed in this essay. Mr. X  is associated with dementia and erratic behavior. My reflection on this scenario is presented along with effect of this incidence on me and behavior and cooperation of other colleagues. Other aspects related to hospital like facilities, human resource and policies are incorporated in the discussion. In the recovery and management of Mr. X both patient related and social aspects are discussed. In summary, I should mention that, I handled this incidence efficiently, however with the improvement in reflection practice and implementation of person centered care, this scenario could be managed more effectively next time.   

References:

Adams, T., & Gardiner, P. (2005). Communication and interaction within dementia care triads Developing a theory for relationship-centred care. Dementia, 4(2), 185-205.

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Baillie, L. (2005). Developing Practical Nursing Skills. London: Hodder Arnold.

Brooker, D. (2003). What is person-centred care in dementia?. Reviews in Clinical Gerontology, 13(3), 215-222.

Colomer, J., &  de Vries, J. (2016). Person-centred dementia care: a reality check in two nursing homes in Ireland. Dementia, 15(5), 1158-1170.

Corrigan, P., Slopen, N., Gracia, G., Phelan, S., Keogh, C., & Keck, L. (2005). Some recovery processes in mutual-help groups for persons with mental illness; 11: Qualitative analysis of participant interviews. Community Mental Health Journal, 14(6), 721-735.

Goel, S. L. (2010).  Health Care System and Hospital Administration: Health policy and programmes. Deep and Deep Publications.

Grace, P.J.  (2013). Nursing Ethics and Professional Responsibility in Advanced Practice. (2^nd ed.). Jones & Bartlett Learning.

Jensen, C.J., & Inker, J. (2015). Strengthening the Dementia Care Triad Identifying Knowledge Gaps and Linking to Resources. American Journal of Alzheimer's Disease and Other Dementias, 30(3), 268-275.

May, R. (2000). Routes to recovery from psychosis: The roots of a clinical psychologist.

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Peters, M. (2016). BMA Complete Home Medical Guide: The Essential Reference for Every Family. Dorling Kindersley Ltd.

Repper, J. & Perkins, R. (2003) Social Inclusion and Recovery A Model for Mental Health Practice. Balliere Tindall, Edinburgh, London.

Roberts, G. & Wolfson P. (2004). The rediscovery of recovery: open to all. Advances in Psychiatric Treatment, 10, 37-49.

Roberts, T. G., & Dyer, J. E. (2004). Student teacher perceptions of the characteristics of effective cooperating teachers: A delphi study. Proceedings of the 2004 Southern Agricultural Education Research Conference, 180-192.