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Nursing Student Reflection Placement Using Gibbs Reflective Cycle

Question

By following the Gibbs reflective cycle prepare a nursing student reflection on placement.

Answer

For a technical subject like nursing, Gibbs reflective cycle is the best model for reflecting the practices followed in class and other curriculums. Normally the Gibbs reflective cycle is done in six stages which i.e., describing the event, feelings you have gone through when you were experiencing it, evaluating the situation and experience, analysis of the experience, conclusion derived from it and the action plan you are going to follow. Below is the nursing student reflection on placement done on a patient who was admitted in the ICU of rehab department in the hospital. (Bulman and Schutz 2013)

As described above in this nursing student reflection on placement, in the beginning stage you have to describe the experience you have gone through, thus providing a valid and concise description of the event. I was pursuing my duty in the day shift and in an emergency my senior assigned me with the task to attend the patient who was admitted in the rehab department of our hospital. His condition was very critical and I was asked to provide him the primary aid in the intensive care unit.

This patient was suffering through the complaint of acute withdrawal syndromes from alcohol, liver cirrhosis, swollen abdomen, and ascites. Since his condition was very critical, I checked the fluid balance, level of fluid, weight etc. on an urgent basis. The level of peripheral edema and the usual rhythm of respiration were checked. The level of sodium and fluid was checked and limited to resist the accumulation of fluid and hence maintain the apt level of dilutional hyponatremia(Keogh 2014, p. 11). The level of albumin and serum in blood were also checked for bringing down any abnormalities. From my knowledge and the results from the tests undertaken I came to a conclusion that the patient is going through serious stage of liver cirrhosis and liver disease from alcohol, which was also confirmed by the complaints while attending him in the hospital. This made me conscious and I started to take actions and procedures which should be taken against a patient suffering from liver cirrhosis. I had conducted the entire test and all the actions by referring to my senior and had monitored every variation in the readings and condition of the patient.

In the second step of the Gibbs model of reflective writing, the feeling the pursuer had gone through while the event should be described which is described in the beginning of this nursing student reflection on placement. While attending the patient I was very confident and was able to handle the situation and the patient very well. I was able to stabilize the critical condition of the patient and had taken care of him during my entire shift. When the situation came in which I was not sure what to do and was sceptical about the next step I asked my senior for guidance. While attending the patient I was very confident and studious in handling the patient and conducting the required tests. . If any abnormality or any uncertainty happened in the condition and the test results of the patient, without any delay I have informed it to the mentor (Mikkelsen et al. 2015, p. 3632). Conducting this patient in the intensive care unit had made me more aware and knowledgeable about how to attend a person who is in a very critical stage. Before attending the patient I was very sceptical and unsure of my practical abilities as I had never a patient in such a critical condition of liver cirrhosis. After pursuing this experience I had acquired great knowledge of the interventions to be conducted in the practices of nursing. I was very cautious and attentive while I was attending the patient. I am now very confident in handling and attending the patients summering from acute liver disease from the consumption of alcohol.

In the next stage i.e., the third stage of the Gibbs model of the reflective cycle described in the beginning of this nursing student reflection on placement the better and regressive aspects of the event or experience is evaluated. The progressive part of the event was that the event helped me in acquiring a lot of confidence. The patient was allocated to me by the senior and I had to take my decisions on my own since, the senior was not always available to help me. This required me to apply every theory and knowledge I have studied in the nursing class regarding liver diseases and alcohol withdrawal symptom to control the situation (Vardy et al. 2013, p. 261). I had to go through the medical history of the patient and had to apply some critical reasoning and decision making ability in that situation. In order to control the aldosterone effect along with restricting the ascites and edema, diurectics like frusemide and spironolactone were used. Since the patient was going through acute liver disease potassium was continuously lost through urine. Thus the external supply of potassium was provided to the patient. To improve the cardiac condition of the patient Arterial vasodilators were injected in the body of patient. Since the patient had recovered from the situation there was no such any regressive aspect in this experience. The patient was allotted to me for only one day, which has limited my opportunity to study more about the medical practices. By this event I was able to gather much information about nursing interventions and has provided me a better stage to learn about the urgency in nursing. The situation was all under control and thus the event was a very pleasant experience for me.

While writing the fourth step of Gibbs reaction model, as described in the beginning of this nursing student reflection on placement, the analysis of the event should be conducted. By attending the patient in the intensive care unit of the rehab unit I have inferred that the main activities in nursing, depends on the clinical judgement and the decision making capacity of the attender. The process of nursing majorly relies on the delivery of quality patient care and arriving at better decisions suddenly which will give the attender a great knowledge and confidence to carry further urgent cases. The practices and the interventions of nursing majorly depends on how the reaches are conducted, the way of collecting the evidence and analysing it, and arriving at a conclusion by going through a thorough critical analysis by keeping in mind the diverse and different patient population and their individual medical history. In the process of attending the patient I had recorded all the interventions carried out in the nursing procedure very accurately. I had made the detailed notes for finding , interventions made and the observations in the event. The interventions carried by me to the patient of primary character, because the patient was just admitted into our department. The interventions noted by were of great importance as the continuing treatment of the patient was to be done by referring to the notes prepared by me. The notes and the interventions drafted by me were well appreciated by the senior as they were very accurate and consisted of in depth analysis of the patient’s condition.

A mentioned in the beginning of this nursing student reflection on placement, the next stage to be done in the Gibb’s reflective cycle is drafting the conclusion about the experience. Various steps has to be followed in this stage. My senior had played a great role in guiding me through th critical situations. I followed each and every guidelines provided by him and it had really helped me in handling the patient. Since this patient was suffering through acute liver disease, he was losing very much nutrients from urine and other media. Thus he was asked to take a very balanced diet and to follow a very healthy routine of food intake. It was recommended for the patient that the intake of alcohol should be stopped on an urgent basis(Jaurigue and Cappell 2014, p. 2154). The family of the patient should be made aware of the seriousness of the situation and should be asked to provide the patient with mental and social support to help him recover and join rehab centre. This situation has elevated my knowledge of liver cirrhosis and I was able to witness the acute withdrawal symptom of alcohol. I wanted to give the patient nursing intervention throughout his medical course as I wanted o gather more knowledge on his condition. I was not able to do this as on my next shift I was allocated with another patient. I was able to achieve my learning goal of studying the nursing interventions. It was a great opportunity for me to apply my theoretical knowledge and by virtue of which attain some practical knowledge.

Last or the sixth stage of the Gibb’s reflective cycle consists of deriving an action plan from the analysis of the experience. I have observed by the analysis of the event that the mutual co-operation and synchronized team work plays a vital role in the process of nursing interventions. I have determined to focus on a patient till his medical course is completed since I was not able to give nursing intervention throughout the patient’s medical course. In my perception that will enhance my knowledge on nursing interventions and give a great boost to my confidence. It was a very pleasant condition since the patient was able to recover from the critical condition but I need to handle same cases again in order to make me well verse in handling the critical situations. My priority would be in handling critical patients without any interference from the senior.

References
Bulman, C. and Schutz, S. eds., 2013. Reflective practice in nursing. John Wiley & Sons.

Jaurigue, M.M. and Cappell, M.S., 2014. Therapy for alcoholic liver disease.World J Gastroenterol, 20(9), pp.2143-2158.

Keogh, K., 2014. Nurses’ role in reducing deaths from liver disease is crucial. Nursing Standard, 29(11).

Mikkelsen, M.R., Hendriksen, C., Schiødt, F.V. & Rydahl‐Hansen, S. 2015, "Coping and rehabilitation in alcoholic liver disease patients after hepatic encephalopathy – in interaction with professionals and relatives", Journal of Clinical Nursing, vol. 24, no. 23-24, pp. 3627-3637.

Vardy, M., Day, E., Webb, K., Russell, C., Sudhakaran, P., Ahmad, I., Cobain, K. and Aldulaimi, D., 2013. PTH-122 a retrospective study to compare the effectiveness of referral methods to alcohol services for specialist treatment from an acute hospital following brief intervention. Gut,62(Suppl 1), pp.A261-A261.

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