Reflection on Student Nurse Experience Using Gibbs Reflective Cycle

Introduction

The Gibb’s reflective cycle is a nature of reflective theory that is used for encouraging individuals to think systematically regarding the experiences they faced during a certain event or situation. The Gibb's cycle consists of six steps that are description, feelings, evaluation, analysis, conclusion and action plan. In this assignment, Gibb’s cycle is to be used for reflecting on my work as a student nurse under the supervision of my mentor and professional health practitioner in different practice placements.

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General and specialist surgical (UK: Adult nursing, surgical) - reflect on participation during an Electroconvulsive Therapy (ECT)

Description: While participating as a student nurse during an Electroconvulsive Therapy, I was asked by my mentor to apply the blood pressure (BP) cuff on the hand of the patient and check the patient’s vitals and ensure the BP cuff is working properly so that it can be used to monitor the patient properly during the treatment. After checking the BP level of the patient before administration of mouth cuff, it was found to be slightly higher than normal. The high level of BP indicates that the individual is in a stressed situation (Zahoor, Masroor & Ali, 2014). Thus, high BP, in this case, means that the patient is still panicked about the therapy and I mentioned my mentor regarding the fact but the person asked me to ignore the values and execute further duties. The anxiety feeling of the patient is required to be resolved properly during the ECT so that the person does not panic (Huang et al. 2019). Since my mentor was more experienced I avoided mentioning that it is wrong not to make the patients clam before mouth cuff is attached for ECT as it may lead the individual to get further panicked and anxious. However, I did as was told and next tried to place the mouth cuff on the patient as further instructed by my mentor. When I tried to place it, the patient was seen to be panicked and threw the mouth cuff from my hand. I tried to calm the patient but was unable to execute it as well as got panicked. Thus, my mentor immediately came to my rescue and helped me to clam the patient together which assisted me make the patient less anxious as well as helped me to attach the mouth cuff on the patient and later participate successfully in providing ECT to the patient.

Feelings: When the BP level of the patient was found to be higher than normal before putting the mouth cuff for ECT and my mentor still asked me to ignore it, I felt I should have asked my mentor if I could clam the patient and then attach the mouth cuff. Moreover, I felt it would be disrespectful to ignore the instruction from my mentor and thus executed the action as told without mentioning that it may be wrong. I was personally panicked and developed fear that the patient may attack me when the individual threw the mouth cuff from my hand. I also felt helpless when even after trying to make the patient clam was not successful. However, I felt supported and gained the courage to come near the patient when my mentor helped me.

Evaluation: During the incidence, I only thing that went well is that I had effective assistance from my mentor whenever I required. However, the thing that did not go well is that I failed as a student nurse to ensure the patient remains calm during the ECT arrangement. I also failed to take proper actions when required which is evident as I failed to make my mentor realise the consequences which may happen by following the person’s instruction regarding ignore the patient’s slightly high BP level during the ECT. The nurse required to have the skill to be clam and constrained in difficulty situation (Acharya, Gaur & Kunigiri, 2018). However, I failed to remain calm and felt helpless as well as panicked when the patient did not cooperate with me.

Analysis: The situation led me to learn that I require voicing my opinion in front of the mentor in a polite way regarding any actions that I feel is executed in the wrong manner without having any fear. This is because if I have asked my mentor that it is essential we clam the patient before putting the mouth cuff for ECT since the patient’s BP levels are still high the negative incidence could have been avoided. I also analysed that as a student nurse I still need to improve my knowledge regarding the way to clam a patient as well as need to improve my skill to be calm in tough situations. This is because if a nurse is unable to be calm in tough situation it would lead the nurse unable to control the situation as well as the patients (LeBlanc et al. 2018). This is evident as I being helpless and anxious during the panicked created by the patient I was unable to clam the individual without my help from the mentor.

Conclusion: I can conclude that my mentor was supportive in nature but I failed to take proper action when required. This led to develop a hindered and chaotic environment during the initiation of the ECT. Moreover, I failed to show my skill of being a clam and contended nurse.

Action Plan: In future, I am going to make my senior realise if any wrong actions are done by talking with them polite and avoid the fear that going against my senior means I am disrespecting them. Moreover, in future, I am going to take lessons regarding the way I can personally clam a panicked patient without help.

Mental Health and psychiatry (UK: Mental Health & Wellbeing---) reflect on the Management of acute schizophrenia -Depot administration

Description: During deport administration for managing acute schizophrenia as a student nurse, I was asked by mentor to check and prepare the site for injection of a patient who are to be injected with medicine as well as prepare the injection so that my mentor can properly inject the medicine without delay. I checked the left buttock of the patient where the injection is to be administered and asked if the person feels pain in the region. The patient informed that he is feeling pain in the area for the last few days and asked if the area could be ignored for the administration. I followed the information checked the right buttock of the patient and asked if there is any perception of pain to ensure if the site can be considered for depot administration. The patient replied he feels no pain in the area and thus I cleared the area with alcohol. Moreover, I also arranged the injection through which the depot administration is to be done by my mentor. After few minutes, my mentor came while talking on the phone and asked me whether everything is prepared and on which side of the buttock the injection is to be administered. I mentioned that it is the left buttock and my mentor picked the syringe and without washing hand administered was place the syringe to be administered on the right buttock. I immediately interrupted my mentor and mentioned it is the left buttock that depot administration is to be done. My mentor immediately considered the matter and said sorry to have not cared of the information. However, I forgot to ask my mentor to wash hands as I the information was totally out of my mind. I did inform the fact to the mentor afterwards to which my mentor replied that I should have mentioned it during the incidence and be careful next time.

Feelings: When my mentor was talking over the phone at the same time asked for the information regarding which place the depot administration is to be done, I felt that the person would ignore my information. Thus, I kept a sharp eye and felt that my mentor may have misheard my information. Further, when my mentor was trying to depot administer on the right side instead of left I felt panicked and immediately asked my mentor to stop even though I felt it would be disrespectful. However, when I remembered I forgot to tell my mentor to wash hands I felt sorry.

Evaluation: The nurses required alert in performing their duties so that duplication and hindered services are avoided (NMC, 2015). Thus, I was alert as a student nurse to take proper step in the settings if required which was the thing that went well. This is evident as if I had not been alert that my mentor overheard my information the person could have depot administered on the right buttock of the patient which the patient request to avoid which would have led to dissatisfaction and increases pain to the patient. The thing that did not go well was that I failed to repeat the information again to my mentor when the person stopped talking on the phone to prepare for depot administration. This is because I felt maybe I was wrong that I thought my mentor misheard me. The duty of the nurses is to maintain proper hygiene to avoid negative health consequences for the patients (NMC, 2015). As a student nurse, I forgot to mention my mentor that the person needs to wash hand before depot administration as during injection the area may be infected. Thus, I failed to ensure proper hygiene for the patient.

Analysis: The situation led me to develop the knowledge that as student nurse I need to be more alert and careful regarding the actions to be made to ensure hygiene for the patient. Moreover, I think I need to work on my memory to execute things as being forgetful regarding actions as a nurse would create negative consequences for the patient.

Conclusion: I have reached the conclusion that student nurses are required to be effectively careful during depot administration as they are mainly involved by their mentor to fulfil different steps for the process. I think I need to improve my memory and be more alert as well as careful.

Action Plan: In future, I plan to develop a checklist for the actions to be maintained during depot administration so that careful and effective action can be taken to avoid any hindrances.

Care of the old and geriatrics (UK: Care of Older people) reflect on the care of an elderly patient (hygiene, nutritional and medication)

Description: While acting as a student nurse, my mentor provided me with the responsibility to assist to take care of nutrition, hygiene and medication of an elderly patient. The patient was unable to personally change clothes for taking bath and often requires assistance while going to the toilet. Thus, while providing the care my mentor ensured that an alarm is kept by the side of the bed of the patient so that the person can call us while going to the toilet or whenever help is required. My mentor asked me to ensure regular bath is provided to the patient and I change the bed sheets regularly. While providing medicine to the elderly patient, he would often refuse to take them. However, my mentor asked me I should make the patient understand the importance of taking medicine and would politely as well as empathetically communicate with him to convince the elderly patient to take the medicine. My mentor asked me I should stand near the patient to ensure the person has taken the medicine so that he does not have the scope to throw it anywhere else. In order to ensure proper nutrition is provided to the patient, my mentor makes sure food is provided to the patient accordingly by maintaining the diet chart provided by the dietician. This is because dieticians are professionals who have effective knowledge regarding which individuals according to their health condition are required to take which nature of foods so that proper nutrition is managed (Beck et al. 2015). However, the mentor not the person asked me to check if the patient was eating the provided food properly.

Feelings: The overall assistance from my mentor in each aspect made me feel lack of hindrance in providing care to the elderly patient. When the elderly patient avoided taking medicine, I felt that it is my duty to make the person feel relaxed and convince to take the medication by informing the individual about the significance of the medicine for the person’s health and well-being. While changing bed sheets for each day, I felt happy that I was able to provide proper care to the individual. I also felt happy that I could ensure nutrition is provided to the patient by following the diet chart provided by the dietician.

Evaluation: The thing which went well is that I with the help of my mentor was able to make proper strategies to make the elderly patient take in proper food that is required according to his health condition for ensuring his nutrition is maintained. The other thing which partially went well is that I was able to ensure hygiene of the individual as I provided the person regular bath and changed bed sheets regularly. However, neither I nor my mentor checked whether or not the elderly patient washed hands after going to the toilet which means I was not able to ensure effective overall hygiene of the individual. I was able to ensure proper nutrition of the patient as the food provided was made according to the diet chart provided by the dietician. However, I make my mentor concerned that the person is required to check whether the elderly individual is eating the meals.

Analysis: The analysis of the situation mentions that to ensure hygiene of the patient I need to discuss with the mentor regarding how to observe that the person is washing hands before and after going to the toilet without getting into the individual personal space. I also analysed that to ensure proper nutrition is provided to the elderly patient the mentor as well as me need to observe that the provided food is eaten by the patient properly. This is because elderly patient often avoid taking meals as they do not feel the zeal to eat or live due to continuous suffering from diseases (Nyberg et al. 2015).

Conclusion: It can be concluded that more focus is required to ensure effective hygiene and nutrition for the elderly patient. I need to have better skills to take decision without accessing help from my mentor.

Action Plan: In future, I am going to ensure that better hygienic condition of the elderly patient is provided by making it sure they wash and clean after going to the toilet. Moreover, I would monitor that after meals are provided to elderly patient they eat the meals properly so that effective nutrition for them can be assured.

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Home Nursing (UK: Community Nursing) - Reflect on LONE WORKING)

Description: As student nurse, I was asked by my mentor to work as lone community nurse. My mentor allocated me the responsibility to visit a certain family in the community to make them aware about dementia and the effects of taking early steps in detecting and managing it because they had a family member who is suffering from dementia but they are not providing the person any services. I went to the family to talk but they initially avoided interacting with me and shut the door in front of me. However, I still tried to convince them that I meant no harm and wish to talk to them for brief amount of time. Later, they opened the door and let me enter. I initiated casual conversation with them and went on to mention them about the cause of dementia as well as the way they can access free services for it to ensure the well-being of any patient suffering from the disease. They listened to the information effectively and participated to know more. However, when I asked them to help me met the dementia patient in the family one of the member in the family threatened me that I cannot meet the person. Moreover, they locked the main door and told me they would not leave me as I already know that they have a dementia patient at home and if they let me go out I would speak to others about the matter which would bring shame to them. I immediately called my mentor and asked what I need to do. My mentor asked me to stay calm and called the emergency to help me get out of the place.

Feelings: While the family did not wish to talk to me, I felt that they may be avoiding me as they do not know me and thus considering me as threat for them. However, when the family let me into their home I feel that I may have been able to convince them that I meant no harm. I was panicked and developed fear when the family locked me into their home but ensure I use my presence of mind to call my mentor to reach emergency to help me get out of the place.

Evaluation: During the activity, the one thing which went well was that I was able to communicate with the family about the causes and healthcare services related to dementia. However, there were many things which did not go well such as I was unable to convince and create change in belief of the family that having a person with dementia is disrespectful in the society. Moreover, while working as lone nurse I was unable to manage my safety. I also failed to meet the patient with dementia in the family to provide the individual assistance to enjoy healthcare services. However, the thing that went well is that my mentor was alert regarding my safety which helped me to get out of the place without harm.

Analysis: The analysis of the situation mentions that while acting as a lone nurse I need to remain in contact with another person and inform about their whereabouts so that in emergency help can be accessed. Further, it can be analysed that the family threatened me because they fear I would hinder their reputation in the community by telling all others they have family member with dementia. Thus, it can be analysed that though I provided them information regarding dementia yet I failed to raise proper awareness to resolve their stigma regarding the disease.

Conclusion: It can be concluded that while acting as lone nurse one need to be in direct contact with the mentor as hindrances and threat may rise at any movement. Moreover, proper evaluation and information about the family to be visited in the community is to be taken while acting lonely so as to avoid unnecessary threat as experienced.

Action Plan: In future, I am going to at first develop detailed knowledge about the family I am going to visit in the community while acting as lone nurse. Moreover, I would study ways in which information regarding mental diseases like dementia can be given to people so that stigma can be controlled and better healthcare can be offered without hindrance to needed individuals.

Learning disability Nursing --Reflect on care for deaf and dumb patients

Description: My mentor asked me to assist the person in taking care of a deaf and dumb patient. As a student nurse, I did not have the information about sign languages but my mentor helped me in this case by assisting me learn basic signs to interact with the patient. This is because visual cues and gestures along with sign languages are the only way to communicate with deaf and dumb person as they are unable to gear and speak (Chowdhry et al. 2016). My mentor personally introduced me with the patient and mentioned through sign language that we both are going to take care of the individual. On the next day, I asked the patient through sign language to mention if he has taken the meal and wish any assistance. In response, the patient avoided talking to me. However, I went on to ask the patient politely through sign languages to which the person replied the person does not wish to talk to me and want my mentor who is the person’s usual carer to come. I asked that my mentor is busy and if the patient needs anything then I can help through signs. The patient avoided responding again but I waited. After watching me wait, the patient informed me that the individual has eaten the meal for the day but had no water. I immediately fetched water for the patient and offered the glass. The patient was seen to be pleased with the gesture and showed interest to further communicate with me.

Feelings: When the patient avoided talking to me, I felt that I may have been unable to use proper sign languages for communication. Moreover, I felt the patient may not trust me when the individual informed my mentor who is the person's usual carer to come. However, I felt satisfied and happy when the patient mentioned that the individual is happy with the way I patiently cared for the person even after the patient did not behave well with me.

Evaluation: In the activity, the thing which did not well is that the patient initially avoided talking to me. This means the patient could not believe I would be able to provide proper care. Thus, I was initially able to provide effective care. However, which went well was that through consistent polite and empathetic way of talking through sign languages I was able to gather trust from the patient that I would be able to provide proper care.

Analysis: It can be analysed that patients who are deaf and dumb are to be provided some time so that they can develop trust regarding accessing care from others apart from their usual carer. Moreover, sign languages are must be learned by nurses to be able to take care of deaf and dumb patients as without it the nurses would be unable to interact and understand the needs of patients.

Conclusion: It can be concluded that nurses to offer care to deaf and dumb patients are required to have knowledge of sign language and need to provide time to the patient to develop trust.

Action Plan: In future, I would access training regarding sign languages so that better conversation with service users can be made to understand their intricate needs and demands regarding care.

References

Acharya, H., Gaur, A., & Kunigiri, G. (2018). Anesthetic and psychiatric implications of accidental awareness under general anesthesia during electroconvulsive therapy. Saudi journal of anaesthesia, 12(2), 335. Retrieved on 12 September 2019 from:

Beck, A., Andersen, U. T., Leedo, E., Jensen, L. L., Martins, K., Quvang, M., ... & Rønholt, F. (2015). Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome: a randomised controlled trial. Clinical rehabilitation, 29(11), 1117-1128. Retrieved on 12 September 2019 from:

Chowdhry, V., Padhi, M., Mohanty, B. B., & Biswal, S. (2016). Perioperative challenges in management of a deaf and dumb patient posted for high-risk cardiac surgery. Annals of cardiac anaesthesia, 19(3), 564. Retrieved on 12 September 2019 from:

Huang, C. J., Lin, C. H., Wu, J. I., & Yang, W. C. (2019). The relationship between depression symptoms and anxiety symptoms during acute ECT for patients with major depressive disorder. International Journal of Neuropsychopharmacology. 38, 1-32. Retrieved on 12 September 2019 from:

LeBlanc, A., Bourbonnais, F. F., Harrison, D., & Tousignant, K. (2018). The experience of intensive care nurses caring for patients with delirium: A phenomenological study. Intensive and Critical Care Nursing, 44, 92-98. Retrieved on 12 September 2019 from:

Nyberg, M., Olsson, V., Pajalic, Z., Örtman, G., Andersson, H. S., Blücher, A., ... & Westergren, A. (2015). Eating difficulties, nutrition, meal preferences and experiences among elderly: a literature overview from a Scandinavian context. Journal of Food Research, 4(1),

22-37. Retrieved on 12 September 2019 from:

Zahoor, M. U., Masroor, R., & Ali, M. W. (2014). Use of lignocaine or nitroglycerine for blunting of hemodynamic stress response during electroconvulsive therapy. Egyptian Journal of Anaesthesia, 30(1), 27-30. Retrieved on 12 September 2019 from:

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