Reflection has become an important concept in nursing, influencing practice and education worldwide. The process of reflecting enables practitioners to better understand themselves and others, and solve problems. One framework that is used is Gibbs' Reflective Cycle, which includes six components to structure reflection: description of what happened, feelings, evaluation, analysis, conclusions, and developing an action plan. This document discusses two clinical scenarios in intensive care and applies Gibbs' framework to reflect on how to improve future practice.
Reflection has become an important concept in nursing, influencing practice and education worldwide. The process of reflecting enables practitioners to better understand themselves and others, and solve problems. One framework that is used is Gibbs' Reflective Cycle, which includes six components to structure reflection: description of what happened, feelings, evaluation, analysis, conclusions, and developing an action plan. This document discusses two clinical scenarios in intensive care and applies Gibbs' framework to reflect on how to improve future practice.
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Reflection
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Reflection Has Become an Important Concept in Nursing Nursing Essay
Reflection has become an important concept in nursing, influencing practice and education worldwide. The process of reflecting enables practitioners to better understand themselves and others, and solve problems. One framework that is used is Gibbs' Reflective Cycle, which includes six components to structure reflection: description of what happened, feelings, evaluation, analysis, conclusions, and developing an action plan. This document discusses two clinical scenarios in intensive care and applies Gibbs' framework to reflect on how to improve future practice.
Reflection has become an important concept in nursing, influencing practice and education worldwide. The process of reflecting enables practitioners to better understand themselves and others, and solve problems. One framework that is used is Gibbs' Reflective Cycle, which includes six components to structure reflection: description of what happened, feelings, evaluation, analysis, conclusions, and developing an action plan. This document discusses two clinical scenarios in intensive care and applies Gibbs' framework to reflect on how to improve future practice.
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The passage discusses the importance of reflection in nursing practice and introduces Gibbs' Reflective Cycle model as a framework to structure reflection. It also describes two clinical scenarios in an intensive care unit to demonstrate how the model can be applied.
Scenario 1 describes the care of an elderly critically ill patient who had been in the ICU for 3 weeks being treated for sepsis of unknown origin. Their condition was deteriorating and the consultant anaesthetist decided to do a CT scan to identify any abdominal issues despite it being unlikely the patient could tolerate surgery.
The author raised concerns about doing another CT scan since one had been done recently with no significant findings. They also suggested informing the patient's family about the planned investigation since withdrawal of treatment had been mentioned if the patient did not improve.
Reflection Has Become An Important
Concept In Nursing Nursing Essay
Introduction In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas & Jasper 2004). Indeed, the capability to reflect consciously upon one's professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede & Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed & Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan.