Reflection on the nursing process, using Gibbs 1988 model

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This is a reflective essay based on a situation encountered during my first six-week placement on an ear, nose and throat ward at a local hospital. In order that I could use this situation for my reflection the patient will be referred to as "Mr H". This is in order that his real name is protected and that confidentially maintained in line with the NMC Code of Professional Conduct to

"Treat information about patients and clients as confidential and use it only for the purpose for which it was given."

In order to help me with my reflection I have chosen Gibbs (1988), as the model to help with my reflective process. This model comprises of a process that helps the individual look at a situation and think about their thoughts and feelings. The experience gained in this can then be used to deal with other situations in a professional manner.

The Nursing process is a framework used by the health care professionals. The framework is made up of four components. Assessment of the patient on admittance to hospital, considering all of the patients individual needs in order to identify any problems. Planning: at this stage the nurse and if necessary carers, relatives and the patient discuss achievable goals and how these can be met. Implementing: This is the direct care needed for the patient, what is to be done for the patient, when and by whom. This gives the patient a clear understanding of what is going to happen to them throughout their stay in hospital. Evaluating: This step of the process informs the carer and the patient whether the goals set have actually been achieved (Kenworthy, et al 2002).


Whilst working on a morning shift I was asked if I would assist a team of nursing professionals and nursing assistants with washing and making a patient comfortable.

Mr H was a 68-year-old patient who had previously undergone cranial facial surgery to remove a tumour, which was invading his left eye. This was a very rare form of cancer. After a recent CT scan it was found that the tumour had reoccurred and this time was inoperable. It was shortly after this diagnosis that he was transferred to our ward for palliative care.

The World of Health Organisation (WHO) defines palliative care as:

"The active total care of patients whose disease no longer responds to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families"

(Lugton, Kindlen 2000)

On admission to the ward the patients care plan was completed with an initial patient assessment, relating to the "Activities of daily living,"(Logan et al 2001). The aim of this care plan was to allow the patient to die with well-controlled symptoms and to help the patient and family receive psychological, spiritual and emotional care during the last days of the patient's life.

It was only through his body language that the nursing staff could tell if the level of medication was correct and whether he was in any pain or discomfort. Mr H was given diamorphine for his pain, cyclizine an anti-emetic drug to prevent sickness and hyoscine to help with his secretions. A syringe driver was used to give a continuous subcutaneous infusion, as at this stage Mr H was unable to swallow.

The patients family were with Mr H and so were asked to wait outside whilst the patient was washed and made comfortable. Mr H had strong wishes not to be catheterised, this was respected and a conveen was put in place. He was given a bed bath, a shave and a clean change of clothes. Throughout the procedures the nursing staff helped protect his dignity by keeping the cubicle door closed and by keeping the patient covered as much as possible.

The nursing staff continually spoke to him and reassured him, whilst I held his hand. Day to day deterioration was occurring, so it was essential that his family were informed of...
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