Nurse :reflective practice experience

All nurses need to develop reflective practice. I still use Gibb’s (1998) reflective cycle, as it
allows a 360-degree view of an incident or activity, and a way for you to make sense of your
experiences.
For this assessment, you are required to consider an event or an incident that has
happened to
you on clinical placement. Choose an incident that caused you to ‘stop and think’ about
teamwork and leadership on a nursing unit. Use the steps in Gibb’s (1998) cycle as
subheadings.
You may use ‘I’, ‘me’, and ‘my’ as directed in APA 6th edition. You need to use references,
and provide a reference list.
Here is a short example from nursing students in Oxford Brooks:

Reflective practice experience
Introduction

The aim of this assignment is to give a critical reflection of an incident that occurred
during the nursing practicum. The Gibbs cycle is used in this assignment to provide a framework
for critical reflective exercise. As indicated in Fig 1, the cycle uses structured debriefing to
facilitate reflection exercise as advocated by “experiential learning cycle” proposed by Kolb,
Dewey, and Piaget. According to these behavioral psychologists, information is transformed
into knowledge through reflection. This indicates that information gathered is only useful if it is
considered from reasoned analysis approach (Health academy, n.d.). In this context, the
reflection exercise in this assignment will be structured as follows; a description of the incident,
critical reflections on the incident, evaluation, analysis, conclusion and action plan.

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Fig 1: The Gibbs reflective cycle

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Description
The incident in question occurred during the handover phase. Handovers in nursing
practice are crucial elements such that if information is missed, patient’s safety will be put at
risk. However, time and space pressures often make the handing over process to be done in
hastily, which can be confusing especially in busy clinical environments (Galt & Paschal, 2011).
In this case, an incident arose where the handover process was done incorrectly. This ward
comprised of geriatric long-term patients, most of whom have had their health status unchanged
for months, so they were under routine care. The nurse who was ending her night shift was in a
rush to leave. Therefore, she did not write down on what was expected and only stated that
nothing had changed since yesterday. That was her hand overstatement and left immediately.
While taking a full assessment of the patients in this ward, I noticed that one of the
patients had a sacral pressure sore. The patient had limited mobility because her limb had been
amputated a few months ago. The patient also had dementia and did not speak. However, the
information about the sacral pressure was missing from the patient’s medical report. On asking
around from the senior care assistants, she was rude and said that there was nothing they could
do as all the nursing processes were ineffectual. This was worrisome and I immediately raised
my concerns of the observations made by my mentor. My mentor was pleased that I had
identified these clinical practice errors and she authorized me to administer the wound using
evidence-based practice when making decisions on the type of dressings and wound management
practices.

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Feelings
The initial feelings were insecurity, surprise, shock, and embarrassment. In class, we are
taught to follow protocols and the high value of these procedures to patient safety. Although gut
feelings and instinct are important, nursing practice is professions that need structure (Buttaro el
al., 2013). Therefore, it was a shocking and uncomfortable experience to observe that a senior
and experienced care assistant break the facility procedures. For instance, when I enquired why
the patient’s records had not been updated in the last three days, the senior carer’s response was
with some negative/ authoritative attitude which made me become defensive. I made a remark
that undermined my personal values and made me appear amateurish. However, I felt that it was
appropriate for me to enquire about poor quality record keeping as it undermines patient safety
(Jaul, 2014).
The feelings of insecurity came from being left with patients without a proper handover.
I did not know where to begin and all information I had was “nothing have changed since
yesterday.” This statement carries a large amount of information that needed to be put into
consideration, but none of it was crystal clear. Although I managed to deliver routine care to the
rest of the patients, there is this one patient who had a pressure ulcer in addition to the other
complex comorbidities. It was a bit scary to be left with that magnitude of responsibility with no
information on the intricacies of this patient, and for a moment I felt vulnerable. However, after
speaking to my mentor, I had a relief feeling as she approved all my care plans, and I managed to
carry out all course of action appropriately.
Evaluation
From this experience, it is evident that one must be prepared for surprises and various
forms of departure from clinical management. This was a good and bad experience. The bad

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experience originated from shock and surprise that made me lose confidence in senior colleagues
as they failed to follow the nursing process procedure to deliver quality care (Ma & Park, 2015).
On the other hand, the good experience is that I was able to learn from the bad experience to
overcome new challenges. My nursing skills were evidenced by my ability to evaluate the
patient’s wound and to provide effective wound management practices. I also provided an
accurate descriptive account of the wound management practice to my mentor. However, I only
attended to the patient physical needs as I did not get an opportunity to conduct a holistic
assessment in greater depth to other patients needs such as poor communication and depression.
This was somewhat frustrating (Harrington & Terry, 2013). 
The reality is that not everyone will follow the protocol. However, it is everyone’s
responsibility to take the best course of action and to offer full support to the patient. I am
pleased that the carer’s feedback was positive and I have noted that she has changed her practice
since this incident. I too have learnt from this incident as it has taught me to respect other
people’s opinion, to remain assertive and sensitive to my colleagues because without teamwork,
patient’s well being is not safeguarded (Catalano, 2015).
Analysis
There is much to make from this experience apart from basic nursing knowledge
acquisition. The emotional and physical responses are also important aspects of nursing practice.
As a nurse, it is important to follow procedures and algorithms accurately because they have
serious implications for the patient’s health. Therefore, a practicum is an important component in
nursing training as it enables one to learn through the visual and kinetic learning process
(Melnyk & Fineout-Overholt, 2014).

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Another notable issue in this practicum experience is that not all nursing profession is
conducted perfectly. Some unexpected experiences/situations may arise but are important for one
to work to the best of their ability. Although nursing environment can be somewhat unsettling,
decision-making processes should be critically analyzed. Another most valuable aspect in this
experience is nurse emotional response during confrontations. For instance, when I became rude
to the senior carer assistant, it distracted her from concentrating on other important actions. I
failed to develop a conducive working environment that could foster effective partnership
(Rouleau, Gagnon & Côté, 2015). Lastly, the importance of having a supportive mentor cannot
be overlooked. All this time, the mentor was there to help with practical solutions whenever I
faced a challenge. However, this was also a weakness. I relied too much on my mentor. I had
high levels of self-doubt which made me seek for affirmation (that lacked within me) from my
mentor.
Conclusion
My nursing exercise and implementation of the care plan was successful. The exercise
demonstrated that I can make a holistic assessment to patient’s care, but I require more training in
communication skills so that I can address patients and other colleagues concerns respectfully
(Kajizono, Aoyagi, Kitamura, & Sendo, 2015). I know understand that effective nursing
frameworks require one to create an all inclusive partnership with the relevant caregiver as it
helps them deliver holistic evidence-based care.
Action Plan
This section addresses the solution or action plans that one would do if the situation rose
again. To start with, it is important for one to seek clarity from their colleagues before they leave
so as to clear out confusions. Secondly, self-determination is inspired by empowerment. In this

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case, I will develop listening skills and also learn to provide constructive criticism that will
motivate my colleagues to actively support or make changes in patient care. This involves
praising my colleagues for the care they provide, politely point out the mistakes identified while
emphasizing the importance of following the set procedures and care plans (Kilpatrick et al.,
2014). As I make the transition from nurse student to nurse practitioner, I will continue to reflect
on my daily practices to identify my strengths and weaknesses and to develop an action plan on
how the identified weaknesses will be addressed to continuously enhance my nursing skills and
competence.

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References
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A
collaborative practice (4th ed.). St. Louis, MO: Mosby.
Catalano, J. (2015). Nursing now! Today’s issues, tomorrow’s trends (7th ed.). Philadelphia, PA:
F.A. Davis Company.p>
Galt, K. A., & Paschal, K. A. (2011). Foundations in patient safety for health professionals.
Sudbury, MA: Jones & Bartlett.
Harrington, N. & Terry, C. (2013). LPN to RN transitions: Achieving success in your new role.
(4th ed.).  Philadelphia, PA: Lippincott, Williams & Wilkins.
Health academy. (n.d.). Teaching reflective writing.
Jaul, E. (2014). Multidisciplinary and comprehensive approaches to optimal management of
chronic pressure ulcers in the elderly. Chronic Wound Care Management And Research, 3.

Kajizono, M., Aoyagi, M., Kitamura, Y., & Sendo, T. (2015). Effectiveness of medical
supportive team for outpatients treated with sorafenib: a retrospective study. Journal Of
Pharmaceutical Health Care And Sciences, 1(1), 6.
Kilpatrick, K., Lavoie-Tremblay, M., Ritchie, J., & Lamothe, L. (2014). Advanced Practice
Nursing, Health Care Teams, and Perceptions of Team Effectiveness. Journal Of Trauma
Nursing, 21(6), 291-299.
Ma, C., & Park, S. H. (2015). Hospital Magnet status, unit work environment, and pressure ulcers.
Journal of Nursing Scholarship, 47(6), 565-573. 

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Melnyk, B., & Fineout-Overholt, E. (2014).Evidence-based practice in nursing & healthcare: A
guide to best practice, 3rd Edition. Philadelphia: Wolters Kluwer/Lippincott Williams &
Wilkins
Rouleau, G., Gagnon, M.-P., & Côté, J. (2015). Impacts of information and communication
technologies on nursing care: an overview of systematic reviews (protocol). Systematic

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