Gibbs Cycle as a Reflection Scheme for a Therapist

Introduction

According to Cotton (2001), reflection is to tackle and decide the contradiction between what the practitioner wants to be in the ideal world and what he actually does in the real world. The desire by the practitioners to make their minds up brings a lot of tension which is creative since it may be resolved in a way that can move the practitioner forward in their carrier. Two forms of reflection have been suggested so far, that is, reflection-in-action which occurs during the event, and reflection-on-action that occurs after the event. The health practitioner or nurses are guided by several models such as Gibbs, Johns and Rolfe (Bondб 1993). According to Bond, Gibbs Reflective cycle is widely used though not sufficiently sophisticated to offer detailed reflection. On the other hand, John’s model offers a structured reflection. Self-reflection has been identified as a vital way of progressing our learning. Students are therefore required to keep a journal recording their experiences from clinical practice. Reflection is a very important part of professional practice as it increases our expertise in the present and for the future by providing us with novel insights incorporating theory into practice.

The impact of feelings on the learning process cannot be over-emphasized. We all have past experiences with negative feelings where some incidents have left us feeling angry and frustrated. On the other hand, experiences resulting from positive incidents such as recognition for quality care from our patients or our peers validate our work as individuals and promote learning. Reflective practice requires you to draw upon your theoretical knowledge in a creative way and practically solve problems in everyday practice. That is, completing the cycle from theory to practice and practice to theory. Reflective thinking can be a complex skill but writing in the form of journaling is a recognized way of developing thinking processes fundamental to reflective practice. Problems of reflection There have been a lot of controversies on reflection. Some researchers have viewed reflection as a means of self-surveillance that ensures that nurses are doing ‘right’. Many nurses have complained of the issue of keeping a diary to record practice and reflections and they want to go home after work and rest. In addition, nurses use negative experiences as a reflection because they are the most memorable. This, however, brings unbalance towards the positive and negative experiences (Harkreader & Hogan, 2004). Advantages of reflection Reflection is compared with Foucault’s idea whereby the specific intellectual seeks the truth for its own sake and not a source of power over others. A reflective nurse reduces his/her traumatic experiences and thereby improving his carrier. Since reflection is a way of seeing or learning the truth, it brings out perception which is normally in the dark into light. Other institutions have described reflection as a “scholarship of practice” as it reflects how the practitioner engages in other areas of nursing scholarship. Gibbs Reflective Model

The Gibbs Reflective Model can provide some structure, guidance, and stimulation to your reflections. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice and learn simultaneously from the experience for better practice in the future. The first stage is the description of the situation followed by the analysis of the feelings. The third stage involves evaluation of the experience; the fourth stage is an analysis to make sense of the experience; the fifth stage is a conclusion of what else could I have done and the final stage is an action plan to prepare if the situation arose again (NHS, 2006). Reflection is about gaining self-confidence, identifying areas to improve your knowledge, learning from your mistakes, being self-aware and improving the future from past experience. In my context, it is important to improve the teamwork relationship. This will enable in achieving success by working together and valuing each other’s skills and contributions. As a member of a team, I was expected to demonstrate the utilization of the Gibbs reflective model within the multidisciplinary team. In teamwork, a sense of trust and mutual understanding exists between members that build a special link of the relationship. The members are expected to be cooperative and active in contributing to team goals and meetings. It was also expected that each one of us would challenge and contribute in a positive manner. These attitudes could be expressed by promoting effective communication and relationships by implementing interpersonal skills. Interpersonal skill is defined as the total ability to communicate effectively with other people (Wold, 2004). On the other hand, communication is defined as the exchange of information, thoughts and ideas either verbally or non-verbally (White, 2005). They further explain that verbal communication consists of speech whereas non-verbal communication consists of gestures, postures and facial expressions.

Mental health case study and teamwork

In this reflection paper, I will discuss my development of teamwork in a mental health care practice. I was on a placement test where I was placed in a psychiatric ward having a 3 weeks clinical placement for mental health care in the third semester. The words had elderly male patients and we were supposed to take care of them. Collaborative teamwork and proper allocation of duties are essential within elderly wards with mental problems. In addition, the ethical responsibilities of nurses are not only set by the Department of Health but also by a team exercising professional responsibilities. It was during a certain time when one elderly managed 67 years refused to be injected and threatened me. I was very shocked by the scenario and I didn’t know my next action. My colleague noticed us and he came over.

I later sat down and reflected on my feelings or thinking that took place before and after the event. Before I prepared to inject my patient, I introduced myself and build a good rapport with him as I explained I was to inject him. He stared at me with a suspicious face and mumbled something I didn’t hear clearly. As I reached for him, he got irritated and kicked my arm to keep me off. My colleague explained to me that the elderly male had a hearing problem and maybe he needed something before the injection. Actually, according to my colleague, he preferred gestures as means of communication. It was my duty to take care of my patient and make sure he gets the best care in the ward. This introduced me to task-centered communication as well as fulfilling the basic conditions as a nurse such as genuineness, warmth and empathy. While taking care of him, I was able to develop my non-verbal communication skills. Caris-Verhallen et al. (1999, p. 809) state that the non-verbal communication becomes important when communicating with elderly people who develop a hearing problem. It is also important to develop some effective ways of communicating with hearing-impaired people such as first gaining their attention before speaking and using sensitive touch (Holman, Roberts & Nicol 2005, p. 31). I feel this is a good experience for me because I learned the importance of teamwork and also, I learned to develop my non-verbal communication. Furthermore, gestures are one specific type of non-verbal communication intended to express ideas and are useful for people who cannot use words. Moreover, I used my facial expression to assure him that all was okay. Sometimes he could put a blurred face but I smiled back to assure him the injection was for the better of his health. My facial expression encouraged him to take the drugs and accept the injection. I also evaluated that my communication skills are very important in the best nursing care to my patient (Heath 2000, pp. 27-28). In a nutshell, my reflection of this event explores how communication skills play a vital role in the nurse-patient and nurse-nurse relationship in order to deliver nursing care towards the patient, especially the adult. As days passed, we became great friends with my patient as I successfully understood him and enabled him to effectively communicate with other staff nurses. I also learned that such patients should not be neglected and nurses should help one another in taking care of such patients (Delaune & Ladner, 2002).

After analyzing the situation, I could conclude that I was able to know the skills for effective communication with the patient such as approaching the patient, asking questions, being an active listener, showing empathy and supporting the patient emotions. My action for the clinical practice in the future if there were patients that I need to help in giving medications or other nursing procedures, I would prepare myself better in handling the patients who have some difficulty in communication. This will enable me to be one of the health care workers in the clinics. Further, I will work with my colleague at all stages of my practice for the benefit of the patients. Most important is to seek clarification from relevant members of the health team regarding the individual’s request to change or refuse certain care.

Another important aspect I learned is to first evaluate the effectiveness of the patient’s response to prescribed treatments, interventions and health education in collaboration with patients and other health care team members. I also indicated in my diary the reflection on the patient feedback on the evaluation of nursing care and health service delivery. The level of understanding of the patient about the health care should be analyzed when answering their questions and providing information. For a patient to understand, one may use formal or informal methods of teaching. Working as a team, I was able to identify my own level of competence and seek assistance and knowledge from my colleagues where necessary. I learnt to reflect upon and evaluate with peers and experienced nurses on the effectiveness of nursing care. The members of the team were cooperative and I could access advice, assistance, debriefing and direction when necessary. This however updated my knowledge on treatments and medications interventions within my area of practice. My colleague took the responsibility for my own professional development by advising me on how to handle my patient (Funnel, Koutoukidis & Lawrence 2005). However, according to my experience, I knew that communication was the fundamental part to develop a good relationship. Good communication is essential to get to know the patient’s individual health status. One should exercise active listening which means listening without making judgments. I must not judge the patients on the basis of their culture, belief and individual means of communication. To add to my action list is to learn the disabilities the patient has such as hearing disability, visual impairment and mental disability. Once I know the disability that a patient has, I could be well prepared with which method of communication to use as these specific groups requires particular skills and considerations. The hearing problem affects elderly people because of the aging process (Sivitier 2004). Conclusion The reason why I chose Gibbs’s (1988) reflective cycle as my framework of reflection is that I am able to explain every stage in the cycle about my ability to develop my therapeutic relationship by using interpersonal skills with one patient as well as one member of the team for this reflection.

References

1. Bond, M. 1993, ‘Stress and self-Awareness: A Guide for Nurses’, Nursing Today, Butterworth Heinesman. Cotton, A. 2001, ‘Private thoughts in public spheres; issues in reflection and reflective practices in nursing’, Journal of Advanced Nursing, vol. 36, no. 4, pp. 512-519.
2. Caris-Verhallen, W. M., Kerkstra, A. & Bensing, J. M. 1999, ‘Non-verbal behavior in nurse-elderly patient communication’, Journal of advanced Nursing, vol. 29, no. 4, pp. 808-18.
3. Delaune, S. C. & Ladner, P. K. 2002, Fundamentals of Nursing: Standard & Practice. 2nd ed, New York: Thomson Learning.
4. Funnel, R., Koutoukidis, G. & Lawrence, K. (eds) (2005). Tabbner’s Nursing Care 4E: Theory & Practice, Australia: Churchill Livingstone.
5. Gibbs, G. 1988, Learning by doing: a guide to teaching and learning methods. London: Further Education Unit.
6. Harkreader, H. & Hogan, M. A. 2004, Fundamental of Nursing: Caring and Clinical Judgment, 2^nd ed. Missouri: Saunders. Heath, H. 2000, ‘Assesing older people’, Journal of elderly care, vol. 11, no. 10, pp. 27-28.
7. Holman, C., Roberts, S. & Nicol, M. 2005, ‘Promoting good care for people with hearing impairment’, Nursing Older People, vol. 17, no. 2, p.31.
8. Sivitier, B. 2004, The Student Nurse Handbook, USA: Baillere Tindall.
9. White, L. 2005, Foundations of Basic Nursing, 2^nd ed. USA: Thomson Delmar Learning.
10. Wold, G. H. 2004, Basic Geriatric Nursing, 3^rd ed. USA: Mosby.