Analyzing Gibb's Model of Reflection - Essay Example

?Gibb’s Model of Reflection Gibb’s model of reflection offers guidance on the of the situation, evaluation of feelings and experience, which helps one to make sense of the situation and to examine what can be done if such a situation were to occur again in future. The model consists of six stages, each of which leads to a greater understanding of the situation. The last stage, which involves the creation of an action plan, is quite effective in professional practice as it is the one that helps one identify future actions in a similar situation. This model can be contrasted to Rolfe’s reflective model which seeks to have three questions: what, so what and now what, answered. Although Rolfe’s model seems to be more structured than Gibb’s, it is shallower. I chose Gibb’s model over Rolfe’s because it is more comprehensive and offers one the chance to examine the best actions to undertake if and when faced with a similar situation. The first step in Gibb’s model is a description of events. What follows here is a description of events. During my clinical practice I was working in a hospital ward designated for the elderly, I admitted a patient who was unconscious. This particular patient was an 81-year old married woman who had had a cerebro -vascular accident, (CVA) a few years prior to the day of admission. The patient could breathe independently though with difficulty. The magnetic resonance imaging (MRI) scanner indicated that the woman was suffering from brain cancer and the cancer had already covered a large part of the brain. The patient’s husband did not have full comprehension of his wife’s health at that particular moment, and he could not easily accept the doctor’s observation that she had a terminal illness. The doctors did not divulge information regarding the patient’s chances of living. The second stage of Gibbs model of reflection is self awareness in terms of feelings and thoughts. My first thoughts about the even were based on the fact that the patient needed immediate medical attention, but she was incapacitated to make any medical decisions for herself. Not only had she lost physical control of her body, she was not in any position to make clear decisions. The patient could not speak hence she could not make a decision concerning her treatment; neither did she understand the potential risks associated as she was unconscious. When the staff nurse reported to the husband the severity of his wife’s illness, he did not want to accept the fact that his wife might die at any time. I felt that the medical practitioners should have considered the patient’s husband’s position before making any medical decisions for the patient. For the most part, I empathized with the patient and thought how sad I would feel if I had the same illness and not be able to contribute to my own treatment. Empathy can be described as the ability of being able to relate to what another person is feeling or going through (Randall and Downie, 2010). I felt relieved by the presence of a qualified nurse who could assist in the personal care of the patient. However, I kept wondering if Mrs. Smith would have approved of the doctors’ and nurses’ actions were she able to make her own decisions. Stage three of Gibbs model is the evaluation stage, in which judgement is made based on the events that occurred. In my evaluation, the patient received very good treatment, medically. The patient was treated with respect, dignity and the best possible care; however, her nearest relative was not treated with as much concern. The husband of the patient was not fully aware of his wife’s condition, and he did not understand the serious state of his wife’s illness. When he was told of her condition, he did not seem to want to accept the fact that she was seriously ill, and it was for this reason that the doctors kept him in the dark regarding her chances of living. I agreed with the doctor’s decision to keep the husband not fully informed of his wife’s condition to avoid trauma. Later on, I realised I was mistaken in my thoughts and feelings. I discussed the position of the husband with my mentor, and she agreed with me that a husband or next of kin should be informed about the patient condition. The Mental Capacity Act, 2005 requires that in case a patient is mentally incapacitated to make a medical decision, there should be a “flexible framework that places individuals at the heart of the decision-making process (Social Care Institute for Excellence, 2011). The next stage in the model is analysis, which involves considering how well or how poorly things were done. In my evaluation, I tried to consider the manner in which events in this situation occurred. This is where the issue of ethics comes into play. It is the responsibility of all medical practitioners to act in their patients’ best interests (Griffith, 2006). Based on the principles of beneficence and least harm, the doctor prescribed a medication that could help the patient to treat some of the symptoms of brain cancer since the MRI had indicated that her cancer was at very advanced stage. Analgesia and sedative were delivered through syringe driver.Mrs. Smith’s symptoms appeared to be well controlled by the morphine, cyclazine, and hyoscine Ellershaw et al. (2001) indicate that the patient in the dying period should be prescribed medication for pain, agitation, and respiratory difficulties. Glare et al. (2003) confirm that pain, distress and breathlessness are the main symptoms in the terminal phase, which can be guided with medication given as required. According to the doctor, the patient had a very short time to live and thus this treatment was considered suitable. Initially, my thoughts and feelings about the actions of the doctor and the whole process were positive. At that time, I thought the doctor was right to have commenced the patient on immediate morphine sedation to reduce pain, agitation or irritability and hence reduce suffering. I also thought it was good for the doctor to administer the analgesia and sedative through a syringe driver since the patient had lost physical control of her body. This means that it was a good idea for the medical practitioners to administer intravenous medication as the patient was unconscious and unable to tolerate oral medication. I also felt it was good for the doctor to make decisions on behalf of the patient since she was unconscious, and therefore, incapacitated to make any medical decisions for herself. Legally, qualified medical practitioners have the power to make decisions on behalf of their patients who cannot do so due do any form of incapacitation. In my evaluation, it is clear that the doctors and nurses responsible for Mrs. Smiths care mostly acted to her best interest medically. The next stage is the conclusion or analysis stage. In my evaluation of events, I came to the conclusion that there are certain elements of healthcare that were omitted by the doctors and nurses responsible for the patient’s care. I realized that there had been lack of effective communication between the healthcare professionals and the patient’s husband, who was also the patient’s next of keen. This was an ethical mistake on the part of the medical practitioners who were in charge of taking care of the patient. They should have given full and accurate details of the patient’s condition to the husband and given him a chance to contribute to his wife’s treatment. Flexibility in decision making is one of the requirements of the Mental Capacity Act. This means that the doctors had the option of getting the husband’s point of view before commencing with treatment. According to Griffith (2006), medical workers are required to act in the best interests of their patients. The law also requires medical practitioners to accept and respect the wishes of a patient and his relatives. Right from the point of admission, the husband should have been made to understand the type of treatment his wife was being put on. The medics should have explained what was happening to his wife and why they were administering the medications. This way, they would have helped him understand his wife’s condition. The medical information should be communicated to the relative in a proper way involving respect to his feelings, in a separate room using a warm and compassionate tone. At first, Mr. Smith wanted s/c fluid to be administered to his terminally sick wife so as to prolong her life. However, the doctors decided to go against the husband’s wishes as prolonging Mrs. Smith’s life would have been tantamount to prolonging her painful suffering. At this point, the medical practitioners were facing an ethical dilemma which pitted allowing a patient to continue living and suffering vis-a-vis letting her die as painlessly as possible. As part of their moral obligations, the nurses were also supposed to ensure that the patient’s spiritual needs were being sufficiently addressed (Sandman, 2005). According to the NMC Code of Conduct (2008), all health professionals should ensure that they gain informed consent before they commence any treatment or care. If they provide care in emergencies, they should also demonstrate that they have acted in the patient’s best interests. The doctors and nurses taking care of Mrs. Smith decided not to give her medication that would prolong her life since they did not want to prolong her suffering and pain. Instead, they gave her some morphine sedation to reduce pain, agitation or irritability and hence reduce suffering. They avoided giving her s/c fluids as the husband wanted, instead they chose to follow the principles of beneficence and least harm (Griffith, 2006). The Mental Capacity Act requires that if anyone has to make a decision on behalf of another who is incapacitated, the decision must be to the person’s best interest. The medical professionals in this case decided that Mr. Smith wanting to prolong his wife’s life was not to her best interest. There are some positives that I observed in this situation. One of these was the execution of the Last Days of Life Pathway for the Dying Patient. According to the National Council for Palliative Care (2005), a patient is entitled to the best possible care in the final days of her life. Wallace (2001) acknowledges that good quality palliative care is performed when all healthcare professionals involved work together as team members and the patient is seen as the central focus of care. In Mrs. Smith’s case, there was a multidisciplinary team to respond to dying patients and their individual care plans, for example, ensuring that adequate comfort measures were in place, including reduction of pain, irritation and agitation. Everything was done to ensure that the patient’s symptoms were managed to give minimal distress. The medications were administered via the best route, a syringe driver. However, there were inadequacies in executing the care pathway plan. There was a chaplain to take care of the patient’s spiritual needs and the husband was there to explain her spiritual values or inclinations. The medical practitioners involved in this case did not consider their moral obligation to effectively fulfil spiritual needs (Sandman, 2005). Instead, the doctors initiated the pathway without explaining it to the patient. At this point, the doctors were required by law to identify any special needs and ensure that those needs are fulfilled. The integrated care pathway for the last days of life also required the doctors and nurses to inform, prepare and support Mr. Smith following his wife’s death. It was also an ethical error to ignore any spiritual needs of the dead patient, as this shows disrespect. In my opinion, though, I can say that the patient died peacefully and did not experience any pain or agitation in the last days of her life. This can be attributed to the Last Days of Life Pathway care plan (Brett and Schofield, 2002). There was sufficient care and support from the multidisciplinary which was formed to make a decision based on Mrs. Smith’s best interests and to ensure that the Last Days of Life Pathway care plan was initiated. It was essential to protect her dignity, comfort and rights and also to consider the views of her relative (British Medical Association, 2010). The doctors followed what was medically required in case a patient was incapacitated. They were professional enough to ensure that the patient was as comfortable as possible despite her state of helplessness. Mrs. Smith’s husband should have been made to understand what was happening to his wife. Nurses’ ethics obligation is to be truthful to patients and their next of kin. Healthcare professionals must be able to demonstrate that they have observed the European Convention on Human Rights in achieving decisions, and to be able to justify them. In this case, the nurses and doctors taking care of Mrs. Smith were supposed to explain to Mr. Smith why they could not prolong his wife’s life. They were to explain to him what the best was for the patient at that tie, and this was to let her die. According to the Bolam test, it is the duty of the doctor or medical practitioner to offer explanation of the form of treatment that a patient is getting. The issue of the husband’s rights versus medical practice also comes out in this case. The husband wanted his wife treated a certain way, which was not considered to be the best course of action for the patient. The doctors after explaining the situation to Mr. Smith, should have left the decision to terminate the patient’s life to him. Furthermore, the four biomedical principles of autonomy, beneficence, nonmalficence and justice are all significant in this case. Autonomy required the doctors and nurses in this case to get permission for treatment from the patient’s husband. The beneficence principle required the doctors to act in a manner that was best for the patient. The nonmaleficence principle required the medical practitioners to act in a way that did no harm to the patient. Justice on the other hand is the principle that addresses the issue of morally acceptable laws and human rights, in this case the rights of the patient and her husband (RCN, 2004). The dilemma in this case was based on the fact that the doctors did not get consent from the patient or her husband in relations to her treatment. However, the form of treatment they offered was for the patient’s benefit and it was not meant to harm her in any way, rather it helped ease her discomfort and pain. The nurses and doctors tried to follow the medical requirements for persons about to die. They administered the correct medications correctly and ensured that the patient was comfortable and well taken care of until she took her last breath. Action Plan If I were to encounter such a situation again, I would ensure that before commencing any treatment, family or next of kin ought to be fully informed about a patient’s condition through contact with the ward manager or qualified nurse. Any form of consent in this situation would have been sufficient to commence treatment. It would also be important to explain why a certain type of treatment would be best for the patient even if the relatives seem to think otherwise. Involving the patient’s husband, as he was the next of kin, in the decision making would have made it easier for him to deal with the situation. For patients experiencing much pain, initially I would ask medical staff to prescribe a dose of analgesia while appropriate medication is prepared for delivery via the syringe driver. This would lessen the pain while ensuring that the patient is as comfortable as possible. Preparation of the family members of dying patients for the patient’s imminent death is important as it makes them accept the loss before the actual death and may help them to cope quickly with it when it happens (McNicholl et al., 2006). Healthcare professionals have a professional obligation of acting in the best interests of their patients and acting as their advocates. References Brett and Schofield, 2002, Integrated care pathways for patients with complex needs. Nursing Standard. 16, 46, 36-40. British Medical Association, 2010. The impact of the Human Right Act 1998 on medical decision making. London: BMA. McNicholl P. et al., 2006 Using the Liverpool Care Pathway for a dying patient.Nursing Standard. 20, 38, 46-50. National Council for Palliative Care, 2005. Guidance on the Mental Capacity Act 2005.London: NCPC. NMC (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. Online: http://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/. Accessed on 8th September, 2011. Randall F., and Downie, R., 2010. End of life choices: consensus and controversy. Oxford: Oxford University Press. RCN, 2004. Informed consent in health and social care research. RCN Guidance for Nurses. RCN, London. Wallace P., 2001. Improving palliative care through effective communication. International Journal of Palliative Nursing.7, 2, 86- 90. Read More