Gibbs' model: example of reflective writing in a healthcare task

Description
In a placement during my second year when I was working in an operating room, I worked under the
supervision of my mentor, caring for a seventy-two-year-old gentleman, Mr. Khan (pseudonym), who had been
undergoing abdominal surgery. I was asked to remove the bandage so that the doctor could
evaluate it during the visit to the room.

I removed the bandage under the supervision of my mentor, using a non-contact procedure, and cleaned the wound.
as requested by the doctor. At that moment, they called my mentor to attend to another patient, so,
At your request, I stayed with Mr. Khan while we waited for the doctor to come see him.

The doctor had been with another patient, examining their wound, and I noticed that she went straight to Mr.
Khan to examine his wound, without washing his hands or using hand sanitizer first. I also noticed that he was wearing
a long-sleeved shirt and I was worried that the cuffs might be contaminated. I thought for a
moment to do or say something, but when I gathered enough courage to say something, I thought it was already too late.
late because she was already examining Mr. Khan.

Feelings
This alarmed me, as I expected the doctor to wash their hands or use hand sanitizer before examining.
Mr. Khan. However, I felt intimidated because I felt that the doctor had more experience than I did as
second-year nursing student; and I didn't want to embarrass her. Besides, I didn't want to worry the gentleman.
Khan confronts the doctor in front of him.

Later, I spoke with my mentor about the incident. She suggested that we talk together with the doctor about it.
My mentor took the doctor aside and asked her if she had washed her hands before examining the gentleman.
Khan. She seemed quite surprised. She said she had been very busy and hadn't thought about it.
the mentor talked to her about the importance of hand hygiene and the doctor assured her that she would wash them
hands before examining each patient in the future.

Assessment
The incident was extremely challenging for me. I regret not having acted to question the practice of
doctor before examining Mr. Khan. However, I am pleased that the doctor responded so
positively to the comments of my mentor and I have observed that now she has changed her practice as
result of this incident. I also learned from the incident, as it taught me the importance of taking action.
assertively with my colleagues, sensitively, to safeguard the well-being of the patients.

Analysis
The Royal College of Nursing (2005) states that hand hygiene is the most important activity for
reduce cross infections and points out that many health professionals do not decontaminate their hands
so often.
as they should. A recent guide published by the Department of Health (2007) highlights the possibility that
staff transmits infections through uniforms and the need to review policies on the
staff clothing. The Professional Code of Conduct of the Nursing and Midwifery Council (2004,
Section 8) states that, as a nurse, 'you must act to identify and minimize risks to patients.
and clients." As a nursing student who cares for Mr. Khan under the supervision of my mentor, this also
it applies to my own practice as a nursing student.

Conclusion
In recalling this incident, I can see that I should have acted earlier and that I should have made sure to
that the doctor washed his hands before examining Mr. Khan. Now I can see that my inaction in this
the incident put Mr. Khan's well-being at risk. After speaking with my mentor, I acknowledge that I need
desarrollar la confianza para desafiar la práctica de mis colegas, poniendo el bienestar de los clientes en primer
plan in my mind. I realize that I need to support my colleagues, understanding the pressures they are under.
They may be subjected, but ensuring that their practice does not jeopardize the clients.

Action Plan
In the future, I will try to develop my assertiveness skills when working with colleagues, to ensure that they
maintain the well-being of customers. In my next placement, I will make this a goal for my learning and
I will discuss with my mentor to develop strategies on how I can achieve it.

*******************

THE END
.... Or is it? This may be the conclusion of a single learning experience, but it is the beginning of
its development as a professional, where their confidence and assertiveness could have a direct impact on the
patient well-being. Next time... start with your action plan. How does it work? What will happen
next time you find yourself in a similar situation? You can continue using Gibbs' reflective cycle to outline your
continuous learning and development.

******************

References
Department of Health (2007) Uniforms and work clothing: an evidence base for developing policies
Available locales in:
[Link]/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078433
(consulted on 16/1/08)

Nursing and Midwifery Council (2004) Professional conduct code of the NMC: standards of conduct,
performance and ethics London: Nursing and Midwifery Council

Royal College of Nursing (2005) Good Practices in Infection Prevention and Control: Guide for the
nursing staff London: Royal College of Nursing

Examples of reflective writing

Example 1

I arrived in the room at 7:30 ready to start a 12-hour shift. After receiving the handover, my mentor
he assigned me the task of bathing Mr. B with the help of a medical assistant. Mr. B suffers from the disease of
Creutzfeldt-Jakob (CJD), a progressive disease of the nervous system with rapid deterioration due to
spongiform encephalopathy. She is not expected to live until Christmas, despite only being 19 years old. It is
mentally aware of what is happening, but physically unable to perform activities of daily life
daily, including eating and drinking, has limited communication skills and has double incontinence. Is not
secure on foot as he moves in a wheelchair.

I approached Mr. B's bed and asked for his consent to take him for a bath. While the bath was...
Open, we began to help him undress. He seemed quite nervous. Thinking that I was in his
position, being the same age as him, I also began to feel embarrassed. I thought it couldn't be
a professional individual if I allowed my shame and sympathy to interfere with my care of
nursing.

We helped Mr. B to enter the bathroom and began to wash him. I knew he felt uncomfortable and wanted to be able to
to wash myself only, but I couldn't do it. It was hard for me to look him in the eyes, especially when it came to
wash the genitals. I tried to alleviate this by starting a conversation, but in a way this made things worse.
things.

After the bath, we dried Mr. B, dressed him, and returned him to bed in the wheelchair. For the
the health assistant was just another job, but the feelings I had afterwards, as I am sure was the case
Mr. B stayed with me for some time.

This reflective narrative provides a good description of the nurse's feelings, but it doesn't go much further.
beyond. What additional information is needed to develop it?

Adapted from Jasper, M. 2003. Beginning of reflective practice: foundations of nursing and care
sanitary. Cheltenham: Nelson Thornes.

Example 2

Mrs. James had been admitted to the ward after a fall and had multiple bruises and cuts.
the body. During her stay in the room, she had been slightly confused and prone to wandering aimlessly without
supervision. As McConnell (1998) states, this is an important concern for nurses in the
hospitals and care centers. They told us that Mrs. James was unstable and that she should not attempt to walk.
alone without help. This is reinforced by the work of Oliver et al (2001), who assert that a greater
Disability can result from anxiety and loss of confidence after a fall.

This reflective writing demonstrates the use of concepts to explain what happened. Please note that this
allows the reader to demonstrate awareness of professional values and the ability to transfer learning to
the professional practice. Examples of understanding that you could take advantage of in your reflective writing could include
practice guidelines, professional codes of conduct or knowledge about diseases or conditions
specific.

Adapted from Jasper, M. 2003. Beginning Reflective Practice: Fundamentals of Nursing and Care
sanitary. Cheltenham: Nelson Thornes.
 Example 3
I will use a reflective model to discuss how I have achieved the necessary level of competence in my program.
of nurse training. The reflective model I have chosen to use is Gibbs' model (Gibbs 1988).
The clinical skill I have chosen to reflect on is the administration of intramuscular (IM) injections.
I chose this because in my first clinical placement it was a method of medication administration.
widely used and I got involved in the process of IM injections. Therefore, I researched the topic of
IM injections and my knowledge in this area developed.

The site used for the IM injection was the gluteus maximus, which is the most commonly used site for administration of
IM injections (Greenway 2004, Workman 1999). The area of the gluteus maximus is thick and fleshy and has a
good blood supply (Watson 2000). It is located in the hip area and forms the buttock (Watson 2000).
Watson (2000) has observed that the gluteus maximus is close to the sciatic nerve, and Greenway (2004) suggests that
this presents a risk of injury threat in the administration of IM injections. When I administered the
IM injection to the patient, I injected it into the gluteus maximus muscle, as the evidence states that this is the best.
practice.

The first stage of Gibbs' (1988) reflection model requires a description of events. I
They asked me to administer a medication to a patient through an IM injection. I had observed this skill.
clinic on various occasions and had previously administered an IM injection under supervision. In this
On one occasion, I was observed by two licensed nurses, one of whom was my mentor. The medication had been
it was prepared and ready to be administered and the patient consented to a student administering it
injection. My mentor was explaining the procedure to me step by step and informed me that I should use a
alcohol wipe to clean the injection site, when the other nurse interrupted me and said no
it was necessary. This was in front of the patient, who then requested that the alcohol wipe be omitted since in
previous occasions had caused him a sensation of burning. My mentor said that this was acceptable and
I continued administering the injection, omitting the use of the alcohol wipe. In previous occasions in
the ones that had administered IM injections had not cleaned the site and had never indicated for me to adopt
this practice.
Although it is well written and referenced, this excerpt is too descriptive. There is no analysis.
clear of the events and, after the initial reference to Gibbs, the model does not particularly apply. It could
improve with a more critical approach and going beyond description to the final stages of reflection: a
discussion of the broader context (the why), perhaps the application of theory and some ideas on what
actions could be taken to perform better in the future. There is very little about what the student
learned from experience.

Adapted from Nursing Student. 2005. Reflection on a clinical skill [online] Available at:
[Link]

Example 4

The purpose of this essay is to reflect on an aspect of my practice or professional development that I have
found throughout my time as a nursing student. For the purposes of reflection, the essay is
I will write in the first person. According to the NMC professional code of conduct (2002), I will maintain
confidentiality and all names will be changed to protect identity. The purpose of the reflection,
as John (1995) states, it is to promote desirable practice through understanding and learning of
trainee about their lived experiences. I have decided to reflect on the first time I made a transfer of
nursing and to structure my reflection I have decided to use John’s (1995) reflection model. This model
encourage professionals to work through a series of reflective signals, the last of which must
ver con el aprendizaje personal. El modelo de John (1995) proporciona un buen ejemplo de un enfoque de
reflection on action (or reflection on practice). The reflection on action, which takes place after the
event allows the practitioner to revisit an experience with the intention of exploring and learning from an activity.
Reflection on action is particularly important for nursing students, as it is often
the basis of formal evaluation.

It was my last placement of my course in a children's pavilion. I was working to reach the level of
performance 5, which involved working independently within a supervised environment. I had been
caring for a patient during my shift, Claire, a 12-year-old girl who had been admitted for treatment.
treatment for her diabetes. Although I had been taking care of her during my shift, I was not prepared to give her
the nursing handover to the next shift. I assumed my mentor would do it as she had in all my
previous shifts. However, on this occasion my mentor told me to do it at the last moment. The
I heard them delivering to their patients and then, when mine arrived, I panicked and confused the
information. I started with basic information about Claire, such as name, date of birth, and reason for
admission. Unfortunately, I got nervous after that and both my mentor and the rest of
The nurses on staff were clear that it was beyond my reach and I needed help. Then my mentor took
the relay and continued with the transfer.

Therefore, I decided to create an action plan to develop my nursing knowledge in this area.
I looked at several nursing magazines that detailed how to perform effective transfers. I also used the tips.
what I found in nursing magazines to plan how I would carry out the transfers. I also continued giving
transfers in the room. At first, I wrote all the information I wanted to convey to the receiving nurse and I
explained the reason why I had written the information.

At first, I discovered that I had to rely heavily on my notes and felt as if I was just reading.
a summary of the patient instead of giving a summary of the care that had been provided. Once, when
I had gained a bit of confidence, I still used the notes, but instead of writing everything I wanted to say,
I wrote down the key elements I wanted to mention to make sure I wouldn't forget them. This was extremely
useful and I continued doing it until I felt ready to submit the document without writing anything. The first time
I submitted without any notes, I was extremely nervous, however, I also felt more confident when
to know that if I forgot any details or got nervous, I would simply consult the patient's folder and the
I used as a guide. Another reason why I feel more secure now is that I feel more comfortable with the
other members of the nursing team and I don't feel as inhibited as I did when I made the transfer the first time
time.

This extract is well written and makes good use of the chosen reflective model, clearly assigning the writing.
to the framework. There are good examples of student learning and development through the reflective process; they
focus on planning actions and improving their performance in future occurrences. The writer
provides a reasonable analysis of the events, but perhaps could have included information
deeper contextual. It mainly concerns the student and does not pertain to the broader environment.
(Should they have suddenly asked him to make the transfer, for example?)

Adapted from Nursing Student. 2005. Reflection on a clinical skill [online] Available at:
[Link]

Setting up positive work environments for nurses: contributions of the

nurses at various organizational levels
M. McGirr and DA Bakker
shared

Abstract
This article focuses on nurses' perceptions of their individual contributions to the work environment.
Fourteen community hospitals participated in the study. At each agency, their Director of Nursing selected a
positive nursing work environment. The selection was based on subjective and objective criteria. All were asked to
nursing staff, to the directors of nursing and to the associate director of nursing with these units that
they responded to an open-ended question that described their perceived contributions in the work environments.
Ninety-two nurses responded, with a response rate of 42%. Overall, the three topics: People,
Practice and Place emerged from 15 categories of responses. The same three themes emerged for the three groups of
nurses, but variations were observed regarding the categories of contributions that the groups reported
more frequently within the topic. In this time of continuous changes in the entire healthcare system,
nurses must be able to articulate and assert their important contributions to the effective shaping of environments
positive health care attention. Focusing on contributions could help team building, development
of leadership and having a significant impact on the quality of patient care outcomes.

I am J Crit [Link] 2006; 15(3):256-67.

Authentic leaders creating healthy work environments

for nursing practice.
Shirey Sr.

Author Information
Abstract
The implementation of authentic leadership can affect not only the nursing staff and the profession but also
also to the healthcare delivery system and to society as a whole. Create a work environment
Healthy nursing practice is crucial for maintaining an adequate nursing workforce; The
the stressful nature of the profession often leads to burnout, disability, and high absenteeism, and in
Ultimately, it contributes to the growing shortage of nurses. Leaders play a fundamental role in the
retention of nurses by shaping the healthcare practice environment to produce quality outcomes for the
nursing staff and patients. However, there are few guidelines available to create and maintain the
critical elements of a healthy work environment. In 2005, the American Nurses Association
Critical Care published a historic post that specifies six standards (qualified communication,
genuine collaboration, effective decision-making, adequate staffing, meaningful recognition and
authentic leadership) necessary to establish and maintain healthy work environments in the healthcare sector. The
Authentic leadership has been described as the necessary 'glue' to maintain a healthy work environment.
Now, the roles and relationships of authentic leaders in a healthy work environment are clarified as follows
way: an expanded definition of authentic leadership and its attributes is presented (for example, authenticity,
reliability, reliability, compassion and credibility). The mechanisms through which leaders are described
authentic leaders can create healthy work environments for practice (for example, involving employees in
the work environment to promote positive behaviors). A practical guide on how to become
in a true leader. A research agenda is proposed to advance the study of authentic leadership in the
nursing practice through collaboration between nursing and companies.

Healthy Work Environment Initiative of the AACN

An initiative to promote the AACN
AACN has prioritized three important advocacy initiatives: healthy work environments, care
palliative care and end of life, and workforce and personnel development. Besides our work
focused on intensive and acute care, we work with other organizations in coalition, providing
our voice to promote these priorities. By participating in working groups, political conferences and
the development of national standards and documents, AACN is working towards our vision of 'a
healthcare system where intensive and acute care nurses can do their
optimal contribution.

Now available: the new free tool for assessing a healthy work environment from AACN
Theweb-based healthy work environment assessment toolwill allow you and
to his team to collectively measure the current health of their work environment compared to the
standards of the American Association of Critical Care Nurses to establish and
maintain healthy work environments.

Establishing and maintaining healthy work environments should be a priority if nurses want to
make their optimal contributions to the care of patients and their families. The link between environments
healthy work and patient safety, retention and hiring of nurses and, therefore, the
The final result is undeniable.

AACN believes that all workplaces can be healthy if nurses and employers
they are determined in their desire to address not only the physical environment but also the less
tangible measures for the safety of staff and patients. However, we know that this will not happen
without an understanding of the factors that contribute to unhealthy work environments and a
commitment to adopt solutions.

The ingredients for success (competent communication, true collaboration, decision-making

effective, adequate staffing, meaningful recognition, and authentic leadership are described
in the AACN Standards for establishing and maintaining healthy work environments. Click on
the links below to download the full version or the executive summary in PDF files.

AACN Standards for Establishing and Maintaining Healthy Work Environments: A Journey Toward
excellenceFull version (44 pages)

AACN Standards for establishing and maintaining healthy work environments: a journey towards
excellenceExecutive Summary (9 pages)

This website space is designed to further assist caregivers and their employers.
implement these standards by connecting them with additional resources. From speakers and consultants
well versed in the Healthy Workplace Environment Standards up to best practices,
you will find the resources you need to make your work environment healthier.

Bridge to the Master of Science in Nursing with an emphasis on Leadership

Nursing in Health Care Systems
Overview of the title
List of courses
Program location

This program Bridge to the Master of Science in Nursing: Leadership in nursing in healthcare systems
The program is designed for experienced registered nurses who have bachelor's degrees in a field.
outside of nursing. Instead of requiring these students to obtain a BSN degree, they take six courses of
our Bachelor of Science in Nursing program and then they launch into the Leadership career in
Nursing in MSN Healthcare Systems.

The bridge to the Master of Science in Nursing with an emphasis on Leadership in Nursing in Systems
Healthcare prepares nurses for leadership roles in healthcare delivery systems.
that are changing rapidly today. Graduates of the nursing leadership master's program
you can look for positions such as charge nurse, nursing director, nursing director, or vice president of
nursing services.

With a focus on nursing leadership in healthcare systems, this program prepares the
students to lead and manage a team of healthcare providers, including specifically areas
budget management, challenges and limitations of staff, conflict resolution, and change management.

The master's program in nursing leadership consists of basic graduate courses in nursing and courses in
leadership taken with the Master in Scientific Leadership (MSL) program. Starting from the basic courses of
postgraduate nursing, students gain the knowledge, values, and skills necessary for the
advanced generalist practice in an evolving healthcare system. The nursing part of the program is
centra en el análisis crítico de la investigación de enfermería y atención médica, así como en la ética, las políticas y las
finance in healthcare. The leadership part of the program provides an overview of the styles
leadership and the functioning of organizations with an emphasis on the communication skills necessary to
establish and maintain effective relationships. Leadership topics include servant leadership, models and theories of
business leadership and the exploration of the behavioral forces and relationships that influence effectiveness and change
organizational.

This program includes a final class and a practicum. The final nursing leadership class provides an opportunity
for students to develop a practice project proposal based on evidence that addresses a
problem, issue, or concern in professional practice. Practice promotes the synthesis and application of
knowledge and skills of the basic nursing course and the leadership courses. Students identify a
mentor and develop a relationship through which they examine the connection between theory and practice.

The bachelor's degree in nursing and the master's degree in nursing from Grand Canyon University are accredited by the
Commission on Collegiate Nursing Education ([Link]

Online program disclosures

Consult the Academic Catalog for more information. Program subject to change.