Reflective Practice Entry

NameSally Sample

Reflective TitleReflection on the nursing process, using Gibbs 1988 model

Date of incident being reflect onSunday 30 June 2013

Stage 1 - Description of EventsWhilst working on a morning shift I was asked if I would assist a team of nursingprofessionals 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 toremove 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 wasinoperable. It was shortly after this diagnosis that he was transferred to our ward forpalliative care.

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

“The active total care of patients whose disease no longer responds to curativetreatment. Control of pain, of other symptoms, and of psychological, social and spiritualproblems is paramount. The goal of palliative care is achievement of the best quality oflife for patients and their families”

Stage 2 - FeelingsI felt extremely self-conscious when standing by the bedside. I did not know howconscious the patient was of the situation around him, so it was obviously important totalk to him. I found it difficult to know what to say and was really conscious of otherslistening to me and wondered if I was saying or doing the right things. The atmosphere inthe room was very quiet, my mentor and other staff present were very concerned he maydie whilst we were washing him, so we were all doing our best to ensure the family wereallowed back into the room as quickly as possible. The family were obviously anxious andupset at being away from him for any length of time.

Stage 3 - EvaluationThe good that came out of the situation was that the care plan for the last days of life hadbeen met. The patients and the family’s psychological, social and spiritual needs hadbeen addressed, and the patient was comfortable and free from pain (Kemp 1999). Thecare that was carried out protected the patients’ dignity and respected him as a human

CPDme - Development for Life Sally Sample

Reflective Practice Entry

being, with his family being involved as much as possible with his care.

The bad thing about the situation was that medically there was nothing more that couldbe done for this patient. All the family could do was to sit by his bedside and wait for theirloved one take his last breath, and to be at peace.

Stage 4 - AnalysisI chose this incident to reflect upon because I found it very rewarding to be part of theteam that helped this patient, in his last days of life, die with the dignity and respect hedeserved. Everything that could be done for the patient and his family was done in a veryprofessional, but also a very caring manner.

The NMC guides us to:

“Promote and protect the interests and dignity of patients, clients, irrespective of gender,age, race, ability, sexuality, economic status, lifestyle, culture and religious or politicalbeliefs” (NMC 2002:4).

I feel that we had achieved this for the patient and his family. I do not believe a persondying to be, part of the routine and ritual of the hospital staff caring for them (Field &James 1993, Walsh & Ford 1989 cited in Lugton, Kindlen 2000).

Stage 5 - ConclusionIn conclusion I can now see that whilst giving palliative care to a patient it can be easierto focus on the care to be implemented than the feelings of the patient and the family. Iwas nervous about giving care to Mr H., as I had never been in this type of situationbefore, I found I concentrated more on my own personal emotions than that of the patientand his family. When implementing palliative care it is important to observe the non-verbal and verbal communication of both the patient and the family, especially that oftouch, which in itself can convey empathy. As a student I need to be more aware of this.

Stage 6 - Action PlanIf I find myself in this situation again I would ensure I was confident enough to implementpalliative care in a professional caring manner, which hopefully will mature with personalexperience and by observing my mentor and other members of staff. I would fully discussthe care to be implemented before approaching the patients’ bedside and ensure I havea better understanding of the patients needs. I would talk to the patient whether or notthey were conscious and also aim to provide support for the family.

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CPDme - Development for Life Sally Sample