Using Gibbs Reflection Tool In Palliative Nursing Practice – My Placement Experience

Reflection using Gibbs Reflection Tool

Discuss about the Reflection On Palliative Care.

Reflection can be utilized as one of the most potent tools for improving quality and competence when considering the palliative nursing practice. This assignment will utilize the Gibbs reflection tool to describe the placement experience that I have attained as a student nurse in the palliative ward and how it has helped me develop my competence and skills. My reflection assignment will focus on the placement experience I have had this year. In November I had been given the opportunity to have a placement experience in the palliative care unit and this has been my first encounter with a terminally ill patient. Hence, it had been a great opportunity for me to understand my skills and competence and discover my weaknesses or limitations so that I can focus on improving it.

Reflection has been described by the Gibbs as the process of learning by doing, as it provides the nursing professional with the opportunity to reflect on their own practice standards and competence and skills (Jayatilleke & Mackie, 2013). As a nursing student, I had been given the opportunity to assist in caring for a 65 year old woman suffering with the last stage of lymphoblastic leukaemia. The confidential details of the patient will not be disclosed for the sake of privacy, although for the reflection I call the patient by the name of Jane. Jane had been in the health care facility for the past few months and the impact of leukaemia and the burdening treatment has had a substantial impact on the psychosocial health and well-being of the patient.  It has to be mentioned in this account that cancer diagnosis and the subsequent treatment can have a life altering impact on the patient’s perception of health and life in general (Ferrell, Coyle & Paice, 2014). The impending death also affects the will to struggle anymore for the patient. In this case the patients had been suffering from acute pain and wanted to be relieved from the pain by any means possible. Although her family was not agreeing with the intravenous morphine therapy intended to use for the analgesia, especially her son. Her son Jake was not agreeing for his mother to be put on such opioid based analgesics and wanted some other alternative pain relieving techniques to be employed for his mother. I would like to mention in this context that the family spent a prolonged amount of time arguing with the entire health care staff and denying the pain management that Jane needed desperately. The doctors and the senior nurses were all trying to explain to Jake that being in the advanced stage of the cancer the only available option for Jane is the opioid based analgesics. Although, the rest of her distant family agree to the analgesic treatment, her son was still adamant about the treatment required from the patient and him being the next of kin of the patient, the care team for Jane was not able to opt for the morphine injections. Unfortunately, the condition of the patient deteriorated quickly and her pain become too much for the patient to endure. However, after close to 15 hours her son agreed after he was consulted by the head oncologist and senior registered nurse with evidence based data regarding the advanced stage of cancer of the patient and how only morphine could help numb the sensation of pain for the patient. The evidence based data helped her so understand the impact of pain and advanced cancer treatment and agreed to morphine being given to her.

Evaluation of the Practice Scenario

It has to be mentioned in this context that this has been the first encounter I had with the palliative care setting and the pain and suffering associated with the end of life care setting had a significant impact on my communication skills and clinical reasoning competence (Dobrina, Tenze & Palese, 2014). First of all, when I first interacted with Jane, she seemed very friendly to me and we easily developed a therapeutic relationship. When she expressed her journey with cancer and her pain, I felt I could relate with her wishes to be relieved from the excruciating oain as soon as possible. She expressed to me in the early hours of our interaction that during the course of her illness she had not ever experienced pain of this magnitude and as a result the patient was overwhelmed with the kind of pain that she had been feeling. Jane also expressed to me and my buddy nurses that she agrees to take any injection or other therapeutic measure if only her excruciating pain would subside for a few moments so that she could breathe. The patient was teary eyed while expressing to us the kind of pain that she was feeling and her desperateness was very conspicuous and clear. Hence, I was inspired to do as much as I could for Jane and to address her wishes to let her pain subside completely. Although, I feel I have not been able to effectively contribute to communicating with Jane and helping her cope with the pain with nonpharmacological means of pain relief while the senior nurses and the doctors were busy trying to communicate with her son to agree to the morphine treatment. I would like to mention that I feel my personal coping strategies were not very useful either as I was moved by the extreme that the patient was in and it clouded my better judgment and i failed to relieve the patent of the anxiety, uncertainty and pain she was going through while her son was refusing morphine to be injected to her. I feel that I still lacked proper communication skills and competence that a nursing student should have while communicating and reassuring critically ill patients.

In the step of evaluation, I would like to mention, that my first encounter with the practice scenario had undoubtedly been one of the greatest experiences for me. This experience gave me the opportunity to understand the different factors associated with a practice scenario with palliative nursing background and has helped develop a passion towards practicing in the palliative care scenario (Prem et al., 2012). First and foremost, I think the health care team had easily developed a strong therapeutic alliance with Jane. The patient could easily express all her doubts and wishes with the care team allotted to her. Along with that care programs designed for her were patient centred and respectful to the wishes and demands expressed by her as well. It has to be mentioned that the patient had been comfortable about expressing the expressing about what she liked and did not like to the care professionals as well. However, the drawbacks of the entire experience include the lack of involvement of her family and lack of proper information sharing with the family members. It has to be mentioned in this context that the family members of a terminally ill patient will need to given all the information with clarity and transparency (Head, Washington & Myers, 2013). In this case, Jane’s son was her next of kin and yet the care team and head nurses had not clearly mentioned to her about Jane’s needs for receiving morphine previously and how important opioid based analgesics are to relieve the terminally ill cancer patients in advanced stages to be relieved from the pain (Grant et al., 2015). The lack of resources and evidence used from the beginning to explain to her son about the right of the patient to choose any means of analgesic or any other kinds of treatments in perfect state of consciousness resulted in a prolonged delay of required treatment to begin and as a result the patient had to undergo a prolonged time of incapacitating pain which could have been relieved much earlier if necessary evidence based effective communication was attempted from the beginning. Along with that, it has to be highlighted here that my personal lack of skills of resilience based practice and ability to handle terminally ill anxious patients with effective communication and nonpharmacological mode of pain relief.

Conclusion

According to the Zimmermann et al. (2014), the palliative care can be defined as the care approach that attempts to improve the quality of life of the terminally ill patient with early assessment and impeccable treatment intervention. Along with that, relieve the patient of the suffering and pain that they are facing (Wiener et al., 2015). Along with that, considering the concepts of patient centred care, the wishes and desires of the patient should be given the ultimate importance in the care planning and implementation. With respect to Australian legislations, an adult patient in full consciousness has all the rights to choose the kind of treatment in proper conscious state. Hence, considering the ethics of patient autonomy, Jane could not be denied of her right to morphine based analgesics to relieve her pain. In this case, the family members of Jane, specifically her son was not aware of standard practices to utilize morphine o other similar strong narcotics for analgesic purposes for cancer patients. Close to 15 hours were wasted while the senior RN, nursing supervisors and the head oncologist is explaining to her son the importance of strong narcotic analgesic for the patient I was in charge of controlling the patient along with my buddy nurse. Even though it was my responsibility to communicate with Jane and help her be relieved from the acute pain, I was not able to invest my 100% to the job and I failed to reassure and calm her while she writhed in pain. As per my own opinion I lacked confidence and compassionate communication and reassuring skills while communicating with Jane. According to the Hui et al. (2014), in nursing practice it is essential for the nursing professionals to have adequate communication skills not only for handling the demands and requests of the patients, but also reassuring and calming the patient in any adverse situation. Me and my buddy nurse failed to relax the patient or distract her with any nonpharmacological mindfulness based intervention, rather we were too consumed with our own discomfort and grief at watching a patient suffer for lack of effective communication with the family members.

Conclusion:

On a concluding note, reflective practice has slowly integrated in the health care scenario as the integral part of the nursing practice providing startling insights regarding the quality of care planning and clinical supervision or decision making. Reflection has been accounted for being the practice that provides an excellent opportunity for the nursing professionals to undergo continuous professional development by means of targeted continuous nursing education. This has been an excellent opportunity for me to discover the different facts associated with caring for a terminally ill patient. Along with that this reflection had been a potent tool for me to discover my strengths and weaknesses that can play profound role in my future practice. In this case the weaknesses that I discovered include lack of confidence, lack of persuasiveness, lack of resilience and coping strategies, lack of effective communication skills, lack of quick clinical judgments and overall skills to handle terminally ill patients.

In this case, I have discovered that lack of effective communication and compassionate interaction skills to help terminally ill patients dealing from acute pain. Hence, I would require a communication skill training program to enhance my skills (Goldsmith et al., 2013). I would opt for therapeutic collaborative resilience building schemes under the provision for development program for nursing students. Along with that I would also join personality development training to enhance my abilities to overcome stress in emotionally exhausting situations while providing care to the patients; so that in future when I encounter such situation i can overcome my own emotional turmoil quickly and invest myself completely in handling the patients and their issues. I would also attempt to maintain a journal to keep track of my progress and will also approach my supervisor to guide me through the entire process.

References:

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