Gibbs Cycle Reflective Essay
Student’s Name
Institutional Affiliations
Gibbs Cycle Reflective Essay
Palliative care nurses acquire new knowledge and skills through experience as they continue to handle patients with terminal illnesses. They need competencies that will enable them to handle patients with complex symptoms and severe pain. Critical reflection is important because it gives nurses an opportunity to identify their strengths and weaknesses and to develop strategies to improve in their weak areas (Martínez-Sabater et al., 2021). Gibbs’ reflective model is one of the evidence-based tools that guide nurses through the process of exploring their experiences. The model involves six stages including description, feelings, evaluation, analysis, conclusion, and action plan (Gibs, 1988). The purpose of this assessment is to demonstrate an improved understanding of advanced concepts in palliative care nursing while assessing and managing pain and other complex symptoms. This assignment will follow Gibbs’ Reflective Model to guide the critical reflection process. The reason for choosing this model is that it provides a good framework that enhances and improved understanding of advanced concepts in palliative care nursing.
Application of Gibbs Cycle
Description of the Event
I met Mr. Andrew, a 70-year-old father and retired teacher on my routine visit to the Macquarie Psychiatric Hospital. Mr. Andrew was diagnosed with testicular swelling 6 months ago and he also has bipolar depression disorder. Initially, Mr. Andrew ignored his reproductive symptoms assuming that they might have occurred due to a sports injury. He also felt embarrassed about sharing those feelings with the doctor. After nine months following the testicular swelling diagnosis, Mr. Andrew developed respiratory and neurological symptoms characterized by breathing difficulties and constant back pain. On visiting the emergency department, Mr. Andrew was diagnosed with lung metastases that occurred with severe pain. This condition resulted from metastases that had developed in the para-aortic lymph nodes. The doctor requested Mr. Andrew’s family to be present to provide the necessary support when the diagnosis was announced considering the fact that he had a poor prognosis. The doctor, accompanied by another nurse, decided to unveil the news to Mr. Andrew and his family in a quiet room. The patient and his family were initially devastated but were later ready to live with the condition following a prolonged conversation with a palliative care nurse.
Feelings
Mr. Andrew’s case was shocking to me because I had not handled such a patient before. His health condition ignited thoughts and feelings of empathy that changed my approach to patients who are suffering from extreme pain. Initially, I thought that most of the conditions that patients are facing can easily be handled using evidence-based practice interventions. During my first interaction with Mr. Andrew and his family, I was not adequately prepared to handle the case since all of them were equally shocked. I was helpless and could not even approach them to offer any help. However, as time went by, I garnered the courage to help the patient and his family.
I learned a new way of approaching patients with extreme pain from my experience with Mr. Andrew and his family. For example, the importance of developing strong therapeutic relationships cannot be ignored when handling patients with terminal illnesses (Wachholtz et al., 2016; Canning et al., 2005). During my conversation with Mr. Andrew and his family, I tried to understand their feelings regarding the diagnosis and the healthcare goals that they wish to obtain from the healthcare professional. The patient’s family acted as key sources of information that was required to develop a care plan for Mr. Andrew. Developing a meaningful relationship with the patient and his family formed a good basis for starting the caring process.
Mr. Andrew’s family was worried about the nature of life that he was going to lead thereafter considering the severity of his health condition. The patient’s symptoms were deteriorating every minute and he was slowly losing the ability to talk and communicate effectively. I managed to utilize my palliative care skills and competencies to enable Mr. Andrew and his family to accept the diagnosis. I also encouraged Mr. Andrew’s family to be there for him and offer supportive care that is highly necessary to help him attain an improved quality of life during end-of-life.
Evaluation
The approach that the doctor used to communicate the diagnosis to Mr. Andrew and his family was a good one. The doctor demonstrated professionalism as he handled the patient and his family. The use of a separate room free from noise ensured privacy and confidentiality. Standard 6 for registered nurses requires Australian nurses to adhere to the relevant practice policies and guidelines to ensure that their patients receive safe and quality care. Ensuring privacy during care is one of the ways to promote safety when working with dying patients (Nurses and Midwifery Board of Australia, 2016). Engaging in effective communication with Mr. Andrew and his family is one of the factors that contributed to success in the caring process. I used both verbal and non-verbal communication strategies during conversation. For example, through verbal communication, I was able to explain pertinent issues to Mr. Andrew and his family. I was also able to provide feedback to their questions and address their concerns. The use of a polite tone encouraged the patient and his family to share information that, in the end, proved to be useful in developing a care plan. Wilkie and Ezenwa (2012) recognize the importance of effective communication in the management of pain and complex symptoms in patients who are receiving end-of-life care.
Although I have never handled a patient with extremely complex symptoms like those of Mr. Andrew, I was able to engage in critical thinking thereby enabling me to address the situation. Critical thinking is a key competency that palliative care nurses need to demonstrate relevant knowledge and skills to meet multiple complex and complex care needs of patients with life-threatening illnesses (Canning et al., 2005). Engaging in therapeutic assessment with the patient and his family at the initial point of care helped to set a clear plan for offering appropriate and evidence-based care. According to Malotte and McPherson (2016), patient assessment is a crucial phase of care in patients who are suffering from pain. It is through comprehensive assessment that the nurse can identify the severity of pain before developing strategies to effectively manage the pain. The Australian Palliative Care Standards direct palliative care nurses to assess their patients at the initial point of care in order to understand their physical, psychological, cultural, social, and spiritual experiences and needs (Palliative Care Australia, 2018).
I was able to learn from things that did not go well during my experience with Mr. Andrew and his family. For example, the surprise that came with the diagnosis delayed the care process because I had to spend some time to allow the patient and his family to come to terms with the diagnosis. Again, it was quite challenging to handle Mr. Andrew’s multiple conditions at a time when he needed quality end-of-life care. According to Atkin et al. (2017), patients with advanced life-limiting diseases often suffer from other co-morbid conditions that negatively affect their quality of life. This call for the need to assess such patients for multiple conditions including anxiety and depression (Combes, 2016; Kozlov et al., 2019). Since I have limited mental health care knowledge, I had to seek help from a mental health practitioner to conduct a psychological assessment and provide the necessary care to Mr. Andrew and his family. I must admit that I was able to offer the necessary help to the patient despite the challenges.
Analysis
I can make some sense of the caring experience with Mr. Andrew and his family. For instance, applying both personal and professional communication strategies helped to form a meaningful therapeutic relationship with the patient and his family. Patients who are experiencing severe pain with complex symptoms might have unique needs that they might want to present to their healthcare providers. This can only happen when their healthcare providers allow them to do so by creating an environment where patients and their families can air their concerns (Krawczyk & Richards, 2018; Hussain et al., 2014). According to Palliative Care Australia (2018), palliative care nurses are expected to integrate care across a patient’s experiences and base care interventions directly on the assessed needs. From Mr. Andrew’s case, I have also learned that involving family members in the care of a dying patient is highly important because such patients need social support that can best be provided by people who are close to them. Family members can help with decision-making during the development of care plans for patients with terminal illnesses (Rhondali et al., 2012; Levine, 2017). From the care experience, I discovered that one of the main areas of focus when handling patients with complex symptoms and severe pain is to engage a mental health practitioner to help identify and manage psychological symptoms that might be preventing the patients from attaining the desired quality of life.
Conclusions
The insights gained from Mr. Andrew’s scenario are of relevance to both learning and professional growth. I was able to learn that patients with complex symptoms and severe pain require specialized care that will not only reduce the level of pain but that which will enable them to attain an improved quality of life (Canning et al., 2005). Again, I have discovered that dying patients and their families benefit greatly from education obtained from their healthcare providers. Therefore, offering symptom-specific education is one of the ways through which palliative care nurses can help to provide quality end-of-life care to their patients (Queensland Health, 2020). I have further learned that the fear of death often caused anxiety in patients with terminal illnesses. The sick patient is not always ready to separate from their family members through death. Therefore, part of their care plan should entail personalized conversations to enable them to accept their conditions and be prepared to die peaceful deaths.
Action Plan
Palliative care nurses who are handling patients with severe pain and complex symptoms required help from a team of healthcare professionals to enable their patients to attain the desired quality of life. Based on the lessons learned from my practice experience with Mr. Andrew and his family, one thing I will do differently when I experience a similar scenario is to involve other members of the healthcare team early enough to help with decision-making and care planning. Palliative care nurses are advised to work in partnership with a team of healthcare professionals while also involving the patient and family members in decision-making for effective goal setting and care provision (Nurses and Midwifery Board of Australia, 2016). As a registered nurse, I will engage in research to obtain best practice evidence for improving service delivery for patients who are experiencing pain and complex symptoms like Mr. Andrew.
Conclusion
Nurses engage in critical reflection not only as a learning process but also as a way to promote continuing professional growth. Evidence-based reflective models such as the Gibbs’ Cycle provide nurses with a framework to relate their practice experiences with theoretical knowledge and clinical practice standards and guidelines. Patients experiencing extreme pain with complex symptoms benefit greatly from palliative care nurses who can develop meaningful therapeutic relationships with them through effective communication. The case study that formed the basis for this assessment is that of Mr. Andrew, a 70-year-old male patient who is experiencing extreme pain and complex respiratory symptoms due to lung metastases. The practice experience generates feelings of sympathy and compassion which have really changed my approach to care when handling terminally ill patients. Among other discoveries, I have learned that patients with terminal illnesses often develop psychological disorders and other comorbidities and would thus benefit greatly from integrated care provided by members of multidisciplinary teams.
References
Atkin, N., Vickerstaff, V., & Candy, B. (2017). ‘Worried to death’: The assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians. BMC Palliative Care, 16(1), 69. https://doi.org/10.1186/s12904-017-0245-5.
Canning, D., Yates, P. & Rosenberg, J.P. (2005). Competency Standards for Specialist Palliative Care Nursing Practice. [PDF report]. Queensland University of Technology. https://www.pcna.org.au/PCNA/media/docs/competystds_1.pdf
Combes, S. (2016). Nursing assessment of anxiety and mood disturbance in a palliative patient: Table 1. End of Life Journal, 6(1), e000026. https://doi.org/10.1136/eoljnl-2016-000026.
Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic, Oxford UK.
Hussain, J., Neoh, K., & Hurlow, A. (2014). Managing pain in advanced illness. Clinical Medicine (London, England), 14(3), 303–307. https://doi.org/10.7861/clinmedicine.14-3-303.
Krawczyk, M., & Richards, N. (2018). The relevance of “total pain” in palliative care practice and policy. European Journal of Palliative Care, 25(3), 128–130.
Kozlov, E., Phongtankuel, V., Prigerson, H., Adelman, R., Shalev, A., Czaja, S., Dignam, R., Baughn, R., & Reid, M. C. (2019). Prevalence, severity, and correlates of symptoms of anxiety and depression at the very end of life. Journal of Pain and Symptom Management, 58(1), 80–85. https://doi.org/10.1016/j.jpainsymman.2019.04.012.
Larkin, P., Cherny, N., La Carpia, D., Guglielmo, M., Ostgathe, C., Scotté, F., & Ripamonti, C. (2018). Diagnosis, assessment and management of constipation in advanced cancer: ESMO clinical practice guidelines. Annals of Oncology, 29, iv111-iv125. https://doi.org/10.1093/annonc/mdy148.
Levine, J. M. (2017). Unavoidable pressure injuries, terminal ulceration, and skin failure. Advances in Skin & Wound Care, 30(5), 200-202. https://doi.org/10.1097/01.asw.0000515077.61418.44.
Malotte, K. L., & McPherson, M. L. (2016). Identification, assessment, and management of pain in patients with advanced dementia. Mental Health Clinician, 6(2), 89-94. https://doi.org/10.9740/mhc.2016.03.89
Martínez-Sabater, A., Chover-Sierra, P., & Chover-Sierra, E. (2021). Spanish nurses’ knowledge about palliative care. A national online survey. International Journal of Environmental Research and Public Health, 18(21), 11227. https://doi.org/10.3390/ijerph182111227
Nurses and Midwifery Board of Australia. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx
Palliative Care Australia. (2018). National palliative care standards (5th ed.). https://palliativecare.org.au/standards
Queensland Health. (2020). Section 5: Patient and family education. In Management of subcutaneous infusions in palliative care. Queensland Government, Brisbane. https://www.health.qld.gov.au/cpcre/subcutaneous/section5
Rhondali, W., Reich, M., & Filbet, M. (2012). A brief review on the use of antidepressants in palliative care: Table 1. European Journal of Hospital Pharmacy, 19(1), 41-44. https://doi.org/10.1136/ejhpharm-2011-000024
Wachholtz, A. B., Fitch, C. E., Makowski, S., & Tjia, J. (2016). A comprehensive approach to the patient at end of life: Assessment of multidimensional suffering. Southern Medical Journal, 109(4), 200–206. https://doi.org/10.14423/SMJ.0000000000000439.
Wilkie, D. J., & Ezenwa, M. O. (2012). Pain and symptom management in palliative care and at end of life. Nursing Outlook, 60(6), 357–364. https://doi.org/10.1016/j.outlook.2012.08.002.