Clinical Placement Reflection
During my clinical placement in the third year, I achieved my goal of improving my knowledge, clinical skills to remain up to date. This was due to the vast amount of resources allocated to the clinical department. I had a strong support from my clinical body nurse and other resource nurses at the ward. In addition, I followed my action plan as outlined since the activities were concise and relevant to the clinical task. My action plan, as it is seen in appendix A, guided me to my desired goal. Prior to commencing the task, of a CVC lumen change, I researched the hospital policies and procedures specific to the task. I clarified the safe practice that was required when completing the clinical skill. Appendix B is the hospital policy and procedure specific to the task I was aiming to complete. It outlined the value of the resource and how it assisted me to achieve my goal.
My second activity was to utilise verbal resources on the unit. I achieved this by making use of my clinical body nurse and the resource nurse on the ward. As it can be seen in appendix C, I interviewed my clinical body nurse about the processes involved in undertaking a CVC lumen change. This gave me a step-by-step approach for undertaking the clinical skill. I identified learning issues from my own independent research and clarified these issues with my clinical body nurse. My action plan also included attending in-services held by the hospital. I attended in-services over the duration of my clinical placement. It helped me with comprehensive knowledge and understanding of desired clinical skills and disease processes seen on the ward. However, no specific in-services were presented on the topic discussed in this essay.
In addition to the activities outlined in my action plan, I would like to incorporate another significant activity I undertook to complete my desired goal. Through the research, I increased my clinical knowledge. As it is described in appendix D, reputable journal articles enhance knowledge of clinical procedures, indications, and associated risks of undertaking the clinical skill (Singh and Sarangi, 2003). The reflection on clinical practice is a fundamental process of nursing. Reflection allows evaluation of the clinical task, the processes preceding the task and the efficacy of our actions. Using Gibbs (1988) model of reflection, I am able to reflect on the action plan I developed and utilised to achieve improvement of my knowledge and clinical skills. The first stage of Gibbs’ (1988) model of reflection entails a description of the events surrounding the clinical task. Prior to commencing clinical task of performing a CVC lumen change, I accessed the clinical resources available to me. I researched what a CVC catheter was the indications and the associated risks of the task I was to perform. This information allowed me to compile a set of questions, or to learn the needs to clarify with my clinical body nurse. Singh and Sarangi (2003) note that clinical policies and procedures are provided by the hospital for a specific task. It outlines steps required to perform the task, and how the task must be undertaken to meet the standards set by the hospital (Singh and Sarangi, 2003).
This document also identified the needed equipment and preparation prior to undertaking the task. Then I directed my learning to my clinical body nurse who talked to me through a step-by step approach for completing the task. I clarified any further learning needs that I had identified from my own research. With this knowledge, I performed the task under the supervision of my clinical body nurse. I received the feedback from my clinical body nurse that I had performed the task successfully with a good understanding of the procedure and related pathophysiology, and maintained safe nursing care for my patient.
Gibbs (1988) model of reflection invites reflections, thoughts and feelings that may have occurred at the time of the event. Prior to commencement of the clinical skill, I was somewhat apprehensive. I believe this was due to the nature, the procedure, and the knowledge of maintaining a strict sterile technique. I was conscious of the patient’s level of apprehension associated with myself, a student nurse undertaking the task. It is evident that my confidence enhanced not only the ability to undertake tasks. Moreover I also instilled a higher sense of security (Singh and Sarangi, 2003). My previous research, as it is outlined in my action plan, had undoubtedly assisted with my knowledge of the clinical skill and confidence came with that
Gibbs (1988) model identifies the need for evaluating the experience and asks what was right or regretful about the experience. My experience of utilising my action plan to project, research and implement nursing care was overall positive experience. The research prior to the task had allowed me to form a thorough foundation of knowledge in the clinical skill. This was a positive aspect of the task as it allowed me to gain confidence and ability to research, identify and investigate my learning needs in order to perform unfamiliar tasks. It became evident that the use of my action plan was a comprehensive method to ensuring I achieved my learning goal. I had no negative association with the event. However, researching the topic and specific information was time consuming; though, the effects of the prior learning clearly demonstrated the importance of undertaking these processes.
Stage four of Gibbs (1988) model of reflection is the analysis of the event. On the ground of the analysis of this event, I can determine the worth of my actions. Utilising the hospital policies and procedures was a significant step in ensuring my goal was reached. I became aware of the physical steps in undertaking the procedure, an important part of safely completing the task. The use of my own research allowed me to gain a basis of understanding of the physiology surrounding the skill. It allowed me to research areas that I may not have had the confidence to ask my clinical body nurse. Using reputable sources permitted me to identify gaps in my knowledge that required further clarification. A verbal resource, such as my clinical body nurse, allowed one to break down the steps into a simple process (Coulehan and Block, 2005). It also provided me with a resource for clarification and support.
Stage five of Gibbs (1988) model addresses the conclusion of the events. I can conclude from my actions, that all my interventions aimed at ensuring knowledge improvement and clinical skills were achieved. The necessary research must be undertaken prior to completing a clinical skill with which one is unfamiliar with. It was necessary to know the underlying pathophysiology of the task as this allows one to be aware of the associated risk factors of maintaining a sterile technique (Rabie, 2006). I believe that not being demonstrated the technique prior to undertaking the task was not detrimental to my learning, instead, it let me interpret the research, inclusive of the policies and procedures to my own advantage. This allowed me to gain further confidence in my ability to undertake a task not previously practiced, seen or demonstrated. This event demonstrated to me the value of my action plan and confirmed the need for comprehensive research and utilizing reliable resources.
The final stage of Gibbs (1988) model is an action plan. It encourages the reflector to consider what could be done if the situation arose again. On final reflection of the events of my action plan, I would encourage myself to repeat this process prior to commencing any unfamiliar task. However, integrating a resource of evidence-based would allow the use of the best practice evidence to influence the clinical task (Tschanz, 2003). Evidence-based practice allows the clinician to utilise recent research and studies that incorporate the ethical values of patient care (Pormann and Savage, 2007). The addition of this research into my action plan would allow a higher level of competency through education and knowledge.
In conclusion, utilising Gibbs (1988) model of reflection allowed me to structure the events that took place and appropriately respond to my thoughts and feelings on the subject. Through the process of reflection, I was made aware of the additional tasks that I could perform to enhance my ability to work towards my goal of improving my knowledge and clinical skills. Clinical nursing skills are further developed through the processes of the action plan, and through reflection, the importance of integrating research and evidence-based practice in the nursing practice became evident (Barrett, 2004).
- Barrett, P. (2004). Science and Theology Since Copernicus: The Search for Understanding. Continuum International Publishing Group
- Coulehan J. L. & Block, M. R. (2005). The Medical Interview: Mastering Skills for Clinical Practice (5th ed.). F. A. Davis.
- Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Oxford Further Education Unit, Oxford.
- Pormann, E. Savage, E. S. (2007). Medieval Islamic medicine, Washington DC: Georgetown University.
- Rabie E. A. (2006). "Contributions of Muhadhdhab Al-Deen Al-Baghdadi to the progress of medicine and urology", Saudi Medical Journal 27 (11): 1631–1641.
- Singh, A. & Sarangi, D. (2003). "We need to think and act", Indian Journal of Plastic Surgery.
- Tschanz, D. W. (2003). "Arab Roots of European Medicine", Heart Views 4 (2).