“Reflective
learning is the process of internally investigating and exploring a subject of
concern which is activated by an experience which creates and explains meaning
in terms of self and which results in a changed conceptual perspective” (Boyd
& Fales, 1983). Throughout this essay reflection will be discussed
alongside Gibbs (1988) Model of Reflection and Johns’ Model of Structured
Reflection (2004). Then there will be a Reflection in practice using the Gibbs
Model. The Nursing
and Midwifery Council states that ‘as a nurse or midwife; a duty of
confidentiality to all individuals who are receiving care’ throughout this work
all confidentiality of any clients will be protected (“The Code”, 2017). All
clients that are discussed have the right to retrieve information about their
condition and must be presented in a way that is understood; consent off a
client should be voluntarily given, with no pressure or influence put onto the
patient by health care professionals, relatives and partners (Consent | Advice guide | Royal College of Nursing”, 2019)

 

Reflection
is an conscious effort to think about an incident or activity that helps a
healthcare professional consider what was challenging or positive and a plan on
how it might be improved or done differently in the future (“Royal College of
Nursing: Reflection”, 2017). Another definition of reflection is that it is a
process of making sense of situations and events in the workplace (Oelofsen,
2015). There are three likewise important workings of reflective practice and
these are; experience, reflection and action. Reflective practice is the
ability to examine one’s actions and experiences with the outcomes of
developing their practice and enhancing clinical knowledge. Reflective practice
affects all levels of nursing from students, to advanced practice nursing
students, as well as practicing nurses. Reflective practice is an important
component of the nursing curriculum. Research has shown the relationship
between student nurses and their mentors is vital. For reflection to be
effective; open-mindedness, courage and a willingness to accept, and act on as
criticism (Bulman, Lathlean & Gobbi, 2012). It is important to use
reflection in nursing as it gives them a chance to improve their knowledge and
review their practice; this helps ensure their ability to provide the highest
quality of care (Jootun, 2017). Laurebach and Becher (1996) says
self-reflection is caring for yourself and purpose reflection helps nurses gain
insight and self-knowledge (Palmer, 2007). As a nurse is self-reflection is
being allowed it can guide nurse practice to improve outcomes, as with a strong
sense of self enables an individual to deal with problems better (Elder, Evans,
& Nizette, 2009, p.6). Reflection is used to help nurses help improve the care
of clients and make sense of work situations. A critical incident is a
situation which could happen to a client, their family or a health
professional, even if it is something positive. Analysis and Reflection of
critical incidents is regarded as an important learning tool for nurses and
requires them to explore their feelings, actions and start analysing the
situation (CD, 2012).

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Johns
(1985) defined reflection as ‘the process of internally examining and exploring
an issue of concern, triggered by an experience, which creates and clarifies
meaning in terms of self and results in changed conceptual perspective’
(Jootun, 2017). Johns’ Model of Structured Reflection (2004) is based on 5
questions which helps break down an experience and then reflect on what
happened and the outcome of this. Johns’ (1985) got his model by using Carper
(1978) as the base of his model by looking at personal knowing, aesthetics,
empirics and ethics and then encouraging the reflective practitioner to explore
how this has changed and better-quality their practice (Johns Model of
Reflection, 2009). The first set of questions that John (2004) suggests is cue
questions; and this is the description of the experience. The next one is to
reflect on the event; an example question is “What was I trying to achieve?”
The next set of questions of this model is influencing factors, an example
question of this is what internal factors helped influence decision making.
Next is “Could I have dealt with the situation better?” and, Finally, is learning
about the experience, such as “How has this experience changed my ways of
knowing, empirics, aesthetics, ethics and personal?” (“Guidance on Reflective
Writing: Model for reflection from tutor/student handbook”. 2012).

 

Gibbs
(1988) model of reflection encourages an individual to think thoroughly about
the phases of experiences and activities (Reflective writing: About Gibbs
reflective cycle – Oxford Brookes University”, 2016). This model is a useful model
which helps reflect after ‘critical incident’ events which have a negative and
a positive effect on an individual and they learn from this. Gibbs (1988) is
more effective in students who are just starting to learn; this model has 6
clearly defined stages and it is important when following this model to ensure
you keep each section simple (Gaynor, 2013). The first stage of Gibbs (1988)
model is description; which is a description of what happened in the situation.
Stage two is how you were feeling during the experience, what did you feel
about it and lastly, what did you think about? The next stage is Evaluation;
which is where you decide what was good and bad about the situation? Analysis
is stage for and this what sense can you make out of the experience? Stage 5 is
the conclusion, and this is what else you could have done, and could you have
learnt anything else about the experience? The final stage of Gibbs (1988)
model of reflection is to have an action plan and something that could be
included in this is how has the experience helped you to improve your practice
and has it revealed your strengths and weaknesses? (Gibbs’ Model of the
Reflective Cycle, 2013). An advantage of Gibbs (1988) model of reflection is
that it is easy to use and is resulting in educating individuals and presents
the individual such as a nurse with certain questions which require to be
answered in order, it also focuses on experiences and helps nurses learn from
the incident which has already happened. But, a disadvantage of Gibbs (1988)
model is that it can lack a mean of closure and that it is more of a
retrospective process and isn’t always moving forward; as one of the main
aspects of this model is to move forward and improve practice (Forrest, 2016).

 

 My chosen incident
is how I attended a support group, I had to gain consent and respect the
clients, also keep their dignity and confidentiality maintained throughout.
During my placement experience I attended a support group which happens once a
month and which included only 7 individuals who were all at different stages of
their diagnosis of Dementia. The support group happened in a room and was very informal;
about half of the support group hadn’t been able to turn up due to the fact it
was snowing, and they were unable to get there. Apart from the 7 clients, other
people who were involved was my mentor who was a community psychiatric nurse, a
support worker and myself. As it was an informal setting and it gave the
clients a chance to discuss their personal lives and problems; such as things
with their relationships, diagnosis and how they are coping. This support group
also gives the CPN and support worker a chance to find out how the clients are
coping and arrange help for them if needed. One client in the meeting
specifically spoke about how her and her partner had to go through marriage
counselling to be able to obtain boundaries between him being a carer and a partner;
this is an example of what clients spoke about during this session. As the
clients were all at different stages of their dementia; some clients were
further down their diagnosis than others. My part in this support group was to
listen to the clients, CPN and support worker; this gave me a chance to learn
and get to know the clients at a more personal level. The results of this
support group were that the clients were able to ask for help if needed; one
client specifically asked if he could have help as he was forgetting to turn his
oven off. The CPN then arranged a sitting service to visit this client once a
day. A sitting service is when 1 or 2 people go to the client’s home to make
sure the client is okay and if they client needs help in any way.

 

Going
into this support group I was nervous as when I went into the support group, I
didn’t feel like I was prepared to go in because I didn’t know what to expect,
as I didn’t know I was attending the group until that day. I was also nervous
as I had to get consent off the clients for me to sit in the group. To get this
consent my mentor asked the clients if they minded me sitting in and
experiencing it for myself, luckily for me they all said it was fine for me to
join. When the support group started I became more relaxed as it was very
informal. Thoughts that I had when it was happening was that you have no idea
what a dementia patient goes through until you are sat in this support group and
listened to how their families cope with the diagnosis and how it affects every
aspect of their lives. I also felt amazed with how open the clients were; and
how they have coped with the diagnosis and again how their families have coped
with the diagnosis as it is a major life change in not only just the client but
everyone they are close to as well. Another feeling I had was thankful as the
clients were all so positive about their experiences, and this session gives
them a chance to be as honest as they can. Finally, I also felt proud about the
outcome of the group as I had learnt more about the diagnosis of dementia and
felt like I got to know the clients more on a personal level.

 

One
advantage of the support group was that it was small as it only had 7
individuals who turned up overall because of the snow. As it was a small group
this gives each client a chance to speak equally as if it was a big group then
some clients could feel intimidated and wouldn’t speak as much as they did when
it was a smaller group. Another advantage of this support group was that it was
very informal, it was made informal by making sure hot drinks and snacks were
provided to make the clients more comfortable; an example of a client being
comfortable enough to talk about their own personal life was that she was cared
for by her 19-year-old daughter and she feels like a burden on her and stops
her doing what she wants to do. The community psychiatric nurse and support
worker decided to help support this client they arranged for a sitting service
to go in twice a week for 3 hours a day to give the daughter 6 hours a week to
be able to do something that she wanted to do. This helped the family as it
took less pressure off the daughter and the client felt less like a burden; if
the group was a more formal meeting then this client might not have been able
to be so open and honest about her feelings. A disadvantage of this support
group is that it only happens once a month, so if a client wanted to speak
about something in the support group then they would have to wait a month
unless it was urgent, then the CPN could then make time and go out and see the
client. But, if the CPN was busy then she may not have the time to go out and
speak to this client.

 

During
this support group I think it went well because all the clients were relaxed as
it was an informal setting so that clients would be comfortable. It was
important to get the clients consent; if I failed to get the clients consent
and sat in on the group then it could be seen in law as trespass against the
person. Consent defines as gaining their permission before they receive any
type of treatment, examination or a meeting. (“Defining Consent”, 2017). It was
important that I gained the clients permission for me to sit in the support
group as they spoke about personal things to them. Gaining the clients consent
also relates to respecting the patient as well; respect is a due regard for the
feelings, rights of others and wishes (“respect Meaning in the Cambridge
English Dictionary, 2017). Due to the clients speaking about their feelings,
and what has happened then it is important as a student nurse to listen to the
patients, also listening to the CPN and Support Worker. Being respectful is
important as it is needed to have positive relationships with the clients, the
CPN and Support Worker. To keep the dignity of the clients then it is important
to respect a patient it is important to keep what is said in the support group
to be kept confidential; which is keeping what is said private. Confidentiality
is also very important and is also linked to dignity and respect.
Confidentiality is keeping information private (“confidentiality | Definition of confidentiality in English by Oxford
Dictionaries”, 2017); this is important in the support group as it
is gaining the clients trust. An example of having to break confidentiality is;
one specific client who lived on their own and they mentioned they were
struggling on their own as their dementia was deteriorating, and they have left
the oven on a couple of times. So, go my mentor organised a sitting service to
in once a day to check on this client. Having communication whilst being in
this support group is probably the most important aspect as it is the exchange
of information, feels and thoughts among individuals using speech (Kourkouta
& Papathanasiou, 2017).

 

From
this support group I have learnt how much dementia affects a client’s life with
everything that they do. Examples of this is when the dementia affects their
short-term memory; like I mentioned before a client forgetting to turn an oven
off, which could then put the client in danger. I also learnt from this group
how much a diagnosis of dementia not only affects the client but also their
family and friends. It affects their relationships in many ways; as one client
said that a few of her friends haven’t spoke to her lately as they aren’t sure
how to act and don’t understand the diagnosis of dementia. Lastly, I have
learnt that I need to improve on my communication skills and improve my
language with medical definitions; as throughout the group medical terms and
abbreviations were used that I had never heard before.

 

If
I were to go to another support session then I would try and input my opinions
more and talk to the clients more than I did; the reason I didn’t do it this
time as because it was my first session I was learning what it entailed, I got
to know the clients more, and experience the session for the first time.
Something else which I would do if I attended another support session is if I
didn’t know the meaning of a medical term or abbreviation of something then I
would ask my mentor or support worker during the session what it meant, and not
wait until the end of the session this would help me get a better idea throughout
the session.

 

In
Conclusion, it is important to make sure that the legal basis for consent to be
valid as a defence in medical treatment is to stop the intention to cause harm
(Entwistle, Shepherd & Ford, 2014). Throughout the essay a comment from the
NMC is mentioned which explains confidentiality, and reflection is discussed,
why it is used, what does reflection do, how do we reflect and finally what
skills are needed to reflect effectively. The chosen situation I chose to do
was about a support group that I attended; that clients were able to talk about
their personal lives. Feelings and thoughts were discussed that happened
throughout the support group, an analysis was also completed, here
confidentiality, consent, communication, dignity and respect were also
mentioned; supporting evidence was also used to back up these comments. A
reflective conclusion was also mentioned, which is what would have been done
differently and finally an action plan was also completed on if the situation
occurred what would be done again.

 

 

 

 

 

 

 

 

 

References

Bulman,
C., Lathlean, J., & Gobbi, M. (2012). The concept of reflection in Nursing:
qualitative findings on student and teacher perspectives. Nursing
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CD,
A. (2012). Reflection on a critical incident. – PubMed – NCBI. Ncbi.nlm.nih.gov.
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confidentiality
| Definition of confidentiality in English by Oxford Dictionaries. (2017). Oxford
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Consent
| Advice guides | Royal College of Nursing. The Royal College of Nursing.
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Defining
Consent.
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Elder, R., Evans, K., & Nizette, D.
(2009). Psychiatric and
mental health nursing(2nd ed.). Australia: Mosby Elsevier.

Entwistle,
F., Shepherd, E., & Ford, S. (2014). What does consent mean in
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Forrest,
M. (2016). On becoming a critically reflective practitioner.
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Gaynor
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Gibbs’ Model of the
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Guidance
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Johns
Model of Reflection. (2009). Retrieved from http://file:///C:/Users/hlg19/Downloads/Johnsmodelofreflection.pdf

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D. (2017). Reflection in Nurse Education. Retrieved 18 December
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 Lautebach, S.S., & Becher, P.H.
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Kourkouta,
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Palmer, P.J. (2007). The courage to teach: Exploring the
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