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Communication in Nursing Practice: Gibbs’ Reflective Cycle Essay

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Updated: Jun 20th, 2022

Introduction

Communication is a fundamental element in nursing practice. This element can possibly determine patients’ satisfaction and even the outcomes of their treatment (2). The situation described in the paper will exemplify the potential role of communication. Gibbs’ Reflective Cycle will help to assess the situation and extract lessons from it. The model is a widely-recognized and crucial learning instrument, allowing individuals to extract lessons from life experiences. The pattern helps one to consider previous experiences, reevaluate them in the light of new knowledge, and implement the freshly obtained insight to improve future practice (1). The cycle is composed of six stages (description, feelings, evaluation, analysis, conclusion, and action plan), on which the reflection regarding the personal experience will be based (1). The paper’s principal objective is to outline a challenging situation from personal practice using Gibbs’ Reflective Cycle. The problematic situation is an encounter with a patient suffering from an infected diabetic foot ulcer and in need of amputation. Overall, the paper aims to critically analyze the situation and transform it into a learning opportunity useful in improving my future practice as a wound care specialist.

The situation concerns a 40-year-old patient with diabetes and an infected foot ulcer who was admitted to the hospital where I was working at the moment. The patient had a long history of diabetes from which he suffered since he was 10 years old. A multidisciplinary team examined the patient and established that he needed an amputation. As I approached the patient to get a consent form, I noticed that he looked upset. Given the described situation, it might be suggested that a communication dilemma here is of ethical character, in particular – it is the delivery of the bad news. By applying Gibbs’ Reflective Cycle, the discussion below will demonstrate what actions were undertaken to resolve the mentioned dilemma.

Description

The incident that will be analyzed happened several years ago when I began working as a wound care nurse. A 40 years old diabetic patient with an infected diabetic foot ulcer was admitted to the hospital. He had a long history of diabetes, suffering from the condition for three decades. A multidisciplinary team examined and communicated with the patient; it was established that he needed a below-knee amputation. The group stated their decision and left, and I had to retrieve the consent form. While retrieving the record, I perceived that the patient looked exceedingly sorrowful and depressed. Nevertheless, I did not know whether I needed to intervene in the situation and left.

Feelings

Although I worked for many years in nursing before the incident, I became a certified wound care nurse relatively recently before it succeeded. At the moment, I saw the situation as irreparable, so I was not sure whether I should have tried to console the patient. I felt anxious and, to an extent, powerless when faced with the man’s grief. I thought that words or an empathic response would not be able to mitigate his sadness. Additionally, I was also somewhat startled that the multidisciplinary team did not handle the conversation more delicately and left rather abruptly. Overall, I did not feel confident enough to handle the situation and was unsure whether my intervention would be appropriate.

Evaluation

I frequently returned to the incident in my thoughts, trying to understand what should have been done instead. Retrospectively, I believe that it helped me to reevaluate the role of therapeutic communication in my profession. Prior to the incident, I did not perceive preoccupation with patients’ emotional well-being as my duty as a nurse. I believed that administering medications and treatment, performing tests, recording medical history, educating patients, et cetera was all that was required of me. Nevertheless, in the described situation, I did not fulfill another vital function. To understand that a holistic approach to care presupposes therapeutic communication, I had to experience the case (2). As a nurse, showing empathy and consoling patients is also a critical function that sometimes is overlooked. Furthermore, the incident demonstrates a lack of cooperation between the nursing staff and the team since communication was needed to ensure that the emotional impact of amputation on the patient was alleviated.

Analysis

Some medical professionals find the process of delivering bad news challenging and feel psychologically unprepared (3). A lack of skills in this aspect can negatively affect patients: they might undergo extra stress, have lower psychological adjustment, and have worse health outcomes (4,5). Furthermore, the way the news is handled can impact patients’ understanding of the situation and adherence to treatment (6). Given the adverse effects, multiple protocols, approaches to communicating bad news, and dealing with its consequences were developed. In the patient- and family-centered approach, the process occurs based on the patient’s needs as well as their cultural and religious beliefs (7). Upon communicating the information, a medical professional is supposed to assess their understanding and show empathy (7). In an emotion-centered approach, a medical professional is supposed to embrace the sadness of the situation and build the patient-medical professional interaction on empathy and sympathy (7). Yet, the patient- and family-centered approach seems more effective since excessive empathy can be counter-productive and impede information exchange.

Managing patients’ reactions is the final and particularly vital step of communicating bad news. Nurses are commonly involved in handling emotional responses, which entails several responsibilities:

  • Additional emotional support should be given to those who cannot accept the information (8).
  • Nurses can find more related information and share it with patients (8).
  • Nurses are supposed to improve the situation if bad news has been delivered poorly (8).

In the case of amputation, heightened emotional attention should be given to the patient, as limb loss is a life-altering procedure. Such patients commonly undergo the six stages of grief (denial, anger, bargaining, depression, and acceptance) and are prone to developing anxiety, depression, and body image issues (9). Hence, upon delivering the news regarding amputation, it is vital to provide a patient with community resources for dealing with emotional and psychological implications.

Action Plan

Currently, I understand more in-depth that delivering and handling the consequences of bad news is an inescapable reality of the nursing profession. The incident allowed me to notice the aspects of my professional development that necessitate more attention and improvement. Hence, I strive to be more empathetic in my clinical practice and not undervalue the role of patient-nurse communication. I attempt to provide psychological and emotional support to patients and console them to the best of my ability and knowledge, especially if a patient has just received traumatic news. Due to the incident, I comprehended better that a patient’s emotional well-being can be dependent on my actions. I also stopped presuming that other medical professionals provide the necessary emotional support. Moreover, I understand that I am not powerless when faced with a patient’s sorrow.

Consequently, I will not neglect the importance of patient-nurse communication for patients’ health outcomes and mental well-being. I will offer hope where it is appropriate, encourage, and validate patients’ emotions to help them deal with traumatic information (10). In the future, I will use verbal and non-verbal communication clues to show that I care and, generally, be more empathetic (11). I will not prevent my insecurities from fulfilling my nursing duties, nor will I allow the feeling of hopelessness to affect my clinical practice. Furthermore, I will rely on evidence-based approaches to handle bad news effectively and facilitate its delivery to patients.

Additionally, I will be more mindful in my nursing practice. Gibb’s reflective cycle will assist me in attaining this objective. I will continue to apply it to the situations occurring at work in order to think systematically as well as analyze and evaluate them. Furthermore, Gibb’s reflective cycle will enhance my ability to learn from my experience. The model will help me to refine my communication skills and make patient-nurse interactions more intuitive and productive (1).

Reflective Conclusion

The situation allowed me to understand the actual value of therapeutic communication in nursing and the need to exercise it in my clinical practice. Learning to provide emotional support and manage the consequences of bad news is an essential quality for nurses, influencing health outcomes and satisfaction from a visit. Additionally, I become more conscious of my own emotions and the way they can prevent me from acting in a patient’s best interests. Overall, the proper tactics of delivering bad news and assisting patients in handling them became a higher priority in my clinical practice.

Conclusion

To conclude, this reflection featured an episode from my practice in which I analyzed a communication situation using Gibbs’ Reflective Cycle. It showed that I need to concentrate on my abilities to resolve the communication dilemma of the delivery of bad news. The above discussion also demonstrated how the implementation of an appropriate and significant evidence-based model – Gibbs’ Reflective Cycle – may result in better patient outcomes.

References

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Abdolrahimi M, Ghiyasvandian S, Zakerimoghadam M, Ebadi A. Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician. 2017;9(8):4968-4977.

Ferreira da Silveira F, Botelho C, Valadão C. Breaking bad news: Doctors’ skills in communicating with patients. Sao Paulo Medical Journal. 2017;135(4): 323-331.

Brown J, Kidd J, Noble L, Papageorgiou A. Clinical communication in medicine. New York: John Wiley & Sons; 2015.

Lamba S, Tyrie L, Bryczkowski S, Nagurka R. Teaching surgery residents the skills to communicate difficult news to patient and family members: A literature review. Journal of Palliative Medicine. 2016;19(1): 101-107.

Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors’ perceptions and practices of breaking bad news: A qualitative study from Greece. Health Communication. 2016;32(6): 657-666.

Monden K, Gentry L, Cox T. Delivering bad news to patients. Baylor University Medical Center Proceedings. 2016;29(1): 101-102.

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Virani A, Werunga J, Ewashen C, Green T. Caring for patients with limb amputation. Nursing Standard. 2015;30(6): 51-60.

Hertzberg S. [Internet]. Avant. 2019.

Bettencourt E. [Internet]. Diversity Nursing. 2017.

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