Case Scenario Reflective Essay 2022

Case Scenario Reflective Essay - using
Gibbs 6 Stage Reflection Cycle

Introduction
The present study focusing on the topics of “falls-prevention-and-harm-from-falls care” and
“My-health-record”. This is a Reflective task based on the scenario of “Patient experience
and partnering” analysing the case study of a 75-year old patient Mr William Taylor, who had
suffered severe falls twice and was under treatment for the same. For analysing the chosen
case scenario the Gibbs 6-stages of reflection has been adopted in the reflective essay,
centred on the theories and concepts of Nursing Care philosophy, Governance Standards of
Nursing, person-centred care and patient-and-family-centred care. The values in terms of
Governance and self-feelings in the practice of Nursing has been used to assess whether the
care delivered to the patient was adequate or inadequate. Two themes of nursing care have
also been identified in addition to 4 indicators (positive and negative) in nurse-patient
partnering for providing right direction to healthcare organisations, family and individuals
towards improvement of services via strategic implementation.
Gibbs Reflection – 6 Stage Cycle (Bulman, 2013)
1. Description
In this section, the care received by William Taylor, post-fall treatment and in Health Records
have been critically discussed. He had suffered 2 consecutive falls within 1 month, with a 30
cm tear in his right shoulder muscle. Before this the patient had also suffered from kidney
stone, and presently has type-2 diabetes, allergic rhinitis, anaemia, deafness of both ears, and
hypertension. In the case of the patients’ fall experience, he was provided the necessary care
and treatment in his GP’s clinic, where an X-ray and GP appointment put him into
physiotherapy (4 times/week) which improved him. Following his second fall, he was
admitted for anaemia and underwent iron infusion wherein he experience full supportive care
treatment from the nurse who was always available and connected to his emotional situation
taking his mind off serious situations to help him relax. This shows how the nurse delivered
person-centred-care to the patient relevant to the theme “to establish therapeutic relation
for care continuance, true partnership and shared decision-making”. In the “my-Health
record” scenario, the patient did not receive care during his kidney stone incident post-
admission to public healthcare unit, wherein he had to suffer a waiting time of 11 hours with
no nursing staff to look after him, in a crowded environment showing gross negligence on the
nurses’ part with no care delivered to meet the physical and emotional needs of the patient.

The person-centred-care theme of “Organised care respectful of patient” was not followed
by the nursing staffs in this scenario.
2. Feelings and Thought
The Nursing Philosophy comprises of ideologies, values and a nurse’s beliefs behind their
actions, staying true to their ethical, personal and moral values while taking care of a patient
(Risjord, 2011). I believe that the care services delivered by nurses must always be person-
centred meeting both physical and emotional wellbeing of patient through values of harmony,
commitment, braveness, respect, decision-making and altruism for individuals and society.
The patient received supportive person-centred-care during iron infusion delivered by a
committed nurse who respected the patient’s opinions and was also emotionally supportive to
his needs. However, during his kidney stone incident, the nurses failed to check up on him
and he alone had to keep checking for medicines. I believe this disrespected the patient’s
physical and emotional needs and failed to deliver patient-centred-care.
3. Values-and Beliefs
Based on the Nursing Philosophy, nurses must be guided by a set of personal values and
governance values for benefitting the patient, family and society. Personal values of
harmony, commitment, braveness, respect, decision-making and altruism must be practised
by nurses to provide person-centred care, where the person’s emotions, decisions, and self-
care is valued in addition to therapeutic care, via patient empowerment (Olsson, Jakobsson
Ung, Swedberg, & Ekman, 2013). The nurse’s should also realise how important a role
family plays in a patient’s life and their involvement must be respected by nurses in
providing patient-and-family-centred- care (Coyne, O’Neill, Murphy, Costello, & O’Shea,
2011). The Code-of-Ethics-for-Nurses, Australia suggests that nurses should value a) quality
care for all b) respect self and others c) people diversity d) informed-decision-making e)
safety-culture f) ethical-information-management g) social-economical-ecological
environmental sustainability (Johnstone, 2016).
4. Analysis
Care quality and adequacy is defined as the extent by which the services provided to patients
improvise their health outcomes via care service which are safe, timely, effective, efficient,
people-centres and equitable (Aiken, Sermeus, Van den Heede, Sloane, Busse, et al., 2012).
If any of the aforementioned criteria’s are not met in patient care then the care delivered is
considered inadequate, as in the case of William Taylor. The patient suffering from kidney

stone pain in public health-care setting, suffered prolonged negligence and had to wait in the
crowded waiting room for 11 hours during which no nursing staff paid him a visit to check up
on his physical health condition, which may have deteriorated. He himself had to look for
medicines to subdue pain, and this shows poor management in health-care setting,
irresponsibility and careless approach. Missed care literatures on nurse and patient surveys
have been carried out by [IHOC]/RN4CAST (Sermeus, Aiken, Van den Heede,
Rafferty, M., Griffiths, et al., 2011). Missed care resulted in patient
mortality episodes as suggested in several literatures and this signifies
how significant and threatening inadequate care services and negligence
can be (Jones, Hamilton, & Murry, 2015). The inadequacy in care can be
considered similar to the inadequate nurse services and care provided to
Mr Taylor during his kidney stone bypass incident in a public health care
setting. This could have led to severe repercussions if the patient was not
emotionally and physically steady enough to deal with the challenging
situation. In the other case of iron-infusion the patient received complete
and dedicated supportive care from the nursing staff who not only
monitored his physical health condition but also looked into his emotional
side supporting him mentally and guiding him at times when he was
undergoing a traumatic situation. The way the nurse diverted his thought
process and light-talked with him, showed genuine person-centred-care
wherein the emotional well-being of the patient was looked into. His
involvement was respected in terms of his health-care service and thus
the patient was provided a holistic and adequate care service in this
scenario (Cho, June, Kim, Cho, Yoo, et al., 2009). Patient-nurse
partnership have been focused upon in this scenario, with due
consideration of the patients emotional and physical needs. A therapeutic
partnership was hence built via non-verbal or verbal communication
strategies of care for developing trusted, genuine and respectful
partnership (Doss, DePascal, & Hadley, 2011).

(Source: Piper, 2010)
5. Conclusion
Nursing-Sensitive-Indicators reflect the three arenas of nursing care – process, structure and
outcomes and there are 10 such indicators of patients-satisfaction centered on 1) pain-
management 2) nursing-care 3) overall care 4) medical-information providence 5) patient
falls 6) pressure ulcers 7) nurse-job-satisfaction 8) nosocomial infection rate 9) hours of care /
patient/ day 10) staffing mix (Nakrem, Vinsnes, Harkless, Paulsen, & Seim, 2009). In the
present scenario 2 positive indicators maintained are: 1) hour of patient care 2) nursing care
- as displayed by the responsible nurse during iron infusion, who showed efficient nursing
care. 2 negative indicators have also been indicative in the patients’ health record history
namely, 1) pain-management – which failed in the public healthcare setting, as the medicines
suggested by nurses subdued the pain merely which recurred within a short time period 2)
overall care – which also was absent as the patient was left unattended in a crowded waiting
room without proper medication and care.

6. Action Plan
The aforementioned case study suggested that efficient nurse-patient-family partnerships are
necessary for improving the overall health of a patient giving due respect to the patient’s
opinions, their family’s opinions regarding to the person’s health matters. In case of
partnering with an aged patient like Mr Taylor, the nurse/service providers need to 1) listen to
patient, 2) engage with them, 3) relinquish some responsibility, 4) share the power and
5) empower the patient as showcased below.
Thus, the following steps needs to be taken for developing a healthy nurse-patient partnership
with an aged person like Mr Taylor:
> Development of partnership care plan, as being meaningful to them within their life’s
context
> Engagement with them in a participatory-decision-making model, respecting their right for
choosing a preferred health intervention by a) collaboration with patients for priority
identification b) information sharing on basis of health-options available c) informed decision
making d) respecting patient’s expertise on themselves and on their life.

Conclusion
The Reflective essay focused on the “patient experience and partnering” case study of an
aged patient suffering from severe fall Mr William Taylor and delved into the topic of “falls
prevention-and-harm-from-falls care” and on the “e-Health record” of the patient. The
nursing care received by the patient have been discussed focusing on the practices of person-
centred-care and family-centred-care services. The Nursing Philosophy, personal feelings and
Governance values of nurses have also been analysed. Themes of nursing care have been
identified to assess the adequacy or inadequacy of care provided in different circumstances.
Finally a holistic patient-nurse relationship development is considered mandatory as a
strategic measure towards improved health care services concerning organisations, nurses,
family members and individuals together. Overall nurses need to be committed, altruistic,
must possess in depth medical knowledge and decision-making-skill to develop a strong
nurse-patient bond through person-centred care for achieving emotional and physical
wellbeing of an the patient.

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