Reflective Practice Models: Kolb's Learning Cycle

This document discusses the use of reflective practice models, specifically Kolb's Learning Cycle, in improving nursing practice. It outlines the four stages of learning in the model and provides a reflection on a case study involving medication administration error and failure to monitor. The reflection highlights the importance of effective monitoring, documentation, and reporting in nursing practice and suggests the implementation of internal auditing to improve the quality of care services.

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CHCPRP003 Reflect on and improve
own clinical practice
Case Study

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Case Study 1:
Medication Administration Error and Failure to Monitor
A 23-year-old woman with no significant medical history presented to ED with flu-like symptoms. She complained of
generalized body ache and had a fever of 38.8. For the past two weeks, she self-administered over- the-counter
medications with no relief. Instead, her condition deteriorated and she developed both shortness of breath and a
cough.
Following an abnormal CT Scan of the chest, an elevated white blood count and abnormal liver function test results,
the emergency department physician admitted the patient to ICU.
The patient was started on oxygen and antibiotic therapy. Blood cultures were drawn and showed Streptococcus
Pneumoniae and antibiotics were appropriately adjusted per recommendation of the infectious disease specialist.
The attending physician first saw the patient in the ICU. At the time of his initial exam, the patient was not in
significant respiratory distress, was responding well to the oxygen and antibiotic therapy, and was subsequently
continued on the same therapy. The attending physician noted that while the patient was not in acute distress, her
blood chemistry was abnormal with a potassium level of 2.9 (normal range is 3.5 to 5.0).
The physician ordered 30mEq of potassium to be added to each bag of the patient’s intravenous fluid, infused at 80
millilitres per hour. The order was to be maintained through the remainder of her course of treatment. Two days
later and despite the potassium added to her intravenous fluids, the patient’s potassium level was noted to be 3.0
and the attending physician ordered 80 mEq of potassium to be administered by mouth.
The patient vomited the medication (amount retained undetermined). The attending physician then ordered two
doses of 40 mEq of intravenous potassium to infuse over a four-hour time period.
Documentation is problematic. It appears that despite the order for two doses of potassium 40 mEq to be infused
over four hours, the nurse administered two intravenous potassium doses of 20 mEq over approximately one hour
(documentation regarding this is inconclusive).
Throughout the day the nurse documented the patient’s heart rate in the patient care record. At 7:30 a.m. it was 72
beats per minute, at 1:30 p.m. it was 96 beats per minute and at 4:30 p.m. it was 116 beats per minute. The patient’s
blood pressure remained stable at 120/80. The nurse did not specifically notify the physician of the pattern of rising
heart rate. When the physician saw the patient that day, he noted that the patient’s white blood cell and platelet
counts remained higher than normal but were dropping.
In addition, her vital signs were within normal range and she was not in respiratory distress. He ordered a pulmonary
consult for possible bronchoscopy but deemed that she was stable, and that vasopressors and aggressive pulmonary
treatment were not necessary at that time. He ordered the patient to be transferred to the High Dependency Unit.
The nurse’s documentation fails to provide the exact time of transfer from the ICU to HDU although it appears to
have been between 7:15 p.m. and 7:30 p.m. The documentation also fails to validate the nurse’s statement that the
patient was on a cardiac monitor during her intensive care stay and that she was transferred to the HDU with a
cardiac monitor and oxygen therapy. The HDU nurse stated the patient did not arrive with a monitor. Other HDU staff
indicated that the unit was in an overflow situation when the patient was transferred and the central monitoring
station was not functioning. Shortly after the transfer, the patient became unconscious and unresponsive. A MET was
called and the critical response team attempted to resuscitate the patient with no success. The patient had gone into
cardiac arrest and died.
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1. Research one of the models of reflective practice (Example: Kolb- Learning Cycle, Gibbs- Reflective
Cycle, Schon- Reflective Practice) and outline the model.
In order to reflect on any incident and successfully reflect on the learning, use of models of
reflective practice like Kolb- Learning Cycle, plays major contributing role. In the chosen
reflective model, there are 4 stages of learning. In these four stages of learning the learner ‘touches
all the bases’. Learning theory of Kolb (1974) provides with 4 particular learning styles, for which,
a four-stage learning cycle for its edifice. Kolb clarifies that different individuals normally prefer a
specific single diverse learning style (Huang, Chen, and Hsu, 2019).
Different variables affect the favoured style of an individual. For example, social condition,
educational experiences, or the psychological state of the person.
1. Concrete Experience - (a new experience or circumstance is encountered, or an existing
knowledge is reinterpreted).
2. Reflective Observation of the New Experience - (any irregularities between comprehension
and experience is of specific significance).
3. Abstract Conceptualization - (reflection provides with another thought, or a change of a
present theoretical idea that the learner has gained from his/her experience).
4. Active Experimentation- (application of individual idea(s) is performed by the learner to
his/her general environment to understand what occurs) (Morris, 2019).
Successful learning occurs only when an individual transcends and experiences four phases of the
cycle: of (1) having a Concrete Experience followed by (2) Reflective Observation of the New
Experience which results in (3) the development of Abstract Conceptualization (revaluation)
and conclusion which, at the specific point of time (4) used in future circumstances to test
hypothesis, bringing new experiences. Kolb (1974) considered learning, as a process that is
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integration of different stages of the cycle, in which, each stage is usually strong of and
encouraging into the following. The cycle can be entered at any stage, which is needed to be
completed in its coherent grouping (Abdulwahed and Nagy, 2009). However, learning becomes
effective only when the learner is able to implement the model’s 4 phases. In this manner, none of
the phase of the cycle is successful as a learning strategy in an individual manner.
Trainer comments: S NYS
☐ ☒
/10
2. Using the model you have outlined above, reflect on the case study as if you were the nurse involved.
Describe the steps you might go through as you reflect on this event and the conclusions you came to in
relation to improvements to your practice.
Concrete Experience -In the provided case of the 23 years old patient suffering from
Streptococcus Pneumoniae, I being the nurse, it was required to perform effective monitoring,
efficacious documentation of her vital signs, reporting regarding any kind of change in the vital
signs and provide with medication in a timely manner. The reason being, in managing the
condition suffered by the care user in this case, effective monitoring and medication is essential,
which was the main duty to be performed by the nurse.
Reflective Observation of the New Experience- In the given case, through it was the
responsibility of the nurse to ensure effective documentation, reporting, monitoring and medication
being provided to the care user, an inconsistency between the understanding and experience can be
noticed to have occurred by the nurse. To elaborate it, in regards to the medication, it can be
noticed that does of intravenous potassium were not given as per the instruction by me. In this
regards the documentation issue can also be noticed, which was inconclusive in nature. Lack of
documentation can also be noticed from documentation of nurse that failed in providing with
required information about time of transfer from ICU to HDU. It also failed in validating that the
care user was on cardiac monitor and when transferred to HDU she was on oxygen therapy and
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cardiac monitor. Being the nurse, lack of effective reporting can be noticed from the fact that she
did not notify physician about rising pattern of heart beat. Lack of effectiveness in the functioning
of nurse can also be noticed from the statement of HDU nurse that stated that when the care user
arrived, she was not with a monitor. These facts clearly reflect an inconsistency between
experience and understanding.
Abstract Conceptualization- Based on the above experience, it is an essential learning that the
duties of nurse like reporting, medication, observation and documentation are significant in the
treatment of a care user. Any kind of negligence in the duties of nurse may result in significant
loss, like in the provided case, lack of monitoring and reporting of rising pattern of heartbeat
resulted in lack of identification of the issue. Due to this, she was not provided with required
medications that lead to cardiac arrest. Hence, the major learning in this case is ignorance of any
duty of the nurse result in irreversible loss.
Active Experimentation- In order to deliver with quality care services to care users, it is trivial for
the nurses to perform their individual duties. For ensuring that nurses are performing their duties
appropriately, internal auditing would be beneficial (Harvey and Kitson, 2015). This initiative
would result in effective performance on the part of the nurses, as a result, of which, irreversible
loss, which occurred in the provided case can be avoided. Thus, the overall quality of care services
would improve.
Trainer comments: S NYS
☐ ☐
/10
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References
Abdulwahed, M. and Nagy, Z.K., 2009. Applying Kolb's experiential learning cycle for laboratory
education. Journal of engineering education, 98(3), pp.283-294.
Harvey, G. and Kitson, A., 2015. Implementing evidence-based practice in healthcare: a facilitation
guide. Routledge, pp.105-150.
Huang, T.C., Chen, M.Y. and Hsu, W.P., 2019. Do Learning Styles Matter? Motivating Learners in
an Augmented Geopark. Journal of Educational Technology & Society, 22(1), pp.70-81.
Morris, T.H., 2019. Experiential learning–a systematic review and revision of Kolb’s
model. Interactive Learning Environments, pp.1-14.
Outcome S ☐ NS ☐
Grade /20
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