Gibb’s Reflective Cycle

This article discusses the use of Gibb’s Reflective Cycle in the context of assessing blood pressure in nursing practice. It highlights the importance of comprehensive assessments, the role of clinical reasoning, and the impact of confidence on performance.

Gibb’s Reflective Cycle
Description
As a Registered Nurse, I will be required to conduct various assessments comprehensively
(Leong, et al., 2014). One of the assessments that is frequently conducted in nursing practice is
the measuring blood pressure (BP). It is essential that BP of all the patients are monitored at their
arrival and during their hospital stay. In the theoretical class, strong emphasis was put by the
teacher in understanding the mechanism and blood pressure assessment. I was confident that I
have learnt it properly and can measure BP accurately. However; in the practical classes I found
that I could not measure BP pf my assigned partner appropriately. My partner’s BP was 135/88
mmHg. I was panicked that I could not measure it properly and measured it several times. Due to
my lack of confidence subsequently, I tried to remember all the assessor’s error that I had learnt
in the theory cuff size, hearing error, inadequate inflation of cuff, inflation of cuff for too long,
cuff over clothing, etc (Golpaygani, 2018). I repeated the assessment making sure that I am not
making any of these errors. Then, my teacher intervened, and we found out that his BP was
elevated due to stress. It took several attempts and classes for me to practically learn measuring
the BP in different situations and for different patient presentations. I also found that it is not
enough to measure BP, but an RN will also be required to use clinical reasoning and interpret the
readings as per patient’s conditions and compare it with assigned normal range (Lee, Lee, Bae, &
Seo, 2016).
Feelings
Initially, when out teacher asked us to begin measurement, but with first measurement I got
panicked on seeing the reading of my partner and my confidence went downhill from that point.
I could not understand the reason for the elevated BP and made a wrong assumption that I must
have measured it inaccurately.
Evaluation

I believe if I was not only focusing on measuring the BP of my partner but also interpreting the
result, I would have not gone in wrong direction and measured the BP multiple times. It also led
to a fall in my confidence which further hampered my performance.
Analysis
According to the Nursing and Midwifery Board of Australia (NMBA), the fourth standard of
Registered Nurse Standards for Practice requires me to comprehensively conducts assessments
(NMBA, 2016). As per the standard I must question to obtain suitable information. I failed to
question my partner effectively, otherwise I would have known that he was undergoing stress
and it could be a reason for high BP. The significant element of the standard is that the RN must
analyse and interpret the data of the assessment accurately to inform practice (Jarvis, Forbes, Watt,
Thomas, & Strandberg, 2016). All I was thinking at that point is my partner is a normal person
sitting in my class who must be having normal BP and therefore, I must be measuring his BP
inaccurately. I failed to demonstrate application of knowledge to selection of health care
strategies. I should have used my knowledge from theory classes regarding the causes of
elevated BP and attempted to reason it out with my partner. Blood pressure is one of the vital
signs that is measured prior to all the procedures in clinical course. Moreover, it can be a
deciding factor in selection of medicine, procedures, etc. In theory, I learnt that blood pressure
may fluctuate frequently with time (Frese, Fick, & Sadowsky, 2011). Therefore, due to all these
factors BP should be measured cautiously. I believe if I had believed in my skills and trusted the
readings at the first time, it would have led to a boost in my confidence. When trying to
rationalize the findings of my partner’s BP assessment, I only focused on the assessor’s errors
and not other factors which can affect the blood pressure.
Conclusion
I believe I faced the difficulty in the assessment because I only focused on the measurement part
of the assessment and not interpretation. The NMBA standards, requires the nurses to conduct
the assessment ‘comprehensively’, while I focused only on certain aspects of the assessment. I
learnt that there are different stages in undertaking an assessment effectively. First, I must have
deep and clear theoretical knowledge of the assessment, next I must be able to implement the
theory in practice and lastly, I must interpret the findings accurately to inform my practice

(Carvalho, Oliveira-Kumakura, & Morais, 2017). All the stages are essential and demand skill and
practice. Other essential factors are confidence and clinical reasoning. If I had confidence in my
skills, I may have tried to find out the reason for my partner’s elevated BP rather than wasting
my time on trying to find the inexistent assessor’s error. I will try to develop these skills in my
future practice so that I can handle such situations efficiently.
Action Plan
In future, I will ensure that I conduct the assessments comprehensively by developing the skill of
clinical reasoning. It is step by step approach which requires the nurse to collect the data from
the patient and apply it with the theoretical knowledge to interpret the findings correctly and
develop necessary interventions. I will ensure that I am aware of the complete and correct
knowledge of the assessment. I will ensure that I assess the readings in correspondence with the
current situation of the patient. I will seek and interpret supplementary information to ensure that
my assessment is comprehensive, and it will lead to correct interventions. I will maintain my
confidence in such situations so that I can adequately take further steps.
References
Carvalho, E. C., Oliveira-Kumakura, A. R., & Morais, S. C. (2017). Clinical reasoning in
nursing: teaching strategies and assessment tools. Rev. Bras. Enferm, 70(3).
Frese, E. M., Fick, A., & Sadowsky, H. S. (2011). Blood Pressure Measurement Guidelines for
Physical Therapists. Cardiopulm Phys Ther J, 22(2), 5-12.
Golpaygani, A. T. (2018). Inaccurate BP measurements due to sphygmomanometer miscuffing.
J Biomed Imag Bioeng, 2(2), 93-94.
Jarvis, Forbes, Watt, Thomas, & Strandberg. (2016). Jarvis's physical examination & health
assessment (2 ed.). Chatswood: Elsevier.
Lee, Lee, Bae, & Seo. (2016). Registered nurses' clinical reasoning skills and reasoning process:
A think-aloud study. Nurse Educ Today, 46, 75-80.
Leong, C., Louizos, C., Frankel, G., Ng, S., Iacovides, H., & Falk, J. (2014). A Physical
Assessment Skills Module on Vital Signs. Am J Pharm Educ, 78(7).

NMBA. (2016). Registered Nurse Standards for Practice. Nursing and Midwifery Board of
Australia. Retrieved April 18, 2019, from
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx