Gibbs Reflective Exercise: Applying NMBA Standards in Nursing Practice

This document presents a student's Gibbs Reflective Exercise, applying the Gibbs cycle to two critical incidents encountered during a surgical ward placement. The first incident involves a doctor's breach of hand hygiene protocol, prompting reflection on the importance of assertive communication and patient safety. The second incident focuses on a patient with a sacral pressure sore and the challenges of professional collaboration, particularly with care assistants, highlighting the need for effective assessment and communication to improve patient outcomes. The student analyzes these experiences, referencing relevant literature, and formulates action plans to enhance future practice, emphasizing the importance of upholding NMBA standards, promoting patient well-being, and fostering collaborative healthcare environments. The reflections cover areas such as hand hygiene, patient assessment, professional collaboration, and the application of nursing frameworks to improve patient care.

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Assignment

Gibbs Reflective Exercise
2
NMBA STNDARD 6
Standard 6: Provides safe, appropriate and responsive quality nursing practice
Description
This is an occurrence during my placement in the surgical wards under the supervision
of mentor caring for old gentleman aged 75 years of age, the patient had undergone
abdominal surgery. My role was to address the wound dressing in order o enable the doctor to
assess during the regular ward rounds.
During my task, I performed the dressing to the patient following the touch procedures
and performed wound cleaning as requested by the doctor concerned. My mentor, a
registered nurse concern was requested to attend to another patient, so I had to remain in the
care of the patient as he waited for the doctor.
The doctor in charge was seeing another patient and examining his wounds, thereafter i
noticed she wanted to come straight to see my patient to examine the wound I was cleaning
for my patient without either washing his hands or wearing any hand protection. I observed
this and I took time through for a while on how to comment on the issue, however, by the
time I wanted to comment, the doctor was already seeing and touching my patient with open
arms.
Feelings
I was really afraid and perplex on the happenings at the moment, as I had thought the
doctor would perform hand hygiene or use hand cleaning solutions before performing. I
thought the doctor had more experienced than me and he knew what he was doing.
Later, on that day I spoke o the registered nurse concerned on the issue. She suggested
that we make contact with the doctor and inquest on the issues. The registered nurse inquired
from the doctor whether he had washed the hands before attending to the patent. The doctor
looked quite shocked and said that he had been busy and did not remember to wash the
hands, the nurse concerned reiterated on the importance of hand hygiene and promised to
wash always his hands before attending to any patient.
Evaluation
The scenario proves to be challenging to me in that I regretted deeply why I could not
have challenged the doctor's medical practice procedure at that moment examining the
patient. However, it was appealing to see that the doctor admitted to having forgotten and
assured that such kind of incident will not happen again in the future.

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The doctor changed immediately his practice and followed the required procure, I
learned extremely important lessons from the incident as it showed me the importance of
assertive working with colleagues in a more proactive manner so as to protect the well being
of the patient.
Analysis
Hand hygiene is the greatest most important activity which helps in reducing infection
and the majority of the health care often don’t wash their hands before handling patients,
(Westbury et al., 2013). Formulated guidelines have shown that there is an increased
possibility of staff increasing the infection rate at the hospitals, (Jacob, 2007).
Further the Nursing and Midwifery Council codes of professionalism , offers
suggestions that a nurse, there is a need for action in a manner which minimizes infection and
risks to patients, thus as a practicing student there is a need for me to improve care to the
patients as to improve quality of care given to the patient.
Conclusion
Reflecting on the incidence, my role should be geared directed proactively sooner and
ensuring that the doctor performs hand hygiene effectively before undertaking any duty.
From this, I can see how my inaction led to the patient being exposed to risks. Hence there is
a need for me to developed confidence in challenging the practice of colleagues so as to
maintain care and improve quality care for the patients we are serving. Thus I need to be
supportive of the healthcare team so as to achieve positive patient outcomes.
Action plan
Future's action plan entails developing and building on assertive skills while working as
a team in the healthcare setting, this geared towards enhancing that the well being of the
patents is well cared for. Thus towards, improving patient care, working with the healthcare
needs collaboration so as to improve the quality f care given to patients and improve clinical
outcomes thereafter.
Standard 4: Building professional collaboration and comprehensively conducts
assessments
Description
The case incident involves undertaking a full assessment of sacral pressure sore patient.
The patient experiences low mobility and had developed dementia. The patient does not
speak. The care assistants assigned in the ward showed a lot of reluctance in the engaging

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nursing process thus making some measurements not to be availed and thus affecting the
patient flow.
As a practicing nurse, in undertaking the responsibility of engaging the registered nurse
to offer me a logical guideline and explanation on how to administer wound and gave a
rationale for wound dressing to be chosen by me. I informed the care assistance of my
intentions and how my actions were going to be of help to the patient.
Feelings
Prior to the assessment, I felt upbeat and confident. I had observed previous on pressure
sores and I had gained prior knowledge of performing pressure and dressing relief. The
patient health records had not been updated, and upon mentioning this to the care assistant,
she was annoyed and began to gain defensive conversation. The care assistant didn’t care
about the maintenance of proper records and assessments done for the patient.
Evaluation
My role regarding this patient revolved around evaluating the patient wound status and
offering accurate information to the registered nurse on the progress. Prior to the discussion,
it ensured that I consolidated all the evidence which were available which supported my
evaluation skills and incorporated my basic wound dressing learned in school into practice. I
performed the assessment and applied a holistic assessment s so as to meet the client’s needs
of dementia and poor communication skills
Analysis
Engaging in professional partnerships can be a risks affair when the nursing in charge
lacks the adequate knowledge to perform ethical assessments in their course of their duties.
The care assistant in the scenario didn't bother to offer professional expertise in undertaking
patient assessments, (Lloyd, Schneider, Scales, Bailey & Jones, 2011).
As a practicing nurse, I failed to incorporate professional partnership in my assessment
practice and I relied heavily on RN, during my assessment. If I had communicated to the care
assistant on his role at the patient, this may have offered him the needed confidence to
perform better. Empowerment often inspires elf determination, (Crawford et al, 2005).
Listening skills and offering encouragement offers effective participation among healthcare
staff, (Collins, 2015).
Conclusion
My assessment of the care plan was finalized. This facilitated the faster healing process
for the patient. This engaged showed me that I can successfully assess patients through a

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holistically approach but needs to focus more addressing patient needs and concerns in
enhancing this utilizing effective nursing framework effectively need to incorporate effective
nursing framework so as to offer inclusive partnerships.
Action plan
In encouraging the participation of other professional colleagues enhances the care
process for the patient. There is a need for identifying appropriate wound care. Engaging in
professional collaboration and assessment is critical for my nursing role. Enhancing
professional collaboration is key in enhancing effective assessments.

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References
Collins, S. (2015). The Geography of Communication and the Expression of Patients’
Concerns. In Linguistic Ethnography (pp. 166-186). Palgrave Macmillan, London.
Crawford, P., & Brown, B. (2011). Fast healthcare: brief communication, traps and
opportunities. Patient education and counseling, 82(1), 3-10.
Jacob, G. (2007). Uniforms and workwear: an evidence base for developing local policy.
NHS Department of Health Policy.
V. Lloyd, J., Schneider, J., Scales, K., Bailey, S., & Jones, R. (2011). Ingroup identity as an
obstacle to effective multiprofessional and interprofessional teamwork: findings from
an ethnographic study of healthcare assistants in dementia care. Journal of
Interprofessional Care, 25(5), 345-351.
Westbury, J. A., Johnson, M. J., Pond, J. P., Toy, C. F., Anderson, L. S., Blake, E., & Leaf,
A. A. (2013). Developing the role of the nurse as a link advisor for research and a
champion for nutrition in the neonatal intensive care unit. Journal of Neonatal Nursing,
19(4), 198-205.