Reflective Practice: Analyzing COPD Patient Care with Gibb's Model

This reflective journal employs Gibb's Reflective Model to analyze experiences from a pulmonary rehabilitation program (PRP) internship, focusing on a 65-year-old COPD patient named Jay. The reflection details the application of purse lip breathing (PLB) techniques to manage Jay's dyspnoea and anxiety, alongside the use of the Modified Borg Scale (MBS) to document his progress. The author reflects on developing calmness and confidence in assisting Jay, the positive impact of morning exercises, and the importance of addressing dyspnoea in COPD patients. The analysis highlights the value of MBS in quantifying dyspnoea and the need to prevent social isolation and muscle deconditioning. The reflection concludes that COPD causes significant distress and emphasizes the importance of patient-centered care, effective communication, and awareness creation, while acknowledging the limitations of short burst oxygen therapy (SBOT) as a mere mitigation rather than a cure.

Running head: USING GIBB’S REFLECTIVE MODEL TO ANALYSE A COPD PATIENT
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Using Gibb’s Reflective Model to Analyse a COPD Patient
Student’s Name
Institutional Name

USING GIBB’S REFLECTIVE MODEL TO ANALYSE A COPD PATIENT
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Using Gibb’s Reflective Model to Analyse a COPD Patient
Description
This reflective journal uses the Gibbs (1998) model, as the guideline of the reflection
during a voluntary internship. The reflection is based on the experience gained whilst in working
at a certain healthcare facility in the department of pulmonary rehabilitation program (PRP). The
name of the client shall be assigned an alias name (Jay) for the sake of confidentiality (Nursing
and Midwifery Council, 2008). Jay is currently 65 year old man, who attends the pulmonary
rehabilitation program because he has a chronic obstructive pulmonary disease (COPD). He was
under the short burst oxygen therapy (SBOT) prescription so as to suppress his symptoms.
According to World Healthcare Organization (2013), COPD is the interference of the
airflow into the lungs as a result of chronic obstruction. COPD makes the patients to develop
abnormal breathing patterns. During the internship, I closely worked with a team that dealt with
PRP. The opportunity provided insight into the COPD’s theoretical knowledge, I previously
learnt. The main caring session I was interested with was the breathing technique of Jay using
purse lip breathing (PLB). I documented most of the exercise score programs of Jay using the
Modified Borg Scale. Jay would occasionally be very anxious, de-saturated and breathless; when
he attempted to walk with the assistance of fellow teammates, family or myself. Thus, I
encouraged Jay to practice the purse lip breathing method during the morning walking exercise.
Jay practiced the PLB technique and would often regain his breathe, relax and be calm after ten
minutes of reassurance. However, Jay would occasionally be unable to apply the PLB technique
without close intervention from the caregivers or family.

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Feelings
Close study of Jay made me calm and confident while assisting patients with COPD
illness. Hence, I developed the two skills that intern assisted Jay to successfully control his
breathe and anxieties. Prior to developing the sense of calmness and confidence, I could not avail
physical assistance; this enervated Jay’s symptoms. However, I began gaining calmness and
confidence towards assisting Jay to lower his symptoms. Therefore, I began introducing the PLB
technique in addition to giving him reassurance, which greatly aided and comforted Jay by
greatly debilitating his symptoms.
Evaluation
The morning exercise that Jay took was very instrumental for balancing his breath’s
patterns. Other teammates joined suit and we built a useful combined morning exercise so as to
ease Jay’s condition; this built a robust therapeutic nurse-patient relationship. Moreover, Jay
perceived the PRP exercise very positively. Furthermore, he commended the exercise and
deemed it very significant for his diagnosis. The conclusion made by Jay is in line with the
studied of McCarthy et al. (2015), Watz et al. (2014), Rochester et al. (2015) and Bolton et al.
(2013), which noted that PRP has an elevated general expectation of patients with either unstable
or stable COPD.
According to National Institute for Healthcare and Clinical Excellence (2010), PRP is
used to mitigate COPD, thereby reducing the admission of patients who are depressed and
anxious. After attending the regular checkup on Jay, I noticed that dyspnoea is a common
challenge even with other patients who lives with COPD. Thus, the timely mitigation of
dyspnoea would have posed limited challenges of COPD on Jay. Dyspnoea examination should
be given the first priority while offering treatment and care to the COPD patients. Anyway, PRP

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and Short burst oxygen therapy (SBOT), was the special program that was put in place by the
management so as to offer care services to the patients, giving Jay’s family a sense of relief and
hopes.
Analysis
Jay’s dysponoea is a common COPD problem. Dyspnoea poses the challenge of
subjective experience, which makes it very hard to measure. Notably, there are significances of
quantifying dyspnoea using MBS scale. The PRP used the MBS scale to assess the rate at which
dyspnoea was perceived, as well as monitoring the patient’s achievements. When Jay could
hardly speak, the tool was useful since it enabled Jay to point his scores without being breathless.
Thus, MBS was an appropriate tool in measuring dysponoea given that it was reliable and valid
(Toren et al., 2017). Jay began experiencing moderate short breath when our team officially
realized the need to participate in the exercise. Hence, it is significant that a patient is assisted at
all times to minimize the risks of social isolation, muscle de-conditioning and loss of confidence
(Sethie et al., 2017). Jay’s de-saturation as per the pulse oximeter recording was at 91% to 78%.
This showed severe SOB, which increased Jay’s rate of anxiety. Contrary, the normal
expectations of oxygen saturation of COPD patients are usually 88% and 92%. When the
unusual situation arose, I would assist Jay to the chair and place him an upright sitting position to
counteract the low breathe pattern.
Historical and social factors of dyspnoe mitigation show that a patient should have a
pulse oximeter of 88% to 92%. However, during any contradiction, then the patient should be
placed in an upright sitting posture. Throughout the implementation of the exercise, it was
evident that other than upright sitting postures of reducing dysponoea, patients can as well sit
down and lean forward as the elbows rests on a table. Additionally, I have learnt that for the

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exercises to be beneficial then it must be practiced continuously for at least twelve weeks.
Moreover, I have learnt that anxiety and depression are robustly associated with COPD patients
(Watz et al., 2014). Additionally, I learnt that SBOT is just a mitigation of the dysponoea and not
a curative; these findings changed my original opinion of COPD diagnosis and care of patients.
Conclusion
In summary, a critical evaluation of the reflection shows that COPD is a weakening
illness that leads to social, physical, emotional and psychological distress among the patients.
Dyspnoea is also the major factor linked to the proposed distresses. As COPD is a longstanding
challenge for most patients including Jay, the patients becomes expert in mitigating their
condition and even comprehend the techniques, which are beneficial to them. However, PRP
program is very significant to Jay since physical and education event may hamper muscle de-
conditioning and social isolation, which are the main factors that degenerates his condition.
Notably, assessing depression and anxiety in COPD patient is significant in gaining insight of the
patients’ needs; this is important lead for future patient centered care programs. My belief before
interacting with short burst oxygen therapy was that it was evidence based approach of
treatment, which aimed at alleviating patient’s symptoms. After the experience, I deduced that
the belief was an inaccurate assumption. Therefore, SBOT and PRP are mitigates of COPD and
not a complete treatment.
Action Plan
If a patient persistently lives with a certain chronic illness for a couple of years then he or
she becomes an expert in mitigating the general symptoms. An effective communication and
listening will be crucial in building a therapeutic relationship between patients and me. Since the
COPD and other related chronic illness patients will be already distressed, it is therefore essential

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to keep calm and be confident while offering treatment, care and reassurance of the condition;
since it’s a legal and ethical nursing consideration during diagnosis. I am also aiming at applying
the new ideas collected from my voluntary internship to create awareness of the COPD and its
contributors.

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