Gibbs reflective cycle Essay Example

Case Study: Gibbs’ Reflective Cycle

Gibbs Reflective Cycle

Introduction

Patients and carers play a significant role in the safe delivery of care to elderly patients with pressure wounds. Although pressure injuries are in general preventable, they can be fatal to elderly patients and are a key contributor to their care needs in hospitals (ACSQHC, 2010). Nurses and doctors should establish a connection with elderly patients and their families to effectively monitor pressure wounds. This paper reflects on a case study demonstrating how an elderly person with degenerative pressure wounds was poorly monitored by nurses leading to significant health deterioration and ultimately death.

In the case study, nursing staff at Opal Aged Care nursing home in Gold Coast poorly monitored and treated pressure wounds on the buttocks and feet of 88-year-old Mr. Zdenek Selir, who later developed gangrene and died. Mr. Selir, who had been taken to the nursing home after he suffered a stroke, had minor pressure wounds. The wounds ate deeper into Mr. Selir’s skin leading to gangrene. Mr. Selir’s raised concerns to the nurses. However, they discounted her concerns and insisted that the wounds could be managed. Ms. Selir decided to transfer the patient to Gold Coast University Hospital. However, it was too late as the infection had already shut down his organs down. An investigation by the Aged Care Complaints Commissioner found that the staff at Opal Aged Care had insufficiently performed wound care. They had failed to monitor the wounds constantly or keep the patient’s GP duly informed of his condition. On account of this incident, I felt frustrated that there is poor collaborative between the nurses and the GP and reluctance to share patient information because of a possible poor interdepartmental coordination. I suspected that poor teamwork among nurses had contributed to inadequate pain management, inadequate coordination of palliative care, poor team approach, and poor monitoring of Mr. Selir’s condition. I also felt exasperated that nurses had failed to build a therapeutic relationship with Mr. Selir, as this is what led to poor monitoring of his wounds. I also feel challenged that nurses had failed to establish a collaborative relationship with the patient’s family yet this is something they can easily achieve.

Nurses and doctors should establish a connection with elderly patients and their families to effectively monitor the patients’ health status. This ensures that the patients’ needs are adequately met, health status closely monitored, and coordinated palliative service provided effectively. The incident has broadened my knowledge on the significance of using a collaborative approach to administer palliative and end of life care to elderly patients. This has an impact on my learning. I have learned that when it comes to wound care, nurses should assess an elderly patient’s psychosocial, physiologic, and environmental factors with a special focus on impairments of the integrity of the skin and likely infections (Elliott et al., 2011). Clearly, Mr. Selir, being 88 years old, needed close monitoring as he was highly vulnerable to degenerative conditions like pressure wounds. However, he was poorly monitored by the nursing staff at the nursing home. According to Hughes et al. (2005), the elderly people are more vulnerable to degenerative conditions, which may be life threatening. Carefully monitoring of the patient can lead to early detection and prevention of gangrene (Aalaa et al., 2012). An assessment of the patient should be adequately comprehensive to comprise physical attributes like the size of the wound, its condition, grade, and location. This is only possible when there is a connection among the nurses, the patient, and the patient’s family. Therefore, nurses should be sensitive to patients and family’s needs, yet also show respect for their emotions while attempting to start or sustain a conversation.

Nurses should be more ethical as well as strive as patient’s advocates. I will exhibit these in my future practice. I realised that nurses at the nursing home were neither ethical nor attempted to act as the patient’s advocate. According to Hughes et al. (2005), the goals of a nurse in wound management include preserving and maintaining the skin’s integrity and preventing further decline of the current wounds as well as the provision of care a patient would wish for. To this end, it also becomes clear that treatment and management of pressure wounds during palliative care is clinical as well as an ethical and emotional issue.

In future, I plan to pursue a personalised, systematic approach to evaluation, planning, treatment, and assessment of the pressure wounds within the context of his palliative care. I would establish a therapeutic relationship with patients and their family when attending to them (Bach & Grant, 2009). This would ensure that I establish a supportive and interpersonal communication with a patient and his family to ensure that the patient’s needs and that of his family are catered do. This is consistent with the NSQHS Standards set up by the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2012). The Standards recommend that nurses should partner with their patients to establish a consumer-centred health system. It will also ensure that the patient is adequately monitored through a patient-centred care (Epstein et al., 2005). I would also encourage and uphold collaborative relationship with other healthcare practitioners. This will ensure there is continuity of care among nurses and the GP through effective teamwork (Leonard et al., 2015). A team management approach will help improve the health systems and governance structures for preventing and managing pressure injuries. This is consistent with recommended standards by the ACSQHC (2012b) for preventing and managing pressure injuries. Therefore, through collaborative care and continuity of care, health data acquired from monitoring a patient’s pressure wounds would be easily shared to the GP and ultimately the physicians.

Conclusion

A therapeutic relationship with patients and their family facilitates a supportive communication and improved health outcome. Mr. Selir was clearly neglected as the nurses failed to monitor his wounds for optimal care. Nurses should connect with patients and their families to effectively monitor their health status. This ensures that the patients’ needs are adequately met and coordinated palliative service is provided to them. If this had been the case, Mr. Selir’s health status would have been adequately monitored. Therefore, collaborative healthcare encourages continuity of care through teamwork.

References

Aalaa.M., Maalazy, T., Sanjari, M., Peimani, M. & Terhani, M. (2012). Nurses’ role in diabetic foot prevention and care; a review. J Diabetes Metab Disord, 11, 24.

ACSQHC. (2010). Preventing and managing pressure injuries standard 8. Sydney: ACSQHC

ACSQHC. (2012b). Safety and quality improvement guide standard 8: Preventing and managing pressure injuries. Sydney: ACSQHC

Australian Commission on Safety and Quality in Health Care. (2012a). National safety and quality health service standards. Sydney: ACSQHC, 2012

Bach, S. & Grant, A. (2009). Communication and interpersonal skills for nurses. London: Learning Matters.

Elliott, R., Bohart, A., Watson, J. & Greengerg, L. (2011). Empathy. Psychotherapy, 48(1), 43–49.

Epstein, R., Franks, P., Fiscella, K. Shields, C., Meldrum, S., Kravitz, R., & Duberstein, P. (2005). Measuring patient-centered communication in patient –physician consultations: theoretical and practical issues. Journal of social science and medicine, 61, 1516- 1528.

Hughes, R., Bakos, A., O’Mara, A. & kovner, C. (2005). Palliative wound care at the end of life. Home Health Care Management & Practice, 17(3):196-202.

Leonard, M., Graha, S. & Bonacum, D. (2015). The human factor: the critical importance of effective teamwork and communication in providing safe care. BMJ, 1(1), 1