Reflective Assignment

Clinical skill in which I have become competent in practicing. I will use a

reflective model to discuss how I have achieved the necessary level of
competence in my nurse training programme. The reflective model I have
chosen to use is Gibbs model (Gibbs 1988). Gibbs model of reflection
incorporates the following: description, feelings, evaluation, analysis, conclusion
and an action plan (Gibbs 1988).

I have chosen this as within my first clinical placement this was a widely used
method of drug administration and I became involved in the process of IM
injections.

The first stage of Gibbs (1988) model of reflection requires a description of

eventsI was asked to administer a drug to a patient via IM injection. I had
observed this clinical skill on a variety of occasions and had previously
administered an IM injection under supervision. On this occasion I was being
observed by two qualified nurses, one of which was my mentor. The drug had
been drawn up and was ready to be administered and the patient consented to
have a student administer the injection. My mentor was talking me through the
procedure step by step and informed me that I should use an alcohol wipe to
cleanse the injection site, when the other nurse interrupted and said that this
was not necessary.

I am now going to enter into the second stage of Gibbs (1988) model of reflection, which is a
discussion about my thoughts and feelings. I was aware of being under the supervision of two
qualified nurses and this made me feel very nervous and self-conscious. Once my mentor
questioned my practice, concerning skin cleansing, I became even more aware of feeling
nervous and under pressure. The patient was present and I did not want the patient to feel that
I did not know what I was doing. I thought that as I had been observed carrying out this
clinical procedure on many other occasions then my practice must have been seen to be
correct. I was now feeling very confused about the use of alcohol wipes in the administration
of IM injection. I was also concerned that the practice of the qualified nurses was so
inconsistent, which led me to evaluate the whole process.
Evaluation is the third stage of Gibbs (1988) model of reflection and requires the
reflector to with state what was good and bad about the event. I was aware that
research by Workman (1999) suggests that the use of skin cleansing wipes is
inconsistent and not necessary in IM.

This experience made me think about my attitude towards literature and how it
is applied in practice. Burnard (2002) suggests that a learner is a passive
recipient of received knowledge, and that learning through activity engages all of
our senses.

Stage four of Gibbs (1988) is an analysis of the event, where Gibbs encourages
the reflector to make sense of the situation. I will do this by exploring the skill
and looking at the evidence underpinning it. An IM injection is the administration
of medication into the muscle; there are many reasons why drugs are given via
the IM route (Workman 1999). These include a rapid absorption rate, the
conscious state of the patient, and the drug effect being altered by ingestion
(Mallet & Dougherty 2000, Workman 1999). Workman (1999) suggests there are
four considerations in giving an injection, the site of injection, the technique, the
equipment and the route.

In conclusion, stage five of the Gibbs (1988) model, I am aware that all nurses do not use
evidence in the same way and may use different methods but as long as my practice is safe
and evidence based then I can practice safely. My future practice will depend on the area in
which I am working and I aim to find out the trust protocol concerning clinical procedures
before I commence any procedure
Within my action plan my aim is to research further into the theory of using alcohol wipes in
the administration of IM injections. I am also planning to have a discussion with the qualified
nurses on the subject of skin cleansing.
In conclusion my reflection skills have developed through the production of this essay. Using
a model of reflection has helped me to structure my thoughts and feelings appropriately. My
level of awareness concerning evidence based practice, and its importance, has been
enhanced with the use of critical reflection. My competence, within this clinical skill, has
been further developed and I now feel that my personal and professional development is
progressing. Using this reflective model has helped me to realise that my learning is
something which I must be proactive in. Furthermore as a student nurse I have recognised
that reflection is an important learning tool in practiceUsing a Model of Reflection
Gibbs' model of reflection (1988)
Using a Model of Reflection
When writing your portfolio of practice you will be expected to include a piece of reflection
after each placement. This reflection must relate to situations in your clinical work where you
feel you have learnt something that is of value to your practice and future career. It maybe a
positive experience where something went well or a negative one where you need to think
about what has happened. From each piece of reflection you must identify what you have
learned from the experience and how this relates to the theory that you have been taught or
researched. To help you with this reflection there are several models that might be useful to
help guide your reflection. You can choose any that you feel will help you. You only need to
use one model. The ones that we recommend are the following, however there are many more
in the literature that you might want to use and references are included for some of these.
(Gibbs, 1988)
Johns' model of reflection (1994)
The following cues are offered to help practitioners to access, make sense of, and learn
through experience.
Description

Write a description of the experience

What are the key issues within this description that I need to pay attention to?
Reflection
What was I trying to achieve?
Why did I act as I did?
What are the consequences of my actions?
• For the patient and family
• For myself
• For people I work with
How did I feel about this experience when it was happening?
How did the patient feel about it?
How do I know how the patient felt about it?
Influencing factors

What internal factors influenced my decision-making and actions?

What external factors influenced my decision-making and actions?
What sources of knowledge did or should have influenced my decision making and actions?
Alternative strategies

Could I have dealt better with the situation?

What other choices did I have?
What would be the consequences of these other choices?
Learning

How can I make sense of this experience in light of past experience and future practice?
How do I NOW feel about this experience?
Have I taken effective action to support myself and others as a result of this experience?
How has this experience changed my way of knowing in practice?
(Johns, C. 1994)

References for Reflection and Reflective Practice

If you wish to review other models or find out more about reflection the following references
may help:
Atkins, S. and Murphy, K. (1994) Reflective Practice. Nursing Standard 8(39) 49-56.
Boud, D., Keogh, R. and Walker, D. (eds) (1985) Reflection: Turning Experience into
Learning. Kogan Page New York.
Chesney, M. (1996) Sharing Reflections on Critical Incidents in Midwifery Practice. British
Journal of Midwifery 4(1) 8-10.
Crouch, S. (1991) Critical Incident Analysis. Nursing 4(37) 30-31.
Ghaye, T. and Lillyman, S. (1997 ) Learning Journals and Critical Incidents: Reflective
Practice for Health Care Professionals. Mark Allen Pub. Dinton
Ghaye. T. and Lillyman, S. (eds) (2000) Caring Moments the Discourse of Reflective
Practice. Mark Allen Pubs. Dinton
Ghaye, T., Cutherbert, S., Danai, K and Dennis, D. (1996) Learning through Critical
Reflective Practice. Self Supported Learning Experiences for Health Care Professionals.
Tyne Pentaxion Ltd. Newcastle Upon Tyne.
Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning methods. Further
Education Unit, Oxford Brookes University, Oxford.
Haddock, J. and Bassett, C. (1997) Nurses Perceptions of Reflective Practice Nursing
Standard 11(32) 39-41.
Jarvis, P. (1992) Reflective Practice & Nursing. Nurse Education Today 12, 174-181.
Jay, T. (1995) The use of Reflection to Enhance Practice. Professional Nurse 10(9) 593-596.
Johns, C. and Graham, J. (1996) Using a Reflective Model of Nursing and Guided
Reflection. Nursing Standard 11 (2) 34-38.
Kolb, D.A. (1984) Experiential Learning: Experience as the Source of Learning and
Development. Prentice Hall, New Jersey
Larrivee. B. (2000) Transforming Teaching Practice becoming a Critically Reflective
Practitioner. Reflective Practice 1(3) 293-308.
Maich, N., Brown, B., and Royle, J. (2000) Becoming Through Reflection and Professional
Portfolios: The Voice of Growth in Nurses. Reflective Practice 1(3) 309-324.
Mezirow, J. (1981) A Critical theory of adult learning and education. Adult Education 32(1)
3-24.
Minghella, E. and Benson, A. (1995) Developing Reflective Practice in Mental Health
Nursing through Critical Incident Analysis. Journal of Advanced Nursing. 21, 205-213.
Schon, D.A. (1983) The Reflective Practitioner. Temple Smith: London.