nursing essay using gibbs reflective cycle

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Gibbs' Reflective Cycle

One of the most famous cyclical models of reflection leading you through six stages exploring an experience: description, feelings, evaluation, analysis, conclusion and action plan.

Gibbs' Reflective Cycle was developed by Graham Gibbs in 1988 to give structure to learning from experiences.  It offers a framework for examining experiences, and given its cyclic nature lends itself particularly well to repeated experiences, allowing you to learn and plan from things that either went well or didn’t go well. It covers 6 stages:

• Description of the experience
• Feelings and thoughts about the experience
• Evaluation of the experience, both good and bad
• Analysis to make sense of the situation
• Conclusion about what you learned and what you could have done differently
• Action plan for how you would deal with similar situations in the future, or general changes you might find appropriate.

Below is further information on:

• The model – each stage is given a fuller description, guiding questions to ask yourself and an example of how this might look in a reflection
• Different depths of reflection – an example of reflecting more briefly using this model

This is just one model of reflection. Test it out and see how it works for you. If you find that only a few of the questions are helpful for you, focus on those. However, by thinking about each stage you are more likely to engage critically with your learning experience.

This model is a good way to work through an experience. This can be either a stand-alone experience or a situation you go through frequently, for example meetings with a team you have to collaborate with. Gibbs originally advocated its use in repeated situations, but the stages and principles apply equally well for single experiences too. If done with a stand-alone experience, the action plan may become more general and look at how you can apply your conclusions in the future.

For each of the stages of the model a number of helpful questions are outlined below. You don’t have to answer all of them but they can guide you about what sort of things make sense to include in that stage. You might have other prompts that work better for you.

Description

Here you have a chance to describe the situation in detail. The main points to include here concern what happened. Your feelings and conclusions will come later.

Helpful questions:

• What happened?
• When and where did it happen?
• Who was present?
• What did you and the other people do?
• What was the outcome of the situation?
• Why were you there?
• What did you want to happen?

Example of 'Description'

Here you can explore any feelings or thoughts that you had during the experience and how they may have impacted the experience.

• What were you feeling during the situation?
• What were you feeling before and after the situation?
• What do you think other people were feeling about the situation?
• What do you think other people feel about the situation now?
• What were you thinking during the situation?
• What do you think about the situation now?

Example of 'Feelings'

Here you have a chance to evaluate what worked and what didn’t work in the situation. Try to be as objective and honest as possible. To get the most out of your reflection focus on both the positive and the negative aspects of the situation, even if it was primarily one or the other.

• What was good and bad about the experience?
• What went well?
• What didn’t go so well?
• What did you and other people contribute to the situation (positively or negatively)?

Example of 'Evaluation'

The analysis step is where you have a chance to make sense of what happened. Up until now you have focused on details around what happened in the situation. Now you have a chance to extract meaning from it. You want to target the different aspects that went well or poorly and ask yourself why. If you are looking to include academic literature, this is the natural place to include it.

• Why did things go well?
• Why didn’t it go well?
• What sense can I make of the situation?
• What knowledge – my own or others (for example academic literature) can help me understand the situation?

Example of 'Analysis'

Conclusions.

In this section you can make conclusions about what happened. This is where you summarise your learning and highlight what changes to your actions could improve the outcome in the future. It should be a natural response to the previous sections.

• What did I learn from this situation?
• How could this have been a more positive situation for everyone involved?
• What skills do I need to develop for me to handle a situation like this better?
• What else could I have done?

Example of a 'Conclusion'

Action plan.

At this step you plan for what you would do differently in a similar or related situation in the future. It can also be extremely helpful to think about how you will help yourself to act differently – such that you don’t only plan what you will do differently, but also how you will make sure it happens. Sometimes just the realisation is enough, but other times reminders might be helpful.

• If I had to do the same thing again, what would I do differently?
• How will I develop the required skills I need?
• How can I make sure that I can act differently next time?

Example of 'Action Plan'

Different depths of reflection.

Depending on the context you are doing the reflection in, you might want use different levels of details. Here is the same scenario, which was used in the example above, however it is presented much more briefly.

Adapted from

Gibbs G (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

Gibb’s Reflective Cycle in Nursing Leadership Essay

Introduction.

In the healthcare setting, nursing leadership plays a critical role in influencing the overall health outcome. The activities involved in patient care are repetitive and tiresome, which sometimes makes nurses exhausted and unable to deliver the best quality services. In such conditions, they require a nurse manager able to inspire and motivate them to work towards achieving the objectives set. To ensure all the processes run effectively in the organization, the leader must reflect on the various encounters to improve the aspect of decision-making and management. By relying on Gibb’s Reflective Cycle, the nurse manager will have the ability to effectively scrutinize experience and establish a proper action plan necessary for better service delivery.

Description

One night at around 11 pm, when I was at home relaxing, I received a phone call from a nurse who was part of the night shift team informing me that other providers refused to attend to the patients. I had already planned the schedule and assigned each of the practitioners their roles (Tawanwongsri & Phenwan, 2019). I was forced to report and assess the situation at the hospital immediately. Several patients did not receive their routine medication, and I had to give it to them despite lateness.

I felt scared knowing how missing medication could worsen the condition of patients. Before I left the healthcare facility, I was confident knowing that I had arranged the night shift program for the providers on duty. The nurse who reported was confused and overwhelmed with duties during the situation. The scenario made the majority of the patients feel that care services were not properly given. During the phone call, I thought most sick individuals would be reactive due to poor services. Later I asked the nurses why they did not attend to the patients, and they said they were tired.

The occurrence made some of the patients change their medication to enable them to reverse the condition. The incident made me understand the value of motivation to staff workers and how it affects their performance (Markkanen et al., 2020). When I arrived, I found the active nurse had given the majority of patients their evening doses. As the nurse manager, I convinced and promised the providers to go slow and better working conditions to improve their participation.

Work burnout is a serious issue in the healthcare setting, and it is upon management to formulate effective ways to manage it. Without proper motivation, providers are more likely to become unresponsive (Dall’Ora et al., 2020). From the incident, I realized that it is important to cater to the well-being of nurses to keep them inspired. Nurse leaders should always be within the facility to intervene immediately in case of such situations.

If I had acted before to motivate the nurses either through a balanced work schedule or other benefits, the incident would not have occurred. It is now clear to me that I failed to act on my capacity to create proper working conditions to prevent work stress that limits providers’ participation. I have realized that as a leader, I must support and ensure nurses’ needs are met to enable them to remain active and ready to work.

Based on the incident, I will ensure to motivate and engage staff members by inquiring about the challenges they are facing that might hinder their service delivery. Such involvement will allow me to prevent the occurrence of such situation that risks the lives of patients. I will further establish a proper routine so professionals have adequate time to relax and refresh their minds to lower issues of burnout.

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review . Human resources for health , 18 (1), 1-17. Web.

Markkanen, P., Välimäki, M., Anttila, M., & Kuuskorpi, M. (2020). A reflective cycle: Understanding challenging situations in a school setting . Educational Research , 62 (1), 46-62. Web.

Tawanwongsri, W., & Phenwan, T. (2019). Reflective and feedback performances on Thai medical students’ patient history-taking skills . BMC medical education , 19 (1), 1-8. Web.

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IvyPanda. (2024, March 11). Gibb’s Reflective Cycle in Nursing Leadership. https://ivypanda.com/essays/gibbs-reflective-cycle-in-nursing-leadership/

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Nursing Reflective Models - Guide

As you undertake your nursing studies, you must reflect on your experiences, encounters, and practice in the workplace or the entire course. For this, you will use various reflective models. Models of reflection help you to systematically organize and critically reflect on your practice as a nursing student and are meant to guide your decision-making process. In addition, you will find them helpful in your personal and professional life as a nurse practitioner. You can apply these models in your nursing reflection essay.

Below, we explore some of the most common nursing reflective models in this guide to help you understand the different approaches to writing reflection essays. In addition, we offer such services if you need professional assistance writing your reflective essay. Check out our services section. But first, get solid with the specific reflective model, framework, or tool to adopt for your nursing reflective essay.

Gibbs' Reflective Cycle

The Gibbs' reflective cycle was developed by Graham Gibbs in 1988 to structure learning from experiences.  Gibb's model  is a cyclic process that allows a person to examine their experiences repeatedly to learn and plan from what went right and wrong.

The famous cyclical model of reflection has six stages that explore an experience: description, feelings, evaluation, analysis, conclusion, and action plan. Let's look at each separately in brief.

• Description. Here, you should describe what happened without judging or concluding anything. When undertaking this step, you need to ask yourself:
• What happened?
• When and where did it happen?
• Who was present?
• What did you and the other people do?
• What was the outcome of the situation?
• Why were you there?
• What did you want to happen?
• Feelings. This step entails describing your reactions and emotions. Here are some guiding questions for this step:
• What were you feeling during the situation?
• What were you feeling before and after the situation?
• What do you think other people were feeling about the situation?
• What do you think other people feel about the situation now?
• What were you thinking during the situation?
• What do you think about the situation now?
• Evaluation. Here, you weigh in or make value judgments on what was good or bad about the experience. Here are some questions to guide you through this step:
• Analysis. Here, you have to analyze the situation to determine if there were similarities or differences in the experience. Then, you will make sense of the situation. Here are some questions to ask yourself as you draft this section:
• Conclusion. Here, you detail the conclusions you can draw from the experience and your analysis. Ensure to include the specific conclusions you can draw about the unique personal encounter or way of working.   Explain what you could have done differently and why. Ask yourself:
• Action Plan.  In this section of your essay, you must explain the steps you will take based on what you have learned. You should explain how you will approach the situation differently and provide a rationale. Questions to ask yourself:

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Dewey's Reflective Thinking Model

According to John Dewey, reflective thinking is an active, persistent, and careful consideration of a belief or supposed form of knowledge of the grounds that support that knowledge and further conclusions to which the knowledge leads. He believed that through active, reflective thinking, learners could assess what they know and need to know and how to bridge the knowledge gap.

Dewey's reflective thinking model has been a foundation for many models that are used today. Below are the steps for reflective thinking as per the model:

• Identifying and defining the problem
• Analyzing the problem.  You investigate the issue in-depth.
• Determining the criteria.  Come up with criteria to address the issues.
• Brainstorming on possible solutions.  Evaluating the potential solutions to solve the problem.
• Organizing ideas.  Selecting the best solution or a combination of solutions.
• Accepting the solution.  Testing, evaluating, and implementing the solution.

Kolb Reflective Model

David Kolb introduced the four-step Kolb's learning cycle, an approach to reflection. It is slightly different because it sites reflection as part of a wider set of processes where a learner (nurse student, nurse educator, nurse leader, or nurse practitioner) is on a journey of discovery to understand their working processes as they undertake different stages of engagement with events, occurrences, or training sessions. It is an experiential model of reflection that assigns higher value to the role of experience in learning.

Kolb's cycle has four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation.

• Concrete experience.  A person encounters a concrete experience, which is the basis of reflection. Therefore, you must describe the situation or experience when using this model. You can also describe a representation of existing experience given new concepts.
• Reflective observation.  Here you critically weigh in on the new experience given your knowledge or existing knowledge. You have to spot the inconsistencies between experience and understanding.
• Abstract conceptualization.  Here, you develop a new idea or modification of an existing abstract concept. You will share what you have learned from the experience. You generate ideas, steps, behaviors, or approaches to address the situation or experience.
• Active Experimentation.  You apply the new ideas and concepts to the world around you to see what changes occur. You test and experiment on the applicability of the new knowledge, steps, policies, behavior, or approaches.

Atkins and Murphy's Model of Reflection

Atkins and Murphy's reflection model was developed in 1993 specifically for nursing practice. The model is based on the premise that nurses face various challenging situations. Further, the model is based on the idea that people find it challenging to think about their uncomfortable experiences but can reflect on such events and find insights when faced with similar situations in the future. Finally, it is also a circular model that has 5 stages:

• In this step, a person gains knowledge or awareness about the triggers that have caused them discomfort. The step entails identifying one's thoughts and emotions that have resulted from the experience. You have to open up and express yourself to become vulnerable to identify the discomforts. When you analyze your personal feelings and thoughts, you can make improvements. At this stage, ask yourself:
• What affected your emotions?
• What were you thinking?
• What were your emotions after the situation occurred?
• What are you thinking now when you look back on the situation?
• Describe the situation.  In the second step, you then describe the situation. Critically describe the setting, the events, and the entire situation. You can use these questions to guide you:
• What was the event?
• Where did it occur?
• When did it occur?
• What was your involvement during the event?
• What did other people do?
• What were the key observations you made?
• Analyze feelings and knowledge.  In the third step of the Atkins and Murphy model, you analyze your assumptions. Next, you must assess your knowledge as an active reflective practice participant. Record your mindset, perspective, or attitudes before the event transpired. You also have to explore the alternatives, where you explain what you would have done differently given the circumstance. To do this step better, ask yourself:
• What did you know already about the situation?
• What were your assumptions or beliefs about the situation?
• How did the reality reflect your assumptions?
• What were the differences?
• How would you react if something else happened?
• In what types of scenarios would the discomfort not occur?
• Evaluate the relevance of knowledge.  This step entails a personal assessment of how the knowledge of the previous step is relevant in explaining the problem. First, you must assess how the problem could be solved or averted. Next, you should identify different scenarios and potential behavior that should be adopted in similar situations. Ask yourself:
• How does it help to explain the situation?
• How did analyzing the different scenarios influence your thoughts?
• How complete was your use of knowledge?
• How can knowledge be useful next time?
• Identify any learning.  The model assumes you have identified learning based on the last four steps. In this step, you integrate emotions, situations, assumptions, lessons learned, and knowledge gained. Ask yourself:
• What have you learned?
• How can you apply what you have learned to future situations?

CARL Framework for Reflection

You can write your reflective essay using the CARL framework for reflection, which entails four steps:

• Describe and contextualize the experience so your readers understand where it occurred and what occurred.
• Explain the actions that you took when the issue occurred.
• Detailing what your actions led to. What happened after you took some action? What went right, and what went wrong?
• Identify and explain the experience and knowledge you have gained from experience. How will you apply the lessons learned in the future? Is the information valuable in your future practice? How and why?

The 5R Framework for Reflection

You can also select the 5R framework when writing your nursing reflection essay. The steps entail five stages that address each aspect of your reflective process. When you systematically go through the stages, you can reflect on an experience or encounter and report the knowledge gained.

1. Here, you describe the scenario or situation. Record your insights on the situation. You can ask yourself:

• What do you think is happening?
• What works well and what does not?
• How do you feel about the experience?
• What specific thing about the experience makes you feel how you are feeling?

2. In this step, you must relate your perceptions of the situation to your professional and personal experiences.Record your perspectives and point of view of the experience. Finalize by evaluating whether you must pursue professional development to gain knowledge to address the situation.

3. In this step, you have to relate to someone else's point of view and how it affects how you react to the situation. Also, check the policies, steps, and guidelines that support your approach and consider the different approaches you could have used. Finally, reflect on how you understand the issue and if other points of view would suffice.

4. Weigh in on what you learned, the knowledge you gained, and how it will affect your future practice.

Driscoll Reflective Model

The Driscoll model of reflection entails three questions whose answers drive the reflective process in nursing. The questions are:

These three stem questions are connected to stages of experience learning cycles and have trigger questions that one answers to complete the reflection cycle. John Driscoll developed the model in 1994, 2000, and 2007. Answering the three questions enables an individual to analyze and learn from experiences.

In  Step 1 (What? ), you must recall and objectively describe what happened in plain and simple terms. You don't have to engage in any criticism yet. Next, you provide the context of the event or experience. The trigger questions for this step include:

• What exactly took place?
• What did you do? Or what was your reaction?
• Was there anyone else involved? If yes, who?
• Was it a good or bad experience? Explain briefly

In S tep 2 (So What?),  you need to look for patterns of meaningful moments. Here, you undertake a structured reflection. Some of the guiding questions for the second step include:

• How did you feel during the event, encounter, or experience?
• What was your reaction and why?
• Did you feel the same about the situation then as you currently do?
• Do you think the past occurrences influence your experience during the situation?
• Did you experience conflicts with your personal values?
• Who else was involved? What was their role, and how did they feel? What was their reaction and why?

In  Step 3 (now what?),  you need to complete your structured reflection by noting what you have learned and how that will help you in future and in other contexts. You must demonstrate knowledge transfer.

Some of the questions to trigger this step include:

• What did you learn from reflecting on the incident, encounter, or experience?
• Could you have done things differently to avert the negative consequences? How?
• What would you do differently if the situation reoccurs in the future?
• What could you have done to prepare for the situation?
• Where did things go last time, and what is your focus going forward?

This reflective framework is straightforward. You can use it to reflect on your leadership experiences, ethics class, MSN, BSN, DNP program, NCLEX examination, etc.

Bass's Holistic Reflection Model

The Bass model of Holistic Reflection is a highly effective and structured model of reflection. It helps learners to delve deeper into their experiences and derive meaningful insights.

The main rationale of the Holistic Reflection Model is that learning is not just about acquiring knowledge. Rather, it also entails internalizing and understanding lessons from personal experiences. It is a model mainly grounded on transformative learning that can be achieved through reflection, critical reflection, and reflexivity. The model has six main phases, as discussed below:

• Self-awareness. Here, the learner is encouraged to maintain an open mind and capture emotions, thoughts, or responses during the experience. You should also identify the present state, including the current thoughts and feelings, as they can influence your perception of events.
•  Description. In the description phase, you (the learner) should offer a detailed factual description of the experience that you are reflecting on. Here, you should describe the experience you are reflecting on without analyzing it.
•  Reflection. Here, you should explore the thoughts, feelings, assumptions, and actions of others and self in greater depth and breadth. To develop a critical reflection, you should also examine the underpinning beliefs, assumptions, and values related to the experience. You should reflect on personal influence during the experience to get a deeper connection and engagement that enables you to make sense of the experience.
•  Influences. In this phase, you draw on diverse ways of knowing to explore the experience holistically. You should use your current level of knowledge and experience to explore what happened and what factors contributed to the outcome through diverse lenses. You can use Davis-Floy’s holistic paradigm or Carper’s Patterns of Knowing. As your knowledge grows, you develop a capacity for critical reflection.
•  Evaluation. In this phase, you should engage in evaluating the process. Your focus should be on objectively stepping back from the event and critically analyzing the aspects of the experience that went well or those that resulted in undesired/unexpected outcomes. The information you get can be used to anticipate strategies to do things differently in the future by applying a solutions-focused approach. As you reflect critically, you draw from multiple ways of knowing by questioning assumptions, analyzing power, pursuing emancipation, and maintaining a social focus. You are now ready to integrate your experience holistically into solving future occurrences through reflexivity.
• Learning . In phase six, you undergo transformational learning. You have to synthesize and integrate the evidence reviewed during the reflective process. You should identify what you have learned about yourself and others from your in-depth reflection on the experience. You should identify and record the changes in perspective and perceptions you underwent as you reflected on the situation/experience. This stage deals more with identifying how you translate what you have learned to practice so that you become a reflective practitioner.

You can read more about this model here: Bass, J, Fenwick, J., & Sidebotham, M. (2017). Development of a model of holistic reflection to facilitate transformative learning in student midwives.  Women and Birth ,  30 (3), 227-235. doi:10.1016/j.wombi.2017.02.010

Schon Reflective Model

Another critical framework for reflexive practice in nursing is the  Schön reflective model . The model was developed by Donald Schön, explaining how professionals can solve problems through reflection in action and reflection on action.

Reflecting in action means experiencing, thinking on your feet, thinking about what to do next, and acting immediately.

On the other hand, reflecting on action means thinking about something that has happened, thinking of what you would do differently next time it happens, and taking your time.

So, the model entails reflection during and after the event or experience. For example, if you are in a class, you might notice that you are distracted by thoughts of a weekend camping trip. Although you want to get the most out of the class session, you can only do so by finding a way to focus. You finally decide to take notes as your instructor teaches. This entire process is a reflection in action.

After the lecture, you notice that you cannot remember what was covered, so the most appropriate thing you do is to find the topic in advance, write questions you need answers and clarifications on, make notes during the lecture to maintain focus, arrange for a consultative meeting with the lecturer and talk to your peers about what was taught to help you form your opinions. You then file the notes and handouts. The second step is reflecting on the action.

Schon believes that professionals must think about their actions while at it, stressing that leaders should use their past experiences to address new conditions or scenarios.

Rolfe’s Reflective Model

Rolfe's reflective cycle is very similar to the Driscoll model of reflection. It is also based on three questions: What? So what? Now what?

The first step entails describing the event and defining your self-awareness. The second step of the Rolfe cycle analyzes the situation and evaluates the circumstances or issues being addressed. Finally, the last step entails a comprehensive synthesis of information and insights from the two steps so that you acknowledge learning and knowledge transfer in readiness for future occurrences of the same event.

Find out more about  Rolfe's reflective model ; an example includes (link to external website)

Brookfield's Reflective Model

Unlike other types of reflection models, Brookfield’s takes a different stance. It promotes the use of reflection in teaching. It proposes considering reflection from four different perspectives:

• Our standpoint (Autobiographies)
• Learners’ standpoint. (Students' eyes)
• That of our colleagues. (Colleagues’ experiences).
• Relationship to wider theory. (Theoretical lens)

Our Standpoint

This involves teachers looking at their own past life and current experiences and their reactions regarding them. This model calls for a thorough inventory and not just a re-assessment of the moment.

Learners’ Standpoint

When some insights might have been missed during self-reflection, Brookfield’s model calls for learners’ perspectives. It involves looking at learners' work, grades, and feedback to gain new insights. Other elements that might be considered include Survey and questionnaire data on the quality of teaching and classroom experience.

Colleagues’ Experiences

A further form of reflection involves going beyond the delf and learners' perspectives and looking at things from colleagues' or peers’ perspectives. Peers’ perspective can reveal a lot of things you might have missed, such as biases and assumptions in one’s teaching style.

Theoretical lens

This model calls for the need to consult literature to understand how to improve the quality of teaching and promote professional development.

Johns's Model of Reflection

This model emphasizes the importance of guided reflection. Johns's model of reflection was developed on the belief that reflection is essential in professional development and improving patient care. It consists of three main stages: description, reflection, influencing factors, what I could have done better, and action.

Description- In this stage, an individual goes into detail about the experience they are reflecting upon. It entails providing details such as what happened, who was involved, and any other relevant information that will provide context.

Reflection- this phase is about reflection itself. It involves asking questions to help you explore thoughts, feelings, and emotions about your experience. You must critically examine your actions, attitudes, assumptions, and other people’s perspectives to understand the situation more deeply.

Influencing factors- what factors led to the event occurring? Talk about factors that influenced your decision-making process, sources of the knowledge gained, and the sources you consulted.

What could I have done better- This is about identifying areas of improvement based on the particular experience.

Action- This last stage focuses on implementing the right actions for future improvement. It involves considering alternative approaches and developing strategies to address any new issues. Additionally, you also have to develop personal and professional development goals.

Tips for Choosing the Suitable Reflective Model or Framework

As you can see above, many reflective models are used for your reflective essay. We have not exhaustively listed and expounded on all of them. Other reflective models and frameworks you can also consider when writing a reflective essay in nursing include:

• Bouds Reflective Model
• The Johari window model

Note that most nursing instructors will often suggest the models they prefer for you to use in your essay. For example, in most nursing reflective essays. Whichever the case, readily available information expands on each model to make it easier to write a reflection essay on a specific aspect of nursing education or practice. Read the assignment rubric and instructions to understand the specific model. If it is unclear, ask for clarification from your instructor early enough.

Final Word on Models of Reflection in Nursing

Models of reflection in nursing are essential components of learning. They provide nurses with different approaches for analyzing and evaluating their experiences. These reflective practices not only enhance professional growth but also improve patient care. As a nursing student, it is important to understand and know how to apply the different models of reflection so that you can experience the key experiences that sparked your interest in nursing.

At NursingMyGrade.com , Our tutors can guide and help you understand these models. We also have a team of qualified writers who can help you tackle difficult nursing assignments. All you have to do is place an order , and we will get to work.

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Nurses and Midwives Reflection Process

Nurses and Midwives in the UK are formally required to record 5 pieces of reflection on either continuing professional development (CPD) or practice related feedback to improve their nursing practice.

Here I start with the theory of reflection (see Framework image) and then give an example from my own nursing history of an awful incident – one I will never forget.

If you don’t want the theory (and let’s face it who does?); scroll down to my real-life example and see how I have applied the Gibbs theory model to a terrible incident which almost made me give up nursing.

Let’s Get Started

To see if Gibbs reflective cycle can help you reflect on aspects of your practice, recall a nursing situation that didn’t turn out as you expected or go to plan.

Look at the Gibbs Model flow chart above –

Stage 1 – Description (Pure Facts)

The first step is to describe what you know. Ask yourself the following questions:

• What are the brief facts of the situation?
• What occurred? Who was involved?
• What did you do? What did others do?

Stage 2 – Description – (Feelings)

• How were you feeling at the time?
• Were there influences affecting others actions/behaviour?
• Were there any known or perceived difficulties with the activity, timing, location, information or resources etc.?

Stage 3 – Evaluation

• What was good and bad about the experience
• How might the facts and feelings (from stage 1 and 2 above) have affected your actions/behaviour
• What other circumstances may have affected your actions or thoughts?
• How issues might influence the activity or practice related feedback?

Stage 4 – Analysis

• Why you picked this incident to reflect on?
• What sense can you make of it? Does it make sense given the preceding 3 stages?
• What is the main area of concern or focus on the future?

Stage 5 – Conclusions

• What have you discovered?
• What have you learned from this incident and circumstances?
• What questions remain?

Stage 6 – Now What? (Action)

You have analysed the incident and want to make sure you improve your practice for next time, so need to move into the action planning stage:

• What will I do differently from now on or the next time this arises?
• What resources/help will you need?

Gibbs, (1988) Learning by Doing: A Guide to Teaching and Learning Methods Further Education Unit, Oxford Brookes University, Oxford.

Example Reflection –  Sadly, a real story!

Night duty drug round.

I am a third-year student nurse ‘in charge’ on night duty, in a London hospital, with a junior nurse to deal with 23 pretty sick people in this medical ward.  A doctor asked me to give a patient (Mrs X,) 0.1 mg of Digoxin (a heart stimulant – steady, slows and strengthens the heartbeat) to relieve symptoms of severe congestive cardiac failure and difficulty breathing.  I had never given such a high dose of Digoxin before and measured 4 tabs from the 0.25 mg bottle.  I checked the script and the tablets with both the doctor, who nodded, and my junior nurse. We were all in agreement. I checked Mrs X’s pulse rate (standard practice for Digoxin), which was in the OK range, before giving the tablets. I kept Mrs X on hourly observations after.

At about 2 am I suddenly realised I had given 10 times the amount of Digoxin as stated on the Doctors script.  In horror, I called the night sister who agreed with me.  We filled in an incident form, informed the doctor and Mrs X’s relatives of what happened. Petrified, I was told to go see the hospital matron in the morning.

Mrs X did not seem to suffer any ill effects from the Digoxin during the night and went on to make a full recovery.

I had been on nights for a long stretch.  It was a very busy ward with only two-night staff and I was “in charge”.  Mrs X was very ill and needed constant monitoring.

I had only ever seen 0.25mgs of Digoxin tablets and did not know there was a paediatric blue table of 0.1 mg made.  I was very reluctant to give such a big dose which is why I checked the four tablets of .25 with the doctor who looked at the tablets and said OK.  I was nervous about the dosage being so high and took Mrs X’s pulse for much longer than the customary 15 seconds.

The doctor too was under tremendous strain, his beeper kept going off and he was rushing about all over the place.  I had never met him before.  He had recently come from a paediatric ward.

Nobody ever blamed me for the incident, neither did they reassure me.  Mrs X went on to make a full recovery and the relatives were very understanding about the situation which was a relief.  Matron was kind to me and impressed I had owned up to the error – nobody would have ever known, she said.

I felt absolutely terrified about the error though and watched Mrs X all night for signs of overdose.  I didn’t sleep all the next day and returned to my next night shift to find Mrs X better.

This incident really frightened me because I had done everything right – I had checked the dosage with both the Doctor and the junior nurse.  I had not known that you could get a 0.1 mg of Digoxin or it was blue.  I have no idea what prompted me to think about the overdose later on that night except that I had been very reluctant to give it.  The Doctor agreed I had shown him 4 white tablets who said “I thought you knew what you were doing” Which isn’t any sort of answer really.  Yet he didn’t get in trouble (like me) at all for overseeing and agreeing my mistake.

I also realised how dependant patients are on the care and insights of the medical profession and the trust they put in us; I’d let Mrs X down.

I believe that this incident was down to a series of incidents linked to overwork, tiredness and misunderstandings. Plus if I’d known the Doctor better I might have had a conversation about the dose.

I was so relieved that Mrs X survived the overdose and the relatives were understanding but, if she had a serious reaction or even died, I’m not sure I could have carried on nursing.

I have learnt to be more careful with drugs and to really understand the dosage.  If necessary now I will look up the drug in the reference books before I give them because it is my responsibility if I do it wrong.

I will always be ultra-careful with new drug scripts in the future and if I am nervous, then to go with my gut feeling and check and check again. Although, as I said to Matron, at the time I’d felt as if I done as much as I could have.

Also, if nurses in my team are involved in incidents where they have made a clinical mistake, I am always on hand to offer support and give them an opportunity to talk to me.

I never want another nurse to go through what I went through alone and I definitely do not want to harm anyone in my care.

Linked to NMC Code of Practice 14 – “Preserving Safety”

Further information.

• British National Formulary (BNF)  the drugs’ bible in the UK, available online with a subscription

Other of my real stories here:

• For a second applied reflection example, see my blog about My Infographic Mistake
• For a third reflection see Dog Walking

I have also published a workbook for nurses where you can see the model and have space to add your own private stories. Available on Amazon With over 400 great reviews.

Thanks for reading and good luck in your career. J

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