In this reflective essay I will discuss a learning outcome in which I have become competent to apply. To think about my learning result I will use Gibbs' reflective model (1988). The Gibbs' reflective model is a favorite and used model in reflective practice. It is made up six steps that i will describe step-by-step as my article will progress. In the nursing good care process this is a responsibility of the nurse to provide alternative care to the individual who is under our treatment. Our emphasis is to allow them to deal, prevent, solve or ease the problem from which they are suffering and not capable of perform their normal life. Our aim is to help and instruct patients how to meet their daily needs in different ways. The learning end result I have chosen to mirror is PEG feeding which is an alternative way to provide nourishment to a patient who is unable to obtain diet through the oral cavity.
The first rung on the ladder of Gibbs' reflective circuit is a explanation of the function. One service consumer in my placement area whom I'll call Mrs. P to maintain her confidentiality (NMC 2008) is experiencing intensifying supranuclear palsy, a disorder where as the problem progresses patient deficits abilities i. e. Swallowing, speech, maintaining balance, eye movement. Because of this condition she developed dysphagia and it had not been possible to keep her diet via oral consumption. Thus, multidisciplinary team and family decided to place her on PEG feeding. PEG pipe is appropriate than nasogastric pipe for permanent nourishing as it avoids delays in feeding and uncomfortableness associated with displacement (National Collaborating Centre for Acute Good care 2006). During my placement one of the nurses asks me to look and present her drinking water through the PEG tube. Although I did it before in my country I was familiar with it but I didn't practice for a long period and as I have seen the condition of Mrs. P. I wasn't confident to handle the task. I mentioned it with my coach and we decide that I can take it as a learning result during my training to make myself proficient with PEG feeding skill.
As I am going in to the second stage of Gibbs' reflective model (1988) in which I will discuss about my thoughts and thoughts. When the nurse asked me to give this particular via PEG pipe, at first I had been feeling myself stupid to require help convinced that what impression I will make on that nurse. This feeling arrived to my mind as a result of any thought that I am a registered nurse in my country therefore i should know this. But I lost my assurance when I travelled in Mrs. P's room and noticed her condition i. e. Slurring conversation, problem with balance, mobility problem and pain in her throat. So I opt to ask the nurse to perform the duty and I also witnessed it. While she was giving her feed, I came across that she was coughing a whole lot and wasn't comfortable. THAT I thought was due to her position and the nurse explained me and justify my thought that it's because of her condition. I was not satisfied with her explanations as a supervised practice nurse I wasn't able to oppose her. I opt to read more about the PEG nourishing and discussed it with my coach.
The third stage of the Gibbs' model (1988) of representation is an analysis which requires the specialist to consider the good and bad things about the event. The patient should be located where the patient can be seated up as much as possible in a reinforced midline position (Dougherty and lister 2008) while providing PEG feeding. The nurse who gave feeding didn't appropriate Mrs. P's position as she is at a semi upright position. Furthermore, before starting and at the end of the feeding, she didn't clean the tip of the pipe. The tip of the pipe should be washed daily with normal water and a little clean (Loser et al. 2005). However, the good practice I observed that nurse enlightened the task to Mrs. P which is important based on the NMC (2008) to make her understand the task and give her consent. Furthermore, to avoid tube adhering to the stoma pores and skin rotate it 360 degree (Bumpers et al, 2003). The other important things my mentor discussed beside me was supervision of medication through the PEG pipe. Matching to BAPEN (2003a), never add medication right to the eternal feed to avoid interaction between medication and feed and flush the pipe after administration to avoid pipe blockage. During the discussion about PEG feeding with my coach I found that other activities to consider with PEG feedings are management of the pipe, patient position and investigations to carry out before feed and it is very important to avoid complications. In my positioning area only Mrs. P offers PEG pipe. So my coach discussed beside me that there are many indications for PEG pipe insertion according to the patient's conditions so it is important to find out about the precise needs of this patient before executing the procedure. She talked about some scenario conditions with me to understand more about any of it. This helped me to comprehend different aspects of the PEG tube
The next level of the Gibbs' reflective routine (1988) is an analysis of the event where reflector must make sense of the function. I will evaluate it by checking out the skill and looking at the data. The PEG feeding is a way of giving nutrients to keep up an optimal healthy support (Country wide Collaborating Centre for Acute Health care 2006). Clinical tests have proven that there are extremely rare problems with PEG pipes, such as leakage (Riera et al. 2002). Through evaluation of the event I have been competent to give PEG feeding and treatment of the tube. The reasons for Mrs. P's coughing described by the nurse was from her daily experience working with her which could be right but what I came across from the referrals was different and data based. THEREFORE I learned from experience and through experience (Burnard 2002). It has boosted my confidence to issue others views regarding my practice.
According to level five of Gibbs' model (1988), I conclude from that every nurse does not find the same information based known reasons for the situation but if I am exercising safe and predicated on facts then my practice is safe. In the foreseeable future I will make sure that I am self-confident and competent to execute the task and also have evidence based description of the situations. Out of this particular learning results I have learned all about a PEG nourishing process and the health care of the PEG tube
The last stage of Gibbs' reflective model (1988) is the action plan. My action plan for the near future practice is to read more recommendations and literatures regarding PEG feeding. There will be numerous conditions regarding PEG pipe in my future practice so it is necessary for me personally to look for more information on this particular at the mercy of make myself stand out. I also ask my mentor to reserve me for a study day to find out more on this skill.
