The Driscoll model is one of the simpler reflection models used in nursing practice. It consists of three stem questions: “what?”, “so what?”, and “now what?”, that are meant to represent the stages of the learning cycle (1). Although many practitioners have a natural ability to reflect on their experiences, using a model such as this can still be beneficial for the quality of their work (2,3). Reflection is a popular concept in many fields of education, but it has to be used profoundly to be effective (4,5). The following section is a concise analysis of 2 scenarios from my nursing practice.
As a nurse, I always wanted to provide the best care for my patients. However, in some cases, people would refuse treatment or ask for an alternative that would better align with their values and beliefs. I tried to explain the benefits of the recommended approach and the potential dangers of their decisions, but this only led to conflict. The patient would not listen to most of my arguments, and their responses sounded increasingly irritated. In the end, I would agree with the patient’s decision, as there did not seem to be a way to persuade them. Afterward, the patient would become more distant and less open about their issues.
What? I was having issues communicating with patients when their values did not align with mine. I tended to argue with them about the importance of correct treatment, which did not bring positive results and was unpleasant to the patients.
So what? This has severely hampered the forming of any professional relationships with them and was reducing the efficiency of my work. The negative experience at the beginning affected all our interactions, as the patients did not seem to trust me as much as others did. This was a substantial risk factor, as the patients could choose not to inform me of some issues.
Now what? Now I have learned to respect the patient’s values and decisions while providing them with the help they need. I intend to prioritize their satisfaction above my personal views to ensure that they receive the care they want.
Working as a tissue viability nurse, I regularly tend to people with substantial injuries almost anywhere on their bodies. Frequently, the bruises and cuts put them in a state of constant pain. I try to alleviate the issue with standard means such as painkillers. However, in certain cases, some lacerations or ulcers would cause other sorts of discomfort in addition to pain. These effects are difficult to describe, and standard care did not cope with them effectively. Consequently, the patients who experienced them became dissatisfied, as they felt that they were not treated well enough.
What? In rare cases, patients with severe wounds or ulcers would not feel dignified during treatment. Some overlooked aspects of their lesions would constantly cause them discomfort, thus making them feel neglected.
So what? It appears that these people’s conditions create too much discomfort, to the point when it can become humiliating when not addressed properly. Not devoting special attention to these issues resulted in significantly lower patient satisfaction. This also might have hurt the patient’s trust.
Now what? I make every effort to ensure that my patients do to have to endure any unnecessary inconveniences or pain. I have concluded that it is easier for the nurse and better for the patient to arrange treatment in a way that would eliminate the effects of these relatively minor issues. To do that, I intend to acknowledge and attend to every aspect of the patient’s experience from the beginning. This would allow me to maintain a respectable level of comfort for them and increase their satisfaction.
Gibbs’ reflective model is a flexible framework that allows for different depths of reflection. It is comprised of 6 stages: description, feelings, evaluation, analysis, conclusion, and action plan (1). This method seems to be most effective when used to govern a discussion between a group of students (2,3). The circular nature of the model illustrates the way people are meant to use their action plan when a similar situation arises (4,5). Presented below is a brief analysis of two cases according to this model.
I was placed in a ward with four elderly patients who had some chronic conditions. I have been working with them for several weeks, and we have established a good professional relationship. At the time, the hospital was hiring new doctors, and candidates were invited for interviews. The process also included a tour of the facility, where a nurse would show the applicants our equipment and share some general information about the hospital. During one of those excursions, a nurse entered my ward and told the candidates what conditions my patients had, as well as the treatment they were undergoing. Since I did not know that my ward would be a part of that day’s tour, I was not prepared for the incident. As it was happening, I did not think to stop the other nurse from breaking the patients’ confidentiality. Understandably, the patients were disturbed by the fact that their private information was shared with outsiders.
- Describe: Another nurse was showing some applicants the hospital and revealed to them the conditions of the patients in my ward.
- Feelings: I felt that it was my duty to protect the privacy of the patients, and I failed to do so.
- Evaluation: This was mostly a negative experience, but it provided a good learning opportunity.
- Analysis: The incident happened due to a lack of coordination within the team.
- Conclusion: I have understood the importance of proper communication with my colleagues.
- Action plan: I intend to take a more active approach to defend the confidentiality of all patients.
A patient arrived at my ward; upon reading his file, I noted that he had severe learning disabilities and communication issues. I have discussed the importance of careful communication in such cases with the other nurses, and we decided to use it to calm the patient in stressful situations. During our first encounter, he was quiet and did not display any abnormal behavior, so I began the standard check-up procedure. After a thorough inspection, I intended to tell the patient what his wounds were, explain their severity, and propose a course of treatment for his approval. When I began describing the lesions to the patient, his facial expression changed, and he began to shriek as if my words caused him pain. I immediately stopped talking, but he remained in distress and even began hitting the back of his head against the bed. I have managed to appease him by speaking in a soft and soothing voice.
- Describe: I had a mentally challenged patient with poor communication; he became very distressed when I described his wounds to him.
- Feelings: I felt unsure of what was the right way to talk to the patient.
- Evaluation: I was aware of the patient’s communication difficulties and failed to act accordingly.
- Analysis: Handling this patient was outside my comfort zone, but, as a medical professional, I should have been able to do it.
- Conclusion: I have become more aware of the challenges of working with patients with special needs.
- Action plan: I will now devote more attention to catering to all deficiencies of my patients.
The Taylor model of reflection is another convenient instrument for analyzing one’s professional experiences. It has seven components that correspond with the letters of the word REFLECT, and are meant to help an individual judge their behavior (1,2). Here is an abbreviated analysis of two scenarios according to this model.
I had an elderly patient who often developed ulcers due to his advanced age and chronic conditions. He usually came to the hospital in a poor state, but eventually recovered and went home after a week or two, only to return in a few months. I spent a significant amount of time tending to him, and we always talked while I was changing his bondages or performing other routine tasks. He shared many stories from his life with me, and I felt that we had connected well over the two years he was coming to my ward. One day, he came to the hospital with an unusually grave condition. I did everything possible to ensure his recovery, but he did not get better for over a week, and eventually died in his sleep. When I heard the news, I cried, even though this was not my first patient death, and I can usually control my emotions.
- Readiness: I am determined to reflect on my experience after concentrating in silence.
- Exercising thought: I am thinking about a frequent patient who died recently, causing a strong emotional reaction from me.
- Following systematic processes: I am going to use practical reflection.
- Leaving oneself open to answers: My critical friend suggested that I am most concerned with my unusual response.
- Enfolding insights: It seems that connecting with that patient made me act less professionally when he died.
- Changing awareness: I am now aware that it is not always correct to avoid emotions at work.
- Tenacity in maintaining reflection: I plan to continue reflecting on my emotional reactions to work-related events.
I was working with a car crash survivor, whose hands were injured and burned so badly in the accident, that they had to be amputated. He was a 34-year-old woodworker with a wife and two daughters who died in the collision with a semi-truck. When he first came to the ward, he refused to talk or eat and did not seem to sleep at night because of shock. The next day he began to consume food, but it was clear that he was emotionally traumatized. When I tried to talk to him about treatment, he mumbled incomprehensibly and turned away. Later that day, he said he had nothing to live for because his family was dead, and he could not continue his career without his hands. I did not know how to respond, as his words seemed logical, and the situation was genuinely desperate.
- Readiness: I am prepared to reflect on past my experience with courage and skill.
- Exercising thought: I am thinking of a patient who lost both arms in a car accident and had very little will to live or receive help.
- Following systematic processes: I choose the practical reflection process.
- Leaving oneself open to answers: I am making an effort to remain open-minded in considering this situation.
- Enfolding insights: My critical friend noted that the patient needed emotional support in this desperate situation.
- Changing awareness: I have realized that my responsibility for maintaining a patient’s mental health is as important as physical treatment.
- Tenacity in maintaining reflection: I intend to put increased emphasis on my patients’ feelings in future practice.
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