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In this reflective essay I am going to discuss a learning outcome in which I have become competent to practice. To reflect on my learning outcome I am going to use Gibbs’ reflective model (1988). The Gibbs’ reflective model is a well known and used model in reflective practice. It consists six steps which I will describe step by step as my essay will progress. In the nursing care process it is a responsibility of a nurse to provide holistic care to the patient who is under our care. Our focus is to enable them to cope, prevent, solve or alleviate the problem from which they are suffering and not able to carry out their normal life. Our aim is to help and teach patients how to meet their daily needs in other ways. The learning outcome I have chosen to reflect is PEG feeding which is an alternative way to provide nutrition to a patient who is not able to obtain nutrition through the mouth.
The first step of Gibbs’ reflective cycle is a description of the event. One service user in my placement area whom I will call Mrs. P to maintain her confidentiality (NMC 2008) is suffering from progressive supranuclear palsy, a condition in which as the condition progresses patient losses abilities i.e. Swallowing, speech, maintaining balance, eye movement. As a result of this condition she developed dysphagia and it was not possible to maintain her nutrition via oral intake. Thus, multidisciplinary team and family decided to place her on PEG feeding. PEG tube is more appropriate than nasogastric tube for long term feeding as it avoids delays in feeding and discomfort associated with displacement (National Collaborating Centre for Acute Care 2006). During my placement one of the nurses asks me to go and give her 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 time and as I have seen the condition of Mrs. P. I wasn’t confident to carry out the task. I discussed it with my mentor and we decide that I can take it as a learning outcome during my training to make myself competent with PEG feeding skill.
As I am going into the second stage of Gibbs’ reflective model (1988) in which I will discuss about my thoughts and feelings. When the nurse asked me to give the water via PEG tube, at first I was feeling myself stupid to ask for help thinking that what impression I will make on that nurse. This feeling came into my mind as a result of a thought that I am a registered nurse in my country so I should know this. But I lost my confidence when I went in Mrs.P’s room and observed her condition i.e. Slurring speech, problem with balance, mobility problem and pain in her neck. So I decide to ask the nurse to perform the task and I also observed it. While she was giving her feed, I found that she was coughing a lot and wasn’t comfortable. Which I thought was due to her position and the nurse explained me and justify my thought that it is because of her condition. I was not satisfied with her explanations and as a supervised practice nurse I wasn’t able to oppose her. I decide to read more about the PEG feeding and discussed it with my mentor.
The third stage of the Gibbs’ model (1988) of reflection is an evaluation which requires the practitioner to consider the good and bad things about the event. The patient should be positioned where the patient can sit up as much as possible in a supported midline position (Dougherty and lister 2008) while giving PEG feeding. The nurse who gave feeding didn’t correct Mrs. P’s position as she was in a semi upright position. Furthermore, before starting and at the end of the feeding, she didn’t clean the tip of the tube. The tip of the tube should be cleaned daily with water and a small brush (Loser et al.2005). However, the good practice I observed that nurse informed the procedure to Mrs. P which is important according to the NMC (2008) to make her understand the procedure and give her consent. In addition, to avoid tube adhering to the stoma skin rotate it 360 degree (Bumpers et al, 2003). The other important thing my mentor discussed with me was administration of medication through the PEG tube. According to BAPEN (2003a), never add medication directly to the eternal feed to avoid interaction between medicine and feed and flush the tube after administration to avoid tube blockage. During the discussion about PEG feeding with my mentor I found that other things to consider with PEG feedings are management of the tube, patient position and checks to carry out before feed and it is very important to avoid complications. In my placement area only Mrs. P has got PEG tube. So my mentor discussed with me that there are many indications for PEG tube insertion according to the patient’s conditions so it is important to learn about the specific needs of that patient before performing the procedure. She discussed some scenario cases with me to understand more about it. This helped me to understand different aspects of the PEG tube
The next stage of the Gibbs’ reflective cycle (1988) is an analysis of the event where reflector has to make sense of the event. I will analyze it by exploring the skill and looking into the evidence. The PEG feeding is a method of giving nutrients to maintain an optimal nutritional support (National Collaborating Centre for Acute Care 2006). Clinical trials have proven that there are very rare complications with PEG tubes, such as leakage (Riera et al. 2002). Through evaluation of this event I have been competent to give PEG feeding and care of the tube. The reasons for Mrs. P’s coughing explained by the nurse was from her daily experience working with her which could be right but what I found from the references was different and evidence based. So I learned from experience and through experience (Burnard 2002). It has boosted my confidence to challenge others views regarding my practice.
According to stage five of Gibbs’ model (1988), I conclude from that every nurse does not find the same evidence based reasons for the problem but if I am practicing safe and based on evidence then my practice is safe. In the future I will make sure that I am confident and competent to perform the task and have evidence based explanation of the situations. From this particular learning outcome I have learned about a PEG feeding procedure and the care of the PEG tube
The last stage of Gibbs’ reflective model (1988) is the action plan. My action plan for the future practice is to read more references and literatures regarding PEG feeding. There will be many different conditions regarding PEG tube in my future practice so it is necessary for me to look for more information on this particular subject to make myself excel. I also request my mentor to book me for a study day to learn more about this skill.
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