The Use of The Jewish Home for The Elderly to Evaluate The Gibbs Cycle

For my first clinical experience, for approximately six hours I worked with my peers at the Jewish Home for the Elderly. Using the Gibbs cycle I describe my clinical experience, talk about my feelings before, during, and after the clinical, evaluate, analyze, and finally conclude on my clinical experience.

Working at the Jewish Home for the Elderly for my clinical placement, the patients I encountered were aged and mostly had some sort of physical or mental disability. The nursing home itself had a building layout very similar to a hospital floor, with a central nursing station, water and ice machine, medicine carts, and a giant poster of the Patient Bill of Rights. According to Mody (2007), nursing homes for the elderly face different risks toward health than the typical hospital environment. Although I have visited nursing homes before, going into a nursing home as a student nurse with the intent of actually caring for patient made this experience especially unique. Based on I had learned in geriatrics and in Mody (2007), maintaining proper infection control was very important in this environment, as elderly people are more susceptible to contracting diseases and have fragile skin. The patient that I worked with had a CVA with left hemiparesis, meaning she was paralyzed on her left side of her body after having a stroke. Typical among the elderly, she also had polypharmacy, taking many drugs together, both prescription and over-the-counter. Due to her left sided paralysis, I was tasked with assisting with her bed bath, which she needed much help with. She also asked very much about the OTC and prescription medication. My patient, despite her current condition, was still very cooperative and glad to have company, and made my first clinical experience easier on my anxiety and enjoyable.

Prior to the experience, I felt very overwhelmed and uncertain of what I would experience at my first clinical. I was thrilled to utilize the practical skills I learned in lab, especially taking vitals. However, although I am comfortable with talking with strangers, I was nervous about staying calm and professional while performing any needed skills efficiently and properly

Despite my initial fears and anxiety toward the approach of my clinical date, once I started and worked during my clinical, I felt more comfortable implementing my skills with the very cooperative patients. According to Holland (2012) 55% of communication between patient and nurse is nonverbal. Therefore, I tried to maintain a positive posture, such as standing straight, not crossing my arms, as well as assisting patients to the best of my ability without giving false reassurance or answers, for which I would let the RN know of their needs. The Jewish Home resemble more like a hospital environment than the assisted living environment that I had seen before, the hospital-like environment made finding materials such as gloves and towels, as well as the nursing station and papers a lot easier. Hand sanitizing stations were easy to find and on every hallway, and there was a giant poster of the patient bill of rights.

After finishing my clinical experience, I walked away with a more confident and assured mentality toward my competence as a student nurse. With the advice and constructive criticism of the RN and the senior nurse assisting with clinical, I was able to implement my skills as well as receive feedback. I felt more able to handle with real people when it comes to practical nurse skills and look forward to do so again.

During clinical, I felt I was successful in talking with patients with a comfortable and professional manner, and maintaining proper infection control by remembering to sanitize my hands when needed. I was able to find radial and brachial pulses, and was able to measure pulses. I learned and was able to, with help, give a bed bath to my patient, who had a stroke was paralyzed on her left side, and needed much assistance.

When I took vitals, I sometimes forgot to take the patient’s respiratory rate, during which either my partner or the senior nurse would have taken it in case I forgot. I was so focused on taking vitals correctly that I can’t believe I missed one. When I did remember to take respiratory rate, I was not sure what to do when the patient was very conversational.

Toward the end of clinical, I thought that based on what skills we had learned and the clinical objectives that by performing the learned skills, getting the constructive criticism and advice from my peers and RN, and going through patient MARs that I was able to get a glimpse of the nursing experience. As I had expected prior to clinical, I took vitals, learned more about geriatric care, and experienced working with actual, real life patients with legitimate physical or mental disabilities. The only thing I thought I lacked from the experience was taking manual blood pressures.

In retrospect to my clinical experience, the mistake I believe was the most erroneous was my failure to record respiratory rate consistently. Unlike the speechless manikins that remain mute and still during lab, the patients at the Jewish Home are lively and communicable. Therefore, adjusting to taking vitals of someone moving, talking, and breathing was opportunistic, as well as a challenge. Respiratory rate was difficult for me to measure as the patients I took care of loved to talk. As it was my first time taking vitals of someone who can respond, I did not want to tell them to stop talking, out of respect, but I also needed to measure an important vital sign.

Things that well during my clinical experience included being able to find and record pulses, finding brachial pulse for blood pressure cuff placement, and other vitals. I had attempted in the past with not as much success to find brachial pulses, but at my clinical I was more successful finding brachial pulses prior to recording blood pressure. I also believe my experience with giving my patient a bed bath very successful. Even with her left side completely paralyzed, the patient was still very helpful and cooperative during the whole process; and her sense of being comfortable of us washing her made me feel not as anxious cleaning her as well. Throughout the whole process of rinsing, cleaning, drying, changing adult diapers, putting on her clothes, and fixing the bed for her comfort, I understood the importance of collaboration and teamwork as defined in the QSEN competencies as assistance from my peers made the procedure more efficient and the patient more comfortable.

I believe I learned much about myself from my clinical experience. I have noticed that I was able to remain calm and mature during intimate procedures with the patient, especially the bed bath (I have never seen a naked woman before). I found myself to be very curious and asked many questions to ensure understanding of what I was doing, which is something I did more in class. On the other hand I realized that my one of my weaknesses is my anxiety and how the patient can easily tell I’m nervous. I realized that if I look nervous, it may cause uneasiness in my patient as well. I also noticed that I need to be more aware of my environment, and be more focused.

Regarding my current knowledge and level of practice, I realized that I have a lot to learn and that as a beginner I do not know everything. What you learn in lecture can deviate from what you experience in the real world. Taking vitals from a real person is very different from a manikin. For my experience, taking vitals seemed easier and practical on real patients, whom respond and communicate back to you. I found that I am aware of how I present myself to the patients, and I watch my intonation and the way that I talk to them. I try my best to be sensitive and aware of their needs and privacy. However, I found it very important to understand and be able to identify patient risks more, and to fully appreciate the need for proper infection control at all times.

Although I think that my first clinical experience was positive, I believe there are certain areas to improve on. When I was taking vitals of the patients, in my mind I knew the processes of taking them, ranges for normalcy, and reasons behind it, but in actual implementation I found myself to very clumsy with the equipment. I knew how to take a temperature orally, for example, but I sometimes put the thermometer too far into the patient’s mouth that they became uncomfortable. Occasionally, I would drop equipment, mainly the blood pressure cuff, from the electronic machine, as I was trying to take multiple vitals at the same time.

In order to be better prepared for this experience in the future, I need to improve my confidence in my practical skills while in the lab scenario before the actual clinical. Although my belief in myself helped me measure vitals and assist the patient easier, I think that if I can practice my skills correctly more often inside and outside the lab, then the procedures upon next clinical should be second nature to me.

With the structure and guidance of the Gibbs cycle, I believe I can and was able to clearly reflect and state my experiences coherently. Although the Gibbs cycle seemed very overwhelming at first, with each stage brought about questions that I would not have contemplated on or experiences to really scrutinize on. By reflecting on my performance from an objective and subjective view, I believe I have better myself by realizing my mistakes, making note of my successes, and building off of my previous experiences to further improve my practice. Before using the Gibbs model, I never pondered about what my “weaknesses” and “strengths” were, but when I used the model to assess and conclude based on the various experiences and ideas I came across during the clinical experience, I found more about who I truly am and what I can actually do to aspire and commit to improvement.