Here is a Gibbs style patient reflection that I completed for my final year placement. I attained a high 2:1 in this assignment, so is a good example of how to structure a patient reflection.
Description
This is a Gibbs style reflection on the care I gave to a 58-year-old woman in
sheltered accommodation while on placement with two paramedic crewmates. Upon
arrival, the patient was sat on the edge of her bed with her feet on a stool, appearing
in discomfort. The patient was complaining of worsening right foot and leg pain for
one week, to a point that the pain was now 10/10. On initial examination, the
patient’s right foot was slightly colder than her other, it was marginally discoloured
and still had a pedal pulse which it quickly lost during the encounter. After a
SAMPLE (JRCALC, 2022) style history was taken, I established the patient also had
worsening difficulty in breathing since her laparoscopic cholecystectomy three weeks
previously. A 12-lead electrocardiogram was completed which showed no dynamic
changes. Due to this, I performed a respiratory system assessment. The patients’
observations are shown in Figure 1. IV access was gained for analgesic purposes
and oxygen was administered. Differential diagnoses of the patient were deep vein
thrombosis (DVT)/ pulmonary embolism (PE) or compartment syndrome, hence a
pre-alert was sent to the hospital.
Initial Observations of the Patient
Oxygen saturations 88% on room air
Blood pressure 143/82
Heart rate 123
Respiratory rate 34
Temperature 36.6°C
Blood glucose 6.7mMol
Figure 1
Thoughts/ Feelings
Before this job I was nervous- this is not unusual for me, as every job we go to is a
new experience and I will never know how unwell the patient is until they are in front
of me. During the job I had a mixture of feelings; anxiousness due to my lack of self-
confidence, and insecurity due to attending a patient with symptoms I had not seen
, before with two new paramedics who did not fully know my capabilities. I also feel
guilty that I did not double check with my mentors that they had remembered to take
out morphine; they had forgotten so subsequently the patient could not have
intravenous (IV) morphine for her pain and was exposed to infection (the cannula)
potentially unnecessarily. Looking back, I feel proud that I so quickly came up with
differential diagnoses for the patient, but I am frustrated with myself for hesitating to
initiate treatment- it must have been frustrating for my mentors that I hesitated with a
time critical patient too. I am worried that my newfound autonomy created a feeling
of being unsupported, which in turn caused me to hesitate and potentially negatively
impact the patient’s prognosis.
Evaluation
There were good and bad aspects to this job. Firstly, I was quick to develop my
differential diagnoses, and in a time critical situation it is important to quickly
ascertain what is wrong with the patient so treatment can be implemented early on.
Fast diagnosis and prompt intervention are critical in minimising the risk of patient
mortality and reducing recurrent venous thromboembolisms (Suede and Ehrman,
2021). This experience has demonstrated this to me, by observing how quickly the
patient deteriorated in the short time I was with her. A further positive aspect to this
job was my communication with the patient; the patient had learning difficulties so I
had to adapt my communication style to a way that the patient could understand and
felt comfortable with. I am pleased with myself for doing this because “most of the
time” (Agaronnik et al., 2019) clinicians do not engage with the patient with learning
difficulties, and instead liaise with family and caregivers. I find this extremely
discriminatory and working in line with the ‘Making Every Contact Count’ approach
(Public Health England, NHS England, and Health Education England, 2016) it is so
important to adapt our communication and empower every patient to be involved in
their own care. This will help create a positive image of healthcare to the patient and
encourage them to be more open in conversation during their next interaction with
health care professionals. Another point to support liaising with patients first, not
carers, is that the first two standards in the Health and Care Professions Council
(HCPC) code of conduct state we are to promote interests of service users, and to
communicate appropriately and effectively (HCPC, 2018). This supports that my
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