Gibbs model of reflection (1988), is focused on the ability to self-reflect on one’s actions with the need to engage in the process of continual learning (Wilding, 2008). It is a framework for examining experiences, and using such as the basis to understand specific areas which may require improvement. The cyclic nature of the model means that it lends itself particularly well to repeated experiences, and potentially repetitive tasks which is why the model then becomes useful for examining experiences within the nursing practice such as repetitive tasks and interactions with other workers and patients (Johns, 2017).
Source: University of Edinburgh (2019:1)
Gibbs originally advocated its use of this model for repeated situations, but the stages and principles apply equally well for single experiences too. For a repeated situation the model allows for self-reflection and thus recommendations which could be used in the future to improve that situation. Though it may also be useful for stand-alone experiences given that the action plan could be more generalised and suggest improvements to a specific behaviour or trait which can be applied in other future situations (Davies, 2012).
Gibbs (1988) stated:
“It is not sufficient simply to have an experience in order to learn. Without reflecting upon this experience it may quickly be forgotten, or its learning potential lost. It is from the feelings and thoughts emerging from this reflection that generalisations or concepts can be generated and it is generalisations that allow new situations to be tackled effectively”
This is a long quote but it helps showcase why Gibbs model of reflection is now commonly used throughout many professions. It is an easy to understand framework with generalised steps which can be applied into all situations (Howatson-Jones, 2016). Also it can be used by the person involved in the situation themselves as self-reflection without the need for someone to instigate the analysis.
There are multiple situations within nursing where Gibbs becomes useful. Think of repetitive tasks such as patient check-ups or consultations or more specialised, and less frequent events such as dealing with a patient under the influence of alcohol, or suffering with mental illness. Gibb’s will allow the nurse to reflect on how they handled the situation and highlight the positives and negatives. This could be operational with Gibbs used to understand how the situation was handled in regards to productivity, paperwork, processes. Or it could also be considered with personal traits and behaviours such as how the nurse dealt with pressure, or empathy among others.
Howatson-Jones (2016) states the importance of Gibbs to nursing given the focus on feelings (or emotions) and acknowledges their importance in the reflection process versus other reflective processes which puts an emphasis solely on the processes and systems in place and how these could be improved.
When reflection in the nursing practiced is discussed, it is important to distinguish between the two types, being reflection-on-action and reflection-in-action (Bulman & Schutz, 2013). On action focuses on the user reliving a past experience while in-action is more interactive as focuses on observations. Reflection allows medical professionals to challenge and develop their existing knowledge, maximising the opportunity for learning and helping them to avoid mistakes that may have been made in the past (Royal College of Nursing, 2012). Bulman & Schutz (2013) cites Gibbs Reflective Cycle as the best model to use given that there is an emphasis on a balanced reflection; focusing on both the good and the bad. This is rare given that most reflective models solely focus on the failures, or the bad points of the situation and with such creates a focus on negativity.
The main reason to use Gibbs is that it is a cyclical model and so the idea is that the person will determine recommendations which can then be set out within an action plan and implemented in the future. As shown in the figure above, there are multiple stages with each stage asking a number of questions. For instance the 1st stage is the description where the user has the chance to describe the situation faced. Gibbs notes helpful questions which will help focus on the description alone such as:
Gibbs is a stepped process which makes it easy to understand and follow by people who not be professionals themselves in self-reflection. After description the focus is then on feelings with the user focusing on who they felt during the experience and how these feelings may have impacted the situation. The model is bitesize given that each stage
Roffey-Barentsen & Malthouse (2013) states that the model is split into two main sections with the first asking the user to collate their experience, while the 2nd section helps the user understand the options available for improvement.
The main benefit of Gibbs is the emphasis on talking about feelings and understanding how emotions can influence the situation. Nursing can often be an emotionally charged career, especially for nurses working in areas such as mental health. The success/ failure of the situation may not just be within the actual processes in place but the mindset of the nurse and how this influences the situation. Gandi et al (2011) and Tajvar et al (2015) are just two researchers who have focused on mental health within nursing, concluding that nurses are more likely to suffer with mental health conditions given the pressures placed on them by their profession. Issues such as insomnia and depression were cited by Perry et al (2015) as being widespread in some nursing communities.
Findings such as this means it is imperative to reflect on situations not only by the systems, regulations and norms in place but also by the emotions felt by the nurse at the time.
The model is not complicated to understand. The self-reflection could be performed orally as a quick reflection by yourself or with the team immediately after the situation. It would be recommended that notes so that the situation, feelings and recommendations are remembered but the ease of the model does allow for it to be done quickly throughout the day. The Gibbs framework could be used multiple times a day to reflect on anything from a team meeting to an interaction with a patient.
Another advantage is that it is a standardised model with a set process which can easily be understood by those new to self-reflection. It can also be used in both professional and personal settings meaning it has universal acceptance. Another advantage is that the model is unique given it includes knowledge, actions, emotions and suggests that experiences are repeated (Jasper, 2013). This differs from Kolb’s Reflective Model (see Kolb, 1984) which focuses on the transformation of information into knowledge.
As shown in the Figure above, Gibbs' model is isn’t specific to one sector with the steps able to be used for any situation, be it within education, health, office-based environments, manufacturing among others. Gibbs can be used for both personal and professional situations. A large proportion of the academic research done into Gibbs model though is focused on the healthcare or education sector. Stonehouse (2011) praises Gibbs as an effective tool for self-reflection within the care sector given that it can be performed by staff members themselves in relatively short time, best after the situation has occurred.
The figure above provides a visual for the cyclical model. At each stage the user needs to work through several questions.
The first step is to describe what you know. This will be done by focusing on questions such as what happened?, who was involved, what did you/ or others do?. It is setting the scene and stating the facts.
In this step the user will consider their emotions at the time by asking questions such as - How were you feeling at the time?
The main aim here is to understand whether there were any influencers within the situation which impacted behaviour, and with this actions. The user may consider whether there were any known or perceived difficulties with the activity, be that with information supplied, access to resources, location or timing. Issues within any of these areas could have impacted on the feelings of the nurse (i.e. stressed/ angry) which may then influence the feelings of the patient.
The main question in this section will be to determine whether this was a good and bad situation, detailing the good/ bad aspects about the experience. Crucially it needs to be considered how might the facts and feelings (from stage 1 and 2 above) have affected your actions/behaviour.
The analysis step is where the user will now look to make sense of the situation and why it happened the way it did. The previous steps have focused on details around what happened in the situation. In this stage the focus is to extract meaning from the situation (Howatson-Jones, 2016). This is where the user may also consider academic theory to understand the relationships between behaviour and outcomes. Key questions to ask include:
1. What sense can you make of it? Does it make sense given the preceding 3 stages?
2. What is the main area of concern or focus on the future?
Summarise the learning from the situation and highlight what changes will be needed in the future. It should be a natural response to the previous steps. Questions to ask:
1. What has been discovered in this situation?
2. What have you learned from this situation and circumstances?
3. What questions remain which may need further work to be answered? (Wilding, 2008)
In this final step the focus in on what would have been done differently in a similar, or related situation presented in the future (Bulman & Schutz, 2013). Within the nursing profession it would be helpful to consider what is needed to act differently. For instance if the reflective cycle identified that stress has been a major cause of failure in the situation the question would be on what resources may be needed in the future to reduce stress. This is where the nursing profession could benefit from viable recommendations being made.
Sometimes just the realisation is enough, but other times reminders and recommendations are helpful to develop a ‘best practice’ for a specific situation.
Gibbs reflective cycle could be classed as a seminal theory given that the original citation for the cycle was Gibbs (1988) though the theory is now cited in multiple sources such as Jasper (2013) and Bulman & Schutz (2013) which expand the reflective cycle.
The foremost citation for Gibbs reflective cycle however is as below;
Gibbs, G. (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic, Oxford.
Conducting a health assessment on a patient who not only suffered with dementia but limited mobility as well as several other underlying health conditions.
The patient was an elderly lady who had only recently been diagnosed with dementia though whose illness was quite advanced. As with some patients there is a delay in seeking out help given the stigma associated with dementia.
The lady become aggravated during the assessment and vocal with myself – nothing physical but it was clear that the lady did not want to be here, though it was vital that we assessed her.
Initially feeling confident given I had an understanding of the patient and their health background. However what I was ill prepared for was the behaviour of the patient who became agitated through the assessment and at sometimes could have been described as aggressive. Unfortunately this could happen with someone suffering with dementia given that the patient here was getting confused and aggressive as they were unsure of where they were.
My mood changed. Under pressure to keep the patient calm my focus on the assessment waned and I felt the pressure getting to me which undermined my knowledge. I felt uncomfortable in this situation and I believed this showed in my body language, potentially coming off as me not caring for the patient, or me being ‘fed up’ of dealing with this patient.
Good – I was knowledgeable and confident I could create a care plan for the patient.
Bad – I allowed by feelings to cloud my mind and in turn impact on the quality of care I could provide at the time. While I was prepared to deal with the patient’s healthcare needs I was not fully prepared to deal with their behaviour during the assessment and given that I was unprepared for their attitude this did impact my own behaviour.
Dinç & Gastmans (2013) identifies that empathy is a vital trait within nursing to build this patient – nurse relationship. The patient needs to feel re-assured that the healthcare team have their best interests at the forefront of any assessment and care plan, while also understanding their personal circumstances. It is a counterbalance between behaving in a way which showcases your authority and status as the healthcare provider while also being empathetic to create a personal, kind and friendly relationship with the patient. You want the patient to know that you have their best interests in mind
From this experience I am more mindful of how my own behaviour and body language during an assessment or other interaction with a patient can directly influence their behaviour.
I am now more aware how easily it is for a patient to sense my feelings from my body language, to how I speak. I need to be more empathetic in situations and also have more courage so that I am not impacted by the behaviour of the patient. I need to remain calm in these situations and maintain a professional manner.
In future I need to be more proactive at speaking with me colleagues and peers over their past experiences so that I can build a better understanding of what behaviour I could experience from dementia patients. Millard (2008) discussed how the behaviour of two dementia patients can vary quite differently; one potentially being subdued while the other aggressive. I need to accept this and become more confident when it comes to dealing with the unexpected.
I understand that I will become more confident over time with this as I am exposed to more situations, and as I get more advice from my peers on how they deal with it.
To summarise the following essay has presented a critical review of Gibbs Reflective Model, showcasing why the model is widely used throughout the healthcare profession. After describing the process to self-reflect noted by Gibbs an example has been presented focused on dementia which ends with a viable action plan which can be implemented.
Bulman, C., & Schutz, S. (Eds.). (2013). Reflective practice in nursing, London, John Wiley & Sons.
Davies, S. (2012). Embracing reflective practice. Education for Primary Care, 23(1), 9-12.
Dinç, L., & Gastmans, C. (2013). Trust in nurse–patient relationships: A literature review. Nursing ethics, 20(5), 501-516.
Gandi, J. C., Wai, P. S., Karick, H., & Dagona, Z. K. (2011). The role of stress and level of burnout in job performance among nurses. Mental health in family medicine, 8(3), 181.
Gibbs, G. (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic, Oxford.
Howatson-Jones, L. (2016). Reflective practice in nursing, London, Learning Matters.
Jasper, M. (2013). Beginning Reflective Practice. 2nd edition. Andover, Cengage.
Johns, C. (Ed.). (2017). Becoming a reflective practitioner, London, John Wiley & Sons.
Millard, F. (2008). GP management of dementia: a consumer perspective. Australian family physician, 37(1-2), 89.
Perry, L., Lamont, S., Brunero, S., Gallagher, R., & Duffield, C. (2015). The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC nursing, 14(1), 15.
Roffey-Barentsen, J., & Malthouse, R. (2013). Reflective practice in education and training, London, Learning Matters.
Royal College of Nursing (2012). An exploration of the challenges of maintaining basic human rights in practice. London, Royal College of Nursing.
Stonehouse, D. (2011). Using reflective practice to ensure high standards of care. British Journal of Healthcare Assistants, 5(6), 299-302.
Tajvar, A., Saraji, G. N., Ghanbarnejad, A., Omidi, L., Hosseini, S. S. S., & Abadi, A. S. S. (2015). Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electronic physician, 7(3), 1108.
University of Edinburgh. (2019) [online]. Gibbs' reflective cycle, Available at https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle, Accessed 16.07.2020.
Wilding, P. M. (2008). Reflective practice: a learning tool for student nurses. British Journal of Nursing, 17(11), 720-724.
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