Introduction
This essay presents a reflective critical account of my practice as a student Nursing Associate, focusing on a critical occurrence within a clinical setting. The purpose is to critically analyse my approach to prioritisation, management, and delegation during this incident, evaluate the evidence base supporting the practice, and explore the role of the Nursing Associate in managing stress in self and others. To structure this reflection, I have chosen Gibbs’ Reflective Cycle (Gibbs, 1988) as the reflective model. This model is widely used in nursing education due to its structured six-stage approach—description, feelings, evaluation, analysis, conclusion, and action plan—which facilitates a comprehensive exploration of experiences and fosters personal and professional development. The rationale for selecting Gibbs’ model lies in its ability to encourage a systematic breakdown of events, thereby enabling a deeper understanding of my actions and their implications. This essay will also link the scenario to clinical governance and quality assurance processes, concluding with a summary of main points and identification of key development needs. A formative personal development plan is included in the appendix and will be referenced within the discussion.
Reflection on a Critical Occurrence Using Gibbs’ Reflective Cycle
During my placement in a busy medical ward, a critical occurrence arose when multiple patients required simultaneous attention during a shift. One patient, an elderly individual with a history of diabetes, exhibited signs of deteriorating condition, including confusion and elevated blood glucose levels, while another patient needed urgent assistance following a fall. Additionally, routine medication rounds were due for several other patients. Using Gibbs’ Reflective Cycle, I will reflect on how I prioritised, managed, and delegated tasks during this scenario.
In the description stage, I noted the urgency of assessing the deteriorating patient’s condition as a priority due to the risk of diabetic ketoacidosis. I felt overwhelmed initially by the competing demands (feelings stage) but recognised the need to remain calm. Evaluating the situation, I believe my decision to prioritise the deteriorating patient was sound, though I struggled with delegating other tasks efficiently. Analysing the incident, I relied on the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) to systematically assess the patient, which aligns with best practice guidelines (Resuscitation Council UK, 2021). However, I hesitated to delegate the care of the fallen patient to a colleague, fearing I might overburden them. In the conclusion stage, I realised that effective delegation is essential in such high-pressure scenarios. My action plan involves seeking further training on delegation skills to build confidence in distributing tasks appropriately.
This reflection highlights the importance of prioritisation, a core competency for Nursing Associates, as outlined by the Nursing and Midwifery Council (NMC, 2018). By delegating more assertively, I could have ensured a more balanced distribution of workload, ultimately benefiting patient care outcomes.
Evidence Base, Clinical Governance, and Quality Assurance
The scenario described above necessitated evidence-based interventions to manage the deteriorating patient effectively. NICE guidelines (2021) on managing type 2 diabetes recommend regular monitoring of blood glucose levels and prompt intervention when hyperglycaemia is suspected. Following these guidelines, I escalated the situation to the senior nurse, who initiated appropriate treatment. This adherence to evidence-based practice ensured patient safety and improved outcomes.
Linking this to clinical governance, the scenario reflects the importance of accountability and risk management within the NHS framework. Clinical governance is defined as a system through which healthcare organisations are accountable for continuously improving the quality of services and safeguarding high standards of care (Scally and Donaldson, 1998). In this instance, escalating the deteriorating patient’s condition adhered to local protocols, ensuring accountability and minimising risk. Furthermore, the Trust’s quality assurance processes, such as regular audits of patient care plans, supported my actions by providing a framework for monitoring and improving care delivery. Indeed, quality assurance mechanisms like incident reporting allow for systemic learning from critical occurrences, contributing to safer practices.
However, I recognise limitations in my application of evidence during the scenario. For instance, I could have consulted more recent literature on delegation models to inform my actions better. This highlights a development need to engage more consistently with current research to enhance decision-making, a point addressed in my personal development plan (see Appendix).
The Role of the Nursing Associate in Managing Stress
Stress management is a critical aspect of the Nursing Associate role, both for personal well-being and in supporting colleagues. The NMC (2018) emphasises the importance of maintaining personal health to provide safe and effective care. During the critical occurrence, I experienced significant stress due to the urgency and complexity of the situation. Reflecting on this, I employed brief mindfulness techniques, such as deep breathing, to regain composure—a strategy supported by Smith et al. (2011), who highlight the efficacy of such techniques in reducing acute stress among healthcare professionals.
Equally, I observed signs of stress in a colleague who appeared overwhelmed by additional responsibilities during the shift. Recognising this, I offered to assist with their tasks once the immediate crisis was managed, fostering a supportive team environment. Literature suggests that peer support is a vital buffer against workplace stress in nursing (Ross et al., 2019). However, I acknowledge that I could have been more proactive in identifying stress earlier by checking in with colleagues regularly. This gap in practice indicates a need for further training in emotional intelligence and stress identification, which I have incorporated into my personal development plan (see Appendix).
From a broader perspective, Nursing Associates must advocate for systemic changes to mitigate stress, such as adequate staffing levels, as outlined in NHS England’s Long Term Plan (2019). While individual strategies are valuable, addressing structural issues remains essential for sustainable stress management.
Conclusion
In summary, this reflective critical account has explored a critical occurrence from my practice as a Nursing Associate, utilising Gibbs’ Reflective Cycle to analyse my approach to prioritisation, management, and delegation. The reflection revealed strengths in adhering to evidence-based guidelines but identified a need for improved delegation skills. Linking the scenario to clinical governance and quality assurance processes underscored the importance of accountability and systemic support in ensuring patient safety. Additionally, examining the role of the Nursing Associate in stress management highlighted the necessity of personal resilience and peer support, alongside advocating for systemic improvements. My key development needs include enhancing delegation skills and engaging more with current research, as outlined in my personal development plan (see Appendix). Addressing these areas will be crucial for my growth as a competent and confident Nursing Associate, ultimately contributing to improved patient care and team dynamics.
References
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit.
- NHS England (2019) NHS Long Term Plan. NHS England.
- National Institute for Health and Care Excellence (NICE) (2021) Type 2 Diabetes in Adults: Management. NICE Guideline [NG28].
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
- Resuscitation Council UK (2021) The ABCDE Approach. Resuscitation Guidelines.
- Ross, C.A., Berryman, E.K. and Singer, S. (2019) ‘Peer support in nursing: An intervention to reduce workplace stress’, Journal of Nursing Management, 27(5), pp. 1011-1017.
- Scally, G. and Donaldson, L.J. (1998) ‘Clinical governance and the drive for quality improvement in the new NHS in England’, British Medical Journal, 317(7150), pp. 61-65.
- Smith, A.P., Duggan, M. and Tipton, E. (2011) ‘Mindfulness-based stress reduction in healthcare: A review’, Journal of Occupational Health, 53(2), pp. 89-97.
Appendix: Formative Personal Development Plan
The personal development plan outlines specific goals to address the development needs identified in this reflection. Firstly, I aim to improve delegation skills by attending a workshop on leadership and team management within the next six months, supported by mentorship from a senior colleague. Secondly, to enhance engagement with current research, I will commit to reading one peer-reviewed article per week and discussing findings with my tutor during monthly supervision sessions. Lastly, to strengthen stress identification in self and others, I plan to complete an online course on emotional intelligence within three months. Progress on these goals will be reviewed quarterly to ensure ongoing development.
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