Introduction
This essay critically reflects on a clinical incident involving a confused patient with Central Nervous System (CNS) Lymphoma who attempted to pull out their Peripherally Inserted Central Catheter (PICC) line, using Gibbs’ Reflective Cycle as a structured framework. As a nursing student, this experience offered valuable insights into patient safety, communication, and the emotional challenges of care delivery in complex cases. Gibbs’ model, with its six stages—description, feelings, evaluation, analysis, conclusion, and action plan—provides a systematic approach to dissect the event and identify areas for professional growth (Gibbs, 1988). This reflection will explore the incident’s context, my response, and the implications for future practice, integrating relevant literature to support my analysis. The aim is to develop a deeper understanding of managing confusion in vulnerable patients while ensuring safety and dignity.
Description of the Incident
During a clinical placement in an oncology ward, I encountered a 62-year-old male patient diagnosed with CNS Lymphoma. The patient exhibited confusion, likely due to the neurological impact of the disease and possibly compounded by medication side effects. While assisting with morning observations, I noticed the patient becoming agitated and attempting to pull at his PICC line, a critical access point for chemotherapy. Immediate intervention was required to prevent harm, such as infection or bleeding. I calmly approached the patient, used a reassuring tone to distract him, and sought assistance from a senior nurse to secure the line and assess the situation. The incident was resolved without physical harm, though it highlighted the risks associated with confusion in clinical settings.
Feelings and Emotional Response
Initially, I felt anxious witnessing the patient’s distress and the potential consequences of PICC line removal. My concern was heightened by my limited experience in de-escalating such situations. However, I also felt a sense of responsibility to act promptly to protect the patient. Reflecting now, I recognise that my nervousness stemmed from a fear of failure, yet it motivated me to seek help and prioritise patient safety. This emotional response underscores the importance of self-awareness in nursing, as emotions can influence decision-making (Bulman and Schutz, 2013).
Evaluation and Analysis
Evaluating the incident, my immediate intervention to calm the patient was a positive step, as it prevented immediate harm. However, I lacked confidence in independently managing the situation, relying heavily on senior support. Analysing this further, confusion in CNS Lymphoma patients can arise from disease progression or treatment effects, necessitating robust communication and safety strategies (NHS England, 2019). Research suggests that non-pharmacological interventions, such as clear communication and environmental adjustments, can reduce agitation in confused patients (Dewing, 2010). Arguably, I could have anticipated the risk by observing earlier behavioural cues, highlighting a gap in my assessment skills. Furthermore, the incident revealed a broader issue of staffing pressures, which limited proactive monitoring.
Conclusion and Action Plan
In conclusion, this incident illuminated the challenges of managing confusion in oncology settings and the critical need for swift, patient-centered responses. It also exposed my developmental needs in risk assessment and independent decision-making. Moving forward, my action plan includes enhancing my knowledge of neurological symptoms in CNS Lymphoma through targeted reading and attending relevant workshops. I will also practice de-escalation techniques via simulation training to build confidence. Finally, I aim to collaborate with multidisciplinary teams to advocate for tailored care plans, ensuring proactive identification of risks (Royal College of Nursing, 2020). This reflection, guided by Gibbs’ framework, has been instrumental in transforming a challenging experience into a foundation for professional growth.
References
- Bulman, C. and Schutz, S. (2013) Reflective Practice in Nursing. 5th ed. Wiley-Blackwell.
- Dewing, J. (2010) ‘Responding to agitation in people with dementia’, Nursing Older People, 22(6), pp. 18-25.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit, Oxford Polytechnic.
- NHS England (2019) NHS Long Term Plan for Cancer Care. NHS England.
- Royal College of Nursing (2020) Principles of Nursing Practice. Royal College of Nursing.
