Introduction
This essay explores the application of the Gibbs Model of Reflection to a clinical encounter involving a palliative care patient experiencing pain and shortness of breath. Palliative care is a critical area of healthcare that focuses on improving the quality of life for patients with life-limiting conditions through symptom management and holistic support (WHO, 2020). The Gibbs Model, developed by Graham Gibbs in 1988, provides a structured framework for reflective practice, enabling healthcare professionals to learn from experiences through a six-stage cycle: description, feelings, evaluation, analysis, conclusion, and action plan (Gibbs, 1988). By reflecting on a specific case, this essay aims to demonstrate a sound understanding of palliative care challenges, evaluate personal and professional responses to patient needs, and consider the implications for future practice. The discussion will focus on the complexities of symptom management, emotional impact, and the importance of interdisciplinary collaboration in delivering compassionate care.
Description of the Experience
During a clinical placement in a hospice setting, I encountered a 68-year-old male patient diagnosed with advanced lung cancer. The patient presented with severe pain in the chest area and significant shortness of breath, which limited his ability to engage in basic activities and communicate effectively. My role as a student nurse was to assist the multidisciplinary team in monitoring the patient’s condition, administering prescribed medications under supervision, and providing emotional support. The patient’s pain was managed with a morphine pump, while oxygen therapy was used to alleviate breathlessness. Despite these interventions, the patient remained distressed, frequently expressing fear about worsening symptoms and dying. This experience highlighted the complex interplay between physical symptoms and psychological distress in palliative care, prompting a deeper reflection on my practice and the care provided.
Feelings and Emotional Response
Initially, I felt overwhelmed by the patient’s visible suffering and the intensity of his emotional expressions. Witnessing his struggle to breathe and hearing his concerns about death evoked a strong sense of empathy but also anxiety about whether I could adequately support him. I questioned my competence as a student nurse, feeling unprepared to address such profound existential fears. However, working alongside experienced nurses and a palliative care consultant helped me manage these emotions. Their calm and empathetic approach reassured me, though I remained frustrated by the limitations of medical interventions in fully alleviating the patient’s symptoms. This emotional response underscores the importance of self-awareness in healthcare, as unaddressed feelings can impact the quality of care provided (Jasper, 2013).
Evaluation of the Experience
Reflecting on the experience, several aspects of the care provided were positive. The use of a morphine pump effectively controlled the patient’s pain to some extent, and oxygen therapy offered temporary relief from breathlessness, aligning with evidence-based guidelines for palliative symptom management (NICE, 2015). Additionally, the multidisciplinary team’s collaborative approach ensured that the patient’s physical, emotional, and spiritual needs were considered. However, there were limitations. The patient’s psychological distress was not fully addressed, as there was limited time for in-depth counselling amidst a busy workload. Furthermore, I noticed a lack of clear communication with the patient about his prognosis, which may have exacerbated his anxiety. This evaluation reveals a gap between ideal palliative care principles and the practical constraints of clinical settings, prompting a need for improved communication strategies.
Analysis of the Situation
Analysing the situation through the Gibbs Model, it becomes evident that managing pain and shortness of breath in palliative care requires a holistic approach beyond pharmacological interventions. Pain and breathlessness are common in advanced cancer, often compounded by psychological factors such as fear of suffocation or death (Booth et al., 2011). While morphine and oxygen therapy addressed physiological symptoms, the patient’s emotional needs required more focused attention. Research suggests that therapeutic communication and psychological support can significantly reduce anxiety in palliative patients, yet these are often under-prioritised due to time constraints (Moore et al., 2013). Additionally, my own lack of confidence in discussing death and dying may have hindered effective reassurance. This analysis indicates that both systemic factors (e.g., staffing levels) and personal factors (e.g., communication skills) influenced the care experience, highlighting areas for professional development.
Conclusion from Reflection
Concluding this reflective process, I recognise that while the physical management of the patient’s symptoms was largely effective, the emotional and psychological dimensions of his care were insufficiently addressed. The experience revealed the complexity of palliative care, where symptom control must be balanced with emotional support and open communication about prognosis. Indeed, the patient’s fear and distress were as significant as his physical symptoms, yet these were not prioritised equally. This reflection also exposed my limitations in confidence and communication skills when discussing sensitive topics like death. Overall, the encounter emphasised the need for a truly holistic approach in palliative care—one that integrates physical, emotional, and existential care to honour the patient’s dignity and individual needs.
Action Plan for Future Practice
Moving forward, I intend to develop specific strategies to enhance my practice in palliative care. Firstly, I will seek training in advanced communication skills, particularly in breaking bad news and discussing end-of-life concerns, as these are critical for reducing patient anxiety (Baile et al., 2000). Secondly, I plan to familiarise myself with non-pharmacological interventions for breathlessness, such as relaxation techniques and positioning, which are supported by evidence as effective adjuncts to oxygen therapy (Booth et al., 2011). Furthermore, I will advocate for more integrated care planning within the multidisciplinary team, ensuring that psychological support is prioritised alongside physical symptom management. Finally, I aim to engage in regular reflective practice using frameworks like Gibbs’ Model to continually evaluate and improve my emotional resilience and clinical decision-making. These steps will equip me to provide more compassionate and effective care in future palliative scenarios, addressing both the tangible and intangible needs of patients.
Conclusion
In summary, applying the Gibbs Model of Reflection to a palliative care experience involving a patient with pain and shortness of breath has provided valuable insights into the complexities of end-of-life care. The reflection highlighted strengths in symptom management through pharmacological interventions but identified significant gaps in addressing psychological distress and effective communication. Analysis revealed systemic and personal factors contributing to these shortcomings, including time constraints and my own lack of confidence. The action plan developed through this process focuses on enhancing communication skills, exploring non-pharmacological interventions, and advocating for holistic care within multidisciplinary teams. Ultimately, this reflective exercise underscores the importance of integrating emotional and physical care in palliative settings to ensure patients receive dignified, person-centred support. The implications for practice are clear: ongoing education and reflective practice are essential for healthcare professionals to navigate the challenges of palliative care and improve patient outcomes.
References
- Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A. and Kudelka, A.P. (2000) SPIKES—A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist, 5(4), pp. 302-311.
- Booth, S., Moosavi, S.H. and Higginson, I.J. (2011) The etiology and management of intractable breathlessness in patients with advanced cancer: A systematic review of pharmacological therapy. Nature Reviews Clinical Oncology, 8(5), pp. 264-274.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit.
- Jasper, M. (2013) Beginning Reflective Practice. 2nd edn. Andover: Cengage Learning.
- Moore, P.M., Rivera Mercado, S., Grez Artigues, M. and Lawrie, T.A. (2013) Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database of Systematic Reviews, (3), CD003751.
- NICE (2015) Care of dying adults in the last days of life. National Institute for Health and Care Excellence guideline [NG31]. Available at: https://www.nice.org.uk/guidance/ng31
- WHO (2020) Palliative care. World Health Organization.
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