The document reflects on a nursing student's experience during clinical practice in a surgical ward, focusing on an incident involving hand hygiene before a doctor's examination of a patient, Mr. Z. Utilizing Gibbs' reflective cycle, the student evaluates their thoughts and feelings about not addressing the doctor's lack of hand hygiene, ultimately recognizing the need for assertiveness in ensuring patient well-being. The conclusion outlines a commitment to developing assertive skills in future placements to advocate for patient safety.

1. Yasmeen 2nd
semesterMSin NursingatUOL, Lahore.
Reflection on action Using Gibbs model:
My reflection that is about a focus on my experiences and feelings on how I feel, experience
when I was on clinical at surgical ward in University of Lahore hospital, Lahore is related with a
patient who was there for post operative care. I will use the Gibbs (1998) reflective cycle as a
guide in this reflection. The Gibbs (1998) Reflective Cycle is one of the most popular models of
reflections consists of six steps are following:
1) Firstly, description is explaining the experiences during reflective situation which
describes as a matter of fact about the situation and what happen during the event.
2) Secondly, feelings and thoughts about the experience of this clinical situation which is
the description or the analysis of what my thoughts and feelings were at the time of this
event.
3) Thirdly, the evaluation is of my experience which is about what is good or bad about my
experience during this event.
4) Fourthly the analysis of my experiences about what I can make out of the situation or it
makes a sense of situation that I feel.
5) Conclusion is the fifth step of this cycle and it is about what else I can do and what do
not, what I learn and what I do differently.
6) The final sixth step is the action plan. For how I will deal with similar situations in the
future, or general changes I may find appropriate. This plan will be about what I will do
if this situation arise again or what I will do differently bearing in mind my experience
from the steps above (Jasper 2003).
Reflective writing is a way of phrasing, expressing and illuminating one’s own and others stories
crafting, determining to, understanding and developing, it will enable practice development
because the outcomes of reflection are taken back into practice improving and developing
(Bolton 2005). Reflection “is a technique to learn from one’s direct experiences, instead of the
second-hand experiences of other” (Cottrel 2003, p6).
Description

2. When I was working in a surgical ward of University of Lahore Hospital, Lahore, Pakistan as a
student of 2nd semester MSc. in Nursing, under the supervision of my mentor, in this ward four
registered nurses and two students of BSc. Nurses were working. I was there to observe and
teach the BSc. Students. There was a patient with seventy-two year old gentleman, Mr. Z
(pseudonym), who had undergone abdominal surgery. Not using the name of my patient and
nurses because of confidentiality (NMC 2015).
One of two students (supposes Nurse X) of BSc. Nursing student had been asked to remove his
wound dressing so that the doctor could assess it on the ward round. She removed the dressing
under my and mentor's supervision, using a non-touch procedure, and cleaned the wound, as
requested by the doctor. My mentor was called to another patient at this point, so at her request I
stayed with Mr. Z while we waited for the doctor to come to see him. The doctor had been with
another patient, examining their wound, and I noticed that she came straight to Mr. Z to examine
his wound, without either washing her hands or using alcohol gel first. I also noticed that she was
wearing a long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I thought
for a moment about what to do or say, but by the time I had summon enough audacity to say
something, I thought it was too late as she was already examining Mr. Z.
Feelings
I was alarmed by this, as I had expected the doctor to wash her hands or use alcohol gel before
examining Mr. Z. However, I felt demoralized because I felt that the doctor was more
experienced than me as a nursing student; and I didn't want to make ashamed her. Also, I didn't
want to make Mr. Z concerned by confronting the doctor in front of him. Later, I spoke to my
mentor about the incident. She recommended that we speak to the doctor together about it. My
mentor took the doctor aside, and asked her whether she had washed her hands before examining
Mr. Z. She looked quite stunned. She said that she had been very busy and hadn't thought about
it. My mentor discuss the importance of hand hygiene with her, and the doctor sure her that she
would wash her hands before examining every patient in the future.
Evaluation
The incident was extremely exigent for me. I was repentant that I did not act to challenge the
doctor's practice before she examines Mr. Z. However, I am contented that the doctor responds

3. so positively to the feedback of my mentor, and I have observed that she has now changed her
practice as a result of this incident. I too have learned from the incident, as it has taught me the
importance of performing assertively with colleagues, in a sensitive manner, in order to defend
patients' well-being.
Analysis
Teare, Cookson, and Stone (2001) established hand-hygiene was a term commonly used for
removing germs with an alcohol-based disinfecting agent and/or soap and water. A healthcare
worker should perform hand-hygiene before patient care, after handling bodily fluids, after an
invasive procedure, and after removing gloves. Recent guidance published by the Department of
Health (2007) highlights the possibility of staff transmitting infections via uniforms, and the need
to review policies on staff dress. The Nursing and Midwifery Council Code of Professional
Conduct (2004, section 8) states that as a nurse 'you must act to identify and minimize the risk to
patients and clients'. As the nurse X caring for Mr. Z under my mentor's supervision, this also
applies to student and my own practice as a student nurse.
Conclusion
Looking back on this incident, I can see that I should have acted sooner, and that I should have
ensured that the doctor washed her hands before examining Mr. Z. I can now see that my
inaction in this incident put Mr. Z well-being at risk. After discussion with my mentor, I
recognize that I need to develop the self-reliance to challenge the practice of colleagues, putting
the well-being of clients at the forefront of my mind. I realize that I need to be supportive to
colleagues, understanding the pressures that they may be under, but ensuring that their practice
does not put clients at risk.
Action Plan
In future, I will aim to develop my assertive skills when working with colleagues, in order to
ensure that the well-being of clients is maintained. In my next placement, I will make this a goal
for my learning, and will discuss this with my mentor to work out strategies for how I can
achieve this.

4. References
Gibbs G (1988) Learning by doing: a guide to teaching and learning methods, Oxford, Oxford
Polytechnic Further Education unit
Moore, C. (2015). A qualitative case study of nurse, physician, and allied clinicians perceptions
on hand hygiene compliance (Doctoral dissertation, University of Phoenix).
Thivichon-Prince, B., Barsotti, O., Girard, R., & Morrier, J. J. (2014). Hand hygiene practices in
a dental teaching center: Measures and improve. European journal of dentistry, 8(4), 481.
Coia, J. E., Duckworth, G. J., Edwards, D. I., Farrington, M., Fry, C., Humphreys, H., ... & Joint
Working Party of the British Society of Antimicrobial Chemotherapy. (2006). Guidelines for the
control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare
facilities. Journal of hospital infection, 63, S1-S44.