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Criteria for marking

This assessment is an exploration of your experience and learning in the immersive simulation of week
11 using Gibbs’ Reflective Cycle.

Word limit: 2500 words including references
Value: 35%
Presentation requirements: Please observe the following formatting instructions:

Word document (doc; docx) [do not PDF or lock the document as Markers will work within the document
to provide feedback]
12 point font and double spaced
Student ID only (no names) in either header or footer
Page numbers

Criteria for marking: To be available at a later stage.

Reflective practice has been shown to close the gap between practice and theory, thereby
improving the quality of care. This is because people critically think about their actions and
experiences to learn what they will do better in the future. Gibbs reflective cycle is the most
preferred model for reflection because it encourages systematic thinking process about an
experience or activity. The model was developed by Professor Graham Gibbs and is useful in
helping reflective practice. The model comprises of 6 stages including; a) Description, b)
feelings, c) evaluation, d) analysis, e) conclusion, d) action plan. This essay is a reflection of my
experience in an oversee hospital (Health Academy, n.d.).
I was visiting an overseas country for some religious function where I fell ill. I was rushed to one
of the healthcare facility in the region and was admitted for further check up. I was given a bed
in a shared room with many other critically ill patients. The ward was very crowded and noisy as
most of the patients have visitors beside their bed. The Ward looked more like a recreational
center more than a healthcare facility. It seems like there was no limit to the number of visitors
that made the room crowded. The room was so crowded that some few visitors were sitting on
the floor and some were even singing. I was issued with a bedpan to use for urine elimination,
but it is hard to pass urine as the room was too crowded, and there were no curtains around my
bed that I can draw to have privacy. The beds were not comfortable, and instead of using white
bed sheets for patient’s bed, they use colorful bed sheets.
After waiting for few hours, the doctor finally came to check me. He did not greet me or at least
introduce himself when he arrived. He just hastily performed physical examination and left. He
is non-English speaker who made it difficult for us to communicate. The doctor-patient

relationship was awkward, and he avoided eye contact. Consent was taken by the resident nurse
when she came to take blood pressure. After a few minutes, the doctor returned to explain some
medical procedure that I was expected to undergo. I did not understand what he was saying, so
he asked the visitors in the room if there was anyone who was fluent in English to help with the
translation. A random stranger offered his help and came to translate the procedure. The medical
procedure involved injecting a needle in my spinal cord to collect some sample. I did not like this
practice as it compromised my confidentiality and dignity. This experience was shocking and
uncomfortable. The anxiety made me call for help from a close friend.
This experience was shocking and uncomfortable. I felt frustrated that I was put in such
scenario. I was annoyed because I was powerless to do much about the situation. I was upset by
my inability to confront the healthcare staff in front of the visitors. I was angry that the doctor
did not bother to develop a good rapport with his patient. He understands the importance of
patient’s dignity, then why did he allow a stranger to translate my medical condition. The
situation left me distressed that made me ring my friend for moral support. It is only when I
reflected on the experience and realized that good healthcare service is not a routine to many but
a privilege. Although I felt hesitated, I knew that it was essential to reveal the mistakes on time
so as to improve the quality of care being delivered in this healthcare facility.
The only good thing observed is that this is a small healthcare facility and that the staff seemed
to work as a team and communication between them was easy. However, the facility was
understaffed, and one nurse was expected to handle more than five patients. I was not happy with
the care provided in this healthcare facility. My main concerns were of the wrong quality of

services; for instance, there was no privacy as the ward was noisy, crowded and I could pick
some stale smells such as smell of urine. We served pureed food in plastic dishes did not provide
any feeding aid even for patients in critical conditions. Moreover, lack of patient’s dignity is
dehumanizing experience and frustrating. The two medical staffs that I interacted with were cold
and uncaring. All these internal and external factors were not in agreement with a healing
environment that supports inherent healing capacity of patients and their healthcare providers.
I believe that the healthcare systems are developed to stimulate and support the healing capacity
of the patients. An effective healing environment is described by people’s relationship and the
surrounding circumstances. Human beings are multidimensional and complex such that their
healing involves cohesion of the mind, body, and spirit. Also, individuals are significantly
influenced by their physical environments. Therefore, a holistic healing calls for a patient
–centered approach (Smith et al., 2013).
These facts are supported by Florence Nightingale environmental theory. Based on this theory,
disease is health restoration process, and the staff has a major role in balancing the internal and
external environments to facilitate quick recovery from the disease. Providing suitable
environments for patients includes an environment with proper ventilation, heat, noise, free from
bad odors and with appropriate lighting. The quality of space and privacy is dear to me and other
patients I believe. Surprisingly, I noticed that the healthcare facility was crowded and dirty. The
spaces between beds were too small that it could not accommodate the visitors appropriately.
Other restrictions observed include lack control over the lighting and noise made by the visitors.
No safety net is put in place in this healthcare facility, which made it difficult to control one’s
emotions and pain (Sakallaris et al., 2015).

Another barrier noted during this experience is cultural and language barriers. From my
knowledge, no assessment was done, they did not ask about my values or beliefs. In fact, the
staff seemed distance and disinterested. To deliver quality care, the healthcare providers must
appreciate the fact that culture plays an important role on the patient outcomes. Culture is
complex as it includes shared beliefs, values, traditions and in some cases language. Each
encounter with a patient is an opportunity to learn about another different culture and to
understand the cultural aspects that should be integrated into the patient care plan (Weaver et al.,
Patients have high expectations whenever they access healthcare. From my experience, the
healthcare staff in healthcare facility lack clinical professionalism and particular imperative
clinical skills. They need to polish their cultural competence to improve their focus on nursing
care. This is because of organizational culture, as well as its staff attitudes plays a vital role in
delivering of care. Therefore, effective and quality care starts with the staff because spot checks
and regulations cannot mitigate poor care (Hatah et al., 2015). Also, patients need to talk openly
about the nursing care they receive. I should have voiced my opinion to the relevant authorities.
Action plan
Respect and dignity are some of the core healthcare professional values. The healthcare staffs are
expected to comply with the patients and to understand their needs, priorities, and abilities. Some
of the action plans that can be adopted by the healthcare facility include undertaking refresher
training on how to engage patients in their care plans. This includes introducing themselves by
their names during their first encounter as it helps to create a good rapport between the patient
and the healthcare providers (Huisman et al., 2012). To improve communication between the

healthcare providers and patients, the healthcare staff should undergo training so that they can
understand the importance of addressing the patients respectfully and to remain culturally
competent. Also, the administration needs to understand the importance of developing a healing
environment. Human dignity and confidentiality are also important aspects for each patient. The
organization should hire a translator who can help with translation instead of asking a total
stranger to translate as this is breach of patient’s privacy and confidentiality (Weaver et al.,
Critical reflection
In my opinion, the healthcare facility that I attended needs a transformational leadership so that
they can focus on patient healing and establish culture excellence. Healthcare facilities are driven
by their commitment to promoting healing and health creation (Neck & Manz, 2012). Therefore,
they must develop appropriate structures, healthcare processes as well as resources that stimulate
and support the healing process using deliberate positive relationships, shared decision making
as well as person-centered care planning. The healthcare organizations should learn to prioritize
and optimize the well-being of their patients (Spring et al., 2015).
Patient’s wholeness is congruence of the mind, body, and spirit experienced through their
interactions with the healthcare providers. Therefore, healing process is operationalized by the
environment. The healing relationship is established deliberately and calls for skillful
communication and attention to the clinical relationships (Sakallaris et al., 2015). Another
critical skill important for healing process is trust. Trust develops slowly and is a consequence of
respect, integrity, and kindness. To inspire trust, it requires congruency between personal morals
and the healthcare disciplinary or professional ethics. Mindful training has been shown to
improve clinician resilience and to enhance their communication skills and consequently

improve physician-patient relationships that result in better patient outcomes (Medeiros, Enders,
& Lira, 2015).
Social support is also important in improving patient well-being. There is substantial evidence on
the effect of social support from healthcare staff, and the family reduces mortality and improves
health outcomes (Strom & Egede, 2012). However, the healthcare providers need to establish
the limit on the number of people visiting patients at a time. This will help create a healing
environment and reduce cross infections incidents. It is important to establish a balance between
the physical environments and social support that does not affect other patients (Medeiros,
Enders, & Lira, 2015). An unlimited number of visitors per patient results into overcrowding
that may result to noncommon aspects important to patient’s health such as aeration. Also,
overcrowding in the ward also influences the sanitary conditions of the ward as it makes it
difficult to maintain hygiene or cleanness and about lighting and spread of contagious infections.
Another common issue presented with poor healing environments includes unnecessary noises
that are dangerous to the patients. It disrupts a piece of mind and may cause increased agitation
(Erenler et al., 2014).
From this experience, I also learned that culture greatly influences health. Culture refers to the
pattern of ideas or behaviors shared by certain group of people in the society. Culture is diverse
and continuously evolving, but their evolution rate varies from culture to culture (Hatah et al.,
2015). When in a foreign country, cultural shock occurs and the struggle between cultures and in
balancing between understanding the new cultural values and respecting their own. For instance,
I found the hospital staff cold and unfriendly. I later came to learn that not looking directly in the
eyes when talking to another person is a sign of respect. Also, they are not unfriendly but that
how they present themselves to people that they respect. However, it would also have been

appropriate if the healthcare providers had explored other cultures so that they can learn and
integrate the patient’s cultural values during care (Iwelunmor, Newsome, & Airhihenbuwa,
One approach to understanding culture is to check if it is ‘individualist’ or ‘collectivist.’
Understanding the difference between the two will help the healthcare providers to learn the best
strategies during care planning. Evidently, the influence of culture on patient outcome is vast.
This is because it affects people’s perceptions about disease, beliefs, causes of illness and health
promotion approaches (Hatah et al., 2015). Understanding patient’s cultural value is important to
prevent cultural bias associated with healthcare perceptions and preferences. Increasing
awareness of cultural values helps the healthcare providers to negotiate the differences and to
incorporate them during diagnosis as well as a treatment plan. If the healthcare providers in this
healthcare facility are trained, they will demonstrate awareness of their culture; promote trust and
better patient’s outcomes (Weaver et al., 2013).
Conclusion of reflection
The recognition of patient strong beliefs and incorporating them in healthcare improves patients
trust and their satisfaction. Developing care plans for more ethnically and diverse populations
should include cultural competence. Healthcare practice is a continuous process that is based on
relevant physician knowledge and appreciation of cultural influences that affect care (Hatah et
al., 2015).
This experience was frustrating and distressing but very informative. Healthcare providers
should be trained to augment their ability to care for the diverse society. The healthcare practice
is a lifelong learning process, and health care providers must learn to integrate new culture into

their care plan. Also, it is important to improve knowledge on the principles of holistic care and
that of a healing environment.

Erenler, A. K., Akbulut, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., & Baydin, A.
(2014). Reasons for Overcrowding in the Emergency Department: Experiences and
Suggestions of an Education and Research Hospital. Turkish Journal of Emergency
Medicine, 14(2), 59–6
Hatah, E., Lim, K. P., Ali, A. M., Mohamed Shah, N., & Islahudin, F. (2015). The influence of
cultural and religious orientations on social support and its potential impact on
medication adherence. Patient Preference and Adherence, 9, 589–596.

Health Academy. (n.d.). Teaching reflective writing.

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