Graham Gibbs

Gibbs Reflective Cycle is named after Professor Graham Gibbs, University of Oxford. After setting up the Open University’s Centre for Higher Education Practice, in 2004 Graham was appointed Director of the Institute for the Advancement of Learning at Oxford University. Gibbs first outlined the Reflective Cycle in 1988 in Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

Gibbs Model for Reflection

One of the most popular models for reflection, entailing a six step process which is one of the few models which take emotions into account.

The Reflective Cycle

 

Six stages of GIBBS Reflective Cycle TEMPLATE

1) Description
Describe as a matter of fact just what happened during your critical incident or chosen episode for reflection.

2) Feelings
What were you thinking and feeling at the time?

3) Evaluation
List points or tell the story about what was GOOD and what was BAD about the experience.

4) Analysis
What sense can you make out of the situation. What does it mean?

5) Conclusion
What else could you have done. What should you perhaps not have done.

6) Action Plan
If it arose again, what would you do differently. How will you adapt your practice in the light of this new understanding?

Six stages of GIBBS Reflective Cycle CASE 2

1) Description
Describe as a matter of fact just what happened during your critical incident or chosen episode for reflection.

Working on an ambulance with my colleague, we received a call to a nursing home for an elderly female "fallen". When we arrived on scene we were met by staff who informed us that the lady had missed her seat as she went to sit down and landed heavily on the floor. Approaching the female I could see that the area she had landed on was carpeted and that she was of slight build and elderly and seemed in a great deal of pain. Her RIGHT leg was shortened and rotated.

2) Feelings
What were you thinking and feeling at the time?

My first concern was that this lady had obviously sustained a RIGHT hip fracture and had the potential of a serious internal bleed. I was also concerned whether it was indeed a simple 'slip' or whether there was any underlying condition that had caused her fall. Rao SS (2005) stated that causes of falls in older people are usually multi factoral but can include: Accident and environmental hazards 31%, Gait and balace disorders 17%, Dizzines and vertigo 13% Drop attack 9%, Confusion 5%, Visual disorders 2%, Syncope 0.3%, Arthritis, acute illness, drugs, alcohol, apin, epilepsy & falls from bed 15%, unknown 5%. I ascertained from my history taking that this lady suffered from dementia and was stage four on the Global Deterioration Scale as identified by B Reisberg, SH Ferris, MJ De Leon & T Crook (1982). This is described as Early Dementia and meant that she was at a stage in her condition where she could no longer function without assistance, was unable to recall major events, home address, phone number or names of her children. She was also taking more than 4 medications for this condition including drugs for depression which could have been a contributing factor as stated in the American Family Physician (2000).

3) Evaluation
List points or tell the story about what was GOOD and what was BAD about the experience.

I was pleased to see that the lady, although in a great deal of pain, appeared to have sustained no other outward physical injury. Her observations were within the normal range and her circulation appeared normal. My major concern was that this call had been classified 'green' in accordance with Government guidelines, and she had, therefore, been lying in this condition for over an hour.

4) Analysis
What sense can you make out of the situation. What does it mean?

This elderly female suffered with dementia but otherwise enjoyed good health,she lived in a nursing home specialising in care of the Elderly Mentally Ill. I was satisfied to learn that she had no previous history of falls and that there had been no change to her medication within the last two months, a recent report (American Family Physician, 2000) stated that the elderly were prone to falls following a change in medication. I was satisfied with her observations and that she appeared to be her normal self.

5) Conclusion
What else could you have done. What should you perhaps not have done.

I feel that the whole process went very smoothly, the lady received pain relief through an IV cannula thus making her move on to the ambulance trolley as smooth and pain free as possible. I explored the history thoroughly and I do not think there was anything that I should not have done.

6) Action Plan
If it arose again, what would you do differently. How will you adapt your practice in the light of this new understanding?

I will continue to reflect and study the causes of falls to further my knowledge. I will seek to contact the local Slips, Trips and Falls Team to gain advice on how they deal with patients who have falls regularly and to see whether I can perhaps put into practice some of their advice to better the service that I can provide to the elderly patient.

Six stages of GIBBS Reflective Cycle CASE 1
1) Description
Describe as a matter of fact just what happened during your critical incident or chosen episode for reflection.

Working with an experienced ECP to update practice. Call received as collapsed patient in a modern sheltered accomodation. On arrival elderly gentleman had been helped, first to sit on a wall and then walked into the lounge. Minor haematoma to the Right side, parietal area, approx 3 cm. No history of unconsciousness.

2) Feelings
What were you thinking and feeling at the time?

First impressions of the patient were that he was alert, dignified and lucid and moved quite well. He seemed shaken and a little pale. Thought about the mechanics of injury and, as my colleague was doing initial checks, went to check out site of fall; did the surface contribute, did he land on grass, concrete.

3) Evaluation
List points or tell the story about what was GOOD and what was BAD about the experience.

Pleased to see that the man did not appear to have sustained injury. Checks carried out on his neck revealed no abnormalies detected, with normal range of movement. Recalled history prior and post event. Fell back against wall and to the ground slowly after losing his nerve on a sloping part. No dizziness, faintness, dyspnoea or chest pains. No injury or pain detected, movement checked in right wrist, elbow and shoulder. Moves legs freely and can stand now, unaided. Did not ask for an Ambulance and did not want hospital treatment. Gentleman in the habit of walking freely around the accomodation often during the day.

4) Analysis
What sense can you make out of the situation. What does it mean?

This 96 year old man has maintained a high degree of independance, despite a history of aortic valve replacement. It seems that he had a fright while negotiating a sloping cobbled and made glacing contact with a wall as he went, fairly gradually, to the floor. The event has shaken him somewhat. Observations including TPR B.P. and Blood Glucose are in the normal range. ECG monitored.Sum of physical injury semms to be a small haematoma, as per R.N.C form

5) Conclusion
What else could you have done. What should you perhaps not have done.

Patient's son in attendance soon after our arrival. He was supportive and attentive and agreed to stay with his father for thw evening. Spoke to patient son and warden with S.O.S. advice in the case of vomitting, visual disturbance, headaches drowsiness

6) Action Plan
If it arose again, what would you do differently. How will you adapt your practice in the light of this new understanding?

We were sufficiently convinced that the slope of the cobbles were a major factor in the fall. I feared for the effect on the patient's confidence and the resultant effect on his mobility. In hindsight I would advise on the use of a stick or other walking aid as well as avoiding areas like sloping cobbles. Also in hindsight-is this an appropriate floor surface for sheltered accomodation?