Gibbs Method Of Reflective Practice

Submitted By Tim-Chivers
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Pages: 6
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Demonstrate an understanding of the need to act in the best interests of the service user at all times. I shall use the Gibbs method of reflective practice cycle to evaluate my thoughts and findings. Description
I was called to an elderly female by neighbours who were concerned the patient was unable to get out of her chair. On arrival the neighbours were with the patient. I performed a primary survey and the result was FAST positive 2/3. I explained to the patient she had the signs and symptoms of an acute stroke and that we needed to get her to hospital for treatment. I was aware the patient was dissatisfied. I tried to explain that her hospital stay may not be a pleasant experience but the outcome and better quality of life if she took the treatment may out way living with the disabling affects of stroke. I was trying to obtain informed consent. The patient flatly refused to leave her house, which led to a long period of a concerted effort to persuade the patient to get treated by myself, crewmate, neighbours who were also careers. I initially assumed that every person should be presumed to be able to make their own decisions.
“Every person should be presumed to be able to make their own decisions”. (http://www.legislation.gov.uk/ukpga/2005/9/contents)
Eventually I deemed the patient not to have capacity and made plans to forcibly remove her without causing harm if possible.
“Non maleficence: avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.” (Beauchamp and Childress; Principles Biomedical Ethics, OUP, 5th edition 2001)
. I explained in very simple terms what had happened to her and what the outcome maybe if she didn’t receive treatment. I asked her to repeat what I had said in five minutes time. She couldn’t do this, I concluded with the help of the carers that normally she would be able to retain and repeat information but since the stroke she was now unable to. At that point she decided to attend hospital for treatment. The patient implied consent in the fact that she unexpectedly got up and walked to the ambulance.
“English law necessitates that before any medical professional can examine or treat a patient, they must obtain informed consent to do so.” (Department of Health Mental Health Acts 1983 and amended in 2007)

Feelings
My initial feelings were positive, that I had recognised stroke, it fell within the time frame for re-perfusion treatment and the outcome may be good for the patient.
“Beneficence: this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient”
(Beauchamp and Childress; Principles Biomedical Ethics, OUP, 5th edition 2001) But I was disappointed when the patient declined aid. I tried to put myself in the patient’s position and respected the patients informed choice.
“Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices.” (Beauchamp and Childress; Principles Biomedical Ethics, OUP, 5th edition 2001) The negative attitude was frustrating. I felt I was possibly breaching patient confidentiality by discussing her health needs in front of careers but I was also feeling grateful for their support. I felt slightly uncomfortable at the careers threats to stop caring if the patient didn’t get treated.
I felt that the capacity tool the LA5 may not have been followed strictly as the carers were on scene and may have been an external pressure influencing her decision making.

Evaluation
It was good that the stroke was recognised early and the patient eventually got treatment and made a recovery. It was also bad that due to my lack of experience regarding consent that the patient perceived that she had
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