A Reflective Account of Person-Centred Care Using Gibbs

Introduction

This reflective account examines a clinical encounter during an acute medical ward placement in which a patient in the early stages of a delirium episode required both immediate assessment and a considered approach to communication with family members who were present and distressed. Reflection is employed here using the Gibbs Reflective Cycle (Gibbs, 1988), which provides a structured framework for moving from description of the experience through emotional processing, evaluation, analysis, and the formulation of a concrete action plan. Reflective practice is central to professional development in nursing, as the Nursing and Midwifery Council (NMC, 2018) establishes in The Code, which requires registered nurses to engage in ongoing reflective learning and to use evidence from reflection to improve their practice.

Description

During a morning medication round, I observed that a 78-year-old patient, Mr P., who had been admitted three days previously following a fall, was showing signs of acute confusion. He was attempting to remove his peripheral cannula, was calling for a family member who was not present, and appeared frightened and disoriented. His family, including his daughter and son-in-law, were present and visibly distressed by the change in his presentation. The nurse in charge was occupied with another patient emergency. I made the decision to remain with Mr P. and his family while summoning a healthcare assistant to alert the nurse in charge. I conducted a brief assessment of Mr P.'s orientation, pain, and vital signs while maintaining a calm and reassuring presence throughout.

Feelings

My initial response was one of concern combined with uncertainty. I was aware that delirium requires urgent assessment, that Mr P. was at risk of self-harm through removal of his cannula, and that his family required immediate support. I felt the tension between competing demands: the clinical need to summon assistance and the relational need to remain present with a frightened patient and a distressed family. I also felt apprehension about communicating with the family in a way that would be informative and reassuring without overstepping my competence level or providing premature conclusions about the cause of Mr P.'s confusion. Reflecting on these feelings, I can identify a degree of anxiety about my own competence and about the potential consequences of the decisions I was making in the absence of direct supervision.

Evaluation

Evaluating what went well and what did not requires honest engagement with both the outcomes and the process of the encounter. Mr P. was assessed by the nurse in charge within five minutes, an urgent medical review was requested, and a delirium care plan was initiated. Mr P. did not succeed in removing his cannula, and his family received an explanation of the situation from the registered nurse that they described as helpful. These outcomes were positive. However, I also recognise limitations in my performance. My communication with Mr P. was primarily task-focused in the initial moments, oriented toward the brief assessment, rather than beginning with the prioritisation of therapeutic presence and orientation that the evidence base for delirium care recommends. O'Malley et al. (2008) identify therapeutic presence and consistent, gentle reorientation as primary nursing interventions in the management of delirium, and I did not deploy these with sufficient consistency in the early part of the encounter.

Analysis

Delirium is defined by the DSM-5 (American Psychiatric Association, 2013) as an acute disturbance of attention, awareness, and cognition developing over a short period and tending to fluctuate in severity. In older hospitalised patients, delirium is common, affecting between 14 and 56 per cent of patients depending on the care setting studied (Inouye et al., 2014), and is associated with significantly increased morbidity, mortality, and length of stay. The nursing role in delirium care is centred on early recognition, environmental modification, and non-pharmacological management. NICE (2010) recommends a first-line approach involving addressing the underlying causes alongside environmental and relational strategies designed to support orientation and reduce distress. The latter include providing clear, consistent verbal orientation, maintaining a familiar and calm environment, and ensuring that family members and carers are appropriately supported and engaged as partners in care. It is in this domain that I recognise the greatest gap between my actual performance and the evidence-based standard.

The communication literature reinforces this analysis. Arnold and Boggs (2020) identify therapeutic communication as a distinct clinical skill requiring the active and intentional use of verbal and non-verbal techniques to establish therapeutic presence and facilitate the expression of feelings and concerns. In the context of Mr P.'s delirium, therapeutic presence involved sitting at eye level, using a calm and reassuring tone, addressing Mr P. by name, and providing simple and repeated orientation information. These are learnable and deployable skills that I could have applied more systematically from the outset.

Conclusion and Action Plan

This reflection has clarified two specific areas for professional development. First, I will deepen my knowledge of delirium assessment tools, specifically the Confusion Assessment Method (CAM; Inouye et al., 1990), which provides a validated and efficient framework for the rapid identification of delirium in clinical settings. Second, I will review the NICE guideline on delirium management and the evidence base for therapeutic communication in acute confusion, with the aim of developing a more practised and deliberate repertoire of orientation and reassurance strategies. As Schon (1983) argues, the reflective practitioner is distinguished not by the absence of difficulty in complex clinical situations but by the capacity to learn systematically from that difficulty, converting uncertain and challenging encounters into structured opportunities for professional growth.