Table of Contents
Type: Reflective Report | Subject: Nursing | Level: Undergraduate | Word Count: ~2,350 words
This model Reflective Report was produced by an Essays UK specialist as reference material for learning purposes only. For support in this field, see our nursing writers.
Overview: This model undergraduate reflective report applies Gibbs’ Reflective Cycle to a single significant event from an adult nursing placement, in which a student nurse identified early signs of clinical deterioration but hesitated to escalate the concern. It works through all six stages of the model, from an objective description of the incident to a forward-looking action plan, and shows how each stage can be supported with professional and theoretical evidence.
Reflective practice has become a defining feature of contemporary nursing in the United Kingdom, embedded in both pre-registration education and the Nursing and Midwifery Council (NMC) revalidation process (NMC, 2018). Learning to reflect in a structured way allows practitioners to convert everyday clinical experience into transferable knowledge, rather than allowing significant moments to pass without examination (Jasper, 2013). This model reflective report demonstrates how a second-year adult nursing student might structure a formal piece of academic reflection around a single significant event encountered during a clinical placement.
The framework used throughout is Gibbs’ Reflective Cycle (Gibbs, 1988), a six-stage model that guides the writer systematically from an objective description of events through to a forward-looking action plan. Gibbs’ cycle has been chosen in preference to simpler two-stage approaches, such as that proposed by Boud, Keogh and Walker (1985), because its iterative structure encourages the depth of analysis expected at undergraduate level while remaining accessible to an early-career practitioner (Howatson-Jones, 2016). The model also complements Kolb’s (1984) experiential learning theory, from which it is partly derived, by emphasising that learning is completed only when reflection is translated into subsequent action.
The report reflects on an episode in which the author identified early signs of clinical deterioration in a patient but initially hesitated to escalate the concern. In line with the NMC Code (2018), all identifying details have been altered and the patient is referred to by the pseudonym ‘Mr Thomas’ in order to preserve confidentiality. The aim is not to present an account of faultless practice but to examine honestly what happened, why it happened and how the resulting learning can be applied to safer, more confident future care. Table 1 summarises how each stage of Gibbs’ cycle is addressed in the sections that follow.
| Stage | Guiding Question | Addressed In |
|---|---|---|
| 1. Description | What happened? | Description |
| 2. Feelings | What were you thinking and feeling? | Feelings |
| 3. Evaluation | What was good and bad about the experience? | Evaluation |
| 4. Analysis | What sense can you make of the situation? | Analysis |
| 5. Conclusion | What else could you have done? | Conclusion |
| 6. Action Plan | If it arose again, what would you do? | Action Plan |
The event occurred during the sixth week of a nine-week placement on a general medical ward within an acute NHS trust. Mr Thomas was a man in his late seventies who had been admitted two days earlier with a community-acquired chest infection on a background of chronic obstructive pulmonary disease. On the morning in question, my practice supervisor asked me to record a routine set of physiological observations for several patients, including Mr Thomas, and to document them on the ward’s electronic observation system. The ward was busy: two patients had been admitted overnight, the registered nurse was supervising a transfer, and the medical team had not yet completed their round. This context is relevant because, as will become clear, my perception of how busy my colleagues were influenced my subsequent decision-making.
When I measured Mr Thomas’s vital signs, several readings fell outside the parameters I had come to expect. He appeared slightly more breathless than on the previous day, his speech was interrupted by the effort of breathing, and he felt warm to the touch. Using the National Early Warning Score 2 (NEWS2) chart adopted across the trust (Royal College of Physicians, 2017), I calculated an aggregate score of six. The individual measurements and their corresponding scores are presented, for illustrative purposes, in Table 2.
| Parameter | Measurement | NEWS2 Score |
|---|---|---|
| Respiration rate | 22 breaths per minute | 2 |
| Oxygen saturation (Scale 1) | 94% on air | 1 |
| Air or oxygen | Room air | 0 |
| Systolic blood pressure | 108 mmHg | 1 |
| Pulse | 95 beats per minute | 1 |
| Consciousness (ACVPU) | Alert | 0 |
| Temperature | 38.2°C | 1 |
| Aggregate NEWS2 | — | 6 |
According to the NEWS2 escalation protocol, an aggregate score of between five and six triggers an urgent-response threshold, requiring the registered nurse to be informed promptly so that a review by a clinician with the appropriate competencies can be arranged (Royal College of Physicians, 2017). Although I recognised that the score was raised, I did not report it immediately. Instead, I spent several minutes re-checking the tympanic thermometer and the oxygen-saturation probe, repositioning the equipment, and recording a second set of readings, which proved broadly similar to the first. Only after this delay of approximately ten minutes did I inform the registered nurse. She attended Mr Thomas without delay, carried out her own assessment, and contacted the medical team, who reviewed him shortly afterwards. His antibiotic therapy was adjusted and controlled oxygen was commenced. Mr Thomas remained clinically stable and was discharged several days later.
Reflecting on my internal response is central to the second stage of Gibbs’ cycle and, as Johns (2017) argues, naming one’s emotions is a precondition for understanding how they shape clinical decisions. In the moments after calculating the score, my predominant feeling was self-doubt. I was aware that the reading was abnormal, yet I questioned whether I had performed the observations correctly, and I feared that I might be raising a false alarm and wasting the registered nurse’s time on an already busy shift.
Underlying this hesitation was a lack of confidence in my own clinical judgement. As a second-year student, I felt that my interpretation of the data might carry less weight than that of a qualified colleague, and I was conscious of not wanting to appear incompetent in front of the team. There was also a reluctance to disturb the established routine of the ward round. Looking back, I can identify a clear tension between my emerging sense of professional accountability and my anxiety about overstepping the limits of a student role.
Once I had escalated the concern and observed the registered nurse respond without hesitation or criticism, my anxiety gave way to a mixture of relief and discomfort. I was relieved that Mr Thomas received timely treatment, but I felt uneasy that my delay could, in a less stable patient, have had far more serious consequences. This discomfort, although unpleasant, became a powerful stimulus for learning, consistent with the view of Boud, Keogh and Walker (1985) that deliberately attending to feelings is essential if reflection is to produce genuine change rather than superficial description. Acknowledging these emotions in writing has also been uncomfortable, but it has allowed me to examine motivations that I might otherwise have rationalised away, such as the way in which concern for the team’s workload was allowed to compete with my responsibility to the patient.
Evaluating the episode in a balanced way requires me to acknowledge both its positive and its negative aspects. On the positive side, I carried out the physiological observations accurately and competently, and I correctly calculated the NEWS2 score, which demonstrates that my underlying knowledge and technical skills were sound. I also recognised that the score was clinically significant rather than dismissing it, and I ultimately did escalate the concern to an appropriate colleague. The eventual outcome for the patient was a good one.
The clear weakness in my practice was the delay in reporting. The ten-minute interval during which I re-checked the equipment, although understandable, was not clinically justified once a raised score had been obtained, and it postponed the point at which a senior clinician could assess the patient. Repeating a single set of observations to confirm the finding was reasonable; allowing uncertainty about my own competence to override an established safety protocol was not. In a rapidly deteriorating patient, such a delay could have contributed to avoidable harm.
A further limitation was the quality of my communication. When I did speak to the registered nurse, I did so informally and without a structured handover, which meant that I did not convey the information as clearly or with as much urgency as the situation warranted. Overall, my evaluation is that my technical performance met the expected standard, but that my decision-making and communication under uncertainty were not yet consistent with the conduct of a safe, accountable practitioner as described in the NMC Code (2018).
The analysis stage requires me to make sense of the experience by drawing on relevant evidence and theory. The central issue was not a deficit of knowledge but a failure to act promptly on knowledge I already possessed. This distinction can be understood through Schon’s (1983) concept of reflection-in-action: an experienced practitioner continually interprets and responds to a changing situation in real time, whereas I became preoccupied with verifying data rather than acting on it. Benner’s (1984) novice-to-expert model offers a complementary explanation. As an advanced beginner, I was still heavily reliant on explicit rules and lacked the experiential grounding that allows more seasoned nurses to trust their clinical judgement, which helps to account for my repeated need to re-check the readings.
The hesitation can also be analysed in terms of professional accountability. The NMC Code (2018) requires nurses, and the students working towards registration, to prioritise people, to recognise and work within the limits of their competence, and to act without delay if they believe there is a risk to patient safety. My delay, although motivated by a wish to be accurate, was inconsistent with the principle of acting promptly on a concern. Importantly, the Code also makes clear that raising a concern is never inappropriate; the duty of candour and the wider culture of patient safety depend on staff escalating uncertainty rather than suppressing it.
A significant contributory factor was the absence of a structured communication tool. The SBAR framework — Situation, Background, Assessment, Recommendation — was designed precisely to give less experienced staff a clear and assertive structure for escalating concern (NHS Institute for Innovation and Improvement, 2008). Had I framed my handover using SBAR, I would have been able to state the situation, summarise Mr Thomas’s background, report the NEWS2 score as my assessment, and recommend an urgent review, thereby communicating with the clarity and confidence the moment demanded. Current clinical guidance similarly stresses that early recognition must be matched by timely, structured escalation if the detection of deterioration is to improve outcomes (Dougherty and Lister, 2015).
Finally, the human-factors literature suggests that hierarchy and the fear of appearing incompetent are recognised barriers to escalation among junior staff (Bulman and Schutz, 2013). Recognising that my behaviour reflected a well-documented pattern, rather than a purely personal failing, is reassuring, but it also underlines the responsibility I share in actively overcoming these barriers. Viewed through Kolb’s (1984) experiential learning cycle, the concrete experience and my reflective observation on it have now to be converted into abstract conceptualisation and active experimentation. Taken together, the evidence indicates that my learning needs centre less on clinical knowledge and more on the confidence, assertiveness and structured communication required to translate accurate observation into timely action.
In concluding this reflection, it is useful to consider what else I could have done when faced with the situation. The most important alternative action would have been to inform the registered nurse immediately on obtaining a NEWS2 score of six, while continuing to monitor Mr Thomas, rather than delaying escalation in order to re-check the equipment. I could also have used the SBAR tool to communicate my concern clearly and assertively, and, if I genuinely doubted the accuracy of my readings, I could have asked the registered nurse to observe my technique, which would have resolved my uncertainty without postponing care.
More broadly, the experience has taught me that competence in nursing is not only a matter of technical skill but also of the professional confidence and judgement required to act on that skill under pressure. I have learned that escalating a concern is a legitimate and expected part of safe practice, not an admission of inadequacy, and that patient safety must always take precedence over my personal anxiety about how I am perceived by colleagues. The episode has also highlighted the value of structured communication tools in supporting junior members of the team. Although my delay did not result in harm on this occasion, honest reflection on it has proved more instructive than a straightforwardly successful experience would have been, and it has directly shaped the action plan that follows.
To ensure that this reflection leads to genuine change in my practice, in line with the final stage of Gibbs’ cycle, I have identified several specific and achievable actions.
I will review my progress against these actions at the midpoint and the end of my next placement, using supervisor feedback and my reflective journal as evidence. By setting measurable goals and a clear timescale for review, I aim to ensure that the learning drawn from this single episode is embedded in a lasting improvement in the safety and confidence of my practice.
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