Renuka Arora



                Reflective learning is the process of internally examining and exploring an issue of concern, triggered by an experience, which creates and clarifies meaning in terms of self, and which results in a changed conceptual perspective, as suggested by Boyd and Fales (1983). Reflective learning is a key to learning from experience (Journal of Humanistic Psychology,23)

 The author is going to use The Gibbs Reflective Cycle (1988) to help her in the process of reflection, as reflection can be a difficult experience without the guidance and support of an expert.


Description of Incident

                As usual I started my shift and was assigned an emergency case of laparatomy. I laid up my trolley and counted all the swabs, needles, blades and instruments with my circulating nurse one by one. The swb, tape and the needle counts were clearly written on the board. The patient was an obese Mr Jones. He was anaesthetised, brought into the operating theatre and was transferred to the operating table. The surgeon and his assistant scrubbed, prepped, draped, attached diathermy and suction and started the operation. Mr Jones had an obstructed bowel, which was removed. However the operation did not go well because of an excessive amount of bleeding, due to which the surgeon put small swabs inside the wound, as he felt the larger swabs with tapes would obstruct his view. Mr Jones was fast deteriorating, so the surgeons were very busy in controlling the bleeding, which at last they achieved; so they put the drain there and started to close the wound. When they were about to have a last look into the abdomen to be satisfied that it is dry, I had already started to count the instruments and swabs with my circulating nurse. While counting the swabs, I opened every AP’s swab (30 x 30) showing the tape to the nurse and then continuing with the count. While doing so, we noticed that one of AP’s swab-tape was cut. So I stopped the surgeon from continuing and insisted him to check the piece of tape inside the patient. The surgeon asked whether I was sure that the tape was cut. I explained to him that before starting the operation, me and my circulating nurse had counted all the swabs and tapes, and they were of complete length. He did not believe this, but I was very confident about checking each and every tape’s length, and so was my nurse. We thoroughly searched the rubbish bin to double check, but we didn’t find anything. We again asked the surgeon to look for the tape inside the patient. At first he didn’t find anything, but found out the tape on a successive search, which was all soaked in blood and stuck to a muscle which could have been cut during the separation of adhesions and could not be seen because of the patient’s obesity and the excessive loss of blood. At last, the tape was found, taken out and after the last swab-tape count being done, the wound was closed. This was possible because of my and the circulating nurse’s insistence.  

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                I felt very angry. The initial stages of this incident endangered an awareness of uncomfortable thoughts and feelings. This was followed by disbelief when the surgeon first looked in the wound and said that the tape was not there whereas both my colleague and I had the feeling that the tape was still there. Even after the surgeon told us otherwise, we both continued to feel this. Benner (1984) suggests that the expert nurse is the one with a wealth of experience, which both me and my colleague had. The fact that the surgeon dismissed so readily the ...

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