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The framework model for reflection is the Gibbs model of reflection for the pain assessment in the

as per the second stage of the clinical reasoning cycle, collect cues/information. The Gibbs model of

reflection has four stages: description of the situation, feeling, evaluation, conclusion, and action

(Koshy et al., 2017).

DESCRIPTION

Theis scenario arises during one of my classroom sessions where our professor narrated us the case

of Mr. Hopkin a 45-year-old male admitted to ICU following the laparotomy procedures for his small

bowel preformation and peritonitis. He has history of opioid dependency and depression and was

shouting in pain. She asked us for the next course of action to which I responded administration of

analgesic medication but my professor asked some questions such as do you know how severe is the

pain; what is the pain scale reading; what pain scale has been used; what is the reliability of the pain

scale and what was the last dose of the pain killer provided to him. I soon realized that I have not

paid attention to the pain assessment correctly and failed to collect the cues to evaluate the

patient's current status.

FEELING

My first feeling was that Mr Hopkin was in severe pain and needed drug administration for it, some

strong analgesic. I was under the presumption that pain is a subjective feeling; hence, he requires

medicine if he is reporting pain. On being asked several questions by my professor I released that in

acute situations, how important is the complete assessment of the patient and collecting

appropriate information and not making emotional decisions based on unempirical emotional

decisions.

EVALUATION

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The complete scenario provided me with the sense of responsibility I hold as a healthcare

professional. I learn and gain information about pain assessment and management. I moved on to

ask further question to my professor on how to establish the proper skills and effective assessment

in this case. To which she replied that the proper methodology was to check his vitals, assess him

according to the reliable FRAAC pain scale, and evaluate his drug charts (Chatchumni et al., 2016).

Not only pain but while caring for a postoperative patient, there are several other accessory

assessments I need to carry out related to dehydration, fluid and electrolyte, urine output, vomiting

(Varndell et al., 2017).

Along with these, vital also play an essential role. As she described the drug chart, my

professor explained to me that Mr. Hopkins was on opioids. I released that all opioids, including the

morphine regime, needs careful monitoring of the schedule and routine assessment of the pain for

regulating the dose within the therapeutic ranges. The pain can be felt due to series of factors like

culture, mood, experiences, beliefs, psychosocial disturbances and personal ability; hence I need to

rely more on the empirical cues present and collect the scientific evidence. She then told me that my

answer was correct but my approach for cues collection and information synthesis was wrong as the

visiting doctor increased the dose of his morphine to 20 mg every 4 hours but only after assessing his

complete presentation. The careful assessment of the pain provides information regarding the dose

regime's underlying pathology, complication, and effectiveness (Sherwood & McNeill, 2017).

ANALYSIS

The whole process of our professor discussing the case was educating and lessoning at the same

time. Mr. Hopkin was given morphine for his pain as the part of the postoperative pain

management. Direct implementation of the medication can be harmful to patients, especially under

anesthetic sedation. The episode left me uncomfortable as my answer reflected my approach clinical

reasoning which was utterly wrong and incomplete. The assessment needs to be complete, holistic

and complied with other supporting information to complete the data that can be used for further

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interventional support to the patient (Varndell et al., 2017). If assessment is done correctly, a

sensible and logical goal can be set. For example, if his pain scale shows a score of 7/10, then the

goal or the outcome of the intervention, the effectiveness can be checked through goal setting of

reaching pain scale rate of 3/10 (Chatchumni et al., 2016). Dydyk & Grandhe, 2021, States that pain

assessment plays a vital role in determining the patient outcome in terms of morbidity and

mortality. Patients like Mr. Hopkins can become maladaptive with hyperalgesia due to their drug and

depression history; hence the critical aspect of the pain is acknowledging the influencing factors,

comorbidities and psychosocial determinants. The presence of mood disorder leads to worsening of

pain and proper history of opioid dependency, trauma, old age, any other comorbidity may also

contribute to pain (Chatchumni et al., 2016)

CONCLUSION

Through this situation, I have drawn two conclusions. The first one is that the overwhelming

response may restrict the empirical and scientific thinking required for the cues collection necessary

for required clinical reasoning in pain management. All aspects of history and documents should be

well studies before commencing the further course of action, both objective and subjective data

should be collected. I have failed to collect the necessary information.

The second fact that I have understood is the crucial importance of assessment before providing any

intervention, especially opioids. A thorough assessment is essential so that information can be

gathered regarding the effectiveness of the medication. So, assessment is vital for understanding the

disease process or pathology and the drug regime effectiveness.

ACTION

If I encounter similar situation in future, my actions will be based on a more analytical and

fundamental approach. I will evaluate the individual case holistically while assessing the complaint,

such as pain. This will include using reliable pain assessment tool such as FAAC, VDS which will

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provide me with a numerical understanding of pain severity. Also, I will undertake other aspects of

pain in the history form that may give clues regarding the pain response, such as habits,

dependency, psychosocial aspects. I will practice my skills, ensuring that I have mastered the

technique of pain assessment.

REFERENCES

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learning conversations as an approach for clinical learning and teaching in critical

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Jones, J., Bion, J., Brown, C., Willars, J., Brookes, O., and Tarrant, C., 2020. Reflection in practice: How

can patient experience feedback trigger staff reflection in-hospital acute care

settings? Health Expectations, 23(2), pp.396-404

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https://doi.org/10.1097/ncq.0000000000000282

Koshy, K., Limb, C., Gundogan, B., Whitehurst, K., & Jafree, D. (2017). Reflective practice in health

care and how to reflect effectively. International Journal Of Surgery: Oncology, 2(6), 20.

https://doi.org/10.1097/ij9.0000000000000020

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Sherwood, G., & McNeill, J. (2017). Reflective practice: providing safe, quality patient-centred pain

management. Pain Management, 7(3), 197-205. https://doi.org/10.2217/pmt-2016-0053

Varndell, W., Fry, M., & Elliott, D. (2017). Exploring how nurses assess, monitor and manage acute

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Dydyk, A., & Grandhe, S. (2021). Pain Assessment. Ncbi.nlm.nih.gov. Retrieved 29 April 2021, from

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Chatchumni, M., Namvongprom, A., Eriksson, H., & Mazaheri, M. (2016). Thai Nurses' experiences of

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