gibbs reflective cycle nursing essay

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Gibbs' Reflective Cycle

One of the most famous cyclical models of reflection leading you through six stages exploring an experience: description, feelings, evaluation, analysis, conclusion and action plan.

Gibbs' Reflective Cycle was developed by Graham Gibbs in 1988 to give structure to learning from experiences.  It offers a framework for examining experiences, and given its cyclic nature lends itself particularly well to repeated experiences, allowing you to learn and plan from things that either went well or didn’t go well. It covers 6 stages:

• Description of the experience
• Feelings and thoughts about the experience
• Evaluation of the experience, both good and bad
• Analysis to make sense of the situation
• Conclusion about what you learned and what you could have done differently
• Action plan for how you would deal with similar situations in the future, or general changes you might find appropriate.

Below is further information on:

• The model – each stage is given a fuller description, guiding questions to ask yourself and an example of how this might look in a reflection
• Different depths of reflection – an example of reflecting more briefly using this model

This is just one model of reflection. Test it out and see how it works for you. If you find that only a few of the questions are helpful for you, focus on those. However, by thinking about each stage you are more likely to engage critically with your learning experience.

This model is a good way to work through an experience. This can be either a stand-alone experience or a situation you go through frequently, for example meetings with a team you have to collaborate with. Gibbs originally advocated its use in repeated situations, but the stages and principles apply equally well for single experiences too. If done with a stand-alone experience, the action plan may become more general and look at how you can apply your conclusions in the future.

For each of the stages of the model a number of helpful questions are outlined below. You don’t have to answer all of them but they can guide you about what sort of things make sense to include in that stage. You might have other prompts that work better for you.

Description

Here you have a chance to describe the situation in detail. The main points to include here concern what happened. Your feelings and conclusions will come later.

Helpful questions:

• What happened?
• When and where did it happen?
• Who was present?
• What did you and the other people do?
• What was the outcome of the situation?
• Why were you there?
• What did you want to happen?

Example of 'Description'

Here you can explore any feelings or thoughts that you had during the experience and how they may have impacted the experience.

• What were you feeling during the situation?
• What were you feeling before and after the situation?
• What do you think other people were feeling about the situation?
• What do you think other people feel about the situation now?
• What were you thinking during the situation?
• What do you think about the situation now?

Example of 'Feelings'

Here you have a chance to evaluate what worked and what didn’t work in the situation. Try to be as objective and honest as possible. To get the most out of your reflection focus on both the positive and the negative aspects of the situation, even if it was primarily one or the other.

• What was good and bad about the experience?
• What went well?
• What didn’t go so well?
• What did you and other people contribute to the situation (positively or negatively)?

Example of 'Evaluation'

The analysis step is where you have a chance to make sense of what happened. Up until now you have focused on details around what happened in the situation. Now you have a chance to extract meaning from it. You want to target the different aspects that went well or poorly and ask yourself why. If you are looking to include academic literature, this is the natural place to include it.

• Why did things go well?
• Why didn’t it go well?
• What sense can I make of the situation?
• What knowledge – my own or others (for example academic literature) can help me understand the situation?

Example of 'Analysis'

Conclusions.

In this section you can make conclusions about what happened. This is where you summarise your learning and highlight what changes to your actions could improve the outcome in the future. It should be a natural response to the previous sections.

• What did I learn from this situation?
• How could this have been a more positive situation for everyone involved?
• What skills do I need to develop for me to handle a situation like this better?
• What else could I have done?

Example of a 'Conclusion'

Action plan.

At this step you plan for what you would do differently in a similar or related situation in the future. It can also be extremely helpful to think about how you will help yourself to act differently – such that you don’t only plan what you will do differently, but also how you will make sure it happens. Sometimes just the realisation is enough, but other times reminders might be helpful.

• If I had to do the same thing again, what would I do differently?
• How will I develop the required skills I need?
• How can I make sure that I can act differently next time?

Example of 'Action Plan'

Different depths of reflection.

Depending on the context you are doing the reflection in, you might want use different levels of details. Here is the same scenario, which was used in the example above, however it is presented much more briefly.

Adapted from

Gibbs G (1988). Learning by Doing: A guide to teaching and learning methods. Further Education Unit. Oxford Polytechnic: Oxford.

Health and Safety Advice in a Fast Changing World

Nurses and Midwives Reflection Process

Nurses and Midwives in the UK are formally required to record 5 pieces of reflection on either continuing professional development (CPD) or practice related feedback to improve their nursing practice.

Here I start with the theory of reflection (see Framework image) and then give an example from my own nursing history of an awful incident – one I will never forget.

If you don’t want the theory (and let’s face it who does?); scroll down to my real-life example and see how I have applied the Gibbs theory model to a terrible incident which almost made me give up nursing.

Let’s Get Started

To see if Gibbs reflective cycle can help you reflect on aspects of your practice, recall a nursing situation that didn’t turn out as you expected or go to plan.

Look at the Gibbs Model flow chart above –

Stage 1 – Description (Pure Facts)

The first step is to describe what you know. Ask yourself the following questions:

• What are the brief facts of the situation?
• What occurred? Who was involved?
• What did you do? What did others do?

Stage 2 – Description – (Feelings)

• How were you feeling at the time?
• Were there influences affecting others actions/behaviour?
• Were there any known or perceived difficulties with the activity, timing, location, information or resources etc.?

Stage 3 – Evaluation

• What was good and bad about the experience
• How might the facts and feelings (from stage 1 and 2 above) have affected your actions/behaviour
• What other circumstances may have affected your actions or thoughts?
• How issues might influence the activity or practice related feedback?

Stage 4 – Analysis

• Why you picked this incident to reflect on?
• What sense can you make of it? Does it make sense given the preceding 3 stages?
• What is the main area of concern or focus on the future?

Stage 5 – Conclusions

• What have you discovered?
• What have you learned from this incident and circumstances?
• What questions remain?

Stage 6 – Now What? (Action)

You have analysed the incident and want to make sure you improve your practice for next time, so need to move into the action planning stage:

• What will I do differently from now on or the next time this arises?
• What resources/help will you need?

Gibbs, (1988) Learning by Doing: A Guide to Teaching and Learning Methods Further Education Unit, Oxford Brookes University, Oxford.

Example Reflection –  Sadly, a real story!

Night duty drug round.

I am a third-year student nurse ‘in charge’ on night duty, in a London hospital, with a junior nurse to deal with 23 pretty sick people in this medical ward.  A doctor asked me to give a patient (Mrs X,) 0.1 mg of Digoxin (a heart stimulant – steady, slows and strengthens the heartbeat) to relieve symptoms of severe congestive cardiac failure and difficulty breathing.  I had never given such a high dose of Digoxin before and measured 4 tabs from the 0.25 mg bottle.  I checked the script and the tablets with both the doctor, who nodded, and my junior nurse. We were all in agreement. I checked Mrs X’s pulse rate (standard practice for Digoxin), which was in the OK range, before giving the tablets. I kept Mrs X on hourly observations after.

At about 2 am I suddenly realised I had given 10 times the amount of Digoxin as stated on the Doctors script.  In horror, I called the night sister who agreed with me.  We filled in an incident form, informed the doctor and Mrs X’s relatives of what happened. Petrified, I was told to go see the hospital matron in the morning.

Mrs X did not seem to suffer any ill effects from the Digoxin during the night and went on to make a full recovery.

I had been on nights for a long stretch.  It was a very busy ward with only two-night staff and I was “in charge”.  Mrs X was very ill and needed constant monitoring.

I had only ever seen 0.25mgs of Digoxin tablets and did not know there was a paediatric blue table of 0.1 mg made.  I was very reluctant to give such a big dose which is why I checked the four tablets of .25 with the doctor who looked at the tablets and said OK.  I was nervous about the dosage being so high and took Mrs X’s pulse for much longer than the customary 15 seconds.

The doctor too was under tremendous strain, his beeper kept going off and he was rushing about all over the place.  I had never met him before.  He had recently come from a paediatric ward.

Nobody ever blamed me for the incident, neither did they reassure me.  Mrs X went on to make a full recovery and the relatives were very understanding about the situation which was a relief.  Matron was kind to me and impressed I had owned up to the error – nobody would have ever known, she said.

I felt absolutely terrified about the error though and watched Mrs X all night for signs of overdose.  I didn’t sleep all the next day and returned to my next night shift to find Mrs X better.

This incident really frightened me because I had done everything right – I had checked the dosage with both the Doctor and the junior nurse.  I had not known that you could get a 0.1 mg of Digoxin or it was blue.  I have no idea what prompted me to think about the overdose later on that night except that I had been very reluctant to give it.  The Doctor agreed I had shown him 4 white tablets who said “I thought you knew what you were doing” Which isn’t any sort of answer really.  Yet he didn’t get in trouble (like me) at all for overseeing and agreeing my mistake.

I also realised how dependant patients are on the care and insights of the medical profession and the trust they put in us; I’d let Mrs X down.

I believe that this incident was down to a series of incidents linked to overwork, tiredness and misunderstandings. Plus if I’d known the Doctor better I might have had a conversation about the dose.

I was so relieved that Mrs X survived the overdose and the relatives were understanding but, if she had a serious reaction or even died, I’m not sure I could have carried on nursing.

I have learnt to be more careful with drugs and to really understand the dosage.  If necessary now I will look up the drug in the reference books before I give them because it is my responsibility if I do it wrong.

I will always be ultra-careful with new drug scripts in the future and if I am nervous, then to go with my gut feeling and check and check again. Although, as I said to Matron, at the time I’d felt as if I done as much as I could have.

Also, if nurses in my team are involved in incidents where they have made a clinical mistake, I am always on hand to offer support and give them an opportunity to talk to me.

I never want another nurse to go through what I went through alone and I definitely do not want to harm anyone in my care.

Linked to NMC Code of Practice 14 – “Preserving Safety”

Further information.

• British National Formulary (BNF)  the drugs’ bible in the UK, available online with a subscription

Other of my real stories here:

• For a second applied reflection example, see my blog about My Infographic Mistake
• For a third reflection see Dog Walking

I have also published a workbook for nurses where you can see the model and have space to add your own private stories. Available on Amazon With over 400 great reviews.

Thanks for reading and good luck in your career. J

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My site may contain affiliate links. Meaning, I get a commission if you purchase through my links, at no cost to you. However, I do not recommend lightly – if I like it I want you to know about it. J

ESSAY SAUCE

FOR STUDENTS : ALL THE INGREDIENTS OF A GOOD ESSAY

Essay: Reflection using Gibbs Reflective Cycle (nursing)

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• Subject area(s): Health essays Nursing essays
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• Published: 17 November 2019*
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Description

I undertook a full assessment on a patient with a sacral pressure sore. The patient had limited mobility, dementia and does not speak. I completed the assessment using observation as a primary source. The care assistants were reluctant to engage with the nursing process rendering some specific measurements as ineffectual compromising the eventual Waterlow score. I conducted the assessment with my mentor and gave a logical explanation how I administered the wound and gave rationale for the dressings I chose. I spoke to the care assistant to reiterate my action plan as it was pivotal to a successful wound healing.

Initially I felt confident. I had observed pressure sores before and I had prior knowledge of dressings and pressure relief. When I discussed about the patient with the care assistant, I ensured we were outside the bedroom as it unprofessional to talk over a client. The health records were of poor quality and had not been updated. When I mentioned this, the carer’s attitude became abrupt and I began to get defensive and made an inconsequential remark, “It does not matter”, just to reengage the carer. This remark I regretted as it undermined my authority and I appeared amateurish. Care records are a legal working document in progress. Poor record keeping will be detrimental to a client’s recovery and must always be challenged. I felt overwhelmed and looked to my mentor to support me.

My role in the nursing process enabled me to evaluate the patient’s wound and give an accurate descriptive account to my mentor. I provided evidence that consolidated my evaluating skills and put my basic wound knowledge into practice, within a safe nurturing environment. I rushed the assessment and regretfully completed it away from the nursing home. I found this frustrating as I could not explore the holistic process in greater depth and it simply became a checklist without breadth to the other client’s needs; dementia and poor communication, which I acknowledged fleetingly.

Payne (2000) identifies that professional partnerships are at risk if a nurse has insufficient knowledge required to perform ethically, thus undermining their own authority. The care assistant knew I was a student nurse and treated me, not as a partner in care but as a learner. I failed to develop the partnership more and relied on my mentor too much when I conversed with the carer. I was looking for affirmation which was lacking within me. If I had communicated how significant the carer’s role was, this would have earned me more respect and empowered the carer. Crawford et al (2005) believe empowerment inspires the self determination of others, whilst Fowler et al (2007) identifies listening skills and the encouragement in the participation of care motivates nurses to actively support changes in patient care. Entwistle and Watt (2007) remind practitioners that participation requires communication skills that are not universally possessed so nurses must be flexible in their approach to champion the participation of others. Using these concepts I could have built a rapport with carers, praising them for the care they provide, promoting partnership in care whilst emphasising the importance of the care plan. I found it difficult to disengage from the patients many problems and only to focus on the wound. When choosing a suitable nursing framework, Roper et al (2000) describe care planning as a proposal of nursing intervention that notifies other nurses what to do and when. This model is used throughout the community and is thought to be a simplistic, easy to use everyday tool that enables nurses to identify actual and potential problems. Page (1995) had reservations about Roper, Logan and Tierney’s model, comparing it to a checklist which, if not used as the authors intended, can be restrictive in clinical practice as fundamental problems can be missed. I used some of Page’s model as a checklist and not as a holistic assessment due to time constraints, the patient’s profound dementia, poor record keeping and being a novice assessor; however I was directed by my mentor to focus on the wound alone. It could be argued that community nurses working within care homes only prioritise physical needs from adapted assessments, as the care home provides the patient’s psychosocial needs. I identified from the patient’s assessment she was at the end stage of the dependence continuum, but I still recognised the importance of holism when completing the package of care and I identified that the promotion of comfort was as important as healing. The main strength of my care plan was in identifying specific measurable outcomes exclusive to the client that were adaptable. I used evidence from reputable sources to identify suitable dressings to promote granulation and healing by sourcing up to date journals from the Cinahl and current trust policies. My weakness was relying on my mentor too much to confirm the evidence I collated on pressure care to the carer’s. Prioritising delegation and assertiveness as part of my learning needs I will now create an action plan that will ensure my future mentors will recognise the effort I extol to succeed in practice.

I conclude my implementation of the care plan was successful. The wound healed and the patient was discharged from the community case load. I demonstrated I can assess patients holistically, but require further practice when addressing client and carer concerns. To use nursing frameworks effectively nurses have to create an inclusive partnership with the client, family, professionals and care providers and demonstrate a broad knowledge of basic nursing care. Successful care plans are universal tools that empowerment others, giving them the direction to advocate safe holistic care based on evidence.

Action Plan

To encourage the participation of others I will become conversant in wound care. I will learn to identify the stages of healing by researching the biology of wound care. I will disseminate this to peers, as the sharing of knowledge is a fundamental part of holistic nursing care. As I develop from a supervised participant to a participant in care delivery I will continue to read research and reflect my practice on a daily basis. Creating new action plans that identify my learning requirements will address my limitations and by acknowledging them I will generate achievable goals to become a competent practitioner.

Reference List

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• Cutting, K. (1999) The cases and prevention of maceration of the skin.Journal of Wound Care. Vol.8, No.4, pp200-210
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• Blackwell Publishing
• Griffiths, R., Fernandez, R., Ussia, C. (2001) Is tap water a safe alternative to normal saline for wound irrigation in the community. Journal of Wound Care. Vol.10, No.10, pp407-411
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• Hampton, S., Collins, F. (2004) Tissue Viability. London: Whurr Publishers
• Hampton, S. (2005) Death by Pressure Ulcer; being held to account when ulcers develop. Journal of Community Nursing. Vol.19, No.7, pp26-29
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• Herman, M., Bolton, L. (1996) the Influence of Dressings on the Cost of Wound Treatment. Dermatology Nursing [on-line]. Vol.8, No.2, pp-93-100. Available at http://gateway.uk/com/gw1/ovidweb.cgi [Accessed 17/07/07]
• Hess, C. (2005) Wound Care (5th Edition). Philadelphia: Lippincott, Williams and Wilkins
• Jones, M., SanMigule, L. (2006) Are wound dressings a clinical and cost effective alternative to the use of gauze. Journal of Wound Care. Vol.15, No.2, pp65-69
• Kaya, A., Turani, N., Akyuz, N. (2005) The effectiveness of hydrogel dressing compared with standard management of pressure ulcers. Journal of Wound Care. Vol.14, No.1, pp42-44
• Kingsley, A. (2002) Wound Healing and potential Therapeutic Options.Professional Nurse. Vol. 17, No.9, p539
• Land, L. (1995) A review of pressure damage prevention strategies. Journal of Advanced Nursing [on-line] Vol. 22, No.2, pp329-337. Available athttp://gateway.uk/com/gw1/ovidweb.cgi [Accessed 17/07/07]
• Moore, Z. (2004) Pressure Ulcer Prevention: nurses’ knowledge, attitudes and behaviour. Journal of Wound Care. Vol.13, No8, pp330-334
• Neander, K., Hesse, F. (2003) The protective effect of a new preparation on wound edges. Journal of Wound Care. Vol.12, No.3, pp369-371
• Nursing and Midwifery Council. (2004) Code of professional conduct. Standards for conduct, Performance and Ethics. London: NMC
• Page, M. (1995) Tailoring nursing models to clients’ needs using the Roper, Logan and Tierney model after discharge. Professional Nurse. Vol.10, No.5, pp284-288
• Payne, M. (2000) Teamwork in Multi Professional Care. Hampshire: Palgrave
• Rainey, J. (2002) Wound Care. A Handbook for Community Nurses.London: Whurr Publishers
• Roper, N., Logan, W., Tierney, A. (2000) The Roper, Logan, Tierney Model of Nursing. Edinburgh: Churchill Livingstone
• Russell, L. (2004) Patient repositioning revisited. Journal of Wound Care.Vol.13, No.8, pp328-329
• Selim, P., Bashford, C., Grossman, K. (2001) Evidenced based practice: water cleansing of leg ulcers in the community. Journal of Clinical Nursing [on-line] Vol. 10, No.3, pp372-379. Available athttp://gateway.uk/com/gw1/ovidweb.cgi [Accessed 17/07/07]
• Smith, L., Booth, N., Douglas, D., Robertson, W., walker, A., Durie, M., Fraser, A., Hillan, E., Swaffield, C. (1995) A critique of “at risk” pressure sore assessment tools. Journal of Clinical
• Nursing [on-line]. Vol.4, No.3, pp153-159
• Available at http://gateway2.uk.ovid.com/ovidweb.cgi [Accessed 10/08/04]
• Southern Derbyshire Health Community Wound Management Guidelines. (2005) Derbyshire Dales and South Derbyshire. NHS: Primary Care Trust
• Thomas, S. (1997) assessment and Management of Wound Exudate.Journal of Wound Care. Vol.6, No.7, pp327-330
• White, R., Cutting, K. (2003) Intervention to avoid maceration of the skin and wound bed. British Journal of Nursing. Vol.12, No.20, pp1186-1192
• Williams, C., Young, T. (1998) Myth and Reality in wound Care. Salisbury: Mark Allen Publishing Ltd
• Wright, K. (2005) Ensure Patients’ Wounds are Best Dressed. Nursing Management. Vol.36, No.11, pp49-50
• Zoellner, P., Kapp, H., Smola, H. (2007) Clinical Performance of a hydrogel dressing in chronic wounds: a prospective observational study. Journal of Wound Care. Vol.12, No.3, pp369-371

1. Client pen portrait. 2. Plan of care 3. Wound evaluation 4. Activities of Daily Living 5. Waterlow Pressure Score

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First refuelling for Russia’s Akademik Lomonosov floating NPP

!{Model.Description}

The FNPP includes two KLT-40S reactor units. In such reactors, nuclear fuel is not replaced in the same way as in standard NPPs – partial replacement of fuel once every 12-18 months. Instead, once every few years the entire reactor core is replaced with and a full load of fresh fuel.

The KLT-40S reactor cores have a number of advantages compared with standard NPPs. For the first time, a cassette core was used, which made it possible to increase the fuel cycle to 3-3.5 years before refuelling, and also reduce by one and a half times the fuel component in the cost of the electricity produced. The operating experience of the FNPP provided the basis for the design of the new series of nuclear icebreaker reactors (series 22220). Currently, three such icebreakers have been launched.

The Akademik Lomonosov was connected to the power grid in December 2019, and put into commercial operation in May 2020.

Electricity generation from the FNPP at the end of 2023 amounted to 194 GWh. The population of Pevek is just over 4,000 people. However, the plant can potentially provide electricity to a city with a population of up to 100,000. The FNPP solved two problems. Firstly, it replaced the retiring capacities of the Bilibino Nuclear Power Plant, which has been operating since 1974, as well as the Chaunskaya Thermal Power Plant, which is more than 70 years old. It also supplies power to the main mining enterprises located in western Chukotka. In September, a 490 km 110 kilovolt power transmission line was put into operation connecting Pevek and Bilibino.

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MOSCOW WIDENS NEW POLICY LINE; Essay, Scored During Rule of Khrushchev, Praised for View of Hard Rural Life

MOSCOW, Dec. 26—A growing reversal of the policies of former Premier Nikita S. Khrushchev, especially in agriculture, was‐extended today to the field of literary criticism.

The literary‐union newspaper Literaturnaya Gazeta published a laudatory review of Yefim Dorosh's essay “Half Rain, Half Sunshine,” which gives what is widely regarded as a realistic depiction of the countryside of central European Russia.

The essay, published last summer in the liberal literary monthly Novy Mir, was violently attacked in the Soviet press just before Mr. Khrushchev's overthrow in October as misrepresenting life in rural areas.

One critique, by L. Lebedev, a collective farm chairman from the Galich area northeast of Moscow, appeared in Selskaya Zhizn (Rural Life), the farm newspaper of the Communist party's Central Committee over whose content Mr. Khrushchev had direct control.

Mr. Lebedev charged Mr. Dorosh with conveying a picture of “prerevolutionary dreariness, despondency, stagnation, and complete hopelessness drifting from every page.”

The farm chairman accused the author of concentrating attention “on an old monastery, an ancient lake, an abandoned grave of some count instead of writing, say, about the new widescreen moviehouse.”

Mr. Lebedev said Mr. Dorosh had misrepresented the cultural level of farm youth and the rural intelligentsia by depicting them as “primitive, uneducated people without interest in literature or the arts.”

Mr. Dorosh had written that the residents of his fictitious country town of Raigorod “read little, went, to be sure, to the movies, but had not been in the regional museum, in the picture gallery, in the theater or at the philharmonic concert.”

Today's review in Literaturnaya Gazeta by Vladimir Voronov, a critic, contended that Mr. Dorosh had performed a useful service by drawing attention to problems that continued to bedevil Soviet agriculture and life in the countryside.

The essay, published while Mr. Khrushchev was still in power, questioned the effectiveness of some reforms inspired by the former Premier and criticized the continuing close supervision of farm production and the imposition of output plans from above.

In an evident allusion to Mr. Khrushchev's style of running Soviet agriculture, Mr. Voronov wrote:

“Dorosh regards the struggle for a growth of the rural economy not as a short‐lived, noisy campaign but as a long, complicated haul.”

Mr. Voronov assailed the farm chairman for having judged the essay simply on the basis that his own area was more prosperous than the one pictured in “Half Rain, Half Sunshine.”

The reviewer said it was not literary criticism to say:

“We live better” and to tell “about a milkmaid who had obtained 800 quarts of milk more from a cow than in the previous year.”

The controversial essay is part of a series of “rural diaries” that Mr. Dorosh, a resident of Moscow, has been writing since 1956 on the basis of periodic visits to an unidentified small town and the surrounding countryside in central Russia.

Gibb’s Reflective Cycle Essay

Action plan.

This event was an unpleasant experience for the patient who expected to get relief from the pain he felt. First, the buddy nurse’s approach to the patient was unreasonable because the patient was in pain, and it was only natural to be agitated. However, I listened to the patient and also avoided confrontation by dragging my buddy nurse away with me. This saved the situation from getting worse although the confrontation that happened was harmful to the patient (Webb, 2011).

My buddy nurse should have stayed calm and listened to the patient’s concerns even if they were offensive. It would have been better if my buddy nurse exercised self-control and stopped the urge to snap back at the patient. While leaving, it was not right for him to make tide remarks to the patient. He should have excused himself to the patient with a promise that he would be back with a solution. The reaction that I gave to the patient was encouraging because I gave him an option of a stronger treatment, which was subject to discussion. Listening to the customer also gave hope that I empathized with his situation (Roussel, Swansburg & Swansburg, 2006). It is also necessary that I should have made a personalized and confidential service to the patient by showing up alone and not with a colleague. This way the patient would feel that he had been assisted because he would be dealing with the nurse who had earlier assisted him. Finishing up with the other patient first may have caused the delay which agitated the patient. It is advisable for a person to make a faster response to avoid cases in which patients get impatient and yell (Williams& Davis, 2005; Koutoukidis, Lawrencem & Tabbner, 2008).

Healthcare forms part of a patient’s healing process, and healthcare professionals should communicate effectively to build therapeutic relationships with the patients (Van, 1997). For instance, talking to the customer nicely and showing empathy would not only work as the pain killer but would give the patient hope. Making the patient angry makes the pain unbearable and may even worsen the situation. Using persuasive language and listening to the patient as well as offering a faster response develops a strong nurse-patient relationship. This improves the healing process. Active communication with the patient also involves the patient in health care and gives them control over their condition and the treatment that they get. In the above scenario, engaging the patient to enlighten him that he had been taking an overdose would make him responsible and prevent any similar future occurrence. He would feel that he had been saved from consuming more drugs than necessary, and this would encourage him to consult in the future. The situation would have been turned around to a powerful healing process by building a healthy relationship that would make the patient realize that holding back the medication was meant to help him and not punish him (Bach & Grant, 2008; White, L., & Rittenhouse Books, 2005).

If a similar event occurs in the future, there are changes that should be made to ensure that the patient is not treated unfairly like it happened. First, I would address the patient with the therapeutic service in mind. I would respond to the call with the aim of improving the patient’s situation, by the way, I talk and respond to his questions and concerns. My buddy friend added to the patient’s misery by snapping back and not giving the patient an opportunity to express his concerns (Rosdahl & Kowalski, 2008). This would be avoided by requesting my colleague to allow me to handle the situation. This could also be improved by establishing a uniform approach in which colleagues would allow others to handle their cases. Intervention should only be allowed when a request is made. This way the probability of harassment by a third party would be minimal. The notion that communicating with the customer is part of the therapeutic process and should be built to ensure that any intervention made is positive (Webb, 2011).

Health care has changed in nature from the treatment of acute illnesses to helping patients to manage chronic conditions. In this case, the patient may not have been healed, considering that it was a situation he was managing even while at home. The patient can be encouraged to adopt an attitude of self-care by informing him that he had been taking an overdose. This would make the patient more responsible for his health care and also establish a good relationship with his nurse (Mitchell & Haroun, 2012). This would promote the quality of his life even if his medical condition is chronic. The patient’s expectation, which is to be free of pain, would be achieved by providing an option that gives him a long-term solution. Overdosing to kill the pain would only be done for a short period while changing the form of medication would correct the past mistake and offer a longer-term solution. Educating the customer on the dangers of taking more dosage than required is involving and makes the process simpler and effective. When patients are aware of the treatment that they receive they learn and assist the health care providers in managing their situation (Dickson, Hargie & Morrow, 2003).

Patient-centered care gives the patient an opportunity to receive services that revolve around him/her rather than fitting into the services availed in the hospital. When they are viewed as active participants in the care offered to them, they feel acknowledged. This can be enhanced by listening to patients and offering services that fit their requirements. For instance, my patient could have been assisted better by proposing a further review by the Acute Pain Service rather than administering the usual PRN medication. The process should have begun by getting feedback on how the patient had been reacting from the PRN he used. Probably, the issue of overdose would have been raised and an alternative offered. This would avoid the confrontation because the patient would be aware that he had been overdosing. Therefore, the patient should be initiating the process by explaining his/her concerns. Recommendations should be based on the patients’ interests rather than what is available in the facility (Chapman, 2009).

Multidisciplinary teams help health care providers to coordinate their roles and expertise to offer patients quality services. The members of the team should understand their role. For instance, my buddy nurse may have treated the patient nastily because he was not his patient. This should not have been the case because teamwork requires them to respect the role of others. He should have achieved this by staying out of the discussion or contributing positively. In the future, such a scenario can be avoided by working at providing integrated health care in which nurses work collaboratively. This way there would be no difference in the way nurses treat a patient who may have been attended by a different nurse (Nurs, 2001).

To ensure that patients get quality services, nurses should be friendly and accept the needs of their patients. The patients should also be allowed to feel that the health care providers are willing to spent time with them. Allowing the patient to participate in the discussion of their health by asking for opinions and offering advice makes the patients feel part of the healing process (Nurs, 2001; O’Toole, 2012). The treatment service should also be tailored to them by addressing them by their names and remembering their situation. Sharing information about similar experiences and giving them hope builds a close relationship. Disagreements with the patients should be treated as a form of discussions without a formal objection which may make them objective. The services provided should offer continuity such that each patient has a health care provider (Martin, 2010; Antai-Otong, 2007). This way, progress can be monitored while a relationship builds between the nurse and the patient. It is also part of the therapeutic process. Serving an individual patient will help build a solid relationship in the future. This will also include basing the approach from the patient’s point of view to ensure that the patients needs come first before the services available can be offered. This will eliminate disagreements between healthcare providers and patients (Mackenzie & O’Toole, 2011; Jasper, 2003; Seago, nd).

Antai-Otong, D. (2007). Nurse-client communication: A life span approach . Sudbury, Mass: Jones and Bartlett Publishers.

Bach, S. & Grant, A. (2008). Communication and interpersonal skills for nurses . Exeter: Learning Matters.

Chapman, K. B. (2009). Improving Communication among Nurses, Patients, and Physicians. American Journal of Nursing . 109(11), 21-25.

Dickson, D., Hargie, O., & Morrow, N. C. (2003). Communication skills training for health professionals . Cheltenham: Nelson Thornes

Jasper, M. (2003). Beginning Reflective Practice – Foundations in Nursing and Health Care. Cheltenham. Nelson Thornes.

Koutoukidis, G., Lawrence, K., & Tabbner, A. R. (2008). Tabbner’s nursing care: Theory and practice . Chatswood, N.S.W: Elsevier Australia.

Mackenzie, L., & O’Toole, G. (2011). Occupation analysis in practice . Chichester, West Sussex: Wiley-Blackwell.

Martin, A. (2010). Non-verbal communication between nurses and people with an intellectual disability: a review of the literature. Journal of Intellectual Disabilities . 14(4), 303-314.

Mitchell, D., & Haroun, L. (2012). Introduction to health care . Clifton Park, NY: Delmar, Cengage Learning.

Nurs, E. J. O. (2001).Communication between nurses and simulated patients with cancer: evaluation of a communication training programme. Discussion . 5(3), 140-150.

O’Toole, G. (2012). Communication. Core interpersonal skills for health professionals . Sydney: Churchill Livingstone, Elsevier.

Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of basic nursing . Philadelphia: Lippincott Williams & Wilkins.

Roussel, L., Swansburg, R. J., & Swansburg, R. C. (2006). Management and leadership for nurse administrators . Sudbury: Jones and Bartlett.

Seago, J. A. (n.d.). Professional Communication . Web.

Van, S. G. M. (1997). Communication skills for the health care professional: Concepts and techniques . Gaithersburg, Md: Aspen Publishers.

Webb, L. (2011). Nursing: Communication skills in practice . Oxford: Oxford University Press.

White, L., & Rittenhouse Books, Inc. (2005). Foundations of nursing . Clifton Park, NY: Thomson Delmar Learning.

Williams, C. L., & Davis, C. M. (2005). Therapeutic interaction in nursing . Boston: Jones and Bartlett Publishers.

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IvyPanda. (2022, May 3). Gibb's Reflective Cycle. https://ivypanda.com/essays/gibbs-reflective-cycle-essay/

"Gibb's Reflective Cycle." IvyPanda , 3 May 2022, ivypanda.com/essays/gibbs-reflective-cycle-essay/.

IvyPanda . (2022) 'Gibb's Reflective Cycle'. 3 May.

IvyPanda . 2022. "Gibb's Reflective Cycle." May 3, 2022. https://ivypanda.com/essays/gibbs-reflective-cycle-essay/.

1. IvyPanda . "Gibb's Reflective Cycle." May 3, 2022. https://ivypanda.com/essays/gibbs-reflective-cycle-essay/.

Bibliography

IvyPanda . "Gibb's Reflective Cycle." May 3, 2022. https://ivypanda.com/essays/gibbs-reflective-cycle-essay/.

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Ian Birchall    |    ETOL Main Page

Ian Birchall

Lukacs as literary critic, (april 1969).

From International Socialism (1st series), No. 36 , April/May 1969, pp. 36–38. Transcribed & marked up by Einde O’ Callaghan for the Encyclopaedia of Trotskyism On-Line (ETOL) .

‘But reality can be seized and penetrated only as a totality, and only a subject which itself is a totality is capable of this penetration ...’ [1]

The publication of Goethe and his Age [2] is a welcome addition to the works of Georg Lukacs available in English. [3] If Marxism is to offer an acceptable world-view to a new generation, the need for works of theory to embrace fields such as literature is very great, and Lukacs’ work can help to break down the deep parochialism of the British Left. [4] At the same time Lukacs’ literary writings contain many weaknesses associated with his political acceptance of Stalinism. There are signs that the bourgeois opponents of Marxism in the cultural field are giving up shadow-boxing with Zhdanov in favour of an attack on Lukacs. This short essay does not attempt a full account of Lukacs’ literary writings, but merely suggests some of their more apparent strengths and weaknesses.

Literature, along with philosophy, was Lukacs’ major interest in his early years in Budapest and Berlin. The First World War and the Hungarian Revolution of 1919 obtruded themselves forcibly into his academic world, and throughout the twenties, when his most notable work in philosophy and political theory was written, he seems to have abandoned literary criticism in favour of direct political involvement in the controversies of the Third International. Only after he had repudiated his earlier work and begun his long sojourn in Moscow did he turn back to literary criticism.

Lukacs’ capitulation to Stalinism cannot be interpreted in terms of cowardice or careerism. Rather it represents a response to the downward turn in the international revolutionary movement. Unwilling to take the desperate gamble of the Left Opposition, and horrified by the impact of fascism on the German culture he loved, Luckacs could see not alternative to Stalinism. One can see parallels not only with many of the old Bolsheviks, but with such writers as Ilya Ehrenburg. Marxism itself is not exempt from the historical pressures it seeks to study. In periods of working-class advance we find the emphasis on human action which characterises Lukacs’ History and Class Consciousness (1923); in periods of defeat, it is replaced by a mechanistic determinism which offers the long-term consolation that ‘history is on our side’. That Lukacs’ work is sensitive to such pressures is suggested by his support in 1956 for the Nagy Government – if not for the Hugarian working class.

In a sense, then, literature offered Lukacs a retreat from action, an alternative to the political defence of Stalinism. At the same time, his choice of the essay form in most of his literary writings has a deeper significance. In his first major work, The Soul and the Form (1911), Lukacs wrote an essay on the essay form, arguing that the essayist stood midway between the poet and the philosopher. The poet deals only with things, which are unproblematic; the philosopher with ideas and the solution of problems. The essayist, while being concerned with general problems, cannot provide solutions, and approaches the general only by way of the specific, frequently taking works of literature as his starting point. For Lukacs under Stalinism, the ambiguous form of the critical essay allowed him to pursue, in an oblique form, the problems that run through his earlier work. In History and Class Consciousness Lukacs wrote:

‘The category of totality, the domination, determining and in all fields, of the whole over the parts, is the essence of the method which Marx took from Hegel.’ [5]

He shows [6] that the achievement of such totality demands the transcendence of individualism. The individual – whether isolated capitalist or fragmented worker – sees the social world as subject to a destiny beyond his control. Action is possible only if he accepts the laws of society as ‘natural laws’, or if he retreats into a purely ethical position. The working class, organised in the form corresponding to its consciousness – the Party – is able to overcome the false dichotomies of bourgeois thought: individual and society, ethics and science, theory and practice, etc. [7]

This theme of totality is a crucial problem for working-class consciousness and organisation, for developing the ability to ‘perceive oneself and the instant of one’s action as a moment of the totality, of the process, to see “defeat” as a necessary stage towards victory.’ [8] But it all raises a central question for the study of literature.

Vulgar Marxism and the bourgeois tradition in the sociology of literature have converged in taking a one-sided point of view. They have attempted to situate works of literature within a social-historical totality, but they have neglected to study the way in which a writer creates a totality within the work. Just as a political organisation is not merely the product of historical conditions, but seeks actively to. change those conditions, so a writer is not merely the product of his age, but seeks, actively to comprehend it. A dialectical study of Shakespeare would not content itself by remarking that his plays centre around a class struggle of nobility versus bourgeoisie, but demonstrate how the dramatic form concentrates and concretises this struggle in a way quite different from a work of history or economics.

Hence the concern with literary form that marks all of Lukacs’ writings. The earliest treatments of this theme go back to his Hegelian phase before the First World War – The Soul and the Form (1911), and The Theory of the Novel [9] The latter work is made unnecessarily obscure by its abstract and at times curiously lyrical style, but it makes a significant advance in the exploration of the theme of totality. Under Hegelian influence, Lukacs relates literary forms to historical epochs. He contrasts the modern age with what he calls the ‘closed civilisations’ of Greece and mediaeval Christianity, a world less rich than our own, but less problematic because of the overriding sense of totality. To this age belongs the epic. With the collapse of this closed civilisation the novel appears – a form for which Lukacs attempts the following explanation:

‘The novel is the epic of a time when the extensive totality of life is no longer immediately given, of a time for which the immanence of meaning to life has become a problem, but which, nonetheless, has not ceased to aim at totality.’ [10]

There is no attempt to connect this disintegration of totality in consciousness with the specific social and economic forms of capitalism, but an important step towards a dialectical concept of totality in class consciousness has been taken. When Lukacs returned to the problem of totality in the novel with The Historical Novel (1937), he had gone through a complex destiny of revolution in Budapest and counter-revolution in Moscow, and it is necessary to separate the strands in his work with care. The final section, a crude eulogy of third-rate novelists prepared to appear on anti-fascist platforms, and complete with a reference to Trotskyist nuisances’ [11] , is a Popular Front period piece. But the earlier section on the nineteenth century historical novel is a masterly analysis of literary totality. Lukacs shows how the historical novel is born from an awareness of his historical change produced by the French Revolution; and how, as a form, it represents an attempt at a methodological coming-to-terms with historical change. The most important distinction is that between the drama and the novel; the drama represents a ‘totality of movement’ – a closed system with complete economy of detail, while the novel represents ‘totality of objects’, a rendering of circumstances in all their richness. Thus he compares the treatment of the family in Shakespeare’s King Lear and Thomas Mann’s Buddenbrooks : in Shakespeare the ‘extreme and ... typical movements form a completely closed system’, while in Mann we see the ‘breadth and abundance of the real circumstances of family life ...’ [12] Scott, the great historical novelist, inspired Balzac, whom Marx and Lukacs agree in seeing as one of the greatest realist novelists of all time. The concept of totality is central to Lukacs’ theory of literary realism and the distinction he makes between realism and naturalism. In History and Class Consciousness he had argued that the whole is not the sum of the parts, but rather determines the parts. Therefore realism will not be achieved by the accumulation of factual details, but by the creation of coherent significant structures which give a place and a meaning to every detail. Naturalism, on the other hand, leads to the very opposite – the tendency in modem art to collage the sticking together of isolated observed details in haphazard juxtaposition. This is not totality, but on the contrary, the admission of failure in any attempt to create a meaningful totality. [13]

The concept of totality is also central to another theme in Lukacs’ work, the much more ambiguous one of humanism. The major essay in History and Class Consciousness , called Reification and the Consciousness of the Proletariat shows how capitalist production destroys man as a totality.

‘The process of labour is fragmented, in an ever increasing proportion, into abstractly rational partial operations, and this disrupts the relations of the worker to the product as a totality, and reduces his labour to a special function repeating itself mechanically.’ [14]

Such fragmentation in production necessarily leads to false dichotomies, such as reason versus feeling. In the work on Goethe and his Age Lukacs vigorously attacks the traditional views of literary history and the distortions of fascist intellectuals who seek to impose such false dichotomies on the history of German culture. The great age of humanism, which had realised in theory if not in practice the ‘unified and comprehensive development of the human personality’, was the Enlightenment. Lukacs demolishes the myth that Germany never had an Enlightenment (which would make it especially prone to fascism), and shows that despite certain reactionary sentiments on a purely political level, Goethe himself represents the culmination of the Enlightenment. But this very humanism, at times so powerful and healthy, and at times so abstract and pernicious, is a key to the great weakness of Lukacs’ work. In discussing the relation of the literary representatives of the petty-bourgeoisie to the class itself, Marx says:

‘According to their education and their individual position they may be as far apart as heaven from earth. What makes them representatives of the petty-bourgeoisie is the fact that in their minds they do not get beyond the limits which the latter do not get beyond in life’. [15]

Similarly Lukacs, in character totally alien to the narrow-minded thugs who held power in the Kremlin, is nonetheless a literary representative of the Soviet bureaucracy. Because of this, Lukacs is unable to see that the analysis he himself applied to the French bourgeoisie of the nineteenth century, that of a ruling class validating itself in the name of revolution, is equally applicable to the Stalinist ruling class. If he criticises this class, it can be only in the name of individual humanism, not from the standpoint of a class. Similarly, he cannot go beyond the point of view of the Communist Parties in the West, who derive their legitimacy from the Russian Revolution, and cannot therefore adapt to changed circumstances, such as the greater weight and sophistication of the working class. In short, for Lukacs history stops dead in 1917; a lucid analysis of political and literary events before then, but only a distorting parody of what came after.

For the modern world, Lukacs recognises two forms of realism, critical realism and socialist realism. The theory of critical realism depends on the belief that the bourgeois intellectual still has a positive role to play. The cult of peaceful coexistence actually led Lukacs to write in 1955:

The real dilemma of our age is not the opposition between capitalism and socialism, but the opposition between peace and war. The first duty of the bourgeois intellectual has become the rejection of an all-pervading fatalistic angst , implying a rescue operation for humanity rather than any breakthrough to Socialism’. [16]

Against this perspective, he sees as politically the most important task the building of a Peace Movement in which all ideological tendencies merge, and artistically the continuation of the great tradition of the nineteenth century liberal novel. The hero of this phase is Thomas Mann, compared to Goethe for his concern with the ‘totality of human relationships’. [17] Mann, with his development from a purely unpolitical stance to his courageous opposition to Hitler, fits the Popular Front paradigm perfectly. All that critical realism need do is to show ‘readiness to respect the perspective of socialism’. [18] The active presentation of the working class is unnecessary.

The concept of ‘socialist realism’ is a more sensitive one for Lukacs than it was for Zhdanov. Nonetheless, it implies the same basic conservatism. At worst, it is the realism of the accepted fact, the glorification of what is at the expense of what might be. At best it involves a critique of abuses in terms of individualist, and thus ethical, humanism. In the essay Solzhenitsyn and the New Realism [19] , Lukacs attacks the art of the Stalin era as naturalism, not realism. But his praise is reserved for the portrayal of ‘a being whose humanity nothing could destroy or disfigure’, and he sees Solzhenitsyn’s work as being ‘a symbolic whole, with a meaning for all humanity’, in which ‘the origins of this bureaucracy and the groupings within it ... remain outside the bounds of the narrative’. [20]

Thus neither critical nor socialist realism goes beyond the limits of liberal humanism. What Lukacs leaves out of his picture is the writer who is revolutionary both in his conscious acceptance of Marxism, and in his treatment of literary form, who tries to write from the standpoint of the working class and its new modes of struggle, and develop new forms to fit the content. Yet such writers do exist – Sartre, Brecht and Breton, to name of three highly diverse cases – though most of them are an embarrassment of official Communism. In a controversy of the early twenties Trotsky argued against any idea of a specifically proletarian culture. [21] But Trotsky, the eternal optimist, did not foresee that fifty years after 1917 workers would be excluded from power in every country on earth. Lukacs in his very salutary concern for totality tends to concentrate on those writers who achieve complete totality within their work, in a harmonious construction rather than those who strive towards totality while engaged in struggle.

As a result, the formal potentialities of modern literature are underemphasised. And this is not merely the case when he is a hack supporter of censorship, as in his statement that Thomas Mann’s Dr Faustus in the ‘fullest artistic and intellectual confirmation’ of the decree of the Central Committee of the Communist Party of the Soviet Union on modern music. [22]

More serious is his treatment of Brecht. Here he argues that ‘Brecht’s political didacticism, his attempt to impose intellectual schemata on the spectator turned his character into mere spokesmen.’ However Brecht developed in a later stage to the portrayal of ‘a complex dialectic of good and evil. Problems of society have become problems of humanity, subsuming the inner conflict and contradictions of the warring parties.’ [23] To assert that the only way to avoid didacticism is by retreating from politics to ethics is to avoid the very central problem of all Brecht’s work – and incidentally to stand History and Class Consciousness on its head. Similarly he argues that Surrealism has a positive aspect, as a stage in the evolution of Eluard and Aragon into socialist writers. But a greater poet than either of these, André Breton, remained a Surrealist while being a life-long revolutionary (albeit a Trotskyist). He is not mentioned. [24] Thus the problem of revolutionary art is again evaded.

In reading Lukacs it is important to criticise radically the heritage of Stalinism. Nonetheless, his concern with totality in form and content, and his humanism, when it is historical, and not abstract and ethical, will help lay the bases for a more wholly revolutionary literary criticism. Bob Dylan has lamented ‘I was so much older then, I’m younger than that now’. If only it were possible that the younger Lukacs might write a critique of the reified consciousness of his older self.

1. Histoire et Conscience de Classe , Paris 1960, p. 60.

2. Merlin, 36s.

3. Also available are Studies in European Realism , Essays on Thomas Mann , The Meaning of Contemporary Realism , The Historical Novel . Our gratitude to Merlin Press for publishing all but the first named may be tempered bv regret at the continuing absence in English translation of any major work written before Lukacs’ act of ‘self-critism’ in 1925.

4. As an example one may quote one of the best recent examples of literary criticism written by a committed socialist. Raymond Williams’ Modem Tragedy (Chatto & Windus, 1966), written in 1964. This contains one passing reference to the work of Lukacs, in which Williams comments that he appears to be more a post-Hegelian than a Marxist, without giving any indication as to which period of Lukacs’ work he is referring to. The work of the Lukacsian Lucien Goldmann on the ‘tragic vision’ is never mentioned. To regret this parochialism is in no way to endorse the thesis argued by Perry Anderson that in order to be a Marxist it is necessary to be foreign – or at least Irish.

5. Histoire et Conscience de Classe , p. 47.

6. In the essay Rosa Luxemburg, Marxist , Ibid. , pp. 47–66.

7. For a full treatment of this theme cf. Lucien Goldmann, Is There a Marxist Sociology ( IS 34 ).

8. Histoire et Conscience de Classe , p. 65.

9. Written 1914, published in 1920. Available in French translation, La Theorie du Roman , Gonthier, 1963

10. Ibid. , p. 48.

11. The Historical Novel , p. 256. In the French translation (Payot, 1965, p. 301). Trotskyists are not merely ‘nuisances’, but ‘vermin’

12. The Historical Novel , pp. 92–95.

13. It is arguable that Lukacs, like Engels, seriously underestimates Zola in this connection, for Zola unlike his mediocre imitators, does produce a meaningful intertwining of individual and social destiny in his best novels

14. Histoire et Conscience de Classe , p. 115.

15. The Eighteenth Brumaire of Louis Bonaparte , Marx and Engels, Selected Works , Moscow 1958, 1, p. 275.

16. The Meaning of Contemporary Realism , p. 92.

17. Essays on Thomas Mann , p. 50.

18. The Meaning of Contemporary Realism , p. 93.

19. The Socialist Register , 1965

20. Ibid. , pp. 208, 206, 210

21. Literature and Revolution , chapter VI.

22. Essays on Thomas Mann , p. 71.

23. The Meaning of Contemporary Realism , pp. 87–88.

24. Ibid. , p. 104.

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