Critical Reflection on Managing Acute Myocardial Infarction Using Gibbs Model: A Nursing Perspective NUR4027

1. Introduction

Critical reflection is an important learning strategy in the nursing industry. It helps the nurses to evaluate their nursing skills and modify them to provide high-quality care to the patients. By incorporating critical thinking, they are able to interpret the requirements of a medical situation from a diverse approach and use their previous learning experiences for application in their professional workplace (Shin et al., 2023).

It facilitates the transition process for nursing students from the academics to the healthcare industry. They are able to organize their learning experiences in a manner that helps them to improve their knowledge, increase their communication skills, and build confidence while suggesting medical interventions for improving the health of the patient (Patel & Metersky 2021). This also increases the level of professionalism in the nurses. They are able to handle more complex medical cases as they develop better problem-solving skills. Thus, critical reflection is generally recommended for newly recruited nurses or nursing students to adapt to the dynamic medical industry and focus on enhancing their skills in the nursing field (Shin et al., 2022).

There are different types of reflection models used in the nursing industry. However, the Gibbs reflection model is generally recommended for critical reflections in the healthcare industry. This model was proposed by Graham Gibbs in 1988 and provides a structured approach for interpreting the learning experiences. It comprises six main stages, namely description, feelings, evaluation, analysis, conclusion, and action plan. The first stage of description provides a brief overview of the case study and highlights the main points of the study (Miller, Ford & Yang 2020). The second stage of feelings uses an emotional approach to express the feelings of the person who is writing the reflection. The third stage of evaluation emphasizes the positive and negative impacts of the case study. The fourth stage of analysis focuses on determining the outcomes of the case study and correlating all the insights obtained. The fifth stage of conclusion summarizes all the parameters of the case study concisely, and the sixth stage of action plan involves introducing suggestive measures that can be implemented in the future for handling the situation (Adeani, Febriani, & Syafryadin 2020).

The given case study of a 71-year-old patient diagnosed with myocardial infarction will be interpreted using the Gibbs reflection model. It will initially begin by describing the medical scenario of the patient, followed by expressing the feelings involved while handling the situation as a nurse. It will then highlight the positive and negative aspects of the nursing interventions utilized for handling the situation and analyze the outcomes of the case study with a holistic approach. In the end, it will recommend some suggestive measures for managing such medical situations in a better way in the future.

2.Description

The given case study discusses the cardiovascular medical condition of a 71-year-old farmer who is living with his sons and grandchildren. He is reported to the emergency department of the hospital with symptoms of acute myocardial infarction. However, there had been a delay in performing the initial physical examination of the patient followed by obtaining the medical history of the patient. This was due to the excessive workload on the nursing staff as a result of which they neglected the initial diagnosis of the patient. It was found that the patient had a critical medical history as he underwent a coronary bypass graft 20 years ago and is also suffering from chronic kidney disease.

Considering the critical situation of the patient, the medical professionals immediately suggested an angiography, which shows the presence of an obstruction of 95% in the right coronary artery and occluded bypass grafts. In addition to this, this medical case became more complicated as his lesions were highly calcified. However, with increasing time, the medical condition of the patient was progressively degrading and led to ventricular fibrillation. There was a delay in providing ventricular defibrillation shocks and cardiopulmonary resuscitation to stabilize the vitals of the patient (Cium?rnean et al., 2021).

On the other hand, it was seen that his regular organ function was declining. After being moved to the intensive care unit (ICU), he spent a whole twelve hours under continuous mechanical ventilation. To further control his impaired liver, heart, and kidney function, inotropes, vasoconstrictors, and diuretics were regularly given to him. His vitals were improving as a result of these medical measures, and he was later moved back to the ward. He was sent to the intensive care unit (ICU) on an emergency basis once more due to cardiogenic shock, which exacerbated the functioning of various organs and precipitated the onset of sepsis. This cycle persisted for an extended period of time. Due to several cardiogenic shocks, the need for inotropes, and ongoing renal replacement, he needed to be admitted to the intensive care unit multiple times.An adverse effect of this medication is that the patient's systolic blood pressure increased to a range of 200 and their diastolic blood pressure levels reached 120 as a result of prolonged usage of inotropes and renal replacement therapy. The doctor ordered a trans-thoracic echo, which showed significant aortic regurgitation, bicuspid regurgitation, and tricuspid regurgitation. His heart was ejecting 11% of its blood, indicating failure. The patient received the best care possible, but his condition continued to deteriorate (Damluji et al. 2020).

Considering the severity of the damage to the medical condition of the patient, a team of medical experts from different domains of the healthcare facility organized a multidisciplinary meeting. The meeting discussed the medical situation of the patient, such as multiple organ failure, increasing sepsis, side effects of the inotropes, and poor outcomes from the treatments. It also considered the financial burden on the family due to repetitive admissions in the ICU. Thus, the allocated cardiologist for the patient explained the severity of the situation to the family members. They told him that maximum efforts have been made by the medical team for improving the condition of the patient, but there is no positive response. The family members were extremely devastated after hearing the news. They decided to not pursue the treatment further and take the patient back home where he can spend the last days of his life peacefully (Clinical Nursing Skills and TechniquesE-Book, 2024).

3.Feelings

As a nurse, I felt extremely guilty that I was not able to address the critical condition of the patient. I did not focus on getting detailed information related to the medical history of the patient. I felt extremely stressed when I came across the critical cardiovascular condition of the patient. With such a complex medical history, utmost care had to be taken while deciding on the treatment plan for him. I had to make the right decision for stabilizing the condition of the patient within a limited time frame. The medical team involved in providing high-quality care to the patient had to be extremely attentive for monitoring the improving abnormal parameters of the patient. The delay in providing cardiovascular defibrillation and cardiopulmonary resuscitation also added to the progressive degradation of the patients health. This can also be observed in the case study when the patient was provided with the inotropes, vasoconstrictors, and diuretics without considering the adverse effects of this drug on the health of the patient. Due to repetitive admission into the ICU as a result of cardiogenic shock and no positive outcomes from the prescribed medical interventions, I felt extremely frustrated. Even after modifying the medications after careful evaluation of the symptoms, the medical team felt exhausted and demotivated as they had given the best medical care by applying their knowledge and expertise. In addition, it was extremely devastating to reveal the disheartening news of the terminal medical condition of the patient to their family (Europe PMC 2024).

The family members of the patient experienced a mixed state of emotions while the patient was admitted to the hospital. Initially, they were extremely concerned with the severity of the myocardial infarction experienced by the patient. They were confused about the medical interventions utilized by the doctors for stabilizing the condition of the patient. Due to frequent admissions of the patient to the ICU, the family members were extremely worried. They were extremely stressed due to the excessive financial burden on them. They got a little hope when the patient was showing improved health conditions, even though it was for a short duration. Towards the end of the treatment, the family members felt extremely disheartened as soon as they got to know about the degrading condition of the patient for which no further medical interventions were available (Zhang, Chen, Huang, & Luo 2022).

4. Evaluation

The management of the deteriorating medical condition of the patient had its own positive and negative impacts. Considering the positive situation of the patient, the medical team took a prompt decision by suggesting angiography. The medical experts and the nurses were continuously monitoring the parameters associated with cardiac health and were modifying them according to the requirements of the patient. Even though the health was repetitively worsening and was requiring immediate care in the ICU, the medical staff was extremely supportive about it. They were continuously addressing the changing needs of the patient even though there were no improved outcomes in the condition of the patient. In addition to this, the doctors and the nurses held a comprehensive meeting on the medical case of the patient. They had a detailed discussion on the possible strategies utilized by the healthcare professionals, followed by any more intervention that can be utilized for improving the health of the patient. They even considered his age and other cultural factors, such as financial burden, before coming to the decision that no more medical help is available for improving the health of the patient. The family members of the patient were informed about the decision of the medical team regarding the treatment of the patient (Dreyer et al., 2021).

There were certain negative impacts associated with the medical interventions involved by the healthcare professionals in improving the condition of the patient. Firstly, the medical team especially the nurses delayed the initial diagnosis of the patient. Rather, they allotted a lot of time in diagnosing the damage to the vital organs such as the heart, liver, and renal system. The vitals of the patients should have been stabilized, and then further thorough examination should have been done. Secondly, the medical team did not refer to any external help while addressing the changing conditions of the patient for admission in the intensive care unit. This would have led to better recommendations from the external doctors who have experience in handling such medical situations. This would have helped in handling the recurring symptoms of the patient. Thirdly, conveying disheartening news to the family members should involve the guidance of a counselor and a nurse who could provide emotional support to the members of the family and help them cope with this difficult situation (Ammirati & Moslehi 2023). Fourthly, the medical professionals were negligent in providing timely cardiovascular defibrillation shocks and cardiopulmonary resuscitation to the patient. In addition to this, they were blindly administering inotropes without considering the adverse effect of the drug on the health of the patient.

5. Analysis

The provided case study emphasizes how crucial problem-solving and decision-making are in situations like these that involve complicated medical issues. Upon admission to the emergency room, the patient disclosed a complicated medical history that included coronary bypass grafts and chronic kidney illness. It was obtained so late that an immediate assessment had to be conducted to ascertain the extent of the myocardial infarction's damage. The angiogram's findings demonstrated the presence of calcium lesions and blockage in the right coronary artery. As a result, an appropriate diagnosis was made in order to assess the patient's condition (Jiang 2022).

The patient needed regular inotrope delivery as well as renal replacement therapy because they were experiencing cardiogenic shock on multiple occasions. The symptoms of organ failure and infection were not adequately managed by the medical team. They did not consult any outside medical advice for changing the patient's treatment plan; instead, they were solely involved in implementing a single, particular method for controlling the patient's worsening symptoms. This prevented them from seeing any indications that the patient's health was improving and from carrying out any improved medical action (Kociol et al. 2020).

The patient was continuously administered with inotropes for regulating his compromised cardiac, renal, and liver functions. He was experiencing acute side effects such as repetitive cardiothoracic shock due to this. The medical professionals should have observed the cause of the symptoms and its effect on the health of the patient. The doctor should have prescribed different medications with comparatively lesser side effects to prevent the rapid progressive decline of the patients health (Velloso et al., 2022).

After determining that the patient was moving towards multiple organ failure along with heart failure, the medical professionals involved in handling the case of the patient took an effective decision to review the medical scenario of the patient. They discussed the issues and concerns faced by the patient due to myocardial infarction, followed by the measures opted for by the medical professionals in stabilizing the condition of the patient and any potential medication or procedure that could help in increasing the life of the patient. Though this strategy was effective in determining that there is a need to shift the patient under palliative care as his conditions were not improving, this also helped in gaining experience for managing situations like these (Hamano et al., 2023).

6. Conclusion

The given case study discusses the medical condition of a 71-year-old male patient who is suffering from acute myocardial infarction. He has a complex medical history of chronic kidney disease and coronary bypass grafts. When he reported to the emergency department, the doctors observed his unstabilized medical condition and immediately preferred him an angiography. The results of the angiography displayed the presence of calcium depositions and blockage in the right coronary artery. In addition to this, the patient was admitted to the ICU multiple times due to recurring symptoms of cardiogenic shock, multiple organ dysfunction, and sepsis. He was regularly prescribed inotropes, vasoconstrictors, and diuretics to regulate the compromised functioning of the different organs. However, his condition was not improving even after repetitive intake of these medications. Towards the end of the treatment strategies available for improving the condition of the patient, his medical condition was severely deteriorating. Thus, the medical experts conducted a meeting to discuss the future treatment course for the patient. After completely overviewing the symptoms of the patient followed by the potential treatment strategies, the meeting came to the conclusion that there were no further medical interventions available that could help in improving the condition of the patient.

This case study highlights the importance of utilizing a holistic approach to medical care for the patients. It initially discusses the importance of prompt decision-making and problem-solving skills for making an appropriate diagnosis for the patient and prescribing suitable medical interventions for his treatment. Followed by this, the patient required continuous admission into the ICU, which was managed by the doctors by prescribing different medications. However, the condition of the patient did not improve significantly, and this led to a discussion among the medical experts regarding the future course of the treatment. The family members of the patient decided to shift the patient under the supervision of palliative care services at home. However, this news was very devastating for the family members, and they found it very difficult to cope with the feelings associated with it.

7. Action Plan

This case study highlights the importance of a holistic approach for providing care to the patients suffering from such critical conditions. Thus, the medical experts and nurses should be skilled enough to provide an appropriate diagnosis within a limited time. In addition to this, the doctors should also consider the cultural and social factors of the patient while planning the course of the treatment. For instance, in this case study, the patient was very old and had multiple ailments due to which his body was not responding to the medications. In addition to this, the patient belonged from a low socioeconomic background, due to which his family was experiencing financial stress for meeting the requirements of the patient.

There is a need for effective palliative care services for patients with chronic terminal illness. They help in providing additional support to the patient in carrying out their daily activities such as walking, grooming, eating, etc. In addition to this, they also ensure that the abnormal parameters related to the diseases are regularly monitored. They provide emotional support to the family members and keep them informed about the health of the patient. In this case study, the patient is moving towards multiple organ failure along with sepsis, for which he requires specialized palliative care services that provide him care customized to his needs (Hinton 2022).

There is a need for a policy or a system in the healthcare facility that helps in taking ethically correct decisions for such critical medical cases. A proper protocol needs to be followed while addressing such cases, and external medical guidance should also be taken. Permissions from the regulatory authorities should be obtained before proceeding with the action taken for the medical case. In addition to this, this will be a very stressful situation for the family members for which additional support and guidance can be provided in the form of family therapy. This will help the family members to cope up with this difficult situation and take relevant decisions for the same. By implementing these actions or plans in the health care industry, a more precise and better management of the disease can be done for such critical cases (Borgstrom in press).

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