Evaluating effect of implementing Gibbs’ reflective model on quality of nurses’ documentation in emergency departments: a clinical trial

Abstract

Emergency nurses are responsible for providing and documenting immediate patient care. Documentation is a fundamental component of their professional practice; however, evidence indicates that documentation standards are often not adequately met. Therefore, innovative training approaches should be employed to improve the quality of nurses’ documentation. The present study aims to evaluate the effect of implementing Gibbs’ reflective model on the quality of documentation by emergency department nurses. This cluster-randomized clinical trial was conducted on 68 nurses working in the emergency departments of two hospitals in the south of Fars Province, Iran, in 2024. Randomization was performed at the hospital level, with one hospital assigned to the intervention group and the other to the control group using simple random sampling. All eligible nurses in each hospital were then invited to participate (34 nurses per group). The intervention group participated in a documentation training program based on Gibbs’ reflective model (four 45 to 60 min sessions over four weeks). The control group received only the hospital’s routine documentation training. Data were collected using a validated checklist to assess documentation quality before and one month after the intervention. Due to significant baseline differences between groups, change scores (post-test minus pre-test) were calculated and compared using appropriate statistical tests based on the normality of the data distribution. In the intervention group, structural quality changed from 12.28 ± 1.54 to 15.47 ± 0.89 (p < 0.001, Cohen’s d = 1.65), content quality from 45.06 ± 8.70 to 61.11 ± 3.28 (p < 0.001, Cohen’s d = 1.70), and overall quality from 57.47 ± 9.51 to 76.58 ± 3.61 (p < 0.001, Cohen’s d = 1.82). In the control group, structural quality changed from 9.76 ± 1.12 to 10.27 ± 1.20 (p = 0.020, Cohen’s d = 0.36), content quality from 34.53 ± 3.89 to 38.29 ± 3.80 (p < 0.001, Cohen’s d = 0.68), and overall quality from 44.29 ± 4.69 to 48.57 ± 4.34 (p < 0.001, Cohen’s d = 0.69). The mean change scores for overall documentation quality were 19.11 ± 10.53 points in the intervention group versus 4.27 ± 6.19 points in the control group (r = 0.67). For structural quality, the change was 3.19 ± 1.93 vs. 0.51 ± 1.41 points (r = 0.65), and for content quality, it was 16.05 ± 9.45 vs. 3.76 ± 5.51 points (r = 0.63). All between-group differences in change scores were statistically significant. This study provides preliminary evidence that a Gibbs’ reflective model-based training program may improve the quality of emergency nurses’ documentation. However, given the baseline differences between groups and the cluster design, these findings should be interpreted with caution. Further multi-center studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and establish the generalizability of this educational approach. IRCT20240421061551N1 ( http://www.irct.ir/ ). Registered on 2024-06-22.”