This essay presents a reflection based on the case scenario of Bill, who suffers from a mental health issue. In nursing practice, conditions about mental health require a higher level of competency skills to manage and understand the needs of the mental health patient (Söderberg, Sundbaum, & Engström, 2017). The process of development of these skills involves the ability to reflect on daily nursing practices, thus reflection is an important part of the nursing curriculum (Wain, 2017). It helps to critically analyze the situation and learn from the different conditions or situations which present as challenges, ineffective and therapeutic decision-making processes, providing care, and obtaining positive treatment outcomes in mental health patients. The process of reflection is well expressed through various steps of GIBBS reflective cycle, namely, "description of the event, describing feelings and thoughts, evaluation of the situation, and analysis, conclusion and action", which has been discussed in the essay (Patterson et al., 2016).
Event: As I was leaving the hospital after the shift was over, I heard a man yelling at people before I could even see him. He looked cold and disheveled. He was found waving his half-drunk bottle of wine and had staggering gait. When I tried to walk past him, he yelled at me, saying, “watch your back or they will get you.” The incident left me in a state of shock. (Paterson & Chapman, 2013)
Emotions: When I heard the yelling of the man, I was scared and too shocked to respond. After a few seconds, I rather hurriedly try to escape from the situation as I did not feel safe at that time, as I heard him yell, “watch your back or they will get you.” I was also very angry at the guy who seemed like a stranger, for misbehaving with the pass goers and yelling and shouting in a half-drunk state of mind. Even before I always feared being caught up in such a situation while working with patients in a mental health ward. I had never come across such an incidence and it made it feel anxious and did not know what to do about the situation I found myself into.
Thoughts: I was trying to gather or remember where have I seen this man before and after a few minutes, I was able to recollect, that he was Bill, the patient with a chronic mental health crisis, who was admitted in the mental health ward recently for an acute episode of violence and aggression. I quickly connected the dots in my mind which resulted in an understanding of this behavior (Wain, 2017). I was curious to know about where were his family members and how did he manage to be alone on the road with a bottle of wine. I thought of calling the hospital staff to verify his name and thought if they could have the contact number of his carers who could be called immediately for his assistance.
Learnings: On the evaluation of the situation I realized that I did not have a proactive approach towards handling the situation of Bill (Ardian, Hariyati & Afifah, 2019). I should have offered Bill some comfort by reaching out to him and bringing him inside the hospital. When I shared the incident with my nursing supervisor, who was still on duty, she helped me to understand that the role of a nurse is to exhibit competency skills in all critical circumstances (Potter, 2015). She encouraged me to talk to Bill and introduce myself. The role of the nurse involves building a therapeutic relationship with the patient and understanding the needs of the patient (Felton, Repper & Avis, 2018). According to research conducted by Powley, (2013) the main signs of aggression include raised voice, yelling, verbal threats, or gestures. These behaviors occur when the patients either feel disempowered or lack of acknowledgment to gain attention from their family members. Both of which can be true in Bill's case, as he was a homeless man. No carer or family member was close to him or who could take care of him.
Application: I attempted to help him and make him comfortable. Bill was reluctant to be admitted at first, and continued to frighten me and yell at me, despite which I continued to wrap him in the blanket and talk to him in a way polite and assuring manner (Delaforce & Dolan, 2013). I told him that no one is coming after him and he did not have to be afraid. I asked the staff to inform his family members and admit him immediately. After Bill was stable and fell asleep, I started the process of the literature search to identify reasons by which patients get violent and to obtain knowledge on how to act under clinically challenging scenarios such as this. According to research conducted by Archer et al., (2013), it was suggested that most of the patients become violent or aggressive under the influence of the alcohol or any other form of intoxication. It was recommended that adequate counselling for addiction and rehabilitation must be provided to the mental health patients and keeping active surveillance on such patients to improve the treatment outcomes. Consultation to a psychologist was also provided for Bill's condition and he was re-admitted for care and observation.
The process of reflection helped me to understand the importance of developing the skill of establishing therapeutic communication with the patients in clinical practice, especially those who suffer from mental health conditions. The impact of therapeutic communication can lead to assurance, calmness in the patient, and inculcate the feeling of security and helps in building a trustworthy relationship between the patient and the nurse. The role of reflection in nursing practice is crucial for identifying the areas of weakness and opportunities to improvise when faced with a similar situation in the future. After the process of reflection, I feel empowered and competent to deal with difficult situations with mental health patients with more confidence.
Archer, J. R. H., Dargan, P. I., Wood, D. M., & Winstock, A. R. (2013). Hospital and prehospital emergency service utilisation as an impact of acute recreational drug and ethanol toxicity. Journal of Substance Use, 18(2), 129-137.
Ardian, P., Hariyati, R. T. S., & Afifah, E. (2019). Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills. Enfermeria clinica, 29, 588-593.
Delaforce, C., & Dolan, B. (2013). Mental health emergencies. Accident & Emergency: theory into practice. 3rd edition. Edinburgh: Bailliere Tindall Elsevier, 211-226.
Felton, A., Repper, J., & Avis, M. (2018). Therapeutic relationships, risk, and mental health practice. International journal of mental health nursing, 27(3), 1137-1148.
Paterson, C., & Chapman, J. (2013). Enhancing skills of critical reflection to evidence learning in professional practice. Physical Therapy in Sport, 14(3), 133-138.
Patterson, C., Moxham, L., Brighton, R., Taylor, E., Sumskis, S., Perlman, D., ... & Hadfield, L. (2016). Nursing students' reflections on the learning experience of a unique mental health clinical placement. Nurse education today, 46, 94-98.
Potter, C. (2015). Leadership development: an applied comparison of Gibbs’ Reflective Cycle and Scharmer’s Theory U. Industrial and Commercial Training.
Powley, D. (2013). Reducing violence and aggression in the emergency department. Emergency nurse, 21(4).
Söderberg, A., Sundbaum, J. K., & Engström, Å. (2017). Nursing students' reflections after meetings with patients and their relatives enacted by professional actors: Being touched and feeling empathy. Issues in Mental Health Nursing, 38(2), 139-144.
Wain, A. (2017). Learning through reflection. British Journal of Midwifery, 25(10), 662-666.
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