Introduction out of the situation, rethinking the situation

IntroductionWithinthis assignment I will be discussing in the first part what is reflection andalso having a discussion on ‘models of reflection’.

Within the second part ofthe assignment I will be going on to talk about my own experience of reflectionwithin practice.I willbe describing the incident and my feelings. But to start off I am going toinsert o quote from the NMC about why it’s important for us nurses / studentnurses to keep confidentiality.

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Since this nicely fits in with reflection in mypoint of view:’As anurse or midwife, you owe a duty of confidentiality to all those who arereceiving care. This includes making sure that they are informed about theircare and that information about them is shared appropriately'(Nursingand Midwifery Council. (2015). Confidentiality.) “A patient’s confidentiality will always bemaintained within all department of the workforce, unless the patient is atserious harm.(Nursingand Midwifery Council. (2015). Confidentiality.

)Whatis reflection?”Reflectivepractice is a key skill for nurses. It enables nurses to manage the impact ofcaring for other people on a daily basis. Reflective practice can be defined asthe process of making sense of events, situations and actions in theworkplace.

“(John Wiley & Sons; 5th Revised ed. edition (25 Mar.2013). (2013). ReflectivePractice in Nursing. England: Wiley Blackwell.

) Reflectioncan also be known as a process that will enable nurses to have a think about acertain / different event that have occurred within their workplace. This couldbe down to them thinking about what happened within the workplace, how theyfelt, assess the positive and negatives that came out of the situation,rethinking the situation to have one last sense of the events, think what theycould have done differently to have a different outcome – a more negative /positive outcome, think how they would react / what will they do differently /similar in the next event that occurs.(RoyalCollege of Nursing.

(2015). Reflection.)Also,when an individual is reflecting they might find it easier to note down allthese thoughts / feelings as they are going along to make it less stressful whenthey are making next plans for next dealing event.

Reflectionis a process of reviewing your practice that then allows you to consider how toappropriately plan and improve actions in the future, especially if thingsdon’t go particularly well.  Studentnurses learn reflection skills by working alongside their mentors or fellowcolleagues, practicing new skills and applying knowledge.  Reflectivelearning skills do not end after qualification but continually build onexisting knowledge throughout an individual’s working life (Jasper et al,2013).  Reflection can be supported by a reflective model. There are a lot ofmodels for structuring reflection. Some of them can be more general whist onthe other hand, the rest have been designed for a specific situation such asthe Johns (2000) in nursing.

 Johns model will suggest that model for structured reflection can becomeuseful within the early stages of learning to reflect. It also is described tobe as the looking in and looking out way of challenging our own naturaltendency to judge ourselves too severely.  Johns model has been based around five different cue questions that willallow you to break down an experience and reflect on the process and outcomesof events.The reflection models will also provide a framework for question askingthat could prompt to think more intensely about the whole process of reflectionand could give support towards becoming a better reflective practitioner. Allof the reflection models will usually have three most common elements ofdescription, analysis and also action.(Skills for learning, 2015).

 Thereare two famous individuals that have studied into reflection that I am nowgoing to talk about. The first individual is Gibb’s reflective cycle. His modelcan be used within any student’s school, college or university work thatincludes reflective writing.Hismodel appeared in the Learning by Doing (1988). Gibb’s model requires sixdifferent stages that is needed for effective reflection and these are:1.

    Description.2.    Feelings.3.    Evaluation.4.    Analysis.5.

    Conclusion.6.    Actionplan.Gibb’shad decided to develop his model by following an earlier model from DavidKolb’s. Which brings me to the next individual I am going to talk about.(2016.Using Gibb’s Reflective Cycle.)(Seeat Appendix 1 at the end.

) Kolb’swas a four-stage experiential learning cycle and was developed within 1984. Hisfour different stages to effective reflection was:1.    Concrete.2.    Reflect.3.    Conceptualise.

4.    Plan. TheGibbs (1998) Model is one of the most popular models used by health careprofessionals and encourages to think systematically about the phases of anevent or incident and is particularly helpful for people to learn fromsituations that they experience on a regular day to day basis. (Oxford BrookesUniversity, 2017). By using the Gibbs Model, itwill aid and also guide to reflect when working in practice and help to makesense and evaluate events that happen, this process also ensures that continuallearning and improving is taking place.I am now going to discuss anevent that occurred while I was out on placement. While I’m explaining thisevent, I will be relating it back to the Gibbs 1988 model of reflection.

I am on placement in the localhealth board in my area. My mentor had an urgent phone call from where Mrs.Rwas under a section 3.”Section 3 of the Mental Health Actis commonly known as “treatment order” it allows for the detention of theservice user for treatment in the hospital based on certain criteria andconditions being met.  These are that the person is suffering from mentaldisorder and that the mental disorder is of a nature or a degree which warrantstheir care and treatment in hospital and also that there is risk to theirhealth, safety of the service user or risk to others.  It also requiresthat the treatment cannot be given without the order being in place and thatappropriate treatment must be available in the setting where it isapplied.” (Lancashire Care NHS FoundationTrust. 2018.

What is a Section 3 of the Mental Health Act?) Meand my mentor travelled up there and this is when I first came into contactwith Mrs.R. Mrs.

R has adiagnosis of schizophrenia with borderline personality. She believes thatsex-traffickers and illegal immigrants are after her and her son.  “In our society there is a powerful negative stigma attached to mentalillness, especially the more severe forms, like schizophrenia. Schizophrenia isa type of psychosisthat is generally characterized by hallucinations, disordered thinking anddelusions.”(David F.

Swink. 2010. Communicating with Peoplewith Mental Illness.) Myself,my mentor, Mrs.R and her doctor was sat in a roomtogether. We were discussing her reason to why she was under a section and whyshe has stopped and refusing to take her medicine. Mrs.R was unawareabout the events that lead to her being under a section.

She has a very littleinsight into the mental health illness. She doesn’t think that she has adiagnosis to her mental health and that’s why she hasn’t been taking hermedicine – because she isn’t ‘ill’ in her words.  Weall gave our opinion in about whether she should or not take medicine and allof us agreed that she should. Mrs.R finallycommitted to take 5mg of Aripiprazole. We felt as though this was anachievement that she agreed to do so. Even though it’s a small dose. But it wasa first step to recovery and getting out of her section to see her son and livea life.

   By having good communication within practice canbecome helpful. Simply, because you can find a lot more information about thepatient, it will also improve yours and the patient’s relationship and help tomaintain a good respect and dignity between them. Asking the patient what theirwishes are and finding out what they want to happen within a situation isparamount and not to naturally assume what the patient wishes for because oftheir culture and ability. (Nursing Times, 2010). Communication involves thereciprocal process in which messages are sent and received between two or morepeople (Blazer-Riley,2016). Communication involves transmitting information and forming arelationship between people, effective communication helps people to open-upand be more honest about things and improves patient/health care workerrelationships, this then has a philosophical effect on the patient’s treatmentoutcome (Zimmermann,2009). After agreeing to this, the doctor suggested that she willtake the 5mg over the weekend and examine her again on the beginning of theweek to see her progress if they will need to upper her medicine.

She gave herconsent to this. We felt as though by sitting down and talking to her she had alot more insight that she needed the support and was in the right place. Wefelt as though we achieved something with Mrs.R. Forconsent to be valid it must be voluntary, the decision to consent to somethingmust be made by the individual themselves and the consent must not beinfluenced or pressured from family members or anybody else. The individualgiving consent must have the capacity to decide and should be informed fully ofany treatment and well informed about what the treatment involves, includingthe negative and positive and its risk and other alternatives if available.(National Health Service Choices 2016). Toobtain consent effective communication skills are essential, good communicationskills are crucial in allowing a message to be received, accepted andunderstood, as many situations have deteriorated due to lack of or poorcommunication and absence of mutual understanding (Welsh Government, 2013).

  One of the most important thing when communicating with anindividual that’s living with a mental health problem that has came to my mindand what I have seen is to be respectful to the individual. I say this simply,because if the individual feels as though you are respecting them then they area lot more likely to return the respect and consider what you have to say.Which in my case with the event, that what happened. For example, the doctorshowed her a lot of respect about her opinions and thoughts and she took thaton board and showed respect back and showing that she was listening by givingher consent to taking the medication. While we were in the room Mrs.

R experienced somehallucinations. We became aware of the hallucinations. We have to remember thattheir hallucinations that they are experiencing are their reality.

We couldn’ttalk her out of her reality. The hallucinations that she was experiencing areas real and are motivated by her. The way that we got forward after this eventwas by communicating that you understand that she experiences those events. Butone of the most important things that we should never do is pretend that usourselves experience what they do. Wethen realised that she started to be a bit paranoid and frightened, the bestthing that we could have done on that point was to give her a bit more bodyspace to make her feel more at ease.

 Afterthis event, I went home and reflected over the situation. I am pleased that Imyself and Mrs.R introduced ourselves to one anotherbecause this gave each of us a better insight into our life’s and what wasgoing on. I am also happy that she gave consent and let me experience a meetingand something that’s actually going on in her life. This gave us a betterinsight into the situation. While I was reflecting I don’t think there isnothing I would change that happened in the situation. I say this because weall did our best, we didn’t force her into nothing she didn’t want.

Weexplained the situation to her and she agreed to take the medicine for her ownhealth and also as she said in her own words “to live a normal life withmy son”.  Listening is also in that slot of the top most importantskills when with patient. It can also be the most challenging out of all. This isbecause, nurses can become worried and anxious themselves, about what they are goingto say next, is what they are saying or asking the patient the right thing to sayor not to say? Should they have said nothing? But, the best thing to do is to ‘sayless and listen more.’ “One common reason for this is that many mental healthnurses believe they are not doing anything when they are just listening(Bonham, 2004) and as a result they underestimate the value of simply listeningand more importantly its therapeutic effect. Listening to a client does notmean that you are doing nothing; instead, you are allowing a space for theperson to talk. Stevenson (2008, p.110) echoes this and states that ‘even ifthe mental health nurse does nothing but listen, there is likely to be atherapeutic effect’.

Several studies have also reported that people who usedmental health services value having the opportunity to tell their story andmore importantly being heard.” (Jensen,2000;KaiandCrosland,2001;Moyle,2003;Koivistoetal.,2004;Gilburtetal.

,2008; Hopkins et al., 2009). I have come to the conclusion that one of the mainimportant thing when with a patient / service user that is needed from a personis excellent communication skills. I say this because good communication skillsare the key to effective practice between the service user / patient and theworker.

 It also shows that by havinggood communication skills it will able you to open pathways / doors to have amuch better relationship with your service user / patient. Also, with effectivecommunication skills it can lead you to avoid having ineffective communicatingbarriers between yourself and the service user / patient.  By reflecting back on the event that occurred it willallow you to think about practice and consciously analyze back over it.

Forexample, the medication that the doctor gave Mrs.R can become life changing forher. She will have a much stable mental health and be able to live a ‘normallife’ as she explained it with her son. These changes are there to be adaptedto have a much-improved life also to improve practice within the future. In my opinion, I thought that having an individualsconsent would be pretty straight forward, I didn’t realize how complex it couldbe to have their consent.

I say this because, when asking for someone’s consentyou have to consider everything about them, such as illness, mental state,their capacity to communicate effectively. There are a lot that you will needto consider. You will have to explain everything through to them, such as thepositives and negative outcomes of the situation.

For example, in my case, thepositive was that she would be allowed visits off her son and parents,negatives could be that her mental state could become a lot more severe withoutmedication. Withinthis essay I have focused on explaining what myself and other think whatreflection is all about, why we all use reflection as a part of a clinicalpractice, how we use it, what it does and what skills is needed to reflecteffectively within practice and on live events.Withinmy next part of the essay I discussed the Gibb’s reflective mode and I followedhis framework of six steps within the model. By following Gibb’s model, it hasmade it a lot easier for me to be able to describe and talk about the eventthat occurred while I was out on placement, it has also supported me to discussmy feelings throughout explaining the event. It has also given me time toevaluate what was the positives and negatives that came out of this situation.Such as Mrs.

R gave consent to take medication was a positive outcome of eventand the negative was that she discharged herself after a couple weeks under hersection.  Also,towards the end of the essay I went in to talk about why consent is such animportant role within the individuals that you are caring / supporting. What italso means and how do you get around to get the person’s consent. While I wastalking about consent I also mentioned how communication, respect and alsodignity can be a massive role within the situation.

I say this because if youhave a good posture, eye contact and talk effectively with the individual theywill start to respect you more and give more trust into you.  I feelas though with this situation that I experience that if it happens again or asimilar event occurs that I know better of how to handle the situation and whatthe outcome could be. I feel as though it has given me a depth sight into whatindividuals living with mental health illnesses go through each day. I willtake everything that I have learned on this placement on board and apply itagain when I am out on my future placement as a student mental health nurse andmost important throughout my career as a qualified mental health nurse. Appendix1.http://www. (Gibbs 1988).          References.Balzer-Riley,J (2016). Communication in Nursing.(5th edition) David F.

Swink. 2010. Communicating with Peoplewith Mental Illness. Retrieved from: Gibbs,G (1988). Beginning Reflective Practice.(2nd edition) GibbsCycle 1988 : Retrieved fromhttp://www. Jasper,M (2013). Beginning Reflective Practice.(2nd edition) John Wiley & Sons; 5th Revised ed. edition (25 Mar. 2013).

(2013). ReflectivePractice in Nursing. England: Wiley Blackwell (Jensen, 2000;KaiandCrosland,2001; Moyle,2003; Koivistoetal.,2004; Gilburtetal.

, 2008;Hopkins et al., 2009). 2011. Core Communication Skills in Mental HealthNursing – Listening. Retrieved from:http://www.mheducation. Lancashire Care NHS Foundation Trust. 2018. Whatis a Section 3 of the Mental Health Act?.

Retrieved from: https://www.lancashirecare.nhs.

uk/Section-3 NationalHealth Service Choices (2016). Consent totreatment: Retrieved from: Nursing and Midwifery Council. (2015). Confidentiality.


uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf NursingTimes (2010). Communication Barriers: Retrievedfrom: OxfordBrookes University (2017) About Gibbsreflective cycle: Retrieved from:

uk/students/upgrade/study-skills/reflective-writing-gibbs/ Royal College of Nursing. (2015). Reflection. Retrievedfrom http://rcnhca.  (2016). UsingGibb’s Reflective Cycle.

Retrieved from WelshGovernment (2013) Putting things RightZimmerman,J (2009): Nurse-patient interactive andcommunication: Retrieved from: 


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