Introduction Reflective practice can be defined as the

Introduction

Within
this assignment I will be discussing in the first part what is reflection and
also having a discussion on ‘models of reflection’. Within the second part of
the assignment I will be going on to talk about my own experience of reflection
within practice.

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I will
be describing the incident and my feelings. But to start off I am going to
insert o quote from the NMC about why it’s important for us nurses / student
nurses to keep confidentiality. Since this nicely fits in with reflection in my
point of view:

‘As a
nurse or midwife, you owe a duty of confidentiality to all those who are
receiving care. This includes making sure that they are informed about their
care and that information about them is shared appropriately’

(Nursing
and Midwifery Council. (2015). Confidentiality.)

 “A patient’s confidentiality will always be
maintained within all department of the workforce, unless the patient is at
serious harm.

(Nursing
and Midwifery Council. (2015). Confidentiality.)

What
is reflection?

“Reflective
practice is a key skill for nurses. It enables nurses to manage the impact of
caring for other people on a daily basis. Reflective practice can be defined as
the process of making sense of events, situations and actions in the
workplace.”

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

 

Reflection
can also be known as a process that will enable nurses to have a think about a
certain / different event that have occurred within their workplace. This could
be down to them thinking about what happened within the workplace, how they
felt, assess the positive and negatives that came out of the situation,
rethinking the situation to have one last sense of the events, think what they
could 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.

(Royal
College of Nursing. (2015). Reflection.)

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

Reflection
is a process of reviewing your practice that then allows you to consider how to
appropriately plan and improve actions in the future, especially if things
don’t go particularly well. 

 

Student
nurses learn reflection skills by working alongside their mentors or fellow
colleagues, practicing new skills and applying knowledge. 

 

Reflective
learning skills do not end after qualification but continually build on
existing knowledge throughout an individual’s working life (Jasper et al,2013). 

 

Reflection can be supported by a reflective model. There are a lot of
models for structuring reflection. Some of them can be more general whist on
the other hand, the rest have been designed for a specific situation such as
the Johns (2000) in nursing.

 

Johns model will suggest that model for structured reflection can become
useful within the early stages of learning to reflect. It also is described to
be as the looking in and looking out way of challenging our own natural
tendency to judge ourselves too severely.

 

Johns model has been based around five different cue questions that will
allow you to break down an experience and reflect on the process and outcomes
of events.

The reflection models will also provide a framework for question asking
that could prompt to think more intensely about the whole process of reflection
and could give support towards becoming a better reflective practitioner. All
of the reflection models will usually have three most common elements of
description, analysis and also action.

(Skills for learning, 2015).

 

There
are two famous individuals that have studied into reflection that I am now
going to talk about. The first individual is Gibb’s reflective cycle. His model
can be used within any student’s school, college or university work that
includes reflective writing.

His
model appeared in the Learning by Doing (1988). Gibb’s model requires six
different stages that is needed for effective reflection and these are:

1.    Description.

2.    Feelings.

3.    Evaluation.

4.    Analysis.

5.    Conclusion.

6.    Action
plan.

Gibb’s
had decided to develop his model by following an earlier model from David
Kolb’s. Which brings me to the next individual I am going to talk about.

(2016.
Using Gibb’s Reflective Cycle.)

(See
at Appendix 1 at the end.)

 

Kolb’s
was a four-stage experiential learning cycle and was developed within 1984. His
four different stages to effective reflection was:

1.    Concrete.

2.    Reflect.

3.    Conceptualise.

4.    Plan.

 

The
Gibbs (1998) Model is one of the most popular models used by health care
professionals and encourages to think systematically about the phases of an
event or incident and is particularly helpful for people to learn from
situations that they experience on a regular day to day basis. (Oxford Brookes
University, 2017). 

By using the Gibbs Model, it
will aid and also guide to reflect when working in practice and help to make
sense and evaluate events that happen, this process also ensures that continual
learning and improving is taking place.

I am now going to discuss an
event that occurred while I was out on placement. While I’m explaining this
event, I will be relating it back to the Gibbs 1988 model of reflection.

I am on placement in the local
health board in my area. My mentor had an urgent phone call from where Mrs.R
was under a section 3.

“Section 3 of the Mental Health Act
is commonly known as “treatment order” it allows for the detention of the
service user for treatment in the hospital based on certain criteria and
conditions being met.  These are that the person is suffering from mental
disorder and that the mental disorder is of a nature or a degree which warrants
their care and treatment in hospital and also that there is risk to their
health, safety of the service user or risk to others.  It also requires
that the treatment cannot be given without the order being in place and that
appropriate treatment must be available in the setting where it is
applied.” 

(Lancashire Care NHS Foundation
Trust. 2018. What is a Section 3 of the Mental Health Act?)

 

Me
and my mentor travelled up there and this is when I first came into contact
with Mrs.R. Mrs.R has a
diagnosis of schizophrenia with borderline personality. She believes that
sex-traffickers and illegal immigrants are after her and her son.

 

“In our society there is a powerful negative stigma attached to mental
illness, especially the more severe forms, like schizophrenia. Schizophrenia is
a type of psychosis
that is generally characterized by hallucinations, disordered thinking and
delusions.”

(David F. Swink. 2010. Communicating with People
with Mental Illness.)

 

Myself,
my mentor, Mrs.R and her doctor was sat in a room
together. We were discussing her reason to why she was under a section and why
she has stopped and refusing to take her medicine. Mrs.R was unaware
about the events that lead to her being under a section. She has a very little
insight into the mental health illness. She doesn’t think that she has a
diagnosis to her mental health and that’s why she hasn’t been taking her
medicine – because she isn’t ‘ill’ in her words. 

 

We
all gave our opinion in about whether she should or not take medicine and all
of us agreed that she should. Mrs.R finally
committed to take 5mg of Aripiprazole. We felt as though this was an
achievement that she agreed to do so. Even though it’s a small dose. But it was
a first step to recovery and getting out of her section to see her son and live
a life.  

 

By having good communication within practice can
become helpful. Simply, because you can find a lot more information about the
patient, it will also improve yours and the patient’s relationship and help to
maintain a good respect and dignity between them. Asking the patient what their
wishes are and finding out what they want to happen within a situation is
paramount and not to naturally assume what the patient wishes for because of
their culture and ability.

(Nursing Times, 2010).

 

Communication involves the
reciprocal process in which messages are sent and received between two or more
people (Blazer-Riley,2016).

 

Communication involves transmitting information and forming a
relationship between people, effective communication helps people to open-up
and be more honest about things and improves patient/health care worker
relationships, this then has a philosophical effect on the patient’s treatment
outcome (Zimmermann,2009).

 

After agreeing to this, the doctor suggested that she will
take the 5mg over the weekend and examine her again on the beginning of the
week to see her progress if they will need to upper her medicine. She gave her
consent to this. We felt as though by sitting down and talking to her she had a
lot more insight that she needed the support and was in the right place. We
felt as though we achieved something with Mrs.R.

 

For
consent to be valid it must be voluntary, the decision to consent to something
must be made by the individual themselves and the consent must not be
influenced or pressured from family members or anybody else. The individual
giving consent must have the capacity to decide and should be informed fully of
any treatment and well informed about what the treatment involves, including
the negative and positive and its risk and other alternatives if available.
(National Health Service Choices 2016). 

To
obtain consent effective communication skills are essential, good communication
skills are crucial in allowing a message to be received, accepted and
understood, as many situations have deteriorated due to lack of or poor
communication and absence of mutual understanding (Welsh Government, 2013). 

 

One of the most important thing when communicating with an
individual that’s living with a mental health problem that has came to my mind
and 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 are
a 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 doctor
showed her a lot of respect about her opinions and thoughts and she took that
on board and showed respect back and showing that she was listening by giving
her consent to taking the medication.

 

While we were in the room Mrs.R experienced some
hallucinations. We became aware of the hallucinations. We have to remember that
their hallucinations that they are experiencing are their reality. We couldn’t
talk her out of her reality. The hallucinations that she was experiencing are
as real and are motivated by her. The way that we got forward after this event
was by communicating that you understand that she experiences those events. But
one of the most important things that we should never do is pretend that us
ourselves experience what they do.

 

We
then realised that she started to be a bit paranoid and frightened, the best
thing that we could have done on that point was to give her a bit more body
space to make her feel more at ease.

 

After
this event, I went home and reflected over the situation. I am pleased that I
myself and Mrs.R introduced ourselves to one another
because this gave each of us a better insight into our life’s and what was
going on. I am also happy that she gave consent and let me experience a meeting
and something that’s actually going on in her life. This gave us a better
insight into the situation. While I was reflecting I don’t think there is
nothing I would change that happened in the situation. I say this because we
all did our best, we didn’t force her into nothing she didn’t want. We
explained the situation to her and she agreed to take the medicine for her own
health and also as she said in her own words “to live a normal life with
my son”. 

 

Listening is also in that slot of the top most important
skills when with patient. It can also be the most challenging out of all. This is
because, nurses can become worried and anxious themselves, about what they are going
to say next, is what they are saying or asking the patient the right thing to say
or not to say? Should they have said nothing? But, the best thing to do is to ‘say
less and listen more.’

 

“One common reason for this is that many mental health
nurses believe they are not doing anything when they are just listening
(Bonham, 2004) and as a result they underestimate the value of simply listening
and more importantly its therapeutic effect. Listening to a client does not
mean that you are doing nothing; instead, you are allowing a space for the
person to talk. Stevenson (2008, p.110) echoes this and states that ‘even if
the mental health nurse does nothing but listen, there is likely to be a
therapeutic effect’. Several studies have also reported that people who used
mental health services value having the opportunity to tell their story and
more 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 main
important thing when with a patient / service user that is needed from a person
is excellent communication skills. I say this because good communication skills
are the key to effective practice between the service user / patient and the
worker.  It also shows that by having
good communication skills it will able you to open pathways / doors to have a
much better relationship with your service user / patient. Also, with effective
communication skills it can lead you to avoid having ineffective communicating
barriers between yourself and the service user / patient.

 

By reflecting back on the event that occurred it will
allow you to think about practice and consciously analyze back over it. For
example, the medication that the doctor gave Mrs.R can become life changing for
her. She will have a much stable mental health and be able to live a ‘normal
life’ as she explained it with her son. These changes are there to be adapted
to have a much-improved life also to improve practice within the future.

 

In my opinion, I thought that having an individuals
consent would be pretty straight forward, I didn’t realize how complex it could
be to have their consent. I say this because, when asking for someone’s consent
you have to consider everything about them, such as illness, mental state,
their capacity to communicate effectively. There are a lot that you will need
to consider. You will have to explain everything through to them, such as the
positives and negative outcomes of the situation. For example, in my case, the
positive 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 without
medication.

 

Within
this essay I have focused on explaining what myself and other think what
reflection is all about, why we all use reflection as a part of a clinical
practice, how we use it, what it does and what skills is needed to reflect
effectively within practice and on live events.

Within
my next part of the essay I discussed the Gibb’s reflective mode and I followed
his framework of six steps within the model. By following Gibb’s model, it has
made it a lot easier for me to be able to describe and talk about the event
that occurred while I was out on placement, it has also supported me to discuss
my feelings throughout explaining the event. It has also given me time to
evaluate 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 event
and the negative was that she discharged herself after a couple weeks under her
section.

 

Also,
towards the end of the essay I went in to talk about why consent is such an
important role within the individuals that you are caring / supporting. What it
also means and how do you get around to get the person’s consent. While I was
talking about consent I also mentioned how communication, respect and also
dignity can be a massive role within the situation. I say this because if you
have a good posture, eye contact and talk effectively with the individual they
will start to respect you more and give more trust into you.

 

I feel
as though with this situation that I experience that if it happens again or a
similar event occurs that I know better of how to handle the situation and what
the outcome could be. I feel as though it has given me a depth sight into what
individuals living with mental health illnesses go through each day. I will
take everything that I have learned on this placement on board and apply it
again when I am out on my future placement as a student mental health nurse and
most important throughout my career as a qualified mental health nurse.

 

Appendix
1.

http://www.nottingham.ac.uk/nmp/sonet/rlos/placs/critical_reflection/models/gibbs_cycle.html

Gibbs
Cycle (Gibbs 1988).

 

 

 

 

 

 

 

 

 

 

References.

Balzer-Riley,
J (2016). Communication in Nursing.
(5th edition)

 

David F. Swink. 2010. Communicating with People
with Mental Illness. Retrieved from:

https://www.psychologytoday.com/blog/threat-management/201010/communicating-people-mental-illness-the-publics-guide

 

Gibbs,
G (1988). Beginning Reflective Practice.
(2nd edition)

 

Gibbs
Cycle 1988 : Retrieved from

http://www.nottingham.ac.uk/nmp/sonet/rlos/placs/critical_reflection/models/gibbs_cycle.html

 

Jasper,
M (2013). Beginning Reflective Practice.
(2nd edition)

 

John Wiley & Sons; 5th Revised ed. edition (25 Mar. 2013). (2013). Reflective
Practice 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 Health
Nursing – Listening. Retrieved from:

http://www.mheducation.co.uk/openup/chapters/9780335238705.pdf

 

Lancashire Care NHS Foundation Trust. 2018. What
is a Section 3 of the Mental Health Act?. Retrieved from:

https://www.lancashirecare.nhs.uk/Section-3

 

National
Health Service Choices (2016). Consent to
treatment: Retrieved from: https://www.nhs.uk/conditions/consent-to-treatment/

 

Nursing and Midwifery Council. (2015). Confidentiality. Retrieved
from

 https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

 

Nursing
Times (2010). Communication Barriers: Retrieved
from: https://www.nursingtimes.net/searcharticles?keywords=communicationbarriers

 

Oxford
Brookes University (2017) About Gibbs
reflective cycle: Retrieved from: https://www.brookes.ac.uk/students/upgrade/study-skills/reflective-writing-gibbs/

 

Royal College of Nursing. (2015). Reflection. Retrieved
from

 http://rcnhca.org.uk/personal-and-people-development/reflection/

 

 (2016). Using
Gibb’s Reflective Cycle. Retrieved from

 

https://www.kcl.ac.uk/campuslife/services/disability/onlineresources/StudyGuides/USING-GIBBS-REFLECTIVE-CYCLE-IN-COURSEWORK-DEC-2016-P-LIA.pdf

 

Welsh
Government (2013) Putting things Right

Zimmerman,
J (2009): Nurse-patient interactive and
communication: Retrieved from: http://www.ssoar.info/ssoar/bitstrem/handle/document/20333/ssoar-jpublichealth-2009-5-fleischer_et_al-nurse-patient_interaction_and_communication-a.pdf?sequence=1