Introduction The objective of this assignment is to reflect upon a good nursing practice which l witnessed during my placement

Introduction
The objective of this assignment is to reflect upon a good nursing practice which l witnessed during my placement. This is to explain what l have learnt, and how l can progress on my There different roles can strengthen the relationship with patients and provide necessary support required, but at times they spend too much time, having long hour meetings which may not necessary benefit the patient, they also have less contact with patient. Therapeutic relationship with service users gives them sense of belonging and nurses feel valued in their duties or roles. All that l learnt with my mentor will be beneficial to my personal development as a nurse and l want to put it in practice. Professionalism plays a vital role in the field of nursing. (Oxford English Dictionary,2005) describes professionalism in nursing as a tool or skills which is required or expected of a professional.

Reflection is way of reflecting on past events, checking and gathering knowledge to gain a unique understanding and how to improve on one’s action when faced with similar situation in future. According to (Flemming,2006) it is equally a process of sharing knowledge with others. Reflective practice helps to acknowledge courage and weakness, which improves advancement, it also encourages continuing professional development (CPD). The NMC requires all nurses to be well informed in their core practice area (NMC,2017) Good communication is very important because it acts as the therapeutic tool in giving care.

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Models
Johns (2000) reflective model is associated with more complex thinking of the event and environment, it has been argued that the model has lots of questions to be answered and could be time consuming. This model emphasis on risk management as main concerns.
Driscoll’s model (2011) uses 3 stages to help analyse practice, something that truly exist, is this real fact “what” happened acquired information “so what” have you learned, how you are going to implement “now what” you have learnt making good use of it, put into good effect all lesson learnt. This model doesn’t talk about individual’s reflection is mainly concerned about the event.

Gibbs reflective model (1988) consists of six stage cycle which helps the reader to describe the actual situations, analyse feelings and evaluate the events, conclude situations and also how the individual can deal with the situation if it re-occurs again. I will be using Gibbs model of reflection (1988) updated by Bulman (2012) as a framework for this assignment because it helps me reflect on the events. (Jasper,2013) the model is easy to understand because it asked series of questions. Siviter (2004, pg.165) says reflection is about being self-confidence, knowing when to improve, and also learning from other people’s mistakes,
Self-awareness and helping to improve future practice from previous experiences.

Stage 1: Description
l was assigned to a female acute rehabilitation ward and psychiatric ward, where patients that are detained under the Mental Health Act (2005) this act gives the authorities the power to detained a person identified with mental health issues in the hospital or the custody of the police and have their mental illness assessed for a period of time, they can also be treated against their wishes. Some of the patients are also identified with border line personality disorder, and schizophrenia, depression. Most of the patients are admitted for a short time stay due to relapse. l had observed how healthcare professionals were working together to give adequate care to patients under their care, based on individual needs (Swientozielskyj,2015). This particular day patient X got up the morning and said she was upset about her ward round which was scheduled for the afternoon session, patient X started head banging on her wall in her bedroom.
Immediately, l approached my mentor and spoke to her about patient X, my mentor responded promptly and had a 1:1 session with her, she was supported and reassured of the team’s support at all times, patient X explained all her fears, worries and anxiety towards her ward round, “I need immediate solution to my problem, she stressed, and you guys do not seem to care about me”. She was further supported and reassured of the multidisciplinary team total commitment to her care and recovery. She was encouraged to attend the ward round because she will be involved in the decision making of her care, however if she doesn’t want to attend the ward round, she can still make a paper request which will be passed over to the MDT.

Later in the day patient X, went over for to her ward round and was involved. She told the team she was happy about the decision made for her care and pathway. Patient X could not stop thanking my mentor for encouraging her to go for the ward round, patient X said she feels supported and made a thank you card for my mentor. She later went on to attend all her other sessions booked in her diary for the day.
Stage 2: Feelings and Thoughts
I was surprised and shocked initially when l found patient X head banging on her bedroom wall, and l thought her head was going to burst open, because of the impact and sound. l found it a little bit difficult to know what to say but tried to speak to her but she did not respond at all. When l got my mentor and other staff members to her bedroom my mentor asked for her permission into come to her bedroom, and sat down beside her on the floor, and not standing above her, this made patient X to brighten up a little bit, even the tone of my mentor voice was very soft.
My mentor empathised with patient X, and also continued to support and reassure patient X which made her feel relaxed. After the incident l felt my mentor had helped patient X by trying to distract her attention from the ward round, however my mentor still spent more time with her talking about her favourite movies, holiday destination, cookery books, pet care books, designer watches and food. I believe this is very vital to have, (Cummings, Clarke and Evans 2015) courage and knowledge while working with patients at all times so as to maintain professional boundaries as a nurse. Empathy is putting others in your own shoes because you understand what they are going through. l felt calm throughout the incident because l was the first person who found her in her bedroom and called out for help.
I noticed that patient X had a diary which she keeps, writing down names of staff who had helped her in her treatment and recovery journey. Towards the end of my placement she called out my name during planning meeting and gave me a star on the board, she told the staff and her peers l had helped her when she needed help some couple of weeks back. This had made me to be fulfilled, for choosing the right profession as a nurse.

Patient X had the power (autonomy) to make decision in the care given to her. Beauchamp and Childress (2009) defined autonomy as the way a patient take or refuse care given to them. They also said the patient opinions should be respected at all times, as long as the opinions or action does not endanger anyone life. For patient X to be part of the ward round is a form of use of autonomy. Every nurse has the responsibility to show best interest of the patients and help them from harming themselves or others.

knowledge or skills (Barksby, Butcher and Whysall,2015). According to confidentiality and safeguarding (Care Act 2014), confidentiality will be maintained (NMC,2008) during this reflective writing. I will emphasize on importance of communication and competence within the field of nursing, with emphasis on the 6C’s ,(NHS,2017) I will discuss about other team members who are involved in patient’s care, multidisciplinary team(MDT).This are professionals from different field of study, who come together to share vital information, knowledge and experiences ,Nursing and midwifery council (2015) i.e. Responsible Clinicians, occupational therapist, social workers, family therapist, clinical psychologists and many others.

Non-maleficence means anything that can endanger lives of people should be avoided, can also be say is not given recognition to patient’s autonomy.

Beneficence is an act of being helpful, kind and giving. It helps the welfare of other people
The Stage 3: Evaluation
The good experience l witnessed during this incident, there was a quick response from my mentor and other staff member, my mentor knows the patient well and had a good professional relationship with the patient. Good professional conduct, and my mentor was calm throughout the incident and maintained a good eye contact with patient X, which can also be perceived as contact staring, throughout the incident which was helpful (The Makaton Charity,2016) is a language technique which involves using actions and symbols to help individuals to communicate and also focusing on facial expression eye contact and body language to gain more information. Although, Childs et al, (2009) identifies that long staring can be perceived as threatening for an individual, who is feeling paranoid and this might lead to an aggressive behaviour, although it was different in this case with patient X, instead it gave her more reassurance and she knows that my mentor was there listening to her, bring different suggestions to remove hers fears, and making her understand that her fears and worries will be dealt with. Active listening indicates you are listening to patient views without been judgmental of them.

During the ward round patient X views was respected and promoted, the team consulted her about her treatment plan or thoughts during the meeting. After the ward round patient X was updated about the plans and care delivery. Patient X said to my mentor after the ward round she was happy about the meeting, and the team made her to be part of the decision making, in terms of her care and treatment (in charge of her care). This gave me confidence and motivated me to continue with my training as a mental health student nurse, (Harling and jewell,2016) “to make every contact count”
What l felt that did not go well during this incident, was when patient X was left on her own for sometimes without checking on her, due to the fact that she did not attend the planning meeting in the morning. Patient X had already told staff she was down, because she does not feel is necessary to attend her ward round, also said she hate ward round days and walked straight to her bedroom and banged her bedroom door behind her.
Stage 4: Analysis
Health care professionals are obliged by law, to provide duty of care towards patients and others in their care. The nursing team made patient X to be aware that, there was an established professional and therapeutic relationship in place for her to give her the appropriate care needed by her. Compassion is, how care is provided, it can also be described as intelligent kindness, and is central to how people see their care (NHS,2017) Compassionate nurses put patients in their shoes every time. Competence is how all health professionals care for individual’s, ability to know display professionalism and do relevant task without any mistakes (Lippincott Solution,2017) Competence can be seen by people’s attitude to work and showing high level of professionalism at all times or when fulfilling daily needs.
Courage can be said, to be the ability to speak boldly, when you see the bad practice or something wrong with the care given to a patient (Dictionary, O.2005). Nurses are meant to give patients the necessary care required. When l called my mentor and other staff member they left what they were doing to attend to patient. My mentor had shown good communication skills while listening to the patient in her bedroom. Good communication is paramount for all professionals, as nurses you must be a good listener when dealing with your patient. According to (Papadantonkai,2006) Listening is very vital and important also what we say as well when communicating with patients, the attention of the nurse is very important this helps to translate the message given by the patient.

The communication between the patient and staff throughout the incident was good, there was commendable team work, among the staff on ground. (NCBI,2017) National centre for bio technology information say for a good communication skills to be achieved between nurses and patients is openness and loyalty. Advised was given to patient, that if she was not satisfied with her own care she can speak to an advocate. (Edwards,2005) An advocate is someone who represent the patient’s opinions and concerns in the ward rounds or care programme approach (CPA) meeting, which patients might at times, see that it is too stressful or afraid to share their opinions because of too many people present.
Stage 5: Conclusion
The Gibbs reflective model as helped me to understand my weaknesses and strength. It has also helped me to identify all different areas l need to work on during my training as a mental health student nurse. The experience l had in the unit has taught me to go the extra mile, in preparation for new experiences and challenges. I will always ask questions if l am not sure of something, and ask for the best approach, l will also do lots of research and reading on different subjects relating to my new experience to gain good understanding and knowledge. I am now aware that reflection is part of nursing professional development. (NMC,2015) Reflection is part of NMC requirement for revalidation process which is to help develop further education through CPD.
I had clinical supervision with my mentor after the incident and she asked me how l felt regarding the incident, because it was my first week in the unit. This opportunity helped me to access the situation and deliberate on the role l played and my feelings. (Jones,2010) defines clinical supervision as a process which helps a professional to reflect and reduce stress from difficult experiences with the possibility of obtaining constructive response.
The experience l gained during this placement has given me more insight and also understanding myself better, l would not be afraid if faced with the same challenge again, l now understands how to go about being professional when incident happens. Patient dignity was respected during the incident, before staff walked into her bedroom she was asked if she was properly dressed, and if she would not mind if staff approach and come into bedroom, however she said she does not want male staff in her bedroom.
(NMC,2008) says the most important thing when carrying out care is to administer care to a person as an individual and also to respect their privacy and dignity always, not to be judgemental to who is receiving the care. Also working with others is important and helps the physical well-being of those at the receiving end of the care. (Equality Act 2012) Individuals should be treated right no matter their race, colour, religion or sexuality. Any steps that the nurses made regarding a patient should be done based on ethnics and values.

Stage 6: Action plan
The experience l gained has made me to be proactive in this setting, l will always try to get involved in everything as much as possible. (Pfaff, Baxter, Jack and Ploeg,2014) illustrated that confidence can be acquired from practice and knowledge from past situation. I have now acquired more experience and by been active in this situation, and this will help me in future role, as a mental health nurse. If l am confronted with same situation in future, l already know what to do. I need to improve on going to library to do more research on various areas which are relevant to my current area of learning.

I have also learnt not to be judgemental towards patients in our care, is good to always give them a voice to hear their concerns.

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