Reflection On Communication In Experiencing Mental Illness Nursing Essay

Reflection On Communication In Experiencing Mental Illness Nursing Essay The purpose of this assignment is to critically reflect upon on aspect of my professional practice and development that arose whilst out in clinical practice. The paper will show emphasise based on communication. This reflection has been chosen to highlight the need for nurses to have therapeutic communication skills in order to provide holistic care and encourage a good nurse-patient relationship. Gibbs (1988) reflective cycle has been chosen as a framework for this paper. To satisfy the requirements of the Data protection Act (1998) as well as the NMC (2007) code of professional conduct, all names have been changed to protect identity in concordance with confidentiality purposes. Reflection is a way of analysing a past incident in order to promote learning and development. Gibbs (1988) reflective cycle can be seen as cyclical in nature which incorporates six stages to enable me to continuously improve my learning from the event for better practice in the future. The six stages are: 1. Description 2. Feelings 3. Evaluation 4. Ananlysis 5. Conclusion 6. Action plan. Description Whilst out in placement I witnessed both positive and negative communication. During handover I was informed Maisey has dementia, deafness, aggression and short term memory loss. During handover Maisey approached the nurses int he office who appeared to look very anxious and upset. The staff nurse raised her voice and in a fixed tone told Maisey to return to her bedroom, shouting we are to busy now, go back to your room. The nurses and health care assistants present in handover giggled amongst themselves, exchanged knowing glances and mimicked Maiseys voice saying she can be such a nuisance. Having not previously met Maisey I offered to assist her with her personal hygiene needs and to make her bed. I knocked on her bedroom door to which I then entered. Maisey stood up defensively and appeared to be very agitated and irate. She shouted that she wanted answers. I explained that I came to help her and would do my best to help her. Maisey then explained that no one had explained to her why she was in hospital nor did she know the where abouts of her daughter (main care giver). Reviewing Maiseys care plan I found out she had a fall at her daughters (Barbara) house and her son informed me that Barbara was away on holiday for a week. After the discussion with Maisey I documented it in her notes so that other members of the Multi-disciplinary team would acknowledge that Maisey was uncertain about the situation she was in. After speaking to my mentor and being more knowledgeable on Maiseys situation, I returned to her with my mentor close by. I pulled up a chair next to her and in a calm, reassuring, comforting manner explained the reason why she was in hospital. However Maisey appeared to look confused and asked me to speak to her in her left ear as she was deaf. I patiently repeated what I had said, she looked brighter after I mentioned her daughters name. Maisey asked a few more questions and I tried to answer them accurately and confidently. Maisey smiled and confided she is aware that she can be forgetful but feels that she is being ignored and that no one cared to what she had to say. She also said she could not sleep as other patients were disturbing her. After the discussion I gave Maisey assistance with her personal hygiene needs to which she thanked me for taking the time and just talking. Maisey had said she felt a lot better that someone took the time to listen to her concers and explain wh at was going on instead of being ignored and left in the dark. Feelings I felt very angry and disappointed that the staff easily agreed as a team that Maisey was just confused and describing her a as nuisance, without investigating as to why she seemed upset. I was in complete shock that as nurses they could be so quick to dismiss Maisey the way the did. I was highly annoyed that they all felt it was alrite to mimic and laugh at a patient. I felt a bit disheartened how no one took the time to explain what was going on to Maisey. Once I helped Maisey I felt happy that I took the time to get to know her and in turn see a different side to things. I felt proud I was able to reassure and relax Maisey so she could rest properly. Evaluation I feel I have learnt a lot from this experience with Maisey and how the nurses responded to her when she was at a very vulnerable time. It was not a nice encounter as I feel things like this should not happen in practice, however in terms of a learning prospective it was good as it taught me that it is paramount to be sensitive towards a patient who is feeling distressed. It went well as I have learnt how important it is to be patient, to take the time to listen to a patient as this can have cumulative effects on that persons well being and the outcome as to how they are feeling. The way the staff nurses reacted was not in the best interests of the patient. I did not like their approach, as they did not make an effort to show support or any understanding as she was known as a difficult patient. Stockwell (1972) wrote the infamous book The Unpopular Patient where she explains that studies of communication in nursing demonstrate inadequacies in nursing practice.   Stockwell (1972) de scribes the nurse-patient interaction, insisting that such interaction is not always satisfactory, especially when dealing with a difficult or unpopular patient. I feel the nursing team were ignorant to the fact that Maisey had difficulty in hearing which must have made it irritating for staff to keep repeating themselves. This could have been part of the reason as to why Maisey was considered an unpopular patient as she was seen as demanding. Analysis There was no interaction between nurse and patient as Maisey approached the nurses station, and to be mocked then dismissed must have been a terrible experience for her.   Davis (2008) explains how hectic times of the day such as handover, mealtimes and ward rounds leave insufficient time to help patients who need it.   However, if the nursing team had engaged in a little conversation with Maisey, she might have felt valued and understood, instead of upset and belittled.   The NMC Code (2008) clearly states many standards of conduct which a registered nurse should be trusted to do, these including You must treat people kindly and considerately and You must listen to the people in your care and respond to their concerns and preferences.   If as nurses we should comply with The Code (2008), a lot of work is required to raise the awareness of the importance of communication in the delivery of care.   In 2007 the NMC introduced Essential Skills Clusters.   These Essential Ski lls are to be delivered by all registered nurses, one of these clusters containing Care, Compassion and Communication.   The NMC introducing these clusters show the importance of interpersonal skills in nursing care, and significance of communication in the nursing profession.   On this occasion, the nursing team did not show care or compassion for Maisey, and certainly did not engage in therapeutic conversation.   As a student nurse I felt I had the knowledge and skills to approach the patient to appropriately calm and reassure her.   Heyward and Ramsdale (2008) explain that a patient who thinks his nurse is not listening to them will lose faith in the service a nurse provides, and in the nurses willingness and ability to do as they have promised.   They explain that sympathising with a patient shows willingness to understand their anxieties and make the patient feel more comfortable.   As I entered the room the patient stood up with a defensive posture, which I assumed was using non-verbal communication to inform me that she was suspicious and distrustful of me.   This was caused by the nursing teams disability to make the patient their first priority and to listen and respond to her concerns.   Santamaria (1993) tells us that nurses must deal with the full range of human behaviour, and at the same time deliver the highest quality of care.   I acknowledged that Maisey was upse t and gave her the opportunity to ask questions and voice her concerns, and in turn made her feel special by giving her my time.   As Maisey asked me to speak loudly into her right ear I wondered if her history of deafness had been accurately assessed, as she was definitely not deaf but having communication difficulties.   Eradicating this problem with help of a speech and language therapist or a hearing aid would have helped Maisey and the impatient staff enormously in this situation.   Although I had been informed that the patient could be aggressive, I managed the situation by relating to her position and understanding her point of view.   Leadbetter and Patterson (1995) explain the prevention and management of aggression should be dealt with by showing empathy and respect for the patients individuality and being genuine, utilising an open and honest manner.   Finally, integrity, and being aware of ones own competence to handle the situation.   Egan (1990) considers non-verbal communication to prevent violent situations such as considering body posture, nodding to show interest and making eye contact, but not as though to threaten the patient in any way. Fortunately, empathy and respect for Maisey helped her to trust and confide in me.   The reason for analyzing this particular section of the scenario was to answer the question, Why did the nurse not feel efficiently equipped to approach the patient herself, instead leaving the potentially aggressive situation with an unsupervised student?   In the NMC Code (2008), advice for a registered nurse is to recognise and work within the limits of your competence, but also to have the skills and knowledge for safe and effective practice.   I believe communication skills within the nursing team must be rigorously developed and maintained as one professional alone cannot meet a patients requirements.   We need to work collaboratively to provide maximum care delivery.   Maisey felt more relaxed, valued and safe, after we identified and resolved her concerns.   Older people generally have more barriers to communicating effectively.   These barriers are worth investigating, as the acquisition of a little understanding and basic skills is a simple and rewarding exercise. (Myerscough, 1992)   The barriers Maisey faced, was the time the nurses had to spend with her, and the fact that she was deaf.   Myerscough (1992) explains that this is overcome by speaking loudly and clearly, using clear lip movements to assist lip reading.   Through actively listening to the patient and encouraging conversation we managed to focus on the problem that was causing unease.   I do believe that Maisey was discriminated against because of her conditions and illness, as she was not given the time and energy that was given to other patients.   The Human Rights Act (1998) Article 14 explains that every person should be treated equally without any discriminat ion on any ground.   This section of the act was broken when the staff failed to treat Maisey as they would the other patients.   Maisey was confused and upset that she had not been given time to adapt to her surroundings, and was in fear due to the separation from her main caregiver.   Most patients do suffer a degree of anxiety and apprehension and admission to hospital is in particular a disturbing experience for anyone. (Lloyd and Bor, 1996)   They offer explanations for these anxieties, such as being in an unfamiliar environment and separation from family and friends.   Loss of personal space is a factor mentioned, as is loss of independence and privacy.   One that closely relates to the scenario is uncertainty of diagnosis and management.   Maisey was uncertain of what was going on.   By providing her with the information she required, she could understand a purpose for her admission and the decisions being made.   Conclusion The reason for Maisey being upset, and the nursing teams reluctance to help her, all stem from the same thing.   As we have discovered communication and ones ability to reflect on practice have enormous effect on the capability to provide the highest possible quality of care.   Additionally time and commitment to our patients is priceless as it can never be taken away from them.   We also need to realise that ones own values have effects on interaction with our patients, so appreciating that our client has different values and beliefs to ourselves help us gain insight into the reasons they think and behave as they do.   Some consider interacting with others as hard work, but we as nurses need to understand that communication is the gateway to successfully helping our patients and improving our skills.   Action Plan On reflection I saw first-hand how easily communication can break down, if not between nurse and patient, then within the multi-disciplinary team.   I will take the experience with me throughout my nursing education, remembering the importance of effective communication, and also the ability to look back at an experience and break it down to discover what really happened.   Taylor (2000) defines how reflection on action occurs perfectly.   He explains that only when details of events are recalled and analysed, unpicked and reconstructed considering all aspects of a situation, can one gain fresh insights and amend actions.   He quotes Critical thinking is essential for safe practice.   (Taylor, 2000)   This should be an ongoing and extensive process for all nurses in practice.   I will be more aware of my interaction with others and will constantly reflect on my experiences to see the whole package of care delivery.   REFERENCES Becker, E.L. (1991) Churchills Illustrated Medical Dictionary. 3rd Edition. USA: Churchill Livingstone Data Protection Act 1998 London: HMSO Davis, C. (2008) Tea and Empathy: discussing a project focusing on patient centred care. Nursing Standard. Vol 22, no. 32,   p.18 Elliss, R.., Gates, B., Kenworthy, N. (2003)   Interpersonal communication in Nursing.   2nd Edition. London: Churchill Livingstone Egan, G. (1990) The Skilled Helper: A systematic approach to effective helping.   4th Edition.   USA: Wadsworth Gibbs, G. (1988)   Learning by doing: a guide to teaching and learning methods. London: Further Education Unit Human Rights Act 1998 London: HMSO Heyward, T. Ramsdale, S. (2008) Interpersonal Skills. Chapter 1 IN Richardson, R. (Editor) (2008) Clinical Skills for Student Nurses.   UK:   Reflect Press Lloyd, M. Bor, R. (1996)   Communication Skills for Medicine.   New York: Churchill Livingstone Myerscough, P.R. (1992) Talking with Patients: A Basic Clinical Skill.   2nd Edition.   Oxford: Oxford University Press Nursing and Midwifery Council (NMC) (2007) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives.   London: NMC Nursing and Midwifery Council (NMC) (2008) Essential Skills Clusters for pre-registration nursing programmes.   London: NMC Santamaria, N. (1993) The Difficult Patient: An Important Educational Need of Registered Nurses. Unknown Stockwell, F. (1972) The Unpopular Patient.   London: Royal College of Nursing Taylor, B.J (2000) Reflective Practice: A guide for nurses and midwives. Buckingham: Open University Press p.64 Timby, B.K   (2009)   Fundamental Nursing Skills and Concepts.   9th Edition.   London: Lippincott, Williams and Wilkins Weller, B.F (2002)   Baillieres Nurses Dictionary.   24th Edition. London: Elsevier

Child Abuse and Neglect Essay

Crisis is a condition, which upsets the balance in the regular functioning of a person, family or a society in a destructive fashion and the situations can not be overcome through general problem solving resources. Crisis leads to a stressful situation, which is generally difficult to cope with, and needs proper and planned ways of intervention to be resolved. To understand crisis, a scenario can be discussed. In this case the person in crisis was a girl of 13 years of age belonging to an Indian tribal family. She worked for a family as domestic help. She was very thin and weak but extremely aggressive in nature. The person who identified her problem was the lady who employed her. The lady was a housewife from a well to do family. According to the lady, the girl started working at her place at the age of 11. She belonged to a local tribal family where girl child was not at all welcome. She had three younger sisters and a brother. Her parents were working as daily laborers. Her father spent all the hard earned money to the local wine shop and her mother found it extremely difficult to support the family with her meager income. She sent her eldest daughter to work and earn money for the family. Not only that, her father used to beat her and her mother regularly for money. The girl was extremely malnourished and neglected and was used as a money earning machine. Her employer tried to send her to a school but did not succeed as according to her family going to school was complete wastage of time. The problems of child labor, lack of education, gender bias, physical abuse, problem between parents all existed together in her life. This was not a typical case but a general picture in several poor backward class families in India. The situation is treated as a crisis because the solution of all these problems was beyond the capacity of the little girl. She was the victim of the situation of chronic crisis in her family and was unable to cope with the situation. It was evident from her aggressive nature, attraction towards bad company, eagerness to shun her family, physical injuries and weakness, etc. She was a victim of developmental crisis. Her parents unknowingly restricted the development of her physical and psychological health. Hailing from a poor tribal family only aggravated her situation. The social class she belonged to was not at all favorable to a girl child. They generally thought of them as family burden as the child was unable to earn for them and after growing up was going to support another family after marriage. Lack of knowledge and education made them treat school education as wastage of time and money. Being a child the girl could not speak her mind or was suppressed forcibly. Thus, she lacked education, was forced to work, losing her psychological balance and was growing to lead a cluttered and abusive life and may also become a problem for the society. Timely intervention at the time of crisis is the most important part in crisis intervention. In most of the cases of child abuse it is often too late before the society comes to know about the occurrence and can take any action to save the child or repair the damage. In this case as the event was of chronic crisis the intervention may start as soon as the crisis was identified. Here the child needed a support system either from family or outside. Her employer in this case could provide the support, which was lacking from her family. (â€Å"Crisis Intervention in Child Abuse and Neglect†) During crisis individuals generally experience some common feelings that can affect psychological balance and produce impact on assessment and treatment of the crisis. These kinds of feelings and their reflection in life should not be treated as mental illness. In such conditions people may show disorganized and confusing behavior where they forget important details or practice inappropriate actions which were helpful in the past. They tend to confuse fear and wishes with reality. To cope with such disorganization they tend to be involved in insignificant activities. Crisis laden people may become hostile or emotionally distant from any sort of intervention. Some people act impulsively without thinking about the consequences and lead to more complex situation. People may depend completely on the person trying to help them in time of crisis, like in this case the child can depend on her employer and expect her to fill the gap created by her parents. Identity crisis, lower self-perception, and withdrawal are also observed as common behaviors. (â€Å"Crisis Intervention in Child Abuse and Neglect†) To intervene to the crisis, the assessment of the situation is the key point. Every individual or family responds to certain situations differently. Still it is necessary to assess the risk of abuse in the given situation. To assess the crisis it is required to consider each member of the family individually as well as the part of the family. Listening to each member’s version of the crisis individually may help reach the root of the problem. Active and careful listening is the most important criterion of the crisis worker while assessing the crisis. Identifying the underlying problem and precipitating events, observing family interactions and conditions and determining the family needs carefully help assessing the risk to the family members accurately. The safety measures can be practiced accordingly especially for children. A few screening instruments may be helpful in this respect, namely, Child Abuse Potential Inventory, Child Maltreatment Interview Schedule, Family Assessment Form (FAF) and few Family Risk Scales. Training to use all such instruments can be very helpful for the crisis worker. Before terminating the service the crisis worker should be very sure that the risk factor has been removed completely and the child or other family members are totally safe. All family members should be involved in each and every step of crisis assessment and intervention. Non-judgmental and open-minded crisis worker helps the family best in crisis assessment and intervention. S/he must understand the social customs and family traditions and must convince the person or family in crisis that s/he came to listen to their problem and to help them in coping with the situation and not to accuse them. Lack of understanding or acceptance at either end may lead to more complicated circumstances. (Blakester) For successful crisis intervention the crisis worker first needs to understand the crisis thoroughly and needs to be competent enough to provide expert support to the victims. Crisis intervention is time limited. Therefore the crisis worker needs to set specific goals to make the intervention as a success. Like in the present case it was not possible to solve all the family problems, which were the root causes of the child’s crisis at a time. So the crisis worker should prioritize the problems to be solved. The worker can first try to make good rapport with the girl and the family of the girl and listen to the problems carefully. The family first needs to understand that their child is facing a crisis due to their behavior. This may help the girl as well as her family to accept his/ her intervention to solve the crisis. S/he can try to find out their actions to deal with the situation. The worker can try to find out the strength of the girl that can improve her self esteem and her needs which need to be taken care of. Her family’s potentials and requirement need also be assessed. The reasons behind the crisis can then be chalked out. Once the reasons are established, the worker can suggest alternative approaches which can motivate the child and her family to overcome the crisis. The crisis worker can then help them with the formulation of goals, objectives and actions based on their priorities. The actions must be achievable at first to increase the confidence of the family. To be successful the worker needs to be focused but at the same time compassionate and flexible to slight changes in goals. In this case, the family can first stop the physical abuse of the child. Then they can try to improve interpersonal relationship by listening to what the girl has to say. If possible they can help her with her needs and if not then try to make her see the reasons peacefully. They can spare her a little time for her education. Simultaneously, the girl’s father needs counseling to cope with his bad habit and be able to support his family. As the crisis worker finds the situation to improve s/he can reduce support slowly and observe the family if they can continue with their own. Follow up must always be done to motivate them to work positively. (â€Å"Crisis Intervention in Child Abuse and Neglect†) An event of successful crisis intervention in a child abuse case can be cited to conclude the discussion on a positive note. Windale in the New South Wales Lake Macquarie region of Australia was declared the most socially disadvantaged community of New South Wales in1999. All possible events of child abuse were present in the community. Percentage of child protection was only 1, the worst in New South Wales. (Blakester)Under these circumstances a community centre named Alcazar Centre was established there attached to the local primary school. The community centre initiated programs as below: †¢ parenting classes; †¢ the staged introduction of preschool-aged children to schools; †¢ joint exercise and sociability groups for isolated mothers; †¢ an Aboriginal health service and community nursing; †¢ the identification of talented youngsters and provision of academic extension opportunities; †¢ locally created scholarships and the Department of Housing’s relocation of some families to make schools more accessible; †¢ the involvement of fathers in making various contributions to the life of the school and a general increased involvement by parents in school life; †¢ a Shop Smart nutrition program; †¢ improved street lighting, enabling safe travel at night, and a Windale ‘welcome’ landmark, building community pride; and †¢ the sponsorship of school and sporting needs by local businesses With regular work on the above programs Windale Primary School became the model of schools as community centres across whole New South Wales. The Alcazar Centre was given an Award for Excellence by the Director General of the NSW Department of Education and Training. Windale community proved that prevention of child abuse is possible with case specific approach and almost insignificant steps can altogether make the difference. The child protection in Windale community was found to reach 25%, being the best in New South Wales in 2003. (Blakester) Works Cited 1) Blakester, Adam, â€Å"Practical child abuse and neglect prevention (Case Study 2)†, Child Abuse Prevention Newsletter, vol. 14 no. 2 Winter 2006, Australian Institute of Family Studies, National Child Protection Clearing House, ISSN 1447-0039 (Print); 1447-0047 (Online), 13 June 2008, < http://www. aifs. gov. au/nch/pubs/newsletters/nl2006/winter. html > 2) â€Å"Crisis Intervention in Child Abuse and Neglect†, U. S. Department of Health and Human Services Gentry, User Manual Series 1994, Circle Solutions, Inc. , McLean, VA, under subcontract No. S-105-89-1730 with Westover Consultants, Inc. , 12 June 2008,

The Freedom Of The State Of Nature - 1754 Words

Man is born free, and everywhere he is in chains (18). It is evident that Rousseau was displeased with the inequalities and oppressions in his current society in the 18th century Europe and his discourses were results of them. Rousseau believed that human beings have the most freedom in the state of nature. He also believed that man is usually a peaceful creature who wants to get along with another humans and avoid conflict. At the same time, there is always going to be that one bad person that has bad intentions. Subsequently, as a result of a possible betrayal, all man’s thinking is that the betrayal can be anyone since no one knows who he is. Therefore, man will be in the state of war and wouldn’t have the most freedom in the state†¦show more content†¦Rousseau indicated that social freedom is superior to the state of nature. He believed that in the state of nature people are ruled by their personal desires instead of by reason. Therefore, they are not completely free. However, Rousseau went into detail about how humans have the innate desire to be to be involved and a part of a social setting to acquire protection and security. Additionally, man possesses the ability to put his actions in prospective and can conclude that it is best for himself and the greater community to be a unified body. Thus, a free and equal society is accomplished by deriving a social contract. Another point that Rousseau develops is that if all humans give up their power and rights for the general will, they will be more free because what they achieve in the social freedom is better for them than the freedom in the state of nature. Therefore, people should abandon and sacrifice their personal freedom in order to achieve social freedom. People give up all their rights to each other and they’ll receive all their rights back through the general will and that s how they become equal. Locke had stated that natural freedom is obtained when the natural law is obeyed. Unlike Lock, Rousseau argued that freedom and authority don t contradict each other since the general will of the citizens are the rules and laws of the legislator. Therefore, by obeying the law the individual is obeying himself Locke and Rousseau both agree

Machiavelli Realism over Idealism Essay - 1084 Words

Luke Pelagio Due 5/27/2011 Period 4 Machiavelli: Realism Over Idealism Nicolo Machiavelli is known as being an archetypical realist; in other words, he was someone who originated the idea that we should not try to figure out how people should be, but rather accept and deal with the world as it literally is. Unlike Machiavelli, Plato posited an idealist view of a philosopher king reigning through virtue. To Machiavelli, this is an extremely dangerous delusion for it ignores what he considers the reality of the human condition: humans are brutal, selfish, and fickle (Machiavelli and Power Politics). You don’t need a philosopher king to secure off enemies and reinforce order/stability; on the other hand, you need a prince or a leader†¦show more content†¦A prince must learn not to be limited to morality when unavoidable; a leader has to be able to use lies, force and deception if required in the world. Whether it is better to be feared or loved clearly addresses the reason for this. You can’t trust people, for they will turn on you. It is inevitable. Human nature means that doing what you must do at all costs according to any moral code simply puts you at a disadvantage. In addition, humans are generally under agreement to throw out such moral concerns if it is to their advantage. â€Å"Men have less scruple in offending one who is beloved than one who is feared, for love is preserved by the link of obligation which, owing to the baseness of men, is broken at every opportunity for their advantage; but fear preserves you by a dread of punishment which never fails,† (Machiavelli, The Prince). This quote perfectly demonstrates Machiavellian realism. First, it is a very opposing and adverse view on human nature. Second, it is realistic and logical. If, by any chance, you are a prince or a leader, and you do not understand the atrocious inherent in 2 men, you will fail. 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