I first met Phil on the first day of my placement, Phil was appropriate and appeared warm when I approached him. I was given a brief case history by my mentor and was told Phil had been aggressive to a number of staff members. I initially felt unsure about approaching Phil, however, I still engaged myself in a conversation with Phil to develop a therapeutic relationship.
In the following two weeks I had daily one to ones with Phil. Phil discussed personal issues with myself and enjoyed the input I was giving him. Phil began to trust me and shown no signs of physical aggression towards myself.
Description of event
I had gone into Phil’s room with a Health Care Assistant to assist Phil to get up for breakfast. We had asked Phil if he wanted to get up because it was time for breakfast and Phil informed us that he wished to get up with our assistance. I assisted the Health Care Assistant preparing the bed bathing equipment. We helped Phil to sit up so we could attend to his personal hygiene.
I explained to Phil that we were going to remove the night shirt he was wearing and give him a bed bath. Whilst the Health Care Assistant was removing the night shirt Phil became agitated and began to shout. We asked Phil was everything alright but he continued to shout at us. We tried to calm Phil down to continue by sitting next to Phil and reassuring him. We tried to get Phil to talk calmly to us so we could find out what had caused his agitation. However, as we went up to Phil again, he proceeded to punch the Health Care Assistant in her stomach.
Recognition of Feelings/Self-Awareness
Having only spent two weeks on the ward and this being the first time I had worked in this clinical setting, I felt that I had little knowledge or experience to deal with this clinical situation. I remember feeling incompetent and useless as Phil punched the Health Care Assistant and I was unable to prevent this happening. I recognise that with experience I would be able to deal with challenging situations and that I did the right thing by removing myself from Phil’s room to prevent a re-occurrence of Phil punching the Health Care Assistant again or even myself. I am aware that students are not expected to care for patients without the support of qualified staff/health care assistants, as situations may occur that I would not be able to handle without sufficient training or skills. I am also aware that a student would not be left alone to tend to the personal hygiene or activities of daily living of clients in a vulnerable position.
My mentor discussed the situation with me and how I handled it at the time. My mentor told me how I should of handled the situation by informing qualified staff immediately after the occurrence, as I waited until both myself and the health care assistant were removed from Phil’s room. I spoke to my mentor about the constructive criticism and how it will improve my standards of Practice (Betts 2002). Mentors, I feel, are allocated to provide the sufficient support and guidance including identifying the priorities in emergency or daily situations. My mentors constructive criticism allowed me to realise, that with experience, I would handle situations in a more effective manner than how I handled it.
I feel that reflective practice was useful after the clinical situation occurred (Heath and Taylor 2002), because I was unprepared for the events and felt that is was useless at the time. However, once I reflected on the situation I realised that I had inadequate training to deal with the situation initially, therefore I handled the situation in the best possible way, in accordance with the NMC code of conduct (2004).
Reflecting on the clinical situation, although the situation was mainly negative, and the therapeutic relationship which was built before, deteriorated after the event, it has provided me with experience that I may use in future situations. I felt that the qualified staff provided me with the knowledge and support that allowed me to reflect upon the situation appropriately.
If I happened to become involved in a similar situation, I would only take part in practices for which I had relevant training, in accordance with the NMC Code of Professional Conduct (2004). I would use questioning to improve my knowledge on the protocols for the ward when such occurrences come about.
Consideration of Modular Theoretical Content
The reflection process does not have to be restricted to the development of skills, but can be used as a tool to understand a subject area and most importantly it is also about gaining self-awareness. This understanding may well reflect upon the relevance and/or relation to practice or understanding the theoretical content of the module.
The module content was to raise awareness of clients with diagnosis’s of mental illnesses. How clients with mental illnesses feel about their illness, their carers and their future with the mental illness. A portion of the module content looked at the assessments of clients and determining the risks to themselves and others.
After the clinical situation, there was a re-assessment of Phil and his risk to others. This allowed me to understand how clients, with a diagnosis of dementia and challenging behaviours, can deteriorate with unnoticeable changes.
Furthermore, the module content looks at how clients with dementia and elderly clients are discriminated against because of there age. There are discriminatory acts that occur, which staff don’t realize they are doing i.e. speaking to elderly clients and clients with a diagnosis of dementia, in a childlike voice resembling them to children. In practice, I found that some staff did use this tone of voice, when speaking to clients and spoke to them as if they had little understanding. However, when I was building a therapeutic relationship with Phil, I explained any actions I was assisting him with to allow Phil the right to refuse my help. Although I found this difficult initially, as Phil was finding it difficult to understand, I therefore allowed Phil time to process what I was saying to him. This increased the response I had from Phil and Phil understood more of what I was saying to him. Dementia Care: Developing Partnership in Practice (1999) discusses the importance of allowing clients time to process what is being said to them, as Dementia affects their cognitive processing. Not allowing a client time to process the cognitive input can make the client confused and they may therefore disengage with the conversation.
Conclusion
In conclusion, my reflection skills I feel have developed through the production of this essay and the discussions with my mentor about the clinical situation. In addition, I felt that using a model of reflection (Atkin‘s and Murphy 1994) has helped me to structure my thoughts and feelings in the most appropriate manner. Also, reflecting upon the module content has informed my practice with the theoretical content. I feel that my competence, in practice, has been further developed and I feel that my personal and professional development is progressing. Furthermore, the reflective model (Atkin‘s and Murphy 1994) that I used, has assisted me to realise that I need to be proactive in my own learning and development. I feel as a student reflection on practice and theoretical content is an important learning aide.