Reflection on Nursing Care of a Psychotic Patient

This assignment delves into a nursing student's reflection on their experience caring for a mentally ill patient named Jessica who exhibited aggressive behaviors. The student analyzes the challenges faced, emphasizing the importance of interpersonal skills, communication, and ethical considerations in providing care to patients with psychosis. The reflection also identifies areas for future learning and development, such as pharmacological interventions and negotiation techniques.

Running head: HEALTH AND SOCIAL CARE
Health and social care
Name of the student:
Name of the University:
Author’s note

1HEALTH AND SOCIAL CARE
Introduction:
In the health care practice environment, the nursing values and ethics plays a critical role
in the demonstration of appropriate professional behavior in health care settings. These values
and ethics also have an impact on the goals, strategies and nursing actions taken for the recovery
of patient. Despite several challenges and issues in nursing practice, critical reflection of practice
is a procedure that enables nurses to review their practice and learn from past mistakes to
enhance professional and personal skills to provide high quality care (Shahriari et al. 2013). This
report mainly provides a critical reflection of nursing values and practice in relation to the case
scenario of an 18 year old patient with psychosis. The reflection is presented by means of Gibb’s
reflective cycle to systematically analyze the experience with patient.
Reflection and analysis of case scenario:
The analysis of the case scenario is presented through six stages of Gibb’s reflection
cycle which are as follows:
Description of the scenario:
A patient named Jessica (hypothetical) was admitted in the emergency department of a
mental health hospital after taking an overdose of sleeping pills. She was an 18 year old girl with
a history of recurrent depressive feeling since the past four years. According to her mother’s
statement, her feeling of depression has intensified since the last six months and she had started
avoiding social contact with people. She had lost about twenty pounds due to loss of appetite and
poor food intake in recent months too. The clinician at the hospital had taken the necessary
action to reduce the effect of sleeping pills. After two days of drowsiness, the patient was finally
oriented and in an active state. I was assigned to care for Jessica at the hospital, however the

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dilemma for me was that the patient was found to extremely aggressive. Although she remained
calm when she was alone, however whenever I came to her for routine medical checkup and
physical assessment, she was found to very aggressive and pushed me away. In this situation, it
was very difficult for me to give the assigned medication to patient.
Feeling related to the scenario:
When I was assigned to care for Jessica, I had only two months experience as a mental
health nurse and I had never came across such aggressive patient so far. Initially while coming
close to Jessica for routine assessment, I was very anxious and I had the fear of being physically
hit by the patient. Although routine medical checkup was a normal activity for me, however
whenever I had to go to Jessica, I was very nervous. The aggressiveness of patient and the
inability to calm her also demoralized me. It made me think that I do have the skills to handle
such patients. In addition, providing medication to her on time was a professional responsibility
for me, however the suspicious nature of Jessica and her little trust on the health care team acted
as a barrier in adherence to medication regimen (Byrne 2007). However, I used my ethical
knowledge and nursing values to finally overcome these challenges in my nursing practice. After
I entered nursing practice as mental health nurse, my core goal was to promote an optimal
quality of live in people and maintain the right of person in aspects of care. According to ethical
and professional standards of nursing practice, it was necessary for me to involve patients in
decision making process and take their preference while delivering care (Stiggelbout et al. 2015).
However, the condition of patient gave me serious challenges. My nursing value of sympathy
and professional competency of managing human relationship through mutual respect and
reliance finally helped me to build an appropriate therapeutic relationship with patient. This was
possible for me because I had taken a training in value based training.

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Evaluation about the experience:
In the scenario of aggressiveness in patient and resistance to take medications on time, I
took the decision to use my nursing value of sympathy and proper communication to reduce
aggressiveness in patient and make the patient trust the health care system for her recovery. The
value based training had taught me to take into account patient values as well as evidence based
strategies to make decisions about care (Rankin, 2013). Hence, I was aware that symptoms
control in patient would be possible if I am successful in building the basis trust with patient.
Therefore, the use of interpersonal and communication skills along with support of other health
care staff helped me to collaborate with patient and improve adherence to medication use.
Evidence has also proved that concomitant involvement and communication with patient has
helped to promote functionally improvement in psychotic patient. The use of antipsychotic
medication in later staged was also an important source to reduce aggressiveness and promote
recovery in patient (Mahone, Maphis and Snow 2016).
Analysis of the situation:
It was a time-consuming process in the beginning as I had to closely observe Jessica to
understand things that increased aggressiveness or caused discomfort to patient. In addition,
appropriate communication and values of sympathy helped me to calm down the patient and
respond to my nursing care. Therefore, my interpersonal skills and nursing value of compassion
and mutual respect for patient helped me to overcome the professional dilemma in nursing
practice. Communication has been found to play a major role in enhancing individualized care
and strengthening nurse patient relationship (Varcarolis 2016).
Conclusion related to the scenario:

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After the overall analysis of the scenario, I have also learned that interaction with
patient’s relative is a useful process in understanding abnormalities in patient and identifying
harmful components that increase the aggressiveness of patient (El Malky, Attia and Alam
2016). However, I feel that I am still incompetent in understanding environmental factors that
perpetuate psychotic symptom of patient. I would like to learn more about this in the future to
control aggressive patients in the ward.
Action plan for the future:
After the professional challenges faced in caring for Jessica, my action plan for the future
is to learn about other alternative options to control aggressive symptoms and promote adherence
to medications in mentally ill patients. In the clinical scenario of Jessica, I used my
communication and interpersonal skills to control symptom in patient, however I aim to enter a
training program and learn pharmacological or negotiation skills to deal with such patients. I aim
to acquire this skill within the next six months.
Discussion and conclusion:
The above reflection presented the ethical and professional challenges faced by patients
in dealing with psychotic patient. The analysis of the case scenario however gave the lesion that
interpersonal skills and communication related competency is an important skill that can help a
nurse to overcome such situation. In addition, appropriate nursing values and knowledge about
ethically safe practice strengthen nurse-patient relationship. Reflecting on nursing practice is
necessary to understand limitations in current practice and identify the area where training or
professional development is needed in the future.

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Reference
Byrne, P., 2007. Managing the acute psychotic episode. BMJ: British Medical
Journal, 334(7595), p.686.
El Malky, M.I., Attia, M.M. and Alam, F.H., 2016. The effectiveness of social skill training on
depressive symptoms, self-esteem and interpersonal difficulties among Schizophrenic
patients. International Journal of Advanced Nursing Studies, 5(1), p.43.
Mahone, I.H., Maphis, C.F. and Snow, D.E., 2016. Effective Strategies for Nurses Empowering
Clients With Schizophrenia: Medication Use as a Tool in Recovery. Issues in mental health
nursing, 37(5), pp.372-379.
Rankin, B., 2013. Emotional intelligence: enhancing values‐based practice and compassionate
care in nursing. Journal of advanced nursing, 69(12), pp.2717-2725.
Shahriari, M., Mohammadi, E., Abbaszadeh, A. and Bahrami, M., 2013. Nursing ethical values
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Stiggelbout, A.M., Pieterse, A.H. and De Haes, J.C.J.M., 2015. Shared decision making:
concepts, evidence, and practice. Patient education and counseling, 98(10), pp.1172-1179.
Varcarolis, E.M., 2016. Essentials of Psychiatric Mental Health Nursing-E-Book: A
Communication Approach to Evidence-Based Care. Elsevier Health Sciences.