What Is Mental Health? | MentalHealth

Running head: MENTAL HEALTH
Mental health
Name of the student:
Name of the University:
Author’s note

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All new graduate nurses expect to become work ready during their clinical placements.
Work readiness is achieved when they effectively apply on-campus theoretical learning and get
exposed to the realities of the clinical setting during clinical placements (Patterson et al. 2016).
Thus, workplace learning is obtained when nurses engage in reflective practice. This involves the
process of reviewing an experience, analysing what was done right and wrong and using this as
an approach to learn about practice. It enables nurse to scrutinize their previously held views by
reflecting on prior learning and identifying the opportunity to improve future practice. Thus,
reflection is an effective learning strategy that provides assistance to nurse to become an
independent professional with sound clinical judgment. This reflective essay will reflect on a
recent clinical placement that I participated as a student nurse and the key lessons that I learnt
during the process (Al-Kofahy and James 2017). The Gibb’s reflective model of reflection will
be used to base the reflection and the significance of using this model in the essay is that it will
allow systematically describing and reviewing the experiences during the clinical placement. The
experience and key professional learning gained will be expressed through the six reflective
steps of description, feelings, evaluation, analysis, conclusion and action plan.
During the clinical placement in a health care setting as a student nurse, a 65 year old
woman named Mrs. Williams (patient’s real identity has been kept confidential) was admitted to
the hospital two days ago because of self-harm behaviour. I was supposed to provide care to
patient on behalf of the medical team by conducting some assessment on patient and
administering the prescribed medication. The patient had a history of depression and her attempt
to cause harm to herself brought her to the hospital. She had tried to cut her hands when she
found a knife in front of her at the dining table. Though she had been taking anti-depressive
medications since the past two years, her condition deteriorated significantly since the past six

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months after the death of her husband. Through the review of her case history, I got to know that
social isolation was the main reason for her deterioration of symptoms as currently she was
living with her daughter, aged 26 years old. Due to her work routine, her daughter could remain
with her only till the morning. She lived alone throughout the day until her daughter arrived by
evening. The problem was that she started showing unusual behaviour since the past two weeks.
During my clinical placement, I was supported to give certain prescribed medication to the
patient. I started with normal greetings and tried to administer her medications. However, she
became very aggressive and started abusing and harming me physically. I was impulsive at time
and in an attempt to protect myself, I quickly tied her hands to the bed and went away.
I had started with a very positive mindset. I was aware that this clinical placement will
give me the opportunity to learn more about practice in real settings. However, the experience of
witnessing sudden aggression in the patient was very overwhelming and fearful experience as I
was a student nurse. I was taken aback by the patient’s sudden attempt to harm me. Though
during my learning experience, I had learnt about symptoms of aggression in some mentally ill
patient, however experiencing the same practically was a different experience. Feeling of fears
and anxiety became dominant for me at that time. Evidence shows that nurses who encounter
such type of violence in clinical settings often suffer from negative physical and psychological
consequences. Psychological outcomes of patient violence include anger, fear, guilt, self-blame
and shame. Similarly, I also experienced these feelings (Al-Kofahy and James 2017; Pekurinen
et al. 2017). However, when reflecting back on my action, I feel that I should have made an
attempt to use other means to controlling Mrs. William’s aggression too. I found my action of
restraining patient to be a very disappointing strategy and I often guilty about my act done during
the placement.

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When reflecting back on the action that I took to control the aggression of mentally ill
patient, there were many things that went wrong. Firstly, I used restraint as a means to protect
against any harm from an aggressive patient. This action was wrong because I did not take any
permission from my higher authorities neither did I escalated the matter to the other medical
team. As a reflex action, I thought restricting the patient was the best act. However, this was an
unprofessional behaviour as I should have collaborated with other interdisciplinary team to
manage such situations. My behaviour not only resulted in poor collaboration process, but also
violation of patient dignity. Kamel, Maximos and Gaafar (2007) report that ordering of restraint
is the responsibility of physicians and their experience determine whether it should be used in
any patient or not. But as nurses are frontline carer of mentally ill patients, they choose restraint
influenced by psychological reactions to the violence. This action was against professional
nursing standards too.. According to the Nursing and Midwifery Board standards (NMBA)
(2017) of practice for registered nurse in Australia, registered nurse must communicate
effectively and be respectful of person’s dignity, culture and rights. Implementation of structured
team approach is an evidence based approach as Wong et al. (2015) supports regarding the use to
team approach that promotes inter-professional collaboration to manage patients with
behavioural emergencies like violence and aggressions. Thus, I feel that I failed to comprehend
the gravity of the situation and improving comprehension of patient violence is an area that I
have prioritized to improve my skills in managing the same situation in the future.
Secondly, the next wrong thing about my action was that I used restraint measures
instead of any therapeutic approach to control aggression. This action was wrong because it
violated patient’s dignity, self-respect and their freedom of choice. I engaged in an act of blindly
implementing physical restraint without thinking about its consequences. Ye et al. (2018) argues

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that such act of blinding implementing physical restraints is a failure of nurse to understand the
patient in a human-to-human relationship. Moreover, this practice violates all major ethical
principles. The principle of justice is violated because restraining is an act that indicates
unfairness and prejudice for patients and ignore of justice. Another ethical principle of nursing is
the principle of beneficence which involves taking all actions to maintain benefit of patients.
However, in this area too, the action of restraint violates the principle of beneficence because
extreme behaviours like use of coercive measures further result in severe risks to patients.
Another reason for regarding regular use of physical restraint as an ethically challenging act is
that it violates the principle of autonomy. According to this principle, obtaining informed
consent from patient is necessary for staffs to respect autonomy of patient (Jegede, Ahmed,
Olupona and Akerele, 2017). However, by tying Mrs. William by a rope, I contravened the
principle of autonomy because it breached the patient’s basic right of freedom (Entwistle 2019).
Through evaluation of my action, I learnt physical restraints may be used while dealing with
mentally ill patients. However, this should be used as the last resort when other measures fail.
Based on critical analysis on my past actions to control aggression of Mrs. Williams and
the research to know the best method to correct my actions, I have gained many useful
knowledge regarding best interventions to prevent and control aggression. I will first start
reflecting on what I learned about the impact of restraint on the affected patients. During my
clinical placement, since I had other patients to take care of, I did not get the opportunity to
witness the consequence of restraint on Mrs. Williams. However, after critical reflection on my
action, I started looking for evidence to understand the impact of my action. Berring, Pedersen
and Buus (2016) argues that mishandling of patents with aggression and threatening behaviour is
challenging as mishandling leads to stereotyped representation of patients. This attitude must be

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changed as such stereotyped attitude results in high level of containment and coercive measures.
I think that I may have adopted the same intervention because I was not aware of the cause of
aggression in the patient. Evidence points out to the use of de-escalation strategies instead of
restraint so that patients could be direct to a calmer personal space. De-escalation is a collective
term for all those psychosocial interventions that gives calm environment to patient by knowing
oneself, knowing the patient, being aware of the situation and having the knowledge about how
to communicate (Spielfogel and McMillen 2017). On review of these evidences, I further feel
guilty of the action that I took during my clinical placement and I have resolved to learn more
about de-escalation measures to calm down violent patients.
Based on comparison of the outcome of a coercive measures and outcome of a de-
escalation measures, I found out why restraint was not an appropriate intervention and why I
should have used better critical thinking to handle such situations. Firstly, coercive measure is an
intervention that leads to physical and psychological harm to both patient as well as staff. The
need to restrain patient is associated with feelings of anger, sadness, embarrassment,
demoralization and humiliation for patients. Moreover, use of restraint has been associated with
range of reactions by mental health nurse such as anxiety, anger, frustration, guilt and isolation
(Moghadam, Khoshknab and Pazargad 2014). Though I did not experienced feelings of guilt
initially, however these feelings overwhelmed me when I finally reflected and analysed the
consequence of the action. Evidence based practice requires using physical restraint only when
other less restrictive measures have failed (Lim and Chow 2017). In contrast to the coercive
intervention, there are many positive effects of de-escalation techniques in aggressive and violent
patient. For example, the systematic review by Spencer and Johnson (2016) revealed that de-
escalation is a beneficial intervention to direct agitate patient to a clam state. However, this

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intervention does not have long-term benefits and it is intended for use only to mitigate
immediate aggressive episode. Rampling et al. (2019) explained regarding other interventions
that could be used in such situations too such as risk assessment intervention like structure risk
assessment of patients, environmental intervention such as relaxation music and exposure to day
light and verbal de-escalation intervention to offer choice and optimism to patient. Hence, it can
be used an early intervention to prevent escalation and progression of patient’s behaviour to the
crisis stage.Thus, this was also an important learning for me which would help to improve my
practice in the future.
Based on critical reflection on the consequence of the intervention that I implemented to
deal with an aggressive client in my clinical placement, it can be concluded that have I learnt
why my action of directly using restraints was an inappropriate action. I am now aware of the
physical and psychological and ethical consequence of using restraint in mental health care
settings. To rectify my action and based on looking for other evidence based approach to deal
with aggressive patient, I learnt about other therapeutic techniques that I can use first instead of
directly using restraint. I also learnt about other professional steps like taking necessary
permission before applying restraint and using critical thinking to control aggression by other
means before using restraint.
Based on the lessons and new learning that I have gained through my reflection on
clinical placement, I have made many actions plans to acquire new skills in using de-escalation
strategies and risk assessment strategies to deal with violent patients in mental health setting.
Firstly, as de-escalation intervention involves use of psychosocial intervention to calm down
aggressive emotions of patient, I have planned to take training in essential communication skills,
de-escalation of violence and current intervention to assess risk of aggression in patients (Baig et

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al. 2018). This form of training would be useful in my future professional development and
increasing my nursing competency to cope with patient aggression.
To conclude, the essay gave a critical reflection on the clinical practice experience of
providing care to a patient with aggression. Through use of Gibb’s reflective framework, I could
understand the rights and wrongs of my action. The main conclusion from the reflection is that
restraint is not an appropriate action to be taken for all patients as it violate their rights and leads
to feelings of stigmatization. Instead, this intervention should always be used as a last measure
when other interventions like de-escalation fail. All mental health nurses must engage in
reflective practice so that they understand and continuously improve their nursing practice.

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