Nursing Assignment: Critical Incident Analysis and Reflection

This essay examines a critical incident that took place during a placement in a mental ward and relates it to theory and understanding of communication and interpersonal skills. The essay uses Gibbs' model of reflection and includes an action plan for improving nursing practice.

Nursing Assignment 1
NURSING ASSIGNMENT
by
Student
Name
Course
Institution
Instructor
Date

Nursing Assignment 2
Nursing Assignment
Table of Contents
Introduction......................................................................................................................................3
Context of the Incident....................................................................................................................3
Description...................................................................................................................................4
Feeling..........................................................................................................................................5
Evaluation....................................................................................................................................5
Analysis........................................................................................................................................6
Conclusions......................................................................................................................................8
Action Plan......................................................................................................................................9
References......................................................................................................................................10

Nursing Assignment 3
Introduction
This essay will examine a critical incident, which took place during my placement in the
mental ward and relate this to the theory in addition to an understanding concerning
communication along with interpersonal skills. Jane is a 51 old woman with mental problems.
Therefore, in order to exhibit consideration of my perspectives on the skill along with the
knowledge of reflection and the matters that surrounds reflective nursing practice, which implies
the skills that were and not utilized in the time of the episode (Barker, 2004) Confidentiality
would be sustained as needed by the Nursing Midwifery Council Code (NMCC). The importance
of the critical analysis, as well as critical incidents, will be briefly explained then followed by the
practice of reflection followed by the reflection founded on the selected model. In this essay, I
will use Gibb’s model (1988) of the reflection cycle. Gibbs (1998) Reflective Cycle is
appropriate for my experience during my placement because it is clear and precise permitting
description, analysis, along with the assessment of the experience making me to make logic of
experiences, as well as examining my practice (Raynor, Marshall, & Sullivan, 2005). The model
will allow me to formulate an action plan towards improving my practice as a nurse in future.
The Context of the Incident
The name of the patient was Jane who was a 51-year old female with mental problems.
The results of my acts for the client would be discussed besides the way they can have got better,
comprising what I learned from the practice at the time the incident occurred. My emotions
regarding the medical knowledge employed to oversee the patient’s care would be recognized

Nursing Assignment 4
and my novel knowledge of the condition in line with the evidence-based practice (EBP) would
be taken into consideration (Nursing and Midwifery Council, 2009).
Description
Jane was a 51-year old female suffering from mental challenges, lack of enthusiasm, as
well as problems in observing her individual cleanliness, as well as the hygiene of her house.
Jane was one of my key adviser’s patient to whom I had been handed over to synchronize along
with supervising her care. As a psychological wellbeing nurse, I knew that I owe the patient the
duty of care and I was expected to provide an elevated typical of care founded on the present
most excellent practice. Jane had been approved Risperidone Consta 36.00 mg fortnightly that is
a modest form of treatment to her condition. Though her situation was delicate, it is not severe
along with the rationale for this kind of treatment was to assist Jane stabilize her thought that will
enable her to support herself in the society (Manderscheid, 2010). Jane did not like visiting the
mental hospital where she skipped three successive doctor appointments. Consequently, my
mentor made the decision to raise the matter of non-attendance during the handover conference
in which the decision was made to see her in the morning, except never met her because she was
not there (Scanlon, 2006). A meeting of the multidisciplinary team (MDT) was called that we
approved that there was a huge challenge if the subsequent medications was ignored by Jane.
The social employee who was present during the meeting agreed that she could organize for a
community support employee to assist clean Jane on weekly basis (Nanovic & Kaplan, 2009).
At the subsequent meeting with Jane after agreeing to come to the hospital, she settled for
a mutual visit with the Community Psychiatry Nurse and myself to re-evaluate her medical state
in addition to possibly reflect on if it was appropriate to refer her case of a counsellor. I was

Nursing Assignment 5
given a chance my mentor to undertake the preliminary assessment that demonstrated that her
behaviour was very impulsive and very neglectful (Marrelli, 2004). Jane’s incapacity to take her
treatment along with to oversee her individual cleanliness showed that she was not fine. The
evaluation instrument that I utilized was the Mental State Examination that assists to establish
the degree of understanding her disease, as well as certainly I established that she in a
denunciation (Yang et al., 2016). During this time, I emphasized to her the significance of
reporting any emerging side effects she might have regarding her treatment to the physician. The
consequences of my actions improved her condition and she was never readmitted to the
hospital. Jane was able to observe daily cleanliness that included bathing and cleaning her
clothes and that of her children. This was a result of frequent attendance and counselling that I
offered to Jane (Delaney, 2009).
Feeling
In the handover meeting, I was anxious as I felt scratchy regarding presenting my
response to the entire team. Therefore, I was nervous concerning making errors in my handover,
which would result in the improper care given to Jane or would result in readmission to the
facility. Being nurse in placement, I felt that I did not have the needed knowledge by presenting
client information to a team of competent colleagues. Nonetheless, I handled this condition with
external calm, as well as in a proficient way. I was very happy that my adviser was accessible in
the time of handover and this improved my confidence (Shattell, Starr & Thomas, 2007).
Evaluation
The good thing regarding my experience was the reality that I was in a position to
undertake an initial assessment and identified what caused Jane’s failure to adhere to medication

Nursing Assignment 6
regime. From the initial assessment, I documented the outcome along with the relation with what
had occurred to the multidisciplinary team with minimum help. Correct compilation of the
client’s care along with the medication must converse to other associates of staff of the MDT to
offer permanence of care. Thus, the knowledge had enhanced my communication competence
and skills considerably; I felt supported all the handover process by my adviser who was
consistently engaged when I overlooked any information. I understood that supervision plays a
leading role as a development tool for nurses in placement. The MDT was very encouraging all
through the course since they took my information with no hesitation (Gamble & Brennan,
2005).
Additionally, what was not excellent concerning my knowledge was the reality that my
adviser had not told me earlier that I was going to present my findings to the team; consequently,
I was not psychologically equipped for the handover. I too felt that I required additional time to
monitor other experts in the MDT undertaking their handovers earlier than I tried to undertake
mine. Throughout the primary multidisciplinary team conference, I felt that we did not offer
adequate time to generously relate with Jane to recognize other mental requirements, which
would affect on her wellbeing (Manderscheid, 2010). Nonetheless, in any occasion, Jane was
incapable to totally connect due to her psychological condition. According top Turley (2000),
nurses must take in their relations with the client while recording evaluation details that may be
utilized to offer proof for prospect planning along with the delivery of healthcare. Thus, health
professionals must utilize listening as a component of evaluating the challenges, wants, and the
resources of the client (Nursing and Midwifery Council, 2008).
Analysis

Nursing Assignment 7
Nurses have the role of safeguarding and promoting the interests of the patients that
include ensuring that the nurse’ knowledge along with the competencies commensurate with the
role being carried out. Communication plays a primary role in promoting effective practice
because it occurs all of the time between individuals in different ways. Clear, effective, and
considerate communication is crucial for healthcare experts, who work with, as well as care for
some persons. The literature concerning communication along with the interpersonal skills is
widespread, as well as vast. I established it hard to converse with the client since I did not
comprehend her state. Therefore, it was too hard for me to understand her behaviour to heart
beside demonstrate feelings at that period, it is apparent that this is a field that I need to develop
for the prospect. Nonetheless, Bulman and Schutz (2008) claim that this is a letdown to inform
and for utilization to discover from the nurse profession, as well as build on judgment skills
(Bulman & Schutz, 2008). Additionally, I could concur with the authors as I learn best from
realistic knowledge, as well as develop it to advance my nursing skills. Thus, with this
philosophy, I am currently focusing on my limitations, in both theories in addition to practice,
along with affirm how, when besides why I plan to enhance my nursing skills (Oberlander,
2008).
In addition, through effective communication, I was in a position to persuade Jane of the
want to resume her medication as scheduled. I was in a position to pass this communication to
the multidisciplinary teams for the permanence of care. According to Roger et al (2003),
communication is an ongoing development; however, may be a tricky procedure while handling
mentally ill patients. In the handover time, I was satisfied to the fact that the multidisciplinary

Nursing Assignment 8
team associates were encouraging, as well as engrossed in what I was uttering and they asked
some queries (Roger et al., 2003).
The patient had no recall of what she had said earlier we were communicating and what
she had told her friends. This enabled me to recognize the fact that I had made nothing wrong
regarding my communication with the patient. My mentor told that this behaviour was attributed
to Parkinson disease that made the person to develop dementia as argued by Rask & Brunt
(2006). Because of my knowledge based on my research regarding Parkinson and the client’s
unresponsive face and her remarks made the client be more violent and worried (Rask & Brunt,
2006). During the communication process, I became aware that developing self-awareness was
crucial. The thought of self-awareness is too imperative for developing effectual communication
skills. Thus, the nurse should be conscious of the elements of themselves, which may
significantly impact the communication process. Reflective practice, as well as the appraisal that
is the purpose of the essay, is one means of becoming conscious, with the eventual objective of
learning from the expression and enhancing the communication skills (Nursing and Midwifery
Council, 2008).
Conclusions
Finally, I have discovered that via efficient communication, any challenge may be
resolved despite the setting, situations or its complication. This was evident in the mental case of
Jane because I was able to use communication to convince her on the need for regular treatment.
Thus, nurses should make sure that they are effective communicators. In addition, nurses should
promote listening while communicating so that they better understand the needs of the patient in

Nursing Assignment 9
question. I have recognized the weakness, which must be turned into strengths for effective
delivery of care to the patient. I am currently working on improving my boldness, self-
confidence along with communication skills. Taking part in the case of Jane gave me the chance
to acknowledge that the first-class background of information in addition to feedback regarding
mental health challenges prior to the provision of care to patients may help in precise diagnosis
along with the progress monitoring. Also, the effective rapport between the patient and nurse is
healing along with assist in establishing trust from the patient. This may be attained through a
free communication process, which permits the patient to articulate their emotions along with
concerns with no panic of threats. From my knowledge, I believe the knowledge that I have
received will help me in the prospect whilst in the nursing profession must such incident arise
once more. This was a great experience that has improved my nursing practice significantly.
Action Plan
To enable me to recognize my key strengths along with the faults in both the practice and
theory effortlessly I ensured that I capitalized on weaknesses and explore opportunities.
Therefore, I will at the present start to work on this, the primary rationale is that I am strong-
minded to be a knowledgeable, proficient nurse in the prospect. I am currently more equipped for
any prospect cleanliness with this illness as I have studied. I would spend some time to converse
with clients to ensure that they are free with me while communicating, prior to offering any form
of care. Finally, if the patients seem troubled, it would get a different staff to assist me to restore
the confidence of the clients (Farley-Toombs, 2011).

Nursing Assignment 10
References
Barker, P. 2004. Assessment in Psychiatric and Mental Health Nursing. Cheltenham, Nelson
Thornes.
Bulman, C. & Schutz, S. 2008. ‘An Introduction to Reflection’. In: Bulman, C. Schutz, S. (ed.)
Reflective Practice in Nursing, 4th edition. Oxford, Blackwell Publishing Ltd, pp 6 – 8.
Delaney, K.R. 2009. ‘Looking 10 years back and 5 years ahead: Framing the Clinical Nurse
Specialist debate for our students’, Arch Psychiat Nurs. 23(2):454-456.
Farley-Toombs, C. 2011. ‘Shaping the future of PMH-APRN practice through engagement’, J
Am Psychiat Nurs Ass. 17(1):250-252.
Gamble, C & Brennan, G. 2005. Working with serious mental illness: a manual for clinical
practice. Oxford: Bailliere Tindall.
Manderscheid, R.W. 2010. Evolution and integration of primary care services with specialty
services in mental health services: A public health perspective. 3rd Ed. B Levin, K Hennessy, J
Petrila, eds. New York: Oxford University. 389-400.
Marrelli, T. M. 2004. The Nurse Manager’s Survival Guide: Practical Answer to Everyday
Problems. United States of America: Elsevier.
Nanovic, L, & Kaplan, B. 2009. ‘Reliability of Medicare claim forms for outcome studies in
kidney transplant recipients: Epidemiology in clinical outcome trials’, Clin J Am Soc Nephro.
4(1):1156-1158.

Nursing Assignment 11
Nursing and Midwifery Council. 2008. The Code Standards of conduct, Performance and Ethics
for Nurses and Midwives. London: Nursing and Midwifery Council.
Nursing and Midwifery Council. 2009. Record keeping: Guidance for nurses and midwives.
London: Nursing and Midwifery Council.
Oberlander, J. 2008. ‘The partisan divide- The McCain and Obama plans for US health care
reform’, New Engl J Med. 359(21):781-784.
Rask, M. & Brunt, D. 2006. ‘Verbal and social interactions in Swedish forensic psychiatric
nursing care as perceived by the patient and nurses’, International Journal of Mental Health
Nursing. 15(2):100-110.
Raynor, M. D., Marshall, J. E., & Sullivan, A. 2005. Decision making in midwifery practice.
Edinburgh: Elsevier Churchill Livingstone.
Roger, B,. Ellis, Bob G, & Neil K. 2003. Interpersonal Communication in Nursing: Theory and
Practice, 2nd edn. Churchill Livingstone, London, UK.
Scanlon, A. 2006. ‘Psychiatric nurses perceptions of the constituents of the therapeutic
relationship: a grounded theory study’, Journal of Psychiatric and Mental Health Nursing.13
(1):319-329.
Shattell. M., Starr, S.S. & Thomas, S.P. 2007. ‘Take my hand, help me out': Mental health
service recipients' experience of the therapeutic relationship’, International Journal of Mental
Health Nursing. 16 (2):274-284.

Nursing Assignment 12
Turley, J.P. 2000. ‘Toward and integrated view of health informatics’, Information Technology
in Nursing, 12 (13): 31-49.
Yang, L., Yan, J., Jin, X., Jin, Y., Yu, W., Xu, S., & Wu, H. 2016. ‘Screening for Dementia in
Older Adults: Comparison of Mini-Mental State Examination, Mini-Cog, Clock Drawing Test
and AD8’, PLoS ONE, 11(12), 1–9.