Reflective Practice: Managing Challenging Behaviour in Community Nursing

This reflective essay explores an incident involving a patient exhibiting challenging behaviour during a community nursing placement. Using Gibbs' reflective cycle, the author analyzes the situation, their feelings, and the lessons learned. The essay highlights the importance of effective communication, empathy, and professional conduct in managing challenging patient interactions. It also emphasizes the need for continuous professional development and the role of reflective practice in enhancing nursing skills.

Contents
Introduction...........................................................................................................................................1
Description-...........................................................................................................................................1
Feeling-..................................................................................................................................................2
Evaluation-.............................................................................................................................................3
Analysis-................................................................................................................................................4
Conclusion-............................................................................................................................................5
Action Plan-...........................................................................................................................................6
Conclusion.............................................................................................................................................7
References.............................................................................................................................................9
1

Introduction
This assignment deals with the reflective writing of the incidence that took place when I was
placed in the District Nursing Healthcare in a Community setting. Using the Gibbs reflective
cycle I would like to share my experience with the patient and what the incidence taught
me. This reflection will help in easy explanation of the incidence and the effect of such
incidence on y clinical practice in both positive and negative manner. By means of this essay,
the nursing practices will be analysed according to the Nursing and Midwifery Council
Professional Code of Conduct. Reflection is an essential part of practice as it enables the
students and future healthcare professionals to enhance their practice by sorting the
strength and weaknesses based on various incidences and their reflective index (Sharp,
2018). The Gibbs cycle has following parts which will be introduced as the heading of the
essay description, feeling, evaluation, analysis, and conclusion and action plan (Smith, 2016).
The incidence that took place was with a patient who will be referred as Mr FX as taking in
consideration the policies and code of conduct of professional nursing practice and keeping
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the confidentiality and information of the patient intact. The patient had a violent outburst
at me and my mentor while we were providing him lessons regarding the insulin
administration. This essay reflects how this incident helped me finish my skills and learn new
things to handle various situations in nursing practice.
Description-
Throughout my nursing practice, I encountered various behaviours and kinds of people and
have developed skills to effectively communicate with each one of them as per their
communicating capability and understanding. The incidence being reflected took place
when I was placed at the District Nursing Home in a community setting. The patient Mr FX is
an elderly man who lives alone in his flat and is recently discharged from the hospital. He is
mentally stable and no signs of mental incapacity are reported by the hospital. He is doing
well with the use of his medication till now when he is being prescribed new medication
during discharge. He is being referred to the District Nursing Care for medicine compliances
and to make him aware of and teach him the technique of using self-administered insulin
for blood sugar regulation and monitoring of the blood sugar at home. The nursing home
was advised to refer this patient at home and visit him for following his care plan. The care
plan of the patient included healthcare teaching for self-administration of the insulin and
blood sugar monitoring procedure and supervising the patient while he performs the
procedure by himself.
It was the first day of my placement at community healthcare with my mentor I visited Mr
FX's house for the following healthcare practice. As we reached there he was not seemingly
happy to attend us but we introduced ourselves took consent from him and marked our
presence. We tried to explain him the procedure and me and my mentor communicated
with him as effectively we can to make him learn the self-administration process. Suddenly
he got upset and started shouting abusive words towards us. The situation got really
uncontrolled but as my past experiences with such situations and knowledge as a student
nurse, I was able to control the situation and handle the inappropriate behaviour of the
patient. It is normal for the elderly and patients who live alone to get outburst when they
have or need to convey something to someone. In such situation, it is important to
communicate effectively and not use restraining approaches at first. The respect and dignity
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of the patient were maintained and proper effective communication was set by my mentor
to calm the patient and explain him the needful (Kaplan-Liss et al, 2018). Proper verbal and
non-verbal communication is essential and the reason for the outburst of the patient or
showing such challenging behaviour should be assessed.
Feeling-
As the incidence took place it was very frightening and made me anxious at first. It showed
negative impacts on the whole setting and on me as it was my first day as the district
student nurse placement. As I never before encountered a patient and such situation in
another setting than the hospital care it was all new and challenging for me. As this incident
took place I felt that usually, the community nursing avails a person to work lonely and in
such situation, one has to have proper and assertive nursing skills to manage such situation
and have a problem-solving attitude towards it. At first, I was afraid to communicate with
the patient after his abusive clauses towards us but as my mentor started to use proper
communication techniques with him he started to calm down and my fear converted to
confidence (Neville & Roan, 2014). This incidence made me feel that no matter how
inappropriate behaviour the patient present to us still he is eligible to be treated by the six
C's of nursing codes that includes, care, compassion, courage, communication, commitment
and competence. The competency of the nursing practice depends on how better I did
manage the situation and was able to calm the patient down and explain the procedure to
him effectively (Riley, 2015). Communication is the key to solve the utmost problem in
healthcare. I felt that the way my mentor communicated with the patient was breakthrough
of the situation. It solved the heat up the situation and made patient calm down. I felt that
there was some underneath reason for the behaviour of Mr FX that he was being resistant
to new change in his life. Also, it was felt that the patient was independent and did not like
prolong visit of any stranger as he did not welcome us with friendly gestures. The incidence
was sudden and made me feel that we should have identified all these verbal and non-
verbal messages from the patient and should have reduced the time of visit and used much
better communication strategies to avoid such situation (Kourkouta & Papathanasiou,
2014).
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Evaluation-
This incidence made me learn various concepts of healthcare and better nursing practice
delivery. Firstly the concept of challenging behaviour was clear to me. Such situations in
nursing care can be presented very frequently where the patient presents inappropriate
behaviour and it can be in any form. Here the patient used verbal abuse as a form to show
challenging behaviour that taught me that challenging behaviour is also a way of the patient
to convey some message to others (Nestel & Bearman, 2015). People who live socially
isolated and alone needs attention from others and this could be a way of them to ask for it.
Anger, aggression, verbal abuse and inappropriate communication can be used by a person
to hide the underlying bigger problems and issues. In this case the patient is firm enough
and independent to handle his own self and house that made him resistive to new things
and new people. He lives alone and does not like interruptions from anyone in his life. The
anger showed by Mr FX presented that it was his way to convey his authority and strength
and that he is capable enough to make better decisions for self. The patient also had some
trust issues that made him unwelcoming us to the house and his property. Second thing I
learnt from this incidence was that healthy and effective communication is the most
essential part of healthcare. Formation of a good communication within nurse-patient
relationship ensures not only individualized and patient-oriented care but also has benefits
such as better patient understanding, information and education regarding the procedure
(O'hagan et al, 2014). Effective communication skills show reduction in disruptive
behaviours from the patient. Communication should be in a manner that should promote
and safeguard the beliefs and values of the patient. This makes the patient feel secure and
form trust with the healthcare professional (Segerstrale & Molnár, 2018). Important thing I
learnt regarding the behavioural changes shown by patient was one should be able to
identify anger and aggressive behaviour and try to find the core reason behind it. Use of
verbal, non-verbal ways of communication is essential to make patient understand and
extract the reasons for his outburst. The needs of the patient are to be fulfilled and the need
for the procedure and the medication is to be explained to the patient. The information
regarding the procedure, teaching and District Nurse visits is important as this will allow
maintaining patient’s respect and making him have trust for the healthcare professionals.
The most important thing I learnt from this incident was that fear and unskilled moves can
worsen such situation so the nurse has to be in sound and calm mind and state to handle
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such challenging behaviour where ever presented. I saw how my mentor used soft tone,
polite statements and made effective communication with the patient that made him calm
and cooperate while the procedure was being explained to him. Communication practices
can be learnt with every such encounter and situations that require different ways and
methods of communication and continuous development of the practice is essential for this
purpose.
Analysis-
The experience with such incidence taught me that my communication skills have to be
modified as per the situation and be appropriate to handle the patient with unique qualities.
Every patient is unique and has different needs and being a nurse I have to work effectively
to achieve individualized care to provide them what they demand. I learnt that in situation
when the patient becomes uncooperative and shows undesired behaviour I should stay
calm and try to form an effective communication loop to understand the reason behind his
behaviour and manage to calm him down (Bach & Grant, 2015). Use of soft tone and slow
pitch, verbal and non-verbal gestures that will make him comfortable, use of appropriate
behaviour pattern to make him feel secure and empathy should be a factor to be involved in
the practice as this helps in achieving appropriate cooperation and trust. I felt I got anxious
at first but managed to overcome my feelings and handle the situation as my mentor
performed. I analysed the situation keenly and extracted some points out of it that includes
limiting the visit time maintains the patient’s respect and values. Asking for consent and
introducing ourselves properly initiate a proper communication cycle. Identifying any
distressing features and preventing them to discomfort the patient is important. I also learnt
that when a patient shows such aggression and anger it is important to identify and assess
the reason behind it and try to know the feelings and emotions the patient is going through.
Empathy towards his feelings made him build trust for the healthcare professional and listen
to what my mentor was saying. I felt that if I would not become anxious at first it would be
more likely I would have intervened and helped in handling the situation on my own. It was
also necessary for me to control my anxiety and act promptly with better nursing knowledge
and information to handle problems. What needs to be done in which situation is learnt by
experience and continuous development of skills and therefore in this situation I learnt that
for any instance that may occur with me like this one I will be able to handle it alone and
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efficiently on my own as I know the approaches to be used to intervene such situation. I also
get to know that my feeling anxious and frightened would have worsened the situation if I
would have behaved in an unwanted manner. Such situation also provide a hint of
underlying mental disorders and issues that a person may be facing and has left
undiagnosed so it is the ability of nurse to identify any such issues and report it for further
help for the patient (Arnold & Boggs, 2015).
Conclusion-
As I witnessed the distress caused to the patient due to inappropriate information provided
or any other cause it made the whole setting impact negatively by the inappropriate
behaviour of the patient. I am now aware of being more assertive if similar situation occurs
in future. Anxiety overloaded me at first but as I got support from my mentor I handled the
situation with his help and managed to control the behaviour of the patient. Such incidence
also has negative impact on my practice as I feel afraid of communicating well with other
patients of such sort (Fitzpatrick, 2018). It also showed that I need more skills to form an
effective communication with the patient to prevent such situation and also use effective
communication tools to handle it. It is essential to build a rapport with the patient to ease
the process and the whole learning setting for the patient. Forming proper and appropriate
rapport with the patient will allow managing the behaviour of the patient and getting
adequate cooperation from them. Nursing is the multidisciplinary teamwork as in this case
the patient being referred from hospital to District Nurses for medicinal compliance
teaching. Such teamwork is possible only when all the members of teamwork appropriately
knowing the patient's needs and provide adequate care (Howatson-Jones, 2016). It is also
essential to know proper information regarding the patient and follow the confidentiality
rule to seek consent and keep the information confidential. This incidence also made me
realize I have to work on my problem solving skills as nursing is a branch where unique
incidences occur and various different problems take place. The competent nursing practice
involves basic knowledge of the nursing procedures and trained qualification for teaching
such procedures to the patient for self-administration of drugs etc. continuous nursing
practice development is the need of the era and is essential as new advancements make it
more appropriate and easy to deal with various different issues in nursing practice
(Sherwood, Brinkmann & Fatone, 2018). This incidence made me clear my concepts
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regarding the importance of communication in nursing and essentials of communication in
challenging situations. According to nursing professional code of conduct communication is
one of important aspect of nursing and every nurse should know how to build a rapport
using effective communication.
Action Plan-
As per the incidence described above I have prepared an action plan to act in most
appropriate manner as possible to ensure that if any such situation occurs I am competent
enough to solve the problem. I learnt how to manage such challenging behaviour when
presented by the patient and use effective gestures and verbal and non-verbal ways of
communication to calm the patient and control the situation. Communication is the best
way to handle such challenging behaviour and it is also a way of behavioural conditioning
therapy that enhances the ability of the patient to understand and take up the information
provided and train the nurse to effectively handle such situation (Baby, Gale & Swain, 2018).
The experience showed that I should work on my communication skills and continuously
develop my skills so that effective and ideal communication can be build and rapport can be
formed with the patient. Patient centred approach is the need of new clinical nursing
practice and is most effective tool in such situations. Need of the patient and fulfilling the
requirements of the patient is most essential part of healthcare. When the patient shows
such behaviour he may be trying to convey some sort of emotions and feelings listening is
the effective part of communication and provides better understanding of patient’s feelings
and reasons for such behaviour. In case in future such incidence occurs I will try to
communicate with the patient to identify the chief cause of such behaviour, than I will try to
build a rapport with the patient so patient can build trust on me and provide me with
essential information that I will keep confidential and use to provide help for his condition
and treatment (Expósito et al, 2018). According to the Nursing Professional codes of ethics it
is essential to keep the information confidential of the patient, provide treatment with
equality, communicate with the patient, respect the dignity and values of the patient,
provide beneficence, prevent any sort of maleficence, provide autonomy to the patient and
provide justice and trustful treatment. I will try to follow all these codes of ethics for nursing
practice as it will provide good nursing practice and develop my clinical practice. I will keep
on performing reflective assessment of my experiences using Gibbs cycle as it helps me to
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improve my practice and find the loops for improvement as well as to identify my strengths
and enhance my skills (Blais, Hayes, Kozier & Erb, 2015). Although this experience was
challenging a difficult to manage at first but now I have better understanding and knowledge
to deal with such situations. Due to this experience I have developed some new qualities
and learnt new behaviours, first of all I have developed that I have to work alone as the
community nurse whenever required and will have to be assertive enough to perform the
procedures and have a problem solving behaviour. Other thing I learnt that in such
situations I have to stay calm and not allow my anxiety over power so as I can have a sound
mind and be able to explain the patient and understand his feelings, this will make me able
to identify the reason behind his behaviour and I can also help in improving the condition.
All these skills will prove to have a positive impact on my clinical nursing practice (Toros &
Medar, 2015).
Conclusion
In the given essay I have used Gibbs reflective cycle that is most widely known for its better
value in explaining the reflective index of a situation or an experience. Gibbs cycle helps to
develop our skills and review the effectiveness of the practice. It is a way that enhances the
practice rather doing the things as usually done, it helps in continuous professional
development as it allows me to know my strengths and weaknesses and improve the
aspects where my skills need refinement. In the experience described above, I learnt various
skills and majorly the importance of effective communication in clinical nursing practice and
the importance of following the code of ethics in every possible situation in nursing care.
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