Driscoll's Model: Reflecting on a Mental Health Nursing Scenario

This report presents a reflective analysis of a clinical scenario in mental health nursing, utilizing Driscoll's model. The student nurse reflects on an interaction with a 60-year-old Aboriginal male presenting with mental health concerns, focusing on the 'what,' 'so what,' and 'now what' aspects of the experience. The 'what' section details the patient's presentation, the nurse's initial approach, and the patient's discomfort and departure. The 'so what' section critically evaluates the nurse's actions, highlighting failures in establishing a therapeutic relationship, considering cultural preferences, and ensuring effective communication, referencing ethical principles and NMBA guidelines. The 'now what' section outlines strategies for improvement, including further study of cultural competence, effective communication, and anti-discriminatory practices, along with plans to modify future interactions to ensure culturally safe care, including seeking referrals to nurses from similar cultural backgrounds and involving patients and their families in the care process. The report emphasizes the importance of reflective practice in enhancing professional skills and improving patient outcomes, particularly for culturally diverse populations.

Running head: NURSING
NURSING
Name of the Student:
Name of the University:
Author Note:

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Introduction:
According to Smith (2016), reflective practice forms an integral aspect of the nursing
profession. Reflection typically includes the element of introspection so as to analyse the
existing strength and weaknesses within the scope of practice and undertake appropriate
measures to enhance the scope of practice so as to ensure effective care delivery. As stated by
Bassot (2015), reflection forms an important education tool in nursing that facilitates
continuous professional development. Research studies have indicated that the use of
reflective practice in nursing has helped in improving the scope of professional practice and
at the same time has promoted improved patient outcome (Bassot 2015; Smith 2016).
Typically, reflective education is devised in a manner that it helps in acquiring specific goals
that is encapsulated with coordinated group facilitating so as to achieve positive performance
output. In addition to this, research studies suggest that reflective practice stimulates learning
within scope of practice and at the same time enhances the professional skillset to implement
acquired knowledge to practice and promote a positive change (Wright and Stickley 2013).
This paper intends to make use of the Driscoll’s method of reflection in order to reflect upon
a clinical scenario and accordingly undertake measures to improve the scope of practice so as
to render effective care to patients.
Driscoll’s Model of reflection:
Driscoll’s model of reflection was propounded by Terry Borton who typically
emphasised upon finding responses to three questions in order to reflect upon a clinical
scenario. The three questions typically comprise of ‘what’, ‘so what’ and ‘now what’ in order
to evaluate a clinical experience. As per Bassot (2015), the three questions included in the
Driscoll method form a part of the experimental learning cycle and in combination help in
introspecting upon a clinical incident in order to identify the existing weaknesses to improve

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the scope of professional practice. In this paper, I am going to make use of the Driscoll’s
model of reflection in order to reflect upon my clinical experience with a 60 year old
aboriginal male who had presented to the mental health clinic to seek assistance with mental
health issue.
What:
Mr. A who was 60 year old, was presented to the mental health care clinic by his
daughter C. C complained about her father behaving awkwardly over the previous week. She
mentions her father to be extremely restricted to himself and aloof at home. She further states
that her father had not consumed a proper meal since two days and has been staying up all
night. She further states that she had overheard her father talking to himself at night and on
asking him what was wrong, he had mentioned about receiving a divine message that told
him, his end was near. This was when, C realized that there was something wrong and had
urged her father to accompany her to the mental health clinic.
Upon presentment, Mr. A looked dishevelled and unkempt and was seen to wear a
lose pair of trousers and a shabby grey shirt. I took Mr. A to the clinic and greeted him and
mentioned to him that I would ask him a few questions about his problem and wanted to help
him with his problem. Mr. A maintained a closed body gesture and avoided eye contact to the
maximum. On asking him about whether he could state the time and place and the purpose of
his visit, he responded accurately, which suggested that he was aligned to the time and place
and was aware of the purpose. Further on asking him about what bothered him, he mentioned
in broken sentences while shivering ‘my end near’. Upon asking him how did he know that,
he mentioned ‘the God’s voice.’ Upon asking him further questions, Mr. A was observed to
fidget with his hands and portray a nervous look and constantly mentioned, ‘Please, let me
go..you no understand..my end near.’ I tried to calm the patient and extended by hands to

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hold his so as to pacify him, but the patient got up and walked out of the clinic in a hurried
manner to meet his daughter who was waiting outside the clinic. As I followed the patient
outside and tried talking to his daughter, the patient was observed to feel increasingly restless
and urged his daughter to take him back home. It appeared as though the patient felt
uncomfortable in my presence.
So what:
Upon critically reflecting upon the scenario, a number of instances can be identified
where I critically lacked to provide effective and a culturally safe care delivery. It might be
on account of these instances that the patient felt extremely uncomfortable and left the care
clinic. As a mental health nurse, it is extremely important to ensure an anti-discriminatory
care environment so as to ensure that patients belonging to the diverse cultural and ethnic
background feel respected and treated with dignity. According to Thompson (2016), within
the mental health care environment it is important to ensure that care professionals
specifically make use of the four key ethical principles that comprise of justice, autonomy,
beneficence and non-maleficence while devising care delivery. Within a mental health care
environment, nurses must ensure that patients belonging to diverse cultural and ethnic
background ensure are treated in a just manner without judging them on the basis of their
background or origin (Fortinash and Worret 2014). Also, it is the duty of the care
professionals to ensure that the patients belonging to the diverse ethnic and cultural
background have their independent right to choose their care preferences or care profession
according to their cultural or religious preferences. In this context, I believe that I failed to
establish an effective therapeutic relationship with the client as I had not taken his cultural
preferences into account (Townsend and Morgan 2017). As an efficient mental health nurse, I
should have specifically asked the patient as well as his daughter if he would like an
aboriginal mental health nurse to conduct the interview. During the brief interview procedure,

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it was clearly evident that the patient felt uncomfortable and was nervous. There could be a
possibility that the patient was not comfortable in my presence as I did not belong to the
similar culture as that of the patient. I should have considered the preference of the patient
and made referral to a fellow RN belonging to the similar cultural background as that of the
patient as this would have helped in building a strong therapeutic relationship. Also, as per
the NMBA guidelines, care professionals must exhibit cultural competence and ensure
cultural safety while delivering care to the patient. In this case, I had missed out on
considering the cultural preferences of the patient. The lack of cultural specific consideration
might have made the patient uncomfortable and as a result the patient might have decided to
leave without seeking care. As revealed by research studies, it has been mentioned that
indigenous population have reduced access to care facilities the primary reasons for the same
being lack of awareness and the discriminatory approach practice by the care professions
(Cameron et al. 2014; Ware 2013; Clifford et al. 2015)). In this case, I feel I should have been
taken into account the linguistic preferences of the patient. As was evident, during the patient
interview process, the patient was finding it difficult to converse in English and it is likely
that the patient was experiencing difficulty in comprehending my questions. Therefore, it can
also be mentioned that I missed out on the underlying principles of effective communication.
Also, another area where I missed out on complying with anti-discriminatory practice and
effective care was when I had greeted the patient and had directly started the interview
process without introducing myself and seeking his consent prior to starting with the
interview process. Although, the patient seemed aware about the purpose of the interview, as
an efficient care professional it is my duty to introduce myself to the patient and seek his
consent before commencing with the interview process. In this case, clearly, I had not given
importance to these elements and this resulted in compromising with the patient autonomy
which made the patient extremely uncomfortable and made him refuse the care service (Daly,

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Speedy and Jackson 2017). As per Ammouri et al. (2015), on most occasions care
professionals involuntarily exhibit discriminatory attitude and perception that results in poor
patient outcome. Care professionals must stringently adhere to the anti-discriminatory
policies as well as the NMBA guidelines in order to deliver effective patient care (Kanerva,
Lammintakanen and Kivinen 2013).
Now what:
On critically evaluating the experience with the patient, I have realised that I had
missed out on delivering an effective and a culturally safe care. In addition to this, I had also
not been able to communicate effectively with the patient. I have realised that I would need to
work on the identified weaknesses in order to strengthen my scope of practice. In order to
acquire an in depth knowledge about cultural safety and effective communication so as to
address the communication barrier while dealing with patients belonging to a diverse cultural
background, I would browse through scholarly literatures available on electronic databases. I
would specifically browse through scholarly literatures available on cultural safety and
cultural competence. In addition to this, I would also browse through academic resources on
anti-discriminatory policies and the professional conduct that must be followed by care
professionals within a care environment. Also, I would browse through the NMBA document
in order to have a better understanding about cultural safety and cultural competence
(Holland 2017). Further, in order to improve my understanding about effective
communication while communicating with culturally diverse patients, I would work in close
association with my supervisors and attend workshops on effective communication
(Varcarolis 2016). Also, I would browse resources on transcultural nursing so as to
communicate effectively with patients in future.

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Also, next time while I am dealing with a patient who belongs to a different culture, I
would ensure that I have specifically considered the culture and religious preferences of the
patient prior to commencing the interview process. In case, if I am dealing with an aboriginal
patient, I would make appropriate referral to an aboriginal nurse so that the patient feels
comfortable and is able to express effectively. Also, in case a patient belonging to a different
cultural background is comfortable with me conducting the health interview, I would at first
greet the patient and then introduce myself to the patient (Garneau and Pepin 2015). This
would help in building a positive therapeutic relationship with the patient. Subsequently, I
would seek consent from the patient prior to conducting the interview process and ensure that
the interview takes place after the patient ascents his consent. Also, I would actively involve
the patient and his family members in the care process so as to ensure shared decision
making. As mentioned by Backett et al. (2013), this would help in rendering an effective and
culturally safe care delivery which would subsequently help in achieving positive patient
outcome and would also ensure improved access to health care facilities for the indigenous
patients.
Conclusion:
Therefore, to conclude, it can be mentioned that while dealing with patients who
belong to a culturally diverse background, it is important to consider their cultural beliefs and
accordingly make use of anti-discriminatory policies so as to ensure effective care delivery. A
number of research studies have revealed that access to healthcare facilities is significantly
reduced among the Aboriginal and Torres Islander individuals. This has been majorly
because of lack of awareness about heath care facilities and discriminatory policies practiced
by the care professionals. Care professionals can specifically make use of the Driscoll’s
method in order to reflect upon the clinical experiences and accordingly adapt measures to
improve their scope of practice. In this paper, I have made used of the Driscoll’s model to

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reflect upon my clinical experience with an aboriginal male who was presented to the mental
health clinic by his daughter to seek help. However, I had lacked as a care professional to
consider his culture specific needs and at the same time had not been able to communicate
effectively with the patient and this has resulted in a negative clinical outcome, where the
patient had walked away without seeking assistance. In order to improve by identified flaws,
I would make use of the available evidence base so as to improve my scope of practice while
dealing with culturally diverse patients in future.

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