University Nursing Reflection: Clinical Integration in Mental Health

This essay is a reflective piece by a nursing student focusing on the challenges of maintaining therapeutic relationships with patients diagnosed with bipolar disorder, particularly during manic episodes. The student uses the '5 R's of reflection' framework (Reporting, Responding, Relating, Reasoning, and Reconstructing) to analyze an article discussing nurses' experiences. The essay highlights the difficulties nurses face in establishing trust and open communication, especially when patients exhibit manic symptoms like rapid speech and aggression. The student reflects on the importance of therapeutic alliance, open communication, and providing a safe environment for patients. The student concludes by emphasizing the importance of ethical boundaries and proactive communication with patients and caregivers to prevent future challenges and ensure effective patient care. References from the original article are also included.

Running head: REFLECTION
Clinical integration speciality practice
Name of the Student
Name of the University
Author Note

1REFLECTION
Introduction- Mental health is an umbrella term that refers to the psychological health
of a person, besides emphasising on the absence of any major mental illness (Townsend &
Morgan, 2017). In other words, it refers to the state of an individual who functions at a
satisfactory level of behavioural and emotional adjustment. My speciality of practice is
mental nursing, and in this essay I shall be reflecting on an article based on the perspective of
nurses, following the '5 R’s of reflection' framework.
Reporting- The issue of concern is the experience of nurses in maintaining a
therapeutic association with patients who have been diagnosed with bipolar disorder and
report several stages of manic symptoms. Also referred to as manic depression, this mental
illness results in periods of abnormal mood and hypomania, which makes a person look
happy, energetic or irritable (Grande et al., 2016). This ailment is the major focus of the
selected article since when such patients manifest manic symptoms, they generally develop a
negative and pessimistic approach towards life, and fail to establish eye contact with others.
This acts as a major form of impediment for the nursing professionals since I have realised
that therapeutic relationship must always be based on trust, respect, hope and faith.
Furthermore, it is significant among person suffering from mental illness since it
encompasses displaying sensitivity and gratification towards others, thus helps in addressing
the spiritual and emotional needs of the patients.
Responding- The article suggested that nurses were subjected to dual loyalty under
circumstances when they were subjected to conflicting interests. They endeavoured to remain
linked to patients and their caregivers with a non-judgmental and open attitude (Beentjes,
Goossens & Jongerden, 2016). This issue made me understand that manic episodes were
commonly exhibited by the patients that made the nurses feel overwhelmed and favour the
caregivers at such instances. It has often been found that during such episodes patients speak
in an uninterruptible and rapid manner, and also become aggressive and violent towards

2REFLECTION
others (Khalsa et al., 2018). Thus, I realised that it became increasingly difficult for the
nurses to spend quality time with their patients, while empowering them to actively
participating in the care process.
Relating- Open communication was generally favoured by nurses for preventing
suspiciousness in the patient, which might make them lose their trust and show reluctance to
treatment (Beentjes, Goossens & Jongerden, 2016). I understood that bipolar disorder patients
generally perceived partnership, empathy, consideration, honesty, and access adequate
information as facilitating factors that increased their adherence to treatment regimen. This is
in accordance to therapeutic alliance theory that emphasises on the way by which a patient
and therapist engage with one another, with the aim of bringing about a beneficial health
change in the former (Zilcha-Mano, 2017). I realised that the nurses often consider the
patients and their caregivers as co-manager of their illness, hence, they try to foster
collaboration with the patients in order to ensure presence of respect, trust, and congruence.
Reasoning- The article highlighted that maintaining a therapeutic association with
both the caregiver and the patient helped the nurses to establish acquaintance and also
facilitated management of all difficulties that were encountered during the manic episode
(Beentjes, Goossens & Jongerden, 2016). This suggested that establishment of therapeutic
association while caring for mentally ill patients is imperative for the recovery process since
it helps the patients to understand that the therapist has the necessary competency, skill and
proficiency for management of the condition (Majumder et al., 2019). I also understood that
such an association is imperative, as it is oftentimes the principal setting in which the
individual in receipt of treatment shares cherished thoughts, principles, and sentiments during
the illness.

3REFLECTION
Reconstructing- To conclude, I learnt that while caring for patients suffering from
mental illness such as, bipolar disorder, it is essential for a therapist to provide an open, safe
and non-judgmental atmosphere where the patient can feel at ease. Owing to the fact that
manic episodes of bipolar disorder encompass euphoria or delirium, when left untreated it
might lead to high-risk impulsive behaviour. Therefore, I learnt that unhealthy therapeutic
association is the outcome of being disrespectful to the ethics and boundaries of standard
behaviour, in relation to mental health nursing. Hence, in order to prevent any such
circumstances in future, while caring for patients diagnosed with mental disorder, I would
pay attention to the variations that they want to make in the treatment, would encourage open
communication, provide accurate and correct information to the patients and discuss all
matters of potential concern with the caregivers.

4REFLECTION
References
Beentjes, T. A., Goossens, P. J., & Jongerden, I. P. (2016). Nurses' experience of maintaining
their therapeutic relationship with outpatients with bipolar disorder and their
caregivers during different stages of a manic episode: a qualitative
study. Perspectives in psychiatric care, 52(2), 131-138.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The
Lancet, 387(10027), 1561-1572.
Khalsa, H. M. K., Baldessarini, R. J., Tohen, M., & Salvatore, P. (2018). Aggression among
216 patients with a first-psychotic episode of bipolar I disorder. International journal
of bipolar disorders, 6(1), 18.
Majumder, P., Vostanis, P., Karim, K., & O’Reilly, M. (2019). Potential barriers in the
therapeutic relationship in unaccompanied refugee minors in mental health. Journal
of Mental Health, 28(4), 372-378.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of
care in evidence-based practice. FA Davis.
Zilcha-Mano, S. (2017). Is the alliance really therapeutic? Revisiting this question in light of
recent methodological advances. American Psychologist, 72(4), 311.