Nursing Assignment: Reflection-in-action on Patient Interaction

This nursing assignment is a reflective report by a graduating nurse detailing an incident involving a paranoid schizophrenia patient in an acute psychiatric unit. The report describes the nurse's experience, response to the patient's aggressive behavior, and challenges encountered, including internal conflicts and lack of engagement in clinical supervision. It highlights the importance of holistic care, empathy, and effective communication in managing patients with mental disorders. The assignment discusses engagement with the patient, her family, and other healthcare professionals, outlining the outcomes of these interactions. The nurse reflects on the incident, identifying areas for professional and personal development, and concluding with insights gained to improve future practice as a registered nurse.

Running head: NURSING ASSIGNMENT
Reflection-in-action
Name of the Student
Name of the University
Author Note

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Executive summary
I am a graduating nurse, currently placed in acute psychiatric unit at a mental hospital. As a part
of my personal and professional development program, I am supposed to assist my seniors in
providing holistic care to verbally abusing and aggressive patients suffering from a range of
mental disorders. This report explains an incident I experienced during my participation in the
treatment of a paranoid schizophrenia patient.

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Table of Contents
1. Introduction..............................................................................................................................3
2. The experience.........................................................................................................................3
3. Response...................................................................................................................................4
4. Challenges or internal conflicts................................................................................................4
5. Engagement with members and its outcomes..........................................................................5
6. Conclusion................................................................................................................................6
References........................................................................................................................................7

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1. Introduction
A professional nurse embarks on a journey that begins from playing the role of a
practitioner and finally achieving the status of a clinical expert in the field of healthcare
(Alexander and Stewart 2016). The report will illustrate how a reflective practice on an incident
affected my transition and facilitated my professional development plan. I am a graduating nurse
with an eagerness to develop competence in the clinical environment. I am currently placed at an
acute psychiatric ward. I had to look after people who suffer from a myriad or disorders like
psychosis, bipolar, depression and schizophrenia (Battié and Steelman 2014). I had to follow up
the patients to see their improved health outcomes.
2. The experience
The incident took place during the second year of my graduation. Ms. Nguyen, aged 55
years, was brought to the mental ward after she tried to inflict self-harm upon herself. She
belonged to the refugee community of Vietnam. She ran a food joint along with her brother and
his wife. She was widowed and lost her son after he succumbed to jaundice. I was assigned the
task of admitting her to the ward. I noticed that she had several bruise marks on her wrist and a
strangulation mark on the back of her neck, which indicated repeated suicide attempts. She
showed non-compliance to medicines and complained of hearing voices that instructed to end
her life. When I went to her bed, she grunted and turned away. On being asked her name, she
took hold of the flower vase by her bedside and threw it across the room. I was startled. I had
never faced any situation where the patient had displayed such aggressive behaviour. I
immediately went to report the incident to the nurse-in-charge. She was not found anywhere. On
returning, I found that she had been tied to a chair and the staffs were forcibly trying to inject

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tranquilisers. When I inquired, they complained that she tried to run away from the ward and
pushed a staff in the process. Thus, the staff tried to inject tranquilizers.
3. Response
I felt tormented as the situation began to unravel. This acted as a transition shock (Chang and
Daly 2015). I became emotional attached to Ms. Nguyen and wanted to try all possible methods
to help her overcome her auditory hallucinations and agitated state of mind. Her medical records
helped me understand that she was a paranoid schizophrenia patient. The negligence and a lack
of professionalism shown by the concerned nurse-in-charge worsened the situation. This incident
forced me to question my role as a future registered nurse and my expected job outcomes. I
wanted to vent out my doubts and apprehensions. I approached a senior registered nurse and
reflected on my feelings about the patient. She acted as my mentor and helped me formulate a
strategy to provide timely care to Ms. Nguyen, for a satisfying experience. I found that holistic
care, empathy towards patients and effective interaction helps to realise that auditory
hallucinations are not real and reduces suicidal ideation (Balhara and Verma 2012). My mentor
taught that listening to their worries with interest and quite disposition helps to build a good
rapport with the patient and reduces chances of physical abuse.
4. Challenges or internal conflicts
In my graduation period, I learned about the diagnosis, pathophysiology and prognosis
diseases. However, I felt anxious on the thoughts of a mental health hands-on experience. Nurses
are expected to respect and acknowledge the cultural identity of their patients to promote
wellbeing. They should involve family members of the patient to gain a deeper understanding of
their culture (Desborough 2012). One major challenge is the lack of engagement in clinical

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supervision. I felt supervision was required to increase the effectiveness of therapeutic treatment
strategies. Development of trust is also integral to treating a mentally ill patient (Stuart 2014).
This challenge was faced when the staff tried to patronize the patient which made her more
aggressive and show reluctance to treatment. Another challenge was presence of stigma among
mental health staff, lack of resources that help in reducing stigma and absence of counselling or
psychological intervention. The staff showed discrimination and ill treatment towards the patient
owing to mental health stigma. This discrimination makes patients show non-compliance to
medications.
5. Engagement with members and its outcomes
I was directly involved in communication with Ms. Nguyen, her brother and his wife during
the entire treatment. My interaction with her brother revealed the incidents that predisposed her
to paranoid schizophrenia. I provided them a clear understanding of the hallucinations that she
reported, her mental progress on adhering to medications and psychological therapies and the
probable precautionary measures they should follow to reduce further incidents of self-harm
(Frith 2014). I also interacted with my peers and nursing teachers to gain more knowledge on the
incident by effective discussion and debates. It helped me devise a plan to meet the situation if it
occurs again in my career. It helped me realise that if the psychologist was consulted before the
staff administered tranquilisers on Ms. Nguyen, the situation would not have escalated quickly.
This challenging experience gave a clear insight into caring for the mentally disturbed and
reducing their distress.

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6. Conclusion
The reflection helped me illuminate the blind spots and advance my professional and
personal development (Usher and Foster 2015). Thus, it can be concluded that this reflection
strengthened my knowledge between clinical knowledge and efficient health practice. I will use
this incident as a developmental tool for enriching my future as a registered nurse.

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References
Alexander, S.J. and Stewart, L., 2016. Establishing and maintaining a professional identity:
portfolios and career progression. Transitions in Nursing: Preparing for Professional Practice,
pp.259-276.
Balhara, Y.P.S. and Verma, R., 2012. Schizophrenia and suicide. East Asian Archives of
Psychiatry, 22(3), p.126.
Battié, R. and Steelman, V.M., 2014. Accountability in nursing practice: Why it is important for
patient safety. Association of Operating Room Nurses. AORN Journal, 100(5), p.537.
Chang, E.M.L. and Daly, J., 2015. Transitions in nursing: Preparing for professional practice
(Vol. 4). Chatswood.
Desborough, J.L., 2012. How nurse practitioners implement their roles. Australian Health
Review, 36(1), pp.22-26.
Frith, C.D., 2014. The cognitive neuropsychology of schizophrenia. Psychology Press.
Stuart, G.W., 2014. Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health
Sciences.
Usher, K. and Foster, K., 2015. Reflective practice for the graduate. Transitions in Nursing-E-
Book: Preparing for Professional Practice, p.277.