Table of Contents
In nursing, reflective practice refers to how nurses and other health care professionals study their experiences to identify various ways through which they can improve their work (Johns, 2017). Reflective practice assists nurses in identifying their strengths and weaknesses. In mental health nursing, where the risk for burnout is high, the importance of reflective practice cannot be understated. It aids the practitioners in self-assessment and re-discovering their passion for nursing (Ellis, 2019). Assessment is usually the first step in the nursing process. It connotes the procedure by which registered nurses obtain information regarding a patient’s physiological, sociological, and spiritual status (Minton et al., 2018). Holistic assessment in health care refers to a form of evaluation the focus of which extends beyond physical health. The assessment looks into the emotional, mental, and spiritual health of the patient (Timmins et al., 2016). Notably, health care professionals take into full consideration the whole condition of the patient. Usually, holistic assessment includes six aspects, physiological, psychological, sociological, developmental, spiritual and cultural (Cusack, Killoury and Nugent, 2017). The integration of the aspects helps the nurses identify an underlying cause of illness and the various factors curtailing the recovery process (Morrison-Valfre, 2016). The approach also assists nurses and health care professionals in garnering information concerning the patient’s beliefs, values, and family dynamics; as such, it results in effective treatment, which culminates into optimal health of the patient.
Arguably, critical assessment is vital in nursing since it ensures patient safety. Besides, providing medical care to the patients, nurses are required to protect the interests of the patients (Fletcher, 2015). In most cases, this means the nurses being fully aware of factors such as culturally sensitive care and drug sensitivities (Varcarolis, 2016). Further, critical assessment helps nurses to make rational decisions in health care. Although health care is a scientific discipline bound by predefined process and formulas, there are particular instances, which require nurses to formulate new ideas (Pratt et al., 2015). Besides, critical assessment is essential in that it ensures nurses positively influence their patients’ care. It helps nurses anticipate the multiple needs of the patients (Giger, 2016). This paper offers a reflection on my mental health assessment of a patient who had sleeping and eating problems and, in particular, the things I did well, things I could have done better, and the lessons learnt from the assessment.
Background
Arguably, reflection is a crucial pillar of professional nursing practice. It assists mental health nurses, and other health care professionals to make sense of their experiences, adapt their clinical practice, develop new insights, and link their theoretical knowledge to the circumstances of clinical practice (Redmond, 2017). Notably, reflective practice assists nurses in performing holistically. Reflection aids nurses in discovering meanings and connecting them to their own experiences, which help in nurturing their self-worth, empathy and identity (Redmond, 2017). Further, reflective practice enables the health care professionals to see the inconsistencies between their ingrained values and their practice, as such, it is vital in triggering behaviour change.
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Moreover, reflective practice assists nurses in promoting healthy relationships with themselves and other parties. It is imperative for nurses to have a unique contact with their patients. Thus, nurses do not only provide care to the body but also to the soul of their patients (Wells, 2017). Health care professionals can only offer this type of soulful nursing only when they are in touch with their inner experiences and selves (Thompson and Pascal, 2012). It is through understanding themselves and the uniqueness of others that nurses fail to impose their inner beliefs and experiences to others (Horton-Deutsch and Sherwood, 2017). In this regard, those nurses who are self-reflective, impact their clients positively through their practice of the art and heart of nursing (Thompson and Pascal, 2012). They are aware of the fact that despite being empathetic, they should not identify with other parties at the expense of their beliefs and values.
Further, reflective practice assists nurses in embracing reality and preventing possible burnout. Usually, the cortical midline structure (CMS) of the brain is the one involved in reflective practice (Nicol and Dosser, 2016). The part is essential in that it provides a reality check; and as such, any damage to it leads to difficulties in assessing problems and may make an individual overestimate his/her capability (Nicol and Dosser, 2016). Reflective practice helps nurses prevent burnout by ensuring that they are in touch with their passion for nursing. It does this by assisting nurses in identifying and rediscovering their passion (Johns and Freshwater, 2009). Notably, passion about one’s career is an antithesis to burnout.
A Descriptive Overview of the Video Session
In this Video assessment, I evaluated Mr Smith who had been referred by his GP. Smith had sleeping and eating problems, which first began when his wife and daughters left him in September. The GP had referred him after he had missed a scheduled appointment. I started the assessment by introducing myself to Smith and informing him who had sent me and what I intended to garner from him. Patient mentioned how he had sleeping and eating difficulties since his wife and daughters had left him. His daughters had left for University whereas the wife had left because of marital problems. Smith also informed me that he had stopped taking the medications, as he did not see any improvement in his condition. However, I encouraged him to continue taking the medication as their effects usually are seen after 4-6 weeks. He also informed the reason why he had missed the Friday appointment. Specifically, he mentioned that the scheduled time for the meeting was too early. Therefore, I promised to reschedule his appointment to a favourable time.
Critical Analysis of What I did Well in the Session
Undoubtedly, my introduction to the patient is one of the things I did excellently. I mentioned to him briefly, who I was and why I was meeting him. Further, I did this in a light manner, explaining to him why it was important to know who he was to ascertain that I was in the right place. Besides, I introduced myself to Smith in a relaxed manner to ensure that I could build a rapport with him quickly. Conceivably, in a mental health assessment, how one introduces him/herself to the client is pivotal. It is advisable to try to make the clients more relaxed immediately (Johns, 2017). It is also essential to assure the client that their information will not be shared with third parties without his content (Tarzian et al., 2015). In some cultures, mental health is a highly stigmatised issue, and thus the clients need their privacy maintained (Patterson et al., 2016). Accordingly, by assuring Smith that none of the information that he would share with me would be provided to other parties, I supressed any inherent fear or doubt he might have had.
Another thing I did well was demonstrating compassion and genuine interest in the client’s needs. For instance, I was concerned by his habit of shaking and holding his fingers during the assessment. Notably, I asked him whether he was sick or it was the cold that was affecting him. Usually, such kind of questions shows the client that the mental health nurse has a genuine interest in their welfare (Johns, 2017). Conceivably this leads to the strengthening of the bond and rapport between the two.
Moreover, another thing I did well in the session is facilitating comprehensive and extensive engagement with the client. I succeeded in engaging the client in other matters besides his problem. For example, I engaged Smith on his favourite football club. Here, he informed me how Derby County was his favourite club; however, the difficulties experienced by the club in recent time had made him entirely distanced from it. Arguably, this was crucial in having him relaxed and assisting me in building a connection with him. Explicitly, when I informed Smith that my favourite football club was Arsenal, this portrayed me to him as an individual having similar interests. An unsaid goal of a mental health session is to get the client as free as possible to share with the nurse all the practical details.
Additionally, another thing I did well in the session was listening effectively. Active listening is vital in mental health counselling since the counsellor is expected not only to listen to what is being said but also why it is being said, and its meaning in the context of the particular client (Redmond, 2017). Notably, it is through active listening that I fully understood why Smith missed his last appointment. I succeeded in linking his sleeping difficulties and side effects of the medications to his failure in attending the meeting (Johns, 2017). Further, a mental health counsellor has to learn to listen without judgement or evaluation (Johns, 2017). Throughout the session, I succeeded in projecting myself as not being judgemental; instead, I portrayed myself as some who had a genuine interest in his difficulties.
Critical Analysis of what I could have Done Differently in the Video Session
Undoubtedly, my ending to the meeting was laborious. As pointed out by the patient I was overly focussed on finishing the session. Notably, I repeatedly asked the patient if he had anything more to add. Although the client in this particular video session did not negatively react to the repeated questions, some clients may find it irritating. Arguably, although there exists no predefined way of terminating an assessment session, it is a venture that requires added skills and expertise more so in instances where the client assumes a lead role in the session (Riley, 2015). Therefore, in this regard rather than continually asking the client if he had anything more to add I could have reframed the important points gathered during the session. Conceivably, this is important in that it offers the client with insights to move forward (Kogan, et al., 2017). As a result, the client can visualise his/her situations clearly and be in a better position to handle it effectively.
Besides, I could also have summarised all that the client had said. Through this, I would have confirmed whether if I had correctly interpreted all that the client had shared with me. Summarising is vital in that it leads to the clients acquiring added insight on the issue as they hear the therapist regurgitate all the information that they have shared (Geldard, Geldard and Foo, 2017). It also leaves the clients with a feeling that their concerns and problems have been appropriately heard (Riley, 2015). It also offers the mental health nurses with an appropriate framework for demonstrating their empathy towards the client.
Further, I could also have used open-ended questions as opposed to close-ended ones. Open-ended questions reveal particular details that the client might have hidden during the entire session. I could also have encouraged the patient to reflect through the session as a means of terminating it. As mentioned in the preceding sections, this could have aided the client in acquiring greater insight about his situation.
Although throughout the entire session I tried to ensure that my communication with the client was active, there were some particular instances where I did not engage the client fully and thus ended up obtaining insufficient details. Unlike in the introduction and the specific cases where I engaged the client on football matters, most of the other sections were like QA (Question and answer sessions). In this regard, I could have asked the client open-ended questions to encourage him to provide more details about himself in the discussion. Such questions are a technique commonly used by counsellors and mental health nurses to assist their clients in providing more information about their situations (Thompson and Thompson, 2018).
Further, to ensure that I kept the client more engaged and thus collected sufficient details about him I could have employed the technique of capping in the assessment. Capping is a technique that entails changing of the flow of conversation from emotional to cognitive (Thompson and Thompson, 2018). It is often applied where the counsellor or a mental health nurses feel that the emotions of the clients need to be regulated. In the session, there was a particular moment where the client appeared withdrawn and low in moods. At this instance, if I had employed the capping technique, I could have galvanised the client’s interest in the session.
Besides, to ensure that the client was more engaged in the course, I could have employed the proxemics technique. The technique is particularly important in that it aids the counsellors or mental health nurses to study the spatial movements and details of communication exhibited by the client (Riley, 2015). If I could have employed this strategy, I could have known better his feelings and emotions and therefore knew how to keep him engaged effectively (Thompson and Thompson, 2018). Besides, I could also have sought clarification from the client to ensure that he is fully committed. Clarification assists counsellors to confirm what the clients are telling them and therefore understand the situation correctly.
Moreover, another thing, I could have done differently is structure the questions. Based on the client’s feedback my questions were not structured. Notably, as averred by the client, as I was asking one question, I was already thinking about the next question. In the end, this led to the collection of insufficient details about the client. Arguably, if I had structured the question better, I would have acquired greater insight into the client’s situation.
Critical Evaluation of the Knowledge Learnt, and its Implication on the Next Steps
Arguably, from the client’s comments, it is evident that his sleeping and eating disorders began when his wife and children left him. Before that, he had been living with them for quite an extended period. It appears he could not keep up with the abrupt change and this is why he started having sleeping and eating problems. Maslow’s hierarchy of needs best explains Mr Smith situation. According to the theory, human actions are usually motivated by the desire to achieve specific needs. It comprises of a five-tier model of human needs (Fives and Mills, 2016). From the bottom of the pyramid going upwards are physiological, safety, love/belonging, esteem and self-actualization needs (Felicilda-Reynaldo and Smith, 2017). Conceivably, Mr Smith is in the third tier of the Maslow Hierarchy of needs. His crave for companionship, belonging, and intimate relationships after his wife and daughters left was what led to him to start experiencing the sleeping and eating disorders. During the assessment, Mr Smith mentioned how he had stopped going to watch his favourite club Derby and going out after his wife and daughters left. Instead, he would only remain at his home reading newspapers. Plausibly, this illustrates a man in dire need of companionship. Since he cannot acquire the sense of belonging and camaraderie outside, he chooses to remain at home thinking about his sudden change of status.
From the above information gathered from the client, the next step I would take is to schedule another appointment with him, where I would help him visualise that his problem arises out of his craving for companionship and belonging. Notably, I will demonstrate to him how his life was fairing on well before the daughters and wife left (Orthwein, 2017). After that, I will help him conceptualise the link between the sleeplessness and eating disorders with his craving for companionship and belonging. Arguably, through this, I will have demonstrated to him the underlying cause of illness. Subsequently, I will assist him in visualising how his inconsistent sleeping patterns interfere with how he takes the prescribed medications thereby rendering them ineffective (Townsend and Morgan, 2017). Undoubtedly, how an individual takes medication significantly impacts their functioning.
Recommendations
Regarding Mr Smith’s case, I would recommend cognitive behavioural therapy for insomnia (CBT-I). CBT-I is a structured program that assists individuals in identifying the thoughts and behaviours which lead to and aggravate the sleep problems and replace them with routines and habits which enhance better sleeping patterns. The advantage CBT-I has over the sleeping medication is that it addresses the underlying causes of the sleeping problems. The CBT-I techniques applicable to Mr Smith’s case include stimulus control therapy and relaxation training. Relaxation training, which encompasses multiple approaches such as meditation and muscle relaxation among others will assist Smith in calming his mind and body and thereby creating the appropriate conditions for sleep. Stimulus control therapy will help Smith discard of the conditions that lead to his mind and body resisting sleep. Further, I would also advise Mr Smith to take all the medications as prescribed. One of the reasons why the drugs were not ameliorating his conditions was that he was not taking them correctly due to his erratic sleeping patterns. He should religiously adhere to the medication if they are to have any meaningful impact. Additionally, Smith needs to move out often and interact with other people to eliminate the feeling of loneliness. It is apparent that Mr Smith by staying all day indoors continually aggravated his problems.
Conclusion
By evaluating what I did best, what I could have done better and learnt from the assessment, the paper has underscored the importance of reflection in the practice of mental health nurses. It assists them identify their strengths and weaknesses. Arguably, this is important in that it leads to the provision of holistic care and prevention of burnout in health care professionals. Moreover, the paper has shown that assessment, which is the first phase in the nursing process, refers to the process by which registered nurses obtain information regarding a patient’s physiological, sociological, spiritual and psychological status. Further, the article has evaluated the concept of holistic assessment which refers to the health care evaluation which extends beyond the physical health. Notably, that holistic assessment considers the mental, emotional and spiritual health of the patients.
