Part One

Ideally, mental health issue encompasses an array of situations that are felt by a particular individual mentally as well as physically. In this light, mental health refers to emotional well-being and mostly defines the way an individual feel, think, and behaves (Wedgeworth, Carter, & Ford, 2017). The relevance of working with patients suffering from mental health difficulty was challenging at the start but with time I got used to it. This paper will focus on a reflective account while at my placement where I came across patients who were suffering from Alzheimer as well as dementia. The paper will achieve this by describing the nursing skills which I undertook while at my placement program using Driscoll’s (2000) reflective cycle. Driscoll’s (2000) reflective cycle is a rather recognised structure that I used when demonstrating my ability, particularly when reflecting on a variety of nursing skills (Driscoll & Masters, 2018). This cycle focuses on three main processes when reflecting on an individual’s practice. Additionally, the processes include what (what took place), so what (what an individual felt including what was good and bad from the experience), and Now what (in case one was to undergo a similar experience, what would be done differently) (Riegel, Jaarsma, & Stromberg, 2018). The main relevance of using Driscoll’s (2000) reflective cycle is that it will assist me to link between theory and practice in my learning and work experience. In this light, I will use Domain 4- Communication and interpersonal skills.

The practice of reflective accounts as stated in the Nursing and Midwifery Council (NMC, 2004), will enable me to explore through experience as well as identify areas of development or rather improvement with an aim of providing the required quality of health care services. In this light, reflection remains a significant way of attaining the desired knowledge as well as understanding the need of patients. Consequently, reflecting on experiences which could turn out to be positive or even negative allows an individual to perform a process of self-criticism.

Through my first skills, I will explore how communication can be enhanced particularly for those clients who have impairments that I raised in one of the multidisciplinary team meeting (MDT). In this light, I intend to draw from the knowledge as well as experience that I gained from that organised meeting which involved social workers, speech as well as language therapist, mental health nurse, adult nurse, and career experience. I will use one patient whom I will not reveal his real name for the purpose of privacy of personal details. In this light, I will go ahead and use the name ‘Jack’.

1st skill: Communication and interpersonal skills

During this experience, I came to understand the level at which nurses, as well as support workers, communicate with other service users are not of the required standard. Apparently, this is simply because they tend to have a rather impairments that included hearing and speaking.

Furthermore, this led me in carrying out a research on the issue of communication something I discovered in the placement.  Notably, other studies have estimated that close to 2.5 million people in the United Kingdom has communication impairment (Communication Forum) (Kelly, Watson, R., Watson, J., Needham, & Driscoll, 2017). The research estimates that about 50 to 90percent of the individuals who have intellectual challenges or disabilities have been found to have communication problems (Cutcliffe & Sloan, 2018). On the other hand, it is estimated that close to 60percent of those individuals with intellectual disabilities have been found to have some sort of skills in symbolic communication by the use of pictures, symbols or even signs (World Health Organization., 2015).

What

The classification of impairment, disability as well as a handicap in relation to communication difficulty in mental health patients as described by the World Health Organization is disruption which tends to alter the normal language-processing or even speech system (Logsdon, Morrison, Myers, Capps, & Masterson, 2018). For instance, such people often find it difficult in finding the right words that they can use or even being unable to read sentences. Additionally, such people have a rather reduced spelling ability as well as the reduced ability to pronounce certain words clearly (World Health Organization. (2015). Communication is considered a process that often involves a significant exchange of information between two people or more through verbal expression and non-verbal strategies. In the same way, people use communication strategies to express their feelings, thoughts, opinions, needs, and conveying facts (Odd, Lewis, & Brook, 2017). When a particular message is received by an individual, it is expected to be interpreted correctly thus resulting in a response. In other individuals, there are obvious delays in relaying response in intended time due to the communication impairment. Notably, this is the same situation that happened to Mr. Jack who I encountered during my placement practice. I felt frustrated at some instances because I felt that the nurses and support workers were not patient enough when handling him.

I tend to recommend the use of both verbal as well as non-verbal communication strategy when handling Jack. This is important especially to make sure that information or rather the intended message has been passed in a clear manner. There is an apparent need to make sure that there are devised strategies of communication with an aim of promoting empowerment while building on the already existing strengths (White, 2017). This way, there would no reinforcement of a sense of helplessness and overall power imbalance. According to recent studies, using non-verbal as well as verbal communication strategies in an appropriate manner can assist nurses or carers and families to communicate while enhancing the communication experience for Mr. Jack. For instances, nurses and carers are required to come up with a rather conducive environment, while listening in a careful manner to everything that Mr. Jack is trying to say while observing his overall body language.

Furthermore, nurses should use a positive body language when conveying warmth as well as reassurance while speaking slowly and making sure that they use short and simple terminologies. Above all, Mr. Jack should be granted an opportunity to speak in an indirect manner with an aim of expressing himself. During this time, I tried my best to emphasise the overall need for us as nurses as well as support workers in being creative, adaptive and most of all being skilful with an aim of avoiding disempowering Mr. Jack given the fact that he has a communication impairment. One way in which individuals with communication impairment are being disempowered is by being outpaced, moving as well as acting in a quick manner that these people are unable to understand what is being relayed. Additionally, such people are disempowered when they let one speak just because they cannot catch up with the pace of the one speaking.

So What

The overall experience with the MDT has hugely emphasized on the significance of the inter-professional working together given the fact that it tends to provide rather holistic care services to the patients. Learning that was obtained from this sort of experience will no doubt have a huge impact on my future practice in different areas that include communication as well as empathy. I am, therefore, mindful of the various difficulties that were experienced by Mr. Jack. Notably, this has therefore increased my understanding of the practice of clinical medical practice where I have observed a variety of cases of mental illnesses which can impair an individual’s ability to communicate. Such cases include dementia, schizophrenia, depression as well as psychosis. In essence, these illnesses have in many cases cause cognitive impairments which have mostly interfered with an individual’s ability to clearly think, manage their emotions, distinguishing between fantasy and reality, making the right decisions, and relating with others. In this case, I have learned a lot regarding Mental Capacity Act of 2005 that tend to provide guidance on the factors that should be considered especially when making decisions in the best interest of an individual particularly patients (McCutcheon, O’Halloran, & Lohan, 2018).

As a qualified nurse, I would make sure that various decisions are being made on behalf of the patients or rather the service users. Notably, this will be arrived at after considering enough consultations with the service users.  In essence, this is because communication advocacy is regarded as a rather universal moral obligation of the nurses while undertaking their service delivery and therefore acts as an important foundation of nursing. In many cases, communication advocacy has been tipped to transform the lives of those individuals who have learning disabilities thus enabling them to be able to express their needs clearly and making good decisions.

In the aspect of mental health nursing, empowerment is often regarded as the intent of ensuring that various conditions are made such that certain individuals can operate as a self-advocate (Squirrell & Hunt, 2018). Notably, this experience has been able to highlight various difficulties that are likely to be encountered when communicating as well as gaining valid consent from patients particularly those suffering from mental illness and thus I will be aware of it in my future practice (Serneels, Villanueva, Imeraj, Vanfraussen, & Lampo, 2017).  

In a nutshell, various steps towards improved health care services can be made through the provision of encouragement as well as support to better communication particularly between the nurses or the support workers and those carers with communication disabilities. This should be done with an aim of reducing any restrictions that would limit people like Mrs. Jack from accessing better health care services.  

References:

Cutcliffe, J. R., & Sloan, G. (2018). Competences for Clinical Supervision in Psychiatric/Mental Health Nursing. In European Psychiatric/Mental Health Nursing in the 21st Century (pp. 123-139). Springer, Cham.

Driscoll, K., & Masters, K. (2018). Law and Professional Nursing Practice. Role Development Professional Nursing Practice, 405.

Kelly, J., Watson, R., Watson, J., Needham, M., & Driscoll, L. O. (2017). Studying the old masters of nursing: A critical student experience for developing nursing identity. Nurse education in practice, 26, 121-125.

Logsdon, M. C., Morrison, D., Myers, J. A., Capps, J., & Masterson, K. M. (2018). Intention to Seek Depression Treatment in Latina Immigrant Mothers. Issues in mental health nursing, 1-5.

McCutcheon, K., O’Halloran, P., & Lohan, M. (2018). Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial. International journal of nursing studies, 82, 30-39.

Odd, D., Lewis, L., & Brook, J. (2017). Research roundup: August 2017. Journal of Health Visiting, 5(8), 370-373.

Riegel, B., Jaarsma, T., & Stromberg, A. (2018). Theory of Self-Care of Chronic Illness. Middle Range Theory for Nursing, 2017341.

Serneels, G., Villanueva O’Driscoll, J., Imeraj, L., Vanfraussen, K., & Lampo, A. (2017). An Intervention Supporting the Mental Health of Children with a Refugee Background. Issues in mental health nursing, 38(4), 327-336.

Squirrell, B., & Hunt, J. (2018). A nursing student’s reflective account of decision-making in a school nursing setting. Nursing children and young people, 30(2).

Wedgeworth, M. L., Carter, S. C., & Ford, C. D. (2017). Clinical Faculty Preceptors and Mental Health Reflections: Learning Through Journaling. The Journal for Nurse Practitioners, 13(6), 411-417.

White, E. (2017). Claims to the benefits of clinical supervision: A critique of the policy development process and outcomes in New South Wales, Australia. International journal of mental health nursing, 26(1), 65-76.

World Health Organization. (2015). The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2015 (including the 19th WHO Model List of Essential Medicines and the 5th WHO Model List of Essential Medicines for Children) (No. 994). World Health Organization.