In nursing profession, it is important for nurses to reflect and evaluate on their practice so as to enhance in their clinical knowledge. According to Gibbs & Andrew, 2001, the process of reflection allow nurses to explore their strength and limitation, it also provide them the opportunity in evaluating their clinical skill. As a psychiatric nurse in the local major tertiary psychiatric hospital, the applying of reflective model in my daily clinical practices served as a reminder in improving my clinical knowledge and skill. Nevertheless, reflective model had enhanced my understanding on my patients’ emotion and behaviour. According to Gibb’s theory of reflection, there are 6 steps actions in Description, Feelings, Evaluation, Analysis, conclusion and Action plan cycle to follow. I will be sharing one of my learning experiences in handling one of my psychiatric patients in my life event by applying the skill in theory of reflection.
Gibb’s theory of reflection
My Bangladeshi foreign patient who was diagnosed with Psychosis, he was admitted to the local major tertiary psychiatric hospital acute psychiatric ward. The patient was assessed in the emergency department by the psychiatrist, due to suicidal ideation, patient was detained in the hospital under Mental Healthcare and Treatment Act as he is required to receive psychiatric treatment. Patient was admitted to my opposite ward as there are 2 admitting wards in each level. During the night time, patient entered to the prohibited area in the dormitory utility room, inside the room, the patient managed to open the window grilled and climbed out of the window. At that time, patient was trying to escape from the ward while walking along the 5th floor of the parapet, the night duty nurse discovered that the patient was standing outside the window and she quickly informed me to help in this situation.
Many thoughts had come to my mind on “how the patient managed to get out of the window and whether he will jump down from the parapet”. When I arrived to the opposite ward, I was shocked to see that the patient is in the brink of falling while pacing along the parapet. Everyone was bewildered and lost in this scenario, as they are unsure on what will happen in the next moment. As soon as the night supervisor had arrived, the supervisor was composed in distracting patient unstable emotion. The supervisor had instructed the assistant nurse to retrieve the key so as to open one of the window grilled, he had also informed the following staff to control the crowd and not to alarm the rest of the patients. After 30 minutes, the patient had finally dropped his idea in escaping and he came back from the window grilled. Our heavy hearts are finally at eased when patient stepped out of the parapet boundaries. The supervisor continues to comfort the patient by body gesture and simple English as there is language barrier between both of them. He also reassured to patient by providing him a warm beverage and some biscuits. In the end, patient was transferred out to high dependency psychiatric unit for closer monitoring.
After the incident, I realised that the whole situation was conducted in a systematic, neat and safe way. During the event, all of us were overwhelmed by the incident. The night supervisor had showed us that we must be calm in handling patient anxiety despite there is fear that patient might have jump out of the parapet. Throughout the event, it is normal that we will have fear and worry about patient safety however all these feeling and thought are not helping when it had control our thinking in this situation. From this incident, I have learned to be mindful of my thoughts and behaviour as it had prepared me to handle my clinical issue in my ward.
The Bangladesh patient is a foreign worker in Singapore, it must be very stressful for him to be admitted in a unfamiliar psychiatric institution. Due to language barrier, it had further hindered him to understand the rule and regulation in the hospital. In this scenario, it is important for us to look into resources that might help the patient. Resources like engaging a Bangladesh translator from embassy and allowing the fellow native colleague in support may prevent the incident from happening. Patient may also gained better insight in handling his emotional more efficiently. Another preventive measure is to identify and evaluate our ward safety in the environment. Many of us had assumed that the ward structure is safe enough for our patients but this incident had alerted us to reconsider our workplace facilities and whether it is safe as we do not want another similar incident to happen again.
After the incident, I realised that this event may lead to tragedy if the night supervisor was not around and we have to handle the situation. I had learned to recognise the important in showing empathy to my patient by listening to their needs and to understand their feeling. According to Morrison, 1998, reflecting on handling patient emotion is essential in constructing a more effective intervention. This event had widened my psychiatric experience in clinical handling and taught me the important in engaging with our patients.
According to Morton & Fontaine, 2018, the holistic nursing approach includes the skills in showing empathy and compassion. All patients are different in their characteristic, diagnosis and even culture. I have learned from the night supervisor that nonverbal communication like body language does interpret greatly in this scenario. The night supervisor was genuine and sincere in his speech, the patient had trusted him and cooperate to return back to the dormitory. The night supervisor action had influenced me a lot on what a psychiatric nurse can do for the patient. Many times, we have to be considerate in patient feeling and to respect their thought.
The clinical practice in model of care has to be change and evolve as patient health and mental conditions are complicated (Driscoll & Nicholls, 2007). Many clinical studies have also suggested on the important of having a guided reflective practice in the clinical setting, it helps to improve the quality of nursing care and improve our patient health condition (Wilshaw & Trodden, 2015). It is essential for nurses to have a guideline in reflection model as it is the most effective way for the nurses to progress in their clinical practices (Gibbs, 1988). According to Wilshaw & Trodden, 2015, the implementing of reflective model reduces nurses’ burnout in meeting the high demand in clinical, it also empowering nurses’ decision in delivering nursing care to our patients. Furthermore, the integrating of reflective model is necessary as it create a healthy, supportive and conducive culture for the nurses and organisation.