This essay will discuss an episode of care for an individual in which I have been involved in during practice placement. I will use a recognised model of reflection, Gibbs Reflective Cycle, as a structure to describe the situation and examine my personal values and beliefs, relating to the individual receiving care, and their families. I will conclude by using theories related to values and beliefs, to explore how these values and beliefs underpin my practice.
Gibbs Reflective Cycle
It is my duty now and throughout my training as a nurse practitioner and also according to the MNC code of conduct, to protect a client or patient’s personal and sensitive information and disclosure. Hence for this reason, I shall refer to the client use concern as Paul throughout this essay. I will be using Gibbs reflective cycle (1988) model. Reflection is a “systematic, critical and creative thinking about action with throw) - intention of understanding its roots and processes” (Fish and Twinn,1997). I have chosen to use Gibbs’ model as a framework because I can explore my thoughts in a descriptive manner.
Considering the Gibbs Reflective Cycle I begin by explaining what happened and the situation I experienced, as per Gibbs. Paul is a 20 years old black male, admitted in a rehabilitation unit under section two of the mental health act, which is being detained for treatment. He has been there for four years. He is from Africa and had originally come to England on a scholar ship towards his higher education. However, he never had the chance to study since he became sick and consequently got hospitalised. Although he has been receiving treatment, he is currently not entitled to any state benefits due to his immigration statues. He is also facing deportation. Paul will regularly help around the unit for a five pounds payment weekly.
Throughout the years, the immigration office has required a regular update on his progress. They are proposing deportation as soon as his doctors and primary nurses confirm he is well enough to go back into the community. Paul however, has been in hospital for a long time and has no recollection about his family and finds difficulties being socially included even within his peers in the unit. He is the youngest client, has neither age mates nor friends in the unit. His personal notes do not also have sufficient information about his life before he arrived in England. Paul has never been visited or knows anyone besides those he has met whilst at the hospital.
Despite this uncertainty, he is still facing deportation. His doctor, social worker and nurses are very unhappy with the situation but there is very little they can do. Also, he has no family known within the country or abroad; hence no guarantees he will be safe, should he return to his home country. There is also evidence Paul is very distressed about the situation and will sometimes try to escape from the unit in fear. There have been three incident reports on abnormal behaviours and attempts to jump off the fences in the last month. As a result a meeting between all his careers and a representative from the home office is called for. I attended this conference together with my mentor. At some point during this meeting, Paul is called into room for some questioning. Two weeks later, a decision is reached and Paul is discharged from the unit. He now awaits deportation.
According to the next stage of the reflection model in Gibbs Reflective Cycle, I then consider my feelings, then an evaluation and analysis of the situation.
This case encouraged and evaluation of the Gibbs Reflective Cycle, helped me to think subjectively and objectively. Although I could understand the dilemma — that is between the law, health professionals and the final decision, I was surprise to see how the client and his careers — including the authorities’ values and beliefs were being taken into consideration.
Values are those assertions or statements that individuals make - through behaviour, language, choice of words or actions — that define what they think is important and for which they are willing to suffer, or even, in some cases die. A value is a personal belief or attitude about the truth, beauty or worth of any thought, object or behaviour’ (Tschudin, 1992).
Objectively and according to the authorities, Paul had over stayed his rights to stay in the country. For this reason, he was to be sent back home as soon as declared fit to travel. On the other hand, his careers knew and accepted he was well enough to travel but disputed the fact he was ready and it was save for him (and other) in the community, especially considering the fact he had no one waiting to receive him back home. I shared the same view with the nurses and doctors that it was not in Paul’s interest to be deported, at least not yet. This action defiled professional values towards the client. Subjectively, I thought, those who eventually sanctioned his return were not in acceptance of Paul’s current concept of ill health. I also questioned if this reflected applying equal quality of care. I say so because, the client who had been receiving care until now, had to stop receiving treatment and care, due to his immigration status. I strongly believe he should have continued his treatments and care until he was well. There was still evidence, Paul was suffering from thought disorder and as a result abscond.
‘Patients’ mental health can be divided into those that are positive and should be respected and those that are unacceptable and should be colluded with’ Colin et al (2001).
Although he will run away from the unit, Paul was happy and had some knowledge and insight of his condition. He will disappear whilst responding to voices — in fear of being captured. This behaviour was not tolerated and there was fear the client while at large and the public were at risk.
Hence, he should have stayed within his careers until more and satisfactory information about his family abroad was established. This way, Paul is safe in a contained environment, where his needs are met respectfully. As a means of containing him, there will sometimes be a fifteen minutes observation chart, to know his movements. Personally, I realised Paul will become more agitated when told he would have to be deported. I think, these issues should not have been discussed with the client. A conversation after his recovery and less pressure would have been a sensible approach. I also thought, Paul should have had a chance to present his situation in court before a final decision. However, his ill health did not permit this.
I also wondered if he was a victim of discrimination and being judged. Clients come from all backgrounds of class, place of origin, life style, sex and physical characteristic. Anti-discriminary practice involves not showing favouritism and not denying care, treatment or attention to anyone on the basis of such difference. (Thompson 1998).
As an evaluation and during my placement at this unit, Paul enjoyed working with me. He would normally say I reminded him of his mother. He believed I was a relative who had come to help him escape. He would regularly write down his detailed plan to escape and give to me. However, on most occasions, he was found and brought back to the unit after going awol. Paul will be so bitter towards me, accusing me of betraying his trust.
This was my first placement. It was also my first experience within a mental health setting. I commence this placement with no expectations and very little research about that kind of unit and what the kind of clients I would encounter. Upon arrival, I immediately felt comfortable with all the clients in the house. They were all friendly towards me and were all dependant around the unit. Paul in particular spends a lot of time talking to me and wanted more attention. As naive as l was, my initial thoughts about learning in order to achieve all my objectives, was to get closer to the clients. It was a good experience to meet a wide range of people with very differently personalities. I spend a lot of time bonding with these clients and forgot to remember I was there to help them with their rehabilitation programmes and were likely to move on some day. I also did not remember I was there for a limited period.
To analyse, our values and beliefs feed into our attitudes and these are of interest because they can and eventually do affect how we behave with others. (Lesley Baillie. 2005)
I felt very emotional on a daily basis. This was a young man, with no family. I was very disappointed with the fact that he lived on hand outs since he had no money. He had very little recollection of home and his life before. I was more concerned about the level of care he will receive should be become of ill health again. My opinion about mental health care in some part of Africa is disturbing. I know third world countries do not have an advanced system as compared to the system here in the United Kingdom; I am referring to a constructive collaboration between professionals working together towards the aim of providing the best care for their patient. Most civilians in certain countries in Africa have to pay for their medications and care. There is no financial help toward this care, even to those on low or no income. That is why I was more alarmed about an adolescent returning with mental health illness into a less adequate community. The Mental Health Foundation (MHF) (1999) stated that: ‘Good mental health isn’t just the absence of mental health problems.’ Protecting the wellbeing and mental health of young people is considered very important, since this is the most crucial part of development. During this rapid and dynamic transition of development, young people with existing chronic health and illness, including health-related problems, could be greatly affected. However, because these challenges and coping strategies will differ accordingly and depending on the individual and their family, there will be instances where some individuals develop mental health problems; hence impairing the young person’s social, emotional and physical health. This can affect the person’s normal functional ability - causing disorders such as; depression, chronic fatigue syndrome, conduct disorders, severe and frequent temper, tantrums beyond the expected age, thought disorder, eating disorders, self-harm and suicide. (British Medical Association 2006).
Finally, after exploring my thoughts and evaluated the situation, I am now able to see where I went wrong and consider what else I could have done and what I will do differently next time.
My mentor, being Paul’s primary nurse, allowed me to have a one to one meeting, whenever he requested. I could understand he preferred talking to me mostly because I appeared interested and being a young female also of an African background. However, I should have controlled how much time I stayed with him and instead concentrated on building a nurse — client therapeutic relationship. I should have also invited my mentor or any staff on duty to seat in during some of those meetings. I should have read his files to know his past history and possible risks if any. Although there were never any case of violence towards me, Paul’s notes stated he had sexually harassed female nurses during his stay in the hospital. I should have also discussed all the notes he wrote to me with my mentors, so that together with other staffs, deal with the situations before it occurred. I had disregarded some of the notes and would return the next day to find out he had done exactly as he had previously told me. I now realise and see how observation and accurate reports to staffs such be the foundation of my future career. I was later thought how to use the system to read and write notes daily. This way, I was updated on issues and changes towards Pauls care in my absence. Next time I would listen carefully during handovers and go through all documentation. I should have approached Paul as per his care plan in place, so as to help him and the nurses towards his recovery, instead of having friendly conversations.
I should have also not encouraged those conversations, within which he thought I was his mother and as result needed too much attention. Personally, I think I got too involve. I attended all his ward rounds and reviews and will regularly see the frustrations amongst the staffs. This lead to myself showing more sympathy that necessary I should have empathised with him instead. I should have realised I was getting too attached emotionally to this particular case and adapted some professional boundaries.
The day Paul was discharged; he was accompanied with a police escort. He was in tears and so was I. Next time I will try to hold my emotions and avoid crying.
Understanding the Gibbs Reflective Cycle and this journey helped me learn more about my clients. I had the opportunity to apply some of the knowledge thought on the course. I use to think I was not judgemental, but I realise how easy it could be to think about it, and base vital decision on personal thoughts.
Check my profile for more articles