Reflective Portfolio on Mental State Examination & Schizophrenia Patient Care Assignment

Exploring Nursing Practice, Interdisciplinary Collaboration, and Personal Development

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Reflective Portfolio on Mental State Examination and Schizophrenia Patient Care Assignment

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Part A

Introduction

The NMC code mainly contains a specific series of truer statements that are usually taken by qualified nurses in every hospital sector. It mainly focuses on the working procedure of the nurses in the hospital and nursing homes. They also have to follow the NMC code in their working procedure.

Discussion about NMC standard

The NMC code includes a huge number of activities in the working sector of the nurse. The chosen standard is “standards 1,2,3,4 and 5”. They are described below-

  • The nurses have to treat people as individuals and also uphold their dignity

All nurses in the hospital and the nursing home have to work properly and they also have to take care of the suffering patients in the hospital sector. They also need to treat all suffering people with kindness and they should respect the patients (Rajan-Brown et al. 2020). It needs to make sure that the fundamentals which are delivered to the patients are very essential for them and the nurses have to take personal care of the patients. In that case, the patients are very helpful to the compassion of the nurses. They also take care of the human rights of the patients. The nurses are also available every time as per the patient's need. They should behave friendly to the patients as the suffering patients can easily trust them on the hospital premises. The nurses should respect the patient's needs and the upholding process should be overcome by qualified nurses in the hospital sector (Code et al. 2021). They have to make sure that any treatment process of the patients has to do on time and doesn't delay the working procedure. It may effective for the patient’s health. The nurses are responsible for the delivery system of essential treatment to suffering patients.

  • Listen to the patients and respond to their concern

The nurses of every organizational sector have to do their work in partnership with the suffering patients and they should deliver the perfect care to the patients it is making sure that the patients are not in dangerous issues in the hospital sector. The nurses have to recognize and respect the effective contribution of the people in the health care society (Shelke et al. 2022). Social care health wellbeing should be very well developed in the hospital sectors. The nurses have to encourage the power of the suffering people as they easily overcome their issues related to health. They have to take proper decisions in the healthcare treatment and effective care for the patients of the hospital. Qualified nurses always respect the high level of the receiving care of patients who are involved in various issues of their health. Every people have the personal right to make the proper decision about their health according to the NMC code. The nurses always respect the rights of the patients the refuse care and treatment (NMC, 2018). Sometimes they are not interested to take care or treatment from the hospital authority, at that time the nurses have to realize their health problem and also convince them to take proper treatment.

  • Make sure that the patient’s physical, psychological, and social needs are responded

Nurses always need to focus on the promoting well-being of the patients and they should prevent the health issues of the patients as per the basic rules and regulations of the hospital sectors. In every life stage, all people fall ill in their life, in this case, they have to consult with qualified doctors as per their needs (Ball et al. 2019). Thus they will overcome health-related issues of their health. The nurses have to take care of the development of the healthcare sectors and they have to recognize compassionately the basic needs of the patients of the hospital. All nurses have to work in partnership in the hospital sectors which will help them to reduce the health-related issues of the patients in the hospital. They also have to keep the basic information about the health-related problems of the patients. Every time they have to support the suffering patients as per their needs. They mainly act as an advocate to challenge poor practices and the different attitudes of the patients. In this process, they have to overcome the related issues of the health of the suffering patients (Ghosal et al. 2022). The workers have to follow the basic rules and regulations of the government as they easily overcome the patient-related issues of the hospitals.

  • Act in the best interest of patients at every time

All qualified nurses have to balance their working procedures and should act in the best interest ratio of the hospital. They also noticed the outcome of the patients about their work. Patient review is most important in the working sector of the nurse (Ball et al. 2019). They should make sure about the documentary of each patient of the hospital. It is to make sure that the proper documentary is made for the patients. The nurses also keep the relevant mental capacity to handle a huge number of patients at the same time and they should overcome the related issues of the patient’s healthcare service. If any problems occur then the nurses have to consult with their managers and colleagues in the hospital. It will help them to provide perfect care to the patients. In that case, the suffering patients are also very helpful from the essential care of the nurses in the hospital (Code et al. 2021). The colleagues need to take responsibility for patient care at every time of their duty. The managers of the nurses have to focus on the crucial work of the nurses in the hospital sector.

  • Respect the patient’s right to privacy

All nurses have to protect the privacy of all patients in the hospital. It is to make sure that the information of the patients is secured and should be private from others (Ghosal et al. 2022). In that case, the suffering patients believe the nurses very easily and also cooperate with them. They also have to be familiar with the suffering patient, which will help them to cure the health problem.

Conclusion

The NMC code is very essential for the working nurse of the hospital. Qualified nurses have to work hard and also properly in their organizational sections. The code also helps them to increase their professional carrier in the hospital and it also influences them to care the suffering patients.

Part B

In the study, the paper provided reflection which is an integral part of Nursing as it encourages current skill improvement by exploring the individualimpact of quality-of-care nursing practice delivery (Kironet al.,2017).There are many types of reflection models that include various methods to illustrate the paper in reflections such as Gibbs, Schon, Rolfe’s and John’s models of reflection. I have had the opportunity to gain experience in various mental health settings such as older adult acute, psychiatry liaison, medium secure forensic service, perinatal community service and currently at the psychiatry intensive care unit (PICU). Throughout this easy, I will use Gibbs’(1988) reflective cycle to analyse and explore my experience during Mental State Examination (MSE) in Liaison Psychiatry Service(LPS), and highlight the impact on my development and nursing learning. Looking back, I have developed many useful transferable skills, especially the leadership skill that will enable me to function efficiently as a nurse and mostly useful in running a shift. Throughout this easy, I will use Gibbs’(1988) reflective cycle to analyse and explore my experience during Mental State Examination (MSE) in Liaison Psychiatry Service(LPS) and an impact on my development and nursing learning. In this essay, I will critically examine interdisciplinary working and refer to local and national guidelines in the delivery of care. I will critically explore effective leadershipand address the skills required to support and supervise students while critically reflecting on an episode of care. In doing this, the 6 cyclical stages of Gibbs modelnamely; description, feelings, evaluation, analysis, conclusion and action planwill be used as guide in my overall reflection. The framework allows me to cite and describe my experience through MSE of patients, reflect on their feelings during the course of event, evaluate the outcome of the situation, analyse it with logical thinking and draw up conclusioWebsitesn that will enhance the action plan or changes to carry forward.

As I am rounding up on my nursing training with final leadership placement and I will soon embark on my preceptorship, my rationale for choosing Gibbs (1988) is based on using the 6-step model to identify my areas of strengths, areas for development and actions I can take to enhance my professional skills for my nursing career. The first three steps of Gibbs Reflective model relate to my overall experience during this past three years of my nursing training. Last three steps will help me focus on how I could improve on my experiences and the outcome in the futureAs quoted by Gibbs (1988) that states that experience is not enough to learn efficiently. The experience needs to be practised thoroughly for the proper generalization of the practice in the role of nursing (Heinenet al. 2019). Over the course of my three years nursing program, both theoretically and in practice

Description

John aged 25, was accompanied to Accident and Emergency (A&E)department of the general hospital by his long-term girlfriend who had become concerned about his recent behavior and bizarre presentation. John terminated his part-time work about 6 months ago,“he increasingly spent more time alone in his flat, then disclosed to his girlfriend that Government scientists had started to perform experiments on him over the last year”. After several persuasions from his girlfriend, John agreed to visit A&E where he was referred to LPS for assessment after he revealed to them during general clinical examination that he “heard the Men’s Voices” as “clear as day”. John went on to explain that the voice told himitwould involve the insertion of an electrode into his brain with gammaWebsites rays transmitted from Government headquarters.

He further complainedthat he feels unsettled in mood when he hears the Neighbor’s dog barking in the middle of the night. Pathophysiology, it was ascertained that he was suffering from visual and auditory hallucinations, as John reported he sees things out of the ordinary; seeing things or people that are not there and reaffirms hears voices. Johnsuffers from extreme paranoia and suspicion including obsessive defensive behaviorsas reported. John states that he always feels the sad and hopeless all the time. According to NICE guidelines, the mental issues John is experiencing and the feelings he expressed could be as a result of limited amount of serotonin.The standard mental state assessment tool (MSE) was used during nursing assessment and formulation. I observed my practice assessor conduct the full mental state assessment and I was permitted to contribute to the questioning session with John’s consent.

I was assigned the task to identify andformulate John’s risks. After using the 5Ps risk formulation to determine the presenting, predisposing, precipitating, perpetuating, and protective factors in connection with John’s current presentation, John was deemed ‘Low Risk’. John explicitly denies having any thoughts to harm himself or take his own life, there was no established risk from others , except from the unfounded belief that the government wants to hurt him. During therisk formulation, there was no factor that indicated that John posed a risk to others.

Since John is not opened to any mental health service, his case was discussed in the team’s clinical hand over meeting. It was suggested by the consultant to start John onSelective Serotonin Reuptake Inhibitor(SSRI) medications like antipsychotic, antidepressant, and mood stabilizers.The discharge plan was to notify John’s GP of his current mental health issues and refer John to the Community Mental Health Team (CMHT) for further recovery support. I explained the plan to John under supervision, and he verbally agreed to the plan. The role of the nurse is very effective in terms of communicating with the patients. Fake-Movahedi et, al., (2016) emphasized that when there are communication barriers; Overcoming a difficult situation is the study of the need to adapt within oneself (Bastableet al. 2021). Throughout my engagement with the patient, I adapted the type of communication that focused on points in a clear and concise manner, to allow John a good understanding of his current situation and the treatment plans mapped out for him.

Feeling

Looking back to my emotional state during the overall mental state examination conducted with John, admittedly, I was somewhat apprehensive when formulating John’s risks and determining the risk category to put him. Justifying the reason for classifying John a low risk patient to more advanved and more experienced Liaison Practitioners was nerve-racking

However, I was reassured and guided by my practice assessor, Iinitially felt uneasy presenting Johns formulation to the team. I became more at easy and confident as I carried on with my delivery when the team agreed with many factors I highlighted in each of the 5Ps category.

Evaluation

My leaning experience with the LPS team boosted my confidence in dealing with patients with different mental health conditions and different bizarre presentation. I was able to developed my MSE skills outstandingly, which help me in my preparation for my OSCE exam. I was able to develop the expected skills 1-10 carefully,with my experience at LPS. This helped me to build my confidence and improved my communication skills which are essential in my nursing role. Another strength of this experience is that I was learnt a lot of valuable nursing skills which are consistent with the guidelines that would enhance care. I was grateful to for my practice assessor’s support during my placement period at LPS. I learn effectively from a vicarious approach as my practice assessor treated me as a colleague with professional respect.

I received some constructive feedbacks and numerous compliments at my time with LPS; one of which is that my nonverbal cues emulated Egan’s ‘SOLER’ principles, which are designed to convey active listening and openness. The use non-verbal cues like maintaining eye contact, but nor staring during the examination is usually reassuring and relaxing. When patient feels actively listened to, they feel heard and they are able to trust their examiner and engage more. This enables patient to feel more at ease with nurses or healthcare practitioner in general. According to…patients are able to open up about their problems, thoughts and feelings when a good trustworthy relationship is built between a care giver and care receiver.

Analysis

The 'SOLER' concepts outlined by Egan (1975) stand out as the most important aspect of my reflection because of the concept potentiallyhad beneficial effects on my OSCE exam and their suitability for integrating pedagogical theory. The application of it by Egan (1975) was demonstrated to be successful when conveying communication and analysis. John’s holistic treatment plan, "I explained it complimented a warm approach that was used by myself," and "holistic care plan" are both registered trademarks of Holistic Health treatment, Inc. Stonehouse (2017). This indicates that it can be a highly valuable method to enhance good rapport and trust in the patient therapeutic relationship-particularly for schizophrenia patients as their sensory perception can be altered. This will put John at ease by proposing and employing therapeutic touch. Stonehouse (2017) highlighted that it can be a very useful strategy to enhance good rapport and trust in the patient therapeutic connection.

Bandura (1977) stated that social learning theories are effective through vicarious reinforcement, as was stated earlier on this page. As I also identify similar personality traits to my examiner, I believe that this strengthens my learning as I noticed myself modelling my behaviour during MSE on the practise that I have witnessed. As I advance in my nursing profession and move closer to becoming a fully licenced nurse, I intend to incorporate this part of social learning theory and reflective framework into my interactions with patients and fellow nurses. Since Ellis and Astelii (2017) emphasise that this would ensure the quality of patient care and it will encourage transparency, safety among lecturer and student to allow examiner comprehend student clearly, it was essential that communicate well and was modified to fit patients and careers.

Conclusion

The study had given a thorough understanding of the importance of communication that needs to be adapted for MSE and Schizophrenia patients. The core principle of the role of a nurse in the study has been reflected in that effective communication skills are highly required for them to interact with the patients and understand their problems. The factor of person-centered care is also involved in the context. Generally, My initial anxiety of observing the MSE with the allocated responsibility to formulate the patient’s risk was due to my inexperience of having an extensive one-to-one discussions with patients. My previous practice experiences were mostly ward-based whereby I had brief, yet substantial interactions with patients regarding their treatments and for therapeutic engagements. The experience of the study encouraged me to understand the learning of the role of nursing in the case of the mental health sector. The study had given me effective strategies to build up my skills to perform efficiently in case of a real situation. The practice will give me efficiency in putting up all the factors together and working for the well-being of the patients. I can now work putting the knowledge of what I have learned and can implement it in the field of profession. It had given me the confidence to perform the role of the nurse in an emergency situation when the condition of the patient is critical. My thinking capabilities are changed and now had implemented in the critical thinking of the study and the process of the nursing practices. 

Action Plan

I will participate in online training to learn more about the illness and what the best practise guidelines are when it comes to providing care for patients or responding to questions about the patient who has schizophrenia. This will allow me to expand my understanding of patients who have schizophrenia and how to continue to use partial and full MSE to deal with patient, understand their mental health issues, be able to formulate their risks and make appropriate recommendations/Websitescontributions for their treatment. I believe that this will be beneficial to my practice because it will enable me to become more aware of how to provide personalised care that is effective and safe for an individual who has multiple complicated requirements. These will motivate me to discuss to follow my action plan and will encourage me to self reflect future events or decisions from time to time. I intend to keep up to date with MSE techniques in practice via regular online refresher training and obtaining certificate of MES training completion to demonstrate that I am actively engaged in maintaining my professional development. This will contribute to my Continuous Assessment of Practice (CAP) document and show that I have achieved one of the specialist Nurse professional learning logs. both of which are necessary for the development of my nursing skills when caring for a patient who has mental health issues. I will shadow a mental health specialist nurse in order to gain more information about the condition described earlier. As I progress through the six stages of Gibbs' cycle, it is safe to say that I will be more prepared for future situations like the one being reflected upon here should they take place. As my action plan continues to contribute to my overall strategy, it is possible that I will incorporate it into the descriptive component of the subsequent iteration of my reflection.

Evaluation

According to Jasper (2013), one of the drawbacks of the Gibbs model is that it has a tendency to focus on narratives and might not offer the rational objectivity that is required to properly understand the repercussions of certain courses of action or other actions, or the mental process that lies behind the acts that are being committed. It is the one-sided paradigm that only takes the perspective of practitioners in one direction. There is no room to take or study the perspective of other side events or the problem that is being handled, despite the fact that there may be helpful insight to be found here that should be believed. The fact that Gibb's cycle model focuses on taking a methodical approach to analysing the many stages of the learning process is one of the model's primary selling points. Despite the fact that it is more complicated than Rolfe's three fundamental questions. The components of Gibbs's headlines are nevertheless easy to understand and approachable. It encourages clear reflection, which can be rendered relevant to others through its communicative potential.

Reference

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Tuomikoski, A.M., Ruotsalainen, H., Mikkonen, K. and Kääriäinen, M., 2020. Nurses' experiences of their competence at mentoring nursing students during clinical practice: a systematic review of qualitative studies. Nurse education today, 85, p.104258.

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Widarsson, M., Asp, M., Letterstål, A. and Källestedt, M.L.S., 2020.Newly graduated Swedish nurses' inadequacy in developing professional competence.The Journal of Continuing Education in Nursing, 51(2), pp.65-74.

Websites

Nmc, 2023. The Code. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on 5th April 2023]

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