Reflective  Journal    Regan Preston - 20825201

Unit: NURS8817 Mental Health    

   

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Table of Contents      

Clinical Placement Reflections  ............................................................................................................  3  

Reflection  ............................................................................................................................................  3  

References  .............................................................................................................................................  6  

 

   

 

 

 

 

 

 

 

 

 

   

 

 

 

 

 

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Clinical Placement Reflection  

This journal is to reflect on the situations that have taken place during my clinical placement at

Graylands Hospital - Frankland Forensic Centre, Claremont, WA, and my community placement

at CATPLA – intense day care unit, Rockingham, WA. This reflection is based on the Gibbs

Reflective Cycle (1988) model.1,2 The Gibbs reflection model consists of six stages to complete

one cycle, which facilitates in my ability to improve my nursing practice continuously and

learning from the experiences for better practices in the future.1,2 The cycle starts with a

description of the situation, analysis of the feelings, an evaluation of the experience, an analysis

to make sense of the experience, a conclusion of what else could I have done and final stage is

an action plan to prepare if the situation arose again.2 Reflection is to generate practice

knowledge, assist an ability to adapt new situations, develop self-esteem, adding value and

professionalizing practice.1,2 However, O’Connor2 explain that reflection is about gaining self-

confidence, identify when we need to improve, learning from our own mistakes, looking at other

perspectives, and improving the future by learning from the past experiences.2 Using a model of

reflection enables me to explore and evaluate all previous clinical experiences. The model

allows me to develop the skills to evaluate and navigate myself through the reflection process

and identify areas of weakness or vulnerability, and laying a platform to upgrade skills to

overcome these deficiencies. Cornerstone to the reflective process is also understanding the

Australian Nursing & Midwifery Council (AMNC) national competency standards for registered

nurses. These core competency standards by which a nurse’s performance is accessed in

obtaining and retaining a license to practice.1,3 Linked together with evidence based theory and

practice, reflection will assist me in my professional development towards becoming a more

competent nurse.4

Reflection  

From the outset, undertaking this mental health placement, I was very anxious and had very

little experience in dealing with clients who had mental health illnesses or conditions. On

completion of our mental heath theoretical course, I had gained insight and knowledge on range

of mental health medical conditions, with respect to pathophysiology and differential diagnosis.

Nevertheless, the thought of being placed in a mental health facility induced a range of anxiety

producing feelings within me. Although I was theoretically trained, and able to fulfill this task in

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providing mental health care, and had the experience in general medical placements and

display the ability to perform the highest level of patient care, responsibly and ethically (ANMC

Competency elements 1.1-3, 2.3 3.1-4, 7.1-8, 9.1-5.), I embarked on this placement with

negative towards mental health due my inexperience.3 Students that some degree of familiarity

with mental illness, having relationship s with relatives, family members or colleagues with

mental illness, were more prone to better coping mechanisms.5 I felt afraid and anxious about

ability to actually help patients. A significant stigma exists regarding mental heath, patients are

labeled as different and stereotyped as deviants with negative behavior traits.6,7 A high level of

discrimination does exist in the general population.6 I was entering this placement with these

shared feelings and emotions and had a negative view on engaging with mental health patients.

On evaluation and analysis, it is evidenced that nursing students that enter mental health

placements are faced with common myths and misconceptions regarding mental health, mental

ill patients and are subject to an array of anxieties.8 Most students that are vulnerable to

anxieties due to their young age and inexperience.9 Themes that exist and are prevalent in

mental health placements, are student s anxiety related to thoughts of not been able to interact

with mental ill patients, feeling of lack of inclusion with mental health facility staff and lack of

adequate debriefing and reflection.10 Research conducted has shown that mental health

hospital staff do not effectively integrate students into their working groups, and students

commonly feel left out or not part of the nursing care team.10 My feelings of being afraid of

mental health patients and inability to feel that I could help them adequately, is consistent with

many studies performed amongst student s on clinical placement.10

Thornicorf (2008) as cited by Schafer7 showed that the negative stigma surrounding mental

health is due to a range of factors, namely ignorance and misinformation stemming from lack of

knowledge is the leading cause to these negative attitudes.5,7 This induced prejudice and

discrimination which results in social exclusion and mental health avoidance.7 Negative attitudes

stem from opinions towards drug addition, alcoholism, negative opinions on schizophrenia and

bi polar disorders.5 Stigma contributes to delay in the treatment process and effects almost

every aspect of a mentally ill patients life.7 These stigmas and negative attitudes greatly affect

mental health patients in varies ways.5 Patients experience exclusion from their families, lose

intimate relationships with spouse and children, experience hostility, lose friends and suffer

social isolation.7 In addition mentally ill patients face increased risk of diabetes, coronary heart

disease, cancers and are found to die younger than average non mentally ill patients.5,7

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This negative stigma adversely affects the level of care administered to mental health patients,

with a reduction in the quality of care.7 Negative attitudes towards mental ill clients has been

identified as major obstacle in recovery form illness and reintegration into the community.5

However the ANMC competency standard instill in all nurses to deliver the most appropriate

care, encompassing ethical and cultural issues, and best care practices (ANMC Competency

elements 1.1-3, 2.3 3.1-4, 9.1-5).3 Mental health education and preparation of student is seen a

vital component for student positive experience of a mensal health placement.10 Happel (2009)11

has shown that high level of nursing education can positively influence attitudes of students

towards mental health.11 Furthermore, perceived lack of explanation and clinical placement

preparedness has been shown to explain negative nursing trends towards mental health as a

whole.11 In addition negative attitudes to metal health are having significant impact of mental

health nursing workforce retention and promotion as a viable nursing career option.11 Reflection

is in addition a vital component of coping in a mental health environment, a process were

nursing student can challenge, compare and critique their value systems and embrace the

process of change to a positive attitude towards mental health.7 Personal development and

promoting collaborative care is a practice, as nurses, we are bound by, as stipulated in the

professional code of conduct umbrella we practice under. (ANMC Competency elements 1.1-3,

2.3 3.1-4, 4.2-4, 3.5, 9.3, 10.4).3

In future, my action plan will reflect that I have come to the realization and understanding that

mental health patient care is embraces the fundamental of basic nursing care, and it is

paramount that as a nurse, I acknowledge and understand the specific nursing care needs that

mental health patients require and deserve, and do away with the misconceptions that I

previously had regarding this element of nursing. Evidence has shown that negative attitudes of

clinicians to mental health services and patients can end up being more debilitating than the

illness itself.8 Preceptorship on mental health clinical placements has been shown to enhance

positive attitudes of student’s and have the ability to manage the emotional wellbeing and

challenges student face on mental health placement,8-10 and I my case, been supported by

experienced practicum scholars, Denese Mackin and Jan Binsharriff, both had a significant

influence and facilitated for my positive perception of mental health and critical to the relief of my

anxieties experienced. Understanding and narrative reflection was offered by my practical

scholars and this in itself can be seen as one of the most important resources on a confronting

placement such as mental health.10 My newly developed positive attitude towards mental health

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nursing will enable me to inspire hope, encourage patients to take control of their lives and

make me a more rounded nurse, delivering truly holistic nursing care.5,7

 

References 1.    Crisp.  Potter  and  Perry's  fundamentals  of  nursing,  Jackie  Crisp;  Catherine  Taylor;  Anne  Griffin  Perry;  Patricia  Ann  Potter;  Amy  Hall;  Patricia  A  Stockert  2009,  Chatswood,  N.S.W.  :  Elsevier  Australia  2009.  2009.  2.    O'Connor  E.  Ellen  O'Connor.    Foundations  in  Nursing  and  Health  Care:  Beginning  Reflective  Practice.  Association  of  Operating  Room  Nurses.  AORN  Journal.  2007  Feb  1;85(2):    429.    In:  Health  Module  [database  on  the  Internet]  [cited  2011  Jul  6].  Available  from:  http://www.proquest.com.ezproxy.library.uwa.edu.au/;  Document  ID:  1214516671.;  2007.  3.    ANMC.    In:  National  Competency  Standards  for  registered  nurse.  2011  4.    Hoffmann.  Evidence-­‐based  practice  across  the  health  professions,Tammy  Hoffmann  Sally  Bennett;  Chris  Del  Mar  c2010,  Chatswood,  N.S.W.  :  Churchill  Livingstone,  c2010.;  2010.  5.    Markström  U,  Gyllensten  AL,  Bejerholm  U,  Björkman  T,  Brunt  D,  Hansson  L,  et  al.  Attitudes  towards  mental  illness  among  health  care  students  at  Swedish  universities  –  A  follow-­‐up  study  after  completed  clinical  placement.  Nurse  Education  Today.  2009  [cited  1/7/2012];29(6):660-­‐665.    6.    Angermeyer  MH.  Labeling-­‐stereotype-­‐discrimination.  Social  Psychiatry  &  Psychiatric  Epidemiology  [Article].  2005  [cited  1/7/2012];40(5):391-­‐395.  Available  from:  pbh  7.    Schafer  T,  Wood  S,  Williams  R.  A  survey  into  student  nurses'  attitudes  towards  mental  illness:  Implications  for  nurse  training.  Nurse  Education  Today.  2011  [cited  1/7/2012];31(4):328-­‐332.    8.    Happell  B,  Robins  A,  Gough  K.  Developing  more  positive  attitudes  towards  mental  health  nursing  in  undergraduate  students:  part  2-­‐the  impact  of  theory  and  clinical  experience.  Journal  of  Psychiatric  &  Mental  Health  Nursing  [Article].  2008  [cited  1/7/2012];15(7):527-­‐536.  Available  from:  a2h  9.    Morrissette,  P.  J.  ;  Doty  -­‐  Sweetnam,  K.Journal  of  Psychiatric  and  Mental  Health  Nursing,  August,  2010,  Vol.17(6),  p.519(9)  [Peer  Reviewed  Journal]    10.    Melrose  S,  Shapiro  B.  Students'  perceptions  of  their  psychiatric  mental  health  clinical  nursing  experience:  a  personal  construct  theory  exploration.  Journal  of  Advanced  Nursing.  1999  [cited  1/7/2012];30(6):1451-­‐1458.  Available  from:  jlh  11.    Happell  B,  Gough  K.  Nursing  Students'  Attitudes  to  Mental  Health  Nursing:  Psychometric  Properties  of  a  Self-­‐report  Scale.  Archives  of  Psychiatric  Nursing.  2009  [cited  1/7/2012];23(5):376-­‐386.