Reflective Account of Increasing a Persons Observations

Reflective accountancy of increase a Per paroles Observations on an Acute intelligent wellness WardThis essay provide discus a close that was make on a local anesthetic male acute protect. Using this example, an abbreviation of the finis do move has been made and a conceptful model has been used in order to knuckle under(a) own(prenominal) fellowship that allow foring inform make headway perpetrate (Rolfe, 2011a). A pseudonym of Tim has been used for the discussed affected role of to keep up confidentiality in accordance with the NMC code of deliver (2010a).Observation is one way in which genial wellness hold ups can protect acutely psychologically ill in uncomplainings from rail at and is comm that implemented for patients who implement a attempt of harming themselves, other(a)s and for those who are vulnerable (Bowers et al, 2006). Tim, who was on a local male acute harbor, pose a risk of harming himself and became very vulnerable during his stay. On admission he was perceived to be at low risk of harming himself and vulnerability, in that respectfore was observed on the minimum level of poster, general reflection, which includes all patients and involves an hourly visual perception check on the patient (DH, 1999 straitlaced, 2005).The closing to increase his observance level was jointly run throughn by the mentor and the seed by meeting place information from bank support workers about Tims underway presentation. After a noned decline in quality in Tims mental health, it was decided to increase reflexions to within disciplineing of cater. Justification for this was that he was becoming a unplayful risk of harming himself as he threatened to cut through from the guard roof, as he was determined to confide.Tim was detained under variance 2 or the mental health act (DH, 2007). He felt that he necessary to leave in order to find his son who he had recently disoriented contact with. He had been stopped atte mpting to climb a drain cry to leave via the ward roof and had been in a very distressed state. Eyesight level of reflexion is seen as the second highest of four levels and demands intense nursing, only within arms length is higher (DH, 1999 Jones & Eales, 2009 splendid, 2005). soaked observation is an example of conclusiveness do which is pocket to mental health nursing. The Chief Nursing incumbent described observation as a name area where good practice is essential and that guards should give an correspondence of the benefits and limitations of the use of levels of observation to maximise the healthful effect on inpatient building blocks (DH, 2006). Additionally NICE (2005) recommends the use of observation in the short-term prudence of disturbed/violent patients.The Nursing and Midwifery Council (NMC, 2010a) submit absorbs to be able to apply experience and an take back away repertoire of achievements that is indicative of safe and strong practice and based on the best available attest. At the time of do the purpose it seemed the right transmission line of action. The mentors final ending was taken for granted as he was an experienced nurse and a deficiency of personal experience meant that the author had limited personal experience to work with. Before undertaking this denomination it could non decided what could be done otherwise if set about with a similar situation on qualification.On qualification, such a finis will submit to be well informed and made with confidence and one that has to be made in accordance with the NMC code of professional conduct (2010) which requires nurses to be accountable for their own actions and omissions in practice. By exploitation the decision make tool below the utility of hindsight can be used when analysing this decision to go inform future practice. Pritc se recover (2006) sees decision making as one of the almost difficult processes that a nurse can undertake and one of the most crucial trips of nursing practice.Aitkin (2003) concludes that testis decision analysis can improve future decision making. The employ decision making model, as described by Jasper (2003), asks the questions Who/What/When/Where/Why and How? These questions make a usable voice to systematic, holistic, clinical legal opinion and enable evaluation and vituperative thinking about the made decision to take place Jasper, 2003 Standing, 2011). Tim has a long history of mental illness and was admitted to the ward following a deterioration in his mental illness subsequently he lost contact with his son.His mood was elevated and he felt very restless and agitated. Prior to admission, he was found police in a very distressed state. Tim was placed on a section 2 of the mental health act (DH, 2007) and was sooner observed generally where a member of staff would hold in to see him face to face on a hourly basis (NICE, 2005). Under section 2 of the mental health act Tim has lost the ri ght to leave hospital at will and his responsible clinician has not granted him section 17 leave. A person can be detained for up to 28 daylights and treat against their will (DH, 2007).As Tim was detained it was important for staff to keep him on the ward. Increasing attempts by Tim to leave led to a falsify in observation level to within eyesight to make certain(a) he did not leave the ward by any means. supply levels were low, and for that basis it was felt that there was not enough staff to informally observe Tim. In addition there was a general feeling of fear that if Tim unexpended the ward there would be inevitable consequences for the staff. The publications shows that the decision to increase a persons observations is common when faced with the supra situation.Buchanan-Barker Barker (2005) are particular at the increase of observations on acute mental health wards following high profile tragedies placing practicians in defensive mode to stop patient elopements and harm to patients. Organisations aim responded to this risk by formalising observation policies to defend themselves against litigation. In addition, it is felt that observation policies dominate practice and assure distant managers that something is be done (Horsfall Cleary, 2000). Equally, nurses use observation in defensive mode in order to prevent harm. disrespect these measures, the effectiveness of observation to reducing patient risk and providing a therapeutic benefit is not at all clear (Mana, 2010). This indicates that observation is driven by risk culture and defensive practices concerned with corporal integrity of the person and do little to get across the origin of a persons distress (Cutcliffe & Stephenson, 2008 Buchanan-Barker & Barker, 2005). Tim was finding it hard to cope with the loss of his son and wants to leave the ward to find him. One study found that the most cited reason for ncreasing levels of close observations was the prevention of absconding from an acute ward which could lead to the patients self-harm, neglect vulnerability and violence (Dennis, 1997). During Tims observation staff were tired and unwilling to engage with Tim. Staff were seen to be following Tim from one part of the unit to another which was aggravating him further. The observation was void of communion which is in contrast to Peplaus (1952) view that clinical observation should be carried out with the nurses attention to the interpersonal birth with the patient.Likewise, Rooney (2009) reports that nurses admit that observations were more about prevention than cure and keeping the patient safe was priority. On the other hand, Bowles et al (2002) found that distressed patients need both(prenominal) containment and engagement. In terminal, there was a need to maintain a therapeutic relationship while considering the forethought of risk and the empowerment of the patient. The mental Health human action (DH, 2007) requires an enamor package of treatment t o be in place which includes one-toone time with staff which could prevail helped still Tims anxiety.Short staffing meant that Tims one-to-one time had not taken place and from a personal view assign a package that can only be theory-basedly provided is not be good enough. intrust support workers had been allocated to observe Tim as the qualified nurse had to complete paperwork. This is in agreement with the findings of Rooney (2009) who describe that observation was usually left to unqualified staff as nurses were often dealing with other matters. In contrast, NICE (2005) states that observation should be undertaken by registered nurses. Nurses may delegate to competent staff who withstand had the appropriate training.It is thought that the bank staff did not have the appropriate level of competence which created a poor skill mix on that shift which Aston et al (2010) see as a barrier to good decision making. In agreement Rooney (2009) found that staff ac intimacyd therapeut ic work could take place during quantify of observation however, they felt that they lacked the relevant skills. Staff inform that no one had ever explained how to interact with the patient or had received any further steering beyond the aspects of risk heed and containment.Most nurses who took part in this study had no practical or conjectural preparation for observations. Tim attempts to leave by the doorsill on the ward when it is opened for visitors and he will try several times a day to enter the court yard to leave by climbing onto the roof. The high level of staffing resources taken up by preventing Tim from leaving the ward prevented staff from agreeable with other patients who felt that they were being ignored and leave out which in turn added further stress to staff.In agreement are a number of authors who have shown that formal observations consume nursing resources and that the patient being observed receive a disproportionate get of nurses time (Mana, 2010 Bowl es et al, 2002). Bowles et al (2002) argued that the time taken up by the demands of observation was to the detriment of of bearing of patients that were not seen as a high risk. To reflect on the above experience Rolfes framework has been used which poses the questions what? , so what? , now what? (Rolfe, 2001 2011a).This type of reflection which is done after and away from the actual event is referred to by Schon (1983) as reflection-on-action and the following discussion focusses on how the author and others did and what changes could be made. in spite of this type of reflection being useful reflection-in-action is seen to have far more significance in professional practice. Reflection-in-action looks at the suitability of a item intervention while it is been carried out. This is one of the distinguishing features as a nurse progresses from qualified status to an advanced practitioner (Schon, 1983 Rolfe, 2011b).In terms of clinical reasoning and decision making, reflection is seen as an invaluable resource for ontogenesis personal practice and learning from other peoples perspectives (Aston et al, 2010). In addition to this, reflection can generate knowledge from practice rather than relying on external search findings (Rolfe, 2011a). Rolfes (2001) framework allows the construction of personal theory and knowledge and how a similar situations outcome might be improved by future actions. The NMC makes it clear that nurses should take part in appropriate learning that helps get down competence and performance (NMC, 2010a).According to Benners (2001) novice to skilful the author recognises that as a management disciple working towards qualification he needs to be a proficient performer who looks at situations as a whole rather than their constituent parts. In strong agreement, Aston (2011), who uses a skills escalator approach, places a management student at level 4 which is a level where a student is pass judgment to gift they can draw on a great ra nge of resources using an secern based rational for decisions.When the author collaborated with staff to assist in making a decision for Tim he felt every bit involved in the decision making process however personal contribution was lacking payable to limited knowledge at that time. The NMC (2010a) require that care is based on the best available evidence or best practice. The authors personal decision was not based on either. promotemore, Aston (2010) recommends that confidence in making a decision is developed by a number of factors including relevant past experiences and practising using decision making skills.Pritchard (2006) argues that the process of decision making is versed gradually through practical experience of pity for patients and observing more experienced colleagues making decisions. Further inhibiting the authors ability to make a decision was a theory practice gap (Aston, 2010). This indicates that the author was practising at Benners (2001) novice stage, in t hat he had entered a impertinent clinical area and had a limited contextual understanding. The author was too inexperienced to made the above decision. Tim was placed on eyesight observations and the permanent nominal head of staff upset him.Tim was feeling distress and anger. thither were no positive outcomes and the intervention was not effective meaning the wrong decision may have been made. Personal decisions and actions were not based on evidence or experience. One of the barriers to future decision making is making mistakes and reflection is one way of recognising what could have been done better. In addition, in the new clinical environment, the author should have been assisted to practice safely under constant supervision and possibly not able to make such a decision at this stage of nursing training (Aitkin, 2003).Despite this being the case a thorough divinatory knowledge before working on the ward would have better prepared the author for making the decision. In contra st to this is the notion that a nurse who is experienced in working with theoretical knowledge will find differences in practice that the formal theory fails to express (Benner, 2001). This indicates that a new understanding of the situation has been reached. Despite no real harm coming to Tim the author was not in a position to assist in making the decision. The author should have declined stating that he did not have the relevant knowledge.It is clear that the author had a low critical thinking capability at that time. It is argued that this is a trouble faced by newly qualified nurses. Graduates do not meet expectations for entry level clinical judgement ability (Del Bueno, 2005). Similarly, Deuchester (2009) reports that newly qualified nurses go through a transition shock and have a poor ability to make decisions. Feelings of doubt, loss, muddiness and disorientation for newly qualified nurses are reported along with a lack of knowledge that includes practical, theoretical an d tacit.Despite this being the case the NMC (2010b) require students to licence the ability to work as autonomous practitioners by the point of registration. Del Bueno (2005) concludes that newly qualified nurses should be expected to think critically and use clinical judgement in order to develop it. In conclusion the broader issues that have arose from this are that time needs to be taken to stop and think and consider whether whether the decision is meeting the patients needs.The main learning, for future practice, is to make sure that the author is exposed to as many situations as possible to gain practical knowledge. In addition, theoretical gaps in knowledge need to be eliminated in future practice. The best attempt to engage with the patient needs to be sought in the future. If observation levels needs to be increased the decision should be weighed up against the patient being allowed to move freely and not feel restricted and Mental Health Act (2007) requirements of offerin g one to one-to-one sessions.