A Critical Reflective Analysis

A Critical Reflective Analysis of Complex Clinical Situation

Introduction

The critical reflection is about the complex clinical situation that I encountered during my clinical placement. The incident entailed JP a patient diagnosed with schizophrenia. JP is a pseudonym used to protect patient confidentiality as required by the National and Midwifery Council ([NMC], 2018) code. The reflective analysis will adopt Gibbs’ 1988 reflective model where I will reflect on the scenario and relate it to mental health nursing decision-making, appraise my clinical decision, and critically analyse factors that promote or limit reflective practice while considering leadership and management strategies utilised to attain effective and safe nursing practice during the clinical situation.

The Gibbs reflective cycle

Description

The incident occurred in the mental health ward, where JP with a diagnosis of schizophrenia. During the routine vital sign checks, I discovered that his blood sugar had increased significantly, raising concern given that he was diabetic. Based on the NMC (2018) standard for working co-operatively, nurses should collaborate and refer matters to those with greater expertise, I reported the issue to the nurse in charge, who in turn informed the physician about it and examined JP. However, before reporting the matter to the nurse in charge I had to seek consent from the client as stipulated in the NMC (2018) standard for prioritising people, a nurse must seek informed consent from the client, family member, or a person in authority before undertaking any action.

A Critical Reflective Analysis of Complex Clinical Situation

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After he departed from the treatment room, I reviewed his notes and noticed that he had a history of suicide attempts, raising concern that his elevated blood sugar could be deliberate. It turned out that JP had been attempting suicide and seemed like he wanted to realise his intention by taking a lot of sugary beverages. As such, he was put on a care plan and 1-2-1 monitoring. The search of his room revealed unhealthy snacks and bottles of Coke, which he consumed at night.

Feelings

Initially, I thought that mental health care was meant for individuals who had been diagnosed with psychological conditions as their primary diagnosis. However, JP’s case surprised me because he had schizophrenia, diabetes, and suicidal attempts. Likewise, research demonstrates that schizophrenia increases the risk of diabetes by two to fivefold (Suvisaari et al., 2016). This can be due to antipsychotic use, physical inactivity, unhealthy diet, inflammation, and genetics (Rado, 2017)

The scenario evoked a mix of emotions as I was concerned with JP’s situation and I understood that, if necessary, steps could not be taken, it could have become fatal. Therefore, as mental health nurse student, I took the responsibility to report the situation to the nurse in charge for quick action, aligning with the NMC (2018) standard of prioritising people which holds that nurses should ensure that any care, treatment, or assistance that they are responsible for should be offered without undue delay.

I developed feelings of anxiety and fear when I discovered that he attempted suicide.  Hagen, Knizek, and Hjelmeland (2017) also found that caring for suicidal patients is psychologically challenging. These feelings emanate from what I have read in newspapers that people with suicidal ideation or those who have attempted suicide usually have mental health problems that if not promptly addressed, they may harm themselves. Therefore, I mustered courage and with the support of the nurse in charge and the ward doctor, I took the necessary initiative to put JP in a care plan and searched his room to ascertain whether there were stressors that were contributing to his condition or items that could facilitate his suicidal attempt. We were surprised when we found out that he was taking unhealthy snacks and sugary drinks to commit suicide and I experienced shock when I discovered that his diabetic condition was intertwined with psychological problems, which complicated the situation. My feeling of empathy occurred when I felt sorry for the client and hence, I took the initiative to ensure his safety assuming that I was the one facing the situation, and hence, we were able to place JP under a care plan and 1-2-1 monitoring.

A Critical Reflective Analysis of Complex Clinical Situation

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Evaluation

Taking vital signs is important in nursing practice as it gives an overview of one’s health while at the same time, it assists in determining any sign of complication for prompt action (Cardona-Morrell et al.,2016). Therefore, my role in taking the patient vital signs was imperative in identifying JP’s elevated blood sugar despite the patient being under medication for diabetes, which indicated that schizophrenia led to the abnormality.

The discovery of elevated blood sugars in the patient compelled me to act quickly by reporting the situation to the nurse in charge who then informed the physician about it hence, JP was examined and placed under a care plan. Therefore, my Initial action was prompted by the NMC (2018) standard on preserving safety where providers need to recognise and work within the scope of their competence. In this case, mental health nurses should accurately observe worsening mental and physical health and in a situation where one is not able to handle a situation, it is necessary to seek assistance from suitably experienced and qualified professionals.

After reviewing the client’s notes, I discovered that he had a suicide attempt, thus giving me insight that schizophrenia exacerbated suicidal ideation and diabetic condition.  Sher and Kahn (2019) found that depression, psychotic medication, and male gender contribute to suicidal habits in patients with schizophrenia like JP. Nonetheless, Fuller-Thomson and Hollister (2016) posit that gender disparities in suicide victims diagnosed with schizophrenia are low.

After reporting my concern to the in-charge nurse and ultimately to the physician, we placed the client in a care plan and 1-2-1 monitoring which at the same time we checked his room and removed sugary beverages and unhealthy diet that JP used to advance his suicidal attempt. According to NICE (2022), it is essential to assess patients for suicidal risks and collaborate with mental health practitioners or other professionals such as physicians to assist the patient from self-harm. Therefore, our decision to remove Coke and unhealthy snacks from JP’s room place him in a care plan, and subject him to 1-2-1 monitoring was aimed at ensuring the patient’s safety and preventing potential self-harm.

Although I took the necessary steps to assess JP and later on discovered that he had attempted suicide while at the same time placing him in a safe care plan, what did not go well is that my focus was only on physical health monitoring and hence, I overlooked the psychological factors that impacted on his condition. Therefore, I could have initially understood JP’s suicide attempts had I explored changes in his behaviour and moods, and if I had proactively started communication with him that could have resulted in him opening up about his psychological problems.

A Critical Reflective Analysis of Complex Clinical Situation

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Analysis

Suicide is a significant public health concern that has called for stringent action to curb its occurrence and complications. People with diabetes have a high risk of suicide due to mental health disorders and diabetes (AbdElmageed and Hussein, 2022). Diabetes is a chronic illness and hence, if unmanaged, it may destroy some nerves leading to intense pain. In addition, patients may develop a feeling of hopelessness especially if they feel that the condition will never be managed while issues such as stigma and general isolation may lead diabetes people to develop mental health illnesses (Robinson et al., 2018). In patients with schizophrenia, intense pain may exacerbate the condition while the feeling of hopelessness may culminate into suicidal thoughts and eventually suicidal attempts (Zara et al., 2024). Therefore, the assessment of the Increased level of sugar in JP’s case, can be viewed from the point of physical health (Diabetes) and mental health attempted suicide (schizophrenia). When the two conditions are intertwined, they complicate the situation, a factor that led to JP being placed on a care plan and subjected to 1-2-1 monitoring.

Mental Health Act (1983) provides a legal framework for assessing, treating, and upholding the rights of individuals with mental health illnesses. The act holds that patients have a right to quality and safe care that is offered by qualified, compassionate, and competent healthcare providers (NHS,2022). Therefore, nurses should be vigilant about the stressors that exacerbate a patient’s mental health care, determine situations that could result in them harming themselves, and set a conducive environment to assist the patient in managing the condition (Vandewalle et al., 2019). This act is augmented by the NMC (2018) standard for preserving safety where nurses and other healthcare experts need to identify and assess signs of normal or worsening mental and physical health in the patient and seek assistance from an experienced and qualified professional in cases where managing the condition is beyond one’s ability. Based on JP’s case, it was imperative to understand the bidirectional relationship between diabetes and schizophrenia that led to increased intake of sugary drinks and unhealthy food that culminated in elevated blood sugar. Therefore, subjecting the client to a care plan and 1-2-1 monitoring was important in ensuring that he does not harm himself through attempted suicide while offering an opportunity for integrated care for both diabetes and his deteriorating mental health status, thus fostering holistic healing and positive patient care (Robinson et al.,2020).

According to the NMC (2018) standard of practicing effectively, healthcare practitioners should work co-operatively and ensure that colleagues are informed by communicating care about patients and any issues that may be of concern. Thus, my clear communication with to nurse in charge regarding JP’s condition led to the prompt action of placing him under a care plan and subjecting him to 1-2-1 monitoring while at the same time, we took the initiative of checking JP’s room and removed foods and drinks that were complicating his health and treatment.

A Critical Reflective Analysis of Complex Clinical Situation

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The leadership strategy that was used to attain effective and safe nursing practice was teamwork. Through teamwork and collaboration, we managed to set a care plan and subjected the patient to 1-2-1 monitoring and after checking the room, we were able to remove unhealthy diet and sugary drinks, thus protecting the patient from harm.  Nevertheless, NMC (2018) indicates that effective teamwork in collaborative working requires respecting other professionals’ expertise, contribution, and skills. Therefore, good teamwork ensured effective communication and hence, I was able to collaborate with the ward doctor, and nurse in charge in ensuring that the patient was well managed.

The managerial strategy applied is assertiveness where I escalated JP’s situation to the nurse as spelled by the NMC (2018) code. Through assertiveness and effective communication, the patient received immediate attention, which further prevented him from harm. Based on the reflective analysis, I have come to realise that collaboration and teamwork are vital in enhancing general patient care and the ability of a nurse to learn new ideas. Through teamwork, providers can ask questions from experienced colleagues and get useful insights instrumental in continuous learning. However, learning can be impeded if there is poor communication, and this may hinder acquiring good clinical skills (Tawfik et al., 2017).

Conclusion

My assessment of vital signs played a crucial role in determining the abnormality in the physical health of the patient. Although my clinical decision to promptly report on JP’s elevated blood sugar levels was excellent, I learned that one needs to also consider mental health through holistic assessment to provide comprehensive care and ensure patient safety. By critically reflecting on the situation and action, I commit to collaborate more with my colleagues, acquire knowledge and undertake self-reflection which is essential in continuous improvement in my clinical skills and abilities. In addition, I intend to integrate the considerations for mental and physical health in my clinical practice in order to provide comprehensive care and holistic healing.

Action plan

In the initial assessment of vital signs, I will engage with patients by asking open-ended questions to determine different aspects of their health which include mental health, physical health, and where necessary their social health (Barnard-Kelly et al.,2020). This will assist in determining areas to integrate in the treatment and comprehensive care to attain positive patient outcomes.                                            Undertake further training on the principles of physical health nursing and the related legal framework to easily identify mental health problems, manage and ethically, and ensure the provision of quality and safe care (Hill et al.,2021). Seek feedback and use journal entries to regularly reflect on clinical decisions and experiences to determine areas for growth and improvement (Jarvis and Baloyi, 2020). Advocate for policies that ensure that the assessment of physical health is part of the assessment of patients with severe mental health such as schizophrenia and comorbid physical health diseases be done continuously during the routine of care. This is important in identifying any underlying physical health problem for urgent action (WHO, 2018).

Conclusion

The complex situation provided useful insight into the need for holistic assessment that considers factors beyond mental health. It calls for healthcare providers to also consider the assessment of psychiatric conditions with physical health to offer comprehensive care where necessary. By adhering to ethical principles, adopting the best standards in nursing, and employing reflective practice, I will enhance my ability to effectively and holistically assess the patient to determine all underlying problems and hence, offer comprehensive care. The experience also highlights the importance of creating awareness of integrating physical health assessment with mental health assessment, particularly in patients suffering from schizophrenia and comorbid physical illnesses.

A Critical Reflective Analysis of Complex Clinical Situation

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References

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By admin in Blog on January 16, 2025