Engagement with a service user can be a challenging process which needs to be reflected upon by the individual nurse (van Os et al 2004). When a critical or unique incident arises reflection enables the practitioner to assess, understand and learn through their experiences (Johns, 1995). It was also suggested by Jarvis (1992) that reflection is not just thoughtful practice but a learning experience.
This assignment is a reflective critical incident analysis of an engagement encounter on a community placement recently using Gibbs (1998) Reflective Cycle (Appendix 1,3). In maintaining confidentiality (NMC, 2004) and privacy, even for reflective pursuance (Hargreaves, 1997), pseudonyms will be used. I will also further reflect on a teaching session I contacted following this incident.
Critical Incident analysis
During a recent clinical placement with the local CMHT there was a distress call from parents of a client, Mat. An immediate visit by the two co-coordinators and me, followed without checking, or doing a risk assessment. This visit resulted in aggressive and abusive encounter and Mat was then admitted to hospital, (Appendix 2).
This incident is critical to me as it presented a learning opportunity as well as a risk of physical harm to me and the nurses with me. As I look back on this incident there are several issues that relate to the role of the nurse.
When I look back at this incident, I felt anxious but my thoughts were that this was a learning experience even when it was clear I was the main focus of the aggressive threats (Fazzone, et al, 2000) I knew I needed to remain calm and to assess for escape routes. I made mental notes of these but still I was not sure and everything was happening so fast and my mentor was already telling us what to do. Being able to remain calm could have help and I feel this was a positive thing. As I reflect if I had panicked visibly this could have encouraged Mat to have a real go. It also helped us to remain in control as we walked out of the house. This could have reassured her parents that the nurses were confident of what they were doing.
This incident was bad as an engagement with the client did not go well resulting with the client going into hospital. This is usually distressing for most people although hospital is regarded as a place of safety in these circumstances. Even guidelines to the mental health act (MHA, 1983) acknowledge this that hospital can be distressing to others. On a positive note the situation was handled well and no physical harm was done to anyone. It was also a learning opportunity for me, as I gained an insight and now the opportunity to reflect on relevant issues related to risk assessment and management in the community. When the message was received about Mat, a decision was made promptly to visit. On each planned visit I would get an update and I was expected to find out more about the client as well. This usually focused on risk and other necessary background information which would help me understand the intervention and interactions with that client. I took this to be good practice and put one in an informed position. I don’t recall Rita finding exactly what was going on from the parents neither did we check documentation on his file. There are protocols and guidelines on managing risk in the community and the local team had its own arrangements. A good risk assessment through the CPA process will minimise distress to staff, carers and the patient in service provision in the community (Manthorpe and Alaszewski, 2000). All these are resources which are available and it is the nurse’s responsibility to use or adhere to them. Rita is a senior CPN and knew about this client. Maybe she decided to react straight on the basis of the cues she picked from her short conversation with the parents making use...