In the mental health nursing environment, nurses and their everyday role may repeatedly be subjected to or witness challenging and / or self-defeating behaviour (Health and Safety Executive 2006). In this assessment the aim will be for me to identify and describe a challenging behaviour. In this case the response was to aggressive behaviour which I witnessed on one of my practice placements as a student nurse. Part of the assignment will be written in the first person when referring to my personal account of the incident. Using literature and the relevant references the essay will critically analyse the incident, an action plan will be placed and a discussion on how it will be implemented (Rolfe et al, 2011). The Marks-Maran and Rose model of reflection will be used to reflect on the challenging behaviour I have chosen. The precipitating factors will be discussed along with the environmental, social and communication factors that can and may have contributed to the behaviour. My emotions and feelings towards the situation will be expressed and discussed. Management of the situation will be analysed through research literature. The conclusion will explain what I have learned from the incident and my awareness of promoting positive behaviour.
Although challenging behaviour was initially applied to people with learning disabilities, it is now accepted in a wide range of settings (Emerson and Einfield 2011). Challenging behaviour can be complex; Emerson (1995) defines it as the intensity, frequency or duration of the behaviour that the physical safety of the person or others is at risk. With this in mind the challenging behaviour which shall be the focus of this essay is on aggression (Emerson 2001).
Following anonymity and confidentiality in respect of the Data Protection Act (1998), (Department of Health 2009) and the Nursing and Midwifery Council (2010: 5) on confidentiality the person involved in the aggressive behaviour will be known as John. On this particular day John’s aggressive behaviour towards staff and other patients escalated. When I first came on duty I said “good morning John” he didn’t answer and his facial expression showed some upset. The morning report indicated that John had no cigarettes left and had no money to buy anymore until he received his benefit. The nursing staff was alerted to Johns arousal and his escalating feelings of anger and frustration. About an hour later I heard shouting and swearing further along the corridor, I quickly approached the scene. John was shouting and swearing at another patient threatening him by saying that his family would “sort him out”. I asked John why he was shouting with which he turned around and started verbally abusing me with derogatory language. The charge nurse and two staff nurses came along and very quickly de-escalated the situation. Aware of the risk to others one of the staff nurses asked the other patients now surrounding the area to go into the sitting room for their own protection; this was also to protect John’s dignity (NMC 2010: 1). The nurse spoke to John in a reassuring and calm tone asking open questions but although John’s body language was still showing signs of anger he non-verbally agreed to go to his room.
The model of reflection to be used in relation to this incident is the Marks–Maran and Rose reflective cycle. This model enables me to generate my own unique body of personal knowledge directly from my own practice. This reflective cycle has four stages; the first stage is the incident, which is a statement of what actually happened. The second stage is reflective observations, which are my thoughts and feelings arising from the incident, the third stage is the related theory, making sense of the incident in light of current knowledge and the fourth stage is future actions, what was learned and how it will influence future action (Marks-Maran and Rose...