Mental Health Nursing

Introduction

Nursing care is referred to the collaborative and autonomous care provided by the nursing professionals to patients of all age group and communities in different settings to ensure them quality health and well-being. The development of effective therapeutic communication between nurses and patients is essential so that the patient needs can be identified and they can be made to comply with care by trusting the nurses. In this assignment, professional practice for registered nurses to be abided according to NMC code is to be discussed. The skills and knowledge required for effective leadership and team management are also to be explained. The professional and political influence in healthcare delivery and the transition from student to registered nurse in developing therapeutic communication is to be discussed. Further, the strategies to support own continuous professional development in therapeutic communication implementation is to be evaluated. . .

Critically evaluating own professional practice

The NMC Code of Practice under “Prioritise People” expects that it is the duty of the registered nurse to ensure safety and care for the service users as well as protect their dignity by recognising their key needs and concerns. The nurses have the duty to keep the interest of the service users at the first while offering care (nmc.org.uk, 2018). This indicates that being a registered nurse it is required of remaining aware of the preferences and interest of patients. This is required to arrange the care and therapeutic communication as per patient’s mentioned needs and demands and to show them dignity and support. The fact is already understood and currently as registered nursing professional while caring or communicating with patients their interest is prioritised. According to the NMC Code under “Practice Effectively”, the registered nurses are expected to develop proper therapeutic communication with the patients to help them understand the need of care being provided and involved them in shared decision-making regarding their care. Moreover, nurses are to communicate and collaborate with colleagues and other professionals to share ideas regarding care to ensure delivery quality support in the end (nmc.org.uk, 2018). The fact is effectively understood and successful therapeutic communications are developed with patients while playing the role of registered nurse in practice so that they are involved in

decision-making regarding care to make them feel empowered. However, acting as registered nurse issues are being faced in making collaborative communication with colleagues to share ideas regarding care which indicate that the aspect of NMC code is partially abided in practice as a nurse. The NMC Code under “Preserve Safety” expects that registered nurses are to perform duty within the limits of their competence and take immediate actions to resolve any concern for the patients to ensure their safety (nmc.org.uk, 2018). As a registered nurse, the standard of NMC code is effectively abided by being proactive in assessing patient’s condition and their care environment through communication. This has allowed determining the safety issues experiencing by patients and ensured immediate actions to be taken to resolve them for assuring their protection. The NMC Code under “Promote Professionalism and Trust” expects registered nurses to uphold their professional responsibility by showing proper commitment to deliver care (nmc.org.uk, 2018). As a registered nurse, the professional standard is maintained by acting according to rules and policies in the care environment as well as showing effective commitment for care without any discrimination towards the patients. Thus, the evaluation indicated that apart from hindered performance of “Practice Effectively” standards all other NMC Code for registered nurses is effectively followed by me in practice. .

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Critically analysing skill, knowledge and competencies in nursing :

The presence of emotional intelligence which is capability of people to identify their own thinking as well as others is required for effective management, leadership and team-working in nursing practice (Hess and Miller, 2017). This is because nurses by understanding emotions of the team members and their subordinates adapt and guide their behaviour and manage feelings to ensure favourable rapport is built with others to act collaboratively. As argued by Nabih et al. (2016), lack of emotional intelligence among nurse makes them act with their subordinates or team members in a non-acceptable way creating confusion and conflict between one another. This is because lack of emotional intelligence makes nurse neglect understanding subordinates and team member’s emotions and thinking as well as tries to overpower them leading towards conflict. As commented by Regan et al. (2016), trust and respect towards the team members are to be shown for successful team-working in nursing. This is because proper trust between team

members makes them develop positive rapport between one another as well as show competence in working collaboratively for successful achievement of work goals. In nursing leadership and management, the presence of integrity which is making right choices through analysis and critical thinking is essential (Kang et al. 2017). This is because it makes the nurse leaders adapt to take decision that supports the needs of the patients and subordinates in effective manner without discrimination. As asserted by Choi et al. (2018), knowledge regarding the way to make successful communication is required in nursing practice for effective leadership and team-working. This is because through interaction nurse leaders is able to identify and resolve the needs of their subordinates to ensure smooth working as well as communicate key vision to be followed to achieve work goals. Moreover, successful communication between team members in nursing helps the nurses to share ideas and make effective decision regarding care for the patients through collaborative effort. As argued by Jakobsen et al. (2018), inability to develop proper communication in nursing leadership, management and team-working lead to create conflict between leaders and subordinates as well as team members. This is because without communication the misconception between the team members and between leaders and subordinates in nursing are not resolved as well as shared decision cannot be reached to ensure smooth management and teamwork.

Critically appraising political and professional influence on healthcare delivery

IThe Brexit is one of the key political issues in the UK that has negatively influenced healthcare delivery to patients and individuals. This is because Brexit has created increased nursing staff crisis in the UK healthcare system which is evident as in the past two years from 2019 nearly 5000 nurses are seen to have quit NHS citing Brexit as the reason (theguardian.com, 2019). In 2013, the recruitment of EU national nurses in the NHS, UK was 2.4% and in 2018 in September it is seen to have risen to 5% (rcn.org.uk, 2018). This indicates that key part of the recruitment of nurses in the NHS is done from the EU nationals, in this case, leaving the nursing duties due to Brexit is creating workforce shortage in the healthcare field. As mentioned by Gray et al. (2018), shortage of nurse in healthcare field leads to create increased workload on existing staffs which makes to lower the quality of care delivered to patients. This is because increased workload on nursing staffs makes them develop error in care as well as duplication of services out of work pressure and confusion in delivering care resulting in lower quality of healthcare delivery. In the UK, it is seen that nurses are the lowest paid individuals in the healthcare system. This is evident as the nurses report that pay rise below inflation rate n the UK has led their salaried to fall by 14% compared to the expected salary as per market condition (thesun.co.uk, 2018). It indicates that lack of proper financial support to nurses to value their effort has professionally led them to less engaged in delivering quality care to individuals and leave their profession. As commented by Imison (2017), proper salary leads nurses to feel financially support to make their life and feel effective remuneration has been achieved for their work effort. This is turn creates satisfaction within the minds to work with greater zeal to ensure delivery of successful care. However, low salary of the NHS nurses in the UK has led them feel lack of value and less satisfied to execute their responsibilities creating difficulty in ensure quality care to the patients.

Critically reflecting transition from student to Registered nurse :

The episode of care on which transition from student nurse to registered nurse is to be reflected is development of therapeutic communication between patients as nurses. As mentioned by Haley et al. (2017), active listening by the nurses is required in therapeutic communication with patients. This is because it makes the patient’s feel being heard with value regarding their needs making them develop gradual trust over the nurses out of respect of listening to their needs. As a student nurse, I was well-aware of maintaining active listening for the mental health patients in learning their needs to develop the care accordingly. However, I still failed to develop effective therapeutic communication which is evident as patients expressed lack of interact to involve in communication with me. During further training to become a registered nurse, I learned that I have also to maintain silence and keep direct eye contact with positive body posture as non-verbal indication for the patients to make them assures they are being actively listened to establish successful therapeutic communication. As argued by Blake and Blake (2019), continuous interruption and lack of eye contact develop hindered therapeutic communication between nurses and patients. This is because continuous interruption makes patients face hindrance in mentioning their needs with focus and lack of direct eye contact makes patients feel the nurses are not attentively listening to their needs making them feel discouraged to share their demands of care. During acting as student nurse in mental health ward, I lacked concept of focussing and summarising skills in therapeutic communication. This is evident as I never make patient .

elaboration on key points shared or summarise their needs at the end of the communication to converse it with them. On gradual learning towards being a registered nurse, it was informed that during therapeutic communication patients are going to mention something particularly essential. The nurses are to focus on it as well as prompt the patient to discuss regarding the essential point in details to ensure establishment of successful identification of essential needs trough communication (Joung and Park, 2019). Moreover, through gradual transition from student nurse to registered nurse, I learned that summarisation of the communication is to be made to effectively understand key needs and demands of the patients. As a student nurse, I was aware that in therapeutic communication empathy and support is to be shown to the patients to make them feel free to communicate their needs. This is because empathy and support from nurses make mentally-ill patients feel valued which in turn make them show attention and provide time in developing interaction with nurses for sharing their care needs (Mitsi et al. 2018). However, I still show failure in establishing successful therapeutic confusion as I as well as patients during interaction often faced issues with how to arrange the flow of conversation so that appropriate needs are identified. It was later learned through further training, care delivery and theoretical analysis towards becoming a registered nurse that apart from empathy to initiate successful therapeutic communication broad opening are to be provided to patients. This is because broad opening during communication helps the mentally-ill patients find idea regarding the way flow of interaction is to be maintained to gradually report their needs and demands to the nurses with success (Sveinbjarnardottir and Svavarsdottir, 2019). On becoming registered mental health nurse, the concept developed that to make successful therapeutic communication clarification by exploring the needs and demands of the patients are to be made (de Azevedo et al. 2017). This is because while acting as student nurse I was not entrusted to develop care plan for the patients. However, on becoming registered mental health nurse I was entrusted the duty to also make care plans for the patients. During care plan development, I found that there was certain confusion regarding needs and demands mentioned by patents during therapeutic communication due to which appropriate care to be delivered could not be determined (Sibiya, 2018). Thus, in the process, I learned that effective clarification of needs and demands mentioned by patients during therapeutic communication is to be made by asking them to be able to deliver proper care to them. According to Knowles Adult learning

theory, the adults are to be internally motivated to learn something new and their learning is based on past experiences (Merriam, 2018). This indicated during transition from student nurse to registered mental health my learning regarding the way to establish therapeutic communication is to be improved on the basis of the past experiences and through internal motivation.

Critically evaluating strategies for supporting continuing professional development :

In order to support my continuous professional development, I require learning information regarding the specific body language to be maintained to ensure the patients during therapeutic communication that they are actively listened. In this process, the SOLER communication model is to be followed. The SOLER model mentions that individuals are to maintain an open posture, lean forward, maintain eye contact and stand in relaxed way to show they are effectively listening to the information provided by the individuals (Cox, 2020). This is because open posture indicates the person is interested and not bored of listening to the individual, direct eye contact indicates active focus on the mentioned information by individual communication, relaxed posture indicates openness to accept more information and leaning forward indicates interest to understand the information being shared (Agboola, 2018). Therefore, SOLER model is to be followed to improve my non-verbal communicating skills to show active listening initiative to patients in establishing successful therapeutic communication. As argued by Bifarin (2017), avoiding to follow SOLER communication model makes nurses unable to manage proper therapeutic communication. This is because they are unable to understand the aspects of non-verbal communication to be managed that would support their success of verbal therapeutic interaction. The strategy to be involved in summarising needs of the patients in therapeutic communication is maintaining a continuous note and recording of the interaction. This is because notes and records of the therapeutic interaction can be replayed to identify certain specific points that are to be explored to identify intricate needs and demands of patients to deliver them high quality care (Abdolrahimi et al. 2017). As argued by Brownie et al. (2016), lack of notes regarding needs mentioned by mentally-ill patients during therapeutic communication leads nurses to deliver hinder care. This is because the nurses forget needs and demands of the patients which may be essential and ignoring them in developing the care plan leads to unsatisfied care towards the .

mentally-ill patients which in turn make them lose trust over the nurses and show non-compliance in accepting care. The continuing professional development goal for establishing successful therapeutic communication among mentally-ill patients is learning regarding the way to avoid interruption during conversation. The strategy to be used in this case is choosing a silent place for interaction with the patient and avoiding interruption during their sharing of information in communication as well as nodding in between communication to mention the patients are being properly heard and understood. However, chaos during therapeutic communication makes mentally-ill patients feel vulnerable that their personal data are exposed in public and interruption makes them unable to report their needs properly leading to hindered therapeutic communication (Ghiyasvandian et al. 2020). .

Conclusion

T The above discussion mentions that all the standards of NMC Code of Practice are abided except "Practice Effectively" where as a registered nurses issues with successful communication with nursing colleagues is faced that led to create hindrance in delivering quality care. The skills and knowledge required in nursing leadership, management and team-working are communication, critical thinking, emotional intelligence and others. The political and professional issues influencing care delivery are Brexit, shortage of nurses and low salary of nurses. The continuous development strategies to be followed based on reflecting transition from student to registered nurse is learning SOLER model for communication, maintaining silence during conversation and others for establishing successful therapeutic communication.

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References :

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M. and Ebadi, A., 2017. Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic physician, 9(8), p.4968. . .

Agboola, S., 2018. Nurses’ communication with dementia clients in a nursing home. Laurea University of Applied Sciences. 2018.pp.17-33. Bifarin, O.O., 2017. Reinforced therapeutic alliance: The way forward in nursing practice. British Journal of Mental Health Nursing, 6(2), pp.95-100.

Bifarin, O.O., 2017. Reinforced therapeutic alliance: The way forward in nursing practice. British Journal of Mental Health Nursing, 6(2), pp.95-100.

Bhat, N.A. and Ganaie, S.A., 2016. Use of e-resources by users of Dr. YS Parmar University of Horticulture and Forestry. DESIDOC Journal of Library & Information Technology, 36(1) .

Brownie, S., Scott, R. and Rossiter, R., 2016. Therapeutic communication and relationships in chronic and complex care. Nursing Standard, 31(6), p.54. Choi, E.H., Kim, E.K. and Kim, P.B., 2018. Effects of the educational leadership of nursing unit managers on team effectiveness: mediating effects of organizational communication. Asian nursing research, 12(2), pp.99-105. . .

Cox, A.M., 2020. Nurse or Psychotherapist? Using Nursing Skills in Therapeutic Relationships and Psychotherapies. In Nursing Skills for Children and Young People's Mental Health (pp. 139-154). Springer, Cham. de Azevedo, A.L., de Araújo, S.T.C., Júnior, J.M.P., da Silva, J., dos Santo, B.T.U. and Bastos, S.D.S.F., 2017. Communication of nursing students in listening to patients in a psychiatric hospital. Escola Anna Nery Revista de Enfermagem, 21(3), pp.1-6.

Dang, D. and Dearholt, S.L., 2017. Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.

Regan, S., Laschinger, H.K. and Wong, C.A., 2016. The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. Journal of nursing management, 24(1), pp.54-61. Sibiya, M.N., 2018. Effective Communication in Nursing. Nursing, 19. pp.56-78.

Sveinbjarnardottir, E.K. and Svavarsdottir, E.K., 2019. Drawing forward family strengths in short therapeutic conversations from a psychiatric nursing perspective. Perspectives in psychiatric care, 55(1), pp.126-132.

theguardian.com 2019, NHS nursing crisis worsened by Brexit exodus, Available at: https://www.theguardian.com/society/2019/may/08/nhs-nursing-crisis-worsened-by-brexit-exodus [Accessed on: 17th April 2020]

thesun.co.uk 2018, Low-pay, years of funding pressures and a lack of staff: why thousands of nurses are leaving the NHS every year, Available at: https://www.thesun.co.uk/news/5361247/low-pay-years-of-funding-pressures-and-a-lack-of-staff-why-thousands-of-nurses-are-leaving-the-nhs-every-year/ [Accessed on: 17th April 2020]

Appendices

Appendix 1:

Reflective Account Form

Reflective account:

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

The nature of CPD activity in the practice was therapeutic communication establishment between nurses and patients in mental healthcare.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

The practice-related feedback led me to learn that effective understanding regarding way to maintain silence during active listening in therapeutic communication is needed. Moreover, learning is required regarding the way to execute summarization of key points and elaboration of key points in therapeutic communication provided by the patients. Further, the feedback mentioned I lacked information regarding the way board opening in therapeutic communication is to be made to ensure smooth flow of the conversation.

How did you change or improve your practice as a result?

he change in practice is made through various strategies such as executing nodding and avoiding verbal interruption during therapeutic communication to ensure patients understand they are properly listened. Moreover, the improvement in practice is made by following SOLER communication model for therapeutic communication. Further, training and developmental programs for therapeutic communication are attended. The assistance

How is this relevant to the NMC Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

The change was relevant to the NMC Code under “Prioritise People” as it led me to determine how the interest of mentally-ill people are to be kept in the forefront to make successful communication to ensure their care plan are accordingly made to deliver quality and satisfactory care. The change led to fulfil “Practice Effectively” as it led to develop skills regarding the way effective communication is to be made with patients to understand their needs and accordingly fulfil them.

Appendix 2:
Action Plan

Action Plan 
Action Plan
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