Health Care: Practical Experience| Reflection| a. bendiks| Related Learning Outcomes Learning Outcome 1 Legislation relevant to nursing practice Effective working relationships and professional attributes Learning Outcome 2 Sensitivity in interactions with individual patient/clients Learning Outcome 3 Help individual patient/clients to make informed decisions during the planning of care Safe and effective practice How to implement a program of care that has been designed and supervised by a registered practitioner Learning Outcome 4
Health and safety principles and policies Recognising and reporting on situations which are potentially unsafe for individual patient/clients, self and others The importance of effective oral and written communication within the team context Recording, entering, retrieving and organising data essential to care delivery On arriving for my shift I was informed in handover that Mr. X, had been placed on constant observations the previous evening, due to his mental state being in a poor condition the clinical team felt this was in the best interests of Mr.
X as he had been experiencing paranoid thoughts and ideas and was a potential risk to himself and others. Within the Orchard Clinic there are 5 levels of service user observation, General Observation, Constant Observation, Special Observation and Seclusion. General Observation requires the floor nurse to be aware of all service users’ whereabouts and will make physical checks at intervals of no longer than 30 minutes on patients with this requirement.
Constant Observation requires a nurse to be assigned the duty of observing a single service user for no more than an hour at a time, a rota is made up to cover the shift duration, staff have to be aware of the patients whereabouts at all times and no more than a minute should elapse without visual contact being made by the designated nurse. Special Observation is the most intensive form of psychiatric nursing care, it requires one-to-one constant observation, this is restricted to service users who are acutely emotionally disturbed and/or at serious risk of self harm, it may also be utilized for short periods prior to E.
C. T or following the administration of medication to ensure compliance. Seclusion is used in extreme circumstances for the protection of others or self from significant harm when a service user is considered to be a risk to staff and/or other service users and where all other means of management have been explored and found unsuitable. This involves placing the service user into one of 3 high dependency units within the ward and locking the door, a nurse would then be assigned to observe this individual throughout the period of seclusion.
Prior to taking over from my colleague, I took a few minutes to read over Mr. X observation notes for the few hours prior to give me an idea of his current mental state, these notes contain entries written by observing nurses detailing service users behaviour, mental state, use of medication and dietary intake, previous notes indicated service user had been responding to visual hallucinations. I was then given a brief verbal update on Mr. X for the previous period of observation, from the current observing nurse. Mr.
X approached myself in the main corridor, where I had been observing him at a non-intrusive distance, he was agitated and distressed, he believed there was listening devices placed in his room and told me he would like them removed, while talking about this he became angry. As the observing nurse, I suggested Mr. X may benefit from some extra medication to allow him to settle. Mr. X refused the initial offer of medication, believing it would not help. I remained with Mr. X during this period and spent the time talking to him about his paranoia and explaining why I felt medication would help.
Due to the terms of his section, a Compulsory Treatment Order (CTO), Mr. X does not have the right to refuse prescribed medication, it was decided Mr. X should be offered oral medication again, however he was also to be informed that his refusal would require him to be assisted in getting the medication required via intra-muscular (IM) injection, under restraint if required, as it was felt it would be detrimental to his mental state to go without medication. I informed Mr. X of his rights and reasoning into why it was felt he needed extra medication and how it would help him in this situation, ncouraging Mr. X to accept oral medication from the staff nurse and reassuring him at the same time. Mr. X eventually accepted oral medication and requested use of the ward quiet area for a while before retiring to his bedroom to get some sleep. On finishing my period of observation with Mr. X, I proceeded to record everything that had taken place throughout my assigned 60 minutes on the Constant Observation sheet including information the nurse-in-charge had asked me to include.
This detailed his behaviour, mental state and that he had received medication and detailing the reasons for this. All the information written on the recording sheet is read and countersigned by a trained nurse, which is then typed into the service user’s notes for future reference. References The Orchard Clinic (2010) Observation Policy, Edinburgh. Scottish Government. The New Mental Health Act: An Easy Read Guide (2007) Retrieved November 26 2011 from http://www. scotland. gov. uk/Publications/2007/09/03145057/11