The development from an undergraduate student to a registered nurse is multidimensional and complex. I have had the experience to reflect on my training period as a graduate nurse in a mental health setup. I had gained knowledge on the pathophysiology, diagnosis and prognosis of mental disorders. However, the thought of a hands-on experience in a mental health ward lead to the development of anxiety within me. There is always a stigma associated with mental health care and the patients are always stereotyped and face discrimination (Corrigan et al. 2014, p.35). I entered the ward with these mixed emotions and feelings and had a negative view on my engagement with such patients.
Transition shock is a dramatic and acute stage in the process of adapting professional role for a nursing graduate. It encompasses a plethora of nursing experiences, which include challenges as well as opportunities (Zerwekh & Garneau 2017, p.251). Several studies have reported that registered nurses consider themselves unprepared for their practice and often become overwhelmed with the new responsibilities allotted to them (Mellor & Greenhill 2014, p.57). In this report I will focus on Driscoll’s reflective framework to explore the situation that took place, an analysis of my feelings, making a sense of my experience and a conclusion of what I could have done and my action plan if such a situation arose again.
The situation, which I will explore, occurred during my third year as a graduate student. I was assigned to admit a 50 year old male Mr. Borgart for paranoid schizophrenia. I was not aware whether he had a medical history of hallucinations or delusions, so I started going through his medical handover. During his conversation with the nurse-in-charge, it became quite evident that he was experiencing paranoid delusions and auditory hallucinations. On further enquiry, he disclosed to a history of physical abuse in childhood (Hesse et al. 2015, p.1409). I felt tormented on hearing that. However, I tried to be an active listener and paid close attention to him. His conversations with were upsetting and I faced difficulty in overcoming my anxiety of interacting with such schizophrenic patients. I felt scared and threatened while talking to him and kept considering him dangerous. Studies revealed that children exposed to different forms of child abuse are more likely to become schizophrenic and psychotic in their life (Muenzenmaier et al. 2015, p.452). His first paranoid symptoms began to appear at 28 years of age. He often had delusions that his friends and family members were trying to take away his property by poisoning his food. He also experienced auditory hallucinations which gave him instructions to fly. This was one of the most dangerous hallucinations I had ever come across because it can be fatal. Earlier, he had fractured his arms and left leg twice following the orders he felt he received. He gradually became uncooperative and aggressive. He started to imagine that all nurses were trying to hurt him in some way or the other and the injections being prescribed to him would infect him with AIDS virus. Tranquilizers were still given and the staff tied him to a chair to prevent confrontation. He was ill-treated. I was made to forcefully pacify him.
I became upset as the situation began to unravel. I was surprised to see my emotional attachment to the patient and wanted to help him overcome his fear of danger from acquaintances. During my graduate programme, I had only focussed on clinical knowledge and never considered hidden aspects of providing health care. I began to question myself, ‘What should my role be?’, ‘What will I do as a registered nurse in future?’ (Duchscher 2009, p.1110). These hidden aspects of nursing influence an individual outside their work environment. I had to choose between the instructions of the nurse-in-charge and what I believed I should have done. According to the Conduct Statement Four in the professional code of conduct for Australian nurses, a nurse should always respect the culture, dignity, values and ethnicity of a patient. A nurse is also expected to ensure patient safety and not discriminate on the basis of human factors (Nursing and Midwifery Board of Australia (NMBA) 2016, p.6). I began to doubt the responsibility I will be entitled on placement as a registered nurse. I wanted to communicate my worries with a senior and wanted to stop all discrimination against Mr. Borgart. This incident helped me recognize the differences between reality and expectations and helped me gain a retrospective contemplation (Spector et al. 2015, p.32). It was a productive experience that will help me in becoming a safe practitioner.
My experience of transition shock raised concerns whether I was appropriately prepared and competent enough to work as a registered nurse. Research indicates that ineffective training leads to poorly prepared nurses who fail to carry out their professional roles efficiently. The transition of recently qualified nurses meets several challenges like little knowledge, decision making abilities, clinical duties and leadership position (Harwood 2011, p.12). Following the incident, Mr. Borgart stated that he wished to see a psychologist and remain there until he gets rid of his paranoid features. I realized that there are certain misconceptions and myths related to mentally ill patients, which make graduate nurses vulnerable to fear and anxiety. I approached a senior nurse and reflected on my thoughts about the patient. She helped me formulate a proper treatment plan. She also instructed me to keep a check on the ward and prevent any forceful or ill treatment until reviewed by the psychologist. This experience helped me understand how to use my strength and build confidence while deciding what the correct treatment for the patient is. However, the thought of going against the nurse-in-charge’s decision of forceful administration on the patient concerned me. This scenario helped me devise strategies to enhance my reflection, engage in discussion of the case with my peers and seek feedback from senior nurses and staff. I also realized that new clinical challenges will boost my confidence and management skills (Kemp 2014, p.19). My transition phase helped in my personal and professional development. My action plan will reflect my understanding that mental health care revolves around therapeutic and emotional aspects of nursing. It will help me get rid of all myths associated with mental illness. I will work on showing empathy and use reflective practice while communicating with the patients (Townsend 2014, p.802). I will develop a positive attitude towards mental illness nursing, encourage them and provide a holistic care.
I can relate to your anxiety and emotional connect with the patient in the incident and can understand his history of being subjected to child abuse made you feel for him. We have to deal with patients who have suffered much in their lives. This incident was complicated and I think taking advice from a psychologist was appropriate. The incident made us think that while evaluating on clinical terms, we should offer emotional support to the patient.
I could understand from Mr. Borgart’s aggressive behaviour that he was facing difficulty in trusting the nurses and their forceful administration of injections and ill treatment worsened his condition. We could have avoided patronizing or forcing him until the psychologist had given us instructions (Rugkåsa et al. 2014, p.889). Engaging him in conversations would help him realize that the hallucinations are false and eliminate his suicidal tendency (Campbell, Yonge & Austin 2016, p.35). We should have prevented access to all windows and the terrace which can make it easier for him to end his life.
This was your first experience in the mental ward and helped you deal with stress and transition shock. Transition shock has been debated and discussed for many years and create a confronting and stressful situation for a graduate nurse. However, you can utilize this incident as an advantage. It will help you learn aspects of nursing which are beyond clinical knowledge. It will also give you a clear insight into caring for mentally ill patients and the different complications they face. You will be able to refer to this situation in coming years while treating other people in distress.
Yes it does! Personal beliefs create negative influence between peers in a workplace. People have differing stigmas, morals and values, which are constantly challenged by such incidents in nursing care. Discussing the scenario with the manager, keeping in mind workplace policies will help you in providing holistic care to the patient (Reavley et al. 2014, p.437). You should raise concerns in regards to response which harm the patient. However, I was happy to see that you felt empathic towards the patient and discussed the negative attitude of the staff. I am quite confident that this incident will help you in your future practice.
Conclusion
This report illustrates the mixed feelings of anxiety, excitement and uncertainty. It elaborates on the different stigmas associated with mental health and how I was apprehensive of the patient initially. It provides a detailed account of the ill behaviour and mismanagement practices shown towards the patient and how I raised a concern. The interview with a senior nurse also helped me gain an insight into the practice of mental health nursing.
References
Campbell, R.J., Yonge, O. & Austin, W 2016, ‘Intimacy boundaries: Between mental health nurses & psychiatric patients’, Journal of psychosocial nursing and mental health services, vol. 43, no. 5, pp.32-39.
Corrigan, P.W., Mittal, D., Reaves, C.M., Haynes, T.F., Han, X., Morris, S. & Sullivan, G 2014, ‘Mental health stigma and primary health care decisions’, Psychiatry research, vol. 218, no. 1, pp.35-38.
Duchscher, J.E.B 2009, ‘Transition shock: the initial stage of role adaptation for newly graduated registered nurses’, Journal of advanced nursing, vol. 65, no. 5, pp.1103-1113.
Harwood, M 2011, ‘Transition Shock-Hitting the Ground Running’, Nuritinga, vol.10, pp.8-18.
Hesse, K., Kriston, L., Mehl, S., Wittorf, A., Wiedemann, W., Wölwer, W. & Klingberg, S 2015, ‘The vicious cycle of family atmosphere, interpersonal self-concepts, and paranoia in schizophrenia—a longitudinal study’, Schizophrenia bulletin, vol. 41, no. 6, pp.1403-1412.
Kemp, D.J 2014, ‘A forgotten equality: a personal reflection on trans awareness training’, Mental Health Nursing, vol. 34, no. 1, pp.19-19.
Mellor, P. & Greenhill, J 2014, ‘A patient safety focused registered nurse transition to practice program’, Contemporary nurse, vol. 47, no. 1-2, pp.51-60.
Muenzenmaier, K.H., Seixas, A.A., Schneeberger, A.R., Castille, D.M., Battaglia, J. & Link, B.G 2015, ‘Cumulative effects of stressful childhood experiences on delusions and hallucinations’, Journal of Trauma & Dissociation, vol. 16, no. 4, pp.442-462.
Nursing and Midwifery Board of Australia (NMBA) 2016, Enrolled nurse standards for practice, NMBA, Melbourne, 2 January 2017, viewed 29 August 2017. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/enrolled-nurse-standards-for-practice.aspx
Reavley, N.J., Mackinnon, A.J., Morgan, A.J. & Jorm, A.F 2014, ‘Stigmatising attitudes towards people with mental disorders: A comparison of Australian health professionals with the general community’, Australian & New Zealand Journal of Psychiatry, vol. 48, no. 5, pp.433-441.
Rugkåsa, J., Canvin, K., Sinclair, J., Sulman, A. & Burns, T 2014, ‘Trust, deals and authority: community mental health professionals’ experiences of influencing reluctant patients’, Community mental health journal, vol. 50, no. 8, pp.886-895.
Spector, N., Blegen, M.A., Silvestre, J., Barnsteiner, J., Lynn, M.R., Ulrich, B., Fogg, L. & Alexander, M 2015, ‘Transition to practice study in hospital settings’, Journal of Nursing Regulation, vol. 5, no. 4, pp.24-38.
Townsend, M.C 2014, Psychiatric mental health nursing: Concepts of care in evidence-based practice, 8th edn, FA Davis, Philadelphia, pp.703-867.
Zerwekh, J. & Garneau, A.Z 2017, ‘Challenges of Nursing Management and Leadership’, in Nursing Today-E-Book: Transition and Trends, 9th edn, Elsevier Health Sciences, pp.204-301.
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