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Essay On Critical Incident Analysis During Location Nursing Essay

This article will think about critical occurrence which occurred at my location. It will format how critical incident analysis is integrated in the treatment provision of people with mental health issues specifically from a medical perspective. I'll also try to explain the weakness and the principles of representation and analyse care provision in a far more structured therapeutic strategy. Bandman and Bandman, (2002) claim that to be able to analyse an incident we need to think critically, reflecting on our values, ideas, feelings and use of words. Gamble and Brennan, (2000) claim that relationship between reflection and critical thinking emphasises the need for critical thinking to be predicated on reflective thinking. In this article I shall also bring on Johns' Reflective Pattern (Pearson et al 1996) to provide the reader a specific understanding and evaluation of the occurrence, highlighting risk management as a major issue of matter. I will also point out the daily dangers, which Mental Health Nurses face in relation to the ethics, policies and steps that guide them. All labels have been transformed for reasons of confidentiality Nursing and Midwifery Council, (2008).

Drawing after an incident within my most recent positioning, the dialogue will think about the therapeutic involvement of family therapy as long-term psychotherapeutic intervention to take care of an determined patient identified as having paranoid schizophrenia. It will critically analyse the huge benefits and shortfalls of the intervention.


Reflecting on the occurrence described later in this essay, I came across it more appropriate to make use of John's Reflective Circuit, (Pearson et al 1996) because it focuses on both the patient and the nurse unlike other models that lack a consumer focus representation mainly on the nurse's emotions, ideas, beliefs and judgements. John's Reflective Cycle (Pearson et al 1996) places great emphasis on the feelings, emotions and information of your client as well as the specialist, that i feel is of increased significance as it offers a far more objective point of view. The reflective routine is also clear, easy to check out, easy to comprehend and provides the reader a specific research of the event which is vital to make sense of the complete reflective process. Johns' reflective circuit illustrates the next framework; first stage- phenomenon, second stage-rationale, third sage-causal essential factors, fourth stage-reflection, fifth stage-alternative activities, sixth stage-conclusion. Third, guideline it is that one may structure their representation and draw out sense to the complete reflective process.

I thought we would write about this event because I feel it emphasizes the potential risks mental health nurses face whenever using emotionally disturbed people. It shows how policies and types of procedures can disempower specialists, placing them at increased threat of intense or disruptive behaviour. I also found it easy to use the critical event analysis strategy to evaluate possible therapeutic intervention in patient good care.

The risk posed by the patient in this scenario might have been reduced if the nurses involved in the patient health care used psychosocial interventions. The incident described in this essay call into question the policies and procedures used in Community Mental Health Services on interacting with turmoil or crisis situation and the work of good care as a role the nurse. Legally and ethically nurses are not permitted to search patients locally, (Thomas et al 1997) which places personnel in an exceedingly susceptible position which is very apparent after reading and reflecting on the scenario.

Zack suffers from Paranoid Schizophrenia. Pursuing is a short synopsis on Schizophrenia in order to provide the reader a picture of the patient's condition. Schizophrenia is a wide term given to band of mental illness that happen to be usually characterised by thought disorder, auditory and visible hallucinations, delusional beliefs along with mental and behavioural disorder leading to progressive deterioration and interpersonal withdrawal Ironbar and Hopper, (1989). This patient in-particular is suffering from Paranoid Schizophrenia, recognized by strong thought disorder, delusions and hallucinations, the sufferer having perceptions, beliefs and ideas of reference that things are being said about them and things being done to them which they believe could cause them harm Thomas et al (1997). Treatment entails long-term use of psychotropic medications such as anti-psychotic drugs and disposition stabilisers. From a social model strategy research has shown that long-term psychotherapy programmes such as family remedy have proven effective Thomas et al (1997).

Patient Account and Context

Zack is 28 yr old male outpatient known to the Mental Health Services since 2001 with a prognosis of Paranoid Schizophrenia. Zack is an asylum seeker from Algeria and of Muslim source, though he's not very demanding with the faith. He visits the medical clinic every fortnight for his depot (Depixol) injection. When is unwell, he develops ideas that Jews and homosexuals are conspiring against him and is convinced he has special capabilities. Both his parents are alive; they believe he brings pity to the family anticipated to his mental disorder. There's been growing concerns about Zack's family not doing enough to help him through his illness and neglecting his needs. Personnel has raised the need to participate the family in family remedy as a means of helping Zack and family cope with his disease but as yet no family members has agreed to this type of involvement.


The Depot medical clinic normally starts at eleven o'clock following each week Community Mental Health Team appointment. Zack was credited for his depot injections that day but he appeared two hours early looking unkempt. The Community Psychiatry Nurse (CPN) and I visited speak to Zack and advised him that people were having a meeting therefore he had to come back when the center starts. Zack said he wanted to have his injections early on because he wished enroll in the Muslim celebrations occurring locally that day. He shown signs to be mentally disturbed, speaking and muttering to himself about obviously meaningless and weird things.

Zack were very hostile and provocative with fluctuating thoughts. The CPN insisted Zack acquired to hold back but he was adamant on receiving the depot immediately. Zack became increasingly agitated, pacing up and down, raising his voice shouting abusive words to us. Zack started to make snacks of arson, proclaiming he had a blade. He suggested he'd stab one folks if we did not adhere to his demands. As soon as he said that and having observed his behaviour, I used to be perplexed on the one hand the necessity to do something positive about this patient who was simply plainly unwell and looking for support and treatment, while also being mindful of the risk to both the CPN and myself.

The CPN decided to minimise the chance by agreeing to give Zack his injections and getting him out of the building as quickly as possible. I felt this is a high-risk decision because if Zack did have a knife we were possibly placing ourselves in better danger by interesting with him further. I drawn the CPN aside I let my thoughts known. The CPN responded by informing me that Zack didn't have a history of violent or hostile behaviour nor was he recognized to carry knives. I noticed we needed to make certain Zack was not carrying any knives or sharps before we gone into the clinical room to give him his injections.

The CPN then asked Zack calmly and politely if he was holding the knife at this time Zack produced a blade from inside his jacket. We adopted the Trust policy for working with equipped and dangerous patients that you must call for back-up; we pressed the alarm alerting other staff for assistance. The authorities were called and arrived rapidly they seized the blade Zack was also found to be carrying a screwdriver. He was taken up to an severe admissions ward of a nearby clinic under Section 2 of the Mental Health Act (1983) for further diagnosis of his mental state. His family were informed but they looked like not to get worried.

Influencing Factors

Family therapy consists of the whole family in the procedure process predicated on the understanding that a particular warning sign or group of symptoms, exhibited by a member of family. Reflecting on Zack's relationship along with his family it's important to notice that because of their culture the family experienced bad attitude towards the condition and they noticed it brought pity to the family. By educating the family, which really is a major element of family therapy, it can help gain understanding into the illness, how they can screen, support and supervise the patient which plays a part in the development of perception and helps reduce threat of relapse and hospital entrance. Fadden, (1999) cited by (Gillam 2002, p106) defines psycho educational interventions as "those interventions where the patient and members of the family are seen together, where is acquisition element in addition to a didactic element where the primary goal is reduced amount of relapse in the individual" It's been shown that those patients who've family who are willing to engage in the patient's attention in a supportive manner own an enhanced possibility of maintaining stability in their mental state.

Therefore, use of family remedy as a long-term psychosocial involvement reduces the chance of relapse, which is exactly what occurred in this situation with Zack. Participating with the patient is very important in providing care and monitoring people who have schizophrenia and it would be very very important to the patient and his family. The family also feel recognized by the therapist who works with those to help develop a knowledge of the illness and reduce their dread and misguided prejudices.

As a nurse/therapist it might be important to understand ramifications of culture in this example and make an effort to bring understanding to the family that mental condition is quite typical and maybe show the family statistics about how many people live with mental condition. It would also make a difference to teach the family on understanding the improvement rate for people who engage into family remedy and benefits. Evidence based practice would be very important whenever using this family as it shows confirmation that treatment can in fact work and has been proven to take action oftentimes. Family therapy has been found to be effective, as an adjunct to medicine therapy in the management of schizophrenia Birchwood, (1994), therefore the family should monitor that patient is taking medication as required. By encompassing family remedy, psycho education it encompass the engagement and support of family in the good care of an individual Gillam, (2002) which is very important in this situation. This can help the family gain understanding into the illness and accepts it even though this may be difficult due their cultural beliefs.

Staffs are always vulnerable to aggressive patients and for that reason there is excellent dependence on risk assessment. Clinical risk is concerned with the risk in which a person might present to themselves or others Gamble and Brennan, (2000). Research has identified that the event of violence, arson and homicide depends on additional situational factors and their accumulation lead to increased risk. In this example having detected the incident from the beginning, I observed Zack's escalating behavior, presentation such as conversation, voice build, gestures plus they determine a great deal in ones state of mind Gamble and Brennan, (2000).

There are other precipitating factors resulting in this incident including the psychosocial environment and stimuli in cases like this your day of the depot coinciding with the activities. If it was a different day, maybe Zack wouldn't normally been very paranoid and holding a knife. Also the fact that staff cannot meet his needs, it made him more aggressive and in ways no one could have known he was taking a blade. Psychiatry nurses face need for risk assessment due to the restrictions they have in looking people who they believe to be dangerous. The fact that Mental Health Clinics have no enough security steps to identify people who generate weapons, it increases the risk. Staffs are limited in the methods of dealing with patients which is unlawful and unethical to undergo patients' things or looking them without their consent Thomas et al, (1997).

Mental ailments can manifest in a manner that can cause distress to both the patient family and carers but with the help of such treatments as family remedy I recommend it.

I assume that Zack could gain more from it. This intervention has been proven useful by research in the management of schizophrenia Gamble and Brennan, (2000), therefore it is useful to use such therapies notify our care within evidence founded practice. Rowland and Goss, (2000), writes about evidence based practice as the dreams nurses should deliver attention and therapy based on steps that are known through research to be effective. Family remedy help the individual manage their condition and improve their standard of living. Family members and carers also gain and by empowering the patient, the family help the patient change their behaviour Slade and Haddock, (1996) cited by Gamble and Brennan (2000). Research completed within the last two decades on high Expressed Sentiment (EE) by the Friendly Psychiatry Product at the Institute of Psychiatry provided proof negative impact of high (EE) on the course of the category of a schizophrenic patient Gamble and Brennan, (2000). People find stress in copying with the condition but they are also confirmed hostile behaviour by the sufferer and eventually become psychologically over engaged. These developments resulted in the introduction of family therapy intervention.

Family therapy reduces the effect of schizophrenia such as hospitalisation and relapse Ironbar and Hooper, (1989). If Zack's family was involved with care, this occurrence might possibly not have happened. Family remedy also boosts patients working and lowers the responsibility on the family. If one gets support from family, he is more likely to improve adherence to medication, less violent and lower negative family result. An element of family therapy includes proposal of people and patients, behaviour, self-management, maintenance of skills, coping with assault, risk management, evaluation, ethnical issues, over engagement and interpersonal boundaries, Gamble and Brennan, (2000). In Zack's situation all the above on family therapy would be helpful and it entails concern on culture hence Zack's family feels he's a disgrace to the family, which is part of the cultural beliefs. Making them understand the illness would become more helpful in dealing with Zack's illness. Research has also found out these psychosocial interventions are more useful than taking daily habit medication treatment and not just profit patient, but also family carers and relatives Ironbar and Hooper, (1989). In helping this patient, this kind of treatment should help him gain perception and doing individualised care with the nurse in the remedy it could be achieved. Gillam, (2002) advises the importance of using drug treatment therapy together with family therapy for maximum benefit to the individual, family and carers.

Reflecting more on this scenario, it brings out issues of matter and critical occurrence evaluation would be very important to steer the whole reflecting process. Producing skills on reflecting allows one to learn more effectively from practice situation and identify what you have discovered in practice John, (2000). There is also emphasis that representation relates to a complex and deliberate procedure for conscious thinking about interpreting experience in order to find out from it.

In this incident I used my knowledge on risk management to lessen the risks Mental Health Nurses face in working with mentally unwell patients. I had been endeavoring to minimise the occurrence of a meeting that would be dangerous. Considering the value of critical occurrence research to analyse this circumstance was since it gives me a knowledge and understanding of the complete Clinical Incident Evaluation (CIT) process. I also chose family therapy because as observed prior to the family could give a lot of help the individual, but only when they can build relationships the patient and understand the mental condition and exactly how they can lower worries and prejudices of living with somebody with a mental disease.

Before this event happened, I thought very stressed that being a student nurse involved in such a hard situation. However, my thoughts transformed later when Zack was found to be having a blade. Having not emphasised on the nurse to check if the individual actually got the knife, this may have business lead into someone getting harmed or even wiped out by the patient. This is also a learning process for me I learnt that besides taking medication like in this situation, the individual was on medication, there are other healing interventions which can be used to lessen the strains in the family of a schizophrenic patient and help the patient manage and deal with his own disease.

Critical incident evaluation was very important in supplying structure to the whole reflection process and gain understanding to healing interventions that nurses may use in handling schizophrenia. On the other hand I recognized it was unethical and against the law to search this patient, but I believed in such incident, nurses should have the power to find regarded as dangerous or threatening to staff. Evidently, according to reports from Office of Health (DH) (2008), there has been a rise in the violent occurrences involving staff working with patients with mental health problems.

The problem of risk management, risk evaluation is something never to dismiss in Mental Health Nursing. Risk management is supposed purpose of assessment process, reducing severeness of identified hazards though they fluctuate over time and circumstances Gamble and Brennan, (2000). Gates et al (2000) identifies clinical risk examination as an established tenet of Psychiatry Medical treatment. The organizations of Country wide Service Framework and Rules (DOH, 2008) have emphasised on professionals on the importance of risk analysis. There were a large number of tragedies and homicidal incidents concerning psychiatry patients therefore there have been high targets in considering risk evaluation as a major tool in mental health nursing.

Alternative Strategies

In this occurrence I felt I had fashioned to remind the CPN on the risk Zack was posing to us, reflecting on practice Thomas et al (1997). This is achieved by evaluating situations and judge how dangerous they may be or how best you can package with them in a specialist and moral way. NMC, (2008) expresses that professionalism and reliability and accountability in all our techniques and when you are accountable, you have a good cause to justify your activities in this situation safety was important.

In future if I face the same situation, I would respond quicker and take safety measures to safety in time. I'd also use good social skills to try and talk to the individual. I would also use my understanding of risk management and safety precautions since nurses have a work to provide for themselves as well as public, than just maintaining the patient Stern and Drummond, (1995). I'd also consider that when working with people who have schizophrenia there is excellent need to engage into psychotherapy interventions, family remedy important adjunct to medicine therapy.

Conclusion- Learning

In bottom line, the essay clearly considers the values of family therapy as a possible psychotherapeutic intervention to be utilized in the management of schizophrenia. In addition, it gives gratitude of the whole process. The article also demonstrates the importance of ongoing professional medical supervision and the role of an Psychiatry Nurse. Evidently throughout the essay, it is clear that mental health nurses face risky in their daily practices in dealing with mentally sick patients. Highlighted is the value of reflecting and using Clinical Occurrence Research (CIT) process as a major tool to help the complete reflective process. The periods of John's reflective cycle were found in the article as it empowered the writer to identify the phenomenon. The necessity for risk assessment and critical thinking it is possible to analyse and reflect on an incident and bring more sense to the audience.

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