Professional Documents
Culture Documents
team (MDT) and how they work with the client to promote
independence.The MDT within the mental health environment
generally comprised of psychiatrist, clinical psychologists, nurses,
occupational therapists and social workers, but other therapists
such as family therapists, psychotherapists, dietician and
counsellors mat also become involved in the care of the client
(Perkins &Repper 1998).
Multidisciplinary involvement is important within mental health
nursing as people with mental health problems have multiple needs,
so a variety of expertise is required to meet the needs of these
people (Darby et al 1999).Ovretveit, (1993) defined the MDT as a
group of practitioners with a wide variety of professional training
who regularly meet to provide a service to clients.Throughout this
reflection, the clients name and clinical setting will not be disclosed
as this would breach confidentiality (NMC 2004). For this reason the
client will be referred to as ‘Martin’.
The first stage of Gibbs (1988) model of reflection requires a
description of events.Martin is a 45 year old male, who is currently
at a mental health rehabilitation unit as he suffers from paranoia
schizophrenia. Paranoia results in episodes of delusions which can
be accompanied by hallucinations, perception disturbances and
auditory variety (BBC 2006). Schizophrenia is a psychiatric diagnosis
that describes a mental disorder characterized by expressions of
reality or by impairments in perceptions (BBC 2006).Martin was
brought into the rehabilitation unit as he suffered from chronic
delusions, which caused him to behave irrationally and destructive.
Before he was admitted into hospital, he was causing danger to
himself and others by setting objects on fire and was very paranoid
about objects in the kitchen. He felt that the instruments in the
kitchen were dangerous and always commented on the cooker and
oven being broken. This resulted in him being unable to prepare
himself food and eating fast food meals everyday.After spending 2
weeks in a mental health hospital he was transferred to a
rehabilitation unit, which he had currently been in for a month.The
MDT had to work together so Martin was able to overcome his fear
of the kitchen and able him to become independent.
I had the opportunity to observe a MDT meeting and participated in
the discussion about Martin. Throughout Martin’s time in the
rehabilitation unit, many of the MDT members individually spent
time with him.The consultant discussed with him any medical
problems Martin may be having and gave Martin a description of the
medication he had been prescribed and why it was essential they
were taken (Kirby et al .2004)The psychiatrist discussed with him
how he was dealing with the paranoia schizophrenia and gave
Martin a better overlook of his overall life and what he would be able
to achieve if he focused on trying to prepare meals. The psychiatrist
allowed Martin to discuss his feelings openly and concentrated on
whether his perception of cooking had changed over the month he
had been in the rehabilitation unit.
The occupational therapist also worked with Martin. The main role of
the occupational therapist is helping individuals with everyday tasks
to promote and maintain their independence and reduce the risk of
relapse (Burke 2006). The occupation therapist guided and
supervised Martin with his cooking which also gave them a chance
to bond and communicate, while preparing their meals (Taylor et al
2001).The dietician was also notified about Martins lack of ability to
prepare food. The dietician explained the risk of poor nutrition and
what affects it could have on Martin.
The social workers main duty was to help Martin cope with the
environmental aspect of his life, by giving him and his family
information about the ways to support him while in rehabilitation
and when he returns home. The social worker also advised Martin to
attend cooking groups so he could gain confidence in cooking. The
social workers also encouraged Martin to join more social
events/groups which would encourage social integration (Thompson
2006).
I am now going to enter into the second stage of Gibbs (1988)
model of reflection, which is a discussion about my thoughts and
feelings.I felt very comfortable and accepted within the MDT
meeting. The atmosphere was friendly and relaxed and the MDT
discussed Martin’s progress. I felt quite nervous in contributing to
the MDT discussion but felt as though I was Martins advocate and
was speaking out on his behalf, as I had gained a strong bond with
him. The MDT listened to my opinions and asked further questions
on how I felt he was progressing. The MDT communicated well with
each other and had Martin’s best interest in mind at all times. The
discussions about Martin were held until the best outcome was
achieved for him. This demonstrated the benefits and importance of
communication within a team and how all contributions within
meetings should be valued (Perkins & Repper 1998). I found it
extremely interesting to see a MDT in action and witness the
teamwork between different disciplines.
Evaluation is the third stage of the Gibbs (1988) model of reflection
and gives an account of the importance of MDT. There are many
positive aspects of this particular MDT as they all worked well
together as a team with the same goal in mind. The team discussed
the different options available and all the problems that may arise.
The MDT have to consider the current state of a client and if the
change in lifestyle would benefit him in the long-term. The
advantage of a multidisciplinary team approach is that all
professionals work together by collecting the facts and by bringing
information together, to obtain a complete view of the possible
problems of each individual patient. In doing this they are able to
make sure that the appropriate range of treatment is given (Onyett
2003).The MDT can have a large impact on the client’s life and can
change their long-term way of living.Although, one of the major
disadvantages of the MDT is that they work individually, therefore
there can be a lack of direction, unclear goals and poor leader ship
(Darby et al 1999) if effective communication between the team is
not achieved. This could affect the care Martin given and postpone
his discharge from the rehabilitation unit.Essential communication is
vital in MDT as it allows the team to gain an understanding of how
the client is coping and if the transfer from the mental health
hospital to the rehabilitation unit benefited him.
Stage four of Gibbs(1988) is an analysis of the event. If I had not
given my opinion on Martin’s care, he may not have benefited from
the MDT as much as he did. Contributing in Martins care meant that
I was able to inform the other members of the MDT about his
progress. I felt I did this well as I gave a description of his emotional
state and how he was progressing with preparing food in the
kitchen. The MDT appreciated me speaking about Martin, as they
were able to identify new targets for him to achieve, so he would
constantly be working towards reaching independence.
In conclusion, stage five of the Gibbs (1988) models, it is clear to
see from the MDT meeting that effective leadership and good
communication between members of the team is vital to ensure
there is a clear understanding of Martin’s outcomes (Taylor 2001).
The MDT has to be equipped with all the information to overcome
Martin’s individual problems (Taylor 2001). The team working
together forms the basis of mental health nursing and can influence
the success or failure of the care and treatment that Martin may
receive (Kirby 2004). The MDT has the potential to achieve positive
outcomes for Martin, and give him the opportunity to reach
independence.
The final stage of Gibbs (1988) model is the action plan. If I found
myself in this type of situation again, I would be more confident in
discussing about the clients and their needs thus participating more
within the MDT meeting. I have learnt from this situation that good
teamwork and communication between each other is vital (Taylor
2001). I have gained a better understanding of the multidisciplinary
team, and how the outcomes of these meetings can affect Martin
and his family’s quality of life, which will help me to think very
carefully about the decisions I make concerning client care in the
future.
References
BBC ,2006, Schizophrenia, BBC news, Available from:[Online]:
http://news.bbc.co.uk/go/pr/fr/-/hi/health/medical_notes/1079451.st
m[Accessed: 20th August 06]
Burke.L, 2006, Occupational therapists, [Online] Accessed from:
http://www.occupationaltherapists.com/[Accessed: 2nd September
06]
Darby, S. Marr, J. Crump, A Scurfield, M (1999) Older People, Nursing
& Mental Health. Oxford: Buterworth-Heinemann.
Gibbs.G 1988, Learning by doing. A guide to teaching and learning
methods, oxford polytechnic, Oxford
Kirby.S, Hart.D,Cross.D,Mitchell.G, 2004, Mental health nursing:
Competencies for practice, Palgrave, Hampshire
Nursing&Midwifery Council, 2004, NMC Code Of Professional
Practice: Standards for conduct, performance and ethics, United
Kingdom
Onyett, S. (2003) Teamworking in Mental Health. Bristol: Palgrave
Macmillan.
Ovretveit, J. (1993) Co-ordinating Community Care: multidisciplinary
teams and care management. Buckingham. Open University Press.
Perkins, R. Repper, J. (1998) Dilemmas in Community Mental Health.
Oxon: Radcliff Medical Press Ltd.
Taylor.C, Lilis.C, Lemone.P, 2001, Fundamentals of nursing: the art
and science of nursing care, 4th edn, Lippincott, Philadelphia
Thompson.N, 2006 , Anti-discriminatory practice 4nd edn. Palgrave
Macmillan, Basingstoke
The therapeutic relationship can be between two people. It is a
relationship that is establish to meet the patient’s needs and
therefore, it is client centered. I felt the need to develop therapeutic
relationships with the client’s so that they could feel they could put
their trust in me, also that I was there to listen and talk to them not
just care for them. My final placement was an elderly rehabilitation
ward which help the patient’s to adapt to changes in their life
circumstances. The ultimate goal is to maximise the social well
being of the individual and enabling them to regain their maximum
quality of life and the rehabilitation involved all the individuals’ daily
activities. I was not sure what to expect from this placement as it
was my first experience of working on an elderly rehabilitation ward,
as my first placement before was on a surgical ward. During my first
days on the ward I found it very different as the patients needed
more assistance with their activities of living, such as mobility when
transferring and their hygiene needs.
However the ward did use the same model of care on the ward as
my last placement which was the Roper, Logan and Tierney
activities of living model. This helped as the purpose of this model of
nursing is to provide a framework mainly for nurses to plan and
individualize nursing for those interventions which are related to the
patient’s activities of daily living. Roper et al (2002, p434) states
that living could be described as an amalgam within the activities of
daily living and the way in which the activities are carried out by
each person contributes to individuality in living.
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In both of these placements I have interacted with a large number
of patients, all of whom have been admitted for a variety of
difference reasons. This involves me admitting these patients, their
overall care during their time either in hospital or in other care
centres right up to their discharge.
When I first started on the ward I was a little bit concerned when
meeting patients when other staff were present as I thought that I
was in the way and I would be unprepared when asked to do
anything or answer any questions that the patient may ask, as the
other staff seemed so professional. Prior to starting each of my
placements I attended classes which involved how to act
appropriately around the patient’s and other members of the team
in which I was working and it was to prepare us for our practice
placement, but when you get out in practice and are faced with the
real thing it is much different.
There are many ways of forming a relationship and gaining the trust
and respect of the patient and I had to work out the different things
that make a good therapeutic relationship. Hinchliff et al (2003,
p102) states there are a number of important elements that make a
good therapeutic relationship, but it is important to make clear that
a therapeutic relationship is a formal relationship between a medical
professional and patient. The Nursing and Midwifery Council (2004)
maintains that at all times nursing staff must maintain appropriate
professional boundaries in the relationships they have with patients
and clients.
The NMC (2004) states that the nurse must recognise and respect
the role of the patient/client as partners in their care and the
contribution they can make to it. This would be the phase of
identification in Peplau’s (1988) model of the nurse patient
relationship. Peplau (cited in Hinchliff et al 2003, p130) views the
nurse patient relationship as passing through four phases
orientation, identification, exploitation and resolution, with
identification being when the patient finding out more about the
reason for health care and the people who can be relied upon for
help and advice and how the patient can become more involved in
their own care.
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This element is important as in the nurse patient relationship the
patient is in a vulnerable position. People become vulnerable
whenever their health or usual function is compromised. This
vulnerability increases when they enter unfamiliar surroundings,
situations or relationships. Older patients and those with dementia
are especially vulnerable. I felt on the placement the patient’s could
put their trust in me as when taking personal information from
patients I would ensure to the patient in the early stages of the
relationship that information provided is treated as confidential, but
will be shared on a need to know basis, with others involved in the
delivery of their care.
The main purpose to this reflection has been to show the difference
between a normal everyday relationship and a relationship between
a medical professional and a patient. In a nurse – patient
relationship as the NMC (2004) states there is a duty of care. This
expresses itself, especially in a hospital setting. One of the
important elements of nursing is establishing a therapeutic
relationship. Until I had considered Gibb’s cycle I had not really
thought about the elements that make up a therapeutic
relationship. These I now appreciate include verbal and non verbal
communication, such as touch, humour, compassion and listening
appropriately to the patient and it id further shaped by the concepts
of power, trust, respect and intimacy.
I have learnt how to listen and talk to patients, staff and family
members for me as a first year student this was a daunting task at
the beginning but I felt I developed this and my confidence come
from personal experience. I would hope in the future to develop
further interpersonal skills and help patients in what ever setting I
find them. I need to make all patients feel equal and attend to all
their needs in privacy and with dignity and cooperate with their
individual needs separately.
In the future and having the knowledge gained through this piece of
reflection I
* Email
* Phone
References
Birrell, J., Thomas. D., Jones. C.A. (2006) Promoting privacy and
dignity for older patients in hospital. Nursing Standard, Vol 20; No,
18 Middlesex: RCN Publishing Company.
In keeping with NMC guidelines, all names and locations have been
changed, to protect the identity of the individuals involved.
However, it must be stated that individuals who work with the client
groups may recognise the individuals concerned, due to the
information provided. In this respect, it is not always possible to
completely protect the individuals concerned; however, it is also the
duty of other professionals concerned to remember their own
responsibilities regarding protecting the client’s rights of privacy and
dignity.
Description
A patient was admitted to the Unit from another ITU, she
spoke no English and had a tracheostomy. Within thirty
minutes we managed to find a healthcare professional within
the hospital who could speak Italian, to explain to the patient
that she was in hospital, quite safe, that her daughter had
been informed and would be arriving in about an hour. When
the daughter arrived, she was able to relay the patient’s
preferences and needs which we decided to not only record in
her notes but to also make a list which was kept on the desk
by her bed to make it easier for staff involved in her care. The
daughter also wrote down lots of useful questions in both
Italian and English, enabling us to try our hand at a bit of
Italian and for the patient to point to any of the questions she
wished to ask us. We also went on the internet and found
some useful words we were able to use.
Feelings
I was aware of how frightening it must be for the patient who
was ill, had a tracheostomy and was surrounded by people
who she did not understand. At times I felt quite useless when
she was trying to talk to me and I had no idea what she was
saying. I could only hold up the questions her daughter had
provided and hope it was something on there that she wanted,
then I would feel really pleased for her if it was and I could
provide what it was. On occasions, when no matter how hard I
tried I could not understand what the patient was trying to ask
me, I would ask a colleague to see if they could understand
what the patient was asking. I am pleased to say that between
us, we always managed to work it out.
Evaluation
The good thing about the situation, was that it really
challenged us and everyone did really well. Also the more we
got to know the patient, the easier it became. On one
occasion, when an x-ray machine was wheeled into her room I
noticed a look of fear on her face. Realising we had no means
to explain an x-ray, I mimed to her that I was holding a
camera and taking a photo and mimed a square on my chest.
She immediately understood that we wanted to take a ‘photo
of her chest’ and she smiled at me and nodded.
The bad thing about the experience was the frustration you
feel when you are trying to understand what the patient is
telling you and you can only imagine the frustration the
patient must feel when, unlike us, she has nobody to help her
try to ‘work it out’. It also made me realise how a situation
could so easily become ‘unsafe’ when a person cannot tell you
in detail how they feel. When verbal communication is so
limited, it is so important to look for body language and
expression if you are to meet this patient’s needs.
When a male nurse was taking care of her and I went to assist
with her personal care, she understood and agreed to a wash
but made it clear she did not want the male nurse to do it by
pushing him away. I asked if she wanted me to do it by
miming a wash and pointing to myself she nodded and looked
relieved that I was going to do it.
Analysis
The language barrier and the tracheostomy provided two
communication challenges with this patient. However,
whatever the communication challenge, you can overcome it
to a degree, certainly enough to communicate with someone.
Non verbal communication becomes even more important in
these situations. We had a Spanish nurse who looked after her
when on duty which worked well as they understood quite a
bit of each other’s language and the patient enjoyed her
company.
Conclusion
I don’t think any more could have been done. The patient was
happy during her stay and everyone made a good effort to
ensure that communication was not only questions and
answers. Our attempts to speak Italian made her laugh a lot
and she liked us to tell her about ourselves, such as if we had
children. We told her the day and the time and many other
things. The patient made it quite clear if she liked or disliked
someone by a simple brush of the hand or holding your hand.
Action Plan
If the situation arose again, I would feel more confident in
trying to learn a bit more about whatever language I was
dealing with. There are many sites on the internet and I would
certainly use that more. I know I could also contact an
interpreter as well.