1 SHADRACH DARE LIFE IN THE ASYLUM- MY EXPERIENCE Misperceptions about the mental home abound within the populace.

Many stories about the mental home paint the asylum as a place of chaos, grand indiscipline and lawlessness. In fact in the Akan society, Ankaful is used as a metonym for a dungeon of mad people. But is this a myth or a reality? Many people have queried. The author, therefore, seeks to clarify this question in this treatise as he reflects on a critical incident he was involved in during his second week placement as a student nurse in the Ankaful Psychiatric Hospital. In this incidence, the author together with a colleague moderated a group therapy. This granted me the opportunity to interact with about a dozen members of the mental home. This incidence is chosen because of the impact the experience has had on my perception about the asylum and my future career at large. Reflective practice is considered one of the cornerstones of modern nursing (Gillies, 2007). Reflective writing is writing which involves consideration of the larger context, the meaning and the implications of an experience or action (Branch & Paranjape, 2002). For Jacques (2005), in an ever changing social and healthcare environment, the ability of nurses to continually improve and update their practice is vital, and is enshrined in professional codes and standards (Nursing Midwifery Council (NMC), 2006). Reflection is considered one of the best tools for the improvement of that practice (Livingstone, 2004). The purpose of this assignment is to apply a reflective model to analyse a critical incident I was involved in. Topics consistent with Gibbs model has been adopted for the sole purpose of this assignment. Since the inception of the term critical incidence as a classification and training method by Flannagan in 1954, there have been varying definitions by several authors in the fields of social, health and behavioural sciences. Fook & Cooper (2003) describe a critical incident as an episode of experience, not necessarily dramatic, which has significance for the

2 observer. It is often an event which made you stop and think, or one that raised questions for you. According to Lassisi (2009) it is an incident which in some way has had a significant impact on your personal and professional learning. It may have made you question an aspect of your beliefs, values, attitude or behaviour. In the clinical setting, critical incidents may relate to issues of communication, treatment, culture, relationships and emotions or beliefs (Dadson, 2006). Reflection can be a difficult skill to acquire. According to Newark and Marine (2010), novice nurses in particular can find it difficult at first. Platzer (1997) identified that learning through reflection is more potent if there is an underlying framework that encourages a structural process to guide the act of reflection. In light of this, Gibbs (1988) reflective model has been adopted in this assignment because it is fairly simple and encourages a clear description of the situation, analysis of feelings, evaluation of experience, analysis to make sense of the experience, conclusion and action plan. Anonymity shall be maintained throughout this assignment for the sole purpose of maintaining patient confidentiality (NMC, 2008). The author shall use subheadings consistent with the requirements of the assignments in order to produce an explicitly organised report. Description of the Situation This is the account of the incidence that has left an indelible snapshot on my mind and most importantly, one that has changed my perception about the mental home. Though not dramatic, this incidence is critical for me because of the impact it has made on my career. The first part of Gibbs (1988) model of reflection requires the author to give a description of the incidence. Someone to lead group therapy today the in-charge enquired, Shadrach, Shadrach! my colleagues acclaimed, and that was how I was chosen to lead group therapy for the day. Although I had witnessed group therapy in my former ward during the past week I had not actually led one. To prepare myself for the session, I revised my notes on principles

3 of group therapy and on personal hygiene, which was the topic for the day. Gillies (2009) state that adequate preparation towards group therapy is a necessity for achieving set goals. I went round the various wards to invite members of the group about 10 minutes ahead of time. In about 5 minutes to time, the clients had converged at a summer hat with seats arranged in a circle in the middle of the ward. The therapy of 13 clients began with a prayer from MR, a mentally ill patient, after which rules for the session were spelt out. The topic for the day, importance of personal hygiene, was then introduced and members of the group contributed immensely to the discussion. At the earlier stages the clients were reluctant to speak but after 1 or 2 of them had contributed, the discussion became very interactive and livelier. During the session, some of the members were not paying attention and a few were disturbing but whenever I called the house to order, they obeyed accordingly. Ending the session, I asked each of them to state one importance of keeping personal hygiene of which all of them did. Okedare (2008) describes evaluation as an important way of assessing the effectiveness of a teaching session. Sincerely, the session seemed to be more ordered and than a group discussion I had with my colleagues in school. Feelings From the time I was assigned to lead group therapy till the end of the incidence, and even up to this time that I reflect on my feelings, a series of feelings run through me. The thought of being in a male psychiatry ward caused me to be afraid. This was partly due to my unresolved perception about the mental patient. I was disturbed of the worse that could happen should these mad men break loose to attack me. This affected how I related with the mental patients. I was unable to play either cards or draft with them like I used to in the female ward during the past week because I was engulfed by fear. My mind could not rest when I was nominated to lead therapy, for I was troubled of how I would tell these mad people to keep quiet, or what if I said something that reminded

4 any of them of a bad incidence and causes him to go crazier? These thoughts caused me to feel a little tensed. The in-charge then approached me and told me it was normal to feel tensed for any first activity but I shouldnt worry because he would be around to support and supervise. I was ashamed to know that my thoughts were so apparent that the in-charge had noticed it. I, therefore, approached my co-moderator to put our thoughts together. As we shared ideas of how to go about it, tension decreased and confidence began to rise. I was surprised at the level of discipline displayed by the so called mad people. They were on time unlike those of us who claim to be normal yet late for meetings and functions. I was impressed at their obedience to the rules we had laid concerning the proceedings. This dispelled my perceptions about them and caused me to like them. As we discussed about personal hygiene, I was amazed at the practical examples they gave. It is, however, worth mentioning that some of the responses some of them gave were totally out of place. This caused some of their colleagues to laugh; this is not uncommon among the general population. Wherein is the root of the misperception and related stigmatisation? Is the mad man, therefore, one who reports to meetings on time or obeys laid down rules at meetings? In fact mental illness should be viewed as disease of the brain, just like myocardial infarction is seen as a disease of the heart. Evaluation What good is education if it does not change the attitude of men to become better people? Nelson Mandela asked a group of educationists during his first visit to a primary school in his home town. Likewise I ask, what good would all the time I spent in class to study mental health or stayed at night to read about psychiatric nursing have been if I continued to stigmatise the mentally ill patient?

5 It is interesting to know that despite the 53 lectures and 1 symposium I had attended on mental health, I did not cease hold of my perception about the mentally ill but after just 30 minutes of a clinical encounter, I ceased cling of my perception, had my fears allayed and interaction with the mentally ill patient improved. I feel I did not go to moderate a group therapy for mental patients rather I had therapy for myself. Experience is indeed the best teacher. The benefits of this experience cannot be overemphasised. This experience came at a time I had almost completed my course in mental health and would have graduated as nurse supposed to have good knowledge about mental illness, which is true, but a part of the drove that stigmatised the mentally ill. My attitude about the mentally ill has been changed. Analysis The use of group therapy as a treatment method has long been effective in resolving many mental health problems. Many people are members of within a number of groups, for inherent in human nature is the desire and drive to join others in similar activities and pursuits (Baker, 1995). Group therapy decreases isolation, creates opportunity for helping others, interpersonal learning and development of coping skills, transference with the therapist while learning the ability to listen to other group members (White, 1997). It also encourages members to use one anothers assets to foster their own growth (Nudelman, 1996). Tuckman (1965) describe 4 stages of group development as; 1. Forming: group members are concerned with orientation 2. Storming: group are resistant to task and group influence 3. Norming: the resistance to the group is overcome by the members 4. Performing: the group enters the problem solving stage and creative solutions emerge.

6 For the sole purpose of this assignment, Tuckman (1965) theory of group development shall be used to analyse this incidence. From the above theory, it could be seen that the group went through this stages. At the earlier stage members introduced themselves and the therapist also introduced himself. Members of the group were reluctant to talk in the early stages and this corresponds to the storming stage of group development. However this resistance was overcome as some of the members spoke motivating the others to do same during the norming stage. In the final and performing stage, the message had been conveyed and all participated as expected. Conclusion A hypothesis I can draw from this incidence is that people continue to stigmatise the mentally ill because of the misperceptions they hold about them. I therefore strongly recommend that student nurses embark on a de-stigmatization of mental health campaign, at least in the university community to dispel the misperceptions people hold about the mentally ill and life in the asylum. Action plan Overall, this incident has had a positive impact on both my studies and the skills and attitude needed in my future career- Nursing. I have realised that I can act confidently once I overcome my initial fears. Now that I have a better and positive view of mental health, I am confident that I shall be able to relate better and professionally with the mentally ill client.