Country : United Kingdom
Service Required : Essay
Subject : Mental Health Nursing
Level of Study : Undergraduate
Target Grade : Undergraduate 1st
See instructions here and attachements: https://we.tl/t-WPYvGolWs2
Assessment Title: A critically reflective and critically analytic examination of an episode of care
Assessment Task
This assessment addresses all module Learning Outcomes.
Core task: You will write a 3000 word semi-structured critically reflective and critically analytic essay examining an episode of care from your own nursing experience. The episode must be a case of complex care you were personally involved in where there was a risk to be managed and where you can debate what the quality nursing care should have been. You will write in the first person.
You will structure the assignment using the following headings, indicated topics and approximate word count:
Introduction (300 words: 10%)
State in what capacity you were involved in the episode of care.
Briefly summarise what happened.
Explain why you have chosen this episode – how it will meet the objectives of the
assignment.
State what the risk was in this episode.
State what nursing care you are going to examine in the assignment.
State your conclusion on the quality of care and if it could be improved.
Evidence-based holistic nursing assessment (600 words: 20%)
In this section consider the person who is receiving nursing care:
Describe their thoughts, feelings & behaviours.
Explain how they experienced the episode of care.
Give a bio-psycho-social assessment of the person:
Briefly discuss relevant history, experiences, environment and life journey.
Discuss how those features were possibly presenting in their current thoughts, feelings and behaviours.
Consider the role of their family, friends, carers, dependants or significant others and the possible impact upon their current thoughts, feelings and behaviours.
Justify assessment of the risk they were presenting with and what nursing care they
needed.
Critical reflection on self (600 words: 20%)
Critically reflect on your experience of the episode of care
Explore and analyse your thoughts, feelings and behaviours you remember at the
time.
Explore and analyse how people responded to you and how you responded to
others.
Explore and focus on your impact on this episode of care.
Critical appraisal of evidence (600 words: 20%)
Using appropriate reading from the module, module reading list and your own literature
searches apply theory to explain the episode of care:
Analyse what the clinical guidelines and evidence tell you should be the correct care
for someone with this kind of presentation.
Apply the evidence to your episode of care.
Critically appraise this underpinning theory and research and examine the quality of
the evidence.
Consider the research you have identified in this section and provide a debate on if it
would be effective for this particular episode of care, justify your opinion.
End this section by summarising what the evidence says about the specific episode
of care that you chose and described in your introduction.
Evidence-based nursing interventions (600 words: 20%)
Using the evidence that you have analysed and summarised in the previous section:
Evaluate if the risks were managed appropriately.
Evaluate if the nursing care was effective.
Analyse the quality of the care given.
Now debate what factors would increase the quality of the care given.
Analyse what improvement mechanisms would be useful.
Evaluate if those mechanisms would be effective in this case, considering the wider
context this care is delivered in.
Conclusion (300 words: 10%)
Summarise your recommendations for this kind of episode of care.
Summarise your findings.
State the recommendation you have identified in this assignment for this kind of
episode of care.
In-depth Assignment Guidance:
DISCLAIMER
We are inviting you to consider a difficult experience which challenged you and to analyse
this. Please be aware that if you disclose things in this assignment which are criminal,
abusive or negligent either in your own practice or about practice you have witnessed we
will have an obligation to act on this information. This may include sharing information with
practice partners, standards boards or external organisations up to and including the police.
Therefore, we would ask you NOT to consider an episode of care which is a serious incident
currently under investigation or a current safeguarding concern. The case you discuss should
be completely anonymised including the identity of the person, location of the care
delivered, and the professionals involved. Please do not disclose unreported criminal
behaviour or confess to any previously undisclosed practice that would trigger fitness for
practice considerations.
DOS and DONTS
Introduction:
DO:
– Use the first person, e.g. In this essay I will
.
– Give the service user in your episode of care a pseudonym e.g. I will refer to the
person in this episode of care as Dave, not his real name
– Make it clear the context of your experience e.g. I was a student nurse on an acute
inpatient unit
– Identify risks and nursing care, e.g. this essay will examine the management of
violence in an inpatient setting and the barriers and opportunities for maintaining a
therapeutic relationship in this context
DONT:
– Break confidentiality e.g. I was in Highcroft Hospital
. Or I was caring for Fred
Smith
– Start giving definitions e.g. Critical reflection is the process of retrospectively
examining your actions
– Use the NMC Code or explain why a pseudonym is needed.
Evidenced-based Holistic Nursing Assessment:
DO:
– Give the perspective of the person e.g. Dave was angry because he felt lied to and
that staff were not taking him seriously.
– Demonstrate an understanding from the persons perspective and why they behaved
in the way they did e.g. Dave was newly admitted and did not know staff members,
he was surrounded by strangers and was realising for the first time he couldnt leave
the ward because he was detained. He was being polite, but his manner suggested
he was trying to control increasing anger and frustration. He said that he thought as
he came to hospital voluntarily, he would be allowed to leave when he wanted and
felt lied to now that he found out he was detained under the Mental Health Act.
– Explore the persons bio-psycho-social needs and link them to how they are being
expressed in the episode e.g. Daves feelings of shame and anger reflect common
experiences of those who are survivors of abuse
– But ensure they remain focused on the person you are discussing e.g. for Dave
alcohol was the key to managing his low self-esteem and anxiety, he was intoxicated
when he was admitted.
–
–
–
Remember: the bio bit of bio-psycho-social doesnt mean genetics or diagnosis.
Keep it specific to the episode of care, e.g. Although Dave had some sleep following
his admission, he was now withdrawing from alcohol and had been neglecting
himself for some time, his only clothing was dirty from sleeping rough and he had
lost weight.
Give some context for the person around the episode, e.g. Since his brother ended
his own life eight months ago Dave had been drinking daily, in the mental health
assessment which led to his admission he described having no hope for the future
and no belief that things could improve. He had expressed a plan to jump from a
motorway bridge. He was socially isolated having cut off his remaining family
members and had been excluded from his temporary accommodation, leading to
him sleeping on the street.
Use relevant evidence to support your assessment e.g. Children who survive
physical abuse are much more likely to have low self-esteem, anxiety, selfdestructive behaviour, suicidal behaviour and a lack of trusting relationships as
adults (Gilbert et al 2007).
DONT:
– Give a medicalised description e.g. Dave was agitated because he has antisocial
personality disorder
– Give a service focused context e.g. Patient was admitted on section 2. Diagnosis of
ASPD. He was placed on 15-minute observations.
– Give a service perspective of his care e.g. Dave was angry because he was paranoid and impatient, staff were busy
– Give general definitions of key terms without reference to the episode e.g. holistic assessment involves considering a persons circumstances and history as an important part of their current presentation
Critical Reflection on Self:
DO:
–
–
–
Say specifically what your experience was. I found Dave quite intimidating, he kept
asking for his medication, but I was waiting for the qualified nurse to return, I told
him I was a student, but I felt quite nervous keeping him waiting in case he lost his
temper
Demonstrate and name what you did well or what didnt go well e.g. I could see
Dave was getting agitated, so I lowered my voice and sat down, to my surprise he sat
down too which de-escalated the situation.
Reflect on what knowledge and personal values influenced what you did and where
they came from e.g. I could see Daves hands were shaking, I originally thought he
was shaking with anger, but I wrote about alcohol dependence in an essay in the
second year and I began to think that this was alcohol withdrawal
–
–
Demonstrate an ability to think about other peoples perspectives in relation to your
own e.g. I could see Kevin the nurse looked worried, I think he thought Dave was
going to be violent, I wanted to tell him I thought it was alcohol withdrawal, but I
wasnt sure how he would react.
Demonstrate being able to critically think why you behaved the way you did e.g. I
didnt say anything about alcohol withdrawal, I think that was because previously
qualified nursing staff have reacted badly to me speaking up, thinking that I was
telling them what to do. Im conscious that sometimes I can be so assertive that
people think I have a problem with them. I didnt know Kevin very well and I didnt
know how he would take it if I spoke up, so I didnt, but I look back now and realise
that was a confidence issue rather than a communication one.
DONT:
– Organise this section with a specific reflective model.
– Describe everything you did, or thought, or felt without critically examining it.
– Give yourself uncritical and unspecific general praise e.g. I have great
communication skills, I have always had them, I used good communication skills in
this episode of care.
– Try to use references for things only you experienced e.g. Dave was angry when he
was told he couldnt go out (Peterson 2020)
– Talk generally about your nursing values and skills without reference to the episode
of care e.g. I have always been a people pleaser, Im very empathetic and I like to
help people, I have done volunteer work from an early age.
Critical Appraisal of Evidence:
DO:
–
–
Use the module content to answer the question e.g. Daves suicide attempt makes
sense in light of Joiners IPT model
Use the University library to find your evidence and use peer reviewed evidence
State what the guidelines and evidence say should be the right care for the person
e.g. Anons (XX) systematic review of evidence around suicidal crises and inpatient
admissions state that effective nursing care comes in two forms; restrictive
measures to reduce the risk of a suicide attempt such as removing ligatures and
intermittent observations, and person-centred care planning which begins with a
thorough assessment and building a therapeutic relationship.
Apply the theory to the person e.g. On assessment Dave had all the risk factors
explained by the IPT model: Dave felt constantly guilty about not being there for his
children, he felt the thwarted sense of belonging of not being part of the family unit
and had the perceived sense of burdensomeness of every meeting going badly due
to his drinking. That he had begun to hurt himself and make plans to end his life
demonstrated an increasing capability to act on the plan.
–
–
–
Criticise the limitations of the theory e.g. Although the IPT model explains why Dave
would feel suicidal, it didnt help explain why he decided at that time to act on those
thoughts
Critically analyse the evidence for the theory e.g. The IPT model has relied heavily
on postmortem data on a national level, it does not account for regional factors such
as higher rates of suicide in rural communities
.
Integrate your analysis with national frameworks and clinical guidelines e.g. NICE
Guidelines for suicide prevention (NICE 2019) recommend reducing access to means
in custodial settings, acute wards are designed to achieve this through a high level of
monitoring and by creating an environment which minimises risk of things like
ligature points
.
DONT:
– Generally, describe research or clinical guidelines e.g. NICE (2022) Guidelines on
treatment of depression in adults says that when offering a person medication for
the treatment of depression, discuss and agree a management plan with the person.
Including the reasons for offering medication the choices of medication (if several
different antidepressants are suitable) the dose, and how the dose may need to be
adjusted
– Use websites which are designed for use by members of the public to support your
points e.g. MIND (2018) confirm that SSRI medication is appropriate for
depression
– Use Google to find your evidence
– Use websites like Cite This for Me
– Copy and paste sections of the evidence you have chosen
– Pick evidence which is unsuitable or unrelated to your episode of care.
Evidence Based Nursing Interventions:
DO:
– Tell us what nursing care was actually given e.g. Kevin invited Dave and me into the
clinic and we spoke away from everyone else.
– Use the evidence from the previous section to appraise the care given, e.g.
Speaking to Dave away from the ward allowed him to speak openly and feel heard,
when we asked if he was withdrawing, he said he was but was too ashamed to say
this. We were able to offer him some medication for the withdrawals, which opened
the door to begin building a therapeutic relationship as Dave felt he was being taken
seriously. This is effective care as it is in line with Anons (XX) review in being person
centred.
– Give your opinion on if the care was safe, effective and high quality e.g. The care
was safe and effective at that point as Daves withdrawals were addressed and we
began a therapeutic relationship with him, but it could have been higher quality as
we didnt use that opportunity to talk to Dave about the reason for his admission
and his suicidal crisis. Later that day Dave went on to tie a ligature around his neck, I
–
–
think if we had spoken more at that point about how he was feeling maybe we could
have seen that coming.
Suggest what could have been done differently based on your reading e.g. Although
Dave given the medication he needed, that interaction could have been used for a
one-to-one conversation about how he was feeling which might have led him to
reveal signs of an imminent attempt, for example his sense of hopelessness and
feeling trapped on the ward along with his impulsivity (OConnor 2019)
Suggest if this was realistic and if not, what improvements are needed to achieve this
e.g. This episode of care happened during the morning medication round and Kevin
was under pressure to get the round complete as he was the only qualified nurse on
that day. The evidence suggests nursing shifts are understaffed and a lack of
resources reduces the quality of assessment and ability to provide bespoke care
(RCN 2021). If Kevin had had a second nurse with him, maybe he could have made
space to follow up with Dave later that morning.
DONT:
– Generally, describe an intervention or tool e.g. When Dave was agitated the staff
should have used de-escalation.
– Generally, introduce a multi-factor model as if it was an intervention e.g. The care
would be better if they used Safe Wards.
– Describe general nursing values as interventions Staff should be empathetic.
– State staff need unspecific training without stating why or in what way they should
be trained or how effective that training would be e.g. Train staff in de-escalation.
Conclusion:
DO:
– Summarise your findings.
– Give a realistic recommendation for what you would do if you saw a similar incident
in practice e.g. In cases like Daves it is important to begin assessing for suicide risk
right from admission, this needs to be more than asking if they will do something,
should be therapeutic in nature and should include a knowledge of suicidal models
such as OConnors list of volitional factors for immediate action.
DONT:
– Introduce whole new arguments or areas of discussion.
– Contradict what you have already said.
Reading lists
Core reading:
Boyle, Mary and ProQuest (Firm), host (2020) A straight talking introduction to the power
threat meaning framework: an alternative to psychiatric diagnosis , A straight talking
introduction to the power threat meaning framework : an alternative to psychiatric
diagnosis. Monmouth, United Kingdom: PCCS Books.
Chambers, Mary, editor. (2017) Psychiatric and mental health nursing: the craft of caring.
Third edition., Psychiatric and mental health nursing: the craft of caring. Third edition. Oxon,
[England]; Routledge.
Background reading (Wider reading):
Wilkinson, Richard G (2018) The inner level: how more equal societies reduce stress, restore
sanity and improve everyones well-being, The inner level: how more equal societies reduce
stress, restore sanity and improve everyones well-being. UK: Allen Lane.
Hari, Johann (2018) Lost connections: uncovering the real causes of depression-and the
unexpected solutions, Lost connections : uncovering the real causes of depression-and the
unexpected solutions. London, England: Bloomsbury.
Hari, Johann (2018) Lost connections: uncovering the real causes of depression-and the
unexpected solutions, Lost connections : uncovering the real causes of depression-and the
unexpected solutions. London, England: Bloomsbury.
Van der Kolk, Bessel A (2015) The body keeps the score: brain, mind, and body in the healing
of trauma, The body keeps the score : brain, mind, and body in the healing of trauma. New
York, New York: Penguin Books.
Suggested general relevant reading
Wilkinson, Richard G and Pickett, Kate (2010) The spirit level why equality is better for
everyone. New [ed.]., The spirit level why equality is better for everyone. New [ed.].
London: Penguin. Available at:
https://www.vlebooks.com/vleweb/product/openreader?id=BirmCity&isbn=978014192115
0.
PDF/Links
Clarke, N 2017, The Student Nurse’s Guide to Successful Reflection: Ten Essential
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[20 June 2024].
Parham, S., Ibrahim, J. & Foxwell, K. (2019). Could the Tree of Life Model Be a Useful
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Narratives in the Suitcase by Ncazelo Ncube-Mlilo
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Smythe, A. et al. (2023) Introduction of the professional nurse advocate role using a
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Smythe, A. & Carter, V. (2022) The experiences and perceptions of newly qualified
nurses in the UK: An integrative literature review. Nurse education in practice.
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Dickens, G. L. et al. (2022) Mental health nurses measured attitudes to people and
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to change mental health nurses attitudes to people diagnosed with borderline
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Mercer, D. & Perkins, E. (2018) Sex, gender and the carceral: Female staff experiences
of working in forensic care with sexual offenders. International journal of law and
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Howard, V. & Eddy?Imishue, G. K. (2020) Factors influencing adequate and effective
clinical supervision for inpatient mental health nurses personal and professional
development: An integrative review. Journal of psychiatric and mental health nursing.
[Online] 27 (5), 640656.
OConnor, R. C. (2011) The Integrated Motivational-Volitional Model of Suicidal
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Batool, S. (2018) Treatment intervention for aggression: Promoting individual
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Kennedy, H. et al. (2019) Consumer recommendations for enhancing the Safewards
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improvement tools, NICE: London – https://www.nice.org.uk/about/what-wedo/into-practice/audit-and-service-improvement
