Running Head: LEARN 1

LEARN

NURS 2021

Bethany Carr

Trent University
LEARN 2

I am placed on a twenty bed forensic unit for my second year mental health placement.

This unit consists of assessment and rehabilitation patients, these patients are on Disposition

Orders from the Ontario Review Board (ORB) and require a secure setting. This is one of my

first direct experiences with mental health, and people of a potentially violent nature or past. This

reflection explains how I felt during a specific experience and my reflection process after.

My first scheduled shift only consisted of about a half hour tour of the unit, where I saw

my assigned patient John (pseudonym). On my second shift, I was introduced to John by the

registered practical nurse (RPN) Jane (pseudonym) when she had him as one of her patients for

the day. John is compliant with vitals and daily medications, and from what I have observed

friendly with staff. As I watched Jane give John his medications, it became very apparent to me

that he was delusional. I did not have any experience with people with delusions and the only

knowledge I brought with me was that of negative stereotypes in fictional movies. He spoke

highly of himself, and referred to himself as God, and having 999 million children. I had been

warned by Jane that John has fixed grandiose delusions, that were often religious in nature and

he is very often to talking about them. John continued to speak about being married to Jennifer

Lopez and having many children with her, as well as winning the lottery and building the first

ever 39 door Jeep. I have never been exposed to anyone with a serious mental illness so I was

caught off guard by the delusions he was sharing with me; seeing him medicated with numerous

different medications but still very strong fixed delusions shocked me because I assumed they

would subside with daily medication. It made me very curious of what kind of life he was living

before entering Centre for Additions and Mental Health or Ontario Shores, potentially

unmedicated and what struggles he faced while not receiving treatment.

LEARN 3

Honestly, I was disappointed to be placed in a mental health setting instead of maternity,

and this is consistent with a study I looked up, which suggested that mental health nursing was

one of the least preferred career options for undergraduate nursing students (Happell, & Gaskin,

2012, p.155). After a few days of feeling sorry for myself, I left my feelings of disappointment

and did my best to remain positive. I had heard from many people that the mental health

placement helped them build therapeutic relationships and continued to help them with active

listening and other desirable communication skills. I dont have any previous mental health

experience, so I felt like I was going in blind. For me, this situation somewhat connects with

other first hand experiences I had had, such as my long-term placement; I had never been in a

nursing home so I felt unprepared and unsure of daily routines and nurse roles. In the same study

that stated nursing students find mental health nursing less desirable, it also stated that classroom

education and clinical placements contribute to positive changes toward the field. After having 3

shifts at my mental health placement I concur, I never thought it mental health nursing would be

something I would be interested in and I find it extremely interesting and can imagine it to be a

satisfying career.

In the situation I chose to reflect on, I dont think I would change anything to handle the

situation better; I think it may have been overwhelming at the time because I didnt know what to

expect but I did not having any unwanted negative feelings such as feelings of stigma and

judgement. My feelings now have somewhat changed about the situation, I am more comfortable

in the unit and with the staff due to unit routine and friendly staff members; and after reading

Johns file, I am more familiar with him and his story. Becoming more aware and familiar with

staff and patients in the unit will support myself better through an informed and confident

perspective and help me to be a more active part of the team. Though being alone on the unit is
LEARN 4

not an option, it will be nice to be more comfortable with staff and patient routines to be able to

help out where I can, such as meals and patients accessing the phone and secured personal

belongings. When I am on the unit, I am doing a lot of observing staff, I always ask if they are in

need of assistance and volunteer myself to accompany staff and patients to activities within the

hospital. Since patients on the unit are there due to committing a criminal offence there are

different power dynamics in play compared to a hospital such as Peterborough Regional Health

Centre (PRHC). My patient is aware of the dynamics of the patient-staff relationships, where he

is the patient and staff are in control of his medications, what he consumes and when he can do

certain activities; sometimes he disagrees with staff when they limit his choices. He also

struggles with the hospital dynamic and rules when he wants to go outside for a cigarette but he

does not have privileges to do so, he becomes easily agitated when told he may not. Since all

hospitals became smoke free properties staff often advocate for patients to be smoke free, this is

also done by prescriptions of Nicorette gum and inhalers. I believe my values line up with the

advocacy for a smoke free life style because I myself do not smoke, nor does anyone in my

immediate family. In a hospital situation the staff are advocating for healthy lifestyle, and smoke

free is a part of living a healthy life style as we know smoking has many associated diseases and

conditions. At Ontario Shores I am establishing meaningful and beautiful relationships with

patients and staff, though I believe miraculous recoveries in this setting are unlikely, it is

meaningful to me to see patients have days without issues or difficulties. During placement my

attention focuses around myself and my safety, as well as the safety and wellbeing of other staff

and patients, as well as maintaining proper and professional boundaries and focusing on my

scope of practice.
LEARN 5

My placements mission statement is we provide leadership and exemplary mental

health care through specialized treatment, research, education, and advocacy (Ontario Shores).

I can see the care and commitment the staff has on my assigned unit and all the different

resources that patients may access. I have seen nurses on my unit advocating for patients and

providing personalized care plans that fit them best. My responsibility is to be a careful and

responsible student on the unit and try to take advantage of the experiences I am able to. The ten

commitments are values of the Tidal Model, I think they are each of great value but I was

specifically drawn to develop genuine curiosity, though my patient loves to talk, he is not an

open book and it takes time and understanding to hear his story. It is also key to allow patients to

become of small changes now can make a big impact later on their lives; it may be hard in a

mental health centre but to give up the power relationship that characterizes normal professional-

client relations. And as Ted Barker said nursing is something, which involves caring with

people, rather than caring for them or even just caring about them. (The Tidal Model) I think it

is important as a nursing student to get into good habits such as time management, so that I may

get to know patients and their goals so that I may work collaboratively with them rather than

work to improve their diagnosis.

References
 LEARN 6

Happell, B., & Gaskin, C. J. (2012). The attitudes of undergraduate nursing students towards

mental health nursing: a systematic review. Journal of Clinical Nursing, 22(1-2),

148-158. doi:10.1111/jocn.12022

Our Mission, Vision and Values - Ontario Shores Centre for ... (n.d.). Retrieved from http://

www.ontarioshores.ca/cms/one.aspx?portalId=169&pageId=664

The 10 Tidal Commitments The Fundamental Principles. (2015). Retrieved from https://

www.tidal-model.com/10%20commitments.html

Stages of Non-reflector Critical

Reflection Reflector
Not Acceptable Developing competence Good/High
Competence
 LEARN 7

Look back and Reflection submitted. Comprehensive, somewhat Articulates and recollects Consistently captures the
elaborate Relevance of able to discriminate key features, including essence and importance of the
Description of description unclear. relevant detail. Ideas link context, thoughts and experience.
situation, Lacks coherence, together in a coherent and feelings. Clear, logical Succinct description of relevant
thoughts and organization and clarity logical way flow and concise features. Fluent comprehensive,
feelings clear and lively

Analysis of Reflection submitted. Limited self-awareness. Some constructive Consistently demonstrates

experience, Lacks self-awareness. Does not consistently show exploration of experience, insight into the situation.
thoughts and Limited evidence of evidence of analysis or of thoughts and feelings. Frequently asks why?
feelings analysis in the recognizing the feelings of Shows an appreciation for Constructive exploration of
discussion others how self and others felt, experiences, thoughts and
reasons for this and how feelings. Shows an appreciation
this influenced the for how self and others felt,
situation reasons for this and how this
influenced the situation

Evidence of Reflection submitted. Implicit evidence of Identifies some learning Provides explicit evidence of
learning. Pearl learning only present implications for self as learning. Identifies implications
of wisdom and None or minimal learner, nurse or personal for self as learner, nurse or
its application evidence of learning self personal self
present

Revision and Reflection submitted. Application of new Identifies how this new Identifies how this new
new trial Application of new learning vaguely identified insight/learning will be insight/learning will be used in
Application of learning not used in future situations future situations. Insight,
new learning demonstrated creativity, problem-solving
and/or critical thinking
demonstrated

Identification of Reflection submitted.
further learning No learning gaps/needs
identified
Identifies some learning
gaps/needs. Rationale and
strategies are missing
Identifies through Clearly identifies through
deliberate reflection some deliberate reflection, learning
learning gaps/needs gaps/needs- areas for further
supported with rationale. learning supported with
Strategies are vaguely rationale. Strategies are clearly
articulated articulated.

Overall Evaluation: Pass Not Acceptable/Needs Revision

Comments: Bethany- your reflection is limited in terms of analysis; it is unclear to

me how you have integrated the various relational inquiry perspectives; please
revise this reflection and resubmit.
Cathy