Introduction
This essay reflects on a challenging situation encountered during a placement in an Accident and Emergency (A&E) unit, involving Estelle Clarke, a 9-year-old girl with autism, and her mother, Ms. Veronica Clarke. Using the Gibbs Reflective Model (Gibbs, 1988), this reflection examines communication failures, their impact on patient care, and strategies for improvement. The analysis considers compassion, ethics, risk management, advocacy, and non-discriminatory practice within the context of mental health nursing. Additionally, relevant legal frameworks, ethical principles, and the roles of the healthcare team are explored. The purpose is to critically evaluate the scenario, identify areas for improvement, and propose solutions to enhance patient-centered care in high-pressure environments like A&E.
Description: Understanding the Scenario
During my placement, Estelle arrived at A&E with abdominal pain, accompanied by her exhausted mother. Having waited over an hour, Estelle became increasingly distressed due to sensory overload from the busy environment. Ms. Clarke, struggling to cope, approached Graham, a nursing assistant, for updates. Tensions escalated when Graham mentioned Ms. Clarke’s husband, an insensitive remark that upset her. Estelle, witnessing this, pushed Graham in distress, leading to his frustrated response. Fortunately, Pam, the Nurse in Charge, returned and intervened. This situation highlighted significant communication breakdowns and their emotional toll on both the patient and her mother, prompting reflection on my role as a student nurse in mental health care.
Feelings: Emotional Response to the Incident
Observing this interaction, I felt powerless and frustrated. Estelle’s distress, exacerbated by sensory stimuli—a common challenge for individuals with autism—evoked empathy (Baron-Cohen and Bolton, 1993). Ms. Clarke’s exhaustion and emotional outburst underscored the strain families face in such settings. Graham’s inappropriate comment and reaction left me uncomfortable, as it deviated from the compassionate care expected in nursing. I questioned how I could have intervened or supported the situation, feeling torn between my student status and the urge to advocate for Estelle and her mother.
Evaluation: What Worked and What Didn’t
Pam’s initial reassurance to Estelle and Ms. Clarke was a positive step, demonstrating an attempt to maintain trust. However, the prolonged wait and lack of proactive measures to address Estelle’s sensory needs were significant failings. Graham’s response lacked empathy and breached professional boundaries by making personal remarks. This poor communication escalated the situation, undermining patient trust and safety. The impact on care was evident: Estelle’s distress intensified, and Ms. Clarke’s frustration turned to despair, highlighting how communication failures can compromise therapeutic relationships (Nursing and Midwifery Council [NMC], 2018).
Analysis: Underlying Issues and Legal-Ethical Considerations
Communication breakdowns in this scenario reflect broader challenges in busy A&E settings, where staff may struggle to balance workloads and patient needs. For individuals with autism like Estelle, sensory sensitivities require tailored approaches, such as providing quiet spaces (National Institute for Health and Care Excellence [NICE], 2016). Ethically, the principle of beneficence—acting in the patient’s best interest—was violated by the delay and Graham’s insensitive comments. Legally, the Equality Act 2010 mandates reasonable adjustments for disabilities, which were not adequately considered here. The NMC Code (2018) further emphasizes respectful, non-discriminatory practice, a standard not met in Graham’s interaction. These frameworks underline the need for compassionate, inclusive care.
Conclusion: Lessons Learned
Reflecting on this incident, it is clear that communication and environmental factors significantly impact patient care, especially for vulnerable individuals like Estelle. Empathy, advocacy, and awareness of legal-ethical principles are essential to prevent escalation. As a mental health nursing student, I recognize the importance of challenging inappropriate behavior and prioritizing patient well-being, even in challenging settings.
Action Plan: Improving Future Practice
To manage such situations more effectively, I will develop skills in de-escalation and sensory awareness for autistic patients, drawing on NICE guidelines (2016). Advocating for reasonable adjustments, such as expedited assessments or quiet areas, will be a priority. I will also seek training in compassionate communication to support families under stress. Understanding team roles—nurses as advocates, assistants within their scope—will guide my collaboration. If a similar situation arises, I will proactively communicate with senior staff to ensure timely intervention, embodying the NMC Code’s emphasis on patient-centered care (2018).
References
- Baron-Cohen, S. and Bolton, P. (1993) Autism: The Facts. Oxford University Press.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Further Education Unit.
- National Institute for Health and Care Excellence (NICE). (2016) Autism Spectrum Disorder in Under 19s: Recognition, Referral and Diagnosis. NICE.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
