Introduction
This essay reflects on a significant clinical encounter in my role as a Psychiatric Liaison Nurse, focusing on the assessment and care of an asylum-seeking male patient from a Middle Eastern country with a complex presentation of post-traumatic stress disorder (PTSD), suicidal thoughts, memory loss, selective mutism, and chronic physical health conditions, including a respiratory illness. The case posed numerous challenges, yet it offered valuable insights into effective communication, patient safety, and the integration of mental and physical health care. This reflection explores how the experience shaped my nursing practice, the lessons learned, and the relevance of my actions to the Nursing and Midwifery Council (NMC) Code of Conduct, specifically under the themes of ‘Preserve Safety’ and ‘Prioritise People’ (NMC, 2018).
Lessons Learned and Impact on Practice
One of the most profound lessons from this encounter was the critical role of communication in nursing care. The patient’s initial lack of cooperation and desire for discharge, despite evident distress, necessitated persistent reassurance and active listening. Through consistent engagement, I was able to gain his consent for further physiological monitoring and subsequent diagnostic tests, which ultimately led to his transfer to a medical ward for suspected sepsis. This reinforced the importance of patience and empathy in building trust, particularly with vulnerable individuals who may struggle to articulate their needs due to trauma or cultural barriers.
Furthermore, this case highlighted the necessity of balancing competing priorities in a high-pressure environment like the Emergency Department (ED). While addressing the patient’s immediate needs, I delegated secondary tasks to Registered Mental Nurse (RMN) colleagues, ensuring that personalised care was not compromised. This experience underscored the value of teamwork and delegation as essential skills in maintaining patient safety and care quality. Additionally, observing a previously unnoticed foot injury and wound during my assessment reminded me of the risk of diagnostic overshadowing, where mental health symptoms can obscure physical health needs. This prompted a deeper commitment to uphold parity of esteem between mental and physical health, aligning with current evidence-based practice (NHS England, 2016).
Lastly, I recognised gaps in my skill set, particularly in interpreting ECG reports and performing venepuncture. These are areas I intend to develop through further training, as they are crucial in settings where immediate medical support may not be available due to the busy nature of clinical environments. Such professional development is vital to enhancing my autonomy and responsiveness in future roles.
Relevance to the NMC Code
This reflective scenario closely relates to the NMC Code’s theme of ‘Preserve Safety’ (NMC, 2018). My timely identification of the patient’s deteriorating physiological state, supported by tools like the National Early Warning Score (NEWS) and the Situation-Background-Assessment-Recommendation (SBAR) communication framework, facilitated early intervention and protected a vulnerable individual from further harm. The swift coordination with the allocated doctor and transfer to a medical ward exemplified an efficient response to safeguard his well-being. Moreover, effective communication with multidisciplinary team members ensured a cohesive approach to care, reflecting the Code’s emphasis on collaborative practice.
Equally, the theme of ‘Prioritise People’ was central to my actions (NMC, 2018). Despite the patient’s distress and initial reluctance, I placed him at the heart of care decisions, considering his views and ensuring interventions were not merely procedural tasks. Contacting his nearest relative as part of the crisis plan further demonstrated this principle, recognising the importance of family involvement in providing contextual information and emotional support. This aligns with the ‘Triangle of Care’ model, which advocates for partnership between patients, carers, and clinicians (Carers Trust, 2013).
Conclusion
In conclusion, this clinical encounter as a Psychiatric Liaison Nurse profoundly influenced my practice by reinforcing the significance of communication, teamwork, and a holistic approach to care. It highlighted the dangers of diagnostic overshadowing and the need for continuous professional development to bridge knowledge gaps. Moreover, it demonstrated adherence to the NMC Code by prioritising patient safety and individual needs through timely interventions and family engagement. Reflecting on this case, I am motivated to further refine my skills and advocate for integrated care, ensuring that both mental and physical health are addressed equitably. This experience serves as a reminder of the complex, yet rewarding, nature of nursing in supporting society’s most vulnerable individuals.
References
- Carers Trust (2013) The Triangle of Care: A Guide to Best Practice in Mental Health Care in England. Carers Trust.
- NHS England (2016) Parity of Esteem: Improving Mental and Physical Health. NHS England.
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
