Introduction
This essay aims to critically reflect on the knowledge, skills, and professional values necessary to provide safe, effective, and evidence-based care in mental health nursing. Using the Driscoll Model of Reflection (2007), I will structure my analysis around an episode of care involving a homeless individual with mental health challenges who was non-adherent to medication and at risk of hypoglycaemia due to poor nutritional intake. The reflection will explore my decision-making process, the integration of theory and practice, and the leadership skills and professional attributes required to manage person-centred care across diverse clinical situations. Key themes such as empathy, communication, and ethical practice will be addressed, alongside a critical evaluation of my actions. This essay will also highlight limitations in my approach and areas for future development, ensuring a comprehensive exploration of the complexities of mental health nursing.
Context of the Episode of Care Using the Driscoll Model: What?
According to Driscoll’s reflective model (2007), the first stage, ‘What?’, involves describing the situation. The individual in this episode of care was a middle-aged man with a diagnosis of schizophrenia, referred to the community mental health team by his GP at the request of his sister. He had been living on the streets since the death of his mother and had a strained relationship with his sister, whom he occasionally visited. His sister expressed concerns about his significant weight loss and non-adherence to his prescribed clozapine, an antipsychotic medication. During the initial assessment, he appeared disengaged, unable to explain why he was not eating or drinking adequately, and demonstrated a lack of insight into the risks of malnutrition and hypoglycaemia. My role as a student mental health nurse was to support the assessment, build rapport, and contribute to developing a care plan under supervision.
Critical Reflection on Knowledge and Skills: So What?
The second stage of Driscoll’s model, ‘So What?’, encourages an analysis of the feelings and implications of the situation. I felt empathetic towards the individual’s circumstances, recognising that homelessness and social isolation likely exacerbated his mental health challenges. However, I also experienced uncertainty in addressing his lack of insight and non-adherence to medication. My theoretical knowledge of schizophrenia informed my understanding that non-adherence to clozapine could lead to relapse and worsening of psychotic symptoms (Kane et al., 2013). Additionally, I was aware of the physical health risks associated with poor nutrition, such as hypoglycaemia, which can be life-threatening if untreated (NHS, 2020).
Critically, I drew on evidence-based practice to justify my actions. For instance, I prioritised building trust through non-judgemental communication, as recommended by Rogers’ person-centred approach (Rogers, 1951). I also proposed a multi-disciplinary approach, suggesting collaboration with a dietitian to address his nutritional needs, aligning with NICE guidelines on managing schizophrenia (NICE, 2014). However, I recognise limitations in my approach, as I struggled to fully engage him in discussing his reasons for non-adherence, possibly due to my limited experience in motivational interviewing techniques.
Professional Values and Leadership Skills in Person-Centred Care
Person-centred care is fundamental to mental health nursing, requiring professional values such as compassion, respect, and dignity (Nursing and Midwifery Council [NMC], 2018). In this case, I endeavoured to uphold these values by acknowledging the individual’s autonomy, even when his decisions—such as refusing medication—posed risks to his health. However, balancing autonomy with the duty of care was challenging. The NMC Code (2018) mandates that nurses act in the best interests of individuals, which led me to escalate concerns about his physical health to my supervisor for urgent intervention. This decision reflected an awareness of my professional boundaries as a student nurse, demonstrating accountability—a key leadership attribute.
Furthermore, effective leadership in mental health nursing involves advocating for vulnerable individuals. I communicated the individual’s social circumstances, including homelessness, to the team, suggesting referral to local housing support services. While I lacked the authority to action this directly, my initiative aligns with literature emphasising nurses’ roles as advocates in addressing social determinants of health (Royal College of Nursing [RCN], 2021). Reflecting critically, however, I acknowledge that my leadership approach was reactive rather than proactive, as I did not sufficiently explore his personal goals or cultural context during the assessment, which could have enhanced the person-centredness of the care provided.
Integration of Theory and Practice: Now What?
The final stage of Driscoll’s model, ‘Now What?’, focuses on learning and future actions. This episode highlighted the importance of integrating theoretical knowledge with practical skills. For example, understanding the pharmacology of clozapine and its side effects (e.g., weight gain, sedation) provided insight into potential reasons for non-adherence (Taylor et al., 2018). Yet, translating this knowledge into effective communication with the individual was challenging, underscoring the need for further training in therapeutic engagement techniques.
Additionally, this experience revealed gaps in my ability to manage complex problems independently. To address this, I plan to engage in reflective supervision and seek mentorship to enhance my confidence in decision-making. Literature supports the role of supervision in developing critical thinking and clinical competence among student nurses (Cleary et al., 2013). Moreover, I intend to deepen my understanding of social issues such as homelessness by engaging with relevant community resources, ensuring a more holistic approach to care in future practice.
Critical Evaluation of Decisions and Actions
Reflecting critically, my decisions were underpinned by a commitment to evidence-based practice, such as adhering to NICE guidelines (2014) and prioritising patient safety by escalating concerns. However, my limited experience meant I was not fully effective in engaging the individual in shared decision-making, a core component of person-centred care (Coulter and Collins, 2011). I also recognise that my initial focus on physical risks, such as hypoglycaemia, may have overshadowed exploration of his emotional and psychological needs, potentially undermining a holistic approach. This limitation highlights the need for ongoing development in balancing competing priorities in clinical practice.
Conclusion
In conclusion, this critical reflection using Driscoll’s model (2007) has illuminated the complexities of providing safe, effective, and person-centred care in mental health nursing. My knowledge of schizophrenia and associated risks informed my actions, while professional values such as compassion and accountability guided my approach to care. However, limitations in communication and leadership skills underscore areas for improvement. By integrating theory with practice, this episode has highlighted the importance of continuous learning and interprofessional collaboration in addressing the needs of vulnerable individuals. Moving forward, I aim to enhance my therapeutic skills and advocacy efforts to ensure more confident and competent management of diverse clinical situations. Ultimately, this reflection has reinforced the significance of critical thinking and evidence-based practice in achieving positive outcomes for those accessing mental health services.
References
- Cleary, M., Horsfall, J., O’Hara-Aarons, M., Jackson, D., & Hunt, G. E. (2013) Mental health nurses’ perceptions of good work in an acute setting. International Journal of Mental Health Nursing, 22(5), 297-304.
- Coulter, A., & Collins, A. (2011) Making shared decision-making a reality: No decision about me, without me. The King’s Fund.
- Driscoll, J. (2007) Practising Clinical Supervision: A Reflective Approach for Healthcare Professionals. Elsevier.
- Kane, J. M., Kishimoto, T., & Correll, C. U. (2013) Non-adherence to medication in patients with psychotic disorders: Epidemiology, contributing factors and management strategies. World Psychiatry, 12(3), 216-226.
- NHS. (2020) Hypoglycaemia (low blood sugar). NHS UK.
- National Institute for Health and Care Excellence (NICE). (2014) Psychosis and schizophrenia in adults: Prevention and management. NICE.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC.
- Rogers, C. R. (1951) Client-Centered Therapy: Its Current Practice, Implications, and Theory. Houghton Mifflin.
- Royal College of Nursing (RCN). (2021) Social determinants of health: What nurses need to know. RCN.
- Taylor, D., Barnes, T. R. E., & Young, A. H. (2018) The Maudsley Prescribing Guidelines in Psychiatry. Wiley-Blackwell.
