Reflection on mental health nursing placement using Gibbs (1988) model of reflection

This is a reflective essay based on my attendance at a multidisciplinary team (MDT) meeting whilst on my two-week placement at a local mental health day hospital. The aim of this essay is to discuss the importance of the multidisciplinary team within the mental health environment and discuss factors that can influence the success or failure of multidisciplinary teams.

Mental health teams generally comprise of psychiatrists, clinical psychologists, nurses, occupational therapists and social workers, but other therapists such as family therapists, psychotherapists and counsellors might also become involved in the care of the patient (Perkins & Repper 1998).

Multidiscipline involvement is important within mental health nursing as people with mental health problems have multiple needs, so a variety of expertise is required to meet the needs of these people (Darby et al 1999).

Multidisciplinary mental health teams can been defined as:

“A group of practitioners with different professional training, employed by more than one agency, who meet regularly to coordinate their work providing services to one or more clients in a defined area” (Ovretveit,1993: 9 cited in Onyett 2003)

The advantage of a multidisciplinary team approach is that all professionals work together by collecting the facts and by bringing information together, to obtain as complete a view as possible of the problems of each individual patient. In doing this they are able to make sure that the proper range of treatments are used in a properly planned way (Onyett 2003).

One of the disadvantages of a multidisciplinary team is that problems can be encountered when different professionals work together, there can be unclear goals, lack of direction and poor leadership (Darby et al 1999).

In order to structure this reflection I have chosen Gibbs (1988) as the model to help with my reflective process. This model comprises of a process that helps the individual look at a situation and think about their thoughts and feelings at the time of the incident. Reflective skills help us to think about what could have been done, so that if a similar situation occurs again the experience gained can be used to deal with the situation in a professional manner (Burns et al 1997).

To enable me to use this situation for my reflection the patient will be referred to as “Kate”. This is in order that her real name is protected and that confidentially maintained in line with the NMC (2002) Code of Professional Conduct.

Description

Kate is a 66-year-old lady, retired from her job as a nurse 10 years ago. She has lived alone since the death of her husband 7 years ago, and has one very supportive son who lives locally and visits 2-3 times a week. Kate was referred to the hospital by her doctor after presenting with an 18-month history of memory problems and it was decided that she should attend the day hospital for a period of six weeks to be assessed and to be involved in therapeutic activities whilst there.

Whilst attending the day hospital she was observed, and found to be repetitive with obvious evidence of fabrication, very disorientated, with poor concentration and very poor short-term memory. The consultant asked the mental health nurses to assess Kate and tests indicated that she may be suffering from a moderate degree of dementia. Dementia is a mental disorder caused by structural changes in the brain and affects around ten per cent of people aged over sixty-five (Newell & Gournay 2000).

An MDT meeting was then arranged to discuss the package of care needed for this lady, to enable her to continue living safely in her own home. The Consultant chaired the meeting by bringing the team to the attention of Kate’s medical history and the problems herself and son had been experiencing. He felt she would benefit from medication to help her memory problems.

The community psychiatric nurse (CPN) then discussed to the team the concerns of Kates son, he had informed her that Kate is wandering at inappropriate times of day and rarely remembering to eat, she is also regularly forgetting to turn off the taps and gas appliances in the house. He is very concerned for the safety of his mother. The occupational therapist suggested she visit to assess Kate’s safety in her home concerning these issues. The social worker discussed the possibility of home carers but the mental health nurse who knows Kate well, tells of her concerns that Kate is never at home.

The social worker suggested a case meeting involving the son who could possibly ensure that his mother takes her medication regularly and to try and ensure that she remains at home until the carers arrive.

It was agreed that if this did not work or was unsuitable for Kate or her son, any problems identified could be discussed and resolved at a future MDT meeting.

Feelings

I felt very comfortable and very accepted within the MDT meeting. The atmosphere was friendly and relaxed and everybody there seemed to have something to contribute. Everyone was encouraged to participate and I felt that I could have contributed to the discussion if I had known the patient better. I feel they would have listened to my ideas and not dismissed them due to me being a student. Everybody communicated well with each other and had the best interests of Kate in mind and so discussions were made until the best outcome was achieved for her. This demonstrates the benefit and importance of communication within a team and how all contributions within meetings should be valued (Perkins & Repper 1998).

Evaluation

There are many positive aspects of this particular MDT they all worked well together as a team with the same goal in mind. The team discussed all the different options available and all the problems that might arise and looked to the future to discuss further meetings to assess if the package of care put into place was suitable.

I found it very interesting to see a MDT in action and witness the teamwork between different disciplines. With the help and support provided by her son and the MDT Kate will hopefully be able to remain living in her own home, safely for as long as possible.

The disappointing aspect of this case is that if Kate is never at home when the CPN, and carers arrive this can have a negative impact on the package of care put in place, and residential care may need to be considered at a later date.

Analysis

This particular mental health team worked extremely well together, the consultant chaired the meeting and was the leader of the meeting. Onyett (2003) suggests that the presence of a clear team leader is associated with team effectiveness.

The NMC (2002) states than nurses should work in a collaborative manner with healthcare professionals and others involved in providing the care for the patient, and recognise and respect their particular contributions within the care team. The case of Kate is evidence of a multidisciplinary team and health professionals working together and breaking down barriers to provide the correct package of care for this individual.

Kate’s illness not only affects her but also members of her family who are trying their best to support her, Darby et al (1999) states that theses difficulties can have a profound impact not only on the life of the individual who experiences them, but also on the lives of those around them. The MDT were fully aware of this and so arranged a case meeting with the son so that all the different options could be discussed.

Kate wanders off alone unaware of the time of day or night. Whilst someone with dementia wandering off and getting lost on a cold night is clearly in danger, little can be done to make a person stay indoors against their wishes. Perkins & Repper (1998) discusses the difficult balance between the wishes, demands and rights of the individual to live as they wish and professional codes of conduct which impose upon the health professionals a “duty of care” to ensure the safety of the individual.

Conclusion

It can be seen from this MDT meeting that clear leadership and good communication between members of the team is vital to ensure they come together with a clear understanding of the outcomes to be achieved and equally equipped with all the information available to overcome patients’ individual problems. Team working forms the basis of mental health nursing and can influence the success or failure of the care and treatment the patient receives. This effective team has the potential to achieve positive outcomes for both Kate and her son now and in the future if needed.

Action plan

If I find myself in this type of situation again, I would be more confident in participating in the MDT meeting. I have learnt from this situation that good teamwork and communication between each other is vital to the outcome of the package of care decided. This reflection has highlighted the need to increase my knowledge and understanding of the multidisciplinary team and the importance of the outcomes of these meetings and how they can affect the patients and family’s quality of life, which will help me to think very carefully about the decisions I make concerning patients care in the future. I will address this learning need by working closely with my mentor and other multidisciplinary team members and by reading relevant literature. As a student I am aware that there is a lot more to learn and with more time and experience and with the help of my mentors I will be able to increase my knowledge and understanding of how different disciplines work together.