mental health nursing reflective essay

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Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis

Giovanna artioli.

1 Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123 Reggio Emilia, Italy

Laura Deiana

2 Medical and Surgical Department, University of Parma, Parma, Italy

Francesco De Vincenzo

3 European University of Rome, Rome, Italy

Margherita Raucci

Giovanna amaducci, maria chiara bassi, silvia di leo, mark hayter.

4 Faculty of Health Sciences, University of Hull, Hull, UK

Luca Ghirotto

Associated data.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: “What are the experiences of health professionals and students in applying reflective writing during their education and training?”

We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals’ and students’ experience using reflective writing during their academic and in-service training by performing a meta-synthesis.

We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users’ experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one’s own and others’ emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.

Conclusions

The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-021-02831-4.

Education of healthcare professionals supportstheir transformation into becoming competent professionals [ 1 ] and improves their reasoning skills in clinical situations. In this context, reflective writing (RW) is encouraged by both universities, and healthcare training providersencourage reflective writing (RW) since its utility in helping health students and professionals nurture reflection [ 2 ], which is considered a core element of professionalism. Furthermore, the ability to reflect on one’s performance is now seen to be a crucial skill for personal and professional development [ 3 ]. Writing about experiences to develop learning and growth through reflection is called ‘reflective writing’ (RW). RW involves the process of reconsidering an experience, which is then analyzed in its various components [ 4 , 5 ]. The act of transforming thoughts into words may create new ideas: the recollection of the experience to allow a deeper understanding of it, modifying its original perception, and creating new insights [ 6 ]. RWis the focused and recurrent inspection of thoughts, feelings, and events emerging from practice as applied to healthcare practice [ 7 ].

Reflection may be intended as a form of mental processing or thinking used by learners to fulfill a purpose or achieve some anticipated outcome [ 2 ]. This definition recalls Boud and colleagues’ view of reflection as a purposive activity directed towards goals [ 8 ]. For those authors, reflection involves a three-stage process, including recollection of the experience, attending to own feelings, and re-evaluating the experience. This process can be facilitated by reflective practices, among which RW is one of the main tools [ 9 ].

Between reflection-on-action (leading to adjustments to future learning and actions) and reflection-in-action (where adjustments are made at the moment) [ 10 ], RW can be situated in the former. It involves theprofessional’s reflections and analysis of experiences in clinical practice [ 11 , 12 ]. Mainly,RWinvolves the recurrent introspection ofone’s thoughts, feelings, and events within a particular context [ 13 ]. Several studies highlight how RWinfluencespromoting critical thinking [ 14 ], self-consciousness [ 15 ], and favors the development of personal skills [ 16 ], communication and empathy skills [ 4 , 17 ], and self-knowledge [ 3 ]. Thanks to the writing process, individuals may analyze all the components of their experience and learn something new, giving new meanings [ 5 ]. Indeed, putting down thoughts into words enables the individual to reprocess the experience, build and empower new insights, new learnings, and new ways to conceive reality [ 6 , 18 – 20 ].

Furthermore, RW provides an opportunity to give concrete meaning to one’s inner processes, mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless [ 21 , 22 ]. The reflective approach of RW allows oneself to enter the story, becoming aware of our professional path, with both an educational and therapeutic effect [ 23 ].

Reflection as practically sustained by RW commonly overlaps with the process of reflexivity. As noted elsewhere [ 24 ], reflection and reflexivity originate from different philosophical traditionsbut have shared similarities and meanings. In the context of this article, we adopt two different working definitions of reflection and reflexivity. Firstly, we draw from the work of Alexander [ 25 ]: who explains reflection as the deliberation, pondering, or rumination over ideas, circumstances, or experiences yet to be enacted, as well as those presently unfolding or already passed [ 25 ]. Reflexivity at a meta-cognitive level relates to finding strategies to challenge and questionpersonal attitudes, thought processes, values, assumptions, prejudices, and habitual actions to understand the relationships’ underpinning structure with experiences and events [ 26 ]. In other words, reflexivity can be defined as “the self-conscious co-ordination of the observed with existing cognitive structures of meaning” [ 27 ].

Given those definitions,a philosophical framework for helping health trainees and professionals conduct an exercise that can be helpful to them, their practice, and – ultimately – their patients can be identified. There is a growing body of qualitative literature on this topic – which is valuable – but the nature of qualitative research is that it creates transferrable and more generalizableknowledge cumulatively. As such, bodies of qualitative knowledge must besummarized and amalgamated to provide a sound understanding of the issues – to inform practice and generate the future qualitative research agenda. To date, this has not been done for the qualitative work on reflective writing: a gap in the knowledge base our synthesis study intends to address by highlighting what connects students and professionals while using RW.

This systematic review addresses the following question: “What are the experiences of health professionals and students in applyingRWduring their education and training?”

This systematic review and meta-synthesis followed the 4-step procedure outlined by Sandelowski and Barroso [ 28 , 29 ], foreseeing a comprehensive search, appraising reports of qualitative studies, classification of studies, synthesis of the findings. Systematic review and meta-synthesis referto the process of scientific inquiry aimed at systematically reviewing and formally integrating the findings in reports of completed qualitative studies [ 29 ].

The article selection processwas summarized as a PRISMA flowchart [ 30 ]; the search strategy was based on PICo (Population, phenomenon of Interest, and Context),and the study results are reported in agreement with Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines [ 31 ].

Selection criteria

Inclusion criteria for the meta-synthesis were:

• Primary qualitative studies published in peer-reviewed English journals.
• With health professionals or health studentsas participants.
• UsingRW in learning contexts (both pre-and in-service training).
• Mixed methods where the qualitative part can be separated.
• Articles should report the voice of participants (direct quotations).

Given the meta-synthesis indications, we excluded quantitative studies, non-primary research articles, meta-synthesis of qualitative studies, literature and systematic reviews, abstracts, unpublished reports, grey literature. In addition, we also excluded studies where participants were using RW in association with other learning tools and where the personal experience was not about using RW exclusively.

Data sources and searches

An experienced information specialist (MCB) performed the literature search on Medline, Embase, Cinahl, PsycInfo, Eric, and Scopus for research articles published from Jan 1st, 2008 to September 30th, 2019,to make sure we incorporated studies reflecting contemporary professional health care experience. Additional searchinginvolved reviewing the references or, and citations to, our included studies.

We filled an Excel file with all the titles and authors’ names. A filter for qualitative and mixed methods study was applied. Table  1 shows the general search strategy for all the databases based on PICo.

Search strategy for databases based on PICo

* truncation

Four reviewers (GAr, MR, GAm, LD) independently screened titles and abstracts of all studies, then checked full-text articles based on the selection criteria. We also searched the reference lists of the full-text articles selected for additional potentially relevant studies. Any conflict was solved through discussion with three external reviewers (LG, MCB,SDL, and MH).

Quality appraisal

We used the Critical Appraisal Skills Programme (CASP): it provides ten simple guiding questions and examples to examine study validity, adequacy, and potential applicability of the results of qualitative studies. Guided by the work of Long and colleagues [ 32 ] and previously used in other meta-synthesis [ 33 ], we created 30 items from the 10 CASP questions on quality to ensure we could provide a detailed appraisal of the studies. FDV and LD independently assessed the quality of included studies with any conflicts solved by consulting a third reviewer (MCB and LG). Researchers scored primary studies weighingthe proposed items and ranking the quality of each included study [ 34 ] on high ( n  > 20 items positively assessed), moderate (10 <  n  < 20), or low quality ( n  < 10).

Analysis and synthesis

MCB created a data extraction table, GAr, GAm, and MRdescribed the included articles (Table  2 ). Quotations were extracted manually from the “results/findings” sections of the included studies by GAr, MCB, LDand inserted into adatabase. GAr, GAm, MR, and FDVperformed a thematic analysis of those sections, along with participants’ quotations. Then, they inductively derived sub-themes from the data, performing a first interpretative analysis of participants’ narratives (i.e., highlighting meanings participants interpreted about their experience). The sub-themes were compared and transferred across studies by adding the data into existing sub-themes or creating new sub-themes. Similar sub-themes were then grouped into themes, using taxonomic analysisto conceptually identify the sub-categories and the categories emerging from the participants’ narratives. This procedure allowed us to translate the themes identified from the original studies [ 28 ] into interpretative categories that could amalgamate and refine the experiences of health professionalsor health students on the use of RW [ 29 ]. The final categories are based on the consent of all the authors.

Summary of articles included in meta-synthesis (divided per groups: students and professionals)

Literature search and studies’ characteristics

A total of 1488 articles were retrieved. Duplicates ( n  = 251) were removed. Then, articles ( n  = 1237) were identified and reviewed by title and abstract. We excluded n  = 1152 articles because they did not match the specified inclusion criteria, based on the title and abstract. Consequently, we assessed 85 full-text articles. Sixty-eight records did not meet the inclusion criteria. At the end of the selection process, 17 reportsof qualitative research were selected. Figure  1 illustrates the search process.

PRISMA flow diagram

Table ​ Table2 2 shows the characteristics of the included studies. Eleven studies involved healthcare students (58%, including nurses, midwives, physiotherapists, doctors, dentists, and oral health students), and six (32%, including doctors, occupational and radiation therapists) were referred to health professionals. In thirteen studies, participants were trained on RW before using it: this information could not be retrieved from the remaining articles.

Five articles reported studies conducted in the US, three in Australia, two in Canada, and two in Israel. The other studies were carried out in Italy, UK, Korea, Taiwan, and Sweden.

Critical appraisal results

We critically evaluatedall 17 studies to highlight the methodological strengthsand weaknesses of the selected studies. No article was removed on a quality assessment basis. Results of the quality appraisal are reported in Table ​ Table2 2 .

Meta-synthesis findings

Through the meta-synthesis, we identified four main categories (and related sub-categories): (i) reflection and reflexivity; (ii) accomplishing learning potential; (iii) building a philosophical and empathic approach; (iv) identifying reflective writing feasibility (for the complete dataset, please refer to supplemental material , where we have listed a selection of meaningful quotations of categories and sub-categories).

Given such categories, we developed an interpretative meta-synthesis model (Fig.  2 ) to illustrate the commonalities of the experience of using RW according to both students and professionals: RWas a vehicle for discovering reflection and allowing users to enter personal reflexivity to fulfillone’s learning potential, alongside the building of a philosophical and empathic approach. In their experience, reflection and reflexivity generate different skills and competencies: reflection matures skills such as professional skills and the ability to activate change and innovation. Reflexivity allows students and professionals to reach higher levels of competencyconcerning inner development and empathy reaching. Finally, from our analysis, participants, while recognizing the value of RW, also defined factors that could encourage or limit its use. Differences among participants’ groups are also outlined.

Meta-synthesis model: RW as experienced by health professionals and students

Reflection and reflexivity

Within this category, we collected the users’ narratives about the experience of applying RW and its disclosing capacity. By using RW, participants confronted themselves with both reflection and reflexivity. This category includes two sub-categories we named: discovering reflection and entering personal reflexivity.

Discovering reflection

The sub-category shows that experiencingRW deepened their reflection on experiences, practice, and profession. Thanks to RW, professionals, and students could explore previously unexplored topics and learn more about themselves.

“ Writing initiated me to think about my experiences … ” (professional) [ 46 ]. “ I think it’s good for physicians to reflect on what we’re doing ” (professional) [ 50 ]

“ Helped (me) reflect on positive aspects ” (student) [ 40 ]. “ I don’t usually think too much about what happens to me, but through critical reflective journaling, I was able to think carefully about things happening around me. This activity helped me to look into my mind ” (student) [ 44 ]

This sub-category explains transversal meanings coming from uniformly professionals and students.

Entering personal reflexivity

This sub-category includes data about RW enabling users’reflexivity. In this context, RW was considered training for reflexivity as it enabled participants to question themselves more often [ 48 ], reflect on their experiences [ 35 ], attitudes, actions [ 38 , 45 ], and also reconsider their actions and identify their strengths and weaknesses [ 40 , 44 ].

“ The questions in this study do make me stop and think about things – how I feel about what I’m doing in residency ”(professional) [ 46 ]. “ Helped me ID (identify) my strengths and weaknesses ” (student) [ 40 ] RW also helped eradicate the background noise that my mind does not yet know how to filter out [ 51 ] .

Interesting to note that this sub-category is more present in students’ narratives. While professionals referred to self-reflection practices (probably already acquired in other contexts), students often reported how RW helped them discover reflexivity.

Accomplishing learning potential

Our analysis showed how users RW used the technique to “Accomplish learning potential.”

According to the studies’ participants, RWcan enable a learning performancethat would be difficult to reach otherwise. In this context, participants addressed RW as a tool for“accomplishing learning potential.”Within this category, three sub-categories were highlighted: the improvement of skills, personal and professional growth, and assisting the change and development process.

Improvement of skills

Participants agreed that the development of skills and abilities through RWwas aimed at their clinical skills and –in relevant areas such as question asking – encouraged reflection and research [ 35 , 46 ]. Communication skills were also enhanced, as were their relationship with patients, family,colleagues, and friends [ 35 , 38 , 46 ].

Participants said:

“ Through reflective journal writing, my attitude towards learning has changed. I have been encouraged to be a proactive learner. (...) I have been able to identify necessary places for improvement and through research, question asking, goal-setting (...). I have improved my skills in relevant areas” (student) [ 35 ]. “I feel that it [participation in the study] has been a positive experience by motivating me to improve on my clinical, communication skills, and also my relationships with colleagues, patients, family, and friends ” (professional) [ 46 ]

Participants also reported that,in their experience, RWprovided an opportunity to assess and improve themselves and to enhance their self-confidence [ 38 , 40 ]. Cognitive skills, includinggaining more profoundknowledge and problem-solving, along withtime-management [ 35 , 40 , 46 , 49 ], were also enhanced: RW,therefore,represented a learning mode [ 45 ].

“ Without reflection, I absolutely believe these skills would be more unattainable for me ”(student) [ 35 ]

This sub-category applies more to students’ narratives. Health students mentioned the tools helping them most to develop their skills. Professionals focused principally on what RWcould improve (communication skills or organizational skills).

Personal and professional growth

Participantsidentifiedthat RWhad promoted personal [ 51 ] and professional growth [ 35 , 46 ]. RW meant for participants:an ameliorated attitude towards work [ 46 ]; a development path for one’s job potential [ 38 ]; an enhancement of their introspective knowledge [ 51 ]; an enrichment of their expressive capability [ 38 ];an improvement of their interpersonal relationships with patients and colleagues [ 50 ] and developed their use of critical and reflective thinking [ 38 ].

“ Reflecting introduces a new aspect to clinic that focuses on the individual’s learning experience ” (student) [ 35 ]. “I think that it does change the way that you think about the practice of medicine and your own personal tendencies and your interactions with your patients and colleagues. And I think it can be a really powerful driver of culture change ” (professional) [ 50 ]

This sub-category is more represented among students than professionals. Students are ‘surprised’ at how important RW was to their learning. Professionals still recognized how RW was an essential driver of change for their clinic activities.

Assisting the change and development process

We labeledthe third sub-category“assisting the change and development process.”The changeinvolvedintroducing modifications tothe way of working [ 48 ], assessing what needed to be changed to achieve a work-life balance [ 51 ], understanding elements that did not allow change, and how to act on them in the future, and also considering new and important issues [ 46 ], further information [ 51 ] and new ways of thinking. This sub-category equally explained the meaning given to RW by students and professionals.

“ I think writing answer to some of these questions has allowed me to reflect back on the year and think about specific important topics that I might not have thought about again.” (professional) [ 46 ]. (Reflective journaling encouraged) “Assessing and focusing on the changes that need to be done to achieve the balance in my life and being able to integrate that with my family and in my work as a nurse.” (Student 16/RJ2) [ 51 ]

However, thischange process could not be possible without witnessing change and becoming aware of it [ 38 , 46 ]. This allowedparticipants to ‘see one’slearning history and path of growth,‘have a picture of the problem, handle things differently, and broadening their vision of the problem [ 48 ].

Building a philosophical and empathic approach

The “Reflection and reflexivity” category is closely aligned with the “Building a philosophical and empathic approach” category. Participants defined RW as a means for nurturing an intimate and profound level of learning, i.e., a philosophical and empathic approach towards real-life professional issues. The third category consists of three sub-categories: the ability to find benefits in negativity/adversity, assuming an empathetic attitude, and the awareness of things, experiences,emotions.

Finding benefits in negativity/adversity

According to participants, RWexerted a therapeutic effect by encouraging professionals and students to focus on the present (43)strictly. It seemed that RWeventually reduced their emotional stress [ 44 , 51 ]. Likewise,in the contextofnegative experiences [ 49 ], its practice acted as a catharsis [ 46 ] that could even allow them tolook back at those experiencesafresh – enabling a change in perspective [ 39 ].

“While writing the journal entry, I felt like I was unloading something from inside myself and being set free. This process made me feel better ” (student) [ 44 ]. “It is always good to pause to reflect on my experiences. The most cathartic question was a few months back when I got to describe my really bad experience.” (professional) [ 46 ] “Very therapeutic. I wrote on a bad experience, but at the end, we were laughing at it.” (professional) [ 49 ]

This specific approach allowed the practitioner/trainee to improve their self-care and focus on work objectives [ 51 ]:

“Self-reflection and reflective journaling promote self-understanding and is another part of self-care.” (Student 5/RJ3) [ 51 ]

Even if more emerging from students’ voices, professionals appeared genuinely amazed at how learning can be generated out of negativity.

Assuming an empathetic attitude

Study participants stressed the fact that RWhelped them develop empathetic attitudes. It seems that RWemphasized the importance of sensitivity and empathy by trying ‘to be in someone else’sshoes,’ especially that of patients or colleagues [ 36 , 37 , 44 ].

“How reflecting on patient encounters through field notes allowed her to “take a walk in someone else’s shoes ” (student) [ 36 ]. “It helps you see the humanity... ” (professional) [ 50 ]

This approach also applied in contexts outside of work and helped the practitioner take off his/her‘white coat’ and understand that before being a professional,he/shewas a person and a human being [ 36 , 37 , 46 , 50 ].

“ Which has made me more open to other’s ideas and thoughts ” (professional) [ 46 ]

As previously mentioned, according to the participants’ statements, awareness was the cornerstone to effective personal and professional growth [ 40 , 51 ].

This sub-category is equivalently present among the participants’ groups. Nonetheless, different meaningscould also be highlighted. Students appreciated RWby stressing its value of allowing them to enter deeply ‘into the other’ inner world (mainly patients). Professionals claimed they could recognize the profession’s human and relational aspects, whichcould also be helpful for their extra-professional relationships (family members, friends).

Awareness of things, experiences, emotions

Impartially balanced among professionals and students, awareness was cited in terms of ‘how things have affected me rather than simply continuing to work in a robotic manner’ [ 46 ], the awareness of who one was and who one has become thanks to the process of change [ 51 ]. This professional and relational awareness made it possible to think clearly about one’s practice and the health resources present in the context of belonging [ 50 ].

“Just being aware of what I know now and what I’ll know by the end of the semester … is a great way to learn who I am and what I can change about me for the better.” (Student 9/RJ1) [ 51 ]

The process of awareness that was facilitated by how their RW allowedthem to transform shapeless and straightforward ideasinto words and givethem a specific value and emotional charge [ 36 , 47 , 51 ]: it wasan authentic opportunity to turn emotions and feelings into something tangible –a journey of discovery and personal acceptance [ 43 ].

“ After two years or so, when you look back, it’s like, oh,that’s how I was feeling at the time, and right now, I feel differently. There is also this level of satisfaction. Like you have matured out of this thinking ” (professional) [ 47 ]

Identifying RW feasibility

The fourth category consists of three sub-categories: perceived barriers/impeding factors, facilitating factors, and when and how to use RW. Students and healthcare professionals who had the experience of practicing the RW in their work identified both limitations and facilitating factors and indications about when and how to use RW.

Perceived barriers/impeding factors

Some study participants (almost entirely students) identified several barriers to their activity. Some students could not see the benefits and thought RW was a waste of time [ 35 , 38 , 51 ]. However, others, who did see the potential benefits still felt that they lacked the time needed to devote to RW [ 42 ] or, sufficient mental space to report and describe a work situation, an excessive similarity of this activity to the regular working practice and, consequently, a lack ofmotivation to write [ 47 , 51 ]. In addition, some described the strainthey felt in writing down personal/professional experiences [ 47 ]. A lack of privacy was another problem, both for the concern about sharing the reflection and for the respect of confidentialityin writing itself [ 51 ]. Taken together,it appeared that some study participants did not recognizeRW as an effective means of help [ 39 , 50 ]. Althoughrealizing the potential of RW,others felt that their tutors did not provide noticeably clearexplanations of the aim of RW– which they would have found useful and motivating [ 45 ].

“ To be honest, not a great deal ( … ) it wasn’t really some revelation ” (professional) [ 50 ]. “ I got a hard time referring it [my experience] to citations … I could have sat and cried yesterday when I did my essay … when I actually read it [my essay] I thought, oh I don’t know what it means, myself ” (Female 2 - student) [ 42 ]

Facilitating factors

This sub-category was exclusively interpreted from students’ narratives. They valued the perspectives to use RWin their practice seeing it as a valuable tool to be applied throughout their career [ 35 , 45 ],with many students reporting that they would continue with this technique [ 38 ]. Studentssaw RW as a valuable means of staying focused on their own goals and needs [ 40 , 51 ]. They remarked that it helped them reduce stress, gain clarity in one’s life and practice [ 41 ], and spiritually connect with themselves [ 45 , 51 ]. Furthermore, RW enabled studentsto discover more information about their health and well-being, ‘it also helped me tie in ideas and beliefs from different sources and relate it to my own’ [ 51 ]. RWhelped maintain awareness and recall the medical being/human being dichotomy [ 37 ]. It remindedstudentsof the difference between studying literature and refining manual skills and the ability to learn from experience and mistakes [ 35 ].

“ During the interview, I felt an element of being more like a ‘normal person’ having a ‘normal conversation’ with another human being. This was a strange realization because it reminded me of the dichotomy that physicians may experience, being doctor versus human ” (student) [ 37 ]

When and how to use RW

Health professionals (a few) and many students finally mentioned the time considered most appropriate to use RW, underlining its usefulness primarilywas during hardship rather than daily practice [ 47 ].Moreover,RWshould not be forced onto someone in any given moment but instead left to individual choice based on one’s spirit of the moment [ 40 , 46 ].

“. .. like if you had a patient die; that would be the only time you might write it down ” (professional) [ 47 ]

Otherparticipantsconsidered instructions on RW to be too forceful and notapplicable to their own experience of reflection [ 40 ]. ‘Reflection wasn’t just signing on the line.’ It allowed constructive feedback for the trainee or the professional. Constructive feedback could be positive or negative, but it was a powerful tool for thinking and examining things [ 45 ].

In this meta-synthesis of qualitative studies, we have interpreted the experiences of health professionals and students who used RWduring their education and training. Given the number of studies included, RW users’ experience was predominately investigated in students. This result, although not surprising, raises the question of whether RW in professional training is being used. RW is not used in professional training as often as it is in the academic training of healthcare students.

As to this review’s aim, we could highlight continuities and differences from study participants’ narratives. Our findings offer a conceptualization of usingRW in health care settings. According to the experience of both students (from different disciplines) and health professionals, RW allows its exponents to discover and practice reflectionas a form of cognitive processing [ 2 ] and enablethem to develop a better understanding of their lived situation. We also interpreted that RW allows users to make a ‘reflexive journey’ that involves them practicing meta-cognitive skills to challengetheir attitudes, pre-assumptions, prejudices, and habitual actions [ 24 , 26 ]. This was particularly true for students: “entering personal reflexivity” appears to be newer for them than for the professionals who are likely to acquire reflexivity during academic training. Students seemed more focused on tools than RW-related results. This consideration makes us affirm that reflective capacity is in progress for them.

Challenging pre-assumptions and entering reflexivityenabledRWusers to realize how RW may develop their learning potential to improve skills and personal/professional growth. Skills to be enhanced are quoted mainly by students. Conversely, professionals could comprehend the final purpose of learning, achievable through RW, in terms of communication or organizational abilities. Professionals interpreted skills from RW as abilities to apply in the clinical activities to find new solutions to problems.

The category “Accomplishing learning potential”confirms what many authors highlight: putting thoughts into words not only permits a deeper understanding of events [ 6 ], enhances professionalism [ 52 ] but also improves personal [ 16 ], communication, and empathy skills [ 4 , 17 ]. In this context, RW fulfills its mandate by letting human sciences [ 53 ] and evidence-based health disciplines affect clinical practice. As noted [ 54 ], students and health professionals’RW training allowed integrating scientific knowledge with behavioral and sociological sciences to supporttheir learning [ 55 ].

Users understood that RWcould be a powerful means of developing empathy and developing their philosophy of care: this consideration is in line with a recent study from Ng and colleagues [ 24 ]. Additionally, some authors [ 4 , 17 ] stressed these empathetic skills and “humanistic”competencies as essential to care for patients effectively [ 56 ]. Professionals were amazed how negativity could generate learning through RW. On the other hand, by recognizingand writing experienced negative situations, students could free themselves from feelings impeding empathy.

By employing RW, users reported factors that could encourage or limit its use. These findings further illustrate that RW is not always a tool that is easy to use without adequate training [ 57 ]. Almost exclusively, students reported hindering factors (limited time, difficulty in writing and understanding assignments, privacy issues, feeling bored or forced). As to professionals, few describedRW as a very stressful activity. Although students could identify impeding factors, they also recognized many positive ones. For professionals, RW was not to be used every day but in ‘extreme’ situations, requiring reflection and reflexivity to be applied. In general, enhancing motivation to write reflectively [ 58 ] should be the first goal of any training to make the process acceptable and profitable for trainees. If this first stage is not accomplished, it will reduce RW’sapparent professional and personal effectiveness among health professionals and students substantially.

Strengths, limitations, and research relaunches

This review may enrich our knowledge about providing RW as an educative tool for health students and professionals. However, the findings must be applied,taking into account some limitations. We focused our attention only on recent, primary, peer-reviewed studies within the time and publication limits. Qualitative studies often are available as grey literature: considering it may result in a different interpretation of students’ and professionals’ experience in using RW. Therefore, our conceptualization should be read bearing in mind a publication bias and the need to expand the literature search to other sources. Besides limiting the risk of missing published qualitative studies, we reviewed the reference listsof included studies for additional items. Our meta-synthesis is coherent to the interpretation of the included studies’ findings.

At least two reviewers have conducted each step of this systematic review. We purposely did not exclude studies based on a quality assessment to maintain a robust qualitative study sample size and valuable insights.

During analysis, all possible interpretations were screened by authors, and an agreement was reached. Nonetheless, we did not cover all the possible ways to interpret the voices of students and professionals.

Since RW is not used in professional training as often as it is in the academic training of healthcare students, a research relaunch could be investigatingwhether and to what extent RW is being used in in-service training programs. Moreover, the studies included in this review were conducted within Western countries. Students’ and professionals’ perspectives from Africa and Asia are underrepresented within the qualitative literature about experiences of using RW. Therefore, geographicalgeneralizations from the present meta-synthesis should be avoided, and our paper reveals the necessity for RW research in other cultures and settings. Nonetheless, authors of primary studies have paid little attention to cultural and regionaldiversity. Therefore, we recommend furtherinvestigations exploring the differences between cultural backgrounds and howRW is recognized within training programs in different countries. Finally, additional qualitative and quantitative research is required to deepen our understanding of RW’s clinical and psycho-social outcomes in high complexity health practice contexts.

Our analysis confirms the crucial role of RW in fostering reasoning skills [ 59 ] and awareness in clinical situations. While its utility in helping health students and professionals to nurture reflection [ 2 ] has been widely theorized, this meta-synthesis provide empirical evidence to support and illustrate this theoretical viewpoint. Finally, we argue that RWis even more critical given the increasing complexity of modern healthcare, requiringprofessionals to develop advanced skills beyond their clinical ones.

Practical implications

Two important implications can be highlighted:

• (i) students and professionals can recognize the potential of RW in learning advanced professional skills. ImplementingRW in academic training as well as continuing professional education is desirable.
• (ii) Despite recognizing the effectiveness of RW in healthcare learning, students and professionals may face difficulties in writing reflectively. Trainers should acknowledge and address this.

Acknowledgments

We thank Dr. Silvia Tanzi for her insightful feedback about this work and Manuella Walker for assisting in the final editing of the paper.

Abbreviations

Authors’ contributions

GArwas responsible for the original concept. MCB performed the literature search on databases. MCB, GAr, GAm, LD, MR were responsible of data curation. GAr, MR, GAm, and LD screened titles and abstracts of all studies. LG, MCB, SDL, and MH served as external auditors. FDV and LD assessed the quality of included studies. MCB and LG gave a third opinion in case of disagreement. GAr, GAm, MR, and FDV derived sub-categories from the data. GAr, LG, MH drafted the first version of the manuscript. FDV, LD composed tables, and figures. All authors read and approved the final manuscript.

Not applicable.

Availability of data and materials

Declarations.

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Growth: reflections from a student mental health nurse

08 September, 2012 By NT Contributor

@laurengoudie, a third year mental health student nurse at the University of the West of Scotland who is doing her placements in NHS Ayrshire & Arran, gives her perspective on her time as a student nurse.

I’d suggest that emotion and learning in combination are powerful sources of meaning and direction; it creates a place for personal and professional development and growth, which has supported my understanding of recovery.

Throughout my training I have grown to understand that the phenomena ‘recovery’ requires self- awareness, drive and acceptance to operate outside the box in improving quality of care shadowed by clinical and educational governance, critical appraisal and synthesis.

A unique process

I consider the process unique - a continuum of expectations, attitudes and values, fruitful of conceptional descriptions entwined with a variety of characteristics representing one’s perception.

If I am honest, I feel recovery is a personal choice flourished on how much the individual sits on the continuum of hope, growth and change. As nurses we develop an unconscious awareness that enables us to build on using our thoughts and experiences ‘self’; the ability to enter the perceptual world of another person. That personal choice challenges our expectations on meeting the highly valued outcomes of our governing cornerstones ‘Person centred, safe and effective care’, giving us movement in implementing change.

I could argue that reflection contributes to the enablement of the flight in understanding recovery for the person. It allows us to recognise resilience, risk and vulnerability, empathises understanding, avoids bias perceptions and attitudes; symbolic interactionism ( World Health Organization, 2002).

Sartre’s quote (1944) ‘Hell is other people’ may at times reflect on the impact of negative perceptions to recovery based on  beliefs and values imposing on how that person values their journey - free of existential obstacles instead a purpose and meaning in life.

Therapeutic use of self

Wherefore questionable, I comprehended the credibility of multifariousness factors, thus the values and principles to understanding recovery i.e. evaluating strengths and barriers, emotional or personal beliefs, goals in establish identity, hope and meaningful life.

Amongst this learning I discovered that the importance of expressing compassion in the therapeutic use of ‘self’ positively within the therapeutic relationship can be crucial in avoiding false hope and maintaining boundaries.

Throughout my training I have had the honour of getting to know different people and their stories, and can confidently say that not one story is the same.

I have learned that their individuality is the key to finding the right direction in enabling footsteps in finding that hope and pathway (The National Framework for Pre-registration Mental Health Nursing Programmes in Scotland, NHS Education for Scotland, 2006).

I have often reflected on my experiences and feel it is important to synthesise findings and develop own coherent understanding - a competent nurse is crucial for the recovery of mental health service users (Mental Welfare Commission for Scotland, 2003).

Personal and Professional Growth

To conclude I have learned that supporting recovery requires a cultural awareness embedded in the vision of values and trust (NHS, Scotland, 2011). Therefore, this working relationship to recovery is a very valuable process which puts an onus on promoting personal and professional  growth and understanding.

Lastly I feel a point to us all: ‘ You are the most important person in your life’  (Purcell, 2009).

Lauren has recently achieved her BSc in MH Nursing.

Cottrell S (2005) Critical Thinking Skills, Developing Effective Analysis and Argument . Basingstoke: Palgrave McMillan

DeSilvia, L .(2011) Self Management . Available: http://athena/ahp/Documents/Helping%20people%20help%20themselves%20-%20evidence%20review%20(FINAL).pdf [Accessed on July 1st 2012].

Gamble, C and Brennan, G (2006) Working with serious mental health illness . A manual for clinical illness – A manual for clinical Practice. Elsevier, London 2006.

Macquarrie, J (1972) Existentialism. Philadelphia; Westminster Press

Mental Welfare Commission for Scotland , (2003) Respecting diversity [online] Available: http://www.mwcscot.org.uk/web/FILES/MWC_Diversity_NewAddress_prf2.pdf [Accessed on 3 July 2012]

Morgan, S. (2000) Clinical Risk Management: a Clinical Tool and Practitioner Manual . London: Sainsbury Centre for Mental Health.

National Institute of Clinical Excellence  (2007) Drug misuse: psychosocial interventions .Available: http://www.nice.org.uk/CG51 [accessed on 30 March 2012]

NHS Ayrshire and Arran (2011) Equality and diversity . Available: httlp://athena/pages/Default.aspx [Accessed on 1 April 2012]  -  NB Intranet of NHS Ayrshire & Arran

NHS Ayrshire and Arran (2008) Scheme of Establishment for Community Health . Available: http://www.isdscotland.org/isd/5352.html#staff_in_post [Accessed on 12 July 2012]

NHS Education for Scotland (2007) 10 Essential Shared Capabilities for Mental Health Nursing . Available: http://www.nes.scot.nhs.uk/mentalhealth/publications/default.asp on 14/2/2010 [Accessed on 19 July 2012]

NHS Education for Scotland (2007) The ten essential shared capabilities for mental health practice . Available: http://www.nes.scot.nhs.uk/media/5822/10escsfacilitatorstoolkit.pdf [Accessed on August 1st 2012].

NHS Education for Scotland and the Scottish Recovery Network (2008) Realising Health Practice – Learning Materials (Scotland) .Availablehttp://www.nes.scot.nhs.uk/mentalhealth/publications/default.asp [Accessed on 1 April 2012]

NHS Scotland, (2010) An Evaluation of the Impact of the Dissemination of Educational Resources to Support Values-Based and Recovery-Focused Recovery Learning Materials . Available http://www.scottishrecovery.net/images/stories/downloads/nes_eval_of_10escs_and_rr_summary.pdf [Accessed on 30 July 2012]

NHS Ayrshire and Arran (2008) Promoting Health Reducing Health Inequalities ..Available http://www.nhsayrshireandarran.com/uploads/5075/PHRImaster.pdf [Accessed on 27 July 2012]

NHS Scotland. (2007) Inequalities Sensitive Practice Initiative Operational Plan . Available http://www.equalitiesinhealth.org/publications/ISPI_OPPS_PLAN_.pdf[Accessed on 1 July 2012]

NHS Scotland. (2011) Trust Social Inclusion and Recovery Project Board .Available: http://www.cpft.nhs.uk/LinkClick.aspx?fileticket=TuJTC8JQCNI%3D&tabid=646&mid=1361&language=en-GB[Accessed on 3 August 2012]

Norman, I and Ryrie, I . (2004) The art and science of mental health nursing – a textbook of principles and practice . Glasgow: Bell and Rain Ltd.

Nursing and Midwifery Council (2004) Standards of Proficiency for Pre-registration Nursing Programmes . London: NMC.

Nursing and Midwifery Council (2007) Guidance for the Introduction of the Essential Skills Clusters for Pre-registration Nursing Programmes . Annexe 1 to NMC Circular 07/2007. People with Special Needs . Ross-on-Wye: PCCS Books

Nursing and Midwifery Council,  (2008) The code . London: NMC

Purcell, J (2009) People Management and Performance . New York. Routledge

Repper J, Perkins R. (2003) Social Inclusion and Recovery. A Model for Mental Health Practice . London: Bailliere Tindall.

Scottish Executive Health Department  (2001) Initial Guidance on shared Care Arrangements. Edinburgh: Scottish Executive .

Scottish Executive Health Department  (2001) National Care standards for care homes for people with drug and alcohol misuse problems. Edinburgh: Scottish Executive .

Scottish Executive Health Department  (2001) Poverty and social Inclusion in rural areas. Edinburgh: Scottish Executive .

Scottish Government   Health Department ( 2011) Rights, Relationshipsand Recovery: The Report of the National Review of Mental Health Nursing in Scotland [online] Available: http://www.scotland.gov.uk/Resource/Doc/924/0097678.pdf [accessed August 1st 2012].

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Critical Thinking and Reflection for Mental Health Nursing Students

• Marc Roberts
• Description

The ability to reflect critically is a vital nursing skill. It will help your students to make better decisions, avoid errors, identify good and bad forms of practice and become better at learning from their experiences. The challenges they will face as a mental health nurse are complex so this book breaks things down to the foundations helping them to build critical thinking and reflection skills from the ground up.

Key features:

· Covers the theory and principles behind critical thinking and reflection

· Explores the specific mental health context and unique challenges students are likely to face as a mental health nurse

· Applies critical thinking to practice but also to academic study, showing how to demonstrate these skills in assignments

See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

For assistance with your order: Please email us at [email protected] or connect with your SAGE representative.

SAGE 2455 Teller Road Thousand Oaks, CA 91320 www.sagepub.com

The set of books is an excellent resource for students. The series is small, easily portable and valuable. I use the whole set on a regular basis. 

I will be referring to this book (ch4) for my values-based practice class. I think the students will appreciate the way this book is written, using the NMC standards as a guide for this learning and making it real with the use of case studies.

Preview this book

For instructors, select a purchasing option, related products.

This title is also available on SAGE Knowledge , the ultimate social sciences online library. If your library doesn’t have access, ask your librarian to start a trial .

Psychiatry Training UK

Webspace by Dr Raja Adnan Ahmed

Reflective Practice – Examples

Important Points to Remember reflections

• Gibbs’ reflection cycle
• Edward de Bono’s six thinking hats
• John’s model of structured reflection
• Boud, Keogh and Walker’s model
• Brenner’s Critical Incident Analysis

Doesn’t matter which one, you can try each and then use the one that suits your personal style better.

• Read GMC guidance on reflection but most important take home message is to keep the details and descriptions of events short, outlining the case anonymously.
• Most of the writing should be about what was learnt including what you will do differently e.g. If using the Gibbs’ reflective cycle this will be the analysis and evaluation section.
• If you’re stuck about what to say about future management, imagine the scenario in a different setting e.g. if you encountered the case out of hours, if had said something differently, if you had tried a different line of treatment etc.
• Theory e.g. you learned how to manage a certain problem, you’ve since read certain guidelines.
• Something you learned about yourself e.g. how to manage your feelings/emotions. It can be something you learned about medical ethics etc.
• A reflection on your ‘soft’ skills e.g. your leadership skills, team working etc.

Here are few examples of reflections

Example # 1:.

Title: Attended a full day GP Update Course (Date – venue)

As a GP it is important to continue to renew our knowledge even in areas that we become experts in such as hypertension, asthma and diabetes. Common things are common but medical research is always evolving hence the importance to continue to update our current knowledge base. It was a useful course and new useful guidance is always gained when attending this course.

Reflection:

Amongst many nuggets of knowledge I learned the following:

NSAIDS & Antidepressants- co-prescribing these increases the risk of intracranial haemorrhage (ICH) particularly in the first thirty days. ( BMJ2015;351:h3517) I have always advised patients on short courses of NSAIDS and AD to beware of GI bleeding but had not considered ICH.

The study also suggests that this risk is across the range of antidepressants such as TCAs, SNRIs as well as SSRIs. I will continue to use these with caution. Of course, nothing is straightforward in General Practice. We do not know of the risk beyond 30 days. This risk is also higher in men but surprisingly no increased risk is seen in older people or those with co-morbidities.

Given that we prescribe approximately forty million prescriptions for antidepressants across the UK, we are unaware of patients using NSAIDS over the counter, we have to use caution and advise our patients against such risks.

This has a direct impact on multimorbidity and polypharmacy in primary care. I have made it clear to patients taking antidepressants about the risks of using NSAIDs. More so, there are a number of patients with depression with chronic pain, these groups are clearly vulnerable to the risks mentioned. There is a suggestion with NICE guidelines that if an SSRI & NSAID is co-prescribed, gastro protection should be advised.

I have discussed this with our practice pharmacist, as she does the majority of our medication reviews, and made her aware of the risks. On a personal note, I will be adding gastro protection where possible and advising patients to avoid OTC NSAIDS. We also discussed the use of NSAIDS which in actual fact cause more deaths than RTA. This has certainly put things into context for me!

Example # 2:

Title: Menopause Masterclass

A refresher about menopause and risks/benefit in the current climate.

Women are far more self-aware of the menopause and approach the doctor to discuss treatment for the menopause than perhaps decades ago. As women are also living longer, as is the general population, so comes with it increasing the risk of cardiovascular diseases and other co-morbidities.

It was useful to look at the quality standards that are now in place for HRT. There were several useful websites for information for both health professionals and patients: British Menopause Society- BMS Menopause  matters.org M anagemymenopause.co. uk Also, for younger women with premature ovarian failure the  daisynetwork.org.uk < br />

There was useful information on the use of testosterone. I had a peri-menopausal lady who requested testosterone gel to improve her libido. I had no experience in this area so wrote to the HRT clinic, she is now a very happy patient on testosterone gel. As long as the testosterone levels are measured every 3months to ensure that low maintenance doses are continued it is acceptable.

Given that I see a lot of women who often come with an agenda and an expected outcome this seminar was very useful in addressing these issues. HRT can have a lot of expectation for women. Some women are very reluctant to stop taking HRT, it is challenging such as stopping HRT after 5years or more when the risk becomes more concerning that I find challenging. The risk increases in term of CVD, obesity and breast cancer.

I have used the BNF statistics to place this risk into context for women who have been on HRT for many years. On one occasion in a 72year old lady, I stopped HRT much to her consternation. I did refer her to the HRT community clinic where it was restarted. Unfortunately, the risk and responsibility fall on the prescriber and I decline to continue to prescribe in this scenario. This seminar reinforces my practice in such unique case scenarios.

This was a good seminar, given the subject, it validated my current practice and helped me develop a more patient-centred paradigm within our current approach.

Example # 3:

Title: Dermatology update day

(Venue) – Evening lectures covering typical skin scenarios commonly seen and dealt with in the primary care setting.

The topics discussed on the day were eczema and skin conditions in young children, vulval rashes and psoriasis in the community. I see a lot of vulval rashes and being contraception lead at my surgery. Also, I have a lot of consultation with women so find that this area needs to be kept up to date.

It was reassuring to know that my management of childhood eczema was in keeping with dermatologist consultant approaches. The key points to take home were that GPs tend to undertreat eczema rather than over treat. It is reasonable to continue a moderate potent steroid cream as long as it is for a short period and stepped down at the earliest possible.

Outcome: I will continue to practice as I have been but will take on board certain practices such as treating superimposed infection in eczema for 2weeks and also despite what the instructions are on steroid creams we can apply to broken and infected skin!

Example # 4:

Subject title: Autism Spectrum Disorder (ASD)

What were you reading?:

I read the article ‘Autism in Adults’ published in InnovAiT in June 2017.

Why were you reading this?:

I identified that this is a learning need of mine from a previous reflection on a case I was involved in.

What did you learn?:

I learnt a lot from this very thorough article. I learnt about the terminology currently in use. I did not know that ASD is now an umbrella term that includes Autism and Asperger’s Syndrome. I learnt about the clinical features of Autism, including challenging behaviour, communication difficulties, processing difficulties and rigid/repetitive behaviours. I learnt how to assess patients with suspected ASD. I also learnt how to manage patients with ASD in primary care. The article suggested reasonable adjustments that can be made at a surgery to make healthcare more accessible to people with ASD and it also gave a number of tips regarding communication during consultations. Reading this article, I was able to reflect further upon a patient I reviewed with ASD who had presented with suicidal ideation. I had found this assessment difficult. I found it difficult to build a rapport with this patient and had a lot of difficulty assessing her level of risk. I identified during the assessment that she was struggling to answer open questions and one of the tips in this article is to ask direct closed questions. It also suggests waiting for a response rather than repeating the question or asking in a different way. This is something that I did whilst trying to assess this patient and may be some of the reason why I failed to do an appropriate, effective assessment on her.

What will you do differently in future?:

In future, I would try to follow some of the communication advice written in this article. That said, another important point raised by the article is that ASD, as the title suggests, is a spectrum. This means that no two patients are the same and while some may respond better to the communication advice provided, others may not. I will therefore keep an open mind and endeavour to adjust my communication technique as I feel appropriate.

What further learning needs did you identify?:

I had already identified that I needed to learn more about ASD. Whilst I now need further practice at managing patients with ASD, this reflection goes some way towards closing this learning cycle.

Example # 5:

Subject title: Urge incontinence

What happened?:

A 41 year old woman presented with a few months history of increasing urge incontinence. She had had one normal vaginal delivery 10 years ago. She reported that she had been consistent with doing regular pelvic floor exercises since the birth of her child. She also reported that she had already tried to cut down on her caffeine intake in an attempt to manage her symptoms. She felt that her symptoms were beginning to have a negative impact on her life and she was beginning to feel reluctant about going out in case of any accidents.

What, if anything, happened subsequently?:

I consulted the NICE CKS guidelines and referred her to the continence team for bladder retraining. I advised her to complete a bladder diary in the meantime.

I learnt that I am not confident at managing patients presenting with urinary incontinence. I learnt from the guidelines that it is advisable to refer patients for bladder retraining prior to initiating medication. I would not feel confident at initiating medication at this stage. I learnt that these symptoms can have a big impact on lots of aspects of someone’s life. This patient is beginning to feel reluctant about going out due to the risk of her being incontinent while she is in public. She was quite tearful as she described how it made her feel even in her own home when she is incontinent in front of family members. She has a young child that she wants to go out with so her symptoms are now beginning to affect their family life. She wishes to lose weight (which would probably benefit her urge incontinence) but is struggling even more with body image and low esteem as a result of these symptoms.

In future, I will refer patients for bladder retraining as I did in this case. I will try to be as sensitive as I can when taking a history as I understand that this can be an embarrassing experience for patients.

I need to learn more about the management of urge incontinence.

How and when will you address these?:

I will undertake some reading on this subject and record what I learn from this in my eportfolio.

Example # 6:

Subject title: Assessing Risk Out of Hours

During an evening shift, along with a member of the Home Treatment Team, I assessed a 22 year old woman who had been referred urgently by her GP due to increasing thoughts of self harm and suicide. She had been referred to the Community Mental Health Services some weeks previously but not yet been assessed. Although she had experienced a number of significant precipitating life events and also disclosed during assessment that she had been sexually abused as a child, there were no specific triggers for the recent deterioration in her mood. She described how over the past 12 months she had been unable to hold down a job or maintain personal relationships. She had fallen out with a number of close friends and been in more than one abusive relationship. She lived with her family and had a very good relationship with her mother. Her mother had accompanied her to the assessment. She also described how she had been arguing with her family and taking out her frustration on them. She felt very guilty about this. Over the past few weeks she had been struggling with insomnia. She had a history of having taken an overdose approximately 6 months prior to this with the intent to end her life and admitted to contemplating doing the same thing again. She had been prescribed medication by her GP for her mood and planned to take an overdose of this.

Following a detailed assessment, myself and the CPN from the Home Treatment Team discussed management options. The options were admission to hospital or discharge home with either follow up from her GP or follow up from the Home Treatment Team. My colleague and I agreed that, although she was relatively high risk for self harm and even possibly suicide, she had a lot of support at home, especially from her mother. We agreed that the best option would be for her to be discharged with follow up from the Home Treatment Team until she felt improved enough to control her thoughts. We discussed the plan with the patient and her mother and asked her to sign a ‘Safety Contract’ that included a plan of action in case she felt like she wanted to act on her thoughts. Both her and her mother were happy with this management plan. We also agreed to give her some night sedation as she was having such difficulty falling asleep. Her mother was to keep these tablets in a safe place.

This was an excellent opportunity for me to practice assessing risk of self harm/suicide. I have assessed this risk on my own many times in the Emergency Department and in General Practice and generally err on the side of caution, as evidenced by a previous reflection on this subject. If I had assessed this patient on my own I would have probably admitted her. This time I was working with an experienced colleague and I valued the opportunity to discuss the risk and subsequent management plan with them. Sharing this decision helped alleviate some of the anxiety I sometimes feel when weighing up the risks myself. I feel anxious as I am concerned about the patient’s safety; I would worry about deciding to discharge a patient home who later seriously self harmed or committed suicide. I felt very moved by this patient’s history and she worried me. Having the opportunity to discuss this case gave me more confidence to decide with my colleague that the patient did not need admission. I also had opportunity to practice completing the WARRN documentation and found this to be a very useful tool to aid our decision making. The WARRN is much like a checklist and can be repetitive but it provided me with a template for considering the level of risk for this patient. There was a lot of detail in this case and the documentation helped to highlight the salient points. I have used checklists in medicine many times and find them very useful. In my experience, not all cases will fit neatly onto a checklist but they are designed so that important points are not missed and all relevant information is recorded. I learnt more about how to investigate symptoms of auditory hallucinations. The patient reported that she was hearing voices telling her to kill herself. Previously, I would have just documented this in the notes. However, my colleague questioned this further and was able to ascertain that rather than auditory hallucinations, the patient was experiencing ruminating thoughts about suicide and becoming increasingly preoccupied by this. I would not have previously been able to make this distinction. Working with a member of the Home Treatment Team gave me the opportunity to discuss with him how this team may be able to help this patient (and others). Previously, I did not know that the Home Treatment Team were able to prescribe medication and I had incorrectly thought that they were less available than they are.

In future, I would feel more confident about assessing risk of self harm/suicide and deciding on appropriate management plans. In General Practice we do not complete WARRN documentation and doing so would take too much time. However, I would try to think about the risk in the way it is set out in a WARRN to aid my decision making. If I had any doubts or concerns that a patient was at high risk of self harm/suicide, I would again err on the side of caution and, as a GP, would refer patients to secondary care on an urgent basis for further assessment. Regarding checklists/proformas, I would look to use such tools in my future practice as I feel they play a role in ascertaining the salient points of a case and ensuring all relevant information is recorded. Whilst they do not fit every case, they can also assist in decision making.

I need to continue to practice assessing risk of self harm/suicide with colleagues and alone. Whilst on this placement, I need to practice using WARRN documentation to become more familiar with the layout.

I will continue to practice assessing risk and reflecting upon my experiences.

Example # 7:

Subject title: Psoriasis vs Lichen Planus

I read information about these two skin conditions from three different resources; Primary Care Dermatology Service, British Association of Dermatologists and DermnetNZ. I also read about differential diagnoses for an itchy rash on the PCDS website.

I had previously identified this as a learning need when I struggled to diagnose and manage a patient with an extensive itchy rash. I noted that two GPs had subsequently treated the patient for a different condition and realised that I needed to do some reading on these topics.

I learnt about Lichen Planus including it’s presentation and management. It can be intensely itchy and is managed with emollients and potent steroids. It usually lasts for two years and as the papules/plaques settle they are replaced by hyperpigmentation. I also learnt about Psoriasis including it’s presentation and management. It presents as symmetrical scaly plaques and is managed with potent steroids, topical vitamin D preparations and coal tar amongst other treatment options. In addition, I learnt about differential diagnoses for an itchy rash, including how to investigate someone with generalised pruritis without rash. I also read about the Dermatology Life Quality Index (DLQI) as a measure for how much a dermatological condition is affecting someone’s life. This would be useful information to consider for referring patients to secondary care. These are three resources that I regularly use when managing skin conditions. It was interesting to compare the three. Two of these resources are UK based and one is specifically for GPs in the UK. The management advice of each was pretty much identical which was reassuring. I found PCDS had more photographs on their website which is particularly useful when learning dermatology. BAD had lots of useful patient information leaflets which are available for printing. Reflecting upon the original case, as I read this information I think that lichen planus and psoriasis could quite easily been mistaken for each other. They both present as itchy plaques, have similar triggers and can present with the Koebner phenomenon. Management for each condition is different, however, and given that this woman did not respond to potent topical steroids that could indicate that lichen planus is not the correct diagnosis. Her diagnosis of lichen planus had been made 10 years ago so it is quite possible that this rash is not the same thing. Additionally, back in 2009, she had been treated with diprosalic ointment which is often used in psoriasis to remove scale. After my reading and after reflecting, I think that psoriasis is the more likely diagnosis here and I will be interested to find out what the dermatologist thinks when she is seen in clinic.

In future, I will have a better idea of differential diagnoses for patients presentingwith itchy papular skin lesions. I will be better able to differentiate between psoriasis and lichen planus and better able to manage them effectively. I also know which resources I prefer to use with regards to dermatology and would be able to direct patients to information that might be helpful to them, in particular the patient information leaflets on the BAD website.

This completes my learning cycle.

Example # 8:

Subject title: Management of agitated patients and rapid tranquilisation

During my OOH psychiatry SHO shift, I was asked by a nurse on an adult psychiatric ward to prescribe anxiolytic and antipsychotic medications in order to reduce a patient’s agitation. This health board revert to a rapid tranquilisation policy for these matters.

This patient was extremely agitated and had already cause some (minor) harm to themselves. There was also a risk of harm to staff and patients on the ward due to the severity, nature and unpredictability of the patient’s aggression. To manage this patient, police needed to be called to help de-escalate the situation before any medications could be administered. The patient was transferred to Psychiatric ICU for further management and assessment.

This was quite a big learning curve during my first on-call: Firstly, was learning how to manage a patient expressing this degree of aggression and agitation as there was limited we could do safely and legally at this point, which is why the police were called to utilise their different skills for managing these patients. Secondly, utilising the rapid tranquilisation guideline – the nurses were most comfortable/familiar with using Haloperidol and Lorazepam as a combination, however, further reading indicates that Haloperidol and Promethazine are a useful combination because there is some evidence that promethazine can help counter-act potential extra-pyramidal side effects associated with Haloperidol. The negative factor is both have the ability to cause prolonged QTc. Finally, was managing my own feelings because admittedly this was not a situation I had previously had to manage and despite one of the nurses having worked on the ward for 22years, all of the staff were looking at me for answers. Unlike medical or trauma related emergencies, I didn’t have an algorithm like <C>ABCDE to resort to in order to reduce my bandwidth and so having headspace to think in this unfamiliar situation was more difficult but definitely helped by delegating tasks or trying to utilise the team by focusing on priorities e.g. “how do we make this situation safer?” to which the nurses suggested calling the police. Luckily this patient was on the ward on a section, had the patient been ‘informal’ then this could have added additional ethical and legal complexities but may have resorted in putting the patient on a section 5(2) if appropriate or giving the medication as a one off dose in the patient’s best interests.

Our on-calls are off-site i.e. they are based in a different community hospital and we travel to patients or give telephone advice: During my first on-call I had to familiarise myself with everything inc. passwords to unlock doors, finding staff members, finding on-call rooms etc. If I ever have to do on-call shifts like this again, I will ensure I shadow a more experienced colleague/at least see the on-call location before I attend my own on-call to reduce the uncertainty and unfamiliarity. This might help me feel more at ease and give me more headspace e.g. wasting time trying to find paperwork or being locked out of a ward. With regard to this specific case, it demonstrated a reversal in my relationship with the nurses i.e. throughout the on-call I was relying on the very experienced nurses to help with explaining how various systems worked, where paperwork was and sometimes providing clinical information that added to my assessments of patients. However, in this emergency situation, it was completely expected for me to take charge and tell people what to do. I found this quite interesting, not dissimilar to what can happen on a medical ward but I believe medical training is set toward managing medical emergencies a lot better than emergencies in mental health and so the answers weren’t so readily available to me. I don’t this affected the clinical situation too much but certainly interesting to reflect on. It also strengthened my relationship with the nurses, perhaps because it balanced out me asking them for help prior to this event! This patient was naïve to antipsychotics and had a normal ECG documented from a previous A&E attendance 3 months prior. It was not appropriate to attempt an ECG for this patient at this point. In terms of choice of anxiolytic, despite evidence showing the use of Promethazine being a useful combination with Haloperidol, I don’t know that I would have used it in this patient due to concomitant risk of prolonged QTc.

1. I need to learn more about antipsychotics as I am not as familiar prescribing them 2. I need to discuss with my consultant methodology for more focussed prescribing of antipsychotics 3. I need to learn more about MHA and police powers, in particular for managing patients like this

1. Self directed learning on antipsychotics 2. Discuss with adult psychiatrist in clinic about antipsychotic prescribing esp. PRN doses and combinations 3. Conduct e-learning on MHA and police sections

Example # 9:

Subject title: DNACPR discussion with patient relative

A patient with advanced dementia and multiple co-morbidities was admitted onto the ward and did not have DNACPR form. The patient did not have any close relatives aside from an elderly brother. His brother was invited in for a discussion about discharge and the subject of DNACPR was raised.

DNACPR form was discussed and signed

Understanding surrounding DNACPR forms seems variable: In particular I have noticed that having the conversation with a family member who is younger e.g. children of the patient is a lot easier to explain than when discussing it with a spouse or similarly aged relative. I don’t know whether this is because the older generation have less understanding and read less about the forms or whether the decision is more difficult because of their own age and potential frailty. The patient’s brother was very alarmed at the idea that he was discussing this for his younger brother and he kept reiterating his difficulty coming to terms with this. The guidance for DNACPR forms is that they should be discussed with relatives, however, relatives can often understand this to mean that it is THEIR responsibility and decision alone and so can feel reluctant to agree to signing it. Another aspect that I think is important for patients to understand is that the DNACPR form doesn’t represent stopping all treatment, just not starting CPR in the event of arrest. I explained this to the patient’s brother and he was content with this. It was more difficult to explain the likely outcome of CPR in this patient and patients in general.

What will you do differently in future? :

It was useful to incorporate the discussion of the DNACPR as part of the discharge planning process. I have previously found these conversations more difficult when there is not a ‘way in’ i.e. the patient is not acutely unwell etc. Although I appreciate the guidance is to have a discussion whilst a patient is well as it promotes a healthier understanding, rather than understanding it to be a part of planning a patient’s death but sometimes it is helpful to discuss this when these sort of planning processes are at the front of the relatives mind. It was clear that the patient’s brother had never heard of DNACPR forms, but when we arranged the meeting, we encouraged him to bring a relative who might help him process the information. He brought his granddaughter, who was a trained GP. Although this was quite daunting for me initially, as I was conscious that another clinician might have their own feelings about how to have this conversation, it was very reassuring for the patient’s brother and so I felt her presence was helpful. She allowed me to explain and then provided reassurance for her grandfather. His main concern was that he didn’t feel, as the patient’s brother, that he was close enough to “sign him off”, I felt it was important to explain the clinician and relatives’ responsibilities in signing DNACPR forms, so that he didn’t have any sense of overburdening of responsibility or feel any guilt. Relatives and patients have different barriers to discussions and decisions surrounding DNACPR and end of life planning. In this case, I believe I understood these barriers and pre-empted them well e.g. by asking the brother to bring a relative to the meeting. It also acts as a “warning shot” i.e. that more complex or serious discussion is planned, which I think probably helped frame his mindset prior to attending. For this case, having a relative who understood the process was reassuring in this case but I felt that overall the conversation we had about the form was set at the right level and pace, so had the relative not been medical, they hopefully would have been reassured. If the relatives had not agreed with the process, I would have addressed their specific concerns and barriers, corrected any areas of confusion and explored their expectations. Failing these conversations I think I would have deferred to the consultant and directed the relatives to NHS website resources to further think about the topic and ask them to return to discuss further.

1) Further experience with DNACPR discussions in different environments 2) Understand palliative care support available in the community inc. for specific needs of certain illnesses e.g. dementia, MND, cancer, MS etc.

1) Reflect on cases in future placements 2) self directed study

Example # 10:

Subject title: Assessing a patient with Learning Disability

I was asked to assess a 21 year old patient out of hours who had a diagnosis of learning disability, living with his mother who also had a learning disability but less severe. His mother explained that the patient had been leaving the house regularly in order to ‘find friends’, resulting in him hanging around homeless persons and searching out known gang members. The patient had been drinking dregs of alcohol bottles/cans left on the street, smoking cigarette butts and taking unknown drugs offered to him by gangs (but his mother suspected they were making a tally of costs he owed). He also had been steered home by these gang members to ask his mother and family for money for them. The incident preceding this admission involved the police following a fight between 2 known gangs carrying machetes. The patient was found by police visibly upset and confused so was taken home. The patient had been developing psychosis over the preceding months causing him to behave aggressively and fleeing his home spontaneously due to fear of his hallucinations of ‘Freddie’.

The patient was admitted due to concerns surrounding his safety. Initially admitted to an adult ward, with a view for transfer over to the learning disabilities ward.

The 2 main learning points of this case were surrounding safeguarding issues and communication. This patient was extremely vulnerable, despite his age, his communication skills and understanding of the world could not have been more than that of a 4-5year old. The hallucinations he was experiencing seemed to re-enforce this because his fears and hallucinations were of ‘Freddy Kruger’, a monster like character, under his bed or in his wardrobe. Hallucinations are often congruous to the persons’ age, culture and experiences. These hallucinations were scaring him and his response was to run away from them, which his mother was having difficulties managing because of her own LD and his violent behaviours. This patient was extremely socially isolated – due to his age there were limited services available to him to help him socialise and make friends, therefore he sought out opportunities to meet people and then mistook the manipulative and exploitive behaviour of the gang members he met as acts of friendship. From the history these gang members were evidently exploiting his vulnerability and perhaps even his mother’s. There was limited support given to the mother, aside from the police, who she regularly called to report the patient as a missing person. I found this quite sad; the mother reported that they had been on the ‘list’ for a social worker for 18months and were still waiting for some support. She was anxious that her son wasn’t arrested for his involvement with gang members and possibly drugs. This consultation required a lot of time: The patient had an obvious processing delay, exacerbated by the sedative medication that he took to manage his psychosis. He had significant poverty of speech and so his mother had to relay a lot of his history, which in itself was not always clear or was missing elements because the mother hadn’t been there. I noticed that the patient had a tendency to agree to things and so I avoided questions with a ‘yes’/’no’ answer, but this was also quite difficult due to the patient’s poverty of speech and general shyness being asked questions by a doctor he had never met. With time, we managed to gain a clear enough picture to be able to understand what had been happening. The patient also had a sister who cared for both the patient and patient’s mother alongside her own young family and so, when it became a more suitable hour, I called her for collateral information and carer’s perspective which was useful.

This was a really difficult case, especially for a GP to manage without rapid support and input from community, social support and mental health services. There were so many safeguarding issues for both the patient and mother’s perspective. They are known to be vulnerable characters in the community and on further information gathering, have been targeted and exploited previously by gang members and also fraud perpetrators. Having said that, the patient had not had a social worker since he was a child and was on a waiting list yet to receive allocation, which illustrates a disconnect between child and adult services. The referral to social services had been made 18months prior, I think this case demonstrates the importance of updating referrals to try and expedite them when a situation deteriorates. This would also be a case I would discuss with the practice to try and share ideas on how to manage this case. A key part of the patient’s perceived problem was that he wanted friends: I think it is easy to overlook the social problems/group them as one big factor that we can’t address easily and then focus on the medical side. I have learned not to underestimate the value of social network groups. Perhaps this patient would have benefitted from being counseled about groups such as ‘mind’ which offer social structures for younger adults. Finally, for patient’s with LD, it is important to try and give more appointment time for them so they can have the opportunity to explain what has happened and more completely understand what counseling or advice is offered, in addition to being able to explore and come up with solutions together. I cannot imagine that a GP would have been able to assess this patient in a 10 minute consultation.

1) More understanding and experience managing patients with safeguarding issues 2) More experiencing communicating with patients who have special communication requirements inc. language barriers

1) Safeguarding e-learning on elfh and other sources 2) Reflect on safeguarding cases in psychiatry, paediatrics and GP placements 3) Attend safeguarding MDT meetings 4) Develop better consultation techniques for patients with LD

Special thanks to my wife and my GP trainees for sharing the examples of reflective practices

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How to Write a Nursing Care Essay for Mental Health Nurses

"Writing a nursing care essay for mental health nurses requires a deep understanding of the topic, critical thinking, and the ability to apply knowledge to real-life nursing practice. Embrace the challenges and grow through the writing process to create a compelling and insightful essay."

I. Introduction

A. Importance of Mental Health Nursing Essays

Mental health nursing is a critical and growing field within the healthcare profession. As mental health issues continue to rise globally, mental health nurses play a vital role in providing care and support to individuals and communities affected by these challenges. Writing mental health nursing essays not only helps students develop their understanding of the subject matter but also equips them with essential skills and knowledge that they will need in their future practice.

These essays provide an opportunity for students to explore various aspects of mental health care, such as biopsychosocial approaches, the role of mental health nurses, evidence-based communication strategies, and ethical considerations. By engaging in this process, students can develop critical thinking skills, improve their ability to analyze and apply concepts, and gain a deeper understanding of the complex world of mental health nursing.

B. The Purpose of This Blog Post

The purpose of this blog post is to guide mental health nursing students through the process of writing a high-quality nursing care essay. We will provide step-by-step instructions and tips to help students focus on relevant topics, apply their knowledge to real-life nursing scenarios, and structure their essays in a way that is both coherent and persuasive.

By following the advice and suggestions presented in this blog, students will be better prepared to tackle the challenges of writing mental health nursing essays and ultimately enhance their understanding of the subject matter.

II. Understanding the Essay Topic

A. Breaking down the essay prompt

Before you begin writing your mental health nursing essay, it is essential to understand the essay prompt thoroughly. This means carefully reading and dissecting the prompt, identifying the main components and requirements, and determining the overall direction of your essay. Start by highlighting the key terms and concepts that you will need to explore, as well as any specific instructions or guidelines provided.

Next, break down the essay prompt into smaller parts that will help you organize your thoughts and plan your research. This may involve creating a list of subtopics, questions, or themes that you will need to address in your essay. By breaking down the prompt, you can ensure that you cover all aspects of the topic and develop a well-structured and coherent argument.

B. Identifying the key questions to address

Once you have broken down the essay prompt, it's time to identify the key questions that you will need to address in your essay. These questions will guide your research, help you formulate your arguments, and ensure that your essay is focused and relevant.

Consider the following questions when identifying the key questions to address:

• What are the main concepts, theories, or frameworks related to the essay topic?
• How do these concepts, theories, or frameworks apply to mental health nursing practice?
• What are the current debates or controversies in the field of mental health nursing, and how do they relate to the essay topic?
• What are the practical implications of the essay topic for mental health nursing practice?
• Are there any ethical, legal, or policy considerations related to the essay topic, and how do they impact mental health nursing?

By addressing these key questions in your essay, you will demonstrate a comprehensive understanding of the topic, showcase your critical thinking skills, and provide a solid foundation for your arguments.

III. Gathering and Organizing Reading Materials

A. Selecting relevant sources

Before you can begin writing your essay, you need to gather and analyze relevant sources that will support your arguments and provide evidence for your claims. Start by conducting a comprehensive literature search, using academic databases, libraries, and online resources. Be sure to focus on reputable sources, such as peer-reviewed articles, books, and official reports, to ensure the credibility and reliability of your information.

When selecting sources, consider the following factors:

• Relevance: Make sure the sources directly relate to your essay topic and address the key questions you have identified.
• Currency: Choose recent sources, as they are more likely to reflect current debates, theories, and research findings in the field of mental health nursing.
• Authority: Opt for sources written by experts in the field, including mental health nursing practitioners, researchers, and academics, to ensure the accuracy and reliability of your information.

B. Taking notes and recording page numbers

As you read through your selected sources, take detailed notes on the key ideas, arguments, and evidence that you will use to support your essay. Be sure to record page numbers for any direct quotes or specific information that you will need to reference in your essay. This will make it easier to cite your sources accurately and avoid plagiarism.

To help you organize your notes, consider using a system such as the Cornell method, which involves dividing your note paper into sections for main ideas, supporting details, and personal reflections or summaries. This can help you keep track of your thoughts and ideas, as well as the sources they come from, making it easier to integrate them into your essay later.

C. Organizing ideas in a coherent manner

Once you have gathered and reviewed your sources, it's time to organize your ideas and information into a coherent structure that will form the basis of your essay. Begin by creating an outline that includes the main sections and subheadings of your essay, along with brief descriptions of the content you will include in each section.

Next, arrange your notes and ideas in a logical order, ensuring that they flow smoothly from one point to the next and support your overall argument. Be sure to use clear transitions and signposting to guide your reader through your essay, highlighting the connections between your ideas and the evidence you have gathered.

By organizing your ideas in a coherent manner, you will create a strong foundation for your essay, making it easier to write a well-structured, compelling, and persuasive piece of work.

IV. Focusing on a Specific Aspect of Nursing Care

A. Choosing a relevant focus for the essay

One of the most important aspects of writing a successful nursing care essay is to choose a specific focus that will allow you to explore the topic in depth. This focus should be directly related to the essay prompt and key questions you have identified, as well as relevant to mental health nursing practice. Examples of possible focuses include a particular intervention, a specific patient population, or a certain aspect of the nurse-patient relationship.

When choosing your focus, consider the following:

• Relevance: Ensure that your chosen focus directly addresses the essay prompt and key questions, as well as reflects current mental health nursing practice and research.
• Interest: Choose a focus that genuinely interests you, as this will make it easier to engage with the topic and write a compelling essay.
• Feasibility: Make sure that your chosen focus can be adequately addressed within the scope and word limit of the essay, allowing you to explore the topic in sufficient depth.

B. Incorporating the focus throughout the essay

Once you have chosen your focus, it is essential to incorporate it consistently throughout your essay. This will help to create a cohesive and focused argument, ensuring that your essay remains on topic and effectively addresses the key questions and issues you have identified.

To incorporate your focus throughout the essay:

• Introduce your chosen focus in the introduction, clearly stating its relevance to the essay prompt and key questions.
• Use your focus as a guiding principle when selecting and organizing your reading materials, ensuring that the sources you include directly relate to your chosen focus.
• Make consistent reference to your focus in each section of your essay, highlighting its significance and relevance to your overall argument.

C. Explaining the significance of the chosen focus

In addition to incorporating your chosen focus throughout your essay, it is important to explain its significance and relevance to the topic of mental health nursing care. This will help to demonstrate your understanding of the subject matter and justify your choice of focus.

To explain the significance of your chosen focus:

• Discuss the implications of your focus for mental health nursing practice, such as the potential benefits or challenges it may present for patients, nurses, and healthcare systems.
• Highlight any gaps or controversies in the current research or practice related to your focus, explaining why further exploration and discussion of this aspect of nursing care is important.
• Use evidence from your reading materials to support your claims about the significance of your focus, ensuring that you provide a well-reasoned and evidence-based argument.

V. Applying Knowledge to Nursing Practice

A. Connecting references to real-life scenarios

In order to create a strong and relevant essay, it is essential to connect the references and theoretical concepts you discuss to real-life nursing practice scenarios. This will help to demonstrate the practical application of your ideas and enhance the overall impact of your essay.

To connect references to real-life scenarios:

• Provide concrete examples of how the concepts and theories you discuss can be applied in a mental health nursing context. This could include specific interventions, patient interactions, or situations that may arise in a clinical setting.
• Use case studies, where appropriate, to illustrate your points and provide context for your ideas. These can be taken from your own clinical experiences, from the literature, or from hypothetical scenarios that you create.
• When discussing research findings, consider the implications for nursing practice and how these findings could be integrated into day-to-day care provision.

B. Discussing the implications for nursing practice

As you write your essay, it is important to consider the implications of your ideas for nursing practice. This will help to demonstrate your understanding of the subject matter and ensure that your essay is relevant and applicable to the field of mental health nursing.

To discuss the implications for nursing practice:

• Consider the potential impact of your ideas on patient care, nursing practice, and healthcare systems. This could include the benefits, challenges, or potential barriers to implementing your suggestions in real-life settings.
• Discuss the ethical considerations associated with your ideas, such as potential conflicts between patient autonomy and the duty of care, or issues related to confidentiality and informed consent.
• Reflect on how your ideas may inform nursing practice, such as how they could contribute to the development of new interventions, inform clinical decision-making, or shape healthcare policy and guidelines.

By connecting references to real-life scenarios and discussing the implications for nursing practice, you will create an engaging and relevant essay that demonstrates your deep understanding of the topic and highlights the importance of your chosen focus.

VI. Guiding the Reader Through the Essay

A. Providing clear explanations and transitions

To effectively guide your reader through your essay, it is crucial to provide clear explanations and transitions between your ideas. This ensures that your essay is easy to follow and allows your reader to better understand the connections between your points.

To provide clear explanations and transitions:

• Start each paragraph with a clear topic sentence that outlines the main idea or argument of the paragraph.
• Use transition words and phrases (e.g., however, therefore, in addition) to create a smooth flow between sentences and paragraphs, helping your reader to follow your train of thought.
• When introducing new concepts or theories, provide clear definitions and explanations, ensuring that your reader is familiar with the terminology and ideas you are discussing.

B. Emphasizing the importance of each idea

As you write your essay, it is essential to emphasize the importance of each idea and argument you present. This will help your reader to understand the significance of your points and how they relate to the overall theme of your essay.

To emphasize the importance of each idea:

• Clearly state the relevance of each point to your essay topic and focus, explaining how it contributes to your overall argument or understanding of the subject matter.
• Provide evidence or examples to support your points, demonstrating the validity and importance of your ideas.
• When discussing research findings or theoretical concepts, highlight their significance for nursing practice and the potential impact on patient care and outcomes.

C. Ensuring a coherent and well-structured argument

Creating a coherent and well-structured argument is essential for guiding your reader through your essay and ensuring that your ideas are presented in a clear and logical manner.

To ensure a coherent and well-structured argument:

• Begin by outlining your essay, organizing your ideas into a logical sequence, and ensuring that each point builds upon the previous one.
• Use clear and concise language throughout your essay, avoiding unnecessary jargon and overly complex sentences.
• Revise your essay carefully, checking for clarity, coherence, and logical flow, and making adjustments as needed to improve the overall structure and organization of your argument.

By providing clear explanations and transitions, emphasizing the importance of each idea, and ensuring a coherent and well-structured argument, you will create an engaging and informative essay that effectively guides your reader through your ideas and arguments.

VII. Critical Thinking and Asking Key Questions

A. Challenging assumptions and considering alternative perspectives

Critical thinking is an essential skill for writing a successful nursing care essay. This involves challenging assumptions, considering alternative perspectives, and analyzing the implications of each idea.

To challenge assumptions and consider alternative perspectives:

• Evaluate the assumptions underlying the theories, research findings, and arguments you discuss in your essay.
• Consider the potential biases or limitations of the sources you are using, and think about how these might influence your understanding of the topic.
• Explore different perspectives and viewpoints, acknowledging that there may be multiple valid approaches to understanding the subject matter.

B. Analyzing the implications of each idea

As you present and discuss your ideas, it is important to analyze the implications of each idea for nursing practice and patient care. This will help you to demonstrate a deeper understanding of the topic and show the relevance of your discussion to real-world nursing practice.

To analyze the implications of each idea:

• Consider the potential impact of each theory, research finding, or argument on nursing practice, including the ways in which it might inform or challenge current approaches to care.
• Discuss the potential benefits and drawbacks of each idea, considering both short-term and long-term implications for patient outcomes and overall quality of care.
• Reflect on the ways in which your discussion might contribute to the ongoing development of nursing practice and the improvement of patient care.

C. Reflecting on how ideas might change nursing practice

Throughout your essay, it is essential to reflect on how the ideas and arguments you present might contribute to changes in nursing practice. This will help you to demonstrate your understanding of the dynamic nature of the nursing profession and the importance of evidence-based practice.

To reflect on how ideas might change nursing practice:

• Consider how the theories, research findings, and arguments you discuss might inform or challenge existing nursing practices and approaches to care.
• Think about the potential implications of these ideas for nursing education, policy development, and practice guidelines, and how they might contribute to improvements in patient care and outcomes.
• Discuss the role of nurses in promoting and implementing evidence-based practice, considering the challenges and opportunities they may face in incorporating new ideas and approaches into their daily practice.

By engaging in critical thinking and asking key questions, you will be able to develop a deeper understanding of your essay topic and demonstrate your ability to think critically and analytically about complex issues in nursing care.

VIII. Writing and Revising Paragraphs

A. Crafting one-sentence summaries for each paragraph

Creating one-sentence summaries for each paragraph helps you to ensure that your essay is focused and coherent. These summaries serve as a quick reference to the main ideas of each paragraph and help you to identify any irrelevant or repetitive content.

To craft one-sentence summaries for each paragraph:

• Read through each paragraph and identify the main point or argument.
• Write a concise summary of this main point in a single sentence.
• Review your summaries to ensure that they accurately reflect the content of each paragraph and that they are consistent with your overall argument.

B. Ensuring a logical flow of ideas

A well-structured essay should have a logical flow of ideas that guide the reader through your argument. This involves organizing your paragraphs in a way that makes sense and ensures that your essay is easy to follow.

To ensure a logical flow of ideas:

• Begin each paragraph with a clear topic sentence that introduces the main idea or argument.
• Use appropriate transitions between paragraphs to guide the reader from one idea to the next.
• Review your essay's structure to make sure that each paragraph builds on the previous one and contributes to the overall argument.

C. Editing and reorganizing as needed

Editing and reorganizing your essay is a crucial step in the writing process. This involves reviewing your work for clarity, coherence, and consistency, as well as identifying areas that may need improvement or revision.

To edit and reorganize your essay as needed:

• Read through your entire essay, paying close attention to the organization, flow, and clarity of your ideas.
• Identify any paragraphs that may be unclear or out of place, and revise them as necessary to improve their clarity and coherence.
• Reorganize your essay as needed to ensure a logical flow of ideas and a well-structured argument.

By writing and revising paragraphs effectively, you can ensure that your essay is clear, coherent, and well-organized, making it easier for your readers to follow and understand your argument.

IX. Embracing the Essay Writing Process

A. Acknowledging the challenges of writing a nursing essay

Writing a nursing essay, particularly one focused on mental health, can be challenging. It requires you to synthesize complex ideas, critically analyze various perspectives, and apply your knowledge to real-life scenarios. Recognizing these challenges and accepting them as part of the essay writing process can help you develop a more positive and resilient approach to tackling your assignment.

B. Learning and growing through the writing process

The essay writing process is an opportunity for personal and professional growth. Through reading, analyzing, and synthesizing information, you will deepen your understanding of the subject matter and enhance your critical thinking skills. By embracing the challenges of essay writing, you can develop valuable skills, such as organization, time management, and effective communication, that will serve you well in your nursing career.

To maximize your learning and growth through the writing process:

• Approach each step of the essay writing process with an open mind and a willingness to learn.
• Reflect on your progress and the challenges you encounter, identifying areas where you can improve and grow.
• Seek feedback from peers, instructors, or mentors to gain insights into your strengths and areas for improvement.

C. Overcoming common obstacles in essay writing

There are several common obstacles that students may encounter when writing a nursing essay. These obstacles may include writer's block, procrastination, or difficulty organizing and structuring your argument. Overcoming these challenges is crucial to producing a high-quality essay.

Here are some strategies for overcoming common obstacles in essay writing:

• Break the task into smaller, more manageable steps. Instead of focusing on the entire essay, concentrate on completing one section or paragraph at a time.
• Set realistic goals and deadlines for each stage of the writing process. This can help you maintain momentum and prevent procrastination.
• Reach out to your peers, instructors, or mentors for support, guidance, and encouragement. They can provide valuable insights and help you overcome challenges.

By embracing the essay writing process and overcoming common obstacles, you can develop the skills, knowledge, and resilience necessary to excel in your nursing career.

X. Conclusion

A. Recap of the main points covered

In this blog post, we have explored various aspects of writing a nursing care essay for mental health nurses. We discussed the importance of understanding the essay topic and breaking down the prompt, gathering and organizing reading materials, focusing on a specific aspect of nursing care, applying knowledge to nursing practice, guiding the reader through the essay, engaging in critical thinking and asking key questions, writing and revising paragraphs, and embracing the essay writing process. By following these guidelines, nursing students can develop a well-structured, coherent, and insightful essay that effectively addresses the key questions posed by the assignment.

B. Encouragement for nursing students to persevere in their essay writing journey

Writing a nursing care essay can be a challenging but rewarding process. It allows you to deepen your understanding of mental health nursing, enhance your critical thinking skills, and demonstrate your ability to apply theoretical concepts to real-life scenarios. As you embark on your essay writing journey, remember that you are not alone. Seek support from your peers, instructors, and mentors, and embrace the learning opportunities that the process presents.

Perseverance, hard work, and a positive attitude can help you overcome the challenges of essay writing and ultimately produce a high-quality, impactful essay that reflects your dedication to the field of mental health nursing. So, keep pushing forward and believe in your ability to succeed. The skills and insights you gain through this process will serve you well in your nursing career and beyond.

Related Blogs 

Mental Health: Nursing Care Essay Sample

Mental Health Nursing Nursing Care Essay Question

6 Simple Steps to Writing a Mental Health: Nursing Care Essay

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“The Doctor as a Humanist”: The Viewpoint of the Students

Conference Report and Reflection by Poposki Ognen (University Pompeu Fabra); Castillo Gualda Paula (University of Balearic Islands); Barbero Pablos Enrique (University Autonoma de Madrid); Pogosyan Mariam (Sechenov University); Yusupova Diana (Sechenov University); and Ahire Akash (Sechenov University)

The practice of Medicine as a profession has become very technical; doctors rely on fancy investigations, treatment algorithms and standardized guidelines in treating patients. In a lot of universities, medical students and residents are trained without appreciating the importance of art and the humanities in delivering good care to patients and their families. Factual knowledge is imposed on us, as students, from scientific evidence delivered by highly specialized professionals: those who know more and more about niche subjects.

As a result, when someone decides to become a doctor , it seems that scientific training is the sole priority, with most attention being given to the disease-treatment model. As medical students, we are taught very specific subjects, leaving little or no space or time for any cultural enrichment programs. And yet, Personal growth as a doctor and a human being cannot be achieved unless one is exposed to the whole range of human experience. Learning from art and artists can be one such means of gaining these enriching experiences. We can learn from historians, and from eminent painters, sculptors, and writers, as well as from great scientists. How do we achieve these ends? The following essay summarizes and reviews one attempt at providing answers. The 2nd “Doctor as a Humanist” Symposium took place at Sechenov University in Moscow from the 1 st to the 3 rd of April, 2019, to explore the holistic perspective of interpersonal treatment.

To begin our essay, we would like to clarify some key concepts, such as culture, humanism and humanities, as they were employed at the conference. Culture is a complex phenomenon that includes knowledge, beliefs, artistic production, morals, customs and skills acquired by being part of a society, which can be transmitted consciously or unconsciously, by individuals to others and through different generations.

The humanities are academic disciplines that study the cultural aspects and frailties of being human, and use methods that are primarily analytical, critical, or speculative, which distinguish them from the approaches of the natural sciences. Humanism is the practice of making the human story central. Consequently, the studies of humanities, so invested in human stories, is one aspect of practicing humanism.

Technological and practical progress in medicine has been impressive in the past fifty years. Nevertheless, patients still suffer from chronic conditions such as heart failure, chronic lung disease, depression, and many others. These are conditions where technology cannot significantly change the outcomes or reverse the underlying condition. One of the ways to alleviate suffering is through compassion and empathy where the doctor is a professional who listens to, understands and comforts the patient, as well as engaging the patient as a fellow human being. We need arts and humanities as doctors’ tools to comfort and, perhaps, even to heal. We also need them to remind us that we are ‘merely human’ ourselves, and that we share our humanity with our patients, as equals.

Unquestionably, there are fundamental requirements that every physician must internalize; the conference goal was to explain that one such requirement is the humanistic view. Opera, poetry, philosophy, history, the study of dialectics, biographical readings, and even volunteering abroad can be means of engaging the world for positive change. Sometimes called  “soft” skills, these are in fact necessary and valuable qualities to empower ourselves as persons, as well as doctors. The 2nd The Doctor as a Humanist Symposium placed the corner stone in a global project that aims to understand medicine as a multidisciplinary subject, and to establish the concept of humanistic medicine both as a science and an art where the patient and the doctor are human beings working together.

STUDENT PARTICIPATION

The event united experts in Medicine and the Humanities from all over the world. The speakers (doctors, nurses and students) were from Russia, the USA, the UK, Spain, Italy, Germany, Mexico and more. Each day’s program was both intense and diverse, and included plenary lectures and panel sessions. Medical students were highly involved in all parts of the conference, offering us a great chance to introduce our projects, share our opinions on various topics, and discuss our questions connected with the role of the humanities in medicine.We participated in roundtable discussions, which were chaired by experts from different countries. Even though this made us nervous, at the same time it was very important for us, as students, to be a part of it. We discussed the future of medical humanities from various perspectives, and above all our thoughts and ideas were listened to and commented on, on an equal basis with the world’s experts. For once, we could see that our views were being taken into consideration, and we hope that in the future this will be the norm and NOT the exception. We are the future of medicine, and our voices should be heard, too.

At the end of the first day there was a students’ session, where we gave our opinions on the relative importance of the medical humanities from a multicultural viewpoint, and on this particular roundtable there were students from Russia, Spain, Iran, Mexico, Italy, as well as a Nursing resident. One of the students during the session shared her view that “I would like to see medicine through the lens of humanism and empathy, and also implement all its principles in my professional life on a daily basis”. All participants agreed, and although we were representing different countries and cultures there was no disagreement about this. Even though we have not yet faced many of the obstacles of the world of medicine, we can see the role of compassion in clinical practice better perhaps than our seniors. We shared our points of view about this question and its relevance in the different countries. It was an incredible moment, as experts and professors demonstrated a great interest in our ideas.

The program was extremely diverse; however, the main idea that most speakers expressed was how to find, sustain and not lose humanist goals. Brandy Schillace gave an impressive presentation entitled “Medical Humanities today: a publisher’s perspective”, which studied the importance of writing and publishing not only clinical trials, but also papers from historians, literary scholars, sociologists, and patients with personal experiences. The nurses Pilar d’Agosto and Maria Arias made a presentation on the topic of the Nursing Perspective that is one of the main pillars of medical practice. Professor Jacek Mostwin (Johns Hopkins University) shared his thoughts on patients’ memoirs. An Italian student, Benedetta Ronchi presented the results of an interview on medical humanities posed to the participants and speakers during the symposium. The plurality of perspectives made this conference an enriching event and showed us how diverse ideas can help us become better doctors. More importantly, it reminded us of our common humanity.

A significant part of the symposium was dedicated to Medicine and Art. Prof Josep Baños and Irene Canbra Badii spoke about the portrayal of physicians in TV medical dramas during the last fifty years. The book “The role of the humanities in the teaching of medical students” was presented by these authors and then given to participants as gifts. Dr Ourania Varsou showed how Poetry can influence human senses through her own experience in communicating with patients. She believed that many of the opinions and knowledge that we have internalized should be unlearned in order to have a better understanding of the human mind. The stimulus of poetry makes this possible. Poetry allows us to find new ways to express ourselves, and thus increase our emotional intelligence and understanding of other people’s feelings.

One of the most impressive lectures was by Dr Joan.B Soriano, who spoke about “Doctors and Patients in Opera” and showed how the leading roles of physicians in opera have changed over the centuries. People used to consider the doctor as the antihero, but with time this view has transformed into a positive one that plays a huge role in history.

It is important to be professional in your medical career, but also to be passionate about the life surrounding you; for instance, Dr Soriano is also a professional baritone singer. For students, this Symposium was full of obvious and hidden messages, which gave us much lot of food for thought. As Edmund Pellegrino, the founding editor of the Journal of Medicine and Philosophy , said: “Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities.”

CHOOSING ONE WORD

To conclude our summary of the students’ viewpoint each of us chose One word to encapsulate our thoughts about the symposium.

The Doctor as a Humanist is a multicultural event where everyone can learn and contribute to this global necessity to put the heart and soul back into medicine. Of course, we are aware and delighted that other organizations are championing the cause of the Humanities in Medicine, and in some cases, such as https://www.dur.ac.uk/imh/ , they have been doing so for many years.

As medical students, we appreciate how we have been placed at the centre of the symposium, which we believe has made this new initiative rather special. We hope that students of Medicine and from other disciplines come and participate in future symposia.

If you want to learn more, and see how you can participate, please contact the International student representatives, Mariam ( [email protected] ) and David ( [email protected] ).

Acknowledgements

Assistance provided by Jonathan McFarland (c) and Joan B. Soriano (University Autonoma de Madrid) was greatly appreciated during the planning and the development of the article.

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