This document describes a reflection on an incident involving a patient at a mental hospital in Sri Lanka. It discusses the patient using cannabis cigarettes in the hospital ward and the feelings this raised. It evaluates the experience as both good and bad, prioritizing legal/ethical, technical, and organizational issues. It analyzes factors like the importance of family education and observation. Finally, it proposes an action plan involving training, allocation of staff, alternative observation strategies, and family education sessions.

1. Reflection Practice
03
Name – Sashini Sandapiyumi
Reg No – ADGN13/16/037

2. Content
 Gibbs Cycle
 Description
 Inculcating Feelings
 Evaluation
 Analysis
 Conclusion
 References

3. Gibbs Cycle
(Diagram: Gibbs G [1988] Learning by Doing: A guide to teaching and learning
methods. Further Education Unit. Oxford Polytechnic: Oxford. (Brookes.ac.uk)

4. Stage 01- Description
 When – 12th of February 2018
Male Acute ward
 Where - Well Reputed Mental Hospital in Sri Lanka.
 Who - Patient X
42 years old and Unmarried.
 What – Admitted due to the opiate withdrawal
 Incident - caught him with weed cigarettes

5. Stage 2- Inculcate feelings
 Scared
 Confused
 Nervous
 Confident
 Happy
 Sorry
 Glad

6. Stage 2- Inculcate feelings
 Before the incident
 Confident
 Happy
 Empathy
 After the incident
 Scared
 Confused
 Nervous
 Confident
 Happy
 Sorry
 Glad

7. Stage 3 - Evaluations
Good Experience
 Knowledge on how to manage such
conflicts.
 Importance of proper observation.
 Importance of Family Education.
 Identify the patient’s actual intention.
 Winning the trust among the Nursing Staff.
Bad Experience
 Patient lost the trust among
Nurse.
 Poor therapeutic effect due to
loosening patient- nurse
relationship
 Patient can be aggressive toward
me.
 Value of Privacy and
Confidentiality.

8. Prioritized problems of the issue.
 Technical issues
 Organizational issues
 Legal and Ethical issues-
 Legally - Breached the confidentiality of the patient.
 Ethically - breach the non maleficence (Do no harm), Responsibility ,
integrity(Accuracy, honesty, truthfulness ) and the justice

9. Stage 4- Analysis

10.  Families are a primary care-giving resource for adults with mental illness, yet they
often lack the knowledge and skills needed to assist their relatives Studies show that
families routinely request information on basic facts about mental illness and its
treatment, behavior management skills, and the mental health system in order to
better cope with their relatives' illnesses
{WHO, 2010}
 Observing peoples’ behavior in psychiatric inpatient units is an essential but
(arguably) undervalued aspect of nursing care.
(Hamilton and Manias, 2007)
 Common situations in which formal forms of observation may be prescribed include
when individuals have self-harmed or attempted suicide, shown potential for self-
harm or suicide, acted aggressively or displayed potential for absconding.
(Bowers et al., 2000).

11. Stage 5- Conclusion
Two of the largest population-based mental health surveys in the USA found that up
to 37% and 53% of the respondents with alcohol use disorder and drug use
disorders, respectively, had at least one comorbid psychiatric disorder.
(Mentalhelp.net)
 Majority of the patient use these substances in order to gain a temporary relief. But
it can cause long term defects to individual physical, psychological and socially.
 Family Education and support is vital for a quick recovery.
 poor observation can leads to severe complication.
 Poor hospital management, leads unwanted substances barge to the hospital.

12. Patient tried to consume cigarettes within in
the ward
Solutions
Good Results
1.Effective
monitoring
system
2.Increase
staff
3.Impose
Strict rules
4.Education
session
5.Strengthen
rules
6.Rewards
& Fund
raising
programs
1.Can observe
individually
2.Can focus
on each
patient.
3.Fear to break
rule.
Less illegal
behaviors
4.Minimise the
mistakes.
5.Less chance
for illegal
activities
6.Worker get
motivated.
Financial
support

13. ECT matrix
 Solution  Effects  Cost  Time  Total point  Rank
 Effective
monitoring
System
06 03 03 12  06
 Increase
Staff
08 02 03 13  05
 Impose
strict rules
08 06 06 20  02
 Education
session
06 07 06 19  03
 Strengthen
the rules
and
regulations
08 08 08 24  01
 Reward for
the good
service
07 02 06 15  04

14. Stage 6- Action Plan
 Have special training on handling the challenging psychiatric patients,
and deescalating the situation.
 Allocate patients for available staff.
 Think alternative and new method or strategies for observation
 Conduct Family Education sessions to improvise their knowledge.
 Provide hand bill which gives a insight.
 Do more research on Hospital Managing strategies.

15. References
 Hurley, J. (1999). Mental health. San Diego, Calif.: Greenhaven Press.
 Sri Lanka hits world record in attempted suicides — depression, alcohol abuse main
causes. (2019). Retrieved from http://www.sundaytimes.lk/171022/news/sri-lanka-hits-
world-record-in-attempted-suicides-depression-alcohol-abuse-main-causes-265155.html
 Ali, S., & Fornai, F. (2006). Cellular and molecular mechanisms of drugs of abuse and
neurotoxicity. Boston, Mass.: Published by Blackwell Pub. on behalf of the New York
Academy of Sciences.
 Saarländische Universitäts- und Landesbibliothek. (2006). Schizophrenie und
Cannabiskonsum: Epidemiologie und Klinik.
 Kalkman, M. (1958). Introduction to psychiatric nursing. N.Y.: McGraw-Hill.