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Running head: REFLECTION ONE 1

Reflection One

Leah Will

Trent University
REFLECTION ONE 2

The first two weeks at my clinical placement for this semester have been great so far. I

am on the Forensic Reintegration to the Community Unit at Ontario Shores. We have completed

two shifts so far. The first shift was more of an orientation to the facility and the staff, as well as

the code of conduct and the various policies and procedures that are put in place for the safety of

the patients and the staff. Our second shift was a full shift on the unit. The day started at 7am

with report from the night shift nurses. I learned that this is when they report on any issues or

specific incidences that happened during the night. We were then paired up with a nurse for the

day and worked with the patients assigned to them. As I was not able to practice giving PO meds

yet, I started out the day shadowing my nurse who gave meds, including a q14D IM injection

that I was able to see.

The majority of my morning was spent in conference. This was a meaningful event as I

was able to sit in for about 2 hours an observe the process of what a conference is, and see

various interpersonal team members and their role in the meeting. At first, I felt very awkward

being there sitting around the table because I knew that I had nothing to contribute. I thanked

everyone for letting me sit in, learn and observe. To the best of my memory there was the charge

nurse, unit manager, an occupational therapist, psychiatrist and the primary nurse and selected

patient present in the meeting. One by one, a patient was brought up as a topic of discussion

regarding any changed in levels and privileges. Any concerns were also brought up to the

psychiatrist during this time, as well as discharge and housing plans for anyone who was leaving

the unit soon.

There was one patient that was brought in for conference that was in the care of the nurse

who I was working with that day, so I had become somewhat familiar with her general situation

after a brief chat that morning. She has a planned discharge in a few months and has been on the
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list for housing, which finally got approved. However, the patient did not know that this had

gotten approved, and no one was to tell her yet. The conference was put in place to discuss a

behavior plan that was made for her following some aggressive behavior towards staff and other

patients. The patient did not handle this information well and was quite upset that she was given

a behavior plan. This was when it got very awkward for me, because I was sitting next to the

patient around the table. The patient began to yell at the psychiatrist, going off topic and trying to

get a change in medication.

The psychiatrist and the unit manager worked really well together to calm the patient

down and bring the focus back to the topic of discussion, which was her behavior plan. They

focused on points such as the fact that the patient needed to follow a behavior plan in order to

secure her spot in housing, despite the fact that she had already been approved, was just unaware.

It was interesting to see everyone work together in the best interest of the patient, even if this

meant that she was not to be told that the housing was approved for her. They wanted to make

sure the patient could focus on her behaviors and the associated consequence before thinking

about making a permanent discharge plan.

It was also interesting to see and hear the staff talking before and after the patient left the

conference room. Before the patient would enter with their nurse, the team would make a loose

plan as to what would be said and what kind of things to avoid saying. I remember one staff

member specifically saying to make sure we keep things positive, and make positive reinforcing

statements to the patient in case things go poorly. I also liked the short debrief at the end of the

meetings after the patient had left. The staff went over things that went well in the meeting and

some things, if any, that didn’t go to plan or could be improved for the next meeting with that
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patient. Technicalities were also discussed and confirmed, such as level increases and changes to

privileges for some patients.

I remember studying this concept in past courses, where we don’t “lie” to the patient, but

we bend the truth or withhold certain information in the best interest of the patient as part of their

care plan. After this clinical day, I did go home and look up more information on the process of

forensic patients in a mental health facility, as well as more details regarding the Ontario Review

Board.

Reflecting on the situation and the patients very aggressive outburst during the

conference, I felt as if my past experience working in the emergency department with many

mental health patients really helped me stay calm and focused. I was able to put my emotions to

the side and really understand the underlying issues that the patient was bringing forward, and

has had in the past that could explain her behavior in this conference. Moving forward, I would

like to have more knowledge of the patients before the patient is brought into the conference.

This would help fill in any gaps that I may have before they arise. However, I feel as if this is

something I will come to learn as I continue to work with the patients and understand the

conference process better in the near future. I was really grateful that the staff allowed me to sit

in during this conference, as it was very instrumental in my learning, especially just having

started in this mental health placement.

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