Psychiatric clients

The aim of this assignment is to reflect on an incident that took place whilst I was on my practice placement. The client involved in the incident will be referred to as “Carol”, for the purpose of maintaining patient confidentiality, as stated in the Code of Professional Conduct (2002). The incident took place whilst I was on practice placement at a local care in the community resource centre, a centre which psychiatric clients used to visit, for support and continuum of care and recovery from their illness. The duration of the placement was seven weeks.

I will explore this incident and give my understanding of the event in relation to professional, legal and ethical considerations. In order to present a well-structured reflection, I have chosen to utilise a framework of reflection by Gibbs (1998) to help me present my reflection in a natural sequence of events. The framework is iterative and enables me to ask myself a series of questions at stopping points, to help me put the experience into an organised manner.


I first met the client Carol in the kitchen of the resource centre on a wet November afternoon. The theme of the Tuesday Caf� was ‘Soup and Rolls’. I had known for a few days that I would be involved in this activity and I was very much looking forward to it. I would assist with the serving of the meal and the collection of the monies. Working alongside two community support workers, I felt confident in my own ability, and sure that I was about to enjoy the next hour and a half of socializing.

A steady flow of hungry clients passed through the kitchen doors, each clutching a bowl of soup and a roll as they left. Carol was one of the last clients to make her way to the kitchen, and to be precise, I had not even realized that she was there until she exhaled a shrilling sound of laughter, after which she spoke so rapidly I could barely understand what she was saying.

“This is Carol”, one of the support workers announced. But before she could finish, Carol had trundled over to me and introduced herself as best as she could. “Are you a nurse? I was a nurse, I used to be in charge, you lot should leave those babies alone”. All this in one sentence, I was quite bewildered but showed interest in her conversation to try and assure her that I was there to listen and support her. Once again Carol began to laugh, it was the kind of laughter that I would remember for a very long time.

The second support worker, who I was not at all familiar with appeared to have a good rapport with Carol, I presumed that they had known each for quite some time as the interaction and communication was good. The professional was jovial and bubbly, and consequently the more extroverted she became, the louder and more excitable Carol behaved. I was truly amazed by all the frivolity and could only think that this was all a normal process of the therapeutic relationship. However, what I was about to witness over the next few moments was to change my perception of this interaction forever.

It happened in a split second, a second which felt like I was watching a scene frozen in time. I remember the worker telling Carol to give her a kiss, the words that she said did not register, until I saw the action, mainly because it was not the expected performance of a professional, by any means. By this I mean the worker encouraged Carol to kiss her directly on her lips in a way that to me appeared sensual. Carols’ lips covered the support workers lips.

This seemed to be normal behavior in the relationship between the two of them, because I turned to look towards the other support worker for some kind of moral understanding, but she did not show any abnormal reaction to the incident. I wanted to say to the professional “what are you doing? This is not right”, but my limited knowledge and experience won the better of me, and I opted in stead just to observe and internalize the situation.


Consequently, the results for me were that I was tormented by my conscience, because deep down inside I knew that there was a potential problem which I was not addressing, and that there was a need to take advice from someone in authority to myself. I felt fearful of the repercussions of reporting the incident, so I tried to use a utilitarian approach to convince myself that by ignoring the incident and making the majority of people happy, that this problem would go away. (Tschudin 1994)

Nevertheless, as a result of my conscience, I decided to briefly mention the incident to a registered nurse, who appeared quite concerned by my findings. She offered me rational advice, but did not appear to point me in the right direction I felt that this advice was not appropriate in respect of the incident. My next step should have been to get more support from my mentor but I did not. I now feel annoyed with myself, because I was then left with the uncertainty of not knowing for definite whether what I had witnessed was right or wrong. I was also now feeling rather apprehensive about my nursing interventions with Carol, knowing that someone else had crossed the boundaries of professionalism with her. I wanted to be able to offer Carol the therapeutic care that she was eligible to.


The more I tried to evaluate this incident, the worst it became in my mind. There did not appear to be much good in a professional to client relationship like the one which I had witnessed. The care given by the professional should have been based on therapeutics. Therapeutic care by healthcare professionals should focus solely on the client (Lyttle & Mathias 2000). Therefore, even though the profession of Carols support worker was not from the nursing field, I think that she would still have been governed by a professional body that administered guidelines for the care of the vulnerable adult.

Thinking about Carol, it is rather difficult to know how she felt about the incident, I can only presume that this was the normal behavior expected by her from this carer. On this occasion she responded in what appeared a positive way, and was only to pleased to oblige. I was not however sure that Carol was fully aware of the implications of her response, as she had mental health problems, which made it questionable as to how she may have perceived the request.


At first, I could not see any good points in this situation itself, however, looking back I can see that it did have its positive side, in as much as allowing me to examine myself and to search for my short fallings in relation to the incident. I feel that if I was not a 1st year student, I would have had more knowledge or communication skills on how to deal with an incident of this description, I also think that because the support worker was not a nurse, it made it more difficult for me to make a decision on what the correct procedure should have been. On further evaluation of this incident, I can see how my first tutorial on module DN2 in relation to professional ethics and a ‘trigger’ relate to this incident. I did not feel good or comfortable with this situation, therefore this was the right time to question why it did not feel right.

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